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J Neuroscience and Neurological Surgery Copy rights@ Giulio Perrotta,
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ISSN: 2578-8868 Page 1 of 7
Bisexuality: definition, humanistic profiles, neural correlates and
clinical hypotheses
Giulio Perrotta
Psychologist sp.ing in psychotherapy with a strategic approach, Forensic Criminologist expert in sectarian cults, esoteric and security profiles, Jurist
sp.ed SSPL, Essayist
Corresponding Author: Giulio Perrotta, Psychologist sp.ing in psychotherapy with a strategic approach, Forensic Criminologist expert in
sectarian cults, esoteric and security profiles, Jurist sp.ed SSPL, Essayist.
Received date: September 26, 2020; Accepted date: October 12, 2020; Published date: October 19, 2020.
Citation: Perrotta G., (2020) Bisexuality: definition, humanistic profiles, neural correlates and clinical hypotheses. J Neuroscience and
Neurological Surgery. 6(5); DOI:10.31579/2578-8868/138
Copyright: © 2020 Giulio Perrotta, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
This work focuses on the study of neurobiological and functional profiles in terms of bisexuality, to carefully evaluate the
direct correlation between anatomical and physiological elements and the choice of sexual preferences oriented on both
sexes, hypothesizing any clinical profiles.
Keywords: Agraphia; neurobiological; neurogenetic field
Definition and humanistic profiles
According to the current position of the scientific community, "bisexuality"
can be considered as a sexual orientation that is substantiated in experiencing
attraction, drive and emotions, linked to the affective and sexual sphere both
for one's sex and for the opposite sex. In the clinical setting, the status of
"bisexuality" has always been nosographically absorbed by the general
category of homosexuality, almost as if it were one of its ribs. Bisexuality
has been known since ancient times and, historically, society's evaluation of
this phenomenon has gone through alternate phases: appreciated by Greek
civilization (which, however, did not accept only homosexual relationships),
tolerated (depending on context) by Roman civilization, but condemned by
the Judeo-Christian tradition. [1]
From the second half of the twentieth century, the first idea of
"homosexuality" was declassified, moving from the psychopathological
condition inherent to the sociopathic personality disorders of the 1954
version of the DSM to the sexual deviance of 1968, only to gradually become
an ego-dystonic form of one's own in 1974 sexual perception and finally a
natural sexual orientation only in 1987 and in the revised version of 1990,
being finally decriminalized reeds by the International Statistical
Classification of Diseases, Accidents, and Causes of Death (ICD) of 17 May
1990, although psychoanalytic thinking was well oriented towards the
opposite; in fact, homosexuality had hitherto been considered a morbid
obsession (Charcot), sexual psychopathy (von Krafft-Ebing), an arrest of
normal development (S. Freud), a narcissistic fixation (Mann and
Ferenczi), a neurotic escape (Adler) or a parapathic neurosis that originates
from the conflict between instinct and inhibition (Stekel). In particular,
Freud spoke, with great scandal for that time, of the "perverse polymorphic"
child, that is, with the potential possibility of having any type of sexual
activity and who, only through education and culture, then makes a more
defined choice. He wrote: “A certain degree of anatomical hermaphroditism
is typical of normality: in no individual of normal male or female training
are there traces of the apparatus of the opposite sex which, or continued to
exist, without having a function, as rudimentary organs or they have been
transformed to take on other functions”. And again: "the proportion with
which the male and female intertwine in the individual is subject to very
significant oscillations". The father of psychoanalysis took the ancient
Greeks as an example: “Among the Greeks, among whom the most virile
men appear among the inverted, it is clear that not the boy's virile character,
but his physical proximity to the woman, as well as his female psychic
qualities - shyness, restraint, the need to learn, to be helped - ignited man's
love. Having become a man, the boy ceased to be a sexual object for man
and perhaps became a pederast himself. In this case, therefore, the sexual
object, as in many cases, is not the same sex, but the union of the characters
of the two sexes, almost the compromise between an impulse that requires
the man and another that requires the woman, firm while remaining the
condition of the virility of the body (of the genitals), so to speak the mirroring
of one's bisexual nature”. However, this evolution has certainly led to an
opening towards social rights but also to a fluidity in sexual orientation,
where the main problems emerge especially in the bisexual position. [2] [5]
With reference therefore to bisexuality, understood as the choice of sexual
orientation to bind sentimentally and sexually to both women and men, the
