A Past and Present Perspective
Homosexuality. Bisexuality. Transsexuality. Intersexuality. Asexuality. Pansexuality. Skoliosexuality.
These sexual orientations are asynchronous to the conjectures of the society and hence were abhorred and regarded as diseases, illnesses, and disorders and deemed iniquitous, sinful, pathological, and criminal for centuries.
In 1899, Albert von Schrenck-Notzin, a German physician, psychiatrist, and psychical researcher asserted that through 45 hypnotic sessions and the use of a bordello, he was capable of manipulating the sexual impulses and reversing the sexuality of a man, thus contriving the phenomenon of conversion therapy. Conversion therapy refers to the pseudoscientific practices which aim to transform the sexuality or sexual orientation of an individual by means of psychological, physiological, and spiritual interventions. It defines the socially inappropriate sexual orientations as consequences of arrested sexual development. It is based on the assumption that forms of sexuality different from heterosexuality are mental disorders that necessitate treatment.
Eugene Steinach, an Austrian psychiatrist and endocrinologist believed that homosexuality is rooted in the testicles of a man which lead him to structure the Steinach Rejuvenation Procedure in 1920. It involved castration and implantation of ‘heterosexual testes’ in homosexual men with the conjecture that it would transform homoerotic tendencies into heterosexual drives.
Sigmund Freud believed that there must be an organic determinant to homoeroticism and that hypnotic suggestion might help in removing homosexuality in unusually favorable conditions. He believed that it was discouragingly difficult to treat homoeroticism. He stated, in 1935, that homosexuality or bisexuality is innate in humans and is not an illness or a neurotic conflict. Isidor Sadger and Wilhelm Stekel held similar views in their treatment of homosexuality through hypnosis. However, their beliefs were largely condemned and criticized by researchers and professionals.
Edmund Bergler’s treatment of homosexuality was primarily based on ‘blaming the victim’. Bergler centered his approach on confrontational therapy; punishing, ridiculing, and bullying his patients. He labeled his patients as worthless, liars, deceivers, and violated the ethic of confidentiality of the patients.
The work of Anna Freud suggested that homosexuals must be treated as neurotics.
Irving Bieber and Charles Socarides held the belief that unconscious childhood conflicts are responsible for the development of homosexuality. Curran and Parr's and Mayerson and Lief's work also suggested psychoanalysis as the appropriate treatment for curing homosexuality.
Individuals with socially unacceptable sexual orientations were involuntarily admitted and forcefully treated in medical and psychiatric institutions. Electroconvulsive therapy was administered on these patients in an attempt to cure their homosexuality. Seizures were electrically induced in the patients in order to change the structure or the chemical imbalance of their brains. Walter Jackson Freeman, an American neurologist, and psychiatrist developed, executed, and popularized his technique of Transorbital Lobotomy on homosexuals. It was one of the most brutal, barbaric treatment approaches in medical history. The procedure involved immobilizing the patient with the use of electroshock therapy and then introducing a sharp ice-pick tool into the frontal lobes in the brain of the patient through the orbit of the eye and moving it back and forth. Freeman believed that homosexuality was a consequence of exaggerated emotions and that cutting the brain will eventually assist in the reversal of their illness. The surgical lobotomies were replaced by chemical lobotomies in 1954 through the introduction of a drug called ‘Thorazine.’
Robert Galbraith Heath pioneered the technique of implanting electrodes directly into the pleasure centre of the brain to administer shocks in an individual. Heterosexual pornography and prostitutes were employed in order to facilitate the process of pleasure conditioning.
In the year 1950, the practice of administering aversion therapy on homosexuals and bisexuals originated. The underlying principle of the therapy was to associate a pleasant stimulus with an unpleasant response; this association leads to the pleasant stimulus becoming unpleasant even in the absence of an unpleasant response. It involved the application of electric shock to hands or genitals or nausea-inducing drugs in the presence of homoerotic stimuli. Devices like visually-keyed shockers were introduced in order to self-reinforce. In certain procedures of aversion therapy, heteroerotic stimuli were also paired with positive responses in an attempt to lure the patients towards heterosexuality.
In the year 1952, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-1) classified homosexuality as a mental disorder. This lead to dire humiliation, ignominy, and opprobrium towards the sexually-deviant individuals.
The covert sensitization method for sexual deviation was introduced by Joseph Cautela in the 1960s. It involved instructing the patients to imagine an unpleasant response to homoerotic stimuli. The unpleasant response might be mental imagery of a nauseous feeling or of an electric shock which leads to the formation of a negative association between the pleasant stimuli and the unpleasant response.
Physical treatments of sexual deviation included Hysterectomy, Ovariectomy, Clitoridectomy, Vasectomy, Pudic nerve surgery, bladder washing, and rectal massage.
