In 2013, California became the first state to pass legislation banning licensed professionals from trying to change the sexual orientation of minors from homosexual to heterosexual. In 2014, similar legislation passed in New Jersey, with other states, including New York, Massachusetts, and Ohio, following suit. However, “reparative therapy,” which grew in popularity with psychiatry’s increased medicalization of same sex erotic desire throughout the 20th century, is hardly a practice of a bygone era. In June 2014, the Republican Party endorsed the support of reparative therapy in Texas, while organizations such as the National Association for Research and Therapy of Homosexuality continue “treating” homosexual men and women in an effort to change their sexual desires to heterosexuality–all with dire consequences to individuals undergoing such treatments.
I was in a form of reparative therapy in British Columbia, Canada, for six years, after which I filed a medical malpractice suit against my former psychiatrist, “Dr. Alfonzo,” for treating my homosexuality as a disease. If these new laws are to be criticized, it is that the use of “change” therapies on people older than 18 should be prohibited as well. I was 24 when I met Dr. Alfonzo, 31 when I left his therapy, and almost 40 when the lawsuit ended in an out-of-court settlement in 2002. Nearly twenty years after leaving the therapy, I am still affected by the consequences of those six years of “treatment.”
It was 1989, and I had just moved from my hometown in Vancouver, Canada. I had come out to my Catholic family two years earlier, and since then our relationship had escalated from constant criticism to outright rejection. Isolated and confused, I sought professional help with psychiatrist Dr. Alfonzo. In turmoil, I asked this doctor how I could best come to terms with my homosexuality as well as with the psychological effects of the sexual abuse I had endured as a child.
Alfonzo seemed to offer hope in a form of treatment based on the principles of “Primal Therapy,” first “discovered” in the late 1960’s by American psychologist and psychiatric worker Arthur Janov. The goal of Alfonzo’s practice was to erase the mental imprints of biological parents via intense, primal sessions, and then to replace these with the “healthy imprints” of surrogate parents (a woman hired to act as our new “mommy,” and Alfonzo, acting as our new “daddy”). “Primals” were twofold: all sessions began with me lying on a large sheeted mattress in the middle of Alfonzo’s dimly lit “workroom,” situated between his private office and the outside waiting room. Keeping my eyes closed, I “moved” as if walking, breathed gutturally, and focused on a specific painful memory from my childhood. If I felt surges of anger, which I often did, I was told to jump quickly to the “batting station” in the corner of the workroom, kneel, pick up the aluminum baseball bat, and strike another rolled-up mattress while staring at a red “X” marked on the wall before me. Talking was prohibited for the first two months of therapy; only “primal sounds” were permitted.
Within six months of beginning therapy, Alfonzo told me that I would never be happy as a homosexual, presented me with conflicting causation theories, and directed me to release my anger and to feel my pain in an effort to “unlearn the error” of my homosexuality. If I dared say I was really gay, Alfonzo became enraged and threatened to throw me out of therapy. If I persisted in arguing with him, his loud, accented voice overshadowed my own. He would point his finger down at me in a menacing and condescending manner, cocking his head to one side. I would know enough to stop talking immediately. No one had the last word when it came to Alfonzo. My already low self-esteem plummeted.
Six months later, Alfonzo ordered me to move, along with four of his other psychiatric patients, into a therapeutic house he called the Styx. At his instruction, we built a makeshift 4’ x 6’ sound-insulated “screaming room” in the basement that we used for self-administered primal sessions. Alfonzo had us compose a written charter, which was “edited” and approved by him, detailing his expectations about what foods we would eat (vegan), and what activities would not be tolerated (smoking, drinking, sex in the house). Nightly meditation was implemented. Members were discouraged from leaving the house during non-work hours except in the company of other members, and from having social contact with anyone outside the therapy. Visitors were forbidden, except for other patients sent by Alfonzo for three-week residential stays or “intensives.”
