Lobotomy for homosexuality

Listed for history and safety. Lobotomy and other psychosurgery used on gay men and others labelled "sexually deviant" caused irreversible harm and, like all conversion practices, did not change sexual orientation. This guide describes these operations only in observable terms, for recognition, and gives no surgical method. It covers the psychotherapist's own work: historical literacy, recognition, assessment, safeguarding, referral, advocacy, and work with survivors, families and descendants. Related guides: 050 (lobotomy) and 056 (hypothalamic psychosurgery on "sexual deviants").

1. Introduction

Version followed: the historical record of frontal lobotomy and leucotomy (1935 to the 1970s and 1980s) as historians, national encyclopaedias, a parliamentary compensation decision and major broadcasters document it, read together with the current position of professional and international bodies on conversion practices (UN Independent Expert report A/HRC/44/53, 2020; APA resolutions of February 2021; UK Memorandum of Understanding on Conversion Therapy, version 2). Clinical guidance in section 4 is largely [synthesis] built on those positions.

What it was. Frontal lobotomy (leucotomy) was brain surgery introduced by the Portuguese neurologist António Egas Moniz in Lisbon in 1935 and spread in the United States by Walter Freeman and James Watts; Watts later broke with Freeman over his methods [source: Store norske leksikon, "lobotomi"]. In the mid-twentieth century, when homosexuality was classed as an illness, some gay men and others labelled "sexual psychopaths" and confined in medical institutions were lobotomised in the belief that it would "cure" homosexuality; the legal historian William Eskridge names Atascadero State Hospital in California as the most notorious such institution [source: PBS American Experience, "Curing" Homosexuality]. The UN Independent Expert's 2020 report records that medical conversion practices "relied archaically on lobotomies or the removal of sexual organs" (para. 46) [source: A/HRC/44/53].

Its claimed mechanism, and what is now known. Proponents held that damaging frontal brain connections would quiet the drives and preoccupations they regarded as pathological, including same-sex desire; a statement attributed to Freeman, that homosexuality "is of little practical importance after frontal lobotomy", is quoted in secondary journalism [uncertain: secondary, unverified; source: Attitude, 2023]. No change of orientation was demonstrated; what the operation reliably produced was irreversible change of personality and serious complications [source: Innst. S. nr. 276 (1995–1996)]. Professional bodies now state that there is no evidence that sexual orientation can be changed and that change efforts are associated with harm, including suicide attempts [source: APA press release, 2 March 2021; A/HRC/44/53 paras. 19–20, 55–58].

How it reaches clients today. The operation is not used for this purpose today. It reaches the consulting room as: older LGBTQ+ clients who lived through psychiatric "treatment" of homosexuality; descendants and relatives uncovering a family member's institutional records; LGBTQ+ clients whose distrust of psychiatry draws on this history; clients exposed to present-day conversion practices, which may be offered covertly under mainstream labels [source: UK MoU v2, para. 2]; and clients interested in LGBTQ+ history [synthesis].

2. Framework

Historical phases of the practice, in outline [source: Store norske leksikon; Museion (University of Copenhagen) on Kragh's thesis; PBS American Experience; Innst. S. nr. 276 (1995–1996)]:

• Introduction (1935 to early 1940s). Moniz's first operations in Lisbon (1935); spread to the United States and Europe; first Norwegian operation at Gaustad hospital, Oslo, 1941.
• Peak (1940s to early 1950s). Mass use in psychiatric hospitals. Norway: an estimated 2,500 to 3,000 people lobotomised; Denmark: about 4,500 psychosurgical operations 1939 to 1983, with women over-represented and at least 20 children from institutions for people with intellectual disability operated on. Whether homosexuality was treated as an indication in Scandinavia is [uncertain].
• Medicalised confinement of gay men (1950s and 1960s). In the United States, gay men committed as "sexual psychopaths" were sometimes lobotomised; Atascadero State Hospital is named [source: PBS American Experience, Eskridge]. Exact numbers of gay patients lobotomised are not documented [uncertain].
• Decline and end (1950s to 1983). Use fell from the mid-1950s; the last known Norwegian operation was in 1974 and Danish operations ended in 1983 after the Ombudsman's intervention and critical reports.
• Reckoning (1973 onward). The American Psychiatric Association removed homosexuality from the DSM in 1973 [source: History.com, 2018]. Norway's parliament approved a flat ex gratia payment for surviving lobotomised people in 1996 [source: Innst. S. nr. 276 (1995–1996)]. International bodies now describe conversion practices as potentially amounting to torture or cruel, inhuman or degrading treatment [source: A/HRC/44/53 paras. 62, 83].

