Homosexuality and the Ethics of the Behavioral Intervention: Paper 2
(The symposium was published in the Journal of Homosexuality, Spring, 1977. 1,900 words.)
Two years ago I received a phone call from an English clergyman who sought my help. I found his story and desperate request of interest. He was homosexually inclined but hated himself for it. The churchmen had consulted a psychiatrist in London in the hope of changing his sexual orientation, as he put it, from abnormal to normal. The psychiatrist refused his request, saying that he did not consider homosexuality to be an illness in need of treatment. The clergyman had next gone to Sweden to consult a psychiatrist there, but was again refused. Undaunted, the churchmen across the Atlantic and made the same request of a Canadian psychiatrist, who also refused. He then came to New York and called me.
The question raised in this symposium is whether we should accede to this man's request to change his sexual orientation. Different people propose different answers. Davison counsels us to refuse. Others disagree. Cautela suggests covert sensitization whereby this man would learn to associate putrid scenes of vomit with homosexual thoughts and actions. Bancroft would shock this man when he's been excited by slides of an attractive naked man or of men having sex together. Heath would put electrodes into this man's brain and apply an electrical current in order to rid him of his homosexual desire. (Heath is fascinated with this exercise in professional sadism while I am horrified.)
I refused the request. He then asked if I would refer him to someone in New York City who would undertake to cure his homosexuality. I refused to make a referral. I do not believe that it is my responsibility to meet any demand on the part of a person seeking therapy that conflicts with my own principles and values. However, if I am agreeing with Davison's position in refusing to assist a person in changing his sexual orientation, nonetheless I feel obliged to state what we should do with such people. To do this, I would like to discuss two essential issues: (a) why trying to change sexual orientation is doomed to fail and (b) what the appropriate treatment might be.
SEXUAL ORIENTATION CHANGE
Let me begin my argument by stating that no one is a "voluntary" patient for sexual orientation change. The myth of the voluntary patient is finally being challenged. Agreeing with Halleck, I believe it is a rationalization for those behavior therapists who act as agents of societal morality. Silverstein stated: "To grow up in a family were the word ‘homosexual’ was whispered, to play in a playground and hear the words ‘faggots and ‘queer’, to go to church and hear of ‘sin’ and then to college and hear of ‘illness,’ and finally to the counseling center that promises to ‘cure’, is hardly to create an environment of freedom and voluntary choice. The homosexual is expected to want to be changed and his application for treatment is implicitly praised as the first step toward normal behavior."
The people who present themselves as candidates for sexual orientation change are suffering from a number of severe problems. As a rule they are men (rarely women) who have hidden their sexuality for many years. The years of loneliness and personal alienation have filled them with guilt about their sexual desires.
They feel guilty about so many things. They have disappointed their parents by not having children. They have disappointed their fathers by not being the "men" they wanted their sons to be. They have disappointed wives who do not understand the special secret, or the reason for marital distance.
Most disturbing is the fact that they are not angry. Seldom have I seen anger in these men. One would expect that a person so frustrated in his emotional and sexual life would be bitter at a society that has defined his potential happiness as sin, social malady, or mental illness. Our "closeted" patient has accepted pejorative labels as truth, and, like the society around him, has defined himself as worthless. Therein lies the therapeutic trap. The extreme lowering of self-esteem and its concomitant well of sin and guilt define the potential therapeutic relationship in a unique way.
The patient asking for sexual orientation change perceives himself as "guilty as charged," and his hidden agenda in therapy is punishment for his sins. He perceives the therapist as an agent of society -- an agent who will punish his wickedness appropriately. In effect, our patient, long familiar with low self-esteem and a deep sense of humiliation, has taken the next step and become a masochist (in a non-sexual sense). Further, his request for sexual orientation change is a request for the therapist to play the role of the punishing sadist. His request is for a formerly defined sadomasochist relationship, with his playing the role of the humiliated and the therapist punishing him for transgressing the rules.
Any form of therapy that encourages guilt or reinforces low self-esteem is a therapy whose meta-message defines a sadomasochistic relationship. Further, therapeutic goals that are directed toward the punishing of humiliating behavior and fantasies are the acting out of this masochistic relationship. The violence in the name of science called aversion therapy, or covert sensitization, and even the bias of certain forms of psychoanalysis, is primarily the acting out of the sadomasochism of both parties, and I would charge both of them to explain their actions.
