More From The Illogical File

If you haven't encountered Dale O'Leary before, you can be forgiven - one has to tread into the swamps of religiously driven pseudo-science to find his writings. (He was one of the authors of the horrendous paper on the "ethics" of gender reassignment surgery I dissected back here)

He's surfaced again - a year late, it seems, to respond to the APA's study on reparative therapy - and like other attempts at reason from this sector, he's busy cherry picking facts and in doing so gets it entirely wrong. (The actual APA report is here)

1) Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality—in other words, they do not indicate either mental or developmental disorders.

The use the term "per se" confuses the issue. It is true that same-sex sexual attractions, behavior, and orientations are not in and of themselves (per se) indicative of anything. Given the variety of human behavior and attractions in different cultures, throughout history, and among the variety of mankind, nothing can be said about all persons with same-sex attraction, everyone who engages in same-sex behavior, or claims a particular sexual orientation. However, there is substantial evidence that same-sex attraction is a sequel of disturbed early childhood, in particular a failure to achieve a secure attachment to the mother1 and a failure to identify with the same sex parent and peers2. There is also evidence that persons with SSA are more likely to have been victims of childhood abuse,3 including sexual abuse,4 or other exposure to age inappropriate experiences. A number of well designed large sample studies have found that persons with SSA are more likely to suffer from psychological disorders, substance abuse problems,5 and suicidal ideation.6 Men who have sex with men are at high risk for contracting an STD, including HIV.7 While not every persons with SSA falls into these categories, a significant percentage do. There is on the other hand no replicated evidence that SSA is genetically or congenitally predetermined and therefore a natural and unchangeable variant.8 Therefore, it can be argued that there is evidence that SSA in some cases (or some might argue in most cases) is associated with a psychological or developmental disorder.

O'Leary makes several assertions here which, had he bothered to actually read the report in its entirety, he would find it addresses.

Assertion: Homosexuality is a result of childhood and/or family dysfunction.

From the APA Report:

Theories that certain patterns of family relationships cause same-sex sexual orientation have been discredited (Bell et al., 1981; Freund & Blanchard, 1983; R. R. Green, 1987; D. K. Peters & Cantrell, 1991).

Assertion: Homosexuality is associated with childhood sexual abuse

From the APA Report:

Some individuals who present with requests for SOCE may have clinical concerns that go beyond their sexual orientation conflicts. These may include mental health disorders, personality disorders, or trauma- related conditions that influence the presentation of sexual orientation conflicts and distress (cf. Brown, 2006; Drescher, 1998a; Glassgold, 2008; Haldeman, 2001; Iwasaki & Ristock, 2007; Lasser & Gottlieb, 2004; Mohr & Fassinger, 2003; S. L. Morrow, 2000; Pachankis et al., 2008; Schneider et al., 2002; Sherry, 2007; Szymanski & Kashubeck-West, 2008). Such conditions may require intervention separate from or in conjunction with the intervention directed at the sexual orientation distress. For instance, some clients who seek SOCE may have histories of trauma (Ponticelli, 1999), and in some individuals sexual abuse can cause sexual orientation identity confusion and other sexuality-related concerns (Gartner, 1999). Other individuals seeking SOCE may make homosexuality the explanation for all they feel is wrong with their lives (Beckstead & Morrow, 2004; Erzen, 2006; Ponticelli, 1999; Shidlo & Schroeder, 2002). This displacement of self-hatred onto homosexuality can be an attempt to resolve a sense of badness and shame (cf. Brandchaft, 2007; Drescher, 1998a), and clients may thus need effective interventions to deal with this self-hatred and shame (Brandchaft, 2007; Linehan, Dimeff, & Koerner, 2007; Zaslav, 1998).

Please note the language of the APA report. Unlike O'Leary, the APA is very careful to describe these conditions as coincidental with, not causally related to, the client's sexual identity. The APA is very cautious about drawing causal relationships between conditions for good reasons - when one looks at the broad spectrum of people who were (for example) victims of child abuse, it's not clear that even a significant fraction of those people turned out to be homosexual.

Assertion: Homosexuals are at a higher risk for other psychological conditions.

The APA Report addresses this concern in the quote I provide above.

Assertion: Men who have sex with men (MSM) are at higher risk for STIs

From a purely psychological perspective, this hardly seems relevant. Although it certainly is indicative of O'Leary's biases, since it is a common assertion made by the religious set to justify their "opposition" to homosexuality.

Assertion: While not every persons with SSA falls into these categories, a significant percentage do. There is on the other hand no replicated evidence that SSA is genetically or congenitally predetermined and therefore a natural and unchangeable variant.8 Therefore, it can be argued that there is evidence that SSA in some cases (or some might argue in most cases) is associated with a psychological or developmental disorder.

