Homosexuality and Hope

Contents

I Considerations

Introduction

1. Not born that way
2. Same-sex attraction as a symptom
3. Same-sex attraction is preventable
4. At-risk, not predestined
5. Therapy
6. Goals of therapy

II Recommendations

Ministry to individuals experiencing same-sex attraction
The role of the priest
Catholic medical professionals
Teachers in Catholic institutions
Catholic families
The Catholic community
Bishops
Hope
Bibliography
Appendix

Introduction

The Catholic Medical Association is dedicated to upholding the principles of the Catholic Faith as related to the practice of medicine and to promoting Catholic medical ethics to the medical profession, including mental health professionals, the clergy, and the general public.

No issue has raised more concern in the past decade than that of homosexuality and therefore the CMA offers the following summary and review of the status of the question. This summary relies extensively on the conclusions of various studies and points out the consistency of the teachings of the Church with these studies. It is hoped that this review will also serve as an educational and reference tool for Catholic clergy, physicians, mental health professionals, educators, parents and the general public.

CMA supports the teachings of the Catholic Church as laid out in the revised version of the Catechism of the Catholic Church, in particular the teachings on sexuality: "All the baptized are called to chastity" (CCC 2348). "Married people are called to live conjugal chastity; others practice chastity in continence" (CCC 2349). "Tradition has always declared that homosexual acts are intrinsically disordered ... Under no circumstance can they be approved" (CCC 2333).

It is possible, with God's grace, for everyone to live a chaste life including persons experiencing same-sex attraction, as Cardinal George, Archbishop of Chicago, so powerfully stated in his address to the National Association of Catholic Diocesan Lesbian & Gay Ministries: "To deny that the power of God's grace enables those with homosexual attractions to live chastely is to deny, effectively, that Jesus has risen from the dead" (George 1999).

There are certainly circumstances such as psychological disorders and traumatic experiences which can, at times, render this chastity more difficult and there are conditions which can seriously diminish an individual's responsibility for lapses in chastity. These circumstances and conditions, however, do not negate free will or eliminate the power of grace. While many men and women who experience same-sex attractions say that their sexual desire for those of their own sex was experienced as a "given" (Chapman 1987[1]) this in no way implies a genetic predetermination or an unchangeable condition. Some surrendered to same-sex attractions because they were told that they were born with this inclination and that it was impossible to change the pattern of one's sexual attraction. Such persons may feel it is futile and hopeless to resist same-sex desires and embrace a "gay identity". These same persons may then feel oppressed by the fact that society and religion, in particular the Catholic Church, do not accept the expression of these desires in homosexual acts (Schreier 1998[2]).

The research referenced in this report counters the myth that same-sex attraction is genetically predetermined and unchangeable and offers hope for prevention and treatment.

1) Not born that way

A number of researchers have sought to find a biological cause for same-sexual attraction. The media has promoted the idea that a "gay gene" has already been discovered (Burr 1996), but in spite of several attempts none of the much publicized studies (Hamer 1993; LeVay 1991) have been scientifically replicated (Gadd 1998). A number of authors have carefully reviewed these studies and found that they not only do not prove a genetic basis for same-sex attraction, they do not even claim to have scientific evidence for such a claim (Byrne 1963; Crewdson 1995; Goldberg 1992; Horgan 1995; McGuire 1995; Porter 1996; Rice 1999).

If same-sex attraction were genetically determined, then one would expect identical twins to be identical in their sexual attractions. There are, however, numerous reports of identical twins who are not identical in their sexual attractions (Bailey 1991; Eckert 1986; Friedman 1976; Green 1974; Heston 1968; McConaghy 1980; Rainer 1960; Zuger 1976). Case histories frequently reveal environmental factors which account for the development of different sexual attraction patterns in genetically identical children, supporting the theory that same-sex attraction is a product of the interplay of a variety of environmental factors (Parker 1964).

There are, however, ongoing attempts to convince the public that same-sex attraction is genetically based (Marmor 1975). Such attempts may be politically motivated because people are more likely to respond positively to demands for changes in laws and religious teaching when they believe sexual attraction to be genetically determined and unchangeable (Emulf 1989; Piskur 1992). Others have sought to prove a genetic basis for same-sex attraction so that they could appeal to the courts for rights based on the "immutability" (Green 1988).

