Editor’s note: This story contains details of violence.
A.O. was 13 when she was first beaten with a broom by a pastor as part of a so-called “conversion therapy” session in Nigeria. Then, at 15, her mother sent her to a church where she was locked in a room, forced to fast and pray, tortured, and humiliated for a month, all in an effort to “correct” her sexual orientation.
A.O. shared her story with the human rights organization OutRight Action International. Her name was altered to maintain confidentiality. She is now 46 and identifies as a lesbian. But those early experiences of “conversion therapy,” consisting of torture and abuse, impacted her for years.
Her story is painfully specific yet disturbingly common. Millions of people who don’t conform to narrow sexual orientation and gender identity norms have had their lives and well-being threatened in similar ways.
Conversion therapy is the pseudo-medical or religious practice of trying to change someone’s sexual orientation or gender identity to heterosexual or cisgender (non-transgender). It occurs in nearly every country in the world and often amounts to torture, according to Victor Madrigal-Borloz. Madrigal-Borloz is the United Nations independent expert on protection against violence and discrimination based on sexual orientation and gender identity (IESOGI).
Conversion therapy often masquerades as a legitimate collection of practices informed by scientific or religious principles. Marketing and misinformation campaigns have bolstered this view for years.
“The persistence of so-called conversion therapy is directly related to beliefs about LGBTIQ people and the degree to which we are accepted within our families, our faiths, and societies at large,” Jessica Stern, executive director of OutRight Action International, told Global Citizen. “When homophobia and transphobia prevail, the consequences are stigma, discrimination, and violence.”
As the nature and scale of conversion therapy become better known, scientific and religious organizations, governmental bodies, and survivor advocates have called for a universal ban on the practice and its promotion.
The continuation of conversion therapy is an ongoing human rights catastrophe that particularly threatens young people, according to the UN.
Efforts to restrict and ban the practice have gained momentum in recent years. But conversion therapy still exists with little interference in much of the world. And the wide range of forms that it takes often undermine legal efforts to stop it.
Ending conversion therapy once and for all requires the public to fully understand the context surrounding the practice, its consequences, and how and why it persists.
“We have known for decades that when people recognize that a person’s sexual orientation and gender identity is not a choice but a feature of who they are, the more likely they will be to support equal rights in general,” said Casey Pick, senior fellow for advocacy and government affairs for the Trevor Project, an LGBTQ+ youth organization.
“So the extent to which conversion therapy continues to promote the idea that a person’s sexual orientation and gender identity is something that can or should be changed, that idea undercuts our ability to win equality in other areas,” she added. “It’s also just an insult to the dignity of LGBTQ+ people and undermines our efforts to have societies accept us for who we are.”
What does conversion therapy look like around the world?
Conversion therapy has been documented in at least 68 countries. Surveys suggest it takes place in all regions of the world, according to a report on conversion therapy published by the UN in June. The practice occurs in institutional settings such as hospitals and churches as well as more informal circumstances, reflecting the cultural characteristics of a given community. As a result, conversion therapy varies widely around the world. The one abiding feature is that it seeks to alter the identity of LGBTQ+ people with techniques that harm, traumatize, and ostracize.
Conversion therapy exists because of the routine discrimination and violence against LGBTQ+ people that takes place on a familial, communal, and systemic level, according to Stern.
“Entire systems and communities are involved in making conversion therapy happen,” said Stern. “Everyone from your aunt to your religious leader to your neighbor.”
“It can be a combination of laws that dehumanize LGBTIQ people, religious or cultural interpretations that perceive us as being less than other parts of humanity, and also family and cultural ideas of who and what makes a family,” she added.
Conversion therapy programs are often fraudulent money-making schemes. They exploit people's fears, prejudices, and misconceptions. Broadly speaking, they can be placed within three categories: psychotherapy, medical, and faith-based, according to the UN.
Psychotherapy programs rest on the assumption that LGBTQ+ people have had certain experiences — such as an unloving mother or an absent father — that explain their sexual orientation or gender identity. These programs insist that different sexual orientations and gender identities represent a character flaw stemming from a childhood trauma.
“The technique [of psychotherapy] might be legitimate but the objectives [of conversion therapy] are illegitimate,” said Pick. “These techniques were never meant to change someone’s sexual orientation or gender identity. That’s why every major medical and mental health organization has condemned the practice as illegitimate at the least, and actively harmful at the worst.”