discussion takes on broader and characterizing contours, precisely because
of the less defined and precise nature of the sexual orientation choice. The
aforementioned fluidity on sexual orientation leads to rather bizarre decision-
making developments and often motivated by unconscious dynamics not
better identified even by the subjects: [2]
a) "bi-curiosity", understood as a series of limited and sporadic
behaviors about the desire to approach sexually individuals of the
same sex, but who do not have the characteristic of persistence and
recurrence over time;
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b) "bi-chic", a term describes people who engage in seductive relationships
with both men and women to make people talk about themselves in a
glamorous perspective;
c) "bi-permissive", understood as the subject who does not actively seek
sexual relations with people of a specific sex but who is "open", that
is, available to make new experiences;
d) "Bi- for pay-bi": the term is applied to people who call themselves
heterosexual but who engage in sexual relations with people of the
same sex in exchange for money;
e) "Heteroflexibility": this term of American origin, often used derisively
or to deny one's bisexuality, refers to a predominantly straight
individual, but who can engage in a homosexual relationship
occasionally because he is temporarily in a favorable context to it;
f) "Lesbians until graduation": this term describes young British (and
American) women who, during their years of study at university,
engage in relations with other women, to then adopt, once they
graduate, a strictly heterosexual attitude and end up getting married
with a man.
Kinsey, author of the editorial work "Sexual behavior in the human male",
proposed a taxonomic scale, which suggested a value from 0 to 6, to
describe those who were exclusively heterosexual (value 0), by those who
considered themselves predominantly straight but with homosexual
tendencies (value 1), with homosexual components (value 2), bisexual
(value 3), mainly homosexual with heterosexual components (value 4),
with heterosexual tendencies (value 5) and finally exclusively homosexual
(value 6). However, this approach does not completely exhaust the
complexity of sexual orientation. In the academic field, therefore, the issue
of bisexuality as an innate orientation or consequence of factors is still
strongly discussed. [2]
The strong interdependence between the concept of "bisexuality" and
"homosexuality" therefore appears evident, despite representing two
different dimensions. This also happens because there is a widespread
belief in the community, in the absence of targeted scientific studies, that
bisexuality is a transitory phase that should lead the person to complete
acceptance of his homosexual nature; these beliefs are strengthened by
some investigations that elaborate certainties on statistical bases (with
unrepresentative samples) such as those which support the following:
bisexuals experience friendship and family ties in a significantly less stable
and lasting way than homosexuals; bisexuals are more likely to experience
unequal treatment in the workplace and intrapersonal settings; bisexuals
have greater difficulties in living a monogamous relationship, being more
oriented towards polygamy. [3-5]
The social identity of the bisexual is still strongly conditioned by the
difficult acceptance of the concept of homosexuality and as such, the
interdependence between the two dimensions slows the natural progress of
the acceptance process also at the socio-cultural and anthropological level
of the former; this difficulty is also accentuated by the clinical hypothesis,
not verified statistically, with a representative sample, that bisexuality is a
paraphilia. [6]
What is evident from the scientific research published so far is that:
1) bisexuality is distinct from the homosexual dimension, even if they
have the same sexual and sentimental attraction for people of the same
sex. The sexual orientation is not unchanged over time and many
factors favor the fluidity of the sexual gender, especially in the case of
bisexuality. Also, men and women who identify themselves openly
bisexual demonstrate a model of sexual interest that is truly geared
towards both sexes, beyond gender, as they have a greater attraction
for both sexes and less gender specificity than heterosexuals and
homosexuals. [7]
2) female bisexuality seems to be more widespread than male bisexuality,
even if the data could be conditioned by a difficulty of acceptance
linked to socio-environmental and cultural components, which have
mostly cleared female bisexuality as a male erotic fantasy, therefore
women they feel judged less than men (however, even in this case, the
statistical sample was not representative). [8] [12]
3) bisexuality is subject to discrimination by homosexuals and
heterosexuals themselves because bisexuals (due to stereotypes,
preconceptions and socio-cultural prejudices) are considered incapable
of taking a firm and decisive sexual position concerning the preferred
