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Reviewed by James D. Weinrich, Ph.D., University of California, San Diego, Department of Psychiatry 0603-H, La Jolla, CA 92093-0603.
This is a precedent-setting book, but probably not in ways that the author would appreciate. It sets a milestone in the history of sexual orientation self-acceptance; after homosexuals and bisexuals, the latest out of the closet are "non-gay homosexuals" -- Nicolosi's term for men who are homosexually responsive but who reject the cultural assumptions of the gay world. As the latest in a long list of books which offer therapy to men who wish to change a homosexual orientation to heterosexual, it sets another precedent in that the author is apparently the first to admit that this change is not possible. It is important to understand why the "prochange" school has finally admitted this fact and why they believe that therapy is advisable nevertheless.
The first six chapters of the book ("Striving for Gender Identity") ground Nicolosi's reparative therapy program in this history of mental health views of homosexuality and set out his main theoretical point: male homosexuality emerges from a disturbance of the father-son bond in childhood. Although Nicolosi believes that only one type of homosexuality is caused in this way, it is the type that he believes is amenable to his treatment. He also criticizes other therapeutic approaches to homosexuality, including gay-affirmative psychotherapy and earlier "change" therapies. Absent from the book is a discussion of any effect Nicolosi's religious beliefs may have had on his convictions; he dedicated the book to the priest founding the homosexual ministry "Courage" and is the founder and clinical director of the Thomas Aquinas Psychological Clinic.
Nicolosi believes that the underlying homosexual attractions felt by non-gay homosexuals rarely, if ever, disappear. Thus, reparative therapy is aimed at reducing their salience, encouraging heterosexual contacts and eventual marriage and children, with celibacy the supported option for those who do not find their heterosexual attraction reaching levels that would allow sexual contacts with women.
In Chapter 3, Nicolosi makes his most important statement about change (p. 22):
In his final work, "Analysis: Terminable and Interminable," Freud concluded that analysis is essentially a lifetime process. This is true in the treatment of homosexuality, which -- like many other therapeutic issues such as alcoholism or self-esteem problems -- requires an ongoing growth process. Yet while there are no shortcuts to personal growth, how long it takes to reach a goal is not as important as the choice of direction. A sense of progress toward a committed value is what is important. The non-gay homosexual is on the road to unifying his sexuality with his masculine identity. That he can look back over the past months and see a realization of some of the goals to which he has committed -- this is what gives hope.Sometimes the change his patients obtain is less than impressive (pp. 165-166):
Usually some homosexual feelings will persist or recur during certain times in the life cycle. Therefore, rather than "cure," we refer to the goal of "change".... As one married ex-gay man described it: "For many years I thought I was gay. I finally realized I was not a homosexual, but really a heterosexual man with a homosexual problem." ... "Now those homosexual fantasies are more like a gnat buzzing around my ear." Another man explained: "A problem that used to have a capital 'H' now has a small 'h'."Nicolosi deserves credit for acknowledging that his theory is not applicable to all homosexual patients (e.g., those lacking a gender identity deficit: pp. 22, 95), although he nevertheless claims to have some insights about the nature of homosexuality (detailed below) which apply to all homosexual men.
The next seven chapters ("Related Problems") situate Nicolosi's approach within the context of related topics: childhood problems, relations with other family members, physiogenetic factors, personality, love relationships, sexuality, and gay liberation. In Chapter 7 ("Problems Emerging in Childhood"), he claims that the roots of homosexuality in boyhood emanate from defensive detachment from other boys and from fathers. This concept (credited to Mary Moberly) is indeed germane for some gay men, but Nicolosi jumps to the conclusion that this shows that homosexuality is pathological. If a boy has a defensive detachment from a father who is physically or verbally abusive, it would not surprise many psychotherapists to find that the boy, having been starved for appropriate male affection, has grown into a gay man who has eroticized older men -- men who will love them in the way they needed their father to do, with the addition of sex. But if a boy has a mother who is physically or verbally abusive, it would not surprise therapists if such boys grew into heterosexual men who are attracted to older women -- women who will similarly love them in both ways. Even if someone regards these outcomes as abnormal, what is the rationale for concluding that one man has a healthy sexual orientation and the other has an unhealthy one? Both arise from the same fundamental mechanism.
Chapter 9 ("Physiogenetic Factors") is particularly weak, weighing in at less than four pages of text. Here, as in several chapters, Nicolosi reviews an area of research and discusses prevalent controversies, but cites only papers which support his point of view or cites them in a way which radically distorts their meaning. Michael Ross, Anke Ehrhardt, Heino Meyer-Bahlburg, John Money, and Thomas Forde Hoult may all be surprised to see their views cited here on Nicolosi's side.
