By Jack Drescher, MD
"Why is it OK for doctors to help a person change their sex from male to female but it is not OK to try and change a person's homosexual orientation to a heterosexual one?"
I first heard this question asked several weeks ago during Joy Behar's interview of a so-called ex-gay man and his wife (at about 7:20 minutes into the video). Then I heard it again on NPR in Alix Spiegel's August 1 interview of another "ex-gay" man (at about 7:30 minutes into the interview). [Disclosure, I declined to appear on Behar's show to offer a professional opinion as my office schedule did not fit their filming schedule. I was also interviewed by Spiegel for "background" on the NPR segment although not taped for the segment.) The questioners were either ex-gay or married to an ex-gay. But they also appear to make their livelihoods promoting and selling ex-gay "ministries" to (mostly religious) people unhappy about their homosexual attractions.
The operative word here is "selling." I once characterized media stories about ex-gay therapies as infomercials. Comparing ex-gay "therapy" to sex reassignment surgery (SRS), for example, primarily functions as a sound bite, a commercial tag-line. And it is a good one that explains why, despite its novelty, it seems to be making the media rounds. Its underlying message is that long-discredited therapies aimed at trying to make gay people "straight" are reasonable, particularly when compared to sex reassignment surgery.
So to repeat, "why is it OK for doctors to help a person change their sex from male to female but not OK to try and change a person's homosexual orientation to a heterosexual one?"
I know that the questioners are not really seeking an answer, but I will provide one anyway. It is an answer that starts with an historical contradiction. Unlike the situation today, in the 1950s and 60s, it was not uncommon for doctors to try and change a person's sexual orientation from gay to straight while few doctors thought it was OK to do sex reassignment surgery (SRS).
For example, in the 1960s, a psychoanalytic research group headed by Irving Bieber and his colleagues claimed that dominating mothers who were too close to their sons "caused" homosexuality. Their published study claimed that 27% of the 106 homosexual men they treated with traditional psychoanalysis made them heterosexual. Yet their claims of cures were never verified and most of the scientific research to date does not support the "pushy mother" theory of homosexuality. All this led, in part, to the 1973 decision by the American Psychiatric Association to remove homosexuality from its diagnostic manual.
During the same era, sexual reassignment for transsexuals was relatively rare. In 1952, the concept entered mainstream sensibilities, albeit in sensationalized form, when American Christine Jorgensen returned from Denmark as a transwoman. The publicity surrounding her transition led to greater popular, medical, and psychiatric awareness of the Transsexual Phenomenon.
Awareness, however, did not immediately lead to acceptance. In a 1960s study by psychiatrist Richard Green, 400 physicians (including psychiatrists, urologists, gynecologists, and general medical practitioners) were asked their professional opinions about a what to do for individuals seeking SRS.
Green found, "The majority of the responding physicians were opposed to the transsexual's request for sex reassignment even when the patient was judged nonpsychotic by a psychiatrist, had undergone two years of psychotherapy, had convinced the treating psychiatrist of the indications for surgery, and would probably commit suicide if denied sex reassignment. Physicians were opposed to the procedure because of legal, professional, and moral and/or religious reasons."
Many of the surveyed physicians did not believe an entity of transsexualism actually existed and thought of these individuals as "neurotic or psychotic." Yet as a result of much clinical and scientific work, medical opinion evolved. The diagnosis of transsexualism eventually made its way into the American Psychiatric Association's diagnostic manual in 1980 and into the International manual in 1990. In the ensuing decades, an expert international consensus on transsexualism was developed, creating Standards of Care (SOC) that have been repeatedly modified and are now in a sixth edition.
Standards of Care focus on important clinical issues such as who to treat, who not to treat, which treatments work, which do not, selection criteria for best candidates, and admission of errors when they occur. Selection criteria, for example, are an important way to prevent harm being done to patients who are not suitable for the treatment. However such care in selecting patients is rarely seen in the ex-gay movement. Perhaps this is because when doing faith healing, one can take all comers. Licensed medical and allied health professionals, on the other hand, are held to a different standard.
Most sobering, although conversion therapies claiming to turn gay people straight have been practiced for decades, there is little scientific data demonstrating their efficacy. That was the conclusion of a 2009 report by the American Psychological Association [Disclosure: Although I am a psychiatrist, I was appointed a member of the psychology APA Task Force that drafted the report].
Unfortunately, much of what is harmful and unscientific was glossed over in the recent NPR segment. The result was another infomercial opportunity for the ex-gay movement to hawk a message of false hope. To anyone in the NPR listening audience who was thinking of buying what the ex-gay movement is selling, I can only offer a time-honored warning: "Let the buyer beware."
About the author:
Jack Drescher, MD, is a Training and Supervising Analyst at the William Alanson White Institute in NYC. He is a Clinical Associate Professor of Psychiatry at New York Medical College and a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders. The author of Psychoanalytic Therapy and the Gay Man, he has written numerous scholarly articles and book chapters and edited a score of books dealing with gender and sexuality.
© 2011 Jack Drescher, All Rights Reserved