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• W4220814894 abstract "Psychiatry has an ugly history concerning sexual orientation and gender, having previously pathologised those attracted to the same sex or who did not conform to feminine or masculine norms. After late-19th century psychiatrists attempted to explain what they saw as innate morbid conditions, early 20th-century psychoanalytic approaches viewed homosexuality as truncated psychosexual development linked to family dynamics and treatable with therapy. Behaviourism added aversion therapy to the toolkit in the 1960s, while cognitive therapists tried to change thought patterns. The position of psychiatry has long since changed—homosexuality was removed from DSM-III-R in 1987 and from ICD-10 in 1992, and minority gender identity was scaled back to gender incongruence or dysphoria. But conversion therapies are not consigned to history. Efforts to change someone's sexual orientation or gender identity and expression (SOGIE) are not well documented, but they have been reported in at least 60 countries in all world regions. These efforts span talk therapies, prayer and religious rituals (eg, exorcism), physical deprivation, aversion therapy (eg, inducing nausea), electroconvulsive therapy, and medication. They are carried out by religious leaders, traditional healers, and private and public mental health professionals. Few of those receiving conversion therapies have sought them out themselves; many are brought by family members, driven by a combination of religion, family honour, and cultural pressure. Although various national governments are currently working towards banning conversion therapy, only five countries have a complete ban and 13 have partial bans. The persistence of conversion therapy is intricately linked to enduring homophobia and transphobia—criminalisation remains in 71 countries. Anti-LGBTQ+ sentiment draws on different reasoning around the world, united by a sense of moral panic: a perceived threat to societal values and interests. Opposition is often based on religious ideas of a natural order or divine plan, as for US Evangelical Christian and European and South American Catholic groups. In some African countries, an LGBTQ+ agenda is seen as neo-colonialism pushed by Western countries, and anti-LGBTQ+ discourse is also framed in terms of public health and the HIV epidemic. Family values are often implicated, as in Russia, where being LGBTQ+ is portrayed as Western decadent liberalism gone too far. Psychiatry offers expertise that can inform these debates, and its past role in promulgating enduring stigma of LGBTQ+ people gives it a responsibility to oppose conversion therapy. The term “therapy” implies the existence of a disorder to be changed, but psychiatry views SOGIE in terms of variation not pathology. The American Psychiatric Association declared that same-sex attraction—as action, fantasy, or identity—does not imply any impairment, has unknown, multifactorial causes, and does not need changing. The psychiatric classification of gender identity relates only to the distress associated with felt discordance in gender. SOGIE minority people have a higher risk of anxiety, depression, self-harm, and suicide, but frameworks like the minority stress theory root this in social and structural forces, through experiences of discrimination, stigmatisation, and rejection or exclusion. A plethora of medical and mental health associations have condemned the use of conversion therapy, declaring it to have no evidence of being effective in inducing change and to be harmful; it has been associated with increased self-hatred, self-harm, depression, anxiety, and suicidality. The psychiatry community must do more. Speaking in a United for Global Mental Health webinar on conversion therapy in February, 2022, Dr Amir Ahuja of the American Psychiatric Association argued that psychiatrists should educate themselves and offer LGBTQ-affirmative therapy, and that mental health practitioners should police themselves by lobbying organisations to ban conversion therapy and to threaten to remove licences. Various psychiatric organisations have brought out affirmative guidelines, beginning with the American Psychological Association in 2000. Such guidelines represent a recognition of diversity among people, including awareness of the struggles and lived experience of LGBTQ+ people and that clinicians’ own attitudes and knowledge are relevant to the therapeutic process. Research is difficult under criminalisation, but a significant step in an LMIC context is the 2013 affirmative position statement from the Psychological Society of South Africa, which evolved into practice guidelines that were co-opted by two other African countries. Affirming the plurality of SOGIE and opposing attempts to change it must remain urgent priorities in the global mental health community. For anti-LGBTQ+ sentiment around the world see The Pink Line: Journeys Across the World's Queer Frontiers. Mark Gevisser. London: Profile Books, 2021For the harmful effects of SOGIE change efforts see Can J Psychiatry 2020; 65: 502–09 For anti-LGBTQ+ sentiment around the world see The Pink Line: Journeys Across the World's Queer Frontiers. Mark Gevisser. London: Profile Books, 2021 For the harmful effects of SOGIE change efforts see Can J Psychiatry 2020; 65: 502–09 Conversion therapy: a violation of human rights in Iranian gay menAlthough the stigma of homosexuality has reduced over the past 20 years, it still persists in some countries worldwide.1 Now accepted in many countries, homosexuality was removed from the DSM-III in 1973 and from the ICD-10 in 2017; however, it carries the death penalty in Iran in accordance with the Islamic penal code (clauses 108 to 126). Religious institutions are opposed to homosexuality, leading to the rejection of gay men by families and society, the promotion of internalised stigma, and the development of pseudoscientific therapies by health professionals. Full-Text PDF" @default.
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• W4220814894 date "2022-04-01" @default.
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• W4220814894 title "When therapy is not therapy" @default.
• W4220814894 doi "https://doi.org/10.1016/s2215-0366(22)00076-1" @default.
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