同性戀成因:先天?後天?, 後同性戀 Post-gay, 認識同志

性傾向是否可以改變? / 關啟文

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香港「後同盟」上街遊行

作者:關啟文教授

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《報告》批評「矯正治療」,認為那些所謂成功個案(如NARTH提供的)有「許多問題與瑕疵」(《報告》,頁10),而且認為「許多人接受治療後非但沒有『擇脫』同性戀,反而造成嚴重的憂鬱症、性無能或自殺。」(《報告》,頁10)這裡引用的唯一論文是Haldeman (1994) 。結論是:「因為既有的文獻顯示同性戀並非精神疾病,再加上各種矯正治療無法證實有效且對個案造成身心傷害」,所以專業團體「都相繼公開反對這種治療。」(《報告》,頁10)

對NARTH的各種批評,我也有初步回應(《愛文》是指陳立言的文章):[1]

「《愛文》「並不贊同改變同性性傾向的行為」,因為「治療通常無效且會傷害受治療的個案,因此目前醫學界已反對這種治療的觀點。」(註16) 我認為這說法是以偏蓋全。他主要是引用Haldeman (1994) 的文章去證明所謂成功改變同性性傾向的案例,「非但沒有「擺脫」同性戀,反而造成更嚴重的憂鬱症、性無能或以自殺收場」。然而這種個案有多少?究竟Haldeman用那種研究方法得出這結論?縱使一些「成功」個案最後發生變化,並發生不良後果,那就表示這些後果是由同性戀的治療產生的嗎?這因果關係如何確立?其實在香港,不少有問題的家庭都曾接受社工輔導,初期情況有好轉,但最後有些案主變本加厲、自盡甚或殺害全家!難道這些悲劇都是因著社工的輔導產生的嗎?

的確有不少專業組織反對同性戀治療,然而另一些專業轉導員、心理學家、臨床心理學家、精神科醫生和學者等並不同意,在美國他們組成了National Association of Research & Therapy of Homosexuality (NARTH),[2]繼續這方面的研究和工作。最近NARTH把當代關於同性戀的研究成果做了一個很詳盡的總結和分析,並對別人的指控作出詳細的回應。[3]他們的回應最少是值得嚴肅探討的,但《愛文》完全沒有提及。例如以下研究就支持改變性傾向的治療是有一定成效和不一定有害的:

1)       Nicolosi et al. (2000) 研究了曾接受治療的689個男同性戀者和193個女同性戀者:34.3%轉變為異性戀(完全或接近完全);67%以前是(完全或接近完全)同性戀,現在只餘下12.8%。那些改變了的人且經歷心理和人際狀況的改善。35%未能成功改變,但大多感到他們的情緒比前更健全

2)       Spitzer (2003)研究200個同性戀者(143男和57女),他們曾接受治療。整體而言,男女都由相當高同性戀的領域轉到相當高異性戀的領域。治療前,沒有人說是完全異性戀,46%男和42%女說是完全同性戀。治療後,17%男和54%女說是完全異性戀。Spitzer說:「就算那些沒有經歷那麼實質改變的人,也說治療在好些方面都是非常有益的。性傾向改變應被視為複雜和連續性[的過程]…這研究提供證據支持一些男和女同性戀者是能夠改變他們性傾向的核心特性的。」(415) 很多同性戀活躍分子攻擊Spitzer,但他們往往用過高和不切實際的標準,若用同樣標準衡量支持同性戀的資料或研究,也同樣不合格。(Schumm, 2008) 這似乎是雙重標準。Hershberger是有名的親同統計學家,他用Guttman analysis的方法檢視Spitzer的數據,卻得出這結論:「在Spitzer的研究中,我們看到同性戀行為、同性戀的自我認同和幻想的改變呈現有秩序、有規律的圖畫,這是強的證據支持修補治療(reparative therapy) 能幫助個體的性傾向由同性戀轉為異性戀。那現在是那些懷疑修補治療的人需要提供同樣強的證據了,以我看來,他們還未做到。」(Hershberger, 2006, 139)

3)       Jones & Yarhouse (2007) 的縱向研究方法論相當嚴謹,主要研究用宗教信仰改變性傾向的努力。77個人完成。結果如下:15%有清楚改變;23%不再受性傾向控制,能保持貞潔;29%有改進,但仍在過程中;15%沒明顯改變;4%感到混亂;8%放棄治療,擁抱同性戀身分。他們說:「我們已提供證據,透過參與出埃及的事工,同性戀性傾向的改變是可能的。…我們也找不到甚麼證據支持參與出埃及的改變過程是有害的。」(387)

