Royal College of Psychiatrists Backtrack on Sexuality Causation

Well now, this is really interesting.

Royal College of PsychiatryThe Royal College of Psychiatrists considers that sexual orientation is determined by a combination of biological and postnatal environmental factors. There is no evidence to go beyond this and impute any kind of choice into the origins of sexual orientation.

The College wishes to clarify that homosexuality is not a psychiatric disorder. In 1973 the American Psychiatric Association (APA) concluded there was no scientific evidence that homosexuality was a disorder and removed it from its diagnostic glossary of mental disorders. The International Classification of Diseases of the World Health Organization followed suit in 1992.

The College holds the view that lesbian, gay and bisexual people are and should be regarded as valued members of society, who have exactly similar rights and responsibilities as all other citizens. This includes equal access to healthcare, the rights and responsibilities involved in a civil partnership/marriage, the rights and responsibilities involved in procreating and bringing up children, freedom to practise a religion as a lay person or religious leader, freedom from harassment or discrimination in any sphere and a right to protection from therapies that are potentially damaging, particularly those that purport to change sexual orientation.

Leading therapy organisations across the world have published statements warning of the ineffectiveness of treatments to change sexual orientation, their potential for harm and their influence in stigmatising lesbian, gay and bisexual people. There is now a large body of research evidence that indicates that being gay, lesbian or bisexual is compatible with normal mental health and
social adjustment. However, it is eminently reasonable that the experiences of discrimination in society and possible rejection by friends, families and others (such as employers), means that some lesbian, gay and bisexual people experience a greater than expected prevalence of mental health and substance misuse problems. Lifestyle issues may be important in some gay men and lesbians, particularly with respect to higher rates of substance misuse.

It is not the case that sexual orientation is immutable or might not vary to some extent in a person’s life. Nevertheless, sexual orientation for most people seems to be set around a point that is largely heterosexual or homosexual. Bisexual people may have a degree of choice in terms of sexual expression in which they can focus on their heterosexual or homosexual side.

It is also the case that for people who are unhappy about their sexual orientation – whether heterosexual, homosexual or bisexual – there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of acceptance of their sexual orientation.

The College believes strongly in evidence-based treatment. There is no sound scientific evidence that sexual orientation can be changed. Systematic reviews carried out by both the APA and Serovich et al suggest that studies which have shown conversion therapies to be successful are seriously methodologically flawed.

Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and there is evidence that they are potentially harmful. The College considers that the provision of any intervention purporting to ‘treat’ something which is not a disorder is wholly unethical.

The College would not support a therapy for converting people from homosexuality any more than we would do so from heterosexuality.

What I find really interesting is that the first few footnotes cite Bailey et al whose twin studies on homosexuality causation have been around for almost a decade and a half. Bailey has consistently shown that there is a large amount of unshared environmental contribution to homosexuality, so finally the RCP have caught up.

When the RCP write,

Nevertheless, sexual orientation for most people seems to be set around a point that is largely heterosexual or homosexual. Bisexual people may have a degree of choice in terms of sexual expression in which they can focus on their heterosexual or homosexual side.

one might want to point them to the research (below) from Lisa Diamond which indicates that this isn’t necessarily so. Diamond found that even amongst those men (female sexuality is much more fluid per se) who identified as “gay” over half of them actually reported other-sex attractions and activity. The “bisexual choice” is in my opinion just an excuse to avoid engaging with this kind of data – by labelling people “bisexual” rather than their self-description of “gay”, one can avoid engaging with the evidence of fluidity of sexual attractions over time.

This is an interesting line (emphasis added).

Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and there is evidence that they are potentially harmful. The College considers that the provision of any intervention purporting to ‘treat’ something which is not a disorder is wholly unethical.

What is “evidence that they are potentially harmful“? Well that is a coded admission that the “studies” of harm from SOCE (sexual orientation change efforts) are merely anecdotal and not statistically rigorous. There is at this time no hard evidence that SOCE cause harm beyond self-reporting, and if you accept self-reporting as a valid measure then you also need to accept self-reported change as a valid measure of the success of SOCE.

Finally, a note of caution. Core Issues are (rightly) excited by this position paper but there is the potential to misunderstand what the position is for those who advocate therapeutic change.

