Homosexual activist groups have targeted the Catholic Church and the American military as institutions especially in need of transformation. Associations of healthcare professionals are also under assault from homosexual activists. It is, nevertheless, appropriate for the Church and the military to defend themselves against this assault, to affirm that homosexuality is incompatible with Christian ethics and military service, and to help homosexuals free themselves from the vice of homosexuality. Arguments that homosexual reorientation therapy is unethical (...) are unsound. Such therapy is consistent with the Christian virtue of charity. (shrink)

Clark Carlton brings a much-needed theological sensitivity to the issues surrounding current debates about homosexuality and the ethics of sexual reorientation therapy. Yet, Carlton’s portrayal seems to mischaracterize and unnecessarily dismiss reorientation therapy on etiological and other theoretical grounds. It is suggested that for most therapists engaged in sexual reorientation therapy the role of developmental factors in homosexual attraction is neither overstated nor minimized.

This article evaluates the phenomenon of sexual reorientation therapy from the standpoint of Orthodox Christian theology. It is argued that homosexual desire is the product of the fall of mankind and cannot be considered “normal.” At the same time, however, reorientation therapies, whether secular or Christian, are inherently reductionistic and fail to address the underlying spiritual pathologies involved in homosexual desire. The purpose of therapeia in the Orthodox Church is the psycho-somatic transfiguration of the whole (...) person into the image of Christ, not merely the cessation of homosexual activity or the “reidentification” of one’s “lifestyle.”. (shrink)

In his paper “The Catholic Church, the American Military, and Homosexual Reorientation Therapy,” David W. Lutz ultimately concludes that it is “appropriate, and highly ethical” for the American military to offer reorientation therapy to help homosexuals overcome “the vice of sodomy.” The major thrust of his paper, however, is to call for abandonment of the “Don’t Ask/Don’t Tell” policy currently in place in the military. Lutz’s paper covers much ground, and this review begins by examining (...) whether such a wide view is necessary for the ultimate conclusions. It goes on to ask whether Lutz has omitted to mention important considerations bearing on this issue, and whether Lutz’s call for the introduction of reorientation therapy is a serious call or a symbolic response to homosexual activities. Lutz fails to address essential issues such as the actual experiences of other nations having homosexuals in the military, and issues regarding what constitutes “reorientation therapy,” the latter leading to questions about how such a therapy would actually be implemented. (shrink)

Professor Mark A. Yarhouse proposes an ‘identity synthesis’ model of sexual modification therapy for homosexuals. This model is meant primarily to target the process by which one’s sexual identity is synthesized, rather than the changing of sexual orientation itself. I highlight some of the advantages of Yarhouse’s model along with some of its potential pitfalls. My primary point of departure with Yarhouse concerns how one ought to direct those self-identified homosexual clients who fall within our clinical sphere of (...) influence and who, in the end, contrary to our better judgment, decide that they would like to pursue a course of “homosexualization.” Based on the “autonomy”-emphasizing aspects of the identity synthesis model, it appears that Yarhouse is willing to sanction the referral of certain clients to “therapists” who are willing to facilitate these clients’ homosexualization. I do not believe that Christians involved in the care of homosexuals can licitly participate in such referrals. (shrink)

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics (...) by reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (shrink)

Implicit metaphysical assumptions concerning the nature of sexual orientation are reflected in the language used to frame ethical debates concerning “reorientation” therapies. An alternative metaphysical construal is presented oncerning sexual orientation and sexual identity development and synthesis. This alternative construal allows for humility concerning what we know and do not know about sexual orientation, underscores the client's self-determination and autonomy, and demonstrates regard for personal and religious valuative frameworks. Rather than focusing on therapies aimed specifically at sexual reorientation, (...) clinicians would do well to provide clients with informed consent and to facilitate identity development and synthesis in keeping with their clients' requests for professional services. (shrink)

The ideal of virtue demands not only right choice and right behavior but also right desire in the emotions. Homosexual desire, then, even if it does not result in overt homosexual behavior, is contrary to virtue, and the completion of virtue demands right desire. If a homosexual has no plan to marry, then right desire implies only the removal of homosexual desire and not the revival of heterosexual desire at which reorientation therapy aims. On (...) the other hands, if a homosexual is married or plans to marry, then right desire includes heterosexual desire for one’s spouse. If homosexual desire is viewed as an emotional disorder, and not merely as a moral defect, then it may require reorientation therapy to bring about heterosexual desire. The pursuit of virtue, then, may recommend reorientation therapy, but even this recommendation is fairly limited, since reorientation therapy may be burdensome and may not be that effective. In conclusion, married homosexuals or homosexuals planning to marry may have a limited moral obligation to pursue reorientation therapy. (shrink)

