Sexual Orientation and Psychoanalysis:
Sexual Science and Clinical Practice
(Richard C. Friedman and Jennifer I. Downey:
New York: Columbia University Press, 2002)
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.
Science and PsychoanalysisAlthough 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.
Homosexuality and ScienceThough 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:
- “It seems that theory building about the origins of any type of sexual orientation requires a multi-factorial model–with biological, psychological and social factors exerting influences at different times and in different degrees.” (P. 58)
- “Sexual orientation is usually not determined by biological factors alone. Biological influences are significant, however, and the way in which they act in concert with psychological and social influences to shape sexual orientation are crucial for psychologists and psychiatrists to be aware of.” (P. 59)
- “What causes homosexuality? It is apparent that biological, psychological, and social factors interacting in complex and various ways, shape human sexual orientation.” (P. 61)
Homosexuality and the Animal WorldRegarding 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.)
Functionalism Causes StructuralismProviding 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?
The Ethics of Conducting Research on HomosexualityFriedman 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)
Unwitting Support For Reparative TherapyAlthough 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.
- “Fantasies may (temporarily) REPAIR (emphasis added) the more profound damage that occurs to self as a result of severe trauma. Fantasies may also soothe, enhance security, and bolster self-esteem or REPAIR (emphasis added) a sense of having been abandoned or rejected.” (P. 6)
- “Sexual fantasies,” they conclude, “occur most frequently in people with high rates of sexual activity and little sexual satisfaction.” (P. 11)
- They quote from Robert Stoller, “The hostility of eroticism is an attempt, repeated over and over, to undo childhood traumas and frustrations that threaten the development of one’s masculinity or femininity.” (P. 36)
- On gender nonconformity (which reparative therapists view as a precursor of homosexuality) where prevention of homosexuality is focused, they note from the research, “Not only did they [Bailey, Dunne and Martin] find that childhood gender nonconformity was far greater among homosexual than heterosexual subjects, they also observed that the degree of gender nonconformity was related to the degree of adult homosexual orientation. They note that the positive relationship between gender nonconformity and homosexual orientation is one of the most robust associations in the behavioral sciences.” (P. 53)
- “Of the many behaviors that are a part of a gender non-conformity pattern of boys on the gay developmental track, one of the most common is aversion during late childhood to rough-and-tumble play. Data from this observation are substantial and come from diverse sources, including studies of patients and nonpatients alike.” (P. 82)
- “The most important aspect of Bem’s theory is that the awareness of being different from same-sex peers…produces heightened physiological arousal…[that] is subsequently transformed into erotic attraction.” (P. 85)
- “Core gender identity is the sense of being male or female. Gender identity is a psychological construct, yet influenced by constitutional biological factors, cognitive development, and psychosocial learning.”( P. 97)
- “With regard to the development of gay youth, their temperamental aversion to RTP [rough and tumble play] is often part of a more general tendency toward cross-gender sex stereotypic interests. Fathers often react to this by withdrawing from them or attempting to change their temperaments, with unfortunate consequences for the father-son relationship.” (P. 107)
- The authors note the occurrence of peer abuse and focus on peers’ intolerance of cross-gender behavior in boys ( P. 118).
- “…the father-son relationship is likely to be problematic among gay youth….problems are extremely common, particularly rejection-either overt or subtle-by the father.” P. 219
- “…poor fit between son and father.. A son may require greater emotional contact than a father can supply for practical and/or emotional reasons…youngsters who hunger for closeness to fathers who are well-intentioned and caring but work hard and long and are temperamentally not in touch with their feelings or expressive. Even though such a father may feel positively about his son, he still may be unable to meet his son’s specific needs for parenting. The situation may be compounded when the son projects angry feelings onto his father and then experiences his father’s withdrawing as motivated by hostility.” (P. 220)
- As far as the relationships between prehomosexual boys and their mothers, the authors note, boys are “…likely to have more interests in common with their mothers” (P. 220)
- “…a triangular situation evolves, with the mother and son becoming allies and excluding the father. ” P. 221.
Hooker, Spitzer, Schidlo and Schroeder: Convenience Samples Differentially TreatedWithout 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.
Homophobia and HeterosexismThe 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)
Gay-Affirmative TherapyAccording 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.”
Clarifications and ContradictionsTo 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.”
Cavalier Rejection of Reparative TherapyFriedman 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.
Science and MoralityThe 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.”
Updated: 3 September 2008
Some people are right-brained. Others are left-brained. Apparently, some are gay-brained.
