Misdiagnosis: How Did We Get Here?

Conversion therapy attempts to change a person’s sexual orientation with no success, only harm, guaranteed.

This article is the first of a three-part series about conversion therapy. Part one explains sexual orientation change efforts and explores the history, theories, and experiments that served as the foundation for what developed into the practice of conversion therapy. Part two will explore the harmful effects of sexual orientation change efforts, and part three will discuss recent legal developments.

The practice of conversion therapy has no validated scientific or medical foundation. The dictionary defines therapy as (1) treatment intended to relieve or heal a disorder; (2) the treatment of mental or psychological disorders by psychological means; (3) treatment to help a person get better from the effects of a disease or injury; and (4) a treatment that helps someone feel better, grow stronger, etc., especially after an illness. By definition, the use of the word “therapy” makes the term “reparative therapy” itself an oxymoron. Reparative therapy is the injury. Ignorance and intolerance are the afflictions, and they have resulted in the subjection of innocent victims to a fraudulently termed therapy process that purports to treat a fictional disorder. How did we get here—and where do we go now?

The effects

The only way I will rest in peace is if one day transgender people aren’t treated the way I was. My death needs to mean something.”

—Leelah Alcorn

The above quote is from the suicide note of a 17-year-old girl who took her own life after subjection to conversion therapy. Her story is just one example of the tragedy that can result from this practice, which has been widely denounced by the medical, psychological, and psychiatric professions.

Conversion therapy is a form of sexual orientation change efforts (SOCE), which is defined as any effort to change an individual’s sexual orientation from homosexual to heterosexual. Despite the definition, conversion therapy, also referred to as reparative therapy, aversion therapy, and reorientation therapy, is not exclusive to homosexuality. It purports to treat all conditions perceived, often mistakenly, to be associated with homosexual tendencies or behaviors. Transgender, for example, concerns an individual’s self-identification, whereas homosexuality concerns an individual’s attractions to others. Although a transgender individual may also identify as homosexual, the two are not the same. Conversion therapy purports to change a person from homosexual to heterosexual. One’s status as transgender may not be related to their sexuality, but the practice is also employed as an attempt to “cure” transgender persons.

The rituals employed in conversion therapy can be painful and barbaric with some practices walking—or crossing—the line into sexual abuse. Supporters of conversion therapy declare it can cure all conditions associated with sexual identity or attractions considered to be uncharacteristic of “normal” feelings, perceptions, or behaviors. Under the guise of this theory, “normal” sexual identity attraction or behavior is equated to heterosexuality.

Calling sexuality a disease

The practice of conversion therapy is misguidedly based on the characterization of homosexuality as a mental or psychological disorder. Lesbian, gay, bisexual, transgender (LGBT), and related sexual orientations were first listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), under the paraphilia category. Paraphilia, previously known as sexual perversion and sexual deviation, is defined as a condition of sexual behaviors that “society may view as distasteful, unusual, or abnormal … in which a person’s sexual arousal and gratification depend on fantasizing about, and engaging in, sexual behavior that is atypical and extreme.” Included in this category were pedophilia, exhibitionism, voyeurism, and sexual sadism, among others. The LGBT status was subsequently classified in the DSM as sexual orientation disturbance, ego-dystonic homosexuality, and sexual disorder not otherwise specified. It was finally dropped from the DSM altogether in 1973. This misclassification is perhaps a leading cause of the maltreatment of LGBT people by way of SOCE.

Predating the APA’s removal of homosexuality from the DSM, the Australian and New Zealand College of Psychiatry Federal Council was actually the first organization in the world to declare that homosexuality was “not an illness.” However, many practices have emanated from the misclassification of homosexuality as a disorder.

Curing the “ill”

The origin of conversion therapy dates to the 19th century. In 1899, a German psychiatrist claimed that he had turned a gay man straight. His experiment included 45 sessions of hypnosis and a few trips to a brothel. The methods in this early account of conversion therapy are mild compared to some practices later integrated.

Homosexuality has historically been looked upon from a cause and effect viewpoint. One such theory is that homosexuality is rooted in a man’s testicles. In 1912, Drs. Eugen Steinach and Robert Lichtenstern, the instigators of this theory, began experimenting with the transplantation of sexual organs in the opposite sex. The experiments involved the castration of guinea pigs followed by implantation of testes in female guinea pigs and ovaries in male guinea pigs. Steinach concluded that the procedure impacted behavioral characteristics. This research stimulated his interest in the role of hormones and mental attributes in relation to homosexuality. His theory led to the practice of testicular transplantation in which the “homosexual testicles” of gay men were removed and subsequently replaced with “heterosexual testicles.”

