How We Came to Battle Over "Conversion Therapy."

And what does that term even mean?

In 2014, a 17-year-old male, born Joshua Alcorn but identifying as a girl named Leelah, took his own life by stepping onto a highway, in front of a semi-truck. Alcorn’s mother had never affirmed his—her—gender identity, insisting that “God doesn’t make mistakes.”

Alcorn had pre-scheduled a suicide note to be published on Tumblr. “The only way I will rest in peace is if one day transgender people aren’t treated the way I was,” Alcorn wrote. “My death needs to mean something. Fix society. Please.”

The Obama administration took up the challenge, responding to a petition to create “Leelah’s Law” “to Ban All LGBTQ+ Conversion Therapy.” That petition read:

Leelah explained how her parents had forced her to attend conversion therapy, pulled her out of school and isolated her in an attempt to change her gender identity. ‘Conversion therapies’ have been documented to cause great harms and in this case, Leelah’s death. Therapists that engage in the attempt to brainwash or reverse any child’s gender identity or sexual orientation are seriously unethical and legislation is needed to end such practices that are resulting in LGBTQ+ deaths. We respectfully seek your help to ban the practice known as ‘conversion therapy’ and name the bill in honor of Leelah Alcorn.

In response, Obama advisor Valerie Jarrett wrote: “As part of our dedication to protecting America’s youth, this Administration supports efforts to ban the use of conversion therapy for minors.”

Jarrett described conversion therapy as “any practices by mental health providers that seek to change an individual’s sexual orientation or gender identity. Often, this practice is used on minors, who lack the legal authority to make their own medical and mental health decisions. We share your concern about its potentially devastating effects on the lives of transgender as well as gay, lesbian, bisexual, and queer youth.” (Emphasis mine.) She continued: “The overwhelming scientific evidence demonstrates that conversion therapy, especially when it is practiced on young people, is neither medically nor ethically appropriate and can cause substantial harm.”

Later, Obama’s Health and Human Services department published a 2015 report, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth,” which claimed that “efforts to change an individual’s sexual orientation, gender identity, or gender expression is [sic] a practice that is not supported by credible evidence.” Engaging in such practices “may put young people at risk of serious harm.”

Eventually, over 20 states did pass conversion therapy bans, each of them lumping LGB and T (or TQ) together, and prohibiting attempts to change both sexual orientation and gender identity—despite the concomitant message that gender identity and sexuality were separate entities. Sexuality is whom you go to bed with, we heard. Gender is whom you go to bed as. (That both have to do with going to bed is a subject we need to talk more about.)

Then, in 2018, the American Academy of Pediatrics (AAP) published a policy statement, “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.” It noted that “’conversion’ or ‘reparative’ treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions,” and that “changing a youth’s gender expression or identity is inappropriate.” The statement marked conversion therapy as “not only unsuccessful but also deleterious.”

I don’t want to downplay the negative effects of actual reparative therapy, chronicled in memoirs like Boy Erased. There have been cases where therapists and other adults in positions of authority really did try to shame and pray the gay away, with techniques like shock therapy and aversive conditioning. The mental health field considered homosexuality a disorder until 1973, and wielded tools to root it out.

In the 1970s and 80s, some gender nonconforming young people were sent to “normalizing therapy,” which attempted to force them into conformity though similarly coercive techniques. One young man who’d been treated by Dr. George Rekers at UCLA eventually committed suicide; his family blamed his death on Rekers’ masculinizing treatments. Though these treatments weren’t officially “conversion therapy,” there was certainly a tacit acknowledgement that ridding the child of gender nonconformity might lead to a straight adulthood. (Rekers was later found to have engaged the services of a male escort, and may have been battling his own internalized homophobia.)

But by the time “gender identity” was drawn into the controversy over conversion therapy, our society had redefined “harm,” so that it included any emotional discomfort or moral injury. This “concept creep” of harm, as psychologist Nick Haslam put it, led to “pathologizing everyday experience and encouraging a sense of virtuous but impotent victimhood.”

The AAP paper wasn’t referring to aversion practices, that really caused harm. Rather, it was asserting that anything other than affirming gender identity was dangerous to trans youth—that not socially transitioning a child, or pushing back on the idea that transitioning would lead to greater happiness, was akin to abuse. Gender-affirming care then exploded as a field, now rid of any checks or balances. Any questioning or skepticism or exploration was now as dangerous as “masturbation reconditioning.” Talk therapy and electric shock: equally vile. Activists have worked hard to make sure that traditional talk therapy is continually recast as conversion therapy. If words are violence, as a generation has been led to believe, then asking about why someone might want to transition is the same as a blow to the head.

As it turned out, gender identity should never have been included in these laws or policies, because the research—the citations in the AAP’s statement—was only about sexuality. Dr. James Cantor fact-checked the statement and pointed out that “there are no studies of conversion therapy for gender identity.” [Emphasis his.] “Studies of conversion therapy have been limited to sexual orientation—specifically, the sexual orientation of adults—not gender identity, and not children in any case,” he wrote.

Laws banning conversion therapy, and the policy statements supporting those laws, had misapplied research from sexuality to gender identity. They had also overstated the risk of suicide, and implied that conversion therapy could lead directly to it, when in reality, suicide is rarely a response to a single event or issue.

Meanwhile, earlier this year I had a fascinating conversation with a gender-affirming therapist and gay man, Lee Beckstead, who did go to some form of “conversion therapy”—not the electric shock kind—and got something out of it. Though he originally set out to ban it, he ended up forming a partnership of sorts with therapists whose views he didn’t agree with, coming up with a set of guidelines to help opposing camps offer the best treatments to patients. He understood that it wasn’t his job to impose his own values onto patients, or even to therapists. As the nonprofit Therapy First, which promotes therapy as the first-line treatment for gender dysphoria, asserts, the job is “to expand and deepen self-understanding.” Why would anyone pass laws to stand in the way of that?

Finally, I’m struck by what Valerie Jarrett wrote all those years ago, about why conversion therapy should be banned: “Often, this practice is used on minors, who lack the legal authority to make their own medical and mental health decisions.” Despite this assertion, somehow these same minors could assent to double mastectomies or cross-sex hormones, to decisions that would affect them for the rest of their lives. Indeed, those in favor of conversion therapy bans often rail against bans on gender-affirming care.

Today, as the Supreme Court hears the case of Chiles v. Salazar, I hope some of this history will come up. The question before the Court is: “Whether a law that censors certain conversations between counselors and their clients based on the viewpoints expressed regulates conduct or violates the Free Speech Clause.”

That is, are these laws bans on speech or on professional conduct? If the former, therapists have a First Amendment right in place. If the latter, then the government has a right to regulate it. You want to ban electric shocking someone out of their proclivities, especially against their will? Okay. You want to conflate talking about the source of distress over one’s sexed bodies? Let’s hope not.