FINNQUEER Sep 9, 2001
FINNQUEER Sep 9, 2001
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Letter from the American Psychiatric Association to the Finnish ParliamentJack Drescher |
The Chair of the American Psychiatric Association's (APA) Committee on Gay, Lesbian and Bisexual Issues, psychoanalyst Jack Drescher, sent the following letter to all Finnish Members of Parliament in September 2001 through the web magazine FinnQueer to inform about the APA's stand on civil unions for same-gender people.
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September 23, 2001
Dear Dr. Stålström,
I am chair of the American Psychiatric Association's (APA) Committee on Gay, Lesbian and Bisexual Issues. I am responding to your letter requesting (I) information about the APA's positions on homosexuality and (II) the APA's position regarding a recent study done by Robert Spitzer, M.D. that was presented at the APA meeting in May of 2001.
In 1973, the APA removed homosexuality from its list of mental disorders (Bayer, 1981). While it is true that protests by gay rights activists provided the impetus to reevaluate the APA's earlier position, it is not correct that the final decision was based on political considerations. The reevaluation was done by a scientific committee of the APA which was chaired by Robert Spitzer, M.D. The committee looked at early psychoanalytic claims that homosexuality was an illness (i.e., Rado, 1940; Bieber et al, 1962, Socarides, 1968) and weighed them against studies that argued that homosexuality was not an illness (i.e., Kinsey et al, 1948, 1953; Ford and Beach, 1951; Hooker, 1957; Marmor, 1965). It was the weighing of the scientific evidence, and not political pressure that led to the APA's decision to remove homosexuality from the diagnostic manual.
It should be noted that the psychoanalytic practitioners of that era who disagreed with the APA's decision have themselves politicized the discussion. For example, after the scientific committee made its decision, those who disagreed with it called for a membership vote on the issue. A petition to force the APA referendum -- a political vote on a scientific decision--was forged and signed by 200 people at a meeting of the American Psychoanalytic Association (Bayer, 1981). After they lost the vote, some have presented a distorted history of those events. For example, in addition to false claims that the change was entirely political, Socarides (1995) has even accused the APA of miscounting the referendum votes.
Because it no longer considers homosexuality to be an illness, the APA's current positions reflect its belief that homosexuality is a normal variant of human sexuality. Therefore, since the 1973 decision, APA has issued many statements in support of gay and lesbian civil rights.
Among the most recent is a 1998 statement regarding so-called reparative therapies. It states that "the American Psychiatric Association opposes any psychiatric treatment, such as 'reparative' or 'conversion' therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation" (APA, 1998; See Appendix 1 for full statement).
In 2000, the APA went even further. It's Commission on Psychotherapy by Psychiatrists issued a statement, approved by the entire APA leadership, that made the following recommendations:
1. APA affirms its 1973 position that homosexuality per se is not a diagnosable mental disorder. Recent publicized efforts to repathologize homosexuality by claiming that it can be cured are often guided not by rigorous scientific or psychiatric research, but sometimes by religious and political forces opposed to a full civil rights for gay men and lesbians. APA recommends that the APA respond quickly and appropriately as a scientific organization when claims that homosexuality is a curable illness are made by political or religious groups.
2. As a general principle, a therapist should not determine the goal of treatment either coercively or through subtle influence. Psychotherapeutic modalities to convert or "repair" homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm. (See Appendix 2 for full statement).
In specific regard to the issue of civil unions, in 2000, the APA's Board of Trustees voted to affirm that "The American Psychiatric Association supports the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities" (See Appendix 3 for full statement).
In May of 2001, the APA held its annual meeting in New Orleans. A symposium at that meeting addressed "Clinical Issues and Ethical Concerns Regarding Attempts to Change Sexual Orientation: An Update." The symposium was sponsored by the Association of Gay and Lesbian Psychiatrists and Dr. Spitzer was invited to present his unpublished findings. As you know, before the Spitzer study was even presented at the meeting, the press picked it up and proceeded to blow its actual research importance out of proportion.
