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.

Gay anarchy

Enigma suggested to me the other day the need for a For the Strength of Gay Youth pamphlet to help SSA people know what is okay and what is not in their unique situation. Yes, we both know that Affirmation already has taken that clever step, but I'm not such a big fan of Affirmation and I'd rather have it from someone I trust (and minimally agree with).

Considering the recent debates about cuddling, outing oneself, straight dating, etc... it makes sense that there ought to be some informed guidance for a guy or girl who wants to keep it all above board. Who do you tell? When? What situations should be avoided?

Of course, the issue is not one that applies merely to the youth. Enigma also mentioned in his comment on my last post that he's apprehensive about coming out because of potential consequences from the scouting organization or the ward. So... what do you do in a situation like that? Stand up and be a martyr so that you can educate the people around you regarding the issue? Or continue as you have before where you can serve the young men and touch those private lives in a way that might otherwise be impossible?

The automatic inclination among gays is going to be to assume that restricting callings based on orientation is just simply born of ignorance, but I don't think it's that simple. I suspect that the young women leaders are always women to keep any possibility for impropriety at bay (ditto the young men leaders being men). As my mom is fond of saying, "we should avoid even the appearance of evil." Considering the likelihood that there will be homosexually attracted youth in pretty much every sizable ward, there's an analogous possibility for the appearance of or actual impropriety in a scenario with a gay leader.

But it's not a perfect analogy, of course. Some suggest (and I believe) that coping with SSA is aided with non-sexual relationships with other men. This is particularly true of men whom one finds attractive, the idea being that a friendship reveals the real person and their appeal is normalized and largely mitigated. Some gay men may have painful memories of their youth and consequently idealize the outgoing, talented guys in the ward. So, in may be helpful to both the youth who need a good role model and the gay leader to have such a calling, despite the remote possibility of scandal.

Considering the homophobic culture that clings to some wards despite explicit doctrine of acceptance (of unchosen gay feelings), there hasn't been enough opportunity for those who have been in situations like this to really stand up and say whether it's been an overall positive or negative experience.

Regardless, the scouting organization, while on friendly terms with the church, may have a completely different approach. And, as Enigma pointed out, it's not likely to be particularly gay friendly, even with the distinction between unchosen feelings and behavior (and a straight-married gay). So, yeah. Major problem.

So, I hereby call to order an online policy making session in which people should discuss what the guidelines should be and why. If the brethren give us a set, I'll be delighted. In the mean time, how do you recommend bringing order to the gay anarchy? ;-)

Hate crimes

I've been meaning to read up more on the hate-crimes legislation changes moving through Congress. I still haven't had a chance to really do the topic justice, but wanted to point out this really cool blog I found and his take on the issue.

That's so gay

I'm irritated. I've tried not to be, but it doesn't seem to be working. Watching the polls and pre-pre-pre-election info for the presidential race, I've seen that quite a few more people are willing to support a gay president than a Mormon president (although this statement combines two polls that didn't have comparable questions). Personally, I'm offended that anybody wouldn't want either kind of president because I think you should elect an official based on their character, policy, and leadership ability not on some ridiculous non-issue like religion or orientation. But the comparison does underline that it's becoming mighty unpopular to be Mormon these days, and apparently increasingly acceptable to be gay.

Well, if I can't have everything, I'll just be glad for the increased tolerance for gays.

But then I had to read the story about the Mormon girl disciplined for saying "that's so gay" in response to being teased about having 11 mothers. So, she was being harassed for being a Mormon, used an inappropriate come-back and lands in the principal's office being disciplined for her crimes while her provokers got off scot free. Hmmm.... Lawsuits and crankiness all around.

I don't think her behavior is acceptable, but I do think it's more likely that she was not being deliberately offensive than it is that the kids who were harassing her were not being deliberately offensive. Basically, it seems that the school's policy is that insulting/harassing Mormons is just fine and dandy, but insulting/harassing gays is hateful and borders on criminal.

