Conversion Therapy: a Brief Reflection on the History of the Practice and Contemporary Regulatory Efforts

• Jurisdiction: United States,Federal
• Citation: Vol. 52
• Publication year: 2022

52 Creighton L. Rev. 419. CONVERSION THERAPY: A BRIEF REFLECTION ON THE HISTORY OF THE PRACTICE AND CONTEMPORARY REGULATORY EFFORTS

CONVERSION THERAPY: A BRIEF REFLECTION ON THE HISTORY OF THE PRACTICE AND CONTEMPORARY REGULATORY EFFORTS

TIFFANY C. GRAHAM ^[*]

I would like to open my remarks by thanking Dean Michael Kelly, Professor Kelly Dineen, and the Creighton Law Review for hosting this conversation about inequities in health care and, in particular, for their kind invitation allowing me to participate in this discussion.

Today I will be talking about conversion therapy, with a particular emphasis on the movement to ban - or at least minimize - the practice. I would like to begin with a simple definition. What is conversion therapy? Very simply, it is a series of practices meant to alter an individual's sexual orientation, gender identity, or gender expression. ^[1] It is rooted in the belief that the lived expression of LGBTQ+ identity is normatively problematic and subject to correction. ^[2] Even though the discussion regarding conversion therapy can extend beyond sexual orientation and enter the world of gender identity, my remarks will focus on sexual orientation.

While there are licensed healthcare practitioners (counselors, therapists, etc.) who offer counseling that is designed to change an individual's sexual orientation, most of the people who are engaged in this work today are actually religious and spiritual leaders. ^[3] The Williams Institute ("Williams"), which is the preeminent think tank in the country focusing on LGBTQ issues, has studied conversion therapy, and as of January 2018, it found some remarkable statistics about the individuals who are receiving it:

Almost 700,000 LGBTQ individuals in the United States between the ages of 18 and 59 had received conversion therapy (approximately 350,000 of whom received it as adolescents);

Nine states had banned licensed practitioners from providing conversion therapy for minors; Williams estimated that in those states, 6,000 youths between the ages of thirteen and seventeen would have received conversion therapy if their states had not banned it;

Williams estimated that 57,000 youths around the entire country would receive conversion therapy from a religious or spiritual advisor before the age of eighteen. ^[4]

How did we get here? What does it really mean to experience conversion therapy? Two very short videos help to illuminate this question. They cover one conversation which was broken into two halves. The speaker is a young man from Iowa named Samuel Brinton. During the videos, he discusses his family's reaction when he realized as a child that he was attracted to other boys. ^[5] Specifically, he reveals the physical abuse he suffered after sharing this information with his father; his parents' decision to send him to conversion therapy; his therapist's use of both emotional manipulation and behavioral modification techniques which linked same-sex desire to excruciating pain; a suicide attempt; his decision to return to the closet in order to restore family relations; and a new experience of family rejection when he came out to them again in college. ^[6] This conversation was filmed in 2010; the forms of therapy Brinton experienced, which he has described as torture, ^[7] occurred in the early 2000s. Despite the recent nature of those events, they hearkened back to earlier points in history when members of the healthcare profession used multiple techniques to try to change their patients' sexual orientations.

Conversion therapy as we currently understand it can trace its origins to late nineteenth century Europe ^[8] and later spread to the United States. Physicians in the United States initially viewed homosexuality as a medical problem, so they implemented medical solutions in order to try to "cure" individuals. ^[9] These interventions included castration, testicle implants, bladder washing, and rectal massage. ^[10] Doctors would "wash a bladder" by inserting a catheter and flushing the bladder with a silver or nitrate solution; rectal massage was exactly what it sounded like - a small device would go into the rectum, and it would be used to massage the prostate. ^[11] By 1913 though, doctors started to realize that these techniques did not work. ^[12]

As psychotherapy became more prominent, the mental health profession began to take the lead in administering conversion therapy. ^[13] This fact notwithstanding, physical interventions did not end as the efforts to change sexual orientation became increasingly prominent during the mid-twentieth century. ^[14] Psychiatrists and psychoanalysts recommended and implemented techniques like electroshock therapy and lobotomies, in addition to talk therapy. ^[15] The techniques were not simply torturous; they did not work.

Physically invasive interventions did not cease despite their failure to alter the sexuality of the affected patients but behavioral therapy techniques became more prominent, especially in the 1960s. ^[16] Behavioral therapy often focused on the application of aversive techniques like inducing nausea or paralysis in response to homoerotic imagery and instructing patients to snap their wrists with a rubber band any time they were aroused by homoerotic images. ^[17] Therapists tried non-aversive techniques as well. They included attempts to improve patients' dating skills with members of the opposite sex; assertiveness training for men (the need for which was often rooted in a belief that weak fathers and dominant mothers produced gay sons); teaching stereotypically masculine and feminine behaviors; orgasmic reconditioning; and, among other techniques, using hypnosis in order to shift the direction of arousal and desire. ^[18]

As the "gilded age" ^[19] of conversion therapy ended in the late 1960s, a profession-wide shift in the view of both the effectiveness and propriety of conversion therapy began to take shape among psychotherapists. In 1968, the American Psychiatric Association published the Diagnostic...