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Artillery Row

Coercive and abhorrent

The contested nature of “conversion therapy”

Pressure continues for legislation to eradicate any “coercive and abhorrent” practice that seeks to change someone’s sexual orientation or get trans people to accept the sex “assigned” to them at birth. Should politicians have less immediate concerns, prohibition could be on course later this year. As proclamations go, criminal and civil measures must ensure all get “stamped out once and for all” throughout “healthcare, religious or other settings”. The “evidence is clear” that this “coercive and abhorrent practice does not work” and causes “lasting damage to those who go through it”. They are “survivors” — equivalent to having escaped a sinking ship or a trench under shellfire. Baroness Helena Kennedy speaks of “untold harm to millions of LGBT+ people” where many “deal with their psychological trauma and shame” by “taking their lives”. With so much purported mortality, morbidity and misery, she wants the government to “implement this legislation without delay”. 

Advocates are angry at how ban proposals come and go, sometimes covering and then omitting, transgender people. Reluctance to speed forward might owe something to how a peek at this can of worms can send anyone scurrying. 

Ban supporters claim that even consultation and investigation put countless lives at risk. Publicly airing divergent opinions is as “outrageous” and “insensitive” as discussing whether torture or FGM should be illegal. Whilst activists insist that a ban is not a matter for debate, shutting it down flouts democratic procedures. Neither can you “legislate without definitions or evidence”, as the Equality and Human Rights Commission reminded advocates as it extricated itself from Stonewall’s “diversity champions” scheme. 

Little beats the call to ban “conversion therapy” when it comes to what the targets might be. Is reality one of quack faith healers shrieking and wielding electrodes? Hollywood and other media fill the canvas, not least for politicians. Alicia Kearns, a Tory MP, claimed that she came into Parliament with “one legislative change I wanted to deliver, which was to ban conversion therapy”. Is this why the constituents elected her? Her inspiration was seeing “on the eve of LGBTQ+ History Month, It’s A Sin” about gay men during the 1980s’ AIDs days. Baroness Kennedy credits a Netflix drama, where victims claim to have been hooked up to electrodes and given injections to vomit whilst made to watch negative images. The camp where this supposedly took place cannot be found. 

With poor pickings for electrocution, the targets slide to counselling

Contemporary cases of LGBTQ+ people being tied down, electrocuted, lobotomised or beaten with Bibles are scarce, along with the “tens of thousands” supposedly coerced in Soviet style re-education camps. There are no court cases where therapists have been found to have used torture or dealt abusively with same-sex attraction or gender discordance. One could emerge, as with many an awful event. The Government Equalities Office has commissioned research from Coventry University (a Stonewall “Diversity Champion”) to inform public policy in advance of the ban. If any could find coercive and abusive or “aversive” practices this might be it, given the researchers’ affiliations and their volunteer sample of interviewees. Disappointingly perhaps, none were reported, apart from one transgender respondent having seen a video of gender reassignment surgery.

The Government admits that “conversion therapy amounting to offences of physical or sexual violence is already illegal … ” along with coercive control which covers pressures to convert or change someone and heavier penalties for offences against those with “protected characteristics”. Is a ban effectively pointless? 

With poor pickings for electrocution and confinement, the targets slide to psychiatric therapies and counselling, where “coercive and abhorrent” is any consensual conversation for people seeking to leave or modify their sexuality or course of sex-change. Advocates are optimistic this will outlaw pastoral conversations or “spiritual guidance”, with clergy criminalised for expounding on sexual ethics. Moving on to general understandings, the goals of a LGBTQ+ Action Plan for Wales are, along with banning “all aspects of LGBTQ+ conversion therapy”, to challenge “heteronormative and cisnormative assumptions”. The acceptance of two biological sexes, male and female, is in the line of fire. 

Prohibition plans propose that members of the public or colleagues may put others under investigation by reporting a “risk of conversion therapy”. The Scottish Parliament’s Equalities, Human Rights and Civil Justice Committee insisted a ban “be fully comprehensive and cover sexual orientation and gender identity, including trans identities, for both adults and children in all settings without exception” and include “consensual” conversion practices. There should be a “distinct reporting mechanism for children”, raising questions of what happens to parents or others who have critical conversations about sex-change. The Cooper Report on How to Legislate against Conversion Practices, signed off by a Forum of 17 chaired by Baroness Kennedy, declared there be “no exemptions for ‘consenting’ adults who seek out conversion practices … ” Family courts must be empowered to use Conversion Therapy Protection Orders to stop parents letting children undergo this “abusive practice”, with a mandatory requirement to report suspected cases. 

Talk involving threats is already illegal. No therapy or counselling will have much success without the client’s cooperation: involuntary therapy is failed therapy. This highlights the silliness of activists who lure well-meaning therapists into setups by asking for a “gay cure”. When the pretender fails to become what they had no intention of being in the first place, the therapist can be “outed” as a coercive charlatan and expelled from their profession. 

When even a private prayer for resolution, change or reconciliation might mean a criminal record, who kickstarts penalisation? Client, bystander, police or Stonewall? Is it not “coercive” to threaten priests with prosecution for giving advice or consolation? When asked to clarify what a ban might mean for churches and Christians, Boris Johnson provoked outrage when he envisaged adults allowed toreceive appropriate pastoral support (including prayer), when exploring their sexual orientation or gender identity” and “did not want to see clergy and church members criminalised”. Activists ignore how major UK churches do not put Christianity at odds with minority sexual orientations, or pastoral counselling to support LGBTQ+ individuals. 

