Hi everyone. We're going to get started. Thank you so much for coming to this lecture today. Good afternoon and welcome. This is the annual John Fryer Award Lecture, and today it's going to be delivered by Dr. Robert Kurtzner. And before he begins his lecture, I just wanted to tell you a little bit about the John Fryer Award. It is co-sponsored by the American Psychiatric Association Foundation and the Association of Gay and Lesbian Psychiatrists, HLP, and it was established in 2005 and honors an individual who has contributed to improving the mental health of sexual minorities. The award is named for Dr. John Fryer, and some of you may have been here for the lecture we did on Sunday. He was a gay psychiatrist who played a crucial role in prompting the APA to review the scientific data and to remove homosexuality from its diagnostic list of mental disorders in 1973. And remember, Dr. Fryer was the psychiatrist who spoke at the 1972 APA with a Nixon mask on. We've come a very long way. So I want to tell you a little bit about Dr. Kurtzner, who will be the recipient of the award. So, Dr. Kurtzner is an Associate Clinical Professor of Psychiatry at Columbia University in the Gender, Sexuality, and Health Research Division and Distinguished Life Fellow of the American Psychiatric Association. He has spent much of his career in sexual minority mental health research with a focus on the mental health impact of HIV, AIDS, and the adult life course in well-being in LGB persons. He concurrently served as a supervisor, mentor, and teacher of medical students, psychiatry residents, and doctoral candidates on these topics, and is also a speaker and writer, bringing a discussion of LGB mental health issues to community groups and scholarly and popular publications. Dr. Kurtzner served as an initial member of the American Psychiatric Association Commission on AIDS, training director of an NIMH-funded postdoctoral fellowship in HIV behavioral health sciences at Columbia University, and consultant to organizations advancing an understanding of human sexuality. He is currently on the board of the Bellevue Literary Press and a blogger for Psychology Today, where he likes to tell stories about unexpected moments in clinical practice, ethical dilemmas, and reflections on where the personal and professional aspects of our work come together. And on a more personal note, I've known Bob throughout my career, and I think of him as a mentor, a colleague, and friend. And I'll share with you one very quick anecdote before we get started, which was we were both in California, and I had worked with a patient who had committed suicide, and there was one person that I wanted to talk to after that really challenging experience, and that was Bob. And so it's my great privilege and honor to present the Fryer Award this year to Dr. Robert Kurtzner, and I'm looking forward, as I know all of you are, to hearing his talk. Let me show you all the award. Thank you. You want a shot? Revolution will be televised. All right. Okay. Thanks, Jim. And while we're posing again... And one very quick thing, we'll be re-presenting the award tonight to Dr. Kurtzner at the Association of Gay and Lesbian Psychiatrists, LGBTQ psychiatrists, I should say, at our award ceremony tonight. And if you would like to come, there are AGLP newsletters and brochures in the back. Thank you. Dr. Kurtzner. Good afternoon, everybody. It's such an honor for me to be here today with friends and colleagues. I'm so honored to be in the company of past recipients of this award. And to stand before you, I happened to go to a session yesterday morning honoring John Fryer, which was a happy circumstance for me to hear what he said in 1972 and to think about how 52 years later he has influenced me in ways that I didn't appreciate until I heard his speech as part of a panel discussion of psychiatry, friend or foe, as part of the 1972 historic session that he participated in. You know, here we are 52 years later. It's remarkable to me that the American Psychiatric Association has an out gay president and an out gay medical director. I think John Fryer began a crescendo of change within the APA that has benefited us, our patients, sexual minority persons in the world in which we live. So I have no disclosures to make, but I have two ulterior motives in making this, in accepting this award today and speaking before you today. And the first, of course, is I really want to acknowledge many colleagues to whom I'm indebted. They have made contributions to LGB mental health. They've influenced my own personal and professional developments. This is an incomplete list for the sake of brevity. I'll start off by acknowledging my academic home, which is the HIV Center for Clinical and Behavioral Studies at Columbia. It's in the gender, sexuality, and health research area in the Department of Psychiatry. This center has supported my research. I'm indebted to Anca Earhart, who is the former director of the HIV Center, and to Bob Ramian, the current director, for both Anca and Bob's encouragement over the past 35 years. I want to also give a shout-out to the late Stuart Nichols and Richard Isay, who were early role models and mentors for me. Ron Winchell, who's here today, is my guru in critical thinking and has engaged me in many productive conversations about my work. Marshall Forstein, who's also here today, has shared with me notes on living and work and loss and resilience and has been an invaluable friend and colleague for many decades. I want to dedicate this talk to Jeff Langley, who was my co-investigator in life. He is a man about whom it was said he knew the answers to the questions before we knew what the questions were, and he's my late husband and partner and husband for 45 years. His influence is very much present in my talk today, and those of you who knew him will sense that. So my second alternative motive in giving this presentation today is to talk about a topic that I've been looking for for many years here at the American Psychiatric Association. That's the notion of positive health, psychological well-being in LGB persons. For a definition of positive mental health, I'm going to turn to the field of positive psychology, which emphasizes the experiences, traits, and strengths, or sometimes called virtues, in environmental resources that contribute to positive mental health. I've taken note that for quite a while there was very little about positive mental health as applied to LGB persons. Huge literature describing positive mental health in the general population, only in the past two decades, work done with sexual minority persons. Understandably, our focus as psychiatrists has been in mental health disparities, that is to say the increased rates of depression and mood disorders and anxiety in LGB persons, largely attributable to stigmatization and discrimination. But I think, and I'm not alone in calling for this, I think it's an interesting venture to think about, okay, so what is well-being, what is positive mental health in LGB persons? That's the topic of my talk today. And why study positive mental health and psychological well-being in LGB lives? Well, we know that despite increased rates of depression and anxiety in sexual minority persons, most LGB persons do not have a psychiatric diagnosis. We also know that the absence of a diagnosis of negative mental health, depression, anxieties, it doesn't tell us much about positive mental health. They're not simply opposites of each other. And I agree with the researchers Vaughn and Rodriguez, who study positive psychology in sexual minority persons, and they wrote, a focus on the negative aspects of LGBT lives serves to offer an incomplete and unintentionally biased understanding of what it means to be a sexual and or gender minority person. And I was very moved yesterday to hear John Fryer speak in the audio tape that was played for us of his 1972 talk in which he said that it's very important for us to live our humanity fully. And he cautioned that one of the greatest losses is not to be able to do this. So 52 years later, I hope to circle around a little bit and to explore the question of, so what does it mean to live our humanity fully? I'm going to take on the impossibly broad question of what this means, and I suspect I'm going to leave you with more questions than answers. And here's what my plan is for today. I'm going to ask what factors promote well-being in LGBT lives, what stories embody it, what qualities exemplify it. That's