Position Statements of the American Psychiatric Association

 

POSITION STATEMENT ON ISSUES RELATED TO HOMOSEXUALITY

Approved December 2013 by the APA Board of Trustees

APA Position:  While recognizing that the scientific understanding is incomplete and often distorted because of societal stigma, the American Psychiatric Association holds the following positions regarding same-sex attraction and associated issues.

It is the American Psychiatric Association’s position that same-sex attraction, whether expressed in action, fantasy, or identity, implies no impairment per se in judgment, stability, reliability, or general social or vocational capabilities.  The American Psychiatric Association believes that the causes of sexual orientation (whether homosexual or heterosexual) are not known at this time and likely are multifactorial including biological and behavioral roots which may vary between different individuals and may even vary over time. The American Psychiatric Association does not believe that same-sex orientation should or needs to be changed, and efforts to do so represent a significant risk of harm by subjecting individuals to forms of treatment which have not been scientifically validated and by undermining self-esteem when sexual orientation fails to change.  No credible evidence exists that any mental health intervention can reliably and safely change sexual orientation; nor, from a mental health perspective does sexual orientation need to be changed.

The American Psychiatric Association opposes discrimination against individuals with same-sex attraction whether it be in education, employment, military service, immigration and naturalization status, housing, income, government services, retirement benefits, ability to inherit property, rights of survivorship, spousal rights, family status, and access to health services.  The American Psychiatric Association recognizes that such discriminations, as well as societal, religious, and family stigma, may adversely affect the mental health of individuals with same-sex attraction necessitating intervention by mental health professionals, for which, the American Psychiatric Association supports the provision of adequate mental health resources to provide that intervention.  The American Psychiatric Association supports same-sex marriage as being advantageous to the mental health of same-sex couples and supports legal recognition of the right for same-sex couples to marry, adopt and co-parent.

ACCESS TO CARE FOR TRANSGENDER AND GENDER VARIANT INDIVIDUALS

Issue: Significant and long-standing medical and psychiatric literature exists that demonstrates clear benefits of medical and surgical interventions to assist gender variant individuals seeking transition.  However, private and public insurers often do not offer, or may specifically exclude, coverage for medically necessary treatments for gender transition.  Access to medical care (both medical and surgical) positively impacts the mental health of transgender and gender variant individuals. 

The APA’s vision statement includes the phrase: “Its vision is a society that has available, accessible quality psychiatric diagnosis and treatment,” yet currently, transgender and gender variant individuals frequently lack available and accessible treatment.  In addition, APA’s values include the following points:

  • best standards of clinical practice

  • patient-focused treatment decisions

  • scientifically established principles of treatment

  • advocacy for patients

Transgender and gender variant individuals currently lack access to the best standards of clinical practice, frequently do not have the opportunity to pursue patient-focused treatment decisions, do not receive scientifically established treatment and could benefit significantly from APA’s advocacy. 

APA Position:

Therefore, the American Psychiatric Association:

  • Recognizes that appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments.

  • Advocates for removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment.

  • Opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician.

Authors: (component and/or members developing the Position Statement)
Jack Drescher, MD
Ellen Haller, MD
APA LGBT Caucus

BACKGROUND ON PROPOSED APA POSITION STATEMENT REGARDING ACCESS TO CARE FOR TRANSGENDER AND GENDER VARIANT INDIVIDUALS

Transgender and gender variant people are frequently denied medical, surgical and psychiatric care related to gender transition despite significant evidence that appropriately evaluated individuals benefit from such care.  It is often asserted that the DSM (and ICD) diagnoses provide the only pathways to insurance reimbursement for transgender individuals seeking medical assistance. However, to date, the APA has issued no treatment guidelines for gender identity disorder (GID) in either children or adults. This omission is in contrast to an increasing proliferation of APA practice guidelines for other DSM diagnoses (1).
The absence of a formal APA opinion about treatment of a diagnosis of its own creation has contributed to an ongoing problem of many health care insurers and other third party payers claiming that hormonal treatment and sex reassignment surgery (SRS) are “experimental treatments,” “elective treatments,” or “not medically necessary,” and, therefore, not reimbursable or covered under most insurance plans. The lack of consistency in how a transgender condition is defined by some institutions further marginalizes these individuals based on their subjective, surgical and hormonal status (2). In addition, treatment is not always accessible to wards of governmental agencies, such as transgender and gender variant individuals in foster care and prison systems. In other words, the presence of the GID diagnosis in the DSM has not served its intended purpose of creating greater access to care--one of the major arguments for diagnostic retention (1).

