Social change, mental health, and the evolution of gay male identities: A clinical ethnography of post-communist Prague (Czech Republic)

This dissertation aims to fill a void in our understanding of the mental health effects of rapid social change (as in the transition in Central and Eastern Europe from communism to democratic capitalism) and of the emergence of alternate forms of sexuality-based community and identity in non-Western countries, by examining the experiences of homosexual and bisexual men in the Czech Republic.; In the first part, I propose that the phenomenon of homosexuality in the modern West is best understood as the outcome of a series of economic and cultural developments, in which a same-sex orientation (heterogeneous and partly biological in origin, occurring at a low base rate in all human populations) is elaborated, via modern Western conceptions of the person and of romantic and sexual relationships, and in the high population densities of urban settings, into a politically constructed identity . The variations on gay identities now emerging in non-Western countries can be understood only in the context of different local histories, politics, and conceptions of the person, romance, and sexuality.; I then describe several aspects of the gay communities and identities which are emerging in the Czech Republic since the end of communism, including the social structure of the gay world, the negotiation of bisexual vs. homosexual self-concepts and lifestyles, Czech conceptions of romance and sexuality and their reflexes among homosexual and bisexual men, and the unequal economic relationships occasioned by the opening of a postcommunist country to Western tourism and enacted in prostitution and pornography.; The second part examines specific issues of depression, dysthymia, and alcoholism in post-communist Czech Republic, much of which may also apply to post-socialist societies or other developing societies more generally. It argues that experiences under socialism and during its aftermath act as a kind of society-wide "learned helplessness," and proposes that a more broadly psychodynamic conception of coping strategies and mediating temperamental variables complements and expands on the best current integrative models of depression. Finally, it explores the mental health vulnerabilities of sexual minority men in a broader context of high rates of alcoholism, suicide, and possibly dysthymia across CEE.