the focus of my talk. And my method will be to share a little bit about the history of how I and others became more interested in positive mental health over recent decades. I'm going to review just a few studies, empirical studies, that have looked at psychological well-being using an interesting measure developed by Carol Riff. And then I'm going to segue into a more descriptive sort of ad-lib discussion of well-being by sharing with you stories and pictures and the thoughts of writers and artists who have spoken to this. I'm going to move from a descriptive mode to more of a prescriptive mode. So let me just share with you some caveats about this presentation. I'm going to focus on adult populations, not adolescents, not those who are in emerging adulthood. Most of my research has been with adults. I'm hoping that some of the points I make today will be applicable to younger people. And also I'm going to be talking about cisgendered individuals because, again, my work and the studies that I'm going to quote were conducted with cisgender populations. We know less about transgender and gender-diverse persons from a life course perspective and what experiences promote well-being beyond the value of affirmative care and transitioning. But, again, I hope we can extrapolate some of my comments to transgender and gender-diverse individuals. Talking about LGB well-being requires humility. Considering that homosexuality is criminalized and prosecuted in various parts of the world, severely punished, and for some people survivorship may be a more relevant consideration than psychological well-being, LGB persons continue to experience discrimination, stigmatization, and trauma, all of which are implicated in mental health disparities, as you're aware. You know, we need to keep in mind that, according to the Human Rights Campaign, there were over 520 anti-LGBTQ plus bills that were introduced in U.S. state legislatures in 2023. That's a record number. And there is one other caveat I want to come back to, which is my favorite caveat. Well, two things that are really important. Elon Mayer, the psychologist and researcher, said we need to be careful when we're talking about positive mental health in LGB populations, and in particular, be careful not to attribute positive and individual traits or virtuals to personal characteristics when, in fact, we really may be looking at social privilege and advantage more than anything else. Well-being, courage, resilience, and other qualities that are sometimes considered to be virtues are really greatly influenced by social and structural factors and really what's possible to express. And I also want to share with you the notion of historical age cohorts. Depending upon what year you're doing research, you're going to be capturing historical effects that define each generation of LG people coming of age. And I think about the researcher Phil Hammock, who wrote the following about 10 years ago. He said there are five generations of gay men alive today, each with unique issues related to health and identity development. And he defined these respective generations as life when homosexuality was considered psychopathology. I suppose that would be the 50s, 60s, and early 70s. The liberation generation, the age generation, and generation is defined by greater equality. Edmund Wright in 1977, this is dated, wrote of a generation of gay men now in middle age, never had a group been placed on such a rapid cycle, oppressed in the 50s, freed in the 60s, exalted in the 70s, and wiped out in the 80s. So that's the historical cohort of people who came of age during the ascendance of AIDS. Of course there are the 90s, the aughts, the teens, and the present decade. And each decade ushers different stories about the experiences of sexual minority persons. And you're going to appreciate my comments are to some extent rooted in my specific historic age cohort, which is, and I'll talk about this a little bit later, coming of age just before HIV AIDS, during the epidemic, and then being fortunate enough to benefit from some of the social changes that took place over the past two decades. We're all part of a transmission of stories. Each of us transmits information that's taken in and modified by subsequent generations. Harvey Milk went to my high school. I missed him by about 18 years, but I met my husband in San Francisco in the cast jar in 1976. And the aura of that city and Milk's role in the headiness of those years is baked into my history and part of this presentation today. So with all of this heterogeneity about LGB lives, so who are we talking about when we talk about sexual minority persons and their mental health? I didn't mention other diversities. I think many of you are familiar with the intersectionality of multiple minority identities that LGB people may have. There are other issues of diversity, which is to say the largest number of LGB people are bisexuals. That's about 55% of people who identify as LGB. People come out at different times during the life cycle. So somebody who's coming out in midlife is going to have a different portfolio of social roles and different identities that's going to shape the course of well-being. And, of course, to return to my question here, which is so what's the common thread here? And it would be the ongoing presence of stigmatization and discrimination over sexual orientation. And Mays and Cochran summarized this in the 2011 Institute of Medicine report. That was the health of lesbian, gay, and bisexual transgender persons. LGBT people have elevated rates of lifetime and day-to-day discrimination with 42% attributing the discrimination partially or entirely to their sexual orientation. So to ask maybe an obvious question, so why is this important? We know that discrimination, concealment of sexual identity, anticipation of rejection, internalized negative attitudes about sexual identity, these are all called minority stressors. It's well documented that they're implicated in increased rates of depression and anxiety in LGB people. And I think any discussion of positive psychology in LGB people is going to need to take these stressors into consideration. A lot is at stake here. While LGB persons have no monopoly on being othered or experiencing discrimination, sexual identity is uniquely tied to who you are and how you experience a sense of authenticity, how you love and how you are loved, how intimacy and pleasure are experienced. Some of these echo Eric Erickson's stages of intimacy and identity, which he thought were way stations on the road to psychosocial development and fuller adult health. And one final point on this slide is that one of the pathways by which discrimination and stigmatization are associated with negative mental health is that they interfere with developing a positive identity and experiencing community connectedness. And both of those are linked to psychological well-being, as I'll discuss shortly. So now for the fun part, which is a little autobiographical detour. And I'm going to take you back 43 years. I'm going to move you uptown 130 blocks to Columbia Presbyterian Medical Center. And the time is 1980. I was a PGY-3 resident. So John Fryer had spoken at the APA meeting only several years beforehand. And the proposition of being an out psychiatrist was precarious. John was, in fact, fired a year after his panel presentation. And he was told by an administrator that if you were gay and flamboyant, we would keep you. If you were flamboyant and not gay, we would keep you. I think I might have misquoted that. But if you were both gay and flamboyant, we cannot keep you. And so against this historical backdrop, I was outed by a psychotherapy supervisor when I was a PGY-3 resident. This supervisor mistakenly assumed it was I who had come out to the process group. It wasn't. It was somebody else. Nobody knew that 30% of our class was gay that year. I don't think they would have handled that statistic. So my supervisor said, I heard you came out to your process group, and there was an internally long silence. I'm just trying to figure out now what. And I said, well, it wasn't me, but it's true. And so began my career as an out psychiatrist. And I remember thinking, well, so much for my psychological well-being, so much for my career. I mean, little would I know that 40-plus years later at my institute, the New York State Psychiatric Institute, there would be an LGBTQI plus affinity group. And I did patch things up with the supervisor many years