Conversion therapy: practices, efficacy, and ethical concerns

Conversion Therapy

What it Is

Conversion therapy, also known as reparative therapy, is a pseudoscientific therapy that purports to be able to change the sexual orientation of a person (American Psychological Association, February 2008). It is controversial since it has had a long history of not only being largely unsuccessful in changing the sexual orientation of the person but also because it has frequently eventuated into depression.

For that reason, California recently came out with a law banning conversion therapy for teenagers and children (Buchanan, 2012), but this decision has had both its proponents and critics. Proponents argue that the bill is long in order; critics argue that it has helped some people (sometimes including them). People should have a choice regarding whether or not they wish to change their sexual orientation, and the government cannot interfere with that privacy. This essay examines both sides of the story.

History of Conversion Therapy

Kenji Yoshino argues that conversion therapy can be slotted into three phases: an early Freudian period, a time when conversion therapy was largely approved by mainstream culture, and a post-Stonewall period when her mainstream medical and psychiatric profession condemned conversion therapy (Just the Facts Coalition, 1999). Freud himself was uncertain about homosexuality largely stating that it was non-pathological and did not need to be changed. By the 1920s, however psychologists saw it as pathological and as requiring change although hope of changing it was pessimistic. In the 1930s and 1950s of America, psychoanalysts such as Bergler strongly opposed Kinsey's statement of homosexuality being a natural orientation and insisted that it could be cured in at least 90% of the time. He saw it as a disease, employing harsh behavioral methods on homosexuals to change their behavior and bullying them into conversion.

The stigma of homosexuality as a pathology continued into the '60s and '70s until pressure from gay activists forced the APA to remove ego-dystonic homosexuality from the DSM-IV in 1987 and to label it as a form of disorder (ibid).

In 2001, United States Surgeon General David Satcher stated that "there is no valid scientific evidence that sexual orientation can be changed." [ U.S. Department of Health and Human Services). But that same year Spitzer conducted a study that showed that highly determined individuals can change their orientation with some form of reparative therapy.[ http://www.apa.org/about/policy/sexual-orientation.aspx]

http://en.wikipedia.org/wiki/Conversion_therapy

He recently recanted his study and apologized to the gay community. In 2009, the 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."

Still today however, some organizations, mainly right wing mental health professionals and pastoral care providers, attempt to treat homosexuality by methods that involve aversive treatments, such as "the application of electric shock to the hands and/or genitals," and "nausea-inducing drugs...administered simultaneously with the presentation of homoerotic stimuli," masturbatory reconditioning, visualization, social skills training, psychoanalytic therapy, and spiritual interventions, such as "prayer and group support and pressure." (Haldeman 2002) Each of these methods believes that homosexuality is a learned response that can be re-conditioned.

Some people also see ex-gay ministries as a type of conversion therapy (ibid). Each however practices different things. Exodus International believes that reparative theory may be helpful whilst Evergreen International thinks it doubtful that therapy can change homosexual feelings.

In the meantime, nearly 70 therapists currently advertise they practice conversion therapy in 20 states of the U.S.A.

Argument for Conversion Therapy

There are some who state conversion therapy to have helped them in changing their orientation. These people wished to do so and they do not see why a therapy should be censored by the Californian court or condemned if it does help some individuals and if these individuals voluntarily choose to become heterosexual.

Mark Yarhouse and Warren Throckmorton, for instance, published "Ethical Issues in Attempts to Ban Reorientation Therapies" in 2002 which argues that the therapy should be allowed because it has some measure of success and because some people want it. They reported that studies show a success rate of mean 30%, and they used the seed principle of "Do no harm" to argue for conversion therapy. Haldeman (2002) uses a similar argument. According to him "For some, religious identity is so important that it is more realistic to consider changing sexual orientation than abandoning one's religion of origin... And if there are those who seek to resolve the conflict between sexual orientation and spirituality with conversion therapy, they must not be discouraged."( pp. 260 -- 264). As long as the client is fully informed of the risks and the procedure, he should be allowed the choice of whether or not to undergo conversion therapy. In fact, NARTH adds that a counselor who persists in telling a client that his only choice remains in continuing to be gay is morally unethical. This is particularly so if he refuses to offer this therapy to a client who requests it.

Argument Against Conversion Therapy

Most studies find that sexual orientation cannot be changed or, if it can, it can only be done at great risk of harm, depression, and guilt to the individual. In 2002, Shidlo and Schroeder interviewed 150 respondents and found that 88% of participants failed to maintain their change in sexual behavior; only 3% reported enduring success from the conversion therapy. Some had gone through conversion therapy for many years, and others felt a sense of shame. Shidlo and Schroeder (2002) also reported that many respondents were harmed by the attempt to change, causing; depression, suicidal ideation and attempts, hyper vigilance of gender-deviant mannerisms, social isolation, fear of being a child abuser and poor self-esteem.