sexual gender (also because it is not this choice always translates into
a definitive position on the part of the bisexual) and therefore they
avoid sexual relations with the bisexuals, probably also for fear that
they may be betrayed or abandoned in favor of the opposite sex. [9] A
recent metanalysis work by Ross has highlighted the negative
consequences of biphobia concerning anxious and depressive
symptoms. Their research showed that, compared to heterosexual
people, but also compared to gay men and lesbian, bisexual people are
more likely to experience anxiety and depression. This is precisely
adduced to the whole series of beliefs, stereotypes, and prejudices that
feed the negative attitudes of biphobia, which bisexual people are
forced to undergo. The work of Israel and Mohr classified these beliefs,
already collected and explored in Eliason's early studies, identifying
three macro-categories of negative beliefs about bisexuality: a)
authenticity: different types of stereotypes are linked to the authenticity
and existence of the bisexuality (bisexuals are confused about their
sexuality, bisexuals are gay and lesbian people who are afraid to admit
it or bisexuality is only a phase of experimentation); b) sexuality: some
attitudes towards bisexual people focus on their sexuality (bisexual
people tend to have more sexual partners than heterosexuals or gays
and lesbians, bisexual people have more flexible attitudes about sex
than heterosexual and bisexual people spread AIDS in the heterosexual
and homosexual community); c) loyalty: other prejudices pertain to the
sphere of loyalty, in the sense of perception of loyalty, sincerity and
loyalty to others: (bisexual people are more likely to have multiple
sexual partners at the same time, a bisexual person is more likely to
leave you for someone of opposite sex to you or bisexual people do not
engage politically and socially like gays and lesbians). As can be seen,
therefore, these beliefs, stereotypes, and prejudices are very specific
and different from those commonly attributed to gay and lesbian
people. Bisexuality is not synonymous with ambiguity. [13-21]
4) bisexuality does not presuppose hypersexuality or a greater
predisposition to the intensification of sexual activity or the presence
of any nosographically identified paraphilias identified in the clinical
manuals. [10] Some data, on the other hand, report a greater intensity
of sexual desire linked to the partner and to the highly eroticized
circumstance, which makes bisexuals more inclined to sex. [61]
5) bisexuality does not imply proving the same attraction or desire for
both sexes equally. Emotions are considered regardless of the gender
of belonging. In general, sexual attraction is unbalanced towards one
side or the other, also according to the period lived and the encounters.
The bisexual feels attracted to the person as such, regardless of the
sexual gender to which he belongs. The sexual choice of the bisexual,
contrary to popular belief, does not affect both male and female
partners at the same time, but it is completely random: this means that
monogamous relationships can take place, even long term, with
subjects of the same sex or of the opposite sex. Like heterosexuals,
bisexuals can also have a monogamous relationship with a partner, and
then occasionally betray him with another person, who in this case can
be both man and woman. [11]
Based on what has been said so far, the writer proposes a theoretical
classification to better frame "bisexuality" and its possible forms: [5-
6]
a) mental images and fantasies with a sexual background, in an
instinctive phase, that the person unwittingly produces, without
however practicing acts of auto-eroticism or searching for the
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b) partner of the same sex, due to the lack of acceptance by the same
of this orientation component (mental bisexuality)
c) fantasies, desires and sexual drives, in the ideational phase, that the
person involuntarily uses or voluntarily produce to get excited and
to enjoy, to practice masturbation, without ever going to the active
phase of the search for the partner of the same sex, therefore
limiting himself to imagination alone (passive bisexuality)
d) sexual attitudes, more or less expressed, aimed at finding a same-
sex partner to satisfy fantasies, desires and drives of a sexual nature
(active bisexuality)
e) attitudes and behaviors of an effective and relational nature, more
or less expressed, aimed at the search for a partner of the same sex
with whom to share both the sexual and the personal aspect,
without however reaching feelings capable of making the person
desire to establish a stable, lasting and mature sentimental
relationship (emotional bisexuality)
f) attitudes and behaviors of a sentimental nature, more or less
expressed, aimed at the search for a partner of the same sex with
whom to share both the sexual and the emotional aspect, coming
to experience feelings that can make the person desire to establish
a relationship stable, long-lasting and mature (sentimental
bisexuality).
