Can therapy turn gay people straight?
Eleven years ago, Robert Spitzer said it could. Spitzer is the professor of psychiatry who led the fight in the 1970s to declassify homosexuality as a mental disorder. But in 2001, he released a study—published two years later in Archives of Sexual Behavior—purporting to show that therapy, commonly known as conversion or “reparative” therapy, could change a patient’s sexual orientation. Anti-gay political groups seized on the report, using it to argue against acceptance of homosexuality.
Spitzer didn’t agree with this interpretation of the study. Now, in failing health, he has apologized for how he presented it. He wants to retract what he wrote. And now it’s the pro-gay groups who are seizing on his words. “Dr. Spitzer’s apology to the victims of ‘pray away the gay’ therapy … marks a watershed moment in the fight against the ‘ex-gay’ myth,” says Truth Wins Out, an organization dedicated to fighting “anti-gay religious extremism.” “It will help to greatly hasten the day when the scourge that is reparative therapy is eradicated forever.”
Hey, I’m as gay-friendly as the next guy. But let’s back off the eradication talk. That kind of zeal was unwarranted and dangerous back when the alleged scourge was homosexuality. It’s still unwarranted and dangerous.
Homosexuality is fundamentally personal, not political. Like heterosexuality, it varies from person to person, and it can evolve over a lifetime. Experience and research suggest it’s extremely unlikely that you can change your sexual orientation, and you’re better off accepting who you are. But what’s true for you may not be true for someone closer to the margins of homosexuality. Tempting as it is to politicize Spitzer’s apology and dismiss the malleability of sexual orientation, resist that urge. Morally and therapeutically, it’s better to treat people as individuals.
Overconfidence and overgeneralization have always corrupted our treatment of gay people. First we mistook homosexuality for a sin. Then we mistook it for a lifestyle. Then we mistook it for a disorder. In the past 20 years, purveyors of conversion therapy, led by psychologist Joseph Nicolosi, have used a Freudian cookie cutter to diagnose every unhappy gay patient as a victim of gender-driven parenting errors. Last month, Gabriel Arana, an editor at the American Prospect, recounted his experience as a patient of Nicolosi's, indoctrinated by Nicolosi’s books, Healing Homosexuality and Reparative Therapy of Male Homosexuality:
Another sheet illustrated the “triadic relationship” that led to homosexuality: a passive, distant father, an overinvolved mother, and a sensitive child. … According to Nicolosi, identification with a parent of the other gender is out of step with our biological and evolutionary “design.” Because of this, it was impossible to ever become whole through gay relationships. … Like a rabbi instructing his student in understanding the Torah, Nicolosi encouraged me to interpret my daily life through the lens of his theories.
What’s chilling in Arana’s account isn’t that Nicolosi failed to understand him, but that he didn’t even try. For Nicolosi and other practitioners of conversion therapy, the theory drives everything. The patient is just an instance, an opportunity to apply the model. When Arana asked Nicolosi about gay men who didn’t fit the model, Nicolosi told him: “After almost 30 years of work, I can say to you that I’ve never met a single homosexual who’s had a loving and respectful relationship with his father.”
This blind commitment to generalization, framed as science, drove the rise of conversion therapy and its promulgator, the National Association for Research and Therapy of Homosexuality. Politics hardened the theory, as religious conservatives used NARTH and conversion therapy to argue that homosexuality could be cured and therefore need not be accommodated. A similar cookie-cutter ideology arose on the left, attributing homosexuality, like skin color, to genes.
This was the polarized world into which Spitzer waded with his study of conversion therapy. He wasn’t trying to vindicate either side’s theory. He wanted to find out whether self-described ex-gays were correct that some people could change their orientation. His answer—yes—instantly became political fodder for the right. In the same way, his apology has now become fodder for the left. But Spitzer’s study never proved anything about patients of conversion therapy in general, much less about homosexuals. It wasn’t designed that way.
The 200 people included in Spitzer’s study weren’t picked at random. They were referred to him by the very advocates whose work and ideology he was testing. Forty-three percent learned about the study through ex-gay religious groups. Twenty-three percent learned about it through NARTH. Nine percent were recruited by their former therapists. The rest, by and large, were referred by conversion therapists or other subjects in the study. It’s hard to conceive of a more biased sample. And there’s reason to believe that the hidden denominator—the number of patients who didn’t turn out well and weren’t referred—was enormous. Spitzer reported:
To recruit the 200 participants, it was necessary to repeatedly send notices of the study over a 16-month period to a large number of participants who had undergone some form of reparative therapy. This suggests that the marked change in sexual orientation reported by almost all of the study subjects may be a rare or uncommon outcome of reparative therapy.
