To Be Cured You Have To Be Ill

While campaigning for re-election in 2011, President Obama famously noted that his attitudes towards same-sex marriage were, to use his own word, “evolving.” And so, clearly, have his opinions about other issues relating to the gay community, which evolution reached its latest stage just this week when the President formally announced his opposition to so-called conversion therapy (also called reparative therapy) undertaken to alter sexual identity. The president did not explicitly call for congressional legislation to ban the practice, but merely encouraged the eighteen states currently considering laws that would do just that to persevere and thus to join California, New Jersey, and Washington, D.C., where this kind of therapy is already forbidden by law. Presumably, the President would like the other thirty states to follow suit. But even without the intimation of future federal legislation, this was the first time the issue was brought so forcefully to the fore as part of a larger national debate about the place of gay people in American society.

White House senior advisor Valerie Jarrett explained the President’s stance in terms of the efficacy of the therapy, nothing that “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.”  And that appears to be the widely accepted view in the medical community as well. As early as 2001, U.S. Surgeon General David Satcher published a report in which he wrote that he knew then of no evidence at all that sexual orientation can be changed. Later studies have confirmed that sentiment.  Even Robert Spitzer, the renowned psychiatrist whose 2003 paper endorsing the potential worth of therapy undertaken to change sexual orientation was very widely cited by groups in favor of the practice, even Dr. Spitzer himself has backtracked, describing his own work as “fatally flawed” and apologizing to the gay community for proffering claims about the efficacy of conversion therapy that he now realizes remain unproven. Nor is this a new line of thought: Freud himself wrote in his 1920 essay, “The Psychogenesis of a Case of Homosexuality in a Woman,” that “in general to undertake to convert a fully developed homosexual into a heterosexual does not offer much more prospect of success than the reverse.” In other words: none at all.

All that being the case, it’s hard to imagine what the fuss is about. Surely no one is in favor of it being legal for snake-oil salespeople posing as therapists to offer cures that do not work, just as no one thinks pharmaceutical companies should be allowed to market drugs that don’t actually do anything or that hospitals should be allowed to permit procedures that merely make the hospital lots of money but do not actually have any sort of salutary effect on the patients who undergo them.  So the President’s stance is hardly too daring a one, just a rational commitment to the more-than-widely-accepted principle that only effective forms of medical or psychological treatment should be permitted by law. But hiding behind this specific discussion is a different, far more interesting one.

White House Senior Advisor Jarrett wrote plainly that conversion therapy should not be allowed because it doesn’t work.  But what if it did work? In other words, what if some way were to be found to alter sexual identity? It’s true that no one seems to know how to do it. But medical procedures we’ve come to think of as ordinary—dialysis, in vitro fertilization, coronary bypass surgery, to name three among a thousand—would also once (and in the lifetimes, I think, of most of my readers) have been dismissed as undoable fantasies. So let’s say that someone somewhere comes up with an actual way to alter sexual identity. Let’s posit it works too, and with no other effect than the desired one. Would it be morally wrong for citizens who wished to be differently oriented to avail themselves of it? Valerie Jarrett used the word “unethical” to describe conversion therapy, but the context of her remarks suggests that she meant that it is unethical because it is foisted on naïve souls as efficacious, which it clearly is not. But what if it were efficacious. What if it did work? Would it still be unethical? To my way of thinking, that is the far more interesting issue and it’s the one I’d like to write about this week.

We live in a society that encourages people to live free, to be what they wish to be, to self-alter if self-alteration is perceived as the path towards future happiness. That much sounds like apple pie, like something you couldn’t debate because there wouldn’t be any rational reason to oppose the concept. People who weigh too much go on diets to lose weight. People who have no natural musical talent take piano lessons because they want to learn how to make music nevertheless and we think that’s admirable, particularly in adults. People who feel held back by their lack of formal education go back to school, even later in life, to self-improve, to self-transform, to become the men and women they feel they could be and they wish to be. So the notion of being dissatisfied with who or what you are and wishing to morph into a version of yourself that better suits your conception of who you could or should or would be…that notion is as basic to the bedrock American value of self-reliance as it is fundamental to the right of every individual to live as he or she wishes and according to his or her own lights.

