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Gay Conversion Therapy: A Dark Chapter in Mental Health Care

Why the profession must change its approach to homosexuality

New Jersey Gov. Chris Christie got it dead right when he recently signed a law prohibiting gay conversion therapy in minors. Already his public prohibition has been challenged twice in the state’s courts, but so far the judges seem to recognize the law’s wisdom. Christie’s condemnation of this unethical and potentially damaging practice should mark the beginning of the end of one of the darkest chapters in the history of mental health treatment.

Reparative therapy evolved in three steps.

• In 1952, the American Psychological Association (APA) published the first Diagnostic and Statistical Manual of Mental Disorders (DSM), with homosexuality included in the list. It was not removed until 1973, per se, and was completely taken out in 1986.

• Theories were constructed to support the belief that homosexuality is a mental disorder. These theories involved complex, unconscious processes that mental health professionals couldn’t prove true or false. Further, these theories not only indicted patients, but their families as well, because ineffective parenting was and continues to be a prominent explanation of homosexuality.

• The profession then created the therapeutic technology to treat the “disorder.” Over the years, this technology has involved techniques from a range of disciplines, including aversion therapy. And it’s not just adults who undergo this “treatment,” but children as well.

The current consensus in the field is that the theory underlying reparative therapy is weak; the overwhelming evidence is that homosexuality has a primarily biological basis. The primary mental health issues associated with homosexuality can be adequately explained by the stigma facing members of the gay, lesbian and bisexual community. Further, the "evidence" for the efficacy of reparative therapy does not meet any accepted standards in the field and has generally been debunked.

Despite the profession recanting its earlier work, the lingering damage of this previously longstanding policy reverberates through our culture.

The discrimination that gay, lesbian and bisexual individuals continue to face is not simply the result of a fringe group of mental health professionals taking a renegade approach to psychoanalysis and treatment. In fact, discrimination has been championed by organizations such as NARTH (National Association for Research and Therapy for Homosexuality), which consists of psychologists who are trained by clinical psychology programs and licensed by the profession’s boards.

By allowing such theories in the practice of mental health, we give people a reason to distrust us. To further such unsubstantiated theories and treatment is insensitive and runs the risk of promoting discrimination. To allow this practice to be conducted on children is unconscionable.

Consider other mental health conditions, like depression, obesity and eating disorders. The field of mental health has a long history of misunderstanding such conditions, only to learn later that they often result from biological or cultural factors.

As a field, mental health experts must step up and speak out against theories and practices like gay conversion therapy. We must not appear passive or accepting of a treatment that has been so damaging. Otherwise, we risk causing our profession to have a negative influence on people who do suffer from a range of mental health conditions.

As mental health professionals, must do more than simply make public statements. Statements are a good start, but they fall short of remedying the damage that has been done. There are several things we should do.

First, organizations like the APA’s Committee on Children, Youth and Families should issue statements denouncing the practice of gay conversion therapy.

Second, such organizations should join grassroots efforts to abolish these practices for children across states.

Third, practitioners and organizations can fund and develop acceptance-based programs to deal with the stress associated with being gay in this culture.

We must present an approach to homosexuality that is unbiased and founded on more than theories. As a profession, this is our mess – if we do not clean it up, we run the risk of destroying one of the founding principles of medicine: do no harm.

Dr. Michael A. Friedman is a clinical psychologist in Manhattan and a member of EHE International’s Medical Advisory Board. His views are his own. Follow EHE on Twitter @EHEintl, and contact Dr.Friedman at