The Future of Conversion Therapy Through Neuroscience: Shall We Turn-Off the Turn-On? - Written by Tague Zachary

There is a video online, starring a mouse in a cage, with cheese strewn about and a wire attached to the top of its head. The wire leads out of the screen, presumably to a researcher with some switch. The power that this man has with the flip of that switch is truly inspiring.

It is also terrifying.

This switch triggers a light to shine into the brain of the mouse. Moments before the switch, the critter was wanders around the cage, maybe sniffing the food, but paying no more attention to it than the rest of the cage. The wire’s light turns on. The mouse immediately begins devouring the food in front of itself, wasting no time to find another piece once the first is gone. And when the light switches off, the mouse goes back to sniffing and wandering, just as quickly as the frenzy had begun.

The possibilities of neurological intervention in disease as well as every-day life are frightening, especially when considering how quickly these interventions can act on the brain and body. With the right set of neural stimulation, people may eventually be able to remake their minds, causing one question the malleability of a personal and seemingly static facet of one’s life: their identity. One such identity that is usually thought of as constant is sexual identity, and an interesting question immediately springs to mind. Should people be allowed to control their sexuality? Yes. It is their body, their life, and their orientation poses no threat to anyone. However: should people be allowed to undergo an operation to reverse homosexuality? I admit, it is hard to imagine what society will be like once we figure out how such a neurological alteration can be performed. However, there is one practice that has been in use and is still in use that provides an interesting context for this discussion: Conversion therapy.

Conversion therapy (i.e. reparative therapy) is a “treatment” aimed at curing people of their homosexual ways. Some techniques of conversion therapy include coupling a homoerotic stimuli with an aversive one, like an electric shock or nausea-inducing drugs. These risks are especially prevalent in minors, who usually do not undergo the therapy by choice, but by the harsh force of their parents. The American Psychiatric Association (APA) strongly maintains that homosexuality and bisexuality are not diseases and are not in need of therapy. Furthermore, they recognize that there is no rigorous scientific evidence supporting the claimed effects of reparative therapy, and that it is potentially dangerous. Much of this research was considered when California passed a law banning reparative therapy on people under the age of 18, where they concluded that “the potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior.” However, despite the body of evidence and affirmation from the APA that this rehabilitation should not be practiced, New Jersey is only one other state that has banned the “cure”.

Figure 1. Conversion therapy for minors is only banned in two states: California and New Jersey.

Outlawing conversion therapy may eventually become common-place in state law, just as legalizing same sex marriage has been realized or is gaining traction in many states. These changes have arisen or will arise due to shift in public opinion towards homosexuality, and it will continue to shift as people are made aware of the harmful effects of conversion therapy.

However, the abuse of conversion therapy may not be an issue in the future if this neurological intervention becomes a reality. A bigot from the 50’s (2050’s) will say, “Hey, with this combination of brain stimulation, we can inhibit all homosexual desires, and we can do it without harming the person!” The harm, however, does not solely lie behind the direct mental and physical damage caused.

Even if we assume that this hypothetical cure did not have any immediate bad side effects, one still must consider the indirect effects of making his operation available to the public. One such effect is coercion. This operation is not a problem for the people who choose to undergo the surgery via their own agency. The issue arises when people are pressured by others in the community to have the surgery. Possibly in addition to the coercion by the community, one might be forced by their parents to have the change made, just like the parents who made their children go through conversion therapy. When teens are considering the terrifying idea of coming out to their parents, they might be less likely to do it if they know that their parents will force them to undergo the operation. With the current politics, as can be seen in Figure 1, most states would feel very little motivation in passing legislation to ban this “treatment”.

Dr. Alice Dreger, from Northwestern University Medical School, wrote an article about the possibility of being able to decide a baby’s sexual orientation while it was still in the womb. She noted that “it seems hard to believe that in practice it won’t lead to support of the idea that one ought to try not to have a gay child”. In the more homophobic communities in the United States, it would become the parents’ fault for not electing to undergo the treatment. This sexual identity, which seems determined from birth, is now subject to the parents’ choice. The same issue arises for people who have the option to undergo the operation themselves. Unfortunately, it will be subject to the influence of the community, which may or may not want what the individual does.

