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Conversion therapy is the
pseudoscientific Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable claim ...
practice of attempting to change an individual's
sexual orientation Sexual orientation is an enduring pattern of romantic or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender. These attractions are generally s ...
,
gender identity Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the ...
, or
gender expression Gender expression, or gender presentation, is a person's behavior, mannerisms, interests, and appearance that are associated with gender, specifically with the categories of femininity or masculinity. This also includes gender roles. These cate ...
to align with
heterosexual Heterosexuality is romantic attraction, sexual attraction or sexual behavior between people of the opposite sex or gender. As a sexual orientation, heterosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to ...
and
cisgender Cisgender (often shortened to cis; sometimes cissexual) is a term used to describe a person whose gender identity corresponds to their sex assigned at birth. The word ''cisgender'' is the antonym of ''transgender''. The prefix '' cis-'' is La ...
norms. In contrast to
evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
and clinical guidance, such practices typically view
homosexuality Homosexuality is romantic attraction, sexual attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to peop ...
and
gender variance Gender variance or gender nonconformity is behavior or gender expression by an individual that does not match masculine or feminine gender norms. A gender-nonconforming person may be variant in their gender identity, being transgender or non-bin ...
as unnatural or unhealthy. 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 in individuals who undergo it. Common methods of conversion therapy are counseling, visualization, social skills training,
psychoanalytic therapy PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might be ...
, and spiritual interventions. Other methods that have been used include ice-pick
lobotomies A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections t ...
; chemical castration with hormonal treatment; aversive treatments, such as "the application of electric shock to the hands and/or genitals" and "nausea-inducing drugs ..administered ..with the presentation of homoerotic stimuli", and
masturbatory Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinatio ...
reconditioning or
hypnosis Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologic ...
. An increasing number of jurisdictions around the world have passed
laws against conversion therapy Conversion therapy is the practice of attempting to change a person's sexual orientation or gender identity. As of December 2022, twenty-two countries have bans on conversion therapy, seven of them ban the practice by any person: Canada, Ecuador, ...
. Conversion therapy may constitute
fraud In law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law (e.g., a fraud victim may sue the fraud perpetrator to avoid the fraud or recover monetary compensa ...
and has been described by experts as
torture Torture is the deliberate infliction of severe pain or suffering on a person for reasons such as punishment, extracting a confession, interrogation for information, or intimidating third parties. Some definitions are restricted to acts carr ...
,
cruel, inhuman, or degrading treatment Cruel, inhuman or degrading treatment (CIDT) is treatment of persons which is contrary to human rights or dignity, but is not classified as torture. It is forbidden by the Universal Declaration of Human Rights, Article 3 of the European Convention ...
, and contrary to
human rights Human rights are moral principles or normsJames Nickel, with assistance from Thomas Pogge, M.B.E. Smith, and Leif Wenar, 13 December 2013, Stanford Encyclopedia of PhilosophyHuman Rights Retrieved 14 August 2014 for certain standards of hum ...
norms.


Terminology

Medical professionals and activists consider "conversion therapy" a misnomer, as it does not constitute a legitimate form of
therapy A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many different ...
. Alternative terms include sexual orientation change efforts (SOCE), gender identity change efforts (GICE)—together, sexual orientation and gender identity change efforts (SOGICE)—and LGBTQA+ conversion practices.Csabs, C., Despott, N., Morel, B., Brodel, A., Johnson, R.
The SOGICE Survivor Statement
, 2018.
"Reparative therapy" may refer to conversion therapy in general, or to a subset thereof.


