Author: HHS Contributor

Stephen T. Casper, The Neurologists: A History of a Medical Specialty in Modern Britain c. 1789-2000

Manchester, Manchester University Press, 2014, 288 pages, hardcover £70.00, ISBN: 978-0-7190-9192-6

Stephen T. Casper’s first book is an interesting reflection on the early origins of neurological sciences and the reasons why they came to dominate descriptions of mental processes and human reasoning.  Casper uses traditional techniques in the history of medicine to reveal the long history of the birth and development of the specialism of neurology in Britain.

One of the most important contributions of this book is its consideration of how late-nineteenth and early-twentieth century descriptions and understandings of the brain and the nervous system fell within a wider humanistic project. Casper’s exploration of the archives of the Neurological Society of London offers a unique window onto the nature of debates on topical issues at the time, in particular the conflict between specialisation and general medicine or generalist approaches to the body and mind.  As Casper argues, ‘specialisation’ was an idea that was ‘peculiar to modernity’ which otherwise employed the language of evolution to develop organic models of society ultimately within functionalist sociology. His reflection on neurology as a discipline thus offers insights into how and why neurological hypotheses and ideas prospered in the British context as well how neurologists themselves negotiated their ability to offer wider insights on human nature whilst simultaneously protecting their own science.

Although the term ‘neurology’ can be traced to 1664 in the work of Thomas Willis, and was used by phrenologists in the late 18^th-century, it appeared rarely in both medical and lay literature until the latter part of the 19^th century.  The specialty of neurology also emerged at this time. Its origins are associated with the foundation of the journal Brain: A Journal of Neurology in 1876. However, Casper argues, neurology did not achieve a coherent form until the interwar period.  And even when it did, there were always attempts to protect it from the constraints of disciplinary limitations and to promote its insights more widely.

The Neurological Society of London had some pretty important members.  In 1886, John Hughlings Jackson became first president of the Society, its members also consisting of David Ferrier, who had famously experimented on cerebral localization of function in animals; Francis Galton, statistician and general polymath; and Herbert Spencer who had been critical in establishing the discipline of psychology using the logic of evolutionary sciences. The society brought thus together a highly significant group of intellectuals, providing a venue for the integration of multiple fields of knowledge.  Most physicians who were members of the Society regarded themselves as generalists with broad interests in physiology, medicine and the general issue of nervous conditions. As Robert Young has argued, these thinkers were critical to harnessing epistemological questions in psychology and relating them to theories of brain and nerve function. [ref]Robert M. Young, Mind, Brain and Adaptation in the Nineteenth Century : Cerebral Localization and Its Biological Context from Gall to Ferrier, History of Neuroscience ; No. 3 (New York ; Oxford: Oxford University Press, 1990).[/ref] Casper’s first chapter reflects on how these ideas influenced the formation of a distinct medical discipline of neurology in the twentieth century.

As many historians have noted, the First World War was critical in the rationalisation of medical practice and the drive for efficiency and economy that compelled the specialisation of both hospital care and scientific disciplines.[ref]Roger Cooter, Mark Harrison, and Steve Sturdy, War, Medicine and Modernity (Stroud: Sutton, 1998).[/ref] Casper’s second chapter explores the significance of this to the science of neurology where, he argues, it was particularly transformational.  This chapter looks in depth at the work of Henry Head and Russell Brain, neurologists at the London Hospital, and their discussions of war injuries.  It also examines how they considered the significance of their own practice, which is very revealing in its grandiosity, for example Head’s claim that he worked ‘in the passage-way between the physical universe and the dwelling place of the mind.’  There is something exceptional about these general claims to cultural and scientific knowledge and Casper elucidates this well.

Chapter three explores a controversial episode in the history of scientific research concerning Kathleen Chevassut’s research under James Morgan Purves Stewart into the spinal fluid of patients with multiple sclerosis. Chevassut claimed to have found an organism responsible for causing the disease and argued that a vaccine could be produced, publishing in the Lancet, but wider medical opinion turned against her, guided by the research of emerging expert Edward Carmichael.  Casper argues that this episode drew attention to the need for further regulation in neurological research and the formation of a new professional association, The Association of British Neurologists, from which Purves Stewart was forever excluded. The scandal brought to light the significance of professional guidelines and the threat of the Victorian ideal of united social and medical investigations.  Casper claims that it demonstrated why the science of neurology was restricted in its scope.