Homosexual aversion therapy enjoyed two brief but intense periods of clinical experimentation: between 1950 and 1962 in Czechoslovakia, and between 1962 and 1975 in the British Commonwealth. The specific context of its emergence was the geopolitical polarization of the Cold War and a parallel polarization within psychological medicine between Pavlovian and Freudian paradigms. In 1949, the Pavlovian paradigm became the guiding doctrine in the Communist bloc, characterized by a psychophysiological or materialist understanding of mental illness. It was taken (...) up by therapists in Western countries who were critical of psychoanalysis and sought more ‘scientific’ diagnostic and therapeutic methods that focused on empirical evidence and treating actual symptoms. However, their attitude towards homosexuality often played a decisive role in how they used aversion therapy. Whereas Czechoslovakian researchers cautioned readers about low success rates and agitated for homosexual law reform in 1961, most of their anglophone counterparts selectively ignored or misrepresented the results of ‘the Prague experiment’, instead celebrating single-case ‘success’ stories in their effort to correct ‘abnormal’ sexual orientation. In histories of queer sexuality and its pathologization, the behaviourist paradigm remains almost entirely unmapped. This article provides the most detailed study to date of aversion therapy literature from both sides of the East/West border. In doing so, it contributes to the project not only of ‘decentring Western sexualities’, but of decentring Western sexological knowledge. Given its Pavlovian origins, the history of homosexual aversion therapy can be fully understood only in the context of Cold War transnational sexological knowledge exchange. (shrink)

That a homosexual -- man or woman -- is neither a sinner nor a sick person is the thesis of this paper by an authority on sexual deviation. Therefore, such a man or woman neither needs penance and pardon nor cure in the medical sense. Nevertheless such individuals sometimes need the help of doctors and must be treated with understanding. The medical profession also has, in the view of the behaviourist school of psychiatrists, of which Dr Bancroft is a (...) member, the duty of influencing social attitudes towards homosexuals. Obviously homosexuals who come into conflict with the law are special cases, and must be treated as such but this is not 'medical' treatment so much as social control even if drugs and other forms of therapy are used. (shrink)

This study aimed to examine the meanings that nurses attached to the ‘treatments’ administered to cure ‘sexual deviation’ (SD) in theUK, 1935–1974. In theUK, homosexuality was considered a classifiable mental illness that could be ‘cured’ until 1992. Nurses were involved in administering painful and distressing treatments. The study is based on oral history interviews with fifteen nurses who had administered treatments to cure individuals of theirSD. The interviews were transcribed for historical interpretation. Some nurses believed that their role was to (...) passively follow any orders they had been given. Other nurses limited their culpability concerning administering these treatments by adopting dehumanising and objectifying language and by focussing on administrative tasks, rather than the human beings in need of their care. Meanwhile, some nurses genuinely believed that they were acting beneficently by administering these distinctly unpleasant treatments. It is envisaged that this study might act to reiterate the need for nurses to ensure their interventions have a sound evidence base and that they constantly reflect on the moral and value base of their practice and the influence that science and societal norms can have on changing views of what is considered ‘acceptable practice’. (shrink)

This article presents the findings of a study about the history of aversion therapy as a treatment technique in the English mental health system to convert lesbians and bisexual women into heterosexual women. We explored published psychiatric and psychological literature, as well as lesbian, gay, and bisexual archives and anthologies. We identified 10 examples of young women receiving aversion therapy in England in the 1960s and 1970s. We situate our discussion within the context of post-war British and transnational (...) medical history. As a contribution to a significantly under-researched area, this article adds to a broader transnational history of the psychological treatment of marginalised sexualities and genders. As a consequence, it also contributes to LGBTQIA+ history, the history of medicine, and psychiatric survivor history. We also reflect on the ethical implications of the research for current mental health practice. (shrink)

In this essay, the author describes how he faced institutionalized homophobia during his psychiatric training, and how he later wrote a play inspired by the life of a gay psychiatrist. Despite Freud’s supportive stance, homosexuality aroused the antipathy of American organized psychiatry and psychoanalysis and came to be listed as an illness in the Diagnostic and Statistical Manual. Dr. John E. Fryer outed himself as “Dr. H Anonymous” at a 1972 meeting of the American Psychiatric Association, and the next year (...) homosexuality was removed from the DSM. The 2014 play Doctor Anonymous offers a fictionalized account of this watershed moment in the history of the gay rights movement. The author discusses his own psychotherapeutic work with gay male patients, including those who had previously been treated with conversion therapy, and explores how the play mirrors his own life experience and the experience of his patients. (shrink)