For the record, a presentation of any study at a meeting of the APA does not mean that the APA endorses the study. The APA meeting provides a forum for the exchange of ideas, even those whose scientific validity have yet to be proven. In other words, the presentation of a study at one of APA's meetings does not carry the same scientific weight as having the study published in a peer- reviewed journal. To date, the study has not been published in a peer-reviewed journal.
As for the scientific merits of his study, I believe it is significantly flawed. One flaw is that the majority of subjects in the study had one 45-minute telephone interview with Dr. Spitzer and no follow-ups. Other than Dr. Spitzer, I can find no reputable researcher who will agree that this is an accurate way to assess whether a person has changed their sexuality. That point was underscored in another study presented at the same symposium. Schroeder and Shidlo's study (in press) found that many individuals who claimed to have changed sexual orientation during a first telephone interview changed their story at a second, follow-up interview.
I know Dr. Spitzer plans to respond to you himself and I am confident he will make his own thoughts clear about the misuse of his study by political and religious groups opposed to gay and lesbian civil rights. Despite our differing interpretations of his study, both Dr. Spitzer and myself are of the opinion that there is a small group of people whose sexual orientation can change, sometimes even without any therapy. But neither of us believe that everyone's sexual orientation can change. To claim that everyone can change or that everyone should change is simply not true. To scientifically argue for that position in opposition to gay and lesbian civil rights is not only a misuse of Dr. Spitzer's study but a travesty of science itself.
If I can be of any further assistance, please do not hesitate to contact me.
Very truly yours,
Jack Drescher, M.D., FAPA Chair Committee on Gay, Lesbian and Bisexual Issues American Psychiatric Association
American Psychiatric Association (1998), Position statement on psychiatric treatment and sexual orientation. Amer. J. Psychiat., 1999; (156):1131. American Psychiatric Association (2000), Commission on Psychotherapy by Psychiatrists (COPP): Position statement on therapies focused on attempts to change sexual orientation (Reparative or conversion therapies). Amer. J. Psychiat., (157):1719-1721.
Bayer, R. (1981), Homosexuality and American Psychiatry: The Politics of Diagnosis. New York: Basic Books.
Bieber, I., Dain, H., Dince, P., Drellich, M., Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C. & Bieber T. (1962), Homosexuality: A Psychoanalytic Study. New York: Basic Books.
Ford, C. & Beach, F. (1951), Patterns of Sexual Behavior. New York: Harper.
Hooker, E. (1957), The adjustment of the male overt homosexual. J. Proj. Tech, 21:18-31.
Kinsey, A., Pomeroy, W. & Martin, C. (1948), Sexual Behavior in the Human Male. Philadelphia, PA: Saunders.
Kinsey, A., Pomeroy, W., Martin, C. & Gebhard, P. (1953), Sexual Behavior in the Human Female. Philadelphia, PA: Saunders.
Marmor, J., ed. (1965), Sexual Inversion: The Multiple Roots of Homosexuality. New York: Basic Books.
Rado, S. (1940), A critical examination of the concept of bisexuality. Psychosomatic Medicine, 2:459-467.
Schroeder, M. & Shidlo, A. (in press), Ethical issues in sexual orientation conversion therapies: An empirical study of consumers. J. Gay & Lesb. Psychother.
Socarides, C. (1968), The Overt Homosexual. New York: Grune & Stratton. Socarides, C. (1995), Homosexuality: A Freedom Too Far. Phoenix, AZ: Adam Margrave Books.
American Psychiatric Association Position Statement on Psychiatric Treatment and Sexual Orientation
December 11, 1998
The Board of Trustees of the American Psychiatric Association removed homosexuality from the DSM in 1973 after reviewing evidence that is was not a mental disorder. In 1987, ego-dystonic homosexuality was not included in the DSM-III-R after a similar review.
The American Psychiatric Association does not currently have a formal position statement on treatments that attempt to change a person's sexual orientation, also known as "reparative or conversion therapy." There is an APA 1997 Fact Sheet on Homosexual and Bisexual Issues, which states that "there is no published scientific evidence supporting the efficacy of "reparative therapy" as a treatment to change one's sexual orientation."
