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Give Us Your Opinions: What Should The APA Symposium Have Looked Like?

Jim Burroway

May 14th, 2008

Yesterday, I wrote about the deficiencies I saw in the make-up of the canceled APA Symposium, “Homosexuality and Therapy: The Religious Dimension.” Dr. David Scasta, the organizer of the symposium, saw my piece and left a thoughtful comment. I want to raise that comment in this post and ask you to share your thoughts on what a useful symposium might look like.

One important thing to remember is this: The symposium was not structured as a “debate.” I didn’t call it that in my post, but I didn’t clarify what it was exactly. It wasn’t a debate. Each participant had a topic on which they would talk on for a few minutes, and then questions would be entertained from the audience — at least that’s how I understand it.

Here is Dr. Scasta’s comment:

Dear Mr. Burroway,

I have read your observations regarding the symposium which I organized. Let me first complement your organization for its stated goal because it could easily be used as a mantra for the symposium. I have taken the liberty of repeating such verbatim because I think it is so well put:

“In the heat of the debate, several things have been lost. We’ve lost the ability to look at the situation calmly, rationally and with civility. We’ve lost the ability to oppose other viewpoints without demonizing those who hold them. We’ve lost the ability to know who is telling the truth and who is practicing deception or spreading falsehoods. We’ve lost the ability to treat each other with respect and dignity. We’ve lost a lot. Box Turtle Bulletin exists to help address this problem. I hope to shed some light, with honesty and integrity, and without rancor. I hope to earn your trust in what we report, and your respect in how we report it.”

I have been distressed that the media hype has so grossly mischaracterized the symposium. The symposium was portrayed unfortunately as a “debate.” All of the panel members on the symposium agreed that it was not to be a debate and that our goal was to be able to present our views in a collegial way that opened discussion instead of angry debate — exactly what the Box Turtle stands for.

All on the panel have also shown a willingness to make some concessions in their belief system when they are presented with new information and perspectives. Dr. Throckmorton, for instance, has distanced himself from his film, “I Do Exist.” A few copies are still available for historical purposes but he has clearly changed some of his views about the appropriateness or likelihood of change. By the same token, I have called into question some of the “scientific facts”” in the film that I helped to fund and create: “Abomination: Homosexuality and the Ex-Gay Movement.” It is not that I do not support the message of the film (that gay people of faith who go through reparative therapies become free when they shake off the chains of dogma and discover an accepting God). It is just that one of the studies seems to imply more “science” than is justified — a point that was effectively pointed out by Dr. Throckmorton. Dr. Mohler has taken extensive heat among his Southern Baptist constituency for suggesting that homosexuality might not be a choice. His concept that a cure for homosexuality should be sought, in the same way that a cure is being sought for Huntington’s chorea, is a concept which deserves fuller discussion. Perhaps as a physician I can give him a different perspective. Whether or not my arguments are persuasive, I can tell you that I have no doubt that Albert Mohler will give me a full and fair hearing and will respond with both insight and incisive thinking. And, he will put me to my proofs. I also believe that, if he is persuaded otherwise, he is the type of person who has the strength and moral fortitude to stand up for what he believes, even when it contradicts what he is “suppose” to believe.

The goal of the symposium was not to settle questions about reparative or change therapies. I do not know where you got the information that the panel was a “response to the APA’s decision to form a working group to review its stance on ex-gay therapy.” This statement is false — completely false. The Assembly of the APA (the legislative body of which I am a member) has asked that ALL position statements be reviewed and updated every five years. We are going through that process now. I sit on the Committee on Gay, Lesbian, and Bisexual Issues of the APA which is reviewing all of the statements related gay and lesbian issues. I can assure you with absolute certainty that the APA does not have a working group to reassess its view on ex-gay therapy and there is absolutely no desire in my committee to change the current stance. My symposium would have addressed how religion colors therapy with gays and lesbians as a separate dimension from therapy; it would not have posited any substantive change in APA position papers on the subject. I have the advantage of knowing the positions that the panel speakers would have taken. It is unfortunate that I was compelled to withdraw the symposium because I believe that rational people would realize that the ultimate outcome of the symposium would have been less change therapy, not more, if it had been allowed to proceed.

