Conversion therapy: Difference between revisions

Conversion therapy, also called reparative therapy, is the pseudoscientific practice of attempting to change an individual's sexual orientation, gender identity, or gender expression through psychological, medical, or spiritual interventions. In contrast to mainstream clinical guidance, such practices typically view homosexuality and gender variance as unnatural or unhealthy, and purport to "cure" lesbian, gay, bisexual, and transgender people to align with heteronormative and binaristic social norms. There is no reliable evidence that such practices can alter sexual orientation or gender identity, and medical institutions warn that conversion therapy is ineffective and potentially harmful. Medical, scientific, and government organizations in the United States and the United Kingdom have expressed concern over the validity, efficacy and ethics of conversion therapy. Jurisdictions around the world have passed laws against conversion therapy.

The American Psychiatric Association (APA) encourages legislation which would prohibit psychiatric treatment "based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change" and describes attempts to change a person's sexual orientation or gender identity by practitioners as unethical.

Contemporary clinical techniques used in the United States have been limited to counseling, visualization, social skills training, psychoanalytic therapy, and spiritual interventions such as "prayer and group support and pressure", though there are some reports of aversive treatments through unlicensed practice as late as the early 2000s, sometimes with residential structure. The term reparative therapy has been used as a synonym for conversion therapy in general, but it has been argued that, strictly speaking, it refers to a specific kind of therapy associated with the psychologists Elizabeth Moberly and Joseph Nicolosi. Techniques that were used in the past in the United States and Western Europe have included ice-pick lobotomies; chemical castration with hormonal treatment; aversive treatments, such as "the application of electric shock to the hands and/or genitals"; "nausea-inducing drugs ... administered simultaneously with the presentation of homoerotic stimuli"; and masturbatory reconditioning.

History

See also: Homosexuality and psychology

The history of conversion therapy can be divided broadly into three periods: an early Freudian period; a period of mainstream approval of conversion therapy, when the mental health establishment became the "primary superintendent" of sexuality; and a post-Stonewall period where the mainstream medical profession disavowed conversion therapy.

During the earliest parts of psychoanalytic history, analysts granted that homosexuality was non-pathological in certain cases, and the ethical question of whether it ought to be changed was discussed. By the 1920s analysts assumed that homosexuality was pathological and that attempts to treat it were appropriate, although psychoanalytic opinion about changing homosexuality was largely pessimistic. Those forms of homosexuality that were considered perversions were usually held to be incurable. Analysts' tolerant statements about homosexuality arose from recognition of the difficulty of achieving change. Beginning in the 1930s and continuing for roughly twenty years, major changes occurred in how analysts viewed homosexuality, which involved a shift in the rhetoric of analysts, some of whom felt free to ridicule and abuse their gay patients.

Europe

Richard von Krafft-Ebing

Richard von Krafft-Ebing was a German-Austrian psychiatrist and one of the founders of scientific sexology. His influential 1886 work Psychopathia Sexualis included a discussion of methods for curing homosexuality through hypnosis. Psychopathia Sexualis widely translated and extremely influential in promoting the model of homosexuality as a pathology.

Krafft-Ebing rejected castration as a cure for homosexuality, and opposed the internment of gay people in asylums except in cases involving sex crimes. He believed that homosexuality could either be inborn or acquired, and that it could very rarely be treated through preventing masturbation and curing the neuroses “arising out of the unhygienic conditions of sexual life,” but that hypnosis was the "only means of salvation" in most cases. He described three cases in which he believed hypnotism had proved satisfactory.

Krafft-Ebing criticized several objections to the medical treatment of homosexuality, asserting that it could be effective. In his view, physicians had a duty to provide treatment if requested, and refusing treament would allow "tainted individuals to propagate their perversions." Later editions of Psychopathia Sexualis included an increased number of autobiographies by gay people who made it clear that they did not wish to change their sexual orientation.

