Psychiatry and Homosexuality
By Robert L. Spitzer, a professor of psychiatry at Columbia University
Wall Street Journal, May 23, 2001
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In 1973, I opposed the prevailing orthodoxy in my profession by leading the effort to remove omosexuality from the official list of psychiatric disorders. For this, liberals and the gay community respected me, even as it angered many psychiatric colleagues. I said then -- as I say now -- that homosexuals can live happy, fulfilled lives. If they claim to be comfortable as they are, they should not be accused of lying or of being in denial.
Now, in 2001, I find myself challenging a new orthodoxy. This challenge has caused me to be perceived as an enemy of the gay community, and of many in the psychiatric and academic communities.
The assumption I am now challenging is this: that every desire for change in sexual orientation is always the result of societal pressure and never the product of a rational, self-directed goal. This new orthodoxy claims that it is impossible for an individual who was predominantly homosexual for many years to change his sexual orientation -- not only in his sexual behavior, but also in his attraction and fantasies -- and to enjoy heterosexuality. Many professionals go so far as to hold that it is unethical for a mental-health professional, if requested, to attempt such psychotherapy.
This controversy erupted recently, when I reported the results of a study that asked an important scientific question: Is it really true that no one who was predominantly homosexual for many years could strongly diminish his homosexual feelings and substantially develop heterosexual potential?
What I found was that, in the unique sample I studied, many made substantial changes in sexual arousal and fantasy -- and not merely behavior. Even subjects who made a less substantial change believed it to be extremely beneficial.
Complete change was uncommon.
My study concluded with an important caveat: that it should not be used to justify a denial of civil rights to homosexuals, or as support for coercive treatment. I did not conclude that all gays should try to change, or even that they would be better off if they did. However, to my horror, some of the media reported the study as an attempt to show that homosexuality is a choice, and that substantial change is possible for any homosexual who decides to make the effort.
In reality, change should be seen as complex and on a continuum.
Some homosexuals appear able to change self-identity and behavior, but not arousal and fantasies; others can change only self-identity; and only a very few, I suspect, can substantially change all four. Change in all four is probably less frequent than claimed by therapists who do this kind of work; in fact, I suspect the vast majority of gay people would be unable to alter by much a firmly established homosexual orientation.
I certainly believe that parents with homosexually oriented sons and daughters should love their children -- no matter how their children decide to live their lives -- and should not use my study to coerce them into unwanted therapy.
However, I continue to hold that desire for change cannot always be reduced to succumbing to society's pressure. Sometimes, such a choice can be a rational, self-directed goal. Imagine the following conversation between a new client and a mental-health professional.
Client: "I love my wife and children, but I usually am only able to have sex with my wife when I fantasize about having sex with a man. I have considered finding a gay partner, but I prefer to keep my commitment to my family. The homosexual feelings never felt like who I really am. Can you help me diminish those feelings and increase my sexual feelings for my wife?"
Professional: "You are asking me to change your sexual orientation, which is considered by my profession as impossible and unethical. All I am permitted to do is help you become more comfortable with your homosexual feelings."
The mental health professions should stop moving in the direction of banning such therapy. Many patients, informed of the possibility that they may be disappointed if the therapy does not succeed, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions. In fact, such a choice should be considered fundamental to client autonomy and self-determination.
Science progresses by asking interesting questions, not by avoiding questions whose answers might not be helpful in achieving a political agenda. Gay rights are a completely separate issue, and defensible for ethical reasons.
At the end of the day, the full inclusion of gays in society does not, I submit, require a commitment to the false notion thatsexual orientation is invariably fixed for all people.