In a conversation with Arana two months ago, Spitzer used Nicolosi to illustrate his suspicions: “In all the years of doing ex-gay therapy, you’d think Nicolosi would have been able to provide more success stories. He only sent me nine patients.”
By several measures, Spitzer's subjects were wildly unrepresentative of the gay population. Ninety-three percent said religion was “extremely” or “very” important to them. Seventy-eight percent had spoken publicly for efforts to cure homosexuality. Such faithful advocates may have been driven by an exceptionally strong will to believe that their orientation could be, and was being, changed. In fact, the study explicitly excluded failures. “To be accepted into the study,” Spitzer explained in his report, participants had to demonstrate after therapy “a change of at least 10 points, lasting at least 5 years, toward the heterosexual end of the scale of sexual attraction.”
None of the things being measured—how gay the subjects had been before their therapy, what kind of therapy they got, how straight they were afterward—was clearly resolved. “Given the fallibility of memory for past events,” Spitzer wrote, “it is impossible to be sure how accurate individuals were in answering questions about how they felt during the year before starting the therapy, which on average was about 12 years before the interview.” The nature of the therapy was never defined, and in half the cases it was administered by a pastoral counselor, support group, Bible study, or other religious practice. As for subjects’ claims that they had stayed gay-free after therapy, Spitzer confessed that he “relied exclusively on self-report” and that this reliance “deserves careful examination in light of the participants’ … high motivation to provide data supporting the value of efforts to change sexual orientation.”
Within these limits, the net result was as scientific as Spitzer could make it—which is to say, not very. The “data set” he produced looked more like a collection of unverified anecdotes from people eager to vindicate conversion therapy. The widespread changes in attraction reported by this group didn’t match the broader experience of Alan Chambers, president of Exodus International—the world’s leading ex-gay ministry—who admitted this year that, regardless of behavioral change, “99.9 percent” of people he had met in the ex-gay world had “not experienced a change in their orientation” to the point of escaping same-sex attraction. Notorious cases of behavioral relapse include the chairman of Exodus and the founder of “National Coming Out of Homosexuality Day.” When the American Psychological Association reviewed the available research in 2009, it concluded:
There are no studies of adequate scientific rigor to conclude whether or not recent [therapies] do or do not work to change a person’s sexual orientation. Scientifically rigorous older work … found that sexual orientation (i.e., erotic attractions and sexual arousal oriented to one sex or the other, or both) was unlikely to change due to efforts designed for this purpose. Some individuals appeared to learn how to ignore or limit their attractions. However, this was much less likely to be true for people whose sexual attractions were initially limited to people of the same sex. … [S]ome individuals modified their sexual orientation identity (i.e., group membership and affiliation), behavior, and values … They did so in a variety of ways and with varied and unpredictable outcomes, some of which were temporary … Based on the available data, additional claims about the meaning of those outcomes are scientifically unsupported.
The gist of the literature is that a few people might manage to change their feelings, and some can change their behavior, but most fail. In his report on the 2001 study, Spitzer argued that even a partial change in attraction after therapy should be acknowledged as significant, as it would be in evaluating a drug. But the FDA doesn’t approve drugs that work only in an unquantified, poorly defined subpopulation, based on self-reporting, when such drugs are also reported to have harmed other patients. Look what happened to Arana. After his conversion therapy, he writes, “I spent hours in front of the window of my third-story room, wondering whether jumping would kill or merely paralyze me.”
Spitzer’s study never was the smoking gun it was cracked up to be. It didn’t substantiate conversion therapy as a cure, or even as a safe treatment, for homosexuals in general. By the same token, his apology doesn’t warrant the therapy’s eradication. What he showed us, anecdotally, is that an unusual subset of highly motivated people can find ways to alter their sexual self-understanding and possibly their behavior. Those people have no grounds to say conversion therapy will work for the rest of us. And we have no grounds to say it can’t work for them.
William Saletan's latest short takes on the news, via Twitter:
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