Conversion therapy

Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, gender identity, or gender expression to align with heterosexual and cisgender norms.^[1] In contrast to evidence-based medicine and clinical guidance, such practices typically view homosexuality and gender variance as unnatural or unhealthy. There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation or gender identity and that it frequently causes significant, long-term psychological harm in individuals who undergo it.^[2]

Common methods of conversion therapy are counseling, visualization, social skills training, psychoanalytic therapy, and spiritual interventions. Other methods that have been used include ice-pick lobotomies;^{[3][4][5][6][7][8]} chemical castration with hormonal treatment;^[9] aversive treatments, such as "the application of electric shock to the hands and/or genitals"; "nausea-inducing drugs ... administered... with the presentation of homoerotic stimuli"; and masturbatory reconditioning.

An increasing number of jurisdictions around the world have passed laws against conversion therapy.^[10] Conversion therapy may constitute fraud and has been described by experts as torture, cruel, inhuman, or degrading treatment, and contrary to human rights norms.

Terminology

Medical professionals and activists consider "conversion therapy" a misnomer, as it does not constitute a legitimate form of therapy.^[11] Alternative terms include sexual orientation change efforts (SOCE), gender identity change efforts (GICE)—together, sexual orientation and gender identity change efforts (SOGICE)^[12]—and LGBTQA+ conversion practices.^[12] "Reparative therapy" may refer to conversion therapy in general, or to a subset thereof.^[13]

History

The term homosexual was coined by German-speaking Hungarian writer Karl Maria Kertbeny and was in circulation by the 1880s.^[14][10] Into the middle of the twentieth century, competing views of homosexuality were advanced by psychoanalysis versus academic sexology. Sigmund Freud, the founder of psychoanalysis, viewed homosexuality as a form of arrested development. Later psychoanalysts followed Sandor Rado, who argued that homosexuality was a "phobic avoidance of heterosexuality caused by inadequate early parenting".^[10] This line of thinking was popular in psychiatric models of homosexuality based on the prison population or homosexuals seeking treatment. In contrast, sexology researchers such as Alfred Kinsey argued that homosexuality was a normal variation in human development. In 1970, gay activists confronted the American Psychiatric Association, persuading the association to reconsider whether homosexuality should be listed as a disorder. The APA delisted homosexuality in 1973, which contributed to shifts in public opinion on homosexuality.^[10]

Despite their lack of scientific backing, some socially or religiously conservative activists continued to argue that if one person's sexuality could be changed, homosexuality was not a fixed class such as race. Borrowing from discredited psychoanalytic ideas about the cause of homosexuality, some of these individuals offered conversion therapy.^[10] In 2001, conversion therapy attracted attention when Robert L. Spitzer published a non-peer-reviewed study asserting that some homosexuals could change their sexual orientation. Many researchers made methodological criticisms of the study, which Spitzer later repudiated.^[10]

Theories and techniques

Aversion therapy

Aversion therapy used on homosexuals included electric shock and nausea-inducing drugs during presentation of same-sex erotic images. Cessation of the aversive stimuli was typically accompanied by the presentation of opposite-sex erotic images, with the objective of strengthening heterosexual feelings.^[15] Another method used was the covert sensitization method, which involves instructing patients to imagine vomiting or receiving electric shocks, writing that only single case studies have been conducted, and that their results cannot be generalized. Haldeman writes that behavioral conditioning studies tend to decrease homosexual feelings, but do not increase heterosexual feelings, citing Rangaswami's "Difficulties in arousing and increasing heterosexual responsiveness in a homosexual: A case report", published in 1982, as typical in this respect.^[16]

Aversion therapy was developed in Czechoslovakia between 1950 and 1962 and in the Commonwealth from 1961 into the mid-1970s. In the context of the Cold War, Western psychologists ignored the poor results of their Czechoslovak counterparts, who had concluded that aversion therapy was not effective by 1961 and recommended decriminalization of homosexuality instead.^[17] Some men in the United Kingdom were offered the choice between prison and undergoing aversion therapy. It was also offered to a few British women, but was never the standard treatment for either homosexual men or women.^[18]

Bioenergetics

Bioenergetics is a therapeutic technique developed by Alexander Lowen and John Pierrakos, who were students of Wilhelm Reich. It has been used to attempt to convert gay people to heterosexuality by Richard Cohen, who has been called one of America's leading practitioners of conversion therapy.^[19] Cohen holds male patients in his lap with the patient curled into the fetal position, and also advocates methods involving shouting or slamming a pillow with a tennis racket.^[20]

