Since Rachel Maddow did such a great job today calling attention to the reparative therapy movement and revealing it for what it is, I thought I'd share parts of a paper I wrote on the same topic for a sexualities course. This will be my first diary and I hope it provides insight into the ex-gay movement and its practices. Apologies in advance if this diary lacks proper formatting or editing. Anyway, enjoy! I hope somebody finds this useful.
Sexual Re-Orientation "Therapy" and the Ex-Gay Movement:
Separating the Rhetoric from the Research
Since the American Psychiatric Association (APA) declassified homosexuality as a mental illness from their Diagnostic and Statistical Manual of Mental Disorders in 1973, a small but strangely persistent group of dissenting mental health professionals has continued to argue that homosexuality is indeed pathological and that conversion from a homosexual orientation to a heterosexual orientation is not only possible but practical. Much has happened since 1973. The advent of HIV/AIDS, the murder of Matthew Shepard and the often cited Spitzer study have all profoundly impacted the ongoing debate, yet despite widespread disavowal, and in light of both medical and scientific consensus strongly suggesting that homosexuality does not require treatment, the growing prominence of the so-called ex-gay movement seems highly unusual and thus its insistent claims surely invite closer scrutiny. Separating the rhetoric from the research in regard to this issue can prove highly difficult, but time and again, assertions of "change" in sexual orientation have been mischaracterized; they are more accurately attributed to religious zealotry, political activism and pop psychology rather than legitimate research or sound practices.
The ex-gay movement has religious and secular branches that often work in tandem. Not coincidentally, Love in Action (LIA) became the first ex-gay ministry in 1973 (apparently in response to the actions of the APA) and began publicizing alleged homosexual to heterosexual converts. As early as 1976, Exodus International began referring gays and lesbians to its network of interdenominational ministries, attempting to "cure" homosexuality through the power of Jesus Christ. (Besen 63). As the most visible ex-gay institution, Exodus has now broadened its reach outside traditional realms and stands as an umbrella organization partnered with a wide variety of groups, including Homosexuals Anonymous (a 14-step program), JONAH (Jews Offering New Alternatives to Homosexuality), Evergreen (for Mormons), Courage (for Catholics), and even a local chapter called the Portland Fellowship. Aside from these religious ministries, more recently, in 1992, Joseph Nicolosi (PhD) founded the National Association for Research & Therapy of Homosexuality (NARTH), a secular yet politically active institution, coining the phrase "reparative therapy" which implies that non-heteronormative orientations need repair. Both religious and secular groups receive ample funding from right-wing organizations such as Focus on the Family and the Family Research Council. (Khan 11).
In his scathing critique of these organizations, Anything But Straight: Unmasking the Scandals and Lies Behind the Ex-Gay Myth, former Human Rights Campaign chairman Wayne R. Besen does quite a bit of investigative journalism and goes undercover to reveal the people and practices involved with these organizations. He often portrays the spokespersons and leadership of the ex-gay movement as peddlers of false hope, fakers, posers, backsliders, sexual predators, quack psychologists and radical ideologues who overstate their accomplishments and who have a history of follies and failures. Although perhaps Mr. Besen took a few quotes out of context, he nevertheless adroitly uses their own words against them, constructing a tremendously persuasive indictment of many ex-gay figures; however, rather than slip into sensationalistic personal attacks, this paper will strive to examine the claims of these individuals and organizations without trying to pass judgment. One should inevitably assess the qualifications of any experts, but more often than not, a direct analysis of their research and arguments will suffice in order to evaluate the methodology and determine the efficacy and ultimate consequences of sexual re-orientation therapy.
One of the first facets of ex-gay research that one should probably address is the methodology and how purported re-orientation works, something that the infamous Spitzer study does not address. Perhaps the most surprising finding of this research investigation is the lack of uniform guidelines or professional standards for this type of "therapy," and the fact that conversion therapists try everything under the rainbow to facilitate change in their clients. No two therapists seem to use the same methods and each ex-gay ministry autonomously employs its own strategy, but overall, the ex-gay forces seem to have a three-pronged approach to "curing" homosexuality.
