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 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 or 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

Main article: History of conversion therapy

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

See also: Behavior modification

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
OneByOne booth at a Love Won Out conference

Main article: Ex-gay

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 article: 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 article: 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

See also: Relationship counseling

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

Further information: Persecution of homosexuals in Nazi Germany

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

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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

Main article: Legality of conversion therapy

Map of jurisdictions that have bans on sexual orientation and gender identity change efforts with minors. .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}  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
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

Main article: Medical views of conversion therapy

Many health organizations around the world have denounced and criticized sexual orientation and gender identity change efforts.[53][54][55] National health organizations in the United States have announced that there has been no scientific demonstration of conversion therapy's efficacy in the last forty years.[22][56][57][58] They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy.[57]

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.[59] 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.[60]

References

  1. ^ "Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth" (PDF). Substance Abuse and Mental Health Services Administration. October 2015. Archived from the original (PDF) on 14 October 2021. Retrieved 26 December 2021. Efforts to change an individual’s sexual orientation, gender identity, or gender expression through behavioral health or medical interventions. Any effort with an a priori goal of a gender expression that aligns with stereotypical norms, cisgender identity, and/or heterosexual orientation, identity, and sexual behaviors.
  2. ^ a b Higbee, Madison; Wright, Eric R.; Roemerman, Ryan M. (2022). "Conversion Therapy in the Southern United States: Prevalence and Experiences of the Survivors". Journal of Homosexuality. 69 (4): 612–631. doi:10.1080/00918369.2020.1840213. PMID 33206024. S2CID 227039714.
  3. ^ Cruz, David B. (1999). "Controlling Desires: Sexual Orientation Conversion and the Limits of Knowledge and Law" (PDF). Southern California Law Review. 72 (5): 1297–400. PMID 12731502. Archived from the original (PDF) on 19 September 2017. Retrieved 25 November 2016.
  4. ^ Yoshino 2002
  5. ^ Burr, Chandler (June 1997). "Homosexuality and Biology". The Atlantic Magazine. Retrieved 25 November 2016.
  6. ^ Harrison, James. "Changing Our Minds: The Story of Dr. Evelyn Hooker" (Documentary Film). imdb. Internet Movie Database. Retrieved 25 November 2016.
  7. ^ Rieber, Inge; Sigusch, Volkmar (1979). "Psychosurgery on Sex Offenders and Sexual "Deviants" in West Germany". Archives of Sexual Behavior. 8 (6): 523–527. doi:10.1007/bf01541419. PMID 391177. S2CID 41463669.
  8. ^ Dieckmann, G.; Horn, H.J.; Schneider, H. (1979). Hitchcock, E.R.; Ballantine, H.T.; Meyerson, B.A. (eds.). "Long-term Results of Anterior Hypothalamotomy in Sexual Offences". Modern Concepts in Psychiatric Surgery: 187–195.
  9. ^ Milar, Katherine S. (February 2011). "The myth buster". Monitor on Psychology. 42 (2): 24. Retrieved 25 November 2016.
