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Sunday, April 09, 2006

問:我知道許多gay affirmative的都是主張同性戀是天生,不可改變的,正常的。不過這是否就是一個科學的判斷?你見過科學判斷用投票方式表決嗎?例如沙士是否可以空氣傳染,會否叫一群醫生投票表決?還是提出理據作結論?APA於1973年作出同性戀不是病態的決定是投票方式進行,你覺得這是否科學?或是政治立場的表決?


我也知道那些和 gay affirmative 沒有關係的組織 (例如英國的醫療組織) 。

問:需要與否不是由治療師決定,否則這正是強迫改變。能否改變是一個可以科學地研究的問題,現有研究指出部份人可以改。你說研究是多餘的,這是否說,若政治上已否決了任何尋求改變的需要,則應禁止進行研究?這是科學的態度嗎?若不能進行改變同性戀的治療,又怎可以知道不能改變呢?莫非靠一些失敗個案就足以支持不能改變這種聲稱?若未能證實傷害與治療的關係(正如同志群體的健康問題一直比非同志群體嚴重,但兩者之確切並微妙關係一天未明朗,都不能夠說同性性行為「造成」健康問題),不能禁止,也不能因此說沒有需要進行治療,因為在造成傷害的因素未明之前,需要是由求助者決定。(若治療本身造成傷害,在醫療倫理的第一原則do no harm下,有理由拒絕治療。)

不要混亂概念。你可以說政治性有人否決研究﹐但仍然無法證明研究的需要性﹐兩者是沒有關係的。NARTH 自己既然認為 reparative therapy有效﹐為何 jump 了需要性的研究﹐要推出來呢﹖
你有沒有留意 NARTH 自己根本也沒有足夠科研支持﹐就斷言同性戀可以改變﹖請參考NARTH 的 statement:
Their new policy stresses that homosexual behavior is not normal. It is viewed as a "failure to function according to design."
你說“現有研究指出部份人可以改” ﹐但問題就是連主持這個研究的 Dr. Spitzer都表示研究的可靠性不夠。換句話說﹐validity是成疑﹐就連所謂可改﹐也並非肯定 (例如是一個異性戀﹑先變同性戀﹑後來變回﹐或者是一個“同性戀” 變成“異性戀) ﹐如何可以根據不確定的科研去排除治療的風險﹖如果沒有排除治療的風險﹐為何不說呢﹖


3. 有關國際出埃及機構的謠言,既然你現在知道失實,請你親自澄清。Gary Cooper從來只是義工,未曾作過任何領導性的位置。五位創會領袖,其中二位仍然活躍於ex-gay ministry,另外兩個雖已退下,但沒有返回同志身份。

那麼 Michael Bussee呢﹖
The original board of Exodus included five formerly gay-identified people, including Mr. Bussee. The incorporators of the group included Frank Worthen, Ron Dennis and Greg Reid. None of these men have returned to homosexuality and two of the three are still in ex-gay ministry. One other original board member, although still straight, requested his name not be included in this article. Let’s do the math: Four out of five of the original board members have not returned to a gay identity.
Just so this is clear, let’s re-cap. Gary Cooper was not one of the co-founders of Exodus. Michael Bussee was on the original board. The men were involved in an ex-gay ministry in Anaheim, were married, left their wives and children and returned to a public gay identity.
我會承認我沒有查清楚﹐但除了. Gary Cooper不是 co-founder﹐Michael Bussee卻是 original board (那麼算不算 founder ?)




