The APA's tast force statement on orientation change efforts

I read a few posts on Warren Throckmorton's blog recently, and I really enjoyed them. The commenters there seem very reasonable, and civil by conventional internet standards. I ended up reading bits of the Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation based on Dr. Throckmorton's suggestion (although he calls himself Warren, so I'm probably going to call him by his first name).

My take?

The overall position is conservative in the sense that it avoids any definitive statement of efficacy or harm, admitting the paucity of evidence. What disturbs is the pervasive bias in the way the data is discussed, regardless of the final, almost reluctant, conclusions. This bias bleeds out as imprecision and equivocation most frequently, but occasionally as blatant inconsistency in the standards to which the evidence is being measured (or even examined at all).

I don't have the time to trot out a lot of examples (or even read every word of the document), but here are a few passages with comments.

We see this multiculturally competent and affirmative approach as grounded in an acceptance of the following scientific facts:

• Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality—in other words, they do not indicate either mental or developmental disorders.

What the task force here calls "scientific fact" is actually consensus opinion, and there's a big difference. Many studies have defeated the long-prevailing belief that homosexuality is or is associated with mental illness. That much I can swallow (but only on a provisional basis). But, as I've mentioned on this blog before, it's odd to me that a discussion of "human sexuality" can so thoroughly and emphatically ignore reproduction as a significant part of the equation. If one assumes, as the task force apparently does, that ejaculating and having viable sperm is all that is necessary to give the thumbs up on normal reproductive capability, then perhaps their consensus statement (which is not a fact) is defensible. However, I beg to differ.

Gay men, lesbians, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects.

This is presented as another "scientific fact". What I think they meant to say was that these folks form said relationships at rates that are not statistically significantly different from heterosexual families in the essential respects that have been examined. This is not even close to the same thing. Maybe the studies satisfy non-inferiority criteria (that are subjectively assigned). Maybe there is statistical significance for the subjective answers to survey questions, but many "essential respects" are not so easily measured, and failing to show a difference is not the same as showing equivalence. They don't bother footnoting this statement, so there's probably some great quality data... but moving from great quality data to proclamations of unequivocal "fact" is a move I highly doubt I would support after reviewing the relevant literature.

...few studies on SOCE produced over the past 50 years of research rise to current scientific standards for demonstrating the efficacy of psychological interventions...

Few studies of anything produced more than a few years ago rise to current scientific standards. They still can inform, even if they can't prove. Because these studies weren't conducted as randomized controlled clinical trials, they can't show us what we'd like to know, but I don't think the task force is correct with: "there is little in the way of credible evidence that could clarify whether SOCE does or does not work in changing same-sex sexual attractions." The evidence that is presented is what it is. Just because it's not the kind of rigorous science that would demonstrate causality doesn't mean that it's not "credible"! If the researchers were found to have manipulated data there would be a credibility problem, but as the data is, it just gives us very limited evidence, albeit legitimate.

Interestingly, a footnote briefly mentions a Nicolosi study that was not included in the task force's consideration because it was published after the review period and "appeared" to be a reworking of an earlier study. I haven't read Nicolosi's 2008 study, but if it provided any new information that met "current standards" in a way that nothing else does, perhaps they could have gone ahead and extended the review period since the limited data is the whole point. And if it was a reworking of an earlier study, that's even more reason to suspect that it was specifically reworked to assuage criticisms of methodology or presentation. In other words, the task force laments having no "credible" data but can't be bothered to look at the most recent data, even when it was published a year in advance of this report.

White men continue to dominate recent study samples. Thus, the research findings from early and recent studies may have limited applicability to non-Whites, youth, or women.

This is certainly true. So is this: old people continue to dominate the cancer literature, so research findings may have limited applicability to young people. The trick is most people with cancer are old. Just like most people who seek out SOCE are white males. So it's okay to go ahead and accept that there's value in the data even if it's not completely generalizable. The population that has been studied happens to be the vast majority of those for whom this research will make any difference.

In general, the results from studies indicate that while some people who undergo SOCE do engage in other-sex sexual behavior afterward, the balance of the evidence suggests that SOCE is unlikely to increase other-sex sexual behavior.

