Why conversion therapies are harmful

March 31, 2024

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 neglected presence of homosexuality as a clinical category in psychopathology; as well as the creation of their corresponding "conversion therapies", "reparative therapies of correction" or "sexual reorientation".

Although in many contexts this last not only is it discredited but legally penalized ; in other places, the medieval and violent idea that homosexuality is a disease or a disorder that can therefore be reversed, continues in force.

With the intention of analyze why conversion therapies are harmful , in this article we will start by reviewing what is and where these therapies come from, to finally see what some of its effects are.

Related article: "5 myths about homosexuality disassembled by science"

Psychopathology and the logic of correction

The idea of "healing", or rather of "correcting", is a logic that goes through the whole production of psychopathology, sometimes explicitly sometimes implicitly. This idea easily becomes a fantasy that fills the gaps of the most conservative Western ideology, and therefore, psychopathology has been offered easily as a powerful control strategy; in this case, of homosexuality .

As Foucault would say in the 70's (cit in Montoya, 2006), since its inception, psychiatry was proposed as an option that was not useful to "cure" in essence, because what it did was to intervene cases of abnormality fixed without precise organic foundation .

What could he do then? Correct that abnormality, or try to control it. Beyond diminishing a psychic malaise, psychiatry acquires a function of social protection; that is, to procure order in the face of the danger represented by what is morally placed as "abnormal". In this context, sexuality, or rather non-heterosexuality, it was not out of the pathological view . In the beginning it is controlled from the corporal, and later from the psychic.

Thus arises an inseparable relationship 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 the synonymous of disease, or at best, as a disorder.

Maybe you're interested: "History of psychotherapy and clinical psychology"

Sexuality always in the spotlight

Being a fundamental part of the human condition, sexuality has remained very present in philosophical, scientific and political debates deeper. At times, these debates have taken the form of moral prescriptions about sexual behavior; which in turn has impacted even the desires, the pleasures, the practices, the identities and in general the visions 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 having been absent in other times and societies, it was until the middle of the last century when sexual dissidence took to the streets to demand the free exercise of sexuality as a human right.

With the so-called "Sexual Revolution", a lot of lives, identities and pleasures that neither morals nor pathology had managed to capture gain visibility; this especially in the European and American context.

This is the reason for the struggle for equal rights and for eradicate forms of discrimination based on sexual orientation . Not only that, but finally, in the year of 1973 the APA withdraws from its compendium of mental disorders to homosexuality. The WHO does 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, a strong conservative current arises that struggles in the opposite direction, that of denying sexual diversity, and advocates granting rights only if sexuality is lived in a heteronormative way. Faced with the problem of how to make it heteronormative, conservative psychology and psychiatry offer the solution: a series of correction therapies they can "reverse", or some even "cure", homosexuality.

Questions about the immutability of sexual orientation

On the other hand, 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 investigations that analyze, for example, the development and gonadal, cerebral and psychological diversity. The latter question the essentialist and immutable view of heterosexuality , in addition to making visible that no genes or anatomical or behavioral factors have been found that can fully account for sexual orientation.

Thus, sexual orientation is not something predetermined and immutable but rather a "process of continuous interaction between the biological and psychic structure of the person and the environment where they express their sexuality" (ibidem: 202).

Emergence and conversion therapies

We have seen from a Foucaultian perspective that, in its beginnings, psychiatry is considered as a correction technology, where sexuality plays a leading role. When the latter was thought to have been overcome, the 21st century comes to condense all of the above in the emergence of techniques that are offered as a corrective option for homosexuality.

Reparative therapy first emerged in 1991, one year after the WHO withdrew 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 to change from homosexuality to heterosexuality. Basically the idea of the "therapeutic" assumes in a generalized way that homosexuality is, in reality, latent heterosexuality, and that it is a condition that generates unhappiness or important psychic discomfort; with which, you have to correct it.

The therapist is thus positioned from a homophobic paternalism that suppresses the autonomy of the person. And part of the options available from aversive conditioning with electroconvulsive therapy to practicing celibacy through reinforcing guilt .

From there, correction therapies are not considered as options based on an integral, comprehensive and respectful vision of diversity, which allows us to explore discomforts beyond the subject (for example, as a consequence of the difficulties of expressing socially the sexuality), but as an attempt to correct the person because they live in a non-normative sexuality.

Perhaps you are interested: "Electroconvulsive therapy (ECT): characteristics and uses in psychiatry"

Damages and ethical questions

The APA (2000) says that "Psychotherapeutic modalities aimed at changing or repairing homosexuality are based on theories of development whose scientific validity is questionable" and also recommends that ethical doctors abstain from attempts to change the orientation of individuals and consider the possible damages.

These last can be psychological effects that include increasing internalized homophobia (with the consequent interruption of sexual freedom and rights), but also clinical manifestations of depression, anxiety and self-destructive behaviors.

In his bioethical analysis on the subject, Montoya (2006) tells us that the main ethical questions that can be done for conversion therapies, are the following:

There is not enough scientifically validated body of knowledge to sustain the effectiveness of reparative therapies .
Due to the above, it can hardly be argued that there are professionals who are really qualified to apply them; individual ideological criteria are easily imposed.
In the informed consent the possibilities of success are emphasized, that is to say, the false reparative consequences and the damages are minimized .
They start from the premise that homosexual behavior and identity are morally unacceptable and therefore a pathology.
They do not know the respect of the autonomy and dignity of the person .
They involve dissuasion techniques by reinforcing in the person the idea that their sexuality is pathological, inferior or reprehensible.
They are not innocuous : increase homophobia and increase the risk of suicide.
They do not know the achieved achievements in human, sexual and reproductive rights.
They hide human diversity.
They misrepresent the power of the doctor.

Bibliographic references:

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.