APA says sexual orientation isn’t biological but from yet to be determined factors


Last week I commented on sexual identity formation in little kids. It spawned a large number of comments, both on and off topic. Hesitantly, I will make another post on the topic of sexual identity–this time from a brochure published by my own clinical association.

The American Psychological Association (APA) has a pamphlet on sexual orientation and homosexuality designed to aid understanding and reduce prejudice. My friend, John Freeman, gave me this to me and pointed out an interesting line which we’ll look at in a moment. But first, let me summarize the pamphlet

Sexual orientation, according to the APA is

“an enduring pattern of emotional, romantic, and/or sexual attractions to men, women, or both sexes. Sexual orientation also refers to a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions.”

Right away it is clear they don’t really distinguish between attraction and identity and orientation and identity. You see the simple equation: attraction=orientation/identity. This is where Yarhouse’s studies with individuals within a gay affirming church give ample concrete evidence that such an equation is simplistic and mischaracterizes a set of complex issues. The reality is that one may recognize an attractional pull without it forming a private or public identity.

The APA document continues with the following,

“According to current scientific and professional understanding, the core attractions that form the basis for adult sexual orientation typically emerge between middle childhood and early adolescence.”

Again we see the attractions = orientation. This fits with the popular identity development theory that one moves from discomfort with to pride in attractions and accepts orientation as a given. Interpretive assumptions are given short shrift here.

Now to the good stuff. The brochure asks the question: What causes a person to have a particular sexual orientation? And here is their answer,

There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientist to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.

This is an interesting paragraph. The APA rightly recognizes that no one factor is likely to determine later orientation. In fact, we’re not really at a point where we can say one factor is X% of the equation. There is no equation yet. It doesn’t mean we won’t have a better sense of it in the future, but as of yet, the problem is not merely a biological process. So, this opens the door to choice and manipulation of one’s orientation unless one subscribes to behavioral naturalism–something most of us would not accept in other areas of life. Obviously no one is suggesting that sexual orientation is as transitory as a passing fancy. And yet the APA recognizes that even when folks don’t experience themselves choosing orientation, there is an interpretative and choice element however subtle and slow the process.

At this point the brochure turns to the problem of discrimination and its impact on gay and lesbian people. No matter your beliefs about homosexuality, you ought to recognize that there is great stigma and mistreatment for those so identified (and also for those who may not fit stereotyped roles but do not have a gay identity). Then the brochure covers the question of mental disorder. 

Is homosexuality a mental health disorder? No says the APA and I agree based on the definition of mental illness where it has to cause distress. Not all with a gay identity are distressed, period. This really isn’t the issue.

The brochure goes on but I will mention only one last section. They discuss the validity of therapy intended to change orientation. They state there is, “no scientifically adequate research to show that therapy aimed at changing sexual orientation is safe or effective.” First, this sentence is full of highly charged words whose meaning can be debated: adequate…safe…effective. What constitutes adequate? Safe? Effective? There is some data that is not merely anecdotal suggesting that change is possible and not unsafe (see Yarhouse and Jones’ Ex-Gays(IVP). Now, their data isn’t as strong as it could be, isn’t overwhelmingly positive, but neither can it be denied as an anecdote. On the flip side, there isn’t any adequately scientific data suggestive that change therapies are unsafe and ineffective. Both sides of the research agenda have the same set of weaknesses that one would expect in researching this particular population (i.e., convenience samples).

I agree with the APA that we therapist must respect and person’s right to self-determination. But the APA violates this very principle by disrespecting those who have carefully thought about change. It is a paternalistic stretch to say that every person who wishes to change orientation only does so because of biases or because of a fundamentalist upbringing. The APA wants to be sensitive to a client’s “race, culture, ethnicity, age, gender, gender identity, sexual orientation, religion…” as long as their religion doesn’t guide them to see sexuality in a different light.

All in all, the APA takes a complex set of factors and ends up with, “It just is, so be nice!” I’m all for reducing mistreatment and violations of constitutional rights. But, I expect my scientific organization to spend my dues in a more balanced manner–faithfully representing what is true, whether attractive or not.  