Alfonzo prescribed increasingly higher doses of medications, which he said were necessary if I was to benefit from his therapy. The medications included a combined or overlapping use of Rivotril, Surmontil, Elavil, Sinequan, and Anafranil. Rivotril, I learned early on, belonged to a class of medications called benzodiazepines, which were generally used as a sedative or to decrease seizures or anxiety. Surmontil, Sinequan and Elavil, all tricyclic antidepressants, were often prescribed in cases of clinical depression. Anafranil, my fourth “tricyclic,” while normally used in cases of obsessive-compulsiveness, was prescribed specifically to deaden my sex drive. Weekly intra-muscular injections of Ketamine Hydrochloride, a hallucinogenic, soon followed. Although we knew that “K” was most commonly used as an animal anesthesia (for horses, cats, dogs, rabbits, and rats, among others), Alfonzo told us that he would be using it on us “mostly during the nurturing sessions to help remove the patient’s observing ego.” When it finally occurred to him, over a year after first injecting us, that he’d never received informed consent, he quickly drafted a form, called all the Styx members to the office, and told us to “shut up and sign it.” Often he double-prescribed my monthly prescriptions, instructing me to bring the extra medication back to him for his personal use. In private, he disclosed intimate details of his life to me, including facts about his own breakdown from which he claimed never to have fully recovered.
Styx members were referred to as “family.” We were required to spend time with him at house meetings and during visits to his private home. We were given chores: to cook his meals, to clean his office and home, to care for his pets (one of which, a dog, he’d had us drug and steal from a nearby farm), to help him write his autobiography, and to renovate his retirement home on a remote island (where he said we’d all one day live communally). If any of us had “a feeling” about any of our many duties, Alfonzo told us to “work it in private,” and not in front of patients who weren’t “part of the family.”
Over the next two years of therapy at the Styx and the office, Alfonzo systematically denigrated my homosexuality, characterizing it as learned behavior and comparing it to a drug addiction. He told me that I needed to carry my “cross” with dignity by remaining celibate and not act on my “insanity.” In deep primal sessions, howling and beating a mattress in Alfonzo’s office, I began to accept–or, at least, not contradict–the doctor’s beliefs that I had self-identified as gay because of poor parental role modeling, the childhood sexual abuse I suffered at the hands of a stranger in a public washroom, and the consequent years I spent “acting out” that abuse by training my body to respond only to men.
As my primal sessions deepened, Alfonzo prescribed ever-higher doses of medications, and I became increasingly unable to function. By late 1992 I was 28 years old and the side effects I suffered as a direct result of the medication included short-term memory loss, breathing difficulties, blurred vision, dry mouth, constipation, urinary retention, involuntary twitching, excessive sweating, weight gain of almost forty pounds, and visual hallucinations. Generally, I felt numb and spaced out all the time.
One icy winter morning in 1993, I stood from my bed and something inside of me unhinged. I collapsed, feeling the air rush past me as if I’d been plunged down an endless elevator shaft. A Styx housemate found me sometime later, conscious but lying motionless on the floor, still feeling as if I were falling through space, the endless landscape of my shattered mind, rootless to myself and my surroundings. Alfonzo added the anti-psychotic Nozinan to my regime of four concurrent medications and placed me on medical disability. He prescribed yet more Anafranil in order to deaden my same sex attractions–which, despite not being sexual with anyone for over three years, remained–saying that I would never be able to “flip to the other side” as long as I was obsessing about “the gay side.” The medication made me feel numb, lifeless, passive. Any light that had remained alive in me was switched off: erections were eliminated, fantasy and arousal eradicated. Fear of the world, my vulnerability, and dependence on Alfonzo, however, increased. On a number of occasions when we’d discuss my increasing passivity, he told me that homosexuals were passive by nature. “You need to work harder at the bat,” he said. “You need to push through your passivity. Remember: your unexpressed anger is what’s keeping you from your heterosexuality.” In the most bizarre form of treatment yet, he ordered me to bottle my feces and sniff them whenever I was attracted to a man, in order to help remind me “where homosexual men stick their penis.” When none of that worked, the doctor threatened to hook my genitals up to electrodes. “Without my help,” he told me once, “you’ll probably just get AIDS and die.”
