Box Turtle Bulletin

Informed Consent

As reported more than two weeks ago, the APA released this statement directed at NARTH and Focus on the Family:

“For over three decades the consensus of the mental health community has been that homosexuality is not an illness and therefore not in need of a cure. The APA’s concern about the positions espoused by NARTH and so-called conversation therapy is that they are not supported by the science. There is simply no sufficiently scientifically sound evidence that sexual orientation can be changed. Our further concern is that the positions espoused by NARTH and Focus on the Family create an environment in which prejudice and discrimination can flourish.”

This apparently sparked some controversy at the APA meeting in New Orleans. On first glance, many took it to be a repudiation of conversion therapy — which would mean a change in the APA’s official policy statement. But a closer reading gives what I believe to be a more accurate understanding, that the APA is concerned about how NARTH and Focus on the Family (which sponsors Exodus) uses conversion therapy — and misrepresented science — to nonscientific (political) ends. At least that’s how I read it. Yes, it calls into question conversion therapy’s efficacy, but the APA does not prohibit it. In my opinion at least, it’s the only way to read this statement without throwing away the APA’s official policy on conversion therapy altogether, which a statement like this does not have the capacity to do.

Neither NARTH nor Focus on the Family responded to the APA statement directly. Instead, they claimed a sort of victory by reporting on a Town Hall Meeting between the APA leaders and members. According to NARTH’s rendition of events, APA President Gerald Koocher said this about conversion therapy:

Highlighting the importance of client autonomy and self-determination, Dr. Koocher stated, “APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction.”

He emphasized that —

1. The choice to enter therapy to diminish homosexual attractions and to strengthen heterosexual potential must be respected.

2. The choice to enter therapy must be voluntary and not coerced in any way.

3. Treatment options must be discussed by the therapist.

4. Treatment goals must be mutually agreed upon.

5. The “iterative process” must be a part of therapy. That is, client choice regarding treatment goals must be reiterated throughout the treatment process.

Focus on the Family issued a statement claiming credit for Dr. Koochers’s “endorsement” of conversion therapy, calling it a “policy change”:

Koocher’s response was simple: “APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction.”

Alan Chambers, president of Exodus International, a network of ministries for those struggling with unwanted same-sex attraction, said it was an unexpected turn of events.

“Given the APA’s track record of the last two years,” Chambers told CitizenLink, “it is very unusual that the president would come out and state our case for us, that people have a right to self-determination — to determine their own path for their mental-health status.”

Chambers said he believes a protest organized by ex-gays and their therapists outside the convention hall had an impact.

Let’s stop here a moment and review what happened. First, Exodus organized a protest by “ex-gays” at the APA convention in New Orleans. The APA responded by issuing a statement denouncing the particular practices of NARTH and Exodus (via Focus on the Family). NARTH and Focus in the Family respond by describing a meeting where Dr. Koocher appears to “endorse” conversion therapy, and Focus goes so far as to claim this “policy change” as a victory brought on by their protest.

First, let’s be clear of one thing. There was no policy change. The APA does not prohibit conversion therapy. Go ahead and read the APA’s policy statement.

But read the whole thing. I’ll wait.

Notice that the APA insists that homosexuality is not a disease, and that all members must refrain from disseminating false information about homosexuality, about gays and lesbians themselves, and about treatment options and success rates. Therapists are required to ensure that the client understands the likelihood of change, what change may mean or may not mean, and the possible negative consequences of pursuing therapy to try to change sexual orientation. This is essential if “informed consent” is to be achieved according to the APA’s policy statement:

THEREFORE BE IT RESOLVED that “psychologists do not make false or deceptive statements concerning … the scientific or clinical basis for … their services,” (American Psychological Association, 1992); and

THEREFORE BE IT RESOLVED that “psychologists attempt to identify situations in which particular interventions … may not be applicable … because of factors such as … sexual orientation” (American Psychological Association, 1992); and

THEREFORE BE IT RESOLVED that “psychologists obtain appropriate informed consent to therapy or related procedures” [which] “generally implies that the [client or patient] (1) has the capacity to consent, (2) has been informed of significant information concerning the procedure, (3) has freely and without undue influence expressed consent, and (4) consent has been appropriately documented”

Maybe due to the free-wheeling nature of the discussion, the issues surrounding informed consent didn’t come up at the town hall meeting. Or maybe they did and NARTH and Exodus neglected to mention them. But Warren Throckmorton posted this follow-up statement from the APA’s Public Affairs office to clarify the importance of informed consent:

One: The therapist has an obligation to carefully explore how patients arrive at the choices they want to make. Therapists must determine whether patients understand that their motives may arise purely from the social pressures of a homophobic environment. No type or amount of individual therapy will modify societal prejudices.