Lack of access to care adversely impacts the mental health of transgender and gender variant people, and both hormonal and surgical treatment have been shown to be efficacious in these individuals (3, 4, 5, 6, 7).  Practice guidelines have been developed based on peer-reviewed scientific studies and are published and available for clinicians to access (3, 8, 9).  The American Medical Association and the American Psychological Association both have position statements stating the critical importance of access to care for transgender and gender variant individuals (10, 11). 

REFERENCES

  • Drescher, J. (2010). Queer diagnoses:  Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual (DSM).” Archives of Sexual Behavior, 39, 427–460.
  • Rosenblum, Darren, "Trapped" in Sing Sing: Transgendered Prisoners Caught in the Gender Binarism" (2000). Pace Law Faculty Publications. Paper 207
  • World Professional Association for Transgender Health (WPATH) Standards of Care. Accessed online May 16, 2011, from: http://www.wpath.org/publications_standards.cfm
  • IOM (Institute of Medicine), 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People:  Building a Foundation for Better Understanding.  Washington, DC: The National Academics Press.  Accessed online May 16, 2011, from: http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx
  • De Cuypere G, TSjoen, G., Beerten, R., Selvaggi, G., De Sutter, P., Hoebeke, P., Monstrey, S., Vansteenwegen A., & Rubens, R. (2005). Sexual and physical health after sex reassignment surgery. Archives of Sexual Behavior, 34(6), 679-690.  
  • Newfield, E., Hart, S., Dibble, S., & Kohler, L. (2006). Female-to-male transgender quality of life. Quality of Life Research, 15(9), 1447-1457.
  • Smith Yolanda L S; Van Goozen Stephanie H M; Kuiper Abraham J; Cohen-Kettenis Peggy T. (2005). Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine; 35(1):89-99.
  • Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ, III, Spack NP, Tangpricha V, Montori VM: Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94:3132-3154
  • UCSF Center of Excellence for Transgender Health Primary Care Protocol for Transgender Patient Care. Accessed online May 16, 2011, from: http://transhealth.ucsf.edu/trans?page=protocol-00-00
  • American Medical Association. Removing Financial Barriers to Care for Transgender Patients.  Accessed online May 16, 2011, from: http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/ama-policy-regarding-sexual-orientation.page?
  • American Psychological Association. APA Policy Statement: Transgender, Gender Identity & Gender Expression Non-Discrimination.  Accessed online May 16, 2011, from: http://www.apa.org/about/governance/council/policy/transgender.aspx

DISCRIMINATION AGAINST TRANSGENDER AND GENDER VARIANT INDIVIDUALS

Issue:
Being transgender gender or variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.  As a result, transgender and gender variant persons face challenges in their marriage, adoption and parenting rights, are regularly discharged from uniformed services or are rejected from enlisting due to their gender identity, and have difficulty revising government identity documents.  Incarcerated transgender and gender variant persons suffer risks to their personal safety and lack of access to comprehensive healthcare.  Further, transgender and gender variant individuals may be inappropriately assigned space in gender-segregated facilities such as inpatient psychiatric units and residential treatment programs. Transgender and gender variant people are frequently harassed and discriminated against when seeking housing or applying to jobs or schools and are often victims of violent hate crimes.

The APA declares in its vision statement that it is, “the voice and conscience of modern psychiatry.” Thus, this position statement is relevant to the APA because discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals.  In addition, APA’s values include “advocacy for patients.”  Speaking out firmly and professionally against discrimination and lack of equal civil rights is a critical advocacy role that the APA is uniquely positioned to take.

APA Position:

Therefore, the American Psychiatric Association:

  1. Supports laws that protect the civil rights of transgender and gender variant individuals
  2. Urges the repeal of laws and policies that discriminate against transgender and gender variant people.
  3. Opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.
  4. Declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon these individuals greater than that imposed on any other persons.

