OK, I'm probably not going to make a lot of friends with this posting, but I think most people read this blog because they want to hear my contrarian viewpoints, not because they agree with me.
By now pretty much everyone's heard of the "Regnerus Study" or the "Family Structure Study". Praised by the religious right & a scorpion in the boot of the gay movement, the study leaves precious few without a strong opinion. If you have no idea what it's about, a good summary of the study and the controversy surrounding it was written by William Saletan at Slate.
I spend a lot of time listening to broadcasts from the religious right: Bryan Fischer at American Family Radio, Liberty Counsel, Family Research Council, National Organization for Marriage, etc. You may drink coffee to get up & going - I listen to these folks.
I think it's important to understand where they are coming from, to understand what arguments they use, what they assume to be true, what they believe about people like me, etc. Often people seem to think these folks are crazy, stupid, or both. I don't think that they are, for the most part. The major spokespeople are far from crazy or stupid. However, they are strong partisans, and have interpreted the Regnerus study with a very partisan bias. They have claimed that it proves that children do best when raised by their biologic mother and father, and that children raised by gay or lesbian parents do worse in most areas than children of single parents. It proves no such thing, but I think it is a valuable addition to the discussion.
As many others have pointed out before me, the study does not have a sample of children raised by gay or lesbian parents upon which to make these claims. They asked a bunch of adults some questions about their parents, and classified anyone who claimed to know that their parent had had a same-sex experience as having been raised by gay or lesbian parents. The study had less than a handful of respondents who had been raised by same-sex parents from infancy.
Many people who I agree with on the substance of family studies have said that the Regnerus study should be pulled, that it is fraudulent and academically dishonest. I don't think it is. I think he clearly and accurately described what he did, and although I encourage people to vehemently disagree with his interpretations and conclusions, that the methodology of the study is not inherently flawed, and was not dishonestly presented in publication. As a result, I don't think it should be pulled.
The controversy around this piece has got me thinking in a lot of different directions, so I hope you'll forgive the scattered nature of the next few paragraphs.
Reaction A: Lots of crap gets published. I'd say over 98% of the studies I read have major methodologic weaknesses, and/or come to conclusions not supported by the underlying data they report. And don't get me started on plagiarism - that problem is out of control, and can even be found in esteemed academic publications. When I started trying to write a series on 'research worth reading' about gay health, it was a real struggle to find anything worth encouraging others to read. I went through hundreds of abstracts, read dozens of papers, and came down to a small handful of papers I thought were 'worth reading'.
Which is a far cry from saying that there isn't a lot to learn from all the crud that gets published.
But it does make me reticent to say that the Regnerus study, with all its flaws, is out of bounds when compared to the vast majority of academic publications. Is it 'worth reading' from the perspective that it skillfully addresses the underlying research question with precisely targeted methodology and conclusions that are well founded in the work itself? No on all counts. But, it is worth reading because it presents a very different perspective than most of the family structure studies out there currently, and it provides a methodologic contrast to them that makes it worth thinking about how to build from the methodologic weakness of the entire field something that would be more reliable.
So, if the Regnerus study frosts your buns, as it should, get off your duff and do a better study. The gauntlet has been thrown down & there's no way to force them to pick it up again and say 'my bad'.
Reaction B: Religious right commentators have claimed that there is a strong liberal bias in this field, and that any study like Regnerus's that challenges the pro-LGBT bias is unlikely to get a fair chance at publication. I'm afraid that they may be right on the first of these, although I doubt the latter.
The larger field of marriage and family structure studies has been very heteronormative with respect to lesbian and gay families, to the point that even when there is a same-sex household included in these studies it usually gets classified as a mixed-sex household because the researchers don't even consider the possibility that there might be same-sex households. But among the small number of studies that do acknowledge same-sex parents, this small subfield has been conducted and interpreted largely by partisans on our side of the debate.
I don't know how many anti-gay studies have been precluded from publication, but I doubt it is very many, if any. It is more likely that these studies just haven't been done. A couple possible reasons: 1) our adversaries often claim that it is obvious common sense that lesbian or gay parents are harmful, so there is no reason to confirm common sense (I'm not agreeing with that, just trying to explain why I think only one anti-gay study has been done so far). 2) Lots of people on the right say that they are tired of talking about homosexuality - by which they mean they wish we would just go away and not ever be part of their lives - ouch! But that sentiment, that they are tired of talking about us, carries through to why they would be unlikely to do a scientific study of family structure, valid or otherwise. Why would you invest time and effort into such a study if you were tired of thinking about it and just wished it would go away? 3) Putting the time and effort into such a study thus requires a significant investment in a heteronormative worldview, an obsession that is unusual in society in general, and academia in particular. Gay and lesbian researchers have an obvious interest in this sort of work, but it takes a heterosexual with a real bone to pick to become similarly invested.
Reaction C: I've been perplexed by the widely-held beliefs among the religious right that they are being persecuted by homosexual activists, and that our gains in society have come at their expense. I know that there's no conspiracy to reign in the religious right because I've seen first-hand how LGBT folks organize. We are way too fractious to pull something like that off intentionally. By the same token, I'm deeply suspicious of claims that "the church" or "the Mormons" are acting in concert as often as we think they are.
In the 90's I tried to do a lot of activism around victimization, and I really think that is a self-defeating way to go. It makes you more paranoid and can become self-fulfilling. So my word to both sides - leave the persecution stuff off the table - it doesn't help anyone.
Reaction D: I wonder how a study on family structure could be done in a methodologically convincing way. It's not easy. Regnerus tried (and failed) to get something close to a random sampling of the general population. That's a tough approach to use because children of lesbian and gay parents are still pretty uncommon, and that's the main reason his method failed. The approach mainly used by our side is to find families headed by same-sex parents and try to find a comparable comparison group of mixed-sex-headed families. That's a tough approach because it is very hard to be sure that the comparison group really is comparable. I think the best approach that might be feasible in the short-term would be to piggy-back on some other very large random sample of Americans and do a follow-up survey with all the same-sex-headed households and a matched sample of mixed-sex-headed households. The Current Population Survey would be, I think, an ideal vehicle for such a call-back survey. They interview about 50,000 Americans every month, so there might just be enough same-sex-headed households contacted through that survey to make it feasible. The Behavioral Risk Factor Surveillance System might work too, but it would be a huge logistic challenge to get permission from each state to call people back. The American Community Survey could work too, but because that is done by the Census, we would first need to get Congress to admit that same-sex marriages do in fact exist, and are worth studying.
Reaction E: Why is it important to compare the children of same-sex to mixed-sex households? I'll admit that it is interesting from an academic perspective, but I think most of the interest is generated by the desire to use evidence in policy debates. But should it matter?
