High-Tech Conversion Therapy The Machine in the Garden of Desire Jenny Dyck Brian, Arizona State University Patrick R. Grzanka, Arizona State University At the end of their article, Earp, Sandberg, and Savulescu (2014) argue that commenters need to take seriously the moral status of the project, and suggest that it would be more productive to focus on the ends for which biotechnolo- gies may be used, rather than the means or the complexities of contemporary culture. We argue that serious moral in- vestigation of the potential therapeutic interventions is not possible if we omit the role of culture in producing the very moral dilemmas raised by scientific and technological “in- novations” or start with simplistic assumptions about users and ends. In our brief commentary, we focus on two of the false analogies and assumptions the authors make with respect to the imagined technology and its potential users. In their attempt to work through the ethical dilem- mas posed by “‘high-tech’ conversion therapies,” Earp and colleagues analogize body modification practices, such as breast augmentation, and sexual orientation (SO) change ef- forts to argue that use of the therapeutic intervention could be considered ethical if an individual demonstrated both suffering and voluntariness. In doing so, they efface the differences between changing the shape of one’s body and eliminating or enhancing feelings of desire, as if cosmetic surgery were directly analogous to neuroscientific transfor- mations of the brain. While investigating the motivations behind such “elective” biomedical interventions, the au- thors acknowledge that sexism, racism, and homophobia are real, but ultimately argue that these social forces do not preclude science and medicine from helping the individual, rational subject achieve her desired ends. From this perspec- tive, social structures are coercive, but the science itself is not. Rather, for the authors, these therapies are potentially liberating. However, this imagination—of the independent actor who is empowered to make rational choices about her body—is problematic because it treats the science as distinct from political, social, and cultural contexts or economic con- siderations, and it views biomedicine only in terms of what it offers rather than how it limits and constrains agency. Abundant evidence, however, has exposed how cultural norms shape and are shaped by the form, content, mar- kets, and delivery of biomedical technologies that target the body, including plastic surgery (Balsamo 1996), sexual enhancement drugs (Mamo and Fishman 2001), treatments of intersex (Fausto-Sterling 2000), and vaccinations for sex- ually transmitted infections (Casper and Carpenter 2008). As technologies emerge, they coconstitute or coproduce so- cial orders, including norms, values, and social categories. In this context, the notion of “agency” is thoroughly un- Both authors contributed equally to this commentary and are listed alphabetically. Address correspondence to Jenny Dyck Brian, PhD, Honors Faculty Fellow, Barrett, The Honors College, Arizona State University, PO Box 871612, Tempe, AZ 85287-1612, USA. E-mail: jenny.brian@asu.edu dermined by the very terms of contemporary biomedical- ization (Clarke et al. 2003), in which health enhancement, body customization, and risk prevention strategies man- ifest as imperatives, not choices. Accordingly, we cannot meaningfully evaluate the moral status of the project if we do not take seriously the structural, ideological work “high-tech conversion therapies” do to reinforce traditional patterns of power, authority, and heteronormativity. There is a reason, of course, that we are not currently debating the ethics of hypothetical neuroscientific treatments to cure homophobia. As such, the ontological categories on which Earp and colleagues base their argument deserve closer scrutiny. In the interest of “opening up” the ethical terms of SO mod- ification technologies, the authors draw upon normative scientific understandings of SO that define the construct in terms of two mutually exclusive components: namely, ba- sic attractions (i.e., desire) and identity (i.e., the personal and social manifestations of psychosexual dynamics). This is neither accidental nor inconsequential; indeed, in order to arrive at the suggestion that the development of SO “con- version” biotechnologies need not be “cause for alarm,” the authors rely upon a tacit ontology of SO that reduces SO to a set of biogenetic and social interactions that are rooted in the body and extend outward into social life. In other words, the body is the source of desire; the social universe, including what people do with those desires—in terms of naming, articulating, and acting upon them—is the consequence. Though this rendering of SO is effectively commonsense knowledge in the biosciences, such a belief system is neither value neutral nor an unfiltered reflection of empirical reality. Indeed, their definition of SO is rooted in a particular “essentialist” epistemology that stands in stark contrast to “social constructionist” accounts of SO that assert radically different ontologies of sexuality. Social construc- tionists, inspired by philosophers such as Michel Foucault (1978) and Judith Butler (1993), as well as rigorous empirical observation of the lived experiences and institutions that imbue SO with meaning, take up contrary positions with important consequences for Earp and colleagues’ argument. Though social constructionists vary in their particular definitions of SO at least as much as essentialists, they tend to agree that the body—its affects, impulses, desires—is less the cause of SO than the ossified effects of social dynamics that produce normal and abnormal bodies, emotions, and behaviors. Butler (1993), for example, sees the body as a so- cial object just like social categories such as sexuality and January–March, Volume 5, Number 1, 2014 ajob Neuroscience 17