Same-Sex Attractions in Youth and Their Right to Informed Consent

This paper was presented at the Twenty-Third Workshop for Bishops in Dallas, Texas, on February 16, 2011, sponsored by The National Catholic Bioethics Center and the Knights of Columbus.

Youth have the right to be provided with the accurate medical and psychological knowledge about homosexuality by pediatricians, mental health professionals, school counselors, educators and parents.  Presently, well-organized attempts are under way to attempt to block youth from being given both the appropriate scientific knowledge, and informed consent about: same-sex attractions, gender identity disorder, transsexual issues, the psychological needs of a child for father and mother, and marriage.

One example of this activity is the American Psychological Association publication, Just the Facts ¹, that was sent to all the school superintendents in this country two years ago. It was sponsored by a coalition of 13 national organizations, including the American School Counselors Association, and the American Academy of Pediatrics. Just the Facts advised schools that all forms of sexual attraction are normal, warned against psychotherapy for homosexual attractions, encouraged on-campus gay clubs, and cautioned schools about the scientific literature—such as studies by the National Association for Research and Therapy of Homosexuality (NARTH)—that presents heterosexuality as normative.

NARTH responded by sending a scientific statement on homosexuality ² that was pertinent to youth to the school superintendents and then, later, so did the American College of Pediatricians (ACOP) ³.  Their statements presented issues related to the lack of genetic origins of same-sex attractions, the fluidity of such actions, the serious dangers to psychological and medical health from homosexual behaviors, the resolution of same-sex attractions, and the right to informed consent.

In response to the ACOP statement, Dr. Francis Collins, the director of the National Institutes of Health, dismissed the peer-reviewed articles on the NIH website, cited by ACOP, as being “misleading and incorrect.” He went on to state: “ . . . it is particularly troubling that they are distributing it in a way that will confuse children and their parents.”  When ACOP asked Dr. Collins to identify the specific research that was misleading and incorrect, he failed to identify a single peer-reviewed article.

Adolescent Mental Health Disorders and Households
Another example of the impact of political correctness upon psychological science and youth was from a study in the November 2010 issue of the leading journal of child and adolescent psychiatry, the Journal of the American Academy of Child and Adolescent Psychiatry. ⁴ In this study of the prevalence of mental disorders in U.S. adolescents, the first table presented the socio-demographic characteristics. Three categories were listed in regard to parents: never married, previously married, and married/cohabiting.

Several years ago the failure to separate married and cohabiting households would have led the editors to return the article to the authors. They would have requested that, given the numerous research studies on the emotional and physical harm to children in cohabitating households, the authors separate the research findings under two different headings.

Seven months before the publication of this study of adolescent psychiatric illness, a report on child abuse by the Department of Health and Human Services, found that children living with two married biological parents had the lowest rates of harm — 6.8 per 1,000 children — while children living with one parent, who had an unmarried partner in the house, had the highest incidence, at 57.2 per 1,000 children. ⁵  Children living in cohabiting households are eight times more likely to be harmed than children living with married biological parents.

Another research study, Pediatrics, concerning the dangers to children in cohabiting households, demonstrated that children, residing in households with unrelated adults, were nearly 50 times as likely to die of injuries, than children residing with two biological parents. ⁶  Children in households with a single parent, and no other adult in residence, had no increased risk of inflicted-injury death.  Another study revealed that the cohabitation experience for adolescents is associated with poor outcomes, and that moving into a cohabiting stepfamily, from a single- mother family, decreased adolescent well-being. ⁷

The author of the adolescent research study, and the editors of the Journal of the American Academy of Child and Adolescent Psychiatry, chose to ignore the overwhelming research that demonstrates the danger to children from living in cohabiting households.   Also, the author has failed to respond to the requests of professionals, who have requested the data in the study, in order to analyze the differences between married and cohabiting households.  A more in-depth analysis of the first study, of the prevalence of mental health disorders in adolescents, could be helpful in the efforts to protect children and marriage.  For example, the extensive research on children in homes without fathers, shows the harm done to the mental health of such children, to families and to the entire culture.  A large and growing body of research indicates that mothers and fathers bring distinctive talents to parenting, and that the children are most likely to thrive when they are raised by their own mother and father.