Two, informed consent: Patients must understand the potential consequences of any treatment, including those intended to modify sexual orientation. Patients must understand that such treatments lack a validated scientific foundation and may prove psychologically harmful.

Finally, I would add that our patients ought to know from the very start that we as their therapists do not consider homosexuality a mental disorder. In fact, the data show that gay and lesbian people do not differ from heterosexuals in their psychological health. By that I mean that they have no greater instance of mental disorders than do heterosexuals.

This is critical, because NARTH and Exodus both are flagrant violators of many components of the APA’s policy on sexual orientation conversion therapy, especially in those areas concerned with ensuring that informed consent is truly “informed.” And for that, they deserve to be singled out for criticism.

Unfocused on the Family

Glenn Stanton, of Focus on the Family, finally got around to responding to the American Academy of Pediatrics’ report on why same-sex marriage is important to children of gay and lesbian couples. (I reviewed that article here.) Unfortunately, he seems to have missed the entire point of the report:

“This report essentially says that research shows that gay and lesbian parents can be as loving and caring as heterosexual parents,” he said. “That is not the same as saying that children who grow up in homes in two-female or two-male adult homes do as well as kids who live with their mother and father in important outcome measures.”

The AAP is skirting some very important issues, he said. For example, the study claims “there are more similarities than differences in parenting styles and attitudes of gay and non-gay fathers.”

While sexual orientation does not seem to affect whether parents prefer their kids to eat healthy snacks, get plenty of exercise, read books, limit television viewing and be kind to their friends, Stanton said there are other important factors the study tries to play down or simply ignores.

Those who try to work with this line of reasoning miss a very important point, the very point that prompted the American Academy of Pediatrics to commission the report in the first place. Gay and lesbian couples are parents. They have always been parents, and they will always be parents. There is simply nothing anybody can do which will ever change that. Like it or not, these children exist, they are growing up, and they will soon become adults themselves. This report is focused on their needs and how best to address them:

This analysis explores the unique and complex challenges that same-gender couples and their children face as a result of public policy that excludes them from civil marriage. In compiling this report it became clear to the contributing committees and section that the depth and breadth of these challenges are largely unknown to the general public and perhaps even to many pediatricians. As such, the AAP Board of Directors approved the broad dissemination of this analysis to assist pediatricians with addressing the complex issues related to same-gender couples and their children.

That’s why they wrote the report: To inform everyone what those challenges are, and why marriage is so important:

In all its work, the AAP is committed to calling attention to the inextricable link between the health and well-being of all children, the support and encouragement of all parents, and the protection of strong family relationships. This analysis was prepared to bring to light the legal, financial, and psychosocial ramifications of recent and proposed public-policy initiatives affecting same-gender parents and their children.

Civil marriage is a legal status that promotes healthy families by conferring a powerful set of rights, benefits, and protections that cannot be obtained by other means. Civil marriage can help foster financial and legal security, psychosocial stability, and an augmented sense of societal acceptance and support. Legal recognition of a spouse can increase the ability of adult couples to provide and care for one another and fosters a nurturing and secure environment for their children. Children who are raised by civilly married parents benefit from the legal status granted to their parents.

You can’t find a stronger endorsement of family values than that.

So, given the very real existence of these children in gay- and lesbian-led families, what exactly would Focus on the Family suggest we do to remove the many roadblocks that these parents face every day so they can provide the best care for their children? We know that Focus on the Family would like gays and lesbians to go away — that’s why they promote and finance ex-gay ministries. Do they have something in mind to make their kids go away too?

What does Focus propose for the children who are already being raised by gays and lesbian couples now and in the future? Don’t these children count? Was Glenn Stanton’s boss really serious when he backed extremely limited domestic partnership benefits in Colorado? James Dobson sure seems to have lost his voice since then. Maybe he took too much heat from fellow conservatives.

Or maybe Focus on the Family can only focus on one kind of family?

Marriage Is for Children

Glenn T. Stanton, senior analyst and Director of Global Insight for Cultural and Family Renewal at Focus on the Family, offered some thoughts on same-sex marriage in a book review on Christianity Today’s web site. In his review of The Meaning of Marriage: Family, State, Market and Morals (Robert P. George, Jean Bethke Elshtain, eds.), Mr Stanton discusses one of the chapters:

Don Browning and Elizabeth Marquardt, self-described religious and political liberals, assert that “same-sex marriage is unjust in many ways and that liberals should be cautious about endorsing it.”

Unjust? Yes, by changing the focus from the needs of children and the larger society to the desires of adults. They warn that civil marriage for homosexuals would change marriage from being concerned about raising a community’s next generation to being concerned about close, personal adult relationships.

After which he adds his own thoughts:

We are moving from this natural, universal model to a greater embrace of what I call “disembodied procreation” in same-sex unions, where sperm and egg meet only in a Petri dish and foreplay is a legal contract.

