neil whitehead – Warren Throckmorton

NARTH, the New Epigenetic Model and Confirmation Bias

Last week, I wrote briefly about the new paper from William Rice et al which describes an epigenetic model of homosexuality. In that post I reported a quote from National Association for the Research and Therapy of Homosexuality (NARTH) spokesman David Pruden regarding the study. Here is Pruden’s statement which was cited in the Christian Post:

“The theoretical model itself attributes only 10-14 percent of the factors to genetics or epigenetics. That leaves the remaining 85 percent or so of the factors to environmental influences,” said Pruden.

That assessment did not sound right to me so I contacted William Rice who informed me that his model accounted for homosexuality generally speaking, not just for “10-14 percent.” The Christian Post rightly printed the correction at the end of the article.

So where did the 10-14 percent figure come from? According to an email from Pruden, that range came from NARTH Scientific Advisory Board member, Neil Whitehead. Whitehead has speculated in the past that the maximum genetic contribution is between 10-14%. While I believe his assessment is low, he has referred to various studies to provide support. However, in the case of the new study, it appears no one at NARTH has even read the paper.

If Pruden read it, he didn’t refer to it. Rather he referred to Whitehead who yesterday placed a brief article on the NARTH website about the paper. Here is the body of Whitehead’s statement:

(A fuller evaluation will appear here on this site: www.mygenes.co.nz when the full paper is available)

Recently (Anonymous, 2012) a summation of a published paper (Rice, W.R., Friberg, U. Gavrilets, 2012) has achieved attention as being an explanation for homosexuality.

Readers should note this is a theoretical model only and that historically many theories have been put forward as the single overriding factor causing homosexuality. The current best consensus is that there is no single over-riding factor – the trait is multifactorial and overwhelmingly environmental. The Rice paper is quite unlikely to be “critical”. Like previous theories, the current epigenetic one may well have a small contribution, but this remains to be established. The authors themselves note that laboratory work has yet to be done. The paper built on previously published work (Rice, Gavrilets, & Friberg, 2008).

Apparently, Whitehead has not read the paper because he said the “full paper” was not available. On the contrary, the paper is freely available online here.

What is striking is what Whitehead says about the topic of the paper before seeing it. He says homosexuality is “overwhelmingly environmental” and opines that the current epigenetic theory is unlikely to make more than a “small contribution” to homosexuality. It appears that Pruden and Whitehead have their minds made up.

NARTH is so committed to an environmental/family model of cause that organization leaders jump to a preferred conclusion before even considering the evidence. This is one way confirmation bias operates. In this case, NARTH representatives said things about the theory before they read or studied it, and what they said came, not from the paper, but from their preconceived ideas.

NARTH Report: Suicide attempts increase during sexual orientation change therapy

Writing in the second edition of NARTH’s (National Association for the Research and Therapy of Homosexuality) Journal of Human Sexuality, Neil Whitehead proposed a reanalysis (NARTH summary here) of a paper by Ariel Shidlo and Michael Shroeder on potentially harmful outcomes of sexual orientation change efforts. NARTH’s headline describing the paper is

Sexual Orientation Change Efforts Do Not Lead to Increased Suicide Attempts.

Contrast NARTH’s headline with the title of my post. After examining Whitehead’s article, I submit that his analysis supports my title as much or more than it does NARTH’s claim.
Shidlo and Shroeder wrote the following about suicide attempts in their 2002 report:

In examining the data, we distinguished between participants who had a history of being suicidal before conversion therapy and those who did not. Twenty-five participants had a history of suicide attempts before conversion therapy, 23 during conversion therapy, and 11 after conversion therapy. We took the subgroup of participants who reported suicide attempts and looked at suicide attempts pre-intervention, during intervention, and post-intervention to see if there was any suggestive pattern. We found that 11 participants had reported suicide attempts since the end of conversion interventions. Of these, only 3 had attempted prior to conversion therapy. Of the 11 participants, 3 had attempted during conversion therapy.

