In the early to mid-1900s, societal attitudes toward homosexuality shifted. The belief that homosexual people were sinners was replaced to some degree by the belief that they were mentally ill. The medical and psychological professions have used drastic treatments in attempting to cure the "illness" of homosexuality. Surgical procedures such as castration were performed in the 1800s. As late as 1951, lobotomy (surgery that severs nerve fibers in the frontal lobe of the brain) was performed as a cure for homosexuality. Psychotherapy, drugs, hormones, hypnosis, shock treatments, and aver­sion therapy (pairing nausea-inducing drugs or electrical shock with homosexual stim­uli) have all been used to the same end (Murphy, 2008).

In 1973, after great internal conflict, the American Psychiatric Association removed homosexuality from its diagnostic categories of mental disorders. In light of contem­porary research on homosexuality—and the fact that both the American Psychiatric Association and the American Psychological Association no longer categorize homo­sexuality as a mental illness—most therapists and counselors have changed the focus of therapy. Rather than attempting to "cure" homosexual clients by changing their sexual orientation, therapists provide gay-affirmative therapy to help them overcome any internalized negative feelings about their sexual orientation and to cope with a society that harbors considerable hostility toward them (American Psychological Association, 2012; Bolton & Sareen, 2011; Kuyper & Fokkema, 2011b).

Some religious groups and mental health practitioners who believe that homosexu­ality is symptomatic of developmental defects or spiritual and moral failings advocate therapy to help dissatisfied homosexual individuals control, lessen, or eliminate their homosexual feelings and behavior through conversion therapy or sexual reorientation therapy. Ministry groups such as Exodus International, a nondenominational Chris­tian organization, blend religious teachings with group counseling to focus on child­hood traumas believed to have caused the participants’ homosexuality: abandonment by fathers, absent mothers, sexual abuse, or violent parents. Individuals who belong to a fundamentalist religion and whose families react negatively to homosexuality appear to be most likely to participate in sexual reorientation therapy (Maccio, 2010).

The American Psychological Association maintains that conversion therapy is, at best, ineffective (American Psychological Association, 2009). For many people who can­not make the changes they wish for, the belief that one can only "be with God or be gay" presents irreconcilable choices, and such a dilemma can contribute to depression and suicide (Crary, 2009; Reitan, 2011). However, a recent longitudinal study of religiously based support groups found that some degree of change in sexual identity, attraction, and functioning were possible for some individuals (Jones & Yarhouse, 2011). Ninety-eight subjects (72 men and 26 women) began the 7-year study, and a total of 65 participants


Irrational fears of homosexuality, the fear of the possibility of homosexual­ity in oneself, or loathing toward one’s own homosexuality.

completed it. At the beginning of the study, most participants indicated some degree of heterosexual attraction along with their predominant homosexual attraction. The 23% who reported increased heterosexual self-identity, attraction, and behavior still main­tained varying degrees of homosexual attraction. These subjects appear to have shifted from the homosexual to the heterosexual direction on a bisexual continuum, rather than from exclusive homosexuality to exclusive heterosexuality (Throckmorton, 2011).

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