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from What do clinical studies say?
Spitzer Study Critiqued
In the Journal of Gay and Lesbian Psychotherapy
(Volume 7, Number 3, 2003)
by A. Dean Byrd, Ph.D., MBA, MPH
"...an over-the-hill stage horse galloping toward the limelight, or a court jester hoodwinked by a scheming religious right"
--Characterization of Robert Spitzer
by gay activist Wayne Besen
A recent issue of the Journal of Gay and Lesbian Psychotherapy was entirely
devoted to Robert L. Spitzer and his study, recently published in the
prestigious Archives of Sexual Behavior. One author after another, the Journal
authors--all gay activists-- devoted their efforts to a critical analysis of the
Spitzer study.
The opening editorial by psychiatrist Jack Drescher set the tone for this issue
of the journal. Drescher couched the malleability of homosexuality as a
question central to the "cultural wars," but not to science. And it's the
cultural wars, not science, that seemed to occupy center-stage in all the
ensuing articles.
Another commentator, Theo Sandfort, suggested that Spitzer should not have
published the study at all because of the delicacy of the topic, because the
issue of homosexuality is "charged" in cultural debates, and because of the
limitations of the study (Sandfort lists his concerns in that order).
Psychiatrist Charles Silverstein, author of The Joy of Gay Sex, devoted his
commentary to a scorching criticism of religious-faith traditions, accompanied
by accusations of bias in Spitzer's subject selection. Silverstein has a
preference for the Shidlo-Schroeder study, which sought to document the harm
experienced by some reorientation-therapy clients. The Shidlo-Schroeder study
was conducted by researchers who at least initially, selected their participants
through an advertisement in gay publications that said, "Help Us Document the
Damage of Homophobic Therapies."
An analysis of the media response to the Spitzer study was provided in the
Journal of Gay and Lesbian Psychotherapy by Lund and Renna. They offer a
"conspiracy" theory of the Spitzer study, noting how "media routines dictate
that coverage of scientific issues which intersect with political or cultural
ones tend to minimize the science, and focus instead on the political or
cultural 'conflict.'" They fail to note, however, that a long series of
gay-friendly media stories during the past ten years--stories about "gay genes,"
"gay brains," and children raised in gay-headed households--has been heralded
almost uncritically, on a scientific level, by the popular media as evidence to
prove the merit of gay social causes.
Much of the rest of the Lund-Renna commentary is basically a critique of the
validity of the ex-gay movement, and an attempt to de-legitimize the efforts of
ex-gays to change.
The article in the Journal by Wayne Besen could only be characterized as
polemical; such polemics were justified by the journal's editor, Jack Drescher,
because they were said to be a "representative sample of the political
reception" of the Spitzer study within the gay community.
The commentary is vintage Wayne Besen. He concludes his diatribe with the
following:
"In the end, however, the real loser is Dr. Spitzer. Whether he was an
over-the-hill stage horse galloping toward the limelight or a court jester
hood-winked by a scheming religious right is unimportant.
"What matters is that Spitzer's embarrassing travesty of scholarship will surely
go down as his defining work, a professional pockmark that will indelibly taint
his once splendid career."
In another article, Stalstrom and Nissinen provided a commentary on the role of
the Spitzer study in the legal recognition of same-sex partnerships in Finland.
The Spitzer study had been offered as evidence (by supporters of traditional
marriage) in the Finnish same-sex partnerships debate. Consistent with his
historical and current political views supportive of gay-activist social causes,
Spitzer made a clarification to the Finnish Parliament on the distinct--and
non-intersecting-- spheres of science and ethics; i.e., that scientific studies
can never settle matters of social ethics; but then in closing, he offered his
personal support for both anti-discrimination laws and civil unions for
homosexuals.
The final article in the Journal of Gay and Lesbian Psychotherapy is a dialogue
between two colleagues: gay-activist psychiatrist Jack Drescher, and Robert
Spitzer. It is difficult to determine how much of the interview was scripted.
But Spitzer, in spite of being subjected to hate mail from the gay community and
rage from colleagues, concluded, " I'm glad I did the study."
It's tempting to provide my own commentary on this issue of the Journal of Gay
and Lesbian Psychotherapy. But beyond simply laying out the facts, I am not
sure there is a need; surely, most professionals will be able to glean for
themselves the differences between legitimate scientific criticisms and
political rhetoric. However, because I am acquainted with Robert Spitzer,
perhaps the following information will come closer to the truth of the matter.
My acquaintance with Robert Spitzer began in May, 2000, when I responded to a
dinner invitation from him. Though discouraged from doing so by some of my
colleagues, I accepted the invitation. Having spent three decades in clinical
practice, I had learned to trust my judgment about people more than depending on
the appraisals of others.