Phases of the psychotherapist's work [synthesis, organised around the positions of the APA (2021), the UK MoU v2 and A/HRC/44/53]:

Session number and length follow the client's goals, risk and capacity and the setting [synthesis].

3. Guiding principles

• Orientation is not a disorder. Neither sexual orientation nor gender identity is in itself an indicator of mental disorder [source: UK MoU v2, para. 4]. In practice: never frame the client's orientation as the problem to be solved.
• Change efforts do not work and cause harm. There is no sound evidence that orientation can be changed [source: A/HRC/44/53 para. 20; APA 2021]. In practice: do not attempt, supervise or refer to any change effort, whatever the method.
• No agenda for an outcome. Practitioners should be free from any agenda that favours one orientation or gender identity [source: UK MoU v2, para. 6]. In practice: follow the client's exploration without steering towards or away from any identity.
• Distress is explored, not converted. Clients unhappy with their orientation may use therapy to live more comfortably, reduce distress and reach self-acceptance [source: UK MoU v2, para. 6]. In practice: work on the distress and its sources, not on the orientation.
• Validate and normalise. Psychologists are encouraged to validate, normalise and help others understand how orientation, gender identity and expression interact [source: APA Guidelines for Psychological Practice with Sexual Minority Persons, as quoted in the APA 2021 press release]. In practice: name stigma as the source of much distress.
• History is told accurately and without spectacle. [synthesis] In practice: describe what was done and its effects in plain terms; no graphic detail, no technique, no glamorising.
• The profession's own history is acknowledged. Most schools of psychology and psychiatry once acted as providers of conversion practices [source: A/HRC/44/53 para. 22]. In practice: own this history when a client raises it rather than defending the field.
• Safety first. Conversion practices are linked to suicidal thoughts and attempts [source: A/HRC/44/53 para. 19; APA 2021]. In practice: assess suicide risk early and follow safe-messaging principles.
• Children's safety overrides confidentiality. [synthesis] In practice: follow local child-protection and mandatory-reporting rules where a minor is exposed to conversion practices.
• Faith and identity can both be honoured. [synthesis] In practice: work within the client's religious framework without making the client choose; respect the client's own resolution.
• Client-led redress. [synthesis] In practice: support, never push, records searches, complaints, compensation or public testimony.
• Never name survivors. [synthesis] In practice: in teaching, writing and supervision use role descriptions only.
• Medical questions go to medical professionals. [synthesis] In practice: route neurological, cognitive or medication questions to the client's doctors; never advise on medicines.

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

None of them involves carrying out, supervising or referring to lobotomy, psychosurgery or any other conversion practice.

4.1 Building the therapist's historical literacy

• Purpose / when: before working with older LGBTQ+ clients, families researching institutional records, or anyone raising this history; prevents both minimising and sensationalising [synthesis].
• Steps: (1) Learn the outline in section 2: dates, countries, the "sexual psychopath" confinements, the decline of the operation, the 1973 DSM change [source: Store norske leksikon; PBS American Experience; History.com]. (2) Read the current professional positions (APA 2021, UK MoU v2, A/HRC/44/53). (3) Note what is not documented, such as numbers of gay men operated on, and say so honestly [uncertain]. (4) Take your own reactions to supervision [synthesis].
• Example language (illustrative): "Yes, that happened. Some gay men in psychiatric institutions in the 1950s were given brain surgery in the belief it would change them. It did not, and it caused lasting damage."
• Watch for: relying on unsourced figures from online articles; graphic detail; distancing the profession from its past. It is working when you can answer a client's question accurately, briefly and calmly.

4.2 Recognising the legacy in a client's story

• Purpose / when: at intake or when themes of institutional psychiatry, family secrets or "a relative who changed after hospital" appear [synthesis].
• Steps: (1) Ask open questions about past mental-health care and family history of institutional care. (2) Listen for references to a relative's sudden personality change, long hospitalisation, or a family silence about sexuality. (3) Do not assume; ask what the client knows and how they know it. (4) Record the client's account in their words [synthesis].
• Example language (illustrative): "You mentioned your great-uncle 'was never the same' after the hospital. What do you know about what happened to him there?"
• Watch for: leading the client to a conclusion the records may not support; retraumatising detail. Working when the client feels able to bring the topic back.

