PumPang PumPang Episode 1: Kembali ke Pangkal Jalan: Is the Pressure to “Change” Real?
PumPang PumPang is a Malaysian queer podcast hosted by Vesha and Alia. In this very first episode, we take a closer look at the effects of sexual orientation and gender identity change efforts. Our hosts speak to Ali, Thomas and a clinical psychologist Vizla Kumaresan to take a closer look at what are sexual orientation and gender identity change efforts, the many formal and informal ways it manifest and its impact on LGBT people.
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Overview of sexual orientation and gender identity change efforts
Sexual orientation change efforts (SOCE) is defined as ‘methods that aim to change a person’s same-sex sexual orientation to other sex, regardless of whether mental health professionals or lay individuals (including religious professionals, religious leaders, social groups, and other lay networks such as self-help groups) are involved’ by the American Psychological Association (APA). These change efforts also known as conversion or reparative therapy employ behavioral, psychoanalytic, medical, religious and spiritual techniques.
Efforts to change sexual orientation and gender identity are rooted in the notion that ‘LGBT identities are a form of illness, disorder aberration that needs to be cured’. the ex-LGBT ministries or movement, or in Malaysia known as LGBT hijrah are an outcome of these efforts often promoted by religious and political organizations.
Stigma that manifest as prejudice and discrimination towards non-heterosexual sexual orientations and identities is a major source of stress for sexual minorities. This stress, known as minority stress, is a factor in mental health disparities found in some sexual minorities.
In 2007 the APA appointed a six-member Task Force on Appropriate Therapeutic Responses to Sexual Orientation to review and update APA’s 1997 resolution, “Appropriate Therapeutic Responses to Sexual Orientation.” the task force was also responsible to produce a report. Some key findings include
- serious methodological problems in this area of research; only a few studies met the minimal standards for evaluating whether psychological treatments such as efforts to change sexual orientation are effective.
- some clients seeking to change their sexual orientation may be in distress because of a conflict between their sexual orientation and religious beliefs. The task force recommended that licensed mental health care providers treating such clients help them “explore possible life paths that address the reality of their sexual orientation, reduce the stigma associated with homosexuality, respect the client’s religious beliefs, and consider possibilities for a religiously and spiritually meaningful and rewarding life.”
- Accurate and affirming information on human diversity, sexual orientation, gender identity and sex
- Acceptance of LGBTQ and other non- heterosexual and cisgender identities as part of the human diversity spectrum
- Training of health care providers and religious groups on human diversity, sexual orientation, gender identity and sex as well as harms caused by efforts to change one’s sexual orientation and gender identity
Preliminary observations and recommendations by the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health Mr. Dainius Pūras Country Visit to Malaysia, 19 November to 2 December 2014
The special rapporteur on health during his visit to Malaysia in November 2014 expressed concerns over the “so-called “corrective therapies” by the state agencies.
Such therapies are not only unacceptable from a human rights perspective, but they are also against scientific evidence, and have a serious negative impact on the mental health and well-being of adolescents. State-led programs to identify, “expose”, and punish LGBT children have contributed to a detrimental educational environment where the inherent dignity of the child is not respected, and discrimination on the basis of sexual orientation and gender identity is encouraged.”
The Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment released in 2013 views conversion or reparative therapies as a form of torture and explicitly calls ‘all States to repeal any law allowing intrusive and irreversible treatments, including forced genital-normalizing surgery, involuntary sterilization, unethical experimentation, medical display, “reparative therapies” or “conversion therapies”, when enforced or administered without the free and informed consent of the person concerned.”
The Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009) concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of sexual orientation change efforts (SOCE) practitioners and advocates.
The report affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity. The task force concluded that the population that undergoes SOCE tends to have strongly conservative religious views that lead them to seek to change their sexual orientation. The report recommends affirmative therapeutic interventions for those who seek SOCE involves therapist acceptance, support, and understanding of clients and the facilitation of clients’ active coping, social support, and identity exploration and development, without imposing a specific sexual orientation identity outcome.
The World Psychiatric Association (WPA) recognises the universality of same-sex expression, across cultures. It holds the position that a same-sex sexual orientation per se does not imply objective psychological dysfunction or impairment in judgement, stability, or vocational capabilities. WPA considers same-sex attraction, orientation, and behaviour as normal variants of human sexuality. It recognises the multi-factorial causation of human sexuality, orientation, behaviour, and lifestyle. It acknowledges the lack of scientific efficacy of treatments that attempt to change sexual orientation and highlights the harm and adverse effects of such “therapies”.
In 2012, the Pan American Health Organization (PAHO) stated that purport to “cure” people with non-heterosexual sexual orientation lack medical justification and represent a serious threat to the health and well-being of affected people. Additionally, PAHO also emphasized that therapy to change sexual orientation brings ‘a serious threat to the health and well-being—even the lives—of affected people.’
International Classification of Diseases (ICD-11) removed of all trans-related diagnoses from the mental disorders chapter as ‘evidence is now clear that it is not a mental disorder, and indeed classifying it in this can cause enormous stigma for people who are transgender, there remain significant health care needs that can best be met if the condition is coded under the ICD.’ Gender incongruence is now reclassified under sexual health conditions in the ICD-11.
DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name “gender identity disorder” with “gender dysphoria,” as well as makes other important clarifications in the criteria. It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition. … Replacing “disorder” with “dysphoria” in the diagnostic label is not only more appropriate and consistent with familiar clinical sexology terminology, it also removes the connotation that the patient is “disordered”.
The American Psychological Association (APA) removed homosexuality from the Diagnostic Statistical Manual (DSM) in the 1975, as “research has found no inherent association between any of these sexual orientations and psychopathology” and “heterosexual behavior and homosexual behavior are normal aspects of human sexuality.”
The prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs)… shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress—explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems.
The compatibility of sexual orientation change efforts with international human rights law. Netherlands Quarterly of Human Rights, 35(3), 176–192. Nugraha, I. Y. (2017).