The potential risks of "reparative therapy" are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone "reparative therapy" relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing the effects of societal stigmatization discussed. The APA recognizes that in the course of ongoing psychiatric treatment there may be appropriate clinical indications for attempting to change sexual behaviors.
Several major professional organizations including the American Psychological Association, the National Association of Social Workers and the American Academy of Pediatrics have all made statements against "reparative therapy" because of concerns for the harm caused to patients. The American Psychiatric Association has already taken clear stands against discrimination, prejudice and unethical treatment on a variety of issues including discrimination on the basis of sexual orientation.
Therefore, the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or "conversion" therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation.
American Psychiatric Association Commission on Psychotherapy by Psychiatrists (COPP) Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies)
Preamble In December of 1998, the Board of Trustees issued a position statement that the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or conversion therapy, which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation (Appendix 1). In doing so, the APA joined many other professional organizations that either oppose or are critical of "reparative" therapies, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, The American Counseling Association, and the National Association of Social Workers (1).
The following Position Statement expands and elaborates upon the statement issued by the Board of Trustees in order to further address public and professional concerns about therapies designed to change a patient's sexual orientation or sexual identity. It augments rather than replaces the 1998 statement.
Position Statement In the past, defining homosexuality as an illness buttressed society's moral opprobrium of same-sex relationships (2). In the current social climate, claiming homosexuality is a mental disorder stems from efforts to discredit the growing social acceptance of homosexuality as a normal variant of human sexuality. Consequently, the issue of changing sexual orientation has become highly politicized. The integration of gays and lesbians into the mainstream of American society is opposed by those who fear that such an integration is morally wrong and harmful to the social fabric. The political and moral debates surrounding this issue have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue. This document attempts to shed some light on this heated issue.
The validity, efficacy and ethics of clinical attempts to change an individual's sexual orientation have been challenged (3,4,5,6). To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of reparative treatments. There is sparse scientific data about selection criteria, risks versus benefits of the treatment, and long-term outcomes of reparative therapies. The literature consists of anecdotal reports of individuals who have claimed to change, people who claim that attempts to change were harmful to them, and others who claimed to have changed and then later recanted those claims (7,8,9).
With little data about patients, it is possible to evaluate the theories which rationalize the conduct of "reparative" or conversion therapies. Firstly, they are at odds with the scientific position of the American Psychiatric Association which has maintained, since 1973, that homosexuality per se, is not a mental disorder. The theories of "reparative" therapists define homosexuality as either a developmental arrest, a severe form of psychopathology, or some combination of both (10-15). In recent years, noted practitioners of "reparative therapy" have openly integrated older psychoanalytic theories that pathologize homosexuality with traditional religious beliefs condemning homosexuality (16,17,18).
The earliest scientific criticisms of the early theories and religious beliefs informing "reparative" or conversion therapies came primarily from sexology researchers (19-27). Later, criticisms emerged from psychoanalytic sources as well (28-39). There has also been an increasing body of religious thought arguing against traditional, biblical interpretations that condemn homosexuality and which underlie religious types of "reparative" therapy (40-46).
Recommendations
1. APA affirms its 1973 position that homosexuality per se is not a diagnosable mental disorder. Recent publicized efforts to repathologize homosexuality by claiming that it can be cured are often guided not by rigorous scientific or psychiatric research, but sometimes by religious and political forces opposed to a full civil rights for gay men and lesbians. APA recommends that the APA respond quickly and appropriately as a scientific organization when claims that homosexuality is a curable illness are made by political or religious groups.
2. As a general principle, a therapist should not determine the goal of treatment either coercively or through subtle influence. Psychotherapeutic modalities to convert or "repair" homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to First, do no harm.