There are barriers to impartial research, given the prevalence of groupthink

In agreement with identity group ideology, many professional organisations already reject “change procedures”. A Memorandum of Understanding to end “conversion therapy” (sponsored by Pink Therapy and Stonewall) was signed by 22 leading medical and psychotherapy bodies, including the NHS, Relate, British Psychology Society, Mind, the Royal College of General Practitioners. Here “conversion therapy” is any “approach” which might suggest “that any sexual orientation or gender identity is inherently preferable to any other”. Are paedophilia, bestiality and varieties of sadomasochism all equally preferable options? As clinicians must “acknowledge the broad spectrum of sexual orientations, gender identities and expressions”, this presumably abnegates help for clients who may seek to leave or reduce one or another. Practitioners who endorse or provide “change therapy” may be denied psychotherapeutic practice training or professional membership, struck off or suspended. 

Ban proposals are often a two-sided enterprise, with recommendations that those uncomfortable with their sexual orientation or gender identity be offered, or even obliged, to undergo “affirmative therapy” — to ensure that they do not seek change. Is it not better to help people move in the direction they want, or explore what they might be comfortable with, rather than be pressured to accept something they don’t want? Otherwise, isn’t this “coercive”? 

When “affirmation” replaced “watchful waiting” for the NHS’s Gender Identity Services (GIDs), this saw a massive increase in youngsters seeking gender reassignment, many aged under 14. Compliance with transitioning has happened irrespective of the profound, irreversible impact of hormones and removal of body parts, with therapists fearing being “transphobic” for investigating possible influences or underlying conditions. Are such “affirmative” services “coercive and abhorrent”? 

Studies of large samples of people over time show how many move in and out and along the dimensions of attractions, practices and identifications, as their gender and sexual identities emerge, change or fade to a lesser or greater degree. Fixed for life for some goes with fluidity for others. 

Some people may want to reduce, or lose, all kinds of behaviours, or manage feelings, attractions and associations. There may be dissatisfaction or distress with aspects of life, conflicts over religious, cultural and moral values, wishes to preserve a marriage or other relationships. Prohibitionists make categorical assumptions about “change” therapy, as something set to completely “convert” same-sex identity into 100 per cent heterosexual identity. Therapy for many conditions is best understood as a continuum rather than a rigid, mono-enterprise. Not everyone or anyone who seeks change, can change. Some can; some never will. Therapies for all manner of problems can have no or poor outcomes, with proportions of adults and children harmed by measures meant to help. 

So far, the “evidence” is not “clear” that “change” or “conversion therapy” as claims go, “does not work” or causes “lasting damage” to its victims, because this “evidence” is hardly there in the first place. There are barriers to impartial, carefully conducted research given the issue’s complexities and the prevalence of groupthink throughout media, academic, political and professional bodies. Universities desperate to avoid offence have little inclination to venture near such fraught subjects and prefer dominant identity groups as their knowledgeable authorities. 

Studies in this field have often used anecdotal or retrospective self-reports from self-selected or volunteer samples. These easily back up the standpoints of the researchers, who may be supporters of prohibitions expecting accounts of harms without change — or, less likely, those hopeful of change without harm. A “gold standard” empirical investigation to assess any results attributable to particular therapies, would be nigh impossible for this subject (along with others in the psychiatric field). This would mean allocating a randomly selected group of people to different procedures or none, with controls for characteristics that might bias the findings and with individuals followed over time. 

People’s freedom to make life choices should be respected

The recent large-scale “generations” survey by the Williams Institute (Berkeley, California), with a credibly representative sample of sexual minority persons (1,518 in three age cohorts), may have provided some of the most useful information so far, although not all who reported having attempted to change their sexual orientation would take part. First to use the data were LGBTQ+ health specialists who described how exposure to any change procedures went with higher odds of suicidal problems (ideation, planning and attempts). Other researchers soon pointed out that suicidality was registered over lifetime as well as for years at Wave 1 and 2. People may have sought change therapy or interventions, clinical or religious, because they were already troubled, rather than having it cause their problems.

The principle of temporal precedence was violated — the cause must precede the effect, not vice versa. Serious cases of suicidal morbidity appeared to have been reduced after change procedures, compared to outcomes for people matched for similarly stressful histories. Problems may have been generally alleviated, irrespective of any effects on unwanted aspects of sexuality or the intentions of practitioners. The recipients who were not helped did not manifest higher psychological distress or discomfort. They were, if anything, more likely to be unconcealed or “out” to family friends or colleagues than enveloped in the shame assumed by ban advocates. 

Dispute continues, with the proper interpretations of the data hotly discussed. As charges go, the scale of change procedures has been underestimated. More and longer exposure would have increased the likelihood of harms and thereby dispels any idea of these preceding therapy. Torture the statistics long enough, and they will deliver the answer. 

Whether any therapeutic practice is condemned might owe more to pressure group influence than still largely undecided matters of help and harm. If, perfectly sanely, someone wishes to follow their own aspirations regarding how they want to live, bans on “change” procedures will make it ever more difficult to get help as the quality and quantity further declines. Some therapists might operate under the radar or rebrand their role as, for example, “reintegration” specialists. Activists out to eradicate “conversion therapy” might be pleased at the lack of options, along with any disappointment or distress for those who undergo poorly managed, ill-informed practices and assorted quackeries.

Rather than appeasing strident factions, there should be investigation of who seeks change and in what form or direction, together with outcomes for various interventions. People’s freedom to make life choices should be respected, including being able to move away from what they do not want and get help to do so. Conversion therapy bans have some very serious implications for personal choice and self-determination, freedom of speech, religion and parental rights. 

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