The Bieber study: A review revisited

A reader sent along a link to a review of the psychoanalytic study of homosexuality headed by Irving Bieber and reported in 1962. Titled Homosexuality: A Psychoanalytical Study of Male Homosexuals, the nine-year study of 106 gay men summarized the reports of psychoanalysts about their patients but did not interview the patients directly.
The pdf of the the review by George Carter, MD is here. Since it is brief, I am going to post it and then comment.

Homosexuality—A Psychoanalytic Study of Male Homosexuals
Irving Bieber et al.
New York, Basic Books, Inc., 1962,358 pp.
A statistical comparison from questionnaires submitted not to their patients, but to a group of
psychoanalytic psychotherapists, gives much interesting information about 106 overtly homosexual male patients, as compared with 100 not overtly homosexual male patients (controls). Most of the study patients were seen once (13%), twice (50%), or three times (31%) a week for periods varying from months to years. The group included patients with character disorders, neurotics, and schizophrenics The questionnaires intensively covered wide areas of development and functioning including relationships between parents,. patient and mother, patient and father, patient and siblings; sexual development and current, functioning; choice of homosexual partner; relation to women; latent homosexuality, etc. The emphasis is on conscious present and past attitudes, experiences, and behavior of the subjects, and does not explore the therapist’s dynamic understanding of the material. It is notable that 74% of the therapists either did reply (55%) to, or answered simply “no” (22%) to the question: “Did the analyst feel the questionnaire explored the fundamental dynamics of the patient?” It is also difficult to evaluate the statistics at times. For example, the authors base some of their theoretical conclusions on the fact that they find ‘latent homosexuality” less frequently (in their controls) than is ordinarily reported in psychoanalytic literature. But the data collection method may not be psychoanalytic, since it is not clear that the reporting analysts asked their patients to free-associate! It is difficult to evaluate the results.
Nonetheless, the study does point up some interesting issues. It suggests most strongly that overt homosexuality is especially apt to occur among those exposed to certain constellations of early family relationships, including what the authors call a close-binding, intimate mother and a distant or detached father. There are many other interesting inferences, especially about prognosis and treatment. However, the authors’ stated basic theoretical conclusion that homosexuality is the result of hidden, but incapacitating fears of the opposite sex seems over-simplified and over-determined, since they started with this as a working assumption, but found direct evidence for it, as I understand it, in only about 70% of the studied group and in at least one-third of the nonhomosexual controls.
GEORGE H. CARTER, M.D.

One observation I had not noticed before relates to the evaluation of the survey by the analysts involved:

It is notable that 74% of the therapists either did reply (55%) to, or answered simply “no” (22%) to the question: “Did the analyst feel the questionnaire explored the fundamental dynamics of the patient?”

If most participants in the study did not believe the instrument captured the essence of the patient how can any conclusions be drawn from the results? There are numerous problems with this research as a study of causation, but this is another serious blow to the validity of the approach Bieber used.
The Bieber study is often cited as a foundation for reparative drive theory. Bieber, like modern day reparative therapists, believed that a “constructive, supportive, warmly related father precludes the possibility of a homosexual son; he acts as a neutralizing, protective agent should the mother make seductive or close-binding attempts.” As the reviewer above pointed out, Bieber went into the study believing that a fear of women as a reaction to a too close mother, was at the root of male homosexuality. He believed that the father could bring the boy out of this problematic attachment, if he was “warmly related.”
The reviewer hints at but does not elaborate on the confirmation bias at work here. Bieber believed homosexuality was the result of a certain set of family forces and found what he expected to find. As Carter points out, the patterns were not universal and existed in the heterosexual controls as well.
However, despite the problems with validity, no follow up, no direct questioning of patients, etc., Bieber made a conclusion which continues to have influence in the modern ex-gay movement. The concept of the father’s intervening role with the overinvolved mother can be seen in the masculinity enhancement approach to reparative therapy. If you make a man more trusting of men (as dad should have done), then you give a man the courage to distance himself from mother (women). Once distant from mother (women) and in the world of the father (men), he loses his fear of being engulfed by mother (women) and finds them appealing. I think the appeal of the New Warriors Training Adventure comes from this view of masculinity. The Mankind Project view is that women have prevented men from being initiated into manhood. Only a man can initiate a man. So since by (reparative) definition, SSA men are fearful of mother (women), the need is to initiate them in the world of men (father) by other men (pretend fathers). What I have never heard addressed by reparative advocates is why these family constellations mark both same-sex and opposite-sex attracted men. If this set of factors was determinative in some general way for all same-sex attracted men, then why do we see SSA men who do not have these backgrounds and OSA men with them?

