Abba E Borowich. Journal of Gay & Lesbian Mental Health. Volume 12, Issue 3, 2008.
More than 20 years ago, I was lecturing at the convention of the Rabbinical Council of America (RCA, a modern orthodox group) about what I thought we knew concerning homosexuality. Primarily, I was hoping the council would adopt a compassionate stance regarding Orthodox Jewish homosexual individuals as they were deliberating the Halachic (Jewish law) issues involved. At the time, I had just experienced something entirely unexpected in my treatment of an observant Jewish homosexual man who had entered treatment as a life-long Kinsey 6 (exclusive homosexuality). He had shortly before announced to me that he was now sexually aroused and emotionally attracted to a woman. In addition, I had seen several other homosexual men, who were Kinsey 4 and 5 in their orientation, get married—ostensibly successfully. Flush with that “success,” I expressed the belief that, at least with some predominantly homosexual men, successful therapy could possibly yield marriageable candidates. I thought I had found an approach that worked (at least with some people) to deal with the “problems” inherent in a homosexual identity.
As those of you who have seen Simcha Dubowski’s award-winning film Trembling Before G-d can attest, the positions of Orthodox Judaism’s rabbinical leaders regarding homosexuality reflect the broad spectrum of belief and practice within the movement. They vary from harsh Biblical-like condemnation to the warm acceptance of the “sinner” but not the “sin.” I vividly recall the reaction of a right-wing, modern Orthodox Rabbi to my RCA lecture. Alluding to the teachings of the revered leader of the movement at the time, Rabbi Joseph B. Soloveitchik, he cautioned against trying to understand the homosexual. Rabbi Soloveitchik allegedly had warned against empathic approaches to a rasha (wicked person), lest such an understanding lead one to forgive wickedness. Instead, this Rabbi suggested, in all earnestness, that all homosexuals should simply be put to death. At the time, I was pleased that the deliberative body of the RCA adopted a nonpunitive approach to homosexual individuals and called for their acceptance in their congregations—even as they expressed strong disapproval of homosexual behavior.
At that time, the approach I had followed, and the psychodynamic understanding I had, very closely adhered to the very penetrating insights described by Jeffrey Satinover (1996) nearly 15 years later. He and others, like Joseph Nicolosi (1991), helped to found the NARTH organization that is dedicated to the so-called “reparative therapy” of homosexuals (see Drescher, 1998, for criticisms of such therapy). My therapeutic goals, at the time, were to counteract the homosexual patient’s self-loathing; provide a warm, hopeful and accepting therapeutic environment; explain that human approaches to sexuality were variable and not monolithic; and provide alternatives to a gay community lifestyle. I hoped that a nurturing relationship with a straight male therapist, who was understanding of the person’s religious sensibilities and feelings, might help detoxify corrosive masculine influences of the past and provide some role-modeling for future identification. This method had appeared to be successful, and I set out to demonstrate that such a technique (which now seems to approximate the reparative approach) could work prospectively with new patients.
While I never set out to skew my practice predominantly to the treatment of homosexual patients, I thought that my psychiatric practice, which already consisted of at least 50% religiously observant Jews, lent itself readily to testing my hypothesis. This was a population that would be particularly amenable to changing sexual orientation via therapy. After all, they started with the assumption that the gay lifestyle could never be acceptable to them (which, by the way, is a central tenet of the reparative movement). As a result, I accepted several orthodox Jewish homosexual patients on a trial basis with the explicit and declared purpose of trying to help them change to a more heterosexual identity. Until then, although my approach was as described, changing sexual identity was not the explicit purpose of the treatment, and the nurturing, hopeful stance I adopted was how I had generally addressed my patients.
In this paper, I first present a summary of Satinover’s (1996) description of the developmental pathway seen in many (but certainly not all) homosexual patients; then discuss the results of my prospective work and give several clinical vignettes that vividly describe my experience over the course of my more than 36-year career; and, finally, comment on conclusions I have reached.
It must be stated from the outset that this work involved a very small sample of people without any randomization and without any control group. Since this is a private practice, funded solely by the patients, many of the patients throughout my career did not desire to pursue the proposed therapy to its conclusion, and many were lost to any followup. This is a particular problem within the Orthodox Jewish population that fiercely attempts to protect their privacy lest their family members be stigmatized by the specter of mental illness of any sort. Lastly, it is quite difficult to be precise in evaluating a person on the Kinsey scale who has practiced homosexual behavior throughout his life, when he has experienced a life where the sexes are completely segregated. Even assuming his fantasy life and his sexual experience are completely homosexual, does that mean that any heterosexual behavior thereafter was the result of a sexual identity re-orientation? Homoerotic play is fairly ubiquitous in the same-sex yeshiva setting of the Haredi (scrupulously Orthodox) community. Nevertheless, I would maintain that much of this needs to be placed in the adventitial homosexuality category pending subsequent developments in the person’s life rather than automatically labeling the person a Kinsey 4, 5 or 6.
