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Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
Beyond Critique
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Beyond Critique

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  • 1. Beyond Critique London 30 January 2013
  • 2. Two documents: 1. Submission by Royal College of Psychiatrists LGB ‘Special Interest Group’ to Church of England’s Listening Exercise on Human Sexuality (2007) 2. UKCP’s Ethical Principles and Codes of Professional Conduct: Guidance on the Practice of Psychological Therapies that Pathologise and/or Seek to Eliminate or Reduce Same Sex Attraction Beyond Critique London 30 January 2013
  • 3. First Document: Submission by Royal College of Psychiatrists ‘LGB Special Interest Group’ toChurch of England’s Listening Exercise on Human Sexuality (2007) Beyond Critique London 30 January 2013
  • 4. Royal College submission to Church of England “Psychiatry and LGB People” Concise, readable, impressive document: - Authoritative source - No fewer than 19 scientific papers cited - Without peer in UK? [‘Best of breed’] - Because the case is set out in writing, we can analyse it Beyond Critique London 30 January 2013
  • 5. 1. History of Psychiatry with LGB People Ref 1 (King & Bartlett) - King and Bartlett’s description seems fair - history of science and HS - from ‘deviance’ to ‘illness’ (to ‘normal’) - a good description of what has happened Note how science reflects the prevailing paradigm in society Beyond Critique London 30 January 2013
  • 6. 2. The Origins of Homosexuality Two versions of the text Both say causation of HS is “biological”, but they define this in two different ways Original Submission to Revised version Church of England (2007)“Genes and hormones” “Genes and/or hormones” Why did Royal College make this change? Beyond Critique London 30 January 2013
  • 7. 2. The Origins of HomosexualityRoyal College says, “... no substantive evidence to support the suggestion that ... early childhood experiences play any role in the formation of a person’s fundamental heterosexual or homosexual orientation. It would appear that sexual orientation is biological in nature, determined by a complex interplay of genetic factors and the early uterine environment” (ie genes and hormones). [Or “genes and/or hormones”, as noted earlier] Beyond Critique London 30 January 2013
  • 8. 2. The Origins of HomosexualityBut there is much evidence of environmental causation:- Large Danish study (Frisch et al) found “childhood family experiences are important determinants of heterosexual and homosexual marriage decisions in adulthood.”- Laumann et al say that if homosexuality were randomly distributed, this would fit a genetic/ biological explanation. But “that is exactly what we do not find.”- Twin studies show that if one identical twin is gay, the other usually is not. This suggests environmental factors, not biology. Why did the Royal College omit discussion of twin studies? Beyond Critique London 30 January 2013
  • 9. 2. The Origins of HomosexualityRoyal College’s three citations to prove ‘biological cause’Ref 2 (Bell & Weinberg 1978) - this study does not address the issue of causation Why did the Royal College cite this study? Beyond Critique London 30 January 2013
  • 10. 2. The Origins of HomosexualityRoyal College citations to prove ‘biological cause’Ref 3 (Mustanski et al 2005) - Looking for causal linkages between human genome and HS - found nothing!Why did the Royal College cite this study? Beyond Critique London 30 January 2013
  • 11. 2. The Origins of HomosexualityRoyal College citations to prove ‘biological cause’ Ref 4 (Blanchard et al 2006) - boy who is left-handed more likely to be gay - boy who has older brother ditto - but boy who is both, not more likely to be gay They conclude: - either the two factors cancel each other out - or they create a ‘toxicity’ which may kill child in the womb Why did the Royal College cite this study? Beyond Critique London 30 January 2013
  • 12. 2. Origins of HS – Summary of the three studies- Bell & Weinberg didn’t address the issue- Mustanski found no genetic linkage- Blanchard study is like science fiction This is all the evidence for ‘biological’ causation offered by the Royal College of Psychiatrists Why did the Royal College cite these studies? Beyond Critique London 30 January 2013
  • 13. 3. LGB M ental Health Problems Why elevated levels of mental illness among LGB?Royal College (2007) Scientific Answer 1: Gilman et al 2001 (RefVersion 6)Discrimination in the precise causal mechanism at this pointsociety ... means that remains unknown. Therefore, studies aresome LGB people needed that directly test mediationalexperience greater than hypotheses to evaluate, for example, theexpected mental health relative salience of social stigmatization andand substance abuse of psychosocial and lifestyle factors asproblems potential contributors Beyond Critique London 30 January 2013
