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.

Crazy gays

I saw Forester's post today, and SG's comment, and some other posts that reminded me that I suspect gays are uncommonly crazy. Anecdotally, as I tally up the gays I know and the gays I know who have some sort of psychiatric problem (whether it be depression, bipolar disorder, OCD, etc...) it's a freaking lot. It's just plain huge.

So, if memory serves, Hooker's research was the first step in showing that homosexuality was not associated with intelligence or mental health. But, if memory serves, that study had an enormous selection bias / exclusion criteria (one that is ignored by all the same folks who spit on the ground every time Spitzer's name gets mentioned).

Conventional wisdom says that any difference in the prevalence of mental problems in gays is directly attributable to a hostile society and the unfriendly circumstances gays must live in. Which, I believe to an extent, but not to the extent of explaining all the mental illness I've observed.

There ain't nothin' morally wrong with being depressed or bipolar or whatever. I'm a big fan of mental illness not carrying stigma. I do wonder, though, why I get the impression that there's such a big correlation.

I don't believe being gay makes you depressed. So, I wonder what it means.

Rational faith 5: Wrap up

While I was writing one of my previous posts, a resident I work with asked me what I was doing. I explained that I write a blog and that I was currently writing about science and religion. He recommended a recent article in Time magazine, so I had a look.

The article includes an interview with Francis Collins, the guy who headed the human genome project. Dr. Collins is actually sort of a hero of mine. I had the chance to meet him at the NIH a while back during a meeting for physician scientists. He was so approachable and happy, I just wish I had the opportunity to be his friend on an ongoing basis.

Anyway, I was happy to see him featured in an article in Time and taking a position similar to mine from the last several posts. Here are a few quotes from the article:

TIME: Dr. Collins, you believe that science is compatible with Christian faith.

COLLINS: Yes. God's existence is either true or not. But calling it a scientific question implies that the tools of science can provide the answer. From my perspective, God cannot be completely contained within nature, and therefore God's existence is outside of science's ability to really weigh in.

...

DAWKINS: I think that's the mother and father of all cop-outs. It's an honest scientific quest to discover where this apparent improbability comes from. Now Dr. Collins says, "Well, God did it. And God needs no explanation because God is outside all this." Well, what an incredible evasion of the responsibility to explain. Scientists don't do that. Scientists say, "We're working on it. We're struggling to understand."

...

DAWKINS: ... It would be unseemly for me to enter in except to suggest that he'd save himself an awful lot of trouble if he just simply ceased to give them the time of day. Why bother with these clowns?

COLLINS: Richard, I think we don't do a service to dialogue between science and faith to characterize sincere people by calling them names. That inspires an even more dug-in position. Atheists sometimes come across as a bit arrogant in this regard, and characterizing faith as something only an idiot would attach themselves to is not likely to help your case.

Collins acknowledges what I believe as well: science is inadequate for answering questions about God. He shows that a brilliant scientist can believe in God and science simultaneously. And Dawkins demonstrates the disdain of certain non-believers who seem to not only disagree with the idea of religion, but resent it. I'll stop short of writing an extended review of his comments (and tone) in the article.

I did have a few more thoughts I wanted to put in this series, but I'm sick of it now. Some other time I'll post those other thoughts on their own. I may not have persuaded anybody that I'm not brainwashed, but it was a great exercise to really look inside myself and realize why I believe as firmly as I do in the gospel even while aware of so-called anti-Mormon points of view. I'm very happy with my current level of testimony and understanding and look forward to a life of learning and growing.

Index to series:
Rational faith 1: Science
Rational faith 2: Spirituality
Rational faith 3: Grand unifying theory
Rational faith 4: Creative calculus

Rational faith 4: Creative calculus

In trying to understand how to value both spiritual and scientific information, I've found the following analogy helpful.

I think everyone in the world is constantly engaged in assessing what is likely to be true, and the assessment is the sum of calculations our mind is constantly performing in the background. It's as if reality is a mathematical function of endless complexity that includes erratic twists and turns when graphed on a Cartesian plane. From the moment we're born, as humans, we gather bits and pieces of information and incorporate them as variables into our own equation that approximates that graph of real reality. The more successfully we are able to match our conception of reality with actual reality, the more empowered we become.

Early on we realize that our variables must be weighted with a relevant coefficient to achieve the best results. Certain pieces of information are deemed reliable and others are judged to be anomalous and are consequently given a low coefficient. We learn to be alternately skeptical and trusting in certain circumstances. We solve parts of the overall equation all the time, compartmentalizing and simplifying the data we have to keep in mind on an ongoing basis. Occasionally we find a clever way to resolve a set of variables that others may miss. It's natural and inevitable that variables drop out over time, either by being incorporated into some larger statement, or from being relegated to the distant past of forgotten experience.

We also have the opportunity to get huge swaths of the equation second-hand from parents and teachers. We can plug this data into our equation to see if it works, or add the information piece by piece based on our own experiences.