Extreme levels of physical, psychological, and sexual coercion along with restraints, brutality, violence, and seclusion were practiced towards these patients. The procedures of chemical castration, hormonal treatment, and treatment with sexual stimulants and sexual depressants were employed in the treatment of sex reversal in order to permute the libido in these patients.
In 1970, John N. Marquis, a clinical psychologist formulated the use of the technique Masturbatory or Organism Reconditioning on homosexuals as an approach to treat them. It involves the use of masturbation to modify the individual’s sexual preferences. The technique comprised of four methods that were believed to influence the sexual impulses of an individual - Thematic shift, Directed masturbation, Fantasy alteration, and Satiation.
The Reparative therapy developed by Elizabeth Moberly and Joseph Nicolosi is based on the postulate that states an association between same-sex attraction and feelings of inferiority. The therapy believes that homosexuality is an attempt at self-repairing those feelings of inferiority and working on those feelings directly will eventually reduce homosexual impulses. William Masters and Virginia Johnson's administration of sex therapy as a treatment approach of sexual orientation change was also regarded as a form of conversion therapy. Spiritual conversion practices to cure homosexuality incorporated the genesis of a corrective and healing relationship with God through excessive praying and performing rituals and ceremonies that would assist in the removal of this social maladjustment.
Between the years 1939 and 1969, conversion therapy received approval from most of the psychiatric and medical establishments. However, the form of therapy was largely discredited post the stonewall riots and gay rights movement of the 1960s and 1970s, which lead to increasing attacks on conversion therapy. Acute activism against the therapy increasingly focused on DSM’s declassification of homosexuality as a psychopathology. After years of criticism, activism, and disputes, the American psychiatric association removed homosexuality from DSM - II in the year 1973. This decision was condemned by critics on the grounds of gay activism being responsible for the change which leads to the conduction of a referendum in 1974 wherein the decision of APA was upheld by 58% of the members of the committee. In 1975, the American Psychiatric Association declared that homosexuality per se is not a mental disorder. The American Psychological Association reaffirmed that same-sex feelings, attraction, and behaviors are positive and normal variations in human behavior that do not necessitate any form of treatment. The diagnosis of ‘homosexuality’ was immediately replaced by ‘sexual orientation disturbance’ which was renamed ‘Ego-Dystonic Sexual Orientation’ in DSM - III which characterized forms of sexual orientation that are causing anxiety and are asynchronous to one’s idealized self-image. It is associated with a desire to change one’s sexuality or become comfortable with it, describing a conflict between the sexual orientation that one wishes to have and the sexual orientation that one possesses. Although the diagnosis of ego-dystonic sexual orientation was removed from DSM-III-R in the year 1987, it was largely subsumed under the diagnostic category of ‘Sexual Disorder not Otherwise specified’ which included ‘persistent and marked distress about one’s sexual orientation’ as a specifier and through the disorder category of ‘Gender Dysphoria’ mentioned in DSM - V which was released in the year 2013. The World Health Organization’s current edition of the International Classification of Diseases (ICD – 10) still includes the diagnostic category of ‘Ego -Dystonic Sexual Orientation.’ Hence, professionals initiated the formulation of therapies and treatment approaches to cure the symptoms mentioned in these diagnostic categories. Practitioners and families labeled ego-syntonic individuals as being ego-dystonic, and institutionalization and treatment were imposed on them despite denial. The administration of conversion therapy on sexually deviant individuals was still consistently tenacious.
Conversion therapy was perpetuated and emerged under different terms and procedures. Ex-gay Ministries or Transformational Ministries were established in order to motivate people to eliminate homosexual desires and to refrain them from pursuing or sustaining a same-sex relationship. Since the 1970s, there have been conversion camps and conferences, faith-based groups, and self-proclaimed experts practicing different conversion techniques ranging from hypnosis to sexual violence to exorcism aiming at the reversal of the sexuality of these individuals. People are isolated, constrained, hypnotized, forced to pray and study the bible, humiliated, ridiculed, insulted, subjected to violence and pastoral counseling, ill-treated, abused, trained on ideal gender roles, and instructed to believe that their sexuality was unnatural and sinful until their sexual impulses subsided. Ex-gay professional counselor, David Matheson developed a version of conversion therapy known as Gender Wholeness Therapy. The therapy was centered on the concept of ‘gender wholeness’ stating that building healthy relationships and addressing emotional issues with other men will help reduce homosexual impulses in individuals. Several organizations have introduced retreats that employ a variety of techniques – Individual, large and small group exercises, journaling, visualization, self-examination, introspection, and intensive emotional release as a way to heal the ‘flawed’ sexuality of people. Joseph Nicolosi played a significant role in backing conversion therapy in the 1990s through the formation of the Alliance for Therapeutic Choice and Scientific Integrity (ATCSI), alongside Charles Socarides and Benjamin Kaufman. This organization opposed the mainstream medical view of homosexuality and aimed to formulate effective conversion therapies for men and women who wanted to reverse their sexuality.
