Abstract
This accomplished monograph is as intriguing as it is disturbing. In it, Tommy Dickinson reveals yet another murky period of psychiatric history: the administration of aversion ‘therapy’ in mental hospitals for homosexuality and transvestism. This he contextualizes within changing attitudes towards ‘sexual deviance’ that juddered along from criminality in the pre-war period to pathology and, finally, to some degree of acceptance in the 1970s. Part of the originality of this study is in Dickinson’s focus not on hubristic doctors, but on the nurses who actively participated in these treatments, some of whom were gay themselves.
How could this have been so? Dickinson draws on a wide range of primary sources to layer his arguments from the widely political to the deeply personal. These include extracts from 25 interviews: eight with former patients who had submitted to the treatments in the hope of being ‘cured’ and 17 with former nurses, both male and female. Two interviewees from the latter group began their nursing careers during the 1930s. Indeed, the careful methodological approach and powerful oral histories that Dickinson has used to underpin his arguments are among the book’s strengths.
Dickinson begins by describing the wider social and political influences that brought about shifting perspectives towards non-normative sexual behaviours. As post-war anxieties around the importance of family life began to dissolve into a growing emphasis on individual rights during the 1960s, homosexual behaviour was viewed as less of a criminal act and more of a treatable pathology, particularly following the publication of the Wolfenden Report in 1957. Men who were caught having sex with other men were increasingly offered the choice of prison or hospital. Unsurprisingly, many choose the latter even though they were largely unaware of what they had signed up for: humiliation, degradation and pain inflicted on them through brutal chemical or electrical aversion treatments. The former involved the use of emetics, including apomorphine, to induce nausea while the patient was simultaneously shown images of naked men and played tape recordings to reinforce the moral abhorrence of his desires. He might then be left to languish in his own faeces, urine and vomit for days. Alternatively, the patient could be wired up to an electrical grid on the floor and painful electric shocks were passed through his feet whenever he became sexually aroused at the sight of a naked man. Both treatments, along with hormone therapy, were acceptable medical fare, despite the evidence that over the longer term they completely failed to achieve their purpose. Indeed, one of the most harrowing aspects of the patients’ stories is their desperation to be cured of their ‘disorder’, so powerful was the force of social opprobrium around non-heteronormativity at the time. Some never recovered from the experience.
What then of the nurses who administered these treatments? Dickinson contends that some became almost inured to the dehumanizing effects of painful and humiliating aversion treatment, due to the more widespread use in mental hospitals from the late 1930s of other somatic therapies such as insulin treatment, electrocompulsive therapy (ECT) and leucotomy. Some nurses, including those who were gay themselves, appear to have genuinely believed that they were helping patients who were tortured by self-disgust and shame due to the nature of their sexual desires. Inevitably, a range of conflicting emotions arose for some of the nurses who were required to inflict punitive treatments on men who were experiencing the same forbidden desires as themselves. How they psychologically processed this is one of the most unsettling aspects of the book.
Other factors were at play that put nurses in an almost impossible position, namely inflexible hospital structures and job insecurities. Until the 1960s – and arguably well beyond – mental health nurses played a distinctly subordinate role to doctors within a rigid hierarchical system that placed them firmly on the lower levels where, literally, the dirty work was done. Adding to pressures from within was the threat of change from without. From the late 1950s, the political impetus to shift mental health care from the asylum to the community began to gather momentum. The prospect of job losses became a real possibility for nurses, and flouting orders by refusing to participate in administering treatments would hardly bode well for their future prospects.
Yet small acts of subversion did take place – and with growing boldness from the 1960s as the notion of treating homosexuality became increasingly unacceptable. This was reinforced by the passing of the Sexual Offences Act of 1967, which decriminalized sex among consenting adult men in private. The Gay Liberation Front, other counter-culture movements and some elements of the popular press played a vital role in bringing gay identities and lifestyles out of the shadows and into the daylight where the process of wider societal acceptance could begin. Even in psychiatry, a decision was finally made in 1973 to remove ‘homosexuality’ from the Diagnostic and Statistical Manual of Mental Disorders (DSM-II). Nursing started to change as well. A new ‘nurse-therapist’ role began to attract university-educated staff whose ideas around personal authenticity and freedom started to destabilize some of the old institutionalized asylum cultures. By the late 1960s, treating men for their sexual behaviours had become disconcertingly inappropriate.
This well structured book makes a valuable contribution to the historiographies of psychiatric treatments, mental health nursing and sexuality, and is therefore highly recommended to both students and established scholars. Not only does it reveal yet another dark episode of twentieth-century psychiatry in Britain, but it raises important questions around clinical empathy and the consequences of societal attitudes and institutional structures on the very real lived experiences of residents and patients.