Conversion therapy providers often subject a person to interrogative questioning about their lives to find potential “abnormalities” and then frame them in prejudiced terms. Aversion therapy, in which providers use painful or distressing stimuli to deter a person from thinking and feeling in certain ways, and behavioral training, in which providers seek to instil stereotypically “masculine” or “feminine” behaviors within a subject, are also common. In various countries, subjects are forced to masturbate while envisioning persons of a different gender, the UN reported.
Medical practitioners of conversion therapy believe non-heteronormative sexual orientations and non-cisnormative gender identities result from a biological dysfunction that can be corrected with pharmaceutical drugs or surgery.
In China, for instance, there are reports of subjects undergoing electroshock therapy and medical injections, while in India, doctors promote hormone therapy as a way to “cure” people, according to the UN. These methods are used around the world.
Faith-based programs often represent the most extreme form of conversion therapy. Practitioners tend to view LGBTQ+ identities as an inherently immoral “choice,” or that subjects themselves are inherently immoral.
Subjects in these programs are often forced to pray, starved, yelled at and berated, beaten with objects, sexually assaulted, and more. Exorcisms, in which practitioners attempt to extract a demonic presence from a subject, happen frequently.
Other faith-based programs force subjects to take a vow of celibacy. In this way, they’re not trying to change a person’s sexual orientation and gender expression so much as definitively suppressing it.
All of these methods have been widely discredited and condemned by medical experts and human rights activists.
“You can’t change someone’s sexual orientation or gender identity by giving someone a pill, or praying it away, or waving a wand,” said Stern. “We are who we are, we can’t change. The world around us needs to change.”
Torture leaves indelible marks on survivors’ body & mind. LGBT persons are exposed to specific acts of torture, such as conversion therapy. Today I honor the resilience & strength of all survivors and reinforce the call to ban conversion therapy and eradicate torture everywhere. https://t.co/SVyuIPOg76— Victor Madrigal-Borloz (@victor_madrigal) June 26, 2020
The effects of conversion therapy
All instances of conversion therapy “are inherently humiliating, demeaning, and discriminatory,” according to Madrigal-Borloz. The consequences are magnified by the fact that the majority of conversion therapy subjects are young people.
An estimated 80% of people who undergo conversion therapy are under 24 years old, while half are younger than 18, the UN reported. Subjecting youth to these harmful practices can result in lifelong psychological and physical repercussions.
“It’s so sad [that people] experience something this traumatic that young,“ said Stern. “It changes you for literally the rest of your life.”
People who undergo conversion therapy report a wide range of consequences.
The UN reports that individuals experience “profound feelings of shame, guilt, self-disgust, and worthlessness, which can result in a damaged self-concept and enduring personality changes. The deep impact on individuals includes significant loss of self-esteem, anxiety, depressive syndrome, social isolation, intimacy difficulty, self-hatred, shame and guilt, sexual dysfunction, suicidal ideation and suicide attempts and symptoms of post-traumatic stress disorder, as well as often significant physical pain and suffering.”
Survivors often drop out of school, lose their jobs, and can experience other material consequences such as homelessness due to the many effects of post-traumatic stress disorder. Eating disorders can develop, as well as gastrointestinal problems and other health complications.
People who undergo forced hormone therapy can face lasting bodily harm, and those who have been beaten may face lasting physical injuries. Individuals often experience sexual assault during conversion therapy sessions that can cause lasting physical and psychological trauma.
These generalized consequences are broad strokes, but they’re corroborated on the individual level by survivors who spoke with OutRight Action International.
“When I tried to kill myself, I didn’t die,” said Re. Nokuthula Dhladhla, a 46-year-old lesbian in South Africa, who was raped and tortured.
“My family disowned me,” said George Barasa, a 28-year-old gay, gender-nonconforming Kenyan living in South Africa. “I was given a choice — change or be disowned. I chose to be disowned. I was so naive, depressed. Some people took advantage of this. In the process, I was infected with HIV. I attempted suicide ... and was found unconscious by neighbors who checked on me.”
“I have tried to move on, but the religious counseling really affected me, and up to now, I have a hard time believing if there is even a God in the first place,” said Jay Angwenyi, a gay man living in Kenya.
“At some point, I made a suicide attempt,” K.A., a 23-year-old gay man in Jordan, told OutRight. “I ... didn’t want to live like that. It seemed like [conversion therapy] wasn’t going to work ... so I was blaming myself for not being good enough for it to work.”
