Sexual Orientation Change Efforts in the Ideological Lions' Den
by Andrè Van Mol, MD
Today's Christian Doctor - Spring 2013
In September 2012, California became the first U.S. state to ban therapeutic sexual orientation conversion efforts (SOCE) involving minors. “[SOCE] . . . has resulted in much harm, including a number of lesbian, gay, bisexual and transgender youth committing suicide . . .This is junk science and it must stop,” said State Senator Ted Lieu, the bill’s sponsor.1 The therapies “have no basis in science or medicine and they will now be relegated to the dustbin of quackery,” Governor Jerry Brown proclaimed after signing the bill into law.2 Though also rejecting conversion therapy, a Los Angeles Times May 11, 2012 editorial “Bill overkill in Sacramento” protested, “Legislators have no special insights into psychiatry. . . . Frankly, it’s worrisome to have them stepping in to tell therapists what they may or may not say or do to treat patients.”
Taking the fight nationally, Rep. Jackie Speier, D-CA, introduced an anti-change-therapy resolution in Congress. Labeling it “quackery,” Rep. Speier finds SOCE “harmful and abusive.” She adds, “Being gay, lesbian, bisexual or transgendered [GLBT] is not a disease to be cured or a mental illness that requires treatment.”
It is all so? Is SOCE a snake oil, a false hope and a harmful pox that must be struck down in the name of science, safety and truth? Is it the science or the ideology that is settled? The answer must address both the record of change therapy and the nature of sexual orientation itself, including the results of behavior based on it.
The (Lack of) Scientific Evidence
SB 1172 is itself unsupported by science. The bill’s only study—Ryan, et al. (2009), 123, Pediatrics, 346-352—examined family rejection and not conversion therapy; used flawed sampling and recruitment bias; excluded youth; and cautioned against generalizing its results. In a press statement, Sen. Lieu erroneously claimed, “There is insufficient evidence that any type of psychotherapy can change a person’s sexual orientation.” But why ban SOCE based on “insufficient evidence?” California’s licensing agencies and mental health associations would surely have issued challenges to therapists’ licensures and memberships if conversion therapy was such a known hazard, yet they have not.
Decades of studies meeting the scientific standards of their time showed positive results of SOCE for those who wished it.3,4 Homosexual practice itself leads to numerous well-documented health hazards, including the loss of 25 to 40 percent of life expectancy with higher rates of infectious disease, cancers, substance abuse, depression, anxiety, multiple psychopathologies, domestic violence and suicide.5 Simply put, gay sex is generally bad for people, change is possible and many with GLBT orientation want change. Why should those willingly seeking a chance at therapy be denied it?
Despite the lack of supporting evidence, the modern move to change the professional view of change therapy came in 1973 when the American Psychiatric Association—through the efforts of its GLBT faction with guidance and financing from the National Gay Task Force—decided to delete homosexuality from the Diagnostic and Statistical Manual, thereby rejecting it as a disorder.6 Neuroscientist and gay activist Simon LeVay boasted, “Gay activism was clearly the force that propelled the American Psychiatric Association to declassify homosexuality.”7 A study four years later in Medical Aspects of Human Sexuality showed 69 percent of psychiatrists did not agree with the decision.8 Psychiatrist and educator Charles Socarides noted that psychiatrists who dissented were marginalized and saw their research papers turned down by journals.9 The process has been repeated in other professional guilds.
Genetic and Biological Input
Levay conceded the self-evident, “. . . people who think that gays and lesbians are born that way are also more likely to support gay rights.”10 Few know of Levay, but when Lady Gaga sings that she was born this way, the public hears. If true, it is a convincing sales pitch for the entire gay rights package. If not, reversibility scuttles the politics.
Stanford geneticist Neil Risch noted in a 1998 Newsweek article that the public misunderstands behavioral genetics. “People very much want to find simple answers . . . A gene for this, a gene for that . . . Human behavior is much more complicated than that.”11 A 1993 scientific literature critique by Byne and Parsons in Archives of General Psychiatry reviewed the 130+ major studies on the subject and found no evidence supporting sexual orientation being primarily determined either genetically or biologically.12 However, the efforts to prove otherwise persisted.
In January 2012, psychologist and educator Stanton Jones posted a marvelous essay, “Sexual orientation and reason: On the implications of false beliefs about homosexuality,”13 which I strongly recommend. Jones details three primary theories predominating in the debate regarding biological origins of same-sex sexual orientation: maternal stress, fraternal birth order and genetics.
