Over the past year I have engaged in a comprehensive review of the mental health literature on the subject of homosexuality. I reviewed literature from the fields of psychiatry, psychoanalysis, psychology, and social psychology. I have also read publications from a marginalized group of counselors who have created a new field of “Christian” psychology (such as Nicolosi, 1991; Moberly, 1983; Dallas, 1991; Consiglio, 1993; and others) -- counselors who base their psychology according to their interpretations of the Bible -- a distinctly nonpsychologic and nonscientific text. The results of my review are contained in an -- as yet -- unpublished paper entitled Homosexuality: A Psychiatrist’s Response to LDS Social Services (1996). Time constraints prevent me from discussing even a tenth of the material from the original paper in this brief session.
Though the title of this paper indicates that my remarks will be directed to LDS Social Services leadership and providers, my comments are meant to reach a broader audience, addressing myths contained in the LDS-SS document which are also widely accepted as facts by many uninformed people in Western cultures, particularly those from Judeo-Christian backgrounds such as ours.
The Question of “Pathology”
History demonstrates that for psychoanalysis the answer as to whether homosexual orientation is a form of mental illness preceded the question by decades. Psychoanalysts had been writing about homosexuals and their treatment efforts to erradicate homosexuality for over 50 years before researchers such as Kinsey (1948, 1953), Hooker (1956, 1957, 1958), and Ford and Beach (1951) began to ask whether homosexuality was a mental illness in the first place. The question was especially important because by the 1950s and 1960s analysts had linked homosexuality with severe mental illnesses such as schizophrenia, obsessional disorders and severe character pathologies (see Lewes, 1995; Bieber, 1962; Socarides, 1960); disorders which simply are not present in the majority of homosexual people but which have been used to butress our society’s antihomosexual prejudices and discriminatory practices.
A couple of points need to be made: 1) Psychoanalysis, a theory and technique-driven form of psychotherapy which originated with Sigmund Freud in the late nineteenth century, dominated early American psychiatry and psychology. Analytic theory has been the only source of psychological justification for labeling homosexuality as a mental illness. However, very few of the components of analytic theory have found support in objective scientific investigations. For instance, penis envy and castration anxiety, concepts which were the starting place for the development of female psychology as well as male homosexuality, have found no support when studied using objective scientific methodology. Analytic concepts are interpretive principles more closely associated with the subjective disciplines of philosophy and literature than modern empirical scientific research (Fancher, 1995). Due to its lack of a scientific base, analysis has lost its authoritative influence in modern mental health. 2) Since it was assumed that homosexuals were mentally ill, no openly homosexual persons were allowed to enter psychoanalytic training. Therefore, homosexual persons had no voice in the formulation of psychoanalytic theory. The evidence of this missing check and balance is clear as one reads the history of psychoanalytic writings on homosexuality (see Lewes, 1995); the articles are full of angry, hostile, sarcastic descriptions of homosexual patients and their problems with an intolerable number of cheap jokes at the patients’ expense. Some analysts have gone so far as to justify and endorse violence against homosexual men and women (Silverberg, 1938). With homosexuals disenfranchised from psychoanalysis, psychoanalytic “experts” on homosexuality exercised tyrannical control over their homosexual patients and spurred hostile public opinion regarding homosexuality (for examples see Bergler, 1956 & 1959).
Additionally, all of the psychoanalytic studies on homosexuality used patients who sought treatment for a variety of symptoms or who were brought to treatment in mental hospitals or prisons. These subjects already had evidence of poor adjustment irrespective of their sexual orientations. Before Evelyn Hooker began her investigations using non-patient groups of homosexuals in the 1950s (Hooker, 1957 & 1958) it had been assumed that the homosexuals in analytic treatment were representative of all homosexuals. Such gross overgeneralizations are misleading. An analogy would be going to a Ford dealership, noticing that all the cars on the lot are Fords, then concluding that all cars are Fords. Selecting out of a population individuals who seem to share a common trait and then stating that all members of the population also share that trait is logically fallacious and yields meaningless and misleading data.
Beginning in the 1940s researchers finally began to question the psychoanalytic assumptions regarding homosexuality (see Kinsey, 1948 & 1953; Hooker, 1957, 1958, 1959, 1965 & 1968; Ford & Beach, 1951). Well designed scientific studies emerged -- studies which removed researchers’ biases from the assessment tools. Without the researchers’ distorting biases the studies conclusively demonstrated that homosexuality was not associated with any mental illness. To be sure, there are some homosexuals who also suffer from mental illness just as there are some heterosexuals who also suffer from mental illness, but there is no objective evidence that links homosexuality to any mental disturbance any more than one can link heterosexual orientation to mental illness.