Catholics believe that sexuality was designed by God as a sign of the love of Christ, the bridegroom, for his Bride, the Church, and therefore sexual activity is appropriate only in marriage. Healthy psycho-sexual development leads naturally to attraction in persons of each sex for the other sex. Trauma, erroneous education, and sin can cause a deviation from this pattern. Persons should not be identified with their emotional or developmental conflicts as though this was the essence of their identity. In the debate between essentialism and social constructionism, the believer in natural law would hold that human beings have an essential nature — either male or female — and that sinful inclinations — such as the desire to engage in homosexual acts — are constructed and can, therefore, be deconstructed.

It is, therefore, probably wise to avoid wherever possible using the words "homosexual" and "heterosexual" as nouns since such usage implies a fixed state and an equivalence between the natural state of man and woman as created by God and persons experiencing same-sex attractions or behaviors.

2) Same-sex attraction as a symptom

Individuals experience same-sex attractions for different reasons. While there are similarities in the patterns of development, each individual has a unique, personal history. In the histories of persons who experience same-sex attraction, one frequently finds one or more of the following:

• Alienation from the father in early childhood, because the father was perceived as hostile or distant, violent or alcoholic (Apperson 1968; Bene 1965; Bieber 1962; Fisher 1996; Pillard 1988; Sipova 1983)
• Mother was overprotective (boys) (Bieber, T. 1971; Bieber 1962; Snortum 1969)
• Mother was needy and demanding (boys) (Fitzgibbons 1999)
• Mother emotionally unavailable (girls) (Bradley 1997; Eisenbud 1982)
• Parents failed to encourage same-sex identification (Zucker 1995)
• Lack of rough and tumble play (boys) (Friedman 1980; Hadden 1967a)
• Failure to identify with same-sex peers (Hockenberry 1987; Whitman 1977)
• Dislike of team sports (boys) (Thompson 1973)
• Lack of hand/eye coordination and resultant teasing by peers (boys) (Bailey 1993; Fitzgibbons 1999; Newman 1976)
• Sexual abuse or rape (Beitchman 1991; Bradley 1997; Engel 1981; Finkelhor 1984; Gundlach 1967)
• Social phobia or extreme shyness (Golwyn 1993)
• Parental loss through death or divorce (Zucker 1995)
• Separation from parent during critical developmental stages (Zucker 1995)

In some cases, same-sex attraction or activity occurs in a patient with other psychological diagnosis, such as:

• Major depression (Fergusson 1999)
• Suicidal ideation (Herrell 1999)
• Generalized anxiety disorder
• Substance abuse
• Conduct disorder in adolescents
• Borderline personality disorder (Parris 1993; Zubenko 1987)
• Schizophrenia (Gonsiorek 1982)
• Pathological narcissism (Bychowski 1954; Kaplan 1967)
• In a few cases, homosexual behavior appears later in life as a response to a trauma such as abortion (Berger 1994; de Beauvoir 1953) or profound loneliness (Fitzgibbons 1999)

3) Same-sex attraction is preventable

If the emotional and developmental needs of each child are properly met by both family and peers, the development of same-sex attraction is very unlikely. Children need affection, praise and acceptance by each parent, by siblings and by peers. Such social and family situations, however, are not always easily established and the needs of children are not always readily identifiable. Some parents may be struggling with their own trials and be unable to provide the attention and support their children require. Sometimes parents work very hard but the particular personality of the child makes support and nurture more difficult. Some parents saw incipient signs, sought professional assistance and advice and were given inadequate and in some cases erroneous advice.

The Diagnostic and Statistical Manual IV (APA 1994) of the American Psychiatric Association has defined Gender Identity Disorder (GID) in children as a strong, persistent cross gender identification, a discomfort with one's own sex, and a preference for cross sex roles in play or in fantasies. Some researchers (Friedman 1988; Phillips 1992) have identified another less pronounced syndrome in boys — chronic feelings of unmasculinity. These boys while not engaging in any cross sex play or fantasies, feel profoundly inadequate in their masculinity and have an almost phobic reaction to rough and tumble play in early childhood and a strong dislike of team sports. Several studies have shown that children with Gender Identity Disorder and boys with chronic juvenile unmasculinity are at-risk for same-sex attraction in adolescence (Newman 1976; Zucker 1995; Harry 1989).