A lot of the debate so far has centered on whether the children of same-sex couples are more likely to "turn" lesbian or gay themselves. Most of the studies on 'our' side have claimed that the answer to that question was no -- because our opponents were so fiercely complaining about gay contagion. But I think it's safe to say that the evidence is that kids of lesbian and gay parents are in fact more likely to realize that they are gay, lesbian, and especially bisexual. In 2009, I heard a great talk by Clifford Rosky which really pushed the audience to ask, "So what?". So what if gay, lesbian, and bisexual kids are more comfortable, more self-realized, after growing up in our households? Isn't that a good thing? (The Regnerus study counts being openly GLB as a 'negative' outcome, by the way!)
And that leads me to wonder what possible relevance the Regnerus study, or the studies on our side, should have in regards to public policy. Of course it would be easy and convenient if the children of same-sex parents were equal in all regards to the parents of mixed-sex parents. But would it really matter if that weren't the case? Shouldn't we expect that the children of same-sex parents would be worse off in some ways and better off in others? And even if the impossible were true: that children of same-sex parents were, on average, worse off in every possible measure, should that preclude every same-sex couple from having children or being able to marry? I'm struggling to see the relevance. The children of wealthy parents are much more likely to be diagnosed with autism - should we sterilize the rich?
No easy way I can see to wrap this all up. Thanks for listening, and feel free to chime in!
Showing posts with label research worth reading. Show all posts
Showing posts with label research worth reading. Show all posts
Saturday, September 1, 2012
Friday, December 23, 2011
Research Worth Reading (4) - trans health in Massachusetts
Gunner Scott, Sewart Landers and pals have served up a very interesting paper in January's AJPH - the first time anyone anywhere has published anything peer-reviewed on a population-representative sample of transgender people.
In Massachusetts, the Behavioral Risk Factor Surveillance Study (BRFSS) has asked the adults it interviews "Do you consider yourself to be transgender?", and a whole lot of demographic and health-related questions.
Many studies in the past have sought out a transgender population to try to say something about the health of the group, but this is the first one to rely on a "random" sample, meaning calling people up at random; and that's probably the best way to be sure that you've got a study population that is fairly representative (at least of people with phones).
In addition to addressing trans health from a population perspective for the first time, this study is also the first to report simple basic demographics of the transgender population in the US as well, including the most basic one - how many transgender people are there?
The answer, in this study, is about 1 in 200 in Massachusetts, about 1 in 110 in a similar study from Vermont, and 1 in 170 in Boston. It is likely (for reasons I've discussed before) that these are overestimates, meaning that the true proportion is probably somewhat lower than that, but how much lower? That's hard to guess, it depends on how many nontrans people answer the wrong way because they are distracted or misunderstood the question. The only way to figure that out is to call back the people who said they were trans and ask them again.
The study is very interesting in that it validates some things trans health activists have known for years, but there isn't strong evidence to support all the health disparities that have been identified from "convenience" samples. Members of the trans population in this Massachusetts study were less likely to be employed, and more likely to be living in poverty than the nontrans population. The study also documented that 36% of the trans population were smokers, compared to 17% of the nontrans population. But markers of access to health care were not particularly different. The trans population was less quite a bit less likely to have health insurance (86%) than the nontrans population (94%), but this did not translate into not having a regular health care provider or not seeing a doctor because they couldn't afford it, and the trans population was even more likely to have had a checkup in the last 12 months (85%) than the nontrans population (75%).
Mental health measures did show some substantive differences: 70% of the trans population reported usually or always getting needed emotional support, but this was quite a bit lower than the 90% of nontrans people who got their emotional needs met; and 14% of the trans population reported being dissatisfied with their life, but only 6% of the nontrans population did.
The authors were very thoughtful about ways that these results might be misleading - for instance that trans people are probably less likely to be stably housed and have a telephone, so these figures may well present a rosier picture than a fully representative sample of trans people would be. And also, not knowing how many cis-gender (nontransgender) folks inadvertently classified themselves as trans, it is hard to know the degree to which true differences between the trans and cis populations are diluted by these inaccurately coded folks. Another possible source of bias might be people who have transitioned, but no longer consider themselves to be transgendered, although I suspect this is pretty unlikely to be a substantial part of the population, because the way the question in Massachusetts was asked, they made it clear that they meant "experience(d) a different gender identity from their sex at birth. For example, a person born into a male body, but who feels female or lives as a woman". But excluding people who no longer consider themselves to be trans would, probably, make the differences seem larger than they actually are. A similar bias would arise from trans people not feeling comfortable describing themselves as trans to a stranger on the phone.
Thanks Gunner & Stewart!
Sunday, June 20, 2010
Internalized Homophobia - Why Measure it?
Recently I saw an article that suggested that measuring internalized homophobia might be a waste of time.
I was intrigued. I have to admit, I've never been a big fan of internalized homophobia. Measuring it, I mean. But I never stopped to think out why the idea made me a bit queasy.
Maybe I should back up a bit. One of the leading theories about how homophobia affects people is that homophobia operates simultaneously at multiple levels: societally, institutionally, interpersonally, and internally.
Multiple levels of homophobia
At the societal level, homophobia (often called heteronormativity in this context), is the shared set of beliefs and assumptions about who ought to be porking whom. But more than that, it is a nexus of assumptions about what family structure and kinship should look like, about what gendered identities are possible and how they should be expressed. That's one reason why the debate over same sex marriage has been so contentious within the gay community - one the one hand it is about equality of opportunity, on the other, marriage is practically the very definition of heteronormative values.
Institutionally, homophobia can be expressed in official policy, or less official actions that intentionally treat sexual minorities differently than heterosexuals, or that result indirectly in the same effect.
Interpersonal homophobia is probably what most people think of when they hear "homophobia" - it's the disparaging words, the punch in the nose (then the gut, the groin, the kick when you're already on the ground, need I go on?). Interpersonal homophobia is the expression of prejudice from one person directed at another.
Internalized homophobia can mean a couple different things depending on who you're asking. Usually it refers to a form of self-loathing among gay men, lesbians, and bisexuals, the internal application of societal views on homosexuality on oneself. Sometimes people talk about internalized homophobia in anyone, including heterosexuals, as the result of internalizing the societal homophobia as being what one believes about homosexual and bisexual people.
So all these levels are in constant interaction with each other as well. A person is unlikely to let off a string of interpersonally homophobic slurs unless they have internalized societal views about homosexuality. They are unlikely to internalize these assumptions unless there is a shared ethos of homophobia in which that person lives, or grew up, and so on.
And all these can be in conflict with one another. For instance, one may live in a relatively non-homophobic society (like Rhode Island) with relatively few institutional policies that hinder people with same sex desire, but be in a more homophobic institution within this (such as a Catholic school), which nonetheless has a strong tradition of supporting individuals within the institution, and exposing them to very little interpersonal homophobia, so long as they maintain an internalized sense that their homosexuality is wrong.
So what's wrong with measuring internalized homophobia?