Homosexuals are not ‘born gay’ according to a recent statement by the Royal College of Psychiatristsi. They now consider, what they previously denied, that the causes are “a combination of biological and postnatal environmental factors.” This is a major admission. It implies that if a child does not encounter such postnatal life experiences, he/she will grow up heterosexual.

That’s not quite what the RCP are saying. For example, it could be that the biological factors predispose you to a post-natal environmental influence that almost all children experience (for example, social interaction with other children) that then causes you to develop a homosexual orientation.

The College has also modified its view on whether orientation can change. “It is not the case that sexual orientation is immutable or might not vary to some extent in a person’s life.” They also concede that bisexuals have “a degree of choice.” If such change is possible, the College has yet to explain why this might not take place in therapeutic contexts.

Well yes, but there is still an argument to be had whether SOCE actually work. Even if environmental (psychological? emotional?) factors are a component of the development of a homosexual orientation, it might be very difficult to “unpick” those factors and “revert” to heterosexuality.

So, a very welcome movement from the RCP on their position, but still lots of unproven assumptions (on both sides).

Update

It’s been pointed out to me that the RCP website has content that is now contradicted by this latest position statement.

Despite almost a century of psychoanalytic and psychological speculation, there is no substantive evidence to support the suggestion that the nature of parenting or early childhood experiences have any role in the formation of a person’s fundamental heterosexual or homosexual orientation (Bell and Weinberg, 1978).

It would appear that sexual orientation is biological in nature, determined by genetic factors (Mustanski et al, 2005) and/or the early uterine environment (Blanchard et al. 2006). Sexual orientation is therefore not a choice, though sexual behaviour clearly is.

Ooooppps.

61 Comments on “Royal College of Psychiatrists Backtrack on Sexuality Causation

  1. There seems to be the usual semantic conflation going on here of self-labelling [gay, straight, bi, etc.] with some sort of objective reality [ie. their statement that bi’s may change, implying gays cannot], when sexual orientation continues to defy any objective medical definition beyond self-labelling, and research such as Diamond’s [thanks for posting that, Peter] throws up increasing evidence of fluidity, and also, of blurred boundaries within those self-labelled identities [e.g. her finding of 40% of gay-identified men experiencing hetero attractions within one year].

    And this statement:
    “The College would not support a therapy for converting people from homosexuality any more than we would do so from heterosexuality.”
    Throws up a false dichotomy that completely ignores biology. Anything deviating from ordinary procreative sexual drives has surely a case to answer in terms of being considered in any way normative behaviour, however it may arise. They seem to have pre-assumed patients’ self-identifications and worked from there, in spite of the evidence.

    • “Throws up a false dichotomy”

      I don’t see this as a dichotomy at all. It is simply a declaration that there is no more reason to tamper with the one kind of sexuality than with the other. (How fluid, blurred etc. the categories may be does not affect that.) I agree.

      • My point is that as reproduction is a biological imperative (like eating, or breathing) ie, something we are anatomically and hormonally equipped to do, if our behavioural inclinations do not line up with that, then that puts them in an entirely different category to the biologically appropriate ones.

        • Reproduction is a hardly a biological imperative in the same way as eating or breathing. You have to eat and breathe to stay alive. You don’t have to reproduce to stay alive. Indeed, in some religious traditions people who refrain both from reproductive sex and from any other kind are regarded as especially holy. (Don’t ask me why; I can’t figure it out.)

          Heterosexual attraction has a tendency to result in sexual behaviour which is frequently, although by no means always, procreative. Sexual behaviour resulting from homosexual attraction, on the other hand, is not potentially procreative. Fine. No “case to answer”. Just a fact of life.

          • The biological imperative term is derived from a Darwinian perspective, i.e. that that we have innate drives for the purpose of surviving both individually an as a species. We are a sexually dimorphic species (as are all mammals) so male-female sex is the only way to perpetuate the species [even IVF or surrogacy is simply male-female sex by proxy] so a hetero drive is implicitly normative, although as you point out, sexual activity is not essential to individual life.
            My point is that the RCP are showing no recognition of this in the way they contrast hetero and homo attraction and behaviour. There is no implied moral judgement in this, it is the reflection of biological realities. That this is missing from the RCP’s case shows it is based on other grounds.

