Therapeutically Incorrect: Atheist psychiatrist argues that gays can change

Christianity Today, April 2005, Vol. 49, No. 4,Page 94

Interview by Douglas Leblanc

Robert L. Spitzer argued in 1973 that homosexuality is not a clinical disorder—key to the American Psychiatric Association arriving at the same conclusion. Thirty years later, Spitzer caused another stir when he argued that some people who want to change their homosexual orientation may do so (Archives of Sexual Behavior, October 2003).

Spitzer is professor of psychiatry at Columbia University and chief of the New York State Psychiatric Institute’s Biometrics Research Department. He describes himself as a Jewish atheist. Contributing editor Douglas LeBlanc interviewed Spitzer by phone.

What prompted you to do a study on reparative therapy for gays?

I was at an annual APA (American Psychiatric Association) meeting, where I spoke to some ex-gays who were picketing the meeting. They explained how they had changed. And that got me interested. Then I tried to organize a debate on the issue. When I was organizing the debate, it became clear that many of the people that I wanted to participate said there are really no good studies of this, it’s all going to be just opinions.

Did anything surprise you as you did your interviews?

I guess it surprised me how convincing the accounts were. Joseph Nicolosi [of the National Association for Research and Therapy of Homosexuality] agreed to refer, I think, 10 or 20 patients to me. But he insisted on getting a summary of the results before going further. He didn’t want to be set up, I guess. But from the very first people that I talked to, I had the feeling they were talking about something real.

What stood out for you as something that made the patients convincing?

You talk to people and you get a sense of whether they’re being candid or not. I had the sense that they were. Also, there was a consistency, the fact that the change was described as slow and not immediate.

Some of your critics say that only fundamentalists would even think about taking up reparative therapy.

The scene has changed drastically over the last 20 or 30 years. When I started clinical practice in 1961, it was very common to get a male patient who wanted to change. Today those people don’t go to psychiatrists because the word is out that the mental health profession doesn’t regard it as a problem.

How has the study affected your standing among your colleagues?

Many colleagues were outraged. I remember when it first appeared in the media, I got a letter from, I think, a dean of admissions at Columbia. He wrote me that it was just a disgrace that a Columbia professor should do such a thing. Within the gay community, there was initially tremendous anger and feeling that I had betrayed them. I think that has largely dissipated. But also, I’m at the point in my career that I don’t worry about such things.

Have you considered conducting a follow-up study?

No. I feel a little battle fatigue. But also I’m not sure what the study would be. Some people have said, “Follow these people, interview them five years later, see how many of them have switched back,” since it’s well known that some ex-gays give it up.

But suppose you found that 5 percent or 10 percent did switch back. I mean, so what? You’d find the same thing if you followed people who had treatment for drug addiction. Some are going to relapse.

The study that ought to be done is a controlled study where people go into the therapy, and then you initially evaluate them, and then you evaluate them later and see how many actually changed. But that study is not going to be done, unfortunately.

Is that because of a lack of interest or funding?

The reasons are, number one, reparative therapists are not scientists—they don’t do studies. The second reason is, if somebody proposed that the National Institute of Mental Health do such a study, I think almost certainly any gays in the study section would say this is a total waste of time: They would say, We already know it’s hokum, so why do it?

You’ve said very clearly that no one should be coerced into reparative therapy.

I think the politically correct term now is reorientation therapy. Reparative already implies something’s broken—of course the reparative therapists believe this, but it kind of infuriates the gays to even call it reparative therapy.

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Commentary: Psychiatry and Homosexuality

By Robert L. Spitzer, a professor of psychiatry at Columbia University

Wall Street Journal, May 23, 2001

In 1973, I opposed the prevailing orthodoxy in my profession by leading the effort to remove homosexuality from the official list of psychiatric disorders. For this, liberals and the gay community respected me, even as it angered many psychiatric colleagues. I said then — as I say now — that homosexuals can live happy, fulfilled lives. If they claim to be comfortable as they are, they should not be accused of lying or of being in denial.

Now, in 2001, I find myself challenging a new orthodoxy. This challenge has caused me to be perceived as an enemy of the gay community, and of many in the psychiatric and academic communities.

The assumption I am now challenging is this: that every desire for change in sexual orientation is always the result of societal pressure and never the product of a rational, self-directed goal. This new orthodoxy claims that it is impossible for an individual who was predominantly homosexual for many years to change his sexual orientation — not only in his sexual behavior, but also in his attraction and fantasies — and to enjoy heterosexuality. Many professionals go so far as to hold that it is unethical for a mental-health professional, if requested, to attempt such psychotherapy.

This controversy erupted recently, when I reported the results of a study that asked an important scientific question: Is it really true that no one who was predominantly homosexual for many years could strongly diminish his homosexual feelings and substantially develop heterosexual potential?

What I found was that, in the unique sample I studied, many made substantial changes in sexual arousal and fantasy — and not merely behavior. Even subjects who made a less substantial change believed it to be extremely beneficial. Complete change was uncommon.

My study concluded with an important caveat: that it should not be used to justify a denial of civil rights to homosexuals, or as support for coercive treatment. I did not conclude that all gays should try to change, or even that they would be better off if they did. However, to my horror, some of the media reported the study as an attempt to show that homosexuality is a choice, and that substantial change is possible for any homosexual who decides to make the effort.

In reality, change should be seen as complex and on a continuum. Some homosexuals appear able to change self-identity and behavior, but not arousal and fantasies; others can change only self-identity; and only a very few, I suspect, can substantially change all four. Change in all four is probably less frequent than claimed by therapists who do this kind of work; in fact, I suspect the vast majority of gay people would be unable to alter by much a firmly established homosexual orientation.

I certainly believe that parents with homosexually oriented sons and daughters should love their children — no matter how their children decide to live their lives — and should not use my study to coerce them into unwanted therapy.

However, I continue to hold that desire for change cannot always be reduced to succumbing to society’s pressure. Sometimes, such a choice can be a rational, self-directed goal. Imagine the following conversation between a new client and a mental-health professional.

Client: “I love my wife and children, but I usually am only able to have sex with my wife when I fantasize about having sex with a man. I have considered finding a gay partner, but I prefer to keep my commitment to my family. The homosexual feelings never felt like who I really am. Can you help me diminish those feelings and increase my sexual feelings for my wife?”

Professional: “You are asking me to change your sexual orientation, which is considered by my profession as impossible and unethical. All I am permitted to do is help you become more comfortable with your homosexual feelings.”

The mental health professions should stop moving in the direction of banning such therapy. Many patients, informed of the possibility that they may be disappointed if the therapy does not succeed, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions. In fact, such a choice should be considered fundamental to client autonomy and self-determination.

Science progresses by asking interesting questions, not by avoiding questions whose answers might not be helpful in achieving a political agenda. Gay rights are a completely separate issue, and defensible for ethical reasons. At the end of the day, the full inclusion of gays in society does not, I submit, require a commitment to the false notion that sexual orientation is invariably fixed for all people.