2. The neural correlates
The data confirming the substantial (and incorrect) absorption of the
bisexual category in the macro-category of homosexuality are offered to
us by scientific research which, although careful in distinguishing the two
dimensions in theory, in practice does not happen [22-50] and the studies
[51-60] that examine the bisexual category distinguishing it from the
homosexual one; however, even these studies, recently temporally, are not
on statistically representative samples. Trying to summarize therefore in
terms of neural correlates in bisexuality these data emerge:
1) in female bisexuality, a particular feature of the functionality of the
ventral striatum has been noted, an area typically known to be
associated with desire. The subjective and neural responses of
homosexual women were found to reflect a greater propensity towards
female stimuli, compared to bisexual and heterosexual women, whose
responses do not differ significantly. These patterns have also been
suggested by analysis of the whole brain, with homosexual women
showing specific activations (by category) of greater extension in the
areas of visual and auditory processing. Bisexual women tended to
show more mixed patterns, with activations more sensitive to female
stimuli in the areas of sensory processing and activations more
sensitive to male stimuli in the areas associated with social cognition.
2) in male bisexuality, the results of the studies are controversial and not
very consistent. Bisexual men constantly exhibit bisexual subjective
arousal patterns, but sometimes have shown category-specific genital
arousal patterns. More recently, a study found bisexual genital arousal
models that used particularly strict inclusion criteria for bisexuality,
requiring that bisexual participants had at least two sexual partners and
one romantic partner (three months or longer in duration) each gender.
Even more recently, studies of subjective and genital sexual arousal in
monosexual (i.e. heterosexual and homosexual) men have repeatedly
found that erotic stimuli describing men's favorite sex produce strong
responses, while erotic stimuli depicting the other sex they produce
many more weak responses. Inconsistent results have previously been
obtained in bisexual men, who sometimes showed distinctly bisexual
responses, but other times they showed patterns more similar to those
observed in monosexual men. By always paying attention to the ventral
striatum, bisexual men tended to show less differentiation between
male and female stimuli, as well as in other areas, such as the occipital
and temporal cortex and the anterior and orbital-front cingulate.