I was greeted by a mild-mannered man who was quite engaging. He was reasonable
and open to hearing my opinion as he posed questions about the malleability of
homosexuality. I was impressed with his genuineness and sincerity. At the risk
of insulting him, I noted a kind of searching depth, almost approaching
spirituality. By the evening's end, I had learned much about the 1973 decision
to remove homosexuality from the diagnostic manual, and much more about Robert
L. Spitzer, the man.
More importantly, my gut-level response told me that Robert Spitzer's
motivations were honorable, and that he had integrity. He genuinely wanted to
know if some homosexual men and women could change from homosexual to
heterosexual, and that he wanted science to guide him. Certainly, with more than
275 publications to his credit, this esteemed scientist at Columbia University
was more than able to conduct such a study.
With the limitations that are inherent to all such studies, Spitzer employed the
best rigor available for such research protocols. I am certain that Spitzer
would have received accolades from the scientific community had he studied a
less controversial topic, employing the exact same methodology as in this study.
His sample size was larger than those in previous studies. He was very
detailed in his assessment and carefully considered the affective components of
the homosexual experience. Any bias in interview coding was virtually
eliminated by near-perfect interrater scores. He limited his pool of applicants
to those reporting at least 5 years of sustained change from a homosexual to a
heterosexual orientation. His structured interview clearly described how the
participants were evaluated. His entire set of data is available for scrutiny
by other researchers.
Spitzer's conclusions are simply this: based on his study, there is evidence to
suggest that some gay men and lesbians are not only able to change
self-identity, but are able to modify core features of sexual orientation,
including fantasies.
One of the few rational, scientific commentaries on the Spitzer study was
offered by Scott L. Hershberger. Dr. Hershberger, a distinguished scholar and
statistician, elected to respond in a Commentary to the Spitzer research
(Hershberger's article was published in the same issue of the Archives of Sexual
Behavior as the Spitzer study was) by conducting a Guttman scalability
analysis. This is a scalogram to determine whether or not reported changes
occur in a cumulative, orderly fashion.
Hershberger's conclusion:
"The orderly, law-like pattern of changes in homosexual sexual behavior,
homosexual self-identification, and homosexual attraction and fantasy observed
in Spitzer's study is strong evidence that reparative therapy can assist
individuals in changing their homosexual orientation to a heterosexual
orientation.
"Now it is up to those skeptical of reparative therapy to provide comparably
strong evidence to support their position. In my opinion, they have yet to do
so."
What I find most intriguing, and somewhat ironic is that Spitzer did in 2001
what he did in 1973: he challenged the prevailing orthodoxy. He challenged the
assumption 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."
In the particular sample he studied, Dr. Spitzer concluded that many
participants "... made substantial changes in sexual arousal and fantasy--not
merely behavior." Even subjects who made less substantial change believed it to
be extremely beneficial.
"Like most psychiatrists," says Dr. Spitzer, "I thought that homosexual behavior
could be resisted, but sexual orientation could not be changed. I now believe
that's untrue--some people can and do change."
Perhaps one of the valued characteristics of the good scientist is the
amenability to form different opinions based on the data. This is precisely
what Robert Spitzer has done. He came to the study skeptical, but open to new
data. And with new data, he has formed a different opinion.
What is also clear from the Spitzer study is that more data is needed, because
his study was very hypothesis-generating (as such studies should be).
In spite of the complaints from activists, the Spitzer study has managed to lift
the thirty-year moratorium on the scientific investigation of homosexuality.
Within the last year, I have had nine graduate students contact me about thesis
or dissertation topics on homosexuality. Other colleagues report similar
inquiries.
Activists suggest that there is no need to study change from homosexuality, and
that even research on this subject will cause harm to self-identified
homosexuals. In spite of a political climate where activism often trumps
science, and where activist claims go uncritically examined, there is no
rational basis for the speculation that studying homosexuality will harm
gay-identified individuals.
In responding to this concern, Michael Bailey noted, in his recent book The Man
Who Would Be Queen, "...it is difficult to argue that good scientific studies,
or rational, open discussions" will harm homosexuals.
When sociopolitical agendas prevent scientists from studying even controversial
topics like homosexuality, no one wins. In fact science can only progress by
asking questions and seeking answers. When research is discouraged and
scientists are intimidated, we begin down a slippery slope that approximates the
censorship of scientific investigation, a very dangerous slope indeed.
The tone of this issue of the Journal of Gay and Lesbian Psychotherapy was not
one that valued the scientific spirit of investigation and openness, but rather
one of suppression and personal attack.
It's unfortunate that attempts are made to hold Spitzer's study to a higher
standard than other similarly-conducted research. Spitzer's study was
peer-reviewed and the limitations noted. It appears that the activist-authors of
the Journal of Gay and Lesbian Psychotherapy were outraged that the study was
published at all, a sad commentary for a professional journal. Spitzer's
motives were questioned, his credibility attacked and his research subjected to
a kind of scrutiny unparalleled in any scientific arena.
As a scientist, I find the journal's approach in this issue to be both
disingenuous and intolerant. Disagreement among scientists is healthy.
Name-calling and intimidation tactics are not. It is unfortunate that the
journal's editorial board, some of whom are respected scientists, would lend
credibility to this issue by their affiliation with the journal.
Updated: 3 September 2008
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