Eugen Steinach

Eugen Steinach (1861–1944) was a Viennese physiologist and pioneer in endocrinology. Steinach theorized that testosterone was responsible for determining sexuality, and transplanted testicles into gay men in attempts to change their sexual orientation. Sigmund Freud cautioned that Steinach's transplant procedures would not necessarily enable a generally applicable therapy, as such procedures could only be effective in changing male homosexuality in cases where it was strongly associated with physical characteristics typical of women, and that no similar treatment could be applied to lesbianism. Steinach said that his research had "thrown a strong light on the organic determinants of homo-eroticism", but his procedure was doomed to failure because the immune system rejects transplanted glands, and it was eventually discredited as ineffective and often harmful.

Sigmund Freud

Main article: Sigmund Freud's views on homosexuality

Freud (1856–1939) was skeptical of the possibility of therapeutic conversion.

Sigmund Freud was an Austrian neurologist and the founder of psychoanalysis. Freud claimed that homosexuality could sometimes be removed through hypnotic suggestion.

In his 1920 paper "The Psychogenesis of a Case of Homosexuality in a Woman", Freud described a young lesbian who had entered therapy because her parents wanted the condition changed. In his view, change was unlikely because of the circumstances under which she entered therapy, and because homosexuality was not an illness or neurotic conflict. Freud wrote that changing homosexuality was only possible under unusually favourable conditions, observing that "to convert a fully developed homosexual into a heterosexual does not offer much more prospect of success than the reverse". Success to Freud meant making heterosexual feeling possible, not eliminating homosexual feelings.

Freud found that gay people could rarely be convinced that heterosexual sex would provide them with the same pleasure they derived from homosexual sex. Patients often only wanted to become heterosexual to avoid social disapproval, which Freud considered a superficial and insufficient motive for change. Some, he said, might have no real desire to become heterosexual, seeking treatment only to convince themselves that they had done everything possible to change, leaving them free to return to homosexuality after the failure they expected.

In 1935, a mother asked Freud to treat her son. Freud replied in a letter that later became famous:

I gather from your letter that your son is a homosexual. ... it is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness; we consider it to be a variation of the sexual function, produced by a certain arrest of sexual development. ... By asking me if I can help [your son], you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies, which are present in every homosexual; in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.

Sándor Ferenczi

Sándor Ferenczi was an influential Hungarian psychoanalyst. Ferenczi hoped to eliminate some kinds of homosexuality entirely, but was content in practice with reducing what he considered gay men's hostility to women, along with the urgency of their homosexual desires, and with trying to make them attracted to and potent with women. In his view, a gay man who was confused about his sexual identity and felt himself to be "a woman with the wish to be loved by a man" was not a promising candidate for conversion. Ferenczi believed that complete cures of homosexuality might become possible in the future when psychoanalytic technique had been improved.

Melanie Klein

Melanie Klein was a pupil of Ferenczi. In 1932 she published her seminal book The Psycho-Analysis of Children, based on lectures given to the British Psychoanalytical Society in the 1920s. Klein claimed that entry into the Oedipus Complex is based on mastery of primitive anxiety from the oral and anal stages. If these tasks are not performed properly, developments in the Oedipal stage will be unstable. Complete analysis of patients with such unstable developments would require uncovering these early concerns. The analysis of homosexuality required dealing with paranoid trends based on the oral stage. The Psycho-Analysis of Children ends with the analysis of a gay man. Klein claimed that this subject illustrated pathologies that enter into all forms of homosexuality: a gay man idealizes "the good penis" of his partner, to allay the fear of attack he feels due to having projected his paranoid hatred onto the imagined "bad penis" of his mother as an infant. She stated that the subject's homosexual behaviour diminished after he overcame his need to adore the "good penis" of an idealized man. This was made possible by his recovering his belief in the "good mother" and his ability to sexually gratify her with his good penis and plentiful semen.

Anna Freud

Sigmund Freud's daughter, Anna Freud, became an influential psychoanalytic theorist in the UK. She reported the successful treatment of homosexuals as neurotics in a series of unpublished lectures, and in 1949, she published "Some Clinical Remarks Concerning the Treatment of Cases of Male Homosexuality" in the International Journal of Psychoanalysis. In her view, it was important to pay attention to the interaction of passive and active homosexual fantasies and strivings, the original interplay of which, she believed, prevented adequate identification with the father. The patient should be told that his choice of a passive partner allows him to enjoy a passive or receptive mode, while his choice of an active partner allows him to recapture his lost masculinity. She claimed that these interpretations would reactivate repressed castration anxieties, and childhood narcissistic grandiosity and its complementary fear of dissolving into nothing during heterosexual intercourse would come with the renewal of heterosexual potency.

