FAMILY RESEARCH REPORT	Journal of the Family Research Institute Founded 1982
How Do Homosexuals "Get That Way?"			Vol. 15 No.5 Aug/Sep 2000

The last issue of Family Research Report [FRR] explored the history of the very modern concept of the term "homosexual." We criticized the notion that homosexuality is an innate condition or pre-determined, unchangeable identity, and noted that Alfred Kinsey the most famous researcher of homosexuals and himself a homosexual also rejected this idea, based on his own studies. To Kinsey, sexual preferences and behaviors ranged along a continuum with an infinite number of combinations and possibilities. Sexuality was a "fluid" enterprise, with any kind of sexual expression being in the realm of possibility for any particular person, given the right set of circumstances.

Certainly, the empirical data support Kinsey's thesis in some important ways. While most heterosexuals stick with heterosexual behaviors exclusively through their lives, especially if they get married, the vast majority of those who classify themselves as homosexual also engage in heterosexual sex on an occasional or fairly regular basis. Homosexuality appears closely associated with sexual experimentation of many flavors, and those who cross the "threshold" of homosexual behavior are often able and quite willing to engage in a wide variety of perverse activities.

Interestingly, Kinsey's view clashed with the medical and psychiatric theorists of his day, who were already quite sold on the idea that homosexuality was indeed an ingrained (but possibly curable) condition, stemming from either hormonal imbalances, physical abnormalities, or deep-seated childhood problems and conflicts with one or both parents. The actual empirical evidence is in FRI's opinion a strong blow to the current popularly-held conception of "homosexuality-as-a-condition/identity." However, it is mostly ignored, not only by gay activists who see tremendous political and social advantage inherent in their being unwitting "victims" of their birth or upbringing, but also by modern psychiatrists and psychologists who have organized their disciplines around the fundamental view that "bad behaviors" are merely signposts of underlying physical or mental conditions.

Depending on the therapist, these conditions may need "treatment" or ought to be regarded as skin color that is, part of the core of human diversity and therefore meant to be celebrated, not discriminated against. Either way, homosexuals are generally not held responsible by the medical and psychiatric professions for their sexual expression, homosexuality being an essential part of their "identity."

Fortunately, the contradictions apparent in the "condition" view of homosexuality are not lost on everyone. Even some homosexuals see their "identity" as more of a social construct than as an accident of birth or upbringing. In the 1982 book, The Homosexualization of America, the Americanization of the Homosexual, homosexual Denis Altman¹ argued that

"Ever since the term 'homosexual' came into use toward the end of the nineteenth century and was taken up enthusiastically by doctors and psychiatry, two things could be said about it: experts rather than homosexuals themselves decided how we would be viewed, and with a few exceptions these experts

were in agreement, however they framed this view, that homosexuality was a less acceptable form of sexual behavior than heterosexuality" (p. 4)

"The concept of homosexuality as an 'illness,' a 'perversion,' or a 'maladjustment' belongs to the gradual development of medicine as both a science and an ideology, with the power to define and categorize certain key areas of human behavior... The adoption of these negative terms underlies both the strengthening of the role of medicine and psychiatrists institutions of power, and simultaneously the developing idea of a homosexual identity, found in the late nineteenth-century writings of men such as Karl Ulrichs and Edward Carpenter." (p. 5)

"the fact that while homosexual behavior among men is very widespread among different cultures, it is only in comparatively modern Western societies that exclusive homosexuals exist in any significant numbers" (p. 42)

"Kinsey, too, stressed that one should never speak of homosexuals as if such an identity were inherent rather than the product of social labeling" (p. 43)

If homosexuality is not an ingrained condition, how does it come about? What triggers men and women to engage in homosexual behavior? As a culture, our readiness to accept both the medical-psychiatric view of homosexuality and gay activists' claims that they were "born that way" is not due simply to our reliance on the supposed "experts" or the way we have become "medicalized" and "psychologized" in our national thinking. It is also due to our bias regarding sexual attraction.
Because most heterosexuals have difficulty imagining themselves being attracted to their own sex (and are usually quite repelled by the thought), there is a natural inclination to infer that homosexuals must feel the same way about heterosexual attraction and that the difference is somehow ingrained in their psyche.

But what does the empirical evidence suggest?

What Homosexuals Claim Influenced Them

If homosexuals were to tell us why they thought they ended up participating in homosexuality, that might be important. Although every homosexual is not an expert on 'homosexuals-in-general,' each homosexual is an "expert" of sorts on his own life. An aggregation of a large sample of homosexuals should then enable us to see whether their "explanation" suggests a "preference" or a "necessity," a learned activity or an uncontrollable, pre-determined urge.

