Response to Dr. Patrick M. Chapman’s Critique of ‘Ex-Gays’ – Part 3
Response to Part 3 of Dr. Patrick M. Chapman’s Review of “Ex-Gays”, posted on Ex-Gay Watch, November, 2007, by Stanton L. Jones and Mark A. Yarhouse.
Response to “Part 3: A Focus on the Results — Examining if it is Harmful”
In this final response, Chapman raises a number of interesting questions, but again continues 1) applying a pattern of logic and argument that would, if applied broadly in the mental health field, establish self-defeating and unsustainable implications for the entire field and 2) on that basis then highlighting isolated findings and anecdotes as if they refute the broader pattern of empirical findings from the study.
In his first paragraph, Chapman chides us for imprecision and inconsistency both in how we characterize the claims about harm made by the various professional organizations, and in how we characterize our own findings and conclusions. He provides a link to the very same American Psychological Association Public Affairs website that we site in our book that cautions about harm from attempts to change sexual orientation. This is one of the less forceful warnings about harm (we cite others in our book in many places; see for example pp. 330-331). Further, public pronouncements by key professional representatives (for instance, psychiatrist Jack Drescher’s op ed piece, titled “Conversion attempts mostly lead to harm”) have yet further heightened the perceived likelihood and severity of risk of harm. Regarding his listing of how we describe this literature in the book, we do regret using “always” harmful (p. 19) as he points out, but the other quotes are reflective of the diverse array of characterizations of the likelihood of harm.
To address his pattern of logic, let’s begin by some simple clarification of how to think about harm. I (Jones) recently had minor knee surgery, and both the surgery itself and the medication prescribed post-surgery had risks. The fact that the rare person has had serious, even devastating reactions to such surgery and medication did not and can not itself invalidate my choice to pursue this procedure or the doctor’s administration of the treatment. The risks have to be weighed against the potential gains I expected in light of my dissatisfaction with the state of my knee prior to surgery and in light of the likelihood of such risks.
The attempt to change sexual orientation is no doubt much riskier and more challenging than knee surgery. But just how severe are the risks and just how likely are they to obtain? It is to answer this question that we framed our search for answers in this area in terms of harm “on average.” Chapman would seem to want to frame the question in terms of evidence that any harm occurs for anyone, a characterization substantiated by his listing of five anecdotes from our book of some level of unhappy reaction to the change process, followed by his rhetorical question, “One wonders what would have to be the reports of the participants for Jones and Yarhouse to declare the ministry harmful?” If only the matter were that simple. We could ask in return, How many positive results of participants would have to be reported, and how many reports of distress and unhappiness in living in the gay community would have to be reported, to justify the continuing existence of an option for attempting change? The type of standard used by Chapman would be completely unrealistic and paralyzing for the mental health field. Many interventions with complicated or distressing conditions produce some negative outcomes. When starting treatment with a depressed person, one always has some sense that if the attempt to intervene is unsuccessful, the person could plunge into despair about the possibility of change and be worse off than before. But such outcomes are not common.
But our answer was not to make that judgment for ourselves, but rather to report changes in distress level on average for those attempting change and to argue that ultimately it is the individuals themselves seeking change — and not Chapman or us — who should make their choices about whether or not to pursue change based on their own reading of the evidence. Chapman would urge that the professional world together declare such intervention attempts invalid based on the power of the anecdotes of harm; we would argue instead that individuals should be empowered with the best array of information available to make their best choices for themselves (see pp. 377-382).
Armed with a poorly developed rationale for how to handle harm, Chapman utterly disregards the pattern of standardized findings showing no escalating patterns of distress on average across the sample, and instead claims that the five anecdotes of distress and harm we present in our transcripts establish an unacceptable level of harm for participants. He states, “Nonetheless, dismissing this possibility and ignoring the statements of the participants that remained in the program, Jones and Yarhouse confidently declare the change process is not harmful. Once again, their conclusion is not based on the evidence: those who declare they are hurt by the process are evidence of harm.” This is both right and wrong. It is right in that we do indeed handle the few anecdotes of harm under the more general umbrella of empirical findings that distress does not increase on average. It is wrong, in that we do not “declare the change process is not harmful,” but rather declare the change process is not harmful on average. For further evidence that this is so, the reader should read our point 9 in our Conclusion (p. 376), in which we state emphatically that “despite our finding that on average participants experienced no harm from the attempt to change, we cannot conclude that specific individuals are not harmed by an attempt to change.” We point out there that harm may obtain because of the type of intervention or because of the emotional vulnerability of the person seeking change. We also allude to the fact of political realities: “It is also necessary to say that claims of harm may be ideologically based and exaggerated for the sake of foreclosing the option of the attempt to change” (p. 376).
