Peer Commentaries on Spitzer (2003)

The issue of whether people can change their sexual orientation has been obscured by moral controversy ever since homosexual orientation was “constructed” in the late nineteenth century (Bancroft, 1989, 1994). On the one hand, any evidence that such change has occurred has been used by those who condemn homosexuality as evidence of its “acquired” nature which, they would argue, is consistent with it being sinful; on the other hand, those who defend the homosexual reject evidence of such change on the grounds that those changed cannot have been true homosexuals in the first place (e.g., Ellis, 1915). Rational debate about the extent to which people can change, and what characteristics might predict the potential for such change, therefore becomes rapidly buried. I am more than familiar with this long-running controversy. In the 1960s, early in my career as a budding behaviorist, I carried out research to assess whether behavioral techniques, such as aversion therapy or systematic desensitization, could modify sexual preference in men (no women presented themselves for such treatment). My experiences fairly quickly led me to conclude that such interventions were ineffective. But in reporting my findings (Bancroft, 1974), I came under attack from members of the Gay Rights Movement for attempting to impose societal norms on those with a homosexual orientation, and in the process reinforcing the social stigma. Thus, somewhat unwittingly, I found myself in the midst of this moral controversy. This, needless to say, caused me to reflect (Bancroft, 1975). In no way had I rejected homosexuality as a sexual lifestyle nor had I regarded it as pathological. In my innocence, I was responding to the requests of some homosexual men to help them to change and escape from the social stigma their sexuality brought upon them. Also, as a researcher, I wanted to know whether the claims of “reorientation” that were being made by other behavior therapists, in particular MacCulloch and Feldman (1967), could be substantiated. The use of such interventions did not imply that homosexuality was a pathology, but rather an aspect of behavioral responsiveness that might be modifiable with these new behavioral techniques that were based on so-called “modern learning theory.” Times were different then. The Gay Rights Movement was early in its development and it was much more likely than it is today that individuals would seek such change. But on reflection, I realized that, whereas I was genuinely trying to help the individual, in the process I was aligning myself with those who reinforced homophobic attitudes and all the consequences of the stigma that ensued. It did not continue to be a dilemma for me, as my own results gave me no reason to continue to use such simplistic interventions. Then, in 1973, the American Psychiatric Association (APA) removed homosexuality from the DSM, in the process rejecting the notion that it was inherently pathological (Bayer, 1981). Although revealing considerable division of opinion within the psychiatric profession on this issue, this step could be regarded as the official end of the medicalization of homosexuality, which up to that time had been pursued steadfastly by the medical profession. As if to reinforce this “demedicalization,” the APA has since periodically issued statements about the immutability of sexual orientation, and that it is unethical for clinicians to attempt to change it with therapy (American Psychiatric Association, 2000). What has happened since 1973 is that “the Church,” in many of its manifestations, has stepped into the breach, reviving religious opposition to homosexuality in terms of immorality rather than pathology. Given that Spitzer played a key role in the APA’s demedicalization of homosexuality in the 1970s, it is interesting that he has recently paused to reconsider, if not the pathology of homosexuality, at least its immutability.