Two large published surveys asked this question. The first, by Kinsey², got answers from 1,434 male and 256 female homosexuals. The second, by the Family Research Institute [FRI], asked 214 homosexuals and 3,328 heterosexuals why they considered themselves homosexual, bisexual, or heterosexual. [A third survey by the Kinsey Institute asked the same question of almost a thousand homosexuals in San Francisco in 1969, but its full results have not been published.]

Respondents in both surveys could give more than one reason there are often a number of main reasons we do anything. Kinsey's data was collected from homosexuals "where he found them." Many were interviewed in prisons,
others from homosexual bars, schools, etc. The FRI survey was a systematic random series of area cluster samples from six American cities. Kinsey asked the question verbally and then coded and grouped the results. FRI had respondents choose possible answers from a list. Any response not given by at least 1% of respondents is not listed in Tables 1 and 2.

Examine Table 1. The nature of Kinsey's reporting does not allow us to determine how many individuals offered multiple answers or to figure out which combinations of responses were the most popular. Still, some intuition can be gleaned by simply adding the percentages of different categories as if each respondent gave only one answer. First consider the medical-psychiatric premise that homosexuality is a condition either inborn or related to childhood pathology.

How much pathology is reported? "Noncongruent gender development" refers to having been slow or fast to mature, or having interests, skills, or proclivities different from one's peers. Given the fact that development occurs at varying ages in any group of children, these differences are not necessarily pathological. And, plenty of heterosexuals experience similar developmental differences. So there is no one-to-one connection between noncongruent gender development and becoming homosexual. Poor relationships with one or both parents might be considered a 'pathology of child-rearing.' Yet no more than 27% of the gays and 31% of the lesbians nominated these reasons for their homosexuality. Even if the categories of "fear heterosexuality" and "physical trait" are added to these totals, a maximum of 35% of gay males and 43% of lesbian females offered any of these possible reasons.

On the other hand, consider those responses directly connected with an experiential or learning model. Combining "early homosexual experience" and "homosexual associates" neither of which would be considered a pathology per se as many as 33% of men and 42% of women made one or both of these choices. Adding "heterosexual partners unavailable," the figures rise to 49% of the men and 50% of the women. And what childhood pathology is connected with "anti-heterosexual training?" Many families, churches, and schools weigh-in against heterosexual fornication while never mentioning homosexuality. Adding this response brings the maximum percentages up to 56% for the gays and 59% for the lesbians.

The bulk of Kinsey's results are squarely in the realm of learning and opportunity just as with any desire that eventually develops into a habit. If these homosexuals were at all accurate about themselves, we might conclude that learning may be considerably more important than any pre-existing "pathology" in the development of homosexuality. That was Kinsey's conclusion and he had a telling point against those who were pointing to hormonal differences as a biologic "cause" of homosexual activity³: "the circumstances of the first sexual experience, psychic conditioning, and social pressures are obvious factors in determining the pattern of the behavior. It would appear that no similar correlation has as yet been shown between hormones and homosexual activity." (p. 428) The same could be said for today's genetic theories of homosexuality.

Although Kinsey interviewed the largest single sample of homosexuals to date, a key weakness of Kinsey's study was that his homosexuals were not drawn in any random or probabilistic manner. How representative they were of the entire homosexual subpopulation is anyone's guess. Furthermore, he had no comparison group of heterosexuals who were asked the same question (or if they were, Kinsey never reported the results). The FRI study corrected these flaws, albeit with a much smaller group of homosexual respondents.

Table 2 from the FRI study offers similarities to Kinsey's data. But the presence of a comparison group allows us to glean important additional information. Remember that the reasons given were for what respondents claimed led or influenced them to become heterosexual or homosexual. This is a bit different from the typical approach of most social science researchers. Usually, if one wanted to, say, link poor parent-child relationships with the formation of homosexuality, one might ask groups of confirmed heterosexuals and homosexuals whether or not they had experienced such difficulties and then determine how the percentages stacked up. In this framework, the researcher decides which factors are or are not important. Rarely is the respondent himself given a chance to explain what he thinks caused the outcome, as in Tables 1 and 2. So while we don't know how many gays and lesbians in the FRI study actually experienced poor relationships with one or both parents, only 20% of the gays and 14% of the lesbians claimed such difficulties influenced their becoming homosexual or bisexual.

One could dismiss these results by arguing that nobody really knows (except the psychiatrists and pychologists!) what determines their own sexual preference. However, we believe that to be a bit presumptuous. While some of the FRI study respondents did indeed claim they were confused or just didn't know what caused their sexual orientation, the vast majority nominated one or more definite reasons.