Based on the above, I obviously think that internalized homophobia is an important part of how homophobia/heteronormativity affect people. If nobody internalized homophobic assumptions, then it could not survive at a societal level either.
So why not measure it?
The article I read said that measures of internalized homophobia had very little predictive value for why some gay men get HIV and others don't. Not only that, but what predictive capacity it once had is rapidly diminishing. So, their argument was that it doesn't predict much, so measuring internalized homophobia may be a bit of a futile exercise.
But that wasn't entirely satisfying to me as a reason to avoid measuring it. So what if internalized homophobia has relatively little impact on HIV transmission - maybe it still plays a big role in some other health issue, like depression.
No, what I've decided bugs me about measuring internalized homophobia is the "internalized" part. I mean, describing "internalized homophobia" as a major health risk may in some sense be an important mechanism, but what sort of intervention does it lead to? How does one use that information to try to prevent disease, or better yet, promote health?
By describing "internalized homophobia" as a major health threat to sexual minority populations, the implication is that there are some of us who are in trouble (those of us who have internalized societal degradation as just), and others of us who are fine (we've coughed up the furball of societal hatred). Then what? Either the people who have internalized societal homophobia need some sort of intervention (which is paternalizing if that person is not actively seeking help), or they have some how brought these problems on themselves, failed to do what they need to do to take care of themselves.
The problem, as I see it, is that a focus on "internalized homophobia" focuses the potential for interventions internally, and doesn't take into account the full spectrum of the levels at which homophobia operates. Focusing on identifying and intervening with individuals who have internalized homophobia in no way explicitly challenges the broader social context within which these internalization processes occur.
-------------------------
Michael E. Newcomb, Brian Mustanski. (2009). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Archives of Sexual Behavior Epub aread of print 04 Nov 2009.
I was intrigued. I have to admit, I've never been a big fan of internalized homophobia. Measuring it, I mean. But I never stopped to think out why the idea made me a bit queasy.
Maybe I should back up a bit. One of the leading theories about how homophobia affects people is that homophobia operates simultaneously at multiple levels: societally, institutionally, interpersonally, and internally.
Multiple levels of homophobia
At the societal level, homophobia (often called heteronormativity in this context), is the shared set of beliefs and assumptions about who ought to be porking whom. But more than that, it is a nexus of assumptions about what family structure and kinship should look like, about what gendered identities are possible and how they should be expressed. That's one reason why the debate over same sex marriage has been so contentious within the gay community - one the one hand it is about equality of opportunity, on the other, marriage is practically the very definition of heteronormative values.
Institutionally, homophobia can be expressed in official policy, or less official actions that intentionally treat sexual minorities differently than heterosexuals, or that result indirectly in the same effect.
Interpersonal homophobia is probably what most people think of when they hear "homophobia" - it's the disparaging words, the punch in the nose (then the gut, the groin, the kick when you're already on the ground, need I go on?). Interpersonal homophobia is the expression of prejudice from one person directed at another.
Internalized homophobia can mean a couple different things depending on who you're asking. Usually it refers to a form of self-loathing among gay men, lesbians, and bisexuals, the internal application of societal views on homosexuality on oneself. Sometimes people talk about internalized homophobia in anyone, including heterosexuals, as the result of internalizing the societal homophobia as being what one believes about homosexual and bisexual people.
So all these levels are in constant interaction with each other as well. A person is unlikely to let off a string of interpersonally homophobic slurs unless they have internalized societal views about homosexuality. They are unlikely to internalize these assumptions unless there is a shared ethos of homophobia in which that person lives, or grew up, and so on.
And all these can be in conflict with one another. For instance, one may live in a relatively non-homophobic society (like Rhode Island) with relatively few institutional policies that hinder people with same sex desire, but be in a more homophobic institution within this (such as a Catholic school), which nonetheless has a strong tradition of supporting individuals within the institution, and exposing them to very little interpersonal homophobia, so long as they maintain an internalized sense that their homosexuality is wrong.
So what's wrong with measuring internalized homophobia?
Based on the above, I obviously think that internalized homophobia is an important part of how homophobia/heteronormativity affect people. If nobody internalized homophobic assumptions, then it could not survive at a societal level either.
So why not measure it?
The article I read said that measures of internalized homophobia had very little predictive value for why some gay men get HIV and others don't. Not only that, but what predictive capacity it once had is rapidly diminishing. So, their argument was that it doesn't predict much, so measuring internalized homophobia may be a bit of a futile exercise.
But that wasn't entirely satisfying to me as a reason to avoid measuring it. So what if internalized homophobia has relatively little impact on HIV transmission - maybe it still plays a big role in some other health issue, like depression.
No, what I've decided bugs me about measuring internalized homophobia is the "internalized" part. I mean, describing "internalized homophobia" as a major health risk may in some sense be an important mechanism, but what sort of intervention does it lead to? How does one use that information to try to prevent disease, or better yet, promote health?
By describing "internalized homophobia" as a major health threat to sexual minority populations, the implication is that there are some of us who are in trouble (those of us who have internalized societal degradation as just), and others of us who are fine (we've coughed up the furball of societal hatred). Then what? Either the people who have internalized societal homophobia need some sort of intervention (which is paternalizing if that person is not actively seeking help), or they have some how brought these problems on themselves, failed to do what they need to do to take care of themselves.
The problem, as I see it, is that a focus on "internalized homophobia" focuses the potential for interventions internally, and doesn't take into account the full spectrum of the levels at which homophobia operates. Focusing on identifying and intervening with individuals who have internalized homophobia in no way explicitly challenges the broader social context within which these internalization processes occur.
-------------------------
Michael E. Newcomb, Brian Mustanski. (2009). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Archives of Sexual Behavior Epub aread of print 04 Nov 2009.
Michael W. Ross, B. R. Simon Rosser, Derek Smolenski. (2010). The importance of measuring internalized homophobia/homonegativity. Archives of Sexual Behavior Epub ahead of print 12 May 2010.
Sunday, August 23, 2009
Research Worth Reading (3)
There's a myth out there that gay men are self-obsessed and narcissistic, and I for one don't buy it.
David Nimmons, in Chapter 3 of his book Soul Beneath the Skin claims that on the contrary, gay men are actually more likely to get involved in volunteerism and altruistic behaviors, in part basing that on the enormous outpouring of volunteer time and energy devoted to AIDS service organizations.
Well, this is the first quantitative random sample analysis that really tries to get to the issue of whether gay men (and lesbians) are more or less altruistic than straight people. And that goal is what makes it 'research worth reading', in my opinion.
This is one of the few analyses that examines assets, rather than risks; one of a very small number of quantitative analyses to do so. So regardless of the results, regardless of the methodologic challenges, this is an important read in terms of thinking about the health of sexual minority populations.
The authors used data already collected as part of the General Social Survey (GSS), a random-dialed telephone survey of the US population conducted annully since the 1960's, a staple dataset for the social sciences.