            • Yes, we are indeed a sexually dimorphic species, and our species can be perpetuated only by male-female sex (which explains why heterosexuality is and always has been decidedly the majority sexual orientation). Like you, I am fully aware of this biological reality, and I wouldn’t be at all surprised if the RCP are aware of it too; it is certainly a distinct possibility.

              “That this is missing from the RCP’s case shows it is based on other grounds,” you say. Yes, of course it is. The RCP’s position is that homosexuality is not a disorder, and therefore does not need “correcting” any more than heterosexuality does. The biological reality to which you refer, indisputable and vital as it is, forms no part of their “case” because it does not affect their position one way or the other. Nor is there any reason why it should.

              • GM,

                Do you believe that heterosexuality occurs in the vast majority of humans because of societal necessity (i.e. it is primarily a social construct) or through biological essentialism (most human beings are intrinsically heterosexual in their attractions and heterosexual societal constructs are simply a way of ordering that essentialism)?

                • The issue here should not wander into whether homosexuality (or for that matter, heterosexuality) should be classified by psychologists as a disorder.

                  Criteria for disorder, such as statistical infrequency, failure to function adequately and deviation from ideal mental health are notoriously difficult to define.

                  A norm within one culture may be frowned on in another. The situation, context and age of a person exhibiting a particular behaviour may also vary our interpretation of actions.

                  Here’s the real issue: The College considers that the provision of any intervention purporting to ‘treat’ something which is not a disorder is wholly unethical’

                  Let’s say that you’ve lost a relative and experience grief, or perhaps, you’re unable to grieve properly. Grief is not a disorder, but a bereavement counsellor will provide an intervention purporting to ‘treat’ it. Does the RCP consider that to be wholly unethical too?

                  • David I expected more from you. Really. You mention grief, and of course there is intervention to help alleviate that grief. But it’s not possible to completely eliminate the grief or to reverse the loss of said relative. The College statement is clear – it states that they don’t support ‘therapeutic’ (aka religious nonsense) intervention to change a persons sexual identify, but they do support therapeutic intervention to support and help people live with who they are. Replies on a postcard please, not an essay :)

                    • ‘But it’s not possible to completely eliminate the grief or to reverse the loss of said relative’

                      The measure of success for a therapeutic intervention is not elimination, but improvement in accordance with the realistic aspirations agreed at the outset.

                      Since sexual identity is more fluid than originally thought, the sexual aspirations by which we construe ourselves may change over time and result in significant behavioural changes. The real question is whether a therapy should support the realistic evolution of a desired change in sexual identity? I can’t see why not?
                      Having a lovely time! Wish you were here!
                      Dave

                    • PS: It’s lost on some, but there’s a world of difference between:
                      1. the RCP refusing to endorse a therapy and
                      2. the RCP claiming that any therapy that doesn’t purport to address a recognised disorder is unethical.

                • I’m sure that there is still an awful lot about human sexuality that we still don’t know or understand, but provisionally I would put my money on the latter option.

                • I don’t think anyone knows the answer to that, although there are studies that suggest that kin selection hypothesis may explain male homosexuality from an evolutionary perspective

                  • Kin selection (the evolutionary strategy that favours the reproductive success of relatives, even at a cost to the organism’s own genetic survival) has been invoked as an explanation of male homosexuality. It would suggest that there is an unconscious altruism of gay sexual behaviour in furtherance of the genetic outcomes of their straight siblings (i.e. nephews and nieces).

                    The kin selection hypothesis has been superseded by the multi-level or group selection hypothesis: that behaviour to improve genetic outcomes goes beyond genetic relateness to include the social organisations that may form.

                    Whether gay couples are unconsciously opting out of reproduction in order to promote the better genetic outcomes for siblings is an interesting theory. However, the quantitative proof of the theory’s validity would be a consequent increase in the genetic survival of their nephews and nieces.

        • Reproduction is actually aligned with the inclusive fitness of our species. This is an evolutionary priority for maintaining our overall genetic diversity. Of course, you won’t personally die without it.

          However, since inclusive fitness is an average, ‘it will reflect the reproductive outcomes of all individuals of a particular genotype in a given environment or set of environments’.

          When compared to more costly efforts to perpetuate genetic diversity (which is crucial to the success of our species), society may inter-generationally prioritise the types of sexual relationships that are naturally (and therefore more readily) capable of furthering the inclusive fitness of human society. It does this through establishing an institution

          What is wrong is to re-purpose and thereby undermine the inter-generational semantic power of an institution like marriage.

