La pseudociencia del dolor: terapia de conversión ante el Tribunal Supremo

Y además, los intentos de hacerlo generan daño documentado y grave.

And attempts to do so cause documented, serious harm.

And when you say documented harm, you're not talking about discomfort.

The numbers are striking.

Studies have shown that young people who undergo conversion therapy are more than twice as likely to attempt suicide.

More than twice.

Exactamente.

Exactly.

El estudio de la Universidad de Cornell de 2020 fue especialmente contundente.

Cornell University's 2020 analysis reviewed dozens of studies and concluded there was no credible scientific evidence conversion therapy worked, but there was solid evidence of severe psychological harm: depression, anxiety, suicidal ideation.

Analizaron decenas de investigaciones y concluyeron que no había evidencia científica creíble de que la terapia de conversión funcionara, y sí había evidencia sólida de daño psicológico severo: depresión, ansiedad, ideación suicida.

These are consequences that persist for years, sometimes for life.

Son consecuencias que se prolongan durante años, a veces durante toda la vida.

So here's the tension at the heart of this ruling.

You have a practice that every major medical body says causes harm and doesn't work.

And you have a court saying, yes, but a therapist has a First Amendment right to offer it.

That framing, I mean, it would apply to a doctor telling a patient that bloodletting cures fever.

Esa es la pregunta clave, ¿verdad?

That is the key question.

¿Hasta dónde llega el escudo de la Primera Enmienda cuando hablamos de una relación de confianza profesional?

How far does the First Amendment shield extend within a professional trust relationship?

Un médico no puede recetar un medicamento sabiendo que es perjudicial.

A doctor can't prescribe a drug knowing it's harmful.

Un abogado no puede asesorar a su cliente de una manera que le perjudique deliberadamente.

A lawyer can't deliberately advise a client to their detriment.

Pero aparentemente, según este tribunal, un terapeuta sí puede aplicar una práctica cuya única consecuencia documentada es el sufrimiento.

But apparently, according to this court, a therapist can apply a practice whose only documented consequence is suffering.

Look, I've covered plenty of courts, plenty of legal systems.

And what's interesting to me is that this argument, treating professional speech as protected expression, has been gaining ground in American jurisprudence for about fifteen years.

It's not invented from nowhere.

But this is, I think, its most consequential application.

Bueno, y lo que me resulta fascinante desde una perspectiva europea es el contraste.

From a European perspective, the contrast is fascinating.

España aprobó en 2023 la Ley para la Igualdad Real y Efectiva de las Personas Trans, que incluye explícitamente la prohibición de las terapias de conversión.

Spain passed a law in 2023 explicitly banning conversion therapy, and no one argued it violated free expression, because in Europe the legal framework starts from a different place: human dignity carries constitutional weight that simply doesn't exist in the same way in the United States.

Y nadie planteó que eso fuera una violación de la libertad de expresión, porque en Europa el marco jurídico parte de un lugar diferente: la dignidad humana tiene un peso constitucional que en Estados Unidos simplemente no existe de la misma manera.

That's a genuinely important distinction.

And I want to stay with Spain for a moment, because you lived this.

How did that law land politically in Madrid?

La verdad es que la ley trans fue enormemente polémica, pero no principalmente por la parte de las terapias de conversión.

The trans law was enormously controversial in Spain, but not primarily because of the conversion therapy ban.

Eso hubo un consenso bastante amplio.

That part had fairly broad consensus.

La controversia se centró en otras cuestiones, como la autodeterminación de género.

The controversy centered on other issues, like gender self-determination.

Lo cual ya dice algo: que prohibir prácticas que dañan a los jóvenes no resultó especialmente divisivo, mientras que en Estados Unidos ese mismo punto se convierte en un campo de batalla constitucional.

Which says something: banning practices that harm young people wasn't especially divisive in Spain, while in the United States that same point becomes a constitutional battlefield.

The religious freedom angle is where this gets really complicated for a lot of Americans, though.

Because many of the practitioners who offer conversion therapy are operating within a religious counseling framework.

And the argument they've been making for years is, this is pastoral care, this is religious practice.

Which the First Amendment also protects.

Es que ese argumento mezcla dos cosas que hay que separar.

That argument conflates two things that must be separated.

Una cosa es que un sacerdote o un pastor, en un contexto puramente religioso, exprese su opinión teológica sobre la homosexualidad.

A priest expressing a theological opinion is one thing.

Eso, uno puede o no compartirlo, pero es un terreno distinto.