Based on the numerous well designed, objective, and independently validated studies discounting the pathology-position combined with the absence of any scientifically sound evidence in favor of retaining homosexuality as a diagnosable mental illness, the American Psychiatric Association removed ‘homosexuality’ from its official list of psychiatric disorders in 1973. All of the mental health professions subsequently followed suit, including the American Psychoanalytic Association which has begun accepting openly homosexual women and men into its institutes.
Gender, Heterosexism and Sexism
Evelyn Hooker (1958, 1959, 1969) found that there is no psychopathology linked to homosexual orientation and that, in fact, there is as much psychological diversity among homosexuals as among heterosexuals. Anyone, like Hooker, who has spent time with homosexual persons finds such observations self-evident. That in 1958 Hooker's findings came as a surprise to many in the mental health professions reveals the extent to which the mental health community relied on stereotypes to form their opinions rather than interpersonal engagement as peers outside of the consulting room. Recent surveys have shown that only one-third of American adults personally know openly homosexual people (Herek, G.M., & Capitanio, J.P., in press; Herek, G.M., & Glunt, E.K., 1993). Studies have also found lower degrees of antihomosexual bias in people who know openly homosexual people on a personal basis (Herek, 1996). A Baltimore City Counselperson was recently condemning homosexuals on a radio talk show. A caller asked him if he personally knew any homosexuals and the Counselperson’s response was an indignant “No, I do not.” The caller then invited the Counselperson to meet and get to know him, his partner and a group of his gay and lesbian friends since many of the things that the Counselperson had said about homosexuals didn’t apply to him or his friends at all. Much of the antihomosexual rhetoric is produced by people who have no personal acquaintance with openly homosexual persons; their rhetoric relies on stereotypes of homosexual persons. Stereotyping a group of people who seem to share a common, undesirable trait essentially reduces complex human beings into a caricature which exaggerates perceived differences and minimizes similarities. William Green (quoted in Pagels, 1995, p. xix) points out: "A society does not simply discover its others, it fabricates them, by selecting, isolating, and emphasizing an aspect of another people's life, and making it symbolize their difference" (see also Volkan, 1994). Stereotyping is an essential feature of interpersonal and institutional discrimination and the basis of a society’s prejudice.
Fernald (1995) reviewed the mounting literature on heterosexism, a social psychology concept closely related to homophobia which is "... composed of the related but independent dimensions of prejudice, stereotypes, and discrimination. In the language of social- psychological behavior theory, heterosexist prejudice refers to negative attitudes toward (i.e., dislike of) lesbians and gay men; heterosexist stereotypes are widely shared and socially sanctioned beliefs about gay men and lesbians that are used to justify anti-gay/lesbian hostility; and heterosexist discrimination includes face-to-face overt behaviors that distance, avoid, exclude, or physically violate lesbians and gay men" (p. 82).
Social psychology studies (Thompson, Grisanti, & Peck, 1985; Dunbar, Brown, & Amoroso, 1973) have shown that the factor most predictive of anti-gay/lesbian bias is a rigid commitment to a traditional, Western culturally-based male sex role which is the basis of Western stereotypes of “masculinity” and “femininity.” Several studies (Taylor, 1983; Simmons, 1965; Steffensmeier & Steffensmeier, 1974; Rooney & Gibbons, 1966; and Jenks, 1988) conducted with heterosexual subjects have provided an image of the American heterosexist stereotype of a homosexual. Homosexual men were perceived as being stereotypically “feminine” while homosexual women were perceived as being stereotypically “masculine.” (See Herek 1984, 1986b; Levitt & Klassen, 1974; Staats, 1978; and Eliason, Donelan, & Randall, 1992.) Gay men were perceived as less aggressive, less strong, poorer leaders, more clothes-conscious, more gentle, more passive, and more theatrical, as well as less calm, less dependable, less honest, and less religious, than heterosexual men (Gurwitz and Marcus, 1978). Lesbians were perceived as more dominant, direct, forceful, strong, liberated, and nonconforming than heterosexual women who were perceived as more conservative and stable (Gross, et al., 1980). To demonstrate the power of the stereotype, Weissbach & Zagon (1975) presented a short video interview of a man to two groups of heterosexual subjects. One group was told that the man in the video was a homosexual. The subjects found the interviewee "weaker, more feminine, more emotional, more submissive, and more conventional when he was labeled gay than when he was not" (Fernald, 1995, p. 92). The perceptions of the man varied dramatically depending on whether the observer thought the man was gay or straight. Seeing the man through the filter of some preconceived stereotype influenced significantly the character traits ascribed to him by the research subjects. This is prejudice.
