Is It Possible to Systematically Turn Gay People Straight?

A century of treatments have ranged from horrifying to horribly unscientific.

By Melissa Lafsky|Wednesday, September 09, 2009
RELATED TAGS: SEX & THE BRAIN

Joseph Nicolosi, a psychologist in Encino, Calif., says he can rid adults, teens, and even children of homosexuality. For nearly 30 years, he has offered a "psychodynamic" form of reparative therapy for people—mostly men—seeking to change their sexual orientation.

"If [a patient] can accept his bodily homoerotic experience while staying connected to the therapist," he wrote in "The Paradox of Self-Acceptance," "the sexual feeling soon transforms into something else: the recognition of deeper, pain-generated emotional needs which have nothing to do with sexuality."

He cites the following case: A 43-year-old married accountant was recalling another man that he had seen at the airport while on a business trip. "This had awakened his sexual fantasies and dreams. I asked him to hold onto that image and observe his bodily sensations while staying connected to me. As he did, he felt an intense sexual longing. But as he followed that fantasy through an imaginary sexual scenario, quite unexpectedly, he then experienced an embodied shift to sadness, longing, and emptiness. In tears, he spoke of his sense of deep unworthiness. 'I would just love him to be my friend! He's the kind of guy that I always wanted to be close to. How much I just want to be friends with a guy like him.'"

All the major psychiatric organizations, including the American Psychological Association and the American Psychiatric Association, have warned against therapies that try to change sexual orientation. Both APAs have ruled that these therapies are unscientific and possibly harmful—not to mention unnecessary, since homosexuality was officially de-classified as an illness in 1973, and therefore can't be "cured." As such, sexual orientation change efforts (SOCE) are rarely practiced by mainstream mental health practitioners, while many therapists are concerned that anyone who does try to change through therapy may do themselves more harm than good.

Still, practices like Nicolosi's have persisted, as has the debate over whether sexual orientation can—or should—be changed. So on August 5, the APA's Council of Representatives took the strongest stand yet, passing a near-unanimous resolution urging mental health professionals not to tell clients that they can change their sexual orientation through therapy or any other methods.

The paper presented at the APA meeting was "the most thorough comprehensive review of the literature ever done, and used the highest standards of analysis," says Judith Glassgold, a psychologist who led the task force. It covered every major peer-reviewed study on SOCE conducted between 1960 and 2007, and found "serious methodological problems" with almost all of them. The few that did have "high-quality" evidence "show that enduring change to an individual's sexual orientation is uncommon," and that treatments intended to change sexual orientation may cause harm, including depression and mental distress.

THE DARK AGES

Homosexuality was officially labeled a mental illness in the U.S. in the 1950s. The debate over same-sex attraction was not new: Sigmund Freud reported on one deliberate attempt to change the sexual orientation of a young woman who'd been brought in for involuntary treatment by her parents. He was unsuccessful, and concluded that attempts to change homosexual orientation were likely to fail.

Experimental treatments were performed throughout the mid-century, sometimes in high profile cases. In 1952, renowned mathematician Alan Turing was convicted of gross indecency in the U.K. after admitting to a sexual relationship with a man, and was forced to submit to estrogen injections as a form of "experimental chemical castration." Two years later, he committed suicide.

Throughout the 1960s and into the mid-70s, treatments in the U.S. mostly consisted of aversion therapy—teaching subjects to associate a strong feeling of dislike or disgust with same-sex attraction until the attraction disappeared. Given that homosexual activity was also criminally prosecuted in the U.S. at that time, the majority of people seeking to change were men who either faced prosecution or feared facing it in the future.

One of the most popular aversion techniques was "orgasmic reconditioning"—men would be shown erotic pictures of other men, and if they became aroused, they would receive an electric shock on their genitals. Therapists also gave patients drugs that induced vomiting or paralysis, or exposed them to noxious chemicals like ammonia, whenever they were aroused by same-sex photos. Some aversion treatments included rewards—including pleasant smells—for arousal in response to pictures of women.

There was also shame aversion therapy, first used in the 1930s, which involved continually subjecting the patient to public shame or humiliation over his same-sex arousal. Another method was satiation therapy, in which a subject was told to masturbate over and over while verbally describing his homosexual fantasies, until they disappeared—or, at least, diminished.

These "therapies" were generally ineffective—the person remained attracted to the same sex—or over-effective—the person was traumatized and lost all sexual arousal entirely. They "were used without people thinking about whether they were humane," Glassgold says.

Not all treatments were so gruesome: Lionel Ovesey, a Columbia University psychoanalyst and author of Homosexuality and Pseudohomosexuality, created a behavioral method in the 1960s. It was based on the idea that homosexuality originated from a fear of taking on the normal qualities of one's gender. Ovesey studied a clinically disturbed group of patients and summarized their unconscious minds as follows: "I am a failure = I am not a man = I am castrated = I am a woman = I am a homosexual." His view mirrored the belief of many clinicians at the time: that homosexuality was based on a phobia of the opposite sex.

Other non-aversive treatments following this theory focused on building "educational skills" like dating techniques, assertiveness training, and affection coaching to increase interactions with women. Also encouraged: plenty of heterosexual intercourse. Cognitive therapists, meanwhile, made a few attempts to change homosexuals' thought patterns by reframing desires—redirecting thoughts away from homosexual activity—or through hypnosis.

"CHANGING" SEXUALITY TODAY

Befitting the times, the mainstream mental health community no longer advocates change treatments, but instead supports approaches that help patients cope with the stress and stigma of being a sexual minority. Still, SOCE is still being practiced within a small group of mental-health practitioners, most of whom cater to a population whose religious beliefs strictly bar homosexuality.