Ex-gay/ex-trans ministry

OneByOne booth at a Love Won Out conference

Some sources^[which?] describe ex-gay and ex-trans ministries as a form of conversion therapy, while others^[which?] state that ex-gay organizations and conversion therapy are distinct methods of attempting to convert gay people to heterosexuality.^{[21][22][23][24]} The umbrella organization Exodus International in the United States ceased activities in June 2013, and the three member board issued a statement which repudiated its aims and apologized for the harm their pursuit has caused to LGBT people.^{[25][better source needed]} Ex-gay/ex-trans organizations often overlap and portray being trans as inherently sinful or against God's design, or pathologize gender variance as due to trauma, social contagion, or "gender ideology."^[26][27]

Psychoanalysis

Main page: Social:Psychoanalysis

Haldeman writes that psychoanalytic treatment of homosexuality is exemplified by the work of Irving Bieber et al. in Homosexuality: A Psychoanalytic Study of Male Homosexuals. They advocated long-term therapy aimed at resolving the unconscious childhood conflicts that they considered responsible for homosexuality. Haldeman notes that Bieber's methodology has been criticized because it relied upon a clinical sample, the description of the outcomes was based upon subjective therapist impression, and follow-up data were poorly presented. Bieber reported a 27% success rate from long-term therapy, but only 18% of the patients in whom Bieber considered the treatment successful had been exclusively homosexual to begin with, while 50% had been bisexual. In Haldeman's view, this makes even Bieber's unimpressive claims of success misleading.^[28]

Haldeman discusses other psychoanalytic studies of attempts to change homosexuality. Curran and Parr's "Homosexuality: An analysis of 100 male cases", published in 1957, reported no significant increase in heterosexual behavior. Mayerson and Lief's "Psychotherapy of homosexuals: A follow-up study of nineteen cases", published in 1965, reported that half of its 19 subjects were exclusively heterosexual in behavior four and a half years after treatment, but its outcomes were based on patient self-report and had no external validation. In Haldeman's view, those participants in the study who reported change were bisexual at the outset, and its authors wrongly interpreted capacity for heterosexual sex as change of sexual orientation.^[29]

Reparative therapy

The term "reparative therapy" has been used as a synonym for conversion therapy generally, but according to Jack Drescher it properly refers to a specific kind of therapy^{[clarification needed]} associated with the psychologists Elizabeth Moberly and Joseph Nicolosi.^[13] The term reparative refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority.^[30][31][32]

Lobotomy

Main page: Unsolved:Lobotomy

In the 1940s and 1950s, U.S. neurologist Walter Freeman popularized the ice-pick lobotomy as a treatment for homosexuality. He personally performed as many as 3,439^[33] lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure,^[34] despite the fact that he had no formal surgical training.^[35] Up to 40% of Freeman's patients were gay individuals subjected to a lobotomy^[36] in order to change their homosexual orientation, leaving most of these individuals severely disabled for the rest of their lives.^[37]

Marriage therapy

Previous editions of the World Health Organization's ICD included "sexual relationship disorder", in which a person's sexual orientation or gender identity makes it difficult to form or maintain a relationship with a sexual partner. The belief that their sexual orientation has caused problems in their relationship may lead some people to turn to a marriage therapist for help to change their sexual orientation.^[38] Sexual orientation disorder was removed from the most recent ICD, ICD-11, after the Working Group on Sexual Disorders and Sexual Health determined that its inclusion was unjustified.^[39]

Nazi human experimentation

Homosexual prisoners were a preferred target of Nazi human experimentation during the last years of Nazi rule. The best-known experiments involving homosexual men were attempts by endocrinologist Carl Vaernet to change prisoners' sexual orientations by implanting a pellet that released testosterone. Most of the victims, non-consenting prisoners at Buchenwald, died shortly thereafter.^[40][41]

Effects

There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation and can cause significant, long-term psychological harm.^[2]

A 2022 study estimated that conversion therapy of youth in the United States cost $650.16 million annually with an additional $9.5 billion in associated costs such as increased suicide and substance abuse.^[42]

Public opinion

A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors.^[43]

A 2022 YouGov poll found majority support in England, Scotland, and Wales for a conversion therapy ban for both sexual orientation and gender identity, with opposition ranging from 13 to 15 percent.^[44]

Legal status

Map of jurisdictions that have bans on sexual orientation and gender identity change efforts with minors.

