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Born this way? How high-tech conversion therapy could undermine gay rights

By Andrew Vierra, Georgia State University and Brian D Earp, University of Oxford

This article was originally published on The Conversation.
Read the 
original article.


Following the death of 17-year-old Leelah Alcorn, a transgender teen who committed suicide after forced “conversion therapy,” President Barack Obama called for a nationwide ban on psychotherapy aimed at changing sexual orientation or gender identity. The administration argued that because conversion therapy causes substantial psychological harm to minors, it is neither medically nor ethically appropriate.

We fully agree with the President and believe that this is a step in the right direction. Of course, in addition to being unsafe as well as ethically unsound, current conversion therapy approaches aren’t actually effective at doing what they claim to do – changing sexual orientation.

But we also worry that this may be a short-term legislative solution to what is really a conceptual problem.

The question we ought to be asking is “what will happen if and when scientists do end up developing safe and effective technologies that can alter sexual orientation?”

Based on current scientific research, it is not unlikely that medical researchers – in the not-too-distant future – will know enough about the genetic, epigenetic, neurochemical and other brain-level factors that are involved in shaping sexual orientation that these variables could in fact be successfully modified.

And here is the important point. If such neuro-interventions are developed, they will have serious implications for a gay rights movement that is largely centered around a “born this way” response to discrimination – and the idea that sexual orientation isn’t something one can choose.

Where the science stands

With Oxford University colleagues Julian Savulescu and Anders Sandberg, one of us – Brian Earp – has proposed dividing potential neuro-interventions into sexual orientation into two categories.

On the one side, there are current and emerging technologies that could diminish (but not necessarily re-orient) same-sex love and desire. These would work by interfering with brain-level systems involved in lust, attraction and attachment that have evolved among mammals including humans. These could be called “anti-love biotechnologies.”

Today, most “anti-love” technologies work by regulating testosterone levels. Some target testosterone directly, such as anti-androgen drugs that are sometimes administered to sex offenders as a condition of parole, while others work more indirectly.

For example, a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), typically used as anti-depressants, can have the “side effect” of a diminished libido. Disturbingly, there are reports out of Israel of ultra-religious Jewish groups prescribing SSRIs to yeshiva students – not to treat depression, but to harness the “side effect” of a reduction in sex drive. The point in these cases is to chemically blunt any same-sex desires or even the urge to masturbate.

However, the effects of these drugs are global. That is, they have a dampening effect on one’s entire libido – whether one has homoerotic desires or otherwise – rather than blocking attraction to a specific person or group of people based on their outward sex-based appearance.

On the other side, then, are what might be called “high-tech conversion therapies.” These are interventions that would change a person’s orientation from predominately same-sex attraction to predominately opposite-sex attraction – or, indeed, the other way around.

While these kinds of technologies are not currently available, based on the trajectory of scientific investigation, one of us has argued that “there is no good reason to think that such conversion may not one day be achievable.”

The upshot is this. All animal behavior — including human behavior — is at least in principle reducible to brain states. It then becomes a matter of figuring out which specific brain-based manipulations would work to alter the higher order drives and capacities that govern one’s sexual orientation.

We know that hormones and genetics play a large role in determining sexual desires. In 1991, Bailey and Pillard found that 52% of male identical twins compared to 22% of male non-identical twins had the same nonheterosexual orientations.

Hormonal studies have found that for many traits that differ between the sexes, gay men share similar characteristics with heterosexual women – including the index finger to ring finger length ratio and certain aspects of bone structure. These are characteristics that appear to be influenced by in utero exposure to androgens and other aspects of the amniotic environment.

Of course, it is no small step to get from learning about how genes and prenatal exposures affect the development of a fetus’s later sexual desires, to determining how we can manipulate those desires in adolescents or adults. But as the ethicists Decamp and Buchanan have pointed out, it is important to “explore a range of possible issues, some of which may not arise, than to be overtaken by events owing to the failure to think ahead.”

So what does thinking ahead about high-tech conversion therapy tell us?

Put simply, the more we learn about the biological processes that underlie sexual orientation, the more likely it is that someone will figure out how to influence those processes directly.

I can’t change, even if I tried?

The advent of high-tech conversion therapy would be disastrous for the “born this way” gay rights movement.

This movement uses a variety of evidence, such as the twin studies mentioned above, as well as the inefficacy of Christian conversion camps, to argue that being gay is biological and – hence – unchangeable. If one is born gay, this argument runs, then one cannot change this fact anymore than one can change one’s height or skin color. This is an idea that has been movingly expressed in the chorus of a recent pop song by Macklemore and Ryan Lewis. As the singer says, “I can’t change, even if I tried, even if I wanted to.”