4. 不是說reparative therapy沒有失敗個案,沒有造成傷害。但正如戒煙戒酒都有失敗個案,不能因失敗而終止其他的嘗試。反而應留意如何減低治療造成的傷害,以及identify在那些情況下會容易造成傷害。

但失敗個案的傷害程度﹐如果引起自殺又如何﹖ 戒煙戒酒都有失敗﹐但未必引起心理問題﹐而指控中﹐失敗個案除了不能成功改變性傾向﹐也引起家庭糾紛﹑抑鬱﹑自殺等。這些情況嚴重程度那麼大﹐是不是應該說出來﹖是不是應該有限度給研究機構去處理﹐而不應該隨便給任何所為 ex-gay ministry 去做﹖一隻新藥﹐臨床試驗﹐都只是選擇有限機構去做﹐不會“派通街” 。請問香港的“新造的人協會” 是一個有資格的科研機構﹑可以進行 reparative therapy 的研究﹑有權用香港的同志作為白老鼠嗎﹖我冇反對繼續研究﹐但未研究之前﹐為何要推廣﹖這是我不斷質疑的地方。




6. 你想藉今次把一切相關的資料都撩出來,給人自行判斷。這一點我很同意,所以我才有興趣加入搵料的行列。我覺你搵的料太一面倒,被你自己對明光社的負面評價所籠罩,似乎只是想要打倒明光社,不是想將資料呈現給大家。

難道明光社搵的料不一面倒﹖如果我不從完全和明光社相反的角度找﹐就不會全面了。我認為明光社需要改變﹐否則他們只是基督教的負累。把一切相關的資料都撩出來,給人自行判斷﹐應該是宣傳“傳媒操守” 的明光社做的﹐我們去做﹐不就正是在打明光社嗎﹖




一、在同性戀的立場上與APA相違。APA及立場相近的機構才是主流意見,NARTH沒有代表性。(這一點是真的,問題是主流立場是否基於科學證據,即本人上次提供的參考資料。)
NARTH不是主流﹐不代表他們立場是有科學證據。留意你的邏輯。我提出的還有更重要的信息﹐就是明光社可以只單單提NARTH ﹐而不提其他研究﹖那在邏輯上面是排除證據的表現。
文中已經提過﹐NARTH 提倡的 reparative therapy都沒有足夠科研證明沒有害處﹐何以要推廣﹖


二、NARTH在引用其他學術刊物的手法,也有不良記錄。前主席CW Socarides曾在一次法律訴訟上歪曲了American Psychoanalytic Association的立場,指其引用該會的舊立場,而沒有引述該會1990的新立場。(這一點本人曾去信NARTH查問,但因Socarides年事已高,且近日身體不適,故不便再查詢。按作者提出的資料,Socarides未必是不實引用立場[不是學術刊物],要看他引用是有沒有誤導人認為那是當時該會的立場。要看當時究竟問些甚麼,Socarides對那一點作供。因為本人沒有資料,希望作者若要用這事件來質疑Socarides的誠信,可以提供更多該事件的詳情。本人於此事沒有立場,只是抱求真的態度而已。)

我提供兩個資料給你參考。其中一個就是 Dr. Roughton﹐即發律師信的那位。

The Human Rights Campaign reported in 1999 that NARTH President, Charles Socarides, had "run into trouble with the American Psychoanalytic Association (APsaA), of which he is a member. According to a letter from Dr. Ralph Roughton of the APsaA, Socarides misrepresented the position of the APsaA in a published paper and a court affidavit. Socarides attempted to make it appear that the APsaA agrees with his positions on homosexuality. He did this by quoting an APsaA document written in 1968, which supported his views and which he called the 'official position' of the APsaA, while ignoring a 1990 revised statement that drastically contradicted his views. The Executive Committee of the APsaA instructed the organization's attorney to write a letter to Socarides asking him to cease this misrepresentation and threatening legal action if he continued. Additionally, the APsaA newsletter decided to stop printing advertisements for NARTH meetings because the organization does not adhere to APsaA's policy of non-discrimination 'and because their activities are demeaning to our members who are gay and lesbian,' according to Roughton."
http://www.religioustolerance.org/hom_nart.htm