Reports of adverse reactions to abortion: How should mental health professional groups respond?

In addition to my work in sexual identity issues, I am quite interested in policy relating to the psychological reactions of women who have had abortions.
I have observed over the past several years that women who associate their abortion with mental health distress have approached the American Psychological Association with their concerns and stories. I blogged about an effort like this in 2007. Briefly, the letter sent by advocacy group, Silent No More, offered to put APA researchers in touch with women who had adverse reactions and asked for a meeting with the APA to discuss means of helping women with post-abortion problems. Georgette informed me that 600 women signed the letter. However, Georgette’s group received no response from the APA.
Another group, Lumina: Hope and Healing After Abortion, led by Theresa Bonopartis, sent a letter to each member of the Mental Health and Abortion Task Force requesting the opportunity to provide information about post-abortion reactions. She also received no response.
Contrast the reaction of the APA to women who believe abortion has triggered harm with the APA reaction to clients who report harm as a result of participation in reparative therapy and/or ex-gay ministries. The APAs (both the psychiatric and psychological groups) have been quite responsive to them, crafting advisories and almost banning reparative therapy in advance of publications systematically demonstrating harm. The major study of adverse reactions by Ariel Shidlo and Michael Shroeder took 5 years to solicit nearly 200 reports of various types of harm. In addition to this study, groups representing glbt people have met with and requested assistance from the APA to oppose reparative therapies.
Before I go on, I need to say that I am in favor of the APA taking seriously client concerns regarding reparative therapy and ex-gay ministries. I have been a persistent critic of reparative approaches as a general response to same-sex attraction. Further, I have consistently acknowledged that harm has been done by various methods to attempt sexual reorientation. The APA should vigorously pursue concerns about client welfare which are presented by clients and their advocates. Due respect should be shown to those who seek such services and ministries, but nonetheless, reports of adverse reactions should be addressed and investigated.
Having noted the appropriateness of the professional groups to attend to reports of adverse psychological reactions, I ask why the APA has not responded to the reports of adverse psychological reactions to abortion? These reports are common and compelling. Many more studies have found adverse reactions associated with abortion than have found such negative reactions to reparative therapy. I recognize that abortion is a much more common procedure than is reparative therapy but this fact should prompt an energetic response. In this context and speaking about APA conclusions about abortion and adverse reactions, I want to quote again a provocative question (see letter #2) from Bill Samuel, President of Consistent Life to APA president Alan Kazdin:

Is there any other phenomenon where the conclusion is based on those who do not have problems rather than on the therapeutic needs of those who do?

I might be misinformed, and in fact have an email in to the APA to check this, but I can find no indication that the APA has met with or responded directly to groups representing women who experienced adverse psychological reactions they attribute to abortion.
Now for some discussion. Am I missing something here? Is there something so different about these adverse reactions that could explain the differential response? At this point, I am thinking out loud…

Tennesee church shooter needed help but didn't get it

The Tennesee church shooter, James Adkisson, sounds like many other mass killers in this article from the Knoxville News-Sentinel. In the USA Today, the note he left was described as “irrational.”
In reading the Sentinel article, you get the sad picture of a person who was in need of mental health treatment but did not get it. His ex-wife attended this church which may have been a motive in the shooting.