The American Psychological Association's (APA's) as well as other professional organizations' (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about exual orientation. Since then, APA (2000) disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, the (...) limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed. (shrink)

This article addresses the treatment of individuals who experience conflict between their religious convictions and their same-sex attraction. Recently, attention has been drawn to the ethical issues involved in the practice of sexual reorientation therapy (SRT) with such conflicted individuals. This article reviews the ethical arguments for and against SRT through the lens of the general ethical principles of the American Psychological Association's (2002) ethics code. Practitioners are then challenged to think about how they might respond virtuously (Meara, (...) Schmidt, & Day, 1996) when presented with such a client. Thought questions are presented to assist therapists to develop in virtue while working with religious clients who are conflicted about same-sex desire. (shrink)

In many ways, we live in propitious times for gay and lesbian people. In 1996, the Supreme Court struck down Colorado law prohibiting any kind of protected status based on sexual orientation. In 2003, the Supreme Court held that states may not criminalize sexual conduct between consenting adults of the same sex in private, so long as no money changes hands. In 2010, the Congress repealed the “Don't Ask, Don't Tell” policy that excluded openly gay men and lesbians from military (...) service. In 2013, the Supreme Court struck down key elements of the Defense of Marriage Act that prohibited any federal recognition of same‐sex marriage. Most states do not allow same‐sex marriage, but more and more states are joining the fold. Likewise, most U.S. states do not forbid discrimination based on sexual orientation, but the number that does is increasing. Arguably, no other social minority has made as much legal progress in so short a time. Despite these advances, the story of gay and lesbian people and the law is not yet finished, and the meaning of homosexuality for bioethics is still being written too. Concerns about gay and lesbian people remain important to bioethics in key domains, especially in seeing to the conferral of optimal health care benefits and in sorting through the priorities and social effects of research. Progress in these domains still involves lifting certain burdens of medical and social misjudgments about same‐sex attraction. (shrink)

Abstract: This essay explores recent trends and major issues related to gay and lesbian philosophy in ethics (including issues concerning the morality of homosexuality, the natural function of sex, and outing and coming out); religion (covering past and present debates about the status of homosexuality and how biblical and qur'anic passages have been interpreted by both sides of the debate); the law (especially a discussion of the debates surrounding sodomy laws, same-sex marriage and its impact on transsexuals, and whether the (...) law should be used to enforce morality); scientific research into the origins of homosexuality (including discussion of arguments against such research); and metaphysics (especially the question of whether homosexuality is socially constructed during particular times and in particular cultures, or whether sexual orientation is an essential trait cutting across times and cultures). (shrink)

Michel Foucault's The History of Sexuality-the first volume of which was published in 1976-exerts a vast influence across the humanities and social sciences. However, Foucault's interest in the history of sexuality began as early as the 1960s, when he taught two courses on the subject. These lectures offer crucial insight into the development of Foucault's thought yet have remained unpublished until recently. This book presents Foucault's lectures on sexuality for the first time in English. In the first series, held at (...) the University of Clermont-Ferrand in 1964, Foucault asks how sexuality comes to be constituted as a scientific body of knowledge within Western culture and why it derived from the analysis of "perversions"-morbidity, homosexuality, fetishism. The subsequent course, held at the experimental university at Vincennes in 1969, shows how Foucault's theories were reoriented by the events of May 1968; he refocuses on the regulatory nature of the discourse of sexuality and how it serves economic, social, and political ends. Examining creators of political and literary utopias in the nineteenth and twentieth centuries, from Sade to Fourier to Marcuse, who attempted to integrate "natural" sexualities, including transgressive forms, into social and economic life, Foucault elaborates a double critique of the naturalization and the liberation of sexuality. Together, the lectures span a range of interests, from abnormality to heterotopias to ideology, and they offer an unprecedented glimpse into the evolution of Foucault's transformative thinking on sexuality. (shrink)

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and (...) patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body. (shrink)