這是當時 ApsaA 的 Dr. Ralph Roughton的一封信﹐交代事件﹕
• Dear Dr. Berggren,
Your query to the American Psychoanalytic Association about NARTH was referred to me for response. I have just completed my 6 year term as Chairman of the Committee on Issues of Homosexuality and have quite a bit of knowledge about NARTH.
There is no connection between the American Psychoanalytic Association (APsaA) and NARTH. However, several of the officers of NARTH are psychoanalysts and are members of APsaA. We do not censor members for their beliefs or disagreements, only for unethical practice; therefore they have remained members even though their views about homosexuality may differ sharply from the majority of our members. However, the APsaA has taken two actions that indicate our official position:
(1) Because Charles Socarides (President of NARTH) misrepresented the position of the APsaA in a published paper and in a court affidavit, the Executive Committee of the APsaA instructed our attorney to write a letter to Dr. Socarides insisting that he cease this misrepresention, and threatening legal action if he continued. (His misrepresentation was to make it appear that his own views about pathology and treatment of homosexuality were consistent with those of the APsaA. He did this by quoting something written in 1968, which supported his views and which he called the "official position" of the APsaA, while ignoring a 1990 revised statement that drastically contradicted his views; he also failed to mention our only "official" policy, which was a 1991 statement of non-discrimination.)
(2) The newsletter of the APsaA has decided no longer to print advertisements for the meetings of NARTH, because that organization does not adhere to our policy of non-discrimination and because their activities are demeaning to our members who are gay and lesbian.
Those are the two official actions. However, there is more that will give a clearer picture of what NARTH stands for and how that differs from the majority of our members.
NARTH's official position is that homosexuality is "a treatable disorder." Dr. Socarides has repeatedly stated in writing that "the homosexual, no matter his or her level of adaptation and functioning in other areas of life, is severely handicapped in the most vital area -- interpersonal relations." He strongly opposed the adoption by the APsaA in 1991 of a resolution that required the selection of analytic candidates and faculty to be based on factors other than sexual orientation. He has written in newspaper articles that the gay rights movement is destroying society, he has supported attempts to overturn gay rights laws in various states, and this fall he and other officers of NARTH will testify as expert witnesses in the state of Louisiana in favor of upholding laws making oral and anal sex between consenting adults illegal. Increasingly, NARTH seems to be attracting membership and financial support from members of the radical religious right, who use their pronouncements as "scientific" backing for their bigoted anti-homosexual activities.
The Executive Director of NARTH, Joseph Nicolosi, PhD, has stated in a printed editorial that he will not work with a homosexual patient who does not want to change his sexual orientation. Dr. Socarides' treatment attempts have been described in the past as being more educative and manipulative than analytic. It is my understanding that he no longer identifies himself in publications as a psychoanlayst, but rather as a psychiatrist. Dr. Nicolosi is a psychologist who has not had psychoanalytic training and works out of a religiously oriented counselling center.
They approach treatment of gay and lesbian patients with the goal of changing their sexual orientation -- clearly not an analytic stance. It is my own personal belief that many of their so-called successful conversions occur in either people with bisexual potential, or as "transference cures" in those who have severe psychopathology with little sense of identity and who are very maleable, or in those who have a strong desire to avoid dealing with their homosexuality and a strong wish to please the authoritative therapist. It is of course possible to learn to inhibit one's sexual desires and to control one's behavior. Another criticism of their claims is that they offer almost no long-term followup data. Many of us know of cases that ended conversion treatment as "cured" in whom the change did not last.
Even if we take their claims for success at face value, they report success rates of only 35 % at best. They do not discuss the 65% who do not change, except to emphasize that those who are highly motivated to change are more likely to be successful. There are growing anecdotal reports from other analysts that they frequently see those patients who attempted such "conversion" therapy and who have suffered serious adverse effects, such as depression, lowered self-esteem, increased shame and self-hatred -- and many who, under the belief that they had "changed," have married and now have children.
There are many analysts, psychiatrists, and psychologists that would like for our organizations to declare this "conversion" or "reparative" therapy unethical. However much some of us might feel this to be true, it also raises questions of state control over freedom to practice therapy and is hampered by lack of valid statistical data to prove that overall the treatment is harmful. We have anecdotal evidence, but not yet statistical data.
Even though we are not in a position to take such prohibitive action against conversion/reparative therapy, we believe that the majority of psychoanalysts and the leaders in the APsaA now accept the idea that homosexuality is not necessarily a manifestation of psychopathology and that treatment for gay men and lesbians should be approached with neutrality and respect for the person's individuality, with no preconceived idea of the outcome, nor any coercive attempts to change sexual orientation -- just as we approach any other patient.
Although the APsaA has no official position beyond the non-discrimination policy, we have officially moved forward with encouraging the acceptance of gay and lesbian candidates for analytic training and the appointment of gay and lesbian faculty members, including training analysts. There are now probably 30 to 40 openly gay and lesbian candidates in training in institutes affiliated with the APsaA. Nearly half of our institutes also have faculty members who are gay or lesbian, and two institutes have a gay or a lesbian training analyst. So you see, by this data, that our organization is strongly opposed to the repressive and negative ideas that NARTH represents, even more than any official statements or actions that have been taken.
Perhaps the most positive indication of support from our organization is the fact that in December 1997, the Executive Council of the APsaA overwhelmingly and without significant dissent voted to endorse a resolution supporting same-gender marriage.
I would be happy to correspond further with you and supply any information that you might wish, including references to back up what I have written here. On a more personal note, I also happen to be a member of the House of Delegates of the International Psychoanalytic Association, and I plan to introduce a resolution opposing anti-homosexual discrimination in the institutes and societies of the IPA. I would be glad to hear from you about the situation in Sweden. Do gay men and lesbians feel free to apply for psychoanalytic training? Do you know if any have been accepted? Do you have any information about the official position of the Swedish Psa Society? Please feel free to contact me directly at:
1175 Peachtree Street, NE Atlanta, GA 30361 e-mail: 76501.2034@compuserve.com
Ralph Roughton, MD
copy to: Susan Vaughan, Chair, Committee on Issues of Homosexuality
Ellen Fertig, Administrative Director, APsaA
http://hem.passagen.se/nicb/psychoanalysis.htm

