‘Not quite normal’ – exploring poor mental health in gay men

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Although legal and social equality for gay people is further advanced in the Netherlands than in most other countries, Dutch gay men have much higher rates of psychological distress than heterosexual men, Sanjay Aggarwala and Rene Gerrets write in the February issue of Culture, Health & Sexuality. Their study suggests that some of this can be explained by the continued privileging of ‘normal’ masculinity, both in wider society and on the gay commercial scene.

Previously, a large, representative study of Dutch adults found that gay men were three times more likely than heterosexual men to report a mood disorder or anxiety disorder, and ten times more likely to report suicidal thoughts. While similar results have been reported in other western countries, the Dutch findings are especially striking given the country’s good record on equality for gay people.

In order to gain a better understanding of this paradox, the researchers used ethnographic methods to gather data in Amsterdam – principally over 400 hours of participant observation in gay social settings, in private homes, and on social media websites, and interviews in which twelve gay men recounted their life histories.



Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged.


A feeling of unease, such as worry or fear, which can be mild or severe. Anxiety disorders are conditions in which anxiety dominates a person’s life or is experienced in particular situations.

drug interaction

A risky combination of drugs, when drug A interferes with the functioning of drug B. Blood levels of the drug may be lowered or raised, potentially interfering with effectiveness or making side-effects worse. Also known as a drug-drug interaction.

representative sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).


A mental health problem causing long-lasting low mood that interferes with everyday life.

Many respondents had grown up in family environments that were accepting of gay rights, but had nonetheless heard derogatory jokes about gay men and were keenly aware that homosexuality was not ‘normal’. The Dutch term gewoon came up frequently in interviews – it can mean ‘usual’, ‘customary’, ‘common’ or ‘normal’. Individuals can be instructed doe gewoon! (behave normally!), while not acting or feeling gewoon could lead to feelings of discomfort or shame. One respondent said:

“I was raised that gay rights are a good thing and that everyone is equal. But for me it was different, because I didn’t want to be part of that group.”

Several aspects of gay life were not gewoon – images of gay men as effeminate and flamboyant; the difficulty of having children and a stable family life; the risk of HIV infection. Few men were concerned about outright rejection from their families, but they were anxious about not living up to expectations.

“You’re afraid that you’re going to disappoint your parents. You’re not measuring up to what other people think you should be. It makes you feel insecure, doubt everything you are doing.”

Many informants raised the issue of having a steady partner during the research – a long-term relationship was perceived to offer increased psychological stability, emotional resilience and social acceptability. However, many found it difficult to form and maintain relationships, and some experienced sadness and loneliness as a result.

When asked why it was difficult to find a steady partner, most explained it in terms of not having gained experience of dating during adolescence, when most respondents were ‘in the closet’. This interviewee began to visit gay bars in his late twenties:

“Although I was 28, I was an adolescent. My body had matured but I was like an adolescent, developing crushes on guys. I think it’s because you grow up straight.”

However, the researchers suggest the manner in which gay men interact with each other also contributes to problems forming stable relationships. They describe informants ‘shopping’ for the ideal man on dating websites and in gay venues. When it became clear that a partner was less than perfect, informants were often quick to switch their focus, with one interviewee putting it like this:

“Amsterdam is like a big pond of fish. One day you catch a beautiful fish and it looks good and it tastes good. But instead of keeping it and being happy with this beautiful species, you just throw it back because you don’t know what bigger fish you could catch the next day. There are too many fish out there in the pond.”

Gay bars and clubs were an important part of many men’s social lives, especially those who were single. They had become more important for some men as they got older and their lifestyles diverged from those of heterosexual friends who had children. One respondent explained the appeal of circuit parties:

“It’s a kind of tribalism. It distinguishes you very much as a different group . . . giving people a really good feeling about being gay, being gay together…  I like dancing, being in this group of men, the friendly atmosphere, the sexual atmosphere, the flirting, the music.”

Men who were considered to be physically attractive said that gay venues provided an ego boost, while individuals who had difficulty meeting those ideals recounted experiences that eroded their self-esteem. This could be a particular issue for older men.

The authors note that different body types are valued by different men and in different gay subcultures – a man unappreciated in one setting might receive considerable attention elsewhere. Nonetheless, a man’s bodily appearance remained a vital currency across the gay scene; respondents were keenly aware of other men judging their physical features.

Men with a more typically masculine body type and behaviour were often seen as particularly attractive, and many respondents wanted a man who was ‘straight-looking’ or ‘straight-acting’, while some described themselves as such on internet dating profiles. Many interviewees also valued self-confidence – it was the quality that made some heterosexual men especially appealing.

Many respondents worked hard to create and project a masculine self-image, with some suggesting that they felt more pressure to do so than their heterosexual peers. But the researchers note that their interviewees rarely challenged mainstream, taken-for-granted ideas about gender and masculinity. “The behaviours and stories of many respondents testified to potent practices of self-regulation as they endeavoured to reach and uphold ideals associated with gewoon and heteronormative masculinity,” they write.

They also suggest that ideas of stigma and self-stigmatisation can provide insights, citing the sociologist Erving Goffman: “Given that the stigmatised individual in our society acquires identity standards which he applies to himself in spite of failing to conform to them, it is inevitable that he will feel some ambivalence about his own self.”

The authors suggest that these factors can help us understand the higher rates of depression, anxiety and suicide experienced by gay men, even in settings of legal and social equality.


Aggarwal S & Gerrets R Exploring a Dutch paradox: an ethnographic investigation of gay men's mental health. Culture, Health & Sexuality 16:105-119, 2014. (Abstract here)