By JANE E. BRODY
Published: December 16, 1986
MOST young boys who persistently act like girls grow up to be homosexuals or bisexuals, a 15-year study of ''sissy boys'' has shown. According to the findings, neither therapy designed to discourage the extremely feminine behavior nor ideal child rearing could guarantee that the boys would develop as heterosexuals, although parental discouragement of the boys' girlish behavior tended to result in a more heterosexual orientation.
Three-fourths of 44 extremely feminine boys followed from early childhood to adolescence or young adulthood matured as homosexuals or bisexuals, as against only one bisexual among a comparison group of more typically masculine boys.
In many cases parents either overtly or subtly encouraged the feminine behavior. But when parents actively discouraged it and took other steps to enhance a male self-concept, homosexual tendencies of the feminine boys were lessened, although not necessarily reversed. Neither did professional counseling divert a tendency toward homosexuality, although it resulted in more conventional masculine behavior and enhanced the boys' social and pyschological adjustment and comfort with being male.
The study was conducted by Dr. Richard Green, a noted sex researcher who is professor of psychiatry at the University of California, Los Angeles and director of its Program in Psychiatry, Law and Human Sexuality. Details of the findings and implications are described in Dr. Green's new book, ''The 'Sissy Boy Syndrome' and the Development of Homosexuality,'' to be published in February by Yale University Press.
Although the study examined extreme cases of boyhood effeminacy, Dr. Green believes the findings may have relevance to lesser degrees of feminine behavior in boys. Such boys, who may, for example, be athletically inept or prefer music to cars and trucks, often have difficulty making friends with other boys and identifying with typically male activities. Dr. Green suggested that to help the boys think of themselves as male, parents might assist them in finding boy friends who are similarly unaggressive and that the fathers might share in activities the boys enjoy, such as going to the zoo or a concert, rather than insist on taking the boys to athletic events. Counseling to guide such parents and enhance the child's masculine self-image may also be helpful, Dr. Green said.
The study did not examine the development of homosexuality in boys whose childhoods are typically masculine. About one-third of homosexual men recall such masculine boyhoods. Nor does the study suggest that all boys with the sissy-boy syndrome are destined for homosexuality. Indeed, one-fourth of the extremely feminine boys followed to maturity developed as heterosexuals.
According to Dr. Green and other experts familiar with his study, the findings indicate that some children may have an inborn ''receptivity'' to environmental factors that encourage a homosexual orientation. Whether such a predisposition is genetic or the result of prenatal factors, or both, is not known. Recent research in animals suggests that prenatal hormonal influences can interfere with programming the brain of the male fetus and result in the birth of males that act like females.
The study supports a recent Kinsey Institute survey of 1,500 adults that singled out ''gender nonconformity'' in childhood as the most important predictor of homosexuality. Dr. Alan Bell of Indiana University, a director of the Kinsey study, said he was pleased and not surprised that the findings of Dr. Green's prospective study corresponded with the retrospective Kinsey data.
''The pendulum is swinging back to biology,'' Dr. Bell remarked. ''Apparently there is a very important physiological component that plays a big role in determining one's sexual identity.''
As have other recent investigations, including the Kinsey study, the new research challenges long-held psychoanalytic beliefs that dominant, overprotecting mothers and ineffectual fathers are primary ''causes'' of a son's homosexuality.
Rather, the study suggests that some boys are born with an indifference to rough-and-tumble play and other typical boyhood interests and that this indifference alienates and isolates them from their male peers and often from their fathers as well. Dr. Green believes that such boys may grow up ''starved'' for male affection, which prompts them to seek love from men in adolescence and adulthood. To Dr. Bell, however, a sense of difference and social distance from males during childhood is what leads to the romantic and erotic attraction to other males.
Dr. Richard Isay, a New York psychoanalyst whose practice is largely homosexual men, said: ''I would agree with Dr. Green. I too see no support for the notion that binding mothers produce homosexual sons, nor do I see any consistent pattern for absent fathers that I don't also see among heterosexual men in analysis.'' Dr. Isay, who is affiliated with Columbia Psychoanalytic Institute and New York-Cornell Medical School, suggested that the common depiction among homosexual men of an absent, distant father is in fact a defense against an underlying erotic attachment to their fathers.
Ah, good old Freudians ...
Dr. Green, who is now studying the development of tomboy girls, said the issue for girls who act like boys is very different. ''There are far fewer sissy boys than tomboy girls, but many more homosexual and transsexual men than women,'' he said.
I believe Green's study of tomboys eventually came up with the common sense finding that not all that many tomboy girls grow up to be lesbians, but a lot of lesbians were tomboys as girls. The number of models, actresses, and other glamor girls who tell interviewers they were tomboys as adolescents is noticeably high. My guess would be that long legs correlate with success in modeling, and long legs correlate with delayed puberty because girls typically stop getting taller around puberty.
Asked to comment on Dr. Green's findings, Dr. Judd Marmor, professor emeritus of psychiatry at the University of Southern California and the University of California at Los Angeles, said that they ''are another indication there is a biological element involved in the genesis of homosexuality, at least for those homosexuals with effeminate qualities.''
He added: ''Some children really feel different from earliest childhood; they are born without the aggressive masculinity other boys have. This is not something created by an overprotective mother or an absent or ineffectual father.''