In 1951, Anna Freud published "Clinical Observations on the Treatment of Male Homosexuality" in The Psychoanalytic Quarterly and "Homosexuality" in the American Psychoanalytic Association Bulletin. In these articles, she insisted on the attainment of full object-love of the opposite sex as a requirement for cure of homosexuality. That same year she gave a lecture about treatment of homosexuality which was criticised by Edmund Bergler, who emphasised the oral fears of patients and minimized the importance of the phallic castration fears she had discussed.

In 1956, Anna Freud recommended that a journalist preparing an article about psychoanalysis for The Observer of London not quote Sigmund Freud's 1935 letter to the American mother, on the grounds that "nowadays we can cure many more homosexuals than was thought possible in the beginning. The other reason is that readers may take this as a confirmation that all analysis can do is to convince patients that their defects or 'immoralities' do not matter and that they should be happy with them. That would be unfortunate."

Vote by European parliament in March 2018

In March 2018, a majority of 435 against 109 representatives in the European parliament passed a resolution condemning conversion therapy and urging European Union member states to ban the practice.

Albania

In May 2020, Albania became the third European country (after Malta (2016) and Germany (2020)) to ban conversion therapy or any pseudo-therapeutic attempts to change a person's sexual orientation or gender identity.

Germany

On 7 May 2020, German parliament Bundestag banned nationwide conversion therapy for minors until 18 years and forbids advertising of conversion therapy. It also forbids conversion therapy for adults, if they are decided by force, fraud or pressure.

Malta

On 6 December 2016, Malta became the first country in the European Union to prohibit the use of conversion therapy.

United Kingdom

See also: LGBT rights in the United Kingdom § Conversion therapy

In 2007, the Royal College of Psychiatrists, the main professional organisation of psychiatrists in the UK, issued a report stating that: "Evidence shows that LGB people are open to seeking help for mental health problems. However, they may be misunderstood by therapists who regard their homosexuality as the root cause of any presenting problem such as depression or anxiety. Unfortunately, therapists who behave in this way are likely to cause considerable distress. A small minority of therapists will even go so far as to attempt to change their client's sexual orientation. This can be deeply damaging. Although there are now a number of therapists and organisations in the USA and in the UK that claim that therapy can help homosexuals to become heterosexual, there is no evidence that such change is possible."

Conversion therapy is legal in the United Kingdom. The Conservative Party promised in 2018 as part of its LGBT Action Plan to make it illegal. On 8 March (International Women's Day) 2021, the UK parliament held a debate on conversion therapy where Parliamentary Under-Secretary of State for Equalities Kemi Badenoch gave no timeline for legislation, did not use the word ban, suggested there may be religious exemptions and did not mention adult conversion therapy. In response to accusations of lack of action by the government, a member of the government's LGBT+ advisory panel, Jayne Ozanne, resigned. In April 2021, after another two members of the panel quit over lack of action on banning conversion therapy, Liz Truss, the equalities minister, disbanded the panel. On 11 May, in the Queen's Speech, the government stated its intention that conversion therapy should become a banned practice throughout England and Wales.

Australia

The Government of Victoria announced in 2016 that it would be legislating to ban all LGBTQI conversion therapy. The new law began operating in February 2017 and allows the Health Complaints Commissioner to act against any health professional engaged in practices that are "found to be making false claims and to be acting in a manner that puts people's physical, mental or psychological health, safety or welfare at risk"—and in a world first, this law applies to conversion therapy for adults as well as for minors. Western Australia and the Australian Capital Territory announced in September 2017 that they are investigating similar laws. Advocates for a ban on conversion therapy argued that reviews need to go beyond the practices of health professionals and into activities of religious groups and the unregulated (non-medical) counselling sector.