In 1997, the American Psychiatric Association stated that there is no scientific evidence for the efficacy of conversion therapy. In 1998, it concluded that it opposes any form of conversion therapy.
Conversion therapy was then modified into forms of psychotherapy, counseling, social skills training, Sexual Attraction Fluidity Exploration in Therapy, Eliminating, reducing or decreasing frequency or intensity of unwanted Same-Sex Attraction, Sexual Orientation Change Efforts, Sexuality counseling, visualization, and healing sexual brokenness.
Sexual identity therapy was developed by Warren Throckmorton and Mark Yarhouse based on individuals synchronizing their sexual identities with their beliefs and values. The therapy comprised of 4 stages: Assessment, Informed consent, Psychotherapy, and Social integration. The use of techniques of LGBT affirming and LGB support groups are extremely predominant. Dean Byrd described the Gender Affirmative Therapy which states that social and emotional variables influence an individual’s gender identity and determines the sexual orientation of the individual. It involved comprehending one’s gender development so as to fully develop a masculine or feminine identity. Context-Specific Therapy developed by Jeffrey Robinson works on diminishing homosexual behaviours and thoughts through the client’s own view of God and religious values. The techniques of cognitive-behavioral therapy, eye-movement desensitization, and re-processing were incorporated into the treatment.
Individual therapy and group psychotherapy are also being increasingly employed in the field. Mind Map Therapy is designed for both, individuals with ego-dystonic sexual orientation and their family members. It defines four paths for the clients: Affirming their LGBT identity, a life of celibacy, developing heterosexual attractions, and exploring more options. Sexual Orientation Change Efforts (SOCE) focuses on Bioenergetics, Syntonic therapy, Marriage therapy, Religious methods, and exploratory therapy.
In 2007, APA set up a task panel to evaluate the effects of conversion and reparative therapies. There were several other studies conducted to study the consequences of the therapy. It was reported that conversion therapies set up an illusion for the patients and their families that cannot be fulfilled. It attempts to alter the essence of an individual despite denial. It states that an individual’s intrinsic sexuality is invalid. It violates the human rights of the people. The practitioners of these therapies are evidenced to have strong hatred, bias, and prejudices against homosexual and bisexual individuals. Conversion therapy has been defined as an improper, intolerant, inaccurate, ethically problematic, and professionally irresponsible procedure and it tends to increase the extent of social prejudices and family rejection against people on the grounds of their sexuality. It leads to the formation of trauma within the patients, tormenting them for life. It was stated that there is no reliable evidence regarding the reversal of sexual orientations and the effectiveness of the techniques employed in conversion therapy. Therapies lacking an empirical methodology may be based on faulty and specious assumptions. Guilt, shame, and pain are an undeniable part of the therapy. It has been reported that conversion therapy might lead to lifelong physical pain. It leads to a crisis in self-identity and intimacy issues. Reparative therapy leads to difficulties in self-acknowledgment and acceptance which leads to desperation, self-loathing, and self-hatred. It was reported that there was an intensive use of coercion in psychiatric treatment settings. It perpetuates the notion that nonconformity to gender roles is an illness and a crime. Conversion therapy was responsible for an increasing incidence rate of social isolation, anger, confusion, grief, hopelessness, deteriorated relationships with family, absconding, self-withdrawal, anxiety, depression, loss of social support, poor self-image, increased distress, loss of faith, substance use, high risk of sexually transmitted diseases, intrusive imagery, suicides, suicidal ideation, and self-destruction. Some studies have reported effects being extended to gastric distress, sexual dysfunction, and nightmares.
In 2013, the American Psychiatric Association stated that it opposes the belief of non-heterosexual orientation necessitating or requiring any changes and that any effort to change the sexual orientation of an individual through treatment or through any other approach might be hazardous for the individual. It also asserted that there is no credible evidence existing to validate that any mental health or medical intervention can safely reverse sexual orientation.
Several international and national medical and mental health organizations like the World Psychiatric Organization, Pan American Health Organization, International Society of Psychiatry, and American Medical Association among several other establishments have denounced any form of conversion therapy. There have been policies, asseverations, legislations, interdictions, and bans against the practice of conversion therapy in several states and countries, worldwide. Despite the directives and deterrents, there has still been a persistent administration of conversion therapy in all forms even in the contemporary world. There have been several studies and reports substantiating imposed, involuntary treatment of ego-syntonic and ego-dystonic sexually deviated individuals in several countries.
Torture. Torment. Trauma. Pain. Suffering. Humiliation. Ignominy. Hostility. Hatred. Opprobrium.
This is conversion therapy. It violates and contradicts our right to personal autonomy - the fundamental right to be who we are as individuals. It’s time that we relinquish our constraints and allow people the freedom to identify, accept, and revere their own individualities and sense of self.