In early 1995, Alfonzo told all of us at the Styx that unless we corrected our life patterns by practicing more “tough love” on one another outside of our workroom, none of us would make it in the world “out there,” nor would we ever be allowed to live with him in his new home. We took his advice to heart. No longer did we work out our feelings in the basement; instead, we brought our primal rage upstairs into our living room, our kitchen and our bedrooms. We became like caged primates, and the house structure quickly disintegrated. Finally, in late 1995 we agreed to disband.
From the Styx I moved directly into a bachelor suit on my own. Because I was still being weaned off the remaining few medications, for the next year I returned for prescriptions. During each of these visits, the doctor continued to make derogatory comments about gays. I said nothing, feeling numb inside when he spoke.
By the time I visited Alfonzo in mid-1996, I realized how many years I’d lost in a futile effort to change. I dreaded returning to his office, but knew that I had to be weaned off the medications. My best defense seemed to be to say as little about my life as possible, get my prescription, and leave. During our last visit, he told me he was concerned for all his former “children,” but in particular for me, since I had stepped back out into the world “with all those homosexuals.” His words sent a jolt through my body, as if I was hearing the hatred in his voice for the very first time.
“I’m one of those homosexuals,” I snapped back at him. “And nothing’s going to change that fact. I can’t hide from the world my whole life, and homosexuals are as much a part of the world as anyone.” I continued to look him in the eyes, not backing down. He said nothing; then, a moment later, turned back to his desk, wrote another prescription and made an appointment for the following month. I never kept it.
I spent much of the next two years in solitude, shell-shocked, weaning myself off all the medications while struggling with memories of Alfonzo and “the family.” Despite the doctor’s ongoing attempts to revert my sexuality to its “base heterosexuality,” there had been no heterosexual in me waiting to emerge. Instead, I felt more like a shell with its innards scooped out.
Gradually, I thawed out and deprogrammed from the therapy. The panic attacks I’d suffered through for years soon dissipated, despite Alfonzo’s constant warnings that they would necessitate a lifetime of medication. With the assistance of a new, healthier, counselor, I not only dealt with issues relating to my childhood sexual abuse, but also with Alfonzo’s systematic attempts to erase my gay identity.
In May 1997, I mailed a five-page letter of complaint to British Columbia’s College of Physicians and Surgeons. Though Alfonzo had 14 days to respond to the complaint, he didn’t respond for seven months. He sent in a 500-page rejoinder, in which he denied all inappropriate conduct. The College consulted an independent psychiatrist who advised them that Alfonzo’s behaviour was considered “acceptable within the framework of his therapeutic model.”
Following a two-year investigation, Alfonzo was directed to attend a conduct review by one of the College’s committees. For two hours they questioned him about everything from his attitude toward homosexuality, to his use of Ketamine on patients and the fact that Styx members had witnessed his own Ketamine-enhanced primal sessions, where he told us he was Christ and that he’d been crucified in a past life. When asked about his use of excessive overmedication, Alfonzo said that such high doses were required for me because I was “quite mentally ill.”
“Are you trying to tell us, Dr. Alfonzo,” the Chair responded, “that this young man is a very, very, very damaged human being who required 550 mg of medication per day just to function?”
After a moment, Alfonzo turned to me. I turned to him. Then we both turned back to the Chair and he said, “Yes.” I caught the eye of one of the Committee members, a woman doctor. She winked at me.
“He looks great now,” Alfonzo added. “Obviously my therapy worked.”
In the coming months, two independent psychiatrists reviewed Alfonzo’s practice. Five months later I received a copy of that review, which amounted to a slap on the wrist, and concluded that the doctor was “clearly trying his best with a difficult patient mix,” and that he was “well-intentioned and approached his work with diligence.” He was not instructed to alter his forms of treatment.
