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The Supreme Court heard oral argument in Chiles v. Salazar yesterday, a culture war-y case about Colorado’s law banning talk therapists from discussing “conversion therapy” with minor clients.
The oral argument ended up hinging on a different culture war question: is strictly talk therapy – without prescriptions, shocks, clinical analysis, official diagnosing, whatever – inherently medical? I.e., is addressing “mental health” through conversation really “health” at all, or is it something far simpler?
Colorado admitted a priest or a life coach could have the very conversations that it was banning therapists from partaking in; why would the difference in title suddenly change the classification of the act itself?
Some arguments tried to say that talk therapy is medical conduct because it triggers a physiological reaction in the brain, but all speech has the capacity to do that – someone telling you they love you can release dopamine and oxytocin; someone telling you “gross, no” after you ask them on a date can create a crushing response; etc. And yet, speech in a general sense continues to receive protections that conduct does not.
Does “medicine” need to be something that physically manipulates and alters the body? Does medicine need to be something directed towards solving an illness?
I can see the argument that mental health as addressed through a clinical diagnosis and prescriptions is medicine. But I am struggling to understanding talk therapy as falling into the medical category, in part because much of talk therapy isn’t related to the prevention, treatment, or cure of mental illness – a lot of talk therapy is simply asking for help with a difficult relationship, achieving a deeper understanding of self, or venting to someone who is trained to recognize self-perception road blocks.
Taking the view that medicine is about preventing/treating illness, it would be especially odd to view conversion therapy conversations as medical – after all, society has moved past viewing same-sex attraction as a disease, supposedly. So why then would conversations about attraction be medical in nature in this context? Is it from a larger need for therapy to be considered health more broadly?
I think you are placing too much on the classification of the conduct rather than the social framing.
To diverge for a bit, there are plenty of personal trainers where the fundamentals of what they do (determine what is an appropriate exercise/stretch and teach it) is substantially the same as what physical therapists do. Same for diet consultants vs dietician. Or even massage artists as compared to chiros as compared to orthopedic surgeons.
What I think is fairly critical is not about what they do in practice but how it's held out to the public and whether that person gets the assurance the practitioner is notionally vetted and supervised in some fashion (I'm not taking a position on whether this training/vetting/supervision is worth anything).
It's also similar to the way society distinguishes between being a financial advisor vs being Jim Kramer giving advice and opinions on the market. Or Caleb for that matter when it's household finances. No one is going to jail for the conduct of recommending index funds (or 0DTE SPY calls) but you can't publicly portray that as professional financial advice.
So in that lens, restrictions on what the licensed folks can do aren't triggered by conduct, but who gets to publicly represent themselves as a specific kind of professional. When the restrictions are paired to that title but not otherwise applied to individuals doings substantially the same thing, it seems clear to me that the conduct itself isn't really what's targeted.
Hold up now. The primary role of an orthopedic surgeon is to provide medical and surgical management for orthopedic issues. A chiropractor is a physical therapist with less training, delusions of grandeur, and a notable fatality rate (dissections).
Everything that a chiropractor can do that is actual medicine is better served by a PT or PM&R doctor, and a lot of what they do is placebo bullshit at best, actively dangerous frighteningly often.
I mean, even ignoring that, a chiropractor normally doesn’t do actual surgery.
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