They looked at four potential measures of altruism across groups of people defined by whether they reported ever having had sex with someone of the same sex, or whether they reported only mixed-sex sexual relationships. The sample size of the GSS is fairly large (they combined 2 years to get 2,031 people), but the number of men and women reporting same sex partners in their lifetimes was pretty small (68 men and 51 women), so they elected not to divide that group farther, but lumped together men who were homosexually active and bisexually active together, and the same for the women.
The GSS asked a 7-item scale intended to measure empathic concern (other-oriented feelings), a 4-item altruistic feelings scale (similar idea, as far as I can tell), a set of 11 altruistic behaviors (things that one does for others that have no self-serving interest, like giving directions to a stranger, even at some risk to one's self, such as donating blood), and 4 reciprocal behaviors (things that one does for another
, but do have self-serving aspects as well, like helping someone you know find a job, or lending a friend a considerable amount of money).
They found that gay/bi
men (at least in terms of reported sexual behavior) were very similar on all of these measures, in terms of the average. Of course, the average is just the average, it doesn't really say much about the distribution of individuals in the population, meaning there might be a bunch of ga
y/bi men who are much more altruistic (for example: helped 7 people find jobs, not just one) but that wouldn't be reflected in the average.
The lesbian/bi women were also very similar across all four measures of empathy and altruism.
So, the results are pretty vanilla. Looks like we're about as caring and other-centered as everyone else.
Blood donations
One interesting side note is that they found lots of people in GSS reporting having given blood recently, over 20% of exclusively hetero men, and almost as many of the gay/bi men. That's similar to what I saw in the same dataset and reported on here.
I suspect that there's something wrong with that variable, not because it shows lots of men with same sex sexual behavior giving blood, but because it shows many many more people of all stripes giving blood than actually do.
I don't know what the problem in GSS is about blood donation. Maybe a lot of people are interpreting it to mean gave blood ever in their lives, rather than just in the last year. Maybe a lot of people are interpreting having given a tube of blood for medical tests as having given blood. I don't know.
But at any rate, there are more credible results on blood donation in the National Health and Nutrition Examination Survey, which I reported on here.
Study limitations
The General Social Survey (GSS) is an amazing dataset. They ask tons of questions, and repeat a lot of them year after year. But, it is also very general, and not necessarily designed for whatever analysis you or I might have in mind, so when re-purposing it, it is important to hold in mind that the results may not be what they seem for a variety of reasons.
As is typical for epidemiologists, I'll break them down into three large categories: errors in assessing sexual orientation; errors in assessing altruism; and other factors that may be associated with both sexual orientation and altruism.
errors in assessing sexual orientation
The GSS is a telephone survey, and it is a really long survey. And not everyone pays close attention the whole time they are on the phone. As a result, some people inadvertently give answers that don't actually represent their reality, and in very rare cases, the interviewer records something other than what the respondent said.
All that would be well and good if a little bit of error here and there gets swapped from one group to another, but it gets problematic when one group is much smaller than the other (like sexual minorities). In this sample, 5% of the women and 6.6% of the men reported at least one sexual partner of the same sex in their lifetimes (since age 18). It's possible that maybe 4% of the women and 5% of the men really did have same sex partners, and the other 1-1.5% represent people who were inattentive or miscoded for some reason (this is purely hypothetical, there's no way to know what the error rate really is). So, if that were the case, then gay/bi men and lesbian/bi women would look more like straight people than they should, because a bunch of the people we think are gay/bi/lesbian really aren't (Scout's Law of Fake Queers).
The GSS actually has more opportunity than most datasets to check on this kind of error, because at different points they ask about sexual partners ever in one's lifetime, in the last five years, and in the last year. And there's always people who say they have had no sex in the last five years, but they have in the last year. No way to tell which of those is correct, but they can't both be true, so you can get a sense of the error rate that way. I haven't done that analysis myself, but it could be done.
Another way to check is to see whether the queers identified in this study look like queers identified in other studies. Most demographic studies have found that people who describe themselves as LBG, or who report same sex partners, tend to be slightly younger, more highly educated, and especially less likely to be married. In this study, they were somewhat younger (much younger for the women), but not more highly educated. The LGB people identified in this study were less likely to report being married, but still about 30% reported being married, which is pretty high.
For those reasons, I'm a bit skeptical that the GSS sample has really accurately described the LGB population, I suspect that there's a fair amount of 'slop' from the heteros mixed in with us.
errors in assessing altruism
Another potential source of error is if altruism is not measured accurately. This is an area I'm much less familiar with, in part because I just don't trust scales. The known inaccuracy of the blood donation question gives me some cause to interpret this study cautiously, but that could be a problem mainly with that one question for whatever reason, and not reflect systemically on the other measures in the study.
other factors associated with sexual orientation and altruism
I don't know enough about how altruism is distributed in the population. They separated the population by sex, and that's probably the biggie. There weren't enough people to do stratified analyses across any other variable (like age, educational attainment), but they did do a mathematically smoothed model to try to partially adjust for these factors simultaneously, and found no big difference from the overall results.
Full disclosure: Susan Cochran, the lead author on this study, was also the external reader for my dissertation. She and I have never discussed this paper, though. I don't think seeing her name on the paper made me especially more likely to choose it, I was hooked by the word 'altruism' before I saw that she was associated with it. I do think that knowing that she and Vickie write good research is why I asked her to be my external reader.
David Nimmons, in Chapter 3 of his book Soul Beneath the Skin claims that on the contrary, gay men are actually more likely to get involved in volunteerism and altruistic behaviors, in part basing that on the enormous outpouring of volunteer time and energy devoted to AIDS service organizations.
Well, this is the first quantitative random sample analysis that really tries to get to the issue of whether gay men (and lesbians) are more or less altruistic than straight people. And that goal is what makes it 'research worth reading', in my opinion.
This is one of the few analyses that examines assets, rather than risks; one of a very small number of quantitative analyses to do so. So regardless of the results, regardless of the methodologic challenges, this is an important read in terms of thinking about the health of sexual minority populations.
- Self-reported altruistic and reciprocal behavior among homosexually and heterosexually experienced adults: implications for HIV/AIDS service organizations.
Susan D. Cochran, Vickie Mays, Heather Corliss, Tom W. Smith, Joseph Turner
AIDS Care 21(6):675-682. June, 2009
The authors used data already collected as part of the General Social Survey (GSS), a random-dialed telephone survey of the US population conducted annully since the 1960's, a staple dataset for the social sciences.
They looked at four potential measures of altruism across groups of people defined by whether they reported ever having had sex with someone of the same sex, or whether they reported only mixed-sex sexual relationships. The sample size of the GSS is fairly large (they combined 2 years to get 2,031 people), but the number of men and women reporting same sex partners in their lifetimes was pretty small (68 men and 51 women), so they elected not to divide that group farther, but lumped together men who were homosexually active and bisexually active together, and the same for the women.