As to parental relationships, both male and female homosexuals disproportionately chose "family problems" as leading to their homosexuality compared to the heterosexuals. However, a small but noticeable percentage of heterosexuals claimed that poor relationships with their parents led them toward heterosexuality. And, such family difficulties were less often nominated by homosexuals than other factors like homosexual experiences or seduction, being afraid of or failing at heterosexuality, or simply trying homosexuality and liking it. All in all, family problems may be a factor in driving some toward homosexuality, but most homosexuals whether from Kinsey's study or our own don't seem to see it that way.

The psychiatric theory of family disturbance as leading to homosexuality doesn't match up well against these data. At best, family disturbance is disproportionately associated with a homosexual outcome that is, it 'causes' or contributes to the development of homosexuality in some cases. So, while "there may be some truth to it," the explanatory power of the psychiatric notion about family disturbance as an etiology appears decidedly modest.

Kinsey's theory that sexual experience and social pressures are the most influential looks more plausible than the psychoanalytic account. Consider reported association with homosexuals or heterosexuals. Almost 15% of gay men, 53% of heterosexual men, 33% of lesbian women, and 51% of heterosexual women said they were influenced by being around either homosexuals, heterosexuals or because it was the "in thing" in their crowd. [The Jan/Feb 1999 issue of FRR noted that a significant fraction of lesbians claimed to grow up around homosexuals in their home.]

Sexual experiences were also influential. 42% of gays and 18% of lesbians claimed that having homosexual sex or being seduced homosexually helped lead to their sexual preference. 50% of gays and 52% of lesbians said that trying homosexuality and liking it was influential. On the flip side, over a third of heterosexual males and almost a quarter of heterosexual females claimed that heterosexual experiences led to their being heterosexual.

Of interest, a small percentage of respondents claimed that homosexual experiences or seduction influenced them to become heterosexual. And modest percentages of homosexuals (10% of gays, 18% of lesbians) said that heterosexual experiences or seduction helped lead them to their homosexual preferences. These results can perhaps be explained by noting that some people are so turned off by certain experiences that they will gravitate to the opposite extreme. The "same circumstance" or "same experience" can have completely different effects on people attracting some, repelling others, and having no apparent effect upon the remainder. Plus, a portion of the gays and lesbians in the FRI study claimed to be bisexual. For some of them, het
erosexual experiences may have influenced them to "go both ways."

As to social pressures and training, note that 40% of heterosexual men and 44% of heterosexual women said they were influenced by the fact that society teaches heterosexuality. A quarter of heterosexual men and over a third of heterosexual women claimed that their parents were influential in their sexual orientation, either because it was what their parents wanted or because of what they saw in their parents' marriage.

On the other side, almost a fifth of homosexuals of both sexes said they were influenced by having been shy or socially inept or as the result of peer pressure because they were labeled a "sissy" or "tomboy." Even larger percentages of homosexuals claimed they were either afraid of heterosexuality or that they failed at it. And small to modest percentages claimed they became homosexual because they either received poor sex education or simply "rebelled against society and its teachings."

The pattern of nominated reasons for adopting one's sexual preference was similar for heterosexuals of both sexes and clearly different from the pattern of explanations chosen by homosexuals of both sexes. Male and female homosexuals were more similar to each other than to the pattern of responses produced by male and female heterosexuals. Inspection of Table 2 suggests that heterosexuals generally emphasized associates and conformity with social pressure while homosexuals emphasized sexual experiences.

Overall, the great bulk of the evidence in Tables 1 and 2 suggests that experience (both positive and negative), social scripting, and opportunity are primary in leading to a homosexual or heterosexual preference. For instance, "I tried it and liked it" and "I was afraid of homosexuality" fit this learning model. Rebellion against the family and/or society "the devil made me do it," "society teaches heterosexuality and I responded," "I rebelled against society and its teachings," "It was what my parents wanted" also supports the notion that homosexuality is a preference for both men and women.

One pattern that does not support a learning model of sexual preference is the choice of "born that way" or "it's natural." Homosexual males were more apt than heterosexual males to make this claim. However, only 38% of homosexual males, 40% of heterosexual males, 29% of homosexual females, and 35% of heterosexual females who chose "born that way" or "it's natural" employed it as their sole response. 53% of gays and 48% of lesbians who said they were "born that way" also nominated either sexual experiences or seduction or trying homosexuality as influential in their becoming homosexual. Fully a quarter of such gays and 10% of lesbians also nominated either poor parental relationships or parental influence of some kind. And over a quarter of the gays and 43% of the lesbians also chose either fears of or failures with heterosexuality and/or social, physical, or character problems as contributing to their homosexual outcome.

