What is LGBTQ ‘conversion therapy’ and why is still prevalent in the South, U.S.?

When Christy Mallory and her colleagues began researching conversion therapy – a catchall term for efforts to change the sexual orientation or gender identity of LGBTQ people – she expected to see that its use had waned over the last decade. After all, the practice has been widely discredited in medical circles even as the LGBTQ community has made gains in mainstream representation and acceptance. 

“But what we found, surprisingly, was the rate of people exposed to conversion therapy as minors was consistent across all age groups,” said Mallory, the legal director at the UCLA School of Law’s Williams Institute, a research center on sexual orientation and gender identity law and policy.  

The Williams Institute’s report estimates nearly 700,000 LGBTQ adults in the U.S. have undergone conversion therapy, including about 350,000 who received it when they were adolescents. 

The research shows “Conversion therapy is still prevalent,” said Mallory, “even though the mainstream belief around this is that it’s a thing of the past.” 

Discredited, sometimes banned

This year, Canada and France passed national bans on conversion therapyWhat . Last year, England announced that that nation would ban the practice, although the nation excluded transgender people, which has led to protests. The United States has not considered such a ban at the federal level. Several states, most of them with Democratic governors or legislatures, prohibit conversion for minors. The practice continues largely unabated in the South, where conservative Republicans and evangelicals control the levers of government.

Conversion therapy is grounded in the idea that being LGBTQ is abnormal and a sign of a mental health disorder. It’s typically practiced by mental health professionals, clergy or spiritual advisers.  

“There used to be a range of techniques used,” said Mallory. Those included talk and behavioral therapy, as well as more extreme techniques like food deprivation and electric shock.  

“Nowadays, it’s usually talk therapy or something similar,” she said. “But exposure to conversion therapy has been linked with negative mental health outcomes, like increased suicidal ideation, a lack of self-worth, and low self-esteem.” 

The consensus of mainstream research and clinical literature is that variations in sexual orientation and gender expression are normal, expected, and not inherently linked to mental illness.  

Major medical organizations in the U.S. and around the world have discredited conversion therapy. The American Medical Association and the American Academy of Pediatrics have issued statements opposing the use of conversion therapy, calling it ineffective and harmful.   

About 25 states – none of them in the South except Virginia and North Carolina – have implemented total or partial bans on conversion therapy. In December, Canadian legislators unanimously passed a strict nationwide conversion therapy ban. 

Many of the U.S. laws apply to minors and target licensed mental health professionals. They don’t restrict the practice of clergy or spiritual leaders. 

Pray away 

When Mark Wingfield was pastor of a large Baptist church in Dallas, Texas, he led his church through an 18-month study on LGBTQ inclusion. He later wrote a book about the process, called “Why Churches Need to Talk About Sexuality.” 

Wingfield is now executive director of Baptist News Global, a nonprofit news organization, and considers himself an ally of the LGBTQ community. Baptist News Global recently co-hosted a webinar called “The Christian Case Against Conversion Therapy.” 

Conversion therapy in a religious context typically involves spiritual counseling and prayer. Wingfield said it stems from the conservative religious belief that sexual orientation and gender identity are a choice that can be altered, he said, “if you just have the spiritual willpower to do it.” 

As some larger Christian-based conversion therapy programs have closed in recent years – one example is Exodus International, the large Florida-based conversion therapy center highlighted in the recent documentary “Pray Away” – the practice has continued but been rebranded, Wingfield said. 

“Churches may not call it conversion therapy anymore, but they still believe sexuality and sexual orientation is a choice, and that gender identity is fixed by God as a binary,” he said. 

In December, after Canada passed its conversion therapy ban, influential California megachurch pastor John MacArthur wrote a public letter to other Christian pastors in the U.S. and Canada urging them to preach on “biblical sexual morality.”  

He called conversion therapy bans an issue where “the gospel of our Lord Jesus Christ is under attack.” 

Wingfield said the battle over conversion therapy is inextricably linked to conservative faith-based views on sexuality and gender identity. 

“In many ways, the battle lines have hardened on this,” he said. “It’s another part of the culture wars that conservative evangelicals have made it a hill on which they’re willing to die.  

“The problem is, they’re not the ones dying.” 

Converting the South 

Conversion therapy has been linked to “significant long-term harm” to the mental health of people who’ve been subjected to it, according to the American Medical Association.  

One study cited by the AMA found that three-fourths of people who went through conversion therapy reported symptoms including depression, anxiety, low self-esteem, alienation and loneliness. 

It’s also been linked to increased suicidal behaviors. Suicide is the third leading cause of death in young adults ages 15-24 according to the U.S. Centers for Disease Control and Prevention, and LGBTQ young adults are more than twice as likely to report a history of suicide attempts compared to their peers. Conversion therapy may further increase that likelihood. A 2020 Williams Institute report found that gay and bisexual people who underwent conversion therapy were nearly twice as likely to think about or attempt suicide compared with peers who hadn’t gone through conversion therapy.  

And yet it’s a multi-million dollar industry in the United States, costing an estimated $650 million annually including services, health insurance reimbursements and fees, according to a study published in March in the medical journal JAMA Pediatrics. Indirect expenses, researchers said, including the expense of treating effects linked to conversion therapy like anxiety, depression and substance abuse, costs an estimated $9 billion.

Read also: In South Carolina, a battle rages over conversion therapy for LGBTQ youth 

There’s not sufficient data to say whether conversion therapy is more prevalent in one region of the country over another, said Mallory. 

But the South is home to about 35% of the U.S. LGBTQ population, a higher percentage than any other region, according to the Williams Institute. And most of the state and municipal laws banning conversion therapy are outside the South. 

A poll in 2019 conducted for Reuters found 20% of respondents in the South believed conversion therapy for children should be legal, compared with 13-19% of respondents in other areas of the country. 

Wingfield said one of the most encouraging changes he’s seen in evangelical Christian spaces in the past several years is the proliferation of resources and advocacy groups aimed at supporting LGBTQ people and their allies. He named Q Christian Fellowship and the Reformation Project as two examples. In his work, he’s found changing opinions among evangelicals, even while some of their “loudest leadership voices” speak out against inclusion. 

“When you dig down, there’s a lot more diversity of opinion than people might imagine,” he said. “It’s just that a lot of those people aren’t brave enough to speak up.” 

Read also: A Mississippi LGBTQ conversion therapy story takes center stage

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