later, who's quite apologetic about that. But something else happened around this time that sort of superseded the questions I had about being out as a psychiatrist. And so as you know, in 1981, the New England Journal of Medicine first reported or ran one of its first articles about what was then called the Gay-Related Immune Deficiency Syndrome, now we know it as AIDS. And so many of our resources went into, mine included, went into HIV prevention, treatment, questions of survivorship, advocacy for HIV-positive persons, and training health professionals in mental health. To muster institutional focus, the American Psychiatric Association initiated a task force, which became an AIDS commission led by Marshall Forstein, who's here. And in 1987, my academic home, Columbia University, received NIMH funding to open one of the first HIV centers. And our center was called the HIV Center for Clinical Behavior Studies. It continues to this day. It's in its fourth decade. That was really to sort of respond to AIDS and to very quickly launch research programs that looked at effective preventive interventions for at-risk populations. I want to give a shout out at this point to Herb Pardes, who's a titan in the field of psychiatry, who died last week. Herb, in 87, said to Anka Earhart, the former director of the HIV Center, we need to do something about AIDS. And pulled together a troika of senior people, Anka, the late Sina Stain, the epidemiologist, and Robert Spitzer, the late Robert Spitzer of DSM fame. And so we began the center. And this was a remarkable collection of colleagues from many different disciplines, people who represented community organizations. You know, the issue of sexual orientation was, it just, it was, I wouldn't say it was a non-issue, because it was related to our work. But it didn't really matter with respect to professional development. And I consider myself to be quite fortunate to have been swept up in the initiation of that center. And as I mentioned before, that's in my home for several decades right now. What I want to say to you is that, you know, at the time of the ascendance of AIDS, we weren't thinking about adult development. We were thinking about survivorship. And we were trying to help people adapt and cope with what was then described as shattered meaning in their lives. And this circled statistic here was figures from the Urban Men's Health Study. It was a study of gay men's, or actually men who have sex with men's, psychological and physical health. And this is the New York City cohort of about 266 individuals. And we looked at men in the study who were between the ages of, I think, 40 and 55, it says here. And you know, there were phenomenal losses of loved ones, friends, to AIDS. And I've circled the fact that 17% of this cohort experienced over 20 deaths. And the range of deaths experienced by respondents was 0 to 400. Many of us who worked as clinicians at that time worked with scores of patients who died of AIDS. And this became the focus of our efforts. However, and let me just advance this one slide. You know, at some point, oh, here's just another slide that illustrates this. A research participant in a study of midlife that I conducted talked about what it was like to live during this time. And he said, you know, I never thought I would make 40, because I think everybody else just assumed they were HIV positive. So now we're going through the phase of, oh, well, we're going to live for an extended period of time. And maybe we should start making paths along these lines, which is something new. And it's quite scary. Here's a graphic from the San Francisco AIDS Foundation, which spoke to the anxiety of younger people who really didn't see any discernible life course. Everybody disappeared in their 40s and 50s and 60s. And the whole generation of storytellers and transmitters of coming out and the experiences of being a gay person getting older was really completely lost. However, HIV treatments improved in the mid-90s. And so this raised the question of survivorship. With longer life expectancies, what would adult development look like in LGB persons? And what was an imaginable life course that would extend into midlife and beyond? I do want to acknowledge that there was work going on in the 70s and 80s that did look at midlife transitions in lesbians and gay men. Barbara Sang, I think, edited a terrific book about midlife transitions in lesbians. And there was a fair amount of work being done of studies of older LGB persons navigating old age. But this was not integrated into what existed in the literature for the adult population, which is a life course model that talked about adult development and plotted out transitions that people would experience in social roles and identity in their 30s, 40s, 50s, and 60s. I remember a gay male patient of mine in his 30s shared with me his apprehension back then that he thought adult development in gay men consisted of the transition from adolescence to obsolescence. I think that's a truncated view of things. But I don't think he was alone in thinking that. So existing theories of adult development did not take into consideration some of the adults being studied were lesbian, gay, or bisexual, or they thought that being LGB precluded full maturation as defined by the hallmarks of heterosexual marriage and parenting. However, there have always been voices that have spoken up. And I give George Valiant credit for singling out the voice of Alan Poe, one of his studies in the Harvard Study of Adult Development. And in the 1977 book, Adaptation to Life, Valiant quotes Alan Poe, one of his respondents. This is a cohort, by the way, that's been going on for 80 years. It's tracking longitudinal developments. It first started with Harvard students, but then it included men from inner city Boston. Alan Poe probably said this to Valiant in the 70s, early 70s. And he said, I've got a bone to pick with you. I am a homosexual. Now, don't get me wrong. I'm not opposed to middle class values. In fact, I rather admire them because I've been so bad at them. But I think true adaptation has a larger dimension. And here's a statement from the sexologists Simon and Gagnon, which I think kind of captures the sort of absence of knowledge about expectable life transitions. And they wrote, in 73, there is a seldom noticed diversity to be found in the life cycle of the homosexual, both in terms of solving general human problems and in terms of the particular characteristics of the life cycle itself. I mean, there just wasn't much to go on to figure out what the scope of LGB lives would look like in a world with longer life expectancies and greater possibilities for openness, recognition of relationships, and acceptance and integration of being gay into family life, work, and community life. So one way to think about seldom noticed diversity that Simon and Gagnon and his colleagues Simon flagged is to sort of think about psychological well-being. And in particular, the field of psychological well-being makes a distinction between subjective well-being, otherwise known as hedonia, that's life satisfaction, that's happiness, and something called objective well-being. And that's a little bit more rooted in the long haul. It's how we grow lives. It's sort of cultivating attributes. It's about growth. It's about self-realization. It's about how humans function and flourish in multiple life domains. And it draws on the formulations of human development and how individuals thrive vis-a-vis existential challenges in life. It's related to Aristotle's notion of the good, in which he spoke about the importance of trying to achieve the best that is within you, to know yourself, to become who you are. It's based on an integration of mental health, clinical, and lifespan developmental theories. And here's one particular model. Carol Riff, a psychologist, developed this model of eudaimonic or objective well-being, in which she postulated that psychological well-being is comprised of six components. You can see from the slide here, environmental mastery, positive relations with others, autonomy, personal growth, self-acceptance, and purpose in life. And on the right, you can see the theoretical underpinnings of her model. So I thought this was, not just me, but many people within the last 20 years said, well, this is really interesting. Maybe this is particularly relevant to people who are reckoning with stigmatized identities, which influences them, sometimes shapes them, but somehow