Chapman asks, “How many lives must be broken before the authors realize the actual damage caused by these ministries outweighs any potential good?” This is a good question, but not the only question. A contrasting question might be “How many testimonies of significant and satisfying change, and how infrequent do the empirically documented evidences of harm have to be, before opponents of such change efforts might be willing to cede to these efforts a continuing right to exist as long as they operate with rigorous levels of informed consent?”
Chapman closes with a nod to the bigger picture: Sexual orientation, he asserts, is determined before birth, “no scientific study has successfully identified any postnatal causal factor or factors,” and therefore sexual orientation is immutable. We, in contrast, 1) would acknowledge that there is intriguing evidence of biological factors involved in causation of sexual orientation, but would also argue that the evidence is far from establishing complete biological determination of sexual orientation; 2) suggest in contrast to Chapman that there is intriguing evidence of postnatal factors in causation (see our pp. 122-125 as well as our previous publications); 3) argue that the establishment of partial biological causation does not in itself logically entail that orientation is utterly immutable for everyone, and 4) join with Lisa Diamond (see our response to Part 1) in concluding that “the more we learn, the more we do not understand.”
How would we present the bigger picture in contrast? Chapman’s review adds validity to our study. He asserts bluntly “sexual orientation cannot be changed,” and clearly feels that harm is so likely and likely so devastating (“How many lives must be broken?”) that there is no merit to the attempt to change. It was precisely to address these questions that we performed our study. Chapman ignores the data from our study that does not fit his conclusions. We believe that a fair read of our study produces a more difficult, complex, challenging set of conclusions (see Chapter 10), namely that: 1) change appears possible for some but not for all, and further this change is for some ambiguous, complicated, conflicted, and incomplete; 2) while harm may occur for some, on average the participants did not experience increased distress as a result of the attempt to change; and therefore 3) we would urge that individual consumers be empowered to make the best choices for themselves based on the best evidence and on full disclosure from multiple sources of information.
This series will conclude with a final word from Dr. Chapman. We thank Dr. Chapman for his thoughtful critique, and Drs. Jones and Yarhouse for their spirited response. After the conclusion is posted, we may provide the entire series via single post or PDF for easy reference.
How best might we measure benefit and harm in any “intervention”?
After I had finally left the ex-gay/celibacy group that I had been a part of for some years, and at about the same time left the church denomination I had been part of for over twenty-five years – I decided to get some “secular” counselling to help sort out what was going on in my mind; the first time I had ever approached any type of counselling not linked to the church.
The counselling service that I went to, sent out a confidential questionnaire before and after the three months of sessions that I attended. It was a simple tick-box affair, where I had to note my level of contentment or dissatisfaction with various parts of my life. I have no idea what the exact results of that were, as I was not shown, but I’m sure they would have shown great improvement.
I assume that the counselling service used these responses to help them check that the approaches and staff that they were using were indeed benefitting their clients, rather than causing problems.
In my fifteen years on-and-off involvment with a couple of ex-gay ministries, including over seven years with one group, I was never asked in any such formal way to rate how I considered I was doing. I assume that this is the case with most ex-gay ministries. Why? Have they just not got around to using these checks as instigated by secular services? Or are they just afraid at what the results might be if they did?
Jones and Yarhouse note that change appears possible , and How many positive results of participants would have to be reported, and how many reports of distress and unhappiness in living in the gay community would have to be reported, to justify the continuing existence of an option for attempting change?
I think that has as much to do with how trustworthy those positive results end up being.
One of the groups I attended (at the time, linked with the Exodus umbrella) repeated the Exodus claims that success was possible for around 30% of participants. 30% seemed like a good enough rate for me to attempt. Also, the only ‘reports of distress and unhappiness in living in the gay community’ were generally all suitably negative.