As long as the therapeutic procedure is defined by attitudes of guilt and punishment, therapy will be a failure. Bancroft's recent review of the aversion therapy literature suggests that aversion therapy is no more effective than psychoanalytic treatment. He also found that from 20 percent to 50 percent of aversion therapy patients either refuse the treatment or leave once it has begun. It's no wonder. Both forms of therapy are sadomasochitic procedures and should be expected to produce similar results. The data we do have about sexual orientation change are probably based upon a rather small sample of homosexual masochists.
It's time we stopped listening to the request and started watching the patient's behavior. If we do, I think we will find that his guilt and humiliation have nothing at all to do with sex. I want to emphasize this point because it's important. The guilt of men who want to change their sexual orientation, as well as the anger of some people against homosexuals, has almost nothing to do with sexual behavior, that is, two men having sex together. How is it that basketball and football players can feel each other up in the most outlandish way, and not be worried they'll be called "queer," and indeed, no one seems to define it that way? How is it that many male hustlers have sex with gay men for money, but don't define themselves as having homosexual sex -- only the other guy is queer?
The answer to my question lies not in the fact of having sex, but in the gender role relationship between the parties. The football player can "potshka" with his friend’s behind on the playing field with thousands of people watching because he is playing a very masculine sport, not one for sissies. He wouldn't do it if he were playing badminton! The male hustler who thinks of himself as a tough, straight guy plays a stereotyped masculine role while having sex with the homosexual man.
What defines the fear of homosexuality in both the homosexual who presents himself for treatment and the heterosexual who hates the homosexual is their common adherence to a social norm that confuses sexual orientation with a strict gender dichotomy between the sexes. The real fear is transgression of the masculine role.
We live in a society where masculinity and femininity are expressed by mutually exclusive behaviors: The feminine is passive and reflective, the masculine is active and competitive. These gender roles have unfortunately been translated into identical sexual roles, so that a man's gender behavior, like competitiveness and aggressiveness, is expected in his genital behavior as well. To act unlike a man is to act more like a woman, and therein lays the problem for our homosexual man.
The request for sexual orientation change from a homosexual man is an expression of fear that he has lost his manliness, and has become more like a woman. He fears the female status because he has been taught that it is lower than his own. He points to his contempt for women by fearing to become one. Other men either reject as absurd the notion that homosexual behavior is female or try to find an androgynous integration of both typically male and female characteristics. These men do not show up for sexual orientation change.
So with these propositions in mind, let us define the problem posed by our original churchmen with whom we started this inquiry. I would suggest that he suffers deeply from depression, and from a deep-seated loss of self-esteem, from a rigid adherence to norms of gender-appropriate behavior, from contempt for women, from a masochistic desire to be punished for his transgression of a proper masculine role, and from a very confused idea of masculinity and femininity. He does not suffer from homosexuality.
And what of the therapist who would agree to change sexual orientation? I suggest that such a therapist is just as confused about these issues as his prospective patient. I see no way out of the logical assumption that the therapist is just as confused about issues of masculinity and femininity, that he is very much concerned about his own self-esteem, and that he would be just as depressed as his patient if he thought he were homosexual. The only important difference between the two is that the therapist acts from a position of power, whereas the patient acts from a position of weakness. But I perceive this as two sides of the same coin.
As long as therapy, of whatever kind, is directed toward changing the genital behavior without dealing with the underlining attitude structure, the therapy will be misguided, useless, and ultimately result in further depression for the person. As long as the therapist cooperates in this sadomasochistic conspiracy to punish the man for his transgressions, our victim will be unable to find his way out of this self-made trap.
The churchman was angered when I refused to refer him. He recognized that I understood his problems, though he didn't understand why I would refuse to refer him. Finally he said that if he went into therapy with me, he might come to feel more comfortable with his homosexuality, and that would create even greater problems with his church affiliation. So he said no, and we parted. I don't know where this man is now, or what he did after he saw me that day. Perhaps he found his punishing agent, or perhaps he is still in that limbo state of humiliation and low self-esteem. But the fact is, I could do no more for him. None of us can really do any more for our patients than point out the truth to them. After that, they must be responsible for their own lives.