Asked Justice Thomas in yesterday's oral argument in Chiles v. Salazar.
He was speaking to the lawyer defending a Colorado law that prohibited licensed therapists from delivering treatments aimed at changing a minor's sexual orientation or gender identity.
The lawyer, Shannon W. Stevenson, responded with a surprisingly early date:Mental health care and healthcare delivered through words were both well-established at the founding of this country. At that time, such practices were primarily carried out by physicians, whose work largely involved giving advice through words.
That's a far cry from the history of regulating therapists, but I'm intrigued by the idea of people in the late 18th century talking to their doctors about their mental difficulties. And when did the licensing of doctors begin? That is a much older idea, going back the middle ages. But I think licensing therapists is much more recent, and Stevenson quickly pivots to that:
Justice Thomas asked:
With respect to this type of regulation, which acts as a prior restraint on speech, what was the first example of that?
Stevenson:
Justice Thomas, I would push back on the idea that this is a prior restraint on speech. There’s no enforcement of this law unless someone files a complaint with the petitioner’s licensing board, followed by an adjudicatory hearing and an opportunity for judicial review. It’s similar to many other statutes in that regard. It identifies a specific practice that violates the standard of care. Such statutes have existed since the late 1800s, initially governing medical professionals and later extending to mental health professionals as the field developed, with regulations now in place in every state.
Later extending to mental health professionals... but when? That was the question. The state is now regulating ideas and who can talk about them to whom. Is that something grounded in tradition? Is that like anything that happened at the time of the framing of the First Amendment? How medical is talk therapy anyway? Is it not speech?
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The phrasing "second half of the 1900s" also makes the dating sound much older than it is. If it was 1951, say that. If it was 1994, say that. I'm sure if you don't have the date at top of mind, the Court would let you look it up.
Even in mid-20th-century America, the "talking cure" was associated with Freud and assumed to be something he invented. He had precursors, but were 18th century doctors really willing to hear patients go on and on about their thoughts and feelings?
It seems at least possible to me that these arguments are intended (in part?) to conflate talk therapy with "gender affirming care," which very definitely has physical aspects*, such that if you question whether gender affirming care is first doing no harm, you have to ask the same question about talk therapy intended to help clients manage their emotional and philosophical priorities. But they're not the same.
* I think it was Strunk and White who objected to the use of "aspect" or "facet" for any but their literal meanings, since they're so vague. But I'm having trouble coming up with the right word.
"How medical is talk therapy anyway? Is it not speech?"
Don't we regulate doctors' practices when it comes to quackery? If a doctor said something patently false, such as "cancer is contagious", wouldn't the medical review boards issue sanctions or perhaps revoke his license? If so, how is therapy different? Yes, it's speech, but it can also be quackery, such as "men can get pregnant." As we've seen, freedom of speech does not mean freedom from consequences, and health care providers are held to higher standards than ordinary citizens.
As a retired psychologist, I have three things to say:
1. I am glad that I retired.
2. Therapists should be regulated in regards to their behavior.
3. Regulating conversion therapy is regulating speech. It is not that complicated an issue. The government cannot and should not do that.
Gender conversion is corruption. Gender affirmation is sex-correlated.
Speach is violence? Physical? Mental? Does it entertain abortive ideation?
Reminds me of Jordan Peterson's much talked about Canadian Bill C16. link to short
"The state is now regulating ideas and who can talk about them to whom."
"These ideas deserve respect but should not be deliberately amplified by people talking to each other. People's private conversations and who can talk to whom is not a dumping ground for negativity. That's an order." - The State of Colorado
Gemini tells me: "Counselors first became licensed in Virginia in 1976, making it the first state to do so, and the licensing process was completed nationwide when California became the last state to license counselors in 2009. The adoption of licensing varied significantly by state, with a large majority having laws by the late 1990s, but it took over a decade for the remaining states to follow suit."
So, the second half of the 1900s and into the 2000s.