          • David consenting heterosexual adults also engage in ‘incongruous’ sexual activity (aka anal sex). Kinky or what! ;)

            • Aw, shucks. You’re making me blush now! ;-) BTW, rumour has it that some of those ‘heteros’ [or less offensively, ‘those with a straight identity’] even get off on polyandrous activity. ‘Ick!’

              That said, consenting adults of any orientation have the legal freedom to engage in whatever private sexual activity they like. That does not justify assigning the same priority of marriage to those types of sexual relationships that are incongruous with furthering of our genetic diversity responsibly.

              A form of sexual activity is not a type of sexual relationship. Also, for that matter, neither is age, nor fertility.

          • Maybe David if us gays indulged in a bit of ‘congruous’ ‘vag’ on the side we would qualify for your ‘institutional validation all of congruous types of sexual relationships,? After all, who’s peering through the bedroom door apart from your imaginary god??

            • ‘After all, who’s peering through the bedroom door apart from your imaginary god??’
              Exactly, so why would anyone want to divert public policy from prioritizing the types of sexual relationships with the potential to generate positive genetic outcomes for the whole society?
              Why should public policy be re-oriented towards using marriage to affirm the moral equivalence of private sexual acts in themselves?

  2. “For example, it could be that the biological factors predispose you to a post-natal environmental influence that almost all children experience (for example, social interaction with other children) that then causes you to develop a homosexual orientation.”

    If we adopt this as a provisional hypothesis, it would seem equally likely that specific biological factors are needed also to interact with this post-natal environmental influence to produce a HETEROSEXUAL orientation in the majority. In other words, most people’s biological profile, which must comprise a vast range, would interact with their post-natal environment to cause a heterosexual orientation. It would be only a biological profile within a very narrow range that interacts with the same environment to result in a homosexual orientation.

    In which case it is possible that, if we discovered those particular environmental features which ex hypothesi contribute to sexual orientation and started officiously altering them, this would simply cause a different set of people to develop a homosexual orientation, viz. those whose biological profile fell within a different range.

    • “If we adopt this as a provisional hypothesis, it would seem equally likely that specific biological factors are needed also to interact with this post-natal environmental influence to produce a HETEROSEXUAL orientation in the majority.”

      No, not necessarily. It could be that the biological default is heterosexuality, but in a small minority *something* happens to alter that. And indeed, given that the overwhelming majority (99%) report some form of heterosexual attractions, that seems to be a much better starting hypothesis that says that everything sexual orientation wise is pretty well up for grabs as soon as an individual pops out of the womb.

      • I agree, Peter. And anatomy indicates it is the default. Our brains are relatively undeveloped at birth and are ‘neuroplastic’ – i.e. they are wired progressively by our experience over our first 18 years at least, and our sense of self takes years to emerge. Everyone is as much a product of nurture as nature.

        • But we don’t know what it is that causes the development of either heterosexual or homosexual attractions. There are theories, of course, any number of them ranging from batty to plausible. But we still don’t know. The facts of experience tell us that heterosexuality, whether exclusive or predominant, is by far the majority orientation. Our anatomy tells us that we are male or female (even if there are some anomalies). It doesn’t impose on us the obligation to be heterosexual or to try to be, even though most people undoubtedly are, and I’m sure always will be.

          • I broadly agree. Our anatomy doesn’t impose on us the obligation to be hetero, and we can’t give easy answers to how homosexual and other orientations develop; there are undoubtedly many factors involved, which makes scientific investigation difficult. But in a predominantly hetero world, anyone who is not comfortable with being ‘different’ should surely be free to explore all therapeutic options if they wish – evidence for the possibility of change continues to accumulate. The political drive for gay rights seems to have trumped individual freedom to determine their own lifestyle choices. That’s a loss to all of us, if it’s allowed to continue, and sadly, RCP are still arguing against that freedom.

