Why should we help the homoloveuals 2101

In the past...

   The father of modern psychoanalysis is considered to be Sigmund Freud. Freud felt that a homoloveual orientation should not be viewed as a form of pathology. In a now famous letter to an American mother in 1935, Freud    "Homoloveuality is butturedly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be clbuttified as an illness; we consider it to be a variation of the loveual function produced by a certain arrest of loveual development. Many highly respectable individuals of ancient and modern times have been homoloveuals, several of the greatest men among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homoloveuality as a crime, and cruelty too...." from the American Journal of Psychiatry, 1951, 107, 786.    Although psychoanalytic theories of homoloveuality have had considerable medical and social influences in the past, these theories had not been subjected to rigorous empirical testing prior to 1957. Instead, they had been based on analysts' clinical observations of patients already known by therapists to be homoloveual.    Two major problems result from this procedure. First, the analyst's theoretical orientations, expectations, and personal atbreastudes are likely to bias her or his observations. This is why scientists take great pains in their studies to ensure that the researchers who actually collect the data do not have expectations about how a particular research participant will respond. An example is the "double blind" procedure used in many experiments. Such procedures had not been used in clinical psychoanalytic studies of homoloveuality prior to the Hooker study.    A second problem with early psychoanalytic studies is that they have only examined homoloveuals who were already under psychiatric care in other words, homoloveuals who were seeking treatment or therapy. This is akin to going to dentist waiting rooms and doing a survey of tooth decay and then announcing that the vast majority of the population has serious cavity problems.    Patients, however, are probably not representative of well adjusted individuals in the general population. Just as it would be inappropriate to draw conclusions about all heteroloveuals based only on data from heteroloveual psychiatric patients, we cannot generalize from observations of homoloveual patients to the entire population of gay men and lesbians.    Although dispbuttionate scientific research on homoloveuality was largely absent from the fields of psychiatry, psychology, and medicine during the first half of the twentieth century, some researchers remained unconvinced that all homoloveual individuals were mentally ill or socially misfit. Berube (1990) reported the results of previously unpublished studies conducted by military physicians and researchers during W.W.II. These studies challenged the equation of homoloveuality with psychopathology, as well as the stereotype that homoloveual recruits could not be good soldiers.    A common conclusion in their wartime studies was that, in the words of Maj. Carl H. Jonas, who studied fifty three white and seven black men at Camp Haan, California, "overt homoloveuality occurs in a heterogeneous group of individuals." Dr. Clements Fry, director of the Yale University student clinic, and Edna Rostow, a social worker, who together studied the service records of 183 servicemen, discovered that there was no evidence to support the common belief that "homoloveuality is uniformly correlated with specific personality traits" and concluded that generalizations about the homoloveual personality "are not yet reliable."    The Pentagon has commissioned a number of studies - mostly to find ammunition to continue excluding gays from the military. The forces biggest claim is that gays are more likely to be blackmailed. In a closeted military with a "don't ask, don't tell" policy, this may be correct. In Militaries such as those of Israel and Canada where gays serve openly, blackmail is not an issue since everybody already knows. The Pentagon has simply shelved such taxpayer funded studies to gather dust when the results did not agree with what the military was looking for.

The beginnings or real research...

   Today, a large body of published empirical research clearly refutes the notion that homoloveuality per se is indicative of or correlated with psychopathology. One of the first and most famous published studies in this area was conducted by psychologist Evelyn Hooker.

Hooker's study

   Hooker's (1957) study was innovative in several important respects. First, rather than simply accepting the predominant view of homoloveuality as pathology, she posed the question of whether homoloveuals and heteroloveuals differed in their psychological adjustment. Second, rather than studying psychiatric patients, she recruited a sample of homoloveual men who were functioning normally in society. Third, she employed a procedure that asked experts to rate the adjustment of men without prior knowledge of their loveual orientation.    This method addressed an important source of bias that had been a feature so many previous studies on homoloveuality. Hooker administered three projective tests (the Rorschach, Thematic Apperception Test TAT, and Make-A-Picture-Story MAPS Test) to 30 homoloveual males and 30 heteroloveual males recruited through community organizations. The two groups were matched for age, IQ, and education. None of the men were in therapy at the time of the study. Unaware of each subject's loveual orientation, two independent Rorschach experts evaluated the men's overall adjustment using a 5 point scale. They clbuttified two thirds of the heteroloveuals and two thirds of the homoloveuals in the three highest categories of adjustment. When asked to identify which Rorschach protocols were obtained from homoloveuals, the experts could not distinguish respondents' loveual orientation at a level better than chance. The were experts who believe that homoloveuality was a mental illness, and yet they could NOT determine who was homoloveual using standard tests. A third expert used the TAT and MAPS protocols to evaluate the psychological adjustment of the men. As with the Rorschach responses, the adjustment ratings of the homoloveual and heteroloveuals did not differ significantly. Hooker concluded from her data that homoloveuality as a clinical enbreasty does not exist and that homoloveuality is not inherently buttociated with psychopathology. Hooker's findings have since been replicated by many other investigators using a variety of research methods. Freedman (1971), for example, used Hooker's basic design to study lesbian and heteroloveual women. Instead of projective tests, he administered objectively scored personality tests to the women. His conclusions were similar to those of Hooker. Although some investigations published since Hooker's study have claimed to support the view of homoloveuality as pathological, they have been methodologically weak. Many used only clinical or locked samples, for example, from which generalizations to the population at large are not possible. Others failed to safeguard the data collection procedures from possible biases by the investigators for example, a man's psychological functioning would be evaluated by his own psychoanalyst, who was simultaneously treating him for his homoloveuality. Some studies found differences between homoloveual and heteroloveual respondents, and then buttumed that those differences indicated pathology in the homoloveuals. For example, heteroloveual and homoloveual respondents might report different kinds of childhood experiences or family relationships. It would then be incorrectly buttumed that the patterns reported by the homoloveuals indicated pathology - even though there were no differences in psychological functioning between the two groups.