This has become a lynchpin in the fight for gay rights. “Since I can’t change who I am,” many gay people have argued, “it isn’t fair to discriminate against me.” On this kind of view, sexual orientation is an immutable characteristic like race – a highly protected category. Yet if biotechnologies of the future do allow people to change their sexual orientations, then the gay rights movement would lose one of its central arguments.

So we think that better arguments are needed – and ones that are not dependent on the current state of technology. Surely, we don’t want to say that if sexual orientation could be changed, it would be therefore OK to discriminate against people who identify as gay!

There are two avenues of response worth considering. First, we can develop – and enforce – strict legal measures to prevent the (future) use of high-tech conversion therapies on children and other minors. As one of us has argued, “When it comes to protecting vulnerable children from the misuse of love- or sexuality-altering technologies, the strong arm of the law could go a long way” in reducing the potential for harm.

Second, we can take a closer look at our concepts about what it means to be gay in the first place, and ask whether being “born this way” is actually necessary to defend against discrimination.

Changeability and discrimination

In a notorious interview recorded earlier this year, Ben Carson, a Republican physician (and possible 2016 presidential candidate), was asked if he thought that being gay is a choice. He answered, “absolutely,” with the implication being that this could be a reason for failing to extend marriage rights to homosexual couples.

Progressive commentators were outraged. In a typical line of response, they took issue with Carson’s empirical claim: being gay isn’t a choice, they insisted, often pointing to studies that seem to show a biological basis for sexual orientation.

But there are at least two problems with this kind of reaction. First, it mixes up “being gay” (which is a question of how one self-identifies, and therefore something about which individuals do have some measure of choice) with “having a same-sex sexual orientation” (in other words, being predominately or exclusively attracted to members of the same sex), only the latter of which is – currently – largely outside of one’s control. But why should we think that a person’s sexuality has to be unchangeable in the first place in order to serve as a basis for equal rights? The activist and author Dan Savage has pointed out the flaws in this line of thinking:

“[R]eligious conservatives knock on doors,” he writes, “distribute pamphlets, proselytize, and evangelize all over the country in an effort to get people to do what? To change their religions. To choose a different faith.” In other words:

[F]aith – religious belief – is not an immutable characteristic. You can change your faith. And yet religious belief is covered by civil rights laws and anti-discrimination statutes…. The only time you hear that a trait has to be immutable in order to qualify for civil rights protections is when [conservatives] talk about [being] gay.

Choice and equality

Savage is right: if it’s unjust to discriminate against people because of their religious beliefs, which – while not necessarily immutable – are certainly central to many people’s sense of self as well as how they engage with the world, then it’s also unjust to discriminate against people because of their innermost sexual desires and orientation (whether these turn out to be immutable or not).

The lesson here is that “choice” is not the point. Whether you’re gay, straight, bisexual – or whether you reject such simplistic labels altogether – you should be free to form consensual relationships with whomsoever you please. And so long as the state is involved in regulating marriage, it should not be allowed to deny its citizens equal treatment before the law, whatever their orientation.

Further reading

Earp, B. D., Sandberg, A., & Savulescu, J. (2014). Brave new love: The threat of high-tech “conversion” therapy and the bio-oppression of sexual minorities. American Journal of Bioethics: Neuroscience, 5(1), 4-12.

Earp, B. D., Wudarczyk, O. A., Sandberg, A., & Savulescu, J. (2012). If I could just stop loving you: anti-love biotechnology and the ethics of a chemical breakup. The American Journal of Bioethics, 13(11), 3-17.

Murphy, T. F. (1997). Gay science: The ethics of sexual orientation research. New York: Columbia University Press.

Savulescu, J., & Earp, B. D. (2014). Neuroreductionism about sex and love. Think, 13(38), 7-12.

————————————————————————The Conversation

This article was originally published on The Conversation.
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15 Comment on this post

  1. I defy anyone to tell me what the real point of this article is, other than maybe scaring the hell out of gay people like myself. However, if we’re talking about changing a person’s identity, why not add that one day scientists may be able to just as easily weed out different skin colors, effectively making certain races obsolete. And scientists may find a way to shrink the sex drives in males before they are born, to slow down over population. Dimishing same-sex desire might not be the only goal of evil scientists… So there, straight people, are you scared now, too?

