Exit: The Appeal of Suicide Movie is Really an Evangelism Effort

The first screen from Exit: The Appeal of Suicide
The first screen from Exit: The Appeal of Suicide

I wrote about this movie in late July when the star of Exit: The Appeal of Suicide Ray Comfort appeared on the David Barton’s Wallbuilders Live show. I didn’t think highly of what they had to say about depression at the time but withheld judgment about the movie because I hadn’t seen it. I watched it recently and cannot recommend it. On balance, I don’t believe it is a helpful movie about suicide or something I can recommend for those who might be contemplating suicide.
The first thing a viewer sees is the image above. The movie never identifies the “many experts” or provides any evidence for their alleged belief that the vast majority of cases aren’t organic. In fact, some cases are probably not organic but the cutting edge of research into depression involves genetics, neuroscience and adaptation. The adaptation aspect of the picture does involve experience but the prevailing view is that depression is the result of many factors operating differently for different people (source). For many people, depression arises without warning or environmental trigger.
However, for the most part, Comfort and crew ignore all of that. Comfort converses with several depressed college students and eventually turns the conversation to their sinfulness in an effort to get them to convert to his approach to Christianity. I say “his approach” because a couple of the students seemed to have some religious background. However, they didn’t answer Comfort’s questions according to his liking and he persisted in pressing for a conversion.
I had planned to review this movie more extensively. However, after watching it, I don’t see the point. Comfort’s answer to depression and suicide is for the depressed person to get saved. If depressed Christians watched this movie, I don’t know what they would come away with. I suspect many Christians watching this movie will question their faith at just the time they need it.  I can’t see how that would be helpful.

An Evangelism Tool

In the end, this movie is an evangelism tool. Comfort wants to make converts and he has used depression and suicide to set the stage for his evangelism pitch. In the end, Comfort and crew offer disclaimers and offer an option to call the National Suicide Prevention Lifeline (800-273-8255). However, the message had already been made very clear. The answer for depression is to become a Christian the Ray Comfort way.
I suspect Comfort and his mates mean well. They don’t want people to hurt or be depressed and I suspect they really believe that Christian salvation is required to be free of depression. However, this is an inadequate assessment of the situation.
Although depression is multi-faceted and for some might be improved by making a spiritual commitment, this is not the case for many others. Devout Christians experience depression without any obvious triggers. For some, their moods simply do not follow a normal course of regulation. Their lows are too low and/or their highs too high. While Christian salvation might help them feel more grounded and connect them to the supernatural, it won’t touch the causes of their mood disorder. Having Christians tell them to pray harder or accept Christ more sincerely is unhelpful and may indeed cause such despair that the efforts become harmful.
Because this movie so badly misses the mark, I can’t recommend it.

Describing Depression: An Experienced Voice

photo-1453574503519-1ae2536262ec_optAfter studying depression for three months, Christian filmmaker Ray Comfort thinks he understands the subject. After his research, he made a movie about suicide, called Exit, which is available on his website for $20. Yesterday, he told David Barton on Wallbuilders Live that after awhile the movie would be free on YouTube.  I haven’t seen the movie yet, but judging from the interview, I have to question how well he understands depression.
Yesterday, I reviewed the Wallbuilders interview and found the advice offered by Barton and Comfort to be unhelpful and possibly harmful for some. For his part, David Barton said the culture promotes depression via acceptance of abortion and homosexuality. He added:

We’re promoting things that cause it we’re now saying, “Well, depression is fine therefore suicide is fine.”

I never heard anybody say that until Barton said it on his program.

Later in the interview Comfort seemed to blame lack of religious belief as a catalyst for depression. I intend to review the movie after I watch it.

What was missing in their discussion was any recognition that depression is a medical problem with a biological foundation. If anything, listeners could easily come away from that interview thinking that depression could be cured by having an evangelical belief system. Experience tells us that is not true.

Describing Depression

Depression as a concept is hard to pin down. What makes the subject difficult to grasp is that mood naturally flows between highs and lows. Sometimes are moods are depressed for no reason, but other times, there are negative circumstances which are hard to accept which gives rise to depression. Thinking through things rationally and with a long view can help to overcome those rough spots. However, suicidal thinking is most associated with chronic depression which is not a bad day or triggered by negative circumstances. This the more complex medical situation which Comfort and the Bartons don’t seem to grasp.

As I was reflecting on the Comfort interview and preparing to watch Exit, I came across the writings of a friend who experiences depression. I have permission from my anonymous friend to reproduce them here. I think they reflect and describe what it is to feel this kind of depression.