Again, this is true. So is this: chemotherapy for breast cancer patients will not give any benefit to a majority of patients but will give toxicity to all of them. The trick is, I don't care what happens to the "majority," I want to know quantitatively whether there was a difference in the rate of other-sex behavior from the therapy (if not causally demonstrated, at least temporally). And it sounds like there was a quantitative difference, even a significant one. But I wouldn't know from this report as they just go ahead and stick with vague dismissals like the quote above.

Two participants reported experiencing severe depression, and 4 others experienced milder depression during treatment. No other experimental studies reported on iatrogenic effects.

Woah. Suddenly the fact that participants are experiencing things in association with treatment can be automatically causally linked. Well, hey, we moved on to harms, so the rules of scientific rigor have all changed. These cases of depression are "iatrogenic". Umm... how do you know? Although the task force does go on to admit that there is no causal attribution for harms or benefits, they go ahead and refer to "some evidence" of harm repeatedly through the report while adamantly holding that there is "no credible evidence" of benefit.

We recommend that APA take a leadership role in opposing the distortion and selective use of scientific data about homosexuality by individuals and organizations and in supporting the dissemination of accurate scientific and professional information about sexual orientation in order to counteract bias.

Ah. Here's something I totally agree with. I just wish they'd followed their own advice. I couldn't find it just now rescanning through, but there's a great gem in there where the task force refers to itself as an example of authoritative and reliable source of scientific information. Ha. Or... maybe individuals can actually go ahead and critically examine things for themselves since science isn't a religion and appeals to authority are both unnecessary and fallacious. A scientist ought to know that.

Way overdue.

This blog has been important in my life, but I think most of that has been in the past. I'm pretty well reconciled with all the topics I've blogged about, and for those areas where I still feel confusion and ambivalence... well, at least it's well defined confusion and ambivalence. :-)

My son and daughter continue to grow up before my very eyes. Yesterday they both disappeared for a while and I had my suspicions they were into some mischief. A few minutes later they both came barreling in to the room where my wife and I were sitting and shoved little containers of applesauce into our hands to be opened. They tried to sneak it but realized they couldn't open it without our help and reconsidered their tactics.

The fact that I'm as gay as ever (gayer?) and still living the all-American dream gives me conflicting feelings. On the one hand, I want to speak out against the nay-sayers who yell and scream that it's an illusion, that such a situation never happens, that it's impossible. I want to speak out and tell people that I've been in shoes very similar to every gay person I hear--doubting the church, questioning my self worth, feeling suicidal, being overcome with an overwhelming sense of unfairness and unending conflict. I want to speak out and say that the church is true and that there are miracles to be had, if we will only listen and obey.

On the other hand, I want to shut up and let it all play out on its own. I'm sort of sick of writing about tolerance, explaining misunderstandings, and promoting more thoughtful and considerate dialog. My efforts have been met with some really ornery people who don't care in the least about what I have to say, only that it appears on the surface to disagree with their own views, so the gloves come off and the punches start flying. These people are plentiful and insistent, and it's just not worth it to try to convince them of the reality I live in. There's a lot of joy to be had in the church, and no amount of insults and rancor can convince me that my wife and my two children are not worth every sacrifice I've made (and for that matter, many that I haven't). And no amount of gnashing teeth will convince me that someone who hasn't made those same sacrifices needs or deserves concessions from me in the form of some fatalistic assessment of what they need to be happy or fulfilled or what their "rights" have to be.

So I've just been a fence sitter. I try to avoid those who want to engage only to foist their bigoted selves onto a soap box. I walk away from that and build a castle with my son instead. But I do see many who are learning about this and looking for truth. So I keep blogging (although mostly at Northern Lights now).

For better or worse, that's my update. It's long overdue, I know.

But you can rest assured that as I learn new things I'll be writing about it.

A Legal Question

Just read this article and I have a question for the legal minds out there.

Why does stabbing someone to death, decapitating them and flashing the head around to other people, then eating the corpse's flesh qualify as SECOND degree murder?

Update

What's to tell? There are a million things that I could blog about in my life right now. How amazing my children are (the stories could be endless), the patience and incredible capacity of my wife, my job, my progress. But, unfortunately, time is always so short.