            • I agree that anyone has a perfect right to change their sexual orientation, if they don’t like it, and to explore ways of doing so. But the inalienable right in principle to do something is no proof whatever that you can actually do it. You say that evidence for the possibility of change continues to accumulate. Not from where I’m standing. The folding up, during the past decade or so, of one “ex-gay” organization after another; the long succession of “ex-gay” leaders who held themselves up, or were held up by others, as living proof of sexual orientation change, but who have sooner or later recanted and admitted that the whole thing was nothing but self-deception; the contradictory claims made by secular or quasi-secular “conversion therapists”; these things are to me accumulating evidence that, no matter what spontaneous changes may occasionally occur and no matter how fluid some people’s sexuality may be, attempts to engineer a deliberate change in their orientation are very seldom successful, if ever.

              To be fair, I have no doubt that many of those who offer “therapy” of this kind do actually believe in what they are doing. But that is certainly not proof that it works, still less is it sufficient reason for the RCP to approve it. Should any old therapy be approved just because its practitioners believe in it and because, like all useless fringe therapies, it offers something that some people want? Of course not; no responsible health organization would or should do that.

              The RCP are not interfering with anyone’s individual freedom by refusing to sanction this kind of “treatment” for a non-illness. Adults remain completely free to dabble in it if they wish. In the same way, I am free to dabble, at my own risk, in Christian Science healing, spirit healing, psychic surgery, bee-sting therapy, biochemic tissue salts etc. I can’t get any of those things from my doctor or my local hospital, and the British Medical Association refuses to endorse them, but that is no infringement of my personal freedom.

              • You’ll certainly get that picture from the Pink press, GM, they would say that, wouldn’t they? The gay community is a self-selecting group of – er – out and proud gay people – you’re not going to hear much from the ones who have moved on, are you, unless you hang around on their blogs all the time – oh wait…… :)

                But at the moment most therapeutic evidence comes down to personal testimonies of patients and therapists, as hardly any longitudinal studies have been done, amongst which there is a very wide diversity of view. Then we have Lisa Diamond’s and similar studies [I’ll refer you also to the excellent article from First Things which Peter posted a few weeks back, written by …speak it softly… an ex-gay man] – which seems to be calling for a more flexible understanding of human sexuality that the old LGB labelling approach. So the RCP ought be calling for more and better research before making the kind of dogmatic assertions seen in the above statement.

                • The Pink press can certainly be interesting from time to time, Broadwood. When I start relying on it for information, I’ll be sure to let you know. If by “the ones who have moved on” you mean people whose orientation has changed from homosexual to heterosexual, then no, I certainly don’t myself hear much from them. They aren’t easy to find. I have been knowingly acquainted with only two, and, as I eventually discovered, they hadn’t really moved on in that sense after all.

                  However, to be fair, I haven’t gone round looking for these people. The discoveries of those who have, e.g. Robert Spitzer, Jones & Yarhouse, have been far from impressive. If we make an absurdly parsimonious estimate of the homosexual population as 1%, the over-18 gay population of the USA is around 2.1 million. Yet Spitzer, after searching for nearly two years, with the help of ex-gay ministries and conversion therapists, could find only 200 (just under 0.01% of the homosexual population) whose claims to have changed their sexual orientation were prima facie convincing enough to be taken seriously, and 40% even of those fell through under closer scrutiny. Fewer than 20% of Jones & Yarhouse’s original 98 subjects converted to a heterosexual orientation, and most of those, according to Jones & Yarhouse, “did not report heterosexual orientation to be unequivocal and uncomplicated”. The last president of Exodus International, Alan Chambers, estimated the failure rate of attempts to change sexual orientation as something like “99.9%”, and the director of Exodus’s biggest and longest-running affiliated ministry (Love In Action) admitted that in his nearly 22 years of running it he had never known a homosexual man to turn heterosexual through ex-gay ministry. Opinions will differ, but I’d say that, irrespective of the fluidity of some people’s sexuality, the evidence for the possibility of deliberately engineered change, far from continuing to accumulate, looks more flimsy by the year.

                  With regard to Lisa Diamond, it should be mentioned that she explicitly repudiated the claim that her research into sexual fluidity in women showed that sexual orientation can be deliberately changed, and she decried the dishonesty of conversion therapists who were citing it as though it did.

                  • “If by “the ones who have moved on” you mean people whose orientation has
                    changed from homosexual to heterosexual, then no, I certainly don’t
                    myself hear much from them.”

                    No, I don’t mean that. I think you’re setting the bar far too high.