  2. Interesting stuff. Is there a difference between pre-emption here and conversion? I can think of four different stages of intervention.

    1. Imagine there was a pill a pregnant woman could take that would mean her child would turn out to grow up X instead of Y.
    2. Imagine there was a pill you could give to small children as they developed that would mean they would turn out to grow up X instead of Y.
    3. Imagine there was a pill an adult could take that would change you from X to Y.
    4. Imagine there was a pill you were forced to take that would change you from X to Y.

    X-Y combinations could be tall/short, black/white, beautiful/ugly, straight/gay, deaf/not deaf, not ginger/ginger etc. And you can reverse all the pairs, too. If particular paths trouble you.

    It seems to me that 4 is clearly poor form, except in those rare circumstances where Y is globally bad news for everyone, such as X=a psychopathic murdering sex offender and Y=virtually anyone else. Making that guy take a pill (even if he doesn’t want to) to turn him off that path to X is good for everyone. But those instances are rare (I would think). Certainly, it seems poor form to make ginger-haired people take a pill to de-ginger them, irrespective of their wishes. At the risk of returning to the theme of the original post for a sentence or so, it seems objectionable – if depressingly likely – that the greatest enthusiasts for a gay-to-straight pill would be repressive regimes.

    I think 2 could be a problem in some situations, too. Since the parents’ choice determine the child’s outcome there are potential principal-agent issues, though how much these matter probably depend on the X and the Y. Some of them might be pretty unproblematic. (I haven’t met many people who would sincerely prefer to be less beautiful or more stupid. They might well be perfectly happy as they are; but they might like a small delta towards beauty and brilliance, too. Wouldn’t make them like themselves any less, I expect.) But in some situations the principal-agent thing might be objectionable. If a racist wants to give an adopted kid a pill to change races, for instance.

    But 3 and 1 both strike me as pretty reasonable, on the whole. I think there are prima facie reasons to let adults choose to be who they want to be. I appreciate that this may have implications for group diversity, but I think those concerns are second-order compared with individual choice. I don’t think adults have obligations to support groups they may happen to belong to – surely that’s up to them. (I don’t think I’m obliged to join collectives advancing the interests of straight white middle-class men, for instance.)

    And as for 1 – the foetus has no group affiliations yet, and only a pretty hazy set of interests. There is already a (pretty big, actually) industry dedicated to outlining to mothers how to eat and look after themselves to influence pre/postnatal development. I don’t see 1 as being a major perturbation to that.

    It may be that the aggregated effects of this sort of influence lead to bad outcomes – we observe tipping phenomena* fairly frequently in the real world. In particular, some cultural preferences for boys could lead to real problems, I think. Tim Fardella (previous comment) makes the case that certain sorts of diversity could be reduced. That may be so. But if that happens because it turns out that no one wants to be X, why should people be denied the ability to move away from X? I mean, imagine no one wants to be Gary-Larson-Cartoon-Ugly (GLCU). We may celebrate diversity through the presence of GLCU people in our midst. But no one actually wants to be that guy. I don’t think it’s fair to limit his options in the name of our (aesthetic?) preferences for diversity. Other GLCU people may want support from an on-going flux of GLCU people into their midst, and if the new choice deprives them of that support, then that is clearly costly, but it is a transient cost – once GLCU people are “obsolete” (as Tim put it) then, on the assumption that people who would have been GLCU ugly but are now not have experienced a genuine welfare gain, then it seems that the benefits of the GLCU-avoidance treatment are on-going (and greater than the costs, across time).

    This being practicethics, I don’t expect anyone will share my intutions. But one way out would be to license only those X-to-Y pills where a Y-to-X pill is also available. That way, if a parent made their kid take an X-to-Y pill, the child, when grown, would have the opportunity to take the Y-to-X pill and revert to their “authentic”** self.

    *See Schelling’s work on the racial segregation of US cities – small preferences at the micro scale can aggregate to large difference at the macro scale.
    **Whatever that may mean.

      1. Thanks Brian – that’s an interesting paper. I definitely agree there are close analogies with cosmetic enhancement, and that working on problematic norms is important, and should (probably? usually?) take precedence over providing X-to-Y treatments. But as you say towards the end of the paper – the question about which norms are problematic is fairly open and is certainly contested. My concern about having conversations about X-to-Y conversion treatments on a case by case basis – rather than as generically as possible – is that we will end up treating like cases differently. People who identify as progressives will favour some X-to-Y treatments simply because they approve of Y and disapprove of X (conservatives, too). They’ll find reasons and marshal evidence, but then will ignore exactly the same sorts of evidence in like cases just because they disapprove of the Y in those cases.