I get a few e-mails a month asking about myself, and I appreciate that gesture of friendship. I suppose it would be a better use of time to just blog more to keep people updated. For those who have written recently to ask me specifically about how I keep things together with my family, reparative therapy, or general gay topics, I'm sorry I haven't had a lot of time to respond. One trick is that I've written quite a bit about these things before and so there's quite a bit to read from the archive if you are interested.

Sorry for the boring post. But, you know. Gotta get to the ward party today and then... well there's plenty of other stuff I've been putting off until today too. :-) Best wishes to all.

Not just a margin

For better or for worse, I'm coming here to feel sorry for myself. I'm that guy. The one that has everything when you look in from the outside. We've got the little family of four, the cute little house and dog, the great career and graduate program between the two of us, and all our health.

But I feel tormented far more than I have any right to feel, I suppose. But does one have to earn their torment? Or does its existence serve as automatic legitimization?

Today I feel on the margin of a margin of a margin. I'm in a minority field of medicine, often unappreciated. I'm in minority situation in my department. I'm a minority within the church in my understanding of gay related issues. I'm definitely in a minority among gays in my empathy for the church. Couldn't I, for once in my life, be surrounded by crowds of people that get me? Get it? Get anything?

Basically, today I feel like there's nobody that understands. Perhaps my wife, and that's it. And that makes me feel all the better that I have her and that I'm not in a different circumstance right now. And that makes me sad that so many other people don't or won't believe such a thing can happen. But then, can it? Or am I just an anomaly--an outlier there too?

It's as if I've spent a lot of effort trying to bridge gaps and shed light where people have closed themselves off, but in the process I've put myself too far into the minds of others and made myself inaccessible to my self. I haven't pulled off the insight I need to peacefully be at one with the majorities in every part of my life. I guess I don't know how to do it. Or, I need to humble myself to try something new.

Mere Meme

JGW tagged me (finally someone did ;-)).

Here are the instructions.

1. Pick up the nearest book (at least 123 pages).
2. Turn to page 123.
3. Find the 5th sentence
4. Post the 5th sentence on your blog.
5. Tag 5 people.

"But what does puzzle people---at least it used to puzzle me---is the fact that Christians regard faith in this sense as a virtue."

C.S.Lewis, Mere Christianity. It's actually a really interesting paragraph (and somewhat appropriate to the things I've read of late). He follows by saying:

I used to ask how on earth it can be a virtue--what is there moral or immoral about believing or not believing a set of statements? Obviously, I used to say, a sane man accepts or rejects any statement, not because he wants or does not want to, but because the evidence seems to him good or bad. If he were mistaken about the goodness or badness of the evidence that would not mean he was a bad man, but only that he was not very clever. And if he thought the evidence bad but tried to force himself to believe in spite of it, that would be merely stupid.

Ah, Lewis. Love his guts. I tag FRM, playa, Craig, ATP, and John Galt.

Changing... changing... changing... same.

For old times sake I did a little "rounding" on the moho blogs this evening. It turns out everything's changed, and yet everything's just the same. There were a bunch of commenters I'd never heard of and never talked to. Bloggers too. But, the topics were the same, more or less. The occasional ironies: vitriol from some sides, the over-reactions, the banding together in defensive victimhood while disparaging those "other guys" in a manner that is completely intolerant.

Sometimes I just feel like people choose a role and move through the motions without even realizing they're doing it. The young gay who feels liberated as he questions authority. The married gay who considers walking away from the life he's built to search for an upgrade. The depressed blogger who manages to create something beautiful and artful and poetic in articulating the struggle of life.

It makes me wonder what role I'm in right now? The sanctimonious, overly self-assured churchy guy? [Yes, I know that's how I'm frequently seen, but it's part of the piety to be in denial, I suppose.] Am I in the calm before the storm--the guy whose life is perfect right before falling apart? Am I to the point where everything is boring because I've pretty much solidified my biases and don't have enough time for online friends?

I dunno. I'm still on a journey. Not sure I can fully appreciate the birds' eye view. But, I'm still truckin'. And trying to refrain from tapping on the restroom floor of the truck stop. :-)