I had to find out for myself that the 30% success was in fact well below 3% for the two groups I attended, and that many of those who were ‘successful’ still harboured strong same-sex attractions. Also, that the minority of those who suffered ‘distress and unhappiness living in the gay community’ were either those who needed to deal with self-esteem and addiction issues, or who were living closeted lives in conflict with the particular branches of faith they were involved with – faiths which usually piled burdens of shame on them simply for existing as gay people. Most of the openly gay people I have since met are no more happy or unhappy than any of the straight people I know.
At least those two organisations are now being more honest about the ‘success rate’, and are not bearing false witness in this respect, at least not to the same degree.
I must assume that any “intervention” with (in my own estimate) a greater than 97% failure rate, despite effort and long-term input by participants, is most unlikely not to leave at least some traces of harm.
Perhaps Jones and Yarhouse do grudgingly admit this lack of ‘success’ when they say: … change appears possible for some but not for all, and further this change is for some ambiguous, complicated, conflicted, and incomplete; … we would urge that individual consumers be empowered to make the best choices for themselves based on the best evidence and on full disclosure from multiple sources of information.
I think that those multiple sources of information might now show how infinitessimally small the chances of complete change really are, and that when they occur it is often more to do with the randomness of human development than any effort on the part of the individual.
If only the churches would take this on board, and help people to come to accept their sexual orientation, rather than shame them into trying to change or suppress it.
(David: minor housekeeping first — the link is to Chapman’s part 2, not 3)
Comparing exgay attempts to change sexual orientation to knee surgery is, at best, trivialisation.
I can be almost 100% certain that Jones’ surgeon made a full diagnosis to begin with, including considering all the treatment options available. The surgeon would have relied exclusively on a vast body of work by his peers, and been able to describe with considerable accuracy what would occur, why it would occur and what could be further done if it didn’t occur. His prognosis would have been backed by physical evidence, such as a scan or even exploratory surgery.
I doubt Jones’ knee was used in an experiment. Nor was he propelled into the operating room gripped by overwhelming fear and self-loathing.
Further, knee surgery that offered only (possibly temporary) minor relief to 11% of a hand-selected group of patients would NOT be considered a successful treatment. Particularly if the “relief” occurred in the elbow, rather than the knee that was treated.
To draw a parallel between what pro-change therapists offer, and what was is offered by qualified surgeons is a terrible insult to qualified surgeons.
A closer parallel would have been to the faith healers of the Philippines who claim to do “surgery” with their bare hands. And yes, they too are able to offer testimonies and anecdotes from satisfied customers.
“change appears possible for some but not for all, and further this change is for some ambiguous, complicated, conflicted, and incomplete”
I’d reword this to remove the unwarranted optimism:
“true change appears at best rare, if in fact a deliberate change in sexual attractions may be caused at all. Reports of change need to carefully examined given the ambiguous, complicated, conflicted, and incomplete language and measurements commonly encountered in reports by those who offer (or encourage use of) the treatment.”
“while harm may occur for some, on average the participants did not experience increased distress as a result of the attempt to change”
Again, it is this type of neglectful (or worse) reporting that is the most egregious.
In those words, where is any consideration shown to those who dropped out?
Dr Jones — you are in no position to make that wild conclusion, because the very participants that could be assumed a priori to be the ones that would show any current and obvious harm are also exactly those people you have no information on.
I’ll leave it at that, and eagerly await Chapman’s response to Jones.
oh sorry: just noticed I’d worded it all as if it was just Jones responding, not both Jones and Yarhouse. Thrown by the knee story.
They have the power, and authority to do just that, but it can take decades, centuries even for the Church to depart from a cherished falsehood. We seem to need a target for our hate as much as the next guy.
Thanks, I changed it.
You still had time to go back and edit 😉
No. I. Did. Not. (still got something not happening. Just us, it seems. /sigh)
As I pointed out to the good doctors once before, my orientation as 100% BIG FAG is also 100% not complicated, ambiguous, distressful, conflicted, or incomplete. I would say the same is true for all of my many straight and gay male friends. So maybe the good doctors can explain to me words that I can understand how their “patients” have changed anything besides some of their behavior and their attitude towards it? I absolutely believe that changing one’s attitude frequently changes one’s experience of reality, and can contribute to eventual change in reality, but does not, in itself, change reality.