History


Sexual Orientation Change Efforts (SOCE)

The term ''
homosexual Homosexuality is romantic attraction, sexual attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to p ...
'' was coined by German-speaking Hungarian writer
Karl Maria Kertbeny Károly Mária Kertbeny (or Karl Maria Benkert) (28 February 1824 – 23 January 1882) was a Hungarian journalist, translator, memoirist and human rights campaigner. He is best known for coining the words ''heterosexual'' and ''homosexual'' as ...
and was in circulation by the 1880s. Into the middle of the twentieth century, competing views of homosexuality were advanced by
psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might ...
versus academic
sexology Sexology is the scientific study of human sexuality, including human sexual interests, behaviors, and functions. The term ''sexology'' does not generally refer to the non-scientific study of sexuality, such as social criticism. Sexologists ap ...
.
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts in ...
, the founder of psychoanalysis, viewed homosexuality as a form of
arrested development The term "arrested development" has had multiple meanings for over 200 years. In the field of medicine, the term "arrested development" was first used, ''circa'' 1835–1836, to mean a stoppage of physical development; the term continues to be use ...
. Later psychoanalysts followed
Sandor Rado Sandor Rado ( hu, Radó Sándor; 8 January 1890, Kisvárda – 14 May 1972, New York City) was a Hungarian psychoanalyst of the second generation, who moved to the United States of America in the 1930s. According to Peter Gay, "Budapest prod ...
, who argued that homosexuality was a "phobic avoidance of heterosexuality caused by inadequate early parenting". This line of thinking was popular in psychiatric models of homosexuality based on the prison population or homosexuals seeking treatment. In contrast, sexology researchers such as
Alfred Kinsey Alfred Charles Kinsey (; June 23, 1894 – August 25, 1956) was an American sexologist, biologist, and professor of entomology and zoology who, in 1947, founded the Institute for Sex Research at Indiana University, now known as the Kinsey Instit ...
argued that homosexuality was a normal variation in human development. In 1970, gay activists confronted the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
, persuading the association to reconsider whether homosexuality should be listed as a disorder. The APA delisted homosexuality in 1973, which contributed to shifts in public opinion on homosexuality. Despite their lack of scientific backing, some socially or religiously conservative activists continued to argue that if one person's sexuality could be changed, homosexuality was not a fixed class such as
race Race, RACE or "The Race" may refer to: * Race (biology), an informal taxonomic classification within a species, generally within a sub-species * Race (human categorization), classification of humans into groups based on physical traits, and/or s ...
. Borrowing from discredited psychoanalytic ideas about the cause of homosexuality, some of these individuals offered conversion therapy. In 2001, conversion therapy attracted attention when Robert L. Spitzer published a non-peer-reviewed study asserting that some homosexuals could change their sexual orientation. Many researchers made methodological criticisms of the study, which Spitzer later repudiated.


Gender Identity Change Efforts (GICE)

Many cultures throughout history have had validating attitudes towards transgender and nonbinary people. Systemic institutionalized
transphobia Transphobia is a collection of ideas and phenomena that encompass a range of negative attitudes, feelings, or actions towards transgender people or transness in general. Transphobia can include fear, aversion, hatred, violence or anger tow ...
present in Western and U.S.-based medical-model narratives historically favored binary gender and pathologized gender diversity. This aided the development and proliferation of GICE, which is based on considering gender identity discordant with assigned sex at birth disordered. Early interventions were rooted in psychoanalytic hypotheses. Robert Stoller advanced the theory that cross-gender presentation and behavior in children assigned male at birth was due to an overly close relationship with their mother. Richard Green continued his research into social engineering. His methods include augmenting contact with fathers, including stereotypical masculine activities, requesting the mother take a step back, and having both parents praise traditional "masculine" behaviors and shame effeminate or cross-gender behavior. These methods did more harm than good, resulting in depression and feelings of betrayal (from parents) that the goals of the "treatment" were impossible. Green's methods were adopted by
Kenneth Zucker Kenneth J. Zucker (; born 1950) is an American-Canadian psychologist and sexologist. He was named editor-in-chief of ''Archives of Sexual Behavior'' in 2001. He was psychologist-in-chief at Toronto's Centre for Addiction and Mental Health (CAMH) ...
, but modified so the focus was primarily preventing the child from developing an eventual transgender identity. His methods include behavioral modifications of cross-gender play interests, encouraging the same-sex parent to engage more and the other to engage less, and treating the child with psychodynamic therapy. The province of Ontario subsequently banned therapeutic programs based on this approach.


Theories and techniques


Aversion therapy

Aversion therapy Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus wit ...
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. 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. Aversion therapy was developed in Czechoslovakia between 1950 and 1962 and in the 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. 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.