Overall, the percentages of homosexuals and heterosexuals who claimed they were "born that way" or "it's natural" and nothing else were rather modest. Only 20% of gays, 8% of lesbians, 13% of heterosexual males, and 9% of heterosexual females made these choices but no others.

Generally, the responses FRI got from homosexuals and lesbians were similar to those reported by Gebhard and Johnson from the original Kinsey dataset². 24% of Kinsey's gays v. 42% of ours reported being influenced by early homosexual experience or seduction, at most 27% of Kinsey's gays v. 20% of FRI's blamed poor parental relationships. 25% of Kinsey's lesbians v. 22% of FRI's pointed to homosexual associates, 9% of Kinsey's lesbians v. 10% of FRI's reported fearing heterosexuality.

However, a significant difference between our datasets is the proportion who claimed to have been "born that way:" 11% of Kinsey's gays and 6% of his lesbians made that claim v. 52% of our gays and 27% of our lesbians. Bell⁴, in his only mention of similar data from a 1969 Kinsey Institute study in San Francisco, reported that 15% of his white gays claimed that they had been born that way while 16% said that early homosexual sexual experiences had influenced them toward homosexuality. The jump from 11% in 1948 when Kinsey published his first volume to 15% in 1969 is not much. But what about the increase to 52% in the early eighties when the FRI study was conducted?

Was there a sudden self-awareness amongst homosexuals that they "had always been gay?" And why wasn't there a corresponding rise in self-awareness among lesbians (only 27% of which nominated the "born that way" option)? We suspect that this choice of "cause" probably occurred be
cause of cultural factors being "born that way" is often mentioned in both the gay and general media rather than as an independent shift in personal theorizing of 'how I got this way.' Of course, Freudianism had its impact upon personal theories as well, so the "trouble with parents" response might be elevated above what homosexuals might have theorized had they been asked the question in, say, 1910.

A comparison of the Kinsey and FRI datasets finds numerous levels of agreement. This is especially significant in that Kinsey's sample was biased toward getting homosexuals, while FRI's was a probability sample from large metropolitan areas. Learning not family disturbance or arrested psychic development seems to account for the bulk of responses in both studies. Certainly, some may be influenced toward homosexuality by a combination of family discord, defective personalities or inadequate social skills, and quirky beliefs (e.g., hatred of men, fear of opposite sex genitals), but how much of this can be laid to the fault of familial patterns of child rearing is obscure. Many children seem to be "born shy or timid" irrespective of what their parents do or don't do.

Being "a tomboy" was disproportionately associated with a lesbian outcome among women, but many of those who chose this response said that they became heterosexual because of it. Considering just this reason, we can understand how this motive could work either way. On the one hand, most such girls "proved" that they were not "tomboys" by becoming heterosexual, dating boys, making out, etc. But about a third of such girls decided that they were more comfortable being a tomboy and so they became lesbians.

Of the 4 men who said that they "hated" women, two became homosexual, while 10 of the 11 women who said that their hatred of women influenced their sexual preference became heterosexual. One woman who wrote additional commentary on the questionnaire said that she hated all women because her grandmother had seduced her when she was age 3. 13 of the 15 men who said that they hated men and 2 of the 8 women who agreed with them became heterosexual because of it. These accounts seem at least as plausible as tapping into Freudian notions of "Oedipus" and "Electra" complexes and other rather fanciful theories. Plus, the explanations given by these non-professionals are intelligible.

The traditional viewpoint and definition of homosexuality based upon the belief that given the right circumstances, most anyone could be lured into engaging in homosexual activity is consistent with most of the results in Tables 1 and 2. Homosexuality looks like any other acquired preference that can become a consuming habit. On the other hand, the medical-psychiatric point of view that homosexuality is the result of a "condition" that necessarily follows from either biology (e.g., genes, hormonal imbalance in utero) or family trouble (e.g., a domineering mother, a hostile/distant father) has considerable difficulty accounting for many of these same results.

Homosexual behavior does not behave like eye color fixed, immutable but rather like ice cream flavor preference. Those who fancy one flavor will almost always "settle" for another if the desired kind is not available — they want ice cream, not just ice cream of that particular flavor. Because they ‘want sex,’ many homosexuals “go both ways” if a homosexual partner to their liking is not available and a heterosexual one is. Much of homosexual sex is ‘quick and easy,’ so if a person is lazy, socially unskilled, or ‘doesn’t have much time,’ homosexuality fits the bill. In some situations, homosexuals find it convenient to have sex with the opposite-sex, and in other situations with the same-sex.