Occasionally, bouts of depression are triggered by obvious catalysts, like losing a job or loved one or some kind of overt trauma. Often, though, nothing is “wrong”. We’re not upset or sad or angry or stressed about anything particular, but our body is deploying hormones as though we’re being attacked.
It is these episodes that are most frustrating to the friends and family of people who have depression; they don’t know what to do to help because there’s seemingly nothing wrong. The victims of those moments find it doubly frustrating, as a silent, crushing dread slowly bears down on our souls, challenging us to find a name for it.

Mental pain is less dramatic than physical pain, but it is more common and also harder to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “My tooth is aching” than to say “My heart is broken,” especially when there’s no obvious reason why or easy descriptors available.*

I don’t know what to do about these moments, how to describe them, or how to trace their causes. And while I can sometimes learn about them when my depression is on vacation, I’ve yet to overcome the moratorium on research it imposes when it’s at work full time.

But I know this: depression is a liar. It whispers that the world is uniquely bad in general and uniquely bad for me in particular. It tells me that the comfort of friends and annoyance of acquaintances are reinforcing, not alleviating, my problems. It inspires coping mechanisms like over sleeping, over eating, substance abuse, or other self-destructive behaviors that rob life of its joy. Depression only looks out for itself, and it lies to you to keep itself safe.

I don’t know what to do about it, and I can’t always find the energy to fight back. But depression is a liar, and it blinds me to what’s really true, noble, excellent, and praiseworthy. It’s hard, but I’m learning slowly not to fall for the lies, to hunt for companionship when I feel most lonely, and to know that what I’m feeling isn’t unique, even if I can’t describe it.

I can’t teach you anything about my depression, and I certainly don’t know anything about what you might be feeling. But we could all use a hand in the dark, particularly when there are so many cheap people offering cheap solutions to expensive problems. If you have a hand to offer, I’m sure you know someone who needs it, and if you need to take my hand, I’ll try to offer it when I’m able.

Our task is to make the whole world our hospital, to provide for the sick and bind up the wounds other people might have. Depressed people don’t know their treatment options or the extent of their diagnosis, but each of us can offer a small glimpse of healing to those who are most ill. I have nothing but thanks for those who have been my doctors, and I hope some day to repay the kindness.

Thanks to my anonymous friend for sharing these thoughts.
For depressed people, it doesn’t help to shame them because they have different beliefs or doubt God. What helps is what my friend describes: medical care, companionship, and a kind hand in the darkness.

*Inspired by C.S. Lewis, The Problem of Pain.

Depression is Not a Culture War Battle

One does not need to be a Christian to oppose suicide. People of all religions and none view suicide as a tragedy.

During his April 21 Wallbuilders Live broadcast, David Barton had Ray Comfort on to discuss his new movie about suicide, Exit.  I intend to watch and review the movie but for now I want to advise readers to be wary. For the most part, the advice given during this episode about depression and suicide is not helpful and in fact for some could be counterproductive.

I want to start by saying that I think the guests on the program probably meant well. I especially picked up from Tim Barton that he wanted to be helpful, saying

Yeah, Rick, one of the reasons that we talked about this before here on this show is that this is something we want to do because- we don’t want to do anything that promotes obviously, this incredibly sad and really unbiblical position, that someone would want to end their life. So we want we want to promote that there’s hope, right?

Suicide is Not a Cultural War Issue

Good intentions or not, there is a troubling thread here which continues throughout the program. The hosts and the guest treats suicide like it is a culture war battle — Christians on one side and non-Christians on the other. The problem with this should be obvious. One does not need to be a Christian to oppose suicide. People of all religions and none view suicide as a tragedy.

Alas, David Barton makes depression about what he’s against and shames those who are on the wrong side.

David: You’re talking about how the culture is now present in things like suicide with the programs out there. Suicide so often stems from depression and Ray will talk about the rising depression numbers in the United States.

What’s interesting is the culture also promotes things that increase depression. For example, when you look at studies on abortion, women who have had an abortion have depression rates three to five times higher than everybody else.
You look at homosexuality. Homosexuals have depression rates three to five times higher than everybody else. So we’re even promoting things now that cause depression. We’re promoting things that cause it we’re now saying, “Well, depression is fine therefore suicide is fine.”

And it’s really not because there is a Biblical side. Depression really comes from being discontent with who you are or what’s going on. It’s not accepting yourself or not accepting the situation.

Barton confuses effects and causes. Being unhappy with oneself is most often an effect of depression. Simply advising a depressed person to accept yourself is like telling an unemployed person to save for retirement. The otherwise sound advice just increases the hopelessness.

Regarding Barton’s claims, there is evidence that depression is higher among women who have had abortion and yes, GLBT people report more depression. However, the matter of cause cannot be ascertained from these facts. Women who have abortions also have other stressors in their lives. For some, especially those who do not believe abortion is right, having an abortion may trigger depression. However, for others there is no link.

