Book Review by Jeramy Townsley
 

 
(Note: the statement "It appears to us that profound change of orientation occurs infrenquently" is in chapter six,  the concluding chapter of the book.)

Book Review by Jeramy Townsley
 

Homosexuality has recently become one of the foremost social issues facing the Western Church.  In the recent writings of John Boswell and Bernadette Brooten, as well as ancient writings of the Apostle Paul and John Chrysostom, we see that homosexuality has been an issue in the church from the very beginning.  Theological arguments about homosexuality have tended to be based on two fields: exegetical and scientific.  Exegetical evaluations of the Jewish and Christian testaments often consider homosexuality to be a sin.  Scientific evaluations have considered homosexuality to be contrary to nature and pathological.  These evaluations have appeared in both ancient and contemporary writings. 

In Jones and Yarhouse’s book, Homosexuality: The Use of Scientific Research in the Church’s Moral Debate, the authors attempt to make two points.  First, from a scientific standpoint they make several interpretations of the current biological and psychological literature about homosexuality.  Second, from a theological standpoint, they reject the idea that science informs the church’s determination about the sinfulness of homosexuality.  In their review of the scientific literature, they interweave the idea that regardless of the prevalence of homosexuality, whether or not homosexuality is found to be biologically determined, whether or not sexual orientation can be changed and whether or not homosexuality is a psychological/social pathology, the church’s judgment about the sinfulness of homosexuality should be made on the foundation of exegesis, not science. 

The authors are fairer in their presentation of the scientific findings than most of the literature coming from the Evangelical community. First, they leave out much of the fringe anti-gay research that has proven controversial in the scientific community (for example, the research of Paul Cameron, et al).  Second, they do not take a belligerent position toward gay researchers —they state their opinions about the research, but tend to provide perspectives that are in opposition to their stated opinions.  Third, they are moderate in their conclusions about causation and fluidity of sexual orientation.  They conclude that genetic variables, brain differences and psychological variables are all involved in causation and that while change of orientation is not impossible it seems to them that profound change of orientation occurs infrequently (pp. 181-2).

One of the strengths of this book is the chapter on biological theories of etiology.  While they do not explore all of the current literature on the topic, they do a thorough job with certain aspects of the research, especially the twin studies and neuroanatomical issues.  They are quite accurate in their assessment that there is currently no proof that homosexuality is biologically determined.   In fact, few researchers would claim that sexual orientation, as with all complex human behavioral and psychological traits, is completely biologically determined.  The authors affirm this position and refer to it as the interactionist hypothesis, a very useful concept in current psychobiological research. 

Two other strengths of the book are a reevaluation of the population statistics on the prevalence of homosexuality and the chapter on change of sexual orientation.  On population statistics, the myth of 10%, that 10% of the population is homosexual, is quite common, though mistaken.  While viewed in its appropriate context, the approximation may be valid, but it is commonly viewed as a firm statistic of lifelong self-identification as gay or lesbian.  Both the history of this myth as well as current research on prevalence statistics are well discussed by the authors.  On the issue of "change", the authors take a moderate position, admitting that just because one wishes to change one’s sexual orientation doesn’t mean that one’s sexual orientation will change, while at the same time presenting evidence that change can and does occur in certain individuals.  They provide a decent review of the Evangelical perspective of the literature on change, as well as mentioning the methodological problems with that literature provided by Rob Goetze, (p. 124, 127; Goetze, 1999). 