A Fairfax Media investigation in 2018 reported that "across Australia, organisations who believe that LGBTI people can or should change are hard at work. Conversion practices are hidden in evangelical churches and ministries, taking the form of exorcisms, prayer groups or counselling disguised as pastoral care. They're also present in some religious schools or practised in the private offices of health professionals. They're pushed out through a thriving network of courses and mentors in the borderless world of cyberspace, cloaked in the terminology of 'self improvement' or 'spiritual healing.'" A study of Pentecostal-Charismatic churches found that LGBTI parishioners were faced with four options: remain closeted, come out but commit to remaining celibate, undergo conversion therapy, or leave the church ... the majority took the last option, though typically only after "agonising attempts to reconcile their faith and their sexuality". The study provides corroboration that conversion therapy remains practiced within religious communities.

Following the Fairfax investigation, Victorian premier Daniel Andrews called on the prime minister, Malcolm Turnbull, to support outlawing conversion therapy as part of the national mental health strategy. Federal health minister Greg Hunt declared that the issue is one for the states as no Commonwealth funding goes to sexual orientation change efforts—though "gay conversion ideology has been quietly pushed in schools as part of the federal government's chaplaincy program". The report noted that the Victorian law applies only to people offering health services and so does not catch religious groups and charities "who say they are helping same-sex attracted people to live in accordance with their faith".

Chris Csabs, a survivor of conversion therapy and LGBT+ advocate, joined Andrews in calling for the federal government to outlaw conversion therapy, declaring that "praying the gay away nearly killed me". He established a petition calling on Turnbull and Hunt to act to outlaw conversion therapy, declaring: "I prayed to God asking him to either heal me, or kill me. I was so depressed, I wanted to die." In April 2018, shadow health minister Catherine King wrote a response to the petition: "I'm writing to let you know that Labor stands with you, Chris Csabs and the medical experts in opposing gay conversion therapy ... two Turnbull Government ministers—the Acting Prime Minister and the Health Minister—have now failed to condemn the practice when given the chance." Shortly after Catherine King's response, the Queensland health minister, Steven Miles, voiced his concerns over the practise and stated that the federal health minister should be working with the states to enact change.

In May 2018, the Victorian health minister, Jill Hennessy, called for an inquiry into gay conversion therapies. In an unprecedented move, the state government indicated it would not only investigate health professionals but will focus on religious and faith-based ministries propagating gay conversion ideologies. The following day, the health minister of the Australian Capital Territory, Meegan Fitzharris, followed Catherine King's lead by also responding to the petition, stating that, "The ACT government will ban gay conversion therapy. It is abhorrent and completely inconsistent with the inclusive values of Canberrans."

In September a 2018 SOCE (Sexual orientation Change Efforts) Survivor Statement, a document written by a coalition of survivors of conversion practices and calling on the Australian government to intervene to stop conversion practices occurring, was sent with the petition to key members of parliament. The authors of the SOCE Survivor Statement, which became known as the SOGICE (Sexual Orientation and Gender Identity Conversion Efforts) Survivor Statement in 2019, coined new terms such as "LGBTQA+ conversion practices", "conversion movement" and "conversion ideology" to more accurately reflect their experiences. The SOGICE Survivors Statement lists survivor-led recommendations to the Australian government in order to stop conversion practices in Australia.

United States

20th century

Psychoanalysis started to receive recognition in the United States in 1909, when Sigmund Freud delivered a series of lectures at Clark University in Massachusetts at the invitation of G. Stanley Hall. In 1913, Abraham Brill wrote "The Conception of Homosexuality", which he published in the Journal of the American Medical Association and read before the American Medical Association's annual meeting. Brill criticised physical treatments for homosexuality such as bladder washing, rectal massage, and castration, along with hypnosis, but referred approvingly to Freud and Sadger's use of psychoanalysis, calling its results "very gratifying". Since Brill understood curing homosexuality as restoring heterosexual potency, he claimed that he had cured his patients in several cases, even though many remained homosexual.