The early identification (Hadden 1967) and proper professional intervention, if supported by parents, can often overcome the gender identity disorder (Rekers 1974; Newman 1976). Unfortunately, many parents who report these concerns to their pediatricians are told not to worry about them. In some cases, the symptoms and parental concerns may appear to lessen when the child enters the second or third grade, but unless adequately dealt with the symptoms may reappear at puberty as intense, same-sex attraction. This attraction appears to be the result of a failure to identify positively with one's own sex.

It is important that those involved in child care and education become aware of the signs of gender identity disorder and chronic juvenile unmasculinity and access the resources available to find appropriate help for these children (Bradley 1998; Brown 1963; Acosta 1975). Once convinced that same-sex attraction is not a genetically determined disorder, one is able to hope for prevention and one is also able to hope for a therapeutic model to greatly mitigate if not eliminate same-sex attractions.

4) At-risk, not predestined

While a number of studies have shown that children who have been sexually abused, children exhibiting the symptoms of GID, and boys with chronic juvenile unmasculinity are at risk for same-sex attractions in adolescence and adulthood, it is important to note that a significant percentage of these children do not become homosexually active as adults (Green 1985; Bradley 1998).

For some, negative childhood experiences are overcome by later positive interactions. Some make a conscious decision to turn away from temptation. The presence and the power of God's grace, while not always measurable, cannot be discounted as a factor in helping an at-risk individual turn away from same-sex attraction. The labeling of an adolescent, or worse a child, as unchangeably "homosexual" does the individual a grave disservice. Such adolescents or children can, with appropriate, positive intervention, be given proper guidance to deal with early emotional traumas.

5) Therapy

Those promoting the idea that sexual orientation is immutable frequently quote from a published discussion between Dr. C.C. Tripp and Dr. Lawrence Hatterer in which Dr. Tripp stated: "... there is not a single recorded instance of a change in homosexual orientation which has been validated by outside judges or testing. Kinsey wasn't able to find one. And neither Dr. Pomeroy nor I have been able to find such a patient. We would be happy to have one from Dr. Hatterer" (Tripp & Hatterer 1971). They fail to reference Dr. Hatterer response:

"I have 'cured' many homosexuals, Dr. Tripp. Dr. Pomeroy or any other researcher may examine my work because it is all documented on 10 years of tape recordings. Many of these 'cured' (I prefer to use the word 'changed') patients have married, had families and live happy lives. It is a destructive myth that 'once a homosexual, always a homosexual.' It has made and will make millions more committed homosexuals. What is more, not only have I but many other reputable psychiatrists (Dr. Samuel B. Hadden, Dr. Lionel Ovesey, Dr. Charles Socarides, Dr. Harold Lief, Dr. Irving Bieber, and others) have reported their successful treatments of the treatable homosexual" (Tripp & Hatterer 1971).

A number of therapists have written extensively on the positive results of therapy for same-sex attraction. Tripp chose to ignore the large body of literature on treatment and surveys of therapists. Reviews of treatment for unwanted same-sex attractions show that it is as successful as treatment for similar psychological problems: about 30% experience a freedom from symptoms and another 30% experience improvement (Bieber 1962; Clippinger 1974; Fine 1987; Kaye 1967; MacIntosh 1994; Marmor 1965; Nicolosi 2000; Rogers 1976; Satinover 1996; Throckmorton; West).

Reports from individual therapists have been equally positive (Barnhouse 1977; Bergler 1962; Bieber 1979; Cappon 1960; Caprio 1954; Ellis 1956; Hadden 1958; Hadden 1967b; Hadfield 1958; Hatterer 1970; Kronemeyer 1989; Nicolosi 1991). This is only a representative sampling of the therapists who report successful results in the treating of individuals experiencing same-sex attractions.