Authors:
Jack Drescher, MD
Ellen Haller, MD
APA LGBT Caucus

BACKGROUND ON PROPOSED APA POSITION STATEMENT REGARDING DISCRIMINATION AGAINST GENDER VARIANT OR TRANSGENDER INDIVIDUALS

In 1973, the American Psychiatric Association removed the diagnosis of homosexuality from the DSM-II (1, 2) and issued a position statement of support of gay and lesbian civil rights (3). In subsequent years, APA continued to expand its public positions regarding gay and lesbian civil rights. In 1990, APA issued a statement opposing “exclusion and dismissal from the armed services on the basis of sexual orientation” (4). In 1992, APA called on “all international health organizations, psychiatric organizations, and individual psychiatrists in other countries to urge the repeal in their own countries of legislation that penalizes homosexual acts by consenting adults in private” (5).

In 2000, following Vermont’s passage of civil union laws, APA endorsed “the legal recognition of same-sex unions and their associated legal rights, benefits and responsibilities” (6). In 2002, APA approved a position statement supporting “initiatives which allow same-sex couples to adopt and co-parent children and supports all the associated legal rights, benefits, and responsibilities which arise from such initiatives” (7).
In 2005, after Massachusetts’ 2004 legalization of marriage equality, APA issued a statement supporting “the legal recognition of same-sex civil marriage with all rights, benefits and responsibilities conferred by civil marriage, and opposes restrictions to those same rights, benefits, and responsibilities” (8).
In contrast to its strong affirmation of lesbian and gay civil rights since the 1973 decision to remove homosexuality from the DSM, APA has not issued position statements in support of transgender civil rights.  The APA Committee on Gay, Lesbian, and Bisexual Issues often functioned as the default clearinghouse for queries to the APA about trans issues.

Gender variant and transgender individuals must cope with multiple unique challenges.  They face significant discrimination, prejudice and hatred and the potential for victimization from violent hate crimes (9). In the workplace, bias may impact transgender people as part of the application process or during their employment precipitated by the individual coming out as transgender (either on their own or by being “outed” by others), or transitioning while an employee. These individuals also need to navigate numerous expensive and complex legal issues such as changing their identity documents including, in part, their social security, driver’s license, and passport (10).  They often experience discrimination when accessing non-gender transition-related health care and are denied numerous basic civil rights and protections (11). Gender variant and transgender people have no federal protection against discrimination on the basis of their gender identity or expression in public accommodations, housing, credit, education, or federally-funded programs.

The mental health of gender variant and transgender people is hypothesized to be adversely impacted by discrimination and stigma.  For example, gender-based discrimination and victimization were found to be independently associated with attempted suicide in a population of transgender individuals, 32% of whom had histories of trying to kill themselves (12). And, in the largest survey to date of gender variant and transgender people with an N of 6,450, 41% reported attempting suicide (13).
Other organizations, including the American Medical Association and the American Psychological Association, have endorsed strong policy statements deploring the discrimination experienced by gender variant and transgender individuals and calling for laws to protect their civil rights (14, 15).

REFERENCES

1. Bayer, R. (1981). Homosexuality and American psychiatry: The politics of diagnosis. New York: Basic Books.
2. Drescher, J., & Merlino, J. P. (Eds.). (2007). American psychiatry and homosexuality: An oral history. New York: Harrington Park Press.
3.http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/
197310.aspx

4.http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/99013.aspx
5.http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/
199216.aspx