                    I agree that someone who has experienced largely same sex attractions hitherto, a complete extinction of those is very probably an unrealistic goal, but this is in any case not important, if what they want is simply to achieve either a contented celibacy or a successful relationship with an OS partner. And many do – that’s what I call moving on. But seemingly you would call them a failure because they may still have some same-sex attractions.

                    So what?

                    Every married, partnered or committedly single person experiences ‘forbidden’ attractions to someone at times, it really doesn’t matter to whom, and the stats show many people have had some same-sex attractions who have never considered themselves gay.

                    People should be free to choose their lifestyle without others wanting to label them as ‘self-hating gays’, ‘uncle toms’ or ‘really’ bi, as so you often hear in the Pink Press. When will we see some tolerance and acceptance in the gay community for that? I just wish we could get away from the labels and the groupthink, and realise we are are all just people who struggle, and if people want help to re-imagine their lives they should be able to get it – and more importantly, that therapists should be able to give it without fear for their careers.

                    Here’s the link for that ‘First Things’ article – https://www.peter-ould.net/2014/02/21/against-homosexuality/ – I really do recommend you read it.

                    • I have no objection whatever to anyone “who has experienced largely same sex attractions hitherto” achieving either “a contented celibacy or a successful relationship with an OS partner” provided that that is what they really want and freely choose (and provided that in the latter case no deception is being practised on the OS partner). What do I object to very strongly indeed is any attempt to pressure such a person in either of those directions by telling them that those are their only moral options, and that gay relationships are morally wrong.

                      I object equally strongly to the making of misleading claims, e.g. that people’s sexual orientation can be deliberately changed through ex-gay or conversion therapy programs. And I certainly do not agree that genuine, accredited therapists should be able to make such misleading claims without fear for their careers. Fringe therapists, on the other hand, should enjoy the same freedom as astrologers, tarot readers and chiromantists to make bogus claims.

                    • “What do I object to very strongly indeed is any attempt to pressure such a person in either of those directions by telling them that those are their only moral options, and that gay relationships are morally wrong.”
                      But often this criticism is leveled at people who of their own volition and religious conviction choose to integrate their sexual identity with their religious beliefs and not their raw emotions.

                      “Fringe therapists, on the other hand, should enjoy the same freedom as astrologers, tarot readers and chiromantists to make bogus claims.”

                      What, like those who practice CBT and Gestalt Therapy? Or perhaps you want to point us to the double-blind studies that show that those work? Or does “fringe” simply mean “those I disagree with”?

                    • If people want to take that kind of course entirely of their own volition and as the result of their religious convictions, that’s entirely up to them. They must have freedom of choice, even if others disagree with their choices.

                      I know nothing whatever about CBT and Gestalt Therapy, so I can’t make any useful comment on them, except to say that if you regard them, whatever they are, as bogus, that is an argument for deleting them from the category of legitimate therapy, not for adding conversion therapy.

                    • ‘I object equally strongly to the making of misleading claims, e.g. that people’s sexual orientation can be deliberately changed through ex-gay or conversion therapy programs.’

                      Okay, let’s deal with realistic claims, like those of the APA http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf:

                      ‘Same-sex sexual attractions and behavior occur in the context of a variety of sexual orientations and sexual orientation identities, and for some, sexual orientation identity (i.e., individual or group membership and affiliation, self-labeling) is fluid or has an indefinite outcome.’

                      ‘Some individuals choose to live their lives in accordance with personal or religious values (e.g., telic congruence).’

                      ‘The available evidence, from both early and recent studies, suggests that although sexual orientation is unlikely to change, some individuals modified their sexual orientation identity (i.e., individual or
                      group membership and affiliation, self-labeling) and other aspects of sexuality (i.e., values and behavior). They did so in a variety of ways and with varied and unpredictable outcomes, some of which were temporary.’

                      ‘Sexual orientation identity exploration can help clients create a valued personal and social identity that provides self-esteem, belonging, meaning, direction, and future purpose, including the redefining of religious beliefs, identity, and motivations and the redefining
                      of sexual values, norms, and behaviors (Beckstead & Israel, 2007; Glassgold, 2008; Haldeman, 2004; Mark, 2008; Tan, 2008; Yarhouse, 2008).’

