Where Did The Ex-Gay One-Third “Success Rate” Come From?
July 18th, 2011
E. Daniel Blatt, otherwise known as GayPatriotWest, responded to the Marcus Bachmann exposé with his thoughts on ex-gay therapy. He didn’t exactly defend ex-gay therapy per se, defending instead the right of Christian groups to “set up such companies, provided they do not coerce anyone to enter treatment.” He doesn’t go into what constitutes coercion in conservative Christian culture, but that’s not the debate he was entering. He adds “that critics of such outfits continue to have the freedom to question the methods of said companies and should continue to exercise that freedom,” but he doesn’t enter into a debate of their methods either. He merely posits those two statements as a prelude to the debate he does enter, the so-called success rates of ex-gay therapy. Blatt concluded that the reported success rates are likely highly self-selecting and consisting of those whose sexuality is more fluid that those who don’t seek to change.Very reasonable assumptions, both, strongly backed by the evidence itself. But then he says this:
The only objective studies I have read of such programs show they have a “success” rate (as defined by them) no greater than 33% (and even that number is likely inflated). And that, let me stress, is not 33% of all gay people, but 33% of those who seek counseling in such facilities.
The caveat is taken, but even with that caveat, the numbers are definitely inflated. And it’s the first sentence that gave me pause: “The only objective studies I have read…” Which studies would those be?
Blatt probably did what many people do in the blogosphere. Most who say they looked into studies almost never actually read the studies. Blatt wrote about the “objective studies I have read,” but he likely should have written about the “objective studies I have read of” — the key point being that he probably relied on others whom he trusted to describe those studies on the assumption that they read them — or that they read of them from others who they trusted, who read them or who read of them from others who they trusted, and so on.
You see where this is going. I suspect that about as many people have actually read studies on efforts to change sexual orientation, whether they support ex-gay therapy or oppose it, as those who have actually read Kinsey’s 1948 Sexual Behavior In the Human Male. Everyone quotes from them and are absolutely certain that their quotes are accurate, but almost nobody has actually read the sources that they claim their quotes came from. (The same argument can be made for other important books like, say, the Bible.) And so I’ve learned a long time ago not to rely on other people’s characterizations of whatever they say they’ve read — or what they said they read of someone else who read it, or who read someone else who read it, etc. I actually have those books and studies in my collection (visitors to my home find my library “interesting,” to say the least) and I have not only read them, but I refer to them more often than I care to.
The 33% statistic, in fact, is not based any any systematic objective studies, but is rather an artifact of lore (much like Kinsey’s 10%) which has a ring of credibility for those who believe it (much like Kinsey’s 10%) but which doesn’t have much of a rigorous statistical basis behind it (much like Kinsey’s 10%). Further, the 33% statistic often appeared more as a rule of thumb than as a reliable statistic. Back when homosexuality was still considered a mental disorder, it was generally believed among mental health professions that about a third could be “cured” and induced to enter heterosexual marriages, a third could become either celibate or bisexual, and a third were more or less hopeless. The one-third/one-third/one-third lore — specifics of the lore varied — became more or less accepted fact despite the absence of evidence to support it.
Exodus no longer touts the 33% statistic on their revamped web site, but before that remodel Exodus claimed (via archive.org) that a success rate of between 30% and 50% was “not unusual.” A similar range of success was repeated by NARTH, the National Association for Research and Treatment of Homosexuality, while a 1997 unpublished, non-peer-reviewed NARTH study conveniently arrived at the the 33% figure right on the nose. In 2009, NARTH appeared to have traced the 33% statistic to Edmund Bergler’s 1956 book, Homosexuality: Disease or Way of Life? I’ll let NARTH describe Bergler’s finding from their “journal.” It’s not online, but I have a copy. On page 20, NARTH writes:
Bergler (1956) reported that in his 30 years of practice, he had successfully used psychoanalysis to help approximately 100 homosexuals change their orientation, and that a real shift toward genuine heterosexuality had indeed occurred. Using psychoanalysis, Bergler and his associates reported a 33 percent cure rate-that is, following treatment these patients were able to function as heterosexuals, whereas before treatment they were exclusively homosexual.