6.http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/
200003.aspx

7.http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/
200214.aspx

8.http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/
200502.aspx

9. National Gay and Lesbian Task Force. Injustice at Every Turn: A report of the National Transgender Discrimination Survey.  Accessed on May 16, 2011, from: http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf
10. Transgender Law Center.  The State of Transgender California Report.  Accessed on May 16, 2011, from:  http://www.transgenderlawcenter.org/pdf/StateTransCA_report_2009Print.pdf
11. National Transgender Discrimination Survey Report on health and health care, Accessed online May 16, 2011, from: http://www.thetaskforce.org/downloads/reports/reports/ntds_report_on_health.pdf
12. Kristen Clements-Nolle PhD, MPH, Rani Marx PhD, MPH &
Mitchell Katz MD (2006): Attempted Suicide Among Transgender Persons, Journal of
Homosexuality, 51:3, 53-69 http://dx.doi.org/10.1300/J082v51n03_04
13. Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011. http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf
14. American Medical Association policies: Continued Support of Human Rights and Freedom, Nondiscrimination Policy, and Civil Rights Restoration.  Accessed online May 16, 2011, from: http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/ama-policy-regarding-sexual-orientation.page?
15. American Psychological Association. APA Policy Statement: Transgender, Gender Identity & Gender Expression Non-Discrimination.  Accessed online May 16, 2011, from: http://www.apa.org/about/governance/council/policy/transgender.aspx

Support of Legal Recognition of Same-Sex Civil Marriage

Approved by the Assembly, May 2005
Approved by the Board of Trustees, July 2005

"Policy documents are approved by the APA Assembly and Board of Trustees…These are … position statements that define APA official policy on specific subjects…" -- APA Operations Manual.

As physicians who frequently evaluate the impact of social and family relationships on child development, and the ability of adults and children to cope with stress and mental illness, psychiatrists note the invariably positive influence of a stable, adult partnership on the health of all family members. Sustained and committed marital and family relationships are cornerstones of our social support network as we face life’s challenges, including illness and loss. There is ample evidence that long-term spousal and family support enhances physical and mental health at all stages of development.

This position statement is about the legal recognition of same-sex civil marriage, not religious marriage, and it does not pertain to any organized religion’s view of same-sex marriage.

Heterosexual relationships have a legal framework for their existence through civil marriage, which provides a stabilizing force. In the United States, with the exception of Massachusetts, same-sex couples are currently denied the important legal benefits, rights and responsibilities of civil marriage. Same-sex couples therefore experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health.

The children of unmarried gay and lesbian parents do not have the same protection that civil marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is often prejudicially presumed as unfit in many U.S. jurisdictions. Furthermore, when unmarried couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though no research has shown that the children raised by lesbians and gay men are less well adjusted than those reared within heterosexual relationships.

As the population ages, the denial of legal recognition of civil marriage has consequences for increasing numbers of older adults in same-sex relationships who face age-related health and financial concerns. Excluding these adults from civil marriage protections of survivorship and inheritance rights, financial benefits, and legal recognition as a couple in health care settings increases the psychological burden associated with aging.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination in matters that have an impact on mental health. APA has also supported same-sex civil unions and the right of same-sex couples to adopt and co-parent children. This is because APA has a longstanding interest in civil rights and legal issues that affect mental health as well as a code of ethics that supports and respects human dignity. Educating the public about lesbian and gay relationships and supporting efforts to establish legal recognition of samesex civil marriage is consistent with the Association’s advocacy for minority groups.

Civil marriage is associated with a unique set of benefits that provide legal and economic protections to adults in committed relationships and to their children. Equal access to the institution of civil marriage is consistent with the APA’s opposition to discrimination based on sexual orientation. Therefore be it resolved that:

"In the interest of maintaining and promoting mental health, the American Psychiatric Association supports the legal recognition of same-sex civil marriage with all rights, benefits, and responsibilities conferred by civil marriage, and opposes restrictions to those same rights, benefits, and responsibilities.” Supporting Documents:

American Psychiatric Association (1973), Position statement on homosexuality and civil rights. American J. Psychiatry, 1974, 131:497.www.psych.org/edu/other_res/lib_archives/archives/730010.pdf

American Psychiatric Association (1990), Position statement on homosexuality and the armed services. www.psych.org/edu/other_res/ lib_archives/archives/900013.pdf

American Psychiatric Association (1991), Position statement:

Homosexuality and the Immigration and Naturalization Service. American J. Psychiatry, 148:1625.

American Psychiatric Association Committee on Gay, Lesbian, and Bisexual Issues (1993), Position statement on homosexuality. American J. Psychiatry, 150:686. www.psych.org/edu/other_res/ lib_archives/archives/ 730010.pdf

Resource Document on Controversies in Child Custody: Gay and Lesbian Parenting; Transracial Adoptions; Joint v. Sole Custody and Custody Gender Issues: Approved by Board of Trustees, December 1997.