  10. ^ a b c d e f Drescher, Jack; Schwartz, Alan; Casoy, Flávio; McIntosh, Christopher A.; Hurley, Brian; Ashley, Kenneth; Barber, Mary; Goldenberg, David; Herbert, Sarah E.; Lothwell, Lorraine E.; Mattson, Marlin R.; McAfee, Scot G.; Pula, Jack; Rosario, Vernon; Tompkins, D. Andrew (2016). "The Growing Regulation of Conversion Therapy". Journal of Medical Regulation. 102 (2): 7–12. doi:10.30770/2572-1852-102.2.7. PMC 5040471. PMID 27754500.
  11. ^ Haldeman 2022, p. 4.
  12. ^ a b Csabs, C., Despott, N., Morel, B., Brodel, A., Johnson, R. 'The SOGICE Survivor Statement', 2018.
  13. ^ a b Drescher 1998b, p. 152
  14. ^ Whisnant 2016, p. 20.
  15. ^ Haldeman 1991, p. 152
  16. ^ Haldeman 1991, pp. 152–153
  17. ^ Davison, Kate (2021). "Cold War Pavlov: Homosexual aversion therapy in the 1960s". History of the Human Sciences. 34 (1): 89–119. doi:10.1177/0952695120911593. S2CID 218922981.
  18. ^ Spandler, Helen; Carr, Sarah (2022). "Lesbian and bisexual women's experiences of aversion therapy in England". History of the Human Sciences. doi:10.1177/09526951211059422. S2CID 245753251.
  19. ^ Transcript of "USA - Gay Conversion Archived 2010-05-13 at the Wayback Machine, ABC TV Foreign Correspondent, 08-22-2006. Retrieved 04-07-2007.
  20. ^ Cohen 2000, p. 152,176
  21. ^ Drescher & Zucker 2006, pp. 126, 175
  22. ^ a b Just the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators and School Personnel (PDF), Just the Facts Coalition, 1999, retrieved 14 May 2010
  23. ^ Haldeman 1991, pp. 149, 156–159
  24. ^ Jones & Yarhouse 2007, p. 374
  25. ^ Chambers, Alan, I Am Sorry, Exodus International, archived from the original on 23 June 2013, retrieved 22 June 2013
  26. ^ Robinson, Christine M.; Spivey, Sue E. (17 June 2019). "Ungodly Genders: Deconstructing Ex-Gay Movement Discourses of "Transgenderism" in the US". Social Sciences. 8 (6): 191. doi:10.3390/socsci8060191. ISSN 2076-0760.
  27. ^ Jones, Tiffany; Jones, Timothy W.; Power, Jennifer; Pallotta-Chiarolli, Maria; Despott, Nathan (12 October 2021). "Mis-education of Australian Youth: exposure to LGBTQA+ conversion ideology and practises". Sex Education: 1–16. doi:10.1080/14681811.2021.1978964. ISSN 1468-1811. S2CID 241018465.
  28. ^ Haldeman 1991, pp. 150–151
  29. ^ Haldeman 1991, pp. 151, 256
  30. ^ Hicks, Karolyn Ann (1999). ""Reparative Therapy": Whether Parental Attempts to Change a Child's Sexual Orientation Can Legally Constitute Child Abuse". American University Law Review. 49 (2): 505–547. Retrieved 28 November 2016.
  31. ^ Nicolosi, Joseph. "What Is Reparative Therapy? Examining the Controversy". Retrieved 28 November 2016.
  32. ^ Bright 2004, pp. 471–481
  33. ^ Elizabeth Day (13 January 2008). "He was bad, so they put an ice pick in his brain". www.theguardian.com. Retrieved 26 December 2013.
  34. ^ "Top 10 Fascinating And Notable Lobotomies". listverse.com. 24 June 2009. Retrieved 26 December 2013.
  35. ^ Rowland, Lewis (April 2005). "Walter Freeman's Psychosurgery and Biological Psychiatry: A Cautionary Tale". Neurology Today. 5 (4): 70–72. doi:10.1097/00132985-200504000-00020.
  36. ^ Stone, Gene (September 2013). "The Tiger Cure". New York Magazine.
  37. ^ Scot, Jamie (28 June 2013). "Shock the Gay Away: Secrets of Early Gay Aversion Therapy Revealed". HuffPost.
  38. ^ Rosik, Christopher H (January 2003). "Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction". Journal of Marital and Family Therapy. 29 (1): 13–28. doi:10.1111/j.1752-0606.2003.tb00379.x. ISSN 0194-472X. OCLC 5154888155. PMID 12616795.
  39. ^ Reed, Geoffrey M.; Drescher, Jack; Krueger, Richard B.; Atalla, Elham; Cochran, Susan D.; First, Michael B.; Cohen‐Kettenis, Peggy T.; Arango‐de Montis, Iván; Parish, Sharon J.; Cottler, Sara; Briken, Peer (2016). "Disorders related to sexuality and gender identity in the ICD‐11: revising the ICD‐10 classification based on current scientific evidence, best clinical practices, and human rights considerations". World Psychiatry. 15 (3): 205–221. doi:10.1002/wps.20354. ISSN 1723-8617. PMC 5032510. PMID 27717275.