There are also numerous autobiographical reports from men and women who once believed themselves to be unchangeably bound by same-sex attractions and behaviors. Many of these men and women (Exodus 1990-2000) now describe themselves as free of same-sex attraction, fantasy, and behavior. Most of these individuals found freedom through participation in religion based support groups, although some also had recourse to therapists. Unfortunately, a number of influential persons and professional groups ignore this evidence (APA 1997; Herek 1991) and there seems to be a concerted effort on the part of "homosexual apologists" to deny the effectiveness of treatment of same-sex attraction or claim that such treatment is harmful. Barnhouse expressed wonderment at these efforts: "The distortion of reality inherent in the denials by homosexual apologists that the condition is curable is so immense that one wonders what motivates it" (Barnhouse 1977).

Robert Spitzer, M.D., the renowned Columbia University psychiatric researcher, who was directly involved in the 1973 decision to remove homosexuality from the American Psychiatric Association's list of mental disorders, has recently become involved with researching the possibility of change. Dr. Spitzer stated in an interview: "I am convinced that many people have made substantial changes toward becoming heterosexual... I think that's news... I came to this study skeptical. I now claim that these changes can be sustained" (Spitzer 2000).

6) Goals of therapy

Those who claim that change of sexual orientation is impossible, usually define change as total and permanent freedom from all homosexual behavior, fantasy, or attraction in a person who had previously been homosexual in behavior and attraction (Tripp 1971). Even when change is defined in this extreme manner the claim is untrue. Numerous studies report cases of total change (Goetz 1997).

Those who deny the possibility of total change admit that change of behavior is possible (Coleman 1978; Herron 1982) and that persons who have been sexually involved with both sexes appear more able to change (Acosta 1975). A careful reading of the articles opposing therapy for change reveals that the authors who see therapy for change as unethical (Davison 1982; Gittings 1973) do so because they view the such therapy as oppressive to those who do not want to change (Begelman 1975; 1977; Murphy 1992; Sleek 1997; Smith 1988) and view those persons with same-sex attraction who express a desire to change as victims of societal or religious oppression (Begelman 1977; Silverstein 1972).

It should be noted that almost without exception, those who regard therapy as unethical, also reject abstinence from non-marital sexual activity as a minimal goal (Barrett 1996) and among the therapists who accept homosexual acts as normal many find nothing wrong with infidelity in committed relationships (Nelson 1982), anonymous sexual encounters, general promiscuity, auto-eroticism (Saghir 1973), sado-masochism, and various paraphilias. Some even support a lessening of restrictions on sex between adults and minors (Mirkin 1999) or deny the negative psychological impact of sexual child abuse (Rind 1998; Smith 1988).

Some of those who consider therapy unethical also challenge established theories of child development (Davison 1982; Menvielle 1998). These tend to place blame for the undeniable problems suffered by homosexually active adolescents and adults on societal oppression. All research conclusions must be evaluated in light of the biases which the researchers bring to the project. When research is infused with an acknowledged political agenda, its value is seriously diminished.

It should be pointed out that Catholics cannot support forms of therapy which encourage the patients to replace one form of sexual sin with another (Schwartz 1984). Some therapists, for example, do not consider a patient "cured" until he can comfortably engage in sexual activity with the other sex, even if the patient is not married (Masters 1979). Others encouraged patients to masturbate using other-sex imagery (Blitch 1972; Conrad 1976).

For a Catholic with same-sex attraction, the goal of therapy should be freedom to live chastely according to one's state in life. Some of those who have struggled with same-sex attractions believe that they are called to a celibate life. They should not be made to feel that they have failed to achieve freedom, because they do not experience desires for the other sex . Others wish to marry and have children. There is every reason to hope that many will be able, in time, to achieve this goal. They should not, however, be encouraged to rush into marriage, since there is ample evidence that marriage is not a cure for same-sex attractions. With the power of grace, the sacraments, support from the community, and an experienced therapist, a determined individual should be able to achieve the inner freedom promised by Christ.

Experienced therapists can help individuals uncover and understand the root causes of the emotional trauma which gave rise to their same sex attractions and then work in therapy to resolve this pain. Men experiencing same-sex attractions often discover how their masculine identity was negatively effected by feelings of rejection from father or peers or from a poor body image which result in sadness, anger and insecurity. As this emotional pain is healed in therapy, the masculine identity is strengthened and same-sex attractions diminish.

