from Books & Reviews
Reviewed by: A. Dean Byrd, Ph.D., MBA, MPH
In this text, Columbia University scientists/psychoanalysts Richard Friedman and Jennifer Downey attempt to build bridges between science and psychoanalysis as they address issues related to homosexuality.
The book is divided into two parts. The first addresses the scientific and theoretical aspects of homosexuality, and the second focuses on clinical aspects of homosexuality, primarily from a psychoanalytic perspective.
Although for the most part, the authors address the scientific issues accurately, they engage in a revisionist treatment of psychoanalysis. They characterize themselves as "modern psychoanalysts," yet the authors take license to select parts of psychoanalytic thought and theory, and to discard others. (p. 290).
Ironically, the science and the authors' revisionist psychoanalysis prove incompatible. For example, they conclude that homosexuality is neither biologically determined nor unchangeable:
"At clinical conferences one often hears...that homosexual orientation is fixed and unmodifiable. Neither assertion is true...The assertion that homosexuality is genetic is so reductionistic that it must be dismissed out of hand as a general principle of psychology." (P. 39)
Yet, the authors ignore the plethora of case studies (i.e., the primary method of research in psychoanalysis) and more than 100 years of psychoanalytic thought on sexual orientation and change. The authors attempt to discredit reparative therapy--which they are unable to do without discrediting psychoanalysis, because reparative therapy is rooted in the psychoanalytic tradition.
Friedman and Downey admit that the political climate makes the discussion of homosexuality difficult, and that healthy, scholarly discussion is plagued by "heated, idealogical and political debate." (P. 41). Then, they proceed to engage in the same kind of narrow politicism about which they complain.
Though the authors give preferential treatment to Hamer's "gay gene" study, they do acknowledge research that contradicts his results. They reluctantly conclude,
"Hamer (1999) and Rice (1999) have debated the significance of their studies, but as of the time of writing of this volume, the conclusion that male homosexuality is even sometimes determined as a result of X-linked transmission cannot be accepted as valid." (p. 55)
They essentially discount Simon LeVay's "gay brain" research in an apologetic way by focusing on providing a sympathetic view of its flaws:
"LeVay's research was difficult to carry out and, as is common with exploratory projects, had a number of important limitations in design. For example, hardly any biographical information was known about the subjects including information about their sexual histories. The study included no (known) homosexual women, and some of the subjects had AIDS. Moreover, although statistically significant differences between experimental and control groups were present, some presumed heterosexual men had small brain nuclei in the critical area, and some presumed homosexual men had nuclei large enough to be within the heterosexual range." (p. 67)
Without clearly stating the obvious, Friedman and Downey suggest that the LeVay study was fatally flawed, should have never been published, and certainly should not have been billed as a biological determination of homosexuality!
Further interpreting the science, they conclude the following:
Regarding homosexuality in the animal kingdom, they succinctly summarize the research, which finds no preferential, same-sex erotic pair bonding in other mammals:
"Although sexual activity between same-sexed individuals occurs throughout the animal kingdom, there is no nonhuman mammalian species in which predominate or exclusive homosexuality occurs in the way it does in humans. For example, among the primates, only humans may form meaningful, lengthy, sexual affectionate relationships between members of the same sex and not seek sexual activity with members of the opposite sex. Moreover, sexual behavior in humans is greatly influenced by gender identity, a psychological construct that influences behavior in a way for which there is no animal model" (P. 62).
Dean Hamer, activist researcher and author of the "gay gene" study, provides an interesting descriptive difference. He notes,
"Pigs don't date, ducks don't frequent stripper bars, and horses don't get married." (Science of Desire, P. 213.)
Providing support for the "functionalism causes structuralism" model, Friedman and Downey cite PET Scan research:
"The PET scan is a brain imaging technique that studies the functional activity of the brain via use of radioactive isotopes. When the subjects became sexually aroused as a result of exposure to erotic films, certain areas of the brain became activated. These included cortical visual association areas, other areas involved in integrating sensory input with emotional states, and yet another area of the cortex ("left anterior cingulate cortex") involved in the higher regulation of the autonomic and endocrine nervous systems.