Resource Document on Same Sex Marriage: Approved by the Board of Trustees, December 1998.

American Psychiatric Association (1998), Position statement on psychiatric treatment and sexual orientation. American J. Psychiatry, 1999; 156:1131. www.psych.org/edu/other_res/ lib_archives/archives/ 980020.pdf

American Psychiatric Association (2000), Commission on Psychotherapy by Psychiatrists (COPP): Position statement on therapies focused on attempts to change sexual orientation (Reparative or conversion therapies). American J. Psychiatry, 157:1719-1721. www.psych.org/edu/other_res/ lib_archives/archives/200001.pdf

American Psychiatric Association (2000), Position statement on same sex civil unions. December 2000American Psychiatric Association (2002),

Position Statement on Adoption and Co-Parenting of Children by Same Sex Couples. November 2002.

Brief for Amici Curiae in the case of Lawrence and Garner v. Texas (signed by American Psychiatric Association), January 2003. www.psych.org/edu/other_res/lib_archives/archives/amicus/02-102.pdf

American Psychological Association (2004), Resolution on Sexual Orientation and Marriage. http://www.apa.org/pi/lgbc/policy/marriage.pdf

Amended APA Resource Document on Same Sex Marriage;

Approved by the Board of Trustees, December 2004.

American Psychiatric Association: Position statement on same sex civil unions (revised); Approved by Board of Trustees, December 2004.

Position paper of the Massachusetts Psychiatric Society on Gay Marriage, November 2004

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Position Statement on Same Sex Unions

Approved December 2000 by the APA Board of Trustees

The APA expresses a valid interest in the well being of heterosexual married couples in such areas as children's mental health and other aspects of family life. Heterosexual relationships have a legal framework for their existence, which provides a stabilizing force.

In the United States, with the recent exception of Vermont, same sex partners are currently denied the important benefits and responsibilities of legal marriage. Same sex couples therefore experience several kinds of state-sanctioned discrimination that affect the stability of their relationships.

The children of gay and lesbian parents do not have the same protection that legal marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is presumed unfit in many U.S. jurisdictions. Furthermore, when couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though research has shown that the children raised by lesbian and gay men are as well adjusted as those reared within heterosexual relationships.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. Educating the public about lesbian and gay relationships and supporting efforts to establish same sex legal unions is consistent with the Association's advocacy for other disadvantaged minority groups.

"The American Psychiatric Association supports the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities".


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"Reparative" Therapy

Committee on Psychotherapy by Psychiatrists (COPP) Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies)
Approved by the Board of Trustees March 2000
Approved by the Assembly May 2000

 

Preamble
In December of 1998, the Board of Trustees issued a position statement that the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or conversion therapy, which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation (Appendix 1). In doing so, the APA joined many other professional organizations that either oppose or are critical of "reparative" therapies, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, The American Counseling Association, and the National Association of Social Workers (1). The following Position Statement expands and elaborates upon the statement issued by the Board of Trustees in order to further address public and professional concerns about therapies designed to change a patient's sexual orientation or sexual identity. It augments rather than replaces the 1998 statement.

Position Statement
In the past, defining homosexuality as an illness buttressed society's moral opprobrium of same-sex relationships (2). In the current social climate, claiming homosexuality is a mental disorder stems from efforts to discredit the growing social acceptance of homosexuality as a normal variant of human sexuality. Consequently, the issue of changing sexual orientation has become highly politicized. The integration of gays and lesbians into the mainstream of American society is opposed by those who fear that such integration is morally wrong and harmful to the social fabric. The political and moral debates surrounding this issue have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue. This document attempts to shed some light on this heated issue.

The validity, efficacy and ethics of clinical attempts to change an individual's sexual orientation have been challenged (3,4,5,6). To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments. There is sparse scientific data about selection criteria, risks versus benefits of the treatment, and long-term outcomes of "reparative" therapies. The literature consists of anecdotal reports of individuals who have claimed to change, people who claim that attempts to change were harmful to them, and others who claimed to have changed and then later recanted those claims (7,8,9).