The Right to Informed Consent in Youth
Just the Facts violates the right to informed consent in youth in regard to the positions taken by the American Psychological Association, the American Academy of Pediatrics, and the American School Counselors Association, in regard to diagnosis, proposed treatment, the risks and benefits of not receiving treatment, and the health risks associated with the homosexual lifestyle. It fails to present the diagnosis of gender identity disorder, the fluidity of sexual attractions in youth, the absence of a biological basis for Same Sex Attraction (SSA), and the serious emotional conflicts in youth with same-sex inclinations, such as a lack of secure attachment relationships with a parent or same-sex peers. Also, it does not identify the serious high-risk behaviors, compulsive masturbatory and sexual behaviors, depression, and excessive anger in those with homosexual inclinations. These numerous conflicts: should not be ignored, are not caused by the culture, and should be addressed, rather than denied.

The next area, in which the criteria for informed consent are violated, is the nature and purpose of proposed treatment and youth. There is a failure to recommend treatment, in spite of serious emotional, behavioral and sexual problems. Even worse, strong advice is given against treatment, except that which affirms a homosexual identity. Also, the risks of not receiving treatment are not identified.

One benefit of treatment of same-sex inclinations that Columbia University psychiatrist, Dr. Robert Spitzer, found in his 2003 study of men and women out of the homosexual lifestyle for at least five years, was that 87 percent found therapy to be helpful in terms of feeling more masculine or more feminine. Also, 93 percent found therapy helpful in developing more intimate, nonsexual relationships with those of the same sex. ⁸

The Origins of Same-Sex Attractions
Today, there is a consensus that there is not a genetic or hormonal origin of homosexuality. A 2008 American Psychological Association publication stated: “although much research has examined the [possibilities] on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles. . . .” ⁹  In addition, Dr.  Francis S. Collins, M.D, Ph.D, former director of The Human Genome Project, wrote: “There is an inescapable component of heritability to many human behavioral traits. For virtually none of them is heredity ever close to predictive…An area of particularly strong public interest is the genetic basis of homosexuality. Evidence [indicates] that sexual orientation is genetically influenced but not hardwired by DNA, and that whatever genes are involved represent predispositions, not predeterminations.” ¹⁰

Emotional Conflicts in Males with SSA
In our clinical work over the past 34 years, with perhaps three to four hundred men and women with same-sex attractions, we have found that the most common cause of same-sex attractions in males is an intense weakness in masculine confidence that is associated with strong feelings of loneliness and sadness. This insecurity arises from a number of factors, including same-sex peer rejection in early childhood as a result of a lack of eye–hand coordination. This challenge in boys interferes with male bonding in sports, and with secure same-sex attachments. Other origins of male insecurity and sadness are an emotionally distant father relationship, a poor body image and, finally, sexual abuse victimization.

Several major research studies of adult and adolescent males with SSA have also demonstrated low self-esteem as being a major conflict in their lives.  The first study from the Netherlands, of 7,076 adults, demonstrated that lesser quality of life in men was predominantly explained by low self-esteem. ¹¹ The authors recommended the importance of finding out how a lower sense of self-esteem comes about in homosexual men.  The other 2011 U.K. study of 10,000 adolescents was notable for boys, with some same-sex experience, reporting less self-esteem, and more experiences of forced sex. ¹²

Other causes of male same sex attractions are a mistrust of women, arising from conflicts with a controlling, angry, and overly dependent mother, or from significant rejection by females. Finally, selfishness and sexual narcissism are factors in some males.

Emotional Conflicts in Females with SSA
In our clinical experience, the most common origin of SSA in females is a mistrust of males, originating primarily from conflicts with fathers, who are excessively angry, alcoholic, abusive, or highly narcissistic. The next conflict, present in women, is a weak feminine identity that can arise from a lack of secure attachment in the mother relationship, peer rejection and loneliness, or from a poor body image. Also, struggles with loneliness, and inability to establish a loving relationship with a man, can lead to intense loneliness, and an attempt to escape this sadness through a homosexual relationship.

A 2010 study of 7,643 women, between the ages of 14 and 44, drawn from the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention (CDC), found that women who grew up in households, where their biological fathers were absent, were three times more likely to have had homosexual partners in the year prior to the survey, than were women who grew up with their biological fathers.