"The investigators suggested that different areas of the cerebral cortex were involved in integrating psychological processes including labeling visual stimuli as sexual, assimilating these stimuli with other emotions so that they were experienced as meaningful for motivation, and integrating these with physiological responses involved in sexual response." (Stoleru et al, 1999:17) (P. 63)"
The PET Scan research is quite supportive of the peer-reviewed study conducted by Dr. Mark Breedlove. Commenting on the role of the brain in sexual behavior, Breedlove, a researcher at the University of California at Berkeley, demonstrated that sexual behavior can actually change brain structure. Referring to his research, Breedlove states,
"These findings give us proof for what we have theoretically know to be the case-that sexual experience can alter the structure of the brain, just as genes can alter it. It is possible that differences in sexual behavior cause (rather than are caused) by differences in the brain." (Breedlove, 1997, p. 801).
Such research provides evidence for what many clinicians and theoreticians have long known to be true: functional change causes structural change in the brain.
No Way to Determine of Sexual Orientation, and Change of Orientation only Occurs in a Minority?
Friedman and Downey note "there is no biological test that discriminates between people on the basis of their sexual orientation," (P. 83). At the same time, they declare that
"...a particular man's sexual orientation may indeed change if he happened to be one of the minority who appears to retain the capacity for sexual plasticity rather than rigid crystallization of sexual fantasies." (P. 18).
Thus the authors conclude, in essence, that there is no way to conclusively determine a person's sexual orientation...yet there is a group of men who they list as "minority" who seem to be able to change their sexual orientation? If these men cannot even be identified as homosexual, how can they be classified as minority of homosexuals?
Friedman and Downey provide an exceptional argument in favor of the study of homosexuality.
"We believe that it is ethical to investigate genetic influences on homosexuality (or other controversial areas such as intelligence, for example) with appropriate ethical scientific guidelines in place...Even the most well-intentioned social policy makers slide down a slippery slope when advocating censorship of scientific investigation."(49).
"The more information that can be acquired about the origin of homosexual orientation, the more will be learned about bisexuality and heterosexuality." (P. 50)
Although Friedman and Downey's refusal to legitimize reparative therapy comes as no surprise, they unwittingly provide tremendous support for the premise that social and emotional variables affect gender identity--which, in turn, determines sexual orientation (the same assumption underlying reparative therapy). Consider the following conclusions which provide support for reparative therapy.
Without being critical of the Hooker research , Friedman and Downey describe the non-representative, convenience samples used in her studies of homosexual men: "Through word of mouth, Hooker recruited highly functional, socially well-integrated homosexual men." (P. 235).
In spite of the non-representative nature of the samples, the authors uncritically accept Hooker's research as being scientifically valid.
Yet they are very critical of Spitzer's similar use of "convenience samples." And they completely ignore the use of convenience samples by Schidlo and Schroeder. For example, Schidlo and Schroeder's solicitation of those who were "harmed by reparative therapy" was a blatant example of bias. (P. 270-271).
Consider the following advertisement for participants in the Schidlo study:
"Help Us Document the Damage of Homophobic Therapies: In association with the National Lesbian and Gay Health Association, we are conducting research on the outcome of treatments that claim to 'cure' homosexuality.
"Our purpose is to document the damage that we believe occurs when a lesbian, gay or bisexual client receives psychological help from a provider who promises to change a person's sexual orientation. We are looking for individuals who have experienced such a program and who are willing to talk about it confidentially by telephone, email or by filling out a written survey."
It is interesting that Schidlo and Schroeder changed the title of their study from "Homophobic Therapies: Documenting the Damage" to "Changing Sexual Orientation: Does Counseling Work?" because some of their study participants actually reported that there were benefits--and, in some instances, change in sexual orientation.
The clinical half of the authors' text unfortunately focuses almost exclusively on homophobia and heterosexism, terms that have activist connotations more so than clinical value. Though they admit that both terms have limitations from a psychoanalytic perspective, they justify their use because they have come to be accepted in the mental health literature ("Everybody does it.")