In his NARTH paper, Whitehead makes a series of assumptions about the participants in the Shidlo and Schroeder study. I think these are questionable assumptions but for sake of discussion, I will play along. First, he assumes that these suicide attempts occur over a span of 25 years (13 years pre-therapy, two years in therapy and then 10 years post-therapy). He then assumes that the attempts occurred at a constant rate over that span to calculate an expected number of suicide before, during and after therapy. Whitehead then compares his expected attempts with the actual number of attempts as reported by Shidlo and Schroeder. Whitehead summarized his findings as follows:

(a) Comparing pre-therapy, therapy, and post-therapy groups, there is overall no significant increase in suicides per unit time.
(b) There is a very clear increase in attempts during therapy.
(c) There is a trend to fewer attempts after therapy.

Using his assumptions, Whitehead wrote:

Suicide attempts reported before therapy were 25, and those reported during and after therapy combined numbered 34. The expected numbers allowing for the time periods and normalized to the above total are 30.55 and 28.44. The expectation on which this is calculated is that therapy has no effect, either positive or negative.

In this analysis, no difference shows up in suicides related to therapy when suicide attempts before therapy are compared with the time period during and after therapy. However, Whitehead does not stop there. About suicide attempts during therapy, he wrote:

For attempts before and during therapy, the observed results are 25 and 23, and the calculated expected normalized figures are 42.18 and 5.82. These are very different from the observed, and the chi-square test produces a result of p < 0.001. They are not the same, and therapy has therefore been associated with a several-fold increase in attempts.

In other words, there is a very large increase in suicide attempts during therapy. The title of my post is accurate. According to this NARTH report, sexual orientation change “therapy has therefore been associated with a several-fold increase in attempts.”
Continue reading “NARTH Report: Suicide attempts increase during sexual orientation change therapy”

Brain plasticity and sexual orientation: Wrapping up with a couple of experts

Earlier this month, I posted three times regarding an article by Neil and Briar Whitehead with the title, “Brain Plasticity Backs Up Orientation Change.” This is a wrap up for those posts to indicate that very little backs up the Whiteheads’ article.

I asked Adam Safron and Norman Doidge to comment about the Whitehead article. Dr. Doidge is the author of the book (The Brain that Changes Itself) misrepresented by the Whiteheads. As I noted in a previous post, the Whiteheads failed to cite Doidge completely and provided quotes which gave the incorrect impression of Dr. Doidge’s views. About sexual reorientation, Dr. Doidge pointed me to the correct passages in his book and wrote in an email:

Readers of all my actual quotes will see that I have made no comments on therapeutic techniques for changing sexual preference and plasticity in my book.

And of course, that is the problem with how the Whiteheads treated Doidge’s book. As I pointed out here, they provided only part of his quotes and failed to include what he actually said about sexual preferences, which was very little.

Adam Safron is a researcher at Northwestern University and the lead author of the article I often cite here titled, “Neural Correlates of Sexual Arousal in Homosexual and Heterosexual Men.” He read the Whitehead article and had several reactions, two of which I will share here. First, the Whiteheads say that changing sexual orientation and learning a musical instrument would be about the same.

Because of brain plasticity it’s quite possible that homosexuals can become more heterosexual and heterosexuals could become homosexual, though persistent work could be needed, about equivalent to learning a new musical instrument.

Safron’s reaction to this was to say, “There is absolutely no evidence for this statement.” However, in spite of no evidence, the Whiteheads press their case regarding musical lessons and sexual preference. They write:

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!

To this proposition, Safron responded,

But the devil is in the details here. How large is the change? How permanent? People can frequently modify their behavior on short time-scales but find themselves going back to their old ways on longer time scales. These arm-chair speculations are no substitution for real studies actually looking at the efficacy of therapy designed to change orientation.

No substitute indeed. Safron makes a good observation. What does plasticity mean in terms of durability? And then how would be able to know unless research can find some verification. Unless the Whiteheads are keeping secrets, we can only go on what research we have. Apparently, learning a new orientation is not as easy as learning a new musical instrument, given the modest changes reported in existing studies.