Women with same-sex attractions can come to see how conflicts with fathers or other significant males led them to a mistrust of male love or how lack of maternal affection led to a deep longing for female love. Insight into causes of anger and sadness will hopefully lead to forgiveness and freedom. All this takes time. In this respect individuals suffering from same-sex attraction are no different than the many other men and women who have emotional pain and need to learn how to forgive.

Catholic therapists working with Catholic individuals should feel free to use the wealth of Catholic spirituality in this healing process. Those with father wounds can be encouraged to develop their relationship with God as a loving father. Those who were rejected or ridiculed by peers as youngsters can meditate upon Jesus as brother, friend, and protector. Those who feel unmothered can turn to Mary for comfort.

There is every reason for hope that with time those who seek freedom will find it, but we must recognize when we encourage hope, there are some who will not achieve their goals. We may find ourselves in the same position as a pediatric oncologist who spoke of how when he first began his practice, there was almost no hope for children stricken with cancer and the physician's duty was to help the parents accept the inevitable and not waste their resources chasing a "cure." Today almost 70% of the children recover, but each death leaves the medical team with a terrible feeling of failure. As the prevention and treatment of same-sex attraction improves, the individuals who still struggle will, more than ever, need compassionate and sensitive support.

PART II - Recommendations

1) Ministry to individuals experiencing same-sex attraction

It is very important for every Catholic experiencing same sex attractions to know that there is hope, and that there is help. Unfortunately, this help is not always readily available in all areas. Support groups, therapists, and spiritual counselors who unequivocally support the Church's teaching are essential components of the help that is needed. Since the notions of sexuality in our country are so varied, patients seeking help must be cautious that the group or counselor supports Catholic moral imperatives. One of the better known Catholic support agencies is an organization known as Courage (See Appendix) and its affiliated organization Encourage. While any attempt to teach the sinfulness of illicit homosexual behavior may be greeted with accusations of 'homophobia', the reality is that Christ calls all to chastity in keeping with the particular state of life. The desire of the Church to help all live chastely is not a blanket condemnation of any who find chastity difficult but rather the compassionate response of a Church seeking to imitate Christ, the Good Shepherd.

It is essential that every Catholic experiencing same-sex attractions have easy access to support groups, therapists, and spiritual counselors who unequivocally support the Church's teaching and are prepared to offer the highest quality help. In many areas the only support groups available are run by Evangelical Christians or by people who reject the Church's teaching. The failure of the Catholic community to provide for the needs of this population is a serious omission which must not be allowed to continue. It is particularly tragic that Courage, which under the leadership of Fr. John Harvey has developed an excellent and authentically Catholic network of support groups, is not yet available in every diocese and major city.

Anecdotal reports of individuals or organizations, under Catholic auspices or directly associated with the Catholic Church, counseling persons with same-sex attractions to practice fidelity in same-sex relationships rather than chastity according to their state in life are quite distressing. It is most important that Church related counselors or support groups be very clear about the nature and genesis of same-sex attraction. This condition is not genetically or biologically determined. This condition is not unchangeable. It is deceitful to counsel individuals experiencing same-sex attractions that it is acceptable to engage in sexual acts provided these occur within the context of a faithful relationship. The teachings of the Catholic Church on sexual morality are explicitly clear and do not allow exceptions. Catholics have a right to know the truth and those working with or for Catholic institutions have an obligation to clearly enunciate that truth.

Some clerics, perhaps because they erroneously believe that same-sex attraction is genetically determined and unchangeable, have encouraged individuals experiencing same-sex attractions to identify with the gay community, by publicly proclaiming themselves gay or lesbian, but live chastity in their personal life. There are several reasons why this is an misguided course of action: 1) It is based on the mistaken idea that same-sex attraction is an unchangeable aspect of the individual and discourages persons from seeking help; 2) The "gay" community promotes an ethic of sexual behavior which is totally antithetical to the Catholic teaching on sexuality and has made no secret of its desire to eliminate "erotophobia" and "heterosexism." There is simply no way the position articulated by spokespersons for the "gay" movement and the Catholic church can be reconciled; 3) It puts easily tempted persons into places which must be considered the near occasion of sin; 4) It creates a false hope that the Church will eventually change its teaching on sexual morality.