Chapter four explores the relationship between neurology and state medicine from the 1940s to the 1960s, pointing out that the success of the Association of British Neurologists and the growing monopoly of neurologists in carving out a well-supported and stable field of clinical practice.  The Association of British Neurologists lobbied the Ministry of Health to appoint an advisor in neurology, which they finally did in 1958.  As Casper notes, it was the success in the formation of neurology as a clinical science that ironically led to its demise as a comprehensive field of scientific enquiry.  At that point, laboratory research was increasingly conducted by basic scientists who did not have a wider interest in clinical problems. Neither did they necessarily have interests in the wider human sciences on the relation between psychology, physiology and evolution. What came to be known as the ‘neurosciences’ were demarcated as a separate field.

As Casper argues in the final chapter, the rise of specialized clinical neurology never fully replaced the earlier model of neurological sciences as part of a wider reflection on human nature and motivation. The formation of the ‘neurosciences’ that drew together biological sciences and social sciences have provided a new kind of outlet for these questions, although within a very different framework of professional expertise.

There are some limitations to Casper’s approach and his focus purely on neurology as a disciplinary practice.  Although this enables precision and focus, sometimes it detracts from the wider debates and discussions about nerves within other fields such as psychoanalysis, psychology and endocrinology.  Furthermore, greater contextualization of debates within the social sciences and the wider political landscape of Britain, particularly in the post-war period, would have enriched the discussion. The history of neurology and the neurosciences is becoming increasingly topical as today’s scholars wrestle again with the hierarchy of the disciplines and the potential of current neuroscience and epigenetics to renew or revitalize the disciplines of sociology and history.[ref]e.g. D. Fitzgerald, N. Rose, and I. Singh, “Revitalizing Sociology: Urban Life and Mental Illness between History and the Present,” Br J Sociol 67, no. 1 (2016).[/ref][ref]e.g. Renwick, C 2016, ‘Biology, Social Science, and History: Interdisciplinarity in Three Directions’ Palgrave Communications, vol 2, 16001 (2016).[/ref] Although Casper makes links between the historical discipline of neurology and today’s neurosciences, it would have been useful for him to have used more innovative questions to engage more strongly with work by Nikolas Rose and Fernando Vidal on the dominance of the neurosciences and the significance of this in relation to other social sciences, particularly in the post-war period.[ref]e.g. Nikolas S. Rose and Joelle M. Abi-Rached, Neuro : The New Brain Sciences and the Management of the Mind (Princeton, N.J.: Princeton University Press, 2013)[/ref][ref] F. Vidal, “Brainhood, Anthropological Figure of Modernity,” Hist Human Sci 22, no. 1 (2009).[/ref] There is much more to be said on how disciplinary lines in the ‘neuro’ disciplines have been drawn and how they may be drawn in the future.

Nevertheless, Casper’s book is a very good reflection on the history of disciplinarity and how knowledge has been created and passed down in the field of neurology. It is an excellent complement to histories of psychological and psychiatric knowledge. It is also a very good reference book as it presents a close reading of archival sources and is meticulously referenced. Casper’s first work also demonstrates his ability to think widely on the connections between disciplines in the creation of medical knowledge. It is thus a welcome addition to the literature on the history of neurology and other disciplines and their relation to the wider history of the human sciences.

Bonnie Evans is a Wellcome Trust Postdoctoral Fellow at Queen Mary, University of London.  She is conducting a project on Neuroscience, Psychology and Education: Autism in the UK 1959-2014. Her peer-reviewed publications include a recent article in History of the Human Sciences: ‘How Autism Became Autism: The Radical Transformation of a Central Concept of Child Development’. Her forthcoming book The Metamorphosis of Autism: A History of Child Development in England (Manchester University Press) is due out in December.

Angus Nicholls, Hans Blumenberg on Myth and the Human Sciences 

New York and London, Routledge, 2015, 277 pages, hardcover £90, e-version £34,99, ISBN: 978-0-415-88549-2

I am fully convinced that this book will become an important tool in research and teaching, not only on the twentieth-century German philosopher Hans Blumenberg (1920-1996) but in the wider areas of myth and anthropology. It may even be of interest to an even more diverse audience, bringing a new level of complexity to current debates between religion and evolutionary theory. The title of the book itself holds the possibility of bridging the gap between cultural studies and natural sciences and reclaims the term “science” from the latter. It demonstrates, through Blumenberg’s work, how interwoven mythologies and the natural sciences actually are. The border between logos and myth is, according to Blumenberg, a fictive one.

Nicholls’ monograph is the very first comprehensive English-language introduction to Blumenberg’s theory of myth, but even compared with introductions that are available in German, it is unique in its commitment to making Blumenberg’s arguments accessible combined with an extraordinary depth of scholarship on his intellectual background.