While this book represents a much more fair treatment of the issue than others from the conservative Christian community, there were several problems that should be addressed.  Early in the book the authors discuss different philosophies for merging theology and science on the issue of homosexuality.  In their categories of methodology, they limit the options to only two pro-gay positions for reinterpreting Scripture in light of science: those who say the Bible is wrong and those who say the Bible is vague (p. 17).  What is left out is a third position--those pro-gays who believe in the integrity of Scripture, believing that contemporary interpretations of an anti-gay message in Scripture are mistaken.  This revisionist position is rooted in the observation of the church’s marked history of being led into power plays and prejudice by cultural bias and often poor scholarship.  These habits are exemplified by the millennia of pro-slavery and anti-woman interpretations of Scripture supported by the church en masse. Ironically, the authors argue repeatedly that the rhetorical tactics of pro-gay groups caricaturize the position of Christians, thus limiting good dialogue.  However, in the same way, the authors create the false dichotomy of the pro-gay position as "the Bible is wrong" or "the Bible is vague," Producing a similar caricaturization.

Is Homosexuality a Psychopathology?

Jones and Yarhouse ask the question, "Is Homosexuality a Psychopathology?" as the title of one of their chapters.  Their position evidences an internal conflict between their two worldviews of science and Evangelical theology. They state  (a) that there is no necessary overlap between sinfulness and status as psychopathology and (b) that homosexuality may not be pathology as mental health professions understand pathology.  However, they go on to state that homosexuality is sinful and that  "same-sex attraction … does not appear to be what God wants for people" (p. 114).  This religious belief seems to strongly bias their discussion of the normal/pathological question: "The origins of homosexuality are unclear but grounded ultimately in our human fallenness and rebellion against God."  (p. 179).

The authors discuss psychoanalytic theories of etiology of homosexuality (p. 53-60).  They present several studies that have been used to support the psychoanalytic tradition of pathologizing homosexuality.  For balance, they should have emphasized several general factors that call into question the psychoanalytic theories they present

1. Most such studies generalize their theories based on a sample from a patient group. Several studies have shown that there are significant psychological differences in people who seek treatment and those who do not seek treatment. It almost becomes a tautology--people who seek professional psychological help tend to have greater psychological problems than those who see no need to seek psychological help.Studies in the past decade on memory construction have verified that people are very suggestible. Memories can easily be planted by psychologists who "think" they know what caused the patient's problems and then geared their counseling strategies to "discover" that history in the patient. While
studies on this phenonemon in the ex-gay therapies have not yet been
done, it has been a widely studied phenomenon in the sexual abuse literature. One might recall the court cases several years ago regarding patients who had very clear memories of sexual abuse, memories that were later discovered could never have happened. After a few cases like this, several studies documented the effect. Given that gay men that seek treatment are likely to already know etiological theories, and ex-gay counselors tend to accept Moberly's/Bieber's/Nicolosi's data, there is high probability for false-memory construction (Brandon, 1998

2. Correlation does not equal causation. Assuming that some of the distant fathers/gay sons cases prove to be true, there still is no causative evidence, which is one of the primary fallacies of psychodynamic theories like Moberly's. For example, it is entirely possible that a son starts out with effeminate characteristics, then becomes rejected by a father who doesn't know how to relate to/is afraid of/is repulsed by his effeminate son. Even if a correlation between distant fathers and effeminate sons could be shown, then it doesn't by any means give us the data to say that distant fathers "cause" effeminate sons. 

3. Within this section of psychoanalytic theories, Jones and Yarhouse discuss the issue of childhood sexual experience (p. 57), both sexual abuse and childhood activity.  Even with a disclaimer that there is no direct causal relationship, the contextual presentation of isolated research studies and life stories are done in a way that can lead a reader to believe a causal relationship exists between childhood abuse/activity and adult homosexuality. 

