This post is part of a series of guest posts on GPS by the undergraduate and graduate students in my Science vs. Pseudoscience course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Pseudoscience.” To that end, each student has to prepare a 1,000ish word post on a particular pseudoscience topic, as well as run a booth on-campus to help reach people physically about the topic.
The Failings of Reparative Therapy by Christopher Jones
Reparative therapy (sometimes referred to as conversion therapy) is the application of a variety of methods designed to extinguish an individual’s homosexual desires in the hopes that the treated individual will, in the absence of homosexual proclivities, be rendered heterosexual. For the past century this approach to converting the homosexual individual has varied in its acceptance and application. However, in recent years the scientific community has concluded that reparative therapy is ineffective and has vehemently rejected claims of the opposite.
Despite being condemned by the medical community as pseudoscience, reparative therapy still has something of a foothold in certain geographic and cultural pockets of the United States. Its resilience, despite decades of gradual opposition to its existence, can likely be attested to the prevalence of Christians in the United States who believe that homosexuality truly can (or should) be “fixed.” It is also possible that some people simply believe that homosexuality violates their cultural and social norms to such an extent that any attempt to suppress it (whether in themselves or others) is less damaging than the attempt itself. Licensed therapists often feel the opposite is true, that it “is more ethical to let a client continue to struggle honestly with her or his identity than to collude, even peripherally, with a practice that is discriminatory, oppressive, and ultimately ineffective in its own stated ends.” (see p. 739)
That religion factors into the equation should be surprising to no one. Most people are aware of “pray the gay away” camps which attempt to remove homosexual urges from individuals (by praying) because they believe that the Bible states it to be a sin, unnatural, etc. We won’t be focusing on the efficacy of prayer; science does not aspire to cure things solely because a specific religion takes exception to them (except maybe ham). The focus of the scientific community is on the harsher aspects of reparative therapy and the pseudoscientific nature of its practices (and results, which are often bad science rather than pseudoscience).
Homosexuality is neither a mental illness nor is it a psychological issue which requires repair. This is the current crux of the issue between the vast majority of the scientific community and a very minor few who insist that further research is necessary. The current champion of Sexual Orientation Change Efforts (SOCE) is The NARTH Institute. Groups such as NARTH attempt to associate themselves with solid scientific rigor insomuch as they can use this association to further legitimize their cause, all the while bemoaning the fact that the vast majority of their field of study stands in stark opposition to them not because of the current scientific data, but because of the absence of sufficient evidence. NARTH columnist Matt Barbers calls them “Gay-Activist Science Deniers,” but NARTH (or anyone else) has yet to produce scientific evidence for anyone to deny. Anecdotal evidence, data derived from poor to abysmal methodology, and a total lack of statistically significant results carry no weight in the scientific community. Admittedly, aspects of SOCE treatments are grounded in legitimate science and psychology, but, elements of behavior therapy techniques that have been known to be successful in some therapeutic treatments are inappropriate in seeking to alter sexual orientation. Aversion therapy and sensitization/desensitization processes may have usefulness in other situations, but the literature indicates that it is simply unsuccessful in SOCE.
As mentioned above, the scientific community no longer considers homosexuality a mental disorder or a behavior disorder. Its occurrence is considered natural, and as such, requires no treatment. Consequently, reparative therapy is opposed by every major mental health organization in the United States. Mainstream health organizations critical of conversion therapy include the World Health Organization, the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American Association for Marriage and Family Therapy, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, and the American Academy of Physician Assistants.
Proponents of SOCE loathe to concede that homosexuality is not some sort of disorder or learned behavior. That homosexuality occurs in nature is irrefutable. NARTH’S approach to this topic is indicative of their overall approach. The NARTH website is rife with scientific jargon and a brief perusal indicates nothing biased. However, the “position statements” page very quickly reveals a religious bias on several topics, all which support the notion that homosexuality is wrong and can be cured through reparative therapy, despite the preponderance of evidence that indicates the opposite.
Regardless of homosexuality’s etiology, the issue that stands is that reparative therapy is almost universally unsuccessful in peer-reviewed studies. Any other results (derived from unscientific conditions) that exist never hold up under scientific scrutiny. The American Psychological Association’s meta-study, the “Task Force on Appropriate Therapeutic Responses to Sexual Orientation,” found that, “the recent empirical literature provides little basis for concluding whether SOCE has any effect on sexual orientation.” Citing a “low degree of scientific rigor,” the APA did not find one recent study that produced statistically significant positive results from reparative therapy. It did find that the best results were from non-scientific studies relying on self-reporting, but anecdotal evidence is psuedoscientific and has no place in the discussion. The only study in the past twenty years to yield results was this 2002 study in which only ~ 3% of the 202 people claimed to have converted to heterosexuality. Of those few, only one did not have previous experience as a practitioner of some form of conversion therapy. It bears brief mention that in that same year renowned psychiatrist Robert Spitzer also studied around 200 people and claimed a success rate of nearly 50%. His methodology was decried for years and he eventually recanted his study and apologized for disseminating unsubstantiated results and for hurting the gay community.
This brings us to the final point: not only is reparative therapy ineffective, it is often very harmful. There are plenty of damaging aversion therapies that have been used in an effort to quell homosexual urges, including shocking genitals with electricity, making subjects ingest emetics while watching homosexual films, “masturbatory reconditioning,” and even castration. These practices, disgusting though they may be, have almost certainly been curtailed in recent years in the United States. Nevertheless, studies have shown that simply being subjected to rejection by one’s family leads to higher rates of suicide attempts, depression, and drug use. This intransigence to irrefutable scientific data by some parties – data which establishes some understanding of an aspect of nature, however antithetical it may be to the previous perception – is ignorance masquerading as assistance. Reparative therapy, despite its denouncement by the experts of the field, is an especially heinous example of this, and here is why: some pseudoscientific practices may typically do little to no harm (reading one’s horoscope), others may cause passive damage (relying on reflexology to cure one’s lymphoma), however, reparative therapy engages in active damage, the therapy itself is harmful to the patient.
The argument against reparative therapy is fairly simple: if it ain’t broke, don’t fix it. Certainly don’t berate it, ostracize it, and hook electrodes up to it for shock therapy. Believing that sexual orientation is a choice when the mountains of evidence suggest the exact opposite only serves to claw at the fabric of society and alienate people whose only mistake was being born in a period in which anti-scientific beliefs lead to anti-scientific causes targeting them. The end does not justify the means, especially when the scientific consensus indicates the means often do harm and the end doesn’t even exist.