Conversion therapy: the path to good law

This is the text of my talk at the Middle Temple LGBTQ+ Forum Inaugural Annual Dinner last night (unchanged apart from the addition of some links).

How do we arrive at good law making a new criminal offence? Robin says good law needs legal certainty, clarity, enforceability, practicability. But those all assume an affirmative answer to the prior question – do we need the proposed new law at all? I don’t share that assumption, so I have a rival four things I say we need:  

  • evidence of harm 
  • a convincing case that the harm is amenable to legislation
  • clear proposals 
  • open public debate 

Starting with the last: debate. 

The proposed ban is one aspect of what we can call the “gender wars” where there has been a strong pressure for “no debate”. Those who have tried have been  shouted down, no-platformed, compared to Nazis, and hounded out of their jobs. 

Debate informed by evidence is how we test ideas and proposals: if they’re any good, they’ll stand up to being poked with pointed questions. If they don’t stand up to being poked, they’re no good. This idea underpins our whole profession. 

So this evening’s discussion is an encouraging development. To find the CEO of Stonewall on a platform with me signals a welcome change of heart. Thank you Nancy – we need to have this conversation.

Evidence of harm 

The evidence-base for this proposal is thin. 

The government has made the proposal for law without waiting for Dr Hillary Cass to complete her independent review of gender identity services for young people. Instead it relies on 30 interviews and a review of existing studies by academics at Coventry University. 

The Coventry review admits that for the UK, it only found 2 studies relating to gay conversion therapy, and none on gender identity. 

The consultation also relies on the government’s 2017 LGBT survey where 5% of respondents said they’d been offered conversion therapy, and 2% that they’d received it.  

But if you look at that survey itself, you find this killer line: 

We did not provide a definition of conversion therapy in the survey 

That means:  

  • We don’t know how many of those 2%  were lesbians who were recording social pressure to accept trans-identifying males as potential sexual partners.
  • We don’t know how many were teenagers whose parents or therapists counselled watchful waiting in place of treatment with puberty-blockers. 
  • We don’t know how many were gender non-conforming children whose homophobic parents or peers had suggested to them that they must be trans. 
  • We don’t even know the sex of the respondents, because the survey didn’t ask. 

We don’t have a clue what these responses mean: they’re not evidence of anything. 

The consultation admits that there’s no real evidence of harm. It says: 

While the exact prevalence of conversion therapy is challenging to establish, it is the view of the government that one incident of conversion therapy is too many.

In other words, the government is saying – we just don’t know whether this is a real problem that needs legislation, but we’re going to legislate anyway.

Case for legislation 

Even if there were evidence of harm, not every harm can be put right with legislation; sometimes the cure is worse than the disease. You’d hope a proposal for legislation would address cost and benefit. 

But this consultation doesn’t get to that point. Having failed entirely to identify a credibly-evidenced or even defined kind of harm that is its target, it can’t hope to explain why criminalising it is a good idea – and it doesn’t even try. 

Last element – clear proposal

The government’s core proposal  focuses on children and vulnerable adults, and criminalises a talking therapy delivered 

 with the intention of changing their sexual orientation or changing them to or from being transgender

This muddles two different things. 

Being gay or bisexual isn’t a medical condition. It doesn’t require treatment. We can all agree that practices that try to change people’s sexual orientation are wrong and futile. 

Gender dysphoria sufficiently severe to make you seek radical alterations to your healthy body undoubtedly is a medical condition. There are two clues. The word: dysphoria – profound unease or dissatisfaction. And the demand for medical treatment. 

Let’s run a thought experiment. Say you’re a therapist. You see an unhappy 10-year-old girl. She wears baggy clothes, and has short hair. She says she’s sure she’s a boy really. She hates her developing breasts, and dreads the onset of periods. She despises all things “girly.” 

Your duty as a therapist is clear. You need to get to the bottom of the child’s distress. Is she struggling to come to terms with the beginnings of same-sex attraction in a homophobic environment? Is she traumatised by exposure to porn? Have her parents let slip that they’d have preferred a son? Has she suffered abuse or other trauma? The heart-breaking stories of detransitioners should be enough to make it clear how important it is to let you do that duty carefully and conscientiously. 

The proposed law contains a safeguard for therapists treating people questioning their gender identity. But it won’t help you: this child isn’t questioning, she’s telling you she’s sure. So the government’s proposals threaten to lock you up for doing what your conscience and your professional duty both tell you you must do.

Gender non-conforming children often grow up to be gay adults. The bitter irony of this proposal is that it entrenches the idea that people can escape being gay by changing sex. This is a lie. Everyone in this room knows that it’s impossible for a human being literally to change sex. But the attempt will exact a terrible price in painful surgeries, loss of sexual function, sterility, and other complications. 

