Friday, December 14, 2007

The Royal College Expresses Our Opinion, Clear and Concise

The British Royal College of Psychiatrists has written a "Submission to the Church of England's Listening Exercise on Human Sexuality," on the topic of lesbian, gay, and bisexual (LGB) people. I'm not sure what that is, exactly, it appears to be a way the scientific community can keep the church informed, I guess. You will find it interesting to see what shrinks across the pond have to say on this matter.

I'll extract the key points here -- it should be clear where I've edited.
The Royal College of Psychiatrists holds the view that LGB people should be regarded as valued members of society who have exactly similar rights and responsibilities as all other citizens. This includes equal access to health care, the rights and responsibilities involved in a civil partnership, the rights and responsibilities involved in procreating and bringing up children, freedom to practice 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.

We shall address a number of issues that arise from our expertise in this area with the aim of informing the debate within the Church of England about homosexual people. These concern the history of the relationship between psychiatry and LGB people, determinants of sexual orientation, the mental health and well being of LGB people, their access to psychotherapy and the kinds of psychotherapy that can be harmful.

1. The history of psychiatry with LGB people.

Opposition to homosexuality in Europe reached a peak in the nineteenth century. What had earlier been regarded as a vice, evolved into a perversion or psychological illness. Official sanction of homosexuality both as illness and (for men) a crime led to discrimination, inhumane treatments and shame, guilt and fear for gay men and lesbians (1). However, things began to change for the better some 30 years ago when in 1973 the American Psychiatric Association 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 Organisation followed suit in 1992. This unfortunate history demonstrates how marginalisation of a group of people who have a particular personality feature (in this case homosexuality) can lead to harmful medical practice and a basis for discrimination in society. Submission to the Church of England's Listening Exercise on Human Sexuality

That is about as concise a summary as you could imagine, the whole history of a subject in one short paragraph. Hey, do you suppose TV shrinks in the UK speak the queen's snooty English with a German accent? I can't imagine that. Tell me, old boy, vot are you-ah feelinks about you-ah mothah?
2. The origins of homosexuality

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 play any role in the formation of a person's fundamental heterosexual or homosexual orientation (2). It would appear that sexual orientation is biological in nature, determined by a complex interplay of genetic factors (3) and the early uterine environment (4). Sexual orientation is therefore not a choice, though sexual behaviour clearly is. Thus LGB people have exactly the same rights and responsibilities concerning the expression of their sexuality as heterosexual people. However, until the beginning of more liberal social attitudes to homosexuality in the past two decades, prejudice and discrimination against homosexuality induced considerable embarrassment and shame in many LGB people and did little to encourage them to lead sex lives that are respectful of themselves and others. We return to the stability of LGB partnerships below.

Neat. It's as if they've been prying through the filing cabinets of talking points memos in the TeachTheFacts International Library.

I like this next one, with its backhand swipe at the Family Blah Blah groups way over here in the USA:
3. Psychological and social well being of LGB 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, the experiences of discrimination in society and possible rejection by friends, families and others, such as employers, means that some LGB people experience a greater than expected prevalence of mental health and substance misuse problems (5, 6). Although there have been claims by conservative political groups in the USA that this higher prevalence of mental health difficulties is confirmation that homosexuality is itself a mental disorder, there is no evidence whatever to substantiate such a claim (7).

The next section is a little longish, so I'm going to pick and choose. You can go check if you think I'm not being fair.
4. Stability of gay and lesbian relationships

There appears to be considerable variability in the quality and durability of same-sex, cohabiting relationships (8, 9). A large part of the instability in gay and lesbian partnerships arises from lack of support within society, the church or the family for such relationships...

There is already good evidence that marriage confers health benefits on heterosexual men and women (10, 11) and similar benefits could accrue from same-sex civil unions. Legal and social recognition of same-sex relationships is likely to reduce discrimination, increase the stability of same sex relationships and lead to better physical and mental health for gay and lesbian people. It is difficult to understand opposition to civil partnerships for a group of socially marginalised people who cannot marry and who as a consequence may experience more unstable partnerships. It cannot offer a threat to the stability of heterosexual marriage...

It is so nice to hear them say this so clearly and neatly. Whoever wrote this gave it a lot of thought and chose their words well.

Doesn't it just make sense to encourage (never mind allow) gay people to form long-term relationships? It just seems so obvious, everybody's life is better when they can settle down with someone they love, the point is not whether the other person is the same or opposite sex from them. Like, for them to just say: It cannot offer a threat to the stability of heterosexual marriage. That's as direct as you can make it. Sorry, Chicken Little, it is simply impossible that gay marriages threaten straight ones.