Catholics must, of course, reach out to individuals experiencing same-sex attraction, to those actively involved in homosexual acts, and particularly to those suffering from sexually transmitted diseases, with love, hope, and the authentic, uncompromised message of freedom from sin through Jesus Christ.

2) The role of the priest

It is of paramount importance that priests, when faced with parishioners troubled by same-sex attraction, have access to solid information and genuinely beneficial resources. The priest, however, must do more than simply refer to other agencies (See Courage and Encourage in the Appendix). He is in a unique position to provide specific spiritual assistance to those experiencing same-sex attraction. He must, of course, be very sensitive to the intense feelings of insecurity, guilt, shame, anger, frustration, sadness, and even fear in these individuals. This does not preclude him from speaking very clearly about the teachings of the Church (See CCC 2357-2359), the need for forgiveness and healing in Confession, the need to avoid occasions of sin, and the need for a strong prayer life. A number of therapists believe that religious faith plays a crucial part in the recovery from same-sex attraction and sexual addictions.

When an individual confesses same-sex attractions, fantasies, or homosexual acts, the priest should be aware that these are often manifestations of childhood and adolescent traumas, sexual child abuse, or unmet childhood needs for the love and affirmation from the same-sex parent. Unless these underlying problems are addressed, the individual may find the temptations returning and fall into despair. Those who reject the Church's teachings and encourage persons with same-sex attractions to enter into so called "stable, loving homosexual unions" fail to understand that such arrangements will not resolve these underlying problems. While encouraging therapy and support group membership, the priest should remember that through the sacrament, he can help individual penitents deal not only with the sin, but also with causes of same-sex attraction.

The following list, while not exhaustive, illustrates some of the ways in which a priest may help the individuals with these problems who come to the Sacrament of Reconciliation:

a) Persons, experiencing same-sex attraction or confessing sins in this area, almost always carry a burden of deep emotional pain, sadness, and resentment toward those who have rejected, neglected or hurt them, including their parents, peers, and sexual molesters. Helping them to forgive can be the first step in healing (Fitzgibbons 1999).

b) Individuals experiencing same-sex attractions often report a long history of early sexual experiences and sexual trauma (Doll 1992). Homosexually active persons are more likely to have engaged in sexual activity with another person at a young age (Stephan 1973; Bell 1981). Many have never told any one about these experiences (Johnson 1985) and carry tremendous guilt and shame. In some cases, those who were sexually abused feel guilty because they reacted to their trauma by acting out sexually. The priest can delicately inquire about early experiences, assuring these persons that their sins are forgiven, and help them to find freedom through forgiving others.

c) Individuals involved in homosexual activity may also suffer from sexual addiction (Saghir 1973; Beitchman 1991; Goode 1977). Those who engage in homosexual activity are also more likely to have engaged in extreme forms of sexual behavior or to have exchanged sex for money (Saghir 1973). Addictions are not easy to overcome; frequent recourse to confession can be a first step to freedom. The priest should remind the penitents that even the most extreme sins in these areas can be forgiven, encouraging them to resist despair and to persevere, while at the same time suggesting that support group designed to deal with addiction.

d) Persons with same-sex attractions often abuse alcohol, prescription drugs and illegal drugs (Field 1977; Saghir 1973). Such abuse may weaken resistance to sexual temptation. The priest may recommend membership in a support group which addresses these problems.

e) Despair and suicidal thoughts are also frequently a part of the life of an individual troubled by same-sex attraction (Beitchman 1991; Herrell 1999; Fergusson 1999). The priest can assure the penitent that there is every reason to hope that the situation will change and that God loves them and wants them to live a full and happy life. Again, forgiving others can be extremely helpful.

f) Persons experiencing same-sex attraction may suffer from spiritual problems such as envy (Hurst 1980) or self pity (Van den Aardweg 1969). It is important that the individual experiencing same-sex attractions not be treated as though sexual temptations were their only problem.

g) The overwhelming majority of men and women experiencing same-sex attraction report a poor relationship with their fathers (see footnotes 17 to 23). The priest, as a loving and accepting father figure, can through the sacrament begin the work of repairing that damage and facilitating a healing relationship with God the Father. The priest can also encourage devotion to St. Joseph.