This is the most savage conversion therapy ever invented.

It’s homophobia that creates the conditions for this conversion therapy: homophobia that tells gay children they are defective. Many of us here grew up in a profoundly homophobic society. Clause 28 was passed in 1988, when I was 22 and my elder brother was 23. My brother was gay. He killed himself on 13 January 1989. I believe that he died, in part, from the toxic effects of homophobia. Those problems of homophobic bullying haven’t gone away. There is  still work to be done, and this is Stonewall’s proper mission.

Conclusion: the Denton’s playbook 

In 2019, law firm Dentons and others published a guide to campaigning strategy for gender self ID. The report says:

In Ireland, Denmark and Norway, changes to the law on legal gender recognition were put through at the same time as other more popular reforms such as marriage equality legislation. This provided a veil of protection, particularly in Ireland, where marriage equality was strongly supported, but gender identity remained a more difficult issue to win public support for.

Only Adults? Good Practices in Legal Gender Recognition for Youth, p.20

That is exactly what we see here. This is a proposal to criminalise something everyone agrees is bad – gay conversion therapy – but to use that as a veil of protection whose real purpose is to criminalise what should be routine  responsible therapeutic work. 

This is fundamentally dishonest. It is certainly not the path to good law. 

28 thoughts on “Conversion therapy: the path to good law”

  1. Thanks Naomi for this intervention and for sharing your personal history. I wanted to translate this speech into Italian and try to get it published. The debate, such as it is, in Italy is very disinformed though they are trying to get self ID in law, and conversion therapy ban of course will follow. May I do that?

  2. Thank you, Naomi. Such a good analysis, particularly on the invidious position that a ban on conversion therapy would put conscientious therapists trying to help children confused about gender in.

  3. Sadly, I think you hadn’t had the time to describe the eye-watering assumptions and tactics in the Dentons Guide; I can only hope it has been exposed and discussed widely in all the Inns. Thank you so much for this. I am glad you were received respectfully.

  4. Thank you for this Naomi. Do you know whether any of the other speakers intend to publish their contributions? Your piece is of course interesting stand-alone but it would also fascinating to hear it in the context of the others. I did follow Maya’s tweeting on the night but it’s not the same as reading full texts!

    (And also to read something from you or from one of the women attending with you about the event as a whole – about the “mood” of the event if that makes sense. How it ‘went’).

  5. This is an outstanding speech. Clear, pointed, and persuasive. And not a word of it could honestly be considered hateful by any fair-minded person. Does this perhaps suggest that the reason Nancy Kelley and those who agree with her have avoided a direct comparison of such arguments with hers is not that preventing this helps the vulnerable, but rather that the contrast does them no favours?

    Previously, the courts were largely the only place that both arguments could be heard expressed in the same room. Now that Middle Temple is also making itself available for such an open debate, here’s to many more rooms having the opportunity to hear both sides in a calm, reasoned manner that befits a peaceful democracy.

  6. What they are doing NOW in the clinics is conversion therapy, the original form, converting gay youth especially young lesbians. They obviously can’t tell outcomes, so they are medicalizing alienation and distress generated by a misogynist porn culture which is now pervasive in media and advertising.

  7. Thanks Naomi for your clarity on this. I have posted a link to your speech to my FB page. I’ve been following the debate and had signed up to receive notifications from the Cass Review. It seems bizarre that the Government are at LEAST not waiting for her report before attempting to legislate. My last job before retirement was working as a policy advisor at the Office of the Children’s Commissioner. This is an issue that the new Commissioner should also be considering though I wouldn’t hold your breath!

    1. I don’t believe this has anything to do with UK society.

      It’s being pushed via the UN (SOGI), Council of Europe, and so on, so it’s more likely to be a ‘cultural weapon’ to use against Russia, China, Iran, etc.

      See the govt’s website on the conversion ‘consultation’:

      ” 6.7 Taking international leadership

      The UK continues to be recognised as one of the top 10 most progressive countries for LGBT rights by ILGA-Europe. We have one of the world’s strongest legislative frameworks to prevent and tackle discrimination and we are keen to build upon this by introducing robust legislation to protect people from conversion therapy.

      This Government is committed to ensuring that LGBT people can be safe and free to live their lives as they wish, here at home and around the world. We are proud to be hosting ‘Safe To Be Me: A Global Equality Conference’, which will take place in June 2022, coinciding with the 50th anniversary of the first official London Pride marches.”

    2. Further to my previous comment on the international organisations pushing this: the UK hosting next June (2022) the Safe to be Me conference comes from the Equal Rights Coalition, the civil society co-chair of which for the UK is…. Stonewall. (Along with the Kaleidoscope Trust, a UK charity for Commonwealth ‘LGBT+’ rights.)