Experience With Homosexuals In Therapy May Have Little Bearing Upon Other Homosexuals

Given the overall etiology nominated by homosexuals on their own behalf in the Kinsey and FRI studies, why the significant disconnect between the “real world” of homosexuals and psychiatric opinion? The ‘homosexuals’ psychiatrists saw prior to 1973 (when homosexuality was delisted as a pathology by the American Psychiatric Association) were a combination of those who were in some way troubled by their participation in homosexuality or just plain troubled. In the ‘gay community,’ where undoubtedly the heaviest concentrations of regular homosexuals can be found, less than half5 and even perhaps as little as 15%6 have been in or claim that they wanted to be involved in any sort of mental health treatment.

Apparently, most homosexuals had nothing to do with mental health practitioners when participation in homosexuality was, as the psychiatrists saw it, a ‘disease.’ Consequently, the psychiatric community had nothing to do with most homosexuals. Since mental health practitioners saw only a small fraction of homosexuals, it would have taken a great deal of luck for them to be able to devise — from that small percentage — a theory that accounted for the etiology of homosexual activity in general. Each personal “theory” of etiology has at least as much to commend it as any pronouncement about etiology from the psychoanalytic camp. And aggregated as in Tables 1 and 2, the theory of etiology that emerges for heterosexuals and homosexuals is probably more reliable than the theories of professionals who only interact with a small portion of homosexuals-in-general.

The Grand Con Job

Very little of the empirical data — either that in Tables 1 and 2 or the evidence presented in the last issue of FRR that homosexuals often claim to have heterosexual sex and/or heterosexual attractions — can be “handled” by the definition of homosexuality as a “condition.” Yet, given the ability of the mental health movement to delude itself and its power to influence public and professional opinion, combined with the voices of gay activists, the “condition” definition continues to predominate even though psychiatry no longer officially regards the “condition” as a defect or pathology.
The adoption of the medical-psychiatric view of homosexuality has resulted, we believe, in enormous harm. Once the psychiatric community no longer regarded all homosexuals as ‘sick,’ homosexual activists were able to perpetrate one of the grandest con jobs of all time. Gay activists claimed:

• the special kind of people who are homosexual were no longer ‘sick’ per se,
• gays have to engage in homosexuality, since psychiatry says so, and
• homosexuality is ‘harmless to practitioners and society’

As Denis Altman1 wrote in 1982, “Two quite new and connected ways of looking at homosexuality came into being in the seventies: the concept of the alternative life style and that of a gay people or minority. Seeing homosexuals as a minority, with a specific life style, meant taking a major step away from the categorization of them as evil, criminal, sick, or deviant. After all, murderers are not usually seen as a minority, nor tuberculosis as a life style.” (p. 6)

In the gay activist worldview, it is only fair that society be re-educated to accept the normalcy of homosexuality. What’s wrong with these contentions? Not everything. Since many, perhaps even most gays were never ‘sick’ in a mental health sense, we don’t disagree with them on this point. But their other contentions were and are false. Most people who abuse drugs or alcohol are not sick in a mental health sense either, but are neither born to drink or drug nor are harmless to themselves or others. The same can be said of homosexuals.

Gays are different — as a rule, quite different. Few others are so sexually-obsessed, generally untruthful and unreliable, and rebellious. But the basic sense in which gays are “a special kind of human” is the same sense in which Russians are “a special kind of people.” Over time, Russians have created their own culture, with a particular language, unique customs, etc. Gays have also created their own subculture, with unique customs, slang, etc. tied to homosexual activity, the promotion of homosexuality, and “twisting the tail” of greater society. No one has to be a Russian — some emigrate to other countries. Likewise, gays don’t have to engage in homosexuality — some change and turn to exclusive heterosexuality. And engaging in homosexuality is harmful to both practitioners and society. “Being” gay is basically the assimilation of and the adhering to the customs, language, and mores of a subculture.

The Shift to Identity

The “homosexual” or “gay” “identity” has been crafted over the past 140 years by homosexual activists with the assistance of mental health professionals. Psychiatrists — in particular — have constructed a “condition” stemming from child-parent relations, which ‘explains’ or ‘accounts for’ and therefore ‘partially excuses’ those who engage in homosexual acts. While most people are mystified by same-sex attractions (even as we are mystified as to why people would become prostitutes, pedophiles, or involved in sadomasochistic sexual activities), psychiatric theorists have made the whole issue much more complicated than need be. Possibly because it got wrapped in technical jargon and complex etiologic theories, the rest of society generally acceded to psychiatrists’ claims that they could properly ‘account’ for the ‘mystery’ of homosexuality.