Bioenergetics

Bioenergetics is a therapeutic technique developed by
Alexander Lowen Alexander Lowen (December 23, 1910 – October 28, 2008) was an American physician and psychotherapist. Life A student of Wilhelm Reich in the 1940s and early '50s in New York, Lowen developed bioenergetic analysis, a form of mind-body psyc ...
and John Pierrakos, who were students of
Wilhelm Reich Wilhelm Reich ( , ; 24 March 1897 – 3 November 1957) was an Austrian doctor of medicine and a psychoanalyst, along with being a member of the second generation of analysts after Sigmund Freud. The author of several influential books, most ...
. It has been used to attempt to convert gay people to heterosexuality by Richard Cohen, who has been called one of America's leading practitioners of conversion therapy. Cohen holds male patients in his lap with the patient curled into the fetal position, and also advocates methods involving shouting or slamming a pillow with a tennis racket.


Ex-gay/ex-trans ministry

Some sources describe ex-gay and ex-trans ministries as a form of conversion therapy, while others state that ex-gay organizations and conversion therapy are distinct methods of attempting to convert gay people to heterosexuality. The umbrella organization
Exodus International Exodus International was a non-profit, interdenominational ex-gay Christian umbrella organization connecting organizations that sought to "help people who wished to limit their homosexual desires". Founded in 1976, Exodus International originall ...
in the United States ceased activities in June 2013, and the three member board issued a statement which repudiated its aims and apologized for the harm their pursuit has caused to
LGBT ' is an initialism that stands for lesbian, gay, bisexual, and transgender. In use since the 1990s, the initialism, as well as some of its common variants, functions as an umbrella term for sexuality and gender identity. The LGBT term is a ...
people. Ex-gay/ex-trans organizations often overlap and portray being trans as inherently sinful or against God's design, or pathologize gender variance as due to trauma, social contagion, or "
gender ideology The anti-gender movement is an international movement which opposes what it refers to as "gender ideology", " gender theory" or "genderism". The concepts cover a variety of issues and have no coherent definition. Members of the anti-gender move ...
."


Hypnosis

Hypnosis was used in conversion therapy since the 19th century by
Richard von Krafft-Ebing Richard Freiherr von Krafft-Ebing (full name Richard Fridolin Joseph Freiherr Krafft von Festenberg auf Frohnberg, genannt von Ebing; 14 August 1840 – 22 December 1902) was a German psychiatrist and author of the foundational work ''Psychopathi ...
and
Albert von Schrenck-Notzing Albert Freiherr von Schrenck-Notzing (18 May 1862 – 12 February 1929) was a German physician, psychiatrist and notable psychical researcher, who devoted his time to the study of paranormal events connected with mediumship, hypnotism and telepa ...
. In 1967, Canadian psychiatrist Peter Roper published a case study of treating 15 homosexuals (some of which would probably be considered bisexuals by modern standards) with hypnosis. Allegedly, 8 showed "marked improvement" (they reportedly lost sexual attraction towards the same sex altogether), 4 mild improvements (decrease of "homosexual tendencies"), and 3 no improvement after hypnotic treatment; he concluded that "hypnosis may well produce more satisfactory results than those obtainable by other means", depending on the
hypnotic susceptibility Hypnotic susceptibility measures how easily a person can be hypnotized. Several types of scales are used; however, the most common are the Harvard Group Scale of Hypnotic Susceptibility and the Stanford Hypnotic Susceptibility Scales. The Harvard ...
of the subjects.


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. 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.


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 associated with the psychologists Elizabeth Moberly and
Joseph Nicolosi Joseph Nicolosi (January 24, 1947 – March 8, 2017) was an American clinical psychologist who advocated and practised "reparative therapy", a form of the pseudoscientific treatment of conversion therapy that he claimed could help people over ...
. The term ''reparative'' refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority. The
World Professional Association for Transgender Health The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and g ...
frequently uses the term to refer to psychotherapy undertaken with the aim to make trans patients identify with their gender assigned at birth.


Lobotomy

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 lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure, despite the fact that he had no formal surgical training. Up to 40% of Freeman's patients were gay individuals subjected to a lobotomy in order to change their homosexual orientation, leaving most of these individuals severely disabled for the rest of their lives.