  8. The problem with this argument is that you engineer the logic of your conclusions at the very beginning by framing transgender identity as a mental illness while being gay is just a natural state. Yet 30 or so years ago it was very common to see homosexuality as a mental illness – this indeed has changed in part as a result of the kind of campaigning carried out by Stonewall. You ought at least to examine the assumptions you start with that gender dysphoria is a mental illness. What if gender identity is more like sexuality? Fixed early, not likely to change, not always aligned with the way it works in the majority of people, and very resistant to change or ‘conversion’? Then you are exactly treating trans people in the way gay people were treated back in the 80s. I have to say, the argument that homophonic parents would rather a trans child than a gay one make zero sense to me. Almost no one I know considers it easier socially or culturally or medically to be trans than gay!!

    1. Fair points. But once you admit that there is uncertainty – that the ten year old girl who thinks she is a boy might, if allowed to go through a normal puberty, decide she is gay – then you need to start looking at the costs of being wrong and whether the child is able to assess these costs in order to consent to her treatment.

      The cost over a lifetime to someone has her breasts removed plus other interventions and later regrets it is surely orders of magnitude higher than the cost to someone who is forced to wait until she is an adult before she can start the process. This by itself should suggest that the therapist’s default assessment should be that the child is gay.

    2. You make the common mistake of assuming an equivalence between human sexuality and gender identity. They are entirely different. The latter is a form of body dysmorphia more appropriately classified alongside anorexia nervosa and certain other conditions such as limb dysphoria.
      It is therefore a reasonable contention that sexuality, an innate and generally immutable thing, should be considered separately from gender, an entirely psychological construct, which very frequently responds to therapeutic intervention.

    3. ” 30 or so years ago it was very common to see homosexuality as a mental illness ”

      30 or so years ago is about 1990. I don’t know which country you’re referring to, but certainly in the UK the consensus was by then well established not only in the medical and psychological fields but also amongst the general public that same-sex attraction was not a mental illness. What I would agree with is a more moderate statement that 30 years ago in the United Kingdom there were more people than there are today who thought that way. But I’m afraid I think you’re mixing up ‘trans’ with ‘gender’. People objecting to ‘gender’ being written ever more firmly into law are not necessarily objecting to legislation which supports, defends, protects, or assists those who experience body dysmorphia or who would describe themselves using the word ‘trans’ or similar terminology.

      “What if gender identity is more like sexuality?”

      What if it isn’t? Making laws about it, creating rights and creating crimes about it, is unwise, if we don’t know what it is or isn’t.

      “You ought at least to examine the assumptions you start with that gender dysphoria is a mental illness.”

      I agree. And you ought to examine your assumption that ‘gender’ is real and/or a useful concept, and your assumption that we all must accept ‘gender’ and make laws on it and create new rights attached to it and create crimes related to changing it, especially if it proves to be non-existent or not what we currently think it is. May I remind you that the word ‘gender’ has been re-defined at least 4 times in the past c.70 years. Legislation which uses it will quickly be rendered out of date.

      “the argument that homophonic parents would rather a trans child than a gay one make zero sense to me. Almost no one I know considers it easier socially or culturally or medically to be trans than gay!!”

      Nobody in my social circle considers it easier or preferable to be ‘trans’ rather than ‘gay’ either, however it doesn’t take much reading to see that there indeed are parents who prefer the idea that their child’s sex can be successfully medically changed into its opposite and that this will resolve same-sex attraction and ‘restore’ it to ‘opposite-sex attraction’.

    4. Being gay isn’t a mental illness because it’s perfectly possible to be a happy, well-adjusted gay adult without your sexuality ever having caused you to seek any medical or psychiatric treatment. All you need is for other people not to be bigots.

      If “being trans” is simply a matter of identifying as the opposite sex (or as non-binary) and either adopting dress, behaviour etc that you consider consistent with that identification (or not, as the case may be) – and it causes you no distress, and requires no medical treatment – then I’d be inclined to agree that that’s not a medical condition.

      But if you suffer dysphoria, then by definition your gender identity is at least causing you distress. And if you want treatment to change your body, then it must follow that you think something is wrong with your body that needs fixing. That has to be a disorder of some kind: either your body needs fixing to conform to what your mind wishes it were; or else your distress about your “wrong” body needs to be treated as a psychiatric problem.

      I’m not sure I understand why we should prioritise the interpretation that says this is a body problem not a mind problem – especially given that if a child goes through a natural puberty and desists, they are left with an intact body and no further need of medical treatment; whereas if a child is treated with puberty blockers, cross-sex hormones and surgery, they will be left as a lifelong medical patient and almost certainly with permanently impaired sexual function and fertility.