Have to agree ben. I am also 100% Big Fag, with no complications, ambiguity, distress, conflict, and it’s entirely complete.
What I see happening, is that by tossing out this stuff it almost seems like…maybe….J&Y….and others like them….have discovered……or at least are trying to make a case for….
Oh wait, that can’t possibly be the case, because, according to this study, and any other study on ex-gays, bisexuals don’t exist!
Hadn’t thought of it that way, Jason, but of course, you’re right. Comments, good doctors?
Did any of your study subjects experience change from a homosexual orientation to a heterosexual orientation that was not ambiguous, complicated, conflicted, or incomplete?
A psychologically healthy person is someone who can use their reasoning ability to meet their biological needs in an appropriate way.
Needs generate tensions which motivate need fulfilling behaviors. When these behaviors are blocked, tensions grow and persist, often leading to a state of chronic anxiety. Attempts to find relief from this anxiety through “self-medication” can lead to alcohol and/or drug abuse.
In addition, treatments which attempt to disassociate a person from satisfying their basic needs can lead to personality disintegration. One’s rational thought processes are asked to resolve the conflict between the body’s natural biological needs and external moral values. Yet no compromise is possible for those with an absolutist moral position. Persistent failure in resolving this conflict can lead to hopelessness, a lack of confidence, low self esteem and clinical depression at times. With no apparent way to improve this situation in sight, suicide is a possibility.
Anxiety, depression; alcohol, drug abuse, and other self-destructive behaviors, including suicide. No wonder the major medical groups disapprove of these treatments.
We need not wonder if those who dropped out of this study suffered these harms or not. At some level of psychic existence, people have an intrinsic sense to avoid doing themselves harm. So it’s more likely they dropped out in order to prevent such harm from occurring in the first place.
It’s the same reason snapping your wrist with a rubber band whenever you have an unwanted feeling doesn’t work. The brain eventually figures out, consciously or subconsciously, that the easiest way to avoid the pain is to stop snapping the rubber band in the first place.
“I (Jones) recently had minor knee surgery, and both the surgery itself and the medication prescribed post-surgery had risks.”
Had your pastor, or a team of people who “think” they know how the knee works and how it’s supposed to work(but are not actually doctors) performed the surgery, this would be an appropriate parallel.
“The fact that the rare person has had serious, even devastating reactions to such surgery and medication did not and can not itself invalidate my choice to pursue this procedure or the doctor’s administration of the treatment.”
Medications are rigorously tested by scientists, not hobbyists, or psuedo scientists. Surgeons are trained and certified by a governing body that holds them accountable, can exodus say the same thing?
“The risks have to be weighed against the potential gains I expected in light of my dissatisfaction with the state of my knee prior to surgery and in light of the likelihood of such risks.”
Did the doctor actually diagnose you with a knee problem? Was there an injury? A genetic abnormality? What other options were presented besides surgery? Did you get a second opinion? Were their ex-rays to verify and isolate the problem?
If instead, you had been troubled by “unpleasant and unwelcome knee feelings”, went to a unlicensed, and uncertified person who immediately agreed with your self-diagnosis without performing any physical tests of their own to verify the situation, and who then decided to operate with little to no discussion of possible problems beforehand, and who afterwards considered you a success with no follow up, and kept no records of other patients ——-then you could compare your knee surgery to an Ex-gay therapy program.
“The attempt to change sexual orientation is no doubt much riskier and more challenging than knee surgery. ”
That is an understatement.
And also undermines your whole analogy here. You admit it’s riskier and more challenging than knee surgery, yet somehow think that has absolutely no affect on possible harm.
You start off suggesting “it’s just like knee surgery” but end by saying it is much riskier and challenging, yet expect the parrallel to be unaffected. Curious.
Shouldn’t something that is, admittedly, more risky and more challenging than knee surgery be held to more standards and a higher level of scrutiny?
