Conversion therapy
Claims | One's sexual orientation, romantic orientation, gender identity, or gender expression can be changed to fit heteroromantic, and cisgender norms. |
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Notable proponents | Ex-gay movement |
(Overview of pseudoscientific concepts) |
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Conversion therapy is the
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.
An increasing number of jurisdictions around the world have passed
Terminology
Medical professionals and activists consider "conversion therapy" a
Advocates of conversion therapy do not necessarily use the term either, instead using phrases such as "healing from sexual brokenness"[9][10] and "struggling with same-sex attraction".[11]
History
Sexual orientation change efforts (SOCE)
The term
Despite their lack of scientific backing, some
Gender identity change efforts (GICE)
Gender Identity Change Efforts (GICE) refer to practices of healthcare providers and religious counselors with the goal of attempting to alter a person's gender identity or expression to conform to social norms. Examples include
Early
In the 1970s,
Gender exploratory therapy
GET is a form of conversion therapy
Multiple groups exist worldwide to promote GET and have been successful in influencing legal discussions and clinical guidance in some regions.
Motivations
A frequent motivation for adults who pursue conversion therapy is their religious beliefs, especially
Theories and techniques
As societal attitudes toward homosexuality have become more tolerant over time, the most harsh conversion therapy methods such as aversion have been reduced. Secular conversion therapy is offered less often due to reduced medical pathologization of homosexuality, and religious practitioners have become more dominant.[41]
Aversion therapy and behaviorism
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.[42] 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.[43]
Other methods of aversion therapy in addition to electric shock included ice baths, freezing, burning via metal coils, and hard labor. The intent was for the subject to associate homosexual feelings with pain and thus result in them being reduced. These methods have been concluded to be ineffective.[44]
Aversion therapy was developed in Czechoslovakia between 1950 and 1962 and in the British 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.[45] 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.[46]
In the 1970s, behaviorist
Brain surgery
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[49] lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure,[50] despite the fact that he had no formal surgical training.[51]
In West Germany, a type of brain surgery usually involving destruction of the ventromedial nucleus of the hypothalamus was done to some homosexual men. The practice was criticized by sexologist Volkmar Sigusch.[52]
Castration and transplantation
In early twentieth century Germany experiments were carried out in which homosexual men were subjected to
Endocrinologist
An unknown number of men were castrated in West Germany and chemical castration was used in other Western countries, notably against Alan Turing in the United Kingdom.[61]
Ex-gay/ex-trans ministries
Ex-gay ministries are religious groups that attempt to use religion to eliminate or change somebody's sexual orientation.
Hypnosis
Hypnosis was used in conversion therapy since the 19th century by
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.[71]
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.[72]
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.[8] The term reparative refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority.[73][74]
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.[75] 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.[76]
Effects
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There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation.[2] Advocates of conversion therapy rely heavily on testimonials and retrospective self-reports as evidence of effectiveness. Studies purporting to validate the effectiveness of efforts to change sexual orientation or gender identity have been criticized for methodological flaws.[77] After conversion therapy has failed to change someone's sexual orientation or gender identity, participants often feel increased shame that they already felt over their sexual orientation or gender identity.[39]
Conversion therapy can cause significant, long-term psychological harm.[2] This includes significantly higher rates of depression, substance abuse, and other mental health issues in individuals who have undergone conversion therapy than their peers who did not,[78][79] including a suicide attempt rate nearly twice that of those who did not.[80] Modern-day practitioners of conversion therapy—primarily from a conservative religious viewpoint—disagree with current evidence-based medicine and clinical guidance that does not view homosexuality and gender variance as unnatural or unhealthy.[2][3]
In 2020,
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.[79] Youth who undergo conversion therapy from a religious provider have more negative mental health outcomes than those who had consulted a licensed healthcare provider.[39]
Public opinion
A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors.[82]
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.[83]
Legal status
Some jurisdictions have criminal bans on the practice of conversion therapy, including Canada, Ecuador, France,[84] Germany, Malta, Mexico and Spain.[85] In other countries, including Albania, Brazil, Chile, Vietnam and Taiwan, medical professionals are barred from practicing conversion therapy.[86]
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.[87]
Conversion therapy on minors may amount to child abuse.[88][89][90]
Human rights
In 2020 the
In media
Efforts to change sexual orientation have been depicted and discussed in popular culture and various media. More recent examples include: Boy Erased, The Miseducation of Cameron Post, Book of Mormon musical, Ratched, and documentary features Pray Away, Homotherapy: A Religious Sickness.[95][96]
Medical views
National health organizations around the world have uniformly denounced and criticized sexual orientation and gender identity change efforts.
See also
- Christianity and homosexuality
- Recovering from Religion
- Sexual orientation change efforts and the LDS Church
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Further reading
- Haldeman, Douglas C. (2021). Sexual Orientation and Gender Identity Change Efforts: Evidence, Effects, and Ethics. Columbia University Press. ISBN 978-1-939594-36-5.