The GSS asked a 7-item scale intended to measure empathic concern (other-oriented feelings), a 4-item altruistic feelings scale (similar idea, as far as I can tell), a set of 11 altruistic behaviors (things that one does for others that have no self-serving interest, like giving directions to a stranger, even at some risk to one's self, such as donating blood), and 4 reciprocal behaviors (things that one does for another
, but do have self-serving aspects as well, like helping someone you know find a job, or lending a friend a considerable amount of money).They found that gay/bi
men (at least in terms of reported sexual behavior) were very similar on all of these measures, in terms of the average. Of course, the average is just the average, it doesn't really say much about the distribution of individuals in the population, meaning there might be a bunch of ga
y/bi men who are much more altruistic (for example: helped 7 people find jobs, not just one) but that wouldn't be reflected in the average.The lesbian/bi women were also very similar across all four measures of empathy and altruism.
So, the results are pretty vanilla. Looks like we're about as caring and other-centered as everyone else.
Blood donations
One interesting side note is that they found lots of people in GSS reporting having given blood recently, over 20% of exclusively hetero men, and almost as many of the gay/bi men. That's similar to what I saw in the same dataset and reported on here.
I suspect that there's something wrong with that variable, not because it shows lots of men with same sex sexual behavior giving blood, but because it shows many many more people of all stripes giving blood than actually do.
I don't know what the problem in GSS is about blood donation. Maybe a lot of people are interpreting it to mean gave blood ever in their lives, rather than just in the last year. Maybe a lot of people are interpreting having given a tube of blood for medical tests as having given blood. I don't know.
But at any rate, there are more credible results on blood donation in the National Health and Nutrition Examination Survey, which I reported on here.
Study limitations
The General Social Survey (GSS) is an amazing dataset. They ask tons of questions, and repeat a lot of them year after year. But, it is also very general, and not necessarily designed for whatever analysis you or I might have in mind, so when re-purposing it, it is important to hold in mind that the results may not be what they seem for a variety of reasons.
As is typical for epidemiologists, I'll break them down into three large categories: errors in assessing sexual orientation; errors in assessing altruism; and other factors that may be associated with both sexual orientation and altruism.
errors in assessing sexual orientation
The GSS is a telephone survey, and it is a really long survey. And not everyone pays close attention the whole time they are on the phone. As a result, some people inadvertently give answers that don't actually represent their reality, and in very rare cases, the interviewer records something other than what the respondent said.
All that would be well and good if a little bit of error here and there gets swapped from one group to another, but it gets problematic when one group is much smaller than the other (like sexual minorities). In this sample, 5% of the women and 6.6% of the men reported at least one sexual partner of the same sex in their lifetimes (since age 18). It's possible that maybe 4% of the women and 5% of the men really did have same sex partners, and the other 1-1.5% represent people who were inattentive or miscoded for some reason (this is purely hypothetical, there's no way to know what the error rate really is). So, if that were the case, then gay/bi men and lesbian/bi women would look more like straight people than they should, because a bunch of the people we think are gay/bi/lesbian really aren't (Scout's Law of Fake Queers).
The GSS actually has more opportunity than most datasets to check on this kind of error, because at different points they ask about sexual partners ever in one's lifetime, in the last five years, and in the last year. And there's always people who say they have had no sex in the last five years, but they have in the last year. No way to tell which of those is correct, but they can't both be true, so you can get a sense of the error rate that way. I haven't done that analysis myself, but it could be done.
Another way to check is to see whether the queers identified in this study look like queers identified in other studies. Most demographic studies have found that people who describe themselves as LBG, or who report same sex partners, tend to be slightly younger, more highly educated, and especially less likely to be married. In this study, they were somewhat younger (much younger for the women), but not more highly educated. The LGB people identified in this study were less likely to report being married, but still about 30% reported being married, which is pretty high.
For those reasons, I'm a bit skeptical that the GSS sample has really accurately described the LGB population, I suspect that there's a fair amount of 'slop' from the heteros mixed in with us.
errors in assessing altruism
Another potential source of error is if altruism is not measured accurately. This is an area I'm much less familiar with, in part because I just don't trust scales. The known inaccuracy of the blood donation question gives me some cause to interpret this study cautiously, but that could be a problem mainly with that one question for whatever reason, and not reflect systemically on the other measures in the study.
other factors associated with sexual orientation and altruism
I don't know enough about how altruism is distributed in the population. They separated the population by sex, and that's probably the biggie. There weren't enough people to do stratified analyses across any other variable (like age, educational attainment), but they did do a mathematically smoothed model to try to partially adjust for these factors simultaneously, and found no big difference from the overall results.
Full disclosure: Susan Cochran, the lead author on this study, was also the external reader for my dissertation. She and I have never discussed this paper, though. I don't think seeing her name on the paper made me especially more likely to choose it, I was hooked by the word 'altruism' before I saw that she was associated with it. I do think that knowing that she and Vickie write good research is why I asked her to be my external reader.
Tuesday, March 31, 2009
Research Worth Reading
A report out of the UK gives some promising news, or is it depressing. I'm not sure.
The authors surveyed 1,328 shrinks of various sorts about how they would deal with a client whose main goal was to change from lesbian, gay, or bisexual into a heterosexual.
Only 55 (4%) said that they would help an LGB person try to become straight.
I don't know if it's promising that so few (UK) psychiatrists and therapists would help someone try to change their sexual orientation, or depressing that so many would.
It gets more depressing when you read on to discover that an additional 10% would try to refer the prospective client to someone else who would be willing to help them try to change.
This comes 52 years after the British Wolfenden Report concluded that "none of our medical witnesses were able ... to provide any reference in the medical literature to a complete change".
I think the most interesting part of the report, though, is the justifications that the shrinks who said they would try to help someone change their sexual orientation gave.
Although they reported a wide range of justifications, I want to focus on the idea of promoting patient autonomy. A quick sample of these follow:
“We have a responsibility to assist our patients with self-determination.”
“It is up to the person themselves to decide which direction to go in. I am just the sounding board for them to make their own decisions.”
“Client ultimately knows best and may have deep religious beliefs that influence them enormously.”
“(the) client is ‘the expert’ and I deal with their realities rather than mine.”
“People should be given the opportunity to choose to redirect their sexual feelings depending on their circumstances. For example the homosexual man I helped to become heterosexual came from a working class background where it was completely unacceptable to deviate from the norm. It was extremely important to him to be accepted by that community.”
The dilemma for me is that I'm a big proponent of autonomy and self-determination; that health care providers should spend more time helping people get where they want to go, and less time telling them where to go.
So, on the one hand, I agree with this (small minority) of shrinks that patient autonomy is a very strong ethic that should not be violated.
Any yet, I wonder how many of these shrinks would be such strong defenders of patient autonomy when presented with someone who wanted to become lesbian or gay? How many would assist someone who wanted to develop the ability to see through walls? Or who felt that their life would be so much better if they were just three inches taller?