13 Comments

Filed under Psychology, sexual identity, sexuality, Uncategorized

13 responses to “APA says sexual orientation isn’t biological but from yet to be determined factors

  1. Scott Knapp, MS

    I am required to join the American Counseling Association (ACA) and it’s corresponding state level organization, in order to be considered for a PhD program in my local area. In recent years, the ACA ethics panel has published guidelines for its members, regarding “unproven” or “developing” treatment techniques, stipulating that members must use therapeutic modalities and techniques which are based on scientific empirical research or a “theory-based” foundation. If a client comes to me requesting treatment that would require me to utilize techniques which don’t pass ACA muster by this litmus, I’m to refer them to a non-member professional, whom I assume they would regard as sufficiently reckless to use these techniques. I’m aware that presently the AACC is challenging this stance, and I hope that something productive can be hammered out. Perhaps the ACA has willingly overlooked Warren Spitzer’s 2003 work on the efficacy of “re-orientation” therapy, or the body of work being done by NARTH. I really do want to become a part of the dialog on this topic in the public arena of ideas, but I question the receptiveness of the “other side” of this debate. At the school at which I’ve applied for post-graduate studies, the president of that school recently made national headlines for his decision to fire an administrator for making statements in the public media which did not align with the values of the school, he said. This woman was African-American, and was interviewed in a local ethnic publication, and made statement to the effect that it was her opinion that homosexuality was not a genetic issue, so much as a choice issue. These comments, to the best of my knowledge, were not made while representing the institution, but as a private citizen; she was identified in the article as connected with the University, however. Presently, she is planning to sue the University over free speech rights, and the story has become a banner issue for conservative talk radio. Now I’m thinking to myself, what chance do I realistically have of getting into this program, given my theologically-oriented education and concise description of my biblically-oriented bent for counseling? As willing as I am to join the dialog, I may not be invited because of this one issue.

  2. Amy

    I have a question. According to the APA criteria for mental illness, sexual orientation is *NOT* a mental illness because it doesn’t cause distress? How would the APA classify situations in which a person was terribly distressed about being attracted to someone of the same sex? (Or would that be due to cultural and fundamentalists bias?)

  3. Wow, required to join to apply for a PhD program? Really? Unless they directly ask (which I would doubt would be part of the interview), would you feel compelled to answer? One of the reasons I blogged on this topic is that many do not know that even the APA is willing to acknowledge that as of yet, we can’t say attraction is biological in origin or at least only biological in origin–even if people experience it that way.

    Amy, the DSM-IV lumps all sexual problems into one large chapter/category. Within the chapter are the subcategories of dysfunctions, paraphilias, and identity disorders. The Gender identity disorder only includes those who have a “persistent cross-gender identification” and a persistent discomfort about one’s assigned sex. Currently there is not diagnosis for distress over attraction. There IS a v code that can be used, v62.89 Religious or Spiritual Problem and 313.82 Identity Problem which mentions distress over sexual orientation. Whether that shows up as a core diagnosis (rather than in “other conditions that may be a focus of clinical attention” in future editions or not remains to be seen. I wouldn’t put money on it just yet.

  4. Scott Knapp, MS

    Hi Phil, yeah it’s a requirement, since the PhD program is in “counselor education and supervision” (not a doctoral program in psychology). And given the recent happenings with the administrator firing, I’m certain it’s a raw issue. In the various essays I had to write to establish my writing capabilities, I had to describe my theoretical orientation, my future plans, and any concerns I might have. One concern was how I’d be received by faculty and students, given my uniquely Christian/biblical theoretical bent. I was very clear that, in my private practice, I planned to counsel from a biblical world view. I wasn’t trying to be “in your face” about it, but I wanted to be clear where I was coming from. We’ll see where it goes.

  5. Scott Knapp, MS

    Amy, I was doing some research of the decision to change the DSM for a paper in graduate school, and I ran across a proposal submitted by Dr. Warren Spitzer some time after he’d successfully lobbied the APA to remove homosexuality as a pathological deviation from normal sexual behavior. He proposed creating another DSM diagnosable referred to as “sexual orientation disturbance (homosexuality)”. Here’s an excerpt from what he wrote: “If homosexuality per se does not meet the criteria for a psychiatric disorder, what is it? Descriptively, it is one form of sexual behavior. Our profession need not now agree on its origin, significance, and value for human happiness when we acknowledge that by itself it does not meet the requirements for a psychiatric disorder. Similarly, by no longer listing it as a psychiatric disorder we are not saying that it is “normal” or as valuable as heterosexuality.