Wilhelm Stekel, an Austrian, published his views on treatment of homosexuality, which he considered a disease, in the American Psychoanalytic Review in 1930. Stekel believed that "success was fairly certain" in changing homosexuality through psychoanalysis provided that it was performed correctly and the patient wanted to be treated. In 1932, The Psychoanalytic Quarterly published a translation of Helene Deutsch's paper "On Female Homosexuality". Deutsch reported her analysis of a lesbian, who did not become heterosexual as a result of treatment, but who managed to achieve a "positive libidinal relationship" with another woman. Deutsch indicated that she would have considered heterosexuality a better outcome.

Edmund Bergler was the most important psychoanalytic theorist of homosexuality in the 1950s. He was vociferous in his opposition to Alfred Kinsey. Kinsey's work, and its reception, led Bergler to develop his own theories for treatment, which were essentially to "blame the victim", in the evaluation of Jennifer Terry, associate professor of Woman's Studies. Bergler claimed that if gay people wanted to change, and the right therapeutic approach was taken, then they could be cured in 90% of cases. Bergler used confrontational therapy in which gay people were punished in order to make them aware of their masochism. Bergler openly violated professional ethics to achieve this, breaking patient confidentiality in discussing the cases of patients with other patients, bullying them, calling them liars and telling them they were worthless. He insisted that gay people could be cured. Bergler confronted Kinsey because Kinsey thwarted the possibility of cure by presenting homosexuality as an acceptable way of life, which was the basis of the gay rights activism of the time. Bergler popularised his views in the United States in the 1950s using magazine articles and books aimed at non-specialists.

In 1951, the mother who wrote to Freud asking him to treat her son sent Freud's response to the American Journal of Psychiatry, in which it was published. The 1952 first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-I) classified homosexuality as a mental disorder.

During the three decades between Freud's death in 1939 and the Stonewall riots in 1969, conversion therapy received approval from most of the psychiatric establishment in the United States. In 1962, Irving Bieber et al. published Homosexuality: A Psychoanalytic Study of Male Homosexuals, in which they concluded that "although this change may be more easily accomplished by some than by others, in our judgment a heterosexual shift is a possibility for all homosexuals who are strongly motivated to change".

In 1961, Richard Green (sexologist) and John Money published a paper titled “Effeminacy in Prepubertal Boys,” which looked at eleven young people assigned male at birth who were referred for their “excessive and persistent attempts to dress in the clothes of the opposite gender, constant display of gestures and mannerisms of the opposite sex, preference for play and other activities of the opposite sex, or a stated desire to be a member of the opposite sex.” They recommended that parents "Look for insidious and irrational ways in which parents may be unwittingly encouraging girlishness and penalizing their son for developing boyishly. [...] Both [parents] should convey to their son their whole-hearted approval of his present and future masculine behavior and sexuality." The paper conflated gender identity, gender expression and sexual orientation, viewing effeminacy in boys as a problem to be fixed so as not to lead to adult "homosexuality and transvestism."

In 1969, there was a riot at the Stonewall Bar in New York after a police raid. The Stonewall riot acquired symbolic significance for the gay rights movement and came to be seen as the opening of a new phase in the struggle for gay liberation. Following these events, conversion therapy came under increasing attack. Activism against conversion therapy increasingly focused on the DSM's designation of homosexuality as a psychopathology. In 1973, after years of criticism from gay activists and bitter dispute among psychiatrists, the American Psychiatric Association removed homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders. Supporters of the change used evidence from researchers such as Kinsey and Evelyn Hooker. Psychiatrist Robert Spitzer, a member of the APA's Committee on Nomenclature, played an important role in the events that led to this decision. Critics argued that it was a result of pressure from gay activists, and demanded a referendum among voting members of the Association. The referendum was held in 1974 and the APA's decision was upheld by a 58% majority.

In 1974, George Rekers and Ole Ivar Lovaas published the article "Behavioral Treatment of Deviant Sex-Role Behaviors in a Male Child." The article cited Green and Money as a source of the "growing evidence that childhood cross-gender manifestations are indicative of later adult sexual abnormalities; e.g., transvestism, transsexualism, or some forms of homosexuality." It noted that many transgender women and gay men reported their "cross-gender behaviors began in early childhood" and the research showed it was difficult or impossible to shift in adults; the authors felt the best way to prevent "future sexual deviance", or at least make it unlikely as possible, was to correct gender noncomforming behavior at a young age. The method the paper detailed was a token based reinforcement system administered by the parents which rewarded gender conformity and punished deviancy. Blue chips were a sign of good behavior and could be swapped for chocolate bars, red chips were a sign of bad behavior and resulted in isolation and beatings. The child with "cross-gender identification" who was featured in the paper and appeared in many later works published by Rekers as proof of successful treatment committed suicide at 38.