Furthermore, none of my data is conclusive in any direction and can be interpreted differently. I can also see that some might suggest that all I will be demonstrating is my incompetence at providing reparative therapy. Although that is a real possibility, I believe I have demonstrated at least some degree of competence in my other therapeutic work, so I do not think these results can be dismissed. Despite all these reservations, I have still proceeded with this discussion because I think these experiences need to be shared, and I look forward to our discussion.
Developmental Theory Underlying Reparative Therapy
Satinover (1996) describes a common but not exclusive pattern of homosexual development. It begins with a set of unique traits that distinguishes the incipient male homosexual. He may be more aesthetic, sensitive and creative and feel somewhat uncomfortable among other boys who indulge in rough-and-tumble play. He also senses a mismatch in his relationship with his father, who may be seen as cold, ineffectual and distant. Reflexively, according to this theory, he detaches from his father, the prototypical masculine role model, and may attach to his mother instead.
Despite being detached from his father, he longs for his father’s nurturance. He develops relationships with other boys, frequently older than himself, to compensate. At puberty, sexual urges get attached to this compensatory relationship and he begins to sexually experiment with them. He feels tremendous satisfaction, enough to more than compensate for the shame and guilt he may also feel. He soon enters the gay community seeking to free himself of his conflicts, and this gay lifestyle subsequently re-enforces his homosexuality. Retrospectively, he tells himself he has always been gay and that it is an integral, unalterable part of him.
The First Cases: Change Seems Possible
Mr. A was the first homosexual man I treated extensively. He initially presented as a 27-year-old graduate student whose chief complaint was “I get attacks of suicidal depression.” He talked of his “deep and profound self-loathing” and stated that his behavior could range from the “bizarre and irrational” to the “silly and ridiculous.”
He said he could be incredibly successful in certain endeavors but he preferentially vilified himself for his failures. If he did not sense that he was the best in something, he would “become hysterical. I’m incapable of maintaining my self-esteem in the absence of outward confirmation in large amounts.”
Mr. A grew up as “the school fairy” who got beaten up four times a week and had a “nervous breakdown” in high school when he also slit his wrists. He knew his parents slept together a total of 7 times in their marriage, that his father “slept with everybody” and re-married a woman half his age after the parents divorced. He felt his father was extremely seductive with him and was attracted to athletic women who looked like boys. He described his mother as “cold, self-centered and unloving.” His mother told him she suspected the father to be a “closet homosexual.”
While in a committed homosexual relationship, Mr. A frequently went to gay sadomasochistic bars and had many promiscuous one-night stands. He felt that sex with his partner “ranged from uninteresting to repulsive.” Nevertheless, he felt quite comfortable with his homosexual orientation: “the only thing I was never conflicted about.” We seemed to have an implicit understanding, as it were, that we would be dealing in therapy with the patient’s poor self-esteem, instability and depression and that the patient’s core gay identity was not at all at issue.
Our therapy progressed quite successfully and uneventfully as the patient gradually moved away from promiscuity and S&M and became much more productive at work. He surprised me one day with the revelation that he had found himself becoming physically attracted to a female graduate student who seemed to be smitten with him. A confounding variable to this discovery was that he also revealed he had an enlarged lymph node that had been present for the past six months and that he had suppressed. Tragically, the subsequent biopsy demonstrated Kaposi’s Sarcoma and the patient succumbed to AIDS several years later without ever having acted on his sexual discovery.
While there may be a number of alternative explanations for the patient’s apparent heterosexual discovery that may fall far short of an actual change having taken place, it should be stated clearly that the patient himself thought he had changed. In fact, at the next-to-last session before his death, the patient said, “I no longer believe there is a great dividing line between gay and straight people.” He had also undergone a change in his religious orientation. He began to read extensively in Jewish sources and had amassed a substantial Judaica library.
Mr. B presented as a 24-year-old Yeshivish ultra-Orthodox Jew who had been referred to me by his rosh yeshiva (head of the yeshiva) because he was dissatisfied with his two prior psychiatrists, whom he had seen over the previous 11 years. At the age of 13, he had noted he had exclusively homosexual fantasies when he masturbated. He also had several homosexual experiences at ages 17 and 18. His major complaint, though, was his “inability to achieve my potential.” He had significant difficulties controlling his eating, masturbation, drug taking and cigarette smoking and would frequently lose his temper with family members—although not with others. He was very needy and could be quite arrogant. Although not raised Orthodox, he had had a “quasi-mystical experience” in a foreign country and decided to become very Orthodox. His father was openly contemptuous of religion and his mother was a lapsed Hassidic woman. His father was ineffectual emotionally but could be very biting and had a bipolar history. His mother dominated the household. The father admitted privately to many heterosexual affairs.
