Altered Sexual Orientation Following Dominant Hemisphere Stroke

Things that make you go, hmmmm….

Check out this story of “change.”

Case Report

The patient, a 57-year-old right-handed man, sustained his first cerebral vascular accident in the right middle cerebral artery region at the age of 45, which resulted in right-sided hemiparesis that resolved completely within 3 months. He continued to run his private business successfully while living with his mother.

The patient lost his father in early childhood. There was no evidence of an emotional or conduct disorder during school years, and the patient eventually obtained his university degree. He continued to manage his successful practice until he sustained the second cerebral vascular accident in the left middle cerebral artery region at age 53.

The patient became aware of his homosexual orientation in his early teens and had several gay partners. He suffered a major depressive episode at age 26 that resolved within a few months. He also had a diagnosis of excessive harmful use of alcohol, but there was no evidence of dependence.

The patient started complaining of his changed personality and heterosexual orientation 6 months after his second stroke. At the same time he complained of excessive mood swings and changed interests. He became preoccupied with photography and had a successful photographic exhibition a year after his second stroke. His sexual orientation remained heterosexual 4 years following the second stroke, and he preferred to describe himself as bisexual because of his previous homosexual orientation.

Discussion

The mechanism by which a person acquires his sexual orientation is complex and ranges from pure psychological theories to more complex biological concepts. Our patient was aware of his homosexual orientation beginning in his early teens. He always enjoyed his gay relationships and had had at some point a live-in partner. He grew up with an absent father and had a strong bond with his mother. He went back to live with his mother after separating from his partner 4 years before his first stroke. It is unlikely that his psychological reaction to his first and/or second stroke could explain his altered sexual orientation, and his sexuality was accepted by his social network and family members.

Taking into consideration the interval between his first and second stroke, it is likely that an organic process within the left middle cerebral artery region is the cause of his altered sexual orientation.

The sexual needs of patients suffering from a brain injury are centered on hyper- and hyposexuality rather than altered sexual orientation. The alteration of sexual orientation raises serious challenges to patients and their care. It may be essential to address the issue of sexual orientation in assessing patient needs following brain injury in addition to other possible behavioral changes that might be encountered.

This is one of those head-scratchers that make you wonder what role “the middle cerebral artery region” plays in sexuality. I have had no chance to look into this but wanted post it due to the nature of the report.

Brain plasticity and sexual orientation: Train it to gain it?

This article about brain plasticity by Neil and Briar Whitehead posted on Anglican Mainstream caught my attention for several reasons. Some relate to classes I teach but for this post, I am interested in discussion surrounding the main reason the Whiteheads wrote about neuroscience: sexual reorientation.

I have a few questions.

Sex and gender researchers working in the belief that the brain and its functions were more less set, believed they might find evidence that homosexuality was hard-wired in the brain. They looked for signs that parts of the brain used in sexual activity were different in homosexuals and heterosexuals, that, for example parts of a homosexual male brain might be more like a woman’s.

Almost without exception these numerous studies produced contradictory conclusions, and were not replicable. Although gay activism sought to use some of these findings to argue homosexuality was biologically ingrained, the most that can be said scientifically about them is that IF any differences exist they are probably the result of homosexual behavior rather than the cause of it. But it is clear now that no-one is stuck with the type of brain they were born with. Our assumption now should be, change is possible in many behaviors – sexual orientation not excluded – and extraordinary effort will produce extraordinary change.

I don’t agree with this assessment of the state of research. We are on the beginning edge of research regarding sexual orientation differences in the brain and some of those differences seem striking. The work of Savic in particular has found some differences in gay and straight males in areas of the brain which may or may not be modified by experience. This study was just last year; there has not been time to publish replications. What research do the Whiteheads refer to here? This is an ongoing process which the Whiteheads describe as though the research program was in some mature state with many contradictory studies. I believe this is a extremely premature statement:

the most that can be said scientifically about them is that IF any differences exist they are probably the result of homosexual behavior rather than the cause of it.

What evidence has been demonstrated that sexual behavior can make these differences? I would like to know what studies have contradicted the Savic research and other studies which demonstrate brain differences, not just in symmetry but responses to sweat, serotonin and visual cues.

The Whiteheads then discuss brain training, noting that musicians and cab drivers have enlarged areas of the brain which are used for the specific tasks used frequently. They then leap to sex.

Monkey experiments have shown that artificial exercise of three digits on the hand increases the area of the brain asso­ciated with those fingers and decreases the other regions proportionately.(1) Violinists have a grossly enlarged area of the brain devoted to the fingers of their left hands. Those who learn a juggling routine for three months produce observable small changes in the small-scale structure of the brain, and these changes reverse when they stop.(3)

London taxi drivers have an enlarged area of the brain dealing with navigation. Is this innate? No. London bus drivers on set routes did not have this enlarged area, and on retirement of the taxi drivers, the brain area involved diminished.(6) Taxi-drivers were not born that way, but developed the brain area through huge amounts of navigation and learning, and only maintained it through constant use. We change our brains at the micro-level through the way we exercise, and anything we do repetitively espe­cially if associated with pleasure (e.g.) sexual activity. So, if brain scientists did find real differences between the brains of homosexuals and heterosexuals, this was probably the result of different sexual behaviors, not the cause of them.