Displacing the physiological model that had held sway in 19th-century medical thinking, early 20th-century hormone research promoted an understanding of the body and sexual desires in which variations in sex characteristics and non-reproductive sexual behaviours such as homosexuality were attributed to anomalies in the internal secretions produced by the testes or the ovaries. Biotypology, a new brand of medical science conceived and led by the Italian endocrinologist Nicola Pende, employed hormone research to study human types and hormone treatments to normalise (...) individuals who did not conform to accepted medical norms. Latin American medical doctors, eugenicists, and sexologists took up biotypology with enthusiasm. This article considers the case studies of Italy, Argentina, and Brazil, and analyses the work of medical doctors who adopted a biotypological mode of reasoning and employed to various extents hormone therapies in their practice. By focusing on hormone therapies that aimed to normalise secondary sexual characteristics and the sexual instinct, the article suggests that while the existence of normality was contested to the point that a number of medical scientists argued that no such thing existed, the pursuit of normality was carried out in very practical terms through the new medical technologies hormone research had introduced. (shrink)

This essay recounts the author’s journey with her father during his prolonged decline due to dementia. The experience pushed her to break out of the confines of conventional scholarly research in her academic field of architectural history to a multi-disciplinary consideration of nineteenth-century environmental, sensory and horticultural therapies for the mentally ill. During her father’s illness, she discovered the tangible therapeutic benefits of momentary engagements with his environment through his five senses and through the emotional filter of poetry. This (...) class='Hi'>reorientation to sensory and poetic experience had a beneficial impact on the caretaker as well. (shrink)

While Garfinkel’s early work, captured in Studies in Ethnomethodology, has received a lot of attention and discussion, this has not been the case for his later work since the 1970s. In this paper, we critically examine the aims of Garfinkel’s later ethnomethodological studies of work programme and evaluate key ideas such as the ‘missing what’ in the sociology of work, ‘the unique adequacy requirements of methods’, and the notion of ‘hybrid studies’. We do so through a detailed engagement with a (...) study that has frequently been singled out as exemplary by Garfinkel for his studies of work programme, namely Livingston’s The Ethnomethodological Foundations of Mathematics. We show how Livingston uses the proof of Gödel’s Incompleteness Theorem as a way to exhibit the work involved in understanding mathematical proofs. We then discuss how Livingston uses this example to introduce a distinction between the written ‘proof account’ and the associated ‘lived work’ of working through that proof, which we argue allows Livingston to provide a powerful critique of a formalist understanding of the objectivity of mathematics. We then discuss three aspects that we find problematic in Livingston’s and Garfinkel’s claims about Livingston’s study. Firstly, we question whether written proofs are best conceived of as descriptions or accounts. Secondly, we interrogate whether an ethnomethodological study could teach mathematicians how to make discoveries. Thirdly, we throw doubt on Garfinkel’s claim that Livingston’s results are results in mathematics. We conclude this paper with a discussion of how Livingston’s study Gödel’s proof highlights key tensions in Garfinkel’s later work. Firstly, we argue that there exists an ambiguity in Garfinkel’s treatment of texts as ‘incompetent’. Secondly, we show that Garfinkel’s attempt to extend his idea of classical studies from sociology to other professions and disciplines is problematic. Finally, we question Garfinkel’s proposals to reorient ethnomethodological studies away from sociological audiences and ask whether ethnomethodological studies promise the delivery of a ‘large prize’ or, rather, provide something like ‘helpful therapy’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.4 (2005) 343-348 [Access article in PDF] Doomed by Nature: The Inevitable Failure of our Naturally Selected Functions Andreas De Block Keywords psychoanalysis, Darwinism, evolutionary psychiatry, pathogenic metaphysics In their very thoughtful and stimulating replies, the three commentators foreground several topics crucial for both psychoanalysis and philosophical psychiatry. In my short response, I focus primarily on what the commentators believe to be the paper's main (...) shortcomings. The first critique reads as follows: Freud never claimed that the Homo sapiens is a fundamentally sick animal, but in fact thought that normalcy is possible and that normal behavior need not be interpreted as neurotic, perverse or psychotic. The second is that current Darwinian psychiatry does not substantiate the view that Homo sapiens is essentially an ill animal, whatever Freud's position might be. Third and last, the proposal that all human beings are ill to the core seems to be more of a religious slogan than a scientifically useful description. What Freud Really Said A transhistorical approach to Freud's work is far from simple, considering that it spans a period of over forty years and that it underwent considerable changes during that time. Not only did Freud introduce some radically new concepts during that time, such as narcissism and the death drive. Also, he regularly changed his position on the aim of psychoanalytic therapy, the ontogenesis of anxiety, and the nature of human sexuality. That Freud sometimes saw homosexuality as an inborn drive did not keep him on other occasions from thinking that homosexual desire was a result of the repression or projection of an oedipal (heterosexual) drive. Examples like these show that any exegesis of Freud's writings inevitably has to deal with some tensions. Freud's work contains numerous apparent, as well as real, contradictions, so that it is no surprise at all that Katherine Morris can produce textual evidence "proving" that Freud never held the view I attribute to him. According to her, Freud thought that we are not all neurotics and that normalcy is possible.I do not deny that several passages in Freud's work underscore the possibility of non-neurotic normalcy. Indeed, Freudian theory even describes processes—sublimation, the transformation from Id to Ego, the resolution of the oedipal complex, among others—that explain how human beings can escape neurosis and other mental disorders. But Freud's illustrations of these mechanisms or processes make clear that he could not conceive [End Page 343] of a nonpathogenic psychodynamics. Consider, for instance, how Freud emphasizes throughout his study of Leonardo da Vinci that Leonardo's sublimations make him extremely vulnerable to psychic exhaustion or "neurasthenia" (1910). Freud never tires of repeating that there is only a gradual difference between a neurotic patient and Leonardo da Vinci, the sublimating ("healthy") artist and scientist.Morris (2005) is right, of course, in arguing that a gradual difference between normality and mental illness does not imply that there is no difference at all. Quantity should not be thought the opposite of quality, because small quantitative differences can transform an "articulation" into a "breach." To use Hegel's famous example, there is a continuum between 110° C and -10° C, but everybody knows that that water evaporates above 100° C and freezes below 0° C. Applied to mental disorders, quantitative differences in levels of testosterone and serotonin may lead to qualitative differences in behavior; in other words, categorical and dimensional approaches to mental illnesses are not mutually exclusive. Having established that, we now need to take a closer look at how Freud articulated the differences between seemingly normal individuals and the mentally ill.Freud held that neurosis, psychosis, and perversion are caused by the interplay between instincts and defense mechanisms. Further, he thought that the pathogenic instincts were almost exclusively sexual. Now, although it is true that he sometimes recognized that the fear of death and the death drive are important factors for psychic life (Deeley 2005) and for the etiology of psychosis, more often than not he interpreted the fear of death as a symbolization of... (shrink)

