Mental health status and homosexuality

Since the LA Times article appeared in October, I have received several emails asking about various aspects of my views that were reported in the article. Some ask about my view that same-sex attraction does not always stem from poor parenting, others ask about my views on homosexuality and increased risk for pathology. I have covered the parenting issues in prior posts and want to address briefly the matter of risk for pathology.

Some wrote to say that when I was characterized by reporter Stephanie Simon as believing homosexuals can have a “fulfilling life” that I ignore research documenting a higher level of mental health problems among homosexuals.

I disagree that the reporter’s characterizations of my views ignore social science research. On the contrary, my views are quite consistent with what we know about homosexual adjustment. While there are consistent reports of elevations of various mental health problems among homosexuals, there are many homosexually identified people who are untroubled by diagnosable conditions.

For instance, the most recent published comparison of gays and straights on suicidality found that homosexuals were more likely to feel suicidal than heterosexual participants, even with psychiatric history considered. However, the effect sizes on dimensions of self-injurious thoughts and behaviors were small to modest (2-4%). For women, when psychiatric history was considered, the relationships disappeared for all indicators except the contemplation of self-harm. Even for men, the modest effect sizes indicate there is much overlap between straight and gay groups; the results cannot be accounted for by sexual orientation differences alone. (Archives of Sexual Behavior, June 2006).

To withhold “even the possibility” (quote from the LA Times article) of homosexuals experiencing happiness is not warranted by the research we have. In all studies of psychiatric problems among homosexuals, large numbers of homosexuals report no psychiatric distress. In the study of suicidality noted above, the majority of homosexuals reported no indication of difficulty. While rates are frequently elevated among homosexual men, and sometime among lesbians, such elevations do not preclude the possibility of a satisfying life. If so, then we would need to extend such thinking to other groups (both essential human categories and those socially constructed as well) where elevated risks are found. For instance, other groups who have elevated risk for depression include the elderly, women, people of low socioeconomic class, people who smoke, people living in high stress situations, and people with chronic medical conditions. Suicide risk is elevated among Native American teens compared to all youth (2.5 times). Higher rates of psychiatric disorders and substance abuse problems have been reported among physicians. Evidence from a large study of physician suicide indicates that the suicide rate among male doctors is twice that of men in general. The rate among female doctors is four times higher than for all women. (South Med J 93(10):966-972, 2000). Women in general are about three times more likely to attempt suicide than men. Would one deny the possibility of a rewarding life to members of these groups? Surely not.

Thus, it would be inconsistent with the research on psychiatric risk to deny members of at-risk groups “even the possibility” of a “fulfilling life,” whether partnered or not. Higher risk, yes; inevitable mental health maladjustment for all members of a group of people? No.

PS – I want to note that some of the correspondence about the LA Times came via a coordinated effort from NARTH to my college with the intent to appear that the effort was not coordinated.

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  • Anonymous

    Dr. Throckmorton: Do you believe NARTH wants to make homosexuality a disorder again?

  • http://www.blogger.com/profile/10337165 Throckmorton

    I do not think NARTH has an official position on the subject. I suspect the position on that question would vary from NARTH member to NARTH member.

  • Anonymous

    Dr. T: “Higher risk, yes; inevitable mental health maladjustment for all members of a group of people? No.”

    I appreciate your scholarship and honesty. There are many who would like to believe that all gays are invariably maladjusted. Thank you for not overstating the facts.

    “Higher risk” may be the result of tougher societal pressure on this group, not a result of being gay.

  • http://www.blogger.com/profile/10337165 Throckmorton

    Anon: Yes, it is true that we do not know if homosexual orientation per se contributes to the higher risk. It is important to note that finding or suggesting orientation based risk is not to be critical, any more than finding group based risk in any group is being critical. A genetically minded researcher could conclude that such risk co-occurs with genetic or pre-natal factors. Conversely, the higher risk could be due to social factors that are precursors to sexual orientation but not the same-sex attraction itself.

