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“Treating” homosexuality in minors: Protected free speech or child abuse?

By Brian D. Earp

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“Treating” homosexuality in minors: Protected free speech or child abuse?

Should mental health providers be allowed to try to “cure” minors of their homosexuality?

In the last legislative session, California governor Jerry Brown signed into law a bill that would prohibit mental health professionals from practicing (on minors) so-called “conversion therapy” – a type of pseudo-science intervention designed to change someone’s sexual orientation from gay to straight.

The Los Angeles Times reported yesterday that a federal judge has blocked this legislation on free-speech grounds, saying that the new law “likely … bans a mental health provider from expressing his or her viewpoints about homosexuality as part of … treatment.” The judge also “found fault with the evidence cited by proponents of the law that conversion therapy puts patients at risk of suicide.”

Unsurprisingly, the Christian legal defense organization bringing the suit applauded the decision. Said Brad Dacus, president of the Pacific Justice Institute:

This victory sends a clear signal to all those who feel they can stifle religious freedom, free speech, and the rights of parents without being contested.

What should we say about a case like this?

If someone really believes that homosexuality is tantamount to mental illness, then you can understand why she’d want to try to “treat” it – especially if she had a willing “patient.” The problem, of course, is that her values are all wrong in the first place, her notion of mental health is inexcusably out-of-date, and the “patient” is too young to be truly autonomous. “The rights of parents” do not extend to child abuse.

Should people be allowed to believe and say stupid things? Ordinarily, yes, but not so much when it translates directly to serious harm of others. The law can stand in the way of harm. “Patients” in these sorts of cases have typically been subjected to extraordinary community pressures, shaming, fear, and so on, all in a coordinated effort to pathologize a perfectly normal and healthy way of being. The illness is in the community, therefore, and not in the patient.

But I have to say: this practice of conversion therapy has been ringing in my ears recently. Last week, I gave a talk on “anti-love biotechnology” that might one day be used to diminish potentially dangerous types of love or attraction. My research with my colleagues on this topic suggests that this kind of technology might be just around the corner, and is already partially here (I won’t get into the scientific details in this post, but you can hear about them in the audio from my talk).

I began by discussing “obviously” harmful types of love, such as domestic abuse cases in which the battered individual forms a strong emotional tie with her attacker as a way to deal with the ongoing trauma. Then I brought up pedophilia, incest, adulterous love, and love for a cult leader. And for these cases, it seemed that there might be at least a surface-level argument for some kind of intervention or “treatment”, although there would obviously be a lot of details to work through first.

But then the issue of “curing” homosexuals came up as an immediate counterpoint. And what about interracial love and inter-caste love? None of these types of devotion seem problematic from a liberal mindset, but they are precisely the sorts of love-related phenomena that certain groups in society might be very happy to stamp out if they had the right set of tools.

So could there ever be a case for using anti-love biotechnology? Here are some of the ethical considerations that I raised in my talk (from the transcript):

A very general sort of concern—before we can look at any details—is that anti-love biotechnology might end up being used to try to homogenize[1] the sexual and relational landscape. And the big concern here would be that people might try to eliminate various sexual preferences or forms of relationship that are not actually harmful—or that might even be healthy or positively worth pursuing—just on the grounds that they weren’t normative, or that they somehow conflicted with a narrow-minded set of supposed values that we should really be spending our time trying to push back against.

What this consideration gives us reason to think about is that there is a much wider debate going on in society about what sorts of values we should hold in the first place with respect to things like love, and sex, and relationships—and also how we should conceive of the notion of health, and mental health, and well-being, and obviously many other things as well. So biotechnology or no biotechnology, there is always going to be this wider conversation between the insights of progressivism and the insights of conservatism – as well as between the forces of secularism, and the forces of religion, and so on – and it’s not something that is in any way unique to the sorts of interventions we’re talking about today.

The question will always be: How can we use new technologies for good rather than for ill, while simultaneously trying to reach some sort of consensus on what sorts of things should be considered good, and what sorts of things should not be considered ill?

The lesson, I think, is that progressive-minded people have their work cut out for them in terms of this wider debate. And “conversion therapy” isn’t the only problem. Indeed, “anti-love biotechnology” is already being used in some communities to “cure” things like masturbation and same-sex attraction. From my talk:

According to the Israeli newspaper Haaretz, “psychiatric drugs are being given to ultra-Orthodox yeshiva students … at the request of rabbis … and marriage counselors” as a way of suppressing sexual feelings, so that the “patients” can find it easier to comply with rigid Orthodox norms about love and human sexuality.

