Homosexuality

Our profession has changed much over the past several years. Psychoanalysis, once an exciting and innovative force, is often described as outdated and dogmatic. Many analysts have responded to postmortem thinking by adapting their theory and style, so that analytic thinking continues to be a useful and creative way of understanding human behavior and the wider social context.

Dr. Harold M. Voth's response in the February 6 issue to Dr. Richard Isay's Viewpoints article in the January 16 issue exemplifies the dogmatic, arrogant, and narrow-minded attitude that is causing so many people to stereotype psychoanalysts and run for safety. In response to the idea that there is a biological basis for homosexuality, he writes, "This, of course, is not true." While most current thinkers are exploring whether there is in fact an objective, measurable truth at all, Dr. Voth seems to be sure that he knows the truth. Dr. Voth talks about what it means if he as a "heterosexual psychoanalyst, converted a homosexual patient into a heterosexual person. . . ." This language is frighteningly biased and unanalytic.

Since when is it the task of a psychoanalyst to convert anyone to anything? What does he imply when he calls the homosexual person he converts a "patient" and the heterosexual into which he has converted him a "person"? Language is powerfully shaping what we perceive to be real. The language that we as psychiatrists use has a large part to play in deciding what is to be considered normal and what is pathological. Our knowledge filters into society and affects people's lives in very real and profound ways. We should be aware of this role we have in shaping people's lives, talking responsibly and rigorously with one another, rather than resorting to bigoted and closed-minded rhetoric, couched in pseudo-scientific language.

Dr. Voth, as a so-called expert, proposes to know the obdurate measurable truth about people's lives. To me this is frightening.

Paul Browde, M.D.
Bronx, N.Y.

In a recent letter published in the March 6 issue, Dr. Socarides and colleagues quote studies that show a homosexual orientation can be changed to a heterosexual one and that it is therefore wrong to say that people cannot change their sexual identities. Those who claim to have effected such changes include Bieber et al. (27 percent), Socarides (35 percent), and Macintosh (23 percent).

Any serious student of this literature knows that numerous methodological criticisms and epistemological questions have been raised regarding the permanence and meaning of these "changes." But even if one were to put those important issues aside and accept those claims at face value, the studies cited do not substantively address the untoward effects on the unchangeable gay men and women in "reparative therapies." This seems a rather glaring omission given the fact that the majority of these patients do not change. What happens to them?

Socarides, in his 1995 book, reports that 65 percent of his nonresponders either moved out of town or were enmeshed in a pathological lifestyle that they could not give up. Unfortunately, this comes across as blaming the patient for the treatment's failure. In clinical practice, many gay and lesbian patients who were unable to change often do blame themselves for the unsuccessful outcome. My own clinical experience with gay men who failed to change in reparative therapy is that they suffered damage to their self-esteem, experienced resultant anxiety and depression, and often felt a deep mistrust of mental health professionals. This mistrust and shame may explain why no good follow-up studies of these individuals exist.

It is not clear, however, if reparative therapists ever provide informed consent to explain these substantial risks to the patients they treat, or even if they are fully aware of the costs to the unrepaired. From the tone of their letter, Socarides and colleagues appear to believe that homosexuality is such a terrible condition that any sacrifice is worth the effort if even one of them can be converted to heterosexuality. In other words, if one heterosexual can be created (or is it saved?), does it matter what happens to the majority who don't and who turn out gay?

The letter's authors state that their clinical position is not homophobic, and I am certainly in no position to guess at their actual motivations. In fact, their attitudes reflect a prevalent cultural belief that heterosexual citizens are more valuable than gay ones. Nevertheless, it should be a cause for concern to APA when its members engage in procedures that, even if they are theoretically helpful to some patients, may be of significant harm to others. Certainly, there is a need to study this matter further.

Jack Drescher, M.D.
New York, N.Y.

In the February 6 issue is a letter to the editor by Dr. Harold Voth of Topeka, Kan., regarding Dr. Isay's Viewpoints article in the previous issue. Dr. Voth states categorically that the idea of a biological basis for homosexuality is simply not true. He says others have discussed this point of view with great clarity. Further, he asks for psychiatry, etc., to call a halt to the ridiculous claims. He insists that homosexuality should be viewed as psychopathology.

It is of interest that a few pages later, Dr. Marvin Margolis is quoted as saying that there is an erosion of the American Psychoanalytic Association's insistence that homosexuality was a form of psychopathology. He goes on to say that there is no consensus on the origins of sexual orientation.

The contradiction between the two analysts is bewildering. One can conclude only that either news travels from the East Coast to Topeka slowly, or vice-versa. Certainly, one doesn't want to doubt Dr. Voth's well-held insistence upon his views. I hate to think that his attitude is typical of everyone in Topeka.

Allan Levy, M.D.
San Mateo, Calif.