Why Ban "Ex-Gay" Therapy But Allow Sex Reassignment?

[clovehitched]

Yesterday, Roger Helmer, a Conservative MEP
tweeted in response to news that a Christian "Ex-Gay" reparative therapist may be struck off as the result of a press sting operation, to say:

Why is it OK for a surgeon to perform a sex-change operation, but not OK for a psychiatrist to try to "turn" a consenting homosexual?

Now Mr Helmer seems rather unreconstructed - I find that looking at his website and some of the comments on his blog are like staring at the aftermath of a car crash. I can only imagine that he prides himself on "plain speaking and common sense", but one man's "plain speaking and common sense" are this woman's "ill-informed spouting of reactionary nonsense". Anyway, I'm getting somewhat distracted from the point I wanted to make here, which is that his question comparing sex reassignment and reparative therapy is one I did at least think about, rather than dismiss out of hand as tosh and nonsense (I'll leave that response to him).

It seems that Jack of Kent has also put some thought into how to answer this question (not that dismissing it isn't a valid response too - trans people are under no obligation to justify our existence to Mr Helmer), and I would really, really encourage people to read the article there and the comments - there are many thoughtful positions expressed there.

My own view, which I'll reproduce here (with the amusing substitutions from my iPad's autocorrect fixed), is as follows:

Where I think this gets interesting is where the gay person in question genuinely wants "turning", perhaps because they have internalised some sort of anti-homosexual message or pressure. Is it ethical to refuse to allow it to be provided to them, on the basis that it's likely to be very bad for their mental health? We allow people to consume things that are bad for their physical health, after all.

My views on this are twofold - firstly, reparative therapy is "quack medicine", and while I think it would be illiberal to ban the pedalling of quackery, I don't think it should be allowed to masquerade as real medicine. I would also apply this to homeopathy, etc..

Secondly, from the patient's point of view, such "services" should be delivered on the basis of informed consent. The patient should understand that it basically won't genuinely be able to change their sexual desire, but at best give them a set of strategies for repressing it, and perhaps coping with entering into a relationship which they may wish to enter into to fulfil some sort of perceived obligation (e.g. To marry and have children), but which will likely entail little or no sexual attraction.

In other words, the cards should fully be on the table.

I also think, by the way, that gender services would be much more appropriately delivered on an informed consent model than the present "gatekeeper" model, which I think is more or less broken by design.

I'd be interested in anyone else's thoughts on this too.

Also posted at http://auntysarah.dreamwidth.org/250350.html - you can comment here or there.

Comments

[jessie-c.livejournal.com]

He's trying to compare apples to oranges. SRS is sought by the patient because it's what the patient needs. Reparative therapy is always pushed upon unwilling recipients by fundamentalist Xtians because the fundies think gays should be eliminated.

[biascut.livejournal.com]

Yeah, the comparison doesn't stand up to the slightest bit of examination. The condition of being trans is pretty much defined by wanting to be the other gender: the condition of being gay is not defined by wanting to be straight!

Anyway, isn't there supposed to be a "talking cure" for trans people, the aim of which is to make you Not Trans? Isn't that what Bindel is always advocating, and rightly being shot down because it's the exact equivalent of "Ex-Gay" ministries?

If anyone does have links to any proper studies into the long-term success rates of ex-gay therapy, I'd be very interested to see them.

ETA: It's not the case that there are no gay people out looking for a "cure" for being gay, by any means. The analogy doesn't work, but that's not WHY the analogy doesn't work.

[auntysarah.livejournal.com]

I have heard of gay people seeking reparative therapy voluntarily. Usually it's because of the standards of their peers, which they have internalised, so the extent to which they are an "unwilling recipient" probably depends on whether you include subconsciously unwilling.

Anyway, I don't think you should stop people doing stuff that's bad for them, if they really want to do it and are fully informed that it's bad for them. I also fully support and applaud professional psychology bodies kicking out people who provide this sort of "therapy" though. Their "services" should come with a health warning, like cigarettes. "Warning, this therapy doesn't work and will probably damage your mental health", that sort of thing.

[jessie-c.livejournal.com]

...Usually it's because of the standards of their peers...

In other words, their "willingness" is coerced, in this case by "peer pressure" or "moral suasion" or however else you wish to define brainwashing to pressure someone to adhere to an outside standard.

[auntysarah.livejournal.com]

In other words, their "willingness" is coerced, in this case by "peer pressure" or "moral suasion" or however else you wish to define brainwashing to pressure someone to adhere to an outside standard.

Where does one draw the line? Don't most os us spend large portions of/our entire lives trying to deal with the expectations subconsciously instilled in us by our parents, for example?