3. Clinical hypotheses
Sexual orientation is therefore commonly debated as a characteristic of the
individual, as well as for biological sex, gender identity, or age. However,
this perspective is incomplete, since sexual orientation is always defined
based on relational terms and necessarily concerns relationships with other
individuals. Sexual acts and romantic attractions are categorized as
homosexual or heterosexual based on the biological sex of the individual
involved in them, relative to the partners. Indeed, it is through performance
- or the desire to lend - with another person that individuals express their
heterosexuality, homosexuality, or bisexuality. Thus, sexual orientation is
fully connected to the intimate personal relationships that human beings
form with others to meet their deepest sentimental needs for love, bond,
and intimacy. In addition to sexual behavior, these constraints include not-
sexual physical affections between partners, sharing goals and values,
mutual support, and constant commitment. Consequently, sexual
orientation is not merely a personal characteristic that can be defined in
isolation. Likewise, one's sexual orientation defines the universe of people
with whom a person can find satisfying and fulfilling relationships which,
for many individuals, comprise an essential component of personal
identity. [2]
On the subject of "bisexuality", the etiological theories that try to explain
this sexual dimension are essentially four:
1) bisexuality is a "sexual orientation", which does not present
pathological features, as was believed in the last century, and has equal
dignity of homosexuality and heterosexuality. [3] This approach,
supported by the entire scientific community, is also supported by the
socio-cultural, political, and anthropological movements that have
fought for the derubrication of the non-heterosexual dimensions in the
manuals of psychopathology from orientation disorder. [6] Recent
neuroscientific discoveries, however, highlight a rather contradictory
aspect of this derubrication (which has the flavor more than a political
action and less than an intervention of clinical value): the
neurocerebral structures of a homosexual and bisexual brain are
significantly different in size and function from a heterosexual brain,
exactly as it happens in any other psychopathological condition
nosographically framed. [2, 62]
2) bisexuality, not being framed canonically in the homosexual and
heterosexual dimensions, must, therefore, embody the manifestation of
a paraphilia, which is substantiated in experiencing excitement towards
the same sex, while experiencing heterosexual attractions and instincts.
This hypothesis recalls the psychoanalytic concept of S. Freud,
influenced by Fliess, according to which every human being
constitutionally has both male and female sexual dispositions, which
are found in the conflicts that the subject tries to assume his sex. The
father of psychoanalysis emphasizes the importance of bisexuality,
especially concerning the Oedipus complex: a) it determines the
outcome of the Oedipal situation: in both sexes, the relative intensity
of the male and female sexual disposition is what determines whether
the outcome of the Oedipal situation will be identified with the father
or mother. This is one of how bisexuality intervenes in the subsequent
events of the Oedipus complex; b) it is responsible for the more or less
complete development (positive and negative) of the Oedipus
complex. This means that a child does not simply have an ambivalent
attitude towards the father, while the object-choice of the mother is
directed exclusively by a current of tenderness; but who instead
behaves simultaneously as a child, showing an attitude of female
tenderness towards the father with a corresponding hostility and
jealousy towards the mother. It is this complication introduced by
bisexuality that makes it so difficult to arrive at a clear vision of the
facts connected with the very first identifications and object choices. It
can even be said that the ambivalence shown in the relationship with
the parents must be entirely attributed to bisexuality and that it is not
developed in identification due to the effect of rivalry; c) at sunset of
the oedipal complex, bisexuality determines the relative intensity of
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3) the identifications: at sunset of the oedipal complex the four tendencies
of which it is composed will group to produce an identification with
the father and one with the mother. The relative intensity of the two
identifications will reflect the preponderance of either of the two
sexual dispositions of each individual. If therefore all people have an
essentially bisexual nature, according to Freud, in those declaredly
heterosexual the homosexual component would only be repressed in
the unconscious but not suppressed, it would be in a latent state, but it
could manifest itself in very different forms, sometimes in form
sublimated as mental disorders. The disturbance deriving from one's
homosexual component and the refusal to accept it would be the
psychological cause of the presumption to consider only heterosexual
behavior as normal and the attempt to rationally justify this claim, a
claim that is considered as dilating the fear of one's homosexual
component to the homosexuality in general, that is, as homophobia. [6]
4) bisexuality is the consequence of a psychological trauma, resulting
from a dysfunctional attachment [63] or a destabilizing sexual event in
the early years of childhood [64]. These hypotheses are not currently
reflected in the scientific community, although some studies have
shown the neuronal correlation between traumatized brains [65] and
the brains of people sexually-oriented towards homosexuality [2].
Furthermore, recent work has shown that social information is already
processed differently in primary sensory cortices. Converging
evidence suggests that prefrontal areas contribute to the process of
social interaction and the determination of social hierarchies. In social
interactions, we identify the gender in seconds, but after centuries of
anatomy we are still unable to distinguish the male and female cortex.
New data reinforce the idea of a bisexual cortical anatomy layout.