As stated by Professor Omer Bonne, director of the psychiatry department at Hadassah University Hospital in Ein Karem, Jerusalem:

Some behaviors put Haredim in conflict with their values and cause them mental problems, even to the point of depression.

My view concerning drug treatment in such cases has changed. For example, when I was young, idealistic and less experienced, whenever I had a case of homosexuality, masturbation – or, as Haredim put it, ‘compulsiveness in sex’ – I would say: ‘Homosexuality is not a mental problem, masturbation is certainly not a mental problem or even a medical problem. I do not treat people who do not have a medical problem.’

Over the years, I saw that people who do these ‘awful’ things suffer terribly because of the conflicts they create. Those urges, impulses or behaviors place them in conflict with their society, and then they become depressed. In these cases, I would indeed prescribe medicines that block these conditions.

As the article goes on to state:

Bonne acknowledges that this may be an exceptional approach, but others agree with it, too. “Currently, their society has no good solution for this,” he says, referring to homosexual urges. His remarks suggest that prescription drugs are often the only way out.

To me, this scenario just underscores the dangers and absurdity of religious fundamentalism, and the importance of trying to push back against this kind of close-mindedness as a general rule. But that is a long-term project. What should be done in the meantime?

Just think about this case with the yeshiva students. Suppose that there really is no practical way for these young Jewish men to leave their Orthodox communities. Their perfectly normal, natural, and healthy sexual urges are in irreconcilable conflict with the values of their religious group. And those values are so firmly and pervasively in place that the rest of us in society may find it impossible (at least in the short term) to effect any sort of change within that alternate reality.

What is a young, gay yeshiva student to do? What if, in virtue of the beliefs and pressures of his community, his sexual orientation is causing him daily, excruciating suffering? Could there be any sort of argument for his going to the local psychiatrist and asking for a chemical “treatment” for his “problem”?

Secular progressives like Governor Jerry Brown of California tried to use the force of law to prevent just this sort of scenario, as I mentioned at the start of this post. But he was rebuffed on grounds of freedom of religion and freedom of speech. These are indeed deeply-rooted, important considerations in Western societies, and some people do find a sort of personal and communal value in adhering to a bronze age, biblical worldview. As Wilfred Owen wrote:

O what insane abuses, desperate pangs,

Annihilations of the Self, soul-suicides,

They wreak upon themselves to purchase—God!

I guess that’s their right to do so. But they don’t have the right to inflict these annihilations of the self—these soul-suicides—on children. Given that the California law was designed to ban conversion therapy on minors specifically, I think it ought to have been allowed to stand. Apparently, the defense was unable to convince the judge that any actual harm is incurred by taking a child to the therapist so that he can have his innermost feelings treated like a disease. Perhaps the judge is a fellow believer; I don’t know.

Any price, it seems, to purchase—God!


[1] Kristina Gupta recently raised this concern in the American Journal of Bioethics.

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7 Comment on this post

  1. I find the free speech application the strangest. If attempting to use a psychological therapy to change a personal trait of a minor is free speech, what isn’t?

    For example, some therapists might believe that being heterosexual is bad (at least some radical feminists appear to have argued the case). Would that mean that their conversion therapy would be protected? And what about conscientious objection to treatments – if the free speech of therapists extends to *performing* a controversial treatment, surely this also implies that they are allowed to refrain from performing any treatment they disagree with?

    However: if I get the ruling right, it seems to be pretty narrow, and is likely not based on any deep *ethical* analysis of free speech, the role of therapists or homosexuality, but rather a *legal* analysis. So while it might have stupid and harmful practical consequences, it is not necessarily wrong legally.

  2. Hmmm… interesting. Suppose the treatment is successful and costless. The kid grows into a happy heterosexual, accepted by their society (and others…). Where’s the harm?

    If you had a reliable, effective, costless biotechnology that toggled sexuality, I don’t think this would be any different from the sort of genetic interventions for “designer babies” some posters have argued for on this board. Just as parents may have preferences over height, physical appearance, intelligence, etc.

