Sunday, 16 January 2011

Is it wrong to "treat" homosexuality?

Via Twitter, the Conservative MEP Roger Helmer asks an "interesting" question:


Why is it OK for a surgeon to perform a sex-change operation, but not OK for a psychiatrist to try to "turn" a consenting homosexual?


It's interesting because it hints at hypocrisies on two sides of a question. It's a bit like asking a Southern Baptist why he opposes abortion on the grounds that only God can take life, and yet supports capital punishment; or (a question I myself posed on Twitter recently) why in "liberal" circles it's acceptable to blame the actions of a disturbed Arizona gunman on the rhetoric of Sarah Palin and the Tea Party, while condemning Jack Straw for "smearing" British Pakistani culture when he pointed out that criminal gangs preying on vulnerable young girls were often brought up with a low opinion of Western women? Helmer's question also works just as well backwards: there will be many who oppose sex changes while supporting "sexuality modification" of the type promoted by Christian therapist Lesley Pilkington, who is facing disciplinary action by the British Association for Counselling and Psychotherapy after her work was "exposed" by an undercover gay activist.

In Helmer's case, his poser provoked many on Twitter to splutterings of outrage. Here's a selection of reactions:

You, Sir, are a disgrace and I'm ashamed you're one of my representatives

How do these people get elected?!

Does anyone know if there is any therapy available to "turn" @RogerHelmerMEP away from being a small-minded homophobe?

You are a moron. I can't be bothered even demonstrating the various holes in your idiotic statement. Get a grip.


Etc, etc. Some responses were more nuanced, the politest suggesting that while one procedure is possible, the other isn't. But even if true, that wouldn't quite answer the question. What Helmer was driving at was not the practicability of either procedure, but rather its moral status. And the replies he received strongly suggest that, for many, while sex-change is self-evidently a good thing, sexuality-change is equally self-evidently wrong. So much that the merest hint of support for it is enough to have one labelled a "homophobe".

I have no idea whether or not Roger Helmer is a homophobe. But his personal feelings towards gay people are in any case irrelevant. The question he raises is, indeed, worthy of consideration. Nor am I convinced by David Allen Green's suggestion that "Helmer is confusing the distinct issues of gender identity and sexual preference." Too lawyerly. They are indeed distinct issues; but the strength of feeling engendered by Helmer's suggestion points to something more at play than a technical distinction.

So let's take it in two parts. Is there anything wrong with a sex-change operation? In my uncontroversial view, provided the person having the change is fully aware of the consequences, such a procedure is almost wholly beneficial. No-one enters into such revolutionary surgery lightly. Typically, it comes after years of the misery of living in the "wrong" body. The feelings may stem from an underlying physical, hormonal or genetic cause, or they may be entirely psychological. They may be present from early childhood or develop only in middle age. But for most people in this situation, the sense of alienation between mind and biology is overwhelming. To deny transsexuals their one salvation would be an act of cruelty. I also set great store by personal autonomy. In any case, to me it is sufficient that someone wants to change their sex. Even if it were done on a whim and later regretted, that would not make it wrong, merely foolish.

While there are some who would deny on philosophical or religious grounds that it is possible to turn a man into a woman, many post-operative transsexuals have little trouble passing the walking duck test. Whether or not it is possible to "turn" a gay person straight (or, for that matter, a straight person gay) remains a hugely contested question. Even to pose it calls into play the very understanding of "sexuality". Is it something innate? God-given? A matter of environment? Is it amenable to free will or conscious choice? Is it fixed or fluid? Is there, indeed, such a thing as "sexual orientation" at all?

Modern western society, including officialdom, seems to have decided that there is, and that it is binary - or at most tripartite. You are gay, or straight, or possibly bisexual, and you'd better make up your mind because there's a box to be ticked on the new diversity survey. The law now puts people into categories based on the sex of the people they live with or find themselves attracted to. Personally, I find this a bizarre way to classify human beings in all their richness and paradox; but then I have an unreconstructed pre-digital mindset, and am fully aware of my own anachronism.

I was struck by a remark - not unlike Helmer's - made by Pilkington's nemesis Patrick Strudwick (who described the therapy he secretly taped as "chilling"):

If a black person goes to a GP and says I want skin bleaching treatment, that does not put the onus on the practitioner to deliver the demands of the patient. It puts the onus on the health care practitioner to behave responsibly.


For Strudwick, sexual orientation is evidently as fixed as racial identity. But what then of gender identity? Might not a white person have a strong conviction that inside them was a black person trying to get out, that they were born in the "wrong body"? The suggestion will strike many as offensive. Yet genetically, race scarcely exists - there can be more variability within a particular racial group than between different races. Race is purely superficial. It has no more intrinsic significance than eye colour. Modern society has however insisted that it is fixed, classifiable (another box to tick) and determinative of personal identity. But if your identity is bound up with your race, why in a free society should you not be able to "change" it cosmetically, in the same way that you can change your gender, or just the shape of your nose?