I have combed through Homosexuality: Disease or Way of Life? but cannot find the 33% statistic. On page 188, Bergler does write, “In nearly thirty years, I have successfully concluded analysis of one hundred homosexuals (thirty other analyses were interrupted either by myself or by the patient’s leaving)” That’s about as close as I can get to finding a statistical citation. I haven’t found NARTH’s claim for a “33 percent cure rate.” Instead, Bergler actually implies that all of those 100 cases were “successfully concluded” and on the next page he triumphantly states, “The theoretical and therapeutic obstacles to curing homosexuals has been surmounted” — all with nary a statistic or measurement in sight. I’m willing to concede that the statistic may be hidden somewhere else in the 302-page volume. But if it’s in there, Bergler himself doesn’t make much of it, and neither do his contemporary book reviewers.
But while I have Bergler’s books off the shelf and on my desk, an examination of his views are illuminating. Bergler wrote some of the most damning books and essays on homosexuality ever published. In 1959′s 1000 Homosexuals, (again, no mention of cure rates that I can find) Bergler describes gay men as “psychic mascochsts,” as he explains in the very first chapter:
Imagine a man who for some mysterious reasons unconsciously wants to be mistreated by a woman, though consciously unaware of this wish. Imagine, further, that this person inwardly fears his own wish, but instead of giving up the wish itself give sup its alleged or imagined central figure, woman. Since there are only two sexes, this leaves him only one alternative in his frantic flight: man.
In Homosexuality: Disease or Way of Life?, Bergler described gay men as acting on utter hatred of women:
The homosexual takes flight to man as an antidote for the woman he fears; the antidote is only secondarily elevated to the status of an attraction. This attraction is mingled with contempt; the hatred and scorn for women shown by the most vilent heterosexual misogynist appears to be benevolence when compared with the contempt shown by the typical homosexual for his sexual partners. This attitude is so marked that frequently the whole personality of the “lover” is obliterated: many homosexual contacts take place in comfort stations, in the obscurity of a park, in Turisk baths, where the sex object is not even seen. This fully impersonal means of achieve “contact” makes even a visit to a heterosexual whorehouse see, like an emotional experience.
In his 1953 book Fashion and the Unconscious, Bergler gave an example of how this so-called hatred of women played out:
It may be surprising but the existence of constrictive and “uncomfortable” fashions can be traced to the paradoxical fact that women are dressed by their bitterest enemies. Male homosexuals, who are inwardly terrified of women, are predominant in designing women’s clothes. Whatever their rationalizations, they hate women, as a defense.
So now that you you know where he’s coming from, let’s leave this digression and get back to the rule of the thirds. If Bergler wasn’t the source, then the next probably source might be Irving Bieber’s 1962 Homosexuality: A Psychoanalytic Study. He touted a 77% “cure” rate, which is at least in the one-third ballpark. More significantly, Bieber’s tome was wildly influential throughout the mental health profession. Anyone who was even mildly interested in trying to cure homosexuality was aware of Bieber’s book. It cared a weight in the psychological world similar to that which Kinsey’s books caried in popular culture. There were other studies which claimed a 33% success rate, but none of them came close to approaching the reach that Bieber’s 358-page book had. If Bieber wasn’t the source of the 33% statistic, he most certainly was the inspiration for the one-third/one-third/one-third lore. His numbers make a good approximation. After treatment, 27% of his sample of 106 gay and bisexual men became “exclusively heterosexual”, 32% became bisexual or inactive, and 41% remained uncured. And thus, the very rough one-third/one-third/one-third rule of thumb was born.
(It’s interesting to note the role that the 30 bisexuals played in this composite statistic: of them, 50% became “exclusively heterosexual”, while 43% of them remained bisexual and two became “inactive”. Meanwhile, only 19% of “exclusive homosexuals” before the study became “exclusively heterosexual” afterwards. Fifty-seven percent of the “exclusively homosexuals” remained stubbornly “exclusively homosexual” after treatment, with the rest reportedly becoming bisexual.)