  • 14. 3. LGB M ental Health ProblemsWhy elevated levels of mental illness among LGB?Royal College (2007) Scientific Answer 2: Bailey et al 1999 (Ref 7)VersionDiscrimination in “... many people will conclude thatsociety ... means that widespread prejudice against homosexualsome LGB people people causes them to be unhappy or worse,experience greater than mentally ill. Commitment to [this position]expected mental health would be premature, however, and shouldand substance abuseproblems be discouraged . In fact, a number of potential interpretations need to be considered ... Beyond Critique London 30 January 2013
  • 15. 3. LGB M ental Health ProblemsWhy elevated levels of mental illness among LGB?Royal College (2007) Version Scientific Answer 3: Mays et al 2001 (Ref 8)Discrimination in society ... “it is unclear whether the greater riskmeans that some LGB people for discriminatory experiences, if itexperience greater than does exist, can account for theexpected mental health and observed excess of psychiatricsubstance abuse problems morbidity seen among lesbians and gay men” Beyond Critique London 30 January 2013
  • 16. 3. LGB M ental Health ProblemsWhy elevated levels of mental illness among LGB?Royal College (2007) Version Scientific Answer 4: King et al 2003 (Ref 5)Discrimination in society ... It may be that prejudice in societymeans that some LGB people against gay men and lesbians leads toexperience greater than greater psychological distress ...expected mental health and Conversely, gay men and lesbians maysubstance abuse problems have lifestyles that make them vulnerable to psychological disorder. Why does the same scientist express one view to the scientific community and a different view to the Church of England? Beyond Critique London 30 January 2013
  • 17. 4. Stability of Gay and Lesbian Relationships Why are LGB relationships so unstable?Royal College (2007) Scientific Answer 1: McWhirter & Mattison (Ref 9)VersionA large part of the The book, The Male Couple by the same authors says,instability in gay and “... all couples with a relationship lasting more thanlesbian partnerships five years have incorporated some provision forarises from lack of outside sexual activity in their relationships.”support withinsociety, the church Any ‘durability’ in gay relationships thus requires non-or the family. monogamy rather than support from society. Beyond Critique London 30 January 2013
  • 18. 4. Stability of Gay and Lesbian Relationships Why are LGB relationships so unstable?Royal College (2007) Version Scientific Answer 2: Kiecolt-Glaser 2001 (Ref 10)“There is already good “Contemporary models of gender ... furnishevidence that marriage confers alternative perspectives on the differentialhealth benefits on costs and benefits of marriage for men’s andheterosexual men and women women’s health.”and similar benefits could [ie The benefits of marriage are gender-accrue from same-sex civil specific]unions. “ Beyond Critique London 30 January 2013
  • 19. 4. Stability of Gay and Lesbian Relationships Why are LGB relationships so unstable?Royal College (2007) Version Scientific Answer 3: Johnson et al 2000 (Ref 11)“There is already good evidence Study confirmed the benefits of marriagethat marriage confers health but did not include same-sex couples, sobenefits on heterosexual men and no evidence of benefits for them.women and similar benefits couldaccrue from same-sex civil unions.“ Beyond Critique London 30 January 2013
  • 20. 4. Stability of Gay and Lesbian Relationships Why are LGB relationships so unstable?Royal College (2007) Scientific Answer 4: King, Bartlett 2006 (Ref 12)Version“There is already good “We do not know whether gay male, same sexevidence that marriage relationships are less enduring because ofconfers health benefits on something intrinsic to being male or a gay male,heterosexual men and the gay male subculture that encourages multiplewomen and similar partners, or a failure of social recognition of theirbenefits could accrue relationships. The ‘social experiment’ that civilfrom same-sex civil unions provide will enable us to disentangle theunions. “ health and social effects of this complex question” Beyond Critique London 30 January 2013
  • 21. 5. Psychotherapy and reparative therapyRoyal College (2007) King et al 2007 (Ref 13)Version“Therapist may wrongly “Both therapist and client need to be aware ofregard HS as root cause of the dominant discourses and stereotypes in theany depression, anxiety LGBT world, because, if they fail to do so, theetc.“ possibility of collusion and shared assumptions may limit the depth and utility of the therapy.” “... no randomised trials of effectiveness of ... (gay affirmative) treatments”. Beyond Critique London 30 January 2013
  • 22. 5. Psychotherapy and reparative therapy - Is change possible? Is it harmful?Royal College (2007) Version Bartlett, King & Phillips 2001 (Ref 14)“A small minority of therapists will even go so far But the study usedas to attempt to change client’s sexual orientation. -no measures of harm, andCan be deeply damaging … no evidence that such - no measures of change.change is possible … no randomised clinical It’s just opinions of certaintrial...” therapists.BUT: Jones & Yarhouse in 2007 published the best study to date. They “contradictthe commonly expressed view ... that change of sexual orientation is impossibleand that the attempt to change is highly likely to produce harm ...”.[They used a validated measure of psychological distress to assess harm, butfound benefit rather than harm. Study was updated in 2011 with similar results.] Beyond Critique London 30 January 2013