The APA removed ego-dystonic homosexuality from the DSM-III-R in 1987 and opposes the diagnosis of either homosexuality or ego-dystonic homosexuality as any type of disorder.

Joseph Nicolosi had a significant role in the development of conversion therapy as early as the 1990s, publishing his first book, Reparative Therapy of Male Homosexuality, in 1991. In 1992, Nicolosi, with Charles Socarides and Benjamin Kaufman, founded the National Association for Research & Therapy of Homosexuality (NARTH), an organization that opposed the mainstream medical view of homosexuality and aimed to "make effective psychological therapy available to all homosexual men and women who seek change". NARTH has operated under the name "Alliance for Therapeutic Choice and Scientific Integrity" (ATCSI) since 2014.

In 1998, Christian right groups including the Family Research Council and the American Family Association spent $600,000 on advertising promoting conversion therapy. John Paulk and his then wife Anne featured in full-page newspaper spreads.

21st century

A survivor and outspoken critic of conversion therapy, in November 2014, Sam Brinton was one of the first two individuals to testify before the UN Committee Against Torture regarding the practice.

United States Surgeon General David Satcher in 2001 issued a report stating that "there is no valid scientific evidence that sexual orientation can be changed". The same year, a study by Robert Spitzer concluded that some highly motivated individuals whose orientation is predominantly homosexual can become predominantly heterosexual with some form of reparative therapy. Spitzer based his findings on structured interviews with 200 self-selected individuals (143 men, 57 women). He told The Washington Post that the study "shows some people can change from gay to straight, and we ought to acknowledge that". Spitzer's study caused controversy and attracted media attention. Spitzer recanted his study in 2012, and apologized to the gay community for making unproven claims of the efficacy of reparative therapy, calling it his only professional regret.

The American Psychoanalytic Association spoke against NARTH in 2004, stating "that organization does not adhere to our policy of nondiscrimination and ... their activities are demeaning to our members who are gay and lesbian". The same year, a survey of members of the American Psychological Association rated reparative therapy as "certainly discredited", though the authors warn that the results should be interpreted carefully as an initial step, not as a final deliberation.

The American Psychological Association in 2007 convened a task force to evaluate its policies regarding reparative therapy.

In 2008, the organizers of an APA panel on the relationship between religion and homosexuality canceled the event after gay activists objected that "conversion therapists and their supporters on the religious right use these appearances as a public relations event to try and legitimize what they do".

In 2009, American Psychological Association stated that it "encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others' sexual orientation and concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation".

The ethics guidelines of major mental health organizations in the United States vary from cautionary statements to recommendations that conversion therapy be prohibited (American Psychiatric Association) to recommendations against referring patients to those who practice it (American Counseling Association). In a letter dated 23 February 2011 to the Speaker of the U.S. House of Representatives, the Attorney General of the United States stated "while sexual orientation carries no visible badge, a growing scientific consensus accepts that sexual orientation is a characteristic that is immutable".

Gay rights groups and other groups concerned with mental health fear that reparative therapy can increase the chances of depression and suicide. President Barack Obama expressed opposition to the practice in 2015.

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. 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.

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. 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.

Ex-gay/ex-trans ministry

OneByOne booth at a Love Won Out conference

Main article: Ex-gay

Some sources describe ex-gay and ex-trans ministries as a form of conversion therapy, while others state that ex-gay organizations and conversion therapy are distinct methods of attempting to convert gay people to heterosexuality. Ex-gay ministries have also been called transformational ministries. Some state that they do not conduct clinical treatment of any kind. Exodus International once believed reparative therapy could be a beneficial tool. The umbrella organization 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. 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."

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.

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.

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 associated with the psychologists Elizabeth Moberly and Joseph Nicolosi. The term reparative refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority.