Although the study involved a relatively small number of boys, Dr. Marmor, who is a past president of the American Psychiatric Association and an authority on homosexuality, called the research ''most important'' in what it revealed about the development of sexual orientation. ''Society tends to treat male homosexuals as if they had a choice about their sexual orientation, when in fact they have no more choice about how they develop than heterosexuals do,'' he said. '
An innate sissiness is ''not the answer to all homosexuality,'' Dr. Marmor said, ''but it is a factor that plays a role in a substantial number of male homosexuals.'' He added that homosexuality could also develop from a seriously distorted family environment but that ''it is much harder to develop that way, without a biological predisposition.''
Boys who participated in Dr. Green's study were first examined in early childhood, when their parents became concerned about the boys' persistent feminine behaviors and dislike of activities boys usually like. Many of the boys also repeatedly said they wanted to be girls. At the outset, Dr. Green thought he was examining the origins of male transsexuals -boys who grow up thinking they are girls trapped in male bodies and who may later seek sex-change surgery.
However, only one of the feminine boys became a transsexual.
In an interview, Dr. Green pointed out that the boys he studied were notably different from other children. While many, if not most, young children - boys as well as girls - occasionally dress up in their mothers' clothes, put on makeup or jewelry, play with dolls or assume the role of the opposite sex in fantasy play, the boys in Dr. Green's study did so almost exclusively. They spurned typical boy games, rough-housing and sports and instead would play with Barbie dolls for hours, frequently don female clothing and nearly always assume a female role when playing house. Many followed their mothers around the house, mimicking the mothers' activities.
The boys and their parents were interviewed every few years, and some were seen several times a year in therapeutic counseling aimed at intercepting the boys' feminine tendencies and encouraging more ''gender-appropriate'' activities.
Although Dr. Green found no evidence that the parents ''created'' feminine boys (many, in fact, had other sons who were normally masculine), certain parental attitudes and actions were correlated with a stronger homosexual orientation.
One of the earliest influences was the prenatal desire on the part of either parent, and the father in particular, that the child be a girl. After the boy was born, the parents often considered their son to be an especially beautiful infant. Even strangers who admired the baby tended to make comments like ''what a pretty little girl.''
One of the most important factors related to a more homosexual orientation in adolescence and adulthood was how parents responded to the boys when they dressed up as girls and pretended to be girls. Many of the parents, Dr. Green said, thought it was cute and directly or indirectly encouraged the cross-gender behavior. For example, photographs of the boys dressed as girls were found in many family albums of feminine boys but in none of the albums of the comparison group of masculine boys.
No relationship was found between later homosexuality and the amount of time a boy spent with his mother. In fact, many of the feminine boys spent less time with their mothers than did the masculine boys. Nor was there any link to a mother-dominated household.
However, less time shared between father and young son was an important factor. In the first year of life, the fathers tended to spend somewhat less time with their effeminate sons than did the fathers of masculine boys. During the next four years, however, the differences increased. By the time the boys were 3 to 5 years old, fathers of feminine boys were spending significantly less time with their sons than were fathers of the masculine boys.
This does not mean, however, that the father rejected the son and that this rejection turned the boy into a sissy. Rather, Dr. Green suggested that the boys' feminine behaviors and rejection of male activities contributed to the fathers' indifference. ''It's not just a question of how parents impinge on a child; the child also impinges on the parents,'' he explained.
In an earlier developmental study of 50 effeminate boys seen at a children's psychiatric clinic in Greenwich, Conn., Dr. Bernard Zuger, a psychiatrist, reported that the boys' ''closeness to the mother and distance from the father spring from their own needs.'' He suggested that parents need not feel guilty if their effeminate sons turn out to be homosexual.
Another factor that interfered with the father-son relationship in Dr. Green's study was that the feminine boys were likely to be sick more often and more seriously than the masculine boys.
That's pretty interesting. Having been a sickly child was a pretty common theme in 19th and early 20th Century culture: e.g., Teddy Roosevelt was famous for having overcome his childhood infirmities through force of will. Many writers and artists had been sickly lads.
In most cases, it was the boys' mothers who cared for them when they were ill, especially if a lot of time was spent in hospitals. This also encouraged a more protective parental attitude toward the feminine boy.
The culture may also play a role, Dr. Green said, though its effects are harder to measure. ''If the culture were less condemning of cross-gender behavior, social stigmatization would be less and perhaps these boys could socialize more with other boys,'' he remarked. ''Certainly that is the case with tomboys, who are treated by society as normal girls.''
On the other hand, he cited studies in several different cultures by Dr. Frederick Whitam, sociologist at Arizona State University in Tempe, who found that homosexuals in these cultures were more likely to remember cross-gender behavior in childhood than were heterosexuals. Dr. Marmor pointed out that in many cultures, including certain American Indian tribes, less aggressive boys are recognized by their elders and are given institutionalized roles, usually as a priest.
Rather than attributing homosexuality to cultural, parental or genetic factors, Dr. Green sees an interaction of the three, as evidenced in particular by a pair of identical twins in his study. One boy was clearly feminine and the other twin typically masculine. The feminine boy was sick a lot and had little to do with his father, whereas the masculine twin had a more typical relationship with his father. As adults, both boys were bisexual, but the feminine twin was far more homosexual than his brother.
''The twins are the metaphor for this study,'' Dr. Green said. ''They are similar but not the same. The degree to which they are not the same can be explained by the early feminine behavior of one, not by genetics.''