The picture with homosexuality is even more complex. The existing research does not confirm that being gay causes depression. When examining a correlation between two variables, variable A may cause variable B or vice versa. However, a third possibility exists. Another variable may effect both variable A and variable B. For instance, shark attacks and ice cream sales in a coastal town might correlate but clearly summer beach going influences both variables.

We know that women are depressed more than men. We also know from brain scan studies that the brains of gay males are more like the brains of straight females than straight males. It is reasonable to hypothesize that there might be a neurological basis for straight females and gay males to report more depression.

Barton wants to make depression about doing right and being on the right side of the culture war. I can assure Mr. Barton that Christian nationalists get depressed. Good Christians get depressed. Straights and women who have never considered an abortion get depressed. Portraying the causes of depression as being about believing the right Christian things is unhelpful and may drive some people away from getting the help they need. Worse, people who hold the “right” views but remain depressed can become even more hopeless. Over 40 years of clinical practice and teaching, I have encountered many Christians who want to give up because they do everything “right” without relief from their depression.

Ray Comfort: A Three-Month Expert

Apparently Ray Comfort is a quick study. After three months of study, he has all the answers.

So I studied it and after about three months of studying, writing a book, and doing a movie I came to the conclusion the world doesn’t know what it’s doing. They have no idea what causes chronic depression and they have no chance of a [against] suicide.

I’m bold enough to say, “We know what causes most chronic depression and we know the answer to it.” And that’s what we put in the movie. And we’re very excited. Our YouTube channel’s got 45 million views. This is a massive platform to reach the lost of the gospel. And we believe this is our best movie ever it’s called, “Exit” for obvious reasons.

The arrogance here is pretty thick. Evangelical circles are full of three-month experts. I intend to reserve judgment on the movie until I see it but I don’t have a good feeling about a person who thinks he has the subject of depression mastered after three months of study.

Atheism is to Blame or Is It?

The bottom line for Comfort in this interview (and perhaps the movie) is that atheism is to blame for increases in suicide. Comfort said:

I was reading recently where American Journal of Psychiatry said, “Religiously unaffiliated subjects, people who were Godless, had significantly more lifetime suicide attempts and perceive fewer reasons for living. Particularly fewer moral objection to suicide.”

So this generation doesn’t object to suicide. So we’re going to see, I believe, a huge increase in the future and the church has got to be ready for it. That’s why we’ve created this movement to train the church so they can see what they say. We’ve also created a study guide a video study guide that goes with it.

Indeed, Comfort gets the 2004 AJP report mostly correct. Here is the abstract from that study:

OBJECTIVE: Few studies have investigated the association between religion and suicide either in terms of Durkheim’s social integration hypothesis or the hypothesis of the regulative benefits of religion. The relationship between religion and suicide attempts has received even less attention.
METHOD: Depressed inpatients (N=371) who reported belonging to one specific religion or described themselves as having no religious affiliation were compared in terms of their demographic and clinical characteristics.
RESULTS: Religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation. Unaffiliated subjects were younger, less often married, less often had children, and had less contact with family members. Furthermore, subjects with no religious affiliation perceived fewer reasons for living, particularly fewer moral objections to suicide. In terms of clinical characteristics, religiously unaffiliated subjects had more lifetime impulsivity, aggression, and past substance use disorder. No differences in the level of subjective and objective depression, hopelessness, or stressful life events were found.
CONCLUSIONS: Religious affiliation is associated with less suicidal behavior in depressed inpatients. After other factors were controlled, it was found that greater moral objections to suicide and lower aggression level in religiously affiliated subjects may function as protective factors against suicide attempts. Further study about the influence of religious affiliation on aggressive behavior and how moral objections can reduce the probability of acting on suicidal thoughts may offer new therapeutic strategies in suicide prevention.

At first glance, it appears that religious belief about the immorality of suicide may be a protective factor against suicide. However, this is not the only study on the subject. Consider the abstract of this 2016 study reported in the Journal of Nervous and Mental Disease:

We aimed to examine the relationship between religion and suicide attempt and ideation. Three hundred twenty-one depressed patients were recruited from mood-disorder research studies at the New York State Psychiatric Institute. Participants were interviewed using the Structured Clinical Interview for DSM Disorders, Columbia University Suicide History form, Scale for Suicide Ideation, and Reasons for Living Inventory. Participants were asked about their religious affiliation, importance of religion, and religious service attendance. We found that past suicide attempts were more common among depressed patients with a religious affiliation (odds ratio, 2.25; p = 0.007). Suicide ideation was greater among depressed patients who considered religion more important (coefficient, 1.18; p = 0.026) and those who attended services more frequently (coefficient, 1.99; p = 0.001). We conclude that the relationship between religion and suicide risk factors is complex and can vary among different patient populations. Physicians should seek deeper understanding of the role of religion in an individual patient’s life in order to understand the person’s suicide risk factors more fully. (emphasis mine)

How are we to understand the different findings? I really can’t say. However, having studied this subject for many more than three months, I can say that contradictory findings are common in this field. What we can say is that being religious and believing in God isn’t a fool proof means of preventing depression and suicidal urges. Among some groups of people, religious beliefs are associated with fewer suicide attempts whereas for other groups (notably those who are depressed), religious affiliation is associated with more attempts.

