It’s not just the buses that we should be bothered about
A twitter storm erupted earlier this afternoon, after plans were announced to plaster adverts on London buses next week with the slogan “Not gay! Ex-gay, post-gay and proud. Get over it!”. The slogan is the brainchild of the Core Issues Trust, a “Christian initiative seeking to support men and women with homosexual issues who voluntarily seek change in sexual preference and expression.” It is their carefully-worded belief that mainstream psychiatric knowledge is incorrect, and that some people who are homosexual do not want to be so, and need help becoming ‘ex-gay’. Thankfully, common sense won out, and a few hours later, Boris Johnson stepped in and blocked the advertising campaign from going ahead. Great, story done.
Well, not quite. Although the quotes from the proponents of the advert campaign didn’t push any published evidence suggesting that so-called ‘reparative’ or ‘reorientation’ therapy works, I am concerned that in the coming days and weeks, when this issue is brought up again in the media, evidence from two papers will be bandied about. The papers in question were published in 2007 and 2011 by two researchers called Jones and Yarmouth. The first, entitled “Ex-gays?: a longitudinal study of religiously mediated change in sexual orientation” (you can read excerpts here) is a book published by InterVarsity Press, the publishing arm of the UK’s Universities and Colleges Christian Fellowship. In other words, it’s not been subjected to the usual rigors of the scientific peer-review process; treat it with a (big) pinch of salt.
The other paper, however, has been peer-reviewed, and appears in the Journal of Sex and Marital Therapy (here, but behind a paywall). The study involved following just under 100 men and women for a period of 6-7 years. The individuals had identified themselves as ‘troubled with their sexual orientation and participated in specific Exodus-affiliated ministries to achieve ’freedom from homosexuality through the power of Jesus Christ’. Using self-report measures of homosexual/heterosexual thoughts, and measures of distress, the authors report that, overall, the individuals experienced a ‘positive’ (their words) shift towards heterosexual experience, and on average, the therapy was not harmful to them.
All of the individuals in this study were members of Exodus International, a coalition of Christian ministries in the United States. Sixteen of these affiliated ministries contacted their members, and it was then up to the individual whether or not they wanted to take part. This creates a problem known as self-selection bias. Put simply, selecting a group of participants for an experiment in this way makes it difficult to determine whether the cause of any results you collect is due to the variables that you’re interested in, or due to a random commonality that the participants share. In the case of this study, one basic issue is that because the authors were relying on participants to contact them to take part in the study, everyone who eventually took part clearly had a specific motivation to be involved. But they might also share other common factors; it’s difficult to speculate on what these might be because the authors don’t report any attempts to assess them.
A second point of contention is that while the authors report that overall, their participants experienced a shift towards heterosexual experience, it’s a pretty weak effect – out of 61 participants remaining in the final year of assessment, 31 reported this shift, and 30 reported no shift or a shift in the opposite direction. Worryingly, for the measures of harm, whilst the authors report some modest yet significant positive trends, they also note in the discussion that they “cannot conclude that particular individuals in this study were not harmed by their attempt to change. Specific individuals may claim to have experienced harm from the attempt to change, and those claims may be legitimate, but although it may be that the attempt to change orientation caused harm by its very nature, it may also be that the harm was caused by particular intervention methods that were inept, harsh, punitive, or otherwise ill-conceived”. Essentially, it appears that there was no standardised method of delivering the therapeutic intervention, and from this sentence, there is the suggestion that some of the interventions were, to put it mildly, inappropriate or unethical.
So to summarise, the paper reports weak trends in a biased sample, which to be honest, isn’t good enough. On the back of this work, it is pretty much impossible to come to any meaningful conclusion about whether sexual orientation can be changed via the use of religious interventions. And it’s really serious that the authors mention that the therapy was causing harm to some participants; there should have been clear ethical guidelines in place, as there are for any good scientific study. All of these issues should have been flagged during the review process for this paper, and I fear that on this occasion, standards might have slipped. But please bear these issues in mind when you see papers like these being thrown about as evidence for the efficacy of reparative therapy.