Beyond Critique

Beyond Critique London 30 January 2013

Two documents:

1. Submission by Royal College of Psychiatrists
LGB ‘Special Interest Group’ to Church of England’s
Listening Exercise on Human Sexuality (2007)

2. UKCP’s Ethical Principles and Codes of
Professional Conduct: Guidance on the Practice of
Psychological Therapies that Pathologise and/or
Seek to Eliminate or Reduce Same Sex Attraction


First Document:
Submission by
Royal College of Psychiatrists
‘LGB Special Interest Group’ to
Church of England’s Listening Exercise on Human
Sexuality (2007)


Royal College submission to Church of England

“Psychiatry and LGB People”

Concise, readable, impressive document:
- Authoritative source
- No fewer than 19 scientific papers cited
- Without peer in UK? [‘Best of breed’]
- Because the case is set out in writing,
we can analyse it


1. History of Psychiatry with LGB People

Ref 1 (King & Bartlett)
- King and Bartlett’s description seems fair
- history of science and HS
- from ‘deviance’ to ‘illness’ (to ‘normal’)
- a good description of what has happened

Note how science reflects
the prevailing paradigm in society


2. The Origins of Homosexuality

Two versions of the text
Both say causation of HS is “biological”, but they define this in two
different ways

Original Submission to Revised version
Church of England (2007)

“Genes and hormones” “Genes and/or hormones”

Why did Royal College make this change?



Royal College says, “... no substantive evidence to support the
suggestion that ... early childhood experiences play any role in
the formation of a person’s fundamental heterosexual or
homosexual orientation. It would appear that sexual orientation
is biological in nature, determined by a complex interplay of
genetic factors and the early uterine environment” (ie genes and
hormones).
[Or “genes and/or hormones”, as noted earlier]


But there is much evidence of environmental causation:
- Large Danish study (Frisch et al) found “childhood family
experiences are important determinants of heterosexual
and homosexual marriage decisions in adulthood.”
- Laumann et al say that if homosexuality were randomly distributed,
this would fit a genetic/ biological explanation.
But “that is exactly what we do not find.”
- Twin studies show that if one identical twin is gay, the other usually
is not. This suggests environmental factors, not biology.

Why did the Royal College omit discussion of twin
studies?


Royal College’s three citations to prove ‘biological cause’

Ref 2 (Bell & Weinberg 1978)

- this study does not address the issue of causation

Why did the Royal College cite this study?



Royal College citations to prove ‘biological cause’

Ref 3 (Mustanski et al 2005)

- Looking for causal linkages between human genome and HS
- found nothing!


Beyond Critique London 30 January
2013


Royal College citations to prove ‘biological cause’

Ref 4 (Blanchard et al 2006)
- boy who is left-handed more likely to be gay
- boy who has older brother ditto
- but boy who is both, not more likely to be gay

They conclude:
- either the two factors cancel each other out
- or they create a ‘toxicity’ which may kill child in the womb


2. Origins of HS – Summary of the three studies

- Bell & Weinberg didn’t address the issue
- Mustanski found no genetic linkage
- Blanchard study is like science fiction

This is all the evidence for ‘biological’ causation
offered by the Royal College of Psychiatrists

Why did the Royal College cite these studies?


3. LGB M ental Health Problems
Why elevated levels of mental illness among LGB?

Royal College (2007) Scientific Answer 1: Gilman et al 2001 (Ref
Version 6)

Discrimination in the precise causal mechanism at this point
society ... means that remains unknown. Therefore, studies are
some LGB people needed that directly test mediational
experience greater than hypotheses to evaluate, for example, the
expected mental health relative salience of social stigmatization and
and substance abuse of psychosocial and lifestyle factors as
problems potential contributors



Royal College (2007) Scientific Answer 2: Bailey et al 1999 (Ref 7)
Version
Discrimination in “... many people will conclude that
society ... means that widespread prejudice against homosexual
some LGB people people causes them to be unhappy or worse,
experience greater than mentally ill. Commitment to [this position]
expected mental health
would be premature, however, and should
and substance abuse
problems be discouraged . In fact, a number of
potential interpretations need to be
considered ...