- Changing sexual behavior (celibacy or hetero-marriage sex only)
- Changing how one self-identifies (semantic re-association and denial)
- Reducing if not eliminating same-sex fantasies and desires (avoidance and repression)
To induce conversions, religious ministries conduct exorcisms, employ marathon prayer sessions, promote celibacy and generally cast the "struggle" with homosexuality as spiritual warfare--the body as a battleground between Jesus Christ and perceived evil forces. In very few cases, orientation converts dubiously claim immediate transformations through divine intervention, but largely, most ex-gays describe the "struggle" between faith and sexuality as a life-long effort comforted by many difficult years of prayer and therapy. Many spiritual leaders quite clearly affirm that such approaches do not exactly "change" one’s sexual orientation, but rather contend that one can overcome temptations associated with same-sex attraction through Christ. (Besen 31). Ex-gays avoid temptation by disassociating with other gays or gay-affirmative individuals, by also not allowing themselves to be alone with anyone of the same sex, and also by abstaining from popular culture, media and many forms of entertainment for long durations. Other strategies include indoctrination of the belief that homosexuality is a sin (according to a fundamentalist interpretation of the Holy Bible) and also instilling faith in the label of "ex-gay" in a type of semantic re-association that encourages "strugglers" to re-define themselves. Adherence to this label precedes any reported changes in sexual attraction, and as long as one remains committed to Christ, even though an individual may still experience homosexual desires, s/he still identifies as "ex-gay" just as one might identify as "born again." Dr A. Lee Beckstead (PhD) describes the various agendas involved in sexual re-orientation therapy, noting that: "a variety of alternate reasons exist, besides the efficacy of re-orientation treatments, as to why and how such participants claim success," and further comments that, "participants reframe their same-sex sexual fantasies as ‘admiration’ rather than eroticism and believe they were heterosexual by eliminating their homosexual behaviors and maintaining their commitments to their family and religion." (Beckstead 75).
Conversely, more secular methods include a wider range of practices, and sometimes far more bizarre ones at that, ranging from the misguided to the ridiculous. Although electroshock therapy and nausea-inducing medications are no longer widely used, Mr. Besen’s undercover operation revealed at least one ex-gay leader who prescribes a disgusting aversion tactic, a form of rancid aromatherapy, suggesting that sniffing bottles of rotten hamburger will effectively inhibit homosexual impulses. (Besen 176). Additionally, the rubber band technique is often mentioned, that is, wearing a rubber band around one’s wrist and snapping it painfully whenever one feels any "inappropriate" sexual urges. Changes in exercise and nutrition and prescriptions for anti-depressants generally accompany behavior modification workshops (i.e. proper lipstick application for lesbians and touch football games for gay men) to properly assimilate "patients" into stereotypical gender roles. Other therapists offer subliminal recordings and hypnosis—at least forty sessions, while others suggest something referred to as non-sexual "touch" therapy whereby heterosexual mentors massage homosexual "strugglers" to supposedly desensitize them to same-sex touch, to diffuse their desires by supplying them with any intimacy that they may have lacked growing up. In addition, conversion therapists usually lead "patients" to identify some traumatic event or triggering cause from the past to explain one’s same-sex attachment deficit as they sometimes call it, a misapplied mainstream technique called memory healing. Ex-gays also misuse a technique called "thought stopping," intended by mainstream mental health professionals for those suffering from severe depression and suicidal thoughts; one interrupts thoughts of desire and attraction (rather than self-destructive thoughts) by yelling "STOP!" (Besen 125-127). These methods epitomize pop psychology and with all the various methods, the ex-gay movement has become a lucrative industry.
One of the more common techniques involves good old-fashioned shame and guilt, used by both the religious and secular branches of this therapy movement. If conversion fails, it’s not due to the incompetence of the clinician or the inadequacy of the therapy itself—the fault lies with the participating "struggler" for not trying hard enough. Social pressure and therapist reinforcement inevitably begin to impose authoritarian (often demoralizing) control over those in their "care" as nearly every manner of their lives becomes regimented by cult-like devotion to this therapy. One might completely write off such behavior as religious zealotry if it were not for the pre-eminent "reparative" therapist Joseph Nicolosi who claims "religion has nothing to do with it." (Besen 139). In his book Reparative Therapy of Male Homosexuality he provides case studies of his converts, and right away, if one couldn’t glean so from the title, his work distinctively lacks lesbian testimonials. In fact, Dr. Nicolosi’s approach concerns itself solely with the demystification of the male body and maleness and with denigrating the so-called homosexual "lifestyle" as unhealthy and unnatural. (Nicolosi 131).
