Digging Out of Stigma
Psychologist & Author Walt Odets Talks with A&U’s Hank Trout About Navigating HIV and Other Issues Impacting Gay Men’s Lives

Photo by Dianne Woods

When your birth name is Walt Whitman Odets, your path in life is pretty much foretold.

The son of one of the most important playwrights in American literature, and named for America’s greatest poet, Walt Odets was born on February 4, 1947, to playwright Clifford Odets and actress Bette Grayson. After Grayson’s death in 1954 and Odets’ death in 1963, Walt frequently stayed in New York city with his legal guardians, Lee Strasberg and Paula Strasberg (of “Method Acting” fame). The Strasbergs were long-time friends of Clifford, dating from the early years of the Group Theatre, which Clifford had helped to found.

Odets trained as a clinical psychologist at San Francisco’s Professional School of Psychology and received his PhD in 1989. While working as a psychology intern in the San Francisco area in the mid-1980s, Odets noticed that more and more gay and bisexual men were seeking treatment for acute depression, hypochondriasis, anxiety disorders and sexual dysfunction. Many of these men were HIV-negative and were referred to as the “worried well.” Many negative men felt alienated from close friends and lovers who had acquired the virus. Not suffering from HIV itself, they often still felt marginalized by the gay community, for whom the AIDS crisis had become the defining issue because of the scope of the crisis.

Not one to shy away from controversy, Odets stirred one up in gay communities by criticizing the widely accepted but ineffective HIV-prevention tactics. Odets called for a re-evaluation of the prevention programs, suggesting that they might be partly responsible for the increase in transmission. Odets stressed that HIV-positive and HIV-negative men should be targeted with different prevention strategies. Odets pinpointed the failure of the prevention groups, arguing that they “had been guilty of ignoring the deepest root of gay men’s unsafety: the psychological root, what they feel.”

Odets’ full-length 1995 study, In the Shadow of the Epidemic: Being HIV-Negative in the Age of AIDS was listed by the New York Times as among the “Notable Books of the Year 1995.” In it, Odets addressed the psychological epidemic of AIDS “survivor guilt” and how it played a crucial part in the failure of HIV prevention campaigns, thus initiating the relatively new focus on HIV-negative people in HIV prevention programs.

Odets’s new book, Out of the Shadows: Reimagining Gay Men’s Lives (Farrar, Straus and Giroux, 2019), acknowledges that even in our modern progressive world, it’s not easy to be a gay man, not even for those from the most educated, liberal of backgrounds. They still struggle to accept themselves and experience stigma, shame, and difficulties with intimate relationships. Add to that the ongoing trauma of the AIDS epidemic, something that is all too often assumed to be history. Drawing on a lifetime’s work as a clinical psychologist, Walt Odets attempts to show us what he has learned about the importance of accepting ourselves as we are—and others as they are.

It was a pleasure to ask the psychologist/author a few questions about Out of the Shadows and more.

Hank Trout: You write, “Society projects its own fear, hated, and self-hatred onto others through stigmatizing treatment, and the stigmatized individual converts that stigmatization into self-stigma and shame. We begin feeling like the person we are treated as….” What kinds of “stigmatizing treatment” have your patients recounted to you?
Walt Odets:
There are many sources of stigma, but the immediate family is probably the most influential. I can sum up the issue with the comment of a twenty-eight year old therapy patient: “When I was seventeen, I told my father I no longer wanted to spend time with him, and when he asked me why, I said, ‘Because you’ve made me hate who I am.’” That kind of familial stigmatization, as well as stigmatization from peers in childhood and adolescence are never completely resolved because the stigmatized person has formed a self-identity partially built on the stigma. In addition to this universal issue, AIDS has complicated and worsened the problem. During the “early epidemic” between 1981 and 1996, we heard “Fags get AIDS,” and many men, with and without HIV, felt shame and guilt about the epidemic. Today we have a group of young men—let’s say under thrity-two or so—who feel that they are “not the kind of person who gets AIDS.” It’s a kind of racism that they engage in because they didn’t grow up in the early epidemic and don’t want HIV to be part of their lives. Young men can be extraordinarily stigmatizing of peers who contract HIV, and those positive young men are often painfully ostracized from their own, new-found communities.

