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Banning conversion therapies

The Governor of California, Jerry Brown, has signed a Bill that will ban ‘conversion’ or ‘reparative’ therapies in that State. These are interventions that aim at ‘curing’ homosexuality or at least, controlling homosexual desires. There have been reported cases of exorcisms, shock treatment and aversive therapies not unlike those that were used in Stanley Kubrick and Anthony Burgess’ A Clockwork Orange.

There are interventions such as female genital mutilation that are banned in  Australia, New Zealand and the United Kingdom and interventions such as Electro Convulsive Therapy that are subject to careful legal governance. So, one interesting feature of this judgment is that it has been made at State level, and that being deemed ‘unprofessional’ by a licensing body, as occurred in Australia a couple of weeks ago after a GP attempted to ‘cure’ homosexuality with Cyprostat, was not enough.

Brown is reported as saying “This bill bans non-scientific ‘therapies’ that have driven young people to depression and suicide. These practices have no basis in science or medicine and they will now be relegated to the dustbin of quackery.” These reasons are ones that can usefully be framed under the principles of beneficence and non-maleficence. The predictable and well-documented harms that are likely to result from such therapies and the lack of any evidence base for them mean that our standard expectations that health care professionals should not cause harm when there is insufficient reason to believe that there will be any benefit, appear to rule such therapies out.

The National Association for the Research and Therapy of Homosexuality (or NARTH) claim they will appeal this decision and do so on the grounds that it violates therapeutic freedom of choice.  Their website reposts an article by Christopher Rosik that describes a number of prerequisites that should occur in order for conversion therapy to be ethically acceptable. Some of the discussion seems highly contestable and I won’t spend time here arguing about this, but there are two arguments that merit further debate. Rosik claims that a therapist should be careful to consider the reasons why a client wishes conversion therapy, to properly inform them. If this occurs then we should respect this as an autonomous wish and not disregard it simply because a client wishes to modify their sexual orientation.

While this appears on the face of it to be a strong argument, it is not for the reasons that I have already mentioned and led to such therapies being banned in California: the existence of knowable and predictable harms and the absence of evidence or efficacy mean that this therapy should not be offered even if there is an autonomous request.

Rosik argues that it is important to “respect people’s dignity, rights, and self-worth” and that this should be taken to include sensitivity to religious differences. He claims that allowing clients who seek conversion therapies to access them, respects their religious diversity. Failing to allow such clients access to therapies discriminates against them.

There appears to be something paradoxical at the core of this. One reason why I think physicians should not attempt to ‘cure’ homosexuality is because I think it is profoundly illiberal in that implies that homosexual orientation is immoral and ultimately fails to respect diversity. However, the objection here is that this liberal commitment ends up restricting the ability of some clients to pursue therapy for something that jars with their value system and this fails to respect diversity.

I’m inclined to think that the debunking of the evidence that was give in support of conversion therapies means that this latter argument is neither here nor there, in that it seems to be trumped by worries about harm and lack of benefit. However, that would be to duck what is an interesting challenge for my liberal argument. I’m not convinced for the following reason: if this is a case where a client wishes to alter his sexual orientation because it conflicts with a value set that sees homosexuality as immoral, then although this appears to be a private act, it is one that embodies values that fail to respect diversity. That would be a different case from one where a client wished to modify their orientation simply because they were committed to a heterosexual relationship, which would be consistent with respecting diverse sexual orientations.

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10 Comment on this post

  1. People who are left-handed cannot be “cured” of their left-handedness. You can amputate their left hands, so that they have no choice but to use the right hand. You can make writing with the left hand illegal. You can tell people who are left-handed that they will surely spend eternity in Hell if they persist in that abnormal behavior. You can threaten them with discrimination and violence, and even tell them they cannot marry the person they love if they do not switch to using their rights hands. But you will never cure them of the knowledge that left-handed was the way God made them.

  2. I’d just like to point out that not all value systems are healthy for the person or society that holds them. I’m, of course, talking about things like burying children in the posts of buildings to keep the gods happy or cutting out the hearts of ones enemies to satisfy the blood-lust of your gods. So when a value system conflicts with the very evolutionary nature of a person — the drive to have sex and form relationships, then that value system must be looked at as suspect and possibly detrimental to that person and society.

    Also, one thing that always struck me as off-kilter about these “conversion” therapies is that even though they claim that they can change someone from gay to straight — or at least reign in their desires; they never claim that they can convert someone from straight to gay, they only seem to believe that sexuality is fluid in one direction.