  40. ^ Whisnant 2016, p. 223.
  41. ^ Weindling 2015, pp. 183–184.
  42. ^ Forsythe, Anna; Pick, Casey; Tremblay, Gabriel; Malaviya, Shreena; Green, Amy; Sandman, Karen (2022). "Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States". JAMA Pediatrics. 176 (5): 493–501. doi:10.1001/jamapediatrics.2022.0042. PMC 8902682. PMID 35254391. S2CID 247252995.
  43. ^ Flores, Andrew R.; Mallory, Christy; Conron, Kerith J. (2020). "Public attitudes about emergent issues in LGBTQ rights: Conversion therapy and religious refusals". Research & Politics. 7 (4): 205316802096687. doi:10.1177/2053168020966874. S2CID 229001894.
  44. ^ "The majority of Welsh people support a ban on trans conversion therapy in Wales | YouGov". yougov.co.uk. Retrieved 30 June 2022.
  45. ^ Branch, Legislative Services (10 January 2022). "Consolidated federal laws of canada, An Act to amend the Criminal Code (conversion therapy)". laws.justice.gc.ca. Retrieved 6 July 2022.
  46. ^ a b Trispiotis, Ilias; Purshouse, Craig (2021). "'Conversion Therapy' As Degrading Treatment". Oxford Journal of Legal Studies. 42 (1): 104–132. doi:10.1093/ojls/gqab024. PMC 8902017. PMID 35264896.
  47. ^ Purshouse, Craig; Trispiotis, Ilias (2022). "Is 'conversion therapy' tortious?". Legal Studies. 42 (1): 23–41. doi:10.1017/lst.2021.28. ISSN 0261-3875. S2CID 236227920.
  48. ^ a b "Conversion Therapy is Torture". International Rehabilitation Council for Torture Victims. Retrieved 31 May 2021.
  49. ^ Canady, Valerie (2015). "New report calls for an end to 'conversion therapy' for youth". The Brown University Child and Adolescent Behavior Letter. 31 (12): 3–4. doi:10.1002/cbl.30088.
  50. ^ Lee, Cory (2022). "A Failed Experiment: Conversion Therapy as Child Abuse". Roger Williams University Law Review. 27 (1). ISSN 1090-3968.
  51. ^ "'Conversion therapy' Can Amount to Torture and Should be Banned says UN Expert". United Nations Human Rights: Office of the High Commissioner. 13 July 2020. Retrieved 20 July 2021.
  52. ^ Nugraha, Ignatius Yordan (2017). "The compatibility of sexual orientation change efforts with international human rights law". Netherlands Quarterly of Human Rights. 35 (3): 176–192. doi:10.1177/0924051917724654. S2CID 220052834.
  53. ^ "Health and Medical Organization Statements on Sexual Orientation, Gender Identity/Expression and 'Reparative Therapy'". lambdalegal.org. Lambda Legal.
  54. ^ a b "Policy and Position Statements on Conversion Therapy". Human Rights Campaign. Human Rights Campaign. Retrieved 12 April 2017.
  55. ^ "Conversion Therapy: Consensus Statement" (PDF). bps.org.uk. UK Council for Psychotherapy. p. 2. Archived from the original (PDF) on 17 May 2017. Retrieved 16 December 2017.
  56. ^ "Answers to Your Questions: For a Better Understanding of Sexual Orientation and Homosexuality". American Psychological Association. 2008. Retrieved 31 January 2015.
  57. ^ a b "Therapies Focused on Attempts to Change Sexual Orientation". Psych.org. Archived from the original on 10 September 2008. Retrieved 18 July 2011.
  58. ^ APA Maintains Reparative Therapy Not Effective, Psychiatric News (news division of the American Psychiatric Association), 15 January 1999, retrieved 28 August 2007
  59. ^ Luo, Michael (12 February 2007), "Some Tormented by Homosexuality Look to a Controversial Therapy", The New York Times, p. 1, retrieved 28 August 2007
  60. ^ "Albania becomes third European country to ban gay 'conversion therapy'". France 24. 16 May 2020. Retrieved 30 June 2022.

Bibliography

Further reading