The issue is not over. There are still legions of lesbian and gay people of faith who say to mental health professionals, “I understand that mental health professionals believe I should accept myself as I am; but, if I do that, I am damned.” It is my goal to find a path out of that conundrum. To do so, we have to begin talking respectfully and rationally with people of faith — including some former enemies. It is time to stop preaching to the choir; but rather to enter into the lions’ den — and tame lions. If your are truly committed to Box Turtle’s goals of talking reasonably to our opponents without demonizing them, we are uncannily on the same page and I ask you for your help and guidance with this project.

David Scasta, M.D., DFAPA

Scasta, D. (2007). “John E. Freyer, M.D., and the Dr. H Anonymous Episode.” Ch. 1, in Homosexuality and American Psychiatry: An Oral History. (J. Marino and J. Drescher, Eds.). Haworth Press; New York

Scasta, D. (1998). “Historical perspectives on homosexuality.” Journal of Gay and Lesbian Psychiatry. 2(4):3-17.

Scasta, D. (1998) “Issues in helping people come out.” Journal of Gay and Lesbian Psychiatry. 2(4):87-98.

Scasta, D. (1998) “Moving from coming out to intimacy.” Journal of Gay and Lesbian Psychiatry. 2(4):99-111.

So readers, here’s the question: If you think a symposium with participation from both sides is a good thing (and I think it is), what do you think should be the makeup of such a symposium? I’ll offer my thoughts later today in the comments to this post.

Discuss! I am especially interested in input from those who support the goals of sexual reorientation therapy as well as those who are opposed. But as a corollary, and to ensure people feel safe in providing their thoughts on the subject, I will ask that everyone be respectful per our Comments Policy.

Comments

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Timothy Kincaid
May 14th, 2008 | LINK

I think the panel as constructed had good choices. But I don’t think that it was adequate to address what is the undoubtedly going to be at the heart of most questions: 1) is sexual orientation innate and is it immutable? 2) what should a “Bible believing Christian” who experiences same-sex attration do?

My first concern is whether Dr. Mohler acknowledges the existence of sexual orientation. Often conservative evangelicals hold to the dogma that orientation is nothing other than confusion and temptation to sin. Often they believe – based on entrenched theology – that all persons are heterosexual if the homosexual temptation were stripped away.

If Mohler seeks to bring this theological argument to the table, then there can be no meeting of the minds. There is no common place, facts become irrelevant, “all things are possible”, and the only discussion can be about religious ideology – a discussion that is never convincing and goes nowhere.

Until there is agreement that some persons will always and only be attracted to the same sex – regardless of efforts or programs or intentions – then we cannot discuss what is morally appropriate for such persons. And until we acknowledge that this “some persons” includes the vast majority of those who go through reorientation efforts, then we can’t discuss the church’s morality (or lack thereof) in demanding that they try.

I agree with Jim that the symposium must have someone well grounded in the current state of research. There must be someone who knows the flaws of the way J&Y was presented, who knows the failure rate of ex-gay ministries, and who knows the limitations of the way that ex-gays use the word “change”.

They must be someone who doesn’t chant the mantra of “born gay” or insist on genetic determination, but instead who is familiar with the limitations of the twin studies, the peculiarity of x-chromosome activation in mothers, the recurring observation of the fraternal birth order, the limited predictability based on gender nonconformity, the sheep research, the hypothalamus work, etc., and do so recognizing the contributions and flaws of each.

Finally, presenting Mohler and Robinson as contrasting voices serves less to demonstrate pro and anti-gay Christian positions than it does to present liberal and conservative Christianity.

It is pointless to tell some Southern Baptist kid that to be gay he must become Episcopalian. If he already shares Robinson’s theology, he doesn’t need what the symposium provides. If he doesn’t share Robinson’s theology, he gets nothing from his presence on the panel. To a conservative evangelical, Robinson might as well be a Buddhist or a Sikh for all the religious authority he brings.