Similarly, their use of the Manosevitz study is problematic (p. 57).  Jones and Yarhouse seem to imply that childhood sexual behavior (CSB) was a causative agent in a person later becoming homosexual.  However, Manosevitz makes the opposite conclusion: that sexual orientation determines the choice of gender for CSB.  While Jones and Yarhouse correctly state that 25% of the homosexual men engaged in CSB with other male children from age 5-9, and 43% from age 10-12, while no heterosexual men reported CSB with male children when they were 5-9, they leave out the statistics that 18% of heterosexual men report CSB with females from 5-9, 23% from age 10-12, 10% of heterosexual men report CSB with other males from 10-12, and 14% of both homosexual and heterosexual men report CSB with both genders.  If we assume that these sampling distributions can be approximated by a normal distribution (nHMS=28, nHTS=22), then there is probably no statistical difference between the amount of CSB of heterosexual men with opposite-gendered children and the amount of CSB of homosexual men with same-gendered children (for 5-9 yrs, z=0.6; for 10-12 yrs, z=1.5).  This lends itself to the interpretation given by the authors of the study--that childhood sexual orientation determines the choice for gender of CSB, not the other way around. 

Using the example of the 1973 action by the American Psychiatric Association (APA), the authors assert that mental health organizations’ affirmations about the good mental health of homosexuals may not rest on scientific findings, but on external political and social pressure (p. 97-98).  However, they fail to report the  positions by various other professional organizations negating the view that homosexuality is pathological: American Psychoanalytic Association, American Psychological Association; American Psychiatric Association, American Medical Association, American Academy of Pediatrics, National Association of Social Workers, American School Counselor Association, et al (see below for references). 

The authors cite a single 1993 study to support their position that mental health care workers disagree with the position of their professional organizations about the general mental health of homosexuals. However, the study, organized by the APA's Office of International Affairs, reports the opinions of psychiatrists in other countries, not of those in the United States. Aside from the difficult issue of cross-cultural interpretations of psychopathology, this study sheds little light on the status of American professional views of the mental health of homosexuals in this country. Jones and Yarhouse fail to report several other studies that contradict their assertions that mental health professionals tend toward a psychological health model of homosexuality, not one of psychopathology.

Historically, psychoanalysts have been the primary opponents to the depathologization of homosexuality in the 1973 APA decision, Socarides and Bieber being by far the most vocal opponents of the decision.  However, a recent survey of psychoanalysts (n=82) found that "no respondents strongly endorsed the type of pathological model proposed by Socarides" (p. 84), and that "the responses of the group as a whole were more towards a health than illness model." (Friedman, 1996).  In another recent study, it was reported that 47.3% of psychiatric training directors (n=198) view homosexuality as normal or somewhat normal, 51.2% view homosexuality as neutral, and 1.5% view it as somewhat pathological or pathological.  (Townsend, 1995).  Similarly, two recent dissertations found that heterosexual therapists did not rate their gay/lesbian patients with higher pathology than their heterosexual patients (Stokes, 1998; Heid, 2000).

Jones and Yarhouse spend significant time attempting to deconstruct the implications of Evelyn Hooker’s classic articles evidencing the good mental health of homosexuals (p. 99-101).  On the surface, they seem to affirm Hooker's conclusion that "not all homosexuals are manifestly disturbed," which is different from saying that homosexuals are as mentally healthy as heterosexuals, the eventual scientific conclusion of the results of Hooker’s, et al, studies.  However, despite this admission, by the very addition of this critique in the larger context of the chapter, they seem to question that conclusion.  They note that Hooker's sample is non-representative and explain why they believe homosexuals are more disturbed than the general population.  There is no question that there are higher rates of suicide, depression and drug abuse in the gay/lesbian population than the general population.  However the conclusion they seem to want the reader to make does not follow the reasoning.  They imply that since there are higher rates of certain psychopathologies within the gay/lesbian population, that the gay/lesbian state is inherently flawed.  But other explanations are possible, explanations that are favored by the psychological and sociological communities.   For example, the authors cite Erwin to support their claim that suicide rates are higher in the homosexual population (p. 105).  However, Erwin's article is not a study that supports their larger claim--it is a review of studies which concludes that anti-gay social factors are probably the causal agents for increased suicide among homosexuals, not individual pathology inherent to the homosexual state.  One of the primary deficits in this chapter is the failure to explore other factors of causation for increased psychopathology among homosexuals, such as those explored by Erwin (see also Safren, 1999, who provides evidence that increased suicidality is related only to increased depression and social stress, not sexual orientation).  Further, they ignore the mass of studies that evidence the good mental health of the homosexuals as compared to heterosexuals ( http://php.iupui.edu/~jtownsle/gay/gayhealth.html ). 