Fluidity of Attraction in Youth
Dr. Laumann’s research, ¹³ at the University of Chicago, has shown that “sexual orientation was found to be unstable over time, in both males and females.” In another study, ¹⁴ Kinnish demonstrated that sexual attraction/orientation is inherently flexible, evolving continuously over the life span, and that women demonstrate greater fluidity than men.

Serious Health Risks Associated with SSA
Well-designed research studies, published in leading peer-reviewed journals, ¹⁵ have shown a number of psychiatric disorders to be far more prevalent in teenagers and adults with SSA: major depression, anxiety disorders, substance abuse, suicidal ideation, suicide attempts and sexual abuse victimization. Many of these studies were done in countries where homosexuality is widely accepted, such as in New Zealand and the Netherlands.

Youth have the right to know the recent research that demonstrates the serious health risk of acquiring cancer in the homosexual life style.  A major study published in the journal, Cancer, in May 2011, revealed that men in California with SSA are twice as likely to report a cancer as heterosexual men.  Most troubling was the median age of onset of cancer in the men with SSA—41 years old. ¹⁶

Gay-Lesbian-Bisexual (GLB) youth, who self-identified during high school, report disproportionate risk for a variety of health issues and problem behaviors, including suicide, sexual risk behaviors, multiple substance abuse use, and victimization. ¹⁷ In addition these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than their peers.

Young men who have sex with men (MSM) are at extremely high risk for contracting a sexually transmitted infection. According to the CDC, the number of MSMs, ages 13 to 24, with newly diagnosed Human immunodeficiency virus (HIV), is increasing each year, and almost doubled since 2000. The number infected increased by 11percent in 2001, and by 18% in 2006. ¹⁸

A 2008 study found the HIV new-infection rate in the U.S. is 40 percent higher than estimated. ¹⁹ Boys who begin to engage in sexual activity with males at an early age are more likely to become HIV positive, or contract a Sexually Transmitted Disease (STD). Intensive condom education has failed to prevent infections. According to Dr. Philip Alcabes, an epidemiologist at Hunter College: “It looks like prevention campaigns make even less difference than anyone thought.”

A study of young men, aged 17–22, who have sex with men, found that 22 percent reported beginning anal sex with men when aged 3 to 14; of these, 15.2 percent were HIV positive. ²⁰  Of those who began sex when they were 15 to 19, 11.6 percent were HIV positive. While of those who began sex with men when they were 20 to 22, only 3.8 percent were HIV positive. It is clear that every year that a male, with SSA, delays sexual involvement, he reduces his risk of HIV.

In a study of 137 young males with SSA, aged 17 to 21, 30 percent admitted to at least one suicide attempt. ²¹  Forty-four percent attributed this attempt to family problems, including marital discord, divorce, and alcoholism. Other factors included: a history of sexual abuse in 61 percent, substance abuse in 85 percent, illegal activities in 51 percent, effeminacy in 36 percent, and prostitution in 29 percent.  The data on the 10,587 youths, from the national longitudinal study of adolescent health, revealed that 1 percent reported same-sex attraction only, whereas 5 percent reported attraction to both sexes. ²²  Those with SSA were twice as likely to perpetrate violence, and were also at greater risk for experiencing and witnessing violence.

HIV and SSA
In March 2010, the CDC reported that the rate of new HIV diagnoses among men, who have sex with men (MSM), is more than 44 times that among other men, and more than 40 times that among women. ²³ The rate of primary, and secondary, syphilis among MSM is more than 46 times that of other men, and more than 71 times that of women. The factors that were listed as causing higher HIV prevalence included greater risk of HIV transmission to receptive anal sex and other sexual activities, complacency about HIV risk particularly among young MSM, difficulty consistently maintaining safe sexual behaviors over the course of a lifetime, and homophobia.

Partner Abuse and SSA
A 2002 study of abuse revealed that 7 percent of heterosexual males reported being abused, whereas 39 percent of males with SSA reported being abused by other males with SSA. ²⁴ Other research demonstrates partner abuse reported by 35 percent to 55 percent of participants.