gets folded into some appreciation of the life that's lived. And I considered it objective measures of well-being, really an effort to really capture, how do we grow a life? And I'm going to just highlight a few studies. This is research that is a little bit like a few pieces of a jigsaw puzzle, and there are a lot of caveats to this. But there is a very large cohort. It's the MIDAS cohort. This was founded by the MacArthur Foundation, and it had, I think, 35, 52 adults. It was a national probability sample. It included 97 LGB respondents. And Riggle and her colleagues did analysis by sexual orientation and reported that sexual minority persons had lower overall psychological well-being and lower scores on subscales of environmental mastery, positive relations with others, purpose in life, and self-acceptance. But they didn't differ on personal growth and autonomy. Riggle and her colleagues thought that the disparity in psychological well-being probably reflected the cultural stigmatized identity of people self-identifying as gay and lesbian, which she thought interfered with their well-being. We did, Alon Meyer, myself, David Frost, and others, did a convenient sample of New Yorkers from 22 different community venues. And we also looked at Carol Riff's psychological well-being measure. We didn't break it out by subscales. We didn't find any differences. And looking just within the sexual minority respondents by age, gender, or ethnic or racial status, we did find that women reported a higher level of depressive symptomatology. And there was no difference in psychological well-being or depression between bisexual and gay and lesbian respondents, although bisexual respondents had lower scores on social well-being. Social well-being, there's a measure that Corey Keyes developed. It's a parallel measure to psychological well-being. But social well-being, which has five subscales, is a better measure of social fit. So we thought that a couple of things about this. You know, you can, if you look at our gender findings, you know, women can be more depressed. But you don't find a corresponding decrease in psychological well-being. So that sort of supports the idea that positive and negative mental health measures, they're not automatically reciprocal of each other. They're not opposites. And we also thought there may be more sensitive measures in psychological well-being to look at some of the difficulties populations such as bisexuals experience. And the last slide, well, let me, yeah, the last slide in this series of slides is just to sort of think about the limitations of this research. As I mentioned before, you know, there were not that many respondent, LGB respondents in the large MIDAS cohort. The effect sizes for differences were small. I think it may be more useful to sort of look at, so what is associated with greater well-being among, within LGB cohorts? And that's what I want to turn to. I'll just make mention of one other set of studies. In our stride cohort, Alon Meyer, myself, David Frost, and others, we found that homosexual identity valence, that's basically positivity versus negativity, and level of connectedness to the LGB community were associated with higher levels of psychological well-being. And Rostovsky came up with a dimension of positive homosexual identity, which had five subscales. And she found that of those five subscales, the most important was a sense of personal identity, or rather, authenticity. And that was associated with all six factors in Carol Riff's psychological well-being. So there's something there. Unexpectedly, Rostovsky found that self-awareness, another component of positive homosexual identity, was negatively associated with environmental mastery and positive relations with others. And I think she thought, these authors thought, that well, if you're living in a hostile, unwelcoming environment, self-awareness may not be the best thing, because it's going to increase vigilance and worry about experiencing victimization and discrimination. So I wanted to do a deeper dive into these themes. So we put together a qualitative study, mixed method studies. We looked at gay men in their 40s. Back then, that seemed to be sort of a pivotal time of people coming of age. This took place right when the shadow of the AIDS epidemic was shortening. And we asked respondents to tell the story of their lives. We also administered various quantitative measures, a measure of Ericksonian, the last four stages of the Ericksonian model of psychosocial development, intimacy, identity, generativity, integrity. And we kind of wanted to see, how can we tease out how people make sense of their stories? And how might this be relevant to constructing a model for psychological well-being? One of the things that we did was we asked respondents. It was not a large study. We had 30 respondents between the ages of 40 and 52. We said, well, how would you title your autobiography? Which is always a fun question to ask people. And these are some of the responses we got. Still crazy after all these years. He did the best he could. Not born with a silver spoon in his mouth, but he sure collected a lot of them afterwards. Finally growing up, maybe a life survived. And these are just a few. They were all very colorful. And I thought there were two themes in the qualitative data analysis that sort of reached out to us. And one was a sense of coherence in how respondents viewed their life histories. Did their lives make sense to them? Did they experience a continuity in their sense of their histories despite the pivot of coming out, moving away from families and communities of origin, living as out adults, and the effects of AIDS-related losses? And the second theme that emerged from the qualitative data analysis was that of reconciliation. That is, taking stock of past difficulties of the road not taken, relinquishments associated with getting older, and reckoning with Mr. Denied opportunities. And we scored the respondents on coherence and reconciliation, either low, medium, or high. And then we triangulated that with quantitative data and found, interestingly, that measures of coherence and reconciliation were correlated with the Ericksonian stages of generativity and integrity, the commitment to homosexuality. That was a reverse score. So there's a reason it looks like it's a negative association. It had to do with the scoring. It moved in the expected direction. It was associated with more commitment to homosexuality identity. And also, it correlated with worry about getting older. So we thought maybe there was some utility to think about these themes of coherence and reconciliation. So this is a segue for me, as promised, to talk with you about a modest proposal about the human condition. And thinking about four key experiences that just may foster coherence and reconciliation in LGB lives, and in so doing, support well-being. So I'm going to talk about four aspects of the human condition, love, being seen, cultural enfranchisement, and religion. We could add to the list. These are just four things I wanted to highlight for you today. And I'll talk about love. You know, so often in the research we do, we don't talk about love. We talk about intimacy. It's folded into love. And we know that loving relationships figure prominently in studies of adult development in the general population with well-being. And for those of you who are clinicians in this room, you're all familiar with the importance of love in the mental well-being of our patients' lives. But we don't generally study it. So I found a fascinating qualitative report in the literature by King and Noel, who actually interviewed about 107 lesbians and gay men. And they were interested in the effect of, well, love and intimacy and power and conflict. And they, from their narratives about coming out stories, thought that the experience of love actually was quite healing for many of the respondents. And they wrote in their summary that in coming out stories, individuals portrayed themselves as having to fight against expectations of heterosexuality, rejection of negative attitudes about homosexuality. And again, to go back to the quote, individuals portrayed themselves as having to fight against expectations of heterosexuality. the experience of love lends a rightness to their experiences as gay people. And this parallels what Richard Isay wrote in 96 when he said that it's the love of another over time that provides the greatest certainty and clarity about