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May 8, 2012 Via Facsimile and First Class Mail Dr. Victor Richenstein

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May 8, 2012 Via Facsimile and First Class Mail Dr. Victor Richenstein Fighting Hate Teaching Tolerance Seeking Justice Southern Poverty Law Center 400 Washington Avenue Montgomery, AL 36104 334.956.8200 www.splcenter.org May 8, 2012 via facsimile and first class mail Dr. Victor Richenstein, M.D. Chair, Ethics Committee Oregon Psychiatric Association P.O. Box 2042 Salem, OR 97308-2042 Fax: 503-587-8063 Re: Ethics Complaint Concerning Dr. <<redacted>><<redacted>> Dear Dr. Richenstein: We write to you on behalf of Maxwell Stanton Hirsh regarding recent unethical treatment Mr. Hirsh received from one of your members, Dr. <<redacted>><<redacted>>. During that treatment, Dr. <<redacted>> regularly challenged and refused to honor Mr. Hirsh’s clearly articulated sexuality—Mr. Hirsh is gay—and, indeed, it appears that Dr. <<redacted>> practiced discredited “conversion ther- apy” against Mr. Hirsh’s wishes in an attempt to make Mr. Hirsh identify as heterosexual. On behalf of Mr. Hirsh, we request that the Oregon Psychiatric Association initiate an ethical proceeding and take appropriate action against Dr. <<redacted>> including reprimand, suspension, or expulsion as a member of your organization. Brief Statement of the Facts: Mr. Hirsh attended therapy sessions with Dr. <<redacted>>, seeking treatment for his depression, from February through August of 2011. During those sessions, Mr. Hirsh repeatedly told Dr. <<re- dacted>> that he was gay, and that he was confident in and comfortable with his own sexual orien- tation. Mr. Hirsh made plain that he was seeking care to treat his depression, not “cure” his sexual orientation. While Mr. Hirsh did express feelings of depression and social anxiety attributable to the homophobia he experienced at his prior college after revealing his sexual orientation to other students, Mr. Hirsh was—and is—comfortable with being a gay man. Mr. Hirsh told Dr. <<redacted>> that the primary objectives motivating his enrollment in treatment were to reduce his feelings of de- pression, enhance his social life, and pursue fulfilling romantic relationships with men. Rather than assist Mr. Hirsh in developing ways of achieving his clearly articulated goals for treat- ment, when Mr. Hirsh explained his negative experiences related to his disclosure of his sexual orientation, Dr. <<redacted>> professed his determination that Mr. Hirsh did “not seem gay.” Indeed, despite Mr. Hirsh’s unequivocal statements about his sexual attractions, Dr. <<redacted>> said that he did not believe that Mr. Hirsh was gay, and made Mr. Hirsh’s sexual orientation a central focus of the treatment. In particular, Dr. <<redacted>> repeatedly delved into stereotyped and discredited potential “causes” of Mr. Hirsh’s same-sex attractions, at different times suggesting that Mr. Hirsh’s poor relationships may 8, 2012 / page 2 with women, deficient bonding with men, distant relationship with his father, or his failures in sports might have “caused” his homosexuality. Dr. <<redacted>> encouraged Mr. Hirsh to try to strengthen his relationship with his father, to engage in more “masculine” pursuits, to get involved in team sports, and to develop platonic relationships with men, including seeking out nurturing, yet non- sexual, father figures. This was despite Mr. Hirsh’s specifically seeking treatment in order to help him improve his romantic relationships with men. Dr. <<redacted>> also told Mr. Hirsh that if he was indeed gay, as Mr. Hirsh kept insisting, then Mr. Hirsh would need to accept that his love life would always be dissatisfying, disappointing, and unstable, thus recasting stereotypical perceptions of gay sexuality as objective medical advice. Fearing that Dr. <<redacted>> was practicing a form of therapy directed at changing his sexuality (“conversion therapy”), Mr. Hirsh discontinued his sessions with Dr. <<redacted>>. In response, Dr. <<redacted>> called and pressed Mr. Hirsh to return as his patient. Dr. <<redacted>> reassured Mr. Hirsh that he had other gay patients but had perhaps expressed some “subconscious homophobia,” which they could address if it came up again. Dr. <<redacted>> said that given the time and work they had undertaken, Mr. Hirsh should continue therapy. Mr. Hirsh, wishing relief from worsen- ing depression, cautiously agreed to resume treatment with Dr. <<redacted>>. But after Mr. Hirsh resumed treatment, Dr. <<redacted>> continued his singular focus on Mr. Hirsh’s orientation. In response to the continued focus on Mr. Hirsh’s sexual orientation, Mr. Hirsh ultimately broached his concerns that Dr. <<redacted>> appeared to be practicing conversion therapy. Dr. <<redacted>> said that he didn’t think that he personally would be able