三、明光社引用的那份NARTH的調查報告指同性戀可以改變是不可靠的,數據是人為扭曲做出來的。(這一點不對,是作者自己錯誤理解該份調查能作出的結論而已。而2003年Spitzer的研究正是補足1995及1997的初步報告的不足。)

Dr. Spitzer 2003年的報告﹐你最多可以說他 intention 是補足 1995 / 1997 初步報告不足﹐但不等於該報告達到預期的效果。

Donald Strassberg, Ph.D., from the University of Utah Department of Psychology, described the study this way in his peer review:
Spitzer is to be congratulated on trying to "light a candle" rather than continuing to "curse the darkness" when it comes to trying to understand what happens as a result of reparative therapy. (正面評價)
It's not hard to see the problems with choosing a result (ex-gay success) and working backwords from it (looking for common characteristics among ex-gays) using limited-scope (45 minute) phone interviews which gather unverified self-reports. As Strassberg put it:
Although Spitzer made some laudable methodological improvements in his approach to an important research question, the design of his survey does not really put it into the category of "scientific evidence supporting the efficacy of reparative therapy" for which so many seem to be looking. (質疑)
But, in testing his hypothesis -- that some predominantly homosexual folks can, with some sort of support, adopt predominantly heterosexual identity and functioning -- Spitzer focused on the change without examining the therapy. It was not a "does reparative therapy work?" study, or even a "what is reparative therapy?" study. It was a "what does self-reported change look like?" study.
It was a micro-sized target, a starting point. (起點﹐那麼算是補足嗎﹖)
http://www.exgaywatch.com/blog/archives/2003/10/spitzer_study_i.html

