Category: Religion and sexuality

Robert Spitzer, Father of Modern Psychiatric Diagnosis, Dies at 83

Robert Spitzer at his home in 2004, screencap from I Do Exist.
Robert Spitzer at his home in 2004, screencap from I Do Exist.

According to the New York Times, psychiatrist and author of the third edition of the American Psychiatric Association’s diagnostic manual Robert Spitzer died on Christmas Day. Spitzer is credited with changing the way mental health professionals view diagnosis of mental disorders. By basing the assessment of mental disorder on personal distress and diminished functioning, Spitzer promoted a more rigorous approach to diagnosis.
More famously, Spitzer’s modifications also paved the way for reconsidering homosexuality as a mental disorder. After meeting gay psychiatrists who did not experience distress over homosexuality, Spitzer, in the early 1970s, led the effort to remove homosexuality from psychiatry’s list of mental disorders.
I first talked to Bob Spitzer when he invited me to take part in a debate over sexual orientation change efforts at the American Psychiatric Association meeting in 2000. The debate was canceled when, near the beginning of the conference, the two psychiatrists arguing against sexual orientation change backed out. Bob later told me that the psychiatrists who declined to participate wanted out because they heard that I was a member of the National Association for the Research and Therapy of Homosexuality (NARTH). While I had been a NARTH member for one year in 1997, I had allowed my membership to lapse by 2000. An irony is that I later became one of NARTH’s biggest critics. Bob knew I tracked NARTH’s actions and about once a year asked about any news on their activities.
Although I was unable to attend, the following year Bob invited me to speak as a part of a symposium where he presented results of his research on ex-gays. Eventually, that study was published in 2003 in the Archives of Sexual Behavior and was one of the most controversial studies in modern psychiatry. At the time, due to his conversations with people who described themselves as ex-gay, Spitzer believed that some gays had been able to modify their sexuality toward the straight side of the continuum. Later, in 2012, Spitzer retracted that interpretation of his research, denounced his earlier beliefs, and apologized to gays.
In 2004, I met Bob Spitzer in person and spent a few hours at his home near New York City while filming for the video I Do Exist, a video with the testimonies of five people who told me they changed from gay to straight. Because one of the main participants retracted his statements and two others had significant changes, I later retracted the video in January 2007. My views were also altered by the emergence of new data on sexual orientation and the failure of change therapy supporters to produce evidence in their favor.
After he published his study, Bob’s collaboration with social conservatives was something he later regretted. On one occasion in November 2008, I sent him a link to Focus on the Family’s website where they had misrepresented his study. He wrote back and said, “That is awful. Whoever wrote it must have known it to be incorrect. Can you do something about it?” Focus later modified the statements slightly but still did not fully represent Bob’s views. 
In 2007, Spitzer told me in a phone call that he endorsed the sexual identity therapy framework that I developed with Mark Yarhouse. The endorsement was later published on the SIT framework site:

I have reviewed the sexual identity framework written by Warren Throckmorton and Mark Yarhouse. This framework provides a very necessary outline to help therapists address the important concerns of clients who are in conflict over their homosexual attractions. The work of Drs. Throckmorton and Yarhouse transcend polarized debates about whether gays can change their sexual orientation. Rather, this framework helps therapists work with clients to craft solutions tailored to their individual situations and personal beliefs and values. I support this framework and hope it is widely implemented.
Robert L. Spitzer, M.D., Professor of Psychiatry, Columbia University, New York State Psychiatric Institute, New York City, NY. Co-editor of the Diagnostic and Statistical Manual of Mental and Emotional Disorders, 3rd Edition and 3rd Edition (Revised).

On a personal level, I liked Bob immediately. He was friendly and very approachable. While he seemed to like the controversy, in my hearing he communicated no malice toward any side of the gay change debate. He seemed to be a genuine truth seeker and wanted to follow the evidence no matter what. I will miss him.
Bob Spitzer, R.I.P.

Interview with Mark Yarhouse on SAMHSA Report Calling for an End to Sexual Orientation Change Efforts for Minors

On October 15, I linked to a report published by SAMHSA which called for an end to sexual orientation change efforts for LGBT minors. At the time, I wrote:

Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth was released today by the Substance Abuse and Mental Health Services Administration. The report recommends the end of change therapies for minors via professional advocacy and legal strategies.

Mark Yarhouse, co-author with me of the Sexual Identity Therapy framework and professor at Regent University, was an evangelical presence on the panel of experts who produced the consensus statements.