    I can think of consequentialist objections if the process was costly, or if the treatment failed dangerous some fraction of the time (say 1 in 1000 kill themselves). But if it was safe and reliable, I’m not sure there could be many objections on grounds of consequences, are there? [And I’d have thought any that do apply would also probably be relevant to other baby/young person tweakings that get a pretty good hearing from philosophers.]

    I can imagine objections on grounds of authenticity (on the grounds that the treatment prevents people from realising who they “really are”.) But these could also apply in principle to other interventions, too (height, straight teeth, nice appearance, higher IQ, whatever). I don’t see how intelligence or a particular personality are in any way less fundamental to who we are than sexuality. But philosophers seem to argue *for* options to customise babies/children along (at least some of) these other dimensions, so why not this one?

    I can also imagine objections on grounds of solidarity – that allowing such a treatment could pose a threat to a legitimate form of human diversity. Maybe. But then so would treatments to improve intelligence or cognitive performance, or genetic interventions to make people taller, better looking, or to address a range of genetic conditions.

    In short I don’t see any difference in principle between a safe, effective biotechnology that toggles sexuality and one that toggles other aspects of personality, cognitive performance or physical abilities. [Obviously there are objections if the treatment is ineffective, has disastrous side-effects, etc. But assuming it doesn’t, I don’t see the objection.] Is there something special about sexuality that I’m missing?

    1. You raise some good points, Dave. The present case might be an instance in which the typical divide between the so-called bioliberals and the bioconservatives gets a little bit flipped around. What I mean is that normally in these sorts of debates, you have, on the one hand, the more futuristic and progressive-minded philosophers who are making arguments for how we should re-shape ourselves using the powers of new technology; and then on the other hand, you have the more cautious, bio-skeptical philosophers making what are sometimes rather thinly-veiled religious arguments to the effect that we should simply appreciate things as they are – and practice adjusting our mindset to tolerate life in all its messiness and sorrow. But, curiously, when it comes to human sexuality, you get a very interesting sort of reversal. And all of a sudden the conservative elements are interested in the possibilities for re-engineering our bodies and emotions into something more sexually and relationally normative—as with the yeshiva students and with various attempts to “cure” homosexuality—and then it’s the liberal commentators making the point that maybe we should just leave well enough alone. So the point is (obviously) that it all depends on what your values are: “it’s the values, stupid.” If you think there’s nothing wrong with being gay, then you get suspicious of people trying to “cure” homosexuality. If you think that natural (or God-given) = good, then you get suspicious of attempts to tamper with the status quo.

    1. Paul wrote: “it all hinges on that word “suppose”.”

      Absolutely. I have no data on this “treatment”. I have no reason to think it’s either safe or reliable, in which case my argument is irrelevant. But I just thought there was an interesting parallel at the core of the issue with various other recent posts.

  3. In my book Gay Science, I made the case (Chap. 3) that parents cannot approach the sexual orientation of their children as if it were simply theirs to control, especially for maturing adolescents.

    Some maturing adolescents have an interest that their sexual orientation – gay or lesbian – continue exactly that way. So, when their parents intervene to modify that sexual orientation, they are acting against the interests of their maturing children.
    The current legal move against sexual orientation therapy is largely on the grounds of consumer protection, namely that it doesn’t deliver what it promises. I think this is a less promising way to contain these therapies because – who knows? – some day a fully effective therapy might come along. So, to my mind, it really isn’t the merits of the therapy that makes it inadvisable so much as the way it contradicts the interests of teenagers who want to have the sexual interests they have.

    Now, this approach also means that maturing adolescents who do not want the sexual interests they have should probably have some strong say in what happens to them. By this I mean: some maturing adolescents might find that their sexual interests conflict with their sexual values. Suppose there was an intervention out that could change their sexual orientation. This is a philosopher’s armchair trick, of course, but what if? Would it be the job of the California legislature to say that no minor should ever have access to it? Maturing adolescents have more and more say all the time in what happens to them in therapeutic settings, even to the point of declining life-sustaining treatments. Would a safe and effective intervention that shifted their sexual desires into line with their sexual values be immoral on the grounds that they ought to only have the sexual identity that chance gave them?

    That said, I will hasten to say that there are no effective therapies, and they aren’t safe in the sense that they do lead people down a lot of dead ends. Adults can assume the risks of the interventions they wish to pursue, and conversion therapy can thrive in church basements everywhere. But in general, adolescents should not be the subject of these interventions so long as – and this is the most important moral reason – they do not want them.

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