Blumenberg’s highly original theory of myth, outlined in the volume Work on Myth (1979; English translation 1985), distinguishes him as the most important German theorist of myth of the second half of the twentieth-century. His work has resonated internationally across academic disciplines ranging from literary theory, philosophy, religious studies and anthropology, to the history and philosophy of science.

Blumenberg’s theory of myth is deeply related to debates within the broad field known as the ‘human sciences,’ particularly to philosophical anthropology and evolutionary biology. Emerging from his view of humans as ‘creatures of deficiency’ – organisms which, by virtue of their capacity for reflective thought, find themselves at odds with the order of nature – his theory breaks with enlightenment ideas by ascribing to myth a rational function. Indeed, the distinctive feature of Blumenberg’s approach is his view of myth as the solution to a problem relating to human evolution rather than a pre-rational mode of thought. Blumenberg, so Nicholls tells us, found that while other organisms adapt to their situations through instincts associated with natural selection, a large part of human adaption is cultural, and is constituted by the construction of stories. Myths constitute human attempts to rationalise and control anxieties concerning the indeterminate and uncontrollable forces of nature by anthropomorphising these forces into distinct and individual mythic objects. The division of the powers of nature into the polytheistic pantheon of myth, says Nicholls, summarising Blumenberg, enables these powers to be tamed and makes them accessible through mythic images and stories. In functioning as the fundamental cultural coping strategy adopted by humans, myth is, in Blumenberg’s view, always an attempt to conceptualise and understand reality by dealing with it in images. This, however, should not be understood as a rational or theoretical approach to a question or dilemma: rather than being such a response to it, myth covers a question in order for it not to become acute, and is therefore not able to produce a fully controlled state between question and answer. Blumenberg asserts that as long as there are elements of external reality that resist the wishes of humankind, there will always be a place for myth within human thought.

The fundamental adaptive and cognitive functions of myths enable us to survive the most hostile surroundings and, therefore, they are the most powerful evolutionary tool that we have. The ‘absolutism of reality’ designates a state in which man is helplessly exposed to natural forces of which he can have no sure understanding, to which he can impute no benign intentions, and from which he needs to distance himself in order to secure his survival as a species. For Blumenberg, all the achievements of human culture presuppose that this state of sheer biological nonviability, this nightmare scenario of ultimate selective disadvantage, has been put behind us through nothing but our ability of telling tales. In this sense, myth is already an attempt to render the world comprehensible, to identify divine or demonic powers, and to manage them, for example, by means of sacrifice or supplication.

It is especially appealing that Nicholls, in the conclusion of his introduction, reflects on Blumenberg’s peculiar neglect of political mythology in his published work, while extended reflections with Ernst Cassirer’s Myth of the State, as well as a departure from the analysis found in his Nachlass, entitled Remythisations. Nicholls also found a text on Hitler’s self mythologisation through a key concept Blumenberg calls ‘Präfiguration,’ a retrospective creation of predecessorship, or quasi magical lineage, which might be what he referred to as the ‘missing chapter’ of Work on Myth in a letter. Nicholls skillfully contextualizes these reflections with Blumenberg’s background in philosophical-theological studies, where he must have been familiar with Auerbach’s discussion of the notion of Noah’s Ark as a praefiguratio ecclesia or Moses as a figura Christi. In analogy to this concept Blumenberg outlines Hitler’s self-mythologisation as the culmination point of a Prometheus project in which Alexander the Great, Frederick the Great and Napoleon were his predecessors. This discovery and an exploration of this avoidance or self-perceived failure to publish those reflections (suggestive perhaps of biographical motives) gives this book a special significance in Blumenberg studies.

Nicholls gives his readers some insight into possible biographical reasons for this (whilst steering clear of any simplistic biographical speculation) that also explain Blumenberg’s delayed presence in the Anglophone intellectual world. Being classed as ‘half-Jewish’ meant that he had to endure gradually worsening hardships from 1933 onwards. He was excluded from the formal part of graduation celebrations at secondary school: he wrote a speech as he had come top of the class, but it was read out by a classmate. Catholic theology was the only subject choice subsequently open to him, as it was offered by the church and not by the state. He then spent time as a compulsory worker at an aeroplane manufacturer before finally being imprisoned in a work camp (where he only survived as a personal protégée of the large-scale industrialist (and NSDAP-member) Heinrich Dräger, a producer of gas masks. After the war, Dräger financed Blumenberg’s university education. However, until the very end of his life, Blumenberg remained unwilling to explore any personal motives for his interest in mythology. He is being largely unknown outside Germany, since he was neither a part of the émigré Jewish elite, nor a part of those implicated for their collaboration with the Nazi regime, but he had an extraordinary career in Germany as a modern academic who recognized the necessity of networking, building influential research clusters and inviting debate, while simultaneously being enviably productive publishing single-authored monographs.