  • Anonymous

    One article on the NARTH website does not mean their official policy is to re-classify homosexuality as a mental illness but this one seems to advocate for this outcome…

  • Anonymous

    Here is a gem from the NARTH article calling for homosexuality to become a disorder again:

    “For these reasons, I do not think it is far-fetched to use the analogy that the “drunks are running the rehab center,” in reference to the APA’s–at least as far as homosexuality is concerned. Active homosexuals can hardly be objective about an addictive behavior they engage in themselves.

  • http://www.BoxTurtleBulletin.com Jim Burroway

    I was, with many others engaged in a debate on another website with a Lutheran author. Everything was going fine, if a bit contentious here and there, when suddenly he let loose with a posting that, in essence… well, let me be accurate:

    “Disease-causing behavior, coupled with denial of lethal dangers, provides strong evidence that gay orientation is a compulsive and addictive condition – with practitioners looking for self-justification in a pseudo-identity.”

    I rather angrily and abruptly put my two cents worth in, and I am still too angry to apologize for my harshness.

    Um, okay, so maybe this homosexual is exhibiting a temporary moment of emotional agitation.

    But I have to say Warren, that your post was one of the finest and most forceful on the subject that I’ve read in quite a while. Thanks.

  • http://www.blogger.com/profile/10337165 Throckmorton

    Thanks Jim. I’ll have to go check that out.

    Let’s look at this another way. There are several spots in the world where people live longer and have much less disease than we do here. Aging researchers call them blue zones.

    Here is a description of Okinawa:
    Okinawa is home to the world’s healthiest, longest-lived people. They live seven years longer than Americans do and suffer about one fifth the rate of heart disease and cancers that kill us. Since studies have shown that 75% of how long we live is determined by lifestyle (genes account for only about 25%), Okinawans literally possess a modern day fountain of youth.

    Should we all move to Okinawa or convert to animistic religions because Okinawans have longer and healthier lives? Getting to a question of principle, is pragmatism the test of morality or propriety?

    Group measures of central tendency can provide clues about healthy lifestyle practices in general but say nothing about what persons in a given class do at the individual level. Efforts to derive a moral position from group lifestyle outcomes can make the average American Christian appear to be in need of a conversion. I, for one, don’t want to base my moral reasoning solely on pragmatics. I am too old to learn Japanese.

  • http://www.straightintogayamerica.com Lars Clausen

    HI Warren,

    A question about the influence of an unaccepting society.

    I recently authored “Straight Into Gay America: My Unicycle Journey for Equal Rights,” (http://www.straightintogayamerica.com) and I’m in a conversation with another Lutheran Pastor who authored “Understanding Homosexuality.”

    Glesne writes in his book that homosexualas are generally not happy.

    What I don’t see anywhere in his book, or anywhere on the bits of NARTH material I’ve read, is any consideration that living in a hostile society is a factor in causing unhappiness and even suicide. (how many more consititutional changes this week to “protect marriage?”)

    I very much appreciate your article here, and would appreciate your elaboration on how living in a hostile society affects suicide numbers. It’s hard for me to understand how people blame the victims rather than understanding societal influences.

    Thank you for your work,
    Lars Clausen

  • http://www.blogger.com/profile/10337165 Throckmorton

    Lars: Thanks for the comment and question. One wishes for much better data to address such a question. I am going off the top of my head so I don’t have exact references but can get them if need be. Some research into the impact of stigma has found a relationship between mental health outcomes and some has not. The most recent study of suicidality for instance, asked participants about perceived discrimination and even factoring this in, homosexuals still demonstrated risk on two of the four dimensions of suicidality (and this being in a country where gays can marry – the Netherlands). I would like to hear your take on these kind of findings in countries where marriage is available.

    As an aside, even in countries where marriage arrangements are available, they are not often pursued. I was very surprised in researching the Danish study of environmental correlates to marriage decisions to find that only 1-3% of Danish gays took advantage of the legal recognition.

    Also, in an English study, gays had higher morbidity but the level of perceived teasing/bullying socially was no different than straights. However, other work has found relationships between perceived discrimination and mental health outcomes.

    In examining the list of groups demonstrating higher depression and suicide, one would not posit discrimination as an explanation which raises the possibility that the higher risks found for gay men and some lesbians are tied to something else, either in addition to discrimination or apart from it. And since we know that health status in general is strongly related to choices in living, it is plausible to wonder if there are certain actions that may associate with worse outcomes. It is not prejudicial to explore this.