There is an inevitable challenge in managing this equation. Some previously resolved portion of the formula eventually ends up contradicting another. There's a division by zero, of sorts. Sometimes when this happens, you can go back and check the math, but that can be entirely impractical for sections of the formula that have incorporated hundreds of thousands of variables over years.

So, we add coefficients. We fudge. And I think we all do this out of necessity. We choose to devalue certain pieces of information to a fraction of their original value because they come into direct conflict with other more powerfully verified portions of the formula. The effort is always to judge rationally which terms carry more collective weight, which have more collective evidence. In really troubling instances, spot checks help sort out the facts. But often there are is no apparent way out of the mess despite that plenty in the peanut gallery claim a certain way to be the only legitimate one--and they frequently don't agree with each other.

The art of life, in my opinion, is learning how to best manage the whole enterprise. We all do it whether we realize it or not--it's just part of life as a biological creature. We assign coefficients to the evidence that presents itself in the cleverest way possible. Ideally we learn how to efficiently secure solved portions of the equation with the highest relevance and value. Life is about finding balance.

Some get carried away inflating the value of some information while zeroing out others. A piece of information zeroed out for its incompatibility with some other weighty established phrase may seem inconsequential alone, but if enough data is neglected serially over a long period of time, the person has managed to deceive himself thoroughly. It is this self-deception that many attribute to people of faith.

Another self-deception happens when new information is given higher credibility than old merely because of it's immediacy on the mind. Years of experience corroborated with a steady stream of consistent information is thrown away in an instant because of some plausible new bit at odds. Certain significant memories of a more ethereal character are more likely to be forgotten. They have to be vigilantly kept in the fore-front to be kept at all.

On the other hand, some people try admirably to keep all the data unmodified, accepting only raw information of the most demonstrable nature as legitimate. This approach is wonderfully successful for filling in certain parts of the graph, but is too inefficient to cover much and largely neglects certain key portions of the graph.

Being fully aware of the aforementioned limitations and pitfalls, I sit perched with my number two pencil and my sheet of graph paper wondering how best to tackle the variables I've assembled. I decide to compartmentalize where possible, and address the data by prioritizing by urgency, importance, and purpose. The process perpetuates itself as solved portions of the equation cast new light on previously obscure variables. In this way I'm persuaded by preliminary results that hope, when used judiciously, can sometimes be a legitimate coefficient. I'm persuaded that observance of certain rituals and covenants has surprising power, while others are silly or harmful. I'm persuaded that Occam's razor isn't always the final word.

The fact that I believe in free will leads me to believe that how I manage the effort will be an expression of who I am most fundamentally. Plunging the depth and breadth, traversing the whole while scooping up critical minutia here and there--it's all an art, a rewarding enterprise, and an expression of my soul.

Index to series:
Rational faith 1: Science
Rational faith 2: Spirituality
Rational faith 3: Grand unifying theory
Rational faith 4: Creative calculus
Rational faith 5: Wrap up

Rational faith 3: Grand unifying theory

The conflict between science and religion is a cliché. It's there demanding to be addressed by anyone who values them both but notes the inconsistencies. Ezra Taft Benson said:

Religion and science have sometimes been in apparent conflict. Yet, the conflict can only be apparent, not real, for science seeks truth, and true religion is truth. There can never be conflict between true religion and scientific fact. That they have occupied different fields of truth is a mere detail. True religion accepts and embraces all truth; science is slowly expanding her arms and reaching into the invisible domain, in search of truth. The two are meeting daily; science as a child; true religion as the mother. Truth is truth, whether labeled science or religion. "Truth is knowledge of things as they are, as they were, and as they are to come" (D&C 93:24). Truth is always consistent. It can never be in conflict with itself.

This is a quote explaining an idea I've long been fond of. It jives with my sense that there's Truth out there with a capital T, objective reality plugging along despite our inability to pin it all down. I love the idea that ultimately there are answers for everything... things work. Proving existence of objective reality is burdensome (and somewhat ridiculous), so I just start with confidence in Benson's notion here.

However, the problem with interpreting Benson's quote is that it may tempt us to try to reconcile faith and religion now, as if we have the means to do so. This effort has been made in the past with some unfortunate outcomes. Churches have dictated what science is allowed to do, and dictated "truths" about the universe based on a presumptive reading of scripture. I'm of the opinion (and I think history supports me on this) that that's a bad way to go about things. I'm a resolute opponent of Intelligent Design masquerading as science, for example.

I see science and spirituality as two separate but effective ways of learning. They teach us about different things and we will be wise to use them only as directed. Science works terrifically for advancing temporal causes, but using it for spiritual pursuits is something like building a tower of Babel or seeking signs. That's not to say that reason isn't central, because I think it is inseparable from a genuine testimony, but the effort to prove religious principles can be antithetical to portions of the plan of salvation.