治療同性戀真的大多有害嗎?未必,Nicolosi et al. (2000) 研究了曾接受治療的882同性戀者,給他們一個有七十種負面後果的清單,只有7.1%選了三項或以上。Jones & Yarhouse (2007) 也有同樣結果。我並不贊成強逼同性戀者改變,然而《愛文》承認「有些具同性性傾向的人,不一定認同或實踐同性性行為」(註13),假若這些人希望改變,尋求輔導和治療,難道幫助他們也不行?《愛文》認為這些尋求改變的同性戀者的「主因在於社會性的壓力」,和「符合家庭與社會的期待。」這種「角色定型」的說法似乎反映《愛文》沒有真正聆聽前同性戀者(ex-gay)的聲音,也忽略了不少證據。我曾直接聆聽不少前同性戀者的故事和與他們談話,他∕她們大多曾多年實踐同性戀生活方式,已不再介意社會或家庭的看法,然而是同性戀生活方式內蘊的各種問題(關係不斷破裂、不能控制的濫交傾向、內心的空虛或良心不安、健康的風險等等)令他們希望擺脫同性性吸引的綑綁。我一些朋友是前同性戀者,已改變多年,並沒有嚴重憂鬱、性無能或自殺,反已聚得嬌妻,誕下孩子,身心愉快。

《愛文》質疑出埃及協會的多數案例「其性傾向並未改變,但以拒絕同性性行為為其目標,這究竟是改變還是壓抑呢?」這說法的理據並不清楚,就我所看的個案分享,有很多都表示於同性性傾向有巨大改變,《愛文》是否假設了只有完全及徹底的改變才算真正的改變呢?這要求並不合理,例如一個人因著自己的暴燥傾向所導致的行為吃盡苦頭,要決心求變,假若他能把這傾向減低60%,不再亂發脾氣,那已是甚大的成功。再者,假設他還未能做到內心完全平和,內心還是有暴燥傾向,但他已學會「壓抑」它,不讓它演變成傷害關係的行為,這種「壓抑」不也是一種進步嗎?假若一些尋求改變的同性戀者主要是害怕持續他們的生活方式會帶來身體傷害(如愛滋病),那只要他們能停止同性性行為,那就不會再感到生命受威脅了,這種治療不也是對他們的巨大幫助嗎?若這類人求助,按照《愛文》的看法,任何人都應拒絕協助,若後來這案主真的患了愛滋病,責任是在誰身上呢?所以同性戀治療的合法性最終建基於求助人的自決權。」

Recent Research on Sexual Orientation Change Published in Respected Scientific Journal

Stanton L. Jones & Mark A. Yarhouse. (2011). “A longitudinal study of attempted religiously-mediated sexual orientation change.” Journal of Sex and Marital Therapy, Volume 37, pages 404-427.

For an introduction, see: http://www.exgaystudy.org/archives/1278

A chorus of voices in the professional world today proclaims that it is impossible to change sexual orientation, particularly homosexual orientation, and that the attempt to change sexual orientation is commonly and inherently harmful. For example, for many years the Public Affairs website of the American Psychological Association stated: “Can therapy change sexual orientation? No. . . . [H]omosexuality . . . does not require treatment and is not changeable.”[1]  Regarding harm, the American Psychiatric Association’s statement that the “potential risks of ‘reparative therapy’are great, including depression, anxiety and self-destructive behavior”[2] is often cited.

Psychologists Stanton L. Jones of Wheaton College (IL) and Mark A. Yarhouse of Regent University have just published in The Journal of Sex and Marital Therapy, a respected, peer-reviewed scientific journal, the final results of their longitudinal study of a sample of men and women seeking religiously-mediated sexual orientation change through involvement in a variety of Christian ministries affiliated with Exodus International. The results stand in tension with the supposed professional consensus.