    Having suggested that homosexuality per se is not a psychiatric disorder, what about those homosexuals who are troubled by or dissatisfied with their homosexual feelings or behavior? These individuals have a psychiatric condition by the criterion of subjective distress, whether or not they seek professional help. It is proposed that this
    condition be given a new diagnostic category defined as follows: “Sexual orientation disturbance.” “This is for individuals whose sexual interests are directed primarily toward people of the same sex and who are either bothered
    by, in conflict with, or wish to change their sexual orientation. This diagnostic category is distinguished from homosexuality, which by itself does not constitute a psychiatric disorder. Homosexuality per se is a form of sexual behavior and, with other forms of sexual behavior which are not by themselves psychiatric disorders, are not listed in this nomenclature.” Homosexuality did go through a few revisions as a DSM diagnosable category, before finally removed altogether. Here was something else Dr. Spitzer noted earlier in this proposal: “The proponents of the view that homosexuality is a normal variant of human sexuality argue for the elimination of any reference to homosexuality in a manual of psychiatric disorders because it is scientifically incorrect, encourages an adversary relationship between psychiatry and the homosexual community, and is misused by some people outside of our profession who wish to deny civil rights to homosexuals. Those who argue that homosexuality is a
    pathological disturbance in sexual development assert that to remove homosexuality from the nomenclature would be to give official sanction to this form of deviant sexual development, would be a cowardly act of succumbing to the pressure of a small but vocal band of activist homosexuals who defensively attempt to prove that they are not
    sick, and would tend to discourage homosexuals from seeking much-needed treatment.” For the full text of this proposal, Google “Homosexuality and Sexual Orientation Disturbance: Proposed Change in DSM-II, 6th Printing, page 44
    POSITION STATEMENT (RETIRED)”.

  6. Barb Boz

    This is a subject that continues to pique my interest. As part of my graduate fieldwork, I am working at a secular non-profit that works with survivors of sexual abuse. I am struck by the number of women (and even the one male that I worked with) who pointedly attribute their same-sex attractions/orientations to their sexual abuse. Thus far, it would seem that the staff have no problem with this.

    So, my question for the larger psychological community would be the following: If a client were to come for therapy with anxiety (or fill in the blank with another symptom: depression, dissociation, hypervigilance, heterosexual promiscuity, etc.) as a result of sexual abuse, we would likely treat the maladaptive responses to the trauma, correct? Why, then, do reactive SSA or homosexuality seem to be ignored as even POSSIBLY maladaptive?

    Thanks for letting me try my question out in this venue. I plan to pose the thoughts to my supervisor during one of our upcoming sessions.

  7. Amy

    Forgive me, I haven’t used the DSM-IV-R since I was working as a therapist..but would “gender identity confusion” fall under Axis 2?

    Sometimes these debates, though fascinating and necessary, fall so short when a person struggling with these issues is sitting in front of you. I knew a guy a couple of years ago who frequented the small mall in which my mom had a store. I would talk to him often about amazing art (very talented individual) and loved his sincerity.

    The weird thing about this guy was his girly scarf, female-looking boots, and his “man boobs”. It wasn’t until he told me that he was in therapy to undergo a sex change that I realized he wasn’t just a weird dresser! One time I had the privilege of seeing him in full out drag (he dressed up just for me..I think it was a compliment). It was hard to know whether to use “him” or “her”. He said that “he” is fine because he was technically still a “he.”

    We talked about the Bible and faith and he was very open to hearing about my experiences and my beliefs, as I was in his. This man had a very painful history of abuse, which he shared a little with me in conversation and explicitly in one of his writings.

    After my mom moved her store to a difficult location, I didn’t see him anymore. I did give him a necklace and a necklace as a parting gift (and flowers at Christmas). I secretly wondered if I was “enabling” or meeting him where he was at–I still don’t know.