Royal College (2007) Version Scientific Answer 3: Mays et al 2001
(Ref 8)

Discrimination in society ... “it is unclear whether the greater risk
means that some LGB people for discriminatory experiences, if it
experience greater than does exist, can account for the
expected mental health and observed excess of psychiatric
substance abuse problems morbidity seen among lesbians and gay
men”



Royal College (2007) Version Scientific Answer 4: King et al 2003
(Ref 5)

Discrimination in society ... It may be that prejudice in society
means that some LGB people against gay men and lesbians leads to
experience greater than greater psychological distress ...
expected mental health and Conversely, gay men and lesbians may
substance abuse problems have lifestyles that make them
vulnerable to psychological disorder.
Why does the same scientist express one view to the scientific
community and a different view to the Church of England?

4. Stability of Gay and Lesbian Relationships
Why are LGB relationships so unstable?

Royal College (2007) Scientific Answer 1: McWhirter & Mattison (Ref 9)
Version

A large part of the The book, The Male Couple by the same authors says,
instability in gay and “... all couples with a relationship lasting more than
lesbian partnerships five years have incorporated some provision for
arises from lack of outside sexual activity in their relationships.”
support within
society, the church Any ‘durability’ in gay relationships thus requires non-
or the family. monogamy rather than support from society.



Royal College (2007) Version Scientific Answer 2: Kiecolt-Glaser 2001
(Ref 10)

“There is already good “Contemporary models of gender ... furnish
evidence that marriage confers alternative perspectives on the differential
health benefits on costs and benefits of marriage for men’s and
heterosexual men and women women’s health.”
and similar benefits could [ie The benefits of marriage are gender-
accrue from same-sex civil specific]
unions. “



Royal College (2007) Version Scientific Answer 3: Johnson et al 2000
(Ref 11)

“There is already good evidence Study confirmed the benefits of marriage
that marriage confers health but did not include same-sex couples, so
benefits on heterosexual men and no evidence of benefits for them.
women and similar benefits could
accrue from same-sex civil unions.“



Royal College (2007) Scientific Answer 4: King, Bartlett 2006 (Ref 12)
Version
“There is already good “We do not know whether gay male, same sex
evidence that marriage relationships are less enduring because of
confers health benefits on something intrinsic to being male or a gay male,
heterosexual men and the gay male subculture that encourages multiple
women and similar partners, or a failure of social recognition of their
benefits could accrue relationships. The ‘social experiment’ that civil
from same-sex civil unions provide will enable us to disentangle the
unions. “ health and social effects of this complex question”


5. Psychotherapy and reparative therapy

Royal College (2007) King et al 2007 (Ref 13)
Version
“Therapist may wrongly “Both therapist and client need to be aware of
regard HS as root cause of the dominant discourses and stereotypes in the
any depression, anxiety LGBT world, because, if they fail to do so, the
etc.“ possibility of collusion and shared assumptions
may limit the depth and utility of the therapy.”

“... no randomised trials of effectiveness of ...
(gay affirmative) treatments”.


- Is change possible? Is it harmful?
Royal College (2007) Version Bartlett, King & Phillips 2001
(Ref 14)
“A small minority of therapists will even go so far But the study used
as to attempt to change client’s sexual orientation. -no measures of harm, and
Can be deeply damaging … no evidence that such - no measures of change.
change is possible … no randomised clinical It’s just opinions of certain
trial...” therapists.
BUT: Jones & Yarhouse in 2007 published the best study to date. They “contradict
the commonly expressed view ... that change of sexual orientation is impossible
and that the attempt to change is highly likely to produce harm ...”.
[They used a validated measure of psychological distress to assess harm, but
found benefit rather than harm. Study was updated in 2011 with similar results.]

- The Spitzer study

Royal College (2007) Version
Why are LGB relationships soSpitzer 2003 (Ref 15)
unstable?