4.3 Taking an affirming, non-directive stance

• Purpose / when: throughout, with every client [source: UK MoU v2, paras. 4, 6; APA 2021].
• Steps: (1) Make clear that orientation is not treated as a disorder. (2) Hold no agenda for any outcome. (3) Validate and normalise the client's experience. (4) Name stigma and its effects. (5) Check your intake forms and language for heteronormative assumptions [synthesis for 4–5].
• Example language (illustrative): "My job isn't to steer you toward or away from any identity. It's to help with what's hurting and what you want for your life."
• Watch for: subtle steering, for example treating same-sex relationships as less stable; clients testing your stance. Working when the client speaks more openly over time.

4.4 Assessment of a client affected by this history

• Purpose / when: for survivors of psychiatric "treatment" of homosexuality, descendants and relatives, or clients exposed to present-day conversion practices [synthesis].
• Steps: (1) Map exposures: what was done, by whom, when, whether voluntary or compelled. (2) Screen for depression, anxiety, self-hatred and post-traumatic stress, the harms the UN report describes [source: A/HRC/44/53 paras. 55–56]. (3) Assess suicide risk (4.5). (4) Ask about physical and cognitive health and current medical care; route medical questions to doctors. (5) Explore supports, community and faith. (6) Agree goals [synthesis for 1, 4–6].
• Example language (illustrative): "I'd like to understand what was done to you, at whatever pace feels manageable. You don't have to give me details you don't want to."
• Watch for: dissociation or flooding when recounting; minimising ("it wasn't that bad"). Working when the client can name what happened and its effects without being overwhelmed.

4.5 Suicide-risk assessment and safety planning

• Purpose / when: early with any client exposed to conversion practices, and whenever distress rises [source: A/HRC/44/53 para. 19; APA 2021 on increased suicide attempts after change efforts].
• Steps: (1) Ask directly and calmly about suicidal thoughts, intent, plans and past attempts. (2) Assess protective factors such as affirming relationships and community. (3) Build a written safety plan with the client: warning signs, coping steps, people to contact, crisis lines. (4) Discuss safe storage and removal of means, without method detail. (5) Give crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). (6) Arrange urgent care if risk is imminent [synthesis for 1–4, 6].
• Example language (illustrative): "People who've been through attempts to change who they are sometimes have thoughts of ending their life. Have you had thoughts like that?"
• Watch for: hopelessness about ever being accepted; family rejection; recent contact with a change-effort group. Follow safe-messaging principles: no method details, no glamorising. Working when the client can use the plan and reports reduced intensity.

4.6 Psychoeducation on conversion practices

• Purpose / when: when a client believes orientation can or should be changed, or blames themselves for a failed change effort [source: A/HRC/44/53 para. 20; APA 2021; UK MoU v2].
• Steps: (1) Ask what the client has been told. (2) Share, briefly and neutrally, the professional consensus: no evidence of change; association with harm. (3) Distinguish orientation from behaviour, identity and distress. (4) Invite the client's reaction [synthesis for 1, 3, 4].
• Example language (illustrative): "Professional bodies worldwide have concluded there's no reliable evidence that sexual orientation can be changed, and that trying often leaves people more depressed. That isn't a failure on your part."
• Watch for: the client hearing this as pressure to adopt an identity; religious conflict (4.13). Working when self-blame eases.

4.7 Responding to a client who asks to change their orientation or gender identity

• Purpose / when: when a client requests change [source: UK MoU v2, para. 6; APA 2021].
• Steps: (1) Thank the client for being open. (2) Explain plainly that you do not attempt to change orientation or gender identity, and why. (3) Offer to explore the distress behind the request: family, faith, safety, internalised stigma, relationship hopes. (4) Keep options open; the client defines their own resolution (including celibacy or a particular relationship form) without that being framed as change. (5) Revisit periodically [synthesis for 1, 3–5].
• Example language (illustrative): "I won't try to change your orientation; the evidence is that it doesn't work and can do harm. But I'd like to understand what makes this feel so urgent for you, and help with that."
• Watch for: the client leaving to seek change elsewhere (offer harm information and keep the door open); your own wish to persuade. Working when the focus shifts from changing to living with less distress.

