Sexual Orientation Change Efforts - Position of Professional Organizations On SOCE

Position of Professional Organizations On SOCE

The World Health Organization's ICD-10, which is widely used internationally outside of North America (where DSM-IV-TR is used), states that "sexual orientation by itself is not to be regarded as a disorder". It lists ego-dystonic sexual orientation as a disorder instead, the diagnosis for which is when "the gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it."

In 2012, the Pan American Health Organization (the North and South American branch of the World Health Organization) released a statement cautioning against "services that purport to 'cure' people with non-heterosexual sexual orientations" as they "lack medical justification and represent a serious threat to the health and well-being of affected people", and noted that "there is a professional consensus that homosexuality is a normal and natural variation of human sexuality and cannot be regarded as a pathological condition". The organization further called "on governments, academic institutions, professional associations and the media to expose these practices and to promote respect for diversity." They further noted that adolescents have sometimes been forced to attend these therapies involuntarily, being deprived of their liberty and sometimes kept in isolation for several months, and that these findings were reported by several United Nations bodies. Additionally, the organization recommended that such malpractices be denounced and subject to sanctions and penalties under national legislation, as they constitute a violation of the ethical principles of health care and violate human rights that are protected by international and regional agreements.

The American Psychiatric Association "affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity; reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation; concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation; encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation; concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation; concludes that the emerging knowledge on affirmative multiculturally competent treatment provides a foundation for an appropriate evidence-based practice with children, adolescents and adults who are distressed by or seek to change their sexual orientation; advises parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth; encourages practitioners to consider the ethical concerns outlined in the 1997 APA Resolution on Appropriate Therapeutic Response to Sexual Orientation, in particular the following standards and principles: scientific bases for professional judgments, benefit and harm, justice, and respect for people’s rights and dignity; encourages practitioners to be aware that age, gender, gender identity, race, ethnicity, culture, national origin, religion, disability, language, and socioeconomic status may interact with sexual stigma, and contribute to variations in sexual orientation identity development, expression, and experience; opposes the distortion and selective use of scientific data about homosexuality by individuals and organizations seeking to influence public policy and public opinion and will take a leadership role in responding to such distortions; supports the dissemination of accurate scientific and professional information about sexual orientation in order to counteract bias that is based in lack of knowledge about sexual orientation; and encourages advocacy groups, elected officials, mental health professionals, policy makers, religious professionals and organizations, and other organizations to seek areas of collaboration that may promote the wellbeing of sexual minorities."

The American Psychiatric Association states: "It is possible to evaluate the theories which rationalize the conduct of "reparative" and conversion therapies. Firstly, they are at odds with the scientific position of the American Psychiatric Association which has maintained, since 1973, that homosexuality per se, is not a mental disorder. The theories of "reparative" therapists define homosexuality as either a developmental arrest, a severe form of psychopathology, or some combination of both. In recent years, noted practitioners of "reparative" therapy have openly integrated older psychoanalytic theories that pathologize homosexuality with traditional religious beliefs condemning homosexuality. The earliest scientific criticisms of the early theories and religious beliefs informing "reparative" or conversion therapies came primarily from sexology researchers. Later, criticisms emerged from psychoanalytic sources as well. There has also been an increasing body of religious thought arguing against traditional, biblical interpretations that condemn homosexuality and which underlie religious types of "reparative" therapy."

Mainstream health organizations critical of attempts to change sexual orientation include the American Medical Association, American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, the American Association of School Administrators, the American Federation of Teachers, the National Association of School Psychologists, the American Academy of Physician Assistants, and the National Education Association.

In the United Kingdom, the Royal College of Psychiatrists states: "The Royal College shares the concern of both the American Psychiatric Association and the American Psychological Association that positions espoused by bodies like the National Association for Research and Therapy of Homosexuality (NARTH) in the United States are not supported by science. There is no sound scientific evidence that sexual orientation can be changed. Furthermore so-called treatments of homosexuality as recommended by NARTH create a setting in which prejudice and discrimination can flourish. The Royal College of Psychiatrists holds the view that lesbian, gay and bisexual people should be regarded as valued members of society who have exactly similar rights and responsibilities as all other citizens."

In Australia, the Australian Psychological Society states: "Even though homosexual orientation is not a mental illness and there is no scientific reason to attempt conversion of lesbians or gays to heterosexual orientation, some individuals may want to change their own sexual orientation or that of another individual (for example, parents seeking therapy for their child). Some therapists who undertake this kind of therapy report that they have changed their client's sexual orientation (from homosexual to heterosexual) in treatment. Close scrutiny of these reports shows that many of the claims come from organisations with an ideological perspective on sexual orientation rather than from mental health researchers. Also, the treatments and their outcomes are poorly documented and the length of time that clients are followed up after the treatment is sometimes too short to be a true reflection of the outcome. In other cases it has been shown that individuals can be assisted to live a heterosexual lifestyle, but that their sexual orientation remains unchanged. In other words, their pattern of arousal to members of the same sex does not alter. The Australian Psychological Society acknowledges the lack of scientific evidence for the usefulness of conversion therapy, and notes that it can in fact be harmful for the individual.".

In China, Western psychiatry and psychology were imported during a "Westernization Movement" in the late 19th century. At that time, the West viewed homosexuality as a mental disorder, and that became the prevailing view in China as well. During this period, homosexual sexual behavior was grounds for persecution, a marked change from the attitude of general (but not total) acceptance found in pre-19th-century China. These views lasted throughout the 1970s, despite changed theoretical models of sexuality orientation in the West, during a period when the Chinese government held a "closed-door" policy on information about human sexuality. After 1980, information became more available, and views began to change. In 2000 and under pressure from both the APAs and the ACA, the Chinese Classification of Mental Disorders (CCMD-III) declassified homosexuality, but added a diagnosis resembling ego-dystonic sexual orientation. Attempts to change sexual orientation are rare in China.

In India, psychiatry and psychology scholars have "preserved an almost complete silence on the subject of homosexuality". One paper discusses behavior modification methods used to treat the sexual orientation of thirteen gay patients. They use the WHO classification of egodystonic sexual orientation, but the People's Union for Civil Liberties reports that doctors will often diagnosis the patient as egodystonic even if the patient really is egosyntonic.

In Italy, little research has been conducted in the mental health community on homosexuality. Early work tended to describe homosexuality as a pathology or a developmental arrest. More recently, attitudes have begun to change: "with a lag of about ten years, Italy has followed ... the attitudes of American mental health professions toward homosexuality".

In Germany, the psychiatry, psychology, and sexology establishment from the early 20th century viewed homosexuality as pathological. However, following the increased visibility of the homosexual community during the AIDS epidemic of the late 1980s and the declassification of homosexuality as a mental disorder in the ICD-10, non-pathological, rather than pathological, models of homosexuality became mainstream.

Japan's psychiatric body removed homosexuality from its list of psychiatric disorders in 1995.

In Norway, a country known for its strong LGBT rights legislation, the shift from a pathological to non-pathological understanding of homosexuality began in the 1970s, following the APA's declassification in 1973. In 2000, the General Assembly of the Norwegian Psychiatric Association overwhelmingly voted for the following position statement on sexual orientation change therapy:

Homosexuality is no disorder or illness, and can therefore not be subject to treatment. A ‘treatment’ with the only aim of changing sexual orientation from homosexual to heterosexual must be regarded as ethical malpractice, and has no place in the health system.