Do we have any research that demonstrates brain areas which enlarge based on frequent sex? Or straight sex or gay sex? I know of none and the Whiteheads offer none but this appears to be what they are suggesting. They also suggest that gay and straight sex might bulk up different brain areas thus reflecting activity rather than causing it. I know of no research which indicates different brain areas for sexual arousal. This study by Safron et al seems to provide evidence against such an idea.

Now here is where stand up comics should get some material.

Doidge sums up the extraordinary plasticity of the brain with the words, Use it or lose it. (Or, for those trying to drop an unwanted behavior, Don’t use it, and you’ll lose it.)

Even if part of the brain is strongly associated with a particular sexuality it should be possible to change it. Stopping a sexual activity and avoiding stimulation of that brain region, and plunging into some other intense brain activity for months would lead to a diminishing of the intensity of that sexual response. Months is about the timescale of first significant change. That can be true for learning a musical instrument too!

Doidge’s conclusion about sexuality is that “Human libido is not a hardwired invariable biological urge, but can be curiously fickle, easily altered by our psychology and the history of our sexual encounters.” and “It’s a use-it-or-lose-it brain, even where sexual desire and love are concerned.” This would apply both to same-sex attraction and opposite-sex attraction.

If we train hard enough, an activity can become automatic and we pay it less conscious attention. That is particularly true of playing a musical instrument. Many of the basic techniques like chords, scales and arpeggios, are so deeply learnt that we don’t think about the details and indeed can’t if the music is fast. Details of driving, throwing a ball, reading, even tying shoelaces don’t and often can’t demand full attention. Anything we do often, we often end up doing automatically. In the same way it can seem that sexual orientation is so deeply embedded that it is innate. But, really, it is no more innate than any complex skill we have worked at to the point where we can do it without thinking e.g. seemingly automatic placement of left-hand fingers on guitar strings to produce a C chord.

Hey, what did you do this summer? Well, I learned to play the…

Changing sexual orientation is like learning to play a musical instrument? Should we have straight lessons? Community colleges could offer them in their continuing education departments. New slogan: “We put the adult in adult development!”

I apparently will need to get this book by Doidge. Whitehead doesn’t offer any of the research Doidge relies on for his startling new discovery about music instruments and sex. I wonder if there are any such studies. Whatever techniques Doidge is aware of, perhaps he ought to share them with Exodus since the changes reported by Jones and Yarhouse do not seem to reflect this new found brain plasticity. (I made this modification here because I have since learned that Doidge does not advocate any techniques of orientation change.).

I suspect this passage in the Whitehead article is deeply insulting to many ex-gays and ex-ex-gays alike (New reparative therapy slogans: “Just train it!” “You’ve got to train it to gain it”). How many such persons have essentially followed this approach: don’t use and you’ll lose it. However, they didn’t lose it.

The Whiteheads then suggest that male and female differences are largely due to experience after birth:

Male and female behavior – let alone ho­mosexuality and heterosexuality – is apparently not hardwired into the brain at birth. In fact, only one quar­ter of the brain is formed in a new-born child; the rest is developed through learning and experience (environ­mental input). We can be confident that whatever male/female differences exist in adult brains (and, no doubt, more will be found at some stage), they will be largely shaped by learning and behavior.

I think researchers in hormones might quarrel with this. I am aware of a recent study which found associations between fetal testosterone levels and sex-typed behavior at age 8.5. Testosterone has an organizing function in the brain prenatally but it is unclear whether it does at or before puberty. There is way too much unknown I believe, for dogmatism here. As with the rest of the claims, I would like to see this research much more than studies about driving and music.

The Whiteheads conclude:

Anatomy is not destiny; change is always possible. The brain is plastic and is in a constant state of change. Indeed the question is rather: what change is not possible?

Well, at the end, an idea is all we have. Essentially, the Whiteheads suggest that because brain plasticity has been associated with driving, musical training and regaining use of motor function, it should be true of sexual orientation change as well. As noted, there are some problems with his facts and no direct evidence for the hyperbolic title of this article.

UPDATE: My comments above about Norman Doidge’s book were made prior to reviewing it. I have since been able to read through parts of it and believe it is a valuable contribution for a lay audience. He does not offer techniques of sexual reorientation nor does he liken orientation change to learning a musical instrument. Neil and Briar Whitehead make those far-fetched connections, not Dr. Doidge. My reaction to the book was solely based on the selective quotations from the Whiteheads. I am sorry if anyone made an impression regarding Doidge’s book based on this post. Readers are encouraged to read the related posts linked below.

