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

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.