Reparative Therapy: An Old Conflict Returns with New Skirmishes Ahead

Reparative therapy is based on the conviction that same-gender attraction and gender identity shifts result from emotional damage and that psychological counseling can repair or reprogram these sexual “disorders.” This perspective is in direct opposition to a growing number of studies that highlight hormonal and biological differences among individuals attracted to the same gender. Biological studies on same-gender attraction have shown correlations with biological markers such as birth order[1]; RH Factor[2]; and finger length[3]. However, genetic influences cannot be seen as genetic determinism. Same-gender attraction and transgender identity are likely the result of a mixture of biological and social factors.

Many who oppose expressions of same-gender attraction on religious grounds insist that sexual orientation (and now gender identity as well) can be reprogrammed through therapeutic interventions[4]. While these interventions have been condemned by all major health and mental health professional associations the resurgence of conservative political leadership has renewed these debates. For instance, the 2016 National Republican Party platform advocated teaching the Bible in public schools and that “lawmakers use religion as a guide when legislating”.

Reparative therapy techniques received heightened attention in December 2014 when 17 year old Leelah Alcorn’s suicide made headlines. Leelah’s family rejected her transgender identity and sent her to religious-based reparative therapy. The teen responded by walking in front of a semi-truck. Her prescheduled suicide note later appeared online:

“The only way I will rest in peace is if one day transgender people aren’t treated the way I was, they’re treated like humans, with valid feelings and human rights. Gender needs to be taught about in schools, the earlier the better. My death needs to mean something. My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say “that’s fucked up” and fix it. Fix society. Please.”

Leelah’s plea highlights the suffering and pain that accompany these questionable efforts to change a person’s gender and sexual orientation.

What does the research say?

Dr. Robert Spitzer was a leading psychiatrist of the 20th century, who pioneered the removal of homosexuality as a mental disorder from the influential Diagnostic and Statistical Manual (DSM) in 1973. It shocked many when Spitzer agreed to review the efficacy of reparative therapy techniques in 2004. Equally shocking — and upsetting to many — was Spitzer’s finding that the therapy appeared to have evidence of effectiveness.

His key finding was that men who had undergone reparative therapy had expanded the range of their sexual behavior[5]. Spitzer’s publication of his findings reignited many debates about the role of mental health research, such as how psychological constructs like sexual attraction can be measured in psychological research. Many criticized the leaps in logic that Spitzer made in finding that men attracted to the same gender can also have sex with women somehow constitutes evidence of a “cure” of homosexuality. In the year before his death Spitzer revised his findings and issued both a retraction and an apology to the LGBTQ community. However, many conservative groups continue to rely on Spitzer’s review, and view his retraction as illustrating the power of the “homosexual lobby.” Spitzer’s retraction was likely influenced by the World Health Organization’s report issued in May 2012 by the Pan American Health Organization[6]. A key finding was that:

“Since homosexuality is not a disorder or a disease, it does not require a cure.”

The WHO statement is at the heart of current debates over reparative therapy and at the center of our ongoing “culture wars.” If same-gender attraction and transgender identity are sinful, and sick, they should be corrected. If they are part of a normal range of human behavior, then individuals should be given support, acceptance, and legal protection as minorities who have experienced longstanding prejudice.

It is now established that LGBT people are included under discrimination protections within the American legal system. In 2008, the California Supreme Court ruled in In re Marriage Cases (2008) 43 Cal.4th 757, that Proposition 22 was invalid. However what is often forgotten is that the decision also declared that due to the historical nature of discrimination based on sexual orientation, under the equal protection clause of the California constitution, California courts must use the higher standard of “strict scrutiny” when reviewing claims of discrimination. This made California the first state to apply this standard of review finding that “like gender, race and religion – sexual orientation represents a constitutionally suspect basis upon which to impose differential treatment”. These ideas set out by the California Supreme Court were then further supported in the US Supreme Court decision validating the legality of gay marriage and further supporting the concept of strict scrutiny in Hollingsworth v. Perry (2013) 133 S.Ct. 2652.

So what does this have to do with reparative therapy for LGBTQ people?

As Leelah’s story highlights, reparative therapy creates increased risk and suffering for LGBTQ youth. If a treatment is unwarranted (and legal protection instead is needed) reparative therapy should have legal restrictions. In fact, efforts to reduce harm caused to youth such as Leelah Alcorn and many other LGBTQ people have now led to the banning of reparative therapy in several states.

In 2012 California passed the first bill restricting reparative therapy. Currently it is illegal in California for a licensed mental health provider to offer reparative therapy to anyone under the age of 18 and violation can lead to a revocation or review of a provider’s license to practice.
New Jersey, District of Columbia, Oregon, Illinois and Vermont and some local municipalities have also issued bans. In the European Union, the country of Malta recently made a similar ruling.

The rights of professional licensing groups to issue these bans have been tested in the courts. The US Appeals Court, in Welch v. Brown 58 F.Supp. 3d 1079 (E.D. CA 2014), unanimously ruled that California’s ban was legal and the US Supreme Court declined review. The licensing bans were then unsuccessfully challenged in New Jersey; the US Supreme Court again declined review.

Reparative therapy will continue to be at the center of new disagreements about sexual orientation. With a new, conservative federal administration moving into power it is likely that these culture battles will continue with renewed vigor over the next four years. For those who see gender identity and sexual orientation through the filter of social construction, there is a comfort with the evolution of gender identity and acceptance of legal recognition for same gender relationships. For those who view same-gender sexual love and gender binary variations within religious or conservative framing, there is a desire to return to more traditional perspectives where these are viewed as conditions to be cured.
Legal precedents barring these “cures” are now coming into place but the pressures on mental health providers and legal advocates to sustain these advances will likely increase over the next four years.

It is hoped that we can hear Leelah Alcorn’s call to resist efforts to further stigmatize and pathologize gender identity and sexual orientation. To use her words: “ that’s f-ed up and fix it. Fix society. Please.”

[1]Blanchard, Ray and Lee Ellis. “Birth Weight, Sexual Orientation And The Sex Of Preceding Siblings.” Journal of Biosocial Science, vol. 33, 2001, pp. 451-467
[2] Ellis, Lee, Christopher Ficek, Donald Burke, et al. “Eye color, Hair Color, Blood Type, and the Rhesus Factor.” Archive of Sexual Behavior, 2008 vol. 37 doi:10.1007/s10508-007-9274-0
[3] Williams, Terrance J., Michelle E. Pepitone, Scott E. Christensen, Bradley M. Cooke, Andrew D. Huberman, Nicholas J. Breedlove, Tessa J. Breedlove, Cynthia L. Jordan & S. Marc Breedlove. “Finger-length Ratios and Sexual Orientation.” Nature vol. 404, pp. 455-456, 30 March, 2000 doi:10.1038/35006555
[4] “NARTH What We Offer.” National Association for Research & Therapy of Homosexuality (NARTH), retrieved 2016
[5];Spitzer, Robert. “Can Some Gay Men and Lesbians Change Their Sexual Orientation?” Archive of Sexual Behavior, vol. 32, pp.403-417
[6]“Cures’ For An Illness That Does Not Exist: Purported Therapies Aimed At Changing Sexual Orientation Lack Medical Justification And Are Ethically Unacceptable.” Report Pan American Health Organization, Regional Office of the World Health Organization, published 2012