Lesley Pilkington takes a straightforwardly religious (many would say bigoted) line on sexual orientation. God, she believes, created everyone heterosexual but "some people have a homosexual problem" caused by upbringing or environment. The alternative is, I suppose, too horrible to contemplate. If homosexual orientation is (as research increasingly suggests that it is) innate, or at least has a significant genetic component, then the notion that God creates everyone heterosexual becomes impossible to sustain. You have rather to say, with the Pope, that some people have a "strong tendency to an intrinsic moral evil"; though that raises the obvious question of why God would (as Christopher Hitchens put it) "create people sick and command them to be well". Or you could take the evidence as suggesting that God actually wants some people to be gay; in which case you merely have to throw away the Bible.

Yet to say that there's a genetic component in homosexuality (or even that it can be explained in Darwinian terms) is not to deny the influence either of culture or of individual choice. Our genes are expressed in culture, after all. And even if the genetic basis is proved, there will still be people without the "gay gene" who are gay, and others who have the "gay" gene without the homosexual feelings. The modern view of homosexuality as an "orientation" would have made little sense even in the era of Oscar Wilde (married, not unhappily, with children) and may - who knows? - seem equally strange to our descendants. In ancient Athens male homosexuality - in a particular, culturally endorsed form - was all but universal; yet while it was expected that a man would take a younger man as his lover it would have caused bemusement if he did not also have a wife. Can an entire civilisation be bisexual? Quite possibly it can. But where does that leave the notion of innate, or biologically determined, sexuality?

Back to Lesley Pilkington. She denies that she believes homosexuality is a "disease", claiming rather to be "helping people move out of that lifestyle because they are depressed and unhappy." As far as I can ascertain, she does not seek aggressively for patients. They come to her.

The SOCE method involves behavioural, psychoanalytical and religious techniques. Homosexual men are sent on weekends away with heterosexual men to “encourage their masculinity” and “in time to develop healthy relationships with women”, said Mrs Pilkington.


She also says, "I have been able to help my son" - who is, however, "still gay." This might suggest that her therapy is not always effective. It's not clear, though, that her son is as unhappy with his sexuality as Mrs Pilkington is. Others more deeply convinced of their desire to be heterosexual might have more success with the "treatment".

The official position of the Royal College of Psychiatrists is that "there is no sound scientific evidence that sexual orientation can be exchanged" and that "so-called treatments of homosexuality create a setting in which prejudice and discrimination flourish". The first may factually be true (though that does mean that there are no people who believe that their sexuality has indeed been changed). The second is more questionable, but gets to the nub of the objections. Even if the treatment were effective, it implies, it would be politically unacceptable for reasons that have nothing to do with therapy. It is not just the treatments offered by therapists like Pilkington that are suspected; more importantly, it is the motives behind them.

Behind such a statement, which is far from unique to the RCP, may lurk the fear that if sexual orientation can be chosen - or might changed by an act of will - then the whole edifice of modern sexuality theory, which is premised on essentialism, will be imperilled. And with it the tolerance. For, politically, discrimination against gay people has been challenged by denying that sexuality can be chosen (and thus is "not their fault"), rather than on the more truly liberal grounds that free people have the right to live their lives in whatever way they choose.

Sexual freedom includes being gay, straight, bisexual, polyamorous, kinky, asexual or a virgin. It also includes being dissatisfied with one's feelings and attempting to change them. Human sexuality is not just a matter of instinct, after all. It is possible to be morally and intellectually committed to a certain lifestyle (monogamy,say) while finding it hard to live up to. As many married people have found. Evolutionary psychologists of the type so often quoted in the Daily Mail like to claim that, for men, promiscuity may be "natural" - a way of spreading their genes. But that doesn't make adultery "right", or the sexual double standard acceptable in the modern world; these can only be moral questions. And moral questions are in the end for individuals to decide.

You may not like it, but some people combine strong homosexual tendencies with a religious commitment to a heterosexual lifestyle. One the one hand, they feel sexually satisfied only in gay relationships; on the other, they feel morally dissatisfied in those same relationships. If they "try" heterosexuality, they fail, hurting both themselves and their opposite-sex partner. Either way, they are miserable. What is such a person to do? In my mind, only the individual can supply the answer. The problem with the RCP's position is its paternalism, its assertion not just of scientific but of moral certainty. It may be that therapies offered by Lesley Pilkington and her like don't work. That is not the same as asserting that sexuality-change therapies cannot work - such a statement is altogether too dogmatic and anyone making it has crossed the line separating science from moralism. If there is a genuine demand for treatment, then the proper response to the failure of current therapies is to work towards the development of a more effective one.

I also wonder if Patrick Strudwick would be quite so outraged by the thought of heterosexuals pleading with psychiatrists to turn them gay