1.3. Homosexuality as a Psychopathology
Homosexuality is not considered a mental illness by the major mental health organizations. It was removed from the Diagnostic and Statistical Manual of Mental Disorders in 1973 by the American Psychiatric Association, and the focus since that time has been on ways to support sexual minorities in their identity development and to treat mental health concerns with which members of the gay community often contend.
For example, many experts today recognize that members of the gay community are at greater risk for mood disorders, anxiety disorders, substance use disorders, suicidality, and poor self-esteem, among other concerns.20 Minority stress models have been the primary lens through which researchers and theorists have understood these elevations, that is, increased psychological distress and social stress associated with being a sexual minority can lead to these and other health concerns.21
Our culture has witnessed a remarkable shift that led to the removal of homosexuality from the list of mental health concerns.22 More than that, we are now part of a sociocultural context in which there is quite a positive view of homosexuality as a healthy expression of sexual diversity. How do these changes impact the Christian sexual ethic? Ultimately, changes in cultural understandings of what constitutes a mental health concern do not drive the Christian understanding of moral concerns. Indeed, there are many mental health concerns—bipolar disorder, panic disorder, posttraumatic stress disorder—that are not moral issues, just as envy, sloth, and gluttony are moral concerns but not mental disorders. While some Christians may prefer to see cultural consensus in areas of morality, mental health, law, and other domains, Christians will have to examine what it is they believe about matters of morality and the Christian sexual ethic, particularly as these other domains change their conclusions in an ever-changing sociocultural context.
1.4. Change of Sexual Orientation
When homosexuality was considered a mental disorder by the major mental health associations, professionals provided treatment to change a person’s sexual orientation from homosexual to heterosexual. These professional treatments included psychoanalysis,23 behavioral therapy,24 and aversive treatments,25 as well as group therapies26 from a number of similar theoretical orientations. The published rates of success were about 30% although it varied what counted as success in these different studies, ranging from decreased self-reported or therapist/analyst-reported reductions in same-sex attraction, fantasy, and/or homosexual behavior to increased self-report or therapist/analyst report of opposite-sex attraction, fantasy, and/or behavior to heterosexual marriage.
More recent surveys suggest that some clinicians still provide therapy to change sexual orientation,27 and two recent studies suggest that change is possible for some people who attempt it. The first was conducted by Robert Spitzer and published in 2003. Spitzer studied 200 people who claimed to have changed orientation. He interviewed them and documented their claims of change by looking at what they said they were like prior to their change attempt and what they were like at the time of the interview.
I was involved in the other recent study on whether sexual orientation can change.28 I worked with Stanton Jones of Wheaton College on a longitudinal study of religiously mediated change of orientation. We reported on data from a group of 98 persons who were initially in a change attempt with a Christian ministry affiliated with Exodus International (the largest umbrella organization of such ministries at that time). Those involved in the change attempt reported an average decrease in attraction to the same sex and a more modest increase in attraction to the opposite sex. These averages suggest that individual participants had more positive results, while others did not.
At the time of our original publication, we categorized participants based on what they said of their change efforts. We used categories such as “success” and “failure” only with reference to the goals of the participants themselves, in terms of being a part of Exodus to experience a change in attractions or orientation. In total, participants fell into six categories. We indicated that 15% were what we called Success: Conversion (which reflected a conversion from homosexuality to heterosexuality), while 23% were categorized as Success: Chastity (or a sufficient reduction in same-sex attraction so that the person reported the freedom to live chaste without it being the burden it once was). Another 29% of the participants were categorized as Continuing change effort, which meant there was some reduction in attraction but not enough to describe themselves as having experienced success. Fifteen percent of participants were designated as having No Response to change effort. Four percent were categorized as Failure: Confused, while 8% were designated Failure: Gay Identity.
Our updated results after six to seven years in the change effort suggested that the average changes made were able to be sustained over time. As with the changes reported after three years in a change attempt, the average gains of diminished same-sex attraction (or away from homosexuality) were stronger than the average gains of increased opposite-sex attraction (or toward heterosexuality). In this assessment, we asked people how they would designate themselves in light of the previous categories we had used, and Success: Conversion (to heterosexuality) rose to 23% of the remaining sample, while Success: Chastity also increased to 30% of the sample.
As important as these findings are for those considering a change attempt, most people do not experience change of sexual orientation; the reported changes are best thought of as gains along a continuum of attraction rather than categorical changes from homosexual to heterosexual. Indeed, most people who report a heterosexual outcome would acknowledge some experiences of attraction to the same sex.
In any case, what is the formal relevance of the change research on the moral debate facing the church today? In the most extreme example, what if nobody experienced change? Although that was not the case, when we look at the debate about whether homosexual orientation can change, Christians understand that change is also not directly relevant to the moral debate. The Christian sexual ethic is a part of a larger identity that is grounded in being faithful to God’s revealed will and honoring God with our lives. From a Christian perspective, if God’s revealed will is that full genital sexual contact should occur only in the context of a life-long heterosexual union, then same-sex behavior is the primary concern rather than same-sex attraction or orientation. If neither attractions nor orientation change, the sexual ethic remains, so believers must take responsibility for whether and how they express their impulses in their behavior. In that sense all people are capable of conforming to God’s expressed will in this area. This response will be viewed as quite foreign and perhaps more radical to a culture that sees no reason whatsoever to resist impulses that feel like self-expression. Indeed, we are a culture of self-actualization, and sexual self-actualization is one of the most salient examples of how people in our culture express themselves.29
1.5. Concluding Thoughts on Relevance of Science to the Christian Sexual Ethic
What role does science play in how Christians think about human sexuality, specifically homosexuality and same-sex behavior? Science offers important insights into our understanding of many things today, not the least of which is same-sex sexuality and its expression. However, science cannot answer the difficult moral questions that are being raised today. The methods of science can tell us about what occurs and what is measurable, about what people do and perhaps provide insight into factors that may contribute to impulses and patterns of behavior, as well as broader concepts such as orientation. However, science cannot tell us what ought to be or how we should live or which impulses we should follow. Students who have taken Philosophy 101 will recognize the naturalistic fallacy, that is, the tendency to confuse what is with what ought to be. The questions related to human purpose and morality and ethics have to be answered by more than what we can measure through the scientific method, as important as that is.
We turn now to an often overlooked concept that is critical for a nuanced Christian understanding of same-sex attraction, orientation, and behavior: sexual identity.