The tenth volume in the Progress in Self Psychology series begins with four timely assessments of the selfobject concept, followed by a section of clinical papers that span the topics of homosexuality, alter ego countertransference, hypnosis, trauma, dream theory, and intersubjective approaches to conjoint therapy. Section III, "A Dialogue of Self Psychology," offers Merton Gill's astute appreciation of "Heinz Kohut's Self Psychology," followed by commentaries by Leider and Stolorow and Gill's reply. The concluding section offers Stolorow and Atwood's "The (...) Myth of the Isolated Mind," followed by discussions by Gehrie and the Shanes. A forum for the kind of spirited, productive exchanges that have long found a home within the self-psychological community, _A Decade of Progress_ builds on the past in responding to the theoretical and clinical challenges of the present. (shrink)

This book has become well established as the leading international reference on sexual deviation. The third edition builds on the outstanding success of its predecessors, and offers readable, and the most up-to-date accounts of findings in the clinical, experimental, and academic aspects of all fields dealing with sexual deviation. Throughout the book there is emphasis on clinical treatments, supported by a summary of the latest experimental findings on the biology of sexual behaviour Distinguished practitioners and academic experts discuss the most (...) recent advances in their fields from a psychiatric, legal, psychotherapeutic, and behaviour therapy point of view, particularly in relation to sex offenders. They also cover significant advances in the psychotherapeutic treatment of gender disorders and homosexuality. There is also a new section on child sexual abuse and the resulting effects on adults. Now available in paperback at a low price, the book will remain required reading for all professionals dealing with sexual deviationpsychiatrists, psychoanalysts, clinical psychologists, counsellors, forensic psychiatrists, lawyers, magistrates, probation officers, and criminologists. From reviews of the second edition: "Psychoanalysts will doubtless enthuse over this book" "The psychoanalysts have provided one of the few beacons in the otherwise unlit domain of sexual perversions" New England Journal of Medicine Nov. 1979 "All of the chapters were well written" American Journal of Psychiatry Jan. 1980 "Forensic aspects are well covered with an up-to-date account of the British and American Law and a detailed description of the treatment of sex offenders using dynamic psychotherapy. It is a valuable reference book" |s British Journal of Sexual Medicine Vol.7 Oct. 1980, "It is clear that a book which is so varied, so wide in its coverage and which arouses in parts strong agreement and in other parts strong diagreement, merits serious and prolonged study and attention" |s International Journal of Psychoanalysis 1981. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Game ChangeMaximo CortezOn November 17, 1983, I was born with a condition called mixed gonadal dysgenesis, and ambiguous genitalia. My gender was not of a big concern at that time. The more urgent matter was that I had a heart murmur, which was repaired when I was twelve months old. [End Page E5]It was not until I turned five, and by issue of the Texas Children’s Protective Services (CPS), (...) that my mother was forced to authorize providers to perform normalization surgeries on me. An anonymous caller tipped the CPS that my mother was raising a boy as a girl. The state intervened and explained to my mother that she would have to consent to these surgeries or else she would lose custody of me. This included a gonadectomy and a clitorectomy. Without any consent, these surgeries were performed “in my best interests.” My mother was an epileptic, Hispanic, Mormon, single parent.I was raised to be a socially acceptable female, though as early as five, I played with “boy” toys and enjoyed TV programs aimed at male youth, like Teenage Mutant Ninja Turtles. It was not until I had those normalization surgeries performed on me that I felt different. I knew that something major had happened to me. I woke up in a hospital bed in a gown. I raised the covers and noticed that I had an “X” carved in my groin area. Doctors mutilated my clitoris by reducing its size, which made me feel alienated and angry that something was wrong with my body.I had a surgery performed on me that was to be kept secret and never talked about. This sense of fear and shame was instilled in me shortly after the surgery. I do not recall any psychological evaluations or counseling to help me cope with such surgeries. Seeing everyone else my age going through puberty during my teenage years, I felt behind. I wasn’t becoming a boy with a deep voice or facial hair. Instead, I visited the doctor’s office with my mom and was told that I would be taking oral estrogen to become a woman. I wasn’t until that moment that I understood I was seeing a doctor to foster the development of female secondary characteristics. I felt betrayed by the medical community and by my own mother.Just a few years later, I saw a urologist to find out whether I was ready for a vaginal construction surgery (vaginoplasty). Thankfully the urologist suggested that I was not ready to move forward with an invasive and irreversible vaginal construction surgery. I never pursued it as an adult, as I have always felt male gendered.Social sexual relationships have always been difficult for me but more so with my attraction to women. I first realized my attraction to women in early middle school. Being raised Mexican and a Mormon and knowing that I was homosexual created a lot of conflict for me. I felt that I was a male–gendered person forced into a castrated, mutilated, and medically created female body. I suffered through depression from an early age and it continues today. My conservative Mormon upbringing brought me much shame. The Mormon religion, as most people understand it, expresses a great intolerance to homosexuals and transgender people. I felt like I was a heterosexual male in a female’s body, but the Mormons would never accept me.My later teenage years and mid–twenties were a dark time in my life. I even attempted suicide in my early twenties. My depression was treated with antidepressants and talk therapy. Once I began testosterone, I gradually stopped taking antidepressants. When I was only on estrogen, I felt very moody, angry, and in an emotional funk. I would cry easily and would become very irritable and emotional without cause. With testosterone therapy, I began to think more clearly, had balanced emotions, and began to think more logically.I began to research intersex online and found a women’s androgen insensitivity (AIS) support group. At one of their national conferences, I met another intersex individual who was raised as a female and who had transitioned to male. Like me... (shrink)

The thymus gland, which plays a key role in the maturation and functioning of the lymphoid system, is implicated in the acquired immune deficiency syndrome (AIDS). The observation that the thymic hormone, thymosin α1, is elevated in individuals at risk for AIDS (as opposed to being depressed in other immunodeficient states) has provided the first direct evidence that the thymus is malfunctioning early in the course of this deadly disease. These observations have been valuable in screening for the syndrome with (...) a rapid radioimmunoassay and in the initiation of the first clinical trials with thymosin in high risk homosexuals and hemophiliacs. If the progressive immune paralysis in AIDS is due to a dying thymus, the early identification of asymptomatic carriers of AIDS or individuals with modest AIDS‐related dysfunction may lead to therapy with thymosin or other thymomimetic agents that can restore immune function and prevent the onset of frank AIDS. (shrink)