Would these shrinks be such forceful advocates of patient autonomy when a person wants help to live as the gender they feel they are, not the body they were born into?
I believe the kindest thing to do would be to explain that the change they are trying to undertake is not possible, but perhaps it is better to humor someone's interest in trying to change their orientation long enough to develop a deeper therapeutic relationship that can begin to help them find more realistic ways to live in their bodies, in their minds, and in their communities in a more harmonious fashion.
Hmmm. Certainly has me confused about what the "right" thing to do is.
Annie Bartlett, Glenn Smith, Michael King. (2009). The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation. BMC Psychiatry 9:11. http://www.biomedcentral.com/1471-244X/9/11
Report of the Committee on Homosexual Offences and Prostitution. (1957). Her Majesty's Stationary Office, London.
The authors surveyed 1,328 shrinks of various sorts about how they would deal with a client whose main goal was to change from lesbian, gay, or bisexual into a heterosexual.
Only 55 (4%) said that they would help an LGB person try to become straight.
I don't know if it's promising that so few (UK) psychiatrists and therapists would help someone try to change their sexual orientation, or depressing that so many would.
It gets more depressing when you read on to discover that an additional 10% would try to refer the prospective client to someone else who would be willing to help them try to change.
This comes 52 years after the British Wolfenden Report concluded that "none of our medical witnesses were able ... to provide any reference in the medical literature to a complete change".
I think the most interesting part of the report, though, is the justifications that the shrinks who said they would try to help someone change their sexual orientation gave.
Although they reported a wide range of justifications, I want to focus on the idea of promoting patient autonomy. A quick sample of these follow:
“We have a responsibility to assist our patients with self-determination.”
“It is up to the person themselves to decide which direction to go in. I am just the sounding board for them to make their own decisions.”
“Client ultimately knows best and may have deep religious beliefs that influence them enormously.”
“(the) client is ‘the expert’ and I deal with their realities rather than mine.”
“People should be given the opportunity to choose to redirect their sexual feelings depending on their circumstances. For example the homosexual man I helped to become heterosexual came from a working class background where it was completely unacceptable to deviate from the norm. It was extremely important to him to be accepted by that community.”
The dilemma for me is that I'm a big proponent of autonomy and self-determination; that health care providers should spend more time helping people get where they want to go, and less time telling them where to go.
So, on the one hand, I agree with this (small minority) of shrinks that patient autonomy is a very strong ethic that should not be violated.
Any yet, I wonder how many of these shrinks would be such strong defenders of patient autonomy when presented with someone who wanted to become lesbian or gay? How many would assist someone who wanted to develop the ability to see through walls? Or who felt that their life would be so much better if they were just three inches taller?
Would these shrinks be such forceful advocates of patient autonomy when a person wants help to live as the gender they feel they are, not the body they were born into?
I believe the kindest thing to do would be to explain that the change they are trying to undertake is not possible, but perhaps it is better to humor someone's interest in trying to change their orientation long enough to develop a deeper therapeutic relationship that can begin to help them find more realistic ways to live in their bodies, in their minds, and in their communities in a more harmonious fashion.
Hmmm. Certainly has me confused about what the "right" thing to do is.
Annie Bartlett, Glenn Smith, Michael King. (2009). The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation. BMC Psychiatry 9:11. http://www.biomedcentral.com/1471-244X/9/11
Report of the Committee on Homosexual Offences and Prostitution. (1957). Her Majesty's Stationary Office, London.
Tuesday, January 13, 2009
Research Worth Reading (2)
Well, the first installment of Research Worth Reading was such a hit I'll try my hand at another.
This article is interesting to me because it attempts to measure the impact of a changing society on gay men's health, which is similar to what my dissertation thesis work was about, too. My interest is mainly in their approach and rationale. Unfortunately, their results didn't pan out the way I would have hoped, but it's important to take negative results humbly into consideration as well.
I came across this article while doing some background reading on excellent health, in my quest to understand why gay men (at least in California) are more likely than str8 men to be in excellent health.
Health-related quality of life in homo- and bisexual men attending a sexually transmitted disease clinic in Sweden.
Lars E. Eriksson & T. Berglund (2007)
International Journal of STD & AIDS 18:207-211.
In 1996, these guys asked 164 men who came to the Karolinska University Gay Men's Health Clinic (basically an STD clinic, from what I can tell) a ton of questions about their well-being and quality of life, and then they did the same thing again in 2004 with 201 different gay/bi men.
They reasoned that since major shifts in Swedish law had occurred between these dates (gay rights protections and recognition of similar gender marriage), the quality of life of gay men would have improved as a result.
So, they compared the average health/well-being/quality of life of the gay/bi men they interviewed in 1996 with the gay/bi men interviewed in 2004. All-in-all, there was not any big improvement, counter to their expectation.
For example, they measured 'general health perception' on a scale from 0-100, and half the men in 1996 gave responses between 72 and 94, while in 2004, half the men gave responses between 67 and 94, so there's really not much difference in these distributions.
Why not?
The authors puzzled over why they didn't see improvements in gay men's health in Sweden: "Firstly, it might require a longer time frame for the positive changes in legislation and attitudes to have positive influences on the individual experience of health-related quality of life. Secondly, other factors could counteract the legal and attitudinal changes... {such as} hate crimes related to homophobia, a phenomenon that has increased in Sweden during the last few years. Another reason could be the increased vulnerability due to health aspects. For example, since the 1990s, the STD incidence among MSM has increased...in Sweden."
Of these, I find the first the most compelling. Although in my own study, there doesn't seem to be much, if any, lag time between the societal attitudinal changes resulting in passing a gay rights law and reductions in white male teen suicide rates. On the other hand, the men they studied were mostly adults, whose general well-being may be more influenced by conditions during their own adolesence than the rapid changes that occurred in Sweden in the late 1990's. If that's the case, they might well see effects if they compared young gay men who "came of age" since 2000 to young gay men who came of age in years past.
The second argument (that some countervailing force undid whatever benefits came about from changes in societal attitudes around homosexuality) rings hollow to me. I base this on the fact that, in the US anyway, one finds the highest hate crime rates in areas that are most tolerant of homosexuality. At first, this doesn't make sense, but when you stop to think about it, crimes are only counted if they are reported, and once reported if they are taken seriously and recorded. So, it is not surprising that hate crime reporting is higher in more tolerant areas, even if hate crime rates may not be.
The third argument (that rising STD rates are responsible for gay/bi men in Sweden not feeling their best) also rings hollow to me. It might affect the gay men who do get STDs, but that's a minority, and the overall distributions of health are pretty much the same in both years, it's not like some men are feeling less healthy and others are feeling healthier, resulting in the same average.