By now, we can revisit the question that was posed earlier: should an operation to inhibit ones homosexuality be allowed to the public? No. The possibility of force or coercion in today’s society poses too great of a threat to homosexual people in a homophobic environment. The medical need for such an operation is not present because homosexuality is not a disease. The operation, however, would mostly be used to reverse homosexuality, propagating the idea that it should be reversed.

Do Sex Differences in Musical Perception and Emotional Response Exist?

Even before birth, humans demonstrate the ability to perceive sound and respond to this stimulus by eliciting heart rate changes and movement (Abrams 1995). This auditory perception may be useful in allowing newborn infants to recognize their mother’s voice and quickly develop an intimate relationship (DeCasper and Prescott 1984). With regards to music, mothers often communicate with infants by exaggerating melodic contour, or the ups and downs of melody, to convey emotional meaning even before the infant can understand their language (Fernald et al. 1989). This communicative strategy simultaneously initiates the infant’s musical development. Several perceptive mechanisms in music emerge from this beginning: harmony, rhythm, pitch relations, scale structure, and discrimination between consonance and dissonance (Winkler et al. 2009).

Some of these mechanisms undergo unique development that mirror essential aspects of human brain activity. For example, infants can actually outperform adults in remembering artificial scales, due to adult enculturation of conventional scales at the expense of unfamiliar ones (Trehub et al. 1999). Composers like Debussy often employ similarly unfamiliar scales in their music, such as the popular Claire de Lune. Alternatively, another study comparing infants and adults discovered that both groups prefer consonant intervals, suggesting that humans may possess a congenital preference for consonance in music, irrespective of specific development (Schellenberg and Trainor 1996). Investigations of brain activity have even discovered specific brain regions that process consonance, regions also involved in the emotional response (Blood et al. 1999). Perhaps this indicates an innate, emotional attraction toward certain sounds in music. Other perceptive mechanisms, such as pitch relations, have been manipulated to confuse listener’s perception. One intriguing project, the Shepard scale, utilizes ambiguous timbre and seemingly never-ending pitch height to arouse emotions (Shepard 1964). This evoked emotional arousal occurs when expectancies of upcoming pitches are not met (Huron 2006), and may further reflect the connection between music and emotion seen in consonance.

Among all the senses, sound has a unique power to arouse intense feelings. As championed by philosopher John Dewey (1934), “sounds come from outside the body, but sound itself is near, intimate; an excitation of the organism . . . vision arouses emotion in the form of interest . . . it is sound that makes us jump.” Music, or the organization of sound, is thus a robust way to convey emotion and immerse oneself in feeling. Emotional contagion (the phenomenon that perceiving an emotion induces the same emotion) occurs frequently in music to dramatic effect: fast, bright music with exaggerated rhythmic contrast may motivate the audience to jovial action whereas a slow, soft performance heavy in vibrato may generate sadness or longing (Thompson 2009). In addition to these psychophysical cues, music can trigger visual images (e.g., a stormy night) that may include emotional connotations, or music itself may remind someone of an emotionally significant memory (e.g., a romantic evening) (Juslin and Sloboda 2013). These evoked emotions, whether psychophysical, multisensory, or relational, sometimes differ between the sexes.

Sex differences in musical perception, especially related to emotion, are intriguing despite a lack of consensus by scholars. For example, a study in which children were subjected to harmonious and inharmonious chord progressions yielded clear differences in electric brain potentials: boys showed lateralized activation in the right brain hemisphere while girls demonstrated bilateral activation (especially Figure 3C, Koelsch et al. 2003).

