December 8, 2001
Confusion about the significance of a scientific report
It is indeed unfortunate that Dr. Spitzer reported his findings this year. When the topic is homosexuality, the profound difference between "not strictly determined" and "voluntarily chosen" is not generally appreciated. Dr. Spitzer provided a paragraph to help clarify this point in my previous Viewpoint posting. As a result, some letters on Presbyweb have been expressed more carefully. However, many concerned, well-intentioned people continue to mention his report as though it calls into question all that is currently known about sexual orientation. It doesn't. More to the point, it provides no information supporting the opposition of Amendment 01-A.
The conversion therapy controversy
In his October 22 letter to Presbyweb, Dr. Rosik emphasized that the scientific data do not support a strict biological determinacy for sexual orientation. This is a key point for all practitioners of conversion therapy. If no change is possible, then there is no justification for treatment. However, most psychiatric professionals regard sexual orientation as effectively fixed, at least in most adults.
If sexual orientation isn't invariably fixed in adult homosexuals, just who are the members of the small subgroup of individuals who show this flexibility? To explore these questions, Dr. Spitzer's controversial study made use of self-reports from conversion therapy patients who had been referred via advocacy groups for this therapy, i.e., the very groups protesting psychiatric meetings. Spitzer's study clearly did not use a carefully balanced (and unbiased) sample of individuals, as scientific standards generally require. Likewise, the unresolved question of risks vs. benefits was deferred to future studies.
In general, the idea of relaxing selection criteria for participants may be viewed as a justifiable preliminary measure if it helps to phrase a new question. Since other scientists and clinicians are aware of the shortcomings of this approach, nothing would be lost if the preliminary findings turn out to be wrong. However, if the findings are replicated after controlling for the obvious sources of error or bias, a new area of research may emerge. Unfortunately, the topic of sexual orientation instantly attracts media attention, which in turn coaxes an unfamiliar public to anticipate the results of research that hasn't even begun.
I've interacted with a number of people of faith and compassion who are advocates of conversion therapy. They argue that their patients seek treatment of their own free will, without coercion. Some of them seem convinced that something akin to a "gay conspiracy" is behind the reluctance of the professional associations to support the technique. Dr. Rosik indicated his own skepticism that further research could ever determine the effectiveness of conversion therapy, adding, "I will consider changing my mind when I see clear statements from such organizations offering or at least calling for funding of research that involves both opponents and proponents of change efforts."
The casual reader may wonder why any client-initiated therapy should be so controversial. As someone who earns his living doing research with human subjects, I have reason to believe that the resistance to conversion therapy is simply a result of measures which have been put in place to protect the rights of the patient. These regulations and constraints on all human research began with the international outcry over so-called "human experimentation" conducted by Nazis. Further increases in red tape have been fueled by public awareness of American mistakes and transgressions, ranging from birth defects after thalidomide to the infamous Tuskegee Syphilis experiment.
According to the Helsinki Declaration, " The responsibility for the human subject must always rest with a medically qualified person and never rest on the subject of the research, even though the subject has given consent.." Such research "should only be conducted if the importance of the objective outweighs the inherent risks and burdens to the subject. This is especially important when the human subjects are healthy volunteers." Further, "Physicians should abstain from engaging in research projects involving human subjects unless they are confident that the risks involved have been adequately assessed and can be satisfactorily managed. Physicians should cease any investigation if the risks are found to outweigh the potential benefits . . ." For these reasons, Dr. Rosik's cynicism does have merit. The general consensus is that conversion therapy poses serious risks to the individual with little, if any, likelihood of success.
Regarding funding opportunities for research on conversion therapy, it's important to recognize that research grants from NIH and NIMH aren't the kind of "pork barrel" that many people believe them to be. Studies must be adequately controlled, based on good science, supported by the literature and pilot data, and have acceptable risks for the perceived benefits. Since they are also highly competitive, a proposed therapeutic treatment would be expected to aim at a health problem (i.e., a disease, disability or handicap), and to report risks and benefits without bias. The researcher must also assure that no conflict of interest can influence the outcome of a study. Unfortunately, the champions of conversion therapy are often therapists or activist patients who have a strong personal stake in the outcome of the study. A final note is that the results of a study won't be publishable in a high caliber scientific journal unless the methods comply with conventional standards. While I applaud Dr. Rosik's preliminary efforts at setting parameters for the ethical application of these methods (Rosik, 2001), there are clearly many issues that must be resolved before mainstream psychiatric and scientific professionals can take them seriously.
Group statistics and homosexual stereotypes: Are they relevant to faithful Presbyterians?
Whenever samples of individuals are used to describe or compare large groups of people, the classification itself should be a valid one, i.e., the classification must reflect real differences, rather than a convenient fiction applied to the group of interest. The sample itself should also be appropriately balanced to represent the entire group. Even after taking these precautions, the characteristics or results from any sample of individuals may not be reproducible, let alone generalizable to groups that are similar, but not identical.
With these requirements in mind, what DO we really know about faithful Presbyterians who happen to be gay? Do we have any reason to believe that faithful Presbyterians who happen to be gay are more prone to the reckless abandon of the "gay lifestyle," as portrayed by the media, than faithful Presbyterians who happen to be heterosexual are at risk to for the mindless promiscuity of being "swingers?" Throughout the decades, what proportion of faithful Presbyterians who happen to be gay were never sampled, indeed never even noticed, simply because they share the traditional conservative belief that church is for worship and fellowship, and not for talk about sex? Throughout the decades, what proportion were never sampled, because they were quietly pushed away by us before they even knew that they were gay?
I would actually argue that it's Presbyterianism, rather than gayness, that's the distinguishing characteristic of homosexual Presbyterians who are called to ordained positions. However, lacking acceptable group statistics or "reasonable" stereotypes, we must resort to interacting with each unique individual face-to-face, on his or her own terms. Our mutual evaluation must rely on our relationships with each other, and with God. Curiously, this is what Amendment 01-A would have us do.
Craig E. Tenke, Ph. D. is a Presbyterian elder in Center Moriches, NY, and a neuroscientist, at the NYS Psychiatric Institute, Columbia-Presbyterian Medical Center, NYC
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