The study “claimed that The study actually said,
change was possible for
- a small minority (13%) of - majority of participants gave reports
LGB people, of change
- most of whom were - from a predominantly or exclusively
bisexual at outset.” homosexual orientation before
therapy
The Royal College misrepresents both starting point
and findings of Spitzer study

- The Shidlo and Schroeder study

Royal College (2007) Version Shidlo & Schroder 2002 (Ref 16)

Study showed ‘little effect as 61% found some help
well as considerable harm.’ 85% found some harm
46% found both help and harm
No measures of effect or help/ harm
were used (as study was retrospective)
A goal of this study was ‘that consumers can make an increasingly informed
choice about engaging in conversion therapy’. This goal is now denied to
clients



Royal College (2007) Oral History (Professionals’ views) King et al
2004 (Ref 17)

Treatments in 1960s and 1970s The practices of this period are no
were very damaging and affected longer relevant to the present debate.
no change in orientation
“Only a small minority believed that current practice denied people
distressed by their homosexuality an effective means to change their
sexual orientation”.
How different today!



Royal College (2007) Oral History (Patients’ views) King et al 2004 (Ref
18)

Treatments in 1960s and As before, the practices of this period are
1970s were very damaging no longer relevant to the present debate.
and affected no change in
orientation
A poignant comment from the study:
“Many participants felt they lacked parental affection
during childhood and adolescence”


Royal College (2007) Haldeman, Gay Rights, Patient Rights 2002 (Ref 19)

People are happiest ... ... gay-affirmative therapists need to take seriously the
when they are able to experiences of their religious clients, refraining from
integrate the various encouraging an abandonment of their spiritual
aspects of the self as traditions in favour of a more gay-affirming doctrine or
fully as possible discouraging their exploration of conversion
treatments.
Haldeman’s conclusion: ”...we must respect the choices of all who seek to live
life in accordance with their own identities; and if there are those who seek to
resolve the conflict between sexual orientation and spirituality with conversion
therapy, they must not be discouraged. It is their choice ...”
[NB Ref 19 is omitted from revised version of text]

Summary of Royal College of Psychiatrists Document
Royal College Submission 2007 Comment

1. History Church and society have caused much hurt

2. Origins of Homosexuality None of 3 papers supports ‘biological’ theory

3. LGB Mental Health Problems Science doesn’t say, “It’s mostly Society’s fault”

4. Stability of Gay Relationships Ditto

5. Reparative therapy “No change is possible” and “great harm”
arguments are not supported by science

Royal College of Psychiatrists needs to revise its Church of England submission


Second Document:

UKCP’s Ethical Principles and Codes of Professional
Conduct:
Guidance on the Practice of Psychological Therapies that
Pathologise and/or Seek to Eliminate or Reduce Same
Sex Attraction


UKCP offers a questionable code of ethics and is
unwilling to address some important questions:

I tried and failed to bring a formal complaint against the
UKCP regarding its ethical document:
Guidance on Therapies that Seek to Reduce Same Sex
Attraction


Two hypothetical case studies:

• A young man has a lady friend whom he would like to marry. He
is concerned, however, that he experiences same-sex
attractions which he fears might derail the relationship. He is
reluctant to risk getting married and would like help in reducing
his same-sex attractions.

• A woman is married with two children. She falls in love with
another woman and is torn between leaving her family or
staying. She would like help to reduce her same-sex attraction
to keep her family intact.


UKCP’s blanket ruling:

“agreeing to the client’s request for therapy for the reduction of
same sex attraction is not in a client’s best interests” (2.1
- 1.1(a))

Hypothetical Client Responses:

The man takes this news badly and goes into depression.
The woman accepts the therapist’s explanation and leaves her
husband and children.


UKCP’s justifying argument (1):

“There is overwhelming evidence that undergoing such
therapy is at considerable emotional and psychological
cost.” [2.1 – 1.1(b)]

My question:
Where is this “overwhelming evidence”?
Can they name any study that has followed clients
prospectively, administered generally accepted psychological
tests to measure distress, and proved that, on average, harm
is caused?