There should be someone included that is of conservative evangelical background that also has embraced inclusive theology.

Jarred
May 14th, 2008 | LINK

If he already shares Robinson’s theology, he doesn’t need what the symposium provides. If he doesn’t share Robinson’s theology, he gets nothing from his presence on the panel. To a conservative evangelical, Robinson might as well be a Buddhist or a Sikh for all the religious authority he brings.

While you make a valid point, it also suggests that the very title of the symposium is a misnomer. Perhaps it should have been called “Homosexuality and Therapy: The Christian Dimension.” After all, there are more religions than Christianity. And people from some of those other religions also have to deal with this issue.

Bruce Garrett
May 14th, 2008 | LINK

His concept that a cure for homosexuality should be sought, in the same way that a cure is being sought for Huntington’s chorea, is a concept which deserves fuller discussion.

I’m trying to wrap my head around this and I just can’t. Mind you…it isn’t what is a fuller discussion with someone who thinks my sexual orientation is like a terrible disease that destroys a person’s control over their body and progressively impairs their mental abilities. It’s how do I, a homosexual, have a discussion with someone who wants to eliminate my kind from the human race? That’s what you would want to do with Huntington’s I presume. Eliminate it. Destroy it. Eradicate it. What he’s saying there is homosexuality is like that in the eradication part, if not so much the destroy the body part. Although he may be saying that too.

How, tell me how, do you have a Discussion with someone who does not recognize your right to exist? Not, mind you, the inevitability of your existence, akin to Christ’s “The poor will always be with us…”. But simply and utterly that the human race would be better off if your kind did not exist. How?

I’m not saying you can’t talk with people like that. I’m not saying you shouldn’t talk with people like that. I’m not saying you have to scream in their faces. But it’s not discussion, it’s confrontation. It may be angry or it may be low key but it is not discussion. It will never be discussion as long as they think we ought not to exist…never mind that they see disease whenever they look at us…because their basic premise regarding us is irreducibly confrontational. When the answer to “how do we all get along together” is ultimately, “you have to be gone”, there isn’t a whole lot of room for discussion. There are however, an entire carnival of opportunities to convince yourself that you are engaging in useful dialogue when you aren’t.

I don’t think anyone who has even casually glanced at the ex-gay movement doesn’t understand that there is a significant religious component to it, and to the issues surrounding it. But science cannot provide an answer to the question of whether or not a homosexual is damned because those questions are beyond the scope of science. All science can do is tell that person that there is nothing either physically or mentally wrong with them and that is because that is what all the evidence indicates.

If a therapist sees their job as helping a patient struggle with their faith then I would suggest they take up the clergy and go find themselves a pulpit. Yes…absolutely…there are places within us that may need the healing only a spiritual guide can provide. Do we allow clergy into hospitals and nursing homes and anywhere doctors see to the needs of the sick and injured, to minister to their spiritual needs? Yes. Of course. And we must. There is more, much more to a human being then flesh and blood and bone. But a clergyman cannot for obvious reasons prescribe medicine and practice surgery and neither should a doctor be prescribing any particular religion.

So I am still left with the basic question as to what this symposium was supposed to accomplish, other then giving some gloss of scientific legitimacy to what by all the evidence is akin to snake oil. Will the AMA follow up with symposium on faith healing next? I’m not saying we shouldn’t be talking to the other side. But context is important. All that science can say at the moment to the ex-gay movement, insofar as I know, is: “no, it doesn’t work”. Or, charitably (very Very charitably), “It works only as long as you stay in.”

I appreciate that this leaves some patients in fundamentalist faiths in a bad place. But it is not the province of therapists to guide them toward a resolution of the religious issue, particularly when their doing so would give a gloss of medical authority to that which has no scientific basis. Or are doctors now supposed to recommend faith healers for illnesses that medicine cannot cure.