        This is why, as a policy issue, I would think it would make most sense to try to bundle all the possible X-to-Y changes together, and work through a big matrix of things that might matter, while keeping it entirely generic. And then see what falls out. I’m very probably missing something, but is there something specific about sexual orientation that means we should discuss it in isolation from other potential changes? Is it the binary or step-wise change (as is usually supposed by people when they discuss “gay to straight” conversions) as opposed to more incremental changes (as in, eg. most beauty modifications, or modifications to our cognitive performance (by doing sudoku or playing chess or whatever))?

        *Or bimodal, or even step-wise.

        1. I think many of the special protected categories that make particular X-to-Y changes are special just because of historical and cultural contingency, rather than inherent properties. Changes of religion, hair color, race or sexual preferences are in a sense esthetic differences that don’t matter in themselves (but might matter insofar the surrounding society cares about them). A change of sociopathy or maybe autism might matter for how a person is a moral agent, and intelligence and longevity changes affects a wide range of possible life projects instrumentally. So I would assume there are at least three big parts of the generic X-to-Y bundle that may have somewhat different import.

          Binariness might be doing work in priming intuition pumps because it suggests a big jump in personal state, hence threatening our identity more than something that could conceivably be slowly amped up (of course, in practice we tend to be frog-in-the-boiling-water about gradual changes to ourselves).

          1. Dave and Anders – I agree with you both: I think it’s important to get a general framework in place to evaluate these kinds of cases rather than just doing an example by example analysis (which usually ends up being a proxy for one’s intuitions about the relevant norms); and I also think that different intuitions about specific cases often turn on social/historical context (and so are hard to evaluate in a vacuum). I wonder if there’s some way to combine these two insights into an overall argument about X-to-Y conversions. Do either of you know of any work that’s been done on this question of X-to-Y conversions considered generally? And, if not, perhaps we should join forces and put together an argument!

              1. This is a very interesting discussion. I am a bit nervous about the idea of creating a framework for x-y conversions before we actually know what it is we are changing. I think a lot of work needs to be done determining e.g. how sexual desires relate to sexual identities and how genitalia relate to sex and gender. Perhaps once more progress has been made in these domains it will be easier to determine what we should be concerned with when we make a principled legal framework. I will give this more thought. Thank you Dave and Anders for the insightful comments.

              2. Same here.

                The “anti-racist pill” is a somewhat similar issue. Do people have the right to be bigoted? Seems one could make an argument that disliking certain groups up to a point is acceptable and part of freedom of thought – it is only when it turns into harmful actions society has a right to step in (big discussion about the required level of harm, of course). But one might still argue that it would be good for people to have access to such pills if they wish to be less bigoted. But would we be symmetrical about access to a racism enhancement pill? Seems less likely, and might be motivated that bigotry in general is a bias that impairs moral judgement, no matter where it is directed.

      2. I read your paper from top to bottom, Brian, and I came away feeling your “thinking ahead” was a bit oversimplified. Here are my thoughts: a sexual minority, like homosexuality, is often considered a protected class here in the United States. If gays aren’t a protected class in certain states, there is currently a push to make them so (indeed the Supreme Court may touch on that in the current same-sex marriage decision as early as June). As such, if “anti-love drugs” truly come into existence, there will be heightened scrutiny applied by the courts on any lawsuit brought by a religious extremist who tries to “convert” a gay person’s sexuality for purposes of religious bigotry. So I don’t think gay people will have that much to worry about, at least in the United States. (2) Heterosexual males, on the other hand, may have alot to be worried about. If you can change someone’s sexuality, you can change someone’s sex drive and when a baby grows up to be an adult heterosexual male, he may find that he has less sex drive than another male next to him, due to the actions of his mother. Historically, one of women’s biggest worries is that a man will cheat on her. If a mother experienced a relationship(s) that left her particularly bitter after her mate cheated on her, she may transfer that bitterness on to her child and request that some kind of change in the level of her unborn son’s sex drive or emotions be accomplished so that “no other woman has to go through what I went through”. In short, he grows up to be a sort of male “Stepford-husband”. Since statisically there are far more heterosexual males than there are gay males and heterosexual males are not a protected class, it may come to pass that this “love drug” that you are endorsing, might in fact be more popularily used, no matter how criminally, on heterosexual males, if the drug – or treatment – is available. Lastly (3): you make no mention in your paper of AI, or “Artificial Intelligence”. Leading futurists Stephen Hawkins and Bill Gates, to mention but two, have recently expressed serious concerns that artificially intelligent machines may come to control us in the future. Now if that is the case, what is to stop a machine from systematizing one span of gay people to be given drugs to convert them to heterosexuality one year, only to reverse that at another interval and force a future population of “straight” men to have their sexuality converted to homosexuality in order to cut down on, say, overpopulation or to cut down on the aggression of heterosexual males who start wars that devastate populations every twenty years or so? There is nothing to stop the love drug from being used in a thusly yo-yo fashion. So I’ll say this gently: I think you have a little way to go before you cement your argument in favor of the development of “love drugs”.