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 lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure, despite the fact that he had no formal surgical training. Up to 40% of Freeman's patients were gay individuals subjected to a lobotomy in order to change their homosexual orientation, leaving most of these individuals severely disabled for the rest of their lives.

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.

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.

Public opinion

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

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.

Studies of conversion therapy

Penile-phallometric assessment studies

Sexologist Kurt Freund used penile plethysmographs which measure bloodflow to the penis to test men's claims of sexual reorientation from homosexual to heterosexual. In a study published in 1960, he found no support for the claim that the homosexual men had become heterosexual – they were still aroused by imagery of men. In 1976 Conrad and Wincze found that physiological arousal measurements did not support the positive reports of men who had participated in conversion therapy – they too were still aroused by imagery of men.

J. Michael Bailey says the available lab studies measuring arousal response have not supported men's claims of sexual re-orientation.

In a prominent 2016 review of the scientific literature on sexual orientation, J. Michael Bailey and six other scientists critique claims of sexual reorientation therapy because they rely on self-reports, not scientific tests of automatic responses to erotic stimuli or other men/women. They say that along with tests of penile blood flow, claims of sexual reorientation could also be tested by measuring relative viewing time of pictures of attractive men versus attractive women, but this is complicated by the possibility that "conversion therapy might encourage the individual to avoid looking at same-sex targets and to look more at other-sex targets. If effective, this would change viewing-time patterns but not necessarily sexual orientation". In 2017, psychologist Warren Throckmorton said that Joseph Nicolosi, a prominent practitioner of conversion therapy, had previously been offered the chance to assess the viability of his therapy by J. Michael Bailey. Bailey informed Nicolosi that he could bring his patients to his lab at Northwestern University to test their automatic responses to erotic cues and images of men and women with brain scanning technology. Throckmorton wrote that "Nicolosi never took him up on the offer" and that Bailey confirmed the offer was still open.

Medical treatments

Attempts to change sexual orientation of gay adults in medical literature have failed. These attempts usually included various forms of behavioral and aversive therapy, often involving showing erotic or pornographic imagery to homosexuals while they swallowed an emetic drug to induce vomiting. Other medical approaches attempted to "cure" homosexuality through castration (removal of testes), injection of various hormones, electroconvulsive shocks, and lobotomy (a surgical removal of the frontal lobe of the brain). American historian Jonathan Katz counted 36 methods used during the 1900s in North America which attempted to cure homosexuality. No reproducible results could ever be achieved.

2001 study by Spitzer

In 2001, Robert Spitzer conducted a study of 143 men and 57 women who claimed they had experienced some measure of change in sexual orientation from homosexual to heterosexual through ex-gay ministries and conversion therapy. In October 2003 he published the results in Archives of Sexual Behavior and gave a presentation on the topic at the American Psychiatric Association's convention in New Orleans. The study was partly a response to the APA's 2000 statement cautioning against clinical attempts at changing homosexuality, and was aimed at determining whether such attempts were ever successful rather than how likely it was that change would occur for any given individual. Spitzer wrote that some earlier studies provided evidence for the effectiveness of therapy in changing sexual orientation, but that all of them suffered from methodological problems.

Spitzer's study relied exclusively on self-reported sexual orientation change from phone interviews. He reported that after intervention, self-reports showed that 66% of the men and 44% of the women had achieved "good heterosexual functioning", which he defined as requiring five criteria: being in a loving heterosexual relationship during the last year, overall satisfaction in emotional relationship with a partner, having heterosexual sex with the partner at least a few times a month, achieving physical satisfaction through heterosexual sex, and not thinking about having homosexual sex more than 15% of the time while having heterosexual sex. He found that the most common reasons for seeking change were lack of emotional satisfaction from gay life, conflict between same-sex feelings and behavior and religious beliefs, and desire to marry or remain married. The paper was widely reported in the international media and taken up by politicians in the United States, Germany, and Finland, and by conversion therapists.