Civil unions

One way to think of marriage is as a bundle of rights associated with what it means for two people to be married. What the First Presidency has done is express its support of marriage and for that bundle of rights belonging to a man and a woman. The First Presidency hasn’t expressed itself concerning any specific right. It really doesn’t matter what you call it. If you have some legally sanctioned relationship with the bundle of legal rights traditionally belonging to marriage and governing authority has slapped a label on it, whether it is civil union or domestic partnership or whatever label it’s given, it is nonetheless tantamount to marriage. That is something to which our doctrine simply requires us to speak out and say, “That is not right. That’s not appropriate.”As far as something less than that — as far as relationships that give to some pairs in our society some right but not all of those associated with marriage — as to that, as far as I know, the First Presidency hasn’t expressed itself. There are numbers of different types of partnerships or pairings that may exist in society that aren’t same-gender sexual relationships that provide for some right that we have no objection to. All that said… there may be on occasion some specific rights that we would be concerned about being granted to those in a same-gender relationship. Adoption is one that comes to mind, simply because that is a right which has been historically, doctrinally associated so closely with marriage and family. I cite the example of adoption simply because it has to do with the bearing and the rearing of children. Our teachings, even as expressed most recently in a very complete doctrinal sense in the Family Proclamation by living apostles and prophets, is that children deserve to be reared in a home with a father and a mother.

-Elder Wickman

I would sometimes like to avoid the subject of gay marriage altogether because it gives me a lot of mental pain. But I don't have that option as it is an important issue right now for so many people (both gay and LDS), and it is playing out in elections and public debates all the time. The recent election and the variations in legislative and constitutional proposals across the country brought it all to the forefront for me again.

My inclination is to favor gay marriage and/or civil unions, but to also follow the advice of the church even when it doesn't necessarily make sense to me. But I don't think it's inappropriate to discuss guidance given by the church, and I think it's actually a spiritual necessity to try to understand it. So, wearily, here goes... (again)...

Elder Wickman mentions that "our doctrine simply requires" us to oppose not only gay marriages but civil unions that accomplish an identical purpose. I don't know what doctrine this specifically is. Gay sex is wrong: check. Chastity is good: check. Freedom to choose: check. The balance of doctrine seems to lean toward allowing civil unions, in my mind. I really would appreciate a clarification, but through some unfortunate oversight I wasn't invited to the Public Affairs interview I've quoted.

Adoption is the other sticking point for me. As many have pointed out before, despite the ideal that every child deserves a home with a father and mother, that hasn't happened for many children and allowing an actual care-giver in a real life situation to properly care for a child seems to be a good idea. When a child comes to the Emergency Department with a gay care-giver who is not related, treatment consent cannot be obtained until the legal parent is available (with a few caveats). This can delay treatment and adversely affect the child's health.

I suppose the objection is that recognizing or supporting gay adoption would have the effect of sky-rocketing the number of children being reared by gay partners rather than fathers and mothers--like we're advocating the better of two unfortunate options. Advocate policy that harms a small number of children today to harm fewer children later... or something like that. But, I can certainly understand the incredulity gay advocates confront this with--the data shows no harm to children from being raised with same-gendered parents.

And I suppose that brings us full circle to the appeal to "doctrine." It may not be doctrine because it's in the scriptures, but by virtue of the fact the 1st presidency says it's the best thing to do. It's an appeal to God's authority, and that's the end of the debate.

So much rides on the question: is the church really God's? Are the prophets really speaking for Him? I wish everyone could respect those who answer those questions differently than themselves without throwing around insults and intolerance. But it has been recently and emphatically demonstrated to me that for both believers and non-believers this is prohibitively difficult.

Religion and public policy

Now, relative to church participation in public debate, when churches or church leaders choose to enter the public sector to engage in debate on a matter of public policy, they should be admitted to the debate and they should expect to participate in it on the same basis as all other participants. In other words, if churches or church leaders choose to oppose or favor a particular piece of legislation, their opinions should be received on the same basis as the opinions offered by other knowledgeable organizations or persons, and they should be considered on their merits.