What makes people gay? Biologists may never get a complete answer to that question, but researchers in Sweden have found one more sign that the answer lies in the structure of the brain.
Scientists at the Karolinska Institute studied brain scans of 90 gay and straight men and women, and found that the size of the two symmetrical halves of the brains of gay men more closely resembled those of straight women than they did straight men. In heterosexual women, the two halves of the brain are more or less the same size. In heterosexual men, the right hemisphere is slightly larger. Scans of the brains of gay men in the study, however, showed that their hemispheres were relatively symmetrical, like those of straight women, while the brains of homosexual women were asymmetrical like those of straight men. The number of nerves connecting the two sides of the brains of gay men were also more like the number in heterosexual women than in straight men.
This would seem further evidence, as if any were needed, that homosexuality is biological rather than “a lifestyle choice.”
Slate’s Will Saletin sees a potentially eerie consequence of this: Homosexuality being treated as a birth defect.
[T]he march of science into the gay brain hasn’t stopped. It has continued, seeking to understand not just what doesn’t cause homosexuality—playing with dolls, growing up with a strong mother, watching Will and Grace—but what does. And the more we understand these biological factors, the closer we get to being able to change them.
Going deeper into the study, we see that the differences in brain symmetry is an effect, not a cause. The most likely cause is “hormonal influences.” It turns out, “homosexuality may be caused by ‘under-exposure to prenatal androgens’ in males and ‘over-exposure’ in females.” This strikes me as quite plausible. Recall that there was a study several years back showing that women who took diet pills during pregnancy were much more likely to have gay children.
But, if it’s a mattering of balancing out hormones . . .
Where science leads, technology follows. Two years ago, scientists in Oregon reported an attempt to “interfere with defeminization of adult sexual partner preferences” in sheep. Their method, as they described it, was to alter hormonal inputs in pregnant ewes “during the period of gestation when the sheep brain is maximally sensitive to the behavior-modifying effects of exogenous testosterone.” When the attempt failed, they concluded that the dosage should be increased.
Would hormonal intervention work in humans? Should we try it? Some thinkers are intrigued. Last year, the Rev. Albert Mohler Jr., president of the Southern Baptist Theological Seminary, wrote: “If a biological basis is found, and if a prenatal test is then developed, and if a successful treatment to reverse the sexual orientation to heterosexual is ever developed, we would support its use.” Mohler told the Associated Press that morally, this would be no different from curing fetal blindness or any other “medical problem.” The Rev. Joseph Fessio, editor of the press that publishes the pope’s work, agreed: “Same-sex activity is considered disordered. If there are ways of detecting diseases or disorders of children in the womb … that respected the dignity of the child and mother, it would be a wonderful advancement of science.”
If the idea of chemically suppressing homosexuality in the womb horrifies you, I have bad news: You won’t be in the room when it happens. Parents control medical decisions, and surveys indicate that the vast majority of them would be upset to learn that their child was gay. Already, millions are screening embryos and fetuses to eliminate those of the “wrong” sex. Do you think they won’t screen for the “wrong” sexual orientation, too?
Oddly, this is happening simultaneously with people becoming far, far accepting of homosexuals and homosexuality. Yet, while they may intellectually agree with the now-shopworn Seinfeld catchphrase, “not that there’s anything wrong with that, most wouldn’t go so far as being indifferent to whether their own kid were gay. Most, I suspect, would indeed take relatively-low-risk medical steps to ensure that their kid is “normal.”
It doesn’t end there. A few years back, Bryan Murley wondred whether the availability of genetic testing for homosexual predisposition would lead to aborting gay fetuses. It almost surely would.
Science that has answered the prayers of gays in demonstrating a biological determinant, proving that they weren’t freaks who made a choice to live a life of sinful disobedience to society’s moral code but merely living “as God made them.” This has helped normalize homosexuality in the eyes of the medical community — it has long since been removed from the list of “mental disorders” — and the minds of most Americans. Yet, we may have come full circle to thinking of homosexuality as something to be cured.
UPDATE: My colleague Alex Knapp notes the large number of homosexuals who have made tremendous contributions to humanity and wonders whether changing “the very structure” of their brains risks might have also taken away their gifts. The snarky retort I generally make to that sort of argument is to note the number of truly rotten people who we might theoretically been saved from. But the real answer is that we’re far from having a sufficient understanding of such things to know what the effects of hormonal “cures” would be. Which is probably as good a reason as any not to attempt them.