Spitzer's study was criticized on numerous ethical and methodological grounds, and gay activists argued that the study would be used by conservatives to undermine gay rights. Spitzer acknowledged that the study sample consisted of people who sought treatment primarily because of their religious beliefs (93% of the sample) and publicly spoke in favor of changing homosexual orientation (78%), and thus were strongly motivated to overreport success. Critics felt he dismissed this source of bias, without even attempting to measure deception or self-deception (a standard practice in self-reporting psychological tests like MMPI-2). That participants had to rely upon their memories of what their feelings were before treatment may have distorted the findings. It was impossible to determine whether any change that occurred was due to the treatment because it was not clear what it involved and there was no control group.

Spitzer's own data showed that claims of change were reflected mostly in changes in self-labelling and behavior, less in attractions, and least in the homoerotic content during the masturbatory fantasies; this particular finding was consistent with other studies in this area. Previous research which did not rely upon self-reports but instead used penile plethysmographs to measure bloodflow to the penis (a measure of sexual arousal) had not supported men's claims of sexual reorientation from homosexual to heterosexual. Spitzer said that the number of gay people who could successfully become heterosexual was likely to be "pretty low", and conceded that his subjects were "unusually religious". Follow-up studies were not conducted.

In 2012, Spitzer renounced and retracted this study, 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. And that's quite an admission on my part." He also apologized to the gay community for making unproven claims of the efficacy of reparative therapy, calling it his only professional regret. Spitzer has requested that all "ex-gay" therapy organizations such as NARTH, PFOX, American College of Pediatricians, and Focus on the Family stop citing his study as evidence for conversion therapy.

"Changing Sexual Orientation: A Consumer's Report"

Ariel Shidlo and Michael Schroeder found in "Changing Sexual Orientation: A Consumer's Report", a peer-reviewed study of 202 respondents published in 2002, that 88% of participants failed to achieve a sustained change in their sexual behavior and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or attempting to remain celibate, with no change in attraction. Some of the participants who failed felt a sense of shame and had gone through conversion therapy programs for many years. Others who failed believed that therapy was worthwhile and valuable. Many respondents felt harmed by the attempt to change, and reported depression, suicidal ideation and attempts, hypervigilance of gender-deviant mannerisms, social isolation, fear of being a child abuser and poor self-esteem. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 worked as ex-gay counselors or group leaders.

"Family Acceptance in Adolescence and the Health of LGBT Young Adults"

When some parents reject the sexuality of their children, they register their children for conversion therapy in order to "repair" their sexuality. A study on the acceptance of LGBT youth was conducted in November 2010 for the Journal of Child and Adolescent Psychiatric Nursing at San Francisco State University. The study compared LGBT people who were accepted, a little rejected, and completely rejected as youths. The results of the study concluded with data proving that youths whose sexual orientation were rejected were more than 8 times more likely to have attempted suicide, nearly 6 times as likely to report high levels of depression, more than 3 times as likely to use illegal drugs.

"Conversion Therapy and LGBT Youth"

In June 2019, the Williams Institute within UCLA's School of Law conducted a study analyzing the study of LGBT adults and estimates the number of youths who are likely to experience conversion therapy as a youth. The study concluded with the following estimations: 690,000 LGBT adults have experienced conversion therapy while 350,000 of those mention experienced conversion therapy as a child. 16,000 LGBT youth (13-17) are to experience conversion therapy before turning 18 in the 32 states that have not banned the practice. 10,000 LGBT youth have been shielded from the practice in the states that have banned conversion therapy. 57,000 LGBT youth will still receive conversion therapy from religiously affiliated conductors in all 50 states.

Other

A report by Cornell University looked at 47 peer-reviewed studies and concluded "that there is no credible evidence that sexual orientation can be changed through therapeutic intervention."

Legal status

Main article: Legality of 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, Germany, Albania, and Mexico. In other countries, including Brazil, Ecuador, and Taiwan, medical professionals are barred from practicing conversion therapy.

Human rights

In 2020 the International Rehabilitation Council for Torture Victims released an official statement that conversion therapy is torture. 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. 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.

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. 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. 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.

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. 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.

Some medical bodies prohibit their members from practicing conversion therapy.

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Further reading

• Haldeman, Douglas C. (2022). The Case Against Conversion Therapy: Evidence, Ethics, and Alternatives. American Psychological Association. ISBN 978-1-4338-3711-1.