Human and sexual loss was followed by anger, another common theme often heard during therapy in response to AIDS. During the height of the epidemic, the seemingly complete disregard by the federal government and by the majority of heterosexual America for the plight of people with HIV and AIDS, as well as discrimination against people with HIV/AIDS and inaction by the Reagan administration — which was clearly rooted in the homophobia of that administration, with its close ties to the religious right wing in America — exacerbated the rage and frustration of the gay community and its allies. Gay men were angry at having lost their carefully built gay families to this plague, at the loss of gay culture, and at the loss of hopefulness and celebration in the gay community.

In a powerful essay entitled “Mourning and Militancy” published in the periodical October, queer activist and cultural critic Douglas Crimp (1989) uses Freud’s essay, “Mourning and Melancholia” (1917) as a framework for examining various reactions gay men had to AIDS early on. Crimp notes that Freud describes mourning as the reaction not only to the death of a loved one, but also “to the loss of some abstraction which has taken the place of one, such as one’s country, liberty, an ideal, and so on” (Freud, 1917, p. 243). Gay-affirmative psychotherapy provided access to sympathetic and understanding professionals with whom men could discuss the multiple losses they needed to acknowledge and grieve as a result of AIDS. As gay men were reeling in response to AIDS, Crimp wrote movingly about how AIDS-related losses affected gay men. Addressing Freud’s discussion of mourning, Crimp asks: “Can we be allowed to include, in this ‘civilized’ list, the ideal of perverse sexual pleasure itself rather than one stemming from its sublimation? Alongside the dismal toll of death, what many of us have lost is a culture of sexual possibility. Sex was everywhere for us, and everything we wanted to venture. Now our untamed impulses are either proscribed once again or shielded from us by latex” (Crimp, 1989, p. 11). If a therapist was not gay affirmative, he or she would most likely not see the value of the sexual culture that gay men had built and now needed to mourn. In my practice I worked with innumerable men who at least initially felt guilty disclosing feelings about the non-death-related losses they were also suffering.

Walt Odets makes a connection between gay men’s mourning in response to AIDS-related losses and unsafe sex. “Mourning and the feelings of loss, grief, and emptiness that accompany it are often fended off by an introjection2 of the dead individual” (Odets, 1994, p. 439). Odets (1994) found that during the height of the epidemic, some gay men had a desire not to survive the epidemic. He believes there were “psychologically comprehensible reasons that some men might not wish to survive the AIDS epidemic,” including depression, anxiety, guilt (including guilt about not being infected and guilt about surviving the epidemic and outliving loved ones who had already died), feelings of emptiness and loss, isolation and loneliness, loss of social affiliation and psychological identity, and dreading a future that held more of the same.

What Odets described was confirmed by my own clinical experience with gay men early in the epidemic. Currently, the gay men in my psychotherapy practice no longer report these same intense feelings of hopelessness and despair as a result of AIDS. Odets describes that introjective fantasies are often a normal part of healthy adult experience when, for example, they are one aspect of the power and emotional significance of sexual intercourse, whether it be oral, anal, or vaginal. While introjection is often conceived of as a relatively primitive reaction to loss, identification is considered to be more mature and constructive than introjection. As Odets reminds us, introjection and identification are not always discrete processes. Both, however, work to fend off the experience of separation and loss. Odets gives the example of an uninfected man who has unprotected sex with his lover who is dying of AIDS as one example of literally and figuratively one man’s trying to injest his beloved at risk to his own health. As Odets reports in the case cited, a gay man immediately after the death of his lover may feel consciously that he is sick and dying, and that it might not even occur to him that he is not. This is evidence of the power of this particular introjection. For other people, having HIV may be indivisible from being gay and receiving infected semen creates a connection or bond to the gay community, which has become merged in an individual’s mind with the community of HIV-infected people.

Yet when talking about the seemingly less tangible losses, many gay men expressed confusion at the intensity of their feelings about the impact of these losses on them and the broader community. They easily understood needing to mourn loved ones who had died. But to quote Crimp again, “To say that we miss uninhibited and unprotected sex as we miss our lovers and friends will hardly solicit solidarity, even tolerance. But tolerance is as Pasolini said, ‘always and purely nominal, merely a more refined form of condemnation’” (p. 11). I would add that a crucial aspect of strengthening the therapeutic bond and thus the potential of healing for any gay man expressing feelings about the loss of being able to freely and spontaneously express his sexual desire during the height of the AIDS epidemic was that the therapist be empathic to these concerns. It is only a therapist who values and affirms the intrinsic nature and health of gay sexual expression who is able to do the sophisticated therapeutic work required to help a grief-stricken gay man delve into his complex feelings and reactions that go beyond his grief over the deaths of friends and lovers.

In 1989, when he wrote his essay, Crimp had profound insights into how the memories of sexual pleasures became linked for some gay men to ambivalence about their sexual histories. This has multiple dimensions, which will be explored in the coming pages. For example, sometimes this ambivalence was related to resentment about having to change sexual practices and the need to think in terms of “protection” rather than pleasure. Mental health professionals were on the front lines of these conversations, rants, and laments. Younger gay men who might not have been sexually active before the onset of AIDS and men who were just accepting their own gay identity at that time were disappointed and angry at the lost opportunities to have carefree sex. Crimp (1989) speaks to this: “For men now in their twenties, our sexual ideal is mostly just that — an ideal, the cum never swallowed. Embracing safe sex is for them an act of defiance, and its promotion is perhaps the AIDS activist movement’s least inhibited stance”  I believe that what Crimp is referring to here when talking about the defiance with which some younger gay men adopted safer sex is a defiance against AIDS and of giving up sex completely.