one's personal identity as a gay man. He writes, only then does being gay become indispensable to everyone's happiness. I think we could fairly say that would be true for lesbians and bisexuals also. Being seen by others is the second experience I want to highlight. Galitzer and Levy and Kohler wrote that the experience of others is a source of sustenance and it supports and fosters enhanced congruence and understanding of the self and identity. And they thought that some lesbians and gay men have problems in realizing effective personal integration of identity because of both covert and overt homophobia and stigmatization of sexual orientation identity. That's pervasive in society. So I have a quote here. This was a New York Times journalist about a year ago published a piece called The Trouble With Not Being Seen Is We Don't Always Know How To See Ourselves. And Chris Beam wrote about the experience of walking hand in hand with her lover, her partner, and everybody saying to them, oh, you must be mother and daughter or you must be sister and sister. Like there was like no registering of the fact that well maybe they're in fact partners or wives. And she commented on the fact that that made it more difficult to know who they are themselves without that kind of ability to be seen by others. And Gail Hurt and I did a paper on the mental health effects of same-sex marriage denial which we published in 2006. You can look at the 1,300 federal and state benefits associated with civil marriage. They're all very important for well-being, but we thought even more important was this intangible immeasurable benefit of lifting from a second-class sexual citizenship status and domestic partnership into a fully recognized civil marriage. And that had incalculable benefits for many of the studies that was expressed in many of the studies that we surveyed. It's a tenet of adult development that the witnessing of life transitions provides meaning and supports well-being and mitigates distress that's associated with loss. You know, I think about the early waves of AIDS bereavements and the much more difficult circumstances of surviving partners who had no relationships with family of origins and his grief was not witnessed or shared and how complicated that made their lives. And Carol Shields, the Canadian author, expressed this sentiment in her 1993 novel The Stone Diaries in which she wrote, life is an endless recruiting of witnesses. It seems we need to be observed in our postures of extravagance or shame. We need attention paid to us. And this is going to show you a picture of a massive recruiting of witnessing events. So this is my husband's mother's partner's 90th birthday and we threw a very big tent party and assembled a wonderful collection of conservative ranching family. That was her family. The women that she came of age with in Berkeley in the 40s, 50s, and 60s, a motley assortment of neighbors and friends. And I don't think Dee had ever had a party like this. And how terrific that she could be honored and celebrated as so many things all at once. As a sister, as a partner, as a lesbian, as a 90-year-old, as a survivor of some very difficult times in her life. This was an exuberantly joyous event for everybody and you can sort of see in this moment, you know, she's a little bit overwhelmed. But the rest of us were, you know, having a gay old time. Cultural enfranchisement, you know, is another important aspect of the human condition. And I want to share with you two contrasting quotes that are 27 years apart. So Edmund White in 1977, I misspoke before when I said he was writing in 1997, it was 1977. He wrote in the Farewell Symphony that, I realized that while gay life is always aberrant, there's not a moment of straight life, no matter how bizarre or melodramatic, that isn't cozily familiar, that can't be associated with a song or a lyric or a movie or a poem. And fast forward to 2024, the chief theater critic for the New York Times wrote a piece entitled, it's a long title. The queer kids are all right and now they're making me better, how watching gay coming of age stories has helped repair a heart stuck in the past and still scarred by a less welcoming world. And he wrote, and you can see this, the movie and TV shows I've been seeing, whatever good they may do to their intended audience's information, cheerleading and entertainment, do something profound for the rest of us. They bring about an otherwise impossible reconciliation with our past and in so doing, connect us to our future. It's the second part of that statement that I find most interesting. It speaks to the importance of a reconciliation as a prelude to a future life, live without concealment or apology and with an embrace of well-being. Religion, the third braille of LGB mental health. So and you know, I just want to share with you a memory I had when I was putting this talk together. When I was a resident and we presented psychodamic case formulations to our late professor, Roger McKinnon, all 10 of us presented our case formulations and he looked at us and he said, you know, none of you talked about your patient's religious or spiritual beliefs, which hopefully was a conceit back then of psychiatry. But that experience came to me in writing this and now in thinking about this right now, how do we, you know, both acknowledge the fact that individuals do experience religious trauma. There is a Z code currently in the DSM which talks about religious or spiritual problems and there's a debate right now about whether or not this should be bumped up to a fully fledged disorder. Yet the Williams report recently, the Williams Institute recently reported a large number of LGB persons identify as moderately or highly religious. It's at least 50% if you lump those two together. And you know, presumably this reflects for many people, adults for whom religious beliefs, practices and community are integral to a sense of well-being. I mean, there's evidence that positive religious coping weakens the effect of internalized heterosexualism on psychological well-being and that religious commitment is linked to eudaimonic well-being. The LGBT committee of the group for the advancement of psychiatrists conducted a qualitative analysis of responses to a Dear Abby column. This was, I think, published fairly recently and found that despite frequent media portrayals of conflict between faith and the LGBT plus community, the reality is more complex and faith and LGBT plus identity can be complimentary. And you know, I would say to you, if we're thinking about a model of psychological well-being or thinking about sense of purpose in life and positive relations with others, we're going to need to think in a more nuanced way about the importance of religion for many people. So you know, as promised, now I want to shift from a modest proposal to the imitation. I want to issue a call for immodesty. And I'm going to be talking about three things, courage, creativity and advocacy and activism. So coming out itself is an existential act. It is about an exercise in the human tasks of responsibility, meaning making and freedom. You know, when we come out, it both feels like it's a necessary thing to do, but more often than not, we're not entirely sure what the replications will be. And that's a human experience, but it's a necessary one and I call it existential because I think it does exemplify this aspect of all of our lives, which is moving forward and sometimes not knowing exactly what the consequences will be. And being out also allows the possibility of being witnessed for who you are. And as I mentioned before, that's a critical dimension to how we know ourselves. Now Obama spoke to this and on the occasion of the 19, actually 2015 SCOTUS Supreme Court decision ruling, it was Obergefell versus Hodges, which found a constitutional right to same-sex marriage. Obama said that it is a consequence of the countless acts of small courage and millions of people across decades who stood up, who came out, who talked to parents, parents who love their children no matter what, folks who are willing to endure bullying and taunts and stayed strong and came to believe in themselves and who they are. It seems only fitting that I would include a quote by John Fryer, who in his comments in the 1972 address, Psychiatry, Friend or Foe, said, pull up your courage by your bootstraps and discover ways in which you and homosexual psychiatrists can be closely involved in movements that attempt to change the