A licensed therapist applying a clinical technique to a minor brought there, usually without full consent, causing demonstrable psychological harm, is something else entirely.

Otra cosa completamente diferente es que alguien con titulación terapéutica aplique una técnica clínica a un menor que ha sido llevado allí, generalmente sin su consentimiento pleno, causándole daño psicológico demostrable.

No, you're absolutely right about that distinction.

And it matters enormously who is in that room.

Because the bans that were struck down specifically targeted licensed mental health professionals, not clergy.

So the court has essentially said that a licensed psychologist can offer a treatment that their own professional body says causes harm.

That's the extraordinary thing.

Y eso tiene consecuencias prácticas inmediatas.

And that has immediate practical consequences.

Ahora mismo, en veintidós estados adicionales, un terapeuta con licencia puede ofrecer estas prácticas a un adolescente de quince años.

Right now, in twenty-two additional states, a licensed therapist can offer these practices to a fifteen-year-old, charge for it, call it therapy, and parents can bring a child there with no legal recourse for the young person.

Puede cobrar por ello.

Puede llamarlo terapia.

Y los padres pueden llevarlo allí sin que el chico o la chica tenga ningún recurso legal.

I mean, the consent question is the one that haunts me.

Adults can make decisions for themselves that others might consider harmful.

That's liberty.

But we're talking mostly about minors.

Kids who are brought to these sessions by their parents.

Exactamente, y eso es lo que diferencia este debate de muchas otras discusiones sobre libertad individual.

That is what distinguishes this debate from many discussions about individual freedom.

Un adulto que voluntariamente busca este tipo de ayuda, en un contexto de autonomía plena, es un caso diferente, aunque la ciencia siga diciendo que no va a funcionar.

An adult seeking this voluntarily is a different case, even if science still says it won't work.

Pero estamos hablando principalmente de jóvenes que son llevados por sus familias, a menudo bajo una presión enorme, y que no tienen capacidad real de rechazar lo que les están haciendo.

But we're mostly talking about young people brought by their families, often under enormous pressure, with no real ability to refuse what is being done to them.

So who's actually still doing this?

Because I think there's a perception that it's fringe practitioners in basements.

But the Trevor Project, which tracks this, estimated that about 700,000 LGBTQ adults in the U.S.

have undergone conversion therapy.

That's not marginal.

No, no es marginal en absoluto.

Not marginal at all.

Y el perfil de los practicantes es más variado de lo que la gente imagina.

The profile of practitioners is more varied than people imagine: well-funded religious organizations, licensed therapists operating within specific ideological frameworks, and so-called residential programs for teenagers, which are especially troubling because they involve confinement and isolation.

Hay organizaciones religiosas bien financiadas, hay terapeutas con titulaciones reales que operan dentro de marcos ideológicos específicos, y hay lo que se llama los programas residenciales para adolescentes, que son especialmente preocupantes porque implican internamiento y aislamiento.

Joseph Nicolosi, the great theorist of reparative therapy until his death in 2017, left a school with international branches.

La figura de Joseph Nicolosi, que fue el gran teórico de la llamada terapia reparativa hasta su muerte en 2017, dejó una escuela con ramificaciones internacionales.

Nicolosi is a fascinating and troubling figure.

He essentially built an intellectual architecture to make this look like legitimate science.

Borrowed the language of psychoanalysis, framed homosexuality as a developmental disorder, incomplete masculine identity.

It had the vocabulary of therapy without the substance.

Y eso es lo más peligroso de la pseudociencia: que cuando está bien construida, cuando utiliza el lenguaje correcto y tiene el envoltorio institucional adecuado, resulta muy difícil de combatir ante el público general.

That is what makes pseudoscience so dangerous: when it's well constructed, when it uses the right language and institutional packaging, it's very hard to combat before the general public.

Requiere que la gente confíe en el consenso científico en lugar de en lo que suena plausible.

It requires people to trust scientific consensus over what merely sounds plausible.

Y en el momento político que vivimos, esa confianza está más erosionada que nunca.

And in the current political moment, that trust is more eroded than ever.

Which connects this ruling to something bigger, doesn't it.

We're living through a moment where the authority of scientific institutions is being contested across multiple fronts simultaneously.

And a ruling like this, whatever the court intended, sends a signal.

Claro, y el señal es inequívoco: que la libertad de expresión puede ser invocada para proteger prácticas que la ciencia condena, siempre que estén suficientemente disfrazadas de terapia o consejo profesional.