Study of Same-Sex Unions
One of the largest studies of same-sex couples revealed that only seven of the 156 couples had a totally exclusive sexual relationship. The majority of relationships lasted less than five years. Couples with a relationship lasting more than five years incorporated some provision for outside sexual activity in their relationship: “The single most important factor that keeps couples together past the 10-year mark is the lack of possessiveness. . . . Many couples learn very early in their relationship that ownership of each other sexually can be the greatest internal threat to their staying together.” ²⁵

Same Sex Adoption
The Catholic Medical Association offers this medical opinion on same sex adoption in its publication, Homosexuality and Hope: “Research on same-sex unions demonstrates that they are markedly different from marriage in that exclusivity and permanency are not present, or desired, in the vast majority of these unions. Same-sex unions suffer a significantly higher prevalence of domestic abuse, depression, substance-abuse disorders, and sexually transmitted diseases. ²⁶ Physicians should caution their patients about the dangers of same-sex unions, and advocate against children being placed in such unstable relationships. The overwhelming body of well-designed research demonstrates that the healthiest environment for child development is a home with a mother and father who are married.” ²⁷

The extensive research on the serious psychological, academic, and social problems in youth raised in fatherless families demonstrates the importance of the presence of the father in the home for healthy child development.  Clinical experience would indicate that the deliberate deprivation of a mother to a child, while not studied as extensively, causes even more severe damage to a child because the role of the mother is so crucial in establishing the ability to trust and to feel safe in relationships.

Research on Children Raised in Same Sex Unions
Extensive research exists that demonstrates the importance of gender complementarity to the healthy development of children.  This literature from peer-reviewed journals cites the importance of both mothering and fathering for the healthy development of a child.  Research published in 2010 by Marquardt, Glenn and Clark demonstrated the following troubling negative factors in donor conceived individuals:  on average, young adults conceived through artificial insemination were more confused, felt more isolated from their families, were experiencing more psychic pain, and fared worse than a matched group of children, who were conceived naturally, in areas such as depression, delinquency and substance abuse. ²⁸

Two major studies that claim no psychological damage to children, who were deliberately deprived of the benefits of gender complementarity in a home with a father and a mother, were published in 2010 by Gartrell and Bos ²⁹  and Biblar and Stacey’s. ³⁰  In the Gartell and Bos article, all data are self-reports by mother and child. Lesbian mothers well know the political agenda of the research.  Also, there is no direct comparison group, only a normative group by Achenbach, when he formed the Child Behavior Checklist (CBCL) , that was used in the study.

Again, in the Biblar and Stacey research, in 31 of the 33 studies of two parent families, it was the parents who provided the data, which consisted of subjective judgments. As in the study published in Pediatrics, this created a social desirability bias in that the homosexual parents knew, full-well, why the study was being done.  They knew the political agenda.  Also, of the 33 studies in two-person families, only 2 studies included men.  This was an examination of published studies of women, not men, and the title implies both.

Treatment of SSA
The goals of therapy are to help the person identify the underlying causes of his or her SSA, which often includes low self-esteem, sadness, loneliness, anger and anxiety. Mental health professionals who treat males with unwanted same sex attractions, often find that treating conflicts in male confidence to be an essential aspect of successful therapy.  Therapy that is initiated to treat emotional conflicts that are associated often with promiscuous sexual behaviors regularly includes a spiritual component, as in the treatment of addictive disorders.

There have been numerous reports of successful therapy of SSA. Success depends on many factors, including: the professional expertise of the mental health professional, the relationship between therapist and client, length of treatment, presence of significant support for treatment, and the presence of other psychological problems, particularly addictions.  Spitzer’s study of 200 men and women, who had sought professional help to deal with SSA ,and who were out of the lifestyle for five years, found that 64 percent of the men, and 43 percent of the women, subsequently identified themselves as being heterosexual. ³¹  Contrary to the claims made by the opponents of therapy, they did not experience an increase in psychological conflicts as a result of therapy.

Dr. Spitzer commented on his study: “Depression has been reported to be a common side-effect of unsuccessful attempts to change orientation. This was not the case for our participants, who often reported that they were ‘markedly’ or ‘extremely’ depressed {prior to treatment} (males 43 percent, females 47 percent), but rarely that depressed {after treatment} (males 1 percent, females 4 percent). To the contrary, {after treatment}, the vast majority reported that they were ‘not at all’ or ‘only slightly’ depressed (males 91 percent, females 88 percent).” ³²

Dr. Jay Wade, at Fordham University, published a 2010 research study that showed that men with unwanted SSA can experience healing by developing healthy, non-sexual relationships, i.e., friendships, with other men.  They also reported: a decrease in homosexual feelings and behavior, an increase in heterosexual feelings and behavior, and a positive change in psychological functioning. ³³