But if there has to be an APA sponsored symposium on this issue, I would politely suggest that it include gay people in it (per your post yesterday) and survivors. After all, it is About Us Isn’t It. Also, and critically, that Everyone on the panel is someone who is willing to respect the evidence. It is not too much to ask that the parties to a symposium sponsored by a major healthcare profession be respectful of the evidence. It’s okay to ponder what we don’t know. It’s okay to question what the evidence really shows. Everyone is entitled to their own opinion. Everyone is not entitled to their own facts.

Virginia Stephenson
May 14th, 2008 | LINK

I think that sitting down with one’s adversary is always useful, especially under pledge to not judge, condemn or disrespect others. The problem is that folks who believe that the Bible is literally true have a tendancy to frame their arguments in an “us and them” way, which normally carries the discussion into acrimony. As a former conservative Christian minister who discovered to my surprise years ago that I was transgender, I have found it easier than some to have compassion on the rightwing, since at one time I was there.
Even so, with every month carrying a story about another Christian who has either come out, or has decided to minister at open and affirming churches, the breach that has been created through literalism may be coming to a close. If we can help that process, we must.

Mike Airhart
May 14th, 2008 | LINK

For a balanced, clinical discussion of gay counselees, religion, and reputable therapy, I suggest:

1. Balance of counselees. Include counselees for whom various types of therapy were ineffective or harmful. Do not include counselees who are employed or contracted by partisan organizations.

2. Maintain therapeutic independence. Do not invite special interests who advance their own therapies or who have a track record of half-truth and evasiveness regarding key concerns. Confine the discussion to informed and independent analysts.

3. Maintain counselee independence. Do not include counselees that are employed or contracted by ex-gay programs or partisan organizations.

4. Maintain religious expertise, independence, and moderation. Include Jews and other non-Christians who have professional knowledge of the pros and cons of various counseling and therapeutic approaches and who do not impose their own religious or ideological biases upon counselees.

I.e., do not invite religious reps who implicitly damn counselees to hell, who pursue political coercion to force people into counseling, or who encourage discrimination and ostracism of counselees who do not change.

Do not invite affirmative religious reps who are uninformed about current and antiquated therapies.

5. Define the symposium in careful written detail so that it cannot easily be misrepresented by antigay organizations, and establish a facility to aggressively and publicly challenge misinformation.

6. Do not ignore warning signs. If a participant says that the symposium is being misrepresented and exploited by Focus on the Family, do something about it.

7. Line up enough participants so that when a few drop out, the symposium remains fair, balanced, and free of partisan misuse of religion.

cowboy
May 14th, 2008 | LINK

Bruce Garrett typed:
“…So I am still left with the basic question as to what this symposium was supposed to accomplish,…”

I have the same concerns of Mr. Garrett and applaud his comments!

The symposium would have been a publicity stunt and I can’t see this accomplishing anything fruitful. Even if such a symposium were shown on prime-time TV all it would accomplish is creating a fresh set of topics to discuss at the office water cooler.

That, and what are the group of gay Mormons expecting to accomplish by meeting with their Prophet this coming August? The Prophet T. S. Monson is fully aware of the issues on both sides (or he wouldn’t be much of a Prophet/Leader) and I predict there won’t be any “revelations”. So, it’s not worth it.

The same goes for Soul Force and what they are doing. Will it help gays in who are still in the closet? Maybe. Will all this further the cause for gay equality? I’m not so sure.

Jim Burroway
May 14th, 2008 | LINK

Well, I was going to let this thread get started before I put my two cents in, but I find practically impossible to add to what Mike Airhart has written. Thanks, Mike.

I’m reminded of the 1972 symposium which featured Frank Kameny, Barbara Gittings and “Dr. H. Anonymous” (Dr. John E. Fryer). That symposium, along with Dr. Robert Spitzer’s efforts, was a landmark in the APA’s coming to grips with homosexuality as non-pathology. When psychiatrists were able to see and hear homosexuals who were not in a clinical setting, it represented a major step in their understanding of the broader implications of homosexuality remaining in the DSM.

I think we’re at the same level here with regard to those who have tried to undergo sexual reorientation (or “sexual identification” as some have put it) therapy. The fact is, that even with the J&Y study which was conducted by ex-gay enthusiasts, only very few experienced “satisfactory” change — and one of those lied out of wishful thinking.