Mr. B had four goals for treatment. He wanted: (1) to become motivated; (2) to be freed of homosexual fantasies; (3) to get married; and (4) to have friends.
The patient fantasized solely about men and “craved the tenderness, kissing and foreplay.” After six months of treatment, Mr. B started going out with a woman to whom he said he felt attracted and, shortly thereafter, his fantasies became heterosexual. On his marital night, he became flaccid but he was able to penetrate with the aid of a lubricant after his wife challenged his masculinity. He said he was motivated to perform out of anger at her and he was gratified to have made her bleed profusely on the second night. When he subsequently had difficulty meeting his wife’s sexual needs, he told her that he had performance anxiety and she became more empathetic to him. Their sex life improved. By mutual consent, we then terminated regularly scheduled sessions.
It was at this juncture that I gave the lecture mentioned above to the RCA and felt I had identified an approach that offered hope to the Orthodox homosexual to change his orientation. I also had several other allegedly predominantly homosexual Hassidic men get married after brief supportive therapy but who were then lost to followup.
The Subsequent Cases: Change Seems Less Possible
I will now describe my subsequent results, including the prospective treatment of Orthodox homosexuals, and illustrate them with several case reports.
Overall, my treatment of the homosexual men who came solely to rid themselves of their homosexuality yielded poor results. It almost appeared to me that treatment had proceeded much better when there was not a predetermined goal of freeing a person of homosexuality but rather when the therapeutic relationship developed around a more sexually neutral, albeit important, emotional focus that was mutually agreeable. None of the male patients who specifically came to change their sexual orientation and who underwent targeted therapy progressed beyond movement of one point on the Kinsey scale, and even that movement was tentative and subject to oscillation at times of stress. None of them married or could get beyond several dates with women. Of the women who came, almost all did not move on the Kinsey scale except for two, each of whom moved one point. There were, however, many young Hassidic men (an approximate total of 200 over the last 36 years) who, during the course of a psychiatric evaluation for other matters, revealed they had had exclusively homosexual fantasies and, in some instances, had had mutual masturbation. None had had anal intercourse because of the strong Biblical prohibition against it, and only a few had participated in oral sex. Virtually all these men wound up getting married, and the majority was lost to followup. Of the men who returned, many did not want to talk about homosexuality, and those who did talk revealed some continuing distress both with heterosexual performance and persistent homosexual arousal.
The continuing story of Mr. B is illustrative of the difficulties encountered with this population. Ten years after we terminated, Mr. B presented again with an uncontrollable physical and emotional attraction to his male learning partner. By this time, he had fathered seven children and was again having trouble performing with his wife. He had also redeveloped a drug abuse problem. With the help of a drug-rehabilitation program and the marriage and a move to another state by the learning partner, the patient settled down again. Several years later, he re-presented; this time the object of the patient’s homosexual attraction was his rabbi’s 14-year-old son. The ostensible reason for his distress was his wife’s having left with their now nine children to vacation in a bungalow colony. Left alone, he felt bereft and deprived.
When the patient’s roughhouse play with this boy began to escalate into quasi-sexual play, I confronted him and explored the real and symbolic meanings of these enactments. I also consulted with a senior colleague about my legal and therapeutic obligations. We both agreed that strong limit-setting was necessary and I informed my patient that he either had to stop physical contact with this young adolescent or I would have to report the matter to the Bureau of Child Welfare, terminate my treatment of him, and refer him elsewhere. The patient immediately got up and left the session while saying, “thanks for the memories.” I wound up referring the patient to a senior colleague who specialized in the treatment of homosexuality, but the treatment went poorly. After several years, through the grapevine, I subsequently learned that he and his wife were divorced and that the patient died under unknown circumstances shortly thereafter.
Mr. C was among the first patients who came to me specifically to change his homosexuality. He said, “I’m 27 years old and I’m only attracted to men. I don’t understand it. I’m unhappy with it. It’s ruining my life. I can’t do anything about it. My rebbe said I had to see somebody. I hate myself. My friends are all getting married and I want to as well.”
His father was described as a warm and peace-loving man who was ineffectual and weak. Mr. C never took to sports as his younger brother did, and the patient felt he had severely disappointed his father. His mother was seen as aggressive and smart but also very warm. The patient felt so close to her that “she could read my mind.”