How does that “self-stigma” manifest itself? Once we recognize that the causes of our self-stigma and shame are external causes, how can we overcome those feelings?
We don’t readily feel—even if we think—that stigma is entirely an external issue, we feel there is something about ourselves that supports it. A simple change of venue—for example, a move to a gay community with potentially-supportive gay friends—doesn’t, in itself, change the self-experience. Once we’ve understood that the stigma is imposed and unfounded, we have to then slowly learn not to act the feelings out—for example by isolating ourselves so that others can’t witness our shame. That shift begins to change our experience with ourselves and others, and slowly the self-identity changes.

You write about the “Condom Code” (i.e. use one every time for a lifetime) as “an impossible standard… a community standard in word only” that has caused “still more shame in a historically coerced and shamed population.” Did early HIV-prevention campaigns and peer-shaming play a role in perpetuating the “code”? How have recent developments, like “U=U,” changed our understanding of the code?
In general, public health has historically taken a simplistic, manipulative approach to HIV prevention. The idea that you give the target population good information and then “rational” people will abide by it is nonsense. Emotional attachment and sexual expression are not rational aspects of human life; they are emotional expressions that take place in altered states of consciousness. Seeing the relatively poor results, public health then resorted to shaming men who didn’t use condoms by using “social marketing” schemes to shame men into compliance. Social marketing uses coercive shaming to manipulate people into adherence by pushing unrealistic standards that they call “prosocial behavior.” Any deviation from prosocial behavior is a failure, which is precisely the approach that young gay people are coerced with simply for being gay. Approaches that tell the truth about HIV and prevention are much more useful and humane.

You write about one patient, Harry, who believed that “his survival was a betrayal of those who had died,” particularly his partner who died of AIDS. What causes some men to suffer survivor’s guilt while others (like me) do not, even if they’ve suffered the same loss and grief?
This is a complicated issue, and the individual’s developmental history plays a significant role. In Harry’s case, his attachment to his mother, who was his only support in the family, ended with him leaving her behind in pursuit of his own better life in San Francisco. He felt guilt about that, as he would later feel it about his partner. Survivor guilt is not only about outliving someone else, it is about simply doing better than others. Survivor guilt is likely to constrict and limit a life because it encourages one to live a life like those who have less, will not survive or have not survived. Guilt of all kinds narrows a life.

Early in the book, you state that “Ronald Reagan has a lot to account for: the early AIDS epidemic unleashed more stigmatization of gay men than any other event in the history of gay life in America, and Ronald Reagan presided as president over the first seven years of that slaughter.” What forces do you think have contributed to the continuation and, in some cases, intensification of that stigma?
With the onset of the epidemic, being gay and having HIV became almost seamlessly entangled, with the stigma of each bolstering the stigma of the other, a kind of catalytic effect. Think of “Fags Get AIDS.” Men who had internalized stigma just for being gay often felt a great deal of shame about the fact of the epidemic, and for half of us, about having HIV. There are no easy answers for this problem, but right now, I think our focus should be on “gay on gay” stigmatization, which is very destructive.

You write that HIV-positive men “find the problem exacerbated when negative men treat them with active, sometimes overtly hostile, avoidance and rejection.” What role do you think current smartphone dating apps, which permit phrases like “clean, Ub2” or “DDF” in their listings, play in the continuation of HIV stigma?
The phone apps certainly support objectification, for they sometimes feel like paging through a shoe catalog. If you’re seeking a pair of brown loafers, you specify it and ignore the other human beings. I mentioned this earlier, but the “clean, DDF, UB2” talk is thoughtless, demeaning and hurtful, and is usually an expression of fear rooted in ignorance. I have no clear solutions for the problem, but certainly we need to educate people about how and when HIV might be transmitted. On the whole public health has been very poor at doing this. Today it is very clear that an undetectable man does not transmit HIV.

What do you want people living with HIV to take from your book? And finally, is there anything I’ve missed that you would like to cover?
The book is largely about digging out of stigmatized pasts, and finding authentic self-acceptance, which allows self-confidence and thus self-realization. All gay people need to pursue that end, but HIV-positive men carry an extra element to deal with. I’ve heard hundreds of positive men say they don’t understand why they “allowed” themselves to contract HIV, and that they are regretful and ashamed of it. My answer is that they contracted the virus in expressing our natural, inborn need for connection and emotional attachment to others, and that sexual interaction is one important expression of those needs. And I’d usually add that much of human life—including love and its sexual expression—is not rational; it is emotionally human. It is in recognition, acceptance and expression of our feelings to others that life is most valuable.

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his fiancé Rick. Follow him on Twitter @HankTroutWriter.