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Concealed Sexual Orientation Is Like an Abscess

Concealed Sexual Orientation Is Like an AbscessI once had an abscessed tooth, and in the absence of a dentist, I considered pulling it myself to end the intense pain. Secrets are like abscesses. They hurt when we touch them but we can’t stop touching them. When a secret is at the center of our integrity it produces excruciating pain. We long for the momentary intense pain that comes with releasing the pressure.

Each of us seeks to maintain a sense of internal integrity, while still making a positive impression on others. We are driven by a fear of being discredited. Sometimes that means keeping secrets, especially when the concealed information is sensitive. Concealment of sexual orientation requires considerable effort, constant vigilance, and behavioral self-editing. Although there is a wish to disclose the secret, the need to make a favorable impression on others often overpowers the need to disclose.

Coming out is a process of initiating forgiveness for what we or others may see as a serious mistake. Initiating forgiveness is associated with higher stress at all ages, but it is particularly complex for the mature man who has been living a heterosexual life. In the research for my book Finally Out: Letting Go of Living Straight, I found that for mature men who have sex with men (MSM), initiating forgiveness creates one of the biggest barriers to their coming out. MSM have intense stress that may worsen their physical health and lead to depression, substance abuse and suicide. MSM may or may not feel guilty about their sexual behaviors, but most are tormented by the potential consequences of revealing their lies and deception.

Evidence exists of increased rates of diagnosable psychiatric disorders and substance abuse in the LGBT community. There is also an alarming rate of suicide, and rates of suicide are underreported. Suicide is one of the three leading causes of death for adolescents. Gay adolescents are four times more likely to commit suicide than their heterosexual peers, a major public health crisis. Prevention programs tend to focus on suicide among teenagers, but in 2007, the suicide rate among middle-aged Americans reached its highest rate in 25 years.

Population-based studies of suicide in the LGBT community are virtually nonexistent. In research of suicide, middle age is overlooked and mature MSM are invisible. The possibility that sexual confusion and conflict about sexual identity might be a contributing factor to suicide in middle age LGBT people is rarely, if ever, considered. Even within the gay community, the subject of gay suicide is taboo because of a fear that talking about suicide will undermine efforts to combat the idea that homosexuality is a form of pathology. Many of the suicides in the gay community – regardless of age — occur while contemplating the public disclosure of sexual orientation and gender identity issues.

Psychiatrists cannot predict who will commit suicide, but there are established criteria used to assess risks. Risks include being male, being depressed and lonely, and abusing drugs and alcohol.

Risk factors for suicide that may be higher in gay men include:

  1. Depression and anxiety
  2. History of alcohol and substance abuse
  3. Loss or failure to meet expectations
  4. Feelings of hopelessness and isolation
  5. Lack of social and spiritual support
  6. Unwillingness to access treatment

Unresolved sexual identity issues heighten anxiety, loneliness, and isolation, and create a fear that life is not going to turn out as planned. Few resources are available for the LGBT community in midlife. The mature man may no longer have parents as a source of support, and early signs of medical problems may accelerate fears of aging. Because of a fear of exposing his secret, MSM frequently resist seeking help.

We live our older years in much the same way as we lived our younger years. Prior life experiences such as education, occupations, and social class influence how people experience their declining years. We all prefer to be a part of a community that accepts and supports us, but for some, isolation makes that very difficult. Those who are isolated may have as much as 65 percent more depressive symptoms. MSM fear rejection by the heterosexual community they’ve been a part of, and they may not feel welcome in the gay community they have experienced in only very limited ways.

When one is part of a stigmatized minority, being in the presence of others like them has a positive effect on self-esteem. Becoming part of a community where you don’t have to always censor your speech or edit your behavior is remarkably liberating. It creates a feeling of finally coming home. Within a network of friends and “family of choice,” the sexual orientation of their companions is less important to gay members than the freedom to be open about their sexual orientation. But the LGBT community will not seek out a mature man who finally chooses to come out. Finding that community will be up to him.

Concealment of sexual orientation requires effort, vigilance, and self-editing of behavior. Although MSM wish to disclose their secret, the need to make a favorable impression on others blinds them to the relief that comes with disclosure. Concealing a secret life is intensely painful, but just like lancing an abscess, MSM long for that relief.

Concealed Sexual Orientation Is Like an Abscess

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Loren Olson, MD

Dr. Loren A. Olson, author of Finally Out: Letting Go of Living Straight (inGroup Press, 2011), is a gay psychiatrist in private practice in Des Moines. He is a Distinguished Life Fellow of the American Psychiatric Association and a recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness. He is a featured blogger for and, and he hosts, a blog for mature gay men. A father and grandfather, Dr. Olson came out when he was 40, after an 18-year marriage. In 2009 he and his long-time partner, Doug, married, six months after the state of Iowa overturned a 10-year-old ban on same-sex marriage.

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APA Reference
Olson, L. (2018). Concealed Sexual Orientation Is Like an Abscess. Psych Central. Retrieved on September 26, 2020, from
Scientifically Reviewed
Last updated: 8 Jul 2018 (Originally: 9 Apr 2011)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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