This has become a growing argument among opponents of same-sex marriage, that gays and lesbians who want to marry are elevating their own desires above the needs of children, especially since, on their own, they cannot have children biologically as a gay and lesbian couple.

Yet gays and lesbian couples become parents through many different means; most of them are the result of a previous heterosexual marriage. The American Academy of Pediatrics note that according to the 2000 census:

— Same-gender couples are raising children in at least 96% of all US counties.

— Nearly one quarter of all same-gender couples are raising children.

— Nationwide, 34.3% of lesbian couples are raising children, and 22.3% of gay male couples are raising children (compared with 45.6% of married heterosexual and 43.1% of unmarried heterosexual couples raising children).

…

— Six percent of same-gender couples are raising children who have been adopted compared with 5.1% of heterosexual married couples and 2.6% of unmarried heterosexual couples.

— Eight percent of same-gender parents are raising children with special health care needs, compared with 8.3% of heterosexual unmarried parents and 5.8% of heterosexual married parents.

— Of same-gender partners raising children, 41.1% have been together for 5 years or longer, whereas 19.9% of heterosexual unmarried couples have stayed together for that duration. …

It is difficult to determine exactly how many children are being raised by a gay or lesbian parent or parents because of many of the same factors that impact the determination of the number of same-gender couples. Estimates range between 1 and 10 million. The majority of these children were born in the context of a heterosexual relationship.

These statistics are instructive. They point out that the impulse to marriage and to raise children is a distinctly selfless impulse. Not only are gay men and lesbians more likely to adopt children who don’t have homes, they are more likely to adopt hard-to-place children than heterosexual couples overall. Gay parents don’t blithely choose to raise children as if they were deciding to take in a homeless puppy — nobody adopts hard-to-place children on a lark. Instead, these couples have demonstrated a selfless willingness to do the hard work and make the commitments necessary to take on the arduous task of raising a child who needs a family. You can bet that these couples are very much “concerned about raising a community’s next generation.”

But what’s more, the impulse to marriage is also a distinctly conservative impulse. Even though these couples are not bound together by a marriage license, they are much more likely to stay together than heterosexual couples who are not bound together by a marriage license. And we know that marriage is a stabilizing influence in a family. Think of how much more stable these gay- and lesbian-led families would be if they were supported by the same civil protections, rights, and responsibilities afforded to and expected of heterosexual couples.

Mr. Stanton’s arguments willfully ignore the simple fact that gays and lesbians have always been parents and they will always be parents. There is nothing in history that says otherwise, nor is there anything in the future that will ever change that reality. And as much as we like to talk about the importance of marriage to gay and lesbian couples, we cannot ignore how vital it is for their children, the vast majority of whom, unlike those of Mr. Stanton’s imagination, were not conceived by the “disembodied procreation” of a petri dish. And because marriage is vital to these children, it is, in the end, a tremendous benefit to society overall — especially the society that our community’s next generation will inhabit.

The False Witness of Focus on the Family

Wayne Besen, founder of Truth Wins Out, has been closely following some recent statements coming from Melissa Fryrear of Focus in the Family, who has misrepresented research twice in as many days.

Yesterday, Wayne reported on Melissa Fryrear’s claims that a recent Canadian study on youth suicide links “pro-gay advocates” with a higher number of suicide attempts by gay and lesbian youths. In her press release, she says:

“Regrettably, they think they have to embrace homosexuality because pro-gay advocates told them that they were born gay,” she said. “And that is absolutely not true.”

Unfortunately for Ms. Fryrear, Wayne asked the researcher, Dr. Elizabeth Saewyc about Ms. Fryrear’s statement, and this is what he learned:

When contacted about Focus on the Family’s claims, Saewyc, the study’s principal investigator, said she was “disturbed” by what “seems to be an attempt to make their opinions more credible by linking them to scientific research — even though the research doesn’t support those beliefs.” She said Focus on the Family draws conclusions well beyond the study results by claiming that lesbians are suicidal because they are “embracing homosexuality,” as well as other inaccuracies in their article.

“Population surveys cannot determine cause and effect,” Saewyc explained, “they can only suggest possible links. Even so, other researchers have not found these sorts of links, and neither have we.”

The Canadian Press has since picked up the story. When they asked Dr. Saewyc for a comment, she responded:

“The research has been hijacked for somebody’s political purposes or ideological purposes and that’s worrisome.”

In fact, said Saewyc, American studies have noted that gay teenagers are at the highest risk of suicide before they come out of the closet. After that, they do quite well unless they’re harassed.

“If they’re trying to kill themselves because they’re embracing homosexuality, one would logically conclude they should all be suicidal,” said Saewyc.

The Canadian Press then asked Ms. Fryrear to respond, and that’s when she chose to misrepresent psychological research for a second time:

Some clinical studies, including one by Dr. Robert Spitzer, have linked contemplating suicide to unwanted attractions to the same sex, she said.