attitudes of heterosexuals and homosexuals towards homosexuality. Creativity is another immodesty that I want to highlight. I'm in correspondence with a poet, a gay man down in Asheville, North Carolina, who is about to turn 80 and actually he had me read his memoirs. And he wrote to me recently about the experience of doubt. He said when he was a very young person, he just knew without completely understanding this that the conventional scripts about who he was supposed to be attracted to and what gender roles were waiting for him weren't applicable to him. And in that moment of doubt or those moments of doubt, it forged for him the beginning of a deeper understanding of the world and its assumptions about sexuality. And he felt it led to new ways of seeing the larger world. And I think he sees that moment of doubt as the impetus for a very creative life that he's lived over the past many decades. And another example of creativity is a wonderful book. Some of you may be familiar with the women's music movement that really, I think, started mostly out in the West Coast in the 70s. And Irene Young is a photographer and she put together a wonderful photo essay entitled Something About the Women. Five decades of seeing women artists, audiences, producers, and others who have had the courage to put forth, this is a quote from her, courage to put forth a different kind of love song and who sprouted a community that changed lives. And if you read this book and look at the pictures, it's 440 pages. It's exuberant. And it's such a wonderful example of joy that was created at a time when there wasn't a great deal of understanding and expectation of embrace for being a lesbian and for gay men, too. And in a similar vein, I'll quote the television producer and writer Ron Niswanger, who put together the recent TV series Fellow Travelers on Showtime. It followed the lives of LGB people beginning with the Lavender Scare in the 1950s when LGB persons were fired for government jobs. And he wrote, in all these dark times, LGBTQ people have found a way to have joy, to have pleasure, to dance, to sing, to make art, and to make love. That's what I really want people to remember. Don't sink into despair. Struggle with joy. Finally, let's talk about activism and advocacy, which play an essential role in fostering well-being. Models of positive psychology recognize that positive institutions are as important as positive emotional states and virtues and traits in promoting well-being. There are so many examples I could cite here. And actually, quite a few of you in the audience have been involved with these efforts, I think, because I don't want to inadvertently not mention certain people. I'm not going to name names. But you know who you are. So I'll start off with the amicus brief supporting the same-sex marriage case, Borgefell v. Hodges, that the American Psychiatric Association joined, the American Psychological Association, and wrote a really wonderful brief. I want to quote it for you in just a second. Well, I'll quote it for you right now. The brief advised the Supreme Court that scientific evidence strongly supports the conclusion that homosexuality is a normal expression of human sexuality, that gay men and lesbians can form stable and committed relationships that are equivalent to heterosexual relationships in essential respects, that same-sex couples are no less fit than heterosexual couples to raise children, that their children are no less psychologically healthy and well-adjusted, and that denying same-sex couples access to marriage is both an instance of institutional stigma and a contributor to the negative treatment of lesbians, gay men, and bisexual people. So this brief that we wrote was one of a handful of over 100 amicus briefs that was submitted to the court. It was one of a handful that Justice Kennedy cited in his majority opinion. So we make a difference. We have an impact. And other examples that I've cited here are speaking out against conversion therapy. We talked about that yesterday at John Fryer's talk. Advancing policy and law that support LGBTQ youth mental health, protecting the human rights for LGBT asylum seekers. And then I think beyond changing law, social policy, and social mores, activism and advocacy have a direct effect on well-being. And I quote Bayard Rustin here, who said, when an individual is protesting society's refusal to acknowledge his dignity as a human being, the very act of protest confers dignity on him. So we mental health professionals play multiple roles in fostering well-being in sexual minority lives, and sometimes it's sitting quietly with individual patients where we not only hope to alleviate symptoms, distress, but we also provide recognition of relationships, milestones, and transitions that are not culturally or socially validated. We can play many other roles to advocate for change in social policy and law, to contribute to public and professional education about sexual minority lives, to speak up about the unrepresented, for instance, homeless LGBT youth, LGBT asylum seekers, and others. I think I omitted from this slide, I was, Saul Levin, the medical director of the APA yesterday said, it's very important to have a seat at the table when policy is being formulated and not to wait to ask to have a seat at the table, but sometimes to say, I want to have a seat at the table. I was quite struck with that, and that has bearing on, I think, my points about activism and advocacy. Just to sort of wrap things up, I think we should be as interested in positive mental health as well as negative mental health. They're not simply inverses of each other. Positive mental health informs us about the human condition, and to go back to Vaughn and Rodriguez's quote at the beginning of this talk, it helps us understand what it means to be a sexual or gender minority person. Carol Riff draws attention to the importance of considering the positive end of the mental health spectrum in her statement. Paradoxically, one of the most important reasons to study the positive end of the mental health spectrum is to identify what is missing in person's lives. The absence of the good provides, thus, another telling characteristic of the human condition, one notably missing in the scientific discourse on mental health. I have a question and a proposal and a prescription, which I'll put out to wrap up my talk. We might ask, okay, so what is the good that we should be looking for in fostering and LGB lives? I'm going to end with a proposal of what this might be. It's based on going back again to King and Newell's analysis of the coming out stories of 107 adults. They characterized those who scored the highest on well-being and adult development. There are articles entitled Happy, Mature, and Gay, Intimacy, Power, and Difficult Times in Coming Out Stories. Here's what they said. They said they found the individual who integrates experience into a complex awareness of the conflict and ambivalence inherent in human life but also retains the capacity for joy may be thought of as manifesting true maturity. I would also add loss, reckoning with loss, to that statement. This is just one particular take on how we might think about moving our work, our clinical work, the way we think about positive well-being in sexual minority persons. Maybe this is a tall order to follow the path of King and Newell, particularly for people who have experienced sexual orientation, discrimination, or rejection because of sexual orientation, but I think it's an order worth pursuing. I think it can, as I mentioned before, inform our work, both research and clinical work and policy also. On that note, thank you very much for your attention. Here's my email. I welcome your comments. We're going to have a time for Q&A here. If you would like a PDF of this presentation, I'm happy to send it to you. Give me a few weeks, actually, to organize it in a coherent way, make sure that the references are accurate, and so on and so forth. I'm happy to send it. Again, thank you so much for being here, and thank you for your attention. I look forward to your comments. Thank you. Thank you. Thanks. So, and please step up to the microphone if you would like to speak. Bob, congratulations, extremely well-deserved, and thank you for that terrific talk. Thinking back to your career on this issue, how you've really doggedly pursued this issue of well-being and sort of healthy development in mostly gay men and so to hear this come together today after all these