The signal is unambiguous: free speech can be invoked to protect practices science condemns, as long as they're sufficiently dressed up as therapy or professional advice.

Eso abre una puerta que va mucho más allá de la terapia de conversión.

That opens a door far beyond conversion therapy.

¿Qué pasa con otros tratamientos desacreditados?

What about other discredited treatments?

¿Dónde está el límite?

Where is the line?

Let's talk about the one dissent.

Eight to one is a striking number.

Who was the lone justice, and what did they argue?

La única voz disidente fue la de la jueza Sonia Sotomayor, que argumentó precisamente lo que acabamos de decir: que la regulación de la práctica profesional no es equivalente a la censura del discurso, y que el precedente sentado por esta decisión podría utilizarse para proteger toda una categoría de daños infligidos bajo el amparo de la supuesta terapia.

The sole dissent came from Justice Sonia Sotomayor, who argued precisely what we've been discussing: that regulating professional practice is not equivalent to censoring speech, and that this precedent could be used to protect an entire category of harms inflicted under the guise of therapy.

Su razonamiento fue, sinceramente, bastante demoledor.

Her reasoning was, frankly, quite devastating.

Eight to one in a politically charged case tells you something about the current composition of that court.

But here's what I find almost more interesting than the ruling itself: the case was called Chiles v.

Salazar.

Salazar being the Colorado Attorney General.

I covered enough litigation to know that the choice of test case matters enormously.

Los casos no llegan al Tribunal Supremo por accidente.

Cases don't reach the Supreme Court by accident.

Hay organizaciones, muchas de ellas bien financiadas por grupos religiosos conservadores, que llevan años construyendo una estrategia jurídica precisamente para llegar a este punto.

Organizations, many well funded by conservative religious groups, have been building a legal strategy for years to reach exactly this point.

Es una táctica que funciona: encuentras el caso adecuado, en el estado adecuado, con el juez adecuado en primera instancia, y vas subiendo.

Find the right case, the right state, the right first-instance judge, and work your way up.

Es litigio estratégico en su forma más pura.

Strategic litigation in its purest form.

I've seen that playbook used in other contexts, press freedom cases, campaign finance.

It's effective.

You build your precedent brick by brick.

And now that precedent exists.

So what happens in states that had those bans?

Do the protections just disappear overnight?

En términos legales, sí, básicamente.

Legally, yes, essentially.

Las leyes que contravengan este fallo serán anulables.

Laws contradicting this ruling become voidable.

Algunos estados intentarán reformular sus prohibiciones de manera más estrecha, quizás centrándose no en el contenido del discurso sino en otras dimensiones de la práctica, como el consentimiento, la edad del paciente o la publicidad engañosa.

Some states will try to reframe their bans more narrowly, perhaps focusing not on speech content but on other dimensions like consent, patient age, or false advertising.

Pero será un camino complicado jurídicamente.

But that will be a legally complicated path.

The false advertising angle is actually interesting.

Because if you're telling a minor and their family that you can change their sexual orientation, and the entire scientific consensus says that's impossible, isn't that just fraud?

Es un argumento atractivo y algunos juristas lo han explorado.

It's an attractive argument that some jurists have explored.

Pero el problema es que los practicantes han aprendido a formular sus promesas de manera muy cuidadosa.

But practitioners have learned to frame their promises very carefully.

No dicen exactamente que van a cambiar la orientación sexual.

They don't say they'll change sexual orientation exactly.

Hablan de reducir conductas no deseadas, de fortalecer la identidad, de trabajar conflictos internos.

They talk about reducing unwanted behaviors, strengthening identity, working through internal conflicts.

Es el mismo producto con un etiquetado más sofisticado.

Same product, more sophisticated labeling.

That careful language is exactly what makes this so hard to fight in court.

And I think about the families, too.

Not just the kids.

Because some of the parents who bring their children to these practitioners are themselves operating from fear and love simultaneously.

That doesn't make it okay.

But it's a complicated human reality.

La verdad es que sí, y es uno de los aspectos más dolorosos de este debate.

That's one of the most painful aspects of this debate.

Hay padres que han sido convencidos, a veces por sus propias comunidades religiosas, de que están haciendo lo mejor para sus hijos.

Some parents have been convinced by their religious communities that they're doing what's best for their children.

El problema es que el daño se produce igualmente.

But harm occurs regardless.

La intención no mitiga la consecuencia.

Intention does not mitigate consequence.

Y el Estado tiene, en teoría, la responsabilidad de proteger a los menores incluso de las decisiones bien intencionadas de sus padres.

