Many jurisdictions around the world now allow gay and lesbian marriages, but “treating” homosexuality remains a politicised topic. Some groups, mainly in the United Kingdom, are visibly displeased by efforts to discredit attempts to change homosexuals.
Despite appearances that we increasingly live in a world where same-sex attraction is acceptable, it’s not been long since homosexuality was considered to be a mental illness. Many psychiatrists though it was curable with “therapies” designed to turn gay people off their same-sex desires.
Like mental health governing bodies in the United States and Australia, those in the United Kingdom, such as the UK Council for Psychotherapy, have long rejected the idea of conversion therapies for homosexuality.
But the practice has still not been entirely eradicated from mental health care. A 2009 UK survey found that while only 4% of therapists reported they would attempt to change a client’s sexual orientation if one consulted asking for such therapy, 17% reported having assisted at least one client/patient to reduce or change his or her homosexual or lesbian feelings.
Opposition to this sometimes National Health Service-supported therapy (in 40% of cases) was raised in parliament by the UK health minister in April 2014. Political pressure to ban conversion therapies is mounting, and not only because the discredited therapy is a waste of public money. Such therapies are homophobic in that they continue to suggest homosexuality is a mental illness and something that can be eradicated.
A wilful misinterpretation
Mental health care has historically held various positions on homosexuality, from trying to cure it, to defending it against the law, to promoting a more positive view of same-sex attraction. In April 2014, the UK Royal College of Psychiatrists (RCP) released a position statement on sexual orientation. This reiterated that homosexuality was not a mental disorder.
This document was an important step in the history of psychiatric engagement with lesbian, gay and bisexualities; it was (rather belatedly) in line with the removal of homosexuality from the Diagnostic and Statistical Manual of the American Psychiatric Association in 1973, and the International Classification of Diseases of the World Health Organisation in 1992.
The College said it: considers that sexual orientation is determined by a combination of biological and postnatal environmental factors. There is no evidence to go beyond this and impute any kind of choice into the origins of sexual orientation.
The statement proved to be controversial, with some religious groups misinterpreting “postnatal factors” (that homosexuality is not only inborn) as a justification for conversion therapies.
The main thrust of the College’s position – that lesbian, gay and bisexuality don’t need to be “treated” – is in keeping with other psychiatric and psychological governing bodies. But in June 2014, Mike Davidson, director of the Core Issues Trust, the same British registered charity that unsuccessfully attempted to advertise “cures” for homosexuality on London buses in 2013, said:
The assumption that people are ‘born gay’ has become deeply rooted in our society and has driven huge political, social and cultural change. As this latest statement [from the College] reveals, that assumption is false and it is vital that professional bodies stand up against it rather than perpetuate it.
This wilful misinterpretation of the College’s position has been echoed by a number of other religious groups hoping to reinstate “cures” for homosexuality.
Push and pull
The debate around whether homosexuality is inborn, acquired, or a vice chosen by the person, is almost as old as modern psychiatry.
While many jurisdictions traditionally made homosexual activity illegal, assuming that the person was choosing to engage in a criminal act, several important sexologists attempted to show that it was inborn. Havelock Ellis’s radical 1897 work Sexual Inversion, for instance, argued homosexuality was innate, natural, found in various periods of history and many cultures, and therefore should not be illegal.
Ellis advocated legalising consensual homosexual sex between adults. But it was many decades before such a law offered lesbian, gay and bisexual people some vestige of legal protection and similar social rights.
It’s only when homosexuality is considered to be acquired that it is sometimes thought to be possible to “treat” it. But this conception requires a belief that it’s actually a mental illness, rather than one of many appropriate means of seeking sexual pleasure and forming emotional bonds.
Psychoanalysts considered homosexuality to be an immature deviation of the sexual object choice, caused by postnatal influences, some of which could be overcome in analysis to turn the analysand to heterosexuality. But in a letter to an American mother of a homosexual man, the father of the movement, Sigmund Freud, insisted:
it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by certain arrest of sexual development.
He thought psychoanalysis would help people deal with the persecution their sexuality received in an unaccepting world.
A better time
After many years of intense persecution by police in efforts to regulate homosexuality, aversion therapies were developed to “cure” people of their prohibited sexual desires in the mid-20th century. Submitting to such therapies was a way of shortening prison sentences for those incarcerated for being gay.
In what effectively amounted to psychological torture, homosexuals were given emetics and shown gay pornography while being kept unwashed and sleep-deprived in rooms that stunk of their own vomit for days on end, to create an aversion to the objects of their desires.
The idea was to forge an association between this horror and their sexual needs. Ultimately, such therapies were unsuccessful. But they did cause intense trauma and suffering in the people on whom they were performed.
Eventually, after criticism from homosexual rights groups, and in the face of evidence that the “treatments” caused more harm while effecting no cure, homosexuality came to be considered a normal and acceptable expression of sexual desire. It was and still is the case that homophobia causes more suffering than homosexuality, which was decriminalised in many jurisdictions between the 1960s and 1990s. It remains illegal in 78 countries.
The UK Royal College of Psychiatrists’ position statement on sexual orientation is important because it underlies the idea that homosexuality should be acceptable, even if it’s not solely inborn. It should make no difference to people’s sexual rights if they are born that way, if they became homosexual because of some influence after their birth, or if they decide to engage in gay sex because they find it pleasurable.
There’s no case for attempting to cure sexual desire for people of the same gender. There is much to be said for banning treatments that have only added to the suffering and persecution of people for their sexual feelings.
The Royal College of Psychiatrists is to be commended for continuing to state that such “cures” are wrong. The religious groups trying to bring back aversion therapy need to catch up.