The priest needs to be aware of the depth of healing needed by these seriously conflicted persons. He needs to be a source of hope for the despairing, forgiveness for the erring, strength for the weak, encouragement for the faint of heart, sometimes a loving father figure for the wounded. In brief, he must be Jesus for these beloved children of God who find themselves in most difficult situations. He must be pastorally sensitive but he must also be pastorally firm, imitating, as always, the compassionate Jesus who healed and forgave seventy times seven times but always reminded, "Go and do not commit this sin again".

3) Catholic medical professionals

Pediatricians need to know the symptoms of Gender Identity Disorder (GID) and chronic juvenile unmasculinity. With early identification and intervention, there is every reason to hope that the problem can be successfully resolved (Zucker 1995; Newman 1976). While the primary reason for treating children is to alleviate their present unhappiness (Newman 1976; Bradley 1998; Bates 1974), treatment of GID and chronic juvenile unmasculinity can prevent the development of same-sex attraction and the problems associated with homosexual activity in adolescence and adult life.

Most parents do not want their child to become involved in homosexual behavior, but parents of children at-risk are often resistant to treatment (Zucker 1995; Newman 1976). Informing them of estimates that 75% of children exhibiting the symptoms of GID and chronic juvenile unmasculinity will without intervention experience same-sex attraction (Bradley 1998) and letting them know the risks associated with homosexual activity (Garafalo 1998; Osmond 1994; Stall 1988b; Rotello 1997; Signorille 1997) may help to overcome their opposition to therapy. Parental cooperation is extremely important if early intervention is to succeed.

Pediatricians should familiarize themselves with the literature on treatment. George Rekers has written a number of books on the subject (Rekers 1988). Zucker and Bradley provide a comprehensive review of the literature in their book Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (1995) as well as numerous cases histories and treatment recommendations.

Physicians encountering patients with sexually transmitted diseases acquired through homosexual activity can inform the patients that psychological therapy and support groups are available, and that approximately 30% of motivated patients can achieve a change in orientation. In terms of disease prevention, an additional 30% are able to remain celibate or eliminate high risk behavior. They should also question these patients about drug and alcohol abuse, and recommend treatment when appropriate, since a number of studies have linked infection with STDs to substance abuse (Mulry 1994).

Even before the AIDS epidemic a study of men who have sex with men found that 63% had contracted a sexually transmitted disease through homosexual activity (Bell 1978). In spite of all the AIDS education, epidemiologists predict that for the foreseeable future 50% of men who have sex with men will become HIV positive (Hoover 1991; Morris 1994; Rotello 1997). They are also at risk for syphilis, gonorrhea, hepatitis A, B, C, HPV, and a number of other illness.

Mental health professionals should familiarize themselves with the works of therapists who have successfully treated persons experiencing same-sex attraction. Because same-sex attraction does not arise from a single cause, different individuals may require different types of treatment. Combining therapy with support group membership and spiritual healing is also an option that should be considered.

4) Teachers in Catholic institutions

Teachers in Catholic institutions have a duty to defend the teachings of the Church on sexual morality, to counter false information on same-sex attraction, and to inform at-risk or homosexually involved adolescents that help is available. They should continue to resist pressure to include condom education in the curriculum to accommodate homosexually active adolescents. Numerous studies have found that such education is ineffective at preventing disease transmission in the at-risk population (Stall 1988a; Calabrese 1987; Hoover 1991).

"Gay" rights activists have insisted that at-risk adolescents be turned over to support groups which will help them "come out." There is no evidence that participation in such groups prevents the long-term negative consequences associated with homosexual activity. Such groups will definitely not encourage the adolescent to refrain from sin and live chastely according to his state in life. Symptoms of GID and chronic juvenile unmasculinity in boys should be taken seriously. At-risk children do, however, need special help, particularly those who have been victims of sexual child abuse.

Educators also have a duty to stop teasing and ridicule of children who do not conform to gender norms. Resources to educate teachers, lesson plans, and strategies for dealing with teasing need to be created and provided to teachers in Catholic schools, CCD programs, and other institutions.

5) Catholic families

When Catholic parents discover that their son or daughter is experiencing same-sex attractions or engaged in homosexual activity, they are often devastated. Afraid for the child's health, happiness, and salvation, parents are usually relieved when informed that same-sex attraction is treatable and preventable. They can find support from other parents in Encourage. They also need to be able to share their burden with loving friends and families.