3. The "reparative" therapy literature uses theories that make it difficult to formulate scientific selection criteria for their treatment modality. This literature not only ignores the impact of social stigma in motivating efforts to cure homosexuality, it is a literature that actively stigmatizes homosexuality as well. "Reparative" therapy literature also tends to overstate the treatment's accomplishments while neglecting any potential risks to patients. APA encourages and supports research in the NIMH and the academic research community to further determine "reparative" therapy's risks versus its benefits.
(1) National Association for Research and Treatment of Homosexuality, (1999), American Counseling Association Passes Resolution to Oppose Reparative Therapy. NARTH Website (http://www.narth.com/docs/acaresolution.html).
(2) Bayer, R. (1981), Homosexuality and American Psychiatry; The Politics of Diagnosis. New York: Basic Books.
(3) Haldeman, D. (1991), Sexual orientation conversion therapy for gay men and lesbians: A scientific examination. In Homosexuality: Research Implications for Public Policy, ed. J. C. Gonsiorek & J. D. Weinrich. Newbury Park, CA: Sage Publications, pp. 149-161.
(4) Haldeman, D. (1994), The practice and ethics of sexual orientation conversion therapy. J. of Consulting and Clin. Psychol., 62(2):221-227. (5) Brown, L. S. (1996), Ethical concerns with sexual minority patients. In: Textbook of Homosexuality and Mental Health. ed. R. Cabaj & T. Stein. Washington, D.C.: American Psychiatric Press, pp. 897-916.
(6) Drescher, J. (1997), What needs changing? Some questions raised by reparative therapy practices. New York State Psychiatric Society Bulletin, 40(1):8-10.
(7) Duberman, M. (1991), Cures: A Gay Man's Odyssey. New York: Dutton.
(8) White, M. (1994), Stranger at the Gate: To be Gay and Christian in America. New York: Simon & Schuster.
(9) Isay, R. (1996), Becoming Gay: The Journey to Self-Acceptance. New York: Pantheon.
(10) Freud, S. (1905), Three essays on the theory of sexuality. Standard Edition, 7:123-246. London: Hogarth Press, 1953.
(11) Rado, S. (1940), A critical examination of the concept of bisexuality. Psychosomatic Medicine, 2:459-467. Reprinted in Sexual Inversion: The Multiple Roots of Homosexuality, ed. J. Marmor. New York: Basic Books, 1965, pp. 175- 189.
(12) Bieber, I., Dain, H., Dince, P., Drellich, M., Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C., & Bieber T. (1962), Homosexuality: A Psychoanalytic Study. New York: Basic Books.
(13) Socarides, C. (1968), The Overt Homosexual. New York: Grune & Stratton.
(14) Ovesey, L. (1969), Homosexuality and Pseudohomosexuality. New York: Science House.
(15) Hatterer, L. (1970), Changing Homosexuality in the Male. New York: McGraw Hill.
(16) Moberly, E. (1983), Homosexuality: A New Christian Ethic. Cambridge, UK: James Clarke & Co.
(17) Harvey, J. (1987), The Homosexual Person: New Thinking in Pastoral Care. San Francisco, CA: Ignatius.
(18) Nicolosi, J. (1991), Reparative Therapy of Male Homosexuality: A New Clinical Approach. Northvale, NJ: Aronson.
(19) Kinsey, A., Pomeroy, W., & Martin, C. (1948), Sexual Behavior in the Human Male. Philadelphia, PA: Saunders.
(20) Kinsey, A., Pomeroy, W., & Martin, C. and Gebhard, P. (1953), Sexual Behavior in the Human Female. Philadelphia, PA: Saunders.
(21) Ford, C. & Beach, F. (1951), Patterns of Sexual Behavior. New York: Harper.
(22) Hooker, E. (1957), The adjustment of the male overt homosexual. J Proj Tech, 21:18-31.
(23) Bell, A .& Weinberg, M. (1978), Homosexualities: A Study of Diversity Among Men and Women. New York: Simon and Schuster.
(24) Bell, A., Weinberg, M. & Hammersmith S. (1981), Sexual Preference: Its Development in Men and Women. Bloomington, IN: Indiana University Press.
(25) LeVay, S. (1991), A difference in hypothalamic structure between heterosexual and homosexual men. Science, 253:1034-1037.