Similarly, intuition and unfounded confidence have to be checked in science. There's room for creativity and fresh ideas, but when it comes down to testing a hypothesis, aberrancies are wrought out and destroyed, precision is pursued with alacrity, and confounders are battled with vigilance. Holding on to any biases not supported by verifiable data is counter-productive. And, as I mentioned before, using doctrines or religious tenets anywhere in the scientific process is a bad idea.

Despite their differences, the effectiveness of both science and spirituality for their respective purposes is undeniable in my mind. As my previous two posts attest, they both work really well for me. It's just the inappropriate inter-mingling of the two methods that causes problems. Just as one should not combine the theory of relativity and quantum physics, the two systems of thought can't be mixed without coming up with some absurdities.

Is there a way to use both together to build a unified world view? Where's the grand unifying theory of science and religion? I'm working on my own version, but it has its problems. I do believe that some such combined world view is possible without resorting to being irrational. Perhaps it won't be provable (just as string theory attempts to reconcile relativity and quantum physics but can't be proved without a particle accelerator the size of a gallaxy) but that lack of proof won't make it automatically irrational.

Next time: my effort at a rational and faith-accommodating world view.

Index to series:
Rational faith 1: Science
Rational faith 2: Spirituality
Rational faith 3: Grand unifying theory
Rational faith 4: Creative calculus
Rational faith 5: Wrap up

Rational faith 1: Science

Those who practiced medicine many decades ago eventually realized that anecdotal evidence just isn’t as helpful as repeatable experiments that give consistent results. Where herb poultices and leeches had occasionally cured certain maladies (and inadvertently caused others), understanding pathophysiology helped invent and direct more reliable cures. We’ve moved toward understanding things and proving things rather than occasionally lucky stabs in the dark. Now, it seems, you can’t even apply common sense to medical problems without conducting multi-phase clinical trials to prove what everyone thought was right from the beginning. This is because evidence-based medicine has been extremely effective in treating disease, so it’s thankfully here to stay.

Science is the system of determining facts about the world through an objective process of measurement. At least, that’s how I think of it. The measurements have to be similar when done by different people at different times, and the facts apply only to conditions unique to the experiment. Testing hypotheses in this way has proven to be a hugely successful way of generating information.

Add on a little math and/or logic, and you can extrapolate facts from other facts. If this experiment shows us this, and this experiment shows us this, we can conclude that this third experiment would result in this, even though actually conducting such an experiment may be impossible. Through rational thought, we move forward.

And thus we have the Internet, antibiotics, space shuttles, etc. Go team.

Unfortunately, the progress from simple direct experiments like Mendel’s pea plants to sophisticated nano-scaled machines means that most of us are just going to have to accept most of science on faith. We can’t know it all for ourselves because the existing body of knowledge is too broad and too deep. The minutia of technology and the esoteric nature of sub-specialized fields of expertise mean that I’m obliged to sit here and happily type my blog without giving a second thought to how it all works. From the binary code of the software to the physics of electricity to the economics of free web-based services, I have no choice but to trust that people have this stuff figured out, and my trust is rewarded with results.

Unfortunately, faith in science can be misplaced. We resident doctors hash out the specific details of scientific papers all the time as a part of our training. In “Journal Clubs” we dissect journal articles to find flaws in their methodology, their study design, and the conclusions they claim to have reached. Contrast this with the press, who often not only fail to question the actual plausibility of a study’s findings but often overstate the conclusion and give the public a completely false impression that some ridiculous idea has been “proven by scientists.”

There are occasional mistakes that take scientists down a false path for a long time before realizing the error. Unfortunately, some errors are deliberately propagated by those who are trying to sell something, both material and ideological. Either way, don’t ever assume that something claimed on “scientific” grounds is a sure thing. Your trust is probably well-placed, but not necessarily.

The good news is that poor science, even the most esoteric kind, is likely to be eventually uncovered. But it’s uncovered by the folks who take the time to really understand the data, not by the peanut gallery who scoff at the unfamiliar. The scoffing is just noise.

My brain has gone all over the place now, and you just have to stay tuned to see why I even wrote this post. There’s no denying that a systematic, ordered approach to demonstrating what we don’t yet know has taken us amazing places--even in my life time. I like science, logic, and rationality, because they work really well.

Index to series:
Rational faith 1: Science
Rational faith 2: Spirituality
Rational faith 3: Grand unifying theory
Rational faith 4: Creative calculus
Rational faith 5: Wrap up

Biology

I don't have a lot of knowledge of the Levay experiment in which the structure of a hypothalamic nucleus was found to be morphologically distinct in straight men, women, and gays. I only know what I've read, and I have not read the primary sources. They are supposed to be significant for the impact the conclusion has on homosexuality being a choice. Because some believe this topic actually has some merit, I googled some responses, and they sound like a mix of legitimate and stupid concerns, but you can find those as easily as I can.