I highly enjoy and respect the three concluding remarks by Jones and Yarhouse, especially the third point,
In my mind, this latter remark is amazing. Here are Christian authors that are pointedly talking about full disclosure from multiple sources of information. This is not a statement that can be taken to mean “We urge Exodus umbrella ministries to continue to ignore the APA statements” or “We encourage Exodus umbrella ministries to not give full and complete information to their clients at the start of counseling.”
Rather, these remarks are actually quite brave, and within my mind and belief system, these authors are bridging a gap between ministry-based and professional psychology-based programs. “Love rejoices with the truth” says the Bible, and these men are opening the doors widely to a truth that some ministry-based counselors may prefer to ignore.
“Let God be true and every man a liar” stated the Apostle Paul, and sadly, some of the ministry-based persons may hold to such a view — insisting that “God’s truth” be the “only truth” preached… a truth of ‘healing for all’ … even though this position is rebuked by II Corinthians chapter 12.
I hope that the many Exodus ministries that are following this dialog recognize that Jones and Yarhouse are urging full disclosure from multiple sources of information. Hopefully, their leaders will develop a “full disclosure” sheet for their subordinate organizations to share with each client at the start of the journey. It’s time to show the love of God is not afraid of the full truth… indeed, true love rejoices in the truth.
I think you need to re-consider what is actually being suggested. J&Y are not saying that Exodus itself should offer full disclosure.
Read it again: “full disclosure from multiple sources of information.”
They are, once again, simply suggesting that a potential client should seek any and all “information” from, say the American Psychological Association… AND Exodus AND NARTH etc; as if these sources were all as equally valid, tested, reliable, motivated and informed as each other.
[This approach is exactly the same one taken by some with the teaching of biology at schools — a demand that non-scientific viewpoints and wild assumptions (eg “intelligent design” or “creationism”) has an equally valid place in the curriculum.]
They did not suggest that Exodus should begin providing only accurate, measured and tested information. What they did suggest is that the potential client (possibly a deeply distressed one at that) bombard themself with information that ranges from the good to the appalling and, somehow, manage to wade through it all and “select” what they want.
As if that would work.
People offering knee surgery are not permitted to work like that, thankfully. They are professionally bound to offer valid information, not whatever takes their fancy. And any person considering knee surgery can and should expect such professionalism from their supporting doctors; a professionalism that excludes “referring” the person to a faith healer for one thing.
We do agree with you about a need for full disclosure. It looks like these, etc… 🙂
David R: looks like the edit function worked — no lock-ups. yippee.
Grantdale: I think the three links you offered are among the types of information that should be given to potential clients seeking to change the identity, the behavior, and/or the orientation.
I would add in statements concerning the possibility of bisexualism, as well. I recall one book that strongly suggested that most changes were occurring within the bisexuals, and not within the 100% hetero or 100% homosexual populations.
But… I acknowledge that Exodus is not a professional psychology-based organization, but is a ministry-based organization. The decision to be ministry-based (to me) is more than just a legal maneuver to avoid licensing requirements of their ‘counselors’. This decision also shows that Exodus wishes to strongly base its approach not on science, but on faith.
To a science-based person, faith is constrained by science. That is, a statement of faith that is considered unreasonable should be rejected. Hence “Jesus rose from the dead” should be rejected. To a faith-based person, science is constrained by faith and even interrupted by faith. Thus, “Jesus rose from the dead” is accepted… and so is “you can change your sexual orientation”.
Therefore, I recommend that we stress a middle-ground with Exodus International, and encourage that they include the science-based statements in the disclosure package that they should give to their clients. I recall that several in the last months have mentioned that their involvement with faith-based programs would have been less damaging IF they were provided the science-based information, as well as the faith-based information.
We should be leading the charge to find the middle ground now that Jones and Yarhouse have opened those doors. If we don’t reconcile at some level with the people-of-faith, then I fear that all this dialog and debate will be in vain.
Look again at Jones and Yarhouse point #1,
We will not win a ‘battle’ with people of faith that are conflicted over their orientation (or gender identity) – but we can reduce the casulties dramatically by pressing for inclusion of such comments in the full disclosure package that should be endorsed by Exodus.
Caryn that’s noble, and I bet the more ethical ones will believe you, but science has always been a sticking point with religion. Let’s not forget Galileo.
