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Conversion therapy: calling for legislation without evidence

Last week at an event at Middle Temple, Sex Matters Chair Naomi Cunningham highlighted the lack of evidence for harm from “gender identity conversion therapy” (a broad and undefined term being used to promote rushed legislation).

Jayne Ozanne, the chief promoter of this proposed legislation, called this “offensive and triggering”. She told Pink News the talk was “very insensitive” and “transphobic” and a “vicious attack” on the trans community. 

But as Kate Harris of LGB Alliance said at the same event, policy-making must be based on facts, not feelings.

The fact are that the government’s own research did not define conversion therapy clearly,  and the research review found no evidence of harm in relation to gender identity.

If you haven’t already emailed your MP, do it now:

Just how bad is the government’s evidence?

A couple of weeks ago we published a rapid review of the Coventry University research commissioned by the Government Equality Office (GEO) in support of its proposal to criminalise “conversion therapy”. We found that review extremely thin, with overheated conclusions.

There are two documents, and as we said at the time they are confusingly named.

One report looks like this:

It states that it was commissioned by GEO, with the research carried out by a Coventry University team lead by Dr Jowett.

The second report looks like this: 

This one says it supplements the first report carried out by Coventry University. It is not immediately clear whom it is by.

Both reports are based on the same 46 studies and use the same “Mixed Methods Appraisal Tool” (the first report also includes highlights from 30 interviews).

Basically, the second report is a summary of the same literature review as in the first report, presented slightly differently. We misread this as being an input study to the larger report – in fact this was wrong. 

The second report is by GEO. It is referred to in the government’s consultation document like this:

The government conducted a further assessment of the international evidence, to supplement the study by Jowett and others (2021), to look in more detail at the distinction between evidence on conversion therapy to change sexual orientation, and that to change gender identity (Government Equalities Office, 2021b).

Perhaps the government was unconvinced by the Jowett study, and so asked the civil servants at GEO to do a further assessment? But the “further assessment” is in fact a reproduction of the same evidence as the Jowett study.

So some of the “sexing up” of the findings which we highlighted in our review of the Coventry study was not in fact the responsibility of the university team, but of GEO. 

In its report GEO summarises the findings in relation to gender identity as showing that:

“conversion therapies were associated with self-reported harms (such as mental health conditions like depression and feeling suicidal).”

The Coventry university team says: 

“There is limited but reasonably strong evidence that self-reported harm is associated with conversion therapy.”

Both of these statements are misleading and do not reflect the underlying evidence.

It appears that GEO officials, under pressure to deliver an outcome for the jamboree event in June 2021, have presented the findings of the research to meet the expectations of activists such as Ms Ozanne and Stonewall, who describe an honest look at the evidence, and a cautious approach to legislation that may promote child transition, as “transphobic”.

In fact there is no evidence of harm 

The word harm communicates a causal relationship. According to the Collins English Dictionary, it means “the damage to something which is caused by a particular course of action”.

Remember, the only evidence in the Coventry University team found that relates negative mental health with experience of “conversion” in relation to gender identity comes from the statistical analysis carried out by a team led by Dr Jack Turban. The title of the Turban study is Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults”. The word harm does not appear in the paper. 

Turban found, within a self-selected survey in the US, a statistical association between subjects recalling any professional (such as a psychologist, counsellor or religious adviser) had tried to “stop you being trans” and severe mental distress predictive of schizophrenia, bipolar disorder or other serious mental disorders. 

But association is not evidence of the causal relationship of harm.

As the Coventry University study itself states:

“There is also a need to be careful when making causal interpretations from such studies. For example, an alternative explanation could be that LGBT people with mental health problems are more likely to seek out conversion therapy.”

More specifically than this, as Roberto D’Angelo et al wrote in their critique of the Turban study, patients with poor underlying mental health may be less likely to be affirmed as transgender, and may experience this as invalidating and describe it by answering yes to the question interpreted as “conversion therapy”. 

As they explain from experience, patients with psychiatric diagnoses can often misinterpret neutral interpersonal interactions as invalidating or rejecting, and it is common where a therapist identifies a patient’s dysphoria as secondary to another condition for the patient to experience this as withholding treatment they desperately want and to respond negatively. 

There is no comparable parallel to this with being gay, lesbian or bisexual, since being homosexual is not a medical condition for which there is a diagnosis or treatment that doctors might withhold. 

Calling this “self-reported harm” is putting the word into the mouths of the research subjects, who in fact reported poor mental health, not harm from conversion efforts.

D’Angelo et al say that any claim of causation implies that exposure to perceived effort to stop someone being trans causes previously mentally well people to develop serious mental illness. They say this is “a highly speculative and implausible hypothesis”, and argue that:

“Presenting a highly confounded association as causation is a serious error, given its potential to dangerously misinform and mislead clinicians, policymakers, and the public at large about this important issue.”

Labour’s statistic

Meanwhile Labour MPs responding to Sex Matters supporters writing to them expressing concerns and asking to extend the consultation have responded with this statistic

“[the] 2020 ‘Conversion Therapy’ and Gender Identity Survey found that over 92% of people who had experienced attempts to change their gender identity had suffered from mental health issues.”

This factoid comes from a self-selected survey carried out by Stonewall, the Ozanne Foundation, GIRES, Mermaids and the LGBT Foundation. They found 38 “gender diverse” people who said they had experienced gender identity conversion therapy. Of these 92% also said they experienced anxiety and depression. Of the 409 gender diverse people who answered the survey saying they hadn’t experienced gender identity conversion therapy 79% experienced anxiety and depression.

This is a poor quality study and no conclusion can be drawn from from the 92% figure.