will invite a host of unwanted and unnecessary immune problems for you, all in order to keep everyone else relaxed.
Here is one vivid account of what it would be like to hide your heterosexual identity if this were required (as in the US military):Try never mentioning your spouse, your family, your home, your girlfriend or boyfriend to anyone you know or work with—just for one day. Take that photo off your desk at work, change the pronoun you use for your spouse to the opposite gender, guard everything you might say or do so that no one could know you’re straight, shut the door in your office if you have a personal conversation if it might come up. Try it. Now imagine doing it for a lifetime. It’s crippling; it warps your mind; it destroys your self-esteem. These men and women are voluntarily risking their lives to defend us. And we are demanding they live lives like this in order to do so.
The ill effects of concealing one’s homosexual orientation are not limited to HIV-positive men. In a sample of twenty-two HIV-negative gay men studied for five years, those who concealed their homosexual identity were about two times as likely to suffer cancer and infectious diseases, such as bronchitis and sinusitis, as those who did not. These results are independent of a variety of potentially confounding factors such as age, socioeconomic status, drug use, exercise, anxiety, depression, and so on. What is especially striking is that for both cancer and infectious diseases, the effect is strictly dose-dependent—the more you are in the closet, the worse for you. Recent evidence suggests that disclosing homosexual orientation may bring correlating cardiovascular benefits as well.
Not all homosexual men are alike, of course; some are more sensitive to rejection than are others and this can have important effects. Those who are more rejection-sensitive are more likely to remain in the closet, where they avoid rejection and benefit from this immunologically. Apparently there is a general cost to remaining in the closet, but a variable benefit when one is rejection-sensitive, and this benefit can overwhelm the cost.
Have you heard of the latest twist in this saga? There are gay men who are said to be living in a glass closet. They project heterosexuality to their friends, because they believe they would be rejected if people knew about their homosexuality, but in fact the friends know about it and merely go along with the charade. It would be interesting to know where these men lie along the immune continuum. I would guess they are healthier than those in conventional closets, but not by much.
POSITIVE AFFECT AND IMMUNE FUNCTION
Direct experimental tests confirm a strong association between positive affect and immune function but are unclear regarding the correlates of negative affect. Challenging people who have never been exposed to hepatitis B with a hepatitis B vaccine shows a clear positive association between positive affect and a strong, positive immune response, no matter whether the measure of positive affect emphasizes calm, well-being, or vigor. Although negative affect has the opposite effect, this was not significant when corrected for positive affect. In general, it seems as if positive affect is not merely the absence of negative and vice versa. In some cases negative and positive affect act as independent variables and in others as only partly independent ones.
The activity of neurotransmitters such as dopamine and serotonin provides a partial explanation. Dopamine shows a phasic spike in single neurons in response to the anticipation of a reward. If the reward equals expectation, the spikes continue apace; if it exceeds, the spikes increase in rate, and if it is less than anticipated, the spikes shrink to less than the spiking baseline rate for negative rewards. Positive affect increases both dopamine and serotonin production, but negative affect has no direct effect on dopamine (though it may indirectly do so via serotonin production). Dopamine modulates immune functioning and there is an asymmetry between positive and negative affect—positive having stronger effects than negative—both on cognitive and immune function. The deeper reason for this asymmetry remains unclear.
Measures of positive affect are also associated with better survival in relatively healthy elderly people who are living independently in their communities, but curiously enough, positive affect appears to be associated with reduced survival among those already institutionalized. Likewise, those with terminal conditions, such as malignant melanoma and metastatic breast cancer, are worse off with positive affect, but in diseases with higher long-term survival, such as AIDS and non-metastatic breast cancer,