Parents and Friends of Ex-gays now has this article up as well.

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

My Genes Made Me Do It and brain plascticity

My Genes Made Me Do It and brain plasticity

Just a postscript to my earlier posts on brain plasticity and sexual orientation…

Neil Whitehead first authored his signature work, My Genes Made Me Do It in 1999. Now he maintains the book on his website saying that “It is under constant review to keep it up-to-date so readers can be asssured (sic) of its on-going relevance.”

In chapter 8, on page 6, Whitehead recommends Norman Doidge’s book on brain plasticity. He takes some of the same liberties with Doidge’s book that he does in the Anglican Mainstream article and again fails to quote what Doidge actually says about sexual orientation.

Doidge gives a neurological principle: Neurons which fire together wire together. In human sexuality this means that if something extraneous is often associated with sexual arousal it will tend to become part of it. In brain maps genital response regions lie alongside the response region for feet, and Doidge wonders if this might relate to sexual fetishes involving feet. It also becomes very reasonable to suppose that (for example) intense emotional focus on someone of the same sex might get triggered together with sexual excitement, and if frequently repeated ultimately seem to be very deeply ingrained homosexuality.

Because of brain plasticity it’s quite possible that homosexuals can become more heterosexual and heterosexuals could become homosexual, though persistent work could be needed, about equivalent to learning a new musical instrument

A prediction of plasticity principles though not mentioned by Doidge, would be that any brain structures associated with sexual activity would be much changed in those very old people for whom such activity has long ceased eg those brain regions would have shrunk and lost function.

Doidge’s conclusion about sexuality is that “Human libido is not a hard-wired 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.

There are numerous problems with Whitehead’s extension of Doidge’s ideas into the area of sexual orientation. However, I will note again that he selectively quotes the book and adds his own ideas as if they come from Doidge’s book.

Whitehead’s predictions that sexual reorientation should be as easy as learning a musical instrument should be offensive to celibate gays, ex-gays, post-gays, and ex-ex-gays. I have heard hundreds of narratives from people who sought change, are seeking change and/or congruence with their nongay-affirming religious beliefs and no one has ever described the process in those terms.

Another problem with this book is a reference to Paul Cameron’s anti-gay pamphlet, The Medical Consequences of What Homosexuals Do in chapter 6. He even incorrectly says the Family Research Council published the thing (Paul Cameron’s DBA Family Research Institute is the actual publisher). He quotes him two additional times in the book as well. One might understand these inclusions better if they occurred in the 1999 version. One could make the case that the degree of Cameron’s bias was not clear at that point. However, since this is an effort “under constant review,” I am assuming that the presence of these references is intentional.

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

This post is a follow up to the one about Neil and Briar Whitehead’s article titled, “Brain Plasticity Backs Up Orientation Change” published on the Anglican Mainstream.

In their article, the Whiteheads liken sexual reorientation to learning to play a musical instrument and proclaim that science leads us to this assumption:

Our assumption now should be, change is possible in many behaviors – sexual orientation not excluded – and extraordinary effort will produce extraordinary change.

In their article, the Whiteheads frequently quote and recommend a book by Norman Doidge called “The Brain that Changes Itself.” To prove their contention about sexual reorientation, the Whiteheads use quotes from Doidge’s book saying:

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.

These quotes come from a chapter titled “Acquiring tastes and loves” and describe human sexuality as being pretty flexible compared to other species. Doidge says “human libido is not a hardwired invariable biological urge” on page 95 and is plucked from the middle of a sentence. Here is the whole sentence:

The plasticity of this man’s sexual tastes exaggerates is general truth: that the 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.

Who is the man Doidge refers to here? While he is not named, he is described.

One homosexual man had successive relations with men from one race or ethnic group, then with those from another, and in each period he could be attracted only to men from the group that was currently “hot.”

Dr. Doidge was talking about a gay man and the variability within his sexual orientation — not about easy movements from one orientation to another. The gay man was not changing his sexual orientation but his attraction preferences. The Whiteheads leave out this aspect of the story.

