New York: I was 34 years old when I came out to my parents as a gay man. Unfortunately, I had to come out over the phone, as I was in the United States and they were in Lebanon at the time. This limitation contributed to an awkward and brief conversation, but the one thing which stood out to me was that my parents were convinced that homosexuality is an illness and they felt I needed urgent psychiatric treatment. There was only one contradicting fact: at the time, I was an attending psychiatrist at the world-renowned Cleveland Clinic. As a co-leader of that institution’s diversity efforts, I helped put into place policies which protect gay and lesbian patients and employees against discrimination, and support better health care for the gay and lesbian population. By the end of the conversation, I convinced my parents that homosexuality is not a disease, therefore requiring no treatment. And even if one wanted to, there was nothing a person can do to change his or her sexual orientation.
My father called a few days later, and from a place of love and concern for my well-being, said, “I asked around about your problem and need to ask one question: have you tried using Viagra?” Realizing my parents still felt unsettled about my sexual orientation, I flew to Lebanon a couple of weeks later for a difficult face-to-face conversation with them; this was the one conversation I had been dreading my whole life. We spoke for several hours and they asked all the questions they had been holding onto for years, allowing me to fully reveal my authentic self in their presence for the first time in my life. I shared I had been gay for as long as I could remember, and clarified that nothing they did contributed to my homosexuality. I described what I tried on my own to prevent myself from being gay, including denial, suppressing my sexual desires, and forcing myself to date girls. I even spoke about seeing a renowned psychiatrist in Lebanon at a younger age, who, after checking my blood for male hormone levels, shipped me off to see a therapist because he did not “deal with these kinds of issues”. I said the only reason I tried all of these routes was because I was unsure they would still love me if I was gay. After this heart-wrenching exchange and other conversations over the years, my parents came to terms with my sexuality.
I went on to co-found, along with several other healthcare professionals, an organization called Lebanese Medical Association for Sexual Health (LebMASH), with the goal to make sure that everyone in Lebanon, regardless of their sexual orientation or gender identity, can receive the highest quality of care. LebMASH established that the first step toward achieving this goal is to eliminate harmful practices within the healthcare system.
Because I was an adult when I came out to my parents, I was lucky in being able to save myself from what is known as Sexual Orientation Change Efforts (SOCE), which are futile and harmful attempts to change one’s sexuality from gay to straight. Unfortunately, these efforts are extremely common in Lebanon. Self-proclaimed “therapists” have appeared on TV, boasting about their practices of SOCE. Over the years, LebMASH learned that many young gay and lesbian individuals are dragged by their parents, usually at the recommendation of a teacher or nurse at school, to see a therapist so they can be “fixed”. The attempts to “fix” these perfectly healthy kids range from shaming them for who they are and coaxing them to behave differently, to prescribing them hormones or medications like Viagra. A urologist said publicly that he uses electro-shock therapy as part of a SOCE treatment plan, though LebMASH was unable to verify this practice. In general, gay and lesbian individuals subjected to SOCE were left feeling depressed, anxious, and at times, suicidal. The tricky issue with how SOCE is implemented is two-fold: it is usually sought out by parents who love their children and believe they are doing what is best for them, and it is administered by providers who also believe they are doing what is best for their patients. One provider told me, “If I don’t keep them in my clinic and pretend that I am doing something, their parents will take them to a quack who will harm them. I prefer to play along with the parents so I can save the kid.” Other providers engage in SOCE because they truly believe in defunct and unproven theories surrounding homosexuality, while there are those who do it for religious motivation or financial gain.
Three major misconceptions fuel SOCE: (1) homosexuality is a choice, (2) homosexuality is due to hormonal imbalance, and (3) homosexuality is a mental disorder resulting from issues related to upbringing. Scientific research has demonstrated that sexual orientation is not a choice and cannot be changed, has no relation to hormonal levels, and that gay and lesbian people do not have any psychological, social, or professional defects that are due to being homosexual in and of itself. The Lebanese Psychiatric Society (LPS) and the Lebanese Psychological Association (LPA) each issued statements in 2013 affirming that homosexuality is not a disease, and that SOCE is harmful and should not be practiced. Despite this, a study in 2015 showed that 72% of people in Lebanon believed that homosexuality is a mental illness, just like my parents did when I first came out to them.
I remember when people smoked on Middle East Airlines (MEA) planes and inside various facilities of the American University of Beirut Medical Center (AUBMC). Thanks to elevated awareness and political advocacy, Lebanon has laws banning smoking in public places. I am hopeful that by raising awareness about homosexuality, as well as the harmful effects of SOCE in our society and within our healthcare system, we can collectively execute a ban on SOCE as well.
Omar Fattal, MD, MPH , is the Assistant Chief for Quality at Bellevue Hospital Department of Psychiatry in New York, Assistant Clinical Professor of Psychiatry at New York University and Co-founder and current board member of LebMASH
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