Tolerance for the full spectrum of human sexuality has made great strides. LGBTQ (lesbian, gay, bisexual, transgender, and queer) issues are frequently in the news. Same-sex marriage is now legal in all U.S. states and in numerous other countries around the world. But in seventy-two countries, homosexuality is a crime, and in thirteen countries, gay acts are punishable by death. And in the United States, anti-LGBTQ hate crimes are on the rise.
Some psychotherapists and religious groups practice gay conversion therapy. They believe any non-heterosexual sexual orientation is a pathology that can be cured. They are wrong. It isn’t pathological and sexual orientation doesn’t change with treatment. In recognition of these facts, gay conversion therapy (GCT) for minors is now banned in eighteen states, Washington, D.C., and Puerto Rico. It has also been banned in several other countries in Asia, Europe, Oceania, and the Americas. Adults can still legally engage in this debunked practice.
Not a Pathology
The American Psychiatric Association (APA) originally categorized homosexuality as a mental illness. First, they called it a sociopathic personality disturbance, then a sexual deviation. It was blamed on internal defects and external pathogenic agents including intrauterine hormone exposure, excessive mothering, inadequate fathering, sexual abuse, and other hypothetical causes. One psychiatrist claimed to have no bias but said, “Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner … [their] shell is a mixture of superciliousness, fake aggression, and whimpering. Like all psychic masochists, they are subservient when confronted with a stronger person, merciless when in power, unscrupulous about trampling on a weaker person.” Wow! If that’s unbiased, what would a biased psychiatrist say?
Sigmund Freud was wrong about many things, but he got it right when he said homosexuality was not an illness and would not respond to treatment. Disregarding Freud, most psychoanalysts continued to believe it was pathological and treatable. Gradually, research in sexology, including the Kinsey reports, revealed that homosexuality was far more common in the general population than was generally believed. Cross-cultural and animal studies revealed that homosexuality was widespread and normal. Same-sex behavior has been documented in over 450 species of animals, from bats to bedbugs. In fact, Petter Bøckman said, “No species has been found in which homosexual behaviour has not been shown to exist, with the exception of species that never have sex at all … .” And there have been many human cultures where more than two genders are recognized.
The APA followed the emerging scientific evidence. Eventually, in 1973, the diagnosis of homosexuality was removed from the third edition of the Diagnostic and Statistical Manual (DSM III).
What Is Conversion Therapy?
Religious groups have claimed it is possible to “Pray the Gay Away.” In addition to prayer, other techniques that have been tried have included icepick lobotomies, chemical castration with hormones, aversive treatments like electroshock to the hands or genitals, nausea-inducing drugs administered with homoerotic stimuli, masturbatory conditioning, the use of commercial sex workers, marriage to an opposite sex partner, counselling, visualization, social skills training, psychoanalytic therapy, and group support. Some treatments have coerced a decrease in same-sex behavior, but no treatment has been successful in eliminating homosexual feelings or changing sexual orientation. There were studies that claimed success, but they were flawed and not properly controlled. Researcher Robert Spitzer repudiated and retracted his study about changing sexual orientation, stating “I was quite wrong in the conclusions that I made from this study. The study does not provide evidence, really, that gays can change.” He apologized, calling it his only professional regret.
Many former conversion therapists have recanted and offered public apologies to their victims. In an ironic but predictable twist, some of the most prominent have turned out to be gay themselves. Alan Chambers was the president of Exodus, a large international organization that declared “all homosexual relationships are sinful” and promoted conversion therapy and freedom from homosexuality. In 2012, he renounced his former beliefs, saying gay conversion therapy doesn’t work and apologizing for the harm that sexual orientation change efforts have done. He confessed his own ongoing sexual attraction to men and announced that he is bisexual. Two other prominent Exodus members, Michael Bussee and Gary Cooper, left Exodus, divorced their wives, participated in a commitment ceremony, and lived together in a homosexual relationship. John Paulk, who founded the ministry Love Won Out, launched by the organization Focus on the Family, claimed to have overcome his homosexuality through counselling, prayer, and his relationship with God. In 2000, he was caught flirting with men in a gay bar. He initially lied and made excuses (didn’t know it was a gay bar, only stopped to use the restroom), but eventually confessed that he is gay. In 2013, he announced that gay reparative therapy was futile and harmful, and he issued a formal apology for his role in advocating the practice.
The World Psychiatric Association has declared that conversion therapy is “wholly unethical.” Yet despite the legal bans, the retractions, the scientific evidence, and consensus statements from numerous major professional organizations (listed here), the practice continues. According to a June 2019 report:
An estimated 16,000 LGBT youth (ages 13–17) will receive conversion therapy from a licensed health care professional before they reach the age of 18. Also, approximately 57,000 youth will undergo the treatment from a religious or spiritual advisor. Researchers also found that approximately 698,000 LGBT adults in the U.S. have received conversion therapy at some point in their lives, including about 350,000 who received it as adolescents.
A 2018 study of young adults whose parents sent them to conversion therapists found that the interventions were associated with depression, suicidal thoughts, suicide attempts, less educational attainment, and less weekly income. Conversion therapy exploits guilt and anxiety, damages self-esteem, and can cause social harm. A recent Perspective article in The New England Journal of Medicine says many survivors of conversion therapy will need treatment for post-traumatic stress disorder and post-religious trauma. Recent movies have raised public awareness of the harms, including Boy Erased and The Miseducation of Cameron Post.
Conclusion: Child Abuse, Not Therapy
Sexual orientation can’t be changed. Gay conversion therapy doesn’t work, causes harm, is unethical, and is illegal for minors in many jurisdictions. It is not treatment: it is brainwashing, physical and mental torture, coercion, and child abuse. Rather than trying to change sexual orientation, psychotherapists could do a lot to help non-heterosexuals by supporting them, validating their gender identity, and helping them deal with the difficulties that modern society creates for them.
This article was originally published as a SkepDoc’s Corner column on the CSI website.