The Whiteheads say that Doidge is talking about same-sex attraction and opposite-sex attraction. However, in the quote provided, Doidge is talking about a gay man. The Whiteheads further obscure Doidge’s views by failing to quote what he does say about sexual reorientation. On page 95 Doidge writes:

Even sexual preference can occasionally change. Though some scientists increasingly emphasize the inborn basis of our sexual preferences, it is also true that some people have heterosexual attractions for part of their lives — with no history of bisexuality — and then “add on” a homosexual attraction and vice versa.

I wonder why the Whiteheads did not quote these two sentences. This is directly on point. Quoting this section and another on page 341 would have presented Doidge’s views more clearly. This is clearly not the same perspective as is portrayed by the Whiteheads.

On page 341, Dr. Doidge provides a reference for his view about adding on sexual responsiveness to an existing orientation. He first says, it is well known that straights can engage in homosexual relations when members of the opposite sex are not present and gives prison and the military as examples. However, he then quotes an authority with no research references.

According to Richard C. Friedman, researcher on male homosexuality, when male homosexuals develop a heterosexual attraction, it is almost always an “add on” attraction, not a replacement (personal communication).

This is far cry from what the Whiteheads would have us believe about brain plasticity and sexual orientation and even about what Norman Doidge says in his book. They could have quoted what Doidge said but didn’t in favor of quotes which misrepresented what the author said. And they really did not need to wonder what Doidge thought since he spelled it out.

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.

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

My Genes Made Me Do It and brain plasticity

Ariel Shidlo comments on NARTH's use of his research

Back in December, 2008, I posted a critique of Neil Whitehead’s re-analysis of Shidlo and Schroeder’s study of harm from reorientation change efforts.
In that post, I noted that Whitehead said Shidlo’s study actually demonstrated the value of reparative therapy because suicides were reduced. In her report on the 2008 NARTH convention, NARTH president Julie Hamilton wrote:

Regarding the claims that reorientation therapy harms clients, Dr. Whitehead cited studies that found suicide rates decrease after therapy. In fact, he pointed out that Shidlo and Schroeder (2002) sought to prove the adverse effects of therapy by collecting stories of harm; however, instead of finding therapy to be harmful, they found it to be helpful, in that suicide attempts by these clients actually decreased after therapy. For more information on the content and references for Dr. Whitehead’s keynote address, see the NARTH Collected Convention Papers or soon-to-be-released book, What the Research Shows: NARTH’s Response to the APA Claims on Homosexuality.

In the original post I cited a number of reasons why Shidlo and Schoeder could not be used to make statements regarding the relationship between change efforts and suicidality. Also, along the way, I asked Ariel Shidlo his response to the NARTH claim and my critique of it. He recently responded:

The [NARTH] claims are obviously a wishful reading of data that does not lend itself to any such conclusions. You make these points eloquently in your column.
Thanks for educating readers to a critical reading of those who throw around “science” in their sermons.

In reviewing the original post, note that the topic was not merely the inappropriateness of the specific NARTH claim but the role of confirmation bias in making various claims regarding sexual orientation. Being aware of this should not prevent theorizing but we should be prepared to acknowledge data which contradict our theories and look for alternative perspectives with new and better research.

Confirmation bias, NARTH and the use of research

I quoted Nickerson in my prior post on confirmation bias. His article is quite good and can be reviewed here. I like this quote in the article attributed to Francis Bacon:

The human understanding when it has once adopted an opinion (either as being the received opinion or as being agreeable to itself) draws all things else to support and agree with it. And though there be a greater number and weight of instances to be found on the other side, yet these it either neglects and despises, or else by some distinction sets aside and rejects; in order that by this great and pernicious predetermination the authority of its former conclusions may remain inviolate.. . . And such is the way of all superstitions, whether in astrology, dreams, omens, divine judgments, or the like; wherein men, having a delight in such vanities, mark the events where they are fulfilled, but where they fail, although this happened much oftener, neglect and pass them by. (p. 36)

Nickerson then outlines several types of confirmation bias:

-Restriction of attention to a favored hypothesis.
-Preferential treatment of evidence supporting existing beliefs.
-Looking only or primarily for positive cases.
-Overweighting positive confirmatory instances.