My impression is that nobody should be surprised if there are brain morphology differences between gays and straights and there should be no surprise if there are genetic contributors to personality and other aspects of human identity. Big fat hairy deal.

All this scientific effort will have shown that people are indeed not "created equal" but that we have to work within our unique set of personal circumstances. It's not fair, true, but a perceptive toddler could conclude as much about life. Hell, make that an UNperceptive toddler. You deal with it the best you can rather than expecting the world to somehow make it up to you by redoing expectations of behavior and morality.

That's not to say that there aren't plenty of non-biological issues related to the morality and social circumstances of gays. But the biological arguments I've never found compelling in the least.

At the same time, the biological experiments wouldn't be as big a deal if it weren't for the monumentally stupid idea that sexual attractions are chosen. But, neither the far right nor the far left feel served by putting the issue in just such precise terms. It's better to discuss the idea that "being gay" is chosen so that both sides can indignantly battle for the broad political implications that follow from affirming or denying that statement, vague as it is.

Misinterpreting the science for a political agenda, most often inadvertently, is the standard practice. The gay rights movement (bless their little hearts) have bought in to the philosophical approach that the end justifies the means, a hair slow in noticing that strong advocacy for aims popular to some gays is harmful to other gays. Much (if not all) of the published scientific data is influenced by bias at some point in the scientific process (largely from advocates--sometimes the scientists themselves), despite all the best efforts to mitigate it (or disguise it).

There's a fair chance I just don't get why all this science has much meaning. But I sort of think the odds are in my favor that it's the scientists and political pundits who just don't get how much the biological science doesn't matter on this topic and other matters of morality.

Detestable

"I don't want to turn our children over to an organization that will teach them to hate their father," he said.

"Gerald," I responded quickly, "you know that there is no person or organization anywhere on this earth that could teach your children to hate you. You know they love and adore you, and they always will."

"But the Church will tell them that I am evil."

"Look, Gerald," I said. "I understand your feelings toward the Church, but without it you wouldn't have developed into the person you are, or have the spiritual interest you do. I think the Church has done a lot for you."

There were tears in Gerald's eyes when he answered me. "That's the trouble, Blossom. I love the Church. And the Church detests me. That's why it hurts so much!"

Carol Lynn Pearson,
in Good-bye, I Love You

I have to admit there's a lot here that I just plain don't get. Not that the actual words have obscure meaning, but the pervasive disagreement about the church's actual attitude toward homosexuality held among gays, members, and SSA practicing Mormons. The church says they love us. Gays say the church hates us.

I was interested to learn that the church had advocated electroshock aversion therapy at BYU and that priesthood leaders have said such offensive things as that it would be better to be at the bottom of the Great Salt Lake with a millstone around your neck than to be gay or that homosexuality is equivalent in depravity to bestiality.

Apologetic apologist or not, I come out with a kind take on the church. I'm inclined to think one can believe whatever one wants about the church in this regard. I wonder if it's one of those things that reflects on the interpreter more than the subject material itself.

For example, priesthood leaders are either plain wrong (not unheard of) or overemphasizing something for its rhetorical impact when they speak of death being better than sin. It's certainly a notion that has home in parts of the scriptures and makes sense in a tactical "how will you make it through life's tests" sort of way. It also has the unfortunate side effect of alienating the vulnerable person who already feels ashamed and desperate--of giving the false impression that the church wants the person dead. Not a strategic repentance-motivating discussion I would endorse, but also not literally technically inaccurate. Rhetorically stupid, yes, but stupidity is more easily excused than hatred.

I haven't given bestiality much thought, but my guess is that it is wholly different from homosexuality and that those who compare them are just plain wrong (and perhaps willfully ignorant, I don't know). I don't know that folks are actually attracted to animals, I've always thought it was kind of an elaborate form of masturbation. It's really disgusting though, and on that basis I can see how some people would compare it to their view of gay sex. Again, poor communication and ignorance are bad, but not necessarily the same as hatred.

Shock therapy doesn't bother me nearly as much as some people. Medical history is filled with unsuccessful interventions that made lots of sense on paper. We hurt people all the time in medicine to bring about some positive result. Surgery is "cut to cure". We literally flay a person's chest open with huge metal retractors and then rip pieces of their body out... and they let us because they're better off afterward. To the extent that participants were not compelled to undergo the shock therapy and the practitioners had reasonable hope that the outcome they all desired was possible, it's not as huge of a deal as it seems. It is grotesque to think about and unfortunate to say the least, but not some scene out of Frankenstein that it's painted to be by the activists I've seen describing it.

The church has repeatedly expressed its love for gays (although they stubbornly use their own language) and its desire based on that love that gays repent and enjoy all the happiness and blessings of the gospel. God, His prophets, and His organization don't "detest" us. However, there is still too much ignorance, still offensive language used, and still misunderstandings, and battling it all is worth a go.