Although there is little scientific data about the patients who have undergone these treatments, it is still possible to evaluate the theories, which rationalize the conduct of "reparative" and conversion therapies. Firstly, they are at odds with the scientific position of the American Psychiatric Association which has maintained, since 1973, that homosexuality per se, is not a mental disorder. The theories of "reparative" therapists define homosexuality as either a developmental arrest, a severe form of psychopathology, or some combination of both (10-15). In recent years, noted practitioners of "reparative" therapy have openly integrated older psychoanalytic theories that pathologies homosexuality with traditional religious beliefs condemning homosexuality (16,17,18).

The earliest scientific criticisms of the early theories and religious beliefs informing "reparative" or conversion therapies came primarily from sexology researchers (19-27). Later, criticisms emerged from psychoanalytic sources as well (28-39). There has also been an increasing body of religious thought arguing against traditional, biblical interpretations that condemn homosexuality and which underlie religious types of "reparative" therapy (40-46).

Recommendations:
1. APA affirms its 1973 position that homosexuality per se is not a diagnosable mental disorder. Recent publicized efforts to repathologize homosexuality by claiming that it can be cured are often guided not by rigorous scientific or psychiatric research, but sometimes by religious and political forces opposed to full civil rights for gay men and lesbians. APA recommends that the APA respond quickly and appropriately as a scientific organization when claims that homosexuality is a curable illness are made by political or religious groups.

2. As a general principle, a therapist should not determine the goal of treatment either coercively or through subtle influence. Psychotherapeutic modalities to convert or "repair" homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.

3. The "reparative" therapy literature uses theories that make it difficult to formulate scientific selection criteria for their treatment modality. This literature not only ignores the impact of social stigma in motivating efforts to cure homosexuality; it is a literature that actively stigmatizes homosexuality as well. "Reparative" therapy literature also tends to overstate the treatment's accomplishments while neglecting any potential risks to patients. APA encourages and supports research in the NIMH and the academic research community to further determines "reparative" therapy's risks versus its benefits.

References

(1) National Association for Research and Treatment of Homosexuality, (1999), American Counseling Association Passes Resolution to Oppose Reparative Therapy. NARTH Website (http://www.narth.com/docs/acaresolution.html).

(2) Bayer, R. (1981), Homosexuality and American Psychiatry; The Politics of Diagnosis. New York: Basic Books.

(3) Haldeman, D. (1991), Sexual orientation conversion therapy for gay men and lesbians: A scientific examination. In Homosexuality: Research Implications for Public Policy, ed. J. C. Gonsiorek & J. D. Weinrich. Newbury Park, CA: Sage Publications, pp. 149-161.

(4) Haldeman, D. (1994), The practice and ethics of sexual orientation conversion therapy. J. of Consulting and Clin. Psychol., 62(2):221-227.

(5) Brown, L. S. (1996), Ethical concerns with sexual minority patients. In: Textbook of Homosexuality and Mental Health. ed. R. Cabaj & T. Stein. Washington, D.C.: American Psychiatric Press, pp.897-916.

(6) Drescher, J. (1997), What needs changing? Some questions raised by reparative therapy practices. New York State Psychiatric Society Bulletin, 40(1):8-10.

(7) Duberman, M. (1991), Cures: A Gay Man€s Odyssey. New York: Dutton.

(8) White, M. (1994), Stranger at the Gate: To be Gay and Christian in America. New York: Simon & Schuster.

(9) Isay, R. (1996), Becoming Gay: The Journey to Self-Acceptance. New York: Pantheon.

(10) Freud, S. (1905), Three essays on the theory of sexuality. Standard Edition, 7:123-246. London: Hogarth Press, 1953.

(11) Rado, S. (1940), A critical examination of the concept of bisexuality. Psychosomatic Medicine, 2:459-467. Reprinted in Sexual Inversion: The Multiple Roots of Homosexuality, ed. J. Marmor. New York: Basic Books, 1965, pp. 175-189.

(12) Bieber, I., Dain, H., Dince, P., Drellich, M., Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C., & Bieber T. (1962), Homosexuality: A Psychoanalytic Study. New York: Basic Books.