Ah ... the classic circularity which confuses correlation with causation. The APA is very careful not to make any assessment of causal factors related to homosexuality because what evidence exists is far from conclusive. Unfortunately for O'Leary, his fantasy that because there has been no "gay gene" found that the causes must lie in other correlations doesn't exactly hold up. (I discussed this in more detail here, here and here.

O'Leary doesn't let reason get in his way though, as he proceeds to try and disprove other basic tenets of the APA's report.

2) Homosexuality and bisexuality are stigmatized, and this stigma can have a variety of negative consequences (e.g., minority stress) throughout the life span.

Sexual acts between two persons of the same sex, along with adultery, fornication, and sexual paraphilias, are condemned by a number of religions as always contrary to God’s law. Since these religions are based on unchangeable revelation, these doctrines cannot be altered. Therefore, engaging in same-sex relations will always be considered by some as unacceptable. Love and compassion for those who struggle with temptation does not require acceptance of these behaviors. Freedom of religion protects the right of persons, who believe that homosexual acts are always wrong, to state their belief publicly and teach this conviction to their children without fear of discrimination. Such convictions are not bigoted, discriminatory, homophobic, or hate speech.

It is true that the realization that a significant portion of the community believes that a person’s behavior is not acceptable may make that person feel bad. Persons engaging in homosexual behavior may wish to silence those who disapprove. They may wish to have their behavior universally accepted; but so long as people have freedom of religion this situation will not change.

I don't know whether to laugh or cry over this self-serving bunch of tripe. Instead of addressing the very real issue of stigmatization, O'Leary provides us with a self-serving justification of why he thinks it's his right to demand that GLBT people be limited in their lives.

I would argue that his interpretation of "Freedom of Religion" is deeply flawed - at least with respect to the Canadian Charter of Rights. I've discussed the principles of how different rights intersect with each other elsewhere on my blog.

... and yes, when those anti-gay statements amount to propaganda, they are no better than what the Nazis spread about Jewish people in the 1930s. Make no mistake about it.

3) 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.

Gay activists would have us believe that SSA is a normal, and unchangeable variant, but numerous studies have found that SSA is fluid.9 If as the evidence shows it is possible for SSA and behavior to change spontaneously, then why can’t a person seek psychological therapy or spiritual counseling to affect a change in SSA or behavior?10

The APA report doesn't actually say this. What it does say is that the evidence supporting reparative therapy is deeply flawed (big shock there), and that reparative therapy doesn't produce the results claimed.

What the APA does advocate is a therapeutic environment that will help the client achieve a degree of self awareness and self acceptance that they did not have before - in a manner that respects the spiritual, social and sexual context that the client lives in.

4) Gay men, lesbians, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects.

Same sex relationships differ in many essential aspects from a marriage between a man and a woman. Two persons of the same sex cannot consummate a marriage - the one and only act that joins a man and a woman as one flesh. They cannot conceive a child that is the fruit of their union and their joint biological offspring. Every child acquired by a same-sex couple has been separated from one or both biological parents. Such a separation is perceived by the child as a loss. Every child raised by a same-sex couple lacks a parent of one or the other sex. Two persons of the same sex lack the psychological and emotional complementarity that is part of a husband and wife union. Finally, it is interesting to note that exclusivity is not considered essential for male couples.11

The usual "but homosexuals can't procreate" argument. I've heard this a thousand times as an argument against gay couples. It's a crock. This argument is based on a myriad of assumptions about heterosexual relationships and how they differ from homosexual relationships ... and aren't based on a single scrap of evidence that I've ever seen.

As for exclusivity, as much as the religious set likes to get their panties in a twist every time they talk about gay promiscuity, they do so while turning a blind eye to the frequency of what they should rightly call adultery among heterosexuals. Extra-marital affairs (on both sides of the marital bed) are surprisingly common, and to criticize homosexual couples for being open about them is hypocritical at best, and a double standard at worst.

As for offspring, how many children are raised in single parent households? By step parents? ... by adoptive or foster parents?

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

Some individuals not only choose to live their lives according to God’s revealed law, but also believe that since truths of revelation and the truths discovered by science come from the same source, when both are properly understood they will agree. The term "values" degrades this belief into mere personal opinion; one person "values" one thing, another "values" something else. Those who believe in the congruence of revelation and science, reject this kind of relativism. They hold that it is possible through revelation and science to approach truth and that certain opinions are simply wrong. However, they respect the right of those who oppose them to be wrong and to defend their beliefs. While gay activists demand universal acceptance and affirmation for themselves, they use every method within their grasp to silence and marginalize those who disagree with them.