What’s the Remedy?

Although Comfort doesn’t give many details about the movie, the hints he gives implies the movie is a way to get people to make decisions to accept Christ as Savior. After acknowledging that religious people get depressed, he seems to say depression will be lifted if you just belief the right things. Again, I will wait to see, but if there is nothing in the film about getting treatment with a message that depression can be managed by competent medical care, then it will be of little value.

There is one good thing I can say about the interview. Comfort and his hosts had some negative things to say about the Netflix series 13 Reasons Why. While I haven’t seen the series, I don’t like what I’ve read about it.

For more information…

Suicide and the Media
Preventing Suicide Media Resources
NIH website entry on depression
National Suicide Prevention Lifeline

Suicide victim endured anti-gay bullying

This time in Buffalo, NY.

Parents carry on anti-bullying message: wivb.com

Jamey Rodemeyer’s parents believe years of bullying drove their son to suicide. The Williamsville North freshman took his life Sunday, he was only 14 years old.
Jamey Rodemeyer posted a message online hoping that others would be inspired by his struggle with bullying. A part of the message reads, “That’s all you have to do. Just love yourself and you’re set. And I promise you, it’ll get better.” 
Soon after coming home from a family camping trip, Jamey was found dead Sunday. His parents say he was always under pressure because of struggles with his sexuality.
Jamey’s mother Tracy Rodemeyer said, “So he hung around with the girls a lot, so then the teasing started happening like ‘Oh you’re such a girl or you’re gay or whatever and that bothered him for many years.”

For religious conservatives reading this: Isn’t it past time to become part of the solution? Criticizing anti-bullying programs on ideological grounds doesn’t help kids or your ideology.
More on the situation:

Death catches attention across nation: wivb.com

Teen’s suicide said to be related to anti-gay bullying

Earlier today, Focus on the Family announced a remodeled Day of Truth (Day of Dialogue). Then just a few minutes ago, I read of a Middleburg, PA youth who ran in front of a truck due to his despair over being bullied. According to this local report, Brandon Bitner had endured bullying for years before walking 13 miles to Route 11 where he ran in front of a tractor-trailer.

There seems to be little doubt in the students’ minds why Bitner did what he did.

“It was because of bullying,” friend Takara Jo Folk wrote in a letter to The Daily Item.

“It was not about race, or gender, but they bullied him for his sexual preferences and the way he dressed. Which,” she said, “they wrongly accused him of.”

The local Daily Item interviewed ministers in this rural Central PA area, all looking for answers. One, Denny Mallonee, seemed to implicate families:

Mallonee said a stronger bond between kids and their parents also will help.

“If the kids can get the message that nothing beats that close family relationship and that close communication with mom and dad … we get busy with so many things that pull that family apart instead of binding it together,” he said.

Another, Karl Polm-Faudre, pointed to anti-gay bias in the church and local politics:

Polm-Faudre said in his regular clergy study group — which encompasses Episcopal, Lutheran and United Church of Christ — everyone was aware of bullying that’s present in there areas, “and these are people from Mazeppa to Lewisburg, Sunbury, Benton, Berwick …” he said.

“I think the message we would want to give is that the community needs to take stock of the anti-gay rhetoric that’s been going on, especially from some political and religious circles,” Polm-Faudre said. “Because this is giving permission for bullying, harassment and name calling.”

And then another, Rev. Julia Beall, offered a helpfuf perspective:

People will come to terms with their pain, Beall said, but to stay there, things will need to change.

“We need to embody that kindness that doesn’t tolerate this kind of hurt, in every small way we live,” Beall said, adding the culture of the church is that “we do affirm that God created us for a purpose, and respect that God created every person for an purpose because that is part of the Christian culture. … We are all loved by God, and we should love one another.”

Seems to me this is the prime dialogue we need to promote.

Another suicide related to bullying?

At least that is what the family and friends of Jaheem Herrera are saying. The story does not mention the anti-gay nature of the harassment but the mother says it in the interview. Sounds like there were multiple issues involved as well. I don’t know all the circumstances but an investigation needs to be conducted.
This is very sad.
What if Focus on the Family and Exodus partnered with GLSEN and PFLAG to issue a joint statement and/or campaign to teach kids that bullying for any reason is immoral? What if the Christian groups made a concerted effort to reach out to youth group leaders with the message that calling kids gay, etc. is harmful?
Can I get a witness?

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.