Tuesday, August 01, 2006

My impotence

My impression was that Drescher's opposition to reparative therapy centers around three main points

  1. It doesn't work
  2. It is unethical
  3. It is harmful
However, when pressed, I think he would acknowledge that none of these are proven to be true.

It doesn't work
The efficacy of reparative therapy has never been shown in a scientifically rigorously way. Some have said (wrongly) that if change were really possible it would have been demonstrated long ago. I don't remember Drescher taking this stance, but he did criticize the theories and studies in support of reparative therapy. Perhaps the most widely known study is Spitzer's. Drescher edited an entire book of responses to Spitzer's work, all attempting to discredit the conclusions. Drescher's own opposition (again, based on my poor memory only) was centered around follow up and failure to document actual sexual orientation through objective testing. More specifically, these men who claimed to change orientation, did they stay changed or was it just temporary? Were they able to persist in their "new" orientation? Long term follow up was not measured, and that is a weakness in the conclusion that change is possible. However, to the extent that Spitzer acknowledged this limitation in his discussion, it doesn't make the study invalid, just limited. That's a big difference.

Drescher also asked Spitzer why he didn't verify orientation with plethysmography (what GayMormon calls a "boner-detector"), and he was unhappy with the candid answer Spitzer provided: he didn't have the funding. Drescher seemed to irrationally believe this was a personal failure on the part of Spitzer. I was quite confused. Again, plethysmography would have improved the study, but its omission does not make the study invalid.

It is unethical
You are probably familiar with the medical aphorism "do no harm." Doctors haven't done a very good job of following that advice without some regulation here and there. For example, regulation of research involving human subjects has greatly improved ethical practices. And "informed consent" is an important part of every medical or psychiatric therapy--research based or not.

Drescher had a list of 6 criteria that must be followed for a therapy to be ethical. I don't remember what they all were, but properly informing the patient about potential benefits and harms, respecting autonomy, etc., were central. Drescher went through the list point by point and made his case that reparative therapy did not meet the criteria. However, I was not convinced. I have actually been in reparative therapy sessions, and the way he described the dialog was simply not reflective of my personal experience. I was indeed given a thorough explanation of potential benefits and risks. My consent was documented carefully. Confidentiality and specific therapeutic goals were discussed. It was all quite professional. I wondered where Drescher was getting his information.

It is harmful
Drescher stated unequivocally that not a single reparative therapy book or practicing therapist was honest in disclosing the risks. Not one. My vast readership [hee] may remember a recent series of posts in which I reviewed a couple books on reparative therapy (Nicolosi and Parks). They were library books, so I can't go back to find pages, but I believe I recall a discussion of theoretical risks in both of them. Regardless, I know my therapist and I discussed the issue. Therefore, I had to restrain myself from standing up and calling Drescher a pig-faced liar. Actually, restraining myself wasn't hard, because the crowd had proven themselves to be completely tolerant of blatantly anti-religious hate-speech. I felt like a mole.

Despite the fact that his own handout specifically noted that the only data regarding risks in reparative therapy are anecdotal (i.e. not scientifically meaningful), he was standing there condemning anyone who would not discuss the harms as if they were real. His take became more and more clear: reparative therapy is an extension of conservative religious fanatics who speak of loving gays publicly, but call them an abomination privately. They have no interest in the individuals, only their own political agenda.

You can imagine how such generalized moral condemnation turned me off. But everyone else seemed to be eating it up. The picture was painted to show down-trodden gays hustled into therapy they didn't choose for themselves, psychologically abused by self-promoting "ex-gay for pay" quacks, and then condemned personally for any poor outcome. Such an exaggerated caricature was so far from my personal experience that I wondered if I would be able to tolerate the discussion. Had he cited examples as examples I would have had no objection, but vilifying an entire demographic whose views differs from your own? Generalizing motivations and unethical conscience?

If this is the national leader in opposing reparative therapy, I must admire the ingenuity of gay activists in getting medical professionals to swallow such swill. It was patently ridiculous. And I was impotent in commenting because of my concerns for personal privacy. It makes me rethink my desire for anonymity. But, not surprisingly, it did not make me rethink my decision to attempt reparative therapy.

And, no, I'm not worried about any other kind of impotence at the moment. :-)


Chris (hurricane) said...

It was patently ridiculous.

