In January the Florida Select Committee on Health Innovation approved House Bill 1639 (HB 1639), which dramatically restricts treatment for transgender individuals. If the bill becomes law, it will make it easier for insurers to refuse to cover gender-affirming care, will require those that cover gender transition to also offer policies that do not and will bar transgender people from updating their driver’s license. It also mandates that insurers provide detransition care to those who want to revert to the sex they were assigned at birth.
In intent, HB 1639 is similar to hundreds of other recent Republican-led bills advancing through state legislatures, including nine heard in one day in Missouri’s legislature and GOP lawmakers’ override of Governor Mike DeWine’s veto of a similar bill in Ohio. They aim to create a climate of panic around young LGBTQ people’s access to health care and participation in sports that can be exploited for partisan ends. The “endgame,” as Michigan and Ohio legislators admitted during a recent X Space (formerly known as a Twitter Space), is banning gender-affirming care “for everyone,” including adults.
The Florida bill would require insurers to cover “mental health or therapeutic services to treat a person's perception that his or her sex ... is inconsistent with such person’s sex at birth by affirming the insured’s sex.” In plain language, HB 1639 endorses so-called conversion therapy: counseling aimed at curing someone of being transgender, viewing it as a form of mental disorder or spiritual failing.
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Going even further, five West Virginia state senate Republicans proposed Senate Bill 194, essentially a total ban on gender-affirming care for young transgender people. It classifies gender dysphoria as a “sexual deviation,” along with pedophilia, exhibitionism and biastophilia (a compulsion to rape), while mandating that any therapy must attempt to “cure” transgender identity. Medical professionals who support transition, rather than pursuing “cure-based recovery,” face losing their licenses and fines up to $10,000.
“Cure-based recovery,” also known as “reparative therapy,” has a medical record that is extensive and well-documented—and abysmal. According to the American Psychological Association, “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.” A 2020 study found that LGBTQ people who underwent conversion therapy “had nearly twice the odds of lifetime suicidal ideation” and were 75 percent more likely to plan to attempt suicide. As one scholar surveying the legal status of conversion therapy wrote, “The practice is not just risky and harmful; it does not work.”
Nevertheless, reparative therapy practitioners have tunneled around antiquackery laws with a parallel licensing infrastructure for so-called pastoral counseling, which is unregulated by the professional organizations that oversee doctors, psychologists and social workers. Groups like the National Christian Counselors Association openly tout their freedom from medical ethics standards, warning in a brochure that “the state licensed professional counselor in certain states is forbidden to pray, read or refer to the Holy Scriptures, counsel against things such as homosexuality, abortion, etc. Initiating such counsel could be considered unethical by the state.”
Pastoral counseling ethics instead might demand telling a transgender teenager that they are headed for eternal damnation. A blurb for the recently published Across the Kitchen Table: Talking about Trans with Your Teen, by reparative therapist Sam Andreades, praises it for putting “today’s confusion about the body and gender exactly where it belongs: in the context of our creation, fall, and redemption.”
In reality, the history of misguided attempts to promote “cure-based recovery” for gay and transgender people is one of the longest and darkest chapters in psychiatry. In the 1930s homosexuality, gender dysphoria and cross-dressing were often grouped together as “sexual inversion.” Some clinicians would wait for a child born with ambiguous genitalia to undergo puberty to determine which gender was “dominant” before considering transition; the child’s sense of their own gender was secondary to stereotypical considerations of appropriate male and female appearance and behavior. Gender reassignment, wrote Jules Gill-Peterson in Histories of the Transgender Child, was often “an attempt to medically produce and reinforce heterosexuality.”
As noted in Gill-Peterson’s book, in the late 1960s a psychiatrist at the influential gender clinic at University of California, Los Angeles, named Lawrence Newman candidly admitted, “If we define a successful treatment of transsexualism as one which would make the transsexual give up his crossgender orientation and become comfortable with his physical sex…, we must acknowledge that nothing approaching this exists.”
But if psychoanalysis wasn’t up to the task, perhaps operant conditioning could get it done. A few years after Newman’s frank admission, another U.C.L.A. psychiatrist, Richard Green, teamed up with behaviorist Ivar Lovaas to launch the Feminine Boy Project, an attempt to employ Skinner-style contingent reinforcement to “extinguish” gender-inappropriate behavior in childhood. Lovaas was then at the height of his fame for his exaggerated claims of “curing” autism with a brutal approach that Life magazine hailed in an article entitled “Screams, Slaps and Love.” For playing with football helmets, rubber knives and electric razors, boys diagnosed with what Green dubbed “sissy boy syndrome” were rewarded with blue tokens that could be exchanged for M&Ms or other treats; for playing with dolls and cosmetics, they were given red tokens that would lead to various forms of punishment at home. “Plays with Barbie dolls at five, sleeps with men at 25,” Green ominously intoned in a TV interview, attempting to strike terror into parents.
The project’s star success story was a young man named Kirk Andrew Murphy, who had been caught by his father posing in the kitchen in a long T-shirt saying, “Isn’t my dress pretty?” In a 1974 paper research assistant George Rekers and Lovaas described Kirk at age five as “‘swishing’ around the home and clinic, fully dressed as a woman with a long dress, wig, nail polish, high screechy voice, [and] slovenly seductive eyes.” At home, Kirk’s father exchanged his son’s red tokens for beatings with a belt, with Rekers’s approval. Eventually, Kirk’s brother Mark started hiding the red tokens to save Kirk from the abuse.
After 60 sessions in the lab, Kirk was declared cured of sissy-boy syndrome. The psychologists noted that after the treatment, the little boy was no longer upset when his hair was mussed and was eager to go on camping trips with his father. Rekers eventually published nearly 20 papers on his client’s alleged metamorphosis, becoming one of the world’s leading proponents of conversion therapy in the process.
Then in 2003, at age 38, after a series of unsuccessful relationships with women, Kirk died by suicide. His sister Maris told Anderson Cooper on CNN that his treatment at U.C.L.A. “left Kirk just totally stricken with the belief that he was broken, that he was different from everybody else.”
Rekers co-launched the Family Research Council (FRC), which has played a prominent role in drafting and promoting the current wave of antitrans legislation. Rekers’s name was scrubbed from the FRC website after an embarrassing incident in 2010 when he was photographed traveling with a young male sex worker whom he claimed he’d hired from Rentboy.com to “lift his luggage.” But his toxic legacy lives on in bills, such as West Virginia’s Senate Bill 194, that mandate ineffective and harmful treatments, pretend that science learned nothing from decades of experimentation on children, and treat certificates from online credential mills as the equivalent of medical licenses.
With many red-state legislators, and the Supreme Court’s far-right partisans, demonstrating that they view LGBTQ people as broken and in need of repair, protecting young people from such harmful quackery requires extra vigilance from all of us.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
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