  • 23. 5. Psychotherapy and reparative therapy - The Spitzer studyRoyal College (2007) VersionWhy are LGB relationships soSpitzer 2003 (Ref 15) unstable?The study “claimed that The study actually said,change was possible for- a small minority (13%) of - majority of participants gave reportsLGB people, of change- most of whom were - from a predominantly or exclusivelybisexual at outset.” homosexual orientation before therapy The Royal College misrepresents both starting point and findings of Spitzer study Beyond Critique London 30 January 2013
  • 24. 5. Psychotherapy and reparative therapy - The Shidlo and Schroeder studyRoyal College (2007) Version Shidlo & Schroder 2002 (Ref 16)Study showed ‘little effect as 61% found some helpwell as considerable harm.’ 85% found some harm 46% found both help and harm No measures of effect or help/ harm were used (as study was retrospective)A goal of this study was ‘that consumers can make an increasingly informedchoice about engaging in conversion therapy’. This goal is now denied toclients Beyond Critique London 30 January 2013
  • 25. 5. Psychotherapy and reparative therapyRoyal College (2007) Oral History (Professionals’ views) King et al 2004 (Ref 17)Treatments in 1960s and 1970s The practices of this period are nowere very damaging and affected longer relevant to the present debate.no change in orientation “Only a small minority believed that current practice denied people distressed by their homosexuality an effective means to change their sexual orientation”. How different today! Beyond Critique London 30 January 2013
  • 26. 5. Psychotherapy and reparative therapyRoyal College (2007) Oral History (Patients’ views) King et al 2004 (Ref 18)Treatments in 1960s and As before, the practices of this period are1970s were very damaging no longer relevant to the present debate.and affected no change inorientation A poignant comment from the study: “Many participants felt they lacked parental affection during childhood and adolescence” Beyond Critique London 30 January 2013
  • 27. 5. Psychotherapy and reparative therapyRoyal College (2007) Haldeman, Gay Rights, Patient Rights 2002 (Ref 19)People are happiest ... ... gay-affirmative therapists need to take seriously thewhen they are able to experiences of their religious clients, refraining fromintegrate the various encouraging an abandonment of their spiritualaspects of the self as traditions in favour of a more gay-affirming doctrine orfully as possible discouraging their exploration of conversion treatments.Haldeman’s conclusion: ”...we must respect the choices of all who seek to livelife in accordance with their own identities; and if there are those who seek toresolve the conflict between sexual orientation and spirituality with conversiontherapy, they must not be discouraged. It is their choice ...” [NB Ref 19 is omitted from revised version of text] Beyond Critique London 30 January 2013
  • 28. Summary of Royal College of Psychiatrists DocumentRoyal College Submission 2007 Comment1. History Church and society have caused much hurt2. Origins of Homosexuality None of 3 papers supports ‘biological’ theory3. LGB Mental Health Problems Science doesn’t say, “It’s mostly Society’s fault”4. Stability of Gay Relationships Ditto5. Reparative therapy “No change is possible” and “great harm” arguments are not supported by scienceRoyal College of Psychiatrists needs to revise its Church of England submission Beyond Critique London 30 January 2013
  • 29. Second Document: UKCP’s Ethical Principles and Codes of Professional Conduct:Guidance on the Practice of Psychological Therapies that Pathologise and/or Seek to Eliminate or Reduce Same Sex Attraction Beyond Critique London 30 January 2013
  • 30. UKCP offers a questionable code of ethics and is unwilling to address some important questions:I tried and failed to bring a formal complaint against the UKCP regarding its ethical document: Guidance on Therapies that Seek to Reduce Same Sex Attraction Beyond Critique London 30 January 2013
  • 31. Two hypothetical case studies:• A young man has a lady friend whom he would like to marry. He is concerned, however, that he experiences same-sex attractions which he fears might derail the relationship. He is reluctant to risk getting married and would like help in reducing his same-sex attractions.• A woman is married with two children. She falls in love with another woman and is torn between leaving her family or staying. She would like help to reduce her same-sex attraction to keep her family intact. Beyond Critique London 30 January 2013
  • 32. UKCP’s blanket ruling: “agreeing to the client’s request for therapy for the reduction of same sex attraction is not in a client’s best interests” (2.1 - 1.1(a))Hypothetical Client Responses: The man takes this news badly and goes into depression. The woman accepts the therapist’s explanation and leaves her husband and children. Beyond Critique London 30 January 2013