Brokering gays

Here's some logic that's guiding the rules on gays these days.

• If homosexuality is a disease, it is not an intrinsic part of a personal identity and can't or shouldn't be the basis for civil rights discussions.
• If homosexuality can be changed (or "cured" depending on the political spin you choose), then similarly it can't be compared to racial or gender-based civil rights arguments since it is not an intrinsic part of an identity.
• If homosexuality is biologically determined (either genetically or environmentally), it might be comparable to race and gender for civil rights arguments even if it can subsequently be changed.

So, really, whether or not homosexuality is a disease has vast political consequences. And nobody is going to concede as long as a scientific opponent can be eviscerated, a religious group slandered, or a gay-rights activist lambasted for their "agenda". Everybody get those bumper-stickers that say "if you're not outraged, you're not paying attention" and then cluster in groups to strategize how best to vilify your enemies and promote your respective love-motivated agendas. But most of all, don't forget to put your best efforts into amassing your arsenal of gays that exemplify your view.

I feel like a commodity. Here I am trying to live my life in a self-actualized sort of way, making choices that are consistent with my values, working to build a family based on love and commitment, and battling my unique set of personal demons, when along comes medical societies, special interests, and churches trying to define the issues and filter my access to information and resources. They want me and my case to be a piece of evidence that promotes their goals. They want me as one of the cards they can play to trump the other side. I sort of get the feeling that my happiness doesn't interest people as much as how I can be used.

I wish people would acknowledge that it doesn't matter whether homosexuality is a disease or not or whether it is biologically determined or not. What matters is that I, as an individual, would like to make informed decisions about how best to live my own life. But all the finger-pointing, moral superiority, and declarations of an objectively scientifically backed view all conspire to decay my confidence in any information I find. And without good information, it's hard to feel informed. I feel like I have to be a pioneer and figure out everything for myself if I don't hop on some particular ideological bandwagon.

But, I'm trying to stay off the bandwagon regardless. I'd rather not be reduced to a chunk on someone's side of the scale. I'll just walk by myself.

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. :-)

Drescher

After reading a few books on reparative therapy by proponents, I asked my therapist whether he thought it would be a good idea to read books debunking the idea. I wondered if he would respond like a priesthood leader might if you asked about reading anti-Mormon literature after having just finished the scriptures, but he did not. He strongly encouraged me to read up on their arguments, to be as informed as I could about all sides of the issue, and to assess it all for myself. Who, I asked, would be a good author to start with? He promptly suggested Jack Drescher, the national leader in the psychiatric field in opposing reparative therapy.

As it turned out, I was able to not merely read something by Drescher, but to meet the man and hear him speak in person at a professional meeting not long afterward. Unfortunately, a few days later I moved across the country and have yet to find the handout and my notes from the presentation! So, regrettably, all I have to go by now is memory.

He introduced the science, the politics, and the history of reparative therapy. The interplay between homosexuality and medical and psychiatric scientists is pretty darn dramatic. Gay advocates got some traction from a gay psychiatrist who agreed to be part of a panel at a national psychiatric conference--as long as he could wear a rubber Nixon mask! Drescher discussed the remarkable way gay rights activists organized and started a cultural revolution of gay tolerance. They began framing homosexuality as an identity characteristic that requires non-discrimination protection under federal law. It was brilliant.

But alas, it wasn't long before Drescher began bashing. It always amazes me how people can become so committed to a worthy cause like opposing hate and bigotry that they then slip into allowing themselves to hate and be bigoted against those they see as enemies. Drescher sees nothing, nothing at all, redeeming about what reparative therapists do. He sees it as unethical. He sees it as harmful. And he sees it as something to spend a great deal of his time and effort to write and speak out against. I respect all of this. It's when he then falsely described the methods of reparative therapists, vilified the practitioners, and derisively described religious conservatives as hypocrites--not some, but all--that I started losing respect. He called NARTH (the National Association for Research and Therapy of Homosexuality) Narth Vadar. Clever. Especially if you're a propagandist. I expect something a little less sensational and perhaps respectful from a scientist.

Answer

Chris asked a question of me in a comment on a recent post that I thought I would answer today.

You are a man of science and rationality. Your chosen profession of medicine demands it. You have written often and eloquently of the need for rigor in understanding scientific data. And yet, you do not seem to demand the same kind of rigor when it comes to matters of religion, even when it impacts you in a profoundly personal way.

Why?

Religious thought should receive the most scrutiny and the most rigorous examination of any human endeavor, in my opinion. Certainly, not less than science. But the kind of scrutiny is totally different. It's a different universe of discourse with different assumptions and different endpoints. Science is determined to describe the truth about the natural world we find ourselves in. It lends itself perfectly to empiric investigation. Religion (to me) is an investigation into the truth about the supernatural world. It's why we've found ourselves anywhere at all.