In at least one case, Nicolosi must (or ought to) have known about a study which directly contravenes his assertion that "physiology has no significant influence" on sexual orientation (p. 90). He does not cite the Kallmann (1952 a, b) or Heston and Shields (1968) twin studies, preferring to quote the book by Arno Karlen published more than 20 years ago. True, he wrote before the publication of the recent twin studies by Bailey and Pillard (1991; Bailey, Pillard, Neale & Agyei, 1993). But the predecessor of these twin studies (whose subjects were non-twin brothers and sisters -- Pillard & Weinrich, 1986) was available. This paper is not mentioned in the main text and is conspicuously absent in this chapter. Curiously, it is listed in Nicolosi's bibliography (p. 333).
In spite of his exclusions of evidence on a genetic basis of sexual orientation, Nicolosi takes pains to head off the argument that if something is genetically caused, then it is unchangeable. He points out that alcoholism has been shown to have a genetic basis and accurately notes that this does not make it impossible to resist with appropriate therapy. The obvious rebuttal is not given -- that alcoholism is reprehensible because it typically hurts people, whereas homosexual behavior need be no more or less likely to hurt people than heterosexual behavior is.
Chapter 11 ("Homosexual Love Relationships") exposes Nicolosi's penchant for stereotyping. He seems to be able to see only negative aspects of gay relationships (pp. 109-110):
Two men can never take in each other, in the full and open way. Not only is there a natural anatomical unsuitability, but an inherent psychological insufficiency as well.... Gay couplings are characteristically brief and very volatile, with much fighting, arguing, making-up again and continual disappointments.... Research ... reveals that [homosexual relationships] almost never possess the mature elements of quiet consistency, trust, mutual dependency, and sexual fidelity characteristic of highly functioning heterosexual marriages.Nicolosi is describing patterns of emotional immaturity, not homosexuality per se. Denial is more likely to be used by the emotionally immature. Given that coming out is a process of renouncing denial, it is easy to understand why Nicolosi perceives such patterns, because he is treating clients with a fundamental homosexual orientation who want support as they continue to deny the importance of their orientation to their lives. But anyone with mature gay friends knows how biased Nicolosi's sample is.
This comes out repeatedly in this chapter. Nicolosi states that "the most volatile domestic relationships I have worked with have been those of male couples. There are typically complaints of intense ambivalence, violent conflicts, and sometimes physical injuries" (p. 118). This astonishing statement may be true in its literal sense that these are the most volatile relationships Nicolosi has seen -- but how representative a group does he see? How many homosexuals? (The dust jacket says "over 100.") How many heterosexuals? How many in daily life outside of therapy? Similarly bizarre statements abound: "I have never heard of a homosexual man having a physical altercation with his father" (p. 46), "Almost without exception, homosexual clients report an increase in preoccupying sexual fantasies when they have experienced a disappointment. They feel most out of control and likely to act out sexually when they are feeling weak, lonely, and generally down about themselves" (p. 103), "I do not believe that any man can ever be truly at peace in living out a homosexual orientation" (p. 149), and "Sarcasm is a common weapon with which homosexual men diminish both others and themselves" (p. 212). This ignorance is not bliss; it results in Nicolosi not offering his patients an option they deserve to have accurately described.
Nicolosi is close to a truth when he discusses the erotic interests of gay men who had poor fathering, but even here he stereotypes (p. 116):
Anna Freud describes cases in which the search for the "strong man" as a sexual partner represented a striving toward one's own lost masculinity. Secondary masculine sex attributes (hair, strength, roughness) were used as determinants of sexual object-choice because they represented what the patient himself lacked. ... The heterosexual, on the other hand, is not as psychologically dependent upon finding the feminine ideal for gratification, since he has no unconscious need to fulfill a deficit in original gender.Does this imply that heterosexual men are often attracted not only to feminine women but also to masculine ones (with hair, strength, and roughness)? Does this imply that Playboy centerfolds (the feminine ideal) are less important in the heterosexual world than Honcho is in the gay world? Although this chapter is one of the few of the genre which do not ritually describe the homosexual world as one which narcissistically overemphasizes youth and femininity (although Nicolosi gets around to this stereotype in the next chapter, pp. 128-129, without realizing that he thus contradicts himself), I doubt that most gay men will be grateful for this forbearance (and please pardon my sarcasm).
Nicolosi is more interested in therapy than in scholarship -- a perfectly acceptable preference -- and this is evident throughout the book. There are numerous errors pertaining to the bibliography (misdated references, missing references, "Stuppe 1982" on p. 134 but "Suppe 1981" on p. 145) or pertaining to details of gay life (the Stonewall Club instead of the Stonewall Inn, p. 131). This interest is also evident in his curriculum vitae. Although the dust jacket states that Nicolosi "is the author of numerous professional articles," these consist (according to his curriculum vitae) of seven items on a variety of sexual and nonsexual topics published in The California Psychologist (1), The Priest (1), The Tidings (2; the official organ of the Diocese of Los Angeles and San Diego), The Alberta Report (1), and Human Development (2), none of which turned up in a search of three computerized academic databases. That search did turn up one additional publication by a J. Nicolosi (1991): a letter to the editor of Educational Leadership criticizing programs for gay students. He also working on a second book, to be published in September 1993. His featured radio and television appearances outnumber his publications by a ratio of 4.9 to 1.