Marriage therapy

Previous editions of the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
'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. Sexual orientation disorder was removed from the most recent ICD,
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
, after the Working Group on Sexual Disorders and Sexual Health determined that its inclusion was unjustified.


Nazi human experimentation

Homosexual prisoners were a preferred target of
Nazi human experimentation Nazi human experimentation was a series of medical experiments on large numbers of prisoners, including children, by Nazi Germany in its concentration camps in the early to mid 1940s, during World War II and the Holocaust. Chief target popul ...
during the last years of Nazi rule. The best-known experiments involving homosexual men were attempts by endocrinologist Carl Vaernet to change prisoners' sexual orientations by implanting a pellet that released
testosterone Testosterone is the primary sex hormone and anabolic steroid in males. In humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate, as well as promoting secondary sexual characteristic ...
. Most of the victims, non-consenting prisoners at Buchenwald, died shortly thereafter.


Effects

There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation and can cause significant, long-term psychological harm. This includes significantly higher rates of depression,
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
, and other mental health issues in individuals who have undergone conversion therapy than their peers who did not, including a suicide attempt rate nearly twice that of those who did not. 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.


Public opinion

A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors. A 2022
YouGov YouGov is a British international Internet-based market research and data analytics firm, headquartered in the UK, with operations in Europe, North America, the Middle East and Asia-Pacific. In 2007, it acquired US company Polimetrix, and since ...
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.


Legal status

Some jurisdictions have criminal bans on the practice of conversion therapy, including Malta, France, Germany, Albania, Mexico and Canada. In other countries, including Brazil, Ecuador, and Taiwan, medical professionals are barred from practicing conversion therapy. In some states, lawsuits against conversion therapy providers for
fraud In law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law (e.g., a fraud victim may sue the fraud perpetrator to avoid the fraud or recover monetary compensa ...
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. Conversion therapy on minors may amount to
child abuse Child abuse (also called child endangerment or child maltreatment) is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to ...
.


Human rights

In 2020 the International Rehabilitation Council for Torture Victims released an official statement that conversion therapy is torture. The same year, UN Independent Expert on sexual orientation and gender identity, Victor Madrigal-Borloz, said that conversion therapy practices are "inherently discriminatory, that they are cruel, inhuman and degrading treatment, and that depending on the severity or physical or mental pain and suffering inflicted to the victim, they may amount to torture". He recommended that it should be banned across the world. In 2021 Ilias Trispiotis and Craig Purshouse argue that conversion therapy violates the prohibition against degrading treatment under
Article 3 of the European Convention on Human Rights Article 3 of the European Convention on Human Rights prohibits torture, and "inhuman or degrading treatment or punishment". An absolute right Article 3 is an absolute right. The right is unqualified and cannot be balanced against the rights and ...
, leading to a state obligation to prohibit it.


Medical views

Many health organizations around the world have denounced and criticized sexual orientation and gender identity change efforts. National health organizations in the United States have announced that there has been no scientific demonstration of conversion therapy's efficacy in the last forty years. They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the
Hippocratic oath The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific e ...
to do no harm and to refrain from attempts at conversion therapy. Mainstream medical bodies state that conversion therapy can be harmful because it may exploit guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about gender identity, sexual orientation, and the ability of LGBTQ people to lead happy, healthy lives. Some medical bodies prohibit their members from practicing conversion therapy.


See also

*
Christianity and homosexuality Throughout the majority of Christian history, most Christian theologians and denominations have considered homosexual behavior as immoral or sinful. Today, within Christianity, there are a variety of views on sexual orientation and homosexual ...
*
Recovering from Religion Recovering from Religion (RfR) is an international non-profit organization that helps people who have left religion, are in process of leaving, or are dealing with problems arising out of theistic doubt or non-belief. RfR provides support gro ...


References


Bibliography

* * * * * * * * * * * * *


Further reading

* * {{DEFAULTSORT:Conversion Therapy Gender identity Human rights abuses Medical controversies Pseudoscience Religion and mental health Religion and science Sexual orientation and medicine Violence against LGBT people