Alternatively, some researchers have uncovered opposite mental recruitment in adult males (Koelsch et al. 2002) or actually increased lateralization in women (Evers et al. 1999). These disparate results suggest that during childhood development, neurological investment in musical perception shifts – an indication of neuroplasticity. However, other studies conclude that no sex difference in physiological responses (e.g., skin conductance, finger temperature, heart rate, and facial expression) occurs during exposure to emotionally powerful music (Lundqvist et al. 2009; Rickard 2004; Robazza et al. 1994). Although this null result is compelling, their conclusion seems questionable considering that they relied on physiological responses instead of brain imaging. Thus, sex differences in the brain’s emotional response may differ by sex even though the body’s responses to emotionally significant music are similar in all people. Further research should explore a potential connection between these lateralized activational studies and induced physiological responses, so that a more complete portrayal of musical perception and emotion can be understood. This future work may not only identify sex differences in this pathway, but evaluate the influence of age, cultural background, and musical training on experiencing the sound of music.

References

Abrams, R. 1995. Some aspects of the fetal sound environment. In I. Deliege and J. Sloboda (eds.), Perception and cognition of music (pp. 83-101). Hove, UK: Psychology Press.

Blood, A., R. Zatorre, P. Bermudez, and A. Evans. 1999. Emotional responses to pleasant and unpleasant music correlate with activity in paralimbic brain regions. Nature Neuroscience 2: 382-387.

DeCasper, A. and P. Prescott. 1984. Human newborns’ perception of male voices: preference, discrimination, and reinforcing value. Developmental Psychobiology 17: 481-491.

Dewey, J. 1934. Art as experience. New York: Minton, Balch.

Evers, S., J. Dannert, D. Rodding, G. Rotter, and E. Ringelst. 1999. The cerebral haemodynamics of music perception. Brain 122: 75-85.

Fernald, A., et al. 1989. A cross-language study of prosodic modifications in mothers’ and fathers’ speech to preverbal infants. Journal of Child Language, 16: 477-501.

Huron, D. 2006. Sweet anticipation: music and the psychology of expectation. Cambridge, MA: MIT Press.

Juslin, P., and J. Sloboda. 2013. Music and Emotion. In Diana Deutsch (ed), The psychology of music (3^rd ed., pp. 583-645). London: Academic Press.

Koelsch, S., et al. 2003. Children processing music: electric brain responses reveal musical competence and gender differences. Journal of Cognitive Neuroscience 15: 683-693.

Koelsch, S., B. Maess, T. Grossmann, and A. Friederici. 2002. Sex difference in music-syntactic processing. NeuroReport 14: 709-712.

Lundqvist, L., F. Carlsson, P. Hilmersson, and P. Juslin. 2009. Emotional responses to music: experience, expression, and physiology. Psychology of Music 37: 61-90.

Rickard, N. 2004. Intense emotional responses to music: a test of the physiological arousal hypothesis. Psychology of Music 32: 371-388.

Robazza, C., C. Macaluso, and V. D’Urso. 1994. Emotional reactions to music by gender, age, and expertise. Perceptual and Motor Skills 79: 939-944.

Schellenberg, E., and L. Trainor. 1996. Sensory consonance and the perceptual similarity of complex-tone harmonic intervals: tests of adult and infant listeners. Journal of the Acoustical Society of America 100: 3321-3328.

Shepard, R. 1964. Circularity in judgments of relative pitch. Journal of the Acoustical Society of America 36: 2345-2353.

Thompson, W. 2009. Music, thought, and feeling. New York, NY: Oxford University Press.

Trehub, S., E. Schellenberg, and S. Kamenetsky. 1999. Infants’ and adults’ perception of scale structure. Journal of Experimental Psychology: Human Perception and Performance 25: 965-975.

Winkler, I., G. Haden, O. Ladinig, I. Sziller, and H. Honing. 2009. Newborn infants detect the beat in music. Proceedings of the National Academy of Sciences (USA) 106: 2468-2471.

