APA Newsletters

Spring 2001
Volume 00, Number 2

Newsletter on Philosophy and Lesbian,
Gay, Bisexual & Transgender Issues

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Homosexuality and Hope

Timothy F. Murphy
University of Illinois at Chicago

In 2000, the Catholic Medical Association (C.M.A.) released a document called "Homosexuality & Hope."1 The document was produced by a C.M.A. task force that included psychiatrists and other physicians, psychologists, nurses, and clergy "engaged in the management and care of homosexual persons." The self-stated goal of this document is to assist people ministering to same-sex attracted individuals (not "homosexuals," thank you, but more on that issue later). More specifically, the goal is to address "a positive program of providing help, support and hope for those homosexual persons who wish to live in union with the Catholic Church." In fact, the document offers both a moral and scientific defense of treatment for homosexuality, for both children and adults. Ultimately, the aim of this treatment is "full communion with the Catholic Church."

As most people know, there is something of an intramural squabble about the meaning of homosexuality within Christianity. I leave it to Catholic and other Christian theologians to determine the theology of homosexuality insofar as that theology depends on religious claims that lie outside the realm of scientific or philosophical evaluation. Insofar as I do not accept these religious claims as the appropriate basis for ethical analysis, I myself have no way of settling the theological debate over homosexuality. I also leave the terms of full communion with a religious congregation to the church in question, again, insofar as those terms depend on theological views whose metaphysical nature belongs to, for example, faith rather than shared tools of scientific and philosophical reason.

I would like to comment, however, on a number of issues raised in this document that do not depend on faith-based assumptions. First, I want to note that despite the preponderance of health care professionals in the membership of the C.M.A. task force, the document does not raise the issue of homosexuality as pathological. It does not, that is, specifically try to build a case for homosexuality as a cognitively disordered and disordering state. There has been a trend away from interpreting homosexuality as mental illness since the 1973 decision by the American Psychiatric Association to declassify homosexuality per se as a mental illness.2 That decision was, of course, contested; nevertheless the official policy of that professional association and others has been that homosexuality is not by itself evidence of any mental disorder justifying prevention and treatment. That kind of conclusion did not, however, bring prevention or therapy to a halt.

Treating Non-Pathological Conditions

After the declassification, some therapists continued to offer treatment in the way that some physicians offer cosmetic surgery, or "enhancement" surgery as it is coming to be called. That is, there may be no inherent problem with one's nose - it works perfectly fine - but it is judged unattractive by the person on whose face it sits. The same logic has been extended to homosexuality. There may be nothing wrong with it - for others - but some people have decided that it interferes with their desired identity. Men wish to be attracted not to other men, for example, but to women whom they can marry and with whom they can have children. They don't want to be identified as homosexual because this sexuality interferes with their life plans, their religious values, or their career goals. The same goes for women.

In a sense it is surprising that the C.M.A. would therefore map out programs of prevention and treatment of homosexuality for something that they do not declare to be pathological in itself. In other words, the guns of medicine are trained on a non-medical problem. That said, the C.M.A. characterization of homosexuality - even if the formal diagnosis of pathology is not invoked - is so woeful that is unsurprising that they want to prevent and treat homosexuality.

According to this document, there is no sense in which homosexuality is meaningful in a metaphysical sense or as a matter of psychological well-being. The document more or less begins and ends with the determination from the Catholic Catechism that"…tradition has always declared that homosexual acts are intrinsically disordered… Under no circumstance can they be approved." While there is no specification of exactly what kind of disorder is involved, it almost doesn't matter given the subsequent characterization of homosexuality as symptomatic of all manner of childhood problems: dysfunctional parents, problems with peer play and gender identification, physical and psychological deficits, sexual victimization, precocious sexual behavior, and so on. Adults, moreover, may manifest depression, suicidal thoughts, anxiety, substance abuse, sexual addition, and so on. Given this characterization it can seem irrelevant whether homosexuality is formally disordered or not; because again, this interpretation is so objectionable that it almost cries out for prevention and treatment.

The Metaphysical Status of Homosexuality

One obstacle said to be standing in the way of widespread repudiation of homosexuality is the belief that it is biological or, more specifically, genetic. The document briefly describes a number of scientific studies that have linked sexual orientation to specific biological traits, including genetic studies. The document notes, rightly, that these studies are not well established. But from there, the authors rush to the conclusion that homosexuality is not determined biologically. As a matter of simple logic, it does not follow that because scientific reports are preliminary that there are no biological or genetic contributions to sexual orientation. For example, monozygotic twins do not always share the same sexual orientation. This is not by itself alone a refutation of genetic or biological contributions to sexual orientation. Each monozygotic twin will have something of a separate genetic destiny after fission of the embryo. The degree of genetic penetrance - the extent to which a gene expresses itself - will vary even in identical twins. The absence of proof regarding the biology of homosexuality does not mean there is no biological involvement.

But putting homosexuality outside biology dovetails nicely with the larger philosophical project of the document: affirming that healthy psychosexual development leads naturally to attraction in persons of one sex to persons of the other sex. The larger schema of human sexual development is said to be destined toward heterosexuality. "Trauma, erroneous education, and sin cause a deviation from this pattern." According to this interpretation, not only is homosexuality not genetic or biological in any meaningful sense, it has no independent metaphysical status of its own. Homosexuality is an artefact of development gone wrong. If all psychosexual development unfolded without obstacle, there would be no homosexuality. Homosexuality is no natural goal or endpoint for human development. That it exists at all is due to obstacles in development, and these include the bugaboos of bad parents, corrupting social environments, and sin.

