In response to recent news coverage on Reparative Therapy, the American Psychiatric Association issued the following media advisory:
Questions and concerns regarding the effectiveness of "reparative" therapy -- a term used to describe treatment attempts to change a person from a homosexual or bisexual orientation to a heterosexual orientation -- are again being raised in the public arena.
The American Psychiatric Association (APA) Position Statement on Psychiatric Treatment and Sexual Orientation, adopted by the APA Board of Trustees in December 1998, states in part: ...the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or "conversion" therapy, which is based upon the assumption that homosexuality per se is a mental disorder...
The February 2000 "Homosexual and Bisexual Issues" fact sheet and list of pertinent APA position statements provided below, and the following expert psychiatric physicians, offer up-to-date medical perspectives on the topic:
Jack Drescher, M.D.
New York City
Dan Hicks, M.D.
Margery Sved, M.D.
Phillip Bialer, M.D.
New York City
Homosexual and Bisexual Issues
In December 1973, the American Psychiatric Association's Board of Trustees deleted homosexuality from its official nomenclature of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II). The action was taken following a review of the scientific literature and consultation with experts in the field. The experts found that homosexuality does not meet the criteria to be considered a mental illness.
For a mental condition to be considered a psychiatric disorder, it must constitute dysfunction within an individual, cause present distress (e.g., a painful symptom), disability (e.g., impairment in one or more important areas of functioning), or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. A homosexual or bisexual individual may experience conflict with a homophobic society; however, such conflict is not a symptom of dysfunction in the individual.
The APA Board recognized that a significant portion of homosexual and bisexual people were clearly satisfied with their sexual orientation and showed no signs of psychopathology. It was also found that they were able to function effectively in society, and that those who sought treatment most often did so for reasons other than their sexual orientation.
When the DSM-III was published in 1980 homosexuality was not included although "ego dystonic homosexuality" was recognized as a category for people "whose sexual interests are directed primarily toward people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation." In the 1987 DSM-III revision, "ego dystonic homosexuality" was deleted as a separate diagnostic category in recognition that "In the United States, almost all people who are homosexual first go through a phase in which their homosexuality is ego dystonic" (DSM-III-R).
"Reparative therapy," also known as conversion therapy, is a term that is used to describe treatment attempts to change a person from a homosexual or bisexual orientation to a heterosexual orientation. There is no published scientific evidence supporting the efficacy of "reparative therapy" as a treatment to change one's sexual orientation. It is not described in the scientific literature, nor is it mentioned in the APA's Task Force Report, Treatments of Psychiatric Disorders (1989).
Sexual orientation, like gender identity, appears to be established early in life. There is no evidence that altering sexual orientation is an appropriate goal of psychiatric treatment. There are single case reports of changes or increased flexibility in the capacity to respond heterosexually -- or homosexually -- during psychotherapy, but no specific treatment to permanently realize such changes has been documented. Clinical experience suggests that attempts to change sexual orientation may occasionally result in behavioral changes for some motivated individuals for limited periods of time, but that such changes often are accompanied by depression, anxiety, and other symptoms.
Homosexuals and bisexuals -- like others -- are raised in a homophobic society and often experience internalized homophobia. Some may seek conversion to heterosexuality on that account. Clinical experience suggests that relief of homophobia allows for better psychological functioning. Those who have integrated their sexual orientation into a positive sense of themselves function at a healthier psychological level than those who have not.
In December 1998, the APA Board adopted a position statement on psychiatric treatment and sexual orientation which said in part: "...the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or "conversion" therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon a prior assumption that the patient should change his/her homosexual orientation." (See "Psychiatric Treatment and Sexual Orientation," for complete text.) Several other major professional organizations including the American Psychological Association, the National Association of Social Workers and the American Academy of Pediatrics also have made statements against "reparative therapy" because of concerns for the harm caused to patients.
Sensitive and Affirmative Therapy
Homosexual and bisexual men and women have experienced increased social acceptance and recognition over the last several decades. Bias, prejudice, and stigmatization of these individuals -- and of homosexuality itself -- however, continue. These factors can contribute to shame and poor self-esteem, and be a component in the mental health presentation of some homosexuals and bisexuals seeking psychotherapy or psychopharmacology.
Therapy that is "gay sensitive" -- that is, therapy provided by a therapist who is well informed about homosexuality and the issues facing homosexual and bisexual people that result from social homophobia‹is most helpful for those individuals. So, too, is therapy that is "gay affirmative"‹that is, therapy provided by a therapist who is positive and supportive about accepting an individual's homosexual or bisexual orientation.