One explanation that they seem not to have considered is that the gay/bi men that they interviewed in both years were generally very healthy on all subscales, so that there just wasn't a lot of (statistical) room for improvement. For example, over half the gay/bi men in 1996 reported no pain at all, and thus scored 100/100 on that scale. So, it would be virtually impossible to show any improvement in that measure. And that was the case for 6 of the 13 subscales they assessed.
At any rate, the thing that excited me about this paper was that it is another example of trying to understand the impact of shifts in public discourse on health, and it was also looking at health as a positive attribute, not the absence of illness. It's too bad that their results didn't pan out...
This article is interesting to me because it attempts to measure the impact of a changing society on gay men's health, which is similar to what my dissertation thesis work was about, too. My interest is mainly in their approach and rationale. Unfortunately, their results didn't pan out the way I would have hoped, but it's important to take negative results humbly into consideration as well.
I came across this article while doing some background reading on excellent health, in my quest to understand why gay men (at least in California) are more likely than str8 men to be in excellent health.
Health-related quality of life in homo- and bisexual men attending a sexually transmitted disease clinic in Sweden.
Lars E. Eriksson & T. Berglund (2007)
International Journal of STD & AIDS 18:207-211.
In 1996, these guys asked 164 men who came to the Karolinska University Gay Men's Health Clinic (basically an STD clinic, from what I can tell) a ton of questions about their well-being and quality of life, and then they did the same thing again in 2004 with 201 different gay/bi men.
They reasoned that since major shifts in Swedish law had occurred between these dates (gay rights protections and recognition of similar gender marriage), the quality of life of gay men would have improved as a result.
So, they compared the average health/well-being/quality of life of the gay/bi men they interviewed in 1996 with the gay/bi men interviewed in 2004. All-in-all, there was not any big improvement, counter to their expectation.
For example, they measured 'general health perception' on a scale from 0-100, and half the men in 1996 gave responses between 72 and 94, while in 2004, half the men gave responses between 67 and 94, so there's really not much difference in these distributions.
Why not?
The authors puzzled over why they didn't see improvements in gay men's health in Sweden: "Firstly, it might require a longer time frame for the positive changes in legislation and attitudes to have positive influences on the individual experience of health-related quality of life. Secondly, other factors could counteract the legal and attitudinal changes... {such as} hate crimes related to homophobia, a phenomenon that has increased in Sweden during the last few years. Another reason could be the increased vulnerability due to health aspects. For example, since the 1990s, the STD incidence among MSM has increased...in Sweden."
Of these, I find the first the most compelling. Although in my own study, there doesn't seem to be much, if any, lag time between the societal attitudinal changes resulting in passing a gay rights law and reductions in white male teen suicide rates. On the other hand, the men they studied were mostly adults, whose general well-being may be more influenced by conditions during their own adolesence than the rapid changes that occurred in Sweden in the late 1990's. If that's the case, they might well see effects if they compared young gay men who "came of age" since 2000 to young gay men who came of age in years past.
The second argument (that some countervailing force undid whatever benefits came about from changes in societal attitudes around homosexuality) rings hollow to me. I base this on the fact that, in the US anyway, one finds the highest hate crime rates in areas that are most tolerant of homosexuality. At first, this doesn't make sense, but when you stop to think about it, crimes are only counted if they are reported, and once reported if they are taken seriously and recorded. So, it is not surprising that hate crime reporting is higher in more tolerant areas, even if hate crime rates may not be.
The third argument (that rising STD rates are responsible for gay/bi men in Sweden not feeling their best) also rings hollow to me. It might affect the gay men who do get STDs, but that's a minority, and the overall distributions of health are pretty much the same in both years, it's not like some men are feeling less healthy and others are feeling healthier, resulting in the same average.
One explanation that they seem not to have considered is that the gay/bi men that they interviewed in both years were generally very healthy on all subscales, so that there just wasn't a lot of (statistical) room for improvement. For example, over half the gay/bi men in 1996 reported no pain at all, and thus scored 100/100 on that scale. So, it would be virtually impossible to show any improvement in that measure. And that was the case for 6 of the 13 subscales they assessed.
At any rate, the thing that excited me about this paper was that it is another example of trying to understand the impact of shifts in public discourse on health, and it was also looking at health as a positive attribute, not the absence of illness. It's too bad that their results didn't pan out...
Friday, January 2, 2009
Research Worth Reading
About a month ago, I was engaged in an on-line discussion about what constitutes 'lousy' research. In my opinion, the majority of health research related to gay men qualifies as 'lousy'. But, I thought it would be a good idea to focus on research worth reading, holding up examples of research that is well conceived and thought-provoking.
So, I went on to webofscience.com and rooted through the most recent stuff pertaining to 'gay' and 'health'. I went through literally hundreds of titles and dozens of abstracts before finding the first article that I actually wanted to read.
So, here's the first installment of 'research worth reading'.
A Phenomenological Investigation of the Experience of Taking Part in 'Extreme Sports'
Carla Willig, City University, London, UK
Journal of Health Psychology 13(5):690-702
DOI: 10.1177/1359105307082459
Abstract: "This article is concerned with what it may mean to individuals to engage in practices that are physically challenging and risky. The article questions the assumptions that psychological health is commensurate with maintaining physical safety, and that risking one's health and physical safety is necessarily a sign of psychopathology. The research was based upon semi-structured interviews with eight extreme sport practitioners. The interviews were analysed using Colaizzi's version of the phenomenological method. The article explicates the themes identified in the analysis, and discusses their implications for health psychology theory and practice."
The thing that grabbed my attention about this article is that it is trying to understand 'risk' from an inherently non-pathological perspective. Basically, the author interviewed eight people who frequently engage in extreme sports (sky diving, mountaineering, etc.) about why they do it and what they get out of it.
I thought that was a brilliant strategy to get past some of the problems presented by risk-oriented thinking in various health fields, and she definitely puts it in that same context.
She encourages the reader to imagine a parallel non-pathologizing approach to understanding health-related risk taking, from smoking and diet, to speeding and unprotected sex. And so I was reading along thinking about what parallels there were to what she reported hearing in those interviews with gay men and sex. Some of it seems to fit perfectly, and some seems incongruous. The point, for me anyway, is not to portray gay sex as entirely analogous to extreme sports, but rather to begin to re-conceptualize the reasons gay men have sex they way they do that isn't about 'making bad choices' on one hand, or being completely overwhelmed by structural forces (the internalization of homophobia, racism, etc.) on the other. Of course, this re-conceptualization happens all the time, but it seems to have a hard time sinking in to public health types.
A choice quote framing her motivation for conducting the study:
"... behavioural choices that do not prioritize health and safety constitute a challenge to psychologists, and one way of meeting this challenge has been to re-conceptualize such choices as the product of psychopathology or false beliefs, and thus not really choices at all. ... An alternative viewpoint would be that there is more than one rationality and that ... it is possible, and worthwhile, to attempt to bring to light their meaning and value to those who engage in them."