Physiological analysis, however, has provided evidence of sex
differences in cortical processing. Unlike other cortical circuits, sexual
processing circuits undergo major rewiring and expansion during
puberty and show permanent damage due to child abuse. [69]
bisexuality has a biological basis and must be sought in genetic
predisposition [66] and hormonal profiles [67-68]. In particular, recent
research has shown, with a statistically representative sample, that genes
affect a percentage ranging from 8 to 25 (percent) and therefore we can
only speak of predisposition and not of bisexuality or genetic
homosexuality. Concerning hormonal values, especially in the gestation
phase, recent research has shown that during the intrauterine period, an
increase in testosterone masculinizes the fetal brain, while the absence of
such an increase causes a brain with more feminine features. Since sexual
differentiation of the brain occurs at a much more advanced stage of
development than sexual differentiation of the genitals, these two
processes can be influenced independently of each other. Sexual
differences in cognition, gender identity (an individual's perception of their
sexual identity), sexual orientation (heterosexuality, homosexuality, or
bisexuality), and the risks of developing neuropsychiatric disorders (such
as paraphilias) are therefore programmed in our brain during early
development. There is no evidence that one's postnatal social environment
plays a crucial role in gender identity or sexual orientation, other than as
an etiological contributing factor, to be accused of a process more akin to
psychological trauma or dysfunctional attachment.
4. Conclusions
5)
In the future, research should focus on the following investigation points:
a) studies aimed at distinguishing paraphilic forms from definitive
orientation choices;
b) studies aimed at finding any differences between heterosexual,
homosexual and bisexual subjects concerning brain structures and the
levels of serum markers of sexual steroids, both in fetuses and in adults,
in all its evolutionary development, thus highlighting any conditioning
can lead to certain sexual orientation choices other than
heterosexuality;
c) studies able to determine the precise direction of the neural circuits
underlying sexual preferences, comparing the results with heterosexual
subjects;
d) studies able to focus research on genetic factors capable of influencing
sexual orientation.
The direct and indirect implications on the confirmation of the clinical
hypothesis of the bisexual condition would bring further complications,
concerning the management of the patients' treatments and therapies, while
making important differences between highly adaptive patients and those
who perceive their condition as dysfunctional concerning the surrounding
environment.
The question to ask, in this theoretical hypothesis, is whether we must
intervene clinically to correct the bisexual condition and lead the patient
towards a heterosexual orientation, or simply accompany him towards a
better perception of his emotions, desires and needs strategically. [70]
What seems certain is that the static and nosographic evaluation of "mental
illness" about bisexuality is not at stake, the more the awareness of a
clinical reality concerning the topic treated and the evaluation by the
therapist of any anamnestic profiles related to high adaptive functionality
or the patient's ego-dystonic and dysfunctional perception.
The confirmation of the clinical nature of bisexuality could also revive or
reawaken the theses set aside in the last century on possible therapies
aimed at correcting dysfunctional sexual orientation, through
psychotherapy (mainly post-Freudian dynamic orientation) or the use of
neurostimulation equipment (for example electroshock), with a whole
series of ethical, moral, social, political and psychological implications that
are not indifferent to the daily needs of the patients.
These profiles must necessarily be directed to the appropriate research
sites, carefully evaluating the patient's medical history and whether his or
her choice of sexual orientation is experienced or not by the patient in a
highly adaptive or dysfunctional way.
In general, even if the clinical nature of the not-heterosexual choice proves,
this condition should not in itself justify treatments contrary to the dignity
and will of the person. The scientific evidence received so far is not
definitive and deserves further investigation to reach meaningful
conclusions capable of determining collective awareness.
There are well-founded reasons, neurobiological, genetic, psychodynamic,
and socio-environmental, to question the derubrication of bisexuality, from
a clinical point of view. The research currently published cannot satisfy the
need for clarification regarding the subject of this publication and therefore
we refer to a subsequent historical moment to resume the discussion from
an exclusively clinical point of view.
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