4.8 Working with internalised stigma and shame

• Purpose / when: when self-hatred and shame are prominent, a harm the UN report highlights [source: A/HRC/44/53 paras. 55–56].
• Steps: (1) Trace where the shameful beliefs came from (family, faith, medical messages, historical labels such as "sexual psychopath"). (2) Separate the client's voice from inherited messages. (3) Use your usual evidence-based methods for shame and self-criticism (for example compassion-focused or cognitive work) within an affirming frame. (4) Connect the client with affirming community where wanted [synthesis].
• Example language (illustrative): "Whose voice is it that says you're broken? When did you first hear it?"
• Watch for: shame increasing when explored too fast; isolation. Working when the client describes themselves with more kindness.

4.9 Working with older LGBTQ+ survivors of psychiatric "treatment"

• Purpose / when: with older clients who were hospitalised, confined or treated for homosexuality in the mid-twentieth century [source: PBS American Experience on 1950s–60s practices; synthesis for steps].
• Steps: (1) Expect and respect mistrust of mental-health services; name it. (2) Offer control over pace, topics and records. (3) Ask about lasting effects, including any brain injury, memory or epilepsy, and coordinate with their doctors. (4) Validate that what happened was harmful and is now recognised as such. (5) Support life-review and meaning-making [synthesis].
• Example language (illustrative): "Given what psychiatry did to you, it would make sense not to trust someone like me. You can tell me if I get something wrong."
• Watch for: retraumatisation by clinical settings; cognitive impairment needing adapted pacing. Working when the client chooses to come back and sets agendas.

4.10 Family and descendant work: a relative was lobotomised

• Purpose / when: when a client learns, or suspects, that a relative was lobotomised, possibly because of their sexuality [synthesis].
• Steps: (1) Explore what is known and what is guessed. (2) Make room for grief, anger and ambiguous loss: the relative lived on but "changed" (the Norwegian parliament recorded general personality change in all lobotomised people) [source: Innst. S. nr. 276 (1995–1996)]. (3) Explore family secrecy and its effects across generations. (4) If the client is LGBTQ+, attend to fears of repetition or identification. (5) Support rituals of remembrance the client chooses [synthesis for 1, 3–5].
• Example language (illustrative): "You're grieving someone you may never have known as they were. That's a real loss."
• Watch for: conflict with relatives who want silence; assumptions about the relative's sexuality that records do not support. Working when the client can hold the story without being consumed by it.

4.11 Supporting records access and archival research

• Purpose / when: when a client wants to find out what happened to themselves or a relative [synthesis].
• Steps: (1) Clarify the client's aim: facts, recognition, redress or remembrance. (2) Help the client identify likely record holders (hospital archives, state or national archives, courts for committal records) and their access rules. (3) Prepare for distressing content: agree how the client will read records (alone, with a supporter, in session) and what to do afterwards. (4) Debrief and help the client integrate what they find. (5) Note that compensation schemes have required documentation that the operation took place, as in Norway's 1996 scheme [source: Innst. S. nr. 276 (1995–1996); synthesis for 1–4].
• Example language (illustrative): "Before you open that file, let's plan what you'll do if it says something hard to read."
• Watch for: records that use stigmatising diagnostic labels; missing records, which can feel like a second erasure. Working when the client feels the search served their purpose, whatever it found.

4.12 Coordinating care for lasting neurological or cognitive effects

• Purpose / when: for any surviving person with effects such as epilepsy, personality change or cognitive impairment documented after lobotomy [source: Museion on Danish post-operative epilepsy; Innst. S. nr. 276 on personality change; synthesis for steps].
• Steps: (1) With consent, liaise with the client's doctors; suggest neuropsychological assessment if not done. (2) Adapt therapy: pacing matched to fatigue, written summaries, involvement of carers with consent. (3) Never advise on medicines; route all medication questions to prescribers [synthesis].
• Example language (illustrative): "Would it help if I wrote down the main points from today so you have them to look at later?"
• Watch for: capacity questions; carers speaking for the client. Working when the client can engage on their own terms.

4.13 Religious clients and families

• Purpose / when: when faith and sexuality are in conflict for the client or their family [synthesis].
• Steps: (1) Use the DSM-5-TR Cultural Formulation Interview, including its supplementary module on spirituality, religion and moral traditions [uncertain: DSM-5-TR wording not verified]. (2) Where the difficulty centres on faith, "Religious or Spiritual Problem" may be recorded as Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]. (3) Work with cultural humility and recognised spiritual and religious competencies (Vieten et al. 2013) [uncertain: not verified]. (4) Explore the client's own theology and the range of views within their tradition, without arguing doctrine. (5) Avoid multiple relationships if you share the client's religious community (APA Ethics Code Standard 3.05) [source: APA Ethics Code]. (6) With consent, include family members to address rejection and safety [synthesis for 4, 6].
• Example language (illustrative): "I'm not here to take your faith away or to take your sexuality away. Let's look at how you might hold both."
• Watch for: pressure from a faith community to seek change; family threats of expulsion; the client's fear that therapy is anti-religious. Working when the client experiences less forced choice.