Supernatural and natural inquiries have different sets of rules, and because I've written a little on this before I'm somewhat surprised you would characterize my religious views as not rigorously examined. I suspect this may be a form of this idea: if you and I haven't come to the same conclusion then you just haven't thought about it enough.

Additionally, I want to go on record with some qualifiers. I am flattered that you have described me as a man of science and rationality. But one of the things that rationality has given me is a healthy skepticism for science. Science done correctly has done immeasurable good for our society. And science done badly has done (and continues to do) immeasurable harm. There are lots of reasons why scientifically accepted dogma is plain wrong. The data was measured wrong. The methodology was flawed. The analysis was biased. Over time we've improved as a society in picking out these errors and building safe-guards into the methodology. And over time the spin-masters, the marketers, and the plain liars have gotten better at obscuring the scientific flaws (perhaps sometimes deliberately). Gay issues are a major caution zone, I've noticed.

Qualifier two is that not all the rules are different for scientific and religious inquiry. Naturalism, yes. Inviolable physical laws, yes. Absolute consistency, yes. But God Himself asks us to "prove me now herewith"... to test things for ourselves. I can think of a number of "clinical trials" in the scriptures, so to speak. I can think of favorable references to logic and reason. It's a big part of what God expects of us. And far from accepting the premise of your first question, I believe my faith to be perhaps one of the most exquisitely consistent and logical of any I know. But ultimately it's a "faith" and not a "science". And therefore I'm okay when people disagree or come to different conclusions. I expect the same courtesy of them, even if what I believe bothers them. And that's the beauty of America--it was built on a constitution codifying just such a sentiment.

By the way, I've written on this before. Oh, and here and here.

Science

Last night I attended a scientific presentation on GLBT psychology and biology. It was very interesting. I was quite nervous beforehand because I feel like there is such a huge fervor on anything gay related, I wondered if it would end up being a circus freak show of medicine. But it wasn't. It was real science, real medicine, presented by nice and caring people. And that made me glad.

However, ever the skeptic, I paid pretty close attention to what the experts were saying to see how much of it I believed. Turns out, even the experts have some real bias issues. I guess there's nothing surprising there. I just hope they realize it. I hope I'm not going to be the only one to challenge the information they've presented because it will appear to be a sensationalization of the topic--exactly what I feared would be imposed on me before attending!

For example, a brief history of early prejudicial paradigms on the subject showed that research results about gay populations were skewed because the only gays enrolled in the study were those in prison for violating anti-sodomy laws. Not exactly scientifically appropriate selection criteria for a study that seeks to say something externally valid (i.e., have generalizable results). Interesting stuff... scientifically appropriate... all good material presented so far.

And then they showed [fanfare music] the new improved methodology that compared non-clinical homosexuals and heterosexuals, controlled for confounding factors like age and religion and excluded individuals with a psychiatric history. The new results completely defied the old ones: rather than gays always having "global deficits" as was previously scientifically demonstrated, they were now shown to be potentially "as adjusted as heterosexuals". Yeah!

Except... doesn't excluding all the gays with psychiatric issues sort of beg the question? Psychiatric issues are much more prevalent among gays, and hand-picking the population of gays to demonstrate "adjustment" is just as inappropriate as using prison inmates! It's not generalizable. And yet, here was an expert in the field completely ignoring this fact.

Later in the presentation the question was posed: "What causes people to be gay?" The answers offered as representative views included:

• parents
• labeling
• poor peer relations
• biology
• choice
• lack of hetero experience
• same sex seduction

Through the magic of statistics and research, most of these possible causes were disproved in the subsequent discussion. Well... sort of, anyway. A statistically significant correlation to a cold father was discussed, but the magnitude of the relative risk was minimized by the lecturer (unbelievable--if you have a statistically significant result, it is by definition SIGNIFICANT). He asserted, "There is no ONE family situation that produces a gay sexual orientation." Ultimately, the lecturer declared that through "path analysis," an esoteric branch of statistics, tautology had been demonstrated to be the cause of sexual orientation. Tautology meaning that the relation between childhood same-sex feelings and adulthood same-sex feelings are that they are one and the same. People are gay because they're gay.

Thank you, science. For nothing.

There was one other particularly interesting point in this lecture. When "gender nonconformity" was measured, it was significantly related to orientation. So, if you don't do masculine stuff, you are more likely to be gay. Hmmm... now whose theories does that remind me of? A woman stood up during the Q&A and asked why that was the case. Lecturer: we don't know. But after the subsequent presentation when the Q&A was reopened for either presenter, he back-pedaled. Someone in the audience had apparently glared disapprovingly at his academically honest indication that the reason wasn't known. So, he wanted to clarify that his conjecture was that gay boys feel different as children because of society's straight projections, and gender nonconformity follows from that. The fact that reparative theory explains the situation much more plausibly was never even entertained.