Handicapping the APA abortion and mental health task force report

Last week, I reported the concerns of peace advocates, Consistent Life, about the upcoming American Psychological Association report regarding potential mental health consequences of abortion. In one of their letters to APA President Alan Kazdin, CL Executive Director, Bill Samuel, wrote:

It is accordingly with great concern we note APA has not taken sufficient care with a highly volatile issue, that of abortion. APA has held a position of abortion as being a civil right for women since 1969, and therefore has a clear political stand. Yet the Task Force on Mental Health and Abortion had no call for nominations; it was formed by Division 35, whose position is stronger and more focused than that of the national organization; and the final make-up of the task force had half the members as strong public advocates of the pro-choice view. Advocates of the view that abortion is violence to both unborn children and to women, which could balance such biases, are ominously absent. There are several well-qualified researchers who would have been pleased to serve on the panel, had the panel been selected with balance in mind.
Consider also that the report of this task force is scheduled to come out during an election year, 2008. The APA position is in accord with that of one of the major political parties, and in opposition to that of the other. When a prestigious organization puts out a report on a politically volatile issue at a time when political passions run particularly high, any imbalance on the task force will not pass unnoticed. Surely critics and observers will highlight the fact that members of such a task force were unbalanced in favor of those whose views matched the political position of the organization. The absence of those who could best challenge assumptions, provide alternative explanations, and offer differing interpretations of the same data will not be overlooked. We hope you will pause to reflect upon how partisan this will appear.

Dr. Kazdin wrote back to say that the APA report “must be grounded in the strongest, peer-reviewed science available…” This is of course the correct answer but I maintain that the Consistent Life people have raised valid points of concern. The task force report is to be released in August at the APA convention if approved by the Council of Representatives.
Beyond the appearance of bias, there is a more obvious indication of how the APA will report the research on abortion and mental health consequences. In the June 2008, APA Monitor, Rebecca Clay wrote an article on how the right wing misuses scientific research. In her article titled, “Science vs. ideology: Psychologists fight back against the misuse of research,” Clay interviews abortion researcher Nancy Adler regarding how anti-abortion psychologists are seeking legitimacy for their perspective by, shudder, doing research and reporting in peer-reviewed journals. Do you think the task force will see things much differently than Dr. Adler?

In other issue areas, special-interest groups have assumed the trappings of science to bolster ideology-driven claims. One example is so-called “post-abortion syndrome,” a scientific-sounding name for something most researchers say doesn’t exist. Nancy E. Adler, PhD, a professor of medical psychology at the University of California, San Francisco, is one of them. She has found that the rate of distress among women who’ve had abortions is the same as that of women who’ve given birth. Adler and other experts reviewed the literature in the late 1980s as part of an APA panel and found no evidence of a post-abortion syndrome. Even the anti-abortion Surgeon General C. Everett Koop, MD, refused to issue a report on abortion’s supposed psychological impact when President Ronald Reagan asked him to, citing the lack of evidence of harm.
Since then, says Adler, anti-abortion advocates have become more world-wise.
“They’re using scientific terminology,” she points out. They’re also gaining credibility by getting published in mainstream journals.
But such research often has methodological problems, Adler claims.
“Women are not randomly assigned to have abortions,” she points out. “Women who are having abortions are having them in the context of an unwanted pregnancy, which usually has some other very stressful aspects. Their partners may have left them. They may have been raped.”
In addition, says Adler, proponents of the syndrome don’t mention the base rate of depression and other psychological problems in society as a whole. And they always attribute such problems to abortion rather than any other possible causes.
A new APA Task Force on Mental Health and Abortion will examine such issues in a report later this year.

I think this is probably signals how the APA’s task force report will turn out. The good guys use good methods and the bad guys use the “trappings of science” and are being sneaky by “getting published in mainstream journals.” I guess the way to tell the good research from the bad is not the quality of peer-reviewed work but the ideology of the researcher. What I get from Clay’s article is this: When an APA-approved policy position is supported, it is science; otherwise, it is ideology.

Kern packs a hot lunch

Why would you need a gun in your legislative office?
Oh, now I get it…

OKLAHOMA CITY – Outspoken state Rep. Sally Kern was turned back by security Wednesday morning when she arrived at the Capitol carrying a pistol in her purse.
Kern, R-Oklahoma City, was nearly as surprised as security when a camera spotted the small handgun when her purse rolled through the camera-equipped conveyer.
The lawmaker, who has a permit to carry a concealed weapon, said she routinely removes it before entering the Capitol, but just forgot this time.
Kern said she asked security if she “could put the gun up.” She returned to her vehicle, left the weapon there, and returned to the Capitol for a meeting.
The lawmaker was not arrested.
Department of Public Safety spokesman Chris West said, “We tell security to use their heads,” and assess this kind of situation before taking action.