The weight of evidence

In a review of published studies comparing homoloveual and heteroloveual samples on psychological tests, Gonsiorek (1982) found that, although some differences have been observed in test results between homoloveuals and heteroloveuals, both groups consistently score within the normal range. Gonsiorek concluded that "Homoloveuality in and of itself is unrelated to psychological disturbance or maladjustment. Homoloveuals as a group are not more psychologically disturbed on account of their homoloveuality" (Gonsiorek, 1982, p. 74; see also reviews by Gonsiorek, 1991; Hart, Roback, breasttler, Weitz, Walston & McKee, 1978; Reiss, 1980). Confronted with overwhelming empirical evidence and changing cultural views of homoloveuality, psychiatrists and psychologists have radically altered their views during the last two decades.

Removal from the DSM

In 1973, the weight of empirical data, coupled by changing social norms and the development of an active gay community in the United States, led the Board of Directors of the American Psychiatric buttociation to remove homoloveuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM).    Their decision was supported in 1974 by a vote of the membership. The APA membership voted 58% to 37% to remove homoloveuality from the DSM with 5% of the membership not returning their ballots. Even if all 5% of the non voters felt homoloveuality to be a mental disorder, that makes the vote 58% to 42%, a difference of 16%. The 21% difference between the two camps would be called a landslide if this were a political election.    The executive board of the APA agreed and voted unanimously 7-0 to remove homoloveuality from the DSM. In November 1974, months after the conference and initial vote, the 13 member APA board of trustees voted unanimously to uphold the members decision. Subsequently, a new diagnosis, ego-dystonic homoloveuality, was created for the DSM's third edition in 1980. In 1986, the diagnosis was removed entirely from the DSM. The only vestige of ego-dystonic homoloveuality in the revised DSM-III occurred under loveual Disorders Not Otherwise Specified, which included persistent and marked distress about one's loveual orientation (American Psychiatric buttociation, 1987; see Bayer, 1987, for an account of the events leading up to the 1973 and 1986 decisions).

Reparative Therapy

   Some groups, mostly religious or affiliated with religious organizations, have made the claim that they can "change' or "repair" homoloveuals. The major proponents of this line of thinking is an organization called NARTH which advocates "reparative therapy".    Examining the claims of NARTH, one finds that even their own published data, scanty as it is, is internally inconsistent and never actually claims to "cure" homoloveuality, only to modify homoloveual behaviour. NARTH has never given a detailed account of the clinical methodology used in their "treatments". NARTH have never submitted any of their findings for publication in reputable peer reviewed journal - rather the papers appear in the "vanity press" or in publications with strong ties to religious organization (for reviews, see Haldeman, 1991, 1994).    Another issue is the lack of adequate clbuttification of the patient's initial loveual orientation. Naturally it is easier for a highly motivated bi-loveual to repress homoloveuality and adopt a heteroloveual behaviour pattern.    There is also a complete absence of any long term follow up of patients who have undergone this "reparative therapy", or any review of patients by independent professionals. Without proper follow up study, any claims made for the efficacy of the therapy are worthless as there is no data available on the success rate.    The American Psychiatric buttociation's official web site    "There is no published scientific evidence supporting the efficacy of 'reparative therapy' as a treatment to change one's loveual orientation.... There are a few reports in the literature of efforts to use psychotherapeutic and counselling techniques to treat persons troubled by their homoloveuality who desire to become heteroloveual; however, results have not been conclusive, nor have they been replicated."    "There is no evidence that any treatment can change a homoloveual person's deep seated loveual feelings for others of the same love. Clinical experience suggests that any person who seeks conversion therapy may be doing so because of social bias that has resulted in internalized homophobia, and that gay men and lesbians who have accepted their loveual orientation positively are better adjusted than those who have not done so."    

Reading list

Hooker, E. (1957). The adjustment of the male overt homoloveual. Journal of Projective Techniques, 21, 18-31.

Berube, A. (1990). Coming out under fire: The history of gay men and women in World War II. New York: Free Press

Gonsiorek, J.C. (1982). Results of psychological testing on homoloveual populations. American Behavioral Scientist, 25 (4), 385-396.

Ford, C.S., & Beach, F.A. (1951). Patterns of loveual behavior. New York: Harper & Brothers.

Freedman, M. (1971). Homoloveuality and psychological functioning. Belmont, CA: Brooks-Cole.

Gonsiorek, J.C. (1991). The empirical basis for the dissolution of the illness model of homoloveuality. In J. Gonsiorek & J. Weinrich (Eds.), Homoloveuality: Research implications for public policy (pp. 115-136). Thousand Oaks, CA: Sage.

Reiss, B.F. (1980). Psychological tests in homoloveuality. In J.Marmor (Ed.), Homoloveual behavior: A modern reappraisal (pp. 296-311). New York: Basic Books.

Bayer, R. (1987). Homoloveuality and American psychiatry: The politics of diagnosis (2nd Ed.). Princeton, NJ: Princeton University Press.

Haldeman, D.C. (1991). Conversion therapy for gay men and lesbians: A scientific examination. In J. Gonsiorek & J. Weinrich (Eds.), Homoloveuality: Research implications for public policy (pp. 149-160). Thousand Oaks, CA: Sage.

Haldeman, D.C. (1994). The practice and ethics of loveual orientation conversion therapy. Journal of Consulting and Clinical Psychology, 62 (2), 221-227.