Most health institutions, in fact, are against conversion therapy, and there has been no reliable study demonstrating its efficacy in the last forty years. The American Psychological Association has time and again reiterated its opposition to conversion therapy seeing it as a shady and unreliable form of therapy. The American Counseling Association shares similar views saying that they do not certify counselors to practice this form of treatment and any counselor who happens to practice it has the ethical duty of information clients that the system is unproven. They emphasize that counselors not refer clients to conversion therapy but they simultaneously admit that "it is of primary importance to respect a client's autonomy to request a referral for a service not offered by a counselor." (http://www.counseling.org/PressRoom/NewsReleases.aspx?AGuid=b68aba97-2f08-40c2-a400-0630765f72f4)

Two Stories

Two stories clearly showcase the issues.

Aron Bitzer, California college student who claims he reversed his own homosexuality through conversion therapy sued the State of California for its ban on "gay cures."

Bitzer is planning to become an ex-gay therapist and he says that the ban threatens them with job loss as well as that it violates free speech, and privacy and freedom of religion. Some people, he claims, are victims of sexual abuse and it is this that has caused them to evidence repulsion to heterosexuality. They wish to change and conversion therapy helps them. (Huff Post (November 14, 2012 )Aaron Bitzer Says Gay Conversion Therapy 'Cured' His Homosexuality, Sues California Over 'Gay Cure' Ban http://www.huffingtonpost.com/2012/10/04/aaron-bitzer-gay-conversion-therapy-california-gay-cure-ban_n_1939908.html)

Ryan Kendell on the other hand was a vociferous proponent of Senate Bill 1172 and presented a moving appeal on its behalf. Forced into conversion therapy at age 14 by his parents who discovered from his diary that he was gay, Kendell claims that he was physically and emotionally abused by NARTH and a so-called therapist before he eventually ran away and arranged to have himself called "independent" of his parents.

Kendell's plea speaks for itself:

As a young teen, the anti-gay practice of so-called conversion therapy destroyed my life and tore apart my family. In order to stop the therapy that misled my parents into believing that I could somehow be made straight, I was forced to run away from home, surrender myself to the local department of human services, and legally separate myself from my family. Though I lived in Colorado, the conversion therapist my family relied on practiced out of Southern California.

At the age of 16, I had lost everything. My family and my faith had rejected me, and the damaging messages of conversion therapy, coupled with this rejection, drove me to the brink of suicide. For the next decade I struggled with depression, periods of homelessness, and drug abuse

It took me a decade to rebuild my life, but we know that too many people are not so fortunate. Conversion therapy inflicts harm by sending the message that there is something defective or immoral about people who are lesbian, gay, bisexual, or transgender. It justifies discrimination by arguing that we can and should change and do not deserve any legal protections. It misleads families into believing that there is something wrong with their child or their loved won. Tragically, it harms the most vulnerable among us -- children. This must stop

Please, send Senate Bill 1172 to the Assembly floor for a vote. It is the right thing to do. Thank you. (Domi,, 2012 ).

My Opinion

Advocates of conversion therapy are correct in maintaining that as long as the therapy helps a quantifiable amount of people, and these people voluntarily choose that theory, it should be maintained. The question is, however, how many other people has it harmed, and what is the extent and intensity of this harm... As in every other aspect, an approach that is harmful needs to be curtailed by the government. The government restricts smoking and drugs since harmful to the person. Advocates label this system as 'therapy', and therefore, say that a patient can choose the type of therapy that he or she wishes. However, the Ninth Circuit addressed this point in 1997 when the following case occurred: So-called therapy can be harmful too. Flagellation can be classified as therapy as well as other forms of maltreatment. "A Russian citizen had been apprehended by the Russian militia, registered at a clinic as a 'suspected lesbian,' and forced to undergo treatment for lesbianism, such as 'sedative drugs' and hypnosis.... The Ninth Circuit held that the conversion treatments to which Pitcherskaia had been subjected constituted mental and physical torture. The court rejected the argument that the treatments to which Pitcherskaia had been subjected did not constitute persecution because they had been intended to help her, not harm her, and stated "human rights laws cannot be sidestepped by simply couching actions that torture mentally or physically in benevolent terms such as 'curing' or 'treating' the victims."( Gans, 1999),