  3. Do you remember Ray Bradbury’s story, “A Sound of Thunder” about a group of wealthy adventurers who travel back in time to go on a guided safari to kill a dinosaur and one of them steps on a butterfly, a small misstep that sets into motion calamitous changes in history? Well, what if reincarnation is real and we each are reborn multiple times. And each time we come here through our unique experiences our souls grow until we become at one in harmony with the universe. Say our experiences are molded each time by various states of being within the limits of human experience, including being born what is considered by the majority to be physically ugly or incredibly beautiful or gay or born a race that people are prejudiced against. By science allowing us to “convert”, would we not be altering the trajectory of our soul’s spiritual growth? What if by bypassing those experiences we actually stunt the evolution of our souls and we never reach nirvana? What if — we’re doing that already?

  4. This is great news!!!!! HOPE!!!!!!
    Imagine using such high tech conversion therapy to cure bigotry!!!!
    Imagine the good to society when the bigots are cured and no longer look down upon nor discriminate against LGBTQ persons!
    Imagine being able to finally tell a bigot to take a pill 🙂
    Imagine! … just imagine!!!

    1. Actually, it is not that inconceivable. Propranolol seems to reduce racist bias, likely just by calming people’s reactions. It would not surprise me if betablockers could reduce bigotry a small amount.

  5. This article touches on a wide range of issues and so do the comments, but the scope and limits got blurred in the process. First of all the transgender issue is separate from the issue of being gay and why people are gay, since ‘transgender’ is not a sexual orientation. Transgender activists don’t say it is, and although some feminists dismiss it as a paraphilia, that would not make it a sexual orientation either. Secondly, acronyms like LGBTQ lump very different groups together, and we can’t consider policy without disaggregating them. In fact, the L and G and B and T and Q don’t seem to get along with each other at all, if you take social media as a guide. Thirdly with the question of a ‘pill for bigots’ the scope of the discussion becomes much broader, because we are talking about biological origins for human behaviour and political views. That is extremely controversial, to put it mildly: it is ‘sociobiology’ and ‘eugenics’, and Godwin’s Law will soon apply. Many sociologists would flatly refuse to consider any evolutionary, biological, neurobiological, and/or genetic hypothesis about social structures and human behaviour.

    On the ‘therapy’ itself, Dave Frame is right to point out that there are several options. I listed the same four in an opinion piece for a news blog, added a time frame, and a fifth option which will probably come first: a ‘gay gene’ test, followed by selective abortion. That was too much for the editors: they refused the article as homophobic. I think that would happen elsewhere as well, certainly gay lobbies would be very uncomfortable with any discussion of such options. Nevertheless it seems necessary to consider them, because there will probably be no simple single ‘gay therapy’, but a range of interventions, with separate ethics issues. We have to consider the role of the parents as well, and indeed their religion, since some would see it as their duty to prevent their children growing up sinful. Even the term ‘therapy’ is suspect – ‘treatment’ or ‘intervention’ would be more neutral.

    I won’t comment further unless others raise specific points, because there are simply too many issues here, to fit in comment format. One issue barely touched on is the justification for the existence of gays, which cannot simply be derived from ‘diversity’. Perhaps some other planet has a humanoid sexual orientation we don’t know about. If the aliens come here and tell us, will we feel we have been missing out? I doubt it, so why exactly should we have this specific form of diversity, or any other specific form of diversity? Also absent from the article and comments is the issue of anti-gay sentiment, which is a political reality. The politics of contradictory values and inter-group hostility can’t be left out, not the response of the state. All in all, enough issues to keep an ethics department busy for years.

  6. “Since I can’t change who I am,” many gay people have argued, “it isn’t fair to discriminate against me.”

    This was always a weak and unnecessarily defensive argument. All that’s really needed is: “Since there is no rationally justifiable reason to discriminate against me, it isn’t fair to discriminate against me.”

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