On April 11, a federal judge awarded two Florida counselors a combined $175,000 after ruling that local conversion therapy bans in Palm Beach County and the city of Boca Raton violated their First Amendment rights to free speech. The two therapists — Robert W. Otto and Julie H. Hamilton — received legal support from a conservative anti-LGBTQ group called the Liberty Counsel to appeal municipal and county-level conversion therapy bans after they went into effect in 2017.
The term “conversion therapy” refers to medicalized practices attempting to eliminate same-gender sexual desires or to change subjects’ gender identities from transgender to cisgender. Research has shown such practices have more often resulted in reduced self-esteem, self-harm or suicide than in lasting change to gender identities or sexual attraction. This is why conversion therapies are illegal in some parts of the world and have been denounced by several major professional mental health organizations as harmful, unethical and ineffective.
In America, 26 states and the District of Columbia at least partially ban using this damaging practice on minors. When Otto and Hamilton’s case was heard by the U.S. Court of Appeals for the 11th Circuit in 2020, the court decided that Otto and Hamilton suffered “content based regulations of speech,” according to Judge Britt Grant. This case also prompted the court to grant a preliminary injunction preventing the enforcement of city- and countywide conversion therapy bans in Florida, as well as Alabama and Georgia. This injunction remains in effect today.
This case demonstrates that, despite bans, denouncements and continuous documented evidence of these programs’ negative effects on patients and survivors over the past century, conversion therapies remain a part of the United States’ medical landscape. This is because conversion therapies, in all their variable historical forms, have never been about offering medical or mental care to recipients. Instead, they have been a tool to eradicate LGBTQ activism, culture and people.
Medical reports of conversion therapies in the United States date to the late 1800s. However, such articles faced criticism and created an uproar because of long-standing medical taboos around open discussion of sexual behavior. For example, when Chicago physician Denslow Lewis attempted to publish his findings on treating female “sexual abnormalities” in JAMA in 1899, his draft for the medical journal was rejected as “more or less filth,” unfit for public discussion.
But in the early 20th century, rising concerns about “criminal sexual psychopaths” who threatened the sexual and moral safety of vulnerable Americans created new opportunities for medical experts to publish books and articles on their conversion therapy efforts. Various doctors concluded that homosexuality and the desire to change one’s gender were biologically quantifiable, treatable medical conditions. In this view, queer people were undeserving of legal punishments because they suffered from a congenital, biological affliction outside of their control. This conviction allowed doctors — not legal experts — to claim greater authority over matters of “abnormal” sexuality and gender expression.
Medical practitioners thus recommended conversion therapies involving hormonal injections, surgery or intensive psychotherapy. Such interventions carried significant risks for patients. “Some we would probably kill,” American physician La Forest Potter admitted in his popular 1933 book, “Strange Loves,” but “others we would cure.”
Not all queer people, however, were deemed worthy of medical intervention. Conversion therapies between 1910 and 1939 focused on native-born, middle- and upper-class White professionals in private clinical settings. This was because, in the words of physician A.A. Brill, “only those of a high type should be reclaimed” by “normal” society.
As new fears of shifting gender norms intensified after World War II, doctors changed their focus toward working-class individuals and people of color in institutional settings like prisons, state hospitals and asylums. As such, conversion therapists in the 1940s were primarily concerned with protecting society from their patients — not helping patients.
These doctors continued to use painful, biologically based interventions. One 23-year-old Black man intermittently confined at Norwich State Hospital in Connecticut from 1941 to 1943 received 21 rounds of electroconvulsive therapy (ECT) after telling hospital staff about his same-sex desires. A report noted that he “remained overtly homosexual” even after these treatments.
And yet, despite the pain inflicted and the documented ineffectiveness, conversion therapy grew more popular, especially among well-to-do patients in private practice. In fact, it expanded in medical literature after 1952, when the American Psychiatric Association (APA) listed homosexuality as an illness in the first edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-I). Conversion therapists’ writings advocated various methods, such as psychoanalysis, aversion therapies, psychedelic therapy and electrical stimulations delivered directly to the brain.
Such interventions were deemed necessary because of the popular and legal conflation of queerness, criminality and Communism from the 1950s into the early 1970s. These sentiments fostered what’s become known as the Lavender Scare, which collided with the vehement anticommunism of the Red Scare to view LGBTQ people as threats to American national security, morality and safety in the midst of the Cold War.
It is then little surprise that conversion therapists like Edmund Bergler negatively characterized queer people as aggressive masochists who were incapable of experiencing happiness and relished opportunities to hurt others. For example, his 1956 book “Homosexuality: Disease or Way of Life?” claimed that “it is significant that there should be so great a proportion of homosexuals among swindlers, pathologic liars (pseudologues), forgers, lawbreakers of all sorts, drug purveyors, gamblers, spies, pimps, brothel owners” and other criminals. This medical language saw LGBTQ people as sick, dangerous criminals based on their sexual desires or gender identities alone.
These ideas did not go uncontested. Gay rights organizations and radical psychiatrists vocally protested homosexuality’s inclusion as an illness in the DSM throughout the postwar period. Their efforts led to the partial removal of homosexuality from the DSM in 1973 and its full removal in 1987. This history operated differently for transgender people and people experiencing gender dysphoria. First, the DSM did not include references to “gender identity disorder” (GID) — the precursor to gender dysphoria — until 1980. Second, transgender people in America often needed to be diagnosed with GID to receive health-care coverage for gender-affirming treatments like hormone therapy or surgery until gender dysphoria replaced this term in the 2013 DSM-5.
But conversion therapies continued to take place in the United States even as mainstream American psychiatrists increasingly denounced the practice during the late 20th century. Changing APA guidelines did little to alter the personal beliefs of some therapists and their patients.
As such, mental health practitioners like Charles Socarides, Joseph Nicolosi and others continued to challenge APA anti-conversion therapy policies while offering these types of treatments well into the 21st century. The 11th Circuit’s undercutting of local conversion therapy bans in Florida last month is a testament to this damaging practice’s longevity within American medical marketplaces. But this case is not simply about medical practice or free speech. It is about political control.
American queer history often features cycles of visibility and backlash: At the same historical flash points where members of the LGBTQ community have demanded equal rights, people espousing anti-gay and anti-trans philosophies have historically reacted through anger, fear, violence and censure of queer people. Conversion therapies were and remain important instruments of this reactionary counterattack against LGBTQ activism and visibility.
It is not a coincidence that the decision to financially award two Florida conversion therapists arrived alongside other attacks on queer and trans rights in the state. For example, Florida expanded its law prohibiting instruction on sexual orientation and gender identity in the classroom to include curriculums up to the 12th grade only eight days after the 11th Circuit made its ruling.
As long as LGBTQ people are targets of oppressive legislation and social debates encouraging them to change themselves — and as long as legal authorities continue to support some therapists’ false promises that this is possible — conversion therapies will continue across the United States.