The only part of the second lecture that I want to comment on right now was a question from the audience. After a presentation of a wide range of scientific data, the executive head of a special interest in San Francisco wanted to know which of all the studies presented was the most concise and compelling in demonstrating that orientation is immutable. The lecturer offered his opinion that a study of pheromones did the trick. The study showed that male scents stimulate the "smell" part of the brain in straight men and gay women, but stimulate the sexual part of the brain in gay men and straight women. There were analogous results for female scents. He concluded from this that sexuality is biologically based and is therefore immutable. I have no idea why showing that sexuality is physiological rather than merely psychological proves anything about mutability, but that's what he said.

And I suddenly feel more at peace with the science. I can appreciate the good science without being taken for a ride by some of the silliness. I'm a huge advocate of science informing public policy. Huge. But although science is good, I will keep looking for understanding in other places too.

Causes

Scientific evidence has confirmed that genetic and hormonal factors do not seem to play a determining role in homosexuality (Birke 1981, Perloff 1965, West 1977). However there continue to be attempts to prove that genetics rather than family factors determines homosexuality. These continuing efforts reflect the persistence of gay advocates to formulate a means by which homosexual behavior may be viewed as normal.

Joseph Nicolosi, Ph.D.
in Reparative Therapy of Male Homosexuality

I don't think it's entirely fair to criticize a 10 year old book in terms of today's scientific knowledge, but it certainly underlines why one should cautiously if ever claim that scientific evidence has "confirmed" anything. That's not really how science works. Depending on the skill of the scientist, the structure of the experiment, and the power of the data one can get a very good idea about whether or not some observation is random or not. How you interpret it will weigh in just as heavily (probably more) in how the "scientific" results are reported. In this case, new methods like new genetic technologies have completely changed the playing field.

Regardless, I disagree with the logical progression he reports for gay advocates. Genetic causality alone doesn't make something normal. Huntington's disease is genetically determined, but it's far from normal. In my view, it's usually an ill-conceived effort to try to ascertain whether homosexuality is genetic or developmental in cause. Nicolosi has based his therapy on the developmental hypothesis. Some gay advocates decry anything but an acknowledgment that orientation is innate and immutable. I think these people are grossly oversimplifying. I doubt there is a universally necessary cause for something as complex as sexual orientation (unlike chicken pox, for example, where the pathogen is always the same... and no, I'm not comparing homosexuality to a disease... right now). It's certainly not a matter of choice. At least, not in any definitive sense. Reparative therapy may be one choice that can influence orientation, and I suppose that's one reason many people hate it so vehemently.

When I first began this book, I thought Nicolosi's main flaw was that he believes one-size-fits-all despite his somewhat frequent (but seemingly contradictory) admissions that there are exceptions. Toward the end, though, he finally explicitly acknowledged limitations of his therapy:

Another type of client who does poorly is the one who does not fit the syndrome decribed in this book.... This type of client usually has no particular difficulties with male friendships or self-assertion, shows no evidence of male gender-identity deficit, and has a family history that does not fit our pattern. The treatment issues we address are not relevant to his issues.

Limitations of gay love

Each one of us, man and woman alike, is driven by the power of romantic love. These infatuations gain their power from the unconscious drive to become a complete human being. In heterosexuals, it is the drive to bring together the male-female polarity through the longing for the other-than-me. But in homosexuals, it is the attempt to fulfill a deficit in wholeness of one's original gender.
...
The inherent unsuitability of same-sex relationships is seen in the form of fault-finding, irritability, feeling smothered; power struggles, possessiveness, and dominance; boredom, disillusionment, emotional withdrawal, and unfaithfulness. As a result of this binding ambivalence, his same-sex relationships lack authentic intimacy.
...
Gay couplings are characteristically brief and very volatile, with much fighting, arguing, making-up again, and continual disappointments.... Research, however, reveals that they almost never possess the mature elements of quiet consistency, trust, mutual dependency, and sexual fidelity characteristic of highly functioning heterosexual marriages.
...
The results show that of those 156 couples, only seven had been able to maintain sexual fidelity. Furthermore, of those seven couples, none had been together more than five years. In other words, the researchers were unable to find a single male couple that was able to maintain sexual fidelity for more than five years.

Joseph Nicolosi, Ph.D.
in Reparative Therapy of Male Homosexuality

It makes me chuckle when I see words like "authentic" used like swords--first the one side swings, then the opponent. Who gets to be acknowledged as really "authentic"?

And why exactly should I buy matter-of-fact statements about the unconscious basis for sexual drives? So, everyone everywhere is subconsciously trying to become a complete human being by filling up personal deficits or consuming "other-than-me" by having sex? I don't like unsupported assertions like that, but I suppose I find it plausible because it is consistent with my own experience--I want to have in a visceral way the object of my attraction. Even with that concession, it seems hokey.