  Criminal prohibition against conversion therapy on the basis of sexual orientation and gender identity

  Only medical professionals are banned from performing conversion therapy

  Conversion therapy is banned only in some subnational jurisdictions

  Ban on conversion therapy pending or proposed

  No ban on conversion therapy

Some jurisdictions have criminal bans on the practice of conversion therapy, including Malta, France, Germany, Albania, Mexico and Canada.^[45] In other countries, including Brazil, Ecuador, and Taiwan, medical professionals are barred from practicing conversion therapy.^[46]

In some states, lawsuits against conversion therapy providers for fraud have succeeded, but in other jurisdictions those claiming fraud must prove that the perpetrator was intentionally dishonest. Thus, a provider who genuinely believes conversion therapy is effective could not be convicted.^[47]

Conversion therapy on minors may amount to child abuse.^[48][49][50]

Human rights

In 2020 the International Rehabilitation Council for Torture Victims released an official statement that conversion therapy is torture.^[48] The same year, UN Independent Expert on sexual orientation and gender identity, Victor Madrigal-Borloz, said that conversion therapy practices are "inherently discriminatory, that they are cruel, inhuman and degrading treatment, and that depending on the severity or physical or mental pain and suffering inflicted to the victim, they may amount to torture". He recommended that it should be banned across the world.^[51] In 2021 Ilias Trispiotis and Craig Purshouse argue that conversion therapy violates the prohibition against degrading treatment under Article 3 of the European Convention on Human Rights, leading to a state obligation to prohibit it.^[46][52]

Medical views

Mainstream medical bodies state that conversion therapy can be harmful because it may exploit guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide.^[53] There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about gender identity, sexual orientation, and the ability of LGBTQ people to lead happy, healthy lives.^[54]

Some medical bodies prohibit their members from practicing conversion therapy.^[55]

References

Bibliography

• Bright, Chuck (December 2004), "Deconstructing Reparative Therapy: An Examination of the Processes Involved When Attempting to Change Sexual Orientation", Clinical Social Work Journal 32 (4): 471–481, doi:10.1007/s10615-004-0543-2 
• Cruz, David B. (1999), "Controlling desires: Sexual orientation conversion and the limits of knowledge and law", Southern California Law Review 72 (5): 1297–400, PMID 12731502, http://www-bcf.usc.edu/~usclrev/pdf/072502.pdf, retrieved 20 May 2015 
• Drescher, Jack (June 1998a), "I'm Your Handyman: A History of Reparative Therapies", Journal of Homosexuality 36 (1): 19–42, doi:10.1300/J082v36n01_02, PMID 9670099 
• Drescher, Jack (2001), "Ethical Concerns Raised When Patients Seek to Change Same-Sex Attractions", Journal of Gay & Lesbian Psychotherapy 5 (3/4): 183, doi:10.1300/j236v05n03_11 
• Drescher, Jack; Zucker, Kenneth, eds. (2006), Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture, New York: Harrington Park Press, ISBN 978-1-56023-557-6 
• Drescher, Jack (1998b), "Psychoanalytic Therapy and the Gay Man", American Journal of Psychoanalysis (Hillsdale, New Jersey: The Analytic Press) 60 (2): 191–6, doi:10.1023/a:1001968909523, ISBN 978-0-88163-208-8, PMID 10874429 
• Haldeman, Douglas C. (1991), "Sexual orientation conversion therapy for gay men and lesbians: A scientific examination", in Gonsiorek, John; Weinrich, James, Homosexuality: Research Implications for Public Policy, Newbury Park, California: Sage Publications, Inc, ISBN 978-0-8039-3764-2, http://www.drdoughaldeman.com/doc/ScientificExamination.pdf, retrieved 30 May 2010 
• Waidzunas, Tom (2016), The Straight Line: How the Fringe Science of Ex-Gay Therapy Reoriented Sexuality, Minneapolis: University of Minnesota Press, ISBN 9780816696154 
• Weindling, Paul (2015) (in en). Victims and Survivors of Nazi Human Experiments: Science and Suffering in the Holocaust. Bloomsbury Academic. ISBN 978-1-4411-7990-6. 
• Whisnant, Clayton J. (2016) (in en). Queer Identities and Politics in Germany: A History, 1880–1945. Columbia University Press. ISBN 978-1-939594-10-5. 
• Yoshino, Kenji (2002), "Covering", Yale Law Journal 111 (4): 769–939, doi:10.2307/797566, http://www.yalelawjournal.org/article/covering 

Further reading

• Haldeman, Douglas C. (2021) (in en). Sexual Orientation and Gender Identity Change Efforts: Evidence, Effects, and Ethics. Columbia University Press. ISBN 978-1-939594-36-5. 
• Haldeman, Douglas C. (2022) (in en). The Case Against Conversion Therapy: Evidence, Ethics, and Alternatives. American Psychological Association. ISBN 978-1-4338-3711-1. 

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