When it is accepted that someone is ‘suffering’ from ‘a condition,’ it inevitably follows that that sufferer — not being entirely responsible for his desires — is not entirely responsible for his choices either. People ‘suffering’ from reduced responsiblity are given a kind of ‘pass.’ The ordinary way of treating them — they did X because they wanted to do X and therefore are responsible for having chosen X — cannot be applied. Instead, homosexuals have latched onto their ‘differentness’ and channeled it into a new identity.

Gay activist Denis Altman1 sees this clearly enough:

“The greatest single victory of the gay movement over the past decade has been to shift the debate from behavior to identity, thus forcing opponents into a position where they can be seen as attacking the civil rights of homosexual citizens rather than attacking specific and (as they see it) antisocial behavior.” (p. 9) “a combination of social pressures and self-definition are creating a strong sense of identity based on homosexuality. This is a reasonably new development; there may have been forerunners of it among small groups since the end of the nineteenth century, but only in the last decades have people been able to say,... that “I find my identity as a gay man as basic as any other identity I can lay claim to. Being gay is a more elemental aspect of who I am than my profession, my class, or my race.” (p. 73)

If homosexuality is — as FRI believes — not something that stems from a ‘condition’ but rather something resulting in part from a bad break (e.g., being seduced as a child), or a bad choice (e.g., deciding to have sex in prison), or loneliness that leads to contact with other homosexuals or the gay movement, or philosophical rebellion (e.g., feminism — a rebellion against ‘male domination’), or just sexual exploration (I wonder what it feels like), then homosexuality can be seen as a bad choice (if it is a one-time or sporadic event) or a bad habit (if it is engaged in regularly).

In either case, the actor is fully responsible for his actions. He is not ‘suffering’ from anything other than having made a bad choice or managing to acquire a bad habit. Homosexuals are like drug users, adulterers, or cigarette smokers in this regard. At times, perhaps there is a tinge of ‘paraphilia’ to some homosexuals’ activities. But no one is ‘born to sniff shoes,’ nor is anyone ‘born to be gay.’

Ultimately, the stronger and more accepted the notion of homosexual identity, the more dangerous it will become. To repackage and relabel a bad habit and risky behavior as a person’s fundamental essence can only promote the breaking of other taboos and the redefinition of other harmful behavior. For as Altman asserted, “someone who, whether male or female, has come to accept himself or herself as homosexual has broken through at least one of the major barriers with which sexuality is surrounded. It is my hunch that it is this that makes gays freer to break other barriers and,..., to help others do the same.... As Charles Shively wrote... ‘We live loosely; we know nothing lasts because there will always be something more. We embody our dreams.’” (p. 185)

References:

1. Altman, D (1982) The homosexualization of America, the Americanization of the homosexual. NY: St Martin’s Press.
2. Gebhard, P & Johnson, AB (1979) The Kinsey data: marginal tabulations of the 1938-1963 interviews conducted by the Institute for Sex Research. Philadelphia: Saunders.
3. Kinsey, AC (1941) Criteria for a hormonal explanation of the homosexual. Journal of Clinical Endocrinology, 1, 424-428
4. Bell, A.P. (1973) Homosexualities: their range and character. In JK Cole & R Dienstbier (Eds.), Nebraska Symposium on Motivation. Lincoln, NE: U Nebraska Press, 1-26.
5. Weinberg MS & Williams CJ (1975) Male homosexuals: their problems and adaptations. New York: Penguin; Bell, AP & Weinberg, MS (1978) Homosexualities: a study of diversity among men and women. New York: Simon & Schuster.
6. Jay K & Young A (1977) The gay report. New York: Summit.

Today, psychiatrists claim that while they may not be able to treat all conditions, they have "the cure for depression." "Counseling" may or may not work, the psychiatric community reports, but it is known with great certainty that "drugs and counseling" work to prevent suicide and alleviate depression. So psychotropic drugs such as Prozac, Zoloft, Paxil, Effexor, Serzone, and Remeron are as a class among the largest sellers in any pharmacy.

Treating depression is one of the largest and most profitable tasks addressed by practicing psychiatrists in the U.S. Unfortunately, the key question "does this treatment work to reduce depression, suicide attempts, and related symptoms?" is difficult to answer. In published studies with a placebo control (that is, using a 'drug' on control patients that is pharmacologically inert), "antidepressant clinical trials have consistently shown placebo response rates of 30% to 50%, drug response rates of 45% to 70%, and drug-placebo differences of 18% to 25%."¹ (p. 311)

Such findings that drugs for depression seem to have a measurable impact have led most European countries to bar the use of placebos in experiments testing new anti-depression drugs and have led to calls from U.S. scientists for the same standard here. However, in a bold new approach to the issue, researchers Khan, Warner, and Brown assembled ALL the research submitted to the federal Food and Drug Administration [FDA] concerning anti-depression drugs over the past 11 years.