1. 該兩份報告都曾在Psychological Report中刊登,經過peer review。

2. Psychological Reports的impact factor不高,若以impact factor來鑑別「權威性的心理醫療專業學刊,則可以說它不算大期刊。但impact factor涉及期刊題目的熱門程度問題,而且若以peer review作為批評,則上述所說明顯是錯的。
然而﹐在 Psychological Reports 刊登﹐代表得到足夠peer review。係唔係一個醫生專業資格因為國籍受到歧視﹐得不到 peer recognition﹐他可以隨便就掛牌行醫﹖我質疑的是 NARTH報告的 quality assurance 。
Psychological Reports能否提供足夠 assurance ﹐保證他們報告的研究方法的可靠性﹑素質嗎﹖
Peer review有好多種既﹐check有沒有 spelling / grammatical mistake可以算係﹐睇裡面的 arithmetic有冇加減錯又係。我文章裡面 peer review的舉例要求好清楚﹐Psychological Reports 有做嗎﹖
你有沒有考究Psychological Reports的學術地位﹖是否他們來者不拒﹐還是經過非常嚴謹的 review才刊登呢﹖(聽過 Sokal Hoax沒有﹖)
請考慮以下對Psychological Reports的評論。
Claims about the "success" of conversion therapies have appeared mainly in the mass media and on the World Wide Web, rather than in high-quality, peer-reviewed scientific journals. A 2000 paper by Joseph Nicolosi and his colleagues was published in Psychological Reports. Psychological Reports is also the major outlet for Paul Cameron, the discredited antigay psychologist. As detailed elsewhere on this site, Psychological Reports has very low prestige among researchers and a low rejection rate. In addition, unlike other psychological journals, it charges its authors a fee to publish their papers.
Paul Cameron好似是明光社的舊愛﹐但因為名聲太差﹐好像他們也棄用了他的所謂研究。而 Psychological Reports基本上好像沒有小心review ﹐以至連一個 discredited psychologist的文章也可以很容易在上面刊登。



3. 著名心理學家,也是APA的資深會員,Nicholas A. Cummings最近在一本他有份編的書中寫道:” Let no one presume that ideology does not influence science. Within psychology today there are topics that are deemed politically incorrect, and they are neither published nor funded. Journal editors control what is accepted for publication through those chosen to conduct peer reviews. … Censorship exist… Now misguided political correctness tethers our intellects. Those viewed as conservative are looked down upon as lacking intelligence. … Dr. Wright and I did not realized how pervasive this shunning and intimidation could be until we began talking with potential contributors, many of whom declined to be included, fearing loss of tenure or stature, and citing previous ridicule and even vicious attacks, described by several chapter contributors.” 這不是特別針對reparative therapy而說的話(他們編的書裡有一章專討論homophobia),但既然reparative therapy受到APA的譴責,在一個這樣的政治環境下,進行對reparative therapy的研究,相信很難能夠在impact factor高的大期刊刊登。上述這位編者來頭原來很勁,cv太長不抄了,有懷疑可以自己上網search。

你引用的論據是一個 double bladed sword﹐難道NARTH﹑明光社的做法就一定不是ideology influencing science ﹖
該作者CV勁是一件事情﹐但主旨是NARTH本身報告的 credibility ﹐裡面研究的 validity ﹐和這位作者 CV勁有咩關係呢﹖Nicholas A. Cummings 是APA的資深會員﹐CV 好勁﹐but he did not endorse NARTH’s “research” 。邏輯上你的論據屬於“偽托權威” 。因為上文根本不可以證明NARTH 沒有任何問題﹐不可以反證NARTH的報告得到過 peer review。

4. NARTH的成員不一定是心理醫療專業,也有律師等,會員也有多種,有clinical, research/academic, general, 甚至student,不同的會藉當然也有不同的地位。當然不是每一個NARTH的成員都會出研究,正如許多律師也不會寫甚麼法學研究一樣,但NARTH的research/academic會員是會出研究報告的,而且NARTH的成員不是專門只進行同性戀的研究,也從事其他心理醫療方面的研究。我在NARTH的網頁上找到他們一位成員Christopher Rosik一篇刊登在The Journal of Pastoral Care, Spring 2001的文章,是關於re-orientation therapy的。同一作者,在Obes Surg 2005年5月發表了一篇講不知甚麼手術後的病人的病徵的文章 “Psychiatric symptoms among prospective bariatric surgery patients: rates of prevalence and their relation to social desirability, pursuit of surgery, and follow-up attendance.” 相信隨便一個上面的例子都足以顯示作者指稱「NARTH其實沒有任何它的會員在任何權威性的心理醫療專業學刊出版他們的有關學術論文」是完全沒有事實根據的。我也想知作者從何而得這種對NARTH的判斷?是從路邊社來?是從同志網來?