Sociologist Lee Ellis proposed a maternal stress theory in 1987 positing that maternal neurohormones functioned in determining the sexual orientation of a fetus.14 Jones found strong selection bias compromising the study in that Ellis surveyed mothers of gay sons, inquiring regarding details of memory, while the mothers were being instructed about maternal stress theory. Selection bias aside, a 1991 study by Bailey, et al, countered Ellis’ maternal stress theory.15 The theory now holds little sway.
Canada’s Anthony Bogaert published a 2003 survey study reporting that the fraternal birth order of men—the number of older brothers born to the same mother—correlated to increase chances of homosexual orientation. The proposed explanation involved the sensitization of the maternal immune system to male-derived proteins. Again, recruitment bias led to non-representative sampling.16 Per Canadian psychiatrist and distinguished fellow of the APA Joseph Berger, “[Bogaert’s study] is rubbish. It should never have been published.”17 However, the media was quick to carry the reported findings.
Jones continues, “Bogaert analyzed two smaller nationally representative samples, finding an exceptionally weak ‘older brother’ effect only for same-sex attraction (and no effect for same-sex behavior).”18 Bogaert then assessed “an independent . . . and representative sample eight times the size those of his previous studies, in which he found that the older brother effect had disappeared.”19 Jones further cites that a study of two million Danish subjects20 and another of 10,000 American adolescents also identified no “older brother” effect.21
The genetic hypothesis of same-sex sexual orientation has long held sway in the media, and twin studies helped propel this. Jones wrote that, in a 1991 Archives of General Psychiatry study, J. Bailey claimed that the concordance rate for homosexuality was 52 percent in identical male twin pairs.22 Bailey had second thoughts about how his study subjects were recruited through advertisements in Chicago’s gay community. He next examined samples from the Australian Twin Registry, producing an identical male twin homosexual orientation concordance rate of 20 percent with simple descriptive matching at 11 percent. Bailey reported finding the genetic contribution to homosexual orientation failing to show statistical significance, but the media did not tune in.23 A 2010 study of the Swedish Twin Registry noted only 9.8 percent of identical male twin pairs matching for homosexual orientation.24 Per N.E. Whitehead, PhD, “. . . if one identical twin—male or female—has SSA, the chances are only about 10 percent that the co-twin also has it. In other words, identical twins usually differ for SSA.”25
In this case, how much of sexual orientation is of genetic versus environmental derivation is the question. Eric Turkheimer, an expert in the field, warns that heritability statistics are tricky due to difficulty in clearly seeing and assessing environmental factors, which he feels contribute strongly to development.26 Elsewhere, Turkheimer states, “. . . there are no known complex human behaviors in which genetics render the actor unable to resist performing a behavior . . . Furthermore, the amount of influence that genes have on behaviors is considerably smaller than one might think.”27 He insists, “. . . genetic essentialists were wrong about gay genes and similar nonsense.”28
Epigenetics analyzes the interaction of genes and environment. Chains of choices and their consequences have a lifelong interplay with our genetic blueprints. For example, the more weight one gains, the more likely diabetes manifests. But even in the genetically disposed, diabetes can often be avoided by the right choices over time. Ultimately, genes determine predispositions, not destiny. Heritability is not inevitability. Were it otherwise, the Olympic games would be held in test tubes.
Even a 2008 APA brochure stated, “There is no consensus among scientists about the exact reasons that an individual develops a [GLBT] orientation. . . no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles . . .”29 The professional literature does not support sexual orientation being primarily genetic or biological. Lady Gaga missed the memo.
But Is Sexual Orientation Immutable?
In Sexual Orientation and Psychoanalysis: Sexual Science and Clinical Practice, Friedman and Downey state, “At clinical conferences one often hears . . . that homosexuality is fixed and unmodifiable. Neither assertion is true” (p. 39). Several large studies demonstrate that spontaneous changes of sexual orientation exist. The University of Chicago’s 1994 National Health and Social Life survey found that 8 percent of 16-year-olds thought they were gay, but by age 25, only 2.8 percent still did. A 1999 New Zealand study followed 1,007 people longitudinally from birth through 21 years, by which age only 2 percent claimed homosexuality/bisexuality.30
During his 20-year tenure as Kaiser-Permanente HMO’s Chief of Mental Health, psychologist and past APA president Nicholas Cummings estimated that 16,000 clients presented at Kaiser facilities with conflicts over their homosexuality. He stated 67 percent had good outcomes, with 20 percent being successful in reorientation and the remaining 80 percent “pursuing sane, sexually responsible gay lives.” He observed, “There are as many kinds of homosexuals as heterosexuals. Homosexuality is not a unitary experience,” and “. . . our clinical experience contradicts efforts to reduce homosexuality to one set of factors.” Per Dr. Cummings, “Given the state of research, the APA should not reject the possibility that sexual orientation might be flexible for some . . . .”31
The 2009 APA task force report on SOCE offered severe critique of pro-SOCE research. 32 The task force made Olympian demands of the pro-SOCE literature for what they deemed adequate scientific standards, such that only six studies made the cut, with each subsequently dismissed. The report stated, “We thus concluded that 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.”33 Dr. Jones observed, “They then had the chutzpah to warmly recommend gay affirming therapy while explicitly acknowledging that it lacked the very empirical validation required of SOCE,” and further warned, “the entire mental health field would grind to [a] stop if the standards articulated for sexual orientation change were applied . . . to low self-esteem, depression, anxiety disorders, eating disorders or personality disorders . . .” It’s called a double standard.