He spends an entire chapter ranting against gay affirmative therapy and the GLBTQ rights movement, injecting political rhetoric where it does not belong, perpetuating myths of symptomology and the "unhappy homosexual." Worst of all, NARTH has become a political arm of the conversion movement as it gets involved not only in the mission of preventing homosexuality but also directly obstructing the GLBTQ rights movement by filing petitions and testifying against gays and lesbians in civil rights cases. (Besen 137). Political viewpoints should have no place in psychological practice, and keeping in mind this political activism, the very existence of NARTH now generates suspicions regarding reparative therapy as a means to adversely affect and reshape the GLBTQ rights debate. One could pen countless pages refuting Dr. Nicolosi’s broad mischaracterizations of the GLBTQ community, but this paper will not dignify his calumny with such a response. At least on the surface, the methodology of ex-gay counselors and therapists thus far seems like nothing more than trendy adaptations of mainstream techniques and downright quackery masquerading as respectable science--the aforementioned aversion techniques and coping methods do not seem likely to offer real change in orientation. Hence, for all these methods, one must truly question whether or not these practices actually do work. Because NARTH does not keep any statistics of its own, any "findings" or "success" stories are usually released to mass media rather than published in peer-reviewed scientific journals, and this certainly reeks of political maneuvering. (Besen 218).
Testimonials and case studies often seem to offer the best evidence in support of this brand of therapy, but for every ex-gay there seems to be an ex-ex-gay, some disillusioned former participant who now vociferously denounces the movement. (Wolkomir 129-130, 163-165). Unfortunately, many ex-gays ultimately blame their sexual orientation for any bad choices they have made rather than taking personal responsibility for their actions. Instead of changing self-destructive behaviors, they try to change their sexual orientation due to self-loathing or social pressure. According to many of the case studies, besides the self-destructive and self-loathing types, the people who enter such programs are:
- young people enrolled by parents who don’t want gay children
- ultra-religious, often sheltered, often sexually inexperienced (or virgins) who fear hellfire and damnation
- sexually-active, often closeted, often married, often bisexual individuals who engage in same-sex behavior who want to change either to save their marriage or due to religious convictions
The first-hand accounts from either side would seem to cancel each other out, and that properly leads us to examine peer-reviewed scientific publications that might reveal more useful information in regard to this divisive issue.
In May 2001, Dr. Robert Spitzer, who was involved in the original declassification of homosexuality as a mental disorder, presented a paper on reparative therapy at the APA annual convention. He reported that 66% of the men and 44% of the women he sampled had achieved "good heterosexual functioning" through therapeutic interventions. (Spitzer 403-417). Proponents of reparative therapy widely refer to this report as evidence of the success and legitimacy of such therapy; however, the APA immediately issued an official disavowal of the paper, noting that it had not been peer-reviewed and bluntly stating that, "There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation." (APA Statement of Policy). One of the major criticisms of Spitzer’s work comes in the form of sample bias as the participants in this study fall within an extremely narrow stratification of the GLBTQ populace. Dr. Spitzer surveyed 200 ex-gays via telephone (143 men, 57 women) and concluded that some "highly motivated" people can change orientation through prayer, therapy and mentoring relationships. However, 78% of the participants confirmed their outspoken support of conversion therapy before entering the study, making it seem like these individuals are little more than well-rehearsed political activists. Furthermore, in the most incredulously biased statistic of all, 48% were ex-gay counselors paid to recruit and convert new clients. (Carlson 91). 97% identified as Christian and 3% as Jewish, but the vast majority (93%) reported that religion was "extremely" or "very" important to them, giving credence to arguments that suggest religious zealotry plays the greatest role of all in claims of conversion. (Spitzer 41). Dr. John Bancroft, former director of the Kinsey Institute for Research in Sex, Gender and Reproduction questions the study’s validity, noting that: "The concept of reparative therapy as described, raises some key ethical issues, the most fundamental being the distinction between medical treatment for a pathological condition and the imposition of moral values under the guise of medical treatment." (Bancroft 71).
In another problem with the sample, 47% of the men and 67% of the women had heterosexual sex before entering therapy; 76% of the men and 47% of the women were married before therapy; 54% of the men and 58% of the women acknowledged attraction to the opposite sex before therapy; and 15% of the men and 39% of the women claimed to have little or no sexual attraction to anyone of the same sex as teenagers, which seems highly unusual as this happens to be when sex drive is usually highest. (Spitzer 49-51). These startling statistics suggest that many participants may have actually been bisexual rather than homosexual, and instead of experiencing change from one orientation to another, might instead have sublimated their homosexual attractions in favor of their heterosexual attractions. As if this were not enough to discredit the sample, the very findings of Spitzer’s paper reveal that only 17% of the men and 54% of the women claimed to have changed "completely." (Spitzer 51). Moreover, considering that sexual orientation is already considered fluid by many theorists in the field, at this point, one does not even have to question the difficulty of defining things like "change" and "good heterosexual functioning" in order to see the problems here.