我可以收回說「NARTH其實沒有任何它的會員在任何權威性的心理醫療專業學刊出版他們的有關學術論文」﹐而 refine as 「NARTH和其會員其實沒有在任何權威性的心理醫療專業學刊出版特別性傾向改變的有關學術論文」。

不過上面你犯了“偽托權威” 的謬誤。我文章討論的權威是就精神分析﹑心理治療專業的代表性﹐你舉那些“外行人” 會員有什麼相干﹖現在討論的是精神分析﹑心理治療專業的代表性的課題﹐律師﹑clinical, research/academic, general, 甚至student等有相關權威嗎﹖
The Journal of Pastoral Care 又是不是權威的心理醫療專業學刊﹖What is its credentials ﹖


「NARTH有會員500名,如果每年他們每人處理的同性戀個案有50人…那麼一看5年處理的個案有十二萬五千,就算減半…,只提供46名,取樣是否太少呢?那個是否representative sample呢?…」這條算術恐怕沒有甚麼意義。因為1. 研究不是要看成功率 2. 提供個案要得當事人肯首,不是做後多就可以任意轉介 3. 每人每年50 人,這數字從那裡得來?

我覺得你仍然是在轉移視線。在 Spitzer的報告裡面﹐46人是他們提供的研究對象﹐而報告最後數目也不能夠反映了他們佔接受輔導的同性戀的比例。

你認為研究不是要看成功率﹐是非常錯誤的。你自己不是說﹐需要研究去查失敗原因嗎﹖如果成功率差﹐就可以在裡面發現失敗的原因﹑集中在什麼地方﹑成功的有什麼因素。這是 research去幫助完善 reparative therapy ﹐為何你自打嘴巴﹖
提供個案要得當事人肯首﹕但提供個案需要經過NARTH提供嗎﹖難道NARTH不可以把所有個案記錄 turn over ﹐容許 Spitzer抽取樣本﹐然後 Spitzer 去取得當事人肯首﹐唔夠就拿到夠為止。
你自己引用Nicholas A. Cummings的說話﹐表示“Let no one presume that ideology does not influence science. ” NARTH沒有 ideology嗎﹖聽過瓜田李下這說話沒有呢﹖NARTH在提供調查對象﹐參與那麼深入﹐就已經予人有操控的嫌疑。

每人每年50 人是一個 intelligent guess ﹐但有根據的
1) 每個病人大約看醫生 30分鐘﹐一天當輔導的工作有10個症﹐每個症是每星期visit一次﹐一星期就已經是 50人。(其實可以更加高)
2) 給醫生輔導3 – 5年﹐平均也有 25人罷﹖500 x 25 = 12500。46人抽 12500是不是太少。
3) 你可以說﹐同性戀個案少﹐不可以用 12500作為基數﹐那麼NARTH等提供個案機構有沒有告訴 Dr. Spitzer sample population 多大﹖沒有。那麼 sample population不清楚下﹐研究的數據就不可以參考了。
如果 ignore數據﹐任何 conclusion都嚴重偏差﹐如何可以算是一個足夠補足 1995 / 1997年研究的報告呢﹖
科研報告重要資料是數據﹐數據的來源是看從什麼 population抽取sample﹐sample size 夠不夠。
1) 報告沒有交代 population
2) 46 人 sample size不知道夠不夠
3) 取樣過程出現“瓜田李下”
上面 (1)﹑(2)﹑(3) 幾個因素﹐足以令報告失去面參考價值。

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