As in other scientific disciplines, the development of psychology has not been free of biases and homophobic practices. Proof of this has been the long and until recently annulled presence of homosexuality as a clinical category in psychopathology; as well as the creation of its corresponding “conversion therapies”, “reparative correction therapies” or “sexual reorientation”.
Although in many contexts the latter is not only discredited but also legally sanctioned ; in other places, the medieval and violent idea that homosexuality is an illness or disorder that can therefore be reversed, remains in force.
With the intention of analyzing why conversion therapies are harmful , in this article we will start by reviewing what it is and where such therapies come from, to finally see what some of their effects are.
Psychopathology and the logic of correction
The idea of “curing”, or rather “correcting”, is a logic that runs through the entire production of psychopathology, sometimes explicitly, sometimes implicitly. This idea easily becomes a fantasy that fills the gaps of the most conservative Western ideology, and for the same reason, psychopathology has easily offered itself as a powerful strategy of control; in this case, of homosexuality .
As Foucault would say in the 70’s (cit in Montoya, 2006), from its beginnings, psychiatry was proposed as an option that was not useful to “cure” in essence, because what it did was to intervene in cases of fixed abnormality without a precise organic foundation.
What could I do then? Correct the abnormality, or try to control it. Beyond diminishing a psychic discomfort, psychiatry acquires a function of social protection; that is, of procuring order in the face of the danger represented by what is morally placed as “abnormal”. In this context, sexuality, or rather non-heterosexuality, was not left out of the view of pathology . At first it is controlled from the body, and later from the psychic.
Thus an inseparable relation arises between morality, which is read in statistical terms of normality; and medicine, which is later derived in psychopathology. As a result, heterosexuality has been understood in many contexts as normal and synonymous with health. And homosexuality as the abnormal and synonymous with illness, or at best, as a disorder.
Sexuality always in the spotlight
Being a fundamental part of the human condition, sexuality has been kept very present in the most profound philosophical, scientific and political debates . At times, these debates have taken the form of moral prescriptions about sexual behavior; this in turn has impacted even desires, pleasures, practices, identities, and general views about sexuality.
In fact, until not long ago, it was difficult to make public the doubt generated by the biological foundations of sexuality, under which the latter is reduced to the reproductive capacity of men and women . Not without being absent in other times and societies, it was until the middle of the last century that sexual dissidence took to the streets to demand the free exercise of sexulity as a human right.
With the so-called “Sexual Revolution”, a lot of lives, identities and pleasures that neither morality nor pathology had managed to capture became visible; this especially in the European and American context.
This gave rise to the struggle for equal rights and to eradicate forms of discrimination based on sexual orientation . Not only that, but finally, in 1973 the APA withdrew homosexuality from its compendium of mental disorders. The WHO did the same until 1990, and in the first year of our century, APA also publicly rejected the implementation of conversion therapies.
On the other hand, but also in the United States, there is a strong conservative current that fights in the opposite direction, that of denying sexual diversity, and advocates granting rights only if sexuality is lived in a heteronormative way. In the face of the problem of how to make it heteronormative, psychology and psychiatry, which are also conservative, offer the solution: a series of corrective therapies can “reverse”, or some even “cure”, homosexuality.
Questions about the immutability of sexual orientation
For its part, and although in a minority way, another part of science has generated knowledge that has allowed us to firmly question the idea of homosexuality as a pathology.
Montoya (2006) tells us about some research that analyzes, for example, gonadal, cerebral and psychological development and diversity. These last ones question the essentialist and immutable vision of heterosexuality , besides making visible that no genes or anatomical or behavioral factors have been found that can completely account for sexual orientation.
Thus, sexual orientation is not something predetermined and immutable but a “process of continuous interaction between the biological and psychic structure of the person and the environment where he expresses his sexuality” (ibidem: 202).
Emergence and conversion therapies
We have seen from a Foucaultian perspective that, in its beginnings, psychiatry is proposed as a corrective technology, where sexuality plays a leading role. When the latter was thought to have been overcome, the 21st century came to condense all of the above in the emergence of techniques offered as a corrective option to homosexuality.
Reparative therapy first emerged in 1991, one year after the WHO removed homosexuality from the compendium of diseases . The term is attributed to the American clinical psychologist Joseph Nicolosi, who proposed it as a therapeutic model that would allow a change from homosexuality to heterosexuality. Basically, the idea of “therapeutic” assumes that homosexuality is, in fact, latent heterosexuality, and that it is a condition that generates unhappiness or significant psychological discomfort; therefore, it must be corrected.
The therapist thus positions himself from a homophobic paternalism that suppresses the person’s autonomy. And part of the options available to him/her range from aversive conditioning with electroconvulsive therapy to practicing celibacy through reinforcing guilt .
From there, corrective therapies are not considered as options based on an integral, comprehensive and respectful vision of diversity, which allows the exploration of discomforts beyond the subject himself (for example, as a consequence of the difficulties of socially expressing sexuality), but as an attempt to correct the person because he or she lives in a non-normative sexuality.
Damages and ethical questions
The APA (2000) states that “Psychotherapeutic modalities aimed at changing or repairing homosexuality are based on developmental theories whose scientific validity is questionable” and also recommends that ethical practitioners refrain from attempts to change individuals’ orientation and consider possible harms.
The latter may be psychological effects that include an increase in internalized homophobia (with the consequent interruption of sexual freedom and rights), but also clinical manifestations of depression, anxiety and self-destructive behavior.
In his bioethical analysis on the subject, Montoya (2006) tells us that the main ethical questions that can be asked about the damage to conversion therapies, are broadly as follows:
- There is not enough scientifically validated body of knowledge to support the effectiveness of reparative therapies .
- For this reason, it is difficult to argue that there are professionals who are really capable of applying them; individual ideological criteria are easily imposed.
- Informed consent emphasizes the possibilities of success, i.e. the false remedial consequences and minimizes the damage .
- They start from the premise that homosexual behaviour and identity are morally unacceptable and therefore a pathology.
- They do not respect the autonomy and dignity of the person .
- They involve techniques of deterrence by reinforcing in the person the idea that their sexuality is pathological, inferior or reprehensible.
- They are not harmless : they increase homophobia and increase the risk of suicide.
- They are unaware of the achievements in human, sexual and reproductive rights.
- They hide human diversity.
- They twist the power of the doctor.
- Montoya, G. (2006). Bioethical approach to reparative therapies. Treatment for the change of homosexual orientation. Acta Bioethica, 12(2): 199-210.
- APA (2000). Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies). APA Official Actions. Retrieved July 25, 2018. Available in position statement on therapies focused APA.