This study meets high standards of empirical rigor. In other studies, in the words of the APA,“treatment outcome is not followed and reported over time as would be the standard to test the validity of any mental health intervention.”[3]  Prior research has been appropriately criticized for

  • Failing to follow subjects over time (i.e., not longitudinal)
  • Relying on memory rather than following change as it occurs (i.e., not prospective)
  • Relying on therapist ratings rather than hearing directly from those seeking change
  • Using idiosyncratic and unvalidated measures of sexual orientation

The Jones and Yarhouse study was designed to address these empirical standards.  The study is a longitudinal and prospective quasi-experimental study of a respectably large sample of persons seeking to change their sexual orientation via religiously-mediated means through Exodus ministries groups.  Among those endorsing the earlier book[4] describing the study and its results at the 3-year mark was Former President of the American Psychological Association Nicholas A. Cummings, Ph.D., Sc.D., who stated “Research in the controversial area of homosexuality is fraught with ideology and plagued by a dearth of science. This study has broken new ground in its adherence to objectivity and a scientific precision that can be replicated and expanded, and it opens new horizons for investigation…. I have waited over thirty years for this refreshing, penetrating study of an imperative, though controversial human condition. This book is must reading for psychotherapists and counselors, as well as academic psychologists studying human behavior and sexuality.

This study assessed the sexual orientations and psychological distress levels of 98 individuals seeking sexual orientation change beginning early in the change process, and then followed them longitudinally with five additional independent assessments over a total span of 6 to 7 years. The researchers used standardized, respected measures of sexual orientation and of emotional distress to test the study’s hypotheses. This new report extends out to between 6-7 years the findings previously reported at the 3-year mark for the subjects in the study. An earlier version of these results were presented at the Annual Convention of the American Psychological Association on August 9, 2009; that two former presidents of the APA, Dr. Nicholas Cummings and Dr. Frank Farley, discussed the findings in that presentation underscores the significance of the study.

The findings in brief:  Of the original 98 subjects (72 men, 26 women), 61 subjects completed the key measures of sexual orientation and psychological distress at the conclusion of the study, and were successfully categorized for general outcome. Of these 61 subjects, 53% were categorized as successful outcomes by the standards of Exodus Ministries. Specifically, 23% of the subjects reported success in the form of successful “conversion” to heterosexual orientation and functioning, while an additional 30% reported stable behavioral chastity with substantive dis-identification with homosexual orientation. On the other hand, 20% of the subjects reported giving up on the change process and fully embracing gay identity. On the measures of sexual orientation, statistically significant changes on average were reported across the entire sample for decreases in homosexual orientation; some statistically significant change, but of smaller magnitude, was reported in increase of heterosexual attraction. These changes were less substantial and generally statistically non-significant for the average changes of those subjects assessed earliest in the change process, though some of these subjects still figured as “Success: Conversion” cases. The measure of psychological distress did not, on average, reflect increases in psychological distress associated with the attempt to change orientation; indeed, several small significant improvements in reported average psychological distress were associated with the interventions.

In short, the results do not prove that categorical change in sexual orientation is possible for everyone or anyone, but rather that meaningful shifts along a continuum that constitute real changes appear possible for some. The results do not prove that no one is harmed by the attempt to change, but rather that the attempt to change does not appear to be harmful on average or inherently harmful. Several cautions are noted in the research report:  The authors urge caution in projecting success rates from these findings; the figures of 23% successful conversion to heterosexual orientation and 30% to successful chastity are likely overly optimistic projections of anticipated success for persons newly entering Exodus-related groups seeking change. Further, it was clear that “conversion” to heterosexual adaptation was a complex phenomenon; the authors explore a variety of possible explanations of the findings including religious healing and sexual identity change. Nevertheless, these findings challenge the commonly expressed views of the mental health establishment that change of sexual orientation is impossible or very uncommon, and that the attempt to change is highly likely to produce harm for those who make such an effort.

[1] American Psychological Association (2005). “Answers to Your Questions About Sexual Orientation and Homosexuality.” Retrieved April 4, 2005, fromwww.apa.org/pubinfo/answers.html.  This statement was removed some time after 2007.

[2] American Psychiatric Association (1998). “Psychiatric treatment and sexual orientation position statement.” Retrieved fromhttp://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001.aspx

[3] American Psychological Association (2005); ibid.

[4] Stanton L. Jones and Mark A. Yarhouse (2007). Ex-gays?  A longitudinal study of religiously-mediated change in sexual orientation. Downers Grove, IL: InterVarsity Press.

 

[1] 關啟文,〈反對同性戀並非基於恐懼──回應陳立言〉,《生命教育研究》第三卷第一期,2011年6月,頁41-56。

[2] 參看網頁http://www.narth.com

[3] James E. Phelan, Neil Whitehead, & Philip M. Sutton, “What Research Shows: NARTH’s Response to the APA Claims on Homosexuality- A Report of the Scientific Advisory Committee of the National Association for Research & Therapy of Homosexuality,” Journal of Human Sexuality, Volume 1 (2009), pp.1-121.

 


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