Since those who claim to change are in such a minority (and so many of them are vocationally tied to ex-gay ministries), it is far more imperative that we examine the much larger population of those who fail to change.

I think a 1972 “Dr. Anonymous” style forum is needed first, before we can begin to address any other issues. Almost nothing is know about those who have “failed”. Other than Shidlo & Schroeder’s 2001 study, there is nothing in the literature about their experiences.

Shidlo & Schroeder’s facts and figures however are no substitute for first-hand accounts of what many of these clients go through. We at Box Turtle Bulletin, as well as our friends at Beyond Ex-Gay, have been assembling some of these stories.

I am frankly dumbfounded at some of the things I’ve learned in the very short time (10 months) I’ve been actively seeking out ex-gay survivors to hear their stories. Before then, I really had no clue about what was going on, and I don’t believe very many others do either.

This is why I found Dr. Throckmorton’s suspicions of last summer’s ex-gay survivor gathering so surprising. It is also why I now find his continuing to sell “I Do Exist” (for “historical purposes” — do customers really buy this video for its historical perspective?) so especially disappointing.

I really believe it is very important for clinicians can hear these survivors’ voices firsthand. After all, a discussion about the clients’ best interest really can’t be expected to be very well informed unless we understand who the clients are and what they’re experiencing.

Zeke
May 14th, 2008 | LINK

Between what Bruce Garrett had to say and the brilliant list of parameters that Mike Airhart presented, there is NOTHING I could add.

Hear, hear gentlemen!

Jim Burroway and Timothy Kincaid, thank you so much for this forum, where these thoughtful, intelligent and civil discussions can take place. Thanks for all the time, energy and thought that you put into this site. I read it every day. You are doing yeoman’s work here.

Thank you, thank you, thank you!

Ephilei
May 14th, 2008 | LINK

I think the heart of the discussion should center around this point from Scasta: “I understand that mental health professionals believe I should accept myself as I am; but, if I do that, I am damned.” In light of that, I think there are a series of questions that should be asked by the APA and answered by the symposium: basically, what is really the conflict and how can we resolve it?

1 What is the problem? How much does the Christianity really prohibit concerning homosexuality? The Bible (seems) to prohibit sex explicitly. What about lust? Attraction? Love? Hugging? Dating? Orientation? What are forgivable sins, damning sins, non-sinning unpleasantness, neutral, positive? I think only anti-gays should address this (perhaps one Southern Baptist and one moderate?) because the pro-gay stance would distract and not convince anyone.

2 What are possible resolutions? I know of only 3 possible: therapy/prayer, celibacy, and gay affirmation. On therapy, ask: is this something Christians should engage in? What’s the effectiveness, ie, how many people change and in what way do they change? What are the disadvantages (money, emotional damage, time, others)? Here you can bring in your psychologists.

3 Acknowledging that some fail at therapy or refuse after considering the risks, what about celibacy? The Church has forgotten its historical celebraction of celibacy. Can someone accept they are attracted to the same sex while choosing to abstain from sexual relations? What are pros and cons? Bring in a good Catholic here.

4 The last resolution is gay affirmation. Don’t dwell on pro-gay theology, again it won’t help. Simply demonstrate that many devote Christians choose this. I think ex-gays would be more effective here than Gene Robinson. An ex-gay survivor who still has a conservative faith that other conservative Christians can identify with.

I think that syllabus keeps scientists and clergy in their respective fields keeps everything very practical: how can we help gay Christians who don’t like their orientation? I don’t think Garrett’s confrontation is necessary or appropriate here (somewhere else, Yes) because it’s addressing people who WANT to kill off their gayness and for them their orientation is exactly like a disease (they call it a “pathology” or “neurosis”) and not their identity. That’s my 2 cents.

howller
May 14th, 2008 | LINK

Cowboy, word has it representatives of Affirmation will not actually be meeting with the LDS President, nor any of the General Authorities. Rather, the meeting will be with LDS Family Services. As such, it is perhaps not everything that might have been hoped for, but it represents a small step in the right direction. As it will be a similar meeting to that discussed on this thread (self affirming LGBT meeting with therapists and counselors), I think Affirmation might take a few pointers from comments posted here.

