This time I went first to Leonore Tiefer's contribution, "Don't Look for Perfects: A Commentary on Clinical Work and Social Constructionism." Tiefer is a psychologist, a sex therapist, and a professor of psychiatry, and author of Sex Is Not a Natural Act (2nd edn, Westview Press, 2004), which I liked. (It's about time to reread it, I guess.) I was disappointed by the opening, under the header "Sexual Orientation: Oppression or Identity?" (Don't you love false antitheses?)
Writing this commentary raises a great irony for me. As a deep social constructionist, I see sexual orientation as an idea that emerged near the end of the nineteenth century as part of the new profession of psychiatry's effort to busy itself segmenting the behavioral and intrapsychic world into neat little boxes of normal and abnormal. In my mind, the categories of heterosexual and homosexual cannot be separated from their historical origins -- everything else is rationalization and a more or less disguised fulfillment of that original psychiatric phase.Tiefer does attempt in the succeeding pages to think of ways people might deal with their problems without the normal/abnormal dichotomy or a belief in an individual's "true sexual nature," ways which turn out to be fairly simple, intuitive and non-paradoxical. They involve careful listening (a client-centered approach that is hardly new) and critical thinking. I approve of these ideas wholeheartedly, but they don't have a lot to do with social constructionism.
Fast-forward to 1998. I am writing this commentary as a clinician, that is, a person who must and does think in terms of normal and abnormal (or else be a total hypocrite) in her or his work. People consult me and listen to me because they have confidence that I can offer insight and advice based on some understanding of normal and abnormal. The social changes of the past third of a century have erased the normal/abnormal dichotomy from sophisticated discussions of "sexual orientation." Now, the term is merely descriptive -- whom does one love and desire, a person of the same sex or a person of the other sex (or both)? The reality of the categories is taken for granted, and the big controversies are about etiology (which some might argue is a sign that the normal/abnormal dichotomy has not really been erased from sophisticated clinical discussions!) .
Being a social constructionist, deep or shallow, doesn't by itself commit you to any particular historical narrative or to any specific construction of a category. Tiefer's opening reminds me of a biologist I debated in the 90s, who said that his training caused him to seek biological explanations for every aspect of human behavior. I responded that his training was, on his account, unscientific if science is supposed to seek knowledge without preconceptions; ruling out non-biological explanations in advance of the evidence is as invalid as ruling out biological ones. It seems to me that Tiefer is taking the latter tack here, motivated by the same kind of binary she's trying to reject, and by an essentialist notion of "psychiatry."
I think her account is also inaccurate historically, for the same reason. "Sexual orientation" as a concept didn't originate in the nineteenth-century, so Tiefer appears to be assuming that the concept has a nature that persists through changes of theory and terminology. "Homosexuality" has always been an incoherent concept, and the advent of the term "sexual orientation" hasn't made it any more coherent. As I've pointed out before, "sexual orientation" is formally defined as the direction of one's sexual desires, but in use it refers to gender inversion, and overlaps confusingly with "gender identity" and other incoherent ideas.
Nor do categories and classifications necessarily involve any assumptions about "the realities of the categories," though it's true that clinicians, like most people, tend to forget this. Consider a hypothetical categorical division, "people shorter than six feet tall" and "people six feet or taller." The differences between the classes are "real" for some understanding of "real," but they aren't absolute. This classification might be useful for some purpose or other, and it would be perfectly valid to use it -- until the clinician or researcher began thinking of the two groups as mutually exclusive and different from each other by nature. In practice that doesn't seem to take very long. The same is true of commonly used dichotomies like "masculine/feminine," "Catholic/Protestant," "theist/atheist," or "bisexual/monosexual." Alfred Kinsey tried to use "homosexual" and "heterosexual" in this neutral way, and encountered fierce resistance not only from clinicians attached to the essentialist use but from later sex researchers who saw themselves as working in his tradition but moving "beyond Kinsey."
"Normal/abnormal" is a prime example of this confusion. If "normal" simply means something like "what most people do" and "abnormal" means "what most people don't do," there's nothing invidious or harmful in the binary. You can be part of a minority, even a small one, and that's just fine. But most people, "sophisticated" or not, have trouble sticking with that construction. Sooner or later, they figure that if you're not jumping off the bridge with everyone else, you're a loser, a freak, uncool, sick. If there weren't something wrong with you, you'd be hanging with or at least admitting the superiority of the cool kids. It's worth remembering of course that the normal-as-normative is often a trait of the few. The cool kids are always a minority, often a small one. People are ambivalent about this, and their attitude is driven by factors other than numbers.
Anyone who wants to assume "the realities of the categories" needs to remember that in the real world, categories tend to be porous, often with very wide variation among the members. Kinsey, who can be classified as an "Aristotelean," cut his professional teeth by studying gall wasps. This brought him face to face with the problems of classification, and he brought that approach to human sexuality, intending to map the variation in sexual behavior rather than locate essences in it. This latter approach, which can be classified as "Platonic," dominated the sciences in his day as it still does. Kinsey's critics argued that he should have looked for essences of human sexuality (the "normal") rather than being distracted by range and variety, which they saw as surface distractions from the Real. (See Peter Hegarty's Gentlemen's Disagreement: Alfred Kinsey, Lewis Terman, and the Sexual Politics of Smart Men [Chicago, 2013] for an intelligent discussion of aspects of this controversy.) But from what I know of him, I don't think Kinsey himself, any more than Aristotle, was a social constructionist. Recognizing and studying variety is perfectly compatible with believing that the variety is a feature of the "real" world.
Consider a case Tiefer mentions later, "a patient who recently came to me when he was increasingly preoccupied with sexual fantasies about (as well as a budding sexual relationship with) his secretary." Tiefer notes that "sexual identity was not an issue for him," though there is an identity available for such a person, namely "adulterer." "[But] the idea of 'true sexual nature" was..." (81). As with the transsexual patients Tiefer discusses, it's possible for a clinician to be useful to a patient without invoking "normal" or "abnormal," which really aren't useful categories most of the time anyway. If your patient is, say, hearing voices that urge her to kill herself, normality and abnormality are beside the point. But ditto for a benign or neutral situation, like a person who doesn't conform to official gender norms. It was surely "abnormal" in various senses for men to grow their hair long in 1960s America (and remember that "long" was highly subjective when a military buzz cut was the standard), but there was nothing wrong with it, nor did it really say anything about their "gender identities."
There probably is no correct answer to a question like "Should I have an affair with my secretary?" or "Should I leave my husband?" or "Should I seek sex/gender reassignment surgery?" ("Sex reassignment" and "gender reassignment," by the way, express different conceptual understandings, though the procedure involved is the same.) Patients asking these questions may be looking for an authority figure to make their choices for them. According to some constructions of authority, that may be what such figures are for, but that shows just how uneasy many people are about the idea of choice. They want to believe that outcomes are predictable -- if you do this, you'll be happy; if you do that, you'll be unhappy -- and that someone (God, a priest, a doctor) knows which one to seek. But there are no guarantees, and this, again, has nothing to do with social constructionism in itself, even if you want to believe, as many of its proponents clearly do despite their disavowals, that social construction gives a true picture of reality.