Ethical concerns raised when patients seek to change same-sex attractions

J. Drescher

Since the American Psychiatric Association removed homosexuality from its diagnostic manual in 1973, mainstream mental health organizations have maintained that an individual's sexual orientation should be respected. Reparative therapists, however, argue that homosexuality is always a symptom of mental illness which should be treated. They have further argued that all therapists have an ethical responsibility to refer individuals with antihomosexual religious beliefs to reparative therapists in order to change their sexual identities. This paper argues that such recommendations are unwise because they are derived from a misleadingly narrow reading of ethical guidelines. Rather than an issue regarding ethical patient care, this argument is a reflection of the culture wars surrounding homosexuality. This paper places those struggles in historical context. It examines reparative therapists' pathologizing of and attempts to "cure" or change same sex attractions. Reparative therapists insist on social and traditional gender conformity as a therapeutic goal, and in doing so operate from an essentialist view of antihomosexual morality. Reparative therapies rely upon gender stereotyping that disrespects a patient's same-sex attractions. Furthermore, as some reparative therapists actively support political activities opposed to granting civil rights to lesbians and gay men, these activities raise ethical issues relevant to the entire psychotherapeutic endeavor. Inevitably, the decision about what social status to accord homosexuality is a moral and ethical issue affecting all patients and clinicians.