Monday, April 20, 2009

A casualty in a holy flamewar

Nefesh, the professional organization of orthodox mental health clinicians, has a listserv. As with ABCT, I'm often unable to resist responding to others' posts.

Like this one:

I would like to add that, even when there are chromosomal abnormalities, there can be a strong environmental component. For example, a man with Klinefelter's Syndrome (XXY) may as a result have a large, rounded body, enlarged breast tissue, and small testicles, and that may well lead to the kind of peer rejection that one so often sees in the childhood history of men with homosexual attractions. A man with Klinefelter's might therefore experience homosexual attractions and attribute it solely to his genetic makeup, when in fact it may be not so much his genes that are responsible for the homosexuality, but rather the wounds and problematic gender self-concept that arose from having gone through childhood looking quite different than the average guy.

The original topic was intersex children -- people who used to be called "hermaphrodites." But pseudoscientific blatherings like this annoy me. It's purely hypothetical and sounds like it oughta make sense. But does the writer have any proof? I'll ask him:

I'd be interested in seeing any peer-reviewed studies showing that men with Klinefelter's Syndrome experience more peer rejection in childhood and/or are more liable to grow up to be homosexual because of that. I'd also be interested in seeing any studies demonstrating that homosexual men experienced greater peer rejection as children, which then caused them to become homosexual.

I would think it more likely that boys who grow up to be gay men are less likely to relate well to boys who grow up to be heterosexual men because even as children their interests and personalities are incompatible.

You can't just say it might be true. You have to have statistics. Does he have statistics? Nope, and neither does this other doofus, who wrote in:

The leading psychiatrist that speaks to social or peer wounds as the principal causative factor for homosexuality is Dr. Gerard van den Aardweg, a Dutch doctor who has written widely. After reviewing several studies, he states in one of his books, "The strongest association, then, is not found between homosexuality and father-child and mother-child relationships, but between homosexuality and peer relationships [...] It should be made the prime suspect in any explanation of homosexuality. [...] Feeling less masculine or feminine as compared to same sex peers is tantamount to the feeling of not belonging. (Gerard J.M.Van den Aardweg, The Battle for Normality: A Guide for Self Therapy for Homosexuality, San Francisco, Ignatius Press, 1997, pp. 41, 48.)

Even some gay identified mental health professionals believe that when healthy, non-sexual bonding occurs during childhood, homosexual orientation is avoided. Indeed the psychological team of David McWhirter and Andrew Mattison [both gay men, one a psychiatrist and one a psychologist] conclude that the earlier boys experience same-sex attraction, the stronger the indication that they "apparently failed to make close-knit associations with other boys, and thus their developing ego formation was not influenced by the powerful molding forces of peer conformity." (McWhirter and Mattison, The Male Couple: How Relationships Develop, Englewood Cliffs, Prentice Hall, 1984, p. 136.)

My own personal experience, having worked with ego dystonic SSA men for the past ten years, leads me to unequivocally state that the majority of individuals I have seen that are affected by same sex attraction experience during childhood both a great loneliness and a profound sense of alienation for others of the same sex and that these feelings caused them to seek male connection and bonding through homosexual fantasies and/or behavior.

I hope this is directly responsive to your question; the literature is relatively clear that a lack of healthy bonding with the same sex is a substantial cause and not the result of homosexual ideation.

He hasn't shown me anything from any valid scientific literature that shows that. Ignatius Press? That's not a scholarly journal; that's a Jesuit organization. According to its founder, "our objective is to support the teachings of the Church." Which means they're not going to publish anything about biological or genetic causes of homosexuality. He's not a leading psychiatrist -- he's a led psychiatrist. And the other book is 25 years old.

Thank you for responding, Doofus. However, I'm a bit troubled by the sources you cite. Even though the authors of "The Male Couple" were themselves homosexual, relying on a 25-year-old book to substantiate an argument is not best practice. In 1984, physicians still believed that gastric ulcers were primarily caused by emotional stress.

The fact that Dr. van den Aardweg has written widely about homosexuality does not render his conclusions valid if they have not been replicated by other researchers. I was unable to find any recent articles (written between 2000-2009) by van den Aardweg in the EBSCOhost database or via Google Scholar. Nor was I able to find any articles in that time period that cited van den Aardweg's works as a reference.

I was, however, able to find a meta-analysis and several studies suggesting that fraternal birth order -- being born after several brothers -- correlates significantly with homosexuality. I was also able to find many articles that suggest experiencing peer rejection -- i.e., bullying -- can lead to a number of psychopathologies, including psychosomatic symptoms, depression, anxiety, eating disorders, and substance use. Virtually every school shooter in the past 20+ years was the victim of years of particularly harsh peer rejection and suffered from severe psychopathology.

If anyone has any recent studies clearly demonstrating a strong correlation between peer rejection and homosexuality, I'd be most interested in seeing them.