(13) Socarides, C. (1968), The Overt Homosexual. New York: Grune & Stratton.

(14) Ovesey, L. (1969), Homosexuality and Pseudohomosexuality. New York: Science House.

(15) Hatterer, L. (1970), Changing Homosexuality in the Male. New York: McGraw Hill.

(16) Moberly, E. (1983), Homosexuality: A New Christian Ethic. Cambridge, UK: James Clarke & Co.

(17) Harvey, J. (1987), The Homosexual Person: New Thinking in Pastoral Care. San Francisco, CA: Ignatius.

(18) Nicolosi, J. (1991), Reparative Therapy of Male Homosexuality: A New Clinical Approach. Northvale, NJ: Aronson.

(19) Kinsey, A., Pomeroy, W., & Martin, C. (1948), Sexual Behavior in the Human Male. Philadelphia, PA: Saunders.

(20) Kinsey, A., Pomeroy, W., & Martin, C. and Gebhard, P. (1953), Sexual Behavior in the Human Female. Philadelphia, PA: Saunders.

(21) Ford, C. & Beach, F. (1951), Patterns of Sexual Behavior. New York: Harper.

(22) Hooker, E. (1957), The adjustment of the male overt homosexual. J Proj Tech, 21:18-31.

(23) Bell, A .& Weinberg, M. (1978), Homosexualities: A Study of Diversity Among Men and Women. New York: Simon and Schuster.

(24) Bell, A., Weinberg, M. & Hammersmith S. (1981), Sexual Preference: Its Development in Men and Women. Bloomington, IN: Indiana University Press.

(25) LeVay, S. (1991), A difference in hypothalamic structure between heterosexual and homosexual men. Science, 253:1034-1037.

(26) Hamer, D., Hu, S., Magnuson, V., Hu, N. & Pattatucci, A. (1993), A linkage between DNA markers on the X-chromosome and male sexual orientation. Science, 261:321-327.

(27) Bem, D. (1996), Exotic becomes erotic: A developmental theory of sexual orientation. Psychol. Review, 103(2):320-335.

28) Marmor, J., ed. (1965), Sexual Inversion: The Multiple Roots of Homosexuality. New York: Basic Books.

(29) Mitchell, S. (1978), Psychodynamics, homosexuality, and the question of pathology. Psychiatry, 41:254-263.

(30) Marmor, J., ed. (1980), Homosexual Behavior: A Modern Reappraisal. New York: Basic Books.

(31) Mitchell, S. (1981), The psychoanalytic treatment of homosexuality: Some technical considerations. Int. Rev. Psycho-Anal., 8:63-80.

(32) Morgenthaler, F. (1984), Homosexuality Heterosexuality Perversion, trans. A. Aebi. Hillsdale, NJ: The Analytic Press, 1988.

(33) Lewes, K. (1988), The Psychoanalytic Theory of Male Homosexuality. New York: Simon and Schuster. Reissued as Psychoanalysis and Male Homosexuality (1995), Northvale, NJ: Aronson.

(34) Friedman, R.C. (1988), Male Homosexuality: A Contemporary Psychoanalytic Perspective. New Haven, CT: Yale University Press.

(35) Isay, R. (1989), Being Homosexual: Gay Men and Their Development. New York: Farrar, Straus and Giroux.

(36) O'Connor, N. & Ryan, J. (1993), Wild Desires and Mistaken Identities: Lesbianism & Psychoanalysis. New York: Columbia University.

(37) Domenici, T. & Lesser, R., eds. (1995) Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. New York: Routledge.

(38) Magee, M. & Miller, D. (1997), Lesbian Lives: Psychoanalytic Narratives Old and New. Hillsdale, NJ: The Analytic Press.

(39) Drescher, J. (1998) Psychoanalytic Therapy and The Gay Man. Hillsdale, NJ: The Analytic Press.

(40) Boswell, J. (1980), Christianity, Social Tolerance and Homosexuality. Chicago, IL: University of Chicago Press.

(41) McNeil, J. (1993), The Church and the Homosexual, Fourth Edition. Boston, MA: Beacon.