More self-serving malarkey from O'Leary. He clearly hasn't bothered to read the entire report from the APA - or if he has, he failed to comprehend a sizable chunk of it. If he had bothered to read the APA's report thoroughly he would have realized that this forms a significant part of how the clinical environment should be managed.

Attempting Erasure of Transsexuals

A paper was published in a journal called "The National Catholic Bioethics Quarterly" last year. Titled The Psychopathology of Gender Reassignment Surgery, this paper attempts to lay out why it is wrong to provide Gender Reassignment Surgery to transsexuals.

I've spent a fair bit of time since I ran across this paper pulling apart its web of tangled reasoning. (and tangled it is) My first inclination is to go through it point by point and describe why each paragraph is leaping to incorrect conclusions or is so filled with assumptions that the authors clearly have failed to adequately research the subject they are writing on. However, that would produce a huge, tedious rebuttal that doesn't really address the underlying problems with this paper.

In my study of this paper, I have come to recognize a series of serious flaws in the assumptions and evidence that the authors have used. These include basing their description of what Transsexualism is on some deeply flawed theoretical models; drawing on sources that are, at best, marginal voices in the research and treatment community and ignoring data and sources that clearly arrive at different conclusions than the authors of the paper set out to find.

In short, the authors set out to confirm the conclusions they already had in mind, and paid little heed to the breadth and depth of the research field.

The first thing that the authors set out to do is invalidate the notion of transsexualism. They do this through several basic tactics. First, they use the emotionally loaded language of "mutilation" to describe Gender Reassignment Surgery. Any reasonable assessment of the ethical implications of a given procedure would be expected to stay away from such language in the early stages of the paper as it clearly prejudices the interpretation of subsequent data.

The paper proceeds to describe transsexualism using Blanchard's notion of Autogynephilia. Fortunately for transsexuals in the world today, Blanchard's model isn't exactly the dominant theoretical model describing transsexuals. In fact, the view that gender identity occurs in a spectrum has become much more prevalent. The problem with the Autogynephilia model is that it uses two fairly absolute categorizations to describe transsexuals - both firmly rooted in the language of sexual identity. Whether we are talking about the "Kinsey Scale" (which was emulated by Harry Benjamin for transsexuals), such attempts to define bounded categories tend to break down when applied to the breadth and depth of human diversity. As a thought experiment, try defining what it means to be 'a man' or 'a woman' in today's society - it's trickier than you might imagine. Then consider how difficult it is to categorize people in general.

The narrative discussion about transsexuals in general focuses intensely on people's sex lives, while ignoring the far more crucial discussions around the individual's adaptation and integration with society. While we are certainly all sexual beings in some capacity, it seems to me more than a little problematic to attempt to describe people based on their sexual behaviours. Worse, the reference material cited to derive this narrative is often based on such small numbers as to be better viewed as anecdotal evidence rather than population evidence. Sadly, the authors hold up numerous anecdotes about poor adaptation and misconceptions as being "the general case", a logical inference that simply does not stand up to any reasonable analysis.

Sadly, they even go as far as to reference a television show called Sex Change Hospital, as if such a program is going to be any kind of meaningful guide to the breadth and depth of experience that is humanity. Even worse, their criticism is that the people who have surgery aren't always "perfectly passable". Transsexuals, like the rest of the population come in all sorts of shapes and sizes - not everybody is model material, how dare they apply such a standard to transsexuals? Such programs tend to emphasize the physical change that surgery brings, but do not (and cannot) explore the complex and often bewildering path that is transition - that goes on with the patient and their therapist over a period of years.

The paper implies that there are always underlying psychological problems associated with Gender Identity Disorder (GID).

Some therapists too readily accept a patient’s “I feel trapped in the wrong body” explanation and do not probe—let alone help the patient to resolve—the patient’s underlying narcissism, anger, and inability to embrace the reality of their sexual identity.

To make such a claim is indeed spurious. The WPATH Standards of Care are very clear about the handling of comorbid conditions.

For Children:

3. Therapy should focus on ameliorating any comorbid problems in the child’s life,

For Adults:

Ideally, the clinician's work is with the whole of the person's complexity. The goals of therapy are to help the person to live more comfortably within a gender identity and to deal effectively with non-gender issues.

Assuming that a therapist is knowledgeable and working within the WPATH SOC guidelines, one might reasonably suspect that recommendations for steps such as surgery aren't likely to be made until other related issues are dealt with adequately.