How did Doofus take that? Not lying down:

To denigrate classical sources in the field because of their age does not speak to their validity. Do you believe that Freud, Jung, and other classic theoreticians in the world of psychology are outdated? Are their findings null and void? Let us not forget that the majority of writing today struggles to keep in tune with the politically correct culture prevalent today; in doing so, many unsubstantiated gay affirmative theses are set forth. A new study to be released shortly in the Journal of Human Sexuality will cover a response to many of the fallacious arguments set forth by these gay affirmative writers.

However if you would like a most current citation that sex same peer wounding is a cause of homosexual ideation, I can refer you to parts of the article by Fitzgibbons, Sutton, and O'Leary, "The Psychopathology of Sex Reassignment Surgery: Assessing its Medical, Psychological, and Ethical Appropriateness" that just came out in the Spring 2009 National Catholic Bioethics Quarterly. Strewn throughout the article are many references to the fact that same sex attraction issues come from childhood wounding. One example out of many is their suggestion that "Therapists are often unable to overcome patient resistance and uncover the underlying problems---serious emotional weaknesses of low self-esteem, sadness, and anger associated with the failure to develop secure attachment relationships in childhood and adolescence." (p.119). You may also wish to review the recent book (I think it came out in 2008) entitled "Gay Children, Straight Parents: A Plan for Family Healing" by Richard Cohen that provides reports to the same effect.

I can also state from personal experience in working with men (in particular) and women with unwanted same sex attraction. In case after case, the client explains how he was rejected by his peers as a young child or perceived himself as separated from his same gender peers. In turn, he began sexualizing an envy of others of his same sex. When we who work with this population are able to provide support groups for him and ultimately explain to him the opportunities to receive healthy, non-sexual bonding with others of his own gender, his same-sex attraction is generally either severely diminished or totally evaporates. Homosexuality is, after all, simply an emotional adaptation (and non-genetic) and a by-product of a confluence of risk factors, including certain unfilled needs for attachment and bonding with his own sex. When those can be filled in healthy non-sexual ways, the homosexual feelings dissipate.

This is fun. He is completely full of crap, and I'm going to pierce his thick skin and let it all ooze out.

Doofus, even groundbreaking theorists such as Freud must be subject to modern critique. Freud famously asked, "What does woman want?" after concluding that in order for man to be happy, he needed love and work. It apparently never occurred to Freud that women might also need work to be happy. Instead, he postulated that they felt incomplete because they lacked penises.

While I'm oversimplifying a bit, my point is that many theories are developed within a narrow cultural context but do not generalize accurately to a wider population. From my understanding, even contemporary psychoanalysts have moved beyond a strict adherence to Freudian theory. But to compare van den Aardweg or McWhirter and Mattison to Freud strikes me as rather premature.

I confess I am not familiar with the National Catholic Bioethics Quarterly. According to its publisher, the National Catholic Bioethics Center, "The National Catholic Bioethics Quarterly addresses the ethical, philosophical, and theological questions raised by the rapid pace of modern medical and technological progress." It does not publish original research.

Furthermore, its title (and a brief overview of its website) indicate that it is as biased against a genetic or biological basis for homosexuality as you state the "PC" studies and meta-analysis I mentioned are biased to find such bases. I would be very interested in seeing the references Fitzgibbons, Sutton, and O'Leary cite that demonstrate how peer rejection in childhood causes homosexuality in adulthood. It is possible that a child who at an early age demonstrates homosexual tendencies might subsequently be rejected by his peers. Childhood memories might not be a very precise determinant of which came first.

Nor does one clinician's admittedly vast experience, and genuine concern and caring for clients' suffering, prove causation. Even Freud was bound by the limitations imposed on his outlook by his culture and upbringing. Without controlled and widely replicated studies by numerous scholar-practitioners, any amount of clinical experience is still anecdotal. Such experience is no doubt invaluable in providing effective therapy and treatment, but it cannot always ascertain the etiology of a person's troubles.

I could not find any reviews of Richard Cohen's book in the scholarly literature. According to the
Washington Post:

[Cohen] is not licensed as a therapist, he explained, because he "didn't want to jump through the hoops and deal with the heterophobia and anti-ex-gay attitudes." He circumvents the licensing requirement by asking for donations to his foundation. "I am not doing therapy per se," he said. "I'm coaching."

In 2002, Cohen was permanently expelled from the American Counseling Association (ACA) for multiple ethical violations. Permanent expulsion is a rarely used sanction, according to David Kaplan, chief professional officer of the Alexandria-based organization. Kaplan said Cohen was found to have violated six sections of the ACA's ethics code, which bars members from actions that "seek to meet their personal needs at the expense of clients," those that exploit "the trust and dependency of clients," and for soliciting testimonials or promoting products in a deceptive manner....

Touch plays a central role in his therapy, said Cohen, who does not treat women. He recommends that clients develop intimate friendships with heterosexual mentors who will cuddle them in a parental, nonerotic way, making up for the love they did not get from their fathers. "You've got to feel it to heal it," he said (emphasis added).

