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Gay Men and the Mental Health Aspects of Monkey Pox

confused man with white t shirt deposit photo 8 6 22Gay Men and the Mental Health Aspects of Monkey Pox

Currently, as of this writing in early August, 2022, no topic is more timely among gay men, apparently worldwide, than Monkey Pox. And while many (most?) people these days refer to anything about sexual and gender minorities as “LGBT,” I find some very real, practical problems with this term, especially as a very long-term (30 years in 2022) specialist psychotherapist and coach for gay men and gay male relationships (my article on why the modern use of the term “LGBT” is problematic is here). Monkey Pox, as a current topic, is not “really” affecting lesbians, bisexual women, or trans men, or intersex folx, but more specifically “men who have sex with men,” which, as “public health” likes to point out, is not “just” (I hate that term) “gay” men.

The raging debate (and what’s not a “raging debate” these days? We can’t seem to have any “debate” today, in the United States, at least, without it being marinated in “rage”) is whether we consider Monkey Pox a “sexually-transmitted infection” (STI) or not. Or whether it’s a “gay disease” (another term I hate) either. But the facts remain that, as of now, Monkey Pox is overwhelmingly (over 90 percent) affecting gay men (or “thereabouts”) in several (Western) countries.

I leave most of the “public health” considerations (which is really just “politics,” another “p” term, with a medical angle to it) to other professionals (and so many non-professionals, who, like assholes, seem to have an opinion about public health issues, whether they have done the work to qualify for any credentials to speak to these, or not). I will leave the medical aspects of disease prevention, transmission, treatment, and aftermath also largely to others.

What I’d like to offer here, as a mental health professional, is a discussion of the “mental health” aspects of Monkey Pox for gay men (using that term hereafter to include “men who have sex with men,” which is a term I find largely as a cop-out to gay or bisexual men who still want to have a foot in all kinds of heterosexual privilege, so they don’t identify as gay or bi, because that would just be, well, “bad for business.” I mean, “Ewwwwww.”)

When we talk about the oppression of the LGBT community worldwide, we’re still really talking about gay men, historically. Mainstream society has always had a problem more with gay men than with lesbians or bisexuals, although nowadays, the trans community has moved to fore of taking shit from mainstream society as the Right wing of politics’ collective punching bag to rally their bigoted base. That is a new and unwelcome phenomenon. But gay men have been the ones, historically, to face the oppression because we are the “gender traitors” to the so-called superiority of being masculine, and both cisgender straight men and women despise gay men for squandering their gender privilege of being male and abdicating their social power, as if it were something we did voluntarily by “choosing” to be gay, rather than “choosing” to be straight men, which in their eyes would have been the “right decision.” Gay men get punished for that over and over worldwide.

And at no time worse than during the AIDS crisis. Before, gay men were “just” stigmatized as being “perverts.” With the AIDS crisis, gay men became not only “perverts,” but as the Diseased Pariah, guilty of infecting with world with pestilence on the spiked heels of already infecting the world with immorality. Gay men were literally murdered for this, as if AIDS wasn’t killing enough of us already.

Fast forward just a blink and now gay men are the Diseased Pariah once again as the vectors of a “refreshingly” new disease that offers disfigurement and pain, but only rarely death. You can’t have everything.

Gay men being seen as the vectors of disease that threaten mainstream society started with their sexual orientation in the first place, as if it were “contagious,”, but this idea was taken a big leap forward during the AIDS crisis, and really ever since – including discussions of syphilis, other relatively minor STI’s, and any “new disease” that comes along in the media, including the “gays over COVID” who were blamed for “super-spreader” gay male social events, while society ignored other major group gatherings such as Trump rallies and, well, just about every airplane flight, which, one might take note, were never curtailed, even at the height of COVID. But, oh, it was the gay events that were the vectors of disease.

We no sooner got “over” COVID when Monkey Pox came on the scene (a controversial statement, right there, but the dying has, largely stopped, with vaccines and boosters, for those smart enough to take them, when they are, indeed, available, even in “poor communities;” some would say, such as in Los Angeles, they are especially available in “poor communities;” to get my COVID vaccines, the first two doses, I had to drive an hour away from my Land of Privilege in West Los Angeles to an outlying community, as West LA didn’t have vaccination sites, but the “poorer” communities far north, south, and east, did). It’s like television; the main season of programs barely ends in Spring before the highly-touted “summer replacement series” start to keep up those ratings. News networks need viewers (and ratings revenue) all year long, not just during “disasters,” diseases, and election season.

