Craig E. Tenke, Ph. D., is a Presbyterian elder in Center Moriches,
NY, and a neuroscientist at the NYS Psychiatric Institute,
Columbia-Presbyterian Medical Center, NYC He submitted this essay to
PresbyWeb in December, 2001, in response to considerable discussion of
the the article published in the
Wall Street Journal by Robert L. Spitzer on May 23,
2001, which was interpreted by some as claiming that homosexuality is
chosen rather than determined by genetic and other factors.
This letter was originally posted on PresbyWeb
on 12-8-01.
Dr. Tenke has shared it with us
in the hope that it may help inform the discussion of Amendment 01-A in
the weeks ahead.
Confusion
about the significance of a scientific report
may sway votes on Amendment 01-A
by Craig E. Tenke
It is indeed unfortunate
that Dr.
Spitzer reported his findings
this year. When the topic is homosexuality, the profound difference
between "not strictly determined" and "voluntarily
chosen" is not generally appreciated. Dr. Spitzer provided a
paragraph to help clarify this point in my
previous Viewpoint posting.
As a result, some letters on Presbyweb have been expressed more
carefully. However, many concerned, well-intentioned people continue to
mention his report as though it calls into question all that is
currently known about sexual orientation. It doesn't. More to the point,
it provides no information supporting the opposition of Amendment 01-A.
The
conversion therapy controversy
In
his October 22 letter to Presbyweb, Dr.
Rosik emphasized that the scientific data do not support a strict
biological determinacy for sexual orientation. This is a key point for
all practitioners of conversion therapy. If no change is possible, then
there is no justification for treatment. However, most psychiatric
professionals regard sexual orientation as effectively fixed, at least
in most adults.
If sexual
orientation isn't invariably fixed in adult homosexuals, just who are
the members of the small subgroup of individuals who show this
flexibility? To explore these questions, Dr. Spitzer's controversial
study made use of self-reports from conversion therapy patients who had
been referred via advocacy groups for this therapy, i.e., the very
groups protesting psychiatric meetings. Spitzer's study clearly did not
use a carefully balanced (and unbiased) sample of individuals, as
scientific standards generally require. Likewise, the unresolved
question of risks vs. benefits was deferred to future studies.
In general,
the idea of relaxing selection criteria for participants may be viewed
as a justifiable preliminary measure if it helps to phrase a new
question. Since other scientists and clinicians are aware of the
shortcomings of this approach, nothing would be lost if the preliminary
findings turn out to be wrong. However, if the findings are replicated
after controlling for the obvious sources of error or bias, a new area
of research may emerge. Unfortunately, the topic of sexual orientation
instantly attracts media attention, which in turn coaxes an unfamiliar
public to anticipate the results of research that hasn't even begun.
I've
interacted with a number of people of faith and compassion who are
advocates of conversion therapy. They argue that their patients seek
treatment of their own free will, without coercion. Some of them seem
convinced that something akin to a "gay conspiracy" is behind
the reluctance of the professional associations to support the
technique. Dr. Rosik indicated his own skepticism that further research
could ever determine the effectiveness of conversion therapy, adding,
"I will consider changing my mind when I see clear statements from
such organizations offering or at least calling for funding of research
that involves both opponents and proponents of change efforts."
The casual
reader may wonder why any client-initiated therapy should be so
controversial. As someone who earns his living doing research with human
subjects, I have reason to believe that the resistance to conversion
therapy is simply a result of measures which have been put in place to
protect the rights of the patient. These regulations and constraints on
all human research began with the international outcry over so-called
"human experimentation" conducted by Nazis. Further increases
in red tape have been fueled by public awareness of American mistakes
and transgressions, ranging from birth defects after thalidomide to the
infamous Tuskegee Syphilis experiment.
According to
the Helsinki Declaration, " The responsibility for the human
subject must always rest with a medically qualified person and never
rest on the subject of the research, even though the subject has given
consent.." Such research "should only be conducted if the
importance of the objective outweighs the inherent risks and burdens to
the subject. This is especially important when the human subjects are
healthy volunteers." Further, "Physicians should abstain from
engaging in research projects involving human subjects unless they are
confident that the risks involved have been adequately assessed and can
be satisfactorily managed. Physicians should cease any investigation if
the risks are found to outweigh the potential benefits . . ." For
these reasons, Dr. Rosik's cynicism does have merit. The general
consensus is that conversion therapy poses serious risks to the
individual with little, if any, likelihood of success.
Regarding
funding opportunities for research on conversion therapy, it's important
to recognize that research grants from NIH and NIMH aren't the kind of
"pork barrel" that many people believe them to be. Studies
must be adequately controlled, based on good science, supported by the
literature and pilot data, and have acceptable risks for the perceived
benefits. Since they are also highly competitive, a proposed therapeutic
treatment would be expected to aim at a health problem (i.e., a disease,
disability or handicap), and to report risks and benefits without bias.
The researcher must also assure that no conflict of interest can
influence the outcome of a study. Unfortunately, the champions of
conversion therapy are often therapists or activist patients who have a
strong personal stake in the outcome of the study. A final note is that
the results of a study won't be publishable in a high caliber scientific
journal unless the methods comply with conventional standards. While I
applaud Dr. Rosik's preliminary efforts at setting parameters for the
ethical application of these methods (Rosik, 2001), there are clearly
many issues that must be resolved before mainstream psychiatric and
scientific professionals can take them seriously.
Group
statistics and homosexual stereotypes: Are they relevant to faithful
Presbyterians?
Whenever
samples of individuals are used to describe or compare large groups of
people, the classification itself should be a valid one, i.e., the
classification must reflect real differences, rather than a convenient
fiction applied to the group of interest. The sample itself should also
be appropriately balanced to represent the entire group. Even after
taking these precautions, the characteristics or results from any sample
of individuals may not be reproducible, let alone generalizable to
groups that are similar, but not identical.
With these
requirements in mind, what DO we really know about faithful
Presbyterians who happen to be gay? Do we have any reason to believe
that faithful Presbyterians who happen to be gay are more prone to the
reckless abandon of the "gay lifestyle," as portrayed by the
media, than faithful Presbyterians who happen to be heterosexual are at
risk to for the mindless promiscuity of being "swingers?"
Throughout the decades, what proportion of faithful Presbyterians who
happen to be gay were never sampled, indeed never even noticed, simply
because they share the traditional conservative belief that church is
for worship and fellowship, and not for talk about sex? Throughout the
decades, what proportion were never sampled, because they were quietly
pushed away by us before they even knew that they were gay?
I would
actually argue that it's Presbyterianism, rather than gayness, that's
the distinguishing characteristic of homosexual Presbyterians who are
called to ordained positions. However, lacking acceptable group
statistics or "reasonable" stereotypes, we must resort to
interacting with each unique individual face-to-face, on his or her own
terms. Our mutual evaluation must rely on our relationships with each
other, and with God. Curiously, this is what Amendment 01-A would have
us do.
Craig
E. Tenke, Ph. D. is a Presbyterian elder in Center Moriches, NY, and a
neuroscientist, at the NYS Psychiatric Institute, Columbia-Presbyterian
Medical Center, NYC