Chapters 14 through 20 ("Psychotherapy") are clearly the ones in which Nicolosi has his heart. He describes the masculinity-focused theme of the therapy, how patients are encouraged to form male friendships and taught how to identify and develop their own masculine strengths -- so that they won't have to seek them erotically from other men. Individual and group psychotherapy are illustrated with session excerpts.
Although these transcripts reveal that Nicolosi is helping his clients come to terms with some important issues from their childhoods, several passages are disturbing. For example, in one session therapist and client discussed what kinds of friends are good ones for non-gay homosexuals to seek (p. 292):
Client: How about [seeking] a friend with the same [homosexual] problem?Note how this client brought up one of Nicolosi's favorite analogies (homosexuality and alcoholism) and turned it in his favor. At this point, the client changed the subject, and the therapist followed his lead.Therapist: There's the possibility of it becoming sexual.
Client: That's the risk you take.
Therapist: But why go to that risky population?
Client: Why does the alcoholic join up with other alcoholics?
In reparative therapy, Nicolosi believes that it is essential for a man to serve as the primary therapist, because the client needs a mature, masculine, heterosexual figure with whom to identify and (initially, at least) to react against (p. 179). The therapist acts also as mentor (p. 185), modeling an appropriate, nonsexual male friendship, which is eventually transferred to men outside of therapy. My jaw dropped as I read that Nicolosi considers heterosexual men to whom the client is sexually attracted to be the friendships with the highest "reparative value" -- the heterosexuality ensuring that no sexual contact will take place (p. 199). He also recommends sports to his clients, encouraging one to continue his golf, swimming, and tennis (p. 235), apparently unaware that these are perhaps the three sports which gay men enjoy the most. And he recommends that clients join a heterosexual gym "where there are no distractions" (p. 193), apparently unaware of the sexiness many gay men ascribe to heterosexual athletes.
One of the most disturbing aspects of this book is that Nicolosi never critically evaluates the heterosexual pathway his clients desire so much. To be fair, let me note that the problems which heterosexuals face are not the focus of the book, so he could perhaps be forgiven for not examining their lives and problems with as critical an eye as he has turned to gay life. But his view of heterosexual partnerships is just as stereotypically rosy as his view of homosexuals is dark. He makes passing reference to the problems that married people can encounter, but does not discuss how those problems might be faced in the context of a successfully treated client. When his success stories get married and have kids, for all we know, they just live happily ever after; I wonder how well he is preparing his clients for the reality of a wife and children.
This rosy view of heterosexuality comes out especially clearly when he opines that the difference between men and women are good things -- for example, that women's domesticity helps keep men's rampaging promiscuity in check. He implicitly assumes that heterosexual couplings will produce the most happiness. Although Nicolosi is hardly the first to assume that Man and Woman were designed for each other's happiness, whether this is true in any sense of the word "designed" is an open question. Models in modern evolutionary biology typically do not assume this, for example, and suggest that husbands and wives will be perpetually at each other's throats in certain circumstances (Diamond, 1993) -- a view closer to Thurber (and the coadaptation of predator and prey) than to Masters and Johnson. I do not insist that the biologists are right and Nicolosi wrong; I simply wish to point out that the assumptions Nicolosi makes are open to question. They short-change heterosexuals by failing to affirm the complexity of their lives and lead me to wonder if Nicolosi knows any more about heterosexuality than he does about homosexuality. We do learn from the preface that Nicolosi is married (p. xiv). I close with an excerpt from the group therapy transcripts, in which several clients express doubt over the progress of their therapy (pp. 304-305):
Marco: I always feel angry at this condition. Like I thought, "Godammit, this six months of therapy investment." I know I get really angry at the struggle when there seems to be no end to it, like it's happening again, happening again. There is no end to this thing.The therapist did not answer this question directly (remember, he believes that progress is often the best that can be hoped for), but changed the subject and told the clients that they have a choice between feeling sorry for themselves or taking the chance to "be real" with the men they meet -- to tell male friends how they really feel, what's really going on in their lives. I agree that such men should choose honesty and being real. The essence of our disagreement is this: Nicolosi believes that this choice will reduce homosexual feelings, and I beg to differ.Darin: I can relate to that. It's the homosexuality, the worrying about it -- sometimes even the not wanting to get rid of it! I mean, the excitement of when you see a guy, the whole fantasy -- all of that, as undesirable as it is -- there is still an exciting energy there.... There's excitement, there's a nice drama there that I don't want to let die. If I succeed in therapy, that excitement is going to go.... [A]nother thing that I'm afraid of -- how long are we going to be doing this?... Okay, I know that I'm making progress. I see it, but I think, in three or four years am I still going to be struggling like this?