There are people who are convinced that homosexuality was taken out of the list of mental disorders for purely political reasons, and that only “courageous” people of faith will deal with the “supposed truth” that gays are sick.
So it’ll be a hard sell to get them to include the same exact scientific reasoning they believe to be “politically correct”.
Caryn, I’m not sure what you’re ultimately suggesting — help!
(I know you haven’t staked out the following positions in these terms — but let’s pretend otherwise… I’ll try and word it so the questions are as clear as possible.)
1) Where is this “middle ground”, and about what???
When the science is available, it should not be corrupted by silence (or worse). Even if it is contrary to any position taken by any tradition within any faith. Science doesn’t have a “position” to defend, per se. It’s correct, or incorrect: useful, or not. End of story.
How people reconcile the information with their own religious viewpoints is a possible subject for, but not a concern of, science.
2) Not sure what we all need to “reconcile”.
If you mean the simple acknowledgement that there are many faiths, and many streams of thought within those faiths, and that faith is important to many people… yeah, sure. Done.
If you mean personally adopting both the attitudes and behaviours that permits other people to follow their faiths etc… again, sure. Done.
So what must we reconcile?
* presume you do not mean faiths that require virgins get thrown into volcanoes etc… although I could make an interesting parallel here about the demands made on non-heterosexuals by some religions… 🙂
When you say you wish to see Exodus provide accurate medical information about sexuality along with their (almost exclusively conservative, Protestant) religious viewpoint — we couldn’t agree more. Alas, this is something that has been requested of Exodus for over 30 years: and they are simply not going to do that. The accurate medical information is contrary to the particular religious framework: one or the other must prevail, in their minds.
And I know what you mean about the recent rewordings etc that now promotes the “ministry-based” aspects… but this is not what Exodus in fact does. (We disagree with you about what caused the rewordings — the timeline suggests less noble motivations, particularly around the time the LIA got itself into hot water).
The bulk of their website, the bulk of their media appearances, the bulk of their claims are all directed at a claimed expertise with the science of sexuality.
The day that Exodus stops referring to what it does as “counseling” (and instead says “ministry”) and stops claiming it is able to “explain how to change sexual orientation” is the day we might be getting somewhere.
Hope you are a very patient person…
Jason: I do agree that what I propose is a ‘hard sell’, especially because I am an person-of-faith and thought to be ‘deceived’, ‘unrepentant’, and a ‘blasphemer’ by some of Christians that I still extend love towards. I am, in short, branded a traitor and an outsider.
But Jones and Yarhouse carry no such branding. They are insiders. They are not being called ‘traitors’ by their fellow insiders.
What if Exgaywatch and/or BeyondExgay were to offer a respectful summit with Exodus International? What if the subject of the summit were the very three points that Jones and Yarhouse concluded their defense with? What if focus was given to a recommended ‘package’ for full disclosure and/or ‘informed consent’?
Grantdale: Such a summit is ‘reconciliation’ within my own faith. To attempt reconciliation is more important within my own faith, than to gain reconciliation. Indeed, in my own faith, to gain one square yard of reconciled ground is worth all the pain, the insults, and the tears. I called it ‘middle ground’, and it is more often called ‘common ground’. Very hard discussions lead to the ‘common ground’ shown in Acts 15. It can happen again.
What would a Christian organization like Exodus gain from such a summit? The answer is that they would be able to answer their Lord and Master on that final day that they had attempted to reconcile per Matthew 5 and per Matthew 18:
— That they had attempted to ‘love their enemies’ , and to ‘carry our burdens’ even an illegal mile; that they had imitated their Christ in turning the other cheek.
— That they had met to reconcile; considered expert witness testimony; and discussed the matter before their church authorities, being obedient to His commands.
— Yes, that they had heard His words and had dared to live out His teaching: “Blessed are the peace-makers, for they shall be called the Sons of God.”
They are my ‘brothers and sisters in Christ’ under national pressures that I cannot comprehend. They have so very much to gain in the eyes of their Jesus. They have so very much to lose in the eyes of man. I feel for them.
Why therefore not offer such a respectful summit with them? Why not base the summit on the concluding remarks of Jones & Yarhouse, and the implications for defining ‘full disclosure’ and ‘informed consent’? Why not then let us make the first offer?