Most interesting is the fact that many medical treatment studies in particular are rejected for scientific publication unless an important new result is reported. That is, if a potential treatment or drug is tested and found to be no different statistically than either a placebo or the standard treatment or drug, the results are often not published.

With the FDA, all clinical trials of a given treatment or drug must be reported, regardless of the results. So while some of the studies of anti-depression drugs had been published, not all had. Consequently, there is more information in the FDA database than graces the scientific literature. All in all, a total of 19,639 patients were included in these trials only some of which were published. Other trials just "sat" in the FDA database until Khan et al did their work.

What Khan et al did

The findings Khan and company collected were an assortment of clinical trials lasting 4 to 8 weeks. While the subjects had to test as depressed major depression of moderate to severe degree — on the HAM scale (Hamiliton Depression Rating Scale), they could not be actively suicidal or posing a serious suicide risk. Also, they could not have a significant concurrent or previous psychiatric illness other than depression. So some of ‘the worst’ of all depressed patients would not be included in these studies.

Overall, 45 studies were located: 23 were 2-armed [that is, subjects were randomly placed on either a placebo or the experimental drug] and 22 were 3-armed [that is, subjects were randomly placed into one of three conditions: placebo, experimental drug, or standard drug]. Four of the studies lasted 6 weeks, 3 for 5 weeks, 29 for 6 weeks, and 7 for 8 weeks. People often drop out of experiments, so their last recorded test was considered the ‘final result’ for them.

Suicide Results

We already know that those who are depressed are more apt to commit suicide. Indeed, one of the ways that depression is assessed is if a person says he is suicidal. Across the 45 studies, 27 (0.8%) of those on an experimental anti-depression drug, 5 (0.7%) of those on a standard anti-depression drug, and 2 (0.4%) of those on placebos committed suicide during the study. Likewise, 2.8% of those on experimental drugs, 3.4% of those on standard drugs, and 2.7% of those getting the placebo attempted suicide. Result? Neither actual suicides nor attempted suicides were statistically significantly different between these three groups.

Suicide is a “hard” fact. It is unlikely that even a few of these suicides were misdiagnosed and instead were murder [unlikely] or accidental. A dead body is hard evidence of depression, and not much argument about it is possible.

“Suicide attempt” is considerably more equivocal. Just what consititutes a “suicide attempt” as opposed to an “attempt to get attention” is difficult to unravel. Neither actual suicides nor attempts, however, differed statistically for the three treatments. If anything, these findings — although not statistically significant — suggest that suicide rate and suicide attempts were slightly higher for the takers of psychotropic drugs than those getting a placebo. Certainly, there is no reason to believe that psychiatry “is a certain cure for depression,” given these findings.

HAM Scores

HAM [depression] scores generally declined over the course of treatment. Overall, for the whole set of studies, the average decrease in the HAM score was 40.7% for those patients getting the experiement drug, 41.7% for those getting the standard or ‘control’ drug, and 30.9% for those getting a placebo. The longer the treatment, the lower the HAM score went: thus for experimental drugs in 4-week trials the decrease in HAM scores was 40.0%, in 5-week trials 40.5%, in 6-week trials 40.6%, and 43.9% in 8-week trials. The corresponding declines for the ‘control drug’ was 28.2% in 4-week, 44.0% in 6-week, and 48.1% in 8-week trials. For those getting the placebo the deceases were 24.7% in 4-week, 31.5% in 5-week, 30.5% in 6-week, and 36.1% in 8-week trials. So “something was going on” in favor of the drug-treatments.

Khan’s Evaluation

As Khan et al noted:

“The less-than-impressive difference between drug and placebo in this and other studies of clinical trials does not speak directly to the effectiveness of anti-depressants in clinical practice. Participants in anti-depressant clinical trials are a highly selected group, not representative of the general population of depressed patients. They are not actively suicidal; they are almost all moderately (not severely or mildly) depressed outpatients; and they are free of comorbid physical or psychiatric illness. They are likely to have a higher placebo response rate than depressed patients who are more severely ill.”