The chapters of Nicholls’ monograph that address different contextualisations of his work within philological, phenomenological, and anthropological discourses (as well as the political reception of his main volume, Work on Myth) stand independent of one another, each comprising a thorough body of references, which will enable scholars from different fields to access Blumenberg’s work more easily. By displaying and introducing his many sources, disciplinary affiliations and comprehensive studies, Nicholls also contextualises Blumenberg’s arguments in relation to philosophers and anthropologists such as Arnold Gehlen, Jacob Taubes, or Erich Rothacker, whose texts are not currently accessible to non-German speaking readers. Context is also provided in relation to the better-known phenomenologists Edmund Husserl and Martin Heidegger, the Heidegger-Cassirer debate, and the philosophers and sociologists of the Frankfurt School. Among those chapters another highlight of this introduction is what Nicholls describes as Blumenberg’s ‘Goethe Complex”'(p.155). in which he analyses Goethe’s Prometheus Fragment and portrays Goethe’s self creation as a culturally constructed massif, that rises up before the reader (p. 158), and then unfolds into an impressively lucid effective history of this poem based on Blumenberg’s analysis.

Nicholls’ remarkable familiarity not only with Blumenberg’s extensive and published and unpublished oeuvre (archived at the Literaturarchiv Marbach where Nicholls was a visiting fellow), but also with the many discourses and disciplines with which it is interwoven, makes this book a treasure trove for anybody with an interest in philology, myth, phenomenology, anthropology, or the intellectual life in 20^th century Germany.

Tina-Karen Pusse, is a Lecturer in German Literature at the School of Languages, Literatures and Cultures at NUI Galway in Ireland, where she is PI of the Research Cluster Transnational Ecologies and Co-Chair of the cluster Gender, Discourses, Identities. Publications include studies on Rainer Maria Rilke, Franz Kafka, Fictionality and Factuality in Autobiography, Theory of Laughter, Elfriede Jelinek and Heinrich von Kleist. Forthcoming in 2016 are the edited volumes “Madness in the Woods. Ecopsychopathologies in Film, Gaming and Literature” as well as an Introduction in Ecocriticism.

Tommy Dickinson, Curing Queers: Mental Nurses and their Patients, 1935-74, Manchester, Manchester University Press, 2013, 272 pages, £70, ISBN 978-0-7190-9588-7 (hbk).

Tom Waidzunas, The Straight Line: How the Fringe Science of Ex-Gay Therapy Reoriented Sexuality, Minneapolis MN and London, University of Minnesota Press, 2015, 336 pages, £65.47 (hbk), £19.07 (pbk), ISBN 978-0-8166-9614-7 (hbk), ISBN 978-0-8166-9615-4 (pbk).

In late 2015, the international campaigning organisation ‘All Out’ launched a new website: Gay Cure Watch. The aim of this was to monitor and ultimately shut down individuals and groups offering so-called reorientation therapies, in which attempts to convert LGBT people to heterosexuality and gender conformity are offered under the guise of medical science. ‘We know you can’t catch “gay” and you can’t cure it either’, the site proclaims. The process through which homosexuality, and particularly male homosexuality in north America and Europe, came to be seen as a matter for medical science over and above legal, religious, or moral considerations has been well-documented; the standpoints of both Gay Cure Watch and the organisations against which it campaigns are legacies of this. They are not the whole story, though, and the story is not a simple one. We urgently need to understand the myriad ways in which theories, practices, and activism surrounding reorientation therapies have been used, by whom, and with what intended and unintended outcomes. Tommy Dickinson’s Curing Queers and Tom Waidzunas’s The Straight Line are both valuable contributions towards answering these complex questions.