                      ‘We encourage LMHP to support clients in determining their own
                      (a) goals for their identity process;
                      (b) behavioral expression of sexual orientation;
                      (c) public and private social roles;
                      (d) gender role, identity, and expression;
                      (e) sex and gender of partner; and
                      (f) form of relationship(s).’

                      So, given the relative fluidity of sexual orientation identity and outcomes that might be as varied as for those exploring their gender identity on the NHS, why is it unethical for a genuine accredited therapist to support a client whose goals for the identity process include achieving telic congruence of their sexual orientation identity with their personal or religious values?

                    • People are free to adopt any identity that they choose. But while some people’s sexual attractions may be fluid, deliberate attempts to contrive a deliberate change in people’s sexual orientation are invariably a failure. Some people have wasted years, even decades, of their lives fruitlessly striving to alter their sexual orientation. If adults insist on doing this, no-one else has the right to stop them. As Sir Oliver Lodge wrote, “The essence of manhood is to be free – for better for worse, free.” But they should not be conned into doing it by giving them misleading information, not even in pursuit of telic congruence with their personal or religious values (still less anyone else’s).

                    • Why would I want to do that, Peter? I can’t see that it would achieve anything, but OK, I’ll do it if it gives you pleasure. Do I believe that some people’s sex is fluid? No. Do I believe that people can change the sex to which they belong by adopting a different sex/gender “identity”? No. Do I believe that people can genuinely change their sex by having surgery, injecting/ingesting hormones etc.? No. Do I believe that people’s sex can be changed at all? No. I would add one rider, however: presumably God, being omnipotent, could in theory change anyone’s sex at any time for some inscrutable purpose of his own. I am not aware of any authenticated instance in which he has performed that whale of a miracle.

                    • Great, so you oppose sexual reassignment surgery for those with gender dysphoria? Or do you support it because it makes people feel better, that it achieves a telic congruence with their life goals and desires?

                    • As I have already made clear more than once, I have little knowledge of transgender matters. So I am reluctant to say that I categorically oppose gender reassignment surgery, but I have no hesitation in admitting that I am uneasy about it. I am hesitant about trying to lay down the law about a situation which I can’t honestly claim to understand. Of one thing I am certain: no-one should be told that their sex will genuinely be changed by gender reassignment surgery, because it won’t. The most that I can do here is to cite the late French Catholic priest and psychiatrist Fr Marc Oraison. I’m quoting from memory, so I can’t claim to be quoting him verbatim, but he wrote something like this about a young man who was considering gender reassignment surgery:

                      “It can be done, as we know. My concern was, would it actually solve his problem, or would it merely complicate it?”

                      But none of this has any bearing on my view of attempts to change people’s sexual orientation.

                    • The question was not whether people are free to adopt an identity, nor whether anyone has the right to stop them. It was why it would be unethical for a genuine accredited therapist to support the client in that above-mentioned identity process.

                    • In my view it would be unethical for any genuine, accredited therapist to encourage a client to pursue what the therapist believes will certainly or almost certainly prove to be a long and possibly detrimental wild-goose chase. It’s just the way I think.

                    • So let’s be clear, it’s not about whether there is an any evidence it WILL be a “possibly detrimental wild-goose chase”, it’s whether the therapist, NOT the client, believes it might be this “wild-goose chase”.
                      And the objective basis for deciding whether it will be “detrimental” or a “wild-goose chase” is what?

                    • The objective basis for deciding that it is likely to be a wild-goose chase is the remarkably poor evidence for the success of attempts to change people’s sexual orientation. Whether or not it will prove detrimental will, I suppose, depend largely on its length. If the wild-goose chase is soon abandoned, then probably not much harm, if any, will be done. If, however, it is prolonged – as in the case of some people who have chased for years or even decades – the waste of precious time, even if no other harm is done, is more than sufficient detriment.

                    • You don’t think, then, that inciting or encouraging people to fritter away years of their lives on chasing an ignis fatuus is doing any harm? Well, I do.

                    • Of course, that’s an opinion to which you’re entitled. Yet, on the basis of gathered evidence, the APA encourages licensed mental health professionals to pursue just such a sexual orientation identity process (despite being like gender identity therapy almost certainly long and possibly detrimental).

                      I suppose the question remains which would be a more sound basis for public health policy: the way you think or the considered position of Task Force appointed by the APA.

                      I would respectfully suggest the latter.