And the state has, in theory, a responsibility to protect minors even from their parents' well-intentioned decisions.

There's a parallel here to vaccine debates, to fluoride debates.

The state's role in protecting children from decisions adults make for them.

But in this case, the science is so clear, and the harm so documented, that I find it harder to see the other side than I do in genuinely contested empirical questions.

Y esa es precisamente la distinción que importa, ¿no?

That's precisely the distinction that matters.

Hay debates científicos legítimos donde la evidencia es ambigua o incompleta.

There are legitimate scientific debates where evidence is ambiguous or incomplete.

Esto no es uno de ellos.

This is not one of them.

El consenso sobre la terapia de conversión no es el tipo de consenso frágil que se construye sobre cuatro estudios mal diseñados.

The consensus on conversion therapy is not the fragile kind built on four poorly designed studies.

Es robusto, es amplio y viene de décadas de investigación sistemática.

It's robust, broad, and built on decades of systematic research.

The extraordinary thing is that in a way this ruling might accelerate a different kind of response.

Because Congress could theoretically pass federal legislation.

And some advocacy groups are already talking about pushing for that.

Though given the current political composition in Washington, I'm not holding my breath.

A ver, el camino federal me parece, en el contexto actual, prácticamente imposible.

The federal path seems practically impossible in the current context.

Pero hay otra vía que me parece interesante: la presión desde las propias organizaciones profesionales.

But there's another route that seems interesting: pressure from professional organizations themselves.

Si los colegios de psicólogos y terapeutas en los distintos estados endurecen sus códigos éticos y amenazan con retirar la licencia a quienes practiquen estas terapias, eso es una herramienta que no depende del legislador.

If state psychology and therapy boards tighten their ethical codes and threaten to revoke licenses for practitioners of these therapies, that's a tool that doesn't depend on the legislature.

That's actually a smart angle.

Professional licensing is state-regulated, it's not purely about speech.

If an ethics board pulls your license, that's a professional consequence, not a legal prohibition.

I wonder if that's where the real battleground shifts.

Exactamente.

And there are interesting movements from health insurers too.

Y también hay movimientos interesantes desde los seguros médicos.

If insurance companies refuse coverage, hospitals and clinics prohibit staff from practicing them, and universities exclude them from training programs, the practical effect can be nearly equivalent to a legal ban without passing through the constitutional filter.

Si las compañías de seguros deciden no cubrir estas prácticas, si los hospitales y clínicas prohíben a su personal ejercerlas, si las universidades las excluyen de sus programas de formación, el efecto práctico puede ser casi equivalente a una prohibición legal, sin necesidad de pasar por el tamiz constitucional.

So let's land this plane.

The science hasn't changed.

Every credible body still says this causes harm and doesn't achieve what it claims.

What's changed is the legal landscape in a significant chunk of the country.

What do you think the real-world impact is going to be over the next five years?

Bueno, mira, lo que más me preocupa no es el número de terapeutas que van a empezar a ofrecer esto de forma abierta, que probablemente no será enorme.

What worries Octavio most is not the number of therapists who will openly offer this, which will probably not be enormous.

Lo que me preocupa es el mensaje que se envía a los jóvenes LGBTQ en esos estados: que el sistema legal no considera que su bienestar psicológico merezca protección.

What worries him is the message sent to LGBTQ young people in those states: that the legal system does not consider their psychological wellbeing worth protecting.

Ese mensaje tiene un coste que no aparece en ninguna estadística inmediata, pero que se paga con sufrimiento real.

That message carries a cost that appears in no immediate statistic, but is paid in real suffering.

I've spent a lot of years in places where the gap between official language and lived reality was enormous.

And the one thing I know is that legal frameworks shape what's socially possible, even before anyone acts on them.

A ruling like this doesn't just open a door for practitioners.

It tells a teenager in rural Alabama something about what the law thinks of them.

Y eso, en última instancia, es lo que convierte este fallo en algo más que una cuestión jurídica técnica.

That is ultimately what makes this ruling more than a technical legal question.

Es una declaración sobre qué vidas importan y quién merece protección.

It is a statement about which lives matter and who deserves protection.

La ciencia ya ha dado su veredicto hace décadas.

Science delivered its verdict decades ago.

Ahora es la política la que decide si ese veredicto tiene alguna consecuencia práctica.

Now politics decides whether that verdict has any practical consequence.

Y la respuesta, por ahora, parece ser que no.

And the answer, for now, appears to be no.