A patient says: from what I know now, I want that cancer treatment that other doctors have discussed with me. Therapist might say: sure go for it. Might say: you're advanced in years, you have been through several procedures, maybe it's time to accept death. A state might say: no therapist can discuss this. Why would a state say: you may say yes, but never no? Either there's something that's up to the professional judgment of a therapist, or not.
Patient wants a healthy limb amputated, in order to feel lovable and whole. Again: is therapist allowed to say nothing other than on to the vascular surgeon?
Background legal.
Alliance Defending Freedom.
Not prepared for a question from Thomas about the historical background? Hell, that’s the one thing for which I would be prepared.
"people in the late 18th century talking to their doctors about their mental difficulties."
The 20th century made everything a medical issue, following the heroic model of science approach that all ills, of whatever kind, could be addressed by medication or other clinical treatment. That doesn't mean mental health awareness started then.
There's the great, if way too long, book Anatomy of Melancholy for instance came out in the early 1600s and reflected conversations of the time
Much mental health therapy, though not called such, took place within religious settings. The early Christian monastics were particularly attentive to mental concerns, though they certainly would be banned by Colorado since their pursuit of stillness was attentive to how the passions/sins disrupt our stillness and peace.
The original approach to sin, like came to be known as the (originally 8) deadly sins, were more therapeutic rather than guilt oriented. They were discussed in order to address underlying causes, connecting issues, practical response, for the purpose of wholeness. Christian confession, then, really was a kind of early therapy session.
Though it later became transactional and about guilt management, then fell out altogether from the Protestant side of things. John Wesley's Band movement as part of his 3 part (Society, Class, Band) Methodist strategy, really was also a kind of therapy, informed by that early Christian approach to confession within community.
The Celtic Christian tradition of soul-friend (anam cara) was even more intentionally what we would call therapy, but with a commitment to each other beyond the financial transaction of current medicalized therapy.
The problem in the modern era is that human experience was separated and spirituality tended to be cut out on the increasingly secular side and thoughtful understanding of physical and experiential realities cut out on the spiritual side. The medical side wouldn't talk or acknowledge spirituality/morality, so has just become at worst a political tool, encouraging dysfunction as valid, and at best a way to cope with realities in a segmented approach to life. The pastoral side became more about guilt and navigating the supposed Holy numinous (in Rudolph Otto's words but implicitly very common across religions). So that side cut out healing and wholeness too, making it about religious transaction in what is basically a pagan sense.
So like with a lot of western endeavors, the once integrated bond between religion/spirituality and science, psychology got divided and a questionable antipathy was imposed between these, so that states like Colorado can't even fathom there being anything other than the politicized versions of contemporary guild managed psychology having some insights into the human situation.
"If a doctor said something patently false, such as "cancer is contagious", wouldn't the medical review boards issue sanctions or perhaps revoke his license?"
I think it's hard to find cases like that, because usually such a doctor doesn't limit himself just to saying that sort of thing, but rather goes on to actually treat the patient in accordance with his quack beliefs. The disciplinary action against the doctor is thus enforcement against quack treatment, not quack statements standing alone.
"Don't we regulate doctors' practices when it comes to quackery? If a doctor said something patently false, such as "cancer is contagious", wouldn't the medical review boards issue sanctions or perhaps revoke his license? If so, how is therapy different?"
There's a lot on this subject in the oral argument, but one thing I'd say is that in talk therapy the talk is the treatment. Saying something wrong, like cancer is contagious, does not purport to be the treatment. Saying something right isn't the treatment either.
If the talk in talk therapy is about, say, how to get comfortable in your own body rather than to need to alter it, then can the state say you're not allowed to talk about that because the legislature has decided there's a scientific consensus that that talk therapy won't work (or might cause you to kill yourself)?
“He was speaking to the lawyer defending a Colorado law that prohibited licensed therapists from delivering treatments aimed at changing a minor's sexual orientation or gender identity.”
So…talking kids into changing their sexual orientation is wrong, but changing their actual sex with a knife is fine. And the SC’s decision on this matter will be informed by the state of medical practice in the eighteenth century. OK….
The Colorado position is, of course, much more religious than it realizes. It assumes a kind of soul, the real self, which is separate from the physical body (the container in which the real self can live). That can be asserted sure, but it's not really scientific to say one's self-perception defines what is really true and real about the self, and the body should be converted to be in tune with the supposed real self. Scientifically the body we have is the body we have and therapists of all people should know that our perceptions of self and others can be affected by all manner of internal and external issues. Indeed, a integrated view of human life is really the only purely scientific view as only that starts with the premise there's nothing other than the physical that makes up our whole being.
Of course people disagree with that last statement but it's absurd to take their feelings of disagreement as somehow mandating universal truth on their side. That's a religious dogma not science.
I've read a shit-ton of history and it's undoubtedly true that people of yore did talk to their doctors about their mental health concerns. Of course, the prescribed cure usually involved some combination of sulfur baths, fresh air, bleeding, opiates, and travel to Italy.
"How medical is talk therapy anyway? Is it not speech?"
Just call it something different, and then you can legislate away on the basis of that new different name. Easy peasy!
Almost all of asset forfeiture escapes Fifth Amendment objections by this method -- It shouldn't, of course, but to our chattering classes manipulating words and symbols is considered to be reality.
A College professor, a therapist and a YouTube influencer walk into a bar and orders 'The Gulag Archipelago' for everybody.
Another thing: talk therapy is not the same as attaching electrodes to genitals and shocking someone every time she shows "improper" arousal. Yet, again, the plaintiff appears to be trying to conflate the two.
A religious exemption seems more appropriate.
Here's a question:
If I'm talking with someone who has gender dysphoria, and I encourage them to transition (or I encourage them to accept their biological sex), am I practicing medicine without a license ?
Conversion therapy is a misnomer. It should be called Confirmation Therapy.
So I'm watching Murdoch Mysteries as I read this. And in one episode Dr. Darcy Garland asks his wife Julia: "So you're going to give up the practice of real medicine to go into this psychiatry stuff?" (from memory, may not be exact...)
I think in the hallowed halls of medicine psychiatry, behind closed doors, is still held in that same high esteem.
From personal experience, which from various discussions many, if not most, have experience of- anyone and everyone I've known who has gone into the practice of psychiatry, psychology, or talk therapy, have been troubled people themselves. Looking for an explanation and perhaps cure of their own problems. Sort of like the insane but true professions or Drug and Alcohol Counselors- can't be one one unless you were an alcoholic or druggie. So us people who've never been either can't go into that field- we don't understand the problems of a druggie or alcoholic. And yet, with all these understanding counselors, there is still no cure...
And then there's the bible of the field- the DSM. And in one homosexuality was a disorder, the next- it isn't! SCIENCE! Or is it? Nope. 100% political, with what is and isn't a disease or disorder determined by consensus, nothing to do with scientific proof. There is something resembling scientific discussion before a vote is taken, but no actual science involved.
As you might well surmise- I have a rather low opinion of talk therapy and therapists and counselors of any kind.
Will parents be permitted to communicate to their child who suffers from gender dysphoria?
In the case of secret not-really-art-club - but actual real secret gender confusion club, shhh don't tell you parents - a child actually did attempt to kill herself.
Can a therapist in CO tell a patient he's not a pony?
Asking for a friend.
Part of the problem is that heavily subsidized medical insurance now pays for talk therapy.
Calling dissuading someone from self-mutilation and delusion to be "conversion" therapy is the usual dishonesty of WWT. They're trying to link it to evil gay conversion, if not Christian.
Why can't these nuts go back to California as soon as the illegals leave room?
Seems there’s more than a few hundred teachers practicing conversion therapy, encouraging gender dysphoria. Plus their peers…. Is that essentially banned as well, at this point? How could all these vectors of information aimed at young people be handled with one case, one ruling?
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