[jessie-c.livejournal.com]

Indeed we do, and many of us are broken by the effort. One should draw the line where the expectations cause harm to the person trying to live up to them. The question should be asked "Is it reasonable to expect this person to strive to meet $_social standard?"

So, the test:

Is it reasonable to expect a person to wear clothing appropriate to the season and their social standing?

Is it reasonable to expect a person to starve themselves in order to meet their damaged perception of how they should look?

Is it reasonable to expect a trans person to seek medical help to correct their condition?

Is it reasonable to persuade, coerce, or otherwise force a person to attempt to change their sexuality because someone speaking for their invisible friend 2500 years ago in a desert didn't like same-sex attraction?

I leave the answers to the student.

[auntysarah.livejournal.com]

Is it reasonable to persuade, coerce, or otherwise force a person to attempt to change their sexuality because someone speaking for their invisible friend 2500 years ago in a desert didn't like same-sex attraction?

It's not, but if someone following that religion wants to engage in quack therapies because of their beliefs, it's absolutely not the job of the state to try and save them from themselves. That way lies authoritarianism.

You can't stop people making bad decisions, that's illiberal.

[jessie-c.livejournal.com]

This is true. However, the State establishes Governing Bodies who in turn issue licenses to practitioners in the expectation that they do no harm in their work. When in fact they do harm, it is the Governing Body's responsibility to revoke their license and announce that fact.

Note that Mr Helmer's tweet was seemingly prompted by just such a case. He is twisting the facts to suit his apparent bias. Reparative therapy has not been banned, a practitioner or same merely lost hir license.

[auntysarah.livejournal.com]

I agree that it is entirely proper for professional bodies to throw out quacks.

[jessie-c.livejournal.com]

The whole case is akin to changing methodologies of treatment. Much more recently than 2500 years ago, the standard of treatment for mentally ill people was to chain them naked in cages (http://en.wikipedia.org/wiki/Bethlem_Royal_Hospital). More recently still they were given straight jackets, lobotomies, drugs and electrical shocks. These have all been superseded when evidence came to light that they did more harm than good. Reparative therapy needs to fall into that category.

[biascut.livejournal.com]

"Reasonable" is just as culturally dependent and subjective, so I don't think that's a particularly good test either.

The best objective test is the one Sarah proposed: evidence-based, with long-term follow-up and all information about success or lack of success publicly available.

[naath.livejournal.com]

I think the analogy here is All Wrong, surely it should be with "talking cures" for other problems - for instance one could compare ex-gay therapy to talking cures for Being Trans (which, er, also don't work very well...) or you could bring in psych issues that can actually be helped with therapy or therapy in conjunction with psych drugs.

I think a much more interesting question would be more like "why do we treat trans people by providing them with the body they want but anorexics by talking them out of it?" to which there are a lot of answers but I think the most persuasive is "some of these things actually work and others of them don't". In my fantasy-land ideal world people would have the option of changing the way their brains and their bodies look and work in whatever way they please (this might run into FAIL with social pressure to be a certain way though) with a combination of drugs, surgery, therapy, whatever; unfortunately we are stuck with medical science as it actually is, and some things are currently beyond us.

There are also questions like "why are people seeking therapy to stop being gay" which I think highlight "interesting" (ugh) features of our society.

[darkwaterfairy.livejournal.com]

"talking cures for Being Trans"

Or as it was known where I grew up, 'School' and 'the Press'.

[nameandnature]

Heresiarch also tackled it.

I think I'd need to know more about the therapy and its effects: if the therapist was making false claims, that'd be a reason for her to be disciplined regardless of what she was claiming, for example. H seems to think that the right position is "I should be able to live my life the way I want", not "I can't help being X".

[haggis.livejournal.com]

I would be far more comfortable if she was offering to help someone who is LGBT (and of a religion that disapproved) to deal with the frustrations of celibacy, without claiming to change them to straight.

But that highlights how unfair that attitude to LGBT people so religions would prefer to say that this is a lifestyle and you can become straight (which is hideously unfair on the person and anyone they marry).

What depresses me is that while this is clearly quack psychology, it's easier to blame the client for not trying hard enough than with other forms of quack science.

[aumentou.livejournal.com]

At the risk of making it seem incredibly simplified...

"Why is it OK for a surgeon to perform a sex-change operation"

Because that has demonstrably useful effects.

"but not OK for a psychiatrist to try to "turn" a consenting homosexual?"

Because that doesn't.

But... I suppose that if the therapist doesn't make any claim they can't prove (and I need to laugh hollowly at that thought), and the state doesn't pay for it (because we wouldn't want the state paying for things that can't be proven to work), then the patient can fuck themselves up just as much as they feel inclined to.

Bit of personal bias in there. Did it show?