But is that the right framework for discussing the question of self-alteration when it touches something as basic as sexual orientation? Not fully apt is the parallel that comes to mind the most easily: the one to the kind of hormonal and surgical therapy intended to help transgendered, or potentially transgendered, people overcome the lack of correspondence they feel between gender and sex. People who suffer from gender dysphoria are possessed of the conviction that they actually are men or women even though they were born into the world in bodies that specifically do not conform to that aspect of their internal identity. But the audience for conversion therapy is hardly made up of gay people who feel that they really are straight people who have somehow been born into the world encased in the psyches of gay people. (I’m not even sure what that would mean.) Instead, the candidates for this kind of therapy understand themselves truly to be gay people, but wish that that weren’t the case…and so they turn to therapy in the hope, apparently the vain hope, that it might alter that aspect of their internal selves and make them not into someone they already truly are, as might a young person in the transgender context, but into someone they aren’t but wish they were. So that parallel doesn’t really work.

Nor is the parallel to plastic surgery entirely right. People, for example, who submit to surgery because they wish they had different shaped noses or breasts, or less plump bellies or more shapely posteriors, are eager to alter some aspect of their appearance so that they will be more pleased with the way they look, not to change something so deeply embedded in the psyche that to alter it would really be to change into a different person almost entirely. So to compare the alteration of one’s sexual identity to the alteration of the shape of one’s nose is to make too little of the one and too much of the other. I don’t suppose there’s any specific reason for people who can afford such procedures not to look as they wish, but, in the end, there’s a reason that kind of surgery is qualified as “cosmetic”: because it is cosmetic and affects only the outer shell, not the inner core, of the person undergoing it.

More relevant than the search for parallels in other arenas of modern life, however, is the fact that desire to alter one’s sexual orientation—always in the direction of gay to straight, of course, and never in the opposite direction—is generally rooted in the kind of self-loathing that society should discourage rather than promote. Thinking you would look better with straighter teeth or a tinier nose doesn’t strike me as something intrinsically negative or harmful because the post-surgery individual with the desired teeth or nose is fundamentally the same individual as the pre-surgery one. But sexual identity, I believe, is more like gender itself: something that is so basic to the integral self that to alter it truly is to alter who that individual is. Many times in the course of all these years of marriage I’ve been told that “if I were a woman, I’d get it.” Clearly, I know what Joan means: that women see things differently than men and, if I were a woman, so would I.  But, her implied meaning notwithstanding, the thought itself doesn’t really make any sense: if my mother had given birth to a baby girl on the day of my birth instead of myself, I would hardly be myself except that I’d be a woman. Gender is too basic, too deeply rooted in the most interior aspects of the psyche, too ineradicable for it to be reasonable to imagine oneself being exactly who one is except of the opposite gender. That person, had my mother done that thing, would be someone entirely different than me. She wouldn’t have my name or look like me. (That poor thing if she did!) But she also wouldn’t have had my experiences, wouldn’t have grown up seeing the world through my eyes, wouldn’t have become who I am except for some few physiological and endocrinological details.  I think we all feel that way about gender, but I think it’s true about sexual identity as well.

And that’s why society is doing well to be moving away from this kind of therapy. It’s not relevant that it doesn’t work. Lots of things in the world used to not work and now they do! What’s relevant is the notion that the desire to undergo conversion therapy is almost always routed in the deeply internalized lesson that being gay is some sort of moral defect that needs to be fixed, that it is a disease that only a crazy person would wish to suffer from instead of being cured of. As the father of a gay man, I have learned not to think of gayness as a burden to be shouldered stoically and bravely, but as a deeply embedded feature of personality. To wish a gay person straight is to wish that person not to exist, and to deny the right of the self—one’s own self or someone else’s—to exist on its own terms is tragic. Gay people who are so miserable that they see no step as too extreme to take to eradicate their sexuality should be helped…not to become different people even if that were possible, but to embrace their inner selves and the constellation of affects that is theirs alone. Only then will such people find the kind of inner peace that is only truly available to those who understand that self-acceptance is the threshold across which all must step who would be accepted by the world beyond the self, by the world of others, by the world of neighbors and potential friends.