Harmful professional practises towards LGBTQI+ people (Reading)
The historical evolution of diagnostic manuals
It would be impossible to start this section without taking into consideration the historical perception of homosexuality and diverse gender identity by psychologists, psychiatrists, other medical professionals and policy makers with the help of the official classification manuals:
- The DSM (standard classification of mental disorders); and
- The ICD (international classification of disorders).
| DSM | ICD |
| 1st edition (1952)
Homosexuality is categorized as “sociopathic personality disturbance.” 2nd edition (1968) Homosexuality is described as a “sexual deviation.” 3rd edition (1973) It is concluded that sexual orientation cannot be changed, same-sex attraction is part of the normal spectrum of human sexuality. 5th edition (2018) “Gender identity disorder” is replaced by “gender dysphoria.” |
6th edition (1948)
Homosexuality is described as a “sexual deviation.”
10th edition (1992) “Sexual deviation” is replaced by “ego-dystonic sexual orientation”, keeping the notion that one’s sexual orientation or gender identity is subject to change.
11th edition (2018) Homosexuality is completely removed, gender identity is replaced by “gender incongruence.” |
Even though homosexual orientation and trans identity are officially not pathological diagnoses, LGBTQI+ persons still experience harmful practices directed towards “healing,” “changing” or “repairing” their sexualities and identities (Bishop, 2019). The World Psychiatric Association states in this regard:
| “Any intervention purporting to ‘treat’ something that is not a disorder is wholly unethical.” |
The harmful effects of conversion therapies
However, based on heteronormative norms, as well as personal, social and institutional bias towards LGBTQI+ persons, there are still some (if not many) mental health care professionals who provide therapies aiming to convert and treat non-heterosexual people and/or non-cisgender people.
“Conversion therapies” or “reparative therapies” is an umbrella term describing these harmful, shameful, degrading practices provided by parents (home-based), mental health professionals, religious activists/gurus and institutions (external, usually initiated by parents or caregivers).
International official data regarding conversion therapies is scarce, but according to a UCLA Williams institute, more than 700,000 LGBTQI+ persons in the US have been subjected to them, with 80,000 youth to experience harmful unprofessional practice in the coming years (Mallory et. al., 2018). Currently, talk therapy in disguise (difficult to pinpoint) and many other forms of shaming, guilt-tripping and blaming are used by mental health providers in order to alter associations related to a person’s desires and sense of self. Historically, “conversion” practises include:
- Aversion treatment, inducing nausea, physically intolerable conditions or vomiting when the person is shown visual stimuli with sexual content;
- Electric shocks;
- Chemical castration;
- Forced medical examinations, including forced anal examinations;
- Forced or coerced psychiatric assessment;
- Forced surgeries, including female mutilation;
- Collective beatings for public display;
- Corporal, institutional, religious punishment, arrests;
- Isolation;
- Rape;
- Humiliation;
- Forced marriages;
- Forced impregnation.
| Even though the most widely used practice nowadays is talk therapy used by professionals, parental rejection and attempts to change their LGBTQI+ child is perceived as harmful as the most outrageous practices described above. |
The long-term effects on LGBTQI+ people of conversion therapies in all their forms, whether or not they are torturous, include:
- Decreased self-esteem; increased self-hatred and self-blame; confusion, depression, helplessness; social withdrawal; suicidality;
- Anger, sense of betrayal; feeling of being dehumanised and untrue to one’s self;
- Hostility toward and blame of parents (believing their parents “caused” their sexuality);
- Intrusive images of sexual stimuli and sexual, romantic and intimate dysfunction with future sex partners (same-sex or other).
An experience of identity crisis and a potential loss of family, close people and social support can cause an LGBTQI+ person to feel on the verge of giving up. Not being able to change who they are might lead to feelings of failure and further isolation.
| The psychologist or other mental health care professional might not state that the aim of “therapy” would be to amend the core personality elements – sexuality or gender identity – disguising the support as affirmative. This approach is one of the most harmful ones, as the client forms a relationship of trust with an authority figure only to be betrayed at a later stage. |