Mike Airhart
May 15th, 2008 | LINK

In addition to my suggestions above:

1. Reputable therapists must establish a treatment scheme, standards of care, recognition of potential harm, and aftercare. As far as I know, no conversion, ex-gay, or “sexual identity” therapist has established these safeguards. In particular, they refuse to do no harm and to acknowledge harm done by their colleagues. And they tend to dump their counselees like a hot potato the moment someone says a therapy isn’t working or is hurting more than helping.

2. APA forums are best suited to the presentation of new science. The ex-gay movement thus far refuses to offer science. Spitzer, Jones and Yarhouse all offered intentionally biased anecdotes of poorly defined success derived from unspecified and poorly defined therapies. Furthermore, their studies suppressed tracking of failure and harm.

When there is new and rational research which, first and foremost, studies ineffectiveness and harm done by specific therapies, and secondly, does not treat homosexuality and heterosexuality with a double standard (one supposedly good and the other bad), then I see the APA playing the professional and clinical role that it is intended to play.

Mike Airhart
May 15th, 2008 | LINK

My point in #1 above being, disreputable therapists and their advocates need not be invited to an APA forum.

If there is a role for religion in an APA forum, it is to honor solid science and not engage in idle conjecture.

Zeke
May 15th, 2008 | LINK

Mike Airhart, in order for reputable therapists to develope a treatment scheme they would have to show a disorder, psychosis or APA recognized bad/harmful behavior that would require treatment. I don’t think that you could find a reputable therapist who believes that homosexuality in and of itself is any of the above.

Now if they want to treat drug abuse, sexual addiction or other problems such as this that’s different but again, no reputable therapist would say that homosexuality causes these things. Homophobia and religious indoctrination may, and do, lead to patients engaging in these officially recognized dangerous and destructive behaviors but that would be the topic of another symposium altogether.

I just don’t think you will find reputable, licensed, peer review published, non religious dogma motivated psychothrapists that would touch gay reorientation “therapy” with a ten foot pole precisely because homosexuality is not something that is broken, dangerous or destructive in need of repair.

I have no doubt however that they could develope such therapy to address a patients negative responses to the homophobia and religious abuse they face. They could certainly develope a SCIENTIFICALLY based therapy to inform their patients of what we know homosexuality is and what it isn’t. They could develope an education therapy to inform patients of the complete lack of scientific evidence that reparative therapy is needed or effective and to fully inform them of the failure and the damage done.

I think that this is where the APA and therapists should focus their time, energy and attention upon, for the sake of their patients.

Paul
May 15th, 2008 | LINK

Ephilei’s description of a possible symposium is one that makes a lot of sense to me. It seems to get to the heart of the issue. Might this be something Beyond Ex-Gay could put on?

Bruce Garrett
May 15th, 2008 | LINK

I am frankly dumbfounded at some of the things I’ve learned in the very short time (10 months) I’ve been actively seeking out ex-gay survivors to hear their stories. Before then, I really had no clue about what was going on, and I don’t believe very many others do either.

Yes. This is pretty much where I’m at. Before the whole thing with Zach came down I had this image of ex-gays and the ex-gay movement and it was superficial and callow and I wince sometimes to think about it. And you are absolutely right. How can you have a symposium about ex-gay therapy without including in it the very people who have been through it? How do you come to terms with what it Is without taking into account the people who walked into it absolutely committed and came away from it deeply wounded?

I can appreciate why the ex-gay ministries themselves don’t want to deal with them. It’s unsurprising. Are any of them to this day doing follow-up on their clients? I can appreciate why the likes of Mohler wouldn’t want to hear it. But why would the APA not care to listen to them? It makes no sense on its face.

I’m thinking now about the look on John Holm’s face as he told us outside the Love Won Out Conference in Memphis last February of the apology he got from one of the people inside for what had happened to him. If anybody needs reaching out to, it’s the survivors.

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