The later Wittgenstein advanced a revolutionary but puzzling conception of how philosophy ought to be practised: Philosophical problems are not to be coped with by establishing substantive claims or devising explanations or theories. Instead, philosophical questions ought to be treated ‘like an illness’. Even though this ‘non-cognitivism’ about philosophy has become a focus of debate, the specifically ‘therapeutic’ aims and ‘non-theoretical’ methods constitutive of it remain ill understood. They are motivated by Wittgenstein’s view that the problems he addresses result from (...) misinterpretation, driven by ‘urges to misunderstand’. The present paper clarifies this neglected concept and analyses how such ‘urges’ give rise to pseudo-problems of one particular, hitherto little understood, kind. This will reveal ‘therapeutic’ aims reasonable and ‘non-theoretical’ methods necessary, in one clearly delineated and important part of philosophy. I.e.: By developing a novel account of nature and genesis of one important class of philosophical problems, the paper explains and vindicates a revolutionary reorientation of philosophical work, at the level of both aims and methods. (shrink)

Definition of the problem: Attitudes and practice of doctors regarding physician-assisted suicide (PAS) in patients with AIDS became considerably more liberal over the last 15 years in large U.S. cities. However, it remains an open question how the highly active antiretroviral therapies (HAART) have influenced the situation since the late 1990s. Methods and results: In 1999/2000 a nonrepresentative sample of medical doctors, psychologists, social workers, nurses and other health care professionals (n=69) in San Francisco und New York gave semistructured interviews (...) about the present situation of PAS in patients with AIDS. On the basis of written protocols a qualitative evaluation of the expert interviews has been performed. The majority of the health care professionals are familiar with PAS in their professional work. With HAART the requests for PAS in gay patients with AIDS dropped rapidly. PAS has not been noted in other subgroups of patients. However, unsolved problems exist in timing, execution and accompaniment of PAS and in competence assessment of PAS patients. No hints of a slippery slope abuse could be identified in the interviews. Conclusion: Although tolerated, the majority of the doctors still feel uncomfortable with PAS and regard PAS as alien to their professional ethos. In practice PAS takes place on request of a subgroup of AIDS patients only. However, the professional experience with PAS in patients with AIDS has changed the attitude of doctors toward a stronger acceptance of their patients autonomy and partnership with them. Open questions remain regarding the competence assessment of seriously ill and dying patients. (shrink)

The purpose of this book is to present some of the critical moral issues that confront contemporary society and to evaluate them in the light of ethical principles aiming to preserve and enhance the dignity of human life. The volume opens with a discussion of the nature and implications of conjugal love, the purpose of domestic society, and the role of sex in marriage, where the author relies heavily on Dietrich von Hildebrand "whose writings for half a century have given (...) us so many invaluable insights into these areas of knowledge". Marriage problems involving impotency, homosexuality, hermaphroditism, and transsexualism are considered and a lengthy section is devoted to the comparatively new field of genetic engineering. Here the author discusses the moral implications of such issues as the process of cloning, sperm and ovary banks, test-tube babies, amniocentesis, artificial insemination, genetic screening, and genetic therapy, each issue being treated with cautious reserve. Following a chapter on family planning, where natural and artificial means of birth control are analyzed, the author approaches the complex topic of abortion, which he sets against the background of the latest biological data and the 1973 U.S. Supreme Court’s decree legalizing abortion. (shrink)

The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline how methods of genetic intervention, such as germ-line gene therapy, are (...) typically defined or classified. We then consider whether techniques of mitochondrial donation fit into these, whether they might do so with some refinement of these categories, or whether they require some other approach to classification. To answer the second question, we discuss the relationship between classification and several key ethical issues arising from mitochondrial donation. We conclude that the properties characteristic of mitochondrial inheritance mean that most mitochondrial donation techniques belong to a new sub-class of genetic modification, which we call ‘conditionally inheritable genomic modification’. (shrink)

The therapy-enhancement distinction occupies a central place in contemporary discussions of human genetics and has been the subject of much debate. At a recent conference on gene therapy policy, scientists predicted that within a few years researchers will develop techniques that can be used to enhance human traits. In thinking about the morality of genetic interventions, many writers have defended somatic gene therapy, and some have defended germline gene therapy, but only a handful of writers defend (...) genetic enhancement, or even give it a fair hearing. The mere mention of genetic enhancement makes many people cringe and brings to mind the Nazi eugenics programs, Aldous Huxley's BraveNewWorld, or the recent movie Although many people believe that gene therapy has morally legitimate medical uses, others regard genetic enhancement as morally problematic or decidedly evil. (shrink)