(42) Pronk, P. (1993), Against Nature: Types of Moral Argumentation Regarding Homosexuality. Grand Rapids, MI: William B. Eerdmans.

(43) Boswell, J. (1994), Same-Sex Unions in Premodern Europe. New York: Villard Books.

(44) Helminiak, D. (1994), What the Bible Really Says About Homosexuality. San Francisco, CA: Alamo Press.

(45) Gomes, P. J. (1996). The Good Book: Reading the Bible with Mind and Heart. New York: Avon.

(46) Carrol, W. (1997), On being gay and an American Baptist minister. The InSpiriter, Spring, pp. 6-7,11._Appendix 1

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Adoption and Co-parenting of Children by Same-sex Couples

POSITION STATEMENT
Approved by the Board of Trustees, November 2002
Approved by the Assembly, November 2002

"Policy documents are approved by the APA Assembly and Board of Trustees…
These are position statements that define APA official policy on specific subjects…" -- APA Operations Manual.

Numerous studies over the last three decades consistently demonstrate that children raised by gay or lesbian parents exhibit the same level of emotional, cognitive, social, and sexual functioning as children raised by heterosexual parents. This research indicates that optimal development for children is based not on the sexual orientation of the parents, but on stable attachments to committed and nurturing adults. The research also shows that children who have two parents, regardless of the parents’ sexual orientations, do better than children with only one parent.

While some states have approved legislation sanctioning second parent adoption, other court judgments and legislation have prohibited lesbian women and gay men from adopting or co-parenting. Therefore, in most of the United States, only one partner in a committed gay or lesbian couple may have a legal parental relationship to a child they are raising together. Adoption by a second parent, however, would not only formalize a child’s existing relationships with both parents in a same-sex couple, it would also provide vital security for the child. Children could avail themselves of both parents’ health insurance benefits, access to medical care, death benefits, inheritance rights, and child support from both parents in the event of separation. Adoption protects both parents’ rights to custody and/or visitation if the couple separates or if one parent dies.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. In 2000, APA supported the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities. APA has also supported efforts to educate the public about homosexuality and the mental health needs of lesbian women, gay men, and their families. Removing legal barriers that adversely affect the emotional and physical health of children raised by lesbian and gay parents is consistent with the goals of the APA.

The American Psychiatric Association supports initiatives which allow same-sex couples to adopt and co-parent children and supports all the associated legal rights, benefits, and responsibilities which arise from such initiatives.

This position statement was drafted and proposed by the Committee on Gay, Lesbian, and Bisexual Issues and was supported by the Council on Minority Mental Health and Health Disparities.

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Parenting Rights for Same-Sex Couples Advanced

On June 15, the American Medical Association became the latest organization to call for equal parenting rights for same-sex couples. Learn more about supportive policy statements of the following organizations:

[ http://www.hrcactioncenter.org/ct/mpzcUY115BTt/ ]American Academy of Child and Adolescent Psychiatry
[ http://www.hrcactioncenter.org/ct/mdzcUY115BTv/ ]American Academy of Family Physicians
[ http://www.hrcactioncenter.org/ct/EdzcUY115BTb/ ]American Academy of Pediatrics
[ http://www.hrcactioncenter.org/ct/m7zcUY115BT5/ ]American Anthropological Association
[ http://www.hrcactioncenter.org/ct/j7zcUY115BT4/ ]American Bar Association
[ http://www.hrcactioncenter.org/ct/E1zcUY115BTg/ ]American Medical Association
[ http://www.hrcactioncenter.org/ct/E7zcUY115BT6/ ]American Psychiatric Association
[ http://www.hrcactioncenter.org/ct/EpzcUY115BTO/ ]American Psychoanalytic Association
[ http://www.hrcactioncenter.org/ct/U1zcUY115BTW/ ]American Psychological Association
[ http://www.hrcactioncenter.org/ct/UdzcUY115BTI/ ]Child Welfare League of America
[ http://www.hrcactioncenter.org/ct/m1zcUY115BTf/ ]National Association of Social Workers
[ http://www.hrcactioncenter.org/ct/jpzcUY115BTr/ ]North American Council on Adoptable Children


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