It is possible the ACA has been conducting a witch-hunt to weed out anti-gay sentiment among its members. However, Cohen was expelled for inappropriate conduct. I only have one female client -- I work with parolees and most of my clients are male -- but I have never cuddled her. If I did, I'd lose my job and quite possibly my license. I do not think Mr. Cohen, M.A., will rival Freud anytime soon.

I appreciate the opportunity to discuss these issues with such experienced and eclectic clinicians.

I threw that in to be polite. I'm really eviscerating him. He's not proving anything, and his "experts" aren't scientifically valid. How does Doofus respond? He evades the essential issue.

You are right in that Richard Cohen was the subject of a witchhunt. You are in error however that "Cohen was expelled for inappropriate conduct." The specific action for which he resigned--he was never expelled--(he chose to not waste time nor energy on a trade group that was a non-licensing agency) was that one of his clients actively worked to promote his books and videos. That was interpreted in the filed complaint as seeking to meet his own personal needs at the expense of clients, having clients solicit and promote products that he created, and thus exploiting the trust and dependency of clients. He was never accused of cuddling a client by the ACA and indeed if you read his website, you will see that he specifically states that a therapist should never hold a client. It always amazes me how the false information gets regurgitated and the true information gets lost.

Is that the case? Not really. And the proof is on video.

One minute into this video clip, Mr. Cohen demonstrates his "holding" technique, which he describes as a substitute for the affection his client's father failed to provide:

Mr. Cohen indeed left ACA after being accused of ethical violations other than holding his clients, but hold them he undeniably does.

Moreover, I cannot believe any responsible clinician would recommend that any client see a person who refuses to obtain a license and abide by the accompanying oversight and standards. Psychiatrists must be licensed in order to prescribe medications. Should we expect anything less from therapists educated as social workers or psychologists? Should we encourage anyone to style himself a "coach" or therapist and proclaim his ability to heal psychopathology without any kind of supervision? What is the next logical extension, exorcisms to rid gay people of their demons?

We have strayed from our main point of disagreement, however. As yet, no one has furnished this listserv with any solid evidence that peer rejection in childhood causes homosexuality in adulthood. Indeed, even Mr. Cohen attests that homosexuality is rooted in the child's failure to bond with the same-sex parent.

Why is Doofus only citing unlicensed counselors? Because Doofus... is an attorney. He has no scholarly or clinical credentials. But apparently I'm not allowed to say that, because it would be perceived as mean-spirited.

I'd share the rest of the exchange with you, but I think it's probably only of interest to clinicians. If it's of interest to anyone. The main point is, Doofus has no valid basis for his interventions or theories, no clinical training, and no oversight. He has a license to practice law, not to give therapy. I don't offer to defend people in court; he shouldn't mess around in people's heads.

Anyway, while Doofus and I duked it out, several Nefesh members emailed me covertly to support my point of view. Including one, Dahlia, who wrote:

I am writing this back-channel just to you alone.

I sincerely hope you are going to go on for a doctorate, publish up 'the pedudies'; teach in university and work as the wonderfully gifted clinician your posts suggest you are.

May emperors around the world be warned and know that your eagle eye has seen them without their 'finery' and for themselves.

I hope you have zillions of children, grandchildren, etc.,etc., etc, as your 'smarts' are too great a gift not to share.

How comprehensive a bracha is that?! I wrote back:

Thank you so much, Dahlia. I probably will end up getting a doctorate, and if I manage to get married, I hope to have children. I very much appreciate your support :)

Which led to... ugh:

Speaking as someone who married after high school, and began the long road to BA, MS, PhD and whatever else as a mother, grandmother and I'm honored to say great-grandmother, you have your priorities out of order!

Get ye that husband, start on the kids and go on for the doctorate and post-doc etc.

All the best and looking forward to meeting B'EH at the Nefesh Conference in L.I., NY in Dec. or in Jerusalem in January.

Keep writing.

Sigh. I know she means well, but that hurts.

Dahlia, you cut me to the heart. I've been seeking a husband for more than 16 years. Believe me, that would have been my first choice, but it hasn't happened despite my greatest efforts. It's wonderful that you married young and didn't have to endure the slow-motion soul destruction known as "dating," and that you're a distinguished matriarch. I'm very glad some of us are able to perpetuate Am Yisroel. 

In contrast, getting 2 master's degrees took me less than 5 years. I know I could get a PhD and teach if I want, and I'll probably also publish more. I think my career will become my major focus in life, because at 38 I'm starting to think that marriage and children will not happen for me.

You and I met briefly at lunch at the last Nefesh conference, but I look forward to seeing you at the next one!

Doofus might be one casualty of this flamewar, but so am I.
Copyright (c) "Ayelet Survivor"

1 comment:

  1. Amazing that some people can't distinguish between correlation and causation.

    In God we trust- all others bring data.