Of course, Spitzer’s infamous piece of research into the efficacy of sexual re-orientation therapy has also not looked at the methodology and only evaluates its results; however, at least one study documents trends in both. In 2002 a peer-reviewed study by Dr. Ariel Shidlo and Dr. Michael Schroeder found that 88% of participants failed to achieve a sustained change in their sexual behavior and only 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or struggling to remain celibate, with no change in attraction. Their study sample included both participants connected with reparative therapy advocates, as well as participants recruited through the Internet, and included a far more diverse religious and racial sample. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 were employed in paid or unpaid roles as ex-gay counselors or group leaders, something which has led many to question whether even this small "success" rate is in fact reliable. The study also documented a large plurality of responses from participants who concluded that they suffered more harm than they experienced benefit. (Shidlo + Schroeder 249). Overall, in a comprehensive compilation of ex-gay research, among thirty peer-reviewed scientific articles, only two supported Spitzer’s findings as evidence of the efficacy of re-orientation therapy. (Drescher + Zucker 29-251). The first article was written by Dr. Joseph Nicolosi, whom this paper has already discussed, and the other by professor of psychology Scott Hershberger (PhD) who trotted out some arcane mathematical formula: CR = 1 – Σ e/N k (Guttman scalability) as evidence to confirm the effectiveness of "reparative" therapy. His scant and evasive analysis obfuscates more than it clarifies. In comparison to the other articles, his was the least revealing and offered little to no substantiation for his claims. He is strongly outnumbered and outargued by his peers. (Hershberger 139).
Under such overwhelming scientific consensus that undermines the validity and efficacy of re-orientation therapy, one is left to puzzle over why conversion therapists and the ex-gay ministry continue to thrive. The issue has even emerged in popular culture in films such as But I’m A Cheerleader, Saved! and X-Men 3, where mutant-ism is a thinly veiled metaphor for homosexuality and the anti-mutant forces develop a "cure" to eradicate them. By the film’s end, however, it remains ambiguous whether or not the "cure" actually works, but there is nothing ambiguous about "curing" homosexuality in real life. Since scientific research does not and cannot justify sexual re-orientation therapy in any way, it seems increasingly apparent that other powerful influences are at work. Sample statistics and testimonials clearly establish the fact that religion enormously influences one’s decision to undergo this therapy in the first place, and ex-gay ministries and their secular counterparts cannot deny receiving funding from anti-gay institutions or getting involved in anti-gay political activities. Additionally, all of the self-reported "changes" that occur have been mislabeled and misrepresented as conversions and "treated" with pop psychological silliness. Religious believers sometimes take vows of poverty, of silence, of chastity or celibacy, and these vows seem more akin to "sexual re-orientation" than the notion that people can genuinely and fundamentally change the gender to which they find themselves attracted.
Works Cited
Bancroft, John. "Can Sexual Orientation Change? A Long-Running Saga." Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics and Culture. Edited by Jack Drescher and Kenneth Zucker. Binghamton, New York: The Haworth Press Inc., 2006.
Beckstead, A. Lee. "Understanding the Self-Reports of Reparative Therapy Successes." Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics and Culture. Edited by Jack Drescher and Kenneth Zucker. Binghamton, New York: The Haworth Press Inc., 2006.
Besen, Wayne R. Anything But Straight: Unmasking the Scandals and Lies Behind the Ex-Gay Myth. New York City, New York: Harrington Park Press, 2003.
Carlson, Helena M. "A Methodological Critique of Spitzer’s Research on Reparative Therapy." Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics and Culture. Edited by Jack Drescher and Kenneth Zucker. Binghamton, New York: The Haworth Press Inc., 2006.
Drescher, Jack (MD) and Kenneth J. Zucker (PhD). Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics and Culture. Binghamton, New York: The Haworth Press Inc., 2006.
Hershberger, Scott L. "Guttman Scalability Confirms the Effectiveness of Reparative Therapy." Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics and Culture. Edited by Jack Drescher and Kenneth Zucker. Binghamton, New York: The Haworth Press Inc., 2006.
Khan, Surina. "Calculated Compassion: How the Ex-Gay Movement Serves the Right’s Attack on Democracy." Washington DC: Political Research Associates, October 1998.
Nicolosi, Joseph. Reparative Therapy of Male Homosexuality. New Jersey: Jason Aronson Inc., 1991.
Shidlo, Ariel and Michael Schroeder. "Changing Sexual Orientation: A Consumer’s Report." Professional Psychology Research and Practice. 2002, Vol. 33, No. 3, 249-259.
Spitzer, Robert L. "Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation." Archives of Sexual Behavior, October 2003.
Wolkomir, Michelle. Be Not Deceived: The Sacred and Sexual Struggles of Gay and Ex-Gay Christian Men. Piscataway, New Jersey: Rutgers University Press, 2006.