Jones and Yarhouse invoke other authors to support their position of the inherently flawed mental health state of homosexuals (p. 102-105).  While again there is little contention that there are higher rates of certain psychopathologies among homosexuals, their use of Saghir and Robins is a poor choice to prove this.  They spend several pages exploring the fact that not only did they choose a homosexual population that excluded subjects who had been hospitalized for psychiatric reasons, but that the homosexual rates of psychopathology were still higher than national averages when compared to a standard sourcebook by Robins  and Regier (RR, 1990).  However, in making this comparison, they fail to mention an important piece of data which seems to border on a fraudulent presentation: Saghir and Robins included an heterosexual control group in their study, matched for several variables (including exclusion of former psychiatric patients) and that this control group had fairly identical rates of psychopathology as the homosexual group in all areas except alcohol abuse. 

The use of RR is appropriate when looking for general incidence rates of disorders.  However, it is inappropriate to use it to compare rates of pathology in unique groups, since only control groups can function in that capacity.  To use RLR to compare groups when no attempt is made to match variables such as age or economic status, represents a gross error in judgment.  Such comparisons are made numerous times in the chapter titled "Is Homosexuality a Psychopathology".  The authors cite Bradford, Ryan and Rothblum (BRR, 1994), indicating a higher incidence of depression in the lesbians in their study, compared to RR (p. 104).  However, an examination of the wording in BRR and age-matched populations in RR gives a different picture.  BRR gives a figure of 37% of women who claimed to have experienced "long depression or sadness at some time in their life (BRR, p. 231)" and 11% who were receiving treatment for depression.  They quote RLR that the general population of women has a 10.2% incidence of depression and "probably less than 1% obtaining treatment for that depression" (p. 104).  This represents a poorly matched sample and a misapplication of diagnoses.  First, the 10.2% RLR figure represents a DSM diagnosis of "clinical affective disorders" for women of all ages.  For women ages 30-44, the approximate age-group represented in the BRR study, the rate jumps up to 15.3% for Caucasian women, 10.5% for African-American women and 13.6% for Hispanic women.  Inclusion of women over 65 dramatically lowers the RLR figure.  Further, the 37% figure in BRR does not represent a clinical diagnosis as is implied in the comparison to RR, but represents a subjective feeling of "sadness."  Given the limitations of the BRR study, the safest assumption to make regarding the data (if a comparison of dissimilar data can be made at all) is that only those women "currently in treatment for their depression" (11%) actually have a clinical diagnosis of depression.  That figure, most readily compared to the RR "1-year" category, are represented in the RLR (female, age 30-44) by 8.3% Caucasian, 5.1% African-American and 7.3% Hispanic.

 AIDS has been a tragic disease, represented disproportionately in the West by the white gay male population.  The authors make the assertion (p. 108) that the high prevalence of AIDS specifically among the gay population should give us reason to doubt the adaptive benefits of homosexuality.  However, this grossly ignores the world epidemiology of AIDS, which is found in primarily an heterosexual population.  It is only in certain Western countries that AIDS is found primarily in the gay population.  Basing one’s opinion about the maladaptiveness of homosexuality on the evidence from the AIDS statistics is questionable to begin with.  However, given that the author’s opinions and presentation fail to acknowledge the larger, world context of AIDS feels more like a rhetorical device that misinforms the reader, rather than shedding light.