to change someone’s orientation, but explained that he thought people’s concerns about it were overblown and that he expected such therapy to increase in prominence in the future. Dr. <<redacted>> claimed that he had not attempted to change a patient’s orientation, but admitted that he had studied under a prominent conversion therapist in New York. In the same conversation, Dr. <<redacted>> further explained that he dis- agrees with the term “homophobia” because it “pathologizes” people who dislike gay people; yet, “heterophobia” is a problem that exists among gay people. Shortly after these discussions, Mr. Hirsh terminated his course of treatment with Dr. <<redacted>>. Violations of Principles of Medical Ethics: The Principles of Medical Ethics (“Principles”) adopted by the American Psychiatric Association (“APA”) help ensure that the public can trust the profession and not be harmed by that trust.1 By discounting and attempting to alter Mr. Hirsh’s sexual orientation through psychotherapy, Dr. <<re- dacted>> violated at least the following Principles and betrayed Mr. Hirsh’s trust. In particular, Dr. <<redacted>>: • failed to provide “competent medical care” and “uphold the standards of professionalism” (Sec- tions 1 & 2); • provided treatment known to present significant risks without established benefit specific to that treatment (Section 5); 1 See APA, The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry (2010), www.psychiatry.org/ practice/ethics/resources-standards/ethics-resources-and-standards. may 8, 2012 / page 3 • failed to obtain informed consent and “make relevant information available” about treatment (Sections 4 & 5); and • failed to provide care with “compassion and respect for human dignity and rights” (Sections 1 & 4). Because those Principles are interconnected, they should be considered collectively, in relation to one another. For example, Dr. <<redacted>>’s treatment reflected inaccurate ideas about sexual orienta- tion leading to a lack of competent care and disrespect for Mr. Hirsh’s orientation. And by failing to uphold standards of competence, client rights, and informed consent, Dr. <<redacted>> created conditions that harmed Mr. Hirsh through false information and abuse of trust. Failure to Provide Competent Care Dr. <<redacted>>’s actions violate Sections 1 and 2 of the Principles requiring competent psychiatric care and adherence to standards of professionalism by failing to respect Mr. Hirsh’s sexual orienta- tion and provide him with the appropriate treatment for his depression and social anxiety. Moreover, Dr. <<redacted>> demonstrated incompetence because rather than work to reduce the effects of the homophobia that Mr. Hirsh had experienced, Dr. <<redacted>> enhanced those harms. Indeed, Dr. <<redacted>> chose to direct his focus on what he believed to be the causes of Mr. Hirsh’s orientation, presumably in order to encourage Mr. Hirsh to question whether he was in fact gay. Dr. <<redacted>> then suggested to Mr. Hirsh that he would likely lead an unhappy life and have unful- filling romantic relationships if he continued to identify as gay—incredibly damaging statements to any patient in a vulnerable state like Mr. Hirsh. Dr. <<redacted>> failed to provide competent care through these actions as well as through failing to adhere to the other Principles discussed below. Provision of Treatment Contrary to “Scientific Knowledge” Related to not providing competent care, Dr. <<redacted>>’s apparent attempts to practice conversion therapy techniques on Mr. Hirsh also violate Section 5 of the Principles. Section 5 states in relevant part that a psychiatrist “shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, [and] make relevant information available to patients.” Dr. <<redacted>>’s treatment reflects discredited views about homosexuality and the efficacy of thera- peutic methods aimed at changing a person’s sexual orientation. Despite his denial, aspects of Dr. <<redacted>>’s treatment unmistakably followed central tenets of conversion therapy. These aspects include Dr. <<redacted>>’s intense focus on Mr. Hirsh’s relation- ship with this father and Mr. Hirsh’s need to develop non-romantic relationships with other men, including other father figures. Dr. <<redacted>>’s repeated prescription to Mr. Hirsh to join team sports is also identical to treatment by conversion therapists for men with a “homosexual problem.” Other indications include Dr. <<redacted>>’s assertion that Mr. Hirsh did not seem gay and his reinforcement of negative stereotypes about gay people, such as an inability to form fulfilling relation- ships. These and the other troubling facts alleged by Mr. Hirsh warrant serious inquiry by the Oregon Psychiatric Association. The practice of conversion therapy violates this Section as well as other ethical standards
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