  3. As for sexual orientation flowing “in one direction,” I’m not so sure that’s always assumed to be gay-to-straight. It seems like there is a lot of societal support for the person who realizes he or she is homosexual, and that person is congratulated for having the courage to live authentically. Yet when the reverse happens–when a person with same sex attraction decides that he or she is truly a heterosexual and would like help making the transition to a healthy hetero lifestyle– that’s seen by many as being in denial, self-hatred, etc. And any entity that tries to help these individuals is now considered unethical. Odd.

    The point of therapy, ethically carried out, is to help the person learn about who he or she really is, and to help that person accept this and develop an emotionally healthy life. Of course, a lot of therapists abuse their position and use unethical methods, but this is probably no more coercive than the pressure straight people endure when they turn away from a gay lifestyle.

    It’s interesting that there is such a double standard which no one wants to address.

    1. It seems like there is a lot of societal support for the person who realizes he or she is homosexual, and that person is congratulated for having the courage to live authentically.

      It may seem that way from your vantage point, but that’s not a perception that any gay person I know would confirm. Social support is sparse even in liberal areas. Often what seems to be support is a purely verbal offering (“How brave of you!”) — done more to establish the offering party’s progressive credentials than to form a real humanizing connection with a homosexual person.

      Subtlely or unconsciously homophobic or heterocentric attitudes are ubituitous. You could only get the impression they’re not if you’re not personally targeted by them.

  4. Might one possible factor be that the line between what is institutionalised (health) care, where restrictions based on verdicts of lack of professionalism or evidence can be created through profession consensus or administrative law, and a general private health service industry (most of them rubbish from a scientific standpoint), is not as clear in the US as it may be in Europe and/or the Commonwealth? I think that there are many examples, e.g., from genetic testing and stem cell banking, but also other areas, that suggest so. In that case, the need felt by California lawmakers to legislate may become easier to understand.

    And, to answer kestrel, I’m sure the law could easily be extended to conversion therapies for straights to become gays, where any such programs in existence anywhere.

  5. Lets not confuse being confused about one’s sexual orientation, and experimenting in homosexuality/bi-sexuality, with actually being homosexual or bi-sexual. An instance of gay sex does not make one homosexual, especially if we agree that it is something biological or hardwired in the brain.

  6. @Chuck, that seems to be one of the key claims in the debate about conversion therapies. If that’s true (and I have no reason to think it is not) then the idea that a person might convert their sexual orientation seems like a recipe for causing them psychological harm. It seems reasonable to expect that would be case for all prospective changes of orientation, including hetero to homosexual.

    @Arin, yes I agree and that is the harder argument that I am trying out here. I found Rosik’s article interesting because he was putting pressure on the idea that a client who wants to convert their sexual orientation must be in denial, feel self hatred or hate others who have that sexual orientation. It seems reasonable to suppose that people could have different and number of reasons why they might wish to change their orientation.

    @Kestrel, your point seems similar to some that Rosik makes. He talks about how an ethical counsellor should approach a request for therapy of this kind and claims, convincingly in my view, that it would be inappropriate to dismiss such a request as merely being from self denial or self hatred. A good counsellor, as you say, should be open and help people to explore who they are to to live a healthier life. One of the things that I find tricky about this debate is that it seems there are so many things that fall under the category of ‘conversion therapy’. Some of the things that have happened are shocking and should not occur, but because this is counselling and not a surgical intervention like female gential mutilation, it is less easy to characterize everything that might fall under that category.

    @Christian, that seems plausible to me and it would explain why they used State legislation. Your point has some relevance for the Australian context too: most allied health care professionals were recently brought under the same national professionalism legislation that regulates doctors and nurses. It is a big deal for a doctor or nurse to be brought before one of these bodies because they can be de-registered and thereby not be able to work. However, recently there was a case of someone who was either a physio (I think) who knew he was going to disciplined by a professional board and could be struck off, so simply resigned from his professional body but continued to pratice under a new description, so a professional body regulating counselling might very well be similarly toothless.

  7. Manchester UK Counselling Services

    Whose to say that conversion therapy is not just brainwashing?! Unfortunately, as much as a powerful technique this is when counselling, it can often be abused, and used for the wrong reasons.

    Often for reasons again the will of the recipient, but also to make someont more minded in the way that someone else is, even if their beliefs or outlook on like is far worse than whats being changed

  8. the victims of these con men it just makes me angry. i think it should be band every where they are even starting this in the UK, the amount of people who kill themselves because of these con men trying to tell people they are broken it is just wrong

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