The CRC started out trying to get conversion therapy or reparative therapy into the sex-ed curriculum, and they kind of gave up on it. They still talk about "ex-gays" as if that was something real, but I think they figured out that reparative therapy was not going to be mentioned.

The British Psychiatric guys have a longish section on this topic:
5. Psychotherapy and reparative therapy for LGB people

The British Association for Counselling and Psychotherapy recently commissioned a systematic review of the world's literature on LGB people's experiences with psychotherapy (13). This evidence shows that LGB people are open to seeking help for mental health problems. However, they may be misunderstood by therapists who regard their homosexuality as the root cause of any presenting problem such as depression or anxiety. Unfortunately, therapists who behave in this way are likely to cause considerable distress. A small minority of therapists will even go so far as to attempt to change their client's sexual orientation (14). This can be deeply damaging. Although there is now a number of therapists and organisation in the USA and in the UK that claim that therapy can help homosexuals to become heterosexual, there is no evidence that such change is possible. The best evidence for efficacy of any treatment comes from randomised clinical trials and no such trial has been carried out in this field. There are however at least two studies that have followed up LGB people who have undergone therapy with the aim of becoming heterosexual. Neither attempted to assess the patients before receiving therapy and both relied on the subjective accounts of people, who were asked to volunteer by the therapy organisations themselves (15) or who were recruited via the Internet (16). The first study claimed that change was possible for a small minority (13%) of LGB people, most of whom could be regarded as bisexual at the outset of therapy (15). The second showed little effect as well as considerable harm (16). Meanwhile, we know from historical evidence that treatments to change sexual orientation that were common in the 1960s and 1970s were very damaging to those patients who underwent them and affected no change in their sexual orientation (1, 17, 18).

Everybody knows these guys are right on the money. I'm glad they took the initiative to file this report with the church, and to spell this out so clearly and neatly.

Their conclusions are good, to:

In conclusion the evidence would suggest that there is no scientific or rational reason for treating LGB people any differently to their heterosexual counterparts. People are happiest and are likely to reach their potential when they are able to integrate the various aspects of the self as fully as possible (19). Socially inclusive, non-judgemental attitudes to LGB people who attend places of worship or who are religious leaders themselves will have positive consequences for LGB people as well as for the wider society in which they live.

Except for the fact that they spell some things funny, the Royal College of Psychiatrists seems to be in perfect agreement with It seems so easy: treat people like people.

Because they put footnotes in their text and I left them in when I copied-and-pasted, and because some of these references are important, I'll include their reference section, too:
(1) King M, Bartlett A. British psychiatry and homosexuality. Br J Psychiatry 1999 August;175:106-13.

(2) Bell AP, Weinberg MS. Homosexualities : a study of diversity among men and women. New York: Simon and Schuster; 1978.

(3) Mustanski BS, DuPree MG, Nievergelt CM, Bocklandt S, Schork NJ, Hamer DH. A genomewide scan of male sexual orientation. Human Genetics 2005 March 17;116(4):272-8.

(4) Blanchard R, Cantor JM, Bogaert AF, Breedlove SM, Ellis L. Interaction of fraternal birth order and handedness in the development of male homosexuality. Hormones and Behavior 2006 March;49(3):405-14.

(5) King M, McKeown E, Warner J et al. Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study. Br J Psychiatry 2003 December;183:552-8.

(6) Gilman SE, Cochran SD, Mays VM, Hughes M, Ostrow D, Kessler RC. Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. Am J Public Health 2001 June;91(6):933-9.

(7) Bailey JM. Homosexuality and mental illness. Arch Gen Psychiatry 1999 October;56(10):883-4.

(8) Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 2001 November;91(11):1869-76.

(9) McWhirter DP, Mattison AM. Male couples. In: Cabaj R, Stein TS, editors. Textbook of Homosexuality and Mental Health.Washington: American Psychiatric Press; 1996.

(10) Kiecolt-Glaser JK, Newton TL. Marriage and health: his and hers. Psychol Bull 2001 July;127(4):472-503.

(11) Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol 2000 May;10(4):224-38.

(12) King M, Bartlett A. What same sex civil partnerships may mean for health. J Epidemiol Community Health 2006 March 1;60(3):188-91.

(13) King M, Semlyen J, Killaspy H, Nazareth I, Osborn DP. A systematic review of research on counselling and psychotherapy for lesbian, gay, bisexual & transgender people. Lutterworth: BACP; 2007.

(14) Bartlett A, King M, Phillips P. Straight talking: an investigation of the attitudes and practice of psychoanalysts and psychotherapists in relation to gays and lesbians. Br J Psychiatry 2001 December;179:545-9.