:Since the advent of recombinant DNA technology, expectations about the potential for altering genes and controlling our biology at the fundamental level have been sky high. These expectations have gone largely unfulfilled. But though the dream of being able to control our biology is still far off, gene editing research has made enormous strides toward potential clinical use. This paper argues that when it comes to determining permissible uses of gene editing in one important medical context—germline intervention in reproductive medicine—issues (...) about enhancement and eugenics are, for the foreseeable future, a red herring. Current translational goals for gene editing research involve a different kind of editing than would be required to achieve manipulation of complex traits such as intelligence, and there are more pressing questions that need attention if clinical use of gene editing in reproductive medicine ever becomes a possibility. (shrink)

This text gives a critical account of various, often conflicting interpretations of slash fiction - stories based on characters from popular TV show, The Star Trek, written by fans. What makes slash fiction, a subgenre of fan fiction, specific is a homoeroticization of characters that in the original narratives are either explicitly or implicitly heterosexual. Whether such?homoerotic pairing? has any foundation in the original Star Trek narrative, remains an open question. Answers to this question vary greatly. An affirmative answer, however, (...) begs a further question: whether these narratives are?homosexual representations? in a strict gay/lesbian sense? The authors propose that slash represents a non-hegemonic narrative which transgresses borders set up in the original narrative - queering, reexamining thus both sex and gender. (shrink)

Cognitive Behavioral Therapy has become the dominant form of psychotherapy in North America. The CBT model is theoretically based on the idea that all external and internal stimuli are filtered through meaning-making, consciously accessible cognitive schemas. The goal of CBT is to identify dysfunctional or maladaptive thoughts and beliefs, and replace them with more adaptive cognitive interpretations. While CBT is clearly effective as a treatment, there is good reason to be skeptical that its efficacy is due to the causal (...) mechanisms posited by the CBT model. This paper will argue that the specific cognitive schemas posited by the CBT model likely do not play a direct role in the development or treatment of psychological illness. Cognitive schemas, as identified in CBT interventions, are likely to be the result of patient confabulation and epistemically under-supported practitioner-based identification. CBT interventions appear to impose coherence on patients’ psychological states, rather than identifying and modifying preexistent causally efficacious core beliefs. (shrink)

Assessing the risk-benefit ratio has always been considered key in designing clinical trials. These benefits can be diverse and may include social value and psychological benefits. When it comes to...

This article presents a conceptual framework within feminist therapy theory for viewing overt and covert racist behaviors as forms of unethical action. Using the personal as theoretical and political, the author traces her process of having her consciousness raised regarding the issue of racism in psychotherapy. Racism is then conceptualized as an ethics problem in terms of lack of mutuality and respect, violation of boundaries, and unethical imbalance of power in the therapy relationship. The concept of antiracism, a (...) proactive stance to address overt and covert racism in therapy, is presented as a strategy for moving toward more ethical therapy practice. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as friends and lovers. (...) There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Mitochondria, the powerhouses of our cells, are essential to life. Normal mitochondrial function is achieved through the cooperative interaction of the nuclear and mitochondrial genomes. New IVF approaches intended to circumvent devastating mitochondrial disease look set to change the ancient pattern of mtDNA inheritance and interaction with unknown consequences.

The normative significance of the distinction between therapy and enhancement has come under sustained philosophical attack in recent discussions of the ethics of shaping future persons by means of preimplantation genetic diagnosis and other advanced genetic technologies. In this paper, I argue that giving up the idea that the answer to the question as to whether a condition is “normal” should play a crucial role in assessing the ethics of genetic interventions has unrecognized and strongly counterintuitive implications when it (...) comes to selecting what sort of children should be brought into the world. According to standard philosophical accounts of the factors one should take into account when making such .. (shrink)

Occupational therapy often uses craft activities as therapeutic tools, but their therapeutic effectiveness has not yet been adequately demonstrated. The aim of this study was to examine changes in frontal midline theta rhythm and autonomic nervous responses during craft activities, and to explore the physiological mechanisms underlying the therapeutic effectiveness of occupational therapy. To achieve this, we employed a simple craft activity as a task to induce Fmθ and performed simultaneous EEG and ECG recordings. For participants in which (...) Fmθ activities were provoked, parasympathetic and sympathetic activities were evaluated during the appearance of Fmθ and rest periods using the Lorenz plot analysis. Both parasympathetic and sympathetic indices increased with the appearance of Fmθ compared to during resting periods. This suggests that a relaxed-concentration state is achieved by concentrating on craft activities. Furthermore, the appearance of Fmθ positively correlated with parasympathetic activity, and theta band activity in the frontal area were associated with sympathetic activity. This suggests that there is a close relationship between cardiac autonomic function and Fmθ activity. (shrink)