In 2011, Drs. Jones and Yarhouse published a longitudinal study of SOCE in the Journal of Sex and Marital Therapy showing positive results.34 In 2000, NARTH published a survey in Psychological Reports of 882 reparative therapy clients, who rated their experience positively across a range of variables. Only 7 percent said they were worse off on three or more of 17 psychological well-being measures.35,36
The categorical (all-or-none) versus the continuum view of change are at war. The former, held by many SOCE critics, views any recurrence of same-sex attraction or arousal as both a disproof and invalidation of therapy. But change occurs along a spectrum, not as an all-or-none result, and this holds true for nearly any form of therapy.37The realm of the probable or possible is not limited to the bad personal experiences or speculations of a few. Any treatment has a failure rate, subpar practitioners, disgruntled patients, the truly abused and the not-so-compliant exaggerating their grievances—the enormous failure rate of drug and alcohol rehabilitation being a case in point—and yet, we do not condemn or ban these therapies.
Much media attention is given to those with negative stories of therapy to overcome their same-sex attraction. Those with positive change experiences are intimidated into silence by the near certainty of vicious attacks and mockery in the press as well as from organizations committed to debunking sexual orientation change efforts as fraud. With good news taking cover, bad news owns the field.
Finding Identity in God
Identity is the rallying cry, and many GLBT-oriented people think of this as their identity. Yet people are not primarily defined by their potentially ever-changing appetites. Sexual orientation is not immutable and behaviors are controllable. What is our identity then? We are each creations made in the image of God, from whom even our Declaration of Independence notes our just rights derive. We should respectfully and compassionately identify people as people, regardless of their sexual orientation. One of my patients told me, “I love you because you always treat me like a woman, not a ‘lesbian woman,’” she emphasized with air quotes.
What if current evidence is one day reliably disproven and it turns out GLBT-oriented people are born that way? Theologically, two things come to mind: (1) that would be only another way that we are all born into sin; all have sinned; we all need a savior; and (2) it doesn’t matter what you were born, you must be born again, as Jesus pointed out.38
I’ve known more than 60 people who formerly were GLBT, along with several currently working on the transition. None of them waited for a medical guild or para church group to finalize their position papers on it before moving for change. Change is possible, as is shown in both scientific and theological literature, and many people of GLBT-orientation want it. Truth and love should be traveling companions. As my wife puts it, “What is loving about telling someone they cannot change?”
The Los Angeles Times had this much right, it is worrisome to have legislators telling therapists how they can treat their patients. However, the broader question here is conscience rights, which are under increasing assault as seen in the abortion/abortifacient fronts of healthcare reform. Government engages in soft totalitarianism by presuming itself the final arbiter of both medicine and of what can and cannot be practiced or protested, thus neutering the First Amendment. This development must be peacefully but vocally challenged by Christian and other culture-of-life physicians, lest ideology completely impair truth, science, medicine and freedom to the detriment of all.
2 Calif. first to ban gay teen ‘conversion’ therapy. Associated Press. October 1, 2012.
3 Stanton L. Jones (January 2012), “Sexual orientation and reason: On the implications of false beliefs about homosexuality,” digitally published at www.christianethics.org or http://www.wheaton.edu/CACE/Hot-Topics.
4 Satinover, Jeffrey, MD, Homosexuality and the Politics of Truth, (Grand Rapids: Baker Books, 1996), p.185-187.
5 “Negative Health Consequences of Same Sex Sexual Behavior” by Dr. Andre Van Mol, pdf at http://tinyurl.com/4xvdghk.