I also said I hoped to have commentary from Mark. Today, I have an interview with him on his committee experience and his views of the consensus. Mark is professor of psychology at Regent University and Director of the Institute for the Study of Sexual Identity. He is co-author with me of the Sexual Identity Therapy Framework, which is a model for ethically and effectively helping clients with distress surrounding their sexual orientation and religious beliefs. For more on SITF, see the website which supports the framework. This will be cross–posted there.
This interview comes amid a bit of a controversy involving Mark and a speaking engagement in Canada. I hope those who assume they know Mark’s views will also read this and the SITF.

Warren Throckmorton: In general, what was your experience like being on the consensus committee? Did you feel the rest of the committee members took religious concerns seriously?
Mark Yarhouse: Overall, it was a good experience. I am always grateful for the opportunity to engage with others around complex issues, to learn from other experts, and to share from my own lines of research. We reviewed existing research and past policy statements, as well as shared from our professional experience working with children, adolescents, and families. In answer to your question about religious concerns, I think committee members wanted to take religious concerns seriously, although the primary focus was the well-being of minors who are navigating sexual identity and gender identity. As you know all too well, the beliefs and values of religious families are important considerations when working with families whose teen may be navigating gender identity or sexual identity concerns. In any case, my experience was that other committee members were interested in the experiences I’ve had – and others had – working with conventionally religious families.
WT: Even though the sexual identity therapy framework (SITF) wasn’t mentioned or cited, do you feel the report is supportive of the approach we take in the framework?
MY: Yes, I think so. We had the opportunity to review many documents, including the SITF and the 2009 APA task force report on appropriate therapeutic responses to sexual orientation, which, as you know, cited the SITF favorably. The kind of practice we saw as helpful would emphasize identity exploration without an a priori fixed outcome. I think the framework does that in the area of sexual identity. However, the framework does not address in much detail working with minors, and that may be something we consider if we offer a revision in the future.
WT: Do you have any comments, reservations about the consensus reported in the paper?
MY: As the SAMHSA report notes, we decided at the outset that we would define consensus as a reasonably high percentage of agreement rather than unanimous consensus. We all agreed to that, but that meant that what counted as consensus in at least a few occasions was not reflecting unanimity. We worked hard for unanimity in all cases, but that did not always happen. I at times found myself in disagreement with some of the wording, for example, but the threshold for consensus was met in those instances, and I understood and respected that process.
WT:It seems to me that the consensus surrounding sexual orientation is more settled than gender identity. How do you see that?
MY: There are fewer professional debates about sexual orientation, which likely reflects the consensus you are referring to. There seem to be more professional discussions about a range of clinical options with gender dysphoria. However, I was impressed by how little research is published on minors – particularly efforts to achieve congruence between gender identity and biological sex.  I was under the impression that more studies of higher quality had been published in some areas, and as the committee looked at them together, we found them lacking. Also, while research was one consideration, we drew on other sources, too, such as committee members’ professional experience and prior reports. In any case, I would have preferred to frame and word various aspects of the consensus report differently, but again that in some cases goes back to what counted as consensus. Without going into too much detail, you could imagine someone favoring the language of  ‘insufficient evidence’ in discussions of effectiveness and harm, to reflect how little published research is available in a given area of inquiry. Other topics, such as how to conceptualize sexual and gender identities and expressions in a diverse and pluralistic culture raise important philosophical and theological questions that were beyond the scope of the discussion.
WT: In general, do you support the recommendations of the paper (or asked another way). Is there anything in the recommendations you have concerns about?
MY: It is important to distinguish the consensus statement from the SAMHSA report. I did provide feedback on portions of the SAMHSA report, especially around family, community, and religious considerations, but it was written by designated persons from that agency. I think it reflects a little more regard for conventionally religious persons and families and provides for more resources than otherwise may have been available. But many committee members provided input and suggestions, and I imagine the author of the report had to balance various considerations in putting together the final document.
As far as concerns, I indicated at the outset that I did not think the government should be involved in legislating around the complexities of clinical practice in these two areas. I prefer to see government support the regulatory bodies that provide oversight to mental health professions in a given jurisdiction. I shared more of my thoughts on that in an interview with First Things. My opinion has not changed on that matter.