Parallels with the experiences of, and motivation to participate in, extreme sports
Just imagine the parallels while reading these quotes about extreme sports participation.
"...among those who practise a particular extreme sport there may exist a strong bond and strong feelings of comraderie generated by being together during moments of great vulnerability."
"The experience offers its participants access to combinations of feelings and sensations which are not available in everyday life."
"In some cases, a sense of loss of control and letting other people take responsibility for one's safety forms an important part of the experience as a whole."
"...taking part in these activities constitutes an extremely important part of one's life and that one's sense of self, identity and well-being is clearly bound up with them. ... life without it was inconceivable."
"Gaining experience and getting better at performing the sport generated a sense of mastery, and this was experienced as rewarding."
"... one's world is reduced to the immediate present. Participants described life becoming very 'simple' and 'straightforward' ... Participants experienced this sense of being in the present as calming and relaxing, comparable to a 'meditative state'. It allowed them to lose themselves in the present and to be momentarily freed from the concerns and responsibilities associated with everyday life."
"...taking part in extreme sports on a regular basis was experienced as therapeutic, reducing stress levels and preventing the build up of tension by minimizing the significance of past and future concerns."
"the experience of extreme sport provided something vital for participants which they could not access in other ways."
"There was a sense of pleasure through feeling alive, energized and vital ... sometimes lasting for days afterwards. They were felt throughout the body and they seemed to lie outside the normal range of emotions experienced by participants in their everyday life."
"...what may appear, from an outsider point-of-view, as reckless ... participants' own accounts suggest that what is required is a carefully staged scenario which produces just the right balance between challenge and comfort in order to allow a certain kind of {transcendent} experience to become possible."
"...the acquisition of the necessary skills and experience takes place over time, ... and may involve status and identity formation within the context of a community of likeminded and supportive peers."
"...taking part in extreme sports activities means more to participants than searching for thrills and excitement, ... they are making informed choices rather than simply acting out unresolved conflicts or implementing distorted cognitions."
"These observations raise questions about the extent to which taking part in extreme sports may itself constitute a therapeutic experience."
"From this perspective, the adoption of what may appear to be extreme, excessive or maladaptive practices or preferences may, in fact, be ways of (re-)establishing psychological balance by adding missing meaning elements and by allowing neglected or marginalized dimensions of existence to be lived."
So, I went on to webofscience.com and rooted through the most recent stuff pertaining to 'gay' and 'health'. I went through literally hundreds of titles and dozens of abstracts before finding the first article that I actually wanted to read.
So, here's the first installment of 'research worth reading'.
A Phenomenological Investigation of the Experience of Taking Part in 'Extreme Sports'
Carla Willig, City University, London, UK
Journal of Health Psychology 13(5):690-702
DOI: 10.1177/1359105307082459
Abstract: "This article is concerned with what it may mean to individuals to engage in practices that are physically challenging and risky. The article questions the assumptions that psychological health is commensurate with maintaining physical safety, and that risking one's health and physical safety is necessarily a sign of psychopathology. The research was based upon semi-structured interviews with eight extreme sport practitioners. The interviews were analysed using Colaizzi's version of the phenomenological method. The article explicates the themes identified in the analysis, and discusses their implications for health psychology theory and practice."
The thing that grabbed my attention about this article is that it is trying to understand 'risk' from an inherently non-pathological perspective. Basically, the author interviewed eight people who frequently engage in extreme sports (sky diving, mountaineering, etc.) about why they do it and what they get out of it.
I thought that was a brilliant strategy to get past some of the problems presented by risk-oriented thinking in various health fields, and she definitely puts it in that same context.
She encourages the reader to imagine a parallel non-pathologizing approach to understanding health-related risk taking, from smoking and diet, to speeding and unprotected sex. And so I was reading along thinking about what parallels there were to what she reported hearing in those interviews with gay men and sex. Some of it seems to fit perfectly, and some seems incongruous. The point, for me anyway, is not to portray gay sex as entirely analogous to extreme sports, but rather to begin to re-conceptualize the reasons gay men have sex they way they do that isn't about 'making bad choices' on one hand, or being completely overwhelmed by structural forces (the internalization of homophobia, racism, etc.) on the other. Of course, this re-conceptualization happens all the time, but it seems to have a hard time sinking in to public health types.
A choice quote framing her motivation for conducting the study:
"... behavioural choices that do not prioritize health and safety constitute a challenge to psychologists, and one way of meeting this challenge has been to re-conceptualize such choices as the product of psychopathology or false beliefs, and thus not really choices at all. ... An alternative viewpoint would be that there is more than one rationality and that ... it is possible, and worthwhile, to attempt to bring to light their meaning and value to those who engage in them."
Parallels with the experiences of, and motivation to participate in, extreme sports
Just imagine the parallels while reading these quotes about extreme sports participation.
"...among those who practise a particular extreme sport there may exist a strong bond and strong feelings of comraderie generated by being together during moments of great vulnerability."
"The experience offers its participants access to combinations of feelings and sensations which are not available in everyday life."
"In some cases, a sense of loss of control and letting other people take responsibility for one's safety forms an important part of the experience as a whole."
"...taking part in these activities constitutes an extremely important part of one's life and that one's sense of self, identity and well-being is clearly bound up with them. ... life without it was inconceivable."
"Gaining experience and getting better at performing the sport generated a sense of mastery, and this was experienced as rewarding."
"... one's world is reduced to the immediate present. Participants described life becoming very 'simple' and 'straightforward' ... Participants experienced this sense of being in the present as calming and relaxing, comparable to a 'meditative state'. It allowed them to lose themselves in the present and to be momentarily freed from the concerns and responsibilities associated with everyday life."
"...taking part in extreme sports on a regular basis was experienced as therapeutic, reducing stress levels and preventing the build up of tension by minimizing the significance of past and future concerns."
"the experience of extreme sport provided something vital for participants which they could not access in other ways."
"There was a sense of pleasure through feeling alive, energized and vital ... sometimes lasting for days afterwards. They were felt throughout the body and they seemed to lie outside the normal range of emotions experienced by participants in their everyday life."
"...what may appear, from an outsider point-of-view, as reckless ... participants' own accounts suggest that what is required is a carefully staged scenario which produces just the right balance between challenge and comfort in order to allow a certain kind of {transcendent} experience to become possible."
"...the acquisition of the necessary skills and experience takes place over time, ... and may involve status and identity formation within the context of a community of likeminded and supportive peers."
"...taking part in extreme sports activities means more to participants than searching for thrills and excitement, ... they are making informed choices rather than simply acting out unresolved conflicts or implementing distorted cognitions."
"These observations raise questions about the extent to which taking part in extreme sports may itself constitute a therapeutic experience."
"From this perspective, the adoption of what may appear to be extreme, excessive or maladaptive practices or preferences may, in fact, be ways of (re-)establishing psychological balance by adding missing meaning elements and by allowing neglected or marginalized dimensions of existence to be lived."
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