4.14 Safeguarding minors

• Purpose / when: when a child or adolescent is, or may be, subjected to conversion practices; the UN Independent Expert urged urgent measures to ban them for children (para. 74) [source: A/HRC/44/53].
• Steps: (1) Know your local child-protection and mandatory-reporting duties before you need them. (2) Explain limits of confidentiality at the start, in age-appropriate language, and seek the young person's assent alongside parental consent. (3) Assess immediate safety, including suicide risk (4.5) and risk of being made homeless. (4) Where a safeguarding threshold is met, report to child-protection services and record your reasoning. (5) Work with parents where safe, using psychoeducation (4.6) [synthesis].
• Example language (illustrative): "What you tell me stays between us, unless I'm worried you're not safe. If that happens, I'll tell you first what I need to do."
• Watch for: the young person withdrawing after disclosure; escalation at home. Never name minors in notes shared outside the record or in teaching. Working when the young person stays engaged and safety improves.

4.15 Duties when a colleague or institution offers conversion practices

• Purpose / when: when you learn that a colleague, service or organisation offers to change orientation or gender identity, including under mainstream labels [source: UK MoU v2, para. 2].
• Steps: (1) Do not refer, co-treat or supervise such work. (2) Where safe and appropriate, raise the concern directly with the colleague. (3) Report to the relevant professional or regulatory body according to its published complaints route; MoU signatory bodies have committed to the position that conversion therapy is unethical and potentially harmful [source: UK MoU v2, para. 3]. (4) Where a minor is at risk, follow 4.14. (5) Document what you did [synthesis for 1–2, 4–5].
• Example language (illustrative): "I'm concerned that what's being offered here is a form of conversion practice, which my professional body regards as unethical. I won't be able to refer clients to it."
• Watch for: retaliation, or clients caught between services; seek supervision and legal or professional advice. Working when clients are protected and your concern is formally recorded.

4.16 Supporting advocacy, redress and commemoration

• Purpose / when: when a client wants recognition, an apology, compensation or public remembrance [synthesis].
• Steps: (1) Follow the client's lead. (2) Share known precedents where relevant: Norway's 1996 flat payment to surviving lobotomised people, granted without individual assessment and not taxed [source: Innst. S. nr. 276 (1995–1996)]; a court-ordered apology and compensation and an ombudsman's reparations framework cited by the UN Independent Expert [source: A/HRC/44/53 paras. 79, 82]. (3) Help the client weigh the emotional costs of testimony. (4) Link to legal advice and survivor-led organisations as they describe themselves [synthesis for 1, 3–4].
• Example language (illustrative): "What would recognition look like for you? We can think through what each route might ask of you."
• Watch for: retraumatisation through repeated retelling; disappointment if redress is refused. Working when the client feels agency, whatever the outcome.

4.17 Repairing trust after harmful care

• Purpose / when: when a client's past experience of conversion practices or institutional psychiatry damages the therapeutic alliance [synthesis].
• Steps: (1) Invite feedback on how therapy feels, regularly. (2) Acknowledge, without defensiveness, the profession's role: most schools of psychology and psychiatry once acted as providers of conversion practices [source: A/HRC/44/53 para. 22]. (3) Name and repair your own missteps quickly. (4) Make collaboration visible (shared notes, joint goals) [synthesis for 1, 3–4].
• Example language (illustrative): "My profession did real harm here. I can't undo that, but I want you to have a say in everything we do."
• Watch for: idealising or vilifying the therapist; silent drop-out. Working when ruptures are spoken about and survived.

4.18 Telling the history when a client asks

• Purpose / when: when a client wants to understand this history for themselves (identity, community history, study) [synthesis].
• Steps: (1) Ask what the client already knows and why they are asking now. (2) Give a brief, accurate outline (sections 1–2), without technique or graphic detail. (3) Point to reputable sources (memorial, academic, public-broadcaster). (4) Attend to the client's emotional response [synthesis].
• Example language (illustrative): "It's part of LGBTQ+ history that's often left out. Would you like the outline, and then we can talk about how it lands for you?"
• Watch for: sensational online material; the client absorbing the history as a threat to themselves. Working when the history becomes a source of meaning or solidarity rather than fear.