    To me, the most troubling empirical hurdle you would need to address is why the health/mental health risks persist in countries where the culture is tolerant and marriage is available. By no means are the data flawless, but it does not seem to trend in the direction you would predict.

    Now having said all of that, I want to be very clear that I think there could be some percentage of the variance that is accounted for by societal disapproval, I currently suspect it is small to modest in amount.

  • Anonymous

    About reclassifying homosexuality as a mental illness, Throckmorton said:

    “I suspect the position on that question would vary from NARTH member to NARTH member.”

    One position they all seem to agree on is that it’s a good idea to keep guys like Berger and Schoenewolf on their panel of expert advisors, so I suspect that most of them would celebrate if the APA decided to call us sick again.

  • http://www.blogger.com/profile/28731968 Michael Bussee

    Dr. Throckmortonm: “The most recent study of suicidality for instance, asked participants about perceived discrimination.”

    What about the discrimination which is NOT precieved? By that, I mean all of those sublte and ubiquitous messages (in advertizing, in the media and even in casual everyday interactions) that straight is better than gay — more acceptable, more expected, more moral, more OK with God and somehow “the way it’s supposed to be if your’re a good an normal person.”

    I am thinking of all those almost subliminal “cues” that tell you who is “OK” and who is not. It doesn’t have to be “percieved”. In fact, it often isn’t. It becomes part of the cultual and enrvironmental gestalt.

    And you sense — your KNOW when you are an “other”. I knew it at age 5. I knew on an intuitive level that I needed to hide who I was in order to be accepted and safe.

    Maybe that internalized sense of being either “one of us” or “one of them” is what adds to the increased suicidalily, not the more overt, consciously perceived discrimation.

  • http://www.BoxTurtleBulletin.com Jim Burroway

    To me, the most troubling empirical hurdle you would need to address is why the health/mental health risks persist in countries where the culture is tolerant and marriage is available.

    I think it would be important to separate the two. A culture can be tolerant, and and marriage may be available. But the fact that marriage is available does not necessarily mean that the culture is tolerant. I thnk it is important to de-couple the two.

    There was a recent high-profile gay-bashing on American Chris Crain, editor of the Washington Blade. The London Times carried this article, in which the Amsterdam Tourist Board warned, “Gay visitors should be careful and alert. Some people in Amsterdam are not tolerant of other people. It is a social problem.”

  • http://www.blogger.com/profile/28731968 Michael Bussee

    I agree with Jim completely:

    “But the fact that marriage is available does not necessarily mean that the culture is tolerant.”

    Ellen Degeneres has a hit TV show and my best friend was stabbed to death for being gay — both in tolerant Southern California.

  • http://www.blogger.com/profile/10337165 Throckmorton

    I agree with your caution, Jim and Michael. I was posing the “hurdle” as a direct answer to Lars’ question about marriage. On point, an ex-gay friend of mine says that Denmark has very strong dislike of gays to the point where it was troubling for him as an ex-gay man and yet Denmark has a reputation for being a very tolerant society.

  • Anonymous

    In the Danish studies you mentioned, do they compare depression (and/or suicidiality) rates of the gay population to the general population? If so how does that compare with rates in the US?

  • Tim Fisher

    Dear Dr. Throckmorton,

    Just a few anecdotal reports about continuing social stigma against gay/lesbians in the Netherlands:

    http://www.deve.org.yu/panel.htm
    http://www.thevillager.com/villager_111/forsomegaypartners.html

    These don’t demonstrate how MUCH stigma persists, of course. Not by any means. It’s just to say that it still exists there.

    For what it’s worth, and without making any grand conclusions, I note several other studies which suggest that social stigma is the likely culprit in the greater amount of distress felt by gay and lesbian people than by heterosexuals. In a review of the relevant literature, Sandfort writes,

    “The effects of social factors on the mental health status of homosexual men and women have been well documented in studies, which found a relationship between experiences of stigma, prejudice, and discrimination and mental health status.”