Now, I’ve read Dr. Spitzer’s study, and can assure you it says no such thing. But for good measure, Wayne asked Dr. Spitzer directly, who responded:

“Unfortunately Focus on the Family has once again reported findings of my study out of context to support their fight against gay rights,” said Dr. Robert Spitzer, a professor of psychiatry at Columbia University. …

“Although a third of the subjects in my study reported having had serious thoughts of suicide related to their homosexuality, not one of them blamed the gay rights movement’s advocating a ‘born-gay’ theory of homosexuality as the cause of their suicidal thinking,” said Spitzer.

Dr. James Dobson’s Focus on the Family often seeks the moral high ground when exploring issues concerning the family and the broader culture. Unfortunately, his “Gender Issues Analyst” needs to brush up on the ethics of misquoting legitimate scientific research. Otherwise, it’s just another False Witness in the service of bigotry.

Spare Change

This article appeared on the National Review’s web site today. Eve Tushnet reports on the June 10^th “Love Won Out” conference, a gathering of evangelical ex-gay ministries, held in Washington D.C. These ministries are an important part of social conservatives’ ongoing efforts to oppose gay rights in the public square, especially in the areas of same-sex marriage, adoption, and anti-discrimination measures.

By framing homosexuality as a behavioral “choice” that can be changed with patience, persistence and prayer, these ministries seek to redefine the public’s understanding of homosexuality as an unchosen orientation. If homosexuality is chosen (goes the thinking) then there is no need to protect gay rights based on this chosen behavior. Many in the ex-gay movement even take this argument to its most extreme conclusion — that there’s no such thing as being gay.

So these “ex-gay” groups play an important role for social conservatives. However, Eve Tushnet observes:

What they (the ex-gay ministries) aren’t is what many conservative evangelicals seem to want them to be: the ultimate answer to the gay-rights movement. The groups’ problems are deeply embedded in their self-understanding.

What’s the problem? These ministries publicly proclaim that “change is possible” without the inconvenience of explaining what “change” means. It is assumed that through various therapeutic practices, a change in sexual orientation will take place. But when pressed, many ex-gay practitioners will admit that this isn’t realistic. According to Mike Haley of Focus on the Family:

“We don’t want people to believe that change means you have to be married and have to have kids,” he said, and then added, “The opposite of homosexuality isn’t heterosexuality, the opposite of homosexuality is holiness. We’re not trying to create people from homosexual to heterosexual.”

This message however is largely missing from the conference, and it’s also conspicuously absent from the slick brochures and billboards put up by Exodus International and other ex-gay ministries. The public face that these ministries provide is that they are offering therapeutic services for those who wish to change their sexual orientation. But on closer inspection, it becomes very clear that these ministries really aren’t offering a cure, but conversion. The same-sex sexual attractions remain. It is up to the individual to “resist temptation,” and when he or she fails (and most of them do), it becomes both a failure in faith and a failure in character. This sense of failing can be devastating, leading some to suicide and others to refusing to have anything more to do with Christianity.

Rita Price of the Columbus Dispatch reported similar findings among members of an ex-gay group in Ohio. One group member, speaking on the difficulty of trying to “change” commented that “This is my being. This is who I am. It’s like telling a black person to stop being black.”

So what does “change” mean? Is it a change in sexual attraction, or just a change in behavior? Ms. Price notes that for some participants, a change in behavior is enough. But for most, the internal schizm that must occur for sustainanble behavioral change is simply too much to handle.

Paul Cameron “Calls Himself A Researcher”

I’ve been furiously updating A Look At Paul Cameron’s Medical Consequences of What Homosexuals Do over the past two weeks. I’ve now added three new sections (parts 7, 8 and 9) for your reading pleasure. The final installments should be ready in another couple of weeks.

Meanwhile, Focus on the Family’s Dr. James Dobson has made a move that has many of his fellow conservatives scratching their heads. On a recent radio broadcast, he endorsed Colorado Senate Bill 166, the reciprocal beneficiaries bill authored by Sen. Shawn Mitchell (R-Broomfield) which would pretty much grant any adult couple living together several important rights which are now difficult to obtain.

Such rights would include decision-making powers over shared property, health care, funerals and organ donations. The couples could be any two adults who live together: two elderly sisters, a parent caring for a disabled adult child, or anyone else who might need these benefits to take care of a friend or loved one. Including gay couples.

This led Paul Cameron to launch a blistering attack on his fellow conservative, which Dr. Dobson brushed off by describing Paul Cameron as someone who “calls himself a researcher” in a recent radio broadcast.

Dr. Dobson isn’t the only conservative to dispute Dr. Cameron’s research credentials. He’s just the latest. And while many conservatives find themselves using some of his “research” in their pronouncements against gays and lesbians, most are loathe to cite him directly by name, including Dr. Dobson.