Recently, several readers asked me about a report on the NARTH website claiming that reorientation therapy reduced suicide attempts. In reviewing the claim, it appears to me to be an example of confirmation bias. However, before I discuss it, I want to assert that I believe confirmation bias is common to humans. For reasons I will lay out in future posts, I believe cognitive activity serves (at least) to simplify complexity, create a sense of predictability to the world, and to justify investments of time and energy – in this case mental time and energy. I am not above it, nor do I believe anyone to be. I do think we can help prevent and/or correct errors by being aware of it.
It is no secret that I think reparative therapists who believe there is only one path to same-sex attraction engage in confirmation bias. Another recent instance from NARTH is the use of a study by Shidlo and Schroeder to make a claim that reorientation therapy reduces suicide risk. President-elect, Julie Hamilton, in her report from the 2008 NARTH conference, wrote:

Regarding the claims that reorientation therapy harms clients, Dr. Whitehead cited studies that found suicide rates decrease after therapy. In fact, he pointed out that Shidlo and Schroeder (2002) sought to prove the adverse effects of therapy by collecting stories of harm; however, instead of finding therapy to be harmful, they found it to be helpful, in that suicide attempts by these clients actually decreased after therapy. For more information on the content and references for Dr. Whitehead’s keynote address, see the NARTH Collected Convention Papers or soon-to-be-released book, What the Research Shows: NARTH’s Response to the APA Claims on Homosexuality.

First, this is misleading because the way it is worded, it sounds as though Shidlo and Schroeder found and reported something they did not intend to find. More relevant to this post, however, is Dr. Hamilton’s reference to an analysis by Dr. Neil Whitehead, bio-chemist with numerous scientific publications including some on sexual orientation. Neil often provides interesting perspectives so I was surprised to see him quoted in this context. When I asked Neil about the claim, he said he reanalyzed the reports of suicide from Shidlo and Schroeder’s paper and stands by it. While I have not seen the reanalysis, I don’t need to in order to know that a relationship between reorientation and suicidality cannot be inferred from an analysis of Shidlo and Schroeder. Even so, Neil stunned me by saying that his analysis did not reach statistical significance but revealed a non-significant trend for reorientation therapy to reduce suicidality among same-sex attracted people. On that basis, he made his claim which was amplified by Dr. Hamilton.
Here is what Shidlo and Schroeder reported about their participants’ suicide attempts.

In examining the data, we distinguished between participants who had a history of being suicidal before conversion therapy and those who did not. Twenty-five participants had a history of suicide attempts before conversion therapy, 23 during conversion therapy, and 11 after conversion therapy. We took the subgroup of participants who reported suicide attempts and looked at suicide attempts pre-intervention, during intervention, and post-intervention to see if there was any suggestive pattern. We found that 11 participants had reported suicide attempts since the end of conversion interventions. Of these, only 3 had attempted prior to conversion therapy. Of the 11 participants, 3 had attempted during conversion therapy.