They criticize homophobic parents, blaming them for internalized homophobia of their children:
"Because children who ultimately become homosexual adults are raised in heterosexist and homophobic settings, their socialization leads to internalization of negative attitudes and beliefs about homosexuality." (P.177)
According to Friedman and Downey,
"the basic premise of a gay-affirmative perspective is that the deleterious effects of biased socialization may be lessened and even largely eliminated with corrective therapeutic experiences that facilitate and support self-actualization and a sense of pride in being gay" (P. 184.)
The authors provide an endorsement of Gay Affirmative Therapy (GAT) without acknowledging that there is no research regarding the efficacy of GAT. (For example, in Psychotherapy, 2001, 38, 4, Winter, P. 482, authors A. G. Lam and S. Sue conclude: "While there has been recent literature discussing the potential benefit of gay affirmative therapy, we could locate no empirical research on the effectiveness of this therapy in treating LGB individuals."
To their credit, Friedman and Downey offer accurate data on the prevalence of homosexuality in the population:
"2.4 per cent of the population ...exclusively attracted to men with an additional 0.7 per cent mostly so" (P. 18). "...1.5% of the female population consider themselves to be homosexual" (P. 55)
They cite the recent population-based studies that report increased psychopathology among gay men and lesbians--but their narrow politicism only allows for consideration of homophobia as the cause. In the Archives of General Psychiatry (1999, Vol. 56 883-884), J. Michael Bailey offered an extensive criticism of these population-based studies. In his commentary on the research on homosexuality and mental illness, Bailey concluded,
"These studies contain arguably the best published data on the association between homosexuality and psychopathology, and both converge on the same unhappy conclusion: homosexual people are at a substantially higher risk for some forms of emotional problems, including suicidality, major depression and anxiety disorder."
These 1999 studies were corroborated by a large well-conducted study from The Netherlands (Archives of General Psychiatry, 2001) which does not provide support to the "homophobia" hypothesis as the source of the higher level of mental-health problems, because Dutch society is recognized as one of the most gay-affirming and gay-tolerant societies in the world, and yet the risk for mental illness among those who engage in homosexuality in Holland remains high, and significantly higher than among heterosexuals in that country.
Bailey--unlike Friedman and Downey--offers alternative hypotheses for the data associating mental illness with homosexuality. He suggests that homosexuality may be a "developmental error," "representing a deviation from normal development and is associated with other such deviations that may lead to mental illness." Bailey also suggests another hypothesis ignored by Friedman and Downey - that "increased psychopathology among homosexual people is a consequence of lifestyle differences associated with sexual orientation...such behavioral risk factors associated with male homosexuality such as receptive anal sex and promiscuity."
Friedman and Downey's cavalier rejection of reparative therapy, and of Dr. Joseph Nicolosi in particular, resembles more of a political attack than a careful analysis. They accuse Dr. Nicolosi of being psychoanalytically uninformed and failing to maintain therapeutic neutrality. Ironically, Friedman and Downey themselves are not neutral at all about reparative therapy!
Even activist Andrew Sullivan provides a more balanced assessment of the reparative model. Referring to reparative therapy, Sullivan concludes,
"As an elaborate and total theory, it certainly cannot be dismissed as n improvised rationalization of bigotry, because its nuances are too refined and its observations too acute." (Love Undetectable, P. 120)
Although Friedman and Downey allude to the relationship between politics and reparative therapy, they fail to acknowledge the narrow politicism that governs their own views about it.
The value of Friedman and Downey's book lies in the authors' assessment--for the most part accurate--of what science has to say about homosexuality. But their preoccupation with condemning homophobia and heterosexism colors their views in the second part of the book.
The authors fail to recognize two important points--first, that science is actually quite supportive of the treatment of homosexuality; and second, that their condemnation of "heterosexism" (which is the belief that heterosexuality is the norm, with homosexually an abnormal variant) is not a scientifically neutral conclusion.
As gay-activist researcher Simon LeVay points out (2000, p. 12):
"First, science itself cannot render judgments about human worth or about what constitutes normality or disease. These are value judgments that individuals must make for themselves, while possibly taking scientific findings into account."