So with Monkey Pox upon us, once again we find the gay male community particularly affected, by some weird epidemiological algorithm, and, once again, we find government indifference and inaction, just like in the early days of HIV/AIDS, because, well, it’s “just” the gays; we don’t really need to worry until it affects, you know, “normal people.” We’ve got time to burn. It’s “faggot-about-it.” Public health officials, such as the notorious Barbara Ferrer in Los Angeles County, Public Health Director, who were so rabid about renewing mask mandates as a means of “protecting” those who chose not to be vaccinated, and to address her stated “health disparities in under-served communities,” was dead silent about Monkey Pox. It’s not that she doesn’t care about minority communities, it just about which ones. And while Los Angeles County, the state of California (and its popular, progressive Governor Gavin Newsom), and now the Biden administration, and the World Health Organization have all proclaimed Monkey Pox a public health emergency, it’s a little like closing the barn door after the horse has run away. Too little, too late; a day late (at least) and a dollar (or quite a few more) short, leaving not “just” (that word again) the gay male community with too-few vaccine doses, but the “real people” as well. Time will tell, like COVID, how bad Monkey Pox gets before vaccines start to put out its epidemiological fire.

It’s in that historical and social context, of the stigmatization of gay men and the politicization of public health, that we address Monkey Pox, not only as a disease which affects the community as a disease, but as the “threat of” disease, which, admittedly, hopefully is the larger group than those who actually have it. And that deserves its own attention and discussion, which, as when it comes to nearly all things about gay men’s mental health, doesn’t get the attention it deserves, usually until I come along and insist on it, which I’m happy to do; it’s been the raison d’etre of my professional life for 30 years now. Glad to be of service.

The Emotions Evoked for Gay Men in the Monkey Pox Pandemic

In no particular order, let’s look at some of the emotions and mental health considerations of Monkey Pox for gay men:

surprised angry young Asian man deposit photo 8 7 221. Surprise – I think the first emotion and mental health impact of Monkey Pox is surprise. It’s like, “What? What is this? What ‘fresh hell’ is this?”
We’re all just “past” (not really) COVID, and now this. Gay men still thrived during COVID, in part due to the demographics the “most” (not all) of the COVID deaths were in older people. “Most” of the Monkey Pox cases, including startling lesions and reports of severe pain, increasingly widespread, are among younger, active, otherwise “virile” gay men. Somehow, that’s more visceral, and hits closer to home in our social circles.

One gay male therapy client I talked to recently now knows, or knows of, eight gay men local to Los Angeles who have it.

Unlike a delightful and unexpected fun thing to happen, this is a surprise, even shock, that none of us needed.

2. Curiosity – After the initial surprise comes lots of curiosity, and lots of questions. What is this? Where did it come from? Why is it here? How did this happen? Who is responsible for this? Why is this already a bad problem, when it might have been dealt with when it was a smaller problem? Where are our world governments to protect us? Why do we pay taxes if they aren’t doing their job to protect us? How do you get it? How do you prevent it? How do you treat it? Is there a vaccine? Where is it? Does it work? For how long?
We have questions, and we, rightfully, demand answers from the people who are literally paid, as their job, to know these things. It’s a reasonable expectation for our, oh, trillions of dollars in taxes paid to public health authorities and politicians (same thing) in governments worldwide.

3. Denial – This week, I’ve also talked with a couple of clients, gay men, who are very irked at their fellow gay men who, just like COVID, seem to be being a bit cavalier about Monkey Pox, just as they were about COVID, in a kind of denial about the magnitude of a significant public health threat. Going to sweaty, high-contact dance clubs. Attending orgies, Hooking up with randos just as frequently in the week. And in all of this, there is this focus on gay men having sex and the awful epidemiological consequences of that, as we continue to ignore the vast majority of people, heterosexuals, and the consequences of their sex this week. How many unplanned pregnancies were there? How many injuries from men raping women? How many STI’s among straight people, in Las Vegas hotels or college campuses? Why are the public health consequences of straight people having sex never discussed, but take the public health consequences of gay men having sex (at least when there are problems, which is only a minority of the time) and the media goes wild and can’t shut up.
Still, with Monkey Pox, it is what it is. Gay sex columnist (while not an accredited or AASECT Certified Sex Therapist, but he’s popular, and that’s the important thing) Dan Savage has been frank in entreating gay men to knock it off a little while with the sex thing to put a leash on Monkey Pox just long enough for the collective world governments (the USA in particular) to get off its notoriously (HIV, anyone? COVID, anyone?) slow-poke ass and get vaccines made, distributed, and administered?

