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The ethics of gay conversion

Oregon recently became the third state in the USA to ban “gay conversion therapy”. Governor Kate Brown, the first openly bisexual governor, signed the law in May.

President Obama called for a national ban on the practice. His senior adviser said: “The overwhelming scientific evidence demonstrates that conversion therapy, especially when it is practised on young people, is neither medically nor ethically appropriate and can cause substantial harm.”

What is gay conversion therapy? Is it harmful? Is it medically or ethically inappropriate?

A book called Then and Now, written by 50 men who have changed their sexual orientation from same-sex attraction (SSA), has recently been published online and shows how therapy can help men with SSA.

The men, who come from no specific religious background, start by saying: “Over the past decade or two, it has become ‘common knowledge’ that homosexuality is inborn, innate and unchangeable – that, in fact, any attempt to change one’s sexual orientation will inevitably cause great psychological harm and perhaps even lead to suicide.”

Through their own experiences however they conclude that this is ideology, not science. “Our own experience is quite different. We know change in sexual attractions is possible – because we’ve experienced it ourselves. No appeal to position papers, talking points, “expert” opinion or even research studies can disprove our own lived experience. We know it because we’ve lived it.”

These men were all conflicted by or dissatisfied with their SSA and wanted to explore the possibility of change. The men used different resources, including different types of support groups and counselling, which they document.

None of them was “converted”, they freely chose to explore this and in none of them was force, shaming, aversion therapy, homophobia or hostility used.

The interventions resulted in improved self-esteem, greater self-confidence, an enhanced sense of masculinity, better friendships, more authentic self-expression and greater peace.

The authors freely admit that their work is a biased sample which is not scientific. However their important witness shows that a) there are people with SSA that are not happy with their situation and b) they can be helped by non-coercive counselling methods if they choose.

Is this therapy harmful? Then and Now cites a survey of 173 men who have attempted therapy for SSA. Some of the men had considered or attempted suicide before the interventions.

Preventing individuals who have same-sex attraction from exploring change through therapy is both medically and ethically inappropriate

Fifty-nine per cent did not find anything harmful, but several said that the worst thing was therapists or family members who insisted that they had to accept being gay because it could not be changed and one considered suicide because of this.

Only two respondents felt that the attempted change had been totally harmful. One because he was not convinced he should change and the other because he could not change however hard he tried. This caused anxiety and depression in one and shame and guilt in the other.

Is gay conversion therapy medically inappropriate? If SSA is not an innate part of our genetic makeup or of “who we are” as people, then it is reasonable to look for environmental triggers that may influence its appearance.

There have been eight major studies of more than 10,000 sets of identical twins. Although some suggest a genetic influence, none support SSA being innately genetic in origin.

In their study of 3,139 pairs of siblings, Bearman and Bruckner did not find any genetic influence independent of social context. In 45 identical twin pairs in which at least one had SSA, only two (7.7%) of 26 male pairs and one (5.3%) of 19 female pairs both had SSA. Non-identical twin pairs were more likely to both have SSA than identical twin pairs.

Genetics may predispose the individual to environmental influences, however. Jannini et al recently confirmed that particular environmental factors may be important. Although people may become aware of SSA at an early age this feeling is not under voluntary control. People with SSA appear to be particularly sensitive individuals who, according to some experts, due to inadequate emotional support in childhood have an arrested heterosexual development.

Whether this is true or not, there is no indication that supporting people with SSA who wish to change is medically inappropriate.

One may ask, however, whether it is ethically inappropriate. Since attempting to help a person with SSA who requests this help is not harmful and can, as we have seen above, have very positive results for the life and well-being of the individual it cannot be unethical to do this as long as it is completely voluntary and non-coercive.

It is clear that some individuals suffer from having SSA. There is also particular suffering and even attempted suicide associated with telling a person that they cannot change their SSA.

Malta is now planning to introduce a law to ban “gay conversion therapy”. The term “gay conversion therapy” conjures up forceful change against a person’s will, which should never be done.

However, preventing individuals who have SSA from exploring change through therapy is both medically and ethically inappropriate. It will isolate individuals who want help and cause undue suffering if this help is withheld.

Patrick Pullicino is professor of clinical neurosciences at the University of Kent.

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