By the same token, churches and church leaders should expect the same broad latitude of discussion of their views that conventionally applies to everyone else’s participation in public policy debates. A church can claim access to higher authority on moral questions, but its opinions on the application of those moral questions to specific legislation will inevitably be challenged by and measured against secular-based legislative or political judgments. As James E. Wood observed, “While denunciations of injustice, racism, sexism, and nationalism may be clearly rooted in one’s religious faith, their political applications to legislative remedy and public policy are by no means always clear.”

-Dallin H Oaks

If it hadn't been the "11th hour," I would have enjoyed the opportunity to think about gay marriage a lot more before deciding whether to support or oppose the particular amendment considered by the legislature. As it was, the reponses I got from my congressman and senators were assuringly rational, if a bit surprising. They agreed that marriage should be between one man and one woman, but that such things ought to be governed by states, not in a federal constitutional amendment. Having been involved in policy making on a very small scale, I think it's interesting to watch a popular idea destroyed because the implementation is all wrong. It's a good thing, certainly, but also a marvel anything ever gets done.

But my reluctance to support the amendment wasn't based on the execution, it was based on the idea itself. And my opposition to the idea was based on the way I thought it was appropriate for goverment to codify religiously based morals. Basically, I've come to believe as Oaks expressed above that religiously informed moral views have every right to be aired, but they are judged on the same basis of every other view. And I thought in this case the only argument I could make was "because God says so," which is a fantastic reason, but one unpersuasive when considered on the same basis as every other view. "On the same basis" means largely for me that science ought to give legitimacy and credibility to a view whenever science has something legitimate and credible to say on that view. The problem is, of course, that science is routinely obscured in favor of pseudo-science marketing crap that makes much stronger conclusions than are warranted. Without science or pseudoscience, the argument often becomes a series of assertions and denials that beg the question.

Anyway, this post isn't about science. It's about religion and public policy. I was excited to find this article from Elder Oaks (who is one of my favorite writers in the church). I found it persuasive. I'd be interested to hear everyone's thoughts.

The 11th hour

I sat down at the computer to e-mail my congressmen about the proposed Marriage Protection Amendment just one day prior to the vote. I knew it was the 11th hour and that my decision about what to write would reflect far more on myself than it would have any impact on what my legislators thought or voted. But church leaders had asked me to "express myself," and I've always been a sucker for the importance of participating in representative government.

I had come to the conclusion that gay marriage was a good thing based not only on what I know and believe about the social impact of gay marriage--that it would be an effective way to encourage gay folks to be committed and monogamous, to provide them the legal tools to properly participate in the domestic affairs of those with whom they had become domestic partners, to choose committed love as an ideal over adultery--but also because it just seemed right and fair in this diverse country to allow people to pursue the brand of happiness they find acceptable for themselves.

I had thought about it a fair amount. And all my reasoning (and the social data) seemed to indicate gay marriage would be a good thing, despite my acknowledgement others may easily come to a different conclusion.

I found loopholes and legalistic reasons why I thought my opposition to the amendment and support of gay marriage were not strictly inconsistent with the counsel of the church. But, some part of me knew that pharisaic approach wasn't going to work in the end.

I sat, thinking and uncomfortable. Fingers perched, ready to type some sense out of the confusion.

I remembered one of the many defining moments on my mission when I received a letter from my parents--both terrified that I was standing at the edge of apostasy's cliff, ready to jump. I had written them some snide comments about a few of our mission rules, and they had been horrified enough to immediately produce a long rebuke. It's one of the few times on my mission that both parents contributed substantially to a single letter.

I think the particular issue may have been my president requiring us to take daily herbal supplements--a position he crowed was backed by scientific evidence (and a position about which science has long since vindicated my skepticism). It didn't matter whether he was right or wrong, my parents said, it mattered that I trusted and obeyed. They weren't stupid. They knew how counter-intuitive that was, how cultish. But they also knew that there would be times in my life later when I would think I understood something better than my priesthood leaders and I would be wrong. Then, it might be on something that mattered. And ultimately, they knew the church was true and that while small injustices would come of trusting leaders (like choking back daily garlic pills), God wouldn't allow the prophet to lead the church astray. They believed, as I do now, that there is singular power in obeying every word of command with exactness. Curious power. And yes, when applied to false prophets, such trust is dangerous. You've got to be certain who you can trust, because ultimately you are responsible for your own decisions.