I am guessing that Neil is taking the 25 and 23 people who reported attempts before and during intervention as being helped by therapy since they apparently (although the numbers may overlap and are not clear) reported no suicide attempts after therapy. The 11 after therapy are perhaps conceded as a minority of clients with an adverse reaction. Since I am not sure, I won’t knock down what might a straw man of my making. However, what seems clear is that whatever effect may have occured, Neil and by extension Dr. Hamilton, assumes it to be a positive benefit from the therapy. However, this seems to me to be a biased attribution with at least one other explanation. Perhaps these people were not suicidal after conversion therapy because they went to a support group for conversion therapy survivors. Perhaps, a fuller examination would find that people are alive today despite the therapy not because of it.
If anything, these reports do not seem favorable to reorientation therapy. Anyone can play with numbers. I could take the 23 plus 11 and come up with a 16.8% (34/202) probability of adverse consequences due to reorientation efforts. However, these reports cannot be the basis for any statements about the general impact of reorientation efforts on suicidality. About all we can say is that some people reported feeling worse due to their reorientation experiences. For at least some same-sex attracted clients, the experience was not benign but was associated with a worsening of their distress. Ordinarily, in absence of prospective studies, professionals should inform their clients of such reports to give clients ability to consent to care. But any general statement of efficacy or probability with regard to suicidality would require a specific study to test that hypothesis.
A study that would permit the statements made by Dr. Hamilton would require a prospective design with follow up and with a control group of people who did not received reorientation therapy but some other appropriate intervention. At the least, a waiting list control group would be required. The prospective nature of the study is crucial to capture not only suicide attempts but any completed suicides which occured during the course of the interventions or thereafter (during the follow up aspect of the study).
Shidlo and Schroeder’s design does not permit any general probablity statement. Just prior to reporting these findings, Shidlo & Schroeder said the numbers should not be viewed as complete or representative of the actual degree of harm:

After participants’ responses to the open-ended question, we followed up with a checklist of symptom areas (self-blame for not trying hard enough to change, self-esteem, depression, difficulties with intimacy, social isolation, loneliness, self-harmful behavior, suicidal thoughts, suicide attempts, feeling paranoid, self-monitoring behavior for “homosexual mannerisms,” and alcohol and substance abuse) and asked them to tell us whether they noticed negative changes in these areas. This symptom checklist was developed in our pilot interviews.
We do not report here on the frequency of responses to these items because of two methodological limitations. First, because we emphasized breadth of inquiry and yet were constrained to keep the interview within a reasonable time limit (approximately 90 min), we used single items for each domain of functioning; this methodological decision came at the expense of sensitivity, reliability, and content and construct validity. Second, participants who felt harmed and unhappy about their therapy experience may have answered affirmatively to a deterioration in a particular area and attributed it to the conversion therapy because of a negative halo-effect or narrative smoothing (Rhodes et al., 1994) rather than having provided an accurate recollection of actual change in that particular area. Thus, instead of using the checklist as a quantitative measure of negative effects, we used these items as qualitative interview-prompts to help respondents explore areas of deterioration. Our results, therefore, focus on the meanings of harm attributed by clients, and the accuracy of these attributions remains to be determined by future process-and-outcome research.

Even though Shidlo and Schroeder have their own confirmation bias issues in this study, here they take a cautious approach. Perhaps, the halo-effect colored the recollections negatively; perhaps some people blocked out suicidal thinking. Without a prospective study with a control group, these numbers tells us nothing reliable about the matter at issue: whether reorientation therapy reduces, enhances, or has no effect on suicidality for the population of people who are inclined to seek it.
Furthermore, as Shidlo and Schroeder note, the actual numbers of attempts of episodes may not be accurate. These were retrospective accounts. It is quite possible that some suicide attempts were not reported to Shidlo and Schroeder.
It seems to me that NARTH’s use of Shidlo and Schroeder illustrates points 2 and 4 above (“Preferential treatment of evidence supporting existing beliefs” and “Overweighting positive confirmatory instances”). In a study where Shidlo and Schroeder set out to confirm a pre-existing view (we believe reorientation is harmful, let’s look primarily for people who have been harmed to test our belief), it is ironic to see Drs. Whitehead and Hamilton engage in the same activity (we do not believe reorientation is harmful, let’s pull these data out of context to confirm the point). I do not mean to imply nefarious motives to Shidlo, Schroeder, Whitehead or Hamilton. Rather, I wonder aloud if both the study and the misuse of it are clear examples of confirmation bias at work.
Bias or not, therapists, ministers and others who advise others about the risks of some kind of reorientation therapy should not provide NARTH’s statement to prospective clients. Instead, these clients can be advised that some people taking these interventions report harm and some report benefit. The best course is to ask the individual counselor or ministry about their specific results. Also, if a person feels worse or becomes depressed, a second opinion or evaluation should be sought.