Research on the Benefits of Courage
A 2009 doctoral dissertation on Courage demonstrated that an increased rate of chastity is negatively correlated with psychopathology: an increased rate of chastity is positively correlated with happiness; the time in Courage is positively correlated with a history of increased religious participation, and extended participation in Courage is positively correlated with chastity. ³⁴

Gender Identity Disorder and Transsexual Issues
Gender identity disorder is a childhood psychiatric disorder, in which there is a strong and persistent cross-gender identification, with at least four of the following: repeated stated desires to be of the opposite sex; in boys a preference for cross-dressing or simulating female attire and, in girls, wearing stereotypical masculine clothing with a rejection of feminine clothing such as skirts; strong and persistent preferences for cross-sex role in play; strong preference for playmates of the opposite sex, and intense desire to participate in games and pastimes of the opposite sex.

Boys who exhibit such symptoms before they enter school are more likely to be unhappy, lonely, and isolated in elementary school. They often suffer from separation anxiety, depression, and behavioral problems, and become targets to be victimized by bullies and even pedophiles. Often they experience same-sex attraction in adolescence, and if they engage in homosexual activity, they are more likely, than other boys, who are not involved in drug and alcohol abuse or prostitution. They are also at greater risk to attempt suicide, to contract a sexually transmitted disease, or to develop a serious psychological disorder as an adult. A small number of these boys will become transvestites or transsexuals.

A loving and compassionate approach to these troubled children is not to support their difficulty in accepting the goodness of their masculinity or femininity, which is being advocated in the media, and by many health professionals who lack expertise in Gender Identity Disorder (GID), but to offer them, and their parents, the highly effective treatment that is available.

The following interventions for boys with GID are helpful:

• Increasing quality time for bonding with the father ;
• Increasing affirmation of the son’s masculine gifts by the father;
• Participating in, and support for, the son’s creative efforts by the father;
• Encouraging same-sex friendships, and diminishing time, with opposite-sex friends;
• Coaching the son in the development of athletic confidence and skills, if possible;
• Slowly diminishing play with opposite-sex toys;
• Encouraging the boy to be thankful for his special masculine gifts;
• Slowly leading the boy into team play, if the athletic abilities and interest improve;
• Working at forgiving boys who may have hurt him;
• Communicating with other parents whose children have been treated successfully for GID, and those who   have come to appreciate and to embrace the goodness of  their masculinity;
• Addressing the emotional conflicts in a mother who wants her son to be a girl;
• In those with faith, encouraging thankfulness for one’s special God-given masculine gifts.

GID vs. Transgendered Child
Some medical centers are, unfortunately, going further, providing hormone treatments to GID children, whom they label as transgender, although there is no such diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).  All children with cross-gender feelings should be evaluated for GID before any hormonal treatment is considered.

Sexual Reassignment Surgery (SRS)
Paul McHugh, MD, University Distinguished Service Professor of Psychiatry and past Chair of Psychiatry at Johns Hopkins University, has a much different view of the attempt to change the sex of children.  His studies of transgender surgery brought the procedures to an end at Johns Hopkins. He has stated that “treating these children with hormones does considerable harm, and it compounds their confusion. Trying to delay puberty, or change someone’s gender, is a rejection of the lawfulness of nature.” ³⁵  A 2011 follow up of sexual reassignment surgery (SRS) from Sweden demonstrated that persons, after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population. ³⁶

In our professional opinion, the vast majority of youth who express a wish to be of the opposite sex have GID, and have the right to the highly effective treatment that is available for this disorder.

Pope Benedict and Homosexuality
Pope Benedict communicated profound wisdom for youth and adults on homosexuality in his book, Light of the World: “Sexuality has an intrinsic meaning and direction which is not homosexual. The meaning and direction of sexuality is to bring about the union of man and woman, and in this way give humanity posterity, children, future. This is the determination internal to the essence of sexuality. Everything else is against sexuality’s intrinsic meaning and direction. This is a point we need to hold firm, even if it is not pleasing to our age.” ³⁷  Youth have the right to be provided informed consent about the serious medical and psychiatric illnesses, and risks, of the homosexual lifestyle.  Pediatricians, mental health professionals, physicians, nurses and school counselors have a clear legal responsibility to do so, and parents, family members, educators, and clergy a grave moral responsibility.