Commentary: Psychiatry and Homosexuality
By Robert L. Spitzer, a professor of psychiatry at Columbia University

Wall Street Journal, May 23, 2001
200 Liberty Street, New York, NY, 10281
(Fax: 212-416-2658 ) 


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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.

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