It follows then that "Persons should not be identified with their emotional or developmental conflicts as though this was the essence of their identity… It is, therefore, probably wise to avoid wherever possible using the words 'homosexual' and 'heterosexual' as nouns since such usage implies a fixed state and an equivalence between the natural state of man and woman as created by God and persons experiencing same-sex attractions or behaviors." Having disposed of homosexuality as a meaningful metaphysical state, the document is then able to wade through the details of various prevention and treatment programs for homosexuality.

Treatment: Adults and Children

I have argued elsewhere that adults who are interested in conforming their sexual interests to their sexual and religious values should be left to do so.3 I don't see this position as a reductio ad absurdum of liberal views toward homosexuality either, as some critics have charged. Most men and women with same-sex erotic attractions do not wish to alter their sexual orientations. I wish those who do well, though I am unpersuaded that most practitioners in this area offer their clients meaningful informed consent about the risks, benefits, and likelihood of success. If adults want to do go down this path, they should at least know what they are getting in to. I am also unpersuaded that there is good scientific evidence that practitioners have a meaningful therapy to offer. There is very little hard evidence that sexual orientation therapies can provide substantial change in sexual interests to randomly selected individuals. The vast majority of this effort seems to have failed. I also see it as an open question as to whether the social treatment of homosexuality has a coercive effect in forcing people to seek liberation from their same-sex interests. I believe nevertheless that adults should be free to make their own mistakes and that if adults want some kind of "enhancement" therapy for their sexual interests, well, who am I to stand in their way? All I ask is that therapists not evade the facts about the likelihood of success in treatment and offer alternatives to the treatment, for example, holding out the view of integrating same-sex interests with other life goals.

What concerns me most about the C.M.A. position is the surveillance it sets up for children who are not freely situated to make their own choices and mistakes. The document outlines a gender surveillance system that in effect establishes a duty to monitor children in a way to promote their heterosexuality. I don't know how many children will be led to therapy with what dubious effect. Without answering them, I will raise a number of questions that go unattended in this document. For example, do children have the right to a particular sexual orientation? Do parents have the right to a child of a particular sexual orientation, such that they may carry out various treatment methods with the child? Some Catholics have seen homosexuality as a charism, the occasion of a blessedness not possible in any other way.4 How does this interpretation square with a blanket program of prevention and treatment? Even if homosexuality is objectionable, it does not follow that anything may be done to prevent it in children. What extent of gender surveillance is justified over children? After all, many children who will develop homosexual interests do not display the gender atypicality that alarms some parents to take their children to gender identity clinics? How strong a system is justified for monitoring predictors of homosexuality when the effect of treatment on such children is not known? What degree of hardship suffered by children specifically in prevention programs and the totality of children under surveillance might justify closing them down? The burdens of gender surveillance are not borne by those with same-sex interests alone; children with heterosexual interests are forced to examine and re-examine their behavior and interests for purity. It is a never-ending cost to be paid for heterosexual purity. In any case, what degree of treatment success would justify treating most children (of Catholic parents) with gender atypicality this way? Do the therapies even work well enough to justify them for some children?

There are a great many unanswered questions about programs of prevention. It is one thing for an adult to consult with a psychologist about unwanted sexual interests. It is another thing altogether for therapists to suspect the worst outcome for all "chronically unmasculine" male children or to drag unwilling teenagers into therapy.

Parents and their Children

Apart from the metaphysical erasure of homosexuals and the surveillance system said to be necessary for children, one of the things that strikes me most about this document is how badly parents come off. Parents do not appear in this text except as men and women who failed to meet high standards of responsibility in regard to the moral, psychological, and sexual well-being of their children. I doubt this characterization fits most parents of lesbian and gay children, whether those children are even now babes or adults. An almost sinister and wholly suspicious view of parents inhabits this document. But in a document that would talk about "the management and care of homosexual persons" it is surprising that no mention is made that children ought to be liberated from objectionable behaviors visited upon them by parents - and as a matter entirely independent of sexual orientation.

There is a philosophical defensibility of homosexuality apart from specific religious views.5 Indeed, much of medicine has seemed to move in that direction - trying to protect and secure the values of same-sex eroticism rather than trying to close them down. This C.M.A. document moves in another direction, and to the extent these matters depend on religious belief it is free to do so. It remains problematic, however, that the Catholic Medical Association puts the health professions are the front line of what it describes primarily as a moral and religious problem. It also remains problematic that the practices of prevention and treatment of homosexuality are treated as if they raised no ethical questions. They do. Anecdotes piled up one on top of another do not establish the scientific validity of prevention and treatment measures. A list of the alleged horrors of homosexuality does not establish the morality of programs of prevention in children. It is to be admitted that there is always the hope that someone may discover an intervention that will control sexual orientation. If we think of hope as a forecast of logical possibilities, it makes no sense to close that door completely. But the moral value of sexual orientation therapy is not a function of its mere possibility. The philosophical question worth asking is whether and to what extent prevention and treatment programs offer their "clients" a more meaningful and valuable life, both for children and parents? As it is, there is no philosophical reason to think that the prevention or treatment of homosexuality are necessary to achieve either of those goals.

References

1. This document is available online at www.cathmed.org.

2. Ronald Bayer, Homosexuality and American Psychiatry, 2nd ed. (Princeton: Princeton University Press, 1987).

3. Timothy F. Murphy, Gay Science: The Ethics of Sexual Orientation Research (New York: Columbia University Press, 1997).

4. Timothy F. Murphy, "Reproductive Controls and Sexual Destiny," Bioethics 1990 (4): 121-142.

5. Timothy F. Murphy, "Homosex/Ethics," in Timothy F. Murphy, ed., Gay Ethics: Controversies in Outing, Civil Rights, and Sexual Science (New York: Haworth, 1994), pp. 9-25.

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APA Newsletters

Spring 2001 Volume 00, Number 2

Spring 2001
Volume 00, Number 2