He has a point. While gay men get really sick and tired of being told by straight people (straight women, in particular, who seem to be especially vocal about this, especially in the history of HIV/AIDS writing) just to “stop having sex,” we do what we have to do. We do need, collectively, to address the risks of collective denial (which, mental health professionals say, is a “primitive defense”, as in “try harder, bucko”) and just do what needs to be done to try to mitigate the mathematical, exponential spread of Monkey Pox and the various pain and suffering thereof.

surprised man looking at laptop white t shirt deposit photo 8 7 224. Fear/Anxiety – As a therapist, much of my work with gay men each week involves helping clients deal with at least some form of anxiety. Sexual performance anxiety, work/life balance anxiety, anxiety that relates to recovery from traumatic experiences, social anxiety, you name it. And Monkey Pox has been alarmingly efficient at evoking fear and anxiety in gay men, because many/most of us have seen either reports on the news or on social media of what having a case of Monkey Pox can be like, when it manifests in an eruption of painful lesions, on the skin surface or even internally or perianally, where much of the most intense pain has been.

With the lackluster response from many governments (but I’ll focus on the United States for now, because, oh boy, nobody ignores a public health crisis quite like the “medical care is a luxury business” United States of America) all but abandoning us in its tone-deaf inaction and failure to anticipate pandemics (despite nearly three years of COVD; hello?), we need to identify ways to mitigate our fear and anxiety on our own. No one’s coming, at least not yet. If there is going to be a mitigation of Monkey Pox, we’re going to have to take care of ourselves. No one else, frankly, cares, unless and until they are forced to by the collective power of some really angry queens who demand it, just as it was the Angry Queens in ACT UP who got HIV medication development hastened. Older gay men like men fought like hell for that, because our lives literally depended on it. I wouldn’t be alive today if the meds that I take now, daily, to sustain my life were developed at the lackadaisical pace that Ronald Wilson Reagan (“666”) and his murderous band of Republican thugs wanted to take.

5. Confusion – Early in a crisis, lots of confusion erupts. Think of 9/11, if you’re old enough to remember that. Wait, why are the buildings burning? Wait, why are both of them burning? Wait; why is it DC, too; I thought it was just New York? Huh?

There’s a saying that “a little bit of information is a bad thing,” because it’s enough to cause questions from people (or even outright panic) but not enough to help us cope and understand the totality of the situation. We are collectively in a state of a very large cohort saying, “I’m confused. Give me answers, so I know what to think, feel, and do in response.”

6. Frustration – We want reassurance, we want comfort, we want safety, we want to be reliably and genuinely promised that our well-being will remain intact. It’s not too much to ask for our taxes paid to those whose job it is to protect our collective well-being. And if we don’t have that reassurance, and the provision of resources (such as vaccines or effective treatment), than our goals are thwarted, resulting in frustration. “And just why not?” we collectively ask. Not only “why not” are they prepared to help more, more soon, in Monkey Pox, but also in the context of the frustration of the reasonable expectation that, “Have we learned absolutely nothing after the pandemics of HIV/AIDS and the immediate past (current) experience with COVID?”

How can we “not” be frustrated when the world has had nothing but a wake-up call on how to identify, develop, sustain, distribute, and administer vaccines or effective treatment to as many as possible, as soon as possible? If we haven’t learned that lesson yet, from HIV/AIDS and COVID, exactly just when will our governments and public health infrastructures learn it? How much more evidence do you need that preparation should be a priority for any number of public health emergency scenarios?

annoyed angry Black man in gray vest deposit photo 8 7 227. Anger – All of these, really, are just variations on anger. Anger at Mother Nature for not leaving us in peace for a while from worldwide, horrific pandemics. Come on. They didn’t use to be every two years; with an effective vaccine campaign (and while we’re at it, it goes without saying, but fuck you, anti-vaxxers), smallpox had been largely vanquished.

It’s like that scene in “The Wizard of Oz”: “I thought you said she was dead?” “That was her sister, the Wicked Witch of the East; this is the Wicked Witch of the West, and she’s worse than the other one was!”

Smallpox’s angrier sister, Monkey Pox, has come to take her revenge. And we’re angry enough that, like Dorothy, we want to vanquish her with the proverbial bucket of water of Monkey Pox vaccines promptly and decidedly.

A colleague of mine once said in a talk, “We don’t want to eliminate anger; we want to manage it. After all, anger is our defense against abuse and exploitation.” There is a place for healthy anger in advocacy, activism, and social protest. Rosa Parks, the famous African-American lady whose experience was a catalyst in the Black Civil Rights movement, refused to give up her seat on a bus in Alabama to a White man, when that was the law then. “No,” she said, “I’m tired.” And that perfectly reasonable stance set off a firestorm because, well, how dare she.

Sometimes, you have to use your anger – or even just your “tired-ness” – to fight back against the tyranny of the majority.

You don’t get what you deserve in this life. You get what you negotiate. We need to negotiate how gay men are treated in the medical, political, legal, social, and even the mental health spheres. There are two sides to any negotiation. Public Health and government can say “just stop fucking” as their oh-so-wise “answer” to Monkey Pox, and we can say back, “No. We’re tired. Of being dismissed, devalued, and disregarded every time a neutral biological phenomenon like a virus happens to strike a somewhat insular cohort/demographic/community like gay men. If this were happening to any other specialization demographic, there would be more visible, active, prompt, effective responses. We are tired. Try harder.”