“The less-than-impressive difference in this and other studies between drug and placebo also recalls that patients who are assigned to placebo treatment in clinical trials are not untreated. The capsule they receive is pharmacologically intert, but hardly inert with respect to its symbolic value and its power as a conditioned stimulus. In addition, placebo-treated patients receive all the components of the treatment situation common to any treatment, i.e., a thorough evaluation; an expert healer; a plausible treatment; expectation of improvement; a healer’s commitment, enthusiasm, and positive regard; and an opportunity to verbalize their distress. Frank and Frank [Persuasion and healing: a comparative study of psychotherapy. Baltimore: Johns Hopkins U Press, 1991] make a compelling case that these ingredients of the treatment situation are the active ingredients of all the psychotherapies.” (p. 316)

FRI’s Evaluation

The Khan et al study provides some evidence — although far from compelling — that the standard “drug + counseling” therapy for depression “works.” In terms of actual suicides, there was no evidence of success. Indeed, there was a hint of failure. For attempted suicides, there was no difference indicated between the placebo-groups and the other treatment groups. However, decent success was indicated for HAM scores.

There also appears to be good evidence that those who are actively suicidal are frequently “calmed” by anti-depression medications. For the “mildly depressed” the evidence is much more equivocal. And as the Khan et al study demonstrates, there is limited evidence of success with the “moderately depressed” when they are given the standard psychiatric treatment.

Certainly, the Khan study suggests that no one is endangered by being put in a placebo group for a month or two. In addition, the Khan study is only mildly supportive of the notion that the current standard psychiatric treatment of drugs + counseling “works” for the moderately depressed.

Bottom line? FRI remains unconvinced that those suffering from mild depression should seek psychiatric assistance. It is expensive and delivers uncertain benefits. For the actively suicidal, FRI suggests the standard treatment. For the “moderately depressed,” we remain unconvinced — especially given the frequency of untoward reactions to pschyotropic drugs. Depression is a “pain” — both psychically to the sufferer and often to his or her family and/or associates. But how often mild or moderate depression progresses to severe depresssion is largely unknown.

Reference:

1. Khan, A, Warner, HA, Brown, WA (2000) Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: an analysis of the Food and Drug Administration Database. Archives of General Psychiatry, 57:311-317.

Corner

A Challenge to Modern Psychiatry

This issue and the last of Family Research Report have important implications. First, our findings put the modern psychiatric understanding of homosexuality into sharp question. It is ever tempting to take what you know about and generalize it to everybody in that situation. Wouldn’t it be “convenient” if the homosexuals who came to mental health practitioners for counseling were representative of all homosexuals? You hang a shingle, they come and pay. And you end up knowing what makes homosexuals “tick.”

Well and good if a random cross-section of homosexuals comes through your door. But if those who come for advice are particularly troubled and not representative of homosexuals-in-general, you’re in intellectual trouble. What you know about homosexuals actually only applies to a small subset of homosexuals. Some of your knowledge probably generalizes to most homosexuals, but what portions of that “some?” The mental health movement has deluded itself into thinking it knows more than it does. And, because psychiatry is held in such respect, society as a whole has been deceived.

Secondly, the notion of “once a homosexual always a homosexual” — being promoted by gays and now by the mental health movement — is at substantial odds with the empirical data. Assertions that it is unethical to attempt to “change sexual orientation/preference” border on the silly. Most homosexuals can “go both ways” and have proven it by doing so. Further, given the mound of uncontestable evidence that homosexual activity is unhealthful and dangerous, why wouldn’t mental health practitioners want to “save” as many of their clients as they could from this harm?

Thirdly, those promoting “reparative therapy” have some explaining to do. If homosexuals are so sexually flexible, why aren’t reparative therapists more frequently successful? Could their emphasis upon “the condition” of homosexuality actually be thwarting their efforts? If these professionals and ministries see their task as having to change “the core essence” of a person to “another core essence,” they may be creating a “mountain of essence” when, from another perspective, a more modest “hill of habit” actually lies in the way.

To be sure, bad habits are readily acquired and often very difficult to break, but it seems rather likely that if the habit is labeled an “orientation” and protected by “personhood,” “personal essence,” and other layers of gobbledygook, it will take far more effort to even get at it than if it is treated, fundamentally, as “a bad habit that needs to be broken.”

The mumbo-jumbo of psychiatrists works absolute wonders in movies and sells a lot of books. One could argue that “people acting weird require weird theories to account for their actions.” But as the recent “rebirthing” accident in Colorado illustrates — in which a little girl was smothered to death by a gaggle of “therapists” who were trying to ‘bond her to her adoptive mother’ — mental health professionals have every reason to fear their state licensing board ever deciding to require that “any therapy be proven to work as advertised or implied.”

Family Research Report critically examines empirical data on families, sexual social policy, AIDS, drug addiction, and homosexuality, digging behind the 'headlines' and breaking new scientific ground.

FRR is published 8 times/year by the Family Research Institute.

Dr. Paul Cameron, Publisher

Dr. Kirk Cameron, Editor

Subscriptions: $25/yr ($40 foreign)

©1999

Family Research Institute

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