6 Socarides, Charles, MD, “How America Went Gay.” www.leaderu.com. Oct. 18, 1995.
7 Satinover, Jeffrey, MD, “Dr. Jeffrey Satinover, M.D. Testifies in Mass. in Defense of the Family,” www.Satinover.com, 4/29/2004.
8 Satinover, Jeffrey, MD, Homosexuality and the Politics of Truth, (Grand Rapids: Baker Books, 1996), pp. 30-37.
9 Socarides, Charles, MD, “How America Went Gay.” www.leaderu.com. Oct. 18, 1995.
10 Satinover, Jeffrey, MD, “Dr. Jeffrey Satinover, M.D. Testifies in Mass. in Defense of the Family,” www.Satinover.com, 4/29/2004.
11 Leland, J. & M. Miller, “’Convert’?” Newsweek, August 17, 1998, p. 49.
12 Byne, W. & Parsons, B. (1993), “Human sexual orientation: the biologic theories reappraised.” Archives of General Psychiatry, 50, p. 229-239.
13 See citation #3.
14 L. Ellis and A. Ames (1987), “Neurohormonal functioning and sexual orientation: A theory of homosexuality-heterosexuality,” Psychological Bulletin, 101, 233-238.
15 J.M. Bailey, L. Willerman & C. Parks, (1991), “A test of the maternal stress theory of male homosexuality,” Archives of Sexual Behavior, 20, 277-293.
16 A.F. Bogaert (2003), “Number of older brothers and sexual orientation: New tests and the attraction/behavior distinction in two national probability samples,” Journal of Personality and Social Psychology, 84 (3), 644-652.
18 A.F. Bogaert (2003), “Number of older brothers and sexual orientation: New tests and the attraction/behavior distinction in two national probability samples,” Journal of Personality and Social Psychology, 84 (3), 644-652.
19 A.F. Bogaert (2010), “Physical development and sexual orientation in men and women: An analysis of NATSAL-2000,” Archives of Sexual Behavior, 39, 110-116.
20 M. Frisch, & A. Hviid (2006), “Childhood family correlates of heterosexual and homosexual marriages: A national cohort study of two million Danes, Archives of Sexual Behavior 35(5), 533-547.
21 A.M. Francis (2008), “Family and sexual orientation: The family-demographic correlates of homosexuality in men and women,” Journal of Sex Research, 45, 371-377.
22 J.M. Bailey & R. C. Pillard (1991), “A genetic study of male sexual orientation,” Archives of General Psychiatry, 48, 1081-1096.
23 J.M. Bailey, et al (2000), “Genetic and environmental influences on sexual orientation and its correlates in an Australian twin sample,” Journal of Personality and Social Psychology, 78 (3), 524-536.
24 N. Långström, et al (2010), “Genetic and environmental effects on same-sex sexual behavior: A population study of twins in Sweden,” Archives of Sexual Behavior, 39, 75-80.
26 E. Turkheimer (2000), “Three laws of behavior genetics and what they mean,” Current Directions in Psychological Science, 9, 160-164; quotes p. 162.
27 Dar-Nimrod, I., & Heine, S.J. (2011b). Some thoughts on essence placeholders, interactionism, and heritability: Reply to Haslam (2011) and Turkheimer (2011). Psychological Bulletin, 137(5), 829-833, (quote on p. 831).
28 Turkheimer, E. (2011). Genetics and human agency: Comment on Dar-Nimrod and Heine (2011). Psychological Bulletin, 137(5), 825-828.
30 “Is Sexual Orientation Related to Mental Health Problems and Suicidality in Young People?” Fergusson, et al. Arch Gen Psychiatry. 1999; 56:876-880.
31 Warren Throckmorton, PhD. “Homosexuality and Psychotherapy: An Interview with Nicholas Cummings.” February 19, 2007.
33 APA Task Force Report (2009); 28.
34 S.L. Jones & M. A. Yarhouse. (2011),“A longitudinal study of attempted religiously-mediated sexual orientation change,” in the Journal of Sex and Marital Therapy, 37, 404-427; see also www.exgaystudy.org.
35 Nicolosi, J., Byrd, A. Dean, Potts, R.W. (June 2000), “Retrospective Self-Reports of Changes in Homosexual Orientation, A Consumer Survey of Conversion Therapy Clients,” Psychological Reports, 86: 1071-1088.
36 Please see citations 6 & 7 for non-exhaustive listings of other studies.
37 NARTH Statement on Sexual Orientation Change. January 25, 2012.
38 Sy Rogers has long taught this point. See www.syrogers.com.
ABOUT THE AUTHOR