    Sandfort’s review also found that

    “Controlling for psychological predictors of present distress seems to eliminate differences in mental health status between heterosexual and homosexual adolescents.”

    In this regard, of particular note is a population-based study of 2,917 adults (73 of whom were non-heterosexual), in which researchers Mays and Cochran came to the following conclusion:

    “[Our] study shows that controlling for differences in levels of discrimination experiences between lesbian, gay, and bisexual persons and heterosexual individuals greatly attenuates the association between sexual orientation and prevalence of stress-sensitive psychiatric disorders and other indicators of mental health difficulties. These findings support the perspective that discrimination has harmful mental health effects for sexual minorities.”

    In another review, Bontempo and D’Augelli report that

    “Victimization has been found to mediate the association of sexual orientation and suicidality. In a representative study, higher levels of an index of violence and victimization were predictive of suicide attempts. Among lesbian, gay, and bisexual youth, suicide attempters have also been found to be more likely than nonattempters to report prior verbal insults, property damage, and physical assaults.”

    Cheers,

    Tim Fisher
    Minneapolis, MN

    Bontempo, D. and D’Augelli, A. (2001). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364–374.

    Mays, V. and Cochran, S. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869-1876.

    Sandfort, T.G. et al. (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands mental health survey and incidence study (NEMESIS). Archives of General Psychiatry, 58, 85–91.

  • Anonymous

    Throckmorton: “Getting to a question of principle, is pragmatism the test of morality or propriety?”

    No. Morality needs a much stronger test than pragmatism. The way I see it, any true morality is based on empathy — the ability to imagine oneself in another’s shoes and to treat others the way we would like to be treated. The world’s great religions seem to agree on this.

    True morality is about kindness, fairness and justice, not about whether or not a particular behavior is on a list of “do’s and dont’s” somewhere. In fact, sometimes rigid obedience to “the list” can be sin — especially if I try to force my list on you.

  • http://www.blogger.com/profile/28731968 Michael Bussee

    Tim Fisher: “I note several other studies which suggest that social stigma is the likely culprit in the greater amount of distress felt by gay and lesbian people than by heterosexuals.”

    This is what gay peiople have been trying to get reparative therapists to understand for years. They still have trouble “getting it”. They blame the victim. Fix the bigotry, not the orientation.

  • Anonymous

    I view the roots of human sexuality as universal. Anybody can have any kind of attraction for anybody. Freud called it “polymorphous perverse”. So Sex orientation is recruited, or found, or taught, but is not genetically imparted, except in extreme second and third son situations, which impart a foetal auto-immune block on second son maleness. These auto-immune scenarios cannot encompass the entire population of same-sex preferences. Basically, much of it is a simple lifestyle choice, the added titillation being found more personally rewarding than a coldly imparted societally-enforced role. The hetero role is not “normal”, only culturally so. However, the homo impulse is not “inevitable”, except in a small minority. Look to bonobo chimpanzees for biologically-near demonstrations of this many-sexualities potential, in an entire population.

  • http://www.blogger.com/profile/10337165 Throckmorton

    Anon (20th comment) – Perhaps you could share with us the data that led you to confirm the materal autoimmune response. Dr. Bogaert will be quite interested in this as will others since no one else has any direct evidence for it. You speak as if the maternal immune response is common knowledge.

  • Tim Fisher

    Dear Dr. Throckmorton,

    You write (above):
    “The most recent study of suicidality for instance, asked participants about perceived discrimination and even factoring this in, homosexuals still demonstrated risk on two of the four dimensions of suicidality (and this being in a country where gays can marry – the Netherlands).”

    After reading the study, I have a few things to note. First, the study reports that there was only one question about “perceived discrimination.” The survey asked if the subject “had experienced discriminatin over the preceding year because of her/his sexual orientation.” A single question, worded very broadly, doesn’t seem like a great measure of perceived discriminatoin.

    Second, and perhaps more important: the question only asks about the previous year, while the questions dealing with issues of suicidal ideation cover the person’s lifetime. Not a great overlap there. The authors acknowledge this limitation.

    Third, the Netherlands didn’t offer domestic partnership registration until 1998, while the study’s info comes from 1996. And that country didn’t allow fully equal same-sex **marriage** until 2001.