But no more so that the untested and unproven claims of reparative therapy advocates who bring political agendas to their work as well.

-L- said...

Umm, yeah, more so.

I've never heard any reparative therapist make character assault categorically on EVERY opponent of reparative therapy. But that's precisely the breadth of Drescher's arrogance. And even if some reparative therapists are charlatans, that doesn't excuse Drescher from being stupid. Also, this was at a professional medical conference, not a rally for gay rights.

Chris (hurricane) said...

I've never heard any reparative therapist make character assault categorically on EVERY opponent of reparative therapy.

I wasn't referring necessarily to therapists, but advocates of reparative therapy, who ROUTINELY demonize the gay community. So fair enough.

Of course, I'm just taking your word for it. And you aren't an uninterested observer here. ;-)

Samantha said...

IS there such a thing as an "uninterested observer" anymore?

Naptastic said...

The reparative therapy position is wholesale BS, and here's why:

In 60 seconds, I could name for you two dozen men who I know personally, who will tell you of the months--years--decades, they spent following the advice of priesthood leaders and reparative therapists, and at the end of it, there was no change in their orientation. These are men who have paid a huge price societally for speaking their truth. For all of them, success in change would have made life simpler in every conceivable way. And yet, success in change did not come.

Looking for men who found success, we find almost universally three big problems: they're anonymous (and I'm not above accusing therapists of making up anonymous patients--if an identity isn't attached, I don't buy it), they don't last (ex-gay watch, anyone?) or they're paid. Being paid to hold an opinion does not invalidate your testimony, but it does invalidate that testimony standing on its own.

Show me a hundred men who put their names and reputations to having changed from gay to straight, stayed straight for a decade, and aren't being paid for it, and I'll back down.

-L- said...

Naptastic, spleen feel better now that it's vented all over my blog?

I'm not particularly interested in the 2 dozen personal friends you have who hate reparative therapy, your inability to accept completely rational explanations for the difficulty in finding legitimately ex-gay men, or your arbitrary "show me a hundred" level of proof. I'm interested in an actually scientific inquiry into the matter. Something that I had high hopes for in Jack Drescher's case. Unfortunately, as detailed above, I was disappointed with him.

Anyway, I appreciate your frustration and skepticism. Thanks for commenting.

Jason Park said...

The efficacy of reparative therapy has never been shown in a scientifically rigorously way. Some have said (wrongly) that if change were really possible it would have been demonstrated long ago.
The efficacy of reparative therapy has been proven for anyone who cares to read about it. See http://evergreeninternational.org/Myths.htm and http://evergreeninternational.org/faq.htm#number and http://evergreeninternational.org/testimonies.htm and http://evergreeninternational.org/Thousands.htmand http://evergreeninternational.org/overcome.htm (see the heading Observations of Others). See also .

I'm also living, breathing, proof. And I personal know another dozen people.

-L- said...

Thanks for the links, Jason! I encourage anyone with an interest in the topic to carefully review the info that is provided there.

However, I don't consider literature reviews and case studies to adequately satisfy the criteria "scientifically rigorous" and presumably neither does the APA. I've commented previously on this blog about the political nature of the APA (and all of organized medicine) but that by no means should imply that I discount everything they may say on the subject.

A scientifically rigorous study would look something like Spitzer's, although would be prospective rather than retrospective. It would include long term follow up and objective measures instead of surrogate endpoints. It should also include control groups that do not undergo reparative therapy to ascertain whether orientation change is causally connected or incidental.

Spitzer's study looked not at reparative therapy's effectiveness but at examples of change for any reason (if I remember correctly). While Drescher's criticisms of Spitzer's study do not invalidate it in my mind, neither is Spitzer's study powerful enough by its own merits to count as more than "some evidence". I'm looking forward to reviewing research that has more weight... that's better constructed and more airtight.

I'm interested in learning more and appreciate the links, but I find much of the discussion to be disingenuous on both sides.

Do you happen to know why the APA does not consider the studies you mentioned to be "scientifically rigorous"? Politics aside, I have some confidence that to make such a statement they have a legitimate rationale, however much I might dispute it. Regrettably I don't have the time to really delve in to the primary literature too much for myself.

lovestone said...

Typical self-centered gay attitude. Offer any theory, practice or musing about the all-mighty quest for your own self-satisfication and then brilliantly respond to reasoned critique with slanderous name-calling. Way to go man.