Similarly, by officially presenting a derogatory stereotype of a homosexual man and woman and their “dysfunctional families,” the LDS-SS document is contributing to the propagation of antihomosexual prejudice among LDS Social Services mental health professionals who are ethically obligated by specific professional ethics guidelines to eliminate prejudice from their clinical work (see Am Psychol A, 1992, Principle B: Integrity, p. 1599 & Principle D: Respect for People's Rights and Dignity, p. 1599; Block & Chodoff, 1991, p. 525; Am Psychiat Assoc, The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, 1995, Section 1, paragraphs 1 & 2).
We see another disturbing trend emerging through the social psychology studies. Heterosexist stereotypes rely on sexist stereotypes. Western sexist stereotypes of “masculinity” and “femininity” exaggerate cultural differences between men and women -- exaggerations which bias the distribution of power toward men. The sexist “feminine” stereotype describes a woman as: a follower, emotional, dependent, weak, submissive, passive, and creative, to name but a few. These are the same features attributed to gay men. The sexist “masculine” stereotype describes a man as: a leader, strong, independent, aggressive, physical, less emotional, etc. These qualities are attributed to lesbians. Thus, anti-gay/lesbian prejudice clearly is another expression of sexist prejudice. Fernald (1995) concludes: "[L]esbians and gay men, by their very existence, challenge the sexist status quo. Because sexist ideology depends on exaggerating the differences between women and men, and explaining gender differences as natural and immutable, gay men and lesbians threaten the foundation of sexism, whether consciously or not. ... Because interpersonal heterosexist attitudes, beliefs, and behaviors, coupled with institutional heterosexist rules and practices, reflect, create, and maintain male dominance as well as heterosexual privilege, any strategies aimed at reducing or eliminating heterosexism must also be concerned with reducing or eliminating sexism" (pp. 108, 110).
The LDS-SS document, in addition to statements by various general authorities of the LDS Church (see Oaks, 1995), have made traditional, Western-culture based gender-role conformity a central tenet of their antihomosexual rhetoric. In recent years the LDS Church has moved away from its more blatant sexist positions (as demonstrated in changes in the temple endowment ritual) but still insists upon the sexist-based, Western cultural conceptualizations of “masculinity” and “femininity” as universal and -- sadly -- eternal. It is upon those essentially sexist grounds that the LDS-SS document and certain church leaders and members have focused their anti-lesbian/gay rhetoric.
That various elements of sexism are institutionalized in the LDS Church, as well as other organizations whose leadership and power are assigned based first on gender, is beyond speculation and speaks more to the historical social contexts during which such institutions arose than to purposeful discriminatory bias. However, that a social prejudice wasn't obvious at one point in time confers no authority to maintain it once it has been identified as such. The more appropriate role for LDS Social Services, as the mental health branch of the LDS Church, is persistent efforts at educating church members and leaders, local as well as general, as to the detrimental effects on individuals and the institution itself of perpetuating sexist and heterosexist stereotypes in the service of maintaining the illusion of social order based on heterosexual male rule.
Sexual Reorientation Therapies
Psychotherapies attempting to change homosexual orientation to heterosexual orientation have been attempted for many years. Even with highly motivated people the results are less than encouraging. Most sexual reorientation studies report less than 30 percent of homosexual subjects achieve a heterosexual outcome, and over half of those who experience some change in their sexual orientation were bisexual at the beginning of treatment (See Haldeman, 1994; James, 1978). Anecdotes on sexual reorientation, particularly those published by the “Christian” reorientation therapists such as Nicolosi, Moberly, and Dallas, are so heavily influenced by researcher biases, flaws in design, sampling techniques and outcome measurement that, according to Haldeman’s comprehensive review of treatment outcomes, "no consistency emerges from the extant database which suggest that sexual orientation is amenable to redirection or significant influence from psychological intervention" (Haldeman, 1994, p. 224). In some people homosexual behavior, like heterosexual behavior, can be restrained for periods of time but there is no evidence that core sexual orientation can be modified through psychotherapeutic techniques.
There are several other serious flaws with the sexual reorientation studies. None of the studies compared outcomes with control groups of subjects who accepted their homosexuality. Studies exist which have demonstrated more favorable therapeutic outcomes in homosexual people who successfully integrate their homosexuality into their private and social identities (for example, see Weinberg & Williams, 1974). Additionally, not a single sexual reorientation study addressed the psychological (or spiritual) damage that occurs in the majority of subjects who fail to achieve a change in sexual orientation. Sexual reorientation therapies attempt to treat a disorder which doesn’t exist using unethical therapeutic techniques which don’t work while simply ignoring the damage they do to the majority of people who fail to change -- people who are judged by the failing therapist to be resistant, morally corrupt, unrepentant, or simply weak.
