January 15, 1999

The APA Board of Trustees endorsed a position statement at its December meeting that opposes therapeutic techniques some psychiatrists and mental health professionals claim can shift an individual's sexual orientation from homosexual to heterosexual.

The Board acknowledged that there is no evidence that these so-called "reparative therapies" have any efficacy in converting someone from one sexual orientation to another.

The Board's unanimous endorsement of the statement and its passage by the Assembly one month earlier came 25 years after APA declared that homosexuality was not a mental illness and would thus be deleted from its Diagnostic and Statistical Manual, Third Edition (DSM-III). As did the 1973 action, this decision by APA attracted considerable media attention, with articles and favorable editorials in several major newspapers throughout the country.

"It is fitting," commented APA President Rodrigo Muņoz, M.D., "that this position opposing reparative therapy has been adopted on the 25th anniversary of the removal of homosexuality as a mental disorder from the DSM. There is no scientific evidence that reparative or conversion therapy is effective in changing a person's sexual orientation." He added that "there is, however, evidence that this type of therapy can be destructive."

The statement also comes at a time when conservative religious groups are intensifying advertising campaigns that spread a message that homosexual desires can be overcome through conversion therapies and Christian transformation ministries.

"Matthew Shepard's death, the use of the media to advertise for reparative therapy, as well as political misstatements by Senate Majority Leader Trent Lott and others have contributed to psychiatrists' realizing the danger to gay men and lesbians of remaining silent while psychiatric labels and treatments are misused for political reasons," emphasized Daniel Hicks, M.D., in an interview with Psychiatric News. Hicks is president of the Association of Gay and Lesbian Psychiatrists (AGLP). "It has taken AGLP members a long time to persuade APA leaders to address this issue. A tremendous amount of discussion and work went into bringing this about," he said.

The statement points out that "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 a patient."

It goes on to emphasize that "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." These so-called therapies rarely if ever help patients understand that they can lead productive, satisfying lives even though they are attracted to people of the same gender some or all of the time. Therapists using these techniques also fail to help patients learn ways in which they can deal with society's stigmatization of homosexuality, according to the statement.

As a consequence of this situation, the statement says, "The American Psychiatric Association opposes any psychiatric treatment, such as 'reparative' or 'conversion' therapy, that is based upon a prior assumption that the patient should change his/her homosexual orientation." The statement then adds that APA "recognizes that in the course of ongoing psychiatric treatment, there may be appropriate clinical indications for attempting to change sexual behaviors."

While some AGLP members have registered concern about this last sentence, Hicks noted that, "As therapists we do sometimes work to help people modify their sexual behavior, as in working to change unsafe or risky practices or to help people control compulsive sexual urges."

Noting that the American Psychological Association, National Association of Social Workers, and American Academy of Pediatrics passed similar condemnations before APA acted, the statement holds that APA "has already taken clear stands against discrimination, prejudice, and unethical treatment on a variety of issues including discrimination on the basis of sexual orientation."

With this statement now official APA policy, "it should be clearer than ever that if psychiatrists see patients who say they are gay but don't want to be, their response should be to help the person explore and understand their sexual orientation," said Margery Sved, M.D. "They will have no basis for telling these patients that they will help them change their orientation or refer them to someone who can." Sved is the Assembly's representative from the Caucus of Lesbian, Gay, and Bisexual Psychiatrists and was instrumental in guiding the statement through the Assembly last year.

The position statement was developed by the APA Committee on Gay, Lesbian, and Bisexual Issues, and then endorsed by the Council on National Affairs. Supporters tried to win endorsement for the statement from APA governing bodies in 1997, but were unsuccessful in winning its passage until several modifications were made. In November 1998, the Assembly passed the current version of the position statement.

Hicks called the position statement "very strong" and added that he is "pleased that APA's leadership felt so strongly about the issue."--K.H.