(26) Hamer, D., Hu, S., Magnuson, V., Hu, N. & Pattatucci, A. (1993), A linkage between DNA markers on the X-chromosome and male sexual orientation. Science, 261:321-327.
(27) Bem, D. (1996), Exotic becomes erotic: A developmental theory of sexual orientation. Psychol. Review, 103(2):320-335.
(28) Marmor, J., ed. (1965), Sexual Inversion: The Multiple Roots of Homosexuality. New York: Basic Books.
(29) Mitchell, S. (1978), Psychodynamics, homosexuality, and the question of pathology. Psychiatry, 41:254-263.
(30) Marmor, J., ed. (1980), Homosexual Behavior: A Modern Reappraisal. New York: Basic Books.
(31) Mitchell, S. (1981), The psychoanalytic treatment of homosexuality: Some technical considerations. Int. Rev. Psycho-Anal., 8:63-80. (32) Morgenthaler, F. (1984), Homosexuality Heterosexuality Perversion, trans. A. Aebi. Hillsdale, NJ: The Analytic Press, 1988.
(33) Lewes, K. (1988), The Psychoanalytic Theory of Male Homosexuality. New York: Simon and Schuster. Reissued as Psychoanalysis and Male Homosexuality (1995), Northvale, NJ: Aronson.
(34) Friedman, R.C. (1988), Male Homosexuality: A Contemporary Psychoanalytic Perspective. New Haven, CT: Yale University Press. (35) Isay, R. (1989), Being Homosexual: Gay Men and Their Development. New York: Farrar, Straus and Giroux.
(36) O'Connor, N. & Ryan, J. (1993), Wild Desires and Mistaken Identities: Lesbianism & Psychoanalysis. New York: Columbia University.
(37) Domenici, T. & Lesser, R., eds. (1995) Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. New York: Routledge.
(38) Magee, M. & Miller, D. (1997), Lesbian Lives: Psychoanalytic Narratives Old and New. Hillsdale, NJ: The Analytic Press.
(39) Drescher, J. (1998) Psychoanalytic Therapy and The Gay Man. Hillsdale, NJ: The Analytic Press.
(40) Boswell, J. (1980), Christianity, Social Tolerance and Homosexuality. Chicago, IL: University of Chicago Press.
(41) McNeil, J. (1993), The Church and the Homosexual, Fourth Edition. Boston, MA: Beacon.
(42) Pronk, P. (1993), Against Nature: Types of Moral Argumentation Regarding Homosexuality. Grand Rapids, MI: William B. Eerdmans.
(43) Boswell, J. (1994), Same-Sex Unions in Premodern Europe. New York: Villard Books.
(44) Helminiak, D. (1994), What the Bible Really Says About Homosexuality. San Francisco, CA: Alamo Press.
(45) Gomes, P. J. (1996). The Good Book: Reading the Bible with Mind and Heart. New York: Avon.
(46) Carrol, W. (1997), On being gay and an American Baptist minister. The InSpiriter, Spring, pp. 6-7,11.
American Psychiatric Association Position Statement on Same Sex Unions Approved December 2000 by the APA Board of Trustees
The APA expresses a valid interest in the well being of heterosexual married couples in such areas as children's mental health and other aspects of family life. Heterosexual relationships have a legal framework for their existence, which provides a stabilizing force.
In the United States, with the recent exception of Vermont, same sex partners are currently denied the important benefits and responsibilities of legal marriage. Same sex couples therefore experience several kinds of state- sanctioned discrimination that affect the stability of their relationships.
The children of gay and lesbian parents do not have the same protection that legal marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is presumed unfit in many U.S. jurisdictions. Furthermore, when couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though research has shown that the children raised by lesbian and gay men are as well adjusted as those reared within heterosexual relationships.
The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. Educating the public about lesbian and gay relationships and supporting efforts to establish same sex legal unions is consistent with the Association's advocacy for other disadvantaged minority groups.
"The American Psychiatric Association supports the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities".