Submission to the Church of England s Listening
Exercise on Human Sexuality.
This report is prepared by a Special Interest Group in the Royal College of
Psychiatrists. We have limited our comments to areas that pertain to the origins
of sexuality and the psychological and social well being of lesbian, gay and
bisexual people (LGB), which we believe will inform the Church of England s
listening exercise.
Introduction
The Royal College of Psychiatrists holds the view that LGB people should be
regarded as valued members of society who have exactly similar rights and
responsibilities as all other citizens. This includes equal access to health care,
the rights and responsibilities involved in a civil partnership, the rights and
responsibilities involved in procreating and bringing up children, freedom to
practice a religion as a lay person or religious leader, freedom from harassment
or discrimination in any sphere and a right to protection from therapies that are
potentially damaging, particularly those that purport to change sexual
orientation.
We shall address a number of issues that arise from our expertise in this area
with the aim of informing the debate within the Church of England about
homosexual people. These concern the history of the relationship between
psychiatry and LGB people, determinants of sexual orientation, the mental
health and well being of LGB people, their access to psychotherapy and the
kinds of psychotherapy that can be harmful.
1. The history of psychiatry with LGB people
Opposition to homosexuality in Europe reached a peak in the nineteenth
century. What had earlier been regarded as a vice, evolved into a perversion or
psychological illness. Official sanction of homosexuality both as illness and (for
men) a crime led to discrimination, inhumane treatments and shame, guilt and
fear for gay men and lesbians. However, things began to change for the better
some 30 years ago when in 1973 the American Psychiatric Association
concluded there was no scientific evidence that homosexuality was a disorder
and removed it from its diagnostic glossary of mental disorders. The
International Classification of Diseases of the World Health Organisation
1
followed suit in 1992. This unfortunate history demonstrates how
marginalisation of a group of people who have a particular personality feature
(in this case homosexuality) can lead to harmful medical practice and a basis
for discrimination in society.
2. The origins of homosexuality
Despite almost a century of psychoanalytic and psychological speculation, there
is no substantive evidence to support the suggestion that the nature of
parenting or early childhood experiences play any role in the formation of a
person s fundamental heterosexual or homosexual orientation. It would appear
that sexual orientation is biological in nature, determined by a complex
interplay of genetic factors and the early uterine environment. Sexual
orientation is therefore not a choice, though sexual behaviour clearly is. Thus
LGB people have exactly the same rights and responsibilities concerning the
expression of their sexuality as heterosexual people. However, until the
beginning of more liberal social attitudes to homosexuality in the past two
decades, prejudice and discrimination against homosexuality induced
considerable embarrassment and shame in many LGB people and did little to
encourage them to lead sex lives that are respectful of themselves and others.
We return to the stability of LGB partnerships below.
3. Psychological and social well being of LGB people
There is now a large body of research evidence that indicates that being gay,
lesbian or bisexual is compatible with normal mental health and social
adjustment. However, the experiences of discrimination in society and possible
rejection by friends, families and others, such as employers, means that some
LGB people experience a greater than expected prevalence of mental health
and substance misuse problems. Although there have been claims by
conservative political groups in the USA that this higher prevalence of mental
health difficulties is confirmation that homosexuality is itself a mental disorder,
there is no evidence whatever to substantiate such a claim.
4. Stability of gay and lesbian relationships
There appears to be considerable variability in the quality and durability of
same-sex, cohabiting relationships. A large part of the instability in gay and
lesbian partnerships arises from lack of support within society, the church or
the family for such relationships. Since the introduction of the first civil
partnership law in 1989 in Denmark, legal recognition of same-sex relationships
has been debated around the world. Civil partnership agreements were
conceived out of a concern that same-sex couples have no protection in law in
circumstances of death or break-up of the relationship. There is already good
evidence that marriage confers health benefits on heterosexual men and
women and similar benefits could accrue from same-sex civil unions. Legal and
social recognition of same-sex relationships is likely to reduce discrimination,
increase the stability of same sex relationships and lead to better physical and
mental health for gay and lesbian people. It is difficult to understand opposition
to civil partnerships for a group of socially marginalised people who cannot
2
marry and who as a consequence may experience more unstable partnerships.
It cannot offer a threat to the stability of heterosexual marriage. Legal
recognition of civil partnerships seems likely to stabilise same-sex relationships,
create a focus for celebration with families and friends and provide vital
protection at time of dissolution. Gay men and lesbians vulnerability to mental
disorders may diminish in societies that recognise their relationships as
valuable and become more accepting of them as respected members of society
who might meet prospective partners at places of work and in other such
settings that are taken for granted by heterosexual people.
5. Psychotherapy and reparative therapy for LGB people
The British Association for Counselling and Psychotherapy recently
commissioned a systematic review of the world s literature on LGB people s
experiences with psychotherapy. This evidence shows that LGB people are open
to seeking help for mental health problems. However, they may be
misunderstood by therapists who regard their homosexuality as the root cause
of any presenting problem such as depression or anxiety. Unfortunately,
therapists who behave in this way are likely to cause considerable distress. A
small minority of therapists will even go so far as to attempt to change their
client s sexual orientation. This can be deeply damaging. Although there is now
a number of therapists and organisation in the USA and in the UK that claim
that therapy can help homosexuals to become heterosexual, there is no
evidence that such change is possible. The best evidence for efficacy of any
treatment comes from randomised clinical trials and no such trial has been
carried out in this field. There are however at least two studies that have
followed up LGB people who have undergone therapy with the aim of becoming
heterosexual. Neither attempted to assess the patients before receiving
therapy and both relied on the subjective accounts of people, who were asked
to volunteer by the therapy organisations themselves or who were recruited via
the Internet. The first study claimed that change was possible for a small
minority (13%) of LGB people, most of whom could be regarded as bisexual at
the outset of therapy. The second showed little effect as well as considerable
harm. Meanwhile, we know from historical evidence that treatments to change
sexual orientation that were common in the 1960s and 1970s were very
damaging to those patients who underwent them and affected no change in
their sexual orientation.
Conclusions
In conclusion the evidence would suggest that there is no scientific or rational
reason for treating LGB people any differently to their heterosexual
counterparts. People are happiest and are likely to reach their potential when
they are able to integrate the various aspects of the self as fully as possible.
Socially inclusive, non-judgemental attitudes to LGB people who attend places
of worship or who are religious leaders themselves will have positive
consequences for LGB people as well as for the wider society in which they live.
3
Professor Michael King
Report prepared by the Special Interest Group in Gay and Lesbian Mental
Health of the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X
8PG.
http://www.rcpsych.ac.uk/college/specialinterestgroups/gaylesbian.aspx
31 October 2007
Reference List
(1) King M, Bartlett A. British psychiatry and homosexuality. Br J Psychiatry
1999 August;175:106-13.
(2) Bell AP, Weinberg MS. Homosexualities : a study of diversity among men
and women. New York: Simon and Schuster; 1978.
(3) Mustanski BS, DuPree MG, Nievergelt CM, Bocklandt S, Schork NJ,
Hamer DH. A genomewide scan of male sexual orientation. Human Genetics
2005 March 17;116(4):272-8.
(4) Blanchard R, Cantor JM, Bogaert AF, Breedlove SM, Ellis L. Interaction of
fraternal birth order and handedness in the development of male
homosexuality. Hormones and Behavior 2006 March; 49(3):405-14.
(5) King M, McKeown E, Warner J et al. Mental health and quality of life of
gay men and lesbians in England and Wales: controlled, cross-sectional study.
Br J Psychiatry 2003 December;183:552-8.
(6) Gilman SE, Cochran SD, Mays VM, Hughes M, Ostrow D, Kessler RC. Risk
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(7) Bailey JM. Homosexuality and mental illness. Arch Gen Psychiatry 1999
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(8) Mays VM, Cochran SD. Mental health correlates of perceived
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Am J Public Health 2001 November; 91(11):1869-76.
(9) McWhirter DP, Mattison AM. Male couples. In: Cabaj R, Stein TS, editors.
Textbook of Homosexuality and Mental Health. Washington: American
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(10) Kiecolt-Glaser JK, Newton TL. Marriage and health: his and hers. Psychol
Bull 2001 July;127(4):472-503.
(11) Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and
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4
(12) King M, Bartlett A. What same sex civil partnerships may mean for
health. J Epidemiol Community Health 2006 March 1;60(3):188-91.
(13) King M, Semlyen J, Killaspy H, Nazareth I, Osborn DP. A systematic
review of research on counselling and psychotherapy for lesbian, gay, bisexual
& transgender people. Lutterworth: BACP; 2007.
(14) Bartlett A, King M, Phillips P. Straight talking: an investigation of the
attitudes and practice of psychoanalysts and psychotherapists in relation to
gays and lesbians. Br J Psychiatry 2001 December;179:545-9.
(15) Spitzer RL. Can some gay men and lesbians change their sexual
orientation? 200 participants reporting a change from homosexual to
heterosexual orientation. Arch Sex Behav 2003 October;32(5):403-17.
(16) Shidlo A, Schroeder M. Changing sexual orientation: A consumers'
report. Professional Psychology: Research and Practice 2002;33:249-59.
(17) King M, Smith G, Bartlett A. Treatments of homosexuality in Britain since
the 1950s--an oral history: the experience of professionals. BMJ 2004 February
21;328(7437):429.
(18) Smith G, Bartlett A, King M. Treatments of homosexuality in Britain since
the 1950s--an oral history: the experience of patients. BMJ 2004 February
21;328(7437):427.
(19) Haldeman DC. Gay Rights, Patient Rights: The Implications of Sexual
Orientation Conversion Therapy. Professional Psychology - Research & Practice
2002;33(3):260-4.
Royal College of Psychiatrists
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5
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