 One of the classic studies on homosexuality is the Bell and Weinberg (1978) study.  Jones and Yarhouse utilize this study in reference to the alleged promiscuity of the homosexual community (p. 109).  The Bell/Weinberg study was an important study, is well accepted and for what it was, represents good research.  However, there are several reasons why the study is absolutely not generalizable to the population and in particular, not able to be compared to standard heterosexual statistics, despite their use of a control (as in the Saghir study mentioned above).  While Jones and Yarhouse admit problems, the inclusion of the study to indicate a baseline number of sexual partners of gay men represents another error in judgment on the part of the authors

 
1. The sampling of the homosexuals in the study was not random, and they admit as much. The heterosexual sample was random, using census data and land tracts to ensure a random sample, and going to exhaustive lengths to make sure those samples were truly random. While they did go to great lengths to get a large sample group of homosexuals, and there is little doubt that their data is representative of the sample they were testing, their data is absolutely not generalizable due to the clear fact that their sample was not a random sample. 

2. Another reason why their data is not generalizable is that while they did a survey of heterosexuals as well as homosexuals, they didn't include the heterosexual data. For example, while they claim that one homosexual respondent claims to have had sex with over 10,000 people, and a large percentage of their sample claim to have had sex with over 500 people, they do not give correlative data on the heterosexual sample. For all the reader knows, the heterosexual sample may have had a greater number of sexual partners than the homosexual sample. Without this control group, we cannot generalize their sample to the population at large, because we do not know that their population represents national norms since we have no heterosexual control group. It is possible that the heterosexual statistics were equally high, and could have shown that the data does not represent promiscuity specifically among gays, but of the sexually active single person in San Francisco in the 1970's.

3. A third problem, still relating to the heterosexual sample, is that it did not represent a true control group. Apart from the fact that the homosexual sample was not random and the heterosexual sample was, the homosexual samples were taken from the following places: singles bars (22%), gay baths (9%), public places (=guys hanging out in parks to find sex partners; 6%), private bars (=sex clubs; 5%), personal contacts (people that the bar people, public place people, bath house people, etc, knew personally and referred; 23%), public advertising + organizations + mailing lists (29%). The heterosexual sample, on the other hand, were people in residential areas, admittedly including married people. These two samples are not parallel, and even if they had included the heterosexual data, they would not be comparable. In order for this data to be generalizable, they would have had to go to heterosexual singles bars, sex clubs, bookstores, etc, to get their population. 

4. Bell and Weinberg used Kinsey 2-6 for their inclusion of homosexual population. Their sample does not represent only homosexual persons, but also includes bisexual persons.

Having presented the Bell and Weinberg study, Jones and Yarhouse fail to explore alternative evidence.  A comparison of two population studies of rates of sexual behavior indicates that homosexual and heterosexual rates may be quite similar, if not reversed from the stereotype.  The first study (n=77 homosexual males of a larger male sample of n=1450) indicates a mean number of homosexual sexual partners at 4.2 per lifetime (Billy, 1993;  calculated separately from the data presented), while a second study (n=3111) found a mean number of heterosexual sexual partners at 7.3 per lifetime (Fay, 1989). 

This data represents a balance for the Laumann (1994) study, another large-scale, well accepted study that is presented by Jones and Yarhouse.  The Laumann analysis certainly seems to indicate dramatically higher rates of promiscuity among gay males than heterosexual males.  However, what Laumann (and subsequently Jones and Yarhouse) fails to explore is the radically skewed nature of the data.  Typically this indicates that the mean, the statistic presented by Laumann, may not be the best measure to report.  A further analysis of the GSS data (on which Laumann based his results) indicates that the median (50th percentile) number of sexual partners for heterosexuals is five and for homosexuals is six (http://php.iupui.edu/~jtownsle/gss/partners.html).  The discrepancy between the mean and median is indicative of a small sub-population of gay males who tend towards high rates of sexual partners, skewing the mean, while the majority of gay men tend to have rates about the same as heterosexual males.  Regardless, while the data among the extant studies may not solve the question of whether rates of sexual behavior differ between homosexuals and heterosexuals, there does seem to be more a question in the literature than what Jones and Yarhouse present.