years of work, your research, your scholarship, is really terrific and I think as a model for us in the audience as clinicians, clinicians, scholars, clinician, researchers, you're a fantastic model. Thank you very much. And one that we all tried to emulate. Thanks so much, yeah. My comment and question, I was so thrilled to see you added religion as one of the four areas to think about because we don't talk about it very much in the lives of LGB individuals. And I was thinking back to during the early days of the HIV AIDS epidemic when so many of my patients were very sick and dying and so many had been losing friends and there was a piece of the therapy that was missing and it was really around religion and spirituality. And I went to my colleague Jim Griffith, a colleague at GW, who wrote a book on encountering the sacred in psychotherapy. And he said to me, do you ever talk to your patients about their conversations with their God? I said no. He said you should. And I'll leave it at that. Yeah, Jeff, thank you for that. You know, I just, you know, I wonder is it was that a cohort effect for when we all came of age where there was for many years a presumed conflict antagonism between LGB mental health and religion. Some of you know that I've lived on the East Coast. I lived on the West Coast. I spent a lot of time in the South right now. And when you live in the South, you think about religion because the streets are empty on Saturday, on Sunday mornings. And also I didn't mention that in the Williams Institute report on religion, LGBT people who live in the South who are African-American who are parents are more likely to be moderately or highly religious. So there are some regional differences. It's both a historical time cohort effect, but also if you live in parts of the country, certain things you cannot observe, help observing. What can I say? We've been talking about this talk for weeks and weeks and weeks and you surpassed your expectations and mine. So thank you. Well deserved. I wanted to add to Jeff's comment about on the South versus the North versus the West East. I think I talk about spirituality and let the patient guide me in terms of what they want to call it. Because I think a lot of gay people were so disenfranchised by their religious upbringing and the continued sort of anti-gay feelings that they had. But they are not opposed to talking about spirituality and what's the meaning of life and all of those questions. So I find that very useful. But my question really is, we have generational differences in terms of how people think about well-being and what the purpose and meaning of life is. And I want to drill it back down to psychiatrists, mental health people, because we also have to think about our positive sense of well-being. One of the things that residents have brought up, I've been a training director for 20 years and one of the things that's happening differently now than before, when I was in training, the thought of any kind of disclosure was anathema to being a good psychiatrist. And we actually were told never do that, even though heterosexual therapists had pictures of their wives and kids on their desk. And I kind of wondered, by being silent, was I contributing to that silent witnessing rather than being present? I was silent in a particular way, not verbally. And so because I was out very early on, it was not possible for me not to at least figure out, what do my patients ask me? What do they want to know? What do they need to know? Were they referred to me as an openly gay psychiatrist? Did they not want to know that, which can happen? But as I've gone through the training with Google, when Google came on board, there's no hiding very much of anything. The question isn't about disclosure, but how and what does it feel like and mean to us to have our lives authentically out there for patients? You know, I've had heterosexual men come to me to see me, knowing I was a gay therapist, because they felt safer than they might with a peer with whom they might recognize some competitive issues. And I think with the younger residents, they live in a much more directly out way of their life than my generation did. So I wonder what your thoughts are, since you've been a teacher and a trainer and supervise residents like I have, your thoughts about how we think about our well-being in the course of disclosure of who we are. And it's not just about sexuality. I want to also want to add in, you know, when we suffer normal course of life, events like loss and grief, where do we figure that out? How do we figure that out? Yeah, yeah. Thank you, Marshall, for that question. There are actually a lot of questions that I think you raised there. You know, I'm just to share with you a couple of recollections I'm having as we speak. I gave a Grand Rounds, I think, at Columbia in the 90s about the issue of self-disclosure. And back then it was a very labored presentation. It was on the one hand, on the other hand, on the third hand, and so on and so forth. I mean, the world has changed a lot. I would just echo something I think you said in your comments, which is, you know, we still listen for what it is that patients might want to know. And we sometimes want to think about why they're asking and what it means. But I don't have sort of a blanket policy any longer about, no, you're never going to self-disclose. You're right, actually. It's almost irrelevant these days, because if anybody ghouls you, it's not going to be a mystery. So I think I would say that, you know, it's a net change. And the other recollection I had is, Marshall and I have talked about this, I wrote a piece about the impact of grief on the psychotherapist, which was published in Psychology Today. I have to tell you, I got more responses to that piece than all of the academic publications I've published in my life. And so I think there's a great appetite for a discussion about this. And it's meaningful for those of us who are colleagues. It's also very meaningful for patients. It's a conversation that we need to continually be in, let me put it that way. Stuart. Bob, thank you. And congratulations. You combine profound scholarship with deep humanity in a way like no one else I know. And I think you've described the arc of a journey toward being seen. I was particularly struck by what you mentioned about being seen and its importance. And it got me thinking about queerness. My question is about queerness, because I think in a way you described a journey towards becoming seen and becoming visible. And I suppose queerness might have meant something very specific for the generations you described. Does it have an enduring value as one is more seen? And what does it mean now? What's its legacy? Well, Stuart, let me give that a little bit of thought. Just to paraphrase your question, you know, how do we think about this aspect of being seen in the current perspective of how lives are lived and how people self-identify? And I don't think that's going to change. By the way, this is not limited to sexual minority persons. This is just an aspect of life. You know, but you may be signaling a challenge. You know, I will also acknowledge that, you know, I can appreciate my comments are probably generationally or cohort bound to an earlier time. And I would think that while the need to be seen, recognized, is the same, and you know, I may be speaking in a not particularly well-informed way, maybe this is personal, I don't know whether younger people who self-identify as queer, gender diverse, pansexual, polyamorous experience a difficulty with being seen and understood. Not so much by their peers, but by their parents and older generations. So I guess here we are on the other side of that ledger, and I think maybe it's a call for us to, you know, be as thoughtful and responsive as we can, because I don't think the issue of being seen and understood changes for anybody. It's still as vital as it was in earlier cohorts, and it's true for everybody. I think life needs to be witnessed. Well, congratulations, Bob, and congratulations to us for having Bob in our midst. And I, you know, one of the elements of well-being certainly derives from our position in our communities, each and every one of us in our personal communities. In that sense, we are fortunate to have our friends and colleagues as our co-therapists for ourselves, ones we don't have to pay. And for asking a question, I want to say, and you in that role, for a number of us in this room, having