California recently passed a law against therapies designed to assist young people to give up their homosexuality. A federal court has just decided that the law does not violate constitutional provisions guaranteeing free speech. They indicated that the state was within its rights and obligations to protect young people from a treatment that is widely regarded as potentially injurious. The law applies to all licensed psychotherapists.
This sort of treatment, and variations on it, are not new. In fact, during the 1960s a number of well-respected psychiatrists were recommending such a therapy. Even as a young psychiatrist, I was outraged about the underlying assumptions of such a treatment—namely, that homosexuality was wrong or sick—or, as I remember an experienced psychoanalyst telling me, “immature.” I felt so strongly about the matter, and still do, that I took up considerable space in my novel “Come One, Come All” inveighing against this idea. Still, I think passing a law that makes “reparative therapy” illegal is unwise.
First, some facts: many people, possibly everyone, falls on a continuum on which sexual orientation varies from pronouncedly and indefatigably heterosexual to a similarly unequivocal homosexuality. Others are sort of in-between. Some men and women have homosexual experiences growing up and never again. Some others are married and never engage in homosexual behavior, but all their fantasies are homosexual. Some self-identified heterosexuals fall in love nevertheless with a particular individual of the same sex. This can happen late in life.
Another fact: A person’s sexual feelings do not change much during the course of psychotherapy, any kind of psychotherapy. It is, of course, possible to pressure someone who is more or less bisexual to give up homosexual behavior and live in a conventional relationship with someone of the opposite sex. It is possible under religious influences, and under other such strong prohibitions, even to live chastely. A therapist cannot change someone’s underlying feelings; but it is possible to change the outward manifestations of them. But at a cost. Such a person feels untrue to himself, or herself. Therapies that are designed to reach such a result are reprehensible.
These treatments are injurious only in one way: they reinforce whatever bad feelings the patient may have had about himself/herself before beginning treatment. The basic assumption of such a therapy is that being homosexual is to be inferior in some way. The fact that such a treatment is doomed to failure makes it worse. A common outcome of this sort of treatment is depression.
I once saw a young man who, on the urging of his previous therapist, ignored his homosexual feelings and married, and then, in the bargain, entered medical school, because that was what his therapist thought he should do. It took a long while for him to disentangle his life. He left medical school and his wife. Not everyone needs to be a doctor—and in the same sort of way, not everyone needs to be married.
But psychotherapy is long and complicated. It pushes patients in many different directions, sometimes inadvertently. It is more like growing up than getting better. Although its practitioners (including me) are convinced that it is helpful in many ways, proving it to be helpful, even in the narrow framework of emotional illness, has shown itself to be problematic. Only a very few studies have shown any effect at all. Something similar could be said about going to college. Is a college graduate better able to handle life? Probably, but that would be very difficult to demonstrate.
Similarly, taking the position that “gay conversion therapy” is always injurious is a matter of faith. There was a time when experienced practitioners believed in it. Now they do not. I think the criticism of this kind of treatment applies equally to any number of therapists and therapies in which the practitioner has an ax to grind. There are some therapists who regard treatment as an opportunity to turn the patient into another version of themselves. How can we outlaw such behavior?
Besides, suppose I see a patient who is homosexual and who remarks to me that he wonders what it would be like to make love to a woman. If I say, “why don’t you give it a shot?” am I engaging in “gay conversion” therapy? If such a patient chooses for any reason to accuse me of doing so, will I have to answer to some governmental authority? Even though I am well aware of some terrible things that have gone on in therapy, I don’t like having to conform what I say to some arbitrary authority.
Besides, the California law only applies to “licensed professionals.” Those kids who are likely to be sent for such a treatment are more likely to end up in the hands of ministers and others who are not licensed.
I think this law is just an odd way of saying that in the opinion of the state, homosexuality is okay. This may be worth saying, but not at the price of intruding into psychotherapy, which by its very nature is private. And it is directed, after all, to helping the patient achieve his own goals, whatever they may be.
(c) Fredric Neuman 2013 Follow Dr. Neuman's blog at fredricneumanmd,com/blog