  • 33. UKCP’s justifying argument (1):“There is overwhelming evidence that undergoing such therapy is at considerable emotional and psychological cost.” [2.1 – 1.1(b)]My question: Where is this “overwhelming evidence”? Can they name any study that has followed clients prospectively, administered generally accepted psychological tests to measure distress, and proved that, on average, harm is caused? Beyond Critique London 30 January 2013
  • 34. UKCP’s justifying argument (2): To offer treatment that might ‘reduce’ same sex attraction would be “exploitative” as “to do so would be offering a treatment for which there is no illness.” 1.3(e)My question: How does that apply to my two examples where neither is described as “ill”? Treatments are not prescribed only for illness. Beyond Critique London 30 January 2013
  • 35. UKCP’s justifying argument (3): It is not a sufficient defence for a therapist to argue that … they were acting in the client’s best interests, or according to the client’s wishes and autonomy, as offering such therapy would be ... reinforcing their externalised and internalised oppression and likely to cause harmMy question: How is desire to reduce SSA to save one’s family a sign of oppression – external or internal? Beyond Critique London 30 January 2013
  • 36. UKCP’s conclusion: Based on the above considerations of ethical practice ... the following are incompatible with UKCP’s Ethical Principles and Code of Professional Conduct: - Offering ‘Sexual Orientation Change Efforts’ ... or similar therapies 3.1 (ii).My observation: In the light of the explanations given in the code of conduct, it seems to me rather that the blanket refusal of therapy is a form of oppression Beyond Critique London 30 January 2013
  • 37. My Questions to UKCP1. Are the client requests in examples reasonable?2. What evidence shows that “agreeing to the client’s request for reduction of same sexattraction is not in a client’s best interests” – that is to say, that there are no cases in which such aclient request should be honoured.3. Do you think Drescher, Shidlo & Schroeder 2002 has “shown that agreeing to theclient’s request for therapy for the reduction of same sex attraction is not in the client’s bestinterests”?4. Can you give references to high quality scientific research which shows “overwhelmingevidence that undergoing such therapy is at considerable emotional and psychological cost.”Such evidence would need to be better than that of Jones & Yarhouse who found to the contrary.5. In the context of the two examples, can you explain how it would be “exploitative” for atherapist to offer treatment that might ‘reduce’ same sex attraction“?6. Are there no circumstances in which UKCP permits therapists to offer treatments “forwhich there is no illness”?7. How is the desire to reduce same sex attractions in order to protect one’s family a signof “oppression?8. Is the denial of a client’s request to receive help to achieve these life goals based onscientific evidence that is of such a high standard as to warrant denial of this basic human right? Beyond Critique London 30 January 2013
  • 38. Narrative of UKCP’s failure to address my questions:Jan/ Feb 2012: I asked BPA (affiliated to UKCP) to answer questions on the above issues. They said I should contact UKCP re ‘their’ ethical principles.8th Feb 2012: I wrote to Prof A Samuels (then Chair of UKCP). He did not reply.27th April 2012: I wrote to UKCP asking to bring a formal complaint against them using their official complaint procedures.30th April 2012: UKCP replied that the issue was ‘a matter of opinion and not a complaint or human rights issue’ they would not take it further.15th May 2012: I reiterated my wish to make a complaint, saying that it was a matter of human rights for clients who were refused therapy.24th May 2012: UKCP replied reaffirming that my view represented a ‘different opinion’ which did not constitute grounds for complaint.30th May 2012: I wrote back that UKCP was contravening a client’s ‘right to choose’. I received no reply.17th July 2012: I wrote to the newly appointed Chief Executive of UKCP referring to my previous correspondence and asking that the document setting out ethical principles regarding reparative therapy should be revised. (Copied to my MP).18th July 2012: He replied that my arguments were adequately addressed in the eethical guidance.18th July 2012: I pointed out that my arguments were mainly in the form of questions, which had not been answered. He did not reply. Beyond Critique London 30 January 2013
  • 39. ConclusionsThe Royal College of Psychiatrists seeks to justify the narrative that homosexuality is biologically caused, that change is impossible, and that the attempt to change is harmful. Yet the very scientific studies to which it appeals do not support this narrative.The UKCP simply assumes the truth of this narrative and refuses to hold its opinion up to the light of science, yet threatens to discipline any of its members whose therapeutic practice is based on a ‘different opinion’.Justice demands that these positions be carefully critiqued in the light of the best science, in the interests of clients who wish to be helped to reduce same-sex attractions, and therapists who are willing to help them. Beyond Critique London 30 January 2013

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