Inevitably, as one might expect, the writers turn to NARTH for more "experts" to reinforce their overt hostility to transsexuality and its treatment. They quote a paper published on NARTH's website by a Dr. Breiner - a particularly offensive piece of work that I have already analyzed here.

Following down the NARTH path further, we find the usual attempt to establish childhood sexual abuse as a causal or root factor in transsexualism. We've seen this before with homosexuality - it wasn't a terribly successful strategy before, and I know of no legitimate research that establishes any kind of reasonable causal relationship beyond the usual assertions that large numbers of have been abused sexually as children. This is an old saw, and one that doesn't deserve further consideration without serious evidence to establish its veracity.

Similarly, the attempt to link transsexuality with masochism is not only a very feeble argument, it's at best spurious to make such an association. While there are no doubt some transsexuals who are interested in S&M play, drawing the conclusion that their masochistic fantasies led them to transition is dubious at best.

When the authors finally do start addressing the ethical issues involved in providing treatment to transsexuals, they do so from this framework of questionable theoretical models, really awful logic and blatant misinformation. Needless to say, their conclusions are similarly flawed.

I'm going to restate some of their conclusions in my own words, in part because the objections the authors raise are often done in a manner that is elliptical relative to what they conclude.

Conclusion #1:

GRS is unethical because it doesn't "really" change someone's sex. (That is to say a MTF transsexual will not be able to bear children after surgery)

I don't think anybody denies the limitations of GRS as it stands today. To say that it is therefore "mutilation" is to suggest that any surgery that reshapes the body at all is mutilation as well.

The accusation that because the person is not able to directly procreate after surgery ignores the fact that for many transsexuals, the dysphoria they experience is so severe that it is unlikely that they would procreate in the first place. Further, it reduces human sexual and romantic partnerships to the production of babies - a position that treats the people involved as mere objects, rather than as human beings.

Transsexuals are really just lying about themselves

This is possibly one of the most offensive accusations that you can level at a transsexual. The journey through one's inner self that is part and parcel of a thoughtful, reasoned transition takes one well beyond the idea that they could be "lying" to themselves.

The archetype of the 'transsexual as deceiver' is rooted in the same rubric that leads the authors to assume that the deeply flawed model of Autogynephilia actually meaningfully describes the overall population of transsexuals. One of the most glaring problems with Bailey's "The Man Who Would Be Queen" book is the fact that most of his subjects were found in drag bars. That's like going into an outlaw biker bar to interview motorcyclists and concluding that all motorcycle riders belong to criminal gangs.

Conclusion #3:

Transsexuals are demanding that others lie on their behalf and they have no right to do so

Those who believe that it is impossible to change a person’s sex do not want to be insensitive to others, but neither should they be forced to lie by calling a man a woman or by calling a woman a man.

If someone is clearly presenting as a woman, treat them as a woman - it's not difficult. To call someone who is obviously MTF trans "sir" or "he" when she is obviously living as a woman is just as wrong as the schoolyard bully calling his target a "sissy".

The religious objection that it is impossible to "change one's sex" is a personal belief, and should be kept personal.

Conclusion #4:

By providing GRS, the caregivers are not providing a medically justified procedure, and as such they are collaborating with the patient's mental disease

This is a restatement of Paul McHugh's position, which I have already addressed on this blog.

I will however, reinforce my statements about McHugh's position with the following from the WPATH Standards of Care (v6):

Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective,"cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.

The ethical objections that are raised in this paper are also addressed quite effectively in the WPATH Standards of Care as follows:

How to Deal with Ethical Questions Concerning Sex Reassignment Surgery. Many persons, including some medical professionals, object on ethical grounds to surgery for GID. In ordinary surgical practice, pathological tissues are removed in order to restore disturbed functions, or alterations are made to body features to improve the patient’s self image. Among those who object to sex reassignment surgery, these conditions are not thought to present when surgery is performed for persons with gender identity disorders. It is important that professionals dealing with patients with gender identity disorders feel comfortable about altering anatomically normal structures. In order to understand how surgery can alleviate the psychological discomfort of patients diagnosed with gender identity disorders, professionals need to listen to these patients discuss their life histories and dilemmas. The resistance against performing surgery on the ethical basis of "above all do no harm" should be respected, discussed, and met with the opportunity to learn from patients themselves about the psychological distress of having profound gender identity disorder.

It is unethical to deny availability or eligibility for sex reassignment surgeries or hormone therapy solely on the basis of blood seropositivity for blood-borne infections such as HIV, or hepatitis B or C, etc.

It is a sad statement that the paper's authors could not even have been bothered to examine the WPATH Standards of Care, which addresses their concerns most directly.