To offer treatment that might ‘reduce’ same sex
attraction would be “exploitative” as “to do so would be
offering a treatment for which there is no illness.”
1.3(e)

My question:
How does that apply to my two examples where neither
is described as “ill”? Treatments are not
prescribed only for illness.



It is not a sufficient defence for a therapist to argue that
… they were acting in the client’s best interests, or according
to the client’s wishes and autonomy, as offering such
therapy would be ... reinforcing their externalised and
internalised oppression and likely to cause harm

My question:
How is desire to reduce SSA to save one’s family a
sign of oppression – external or internal?


UKCP’s conclusion:

Based on the above considerations of ethical practice ... the
following are incompatible with UKCP’s Ethical Principles and
Code of Professional Conduct:
- Offering ‘Sexual Orientation Change Efforts’ ... or similar therapies
3.1 (ii).

My observation:
In the light of the explanations given in the code of conduct, it
seems to me rather that the blanket refusal of therapy is a form
of oppression


My Questions to UKCP

1. Are the client requests in examples reasonable?
2. What evidence shows that “agreeing to the client’s request for reduction of same sex
attraction is not in a client’s best interests” – that is to say, that there are no cases in which such a
client request should be honoured.
3. Do you think Drescher, Shidlo & Schroeder 2002 has “shown that agreeing to the
client’s request for therapy for the reduction of same sex attraction is not in the client’s best
interests”?
4. Can you give references to high quality scientific research which shows “overwhelming
evidence that undergoing such therapy is at considerable emotional and psychological cost.”
Such evidence would need to be better than that of Jones & Yarhouse who found to the contrary.
5. In the context of the two examples, can you explain how it would be “exploitative” for a
therapist to offer treatment that might ‘reduce’ same sex attraction“?
6. Are there no circumstances in which UKCP permits therapists to offer treatments “for
which there is no illness”?
7. How is the desire to reduce same sex attractions in order to protect one’s family a sign
of “oppression?
8. Is the denial of a client’s request to receive help to achieve these life goals based on
scientific evidence that is of such a high standard as to warrant denial of this basic human right?

Narrative of UKCP’s failure to address my questions:
Jan/ Feb 2012: I asked BPA (affiliated to UKCP) to answer questions on the above issues. They said
I should contact UKCP re ‘their’ ethical principles.
8th Feb 2012: I wrote to Prof A Samuels (then Chair of UKCP). He did not reply.
27th April 2012: I wrote to UKCP asking to bring a formal complaint against them using their official
complaint procedures.
30th April 2012: UKCP replied that the issue was ‘a matter of opinion and not a complaint or human
rights issue’ they would not take it further.
15th May 2012: I reiterated my wish to make a complaint, saying that it was a matter of human rights
for clients who were refused therapy.
24th May 2012: UKCP replied reaffirming that my view represented a ‘different opinion’ which did not
constitute grounds for complaint.
30th May 2012: I wrote back that UKCP was contravening a client’s ‘right to choose’. I received no
reply.
17th July 2012: I wrote to the newly appointed Chief Executive of UKCP referring to my previous
correspondence and asking that the document setting out ethical principles regarding reparative
therapy should be revised. (Copied to my MP).
18th July 2012: He replied that my arguments were adequately addressed in the eethical guidance.
18th July 2012: I pointed out that my arguments were mainly in the form of questions, which had not
been answered. He did not reply.

Conclusions

The Royal College of Psychiatrists seeks to justify the narrative
that homosexuality is biologically caused, that change is
impossible, and that the attempt to change is harmful. Yet the very
scientific studies to which it appeals do not support this narrative.
The UKCP simply assumes the truth of this narrative and refuses to
hold its opinion up to the light of science, yet threatens to discipline
any of its members whose therapeutic practice is based on a
‘different opinion’.

Justice demands that these positions be carefully critiqued
in the light of the best science, in the interests of clients
who wish to be helped to reduce same-sex attractions,
and therapists who are willing to help them.

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