The Importance of Gender in Medical Practice

          Narratives about treatment and rates of disease often involve conversation around the role sex plays in these statistics, including mortality and morbidity rates. Governments and private organizations spend considerable amounts of money towards identifying and focusing research on diseases that predominately affect one sex over another. For example, prostate and breast cancer, found primarily in men and women respectively, receive significant funding and generate considerable public interest.

Sociologically, sex refers to the biologically determined aspect of an individual’s identity, while gender is considered to be culturally or socially constructed. While the role that sex plays in the dimorphism of these diseases is evident, gender’s role is far less clear and researched. In a medical world where treatment paths are largely determined by the patient, individuals must choose an option that they are most comfortable with.^2,4 In the case of prostate cancer, men are often faced with impotence or other sexual deficiencies resulting from treatment. Similarly, the focus on breast cancer treatment often stresses saving the breasts rather than the woman herself. Decisions about how to proceed in the treatment process in such cases can be heavily influenced by conceptions of gender. For example, a man’s idea of masculinity may affect his choice to lose sexual function.¹ Treatment time with procedures such as chemotherapy and radiation may be extended, despite the fact that radical prostatectomy or other procedures that damage nerves may be more effective in preventing mortality. However, these procedures damage sexual function, making them less desirable for some men. 

Additionally, gender plays a critical role in how individuals experience coping strategies both during and following treatment. Sharing of one’s personal feelings is considered by society to be a feminine quality; therefore fewer men feel comfortable participating in group sessions due to this stigma.⁴ Research suggests that gender, not sex perceptions play a role in these results. This is important because counseling or the ability to speak openly about personal psychosocial issues surrounding treatment has been associated with morbidity rates.² Specifically, several studies have focused on psychiatric morbidity rates of patients experiencing treatment and how counseling affects these rates. One such study looking at mastectomy patients showed that morbidity rates were significantly less in counseling patients than those in a control group (12% to 39%).³

           If the ultimate goal of medicine is to reduce morbidity and mortality rates, then consideration of gender before, during, and after treatment must be taken into account. Health professionals must be aware of gendered belief systems and speak with patients openly about ramifications of conforming to these societal notions. Individuals also must be made aware of their own gender perceptions in order to allow them to best select treatments. For example, a male undergoing prostate procedures may be driven by gendered expectations of masculinity towards certain treatment options. The idea of losing sexual ability often conflicts with a man’s idea of how masculinity is maintained. If he is not able to engage with his partner sexually, the ability to perform masculinity may be compromised. By making him aware of gendered notions of masculinity and clearly presenting why certain treatment options are stigmatized, procedures that decrease mortality and morbidity, rather than those that preserve notions of gender, may become more desirable. Ignoring gender in medical practice is a detriment the moral codes of the medical community as well. As I mentioned earlier, the institution of medicine is more concerned with saving what is considered important for masculinity or femininity, rather than what is necessary for the individual, both phsyically and emotionally. This is not simply an issue of intellectual discourse, but notably affects medicine at an economic and moral level. If we are to believe that medicine is concerned with reducing illness and death, then taking gender into account, rather than simply sex, is important to combating vital psychosocial effects related to the experience of disease.

                                                            References

1. Kiss A and Meryn S. Effect of sex and gender of psychosocial aspects of prostate and breast cancer. BMJ. 2001: 323(7320): 1055-1058.
2. Krizek C, Roberts C, Ragan R, Ferrara JJ, Lord B. Gender and cancer support group participation. Cancer Pract. 1999:7:86–92.
3. Maguire P, Tait A, Brooke M, Thomas C, Sellwood R. Effect of counselling on the psychiatric morbidity associated with mastectomy. BMJ. 1980; 281:1454–1456.

4. Volkers N. In coping with cancer, gender matters. J Natl Cancer Inst. 1999:91:1712-1714.

Social or biological factors: What decides the differences in self-disclosure between the two sexes?