                    • Extract from the Resolution of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation:

                      “BE IT FURTHER RESOLVED, That the American Psychological Association concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation;

                      “BE IT FURTHER RESOLVED, That the American Psychological Association encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation;”

                    • I’m not sure that I understand the concept of “sexual orientation identity”. Does it refer to a kind of charade – going through life playing the silly game of pretending that one’s sexual orientation is different from what it really is? I thought that the need to do that had evaporated long ago. I remember my mother saying that living your life trying or pretending to be something that you’re not is a short cut to a nervous breakdown. I’m sure that she was right.

                    • ‘Does it refer to a kind of charade – going through life playing the silly game of pretending that one’s sexual orientation is different from what it really is? I thought that the need to do that had evaporated long ago’

                      Since the APA hold that there is a genuine distinction between sexual orientation identity and sexual orientation, your response is self-defeating undermining the credibility of the very institution whose resolution you have quoted.

                      Strange that you don’t attach the same cynicism to the distinction between gender identity and gender. You simply claimed that you didn’t know enough about it. Pleading a similar level of ignorance about sexual orientation identity would have been significantly more coherent.

                    • Ignorance about sexual orientation identity is precisely what I have pleaded. Whether or not it’s down to my own lack of knowledge or perspicacity, I am not certain that I fully and correctly understand the concept. If, as you seem to imply, it’s clear to you, a direct “yes” or “no” in answer to my question would have been most helpful, and if the answer was “no”, you could have explained in very simple terms where I was going wrong.

                      So by querying the precise meaning of the term “sexual orientation identity” I have undermined the credibility of the APA, have I? By Jove, I had never realised until now that I possessed such power! It’s quite scary. But are that august institution, the APA, aware that they’ve been scuppered? Just in case they’re not, I think that you should write to them post-haste to warn them. Better still, send an urgent telegram.

                    • Apparently, the erosion (that undermining implies) can take place without incurring irreparable damage. Hence, alacritous communication will not be required.

                      As Peter said: ‘Sarcasm doesn’t suit you’…especially when you question why a direct ‘yes’ or ‘no’ isn’t forthcoming from me.

  3. Two points:

    Bi-sexuality – if “straight” and “gay” can be regarded as unchosen emotional states, then so can bi-sexuality. The choice inherent to bi-sexuality is the choice between male or female, not the choice between “being gay” or “being straight”.

    Disorder – same-sex sexual desire cannot be a psychiatric disorder, yet it is a disorder, since the desire is against the order of the body. Our sexual desires are either orientated correctly or not (dis-orientated).

  4. Peter, your desire to find pinholes in any statement by the RCP, or twist words to make it appear that pinholes exist, are undermined by always a mention of the inappropriately named Core Issues Trust as if they were a valid counterpoint. Let me remind you what they claim:

    “Core Issues Trust does not believe that people who experience same-sex attraction were ‘born gay’. …. Science suggests that most of them ‘became that way’ as a result of real or perceived traumatic experiences in early life. …. The Trust considers human sexuality in both men and women to be fluid, and the brain malleable…”

    Those sweeping statements are false, bluntly, being without any basis in science (and tellingly unreferenced) and being contrary to the lived experience of men and women; gay, straight or anywhere in between. The RCP is using ‘environment’ in a specific way, and you may know that by the references they give. They are not talking about people’s sexual attractions being turned gay because of real or perceived childhood experiences. Unfortunate childhoods do cause any number of outcomes to the lives of adults, as the RCP recognise, but underlying sexual attraction is not shown to be one of them; regardless of unfounded, sweeping statements by some to the contrary.

    Core Issues compound that error by deliberate association with repellant individuals such as Robert Gagnon and Andrea Williams who have no qualms about using such misunderstandings to further social and religious ends, and yet is to them who you make reference. Understandably you are required to scrape the bottom of the barrel to promote your own views but, please, it is also clear that the standards to which you hold Core Issues and the RCP are very clearly divergent. Referencing Diamond’s work around the sexual identities and behaviour of functional bisexuals does not talk to the lives of men or women at either end of the scale and does not offer any support to the CIT statements above. Ask her, should you wish.

    People have the ‘right’ to flap their arms and attempt to fly to Florida for the winter, but any travel agent selling a holiday on those terms should rightfully be regarded as fraudulent and treated accordingly.

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