In their review of statements on homosexuality made by various general authorities of the LDS church, Bingham and Potts (1993) approvingly noted:
The Church has supported efforts of the LDS Social Services and other consulting professionals to research the issues and to offer a reparative therapy approach which assumes that homosexual behavior can be changed. (p.14)
By “the Church” I suspect that Bingham and Potts are referring to a small number of general church leaders who have been unusually outspoken in voicing their sexist and heterosexist biases as if they were doctrine and -- perhaps worse -- as if they were science. “The Church," which has no authority in professional, scientific matters, has declared homosexuality a curable mental illness and has required LDS Social Services to agree. Because such biases have been recognized as incompatible with the ethical practice of mental health, all of the mental health professions have included specific warnings against these biases in their ethics guidelines (see Am Psychol A, 1992, Principle B: Integrity, p. 1599 & Principle D: Respect for People's Rights and Dignity, p. 1599; Block & Chodoff, 1991, p. 525; Am Psychiat Assoc, The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, 1995, Section 1, paragraphs 1 & 2). In order for LDS Social Services “to offer a reparative therapy approach which assumes that homosexual behavior can be changed,” they had to leave the mainstream of the mental health professions and shop around for anyone whose own prejudices match those of “the Church” no matter how unjustified, antiquated, unscientific, ineffective, harmful and unethical their beliefs and practices may be. This unfortunate collusion has compromised the scientific integrity of LDS Social Services and -- by extension -- the LDS church; a retreated, closed, propagandistic and anxiety-maintained position which is untenable for a people whose prominent motto is "the glory of God is intelligence."
We may ask: If a majority of people in a society agree that certain groups of people are undesirable, why should we fight against such an attitude? There are a number of reasons why we should fight against socially sanctioned hate and discrimination, not the least among them being the example of one Gallilean Jew who dined with publicans, associated closely with women, defended and befriended prostitutes, and ministered to Samaritans -- hated, demeaned, subserviant or simply ignored out-groups of the culture of his day, for which he was derided and chastised even by his closest associates and disciples. It is he whom we recognize as The Judge. It is his example we seek to emulate -- including his manner of judging (or, as he has wisely commanded, not-judging -- withholding the impulse to judge and condemn one's fellow human beings -- the remedy for prejudice and a corrective for pride). I make this point to demonstrate that the LDS Church (or its members) discriminating against any group of people according to stereotypes and prejudices is incompatible with core LDS beliefs. Indeed, we are obligated morally to weed-out of society and the church lies which perpetuate attitudes and actions of hate. LDS Social Services should be at the forefront of this struggle, using insights gathered from the mental health and social sciences to help "perfect the Saints" by eliminating such individually and collectively corrupting falsehoods rather than distort knowledge and facts to justify oppressive standards and norms.
There are several tasks which need to be accomplished by LDS Social Services:
As a matter of personal and professional integrity, firmly commit to the principles of ethics established by the mental health professions to which LDS Social Services providers belong.
Any mental health professional whose personal feelings or biases toward a patient or class of people cannot be contained is obligated ethically to seek out supervision or consultation or refrain from treating such people.
Carefully read (or read again) the abundant scientific literature on homosexuality even if it seems to contradict one’s personal biases. Critically assess all literature according to the objective standards accepted by the scientific committees of the various mental health professions.
Be willing to reevaluate one’s own biases and prejudices. This is an opportunity for personal and professional growth.
As an obligation to one’s society, use insights gained through one’s professional and personal development to combat social prejudices and discrimination.
Do not make the mistake of denying any church leader his humanity. Psychology has taught us that we all have conflicts, fears and unfounded biases -- conscious or otherwise -- which influence our thoughts and behavior; it is not fair to church leaders to assume that they do not. They, too, are in need of growth experiences.
Refrain from utilizing stereotypes in clinical and personal endeavors. Each personal and professional encounter with another human being is a chance to learn and share on equal grounds with someone as complex and deserving of respect as oneself. Emmerson said: “The sign of a true scholar is that in every man there is something wherein I may learn of him. In that, I am his pupil.” This humble approach to one’s clinical work and interpersonal engagements can only better oneself as a clinician and as a human being.
Since only one-third of Americans know an openly homosexual man or woman, an important way to challenge one’s own culturally-sanctioned heterosexist prejudices is to associate with openly homosexual persons on equal social footing rather than as a leader, therapist, or otherwise social judge. Stereotypes lose their validity when confronted with the whole reality of another human being.
This list of suggestions is a starting place. Prejudice, hate and discrimination against people whom we don’t know and don’t understand prevents mutually beneficial interactions. There is much we can learn about our common humanity if we can get past the tendency to reject those who think, feel, love or believe differently or who come to represent aspects of ourselves which we may wish to banish. Christ taught that God is love. Let us recommit to honoring this principle in our personal and professional endeavors.
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