  9. I have responded to the consultation and it certainly requires challenge as there is no clear definition of what they mean by conversion therapy as you rightly say is the killer line . You get the sense this is going to be the same as the Self ID debacle and they will end up doing nothing at all or making it impossible for professional therapist to do their jobs.
    An excellent speech btw thank you

  10. You ask fair questions. Fair to ask “what if gender identity is more like sexuality”. But the serious matter of dissatisfaction with one’s sex, or disbelief in it, is a matter too complex to reduce to the simple formula you’ve used.
    Nothing should be imposed on people, in the way that antigay conversion therapy has been imposed, and there should be no moral pressure. I hope that’s not what Cunningham is suggesting. It’s acceptable to allow for the possibility that there are personal struggles to explore. Struggles which are not about social stigma, but which are internal or psychological. I think the evidence probably supports that these struggles exist.

  11. This a brilliant dissection of the flaws in the Government’s strategy. The fact that you were able to do it with so few words shows that it hasn’t been formulated with any degree of critical thought, or appreciation of the problems inherent in conflating sex and gender ideology in law.

  12. My position is one of being critical of a gender critical viewpoint, but that’s not really my focus in this comment. What concerns me is that your main points are founded on misinformation and unrealistic assumptions.

    Starting with gender dysphoria, “sufficiently severe enough to make you seek radical alterations to your healthy body undoubtedly is a medical condition” is a niche non-expert view of gender dysphoria. Both DSM-5 and WHO’s IC-11 do not classify gender dysphoria as a disorder. The NHS website states this clearly as, “Gender dysphoria is not a mental illness, but some people may develop mental health problems because of gender dysphoria.” The prevailing professional view is that gender dysphoria is secondary to the mental health issues. Alternative professional viewpoints focus on shame as being the primary driver of mental illness in trans people, challenging the assumption that gender dysphoria is secondary.

    The second main issue concerns your example client, they are an a-typical client, but that’s not the main issues here.

    The first issue is that, when you talk about “getting to the bottom of”, you present issues such as trauma and abuse as underlying gender dysphoria. This view has an extremely very weak evidence base. It’s similar to viewpoints which suggested that abuse was causally related to BDSM, it isn’t. Autism was believed to be caused by a cold and distant Mother, which again is not true. Gender dysphoria begins around age 7, and for most people it subsides following puberty. It’s thought to be caused by a combination of hormonal, genetic, and environmental factors – i.e. we don’t entirely know.

    The second main issue is the fear you raise that the Law would criminalise therapists from doing their jobs, is just that a fear. It has no basis in reality. The role of a referral to a gender dysphoria service (GDS) would be to determine if the client had gender dysphoria, “being sure” does not by itself indicate that they have gender dysphoria. The proposed legislation would not take away the GDS duty of care to competently perform a diagnosis. In your client’s case if they were sure about being male, due to a history of abuse, then they wouldn’t typically have gender dysphoria, rather they would need support (and safeguarding) for the abuse they had suffered.

    It is possible that they have both, a history of abuse and gender dysphoria, but the bar to working with them would not be a legal one, the main bar is actually institutional. That is a gender dysphoria service tends to focus on a single issue, and they are liekly to refer someone with a significant history of abuse to another service, before they will work with their gender dysphoria. The main issue with services is that they tend not to be very joined up. So your young person may end up with a referral to CAMHS.

    Most services have been working under a conversion therapy ban since at least as far back as 2017, when they signed a Memorandum of Understanding, which is based upon the earlier 2015 DoH MoU, which exclusively focused on sexual orientation. Those bodies which have signed the MoU do welcome conversion therapy ban. The main concern however is the impact of “unintended consequences” of the upcoming change in Law in being able to offer therapy.

    For instance, adoption has recently experienced a change in the law, requiring services to be registered if they wish to work with people who are adopted, which has had the effect of making services for adoption more costly and less widely available. It is still possible for non-registered services to work with adopted clients as long as adoption is not the main presenting issue. For trans clients it’s not unusual for them to work in tandem with more than one service. One service provider can be helping them with mental health issues, while another is supporting them with their gender dysphoria. Making it illegal for the service provider to help them with their mental health issues would be an undesirable outcome.

    I understand that you have a philosophical position on gender and sex, and advance a particular view about how we as a society should legislate around sex, but the misinformation you present in this article is in my view harmful to the one group of people I believe you are trying to protect, trans people.

    The suicide risk for trans people is 20x higher than for the general population, and shame is a very signifcant factor in that figure. So when someone says to me, I would like you to use this pronoun, or use this gendered term to refer to me, I just do. If I can for very little cost make that person feel a bit more accepted, and if by me showing that I accept them, just as they are, make them a little less likely to want to kill themselves, then I think that’s worth so much more than me being right or proving my point.

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