4.19 Referral to affirming services and community

• Purpose / when: for additional support: LGBTQ+ community groups, peer support, affirming faith groups, medical or neuropsychology services, legal advice [synthesis].
• Steps: (1) Check that any service is affirming and does not offer change efforts. (2) Discuss the referral with the client and agree what is shared. (3) Follow up [synthesis].
• Example language (illustrative): "I've checked that this group doesn't try to change anyone. Would you like me to tell you more about it?"
• Watch for: services that use mainstream labels for change efforts [source: UK MoU v2, para. 2]. Working when the client uses the support.

4.20 Therapist self-examination and supervision

• Purpose / when: ongoing; especially when the history provokes strong reactions or when your own beliefs differ from the client's [synthesis].
• Steps: (1) Reflect on your own assumptions about orientation, faith and the profession. (2) Bring cases to supervision with someone knowledgeable about LGBTQ+ affirming practice. (3) Seek training where gaps appear [synthesis].
• Example language (supervision, illustrative): "I noticed I became defensive when the client criticised psychiatry. I'd like to look at that."
• Watch for: vicarious distress; unexamined bias. Working when your stance stays steady and non-directive under pressure.

5. Handling problems

Guidance in this section is [synthesis] unless a source is given.

• The client is stuck in self-blame for a "failed" change effort. Return to psychoeducation (4.6): the failure lies in the method, not the person [source: A/HRC/44/53 para. 20]. Work on shame (4.8).
• The client insists on change. Restate that you will not attempt it and why, then keep exploring the distress (4.7) [source: UK MoU v2, para. 6]. If the client leaves to seek change elsewhere, give harm information, a crisis plan (4.5) and an open invitation to return.
• Resistance born of mistrust of the professions. Treat it as reasonable, given the history; acknowledge it openly (4.17) [source: A/HRC/44/53 para. 22]. Do not push disclosure.
• Overwhelm when recounting or reading records. Slow down, ground the client in the present, shift from detail to meaning, and plan before further disclosure (4.4, 4.11). Use your usual trauma-informed stabilisation methods.
• Rising suicide risk. Reassess at once, update the safety plan, involve crisis services if needed, give 988 (US) or Samaritans 116 123 (UK and Ireland) (4.5). Safe messaging: no method details, no glamorising.
• Non-attendance or drop-out. Reach out once with warmth and no pressure; for minors and high-risk clients follow safeguarding and risk procedures (4.14).
• Ruptures over the therapist's stance ("you're pushing a gay agenda" or "you're not affirming enough"). Reflect, clarify the non-directive stance (4.3), repair (4.17). The aim is no agenda for any outcome [source: UK MoU v2, para. 6].
• Family conflict or rejection. Consider family sessions with consent; psychoeducate parents; assess the client's safety at home, including risk of homelessness (4.10, 4.13, 4.14).
• A minor disclosing current conversion practices. Follow child-protection and mandatory-reporting procedures; tell the young person what you must do and why (4.14).
• A colleague or service still offering change efforts. Do not refer; raise the concern; report through your professional body's published route (4.15).
• Legal uncertainty in the US. On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain]. Before the ruling, 23 states and the District of Columbia prohibited licensed providers from conversion therapy [source: America Magazine, 31 March 2026]. Whatever the legal position, professional ethics positions on change efforts stand [source: APA 2021; UK MoU v2].
• Legal status elsewhere. Bans exist or are proposed in several countries, but lists change; check official or major-news sources, dated, before advising a client [uncertain: country list not verified].
• Records are absent or ambiguous about the reason for an operation. Help the client tolerate uncertainty; avoid concluding that sexuality was the reason without evidence (4.10, 4.11).
• Cognitive impairment limits standard therapy. Adapt and coordinate (4.12); involve carers only with consent.
• The client's community or faith leader opposes therapy. Explore the client's own wishes; avoid multiple relationships (APA Ethics Code Standard 3.05); do not set yourself against the community (4.13).
• Therapist distress or defensiveness about the profession's history. Take it to supervision (4.20).
• Requests for technical detail about how the operation was done. Decline the detail; explain that you can discuss what happened and its effects, not technique; redirect to the meaning of the question for the client.