Parents should be informed about the symptoms of Gender Identity Disorder and the prevention of gender identity problems, encouraged to take such symptoms seriously and to refer children with gender identity problems to qualified and morally appropriate mental health professionals.

6) The Catholic community

There was a time in the not too distant past when pregnancy outside of marriage and abortion were taboo topics and attitudes toward the women involved were judgmental and harsh. The legalization of abortion forced the Church to confront this issue and provide an active ministry to women facing an "unwanted" pregnancy and to women experiencing post-abortion trauma. In a few short years the approach of dioceses, individual parishes, and the Catholic faithful has been transformed and today true Christian charity is the norm rather than the exception. In the same way the attitudes toward same-sex attraction can be transformed, provided each Catholic institution does its part.

Those experiencing same-sex attractions, those who are engaging in homosexual behavior, and their families often feel that they are excluded from the loving concern of the Catholic community. Prayer for persons experiencing same-sex attractions and their families offered as part of the intentions during Mass is one way to let them know that the community cares for them.

The members of Catholic media need to be informed about same-sex attraction, the teachings of the Church, and resources for prevention and treatment. Pamphlets and other materials, which clearly articulate the Church's teaching and provide information on resources for those with immediate needs in this area, should be developed and distributed from racks already present in many churches.

When a member of the Catholic media, a teacher in a Catholic institution, or a pastor, misstates the Church's teaching or gives the impression that same-sex attraction is genetically determined and unchangeable, the laity can offer information designed to correct these misunderstandings.

7) Bishops

The Catholic Medical Association recognizes the responsibility which a diocesan bishop has to oversee the orthodoxy of teaching within his Diocese. This certainly includes clear instruction in the nature and purpose of intimate sexual relations between persons and the sinfulness of inappropriate relations. The CMA looks forward to working with bishops and priests in assisting in the establishment of appropriate support groups and therapeutic models for those struggling with same-sex attractions. While we see the Courage and Encourage programs as very useful and valuable and actively promote them, we are certain that there are other modes of support and are willing to work with any psychologically, spiritually and morally appropriate program.

8) Hope

Jeffrey Satinover, MD and Ph.D., has written of his extensive experience with patients experiencing same-sex attraction:

I have been extraordinarily fortunate to have met many people who have emerged from the gay life. When I see the personal difficulties they have squarely faced, the sheer courage they have displayed not only in facing these difficulties but also in confronting a culture that uses every possible means to deny the validity of their values, goals, and experiences, I truly stand back in wonder... It is these people — former homosexuals and those who are still struggling, all across America and aboard — who stand for me as a model of everything good and possible in a world that takes the human heart, and the God of that heart, seriously. In my various explorations within the worlds of psychoanalysis, psychotherapy, and psychiatry, I have simply never before seen such profound healing. (Satinover 1996)

Those who wish to be free from same-sex attractions frequently turn first to the Church. CMA wants to be sure that they find the help and hope they are seeking. There is every reason to hope that every person experiencing same-sex attraction who seeks help from the Church can find freedom from homosexual behavior and many will find much more, but they will come only if they see love in our words and deeds.

If Catholic medical professionals have in the past failed to meet the needs of this patient population, failed to work diligently to develop effective prevention and treatment therapies, or failed to treat patients experiencing these problems with the respect due every person, we ask forgiveness.

The Catholic Medical Association recognizes that health care professionals have a special duty in this area and hopes that this statement will help them to carry out that duty according to the principles of the Catholic Faith.

The research referenced in this report is drawn from a wide variety of sources. In most cases, numerous other sources could have been cited. For those desiring to make an in-depth study of the issues raised, a comprehensive bibliography can be obtained (74747.2241@compuserve.com) along with reviews of the relevant literature.

It should also be pointed out that many of the authors cited do not accept the Church's teaching on the intrinsically disordered nature of homosexual acts. No effort has been made to distinguish between those who do and those who don't, since those who favor prevention and treatment and those who support gay-affirming therapy present essentially consistent statistical evidence and case material, differing on the interpretation and relevance of the evidence.

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Appendix

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