 A final point of concern is the author’s use of the following quote: "An emerging area of concern is the move in some pro-gay circles toward acceptance of sexual relations with children before the legal ages of consent" (p. 111).  This statement is inflammatory and misleading.  There are no widespread movements from within the homosexual community advocating inclusion of groups like NAMBLA into the arena of appropriate social discourse.  While groups such as NAMBLA exist, they represent a small minority in the homosexual community and have mirror representatives in the heterosexual community.  Such groups are not allowed at state-wide Gay Pride events, they are not allowed at major gay-related fundraising events, nor are they given any credence by the homosexual community at large.  Jone’s and Yarhouse’s statement is "technically" true that "some pro-gay" groups advocate NAMBLA, et al.  However, the statement does not represent an accurate portrayal of the homosexual community at large any more than the statement "some Evangelical groups advocate the death penalty for homosexuals" (http://www.godhatesfags.com) accurately portrays the Evangelical community.  The inclusion of such statements in a document that purports to represent a fair representation of a community shows the clear bias of the authors since it clearly does not represent the community and plays on fears rooted in the traditional rhetoric against the homosexual community.  Rhetorical associations between pedophilia and homosexuality throughout Western history has damaged the homosexual community’s standing within the larger society, the homosexual community’s view of itself and individual homosexual’s perceptions about themselves, just as rhetorical accusations of bigotry and hatred have damaged the credibility of the Evangelical community. 

In the same way, in regards to the mythical practice of "gerbilling" (p. 173) the authors show bias that appears to transcend their fact checking. Jones and Yarhouse define gerbilling, an urban legend, as the "insertion of live animals into the rectum for sexual stimulation."  This practice is unknown as a sexual practice, but the myth is propagated by certain organizations as a means to illustrate the depravity of homosexuals.  A quick e-mail to the heads of departments in gastroenterology and emergency medicine of several major metropolitan teaching hospitals (San Diego, Minneapolis, New York, San Francisco) verified that neither field has any evidence that the practice exists. Additionally, I did a search of the database of the National Library of Medicine (which has more than 16 million citations for medical abstracts and journal articles dating back to1966) and did not find a single reference to the practice of gerbilling.  Similarly, other investigators have failed to find evidence for the practice: http://www.baywindows.com/pridenet/bw/back_issues/March_09_1995/950309_gerbilling.html, http://www.snopes2.com/sex/homosex/gerbil.htm . 
 

Conclusion

 In all, this book represents a treatment of the issues surrounding homosexuality in a more fair light that most books of its kind.  However, the bias of the authors is clearly visible in the studies they choose to discuss and the sometimes incomplete presentation of data and conclusions from those studies.  There are parts of the book, as described above, that deal quite fairly with the data, and parts that reveal false myths that have infiltrated the gay community, the larger secular community and the scientific community.  If nothing else is to be taken from this book, two aspects stand out.  First, that while science informs theology, it does not mandate it.  Further, the two disciplines are not in competition for a single truth—they are offering truth claims about distinct categories, though categories which may partially overlap (p. 15).  The two are separate entities and for the believer, exegesis must ultimately supersede secular interpretations of nature.  Second, the book represents a balance to the anti-ex-gay movement that is becoming apparent in the mental health communities.  While it has been shown that ex-gay ministries, in some instances, have the capacity to harm, in some cases they also have the capacity to heal.  A patient has the right to choose his or her mode of therapy, even if that mode is not fully accepted by professional organizations.  The work of the mental health communities should turn to ensuring the best treatment modality for patients, based on their own personal goals, even if that involves researching methods of ex-gay counseling that is most beneficial to clients and possibly what types of clients are best served by ex-gay modalities.
 

