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.