Curing Queers delves into the history of aversion therapy in Britain. It is rooted in original oral history interviews, conducted not only with eight individuals who received such treatment to cure them of homosexuality, but also with 17 nurses who were involved in providing it. The goal is to examine their experiences, their impressions and their motivations as they attempted to cure or be cured, and the memories shared in these interviews are deployed effectively throughout. The first two chapters situate aversion therapies and the nurses who delivered them within their medical and cultural context. The first chapter provides an overview of clinical theories and treatments surrounding homosexuality, the impact of the Second World War on sexual attitudes and behaviour, post-war anxieties surrounding gender roles and loss of empire, and the impact of newspaper reporting of the homosexual ‘problem’ and key events such as the publication of the Wolfenden Report. The value of examining the experiences and views of both patients and nurses is brought out here: the mixed messages and confusion about what ‘caused’ homosexuality and what should be done about it affected patient and nurse alike. Men who were troubled by their same-sex attraction were encouraged to seek medical help, albeit often only as a desperate alternative to imprisonment, and nurses were encouraged to see homosexuality as a potentially damaging but curable condition. Widespread condemnation of homosexuality enabled nurses to participate in aversion therapy on the grounds that it could be beneficial for the individual patient who had sought out a cure, even though some nurses were homosexual themselves.

This is perhaps one of Dickinson’s most striking findings. The mental hospital itself could be a particularly welcoming environment for gay men on its staff: it was an enclosed community, slightly separated from the social mores of the wider world, and some nurses recalled a lively gay subculture. And yet, delivering aversion therapies to gay men rarely created the personal or professional tensions that we might expect. Patients were understood to be fully consenting and to be so very distressed and desperate to change that they were prepared to undergo almost anything. In this, they were perceived by nurses who were content with their homosexuality as entirely different from themselves, and perhaps able to benefit from treatment. This and other features of the professional context in which aversion therapy was practised are described in the second chapter. The nature of nursing education, hospital hierarchies, the rise of somatic explanations and treatments for all forms of mental illness, and the move towards treatment in the community in the post-war era, are all carefully outlined. Each contributed to creating an environment in which aversion therapy for homosexuality was widely and often unquestioningly accepted by nursing staff.

Chapters 3 and 4 then turn to the responses and reactions of nurses in more detail. They are divided into the submissive and subversive, with the former drawing on comparisons with nursing staff working for the Nazis and taking part in the infamous Tuskegee experiments, in which African American men participating in a decades-long medical study of syphilis were denied treatment and information that could have saved many lives. Nurses, Dickinson argues, have used a variety of methods to justify and cope with their participation in unethical and dangerous treatments. These have included a focus on their own specific role rather than the larger programme, faith in the overall benefits of their activities and the ready consent of their patients, failure to empathise with their patients, and an acknowledged need to fit in to the wider hospital community and to protect their job. However, not all nurses simply obeyed orders. Two of Dickinson’s interview subjects described acts of subversion, from simply chatting to patients to offer reassurances about their homosexuality, to throwing away medication and lying to superior staff about witnessing behaviour that suggested a successful ‘cure’. These nurses are quoted at length, bringing their personalities and experiences vividly to life. It is only a shame that more first-hand accounts could not be found to flesh out the analysis.

The final section of Curing Queers considers changes from the 1950s in the worlds of nursing and gay liberation campaigns alike. New nurse therapists brought a greater theoretical awareness of psychiatric diagnoses and treatments, Dickinson argues, while critiques of psychiatry in general and aversion therapy in particular challenged the status of homosexuality as an illness with a recognised cure. This final chapter perhaps does not connect these changes to the experiences of patients and nurses as much as it might. However, the most striking omission in Curing Queers is the lack of recognition of the very different scientific and ethical standards that were in place during the period under examination. It was not only this group of patients whose consent to treatment was neither adequately informed nor freely given, by today’s standards; coercion and questionable consent having a long history within mental health medicine. Nor was it unusual to find that evidence of efficacy in mental health medicine relied upon a handful of individual case studies, patient self-report, and no long-term follow up. It is around these matters of changing ethics and scientific practice that The Straight Line provides an ideal companion piece.

The Straight Line takes up the story on the other side of the Atlantic, examining reorientation therapies (as aversion therapies and their companion treatments within psychoanalysis and psychotherapy came to be known) from the late 1940s through to 2010. Its approach and objectives are rather different from those of Curing Queers. With a background in the sociology of scientific knowledge, Waidzunas seeks to trace the shifting meaning of sexual orientation and homosexuality, and the changing nature of credible scientific evidence. Through careful and intellectually rich analysis of the battles during these decades between psychiatrists, religious leaders, gay activists, and ex-gay campaigners, he plots transformations in what it meant to be homosexual or heterosexual, to be cured, and to prove such states with science. Beginning with the psychoanalytic understanding of orientation that dominated in post-war America, he emphasises that the case study, relying upon the patient’s own report of their sexuality, was initially accepted as persuasive evidence thanks to the pervasive influence of Freud’s case studