Protestors march through Chinatown en route to the Justice department after a rally in response to the suicide of transgender Ohio teenager Leelah Alcorn, on Jan., 10, 2015 in Washington, DC. (Photo by Bill O'Leary/The Washington Post)

“If you are reading this, it means that I have committed suicide and obviously failed to delete this post from my queue. Please don’t be sad, it’s for the better. The life I would've lived isn't worth living in … because I'm transgender.”

Seventeen-year-old Leelah Alcorn wrote this line in a suicide note she posted on her Tumblr blog in December 2014. Born Joshua Ryan Alcorn in Kings Mills, Ohio, outside Cincinnati, Alcorn came from a conservative Christian household, which, she wrote, reacted “extremely negatively” to her decision to come out as transgender. Convinced that she would never be able to transition successfully into a woman, Alcorn committed suicide by walking out into traffic on Interstate 71 in Ohio on Dec. 28.

A message that Alcorn posted on Reddit in November, a month before her death -- titled “Is this considered abuse?” -- shows just how trapped she felt by her situation. Alcorn said her parents denied her request to start treatment to transition to a woman and cut her off from friends and social media. "The[y] would only let me see biased Christian therapists, who instead of listening to my feelings would try to change me into a straight male who loved God, and I would cry after every session because I felt like it was hopeless and there was no way I would ever become a girl," she wrote of her attendance in these sessions, known as "conversion therapy."

"Please help me, I don't know what I should do and I can't take much more of this," she writes at the end of the note. "I'm stuck.”

Her post generated a huge response on Reddit: In more than 100 comments, people variously counseled her to stick it out until she turned 18, seek legal emancipation, or reach out to child services or LGBT organizations for help. "Stay strong and don't allow yourself to internalize any of their hate. You are good, you are worthy of love, and you can be exactly who you want to be," responded Reddit user Alyssa_B.

Alcorn's death has helped power a political movement to ban the type of counseling that she received. And it was a stark and painful reminder that the feelings Alcorn experienced are common among lesbian, gay, bisexual and transgender teens, who face harassment, discrimination and a sense of being different in addition to the normal pressures of teenage life.

Following her death, the Transgender Human Rights Institute, an advocacy organization, started a petition on the White House Web site in January to call on U.S. government leadership to forbid licensed clinicians from practicing conversion therapy -- a range of mental health practices that seek to change the sexual orientation or gender identities of gay, lesbian, bisexual and transgender people -- on minors. Psychoanalytic and therapeutic treatments for sexual orientation fell out of favor in the medical community after the 1960s, but have continued to receive support from some religious organizations and practitioners that see what they call "unwanted homosexuality" as a condition that can be cured or suppressed.

The petition, dubbed “Leelah’s law,” gathered more than 100,000 signatures by April. On Wednesday, the White House responded to the petition, supporting efforts at the state level to ban conversion therapy for minors. "The overwhelming scientific evidence demonstrates that conversion therapy, especially when it is practiced on young people, is neither medically nor ethically appropriate and can cause substantial harm," wrote Valerie Jarrett, a senior adviser to President Obama.

Two days after Alcorn's death, mother Carla Alcorn gave an interview to CNN in which she referred to her child as "Josh" and said she and her husband didn't support their child being transgender because of religious reason. "But we told him that we loved him unconditionally. We loved him no matter what."

In many parts of America, conversion therapy is still a divisive issue. California, New Jersey and Washington, D.C. have all banned licensed professionals from using conversion therapy on minors, and 15 other states are considering similar legislation. (Alcorn apparently saw a psychiatrist who prescribed her medication, but it isn't clear whether the Christian therapists she talked about were licensed.) But a ban on conversion therapy for minors failed in the Colorado Senate on Wednesday, and a similar bill failed to pass in New York last year.

In the opposite direction, some states are now considering legislation to protect practitioners of conversion therapy. A bill introduced in Oklahoma would bar state or local governments from restricting or prohibiting same-sex attraction or “gender confusion” counseling, as long as it did not involve electro-shock, ice baths, touch therapy and certain other techniques. The bill died in March without coming to a vote.

The map below shows states considering legislation that would roll back LGBT protections or promote conversion therapy, as of March 24, according to the Human Rights Campaign.


Map of LGBT-related state legislation, as of March 24, 2015. Human Rights Campaign

Opponents and proponents of conversion therapy are also fighting it out in the courts. In New Jersey, the Southern Poverty Law Center filed a lawsuit in November 2012 against a gay conversion therapy referral service, called Jews Offering New Alternatives for Healing, on behalf of four men who say therapists affiliated with the service subjected them to humiliating treatments. The judge in the case ruled in February that advertising homosexuality as a curable mental disorder would violate the state’s Consumer Fraud Act.

The fraught history of conversion therapy

The battle over conversion therapy revolves around the nature of homosexuality, what exactly conversion therapy consists of, and whether it is harmful or coercive when practiced on minors.

The American Psychiatric Association declassified homosexuality as a disorder in 1973, and echoing the broad consensus, the American Psychological Association clearly says that "both heterosexual behavior and homosexual behavior are normal aspects of human sexuality." A slew of medical organizations -- including the American Medical Association, the American Psychiatric Association, the American Psychological Association, and the World Health Organization -- have spoken out against conversion therapy. The American Psychoanalytic Association has said there is no evidence that it works, and that it can result in “substantial psychological pain by reinforcing damaging internalized attitudes.”

"The bottom line from a scientific perspective, from our perspective, there is no scientific evidence to support such therapies, that they work or that they’re safe," says Clinton Anderson, the director of the Lesbian, Gay, Bisexual and Transgender Concerns Office of the American Psychological Association.

But while it fell out of favor with the broader mental health community, conversion therapy began to resurface elsewhere in the late 1980s, in part due to support by conservative religious organizations such as Focus on the Family.

Dr. Jack Drescher, a psychiatrist and psychoanalyst who is a leading voice against conversion therapy, described its rise as a backlash to the gay rights movement, part of the politics and culture wars that accompanied the push for expanded gay rights and gay marriage.  "Any time a committee," Drescher said, "was considering passing a gay rights law, the hearings would include testimony from so-called ex-gays saying, 'I used to be gay, I’m not anymore. You shouldn’t be giving gay people rights, because they’re not like black people. No one is born gay, and they can change it if they just change their minds.'"

Proponents of conversion therapy reject this political motivation and say they are truly trying to help. "I was part of Exodus [International, an "ex-gay" Christian ministry] in the 80s and 90s ... and the goals of Exodus were to try to provide help for people that wanted it," said Jeff Johnston, an issues analyst at Focus on the Family. "And we were grateful when organizations like Focus on the Family came along and said, yeah, we want to let other people know that there’s help and that people can leave homosexuality if they want."

Dr. Joseph Nicolosi, a clinical psychologist who developed a type of conversion therapy called reparative therapy, describes his practice as a kind of non-coercive talk therapy. Reparative therapy, which seeks to repair "the male homosexual's emotional alienation with men," engages clients in a dialogue and provides them with education that is "scientifically grounded," says Nicolosi. "We are not forcing people to change, we are not shaming them, we are not making them feel bad about themselves."

Critics cite numerous examples of abuse and impropriety. Part of the issue is that what constitutes "conversion therapy" is somewhat ill-defined; it encompasses a broad range of practices that draw on behavioral and psychoanalytic therapy, hypnosis, and prayer, among other influences. “Conversion therapy involves techniques that people learn on the street," says Drescher. "It’s not really taught in training programs for psychiatrists or psychologists or clinical social workers.”

And other accounts show conversion therapy can wander into more unusual territory, from touch therapy to Aboriginal ceremonies to hypnosis. And many individuals have reported abuse. Some conversion therapists employ a form of psychological treatment known as “aversion therapy,” for example inducing discomfort, pain, electric shocks, nausea or vomiting while showing the patient homoerotic images. In the case against JONAH in New Jersey, the plaintiffs allege that conversion therapists had them engage in degrading practices, like stripping naked and beating an effigy of one of the plaintiff's mothers. (Defenders of JONAH say the lawsuit is without merit.)

Mental health professionals are particularly concerned about increasing psychological pressure on LGBT kids, who already have much higher rates of depression, anxiety and suicide compared with heterosexual youth. In a poll by the Pew Research Center, roughly one-third of LGBT respondents said they had been physically threatened or  attacked, while 40 percent said they had been rejected by a friend or family member because of their sexual orientation or gender identity.

SDT-2013-06-LGBT-0-02

A study by San Francisco State University found that LGBT youth who were "highly rejected" by their parents or caregivers because of their sexual orientation or gender identity were eight times more likely to have attempted suicide and six times more likely to report high levels of depression than other LGBT youth.

Anderson says the idea of promoting a therapy to change something that is not a disorder "fundamentally problematic." "We think [it] contributes to the atmosphere in society of stigma that causes prejudice, causes discrimination, causes great distress."

An experience with conversion therapy

Mathew Shurka, a 26-year-old who was raised in Great Neck, a suburb of New York, said he also experienced odd and coercive treatment during his five years of conversion therapy. Between the ages of 16 and 21, Shurka saw four different conversion therapists and went to one conversion therapy camp, called Journey to Manhood. He is now a spokesman for the National Center for Lesbian Rights’ anti-conversion therapy campaign, called #BornPerfect.

Shurka says his experience consisted mostly of talk therapy, with a few more disturbing practices. One therapist encouraged him to use masturbation and pornography as a tool to associate with "the imagery of the female body,” he says.

He also prescribed an intense program of male bonding, which involved spending as much time with men and avoiding women in an effort to eschew effeminate behaviors. Unfortunately, this also meant that Shurka avoided contact with his sisters and his mother for three years. “The goal was to have as little communication with her as possible,” he says of his mother. “It started to really tear apart my home."

Shurka at 18, when he was in conversion therapy. Photo courtesy of Mathew Shurka. Shurka at 18, when he was in conversion therapy. Photo courtesy of Mathew Shurka.

As he got older, Shurka says that his efforts at male bonding actually made him more popular at school, and he became intimate with a woman. At the time, he saw that as a sign that the therapy was working. But he said his depression and attraction to men was only growing. His grades dropped and he began to contemplate suicide. And every time he got into a sexual situation with a woman, he would have a panic attack.

Shurka says the darkest point came when his therapist and his father sought to get him Viagra pills to help him sleep with women. “This is probably the most traumatizing part, because I’m 18 years old, I was healthy, I was young, I did not have erectile dysfunction, and I’m in this bathroom taking these pills waiting to have sex with a woman in the room next door, just so I can get the approval of my community or my therapist or my father,” he says. “I really felt like I was disabled.”

Like other kids who have gone through conversion therapy, Shurka couldn't shake the belief that, because he was still gay, he had failed. After becoming estranged from his father and reuniting with his mother, he enrolled himself back into conversion therapy for several years, before accepting his sexual orientation at 21.

Related stories:

-Leelah Alcorn's death was tragic, but harassing her parents is not the answer

-The U.S. is still divided on what causes homosexuality

-Map: More than half of states may roll back LGBT rights