Conversion therapy, the attempt to change someone’s sexual orientation or gender identity, is causing deliberate harm to lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. That’s why three colleagues and I felt compelled to call for statewide bans on conversion therapy in the New England Journal of Medicine last week.
Historically, conversion therapies have used electroshock therapy, chemical drugs, hormone administrations, and even surgery. While these extreme practices are becoming rarer, many other harmful actions still take place, impacting LGBTQ children and adolescents as well as adults.
Professional health associations have publicly denounced conversion therapy and documented the significant harm it can cause. As the American Psychiatric Association, the American Psychological Association, the American Academy of Pediatrics, the American Medical Association, and other organizations have indicated: “The idea that homosexuality is a mental disorder or that the emergence of same-sex attraction and orientation among some adolescents is in any way abnormal or mentally unhealthy has no support among any mainstream health and mental health professional organizations.”
Despite consensus among health professionals on the harms of conversion therapy, only 18 states have laws banning this dangerous practice for minors. Adults can access or be coerced into conversion therapy in all states and territories. In Pennsylvania, while multiple municipalities have banned this therapy for youth, there’s no statewide protection for minors nor adults. This month, North Carolina became the first southern state to ban state funding for therapy targeting minors, but also lacks a comprehensive ban.
As a result of the lack of regulation, many adults and children continue to be defrauded, harmed, and traumatized in the U.S. every day. Conversion therapy has been linked to increased rates of depression, suicide attempts, decreased self-esteem, and lower social support. Further, conversion therapy has long-term socio-economic effects, including lower educational attainment and subsequently lower income, effectively trapping young adults.
Health-care professionals, particularly pediatricians and physicians, must be vigilant about this issue given that many victims of conversion therapy are often silent about it. Although people of many ages and gender identities experience conversion therapy, we’ve seen in our clinical practice and advocacy efforts that the most common participant is a young adult male from a conservative religious background with a rejecting family. Survivors of conversion therapy often need treatment for post-traumatic stress disorder and post-religious trauma.
In caring for patients, health professionals must:
Take into account developmental factors for each stage of the life span.
Adopt appropriate and supportive therapies that affirm one’s sexual and/or gender identity.
Provide current, targeted, and accurate resources and information for all same-sex attracted and/or transgender or gender nonconforming patients and their families.
In tandem with this last principle, clinicians must understand the scientific and ethical hazards of conversion therapy, along with appropriate responses for survivors and at-risk patients. Building supportive environments and working to eliminate negative social attitudes will reduce health disparities and improve the health and well-being of all sexual and gender minority individuals.
Of equal importance, medical educators need to reform the curricula of medical schools and training programs to better prepare future physicians to care for LGBTQ people, including identifying and treating past trauma.
There is ample evidence that current physicians are ill-equipped to help victims of conversion therapy and LGBTQ people at large. This is largely because education on LGBTQ health is not a mandated part of medical schools’ curricula, so most doctors never learn to care for these patients’ general health needs properly, much less the trauma caused by conversion therapy.
Put simply, these harmful and fraudulent practices need to end. Eliminating conversion therapy can begin with current state bans, and ideally a federal ban as well, to protect minors.
Another method would include building upon the consumer fraud precedent set by the SPLC’s 2015 lawsuit Ferguson v. JONAH. In this landmark case, a New Jersey jury found the defendants liable for consumer fraud and unconscionable business practices for selling conversion therapy services. This method ensures adults as well as minors would be legally protected from being sold a dangerous and fraudulent product.
We need to work across sectors to ensure that individuals of all ages receive appropriate, comprehensive care by trained medical professionals in a supportive environment. Ultimately, there must be wider social acceptance of diverse sexual and gender identities, removing any sense of shame that pushes individuals toward the false promises of conversion therapy.