New SAMHSA Report Calls for End to Change Therapy for LGBT Youth

I may have more to say about this report in the coming days, hopefully with some commentary from Mark Yarhouse, but for now, I am going to link to it.
Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth was released today by the Substance Abuse and Mental Health Services Administration. The report recommends the end of change therapies for minors via professional advocacy and legal strategies.
Mark Yarhouse, co-author with me of the Sexual Identity Therapy framework and professor at Regent University, was an evangelical presence on the panel of experts who produced the consensus statements.
The most controversial parts of the report, in my opinion, deal with gender identity. I think most therapists now understand that sexual orientation is durable and rarely, if ever, changes dramatically as the result of change therapy. However, the recommendations on gender identity are more controversial. Despite the use of the word consensus, I question whether there is a consensus among professionals of all ideologies about how to respond therapeutically to youth dealing with stress over gender expression.
As for the goal of ending change therapy for youth, I am a supporter. Despite years of research and effort, no safe, effective and ethical approach to sexual orientation change has emerged. The very few people who still claim effectiveness are small operations with no research of their own methods. The anecdotes of harm are convincing and the candid admissions of people like Alan Chambers that the change they claimed didn’t happen is enough to cause significant skepticism. My own professional experience researching change efforts in clients and research participants informs me that any claimed change is unlikely to be lasting or complete. The biological research, while not conclusive, supports a very early establishment of sexual desires (especially for males). The available options for attempting change are often bizarre and carry potential to create psychological problems. Thus, limiting these efforts in a free society to adults seems like a reasonable professional position.
 

Southern Baptist Seminary Leaders Reject Reparative Therapy

Let me just say that I opposed reparative therapy before it was cool to oppose it.
Yesterday, Al Mohler and others articulated their position against reparative therapy, also known as sexual orientation change efforts.
Atlantic has an article on Alan Chambers’ new book and chronicles the demise of the ex-gay movement from Alan’s point of view.
Essentially, Mohler and colleagues believe changing orientation is not the Christian goal. Rather, avoidance of same-sex sexual relations is the objective in the narrow sense, and more broadly, pursuit of a spiritual life is what Christians should seek. Some same-sex attracted people are bisexual and others sometimes fall in love cross-orientation to form a mixed orientation marriage.
Although it is dated, I have a page on reparative therapy which demonstrates my approach to the issues in the professional sense.

Reaction to the Supreme Court Ruling Requiring Recognition of Same-Sex Marriages

In the most anticipated decision of the term, the Supreme Court this morning ruled that

The Fourteenth Amendment requires a State to license a marriage between two people of the same sex and to recognize a marriage between two people of the same sex when their marriage was lawfully licensed and performed out-of-State.

The decision is here.
Reaction was swift.
Russell Moore representing the Southern Baptists: Don’t panic, articulate a counter-cultural view of marriage. Watch:
[youtube]https://youtu.be/qsp59P1sFro[/youtube]
GOP presidential candidate Scott Walker: “I believe this Supreme Court decision is a grave mistake. Five unelected judges have taken it upon themselves to redefine the institution of marriage, an institution that the author of this decision acknowledges ‘has been with us for millennia.’”


Mark Woods writing for UK’s Christian Today asks readers not to worry. He writes:

So here’s a discussion starter.
It is entirely up to the state to declare what relationships it will recognise as marriage, and the Church should not have a problem with that.
It is entirely up to the Church to declare what relationships it will recognise as Christian marriage, and the State should not have a problem with that.
The state should jealously guard its prerogative from the Church, and ensure that it provides equality under the law for all its citizens.
The Church should jealousy guard its prerogative from the state, and ensure that it is never coerced into bringing its beliefs and practices into line with those of the majority if it doesn’t want to.
Evangelicals (and others) have got themselves into a knot because they think the state is trying to define Christian marriage. It isn’t; it can’t, and it never could. But the long history of Christendom has allowed Christians to think that the two are the same. Most Americans have always been keen on the separation of Church and state; well, now’s the chance to find out whether you mean it.


My reaction is more along the lines of Mark Woods’ and Jonathan Merritt’s.
I sat in a meeting in 2005 at Catholic University where lawyers, theologians, and social scientists were strategizing about how to prevent this day. I recall a couple of the lawyers who were there opposing gay marriage saying that today was probably inevitable. Anyone who was paying attention over the last decade should not be surprised by the decision today.
I’ll have more to say about the decision once I have read it completely, but my impression is that the five justices see same-sex attraction as an enduring aspect of existence. The state has no compelling interest in requiring people to change it to marry, so the law requires equal recognition of bonds formed by two people so constituted.