In 1918, Lichtenstern conducted experiments using vasoligation, a surgical ligation of a vessel, especially of the vas deferens. In these experiments, he observed the sexual tendencies of the subjects after the procedure. The two doctors subsequently produced a publication entitled “Conversion of Homosexuality through Exchange of Puberty Glands,” concluding that homosexual tendencies were replaced by heterosexual tendencies as a result of the transplant procedure. Within a few short years, the procedure gained popularity. Steinach did not perform the procedure himself but documented the outcomes of other doctors to determine its success. Varying results later led doctors and researchers to doubt its effectiveness.

The damage done

For centuries, the scientific aspect of “curing a disorder” and altering a person’s mental state and behaviors to match society’s interpretation of “the norm” has been the core focus of SOCE. However, the paradigm is currently shifting.

To demonstrate the damage conversion therapy causes, it is important to discuss methods that have been employed in the facilitation of its practice. Many conversion therapy methods can be deemed barbaric. These therapies include castration; administering electroconvulsive shock therapy to “repair” the brain; shocking the fingers or genitals while showing homoerotic images; aversive conditioning (the use of something unpleasant, or a punishment, to stop an unwanted behavior); inducement of nausea, vomiting or paralysis while displaying homoerotic images (a form of Pavlov’s Classical Conditioning); requiring the individual to snap an elastic band around the wrist to cause pain when aroused by homoerotic images or thoughts; shaming techniques; orgasmic or masturbatory reconditioning; satiation therapy, a technique historically used in sex offender rehabilitation; attempting to make patients’ behavior more masculine or feminine; teaching heterosexual dating skills; and hypnosis. British Psychologist Ian Oswald’s technique included pumping gay men full of nausea-inducing medications, surrounding them with glasses of urine, and playing audio of gay men performing sexual acts in an attempt to “overdose” the individual with homosexuality. His belief was that overdosing a patient would reduce the individual’s desire for that particular behavior or obsession.

Another physician, Denslow Lewis, claimed to treat women suffering with “sexual hyperesthesia” (excessive sensitivity to stimuli) with cocaine solutions, saline cathartics, surgical “liberation” of “adherent clitorises,” and even the administration of strychnine. Victims have reported appalling conditions and treatment while in conversion camps, such as beatings, starvation, and having been forced to consume their own waste.

Chaim Levin twice underwent conversion therapy at the recommendation of Jews Offering New Alternatives for Healing (JONAH), and in several interviews, recalled occasions in which he was encouraged to remove all of his clothing and hold his private parts in front of other patients and staff members. He further recounts instances in which patients were forced to stand naked in a mirror and say degrading things about their bodies, and at other times, was instructed to hug staff members while naked. In 2015, JONAH was forced to shut down. After a landmark case found that its claims to be able to change a person’s sexual orientation from homosexual to heterosexual constituted fraud, the court ordered it to pay restitution to the plaintiffs and to close its doors within 30 days. Just 11 days after the verdict, using JONAH’s assets, the organization formed another conversion therapy establishment under the name Jewish Institute for Global Awareness (JIFGA). In June 2019, a New Jersey judge ordered further restitution to new plaintiffs and, again, ordered the closing of the organization’s doors.

Not all conversion therapy techniques are barbaric in nature on their own, such as talk therapy; however, they are often used in conjunction with harsher methods. No matter the level of severity of any particular method, the probability of harm endures, and the underlying message is the same: You are not normal, you are not acceptable, you are broken, and you need to be fixed. Regardless of the techniques employed, the harm is the same.


Wansong Harley is a 3L at the Santa Barbara and Ventura Colleges of Law. She has obtained her bachelor’s in Business Management and completed coursework for an MBA with a concentration in accounting at Albany State University. She believes in giving back, paying it forward, and helping the homeless. Wansong believes self-improvement should be a life-long commitment and her favorite saying is “Every man who has gotten where he is – started where he was.” When her head isn’t in the books, she loves to look out her window and watch the waves hit the shore.

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