    To me, this man was definitely struggling with his identity, never having a proper male role model. Having been abused by men, his gentle nature caused him to identify with his mother. Plus, he was accepted by females, not male. It was natural (in an unnatural way) for him to want to be a woman, not wanting to be a “destructive” male. He talk to my mom and me, but seemed to shun the males around (then again, they were the ones making the smart remarks behind his back). It seems more of a nurture than a nature situation in this case. Though his nature is/was sensitive, not traditionally masculine.

  8. Barb,

    Do let me know about your supervisor’s response. You make a good point. I’d be curious what she thinks of your analogy, at least in cases where there is a clearer connection between the abuse and the identity.

    Amy,

    You would put GID on axis I. and your are right that our debates aren’t always meeting folk where they are at. Thanks for the story you shared.

  9. Phil,

    Thanks for post. I am not a therapist, but a priest, so I don’t have your professional training. I have some SSA people that I give spiritual counseling to who are members of Courage, a Catholic organization of SSA Catholic seeking to live a chaste life. I am intrigued by you comments on attraction and identity.

    Courage does not use the language of identity or orientation but rather attraction for a couple of reasons. First, not all same-sex attracted people call themselves gay or homosexual because some have never acted on their attraction or because they do not want to identify themselves with the gay community and its values/disvalues. Second, Courage speaks of same-sex attraction because theologically a person should not be primarily identified by their sexual interests but by their relationship with God. So, Courage uses the term same-sex attraction in place of homosexuality and same-sex attracted or just SSA in place of the term gay.

    I think Courage’s approach is wise, but am wondering how it fits with what you are saying about attraction and identity being different things.

  10. Barb Boz

    Well, I asked my supervisor the question: when would a therapist consider a client’s SSA or homosexuality as a maladaption from childhood sexual abuse? She seemed surprised that I asked! (She is a terrific lady, but has a different worldview than I.) She said, “Well, I guess it would depend if the client thought it was maladaptive or not.”

    She then referred me to read an article that they use as part of their group therapy, written by David Finkelhor and Angela Brown (1985), which talks about traumatic sexualization. I haven’t read the entire article yet, but find this sentence interesting: “Children who have been traumatically sexualized emerge from their experiences with inappropriate repertoires of sexual behavior, with confusions and misconceptions about their SEXUAL SELF-CONCEPTS, and with unusual emotional associations.” (emphasis mine)

    So far, however, I see no mention in the article of SSA as being one of the possible sexual misconceptions….

  11. APA doesn’t simply state that Sexual Orientation isn’t a disorder if it doesn’t cause emotional or psychological distress, but that Heterosexuality, Bisexuality, and Homosexuality (Sexual Orientation) in and of themselves are not disorders. Sexual Orientation isn’t a disorder because “Sexual Orientation” by modern scientific opinion is Hetero, Bi, and Homo, and none are to be considered disordered. However, if a person experiences distress due to their Sexual Orientation it still isn’t the Orientation that is a disorder, but rather “Ego-Dystonic Sexual Orientation Disorder” or “Dysphoric Sexual Orientation Disorder.”

  12. ” I’m all for reducing mistreatment and violations of constitutional rights. But, I expect my scientific organization to spend my dues in a more balanced manner–faithfully representing what is true, whether attractive or not.”

    I think the amount of truth squashing we’ve seen recently is appalling. As a student of history, it’s amazing to me that the cycles repeat again and again and not enough of us learn to say no to the desire to control others. Human oppression, suppression of thought, speech, action, all for the struggle of ideas. It’s not right on one side, and it’s not right on the other.

    Tolerance is a two way street.

  13. Zetna

    I wish religion would stay out of the equation. Sometimes I think the world does not understand “shades of gray”. I have no doubt that totally gay or totally straight people may be at either end of the spectrum, but there are bi, transgendered, those wanting to “change” their sexuality, those heterosexuals who “dress up”, those heterosexuals who are effeminate, those homosexuals who are “butch”; just a realm of different people and their sexuality. I wish sometimes people would get out of their books and biases and just accept people for who they are! I know this may sound simplistic as I have no degree in psychiatry, but there are so many other things to put intellectual focus on vs. “who is and who isn’t” gay or straight!

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