Harm account

What was actually done

• The operation. Frontal lobotomy or leucotomy, brain surgery that severed connections in the frontal lobes, was introduced by António Egas Moniz in Lisbon in 1935; Moniz received the Nobel Prize, and calls to revoke it have not succeeded. Walter Freeman and James Watts promoted it in the United States; Watts broke with Freeman in 1947, judging his later approach unethical [source: Store norske leksikon].
• Use on gay men and "sexual deviants". In the mid-twentieth century United States, gay people sent to medical institutions as "sexual psychopaths" were sometimes lobotomised by doctors who believed it would cure homosexuality; Atascadero State Hospital in California is named as the most notorious institution [source: PBS American Experience, William Eskridge]. A public-broadcast account describes an older gay man whose family had him sent for frontal brain surgery "because he was homosexual" [source: PBS American Experience]. Secondary journalism attributes to Freeman claims of operating on homosexual men, including at Atascadero [uncertain: secondary, unverified; source: Attitude, 2023]. The UN Independent Expert records lobotomy among archaic medical conversion practices (para. 46) [source: A/HRC/44/53]. Historians of psychosurgery such as Valenstein (1986) document the wider practice [uncertain: not verified].
• Scale of lobotomy generally. Norway: an estimated 2,500 to 3,000 people, 1941–1974, many under compulsory care [source: Store norske leksikon; Innst. S. nr. 276 (1995–1996)]. Denmark: about 4,500 operations 1939–1983, women over-represented, children with intellectual disability included [source: Museion, University of Copenhagen, on Kragh's thesis Det hvide snit]. How many people were operated on because of their sexuality is not documented in these sources [uncertain].
• Related psychosurgery. Hypothalamic operations on men labelled sexually deviant are covered in guide 056; brain-stimulation experiments aimed at changing gay men's orientation are associated with the New Orleans psychiatrist Robert Galbraith Heath, whose methods have been criticised [source: History.com, 2018].

What it looked like to patients and families. Lobotomy was an operation on the frontal lobes of the brain, carried out on patients in state hospitals and other institutions, frequently under compulsory care and against their will; what those selected commonly had in common was agitated or "disruptive" behaviour [source: Store norske leksikon]. Afterwards many patients were apathetic and emotionally and intellectually dulled; some had repeated severe seizures, confusion or incontinence; and in some periods death after the operation was common [source: Store norske leksikon]. In PBS American Experience, a gay man recalled an older acquaintance whose family had him sent for an operation on the front of his brain because he was homosexual, and who was afterwards, in his words, a "walking vegetable" [source: PBS American Experience]. The legal historian William Eskridge describes gay people committed to medical institutions as "sexual psychopaths" who were sometimes sterilised, occasionally castrated, or lobotomised, and says Atascadero was known in gay circles by a name likening it to a Nazi concentration camp [source: PBS American Experience]. In Norway a government commission appointed in 1991 strongly criticised the practice and found too little documentation that it worked, and in 1996 the Storting offered ex gratia compensation to people who had been lobotomised; several hundred received it [source: Store norske leksikon; Innst. S. nr. 276 (1995–1996)].

How it caused harm

• No change of orientation. There is no sound scientific evidence that sexual orientation can be changed [source: A/HRC/44/53 para. 20]; the APA states "there is no evidence of sexual orientation change" [source: APA press release, 2021].
• Irreversible injury. Norway's parliament recorded that the operation led to an irreversible result, that all lobotomised people experienced general personality change, that complications such as epilepsy were frequent, and that many died [source: Innst. S. nr. 276 (1995–1996)]. In Denmark, mortality in the 1940s was often reported at 6–10%, and at one state hospital over 30% of patients developed post-operative epilepsy [source: Museion, Kragh]. Mortality of up to about 30% in some periods is reported for Norway [source: Store norske leksikon].
• Coercion and loss of liberty. Operations were done on people under compulsory care [source: Innst. S. nr. 276 (1995–1996)]; gay men were confined as "sexual psychopaths" [source: PBS American Experience].
• Psychological harms of conversion practices. Depression, anxiety, self-hatred, post-traumatic stress and suicidal thoughts are reported; 98% of 940 surveyed people reported damage [source: A/HRC/44/53 paras. 19, 55–56]. Young people who experienced change efforts were significantly more likely to report suicide attempts [source: APA press release, 2021]. The UN Independent Expert concludes that these practices are "by their very nature degrading, inhuman and cruel" and can amount to torture (paras. 62, 83) [source: A/HRC/44/53].
• Families and descendants. Secrecy, loss of a relative as they had been, and stigma passed across generations [synthesis].