APA Position Statements on Homosexuality
The American Psychiatric Association is officially on record with the following position statements:
Homosexuality and Civil Rights -- Whereas homosexuality per se implies no impairment in judgment, stability, reliability, or general social or vocational capabilities, therefore, be it resolved that the American Psychiatric Association deplores all public and private discrimination against homosexuals in such areas as employment, housing, public accommodation, and licensing, and declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon homosexuals greater than that imposed on any other persons. Further, the American Psychiatric Association supports and urges the enactment of civil rights legislation at the local, state, and federal level that would offer homosexual citizens the same protections now guaranteed to others on the basis of race, creed, color, etc. Further, the American Psychiatric Association supports and urges the repeal of all discriminatory legislation singling out homosexual acts by consenting adults in private. (The Amer ican Psychiatric Association is, of course, aware that many other persons in addition to homosexuals are irrationally denied their civil rights on the basis of pejorative connotations derived from diagnostic or descriptive terminology used in psychiatry and deplores all such discrimination. This resolution singles out discrimination against homosexuals only because of the pervasive discriminatory acts directed against this group and the arbitrary laws directed against homosexual behavior.) (November1973)
Discrimination Based on Gender or Sexual Orientation -- Irrational employment discrimination on the basis of gender and sexual orientation has received considerable attention in law, business, sociology, and, to a lesser degree, psychology. It is well known that sexual harassment and other forms of irrational gender-based employment discrimination are potentially severe occupational stressors. Complaints of sexual harassment and gender based discrimination have increased in recent years, and this trend is likely to continue because employees are increasingly aware of legal prohibitions against these and other forms of employment discrimination. While the psychiatric needs of self-identified discrimination victims have been under-recognized, both in and out of the workplace, psychiatrists can expect increasing consultations regarding these issues. It is important that psychiatrists appreciate and help others to understand the emotional consequences of irrational employment di scrimination based on gender or sexual orientation. (June 1988)
Homosexuality and the Armed Services -- APA, since 1973, has formally opposed all public and private discrimination against homosexuals in such areas as employment, housing, public accommodations and licensing. It follows that APA opposes exclusion and dismissal from the armed services on the basis of sexual orientation. Furthermore, APA asserts that no burden of proof of judgment, capacity, or reliability should be placed on homosexuals which is greater than that imposed on any other persons within the armed services. (December 1990)
Right to Privacy -- The American Psychiatric Association supports the right to privacy in matters such as birth control, reproductive choice, and adult consensual relations conducted in private, and it supports legislative, judicial, and regulatory efforts to protect and guarantee this right. (December 1991)
Homosexuality and the U.S. Immigration and Naturalization Service -- The American Psychiatric Association strongly opposes all public and private discrimination against homosexuals in such areas as employment, housing, public accommodations, licensing, and immigration and naturalization decisions. The U.S. Immigration and Naturalization Service, at least until 1990, considered homosexuality to be a mental illness and used this determination as a basis for the discriminatory exclusion of homosexual visitors and immigrants to the United States. The American Psychiatric Association successfully opposed the continued inclusion of homosexuality as a mental illness by the Immigration and Naturalization Service. The APA believes that neither physical illness nor mental illness nor sexual orientation per se should be a basis for immigration or naturalization exclusion. (1991)
Homosexuality -- Whereas homosexuality per se implies no impairment in judgement, stability, reliability, or general social or vocational capabilities, the American Psychiatric Association calls on all international health organizations, and individual psychiatrists in other countries, to urge the repeal in their own country of legislation that penalizes homosexual acts by consenting adults in private. And further, the APA calls on these organizations and individuals to do all that is possible to decrease the stigma related to homosexuality wherever and whenever it may occur. (December 1992)
Bias-Related Incidents -- Bias-related incidents, arising from racism, sexism, and intolerance based on religion, ethnicity, and national/tribal origin, and anti-gay and lesbian prejudice are widespread in society and continue to be a source of social disruption, individual suffering, and trauma. These incidents are ubiquitous and occur in both urban and rural areas. Such hate-based incidents consist of acts of violence or harassment. These incidents result in emotional and physical trauma for individuals, as well as stigmatization of affected groups. Ethnic and cultural biases, vividly manifested in bias-related incidents, serve to frustrate the basic human need for dignity, resulting in despair and hopelessness among the victims which ultimately affect the whole nation. The APA deplores such bias-related incidents. Moreover, the APA encourages its own members and components to take appropriate actions in helping to prevent such events, as well as to respond actively in th e aftermath when such bias-related incidents occur locally. (December 1992)
Psychiatric Treatment and Sexual Orientation -- The potential risks of "reparative therapy" are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone "reparative therapy" relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed. Therefore, the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or "conversion" therapy which is based upon the priori assumption that homosexuality per se is a mental disorder or based upon the assumption that the patient s hould change his/her homosexual orientation. (December 1998)
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