At the age of 10, the patient was drawn to a strong male counselor at camp. He began to fantasize about him sexually. Although he longed to be held and caressed by this counselor and, later on, by other strong male figures, he recoiled at the touch of his father. His first overt sexual encounter took place in his senior year at college and, subsequently, he began frequenting gay bathhouses. “I felt like a kid in a candy store. I could finally be myself.”
After seven months of treatment, the patient had his first-ever heterosexual arousal dream. Nevertheless, he never moved beyond that. He went on many dates but never felt close to any woman. After 10 years of trying everything we could, we terminated treatment. He remains unmarried to this day, years later.
In contrast to Mr. C, Mr. D was referred to me for treatment of a panic attack. He was a 19-year-old Hassidic male. While taking his history, Mr. D said he had “a very big passion for sex,” specifically for sex with Chaim, a friend who was one year younger than he. “When I saw him, I got erections and, when I masturbated, I thought of Chaim.” He had been attracted to him since age 11 and once had to fend Chaim off when Chaim came into his bed at the yeshiva dormitory. Eventually, they mutually masturbated.
Mr. D described his father as cold and his mother as overintrusive. He knew he had reached the age of shidduchim (arranged marriages), and he was frightened about what the future held for him. He had been learning mussar (penitential) books and knew he had at least merited meesa beeyeday shamayim (a heavenly death decree). As a result, he was constantly checking his heart rate to see if he was about to die, and hence the onset of his panic attacks.
He was treated with an antipanic medication and gradually was able to separate from Chaim. He subsequently married a lovely, personable, and intelligent Hassidic girl with diabetes in her family. He had to accept a so-called “lesser shidduch” because it had become known that he had had a panic attack. Treatment was soon terminated.
Several years and several children later, he reappeared. He indicated he found his wife’s tush (butt) very unappealing and had been looking at boys and young men at the mikveh (ritual bath). He found himself getting erections again and seemed compelled to fondle the penises and buttocks of boys there. He said he had lost his passion for his wife. When I warned him that this behavior could get him in serious trouble and could damage the boys, he felt I had become unempathetic and dictatorial and left treatment.
There are many other case studies I can cite, but they fundamentally resemble the cases already described.
To summarize, virtually all my male homosexual patients who were in an intensive therapy moved at least one point on the Kinsey scale toward heterosexuality. However, that movement was not solely unidirectional. Reversions occurred in response to stressful events of various sorts—at times compromising an intact and extensive nuclear family and leading to catastrophic results. Of my many Hassidic patients who ostensibly had exclusively homosexual fantasy and, at times, practice, almost all of them got married. However, because of the special circumstances surrounding Hassidic life, most of them never returned for followup. Of course, most of them did not identify their behavior as homosexuality, per se, and were not especially troubled by it. In contrast to the men, I found it virtually impossible to achieve significant movement with homosexual women. It certainly is possible that female therapists may relate better to lesbians. It appeared to me that, at least in terms of inducing significant movement, more seemed to be accomplished when there was no direct expectation that change in sexual orientation was the specific goal. In other words, I found much less internal resistance when the sexual reorientation happened as a result of organic change as a part of a successful therapy for mutually agreed emotional problems.
I have many questions about these cases. Would reparative therapists consider my “failures” successes? After all, virtually every male moved along the continuum toward heterosexuality. I considered them failures because I distrusted the integrity and stability of the movement achieved and felt it inadequate to sustain a heterosexual lifestyle when confronted by stresses. Should I have extended the therapies even though I saw what I considered to be endless repetitions of the same dynamics? One reparative therapy author contends this therapy needs to be continued for at least the length of most failed marriages.
Another question: Why do I consider the difficulties experienced here any different from all other therapies? After all, are there not multiple regressions, resistances, and endless repetitions of the same dynamic issues in all therapies? Certainly, no therapy of any sort is guaranteed to work. My answer is that when I was dealing directly with an emotional problem, my work was usually successful. I do not consider homosexuality to be an emotional problem, and that is one of the reasons I believe the “therapy” did not work so well.
Another question is why do I call this a form of reparative therapy? I call this failed reparative therapy because, at the time, the dynamic understanding I was basing my therapy on was virtually identical to that of reparative therapists and I suspect, although I do not know for sure, that the therapy was similar if not identical. If so, does this mean I think the reparative therapists are lying about their results? I really do not know the answer. It is possible there is a lot of wishful thinking going on here and a strong desire to please the therapist and, perhaps, God. That certainly was that possibility in the case of Mr. A. It is possible that, with sufficient time allotted for followup, more failures would become apparent. Of course, an alternative explanation is that they are just a lot better doing this therapy than I was.