The center of this so-called "reparative therapy" is the National Association for Research and Therapy of Homosexuality (NARTH). Its membership—around 1,100 people, according to current NARTH president Julie Harren Hamilton—is dwarfed by the APA's 150,000 members.

Treatments follow from the assertion that homosexuality is not an innate trait, but rather a result of childhood trauma and lack of attachment to members of the same sex.

"The treatment is different for men and women," Nicolosi, one of NARTH's former presidents, told DISCOVER. "The principles are the same—we find that for the lesbian, there is a traumatic attachment loss with the mother, and for the males it's a traumatic attachment loss with the fathers. We believe the male homosexual should work with a male therapist, and the lesbian should work with a woman."

These treatments take on several approaches. "Psychological care for individuals with unwanted homosexual attractions includes a variety of approaches. There are many paths that lead into and out of homosexuality," NARTH president Julie Harren Hamilton wrote DISCOVER in an email. "Therapists who assist clients with unwanted homosexual attractions vary in their…methods, [which include] object relations, interpersonal therapy, cognitive-behavioral therapy, family therapy, and many others."

A. Dean Byrd, vice president of NARTH and a clinical professor at the University of Utah treats patients—whom he describes as "primarily...men between the ages of 30 and 45 who have spent significant time in the gay lifestyle and have been unhappy"—using what he describes as cognitive-behavioral/interpersonal therapy. The treatment involves four phases:

  1. A psychological assessment for "dependency, hysteria, anxiety, and depression."
  2. A "strong behavioral approach" with the goal of "help[ing] patients organize and stabilize their lives."
  3. "Shift[ing] from a behavioral to a cognitive emphasis," using relaxation and guided imagery to "help the patient explore, interrupt and eventually break the homosexual arousal processes."
  4. The last phase involves a mix of individual, group, and family therapy, developing non-erotic support systems with men, and introducing the patient to a married couple that "function[s] as special companions."

By far the biggest SOCE provider today is Exodus International, the leading Christian organization claiming to offer reorientation of same-sex attraction. Exodus does not bill itself as a clinical facility, and their Web site states that the group "does not conduct clinical treatment of any kind"; rather, their activities are restricted to faith-healing efforts like discussion groups, worship, and prayer—none of which has been rigorously studied.

SOCE advocates have done studies in recent years to try and show that their efforts are working. One of the more influential among sexuality-change advocates was a study by two professors at Christian colleges: Mark Yarhouse, a psychology professor at Regent University, and Stanton Jones, provost and professor of psychology at Wheaton College.

The six-year study started with 98 subjects, most of whom were white, male, and religious—92 percent identified themselves as "born again." All of the treatments were provided by Exodus International. Of the 61 who provided data in all six years, 14 of them—23 percent—reported that they had successfully converted to heterosexuality "in some form or another," according to Jones. Meanwhile, 18 subjects—30 percent—reported that they had dis-identified as homosexuals and were now "chaste," meaning no overt sexual activity at all. The results were based entirely on self-reported surveys.

The study was dismissed by the APA task force on multiple grounds, and held as an example of the systematic scientific problems of SOCE today. "Everything was wrong with that study," Glassgold says. "[Yarhouse and Stanton] chose the wrong statistics to evaluate, they violated statistical laws, and they didn't have a control group—just a small sample of people recruited from religious groups. They followed the individuals over a couple of years, but didn't specify that the subjects should only try one intervention at a time, so they tried many at the same time. So we aren't sure which, if any, intervention was causal."

THE DILEMMA: EVALUATING THE TREATMENTS

So can homosexuality be changed through therapy? Determining the question once and for all would be extremely difficult from both ethical and practical standpoints. "The best way to do a [definitive] study would be to take a group of people who are distressed about their sexual orientation, and allocate one group of them at random to receive a very well-described treatment, while the other group receives either nothing, or a placebo—a treatment that is not intended to change their sex orientation, but rather do something like improve their nutritional health," says Robin Miller, a psychology professor at Michigan State University who sat on the APA task force. "Then you'd have to follow the people over time and record important measures that have to do with their sexual attraction, arousal, mental health, and quality of life."

Researchers could use self-reporting to gather data, but self-reported surveys—the only data presented in the Yarhouse and Stanton study—can be highly subjective and notoriously unreliable. "Sometimes people want to tell you what they want to believe in self-reporting," Glassgold says. "Especially people for whom sexual arousal is a sin, they're highly motivated to report one way."

As such, additional data-gathering, like measuring male arousal by placing a gauge on a subject's penis while he views erotic photos, would mean more accuracy. "It will always be better if you have multiple measures that have off-setting strengths, to validate the self-reports," Miller says. Plus the research would need to be replicated by other researchers in other settings.

Of course, there’s still the matter of finding subjects: Even if a team set out to do such a study, it's doubtful that people who want to change their sex-preference would choose to participate. "A lot of the people [attempting change] are highly religious," Yarhouse says. "If you were to use arousal responses of showing them erotic stimuli…you really can't show them explicit images. I don't see a review board approving that."

Then there's the larger question of whether science should study treatments for a condition that is not, in mental health terms, a problem. "All the major mental health organizations have concluded that homosexuality is not an illness, and there's no reason to try to change it or treat it," Miller says. "So whether it's appropriate, or ethical, to do such an experiment is a serious consideration."

The question gets at the heart of a psychologist's true job. "Where NARTH has raised complex questions is in determining the proper role of a patient's own wishes in treatment," says Jack Drescher, a psychiatrist and member of the APA task force. "If a patient comes in and says, 'I want to change,' can you give that patient what he wants?"

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