The final position I took with my congressmen was one of support for the amendment. I was true to myself in a strangely contradictory way. I know the church is true. I know prophets are real. So, when Elder Maxwell says,

"So it is that real, personal sacrifice never was placing an animal on the altar. Instead, it is a willingness to put the animal in us upon the altar and letting it be consumed! Such is the sacrifice unto the Lord of a broken heart and a contrite spirit, (D&C 59:8), a prerequisite to taking up the cross, while giving away all [our] sins in order to know God (Alma 22:18) for the denial of self precedes the full acceptance of Him."

I interpret that in one sense to apply to times like these. It's perhaps an application of a skill I've learned through my homosexuality--to believe that what feels right is not necessarily so. And that the balance due in confidence and affirmation for truly right decisions may come in unexpected ways.

At the same time I feel confused and sad. I feel a great desire to contact Scot and Chris and David and apologize. Sometimes having faith is hard, and not being ashamed of it is also hard.

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.

A Congregation of One, part 7

I wasn’t particularly surprised to find the Planned Parenthood presenter a bit off-putting. The last lecturer I remembered from Planned Parenthood staff had played a phone recording from an abortion hotline in which a young woman wailed about the physician who had turned her away. This was the type of thing that brought people to attempt abortions on themselves with coat hangers, we were told. Valid point, certainly, but perhaps she could have emphasized it more with bright lights shining in my face after a period of sleep deprivation.

There was no attempt to address the elephant in the room—what were physicians to do when their personal values held performing an abortion to be immoral? Ignore or change their values? It was an interesting question that was smoothly bypassed giving the impression there was only one answer—physicians were to put aside their personal issues in the best interests of the patient.

Now, this new Planned Parenthood lecturer had asserted with complete finality that reparative therapy had been shown to be “ineffective, unnecessary, and harmful.” In an e-mail I requested primary sources for this claim. He directed me to the American Psychiatric Association’s position statement on the topic. I responded by quoting their position statement: “To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of ‘reparative’ treatments.” Changing tacks, he asked why I was so interested in the topic. I replied that I was concerned that science and not politics inform our medical education. Then, he wanted to know why I was bringing politics into the discussion at all.

Why indeed. There’s nothing political about homosexuality. Oh no, nothing at all.

He suggested if I had further questions to direct them to the course directors. I did, but I never heard back. I didn’t really expect to. I had spent hours and hours—collectively, probably days—filling out evaluation forms, but I had never received any indication that my feedback on sensitive issues was heard or appreciated. Sure, when I suggested they change the date of a test it was given some thought. But when I evaluated FCP’s sexuality course, I imagined they had done the opposite of my suggestion the following year just to spite me.

So, again, I was left to wonder about reparative therapy all on my own. Was it just “psychobabble”, as one of my psychiatry mentors had derisively dismissed it? Irresponsible and unethical therapists preying on desperate gay men with nowhere else to turn, now exploiting guilt and shame to promote their own political agenda while ignoring the diabolical risks of failure, despair, and suicide?

Please. I couldn’t believe the pervasive ignorance on the subject among the ivory tower that was my medical school. I had read some books, and they made sense to me. I had a friend who was undergoing reparative therapy and he seemed far happier than before. I had been referred to a reparative therapist for myself, and he claimed to be a man who had changed his sexual orientation many years before. He had written a book about his experience. I read it. I doubted. I hoped. I wondered.

Was this my coat hanger? Too bad the APA had encouraged therapists to turn me away, to attempt to abort my homosexuality in a closet at home with nobody to watch for side effects. Nobody to mitigate the risks.

Index for A Congregation of One
part 1
part 2
part 3
part 4
part 5
part 6
part 7
part 8