“[Conversion therapy] makes you feel disgusted about yourself,” said Jamal Jonathan, a 28-year-old gay man in Tanzania. “It is very damaging. It makes you feel not like a human. It makes you lose your confidence. But we cannot talk about this publicly.”
The movement to stop conversion therapy
Organizations like the United Nations, the Trevor Project, and OutRight Action International are advocating for a worldwide ban on conversion therapy on the grounds that every instance of the practice is a human rights abuse that violates international law and threatens the well-being and safety of LGBTQ+ people.
To date, five countries — Germany, Malta, Ecuador, Brazil, and Taiwan — have outlawed conversion therapy, and more than a dozen other countries are consideringsimilar policies. Hundreds of cities and towns around the world have enacted bans on the local level.
Getting to this point, however, has been an arduous process involving extensive advocacy and grassroots work.
Stern of OutRight Action International and Pick of the Trevor Project both said that building a broad coalition of religious leaders, public figures, politicians, and everyday citizens is key to banning the practice.
The first step is raising awareness.
“OutRight believes that if more people were aware of the prevalence and the egregious consequences of conversion therapy, more people would be moved to action,” Stern said.
“If we can create a snowball effect, if we can create international norms and standards that say conversion therapy amounts to torture, then it becomes easier for states to ban it in law, it becomes easier for medical associations to bar doctors from performing it,” she added.
Pick said that it’s important for countries to fund educational campaigns about the harms of conversion therapy. Survivors sharing their stories can show how harmful and traumatizing the practice is for individuals, giving a personal voice to what may otherwise seem like an abstract scenario that happened in the past, or happens elsewhere.
“There is a challenge in making it known that this is an ongoing issue,” Stern said. “Many people believe that it was a problem in the 1970s, when homosexuality was removed from the textbooks as a disorder.”
Pop culture also has a role to play. Diverse LGBTQ+ representation in movies and television helps the public to better understand and dignify different expressions of sexual orientation and gender identity.
Films and documentaries such as Boy Erased, The Miseducation of Cameron Post, and Pray Away have elevated the fight against conversion therapy.
Religious leaders also must condemn the practice and demonstrate their support for LGBTQ+ people, Pick said.
“When you have a broad base of support raising this issue up, then you find champions among your lawmakers, bipartisan leaders, who want to prioritize this, and they will introduce the legislation,” she said.
Ultimately, banning conversion therapy is only the first step of what it takes to societies that allow LGBTQ+ people to thrive.
“Conversion therapy is the bare minimum of ‘do no harm,’” said Pick. “There is so much that we can do to create welcoming and fully embracing societies.”
Countries must also ban all forms of discrimination against LGBTQ+ people in the workplace, in private establishments, in public, and in homes.
Because of widespread discrimination, LGBTQ+ people are more likely to experience poverty than the broader public, and this has been especially true during the COVID-19 pandemic, which has exacerbated existing inequalities.
Currently, 73 countries outlaw homosexuality and various other countriers legally allow discrimination against LGBTQ+ people. These laws encourage widespread violence and cruelty and cause LGBTQ+ people to be marginalized and dehumanized.
"Because so-called conversion therapy is a practice done to LGBTIQ people, we don’t think about it as a form of assault. We don’t think about it as rape. We don’t think about it as starvation or kidnapping. We don’t think of it as medical malpractice, but it is. But it is all of these things," said Stern.
“The laws of society and the principles of human morality must also apply to how we treat LGBTIQ people."
Once laws are put in place that protect LGBTQ+ people, countries can then go about creating actively beneficial living conditions.
Schools have to invest in suicide prevention and mental health policies in schools, with the understanding that LGBTQ+ youth are up to five times more likely to attempt suicide than the general public. Schools also have to develop sexual education curriculums that reflect the full spectrum of sexuality and gender identity, empowering young people with the knowledge and language to discover and own their sexual orientation and gender identity.
“We can protect our youth from bullying based on who they are and who they care for,” Pick said.
Empowering LGBTQ+ people also depends on providing basic human rights: adequate health care, housing assistance, educational and employment opportunities, financial support, nutritional food, clean water, and a clean environment.
“In order to end conversion therapy, we don’t just need good laws on the books, but also love and acceptance of LGBTQ people within our religious groups, families, and societies,” Stern said.
“That’s the only thing that’s going to end this barbaric practice.”
If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255 (US). The Trevor Project has an LGBTQ+ specific hotline and chat service. You can find international resources here.