you in our lives in our community has helped each of us make, you know, attain some well-being. You know, about well-being, and I, you know, positive psychology is a wonderful concept. And my question is going to be technical, about how to help people achieve that. Yeah. You know, for many of our patients, we're lucky if with some of them, well, for many, hopefully, we have the opportunity to help them merely by helping clear out the obstacles in their lives, help them deal with some of the conflicts and necessary self-awareness, so that their own inherent skills and strengths can take them forward and achieve, you know, the kind of positive levels of self-actualization you're talking about. But then we have other patients where it's not nearly that simple. You know, I've always been a little bit of a cynic about Max Frankel. You know, his idea of logotherapy and that there be some existential thing that if it's outside of yourself, you can attach to it. I think he made, I suspect he made a fundamental mistake in observation. You know, he was looking at people who thrived despite being in concentration camps. Thrive is a strong word. Survived, okay, despite being in a concentration camp. And he thought this had to do with their existential connectedness to something outside and beyond. Frankly, I think he was observing those people who had the inherent capacity to survive that, and he was identifying those who still maintained hedonic capacity. We therefore could think about something outside themselves. What do we do with people come to us with much more complicated psychic structures? We're really consumed with the day-to-day anxieties. We know that they're at a point in life where we need to get into some sort of positive... Right. Ron, let me catch up if you want. I'll make some comments because they're... You'll never catch up, Bob. A lot of points I want to make are... Actually, you're alluding to my favorite topic on all of this, which is what's the relationship between psychotherapy and our interventions in adult development? There are a lot of different ways you can think about that, and I will circle back to what to do with people who are greatly handicapped with the traditional problems that people bring to psychotherapy. So many theorists have really talked about, you know, the work we do as psychotherapists is to sort of remove impediments that then will let adult development proceed in a relatively uninhibited fashion, and so people can experience the fruits of their developmental labors. But, you know, that's not so clear-cut much of the time. So... And I didn't mention, by the way, you know, there is a emerging field within psychiatry which is called positive psychiatry. Dilip Jeste, there's a book here recently published at the APA book stand upstairs, which is a sort of a wonderful up-to-date summary of what is positive psychiatry. That's specifically focused on patienthood and clinical interventions. It's a parallel conversation to psychological well-being. I'm not really talking about patient populations, as you notice here. And that would be one place to sort of address some of the questions, because it does a deep dive into what do you do with people who have significant psychopathology, and what are expectable or what are realistic outcomes to have for people. So... But you're asking a really big question, which is, you know, we as clinicians and psychotherapists, I've always thought this, we can only do so much. But what we do is pretty significant. But yeah, I think if I'm going to be grandiose and talk about the human condition and issue a call for a modesty, I need to be modest and say that, you know, these are aspirations. Sometimes it's very difficult for people to reach them. So, thank you, Ron. Hey, I'm Chris from Virginia. Thank you so much. This is a great talk. I just wanted to make a comment about sort of mentorship and role modeling. AIDS just slaughtered a total whole generation of people that were potential role models for me growing up. I'm 52, so I grew up when sex was just scary. And one of the impediments to finding joy for younger gay people, people that were my age, frankly, and a little younger, was that our potential role models for joy building all died. And so somebody was talking recently about all the artists that died and decimated the stages of New York and the ballet and the opera world. But bigger than that was that the audience all died. And so learning how to become somebody that loved opera and loved ballet became harder because those potential role models died. And we have the opportunity now to start constructing that back, but like we were impaired by the loss of that generation of men. Specifically, I want to just talk a little bit about psychiatry. And, you know, where I went to medical school, there were really no gay male role models. But I found them at meetings, and I found them with Shelley Klinger, who's right there, who was a mentor to me. And from Phil and from Marshall, who doesn't know who I am, but I went to so many sessions of his over time, and what an inspiration that was for me to just see that role modeling. And that's something that we have the opportunity to do now for the younger generation, and it's so powerful. Sometimes it feels like they don't need our role modeling because their lives are so much different than ours, but they do. Yeah, yeah. I mean, thank you for all those comments. This is a good opportunity for me to tell everybody that the Association of Gay and Lesbian Psychiatrists is having a reception this evening, to which you're all invited at 7 PM. It's in the Pod Hotel? Yodel. Yodel Hotel. Okay, and what room is it in? The Fig Room? Fourth floor. Okay. Gene wanted to be sure to mention that. Mentorship is so important. I mentioned Richard Isay and Stuart Nichols. I remember Stuart Nichols in 82 gave grand rounds at the New York State Psychiatric Institute on homosexuality. It was the first time that anybody ever... Well, first of all, identified as a gay man, and second of all, did not talk about homosexuality as a psychopathology. And I thought the ceiling was gonna collapse because this was so earth shattering. But so great, what I didn't show you is I have a handout. Those of you at Columbia are gonna know some of these characters. Heino Mayer Baalberg, Donna Carson, Human Sexuality, and he handed out a reading list about homosexuality in 1981, which was not a psychoanalytic list of Bieber and Socrates. I kept that handout. It's a mimeographed two page sheet. That's a talisman. I'm gonna frame it and hang it up someplace. Because these things were so historic and also for me, yes, Stuart Nichols, Richard Isay, Bert Schaffner, there were a legion of many people who aren't here any longer, but they were incredibly important. I think that remains really important too. And I think one of the points you might be making is we might think, oh, well, you have exposure these days, everybody, the world is much more familiar with LGB issues. But within the ranks of our professions, it's very helpful to have a conversation with somebody who has been several steps ahead in forging an identity and figuring out the balance between private and personal life and professional life. So your point's well taken. David Mixner, who, as you know, was a celebrated gay activist. I think he had some influence on Bill Clinton, I'm trying to remember, passed away about a month and a half ago. And he said, quite poignantly, that a generation of storytellers died. There's nobody left any longer who can share memories with him of what it was like to come of age at a time when he was a young man. And many people have really talked about that. It's a loss. So, you know, I just wanna say this is a wonderful opportunity for me to think about the work I've done. I've shared this with some of you before. I haven't really been actively involved in academic publishing, thank goodness for quite a while. But the dust needed to be brushed off some of my papers and files and putting together this thought. This talk enabled me to do that. That's a gift to me, too. And I wanna thank all of you for making this gift possible. Any other questions? You're all experiencing well being? That's my aim. Okay. Well, again, thanks for coming and everybody be well. What can I say? Right?

John Fryer Award

Robert Kurtzner

sexual minorities

mental health

LGB community

HIV/AIDS

positive mental health

cultural enfranchisement

psychological well-being

mentorship

advocacy