8. Resentment – Early in the AIDS epidemic, gay men were told to “just not have sex.” Close the bathhouses and stay at home, preferably back in the closet “where you belong.” To a generation of gay men who had survived and emerged from Stonewall in 1969 and enjoyed the long-withheld sexual liberation of the 70’s, those were very unwelcome words. “Oh, Hell no!” was the general reaction. Today, we have it again from the same idiot Right-wing (is there any other kind of Right wing?) politicians and pundits with Monkey Pox. Their simplistic, dismissive, “if all y’all would just stop yer fuckin’, we wouldn’t have no Monkey Pox problem infecting our keee-ids.” Again, there is a resentment that instead of intelligent, science-informed approaches to handling a biological disease and its spread among world populations, ignorant-ass platitudes from morons dominate the sound-bites in media.

Of course we resent it. Never mind that “having fewer sexual partners” and “employing risk-reducing behaviors” are practical, sure. And probably even “wise” to do right now. But we still get to resent that the age-old homophobic, dismissive, condescending, patronizing attitudes come from the elected officials who are charged with protecting the well-being of all citizens as part of not only their job, but also their solemnly-undertaken Oath of Office, and not just pandering to their cretin, moronic, Base of Bigots with alarmingly-increasing social, legal, and political influence in the United States, seemingly unchallenged. ACT UP. FIGHT BACK.

9. Determination – Our community of gay men have proven, over and over, that we are nothing if not determined. We’ve had to be. Our lives and livelihoods have demanded it. We are also nothing if not resilient. This, too, shall pass, but it’s because we make it pass, by sheer determination. A determination to demand solutions to the problems that affect us, whether it’s a lack of legal equal civil rights, or a virus that has recently (at least at first) very unwelcomingly entrenched itself in our community like an undesirable house guest.

We remain determined to help ourselves any way we can, but also to demand that we are given the resources (again, that we have already purchased with our tax dollars) that we need to send Monkey Pox back off into the wilds of the jungle, never to be heard from again.

arrogant young man in suit taking a selfie deposit photo 8 7 2210. Over-Confidence – Some of my clients this week bemoaned the over-confidence (see above with “denial”) that gay men can have. We had this during COVID, when many (not all) gay men were really taking risks that they probably shouldn’t have from a COVID containment point of view. The fact that COVID wasn’t worse among these guys in Puerto Vallarta, Tulum, Fire Island, etc. is just lucky, and perhaps part of that “youthful resilience” factor in the pandemic, plus our generally active and early uptake of vaccine opportunities. Those of us who take HIV meds daily to stay alive, or take PrEP meds to not get HIV in the first place, know all about Better Living Through Chemistry, and that includes demonstrably reliable, safe, and effective vaccines.

‘But the risk of over-confidence is real. Without intervention, Monkey Pox can and will spread its infectiousness, and with that, real pain and suffering to at least some of our brethren. And we need none of that. We want to have hope and resilience, but you don’t go fight the Wicked Witch of West without, as Dorothy’s companions did, an axe, a butterfly net, a giant wrench, and a big spray can of Witch Remover (go back and watch the Haunted Forest scene again, more closely, if you don’t know what I’m talking about. Renewal of your Gay Card depends on this.)

relived yong man in blue polo shirt deposit photo 8 7 2211. Relief – I truly belief that meaningful relief from the current, timely scourge of Monkey Pox is coming. The question is, is it soon enough? We will have relief, just not yet. “There’s got to be a morning after, if we can hold on through the storm,” as the song from Maureen McGovern said in the 70’s from “The Poseidon Adventure,” when a tidal wave at sea made a ship turn upside down. Monkey Pox has turned our fabulous gay cruise ship upside down. And while relief is coming, we must do what we can – medically, socially, and even, yes, psychologically, to adaptively cope (that thing I tell my clients about a lot, “adaptive coping” for any life challenge) until then.

We will not “go back” on the gains that gay men, and all our LGBT community, worldwide, have made. Even when they are currently being challenged, whether it’s by Right-wing Republicans like Donald Trump, Marjorie Taylor Green, Lauren Boebert, or any “parental rights” suburban “Karen” who has a fit about “drag queen story time.” Fuck those people. Silence = Death. ACT UP. We Say Gay.

And Monkey Pox: Gurl, sashay away.

KHprofpicJune2019 pink shirt
Ken Howard, LCSW, CST

If you would like help or support for any kind of stressor or life goal, consider therapy (for residents of California) or coaching services in other states or countries. If you’re looking for a public speaker, I do that. If you’re looking for an expert witness in LGBT+ or HIV/AIDS issues, or others, I do that. For more information, email, or call/text 310-339-5778.

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