(15) Spitzer RL. Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Arch Sex Behav 2003 October;32(5):403-17.

(16) Shidlo A, Schroeder M. Changing sexual orientation: A consumers' report. Professional Psychology: Research and Practice 2002;33:249-59.

(17) King M, Smith G, Bartlett A. Treatments of homosexuality in Britain since the 1950s--an oral history: the experience of professionals. BMJ 2004 February 21;328(7437):429.

(18) Smith G, Bartlett A, King M. Treatments of homosexuality in Britain since the 1950s--an oral history: the experience of patients. BMJ 2004 February 21;328(7437):427.

(19) Haldeman DC. Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy. Professional Psychology - Research & Practice 2002;33(3):260-4.


Anonymous Anonymous said...

"WASHINGTON (Dec. 14) - With Democrats beginning to give in to the White House on energy and spending bills, and with their hopes of expanding a popular children’s health program all but dashed, President Bush has scored three political victories this week on Capitol Hill.

As with earlier battles over the war in Iraq, the victories underscore the surprising amount of clout that Mr. Bush still wields against a Democratic-run Congress. Late in his presidency, with his poll numbers stuck at record lows, he has been able to persuade Republicans to stick with him."

Big ol' smile!

December 14, 2007 4:20 PM  
Anonymous Anonymous said...

Jeez Jim, perhaps they shouldn't have bothered with the list and just said "ref: Teach The Facts" :)

More seriously...

The anti-gay have lost the "debate" over "conversion therapy" (all bar the shouting at the end). There's always that reprobate rump to deal with but they will be increasingly marginalised.

Conversion therapy has always relied on unsubstantiated claims, mostly anecdotal and never followed long-term, and it deliberately promoted whatever doubts that could be caused in the minds of people predisposed with negative attitudes.

They have also failed, completely, to produce any evidence that attempts at conversion actually work. Jones & Yarhouse being but the latest in a long line of miserable failures for this "medical model of anti-homosexuality" dating back over 100 years.

The response by the professional bodies has been way too slow (IMO), but if the mill grinds slowly at least it does grind very fine.

They lost. Time to move on, and re-group.

What we are now observing from the anti-gay is a slide away from claims about true conversion, per se.

Increasingly, we're seeing testimonials about people who have forced themself to act contrary to their sexuality; and (by extension) the suggestion that this would be possible for any non-heterosexual.

New buzz words: "living in alignment with their values" etc. (ref: Throckmorton)

Of course it should hardly be any news that at least some people are well able to force themself to have sex with people they are not actually attracted to, particularly in the short term. (prostitutes have been doing that since year dot and, likewise, many gay men and women went into sham marriages in previous times).

The beginning of the end for the medical model, perhaps.

But perhaps also a return to a far older model: very unsubtle social and personal repression.

The silver lining is that a far greater proportion of people are better able to understand the consequences of such repression.

If Joe and Jane Public felt somewhat overwhelmed about that anti-gay medical model and the rubbish "studies" that claimed to support it, at least they can well appreciate the destruction that results from forcing people into white-knuckled celibacy or unsuitable relationships.

At least, we live in hope that they do, I mean.

December 14, 2007 9:44 PM  
Blogger JimK said...

Hey Grantdale, always a pleasure to hear from you. Seems to me, if people have some understanding of sexual orientation it will be harder for the anti-gay industry (Alvin's term) to lie about it. At some point, it can be a dimension that is ignored except when someone is interested in dating, say, in which case you do want to find someone whose romantic ambitions complement your own. The other path is that gay people are forced back into darkness, the mystery is retained, and any lie that can be told has some possibility of being believed.

Personally, I think we've gone past that. But you know me, I'm just a big old optimist, I see the bright side of everything.


December 14, 2007 9:56 PM  
Anonymous Anonymous said...

Oh, and in case anyone has doubts, Imperial, Royal College of Science, Mining, and Medicine in London, England is one of the worlds highest respected universities in all of the applicable fields with numerous nobel laurets on staff in each area. I'm most familiar with the Physics department, but I understand the same exceptionally high standards (in some cases higher than Oxford or Cambridge) are applied here.

December 17, 2007 1:26 PM  
Anonymous Anonymous said...

"Oh, and in case anyone has doubts, Imperial, Royal College of Science, Mining, and Medicine in London, England is one of the worlds highest respected"

Also, there's the British Royal Astronomer who thinks anthropomorphism is a major breakthrough.

December 19, 2007 11:56 PM  
Anonymous Anonymous said...

OK, not sure what you are referencing, but Martin Rees, current Royal Astronomer since 1995 is no slouch...

December 20, 2007 2:47 PM  

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