Related Posts:

NARTH authors again mislead readers: More on brain plasticity and sexual orientation

My Genes Made Me Do It and brain plasticity

WHYY interview with Judith Glassgold about APA task force report

Yesterday, I was on WHYY out of Philadelphia for an interview with Judith Glassgold, chair of the recently released APA Task Force report. Marty Moss-Coane is the host of Radio Times, a show broadcast over NPR as well as locally on WHYY.

You can listen to the interview here. It is long (about an hour) but the long format allowed us to unpack the report and some of the clinical issues involved.

Among other points, Dr. Glassgold affirmed my understanding and analysis of the APA task force report and the value it has for people working within a sexual identity therapy framework. There is much more of interest so if you groove on this topic, this is a good interview without pressure to create sound bites.

New Scientific Research revisited

In the category of “Old Business.”

On July 23, I asked blog readers what the phrase “new scientific research” meant.

Here is what some of you said:

New: Recently reported (not in media for more than 3 months)

Scientific: Can document measuring criteria, tested, revealing a need to do further research

Research: Primary Data

If it’s new, it’s not a review of past literature.

Data that hasn’t been reported before.

Not –

A literature review

A meta-analysis

A re-analysis of data that has been previously been reported with a different analysis.

Study with new data…Not a literature review. Not a review to undermine the own viewpoints with no diversity view.

That’s what I think too. Therefore I was surprised to see NARTH headline their recent press release for the summary paper, “What Research Shows…” as

New Scientific Research Refutes Unsubstantiated Claims Regarding Homosexuality

The problem is that there is no new scientific research in the paper. The paper itself is not new scientific research but rather a collection of prior studies.

I asked NARTH leaders about the decision to call their paper “new scientific research.” I did learn in the process that the NARTH Governing Board had reviewed the press release and title and approved it. When I pressed about why the paper was called “new scientific research,” NARTH past-president Dean Byrd then wrote to me twice say that he did not have time to answer the question.

Wall Street Journal covers APA task force report and sexual identity therapy

The Wall Street Journal’s Stephanie Simon has captured well the application of the APA task force sexual orientation report in an article out this morning. Of course I would say that…

The men who seek help from evangelical counselor Warren Throckmorton often are deeply distressed. They have prayed, read Scripture, even married, but they haven’t been able to shake sexual attractions to other men — impulses they believe to be immoral.

Dr. Throckmorton is a psychology professor at a Christian college in Pennsylvania and past president of the American Mental Health Counselors Association. He specializes in working with clients conflicted about their sexual identity.

The first thing he tells them is this: Your attractions aren’t a sign of mental illness or a punishment for insufficient faith. He tells them that he cannot turn them straight.

But he also tells them they don’t have to be gay.

For many years, Dr. Throckmorton felt he was breaking a professional taboo by telling his clients they could construct satisfying lives by, in effect, shunting their sexuality to the side, even if that meant living celibately. That ran against the trend in counseling toward “gay affirming” therapy — encouraging clients to embrace their sexuality.

But in a striking departure, the American Psychological Association said Wednesday that it is ethical — and can be beneficial — for counselors to help some clients reject gay or lesbian attractions.

The APA is the largest association of psychologists world-wide, with 150,000 members. The association plans to promote the new approach to sexuality with YouTube videos, speeches to schools and churches, and presentations to Christian counselors.

According to new APA guidelines, the therapist must make clear that homosexuality doesn’t signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation.

But if the client still believes that affirming his same-sex attractions would be sinful or destructive to his faith, psychologists can help him construct an identity that rejects the power of those attractions, the APA says. That might require living celibately, learning to deflect sexual impulses or framing a life of struggle as an opportunity to grow closer to God.

While the report doesn’t use my exact words (e.g., I don’t say ‘you don’t have to be gay’), she does catch important aspects of the APA report and the stance I use within the sexual identity therapy framework. Furthermore, I don’t show the video at the same time in the same order of things to clients and then they make a decision about their direction. I do however, do extensive informed consent and answer lots of questions which involves videos and slides to answer. Thanks for Michael Bailey for those vids.

This report captures the essence of the novel findings in the APA report in contrast to the AP report which continues to present a polarized picture. For sure, as long as the dialogue around change is important to people, we keep talking past each other. However, when you look at what both sides actually claim, they are not that far apart. According to the AP report, Jones and Yarhouse are going to report over half of 61 subjects either changed or are celibate. Whatever the percentage, it is clear that change cannot be promised to clients as a predictable function of therapy or ministry. We should be able to agree about that and then place emphasis on belief and value congruence. From there, see what happens.

I will have other posts on the media reaction and additional analysis…