Self-disclosure is the process through which one person shares private information about him- or herself with others, usually for the development of an intimate relationship. This information, which covers virtually everything about the person, can include and is not limited to thoughts, feelings, dreams, goals, fears, and likes or dislikes. Although populations from different regions or cultures tend to view self-disclosure differently, people strikingly can spend up to either 60% or 80%, depending on where the conversation takes place, of their conversations talking about themselves.

Among the factors that contribute to the differences in self-disclosure, several have been well studied as pure social factors. These include image of the self, social norms of self-disclosure, topics of the conversation, and expectation of the future between the speaker and the listener. The role of one interesting factor, however, remains controversial—sex. It has been reported in multiple studies that males and females self-disclose differently. In general, females are more willing to self-disclose more personal information at higherfrequencies than males do. While most researchers agree that males are more reluctant to speak about themselves (Chelune, 1976; Rosenfeld, 1979) due to social expectations of male gender rolesand a greater need to control their privacy, it is indicated in a study by Chelune (1976) that females do not disclose more information than males do. Instead, females simply share a smaller amount of information each time at much higher rates. Regardless of this minor disagreement, it appears convincing to say that males and females differ in self-closure due to social factors. Therefore, sex induces differences in self-disclosure via different social expectations of the two sexes.

But wait! Can we safely conclude that sex functions solely as a social factor, as it is more than clear that the definition of sexes derives from biological differences between males and females? Let’s first find out whether self-disclosure can be biologically explained. Self-disclosure was found to be able to activate multiple regions in the dopamine pathway. Results of a recent study (Tamir, & Mitchell, 2012) suggest that subjects, when self-disclosing instead of describing characteristics of another person, had significantly more activation (see attached figure) in the nucleus accumbens (NAcc) and ventral tegmental area (VTA). These two regions are directly involved in the dopamine pathway, controlling the secretion and transduction of dopamine. Therefore, the activation of the NAcc and VTA will naturally lead to a dopamine-induced euphoric feeling, which makes self-disclosure a rewarding behavior.

This finding led to my suspicion that there could be sex-differentiated activation in those two regions, so that males may find self-disclosure less rewarding, compared to females. A significant amount of research has indicated that heterosexual and homosexual males and females differ in brain activations and behavioral responses when performing various tasks (smelling sex hormones, doing mental rotations, etc.). Similar to these findings, homosexuals and heterosexual females are found to be more engaged in self-disclosure than heterosexual males (Bliss, 2000), suggesting that NAcc and VTA activation may differ between sexes, and even within the same sex. Unfortunately, the exact differences in brain activation patterns were not examined. As a result, it remains unknown whether biological differences between the two sexes in NAcc and VTA activation can explain differences in self-disclosure. If such biological differences are confirmed in the future, we will have a much deeper understanding of self-disclosure, a major component of human conversations, and of peoples’ preference for self-disclosure. It is then possible to say that males, or even individuals with less sensitive NAcc and VTA, are not socially forced to self-disclose less, but are just born to find self-disclosure less rewarding. In other words, stereotypes may be reduced to simple differences.

Reference

Bliss, G. K. (2000). Self-disclosure and friendship patterns: Gender and sexual orientation differences in same-sex and opposite-sex friendships. (Order No. AAI9973608, Dissertation Abstracts International Section A: Humanities and Social Sciences, , 1749. Retrieved from http://search.proquest.com/docview/619562839?accountid=7379. (619562839; 2000-95021-096).