    Now, I am a little confused as to what numbers you are looking at when you say “even factoring [perceived discrimination] in, homosexuals still demonstrated risk on two of the four dimensions of suicidality.” Which column of which table are you looking at?

    Thanks,

    Tim Fisher
    Minneapolis, MN

  • http://www.blogger.com/profile/29290591 Timothy Kincaid

    Anon (20th comment), I agree with Dr. Throckmorton that you are making some rather unsubstantiated claims.

    Not only is the auto-immune block a hypothesis (well, really little more than a guess), but there is literally NOTHING to support your supposition about “simple lifestyle choice”. I don’t think there is any informed credible person in the debate that believes this – not even many of the religious anti-gay activists.

  • http://www.blogger.com/profile/10337165 Throckmorton

    Tim: Those are all important limitations of this study. Nonetheless, the study provides data on point to Lars question. The narrative of the study is where I saw the discrimination-suicidality relationship. I will look at the study for the page number when I get a chance.

  • Anonymous

    One can’t say that there is literally nothing to support the idea of homosexuality being a lifestyle choice in some cases: some gays and lesbians believe they chose their orientation, and this shouldn’t count for more or less than the beliefs of other gays and lesbians that they were born that way.

  • Anonymous

    “some gays and lesbians believe they chose their orientation.”

    Some people believe the world is flat. I am not trying to deny their inner experience, but believing something does no make it so.

  • http://www.blogger.com/profile/29290591 Timothy Kincaid

    Anon,

    Please don’t keep making unsupported statements that have no basis in fact. It’s embarrassing.

  • http://www.blogger.com/profile/28731968 Michael Bussee

    I have a couple of gay friends who believe they “chose their orientation.” When pressed to clarify, they tell me that they accepted it, or came to terms with it — not that they decided who to be attracted to and who not. That basic attraction seemed to be “buit-in” somehow. It did not seem to be a matter of choice for them — or for anyone I know.

  • Anonymous

    It would help if Timothy Kincaid could indicate which anonymous comment his remark was about. Assuming his remark was about my suggestion that some gays and lesbians believe they chose their orientation, I’m a little puzzled: does he really think that no one has ever claimed this? People have.

    Simon LeVay notes on pages 6 and 7 of Queer Science that Darrell Yates Rist claimed to have chosen his homosexuality. Rist is quoted saying, “It seems to me cowardly to abnegate our responsibility for the construction of sexual desires. Rather, refusing the expedient lie and insisting instead on the right to fulfill ourselves affectionally – in what ever directions our needs compel us, however contrary to the social norm they may be – is both honest and courageous, an act of utter freedom.”

    LeVay also cites an Advocate survey in which 15 per cent of lesbians said that choice had something to do with their sexual orientation.

  • http://www.blogger.com/profile/15371855 Boo

    It would help if Timothy Kincaid could indicate which anonymous comment his remark was about. Assuming his remark was about my suggestion that some gays and lesbians believe they chose their orientation, I’m a little puzzled: does he really think that no one has ever claimed this? People have.

    People can claim anything they want, the question is whether the claim has basis in fact. I know of no credible evidence to support the claim that one chooses what one finds arousing.

  • http://www.blogger.com/profile/10337165 Throckmorton

    Lesbians will say they chose to pursue same sex relations more so than men. With men, however, we are probably talking about a limited subset of men who intentionally pursue homosexual relationships. This website might be of some interest to this discussion: Queerbychoice.com

  • Tim Fisher

    I find it difficult to know what to make of some of the statements I find on the Queerbychoice website. By no means do I discount everything I see there. But then I come across things like this:

    “Myth #7: When we call our queerness a choice, that must mean we’re really bisexual.

    “Reality: Some of us are certainly bisexual, but others of us will tell you that we are not attracted to the opposite sex in the least. Some of us may have experienced attraction to the opposite sex in the past and ceased to do so, but others of us state in no uncertain terms that we have never experienced the slightest attraction to the opposite sex in all our lives. What we all have in common, however, is that we feel that our attraction or non-attraction results from choices we have made and/or continue to make.”