Recognising it today

• Lobotomy is no longer performed to change sexual orientation. Its legacy appears in older survivors and their families, institutional and court records, and LGBTQ+ clients' mistrust of psychiatry [synthesis].
• Present-day conversion practices may be offered covertly under mainstream labels such as therapy or counselling [source: UK MoU v2, para. 2]. Warning signs: any service, medical or otherwise, that assumes one orientation or gender identity is preferable and aims to change or suppress it [source: UK MoU v2, para. 2]; claims of "cure"; pressure from family or community to attend [synthesis].
• Offering such practices has been characterised as deception, false advertising and fraud [source: A/HRC/44/53 para. 21]. The Associated Press reported that a New Jersey jury found JONAH liable for consumer fraud in June 2015 (see 076), and Religion News Service reported Exodus International's June 2013 closure and its president's apology (see 074).

What to do instead and how to help those harmed

• Supported care. Affirming, non-directive therapy that explores distress and supports self-acceptance without an agenda for any outcome [source: UK MoU v2, paras. 4, 6]; validation and normalisation of sexual minority experience [source: APA guidelines as quoted in the APA 2021 press release]. See interventions 4.3–4.8.
• Survivors' support. Trauma-informed work, repair of trust, records support and coordination of medical care (4.9, 4.11, 4.12, 4.17); peer and survivor-led organisations as they describe themselves (4.19).
• Family support. Grief and secrecy work with descendants (4.10); family work around rejection and faith (4.13).
• Reporting and legal routes. Report colleagues or services offering change efforts through professional bodies (4.15); child-protection reporting for minors (4.14). Redress precedents include Norway's 1996 payment to surviving lobotomised people [source: Innst. S. nr. 276 (1995–1996)] and the court-ordered apology and compensation and ombudsman reparations framework cited by the UN Independent Expert [source: A/HRC/44/53 paras. 79, 82]. The UN Independent Expert recommends that States ban these practices (para. 87(a)) [source: A/HRC/44/53]. On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain].
• Crisis resources. 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland).

Sources

• Practices of so-called "conversion therapy": Report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, A/HRC/44/53 (1 May 2020)
• APA press release, 2 March 2021: resolutions on Sexual Orientation Change Efforts and Gender Identity Change Efforts (adopted 26 February 2021)
• Memorandum of Understanding on Conversion Therapy in the UK, version 2, revision A (2019), BACP
• Store norske leksikon: "lobotomi" (Per Holck, Svein Atle Skålevåg)
• Stortinget: Innst. S. nr. 276 (1995–1996), section 4, compensation to lobotomised persons
• Museion, University of Copenhagen: Jesper Vaczy Kragh, Det hvide snit: Psykokirurgi og dansk psykiatri 1922–1983 (PhD thesis)
• PBS American Experience: "Curing" Homosexuality (clip, 2011)
• History.com: Erin Blakemore, article on the origins of gay conversion therapy (22 June 2018, updated 2025)
• Attitude: Hugh Kaye, "The dark history of gay men, lobotomies and Walter Jackson Freeman II" (25 April 2023) [secondary; used only for claims marked uncertain]
• America Magazine: Supreme Court ruling on Colorado conversion therapy ban, Chiles v. Salazar (31 March 2026)
• SCOTUSblog, Chiles v. Salazar case page
• NPR (via KUNC), Supreme Court strikes Colorado ban on conversion therapy, 31 March 2026
• Jury finds promise of gay conversion therapy was a fraud (AP via CBS News Philadelphia, 26 June 2015)
• Exodus International to shut down after president's apology to gay community (Religion News Service, 20 June 2013)
• APA Ethics Code
• ICD-10-CM Z65.8 (Unbound Medicine)
• Books and papers cited: Valenstein, E. S. (1986), Great and Desperate Cures [uncertain: not verified]; Vieten, C., et al. (2013), spiritual and religious competencies for psychologists [uncertain: not verified]; APA (2009), Task Force report on appropriate therapeutic responses to sexual orientation [uncertain: not verified]; IRCT (2020) statement on conversion therapy [uncertain: not verified]; Blosnich et al. (2020), American Journal of Public Health, on sexual orientation change efforts and suicide [uncertain: not verified].