Bieber’s anti-gay rhetoric was considerably more restrained than Bergler’s but his views of gay people were nevertheless similar. During the 1973 debate over the APA’s removal of homosexuality from its list of mental disorders, Bieber told a reporter, “a homosexual is a person whose heterosexual function is crippled, like the legs of a polio victim.” Bieber died in 1991, but his wife Toby Bieber, who was one of the book’s nine other co-authors, continued her husband’s legacy and helped to create NARTH, where today she sits on their so-called Scientific Advisory Committee. She also backed Paul Cameron’s abandoned online “journal.”
So what about the ex-gay success rate? Well, the more I look personally at the studies, including Bieber’s and Bergler’s, the less I find that any of them are objective. The few that are, are burdened with poor methodologies, missing or inconsistent definitions of what “success” means, and minimal or absent long-term follow-up — also like Bieber’s and Bergler’s. And it’s not just me saying so. The American Psychological Association agrees. An APA task force in 2009 concluded (PDF: 816KB/138 pages) that “enduring change to an individual’s sexual orientation is uncommon,” and that “there was some evidence to indicate that individuals experienced harm” from such therapies.
Oh, and it’s not just the APA saying change is extremely rare and much, much lower than 33%. It’s ex-gay proponents themselves, when you take the time to dig into their data and ignore their press releases. In 2007, Stanton Jones and Mark Yarhouse, two proponents of ex-gay ministries, published their study in a book titled, Ex-Gays? A Longitudinal Study of Religiously Mediated Change in Sexual Orientation. (An important caveat to note is that this book was not peer-reviewed. It was also funded and supported by Exodus International.) As I noted then, one of the diffuculties of that study was that, despite Exodus’s boast that they have helped “hundreds of thousands” find “freedom” from homosexuality, Jones and Yarhouse had a very difficult time finding people to study:
The sample size was disappointingly small, too small for an effective retrospective study. They told a reporter from Christianity Today that they had hoped to recruit some three hundred participants, but they found “many Exodus ministries mysteriously uncooperative.” They only wound up with 98 at the beginning of the study (72 men and 26 women), a population they describe as “respectably large.”
Fewer than a hundred is a tiny sample on which to assess the efforts of an entire movement, but let’s press on. In 2009, Stanton and Jones issued a follow-up with updated figures for that study. So overall, here’s what happened:
- Success: Conversion – 14 (14%)
- Success: Chastity – 18 (18%)
- Non-Success – 29 (30%)
- Drop-Outs – 37 (38%)
And what was “Success: conversion?” Stanton and Jones defined it in their book as — and this has to be my favorite definition of all time — “satisfactory, if not uncomplicated, heterosexual adjustment.” Let’s just pause here and let that sink in. It’s not heterosexuality. It’s a close-enough-for-hand-grenades adjustment to heterosexual behavior, with complications. I’ll bet, because when looking at average changes in Kinsey scores during the study, the prospective sample (a critical subset of the overall study — they were the only ones measured from the beginning of their entry into ex-gay therapy and were thus less self-selecting) reported, on average, virtually no change in attractions and a small increase in homosexual behavior. That’s probably why Jones and Yarhouse gave this caution:
[W]hile we found that part of our research population experienced success to the degree that it might be called (as we have here) “conversion,” our evidence does not indicate that these changes are categorical, resulting in uncomplicated, dichotomous and unequivocal reversal of sexual orientation from utterly homosexual to utterly heterosexual. Most of the individuals who reported that they were heterosexual at T6 did not report themselves to be without experience of homosexual arousal, and they did not report their heterosexual orientation to be unequivocal and uncomplicated.
Somehow, that doesn’t sound like anything close to being a “cure” to me. And as for defining chastity as “success,” well, I’ll let you decide if a lifetime of loneliness is acceptable to you.