    What can it possibly mean to “choose” to be attracted to the one sex if you have never been attracted to the other in the first place? It seems that the site, at least sometimes, is working from a different sense of “choose” than me.

    It seems there is at least a modicrum of politics going on here. I don’t mean “politics” in the Liberal vs. Conservative sense, but rather in the sense that people will sometimes “claim and name” something in order to gain a certain sense of personal and social empowerment.

    One thing I certainly agree with, is that, in many many cases, an individual indeed “choose” to love another individual. In my case, for instance, I am “oriented” toward my wife. On that level, at least, I can agree with the sense of “choice” that the site seems to work with.

    Tim Fisher
    Minneapolis, MN

  • http://www.blogger.com/profile/28731968 Michael Bussee

    About choosing one’s orientation, Anonymous (11/15/05) said: “I’m a little puzzled: does he really think that no one has ever claimed this? People have.”

    People have claimed lots of things. Once again, claiming or believing something does not make it so. Not all beliefs have equal validity even if one believes them very strongly. One can be sincerely wrong.

    Or they can be using the term “choose” in a different sense than most people understand the word.

    Let’s look at your quote from Simon Levay: “…insisting instead on the right to fulfill ourselves affectionally – in what ever directions our needs compel us, however contrary to the social norm they may be – is both honest and courageous, an act of utter freedom.”

    Pay attention to that phrase “in whatever direction our needs compel us”. He seems to be talking about the courageous choice to live in accordance with one’s “compelling need” (what I call orientation) even if society says that only heteroseuxality is legitimate.

  • Anonymous

    If it is fair to use the fact that most gay people believe their homosexuality was not a choice to support the theory that it is not a choice, then it is also fair to use the fact that some gay people believe their homosexuality was a choice to support the theory that for some people it is a choice.

    There is no direct proof that homosexuality can never be a choice. That biological factors likely play a role influencing sexual orientation does not prove that choice cannot also be involved: ‘it is possible to construct a hypothesis whereby both “gay genes” and a desire to be homosexual are necessary for a person actually to become homosexual’, notes Simon LeVay (Queer Science, p. 244) People who feel that their sexual orientation was a choice may understand choice differently from most people, but this does not necessarily mean that their understanding is wrong.

  • http://www.blogger.com/profile/28731968 Michael Bussee

    Anon: “People who feel that their sexual orientation was a choice may understand choice differently from most people, but this does not necessarily mean that their understanding is wrong.”

    Perhaps not, but it sure makes English language kinda mushy and ill-defined. Using Anon’s reasoning, people can use words to mean whatever they want them to mean and not be “wrong”. A psychotic person could “understand” that purple midget demons are coming through the radio — and be right.

    I could say “I am Adolf Hitler”, by which I mean “I’m a nice guy” and I plan to “cut my ears off with a pocket knife”, by which I mean “take a bath and shave this afternoon”.

    We have a similar problem when we use words like “change” and “choice” and “heterosexual” — and leave the meanings fuzzy. How would we convey the truth of the Gospel if we were sloppy about what the words mean? I find it interesting that Jesus is called “the word”. Clearly stated and understood words are what ministers use to call “sinners” to “repent” and “accept Christ as Savior and Lord”.

    So, I think it’s very important that people try to come to some degree of mutual understanding about the words that make up the English language. That’s why God invented dictionaries — by which I mean “Joseph Nicolosi deserves the Nobel prize for discovering the cure for gayness.”

  • Anonymous

    I am wondering how anonymous would react if his/her spouse had a different understanding of what was meant by “choosing to be monogamous”?

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  • http://www.straightintogayamerica.com Lars Clausen

    Thank you for these comments, especially the ones working with the effects of social stigma.

    In my continuing blog conversation with Pastor Dave Glesne, one of the major hurdles is in even discovering a level playing field from which to converse, especially in terms of scientific data, cultural life, and biblical understanding. http://www.larsclausen.blogspot.com

    I appreciate the work going on here.

    Lars

  • http://www.patheos.com/blogs/warrenthrockmorton/ Warren

    Thanks Lars, Tim and all those who commented on this post. I may lose my membership in the giant right wing conspiracy over some of my comments here :)

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