Why conversion therapies are harmful

As in other scientific disciplines, the development of psychology has not been exempt from homophobic biases and 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", "remedial correction therapies" or "sexual reorientation".

Although in many contexts the latter not only discredited but legally penalized; elsewhere, the medieval and violent idea that homosexuality is a disease or disorder that can therefore be reversed continues to hold.

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

• Related article: "5 myths about homosexuality debunked by science"

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. Such an idea easily turns into a fantasy that fills in the gaps of the more conservative Western ideology, and for this reason, psychopathology has been easily offered as

a powerful control strategy; in this case, of homosexuality.

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

What could she do then? Correct the abnormality, or try to control it. Beyond reducing mental discomfort, psychiatry acquires a social protection function; that is, to seek order in the face of the danger posed by what is morally placed as "abnormal." In this context, sexuality, or rather non-heterosexuality, it was not left out of the pathology gaze. At first it is controlled from the bodily, and later from the psychic.

Thus arises an inseparable relationship between morality, which is read in statistical terms of normality; and medicine, which is derived later in psychopathology. As a result, heterosexuality has been understood in many contexts as normal and synonymous with health. And homosexuality as abnormal and synonymous with disease, or at best, as a disorder.

• You may be 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, pleasures, practices, identities and in general the visions about sexuality.

In fact, until not long ago, the doubt generated by the biological foundations of sexuality was hardly made public, under which the latter is reduced to the reproductive capacity of men and women. Not without it having been absent in other times and societies, it was until the middle of the last century that sexual dissidence takes to the streets to demand the free exercise of sexuality as a right human.

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

With this arise the struggles for equal rights and for eradicate forms of discrimination based on sexual orientation. Not only that, but finally, in 1973, the APA removed homosexuality from its compendium of mental disorders. The WHO does the same until 1990, and in the first year of our century, the 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 fights in the opposite direction, that of denying sexual diversity, and advocates granting rights only if sexuality is lived in a way heteronormative. Faced with the problem of how to make it heteronormative, also 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

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, brain and psychological development and 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 it expresses her sexuality ”(ibidem: 202).

Emergence and conversion therapies

We have seen from a Foucauldian perspective that, in its beginnings, psychiatry was considered as a correction technology, where sexuality has a leading role. When the latter was believed to have been overcome, the 21st century came 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, a 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. Deep down, 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 mental discomfort important; with which, it must be corrected.

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

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

• You may be interested: "Electroconvulsive therapy (ECT): characteristics and uses in psychiatry"

Damages and ethical questions

The APA (2000) says that “The psychotherapeutic modalities destined to change or repair homosexuality are based on developmental theories whose validity scientific is questionable ”and also advises ethical practitioners to refrain from attempts to change the orientation of individuals and consider possible damage.

These last may 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 questions ethical that for their damages can be done to conversion therapies, are broadly the following:

• There is not enough scientifically validated body of knowledge to support the efficacy of reparative therapies.
• Due to the above, it can hardly be argued that there are professionals really trained to apply them; Individual ideological criteria are easily imposed.
• Informed consent emphasizes the chances of success, that is, false reparative consequences and 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 autonomy and dignity of the person.
• They involve deterrence techniques through reinforcing in the person the idea that her sexuality is pathological, inferior or reprehensible.
• They are not innocuous: increase homophobia and increase suicide risk.
• They do not know the 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 at position statement on therapies focused APA.