Bibliography:

Bell A and Weinberg M. Homosexualities: A Study of Diversity Among Men and Women. New York: Simon & Schuster; 1978.
Billy, JO. The sexual behavior of men in the United States. Family Planning Perspectives 1993 (25): 52-60
Boswell, John. Christianity, Social Tolerance, and Homosexuality. University of Chicago Press: Chicago, 1980
Bradford J, Ryan C and Rothblum ED. National Lesbian Health Care Survey: Implications for Mental Health Care. Journal of Consulting and Clinical Psychology . 1994 (62): 228-42.
Brandon, S. Recovered memories of childhood sexual abuse. Implications for clinical practice. British Journal of Psychiatry 1998 (172): 296-307
Brooten, Bernadette. Love Between Women. University of Chicago Press: Chicago, 1996.
Erwin, Kathleen.  Interpreting the Evidence: Competing Paradigms and the Emergence of Lesbian and Gay Suicide as a "Social Fact."  International Journal of Health Services 1993 (23): 437-453.
Fay, R. Prevalence and patterns of same-gender sexual contact among men.  Science 1989 (243): 338-348
Friedman, Richard. An empirical study of the beliefs of psychoanalysts about scientific and clinical dimensions of male homosexuality. Journal of Homosexuality 1996 (32): 79-89.
Goetze, Rob. http://www.newdirection.ca/a_chang2.htm . Toronto: New Direction For Life Ministries, 1997.
Goetze, Rob. http://www.newdirection.ca/a_chang3.htm . Toronto: New Direction for Life Ministries, 1998.
Hausman, Kenneth.  U.S. Psychiatrists' Views on Homosexuality Differ From Colleagues' in Other Countries.  Psychiatric News 1993, Sept 3: 2, 21.
Heid, Richard. Relationships Between Sexual Orientation, Psychologist Attitudes and Perception of Psychotherapeutic Prognosis. Temple University, 2000
Hooker, Evelyn. The adjustment of the male overt homosexual. Journal of Projective Techniques 1957 (21):18-31
Laumann, Edward, et al.  The Social Organization of Sexuality : Sexual Practices in the United States.  Chicago: University of Chicago Press, 1994.
Manosevitz, Martin.  Early Sexual Behavior in Adult Homosexual and Heterosexual Males.  Journal of Abnormal Psychology 1970 (76): 396-402.
Robins LA, Regier DA (eds). Psychiatric Disorders in America.  New York: Free Press, 1990.
Safren, Steven.  Depression, Hopelessness, Suicidality and Related Factors in Sexual Minority and Heterosexual Adolescents. Journal of Consulting and Clinical Psychology 1999 (67): 859-866.
Shrier, Diane.  Sexual Victimization of Boys: An Ongoing Study of an Adolescent Medicine Clinic Population.  Journal of the National Medical Association 1988 (80): 1189-93.
Stokes, Tami. Sexual Orientation and Clinical Decisions. New School University, 1998.
Townsend, Mark. Gay and Lesbian Issues in U.S. Psychiatry Training as Reported by Residency Training Directors.  Academic Psychiatry 1995 (19): 213-218

Professional Organizations’ Affirming Opinions of Homosexual Mental Health

American Psychiatric Association: http://www.psych.org/pract_of_psych/copptherapyaddendum83100.cfm
American Psychoanalytic Association: http://apsa.org/pubinfo/homosexuality.htm
American Psychological Association: http://www.apa.org/pubinfo/answers.html
American Medical Association: JAMA 1996 (275):1354-1959 
link to a long AMA url
American Academy of Pediatrics: http://www.aap.org/policy/05072.html
National Association of Social Workers: http://www.naswdc.org/NASW/Diversity/lgbt/reparative.htm
American School Counselor Association: http://www.schoolcounselor.org/pdf/sexorient.pdf

Jones and Yarhouse respond to this review

online article by Jones and Yarhouse
"Science and the  ecclesiastical homosexuality debates"