Lastly, I don't buy the qualitative difference he suggests between gay and straight sex because two gay men have the same "deficits" and a man and a woman don't. This just all seems like what one of my psychiatry mentors calls "psychobabble". I try, I really try, not to think psychology is crap-science. But it's hard. :)

What I DO buy is the data about long term relationships. These couples had made a commitment of fidelity and the outcomes were measured by gay researchers. Lacking some other explanation for it, I suppose his theory takes on some credibility.

Sensitivity

Contributing to my retreat into homosexuality was that I was one of those sensitive, "artistic" children with neither the talent nor interest in any of the usual "masculine" pursuits. I hated physical activity--sports and games most of all--and when I would make an effort to be a part of the gang I would fail so miserably to perform well that for a long time afterward I would suffer from the shame of ineptitude.... I was a classic case in that I (later) felt out of place in a man's world, and comfortable and capable in a more esoteric environment.

Willam Aaron in his biography as quoted by
Joseph Nicolosi, Ph.D.
in Reparative Therapy of Male Homosexuality

I got straight A's through elementary school except one C in gym. I embarrassed myself with regularity in P.E. during middle school and by the time I got to high school I was all sorts of enthusiastic to avoid P.E. altogether by being in the marching band. I hated church basketball and softball because I couldn't handle being the charity case. My mom always told me I had "thin skin" and I shouldn't worry so much about what other people think. I was too sensitive, she said. As an adult, I've been told I "throw like a girl". I hate it when conversations turn to sports or cars during social events--topics I know virtually NOTHING about.

Compare that with my less masculine abilities. I love performing in theater, singing, playing the piano, I'm quite a good artist, I have a great eye for design and photography, and I like cooking and gardening. I'm damn good at all that stuff and I know it. People respect me when I, for example, have my art in a professional show, and I'm proud of myself. So proud, I occasionally feel smarter and more sophisticated than the guys who woop at Monday night football and talk up Harley Davidsons. I find myself alternately disdainful and envious of them at odd times.

I just can't get myself to believe there is nothing to what Nicolosi is getting at. Sure, he presents his info in a way that bothers me (pretty much all social sciences do), but if I get past that, it compels me.

What politics?

Reparative therapy is fascinating stuff. I've started reading Nicolosi's book on the subject, which from what I understand, is sort of the definitive text right now. He gives a pretty large set of references for prior work on the subject and the measured "successes" of past efforts. But, of course, those references and their supposed success cases have been criticized widely as not scientifically rigorous. This is understandable to me, but I find it a little amusing that there is now a propensity for people to go so far as to say reparative therapy has been shown to be unnecessary, ineffective, and harmful.

Unnecessary? I'll buy that. It surely depends on what one considers to be a necessity. If a person wants to live a happy and well-adjusted life as a gay man, no reparative therapy is necessary. But what I find interesting is that although the science is sketchy at best, there are many examples in the reparative therapy theory that have real and compelling applications in my life. I can identify dozens of experiences I've had consistent with "defensive detachment" and problems with masculine identity. (I can think of many inconsistencies too.) Pondering the lack of certain kinds of male companionship in my life helps me to realize that I can pursue those relationships through reparative therapy completely irrespective of the goal of sexual orientation change, and my life will be richer for it. In a word, although it's not necessary, it's desirable to me (and presumably anyone whose past abuse and disenfranchisement by male peers bothers them) even if no actual change in sexual orientation follows.

But what about those darned risks? Since reparative therapy has been "shown" to be harmful, surely it's a bad idea to go there. Well... I must reserve judgment as I'm not familiar with the primary data on the subject. However, it's not a closed case, and anyone claiming it is well understood and dangerous reads from a script I'm starting to become familiar with--the activist script. Nothing wrong with activism, as long as it doesn't masquerade as science. Even the APA says in their position that "To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of 'reparative' treatments."

When reparative therapy was discussed in my medical curriculum, I asked the Planned Parenthood presenter for primary sources to support his claim that it is ineffective and harmful. He referred me to the APA's position statement. I pointed out that I was already familiar with the statement and that it actually says that reparative therapy has not been shown to be effective (not the same as 'shown to be ineffective') and that risks have been ignored or minimized by those who practice reparative therapy (not the same as 'shown to be harmful'), and that I was concerned that the material in our curriculum was more political than scientific in a way similar to that described by the APA statement. He questioned my motivations by asking why I was bringing politics into a discussion on healthcare.

Ummm... are you stupid? I'm not one to be thwarted by the ol' "you're making this political when any rational person can clearly see that I'm right even though the reference I use to back my claims actually CONTRADICTS my position."

Politics? What politics?

Okay, buddy, try pulling your head out and acknowledge that there is wide disagreement on this controversial subject. How can we talk about it if you seek to discredit my motives as "political" when I have merely asked for scientific references? The APA explicitly acknowledged the political nature of the debate. So sorry for asking for references from your one-sided and unannotated lecture.