I filed a medical malpractice suit against Alfonzo in 1999, four years after I left the Styx. The Court scheduled a four-week trial, and over the next year and-a-half, two more independent psychiatrists interviewed me for twenty hours. In December 2001 I attended the Defence’s Examination of Discovery, along with my lawyer, Mackenzie, two Defence counsel, and Alfonzo. Throughout the next seven hours I answered every one of Defence’s questions about my childhood sexual abuse to my active sexual history, my coming out process, and my deteriorating relationship with my family–all of which, I was well aware, had nothing to do with the facts of my claim. With each passing moment I felt myself being opened up and ground down: I felt exposed and exhausted, had trouble focusing, remembering, understanding what could possibly have motivated me to stay with this doctor, to have once said that he was helping me, that I felt safe with him, that I was better off with his therapy. When asked about my “visiting bars frequented by male homosexuals,” suddenly it struck me just how homophobic the context of the suit truly was: would anyone ever be asked if they visited bars frequented by female heterosexuals?
Finally, when Defence asked what harm or ill effects the doctor had caused, I felt as if I were being asked to articulate how my rapist had damaged me. I tried to tell them something of the emotional harm his therapy caused, but after so many years and all that had happened, my words felt stilted, inadequate, pointless.
Six months later my lawyer, Mackenzie, a gay man himself, told me his firm had decided to settle out of court. “This is a business decision,” he advised. “It’s about money.” He mentioned the “shit in the bottle,” and said that, “within the confines of Alfonzo’s paradigm it had its own internal logic.” I was shocked, tried to argue, reminded him of why I filed the suit in the first place: to create legal precedent; to bring public awareness to this kind of abuse; to stop people like Alfonzo from inflicting this type of harm on anyone else. My lawyer was reassuring. He told me that physicians would be dissuaded from practicing similar therapies because the doctor’s Mutual Defence Organization sent documentation of all malpractice suits to all Canadian doctors.
Months of offers and rejections later, in December 2002 I received a settlement of $30,000.
In the aftermath, I tracked down and read through every one of the Association’s bulletins. No details of my suit in any shape or form appeared. I called Mackenzie fourteen months after settling. He told me that if the Association chose not to document my case, there was nothing he could do about it after the fact. I also read through four years of bulletins from the College of Physicians and Surgeons. The details of my complaint were never outlined.
Today, 25 years since first meeting Dr. Alfonzo and almost 20 years since leaving the Styx, not one day passes where I do not think about what happened to me, and worry what might still be happening to others. Use of psychiatric medication has only increased since I was referred to Alfonzo in 1989. I had never heard of “reparative therapy” when I started my own therapy; at 24 years old I just wanted to end my feelings of emotional distress. Despite new laws in California and New Jersey, and others that will likely follow, I am left to wonder: What has really changed? The American Psychiatric Association may have ceased classifying homosexuality as a mental illness over 40 years ago, but this has not stopped some of its practitioners from treating it as one.
For those practitioners who do continue endorsing the use of reparative therapy, and especially for those individuals who would like to believe that they can “change” their sexual orientation, I would say that “change” therapies “work” by dissociation: The person undergoing treatment is viewed as separate from their sexuality, and so they dissociate themselves from everything they have conflated with the idea of “being gay.” In retrospect I now understand that I had always objectified my sexuality; throughout the six years of my own therapy I had talked about “leaving homosexuality” as if “the gay world” was a thing in itself, some “thing” that I could leave behind, move beyond. But if my own experiences have taught me anything it is that a change to the “map” of my identity from homosexual to heterosexual will never change the “territory” of my experience from same-sex to opposite-sex desire. A map is not the territory it represents.
Reparative therapy confuses the map for the territory: The patient erroneously believes that by changing their map of identity they will also, perhaps through an act of providence or magical thinking, change their territory of experience. They don’t. What they do experience while in treatment is cognitive dissonance (identifying as heterosexual while experiencing same-sex erotic desire), and they often leave treatment dissociated, depersonalized, depressed, and, at times, suicidal.
Enacting laws to make it illegal to practice reparative therapy on minors is only a start. Reparative therapy may be a lie, but the lie begins not with the idea that we can change from gay to straight, but with the belief that we are who the culture tells us we are, that a change to the map of our identity is a change to the territory of our experience. And no one, no matter what age or sexual identity, is safe from that.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.