Chelune, G. J. (1976). A multidimensional look at sex and target differences in disclosure. Psychological Reports, 39(1), 259-263. Retrieved from http://search.proquest.com/docview/616097333?accountid=7379

Rosenfeld, L. B. (1979). Self‐disclosure avoidance: Why I am afraid to tell you who I am. Communication Monographs, 46, 63-74

Tamir, D. I., & Mitchell, J. P. (2012). Disclosing information about the self is intrinsically rewarding. PNAS Proceedings of the National Academy of Sciences of the United States of America, 109(21), 8038-8043. doi:http://dx.doi.org/10.1073/pnas.1202129109

Medicalization of Homosexuliaty

Medicalization of Homosexuality

            Binary terms such as healthy and diseased, normal and pathological offer grounds for discrimination of those individuals who do not strictly fall into one of the two categories. Scientists who seek to study etiology of an individual’s sexual identity, often will describe non-heterosexual individuals as different, even claiming that this condition has an “abnormal” underlying neurological basis. By categorizing people into sexual groups, medical society develops an authority over sexual minorities. This practice leads to medicalization of behavior, which implies an understanding of a sexual identity in a medical frame. Medicalization of homosexuality hints at the danger of treating homosexuality as a disease, which by definition should be cured.  Carl Friedrich Otto Westphal, a 19^th century German neurologist was first to describe homosexuality as a psychiatric condition (Foucault 1978).  However, in 1973 as a result of gay liberation movement, homosexuality became demedicalized, and consequently it was taken out of Diagnostic and Statistical Manual of Mental Disorders (Conrad, 1992). However, there is a threat that novel research, carried in the field of neuroscience, might prompt the medicalization of homosexuality.

In 21^st century, modern scientists try to explain a sexual identity of an individual, in terms of physiological differences. In other words, they are seeking a specific mechanism to explain a behavior. The question becomes; could we face a threat that ongoing scientific research might bring us back to a framework of treating homosexuality as a medical condition? Previous research has pointed out the differences in the functioning of brain regions of heterosexuals vs. non-heterosexuals. For example, Savic et al. conducted a study, which showed differences in cerebral asymmetry and functional connectivity between heterosexual and homosexual participants (2008). The research concluded that heterosexual males and homosexual women have asymmetrical volumes while no cerebral asymmetry was shown in heterosexual women and homosexual men. When comparing the functional connectivity in amygdala region Savic et al. found that in homosexual males, the connections were more widespread from the left amygdala, while in homosexual women from the right amygdala. The study also showed cerebral connections with the contralateral amygdala, the anterior cingulate, the subcallosum, and the hypothalamus in both homosexual men and heterosexual women. However, the same pattern was not observed in homosexual women, as they displayed no connection with the contralateral amygdala (Fig.1).

Fig.1. The MR image shows the sexual dimorphism in hemispheric asymmetry and functional connections from the left and the right amygdala, in heterosexual men and women and homosexual men and women. 

Neurological studies on the topic of sex and gender indicate that sexual orientation is related to dichotomy in brain function. At this stage, it is important to ask what is the purpose of carrying out research, which aims to determine the etiology of non-heterosexuality. Will the data obtained form scientific experiments be used to help individuals with Gender Identity Disorder or will it be used to find a quick “fix” for their non-heterosexual identity? The scientific language used in the science journal articles might also be abusive of sexual minorities. This prompts scientific society to develop gender-neutral language in which words such as abnormal could be changed to different.

The history of homosexuality shows us that non-heterosexuals were first accused of immorality however, afterwards they became “not bad but mad”(Hart et al. pg. 897). In the 20^th century there was an attempt to treat the “deviance” in sexual behavior of non-heterosexuals. In the 21^st century trying to “treat” and “help”, could modern research lead to not only stigmatization but also illegitimate abuse of sexual minorities? Again, it is important to answer this question before scientists dwell into research regarding the etiology of homosexuality.

Bibliography

Conrad, P. (n.d.). Medicalization and Social Control. Annual Review of Sociology, 19, 209-232.

Foucault, M. (1978). The History of Sexuality (Vol. 78, pp. 1-133). United States of America: Random House.

Hart, G., & Wellings, K. (n.d.). Sexual behavior and its medicalization: In sickness and in health. British Medical Journal, 324, 896-900.

Savic, I., & Lindstrom, P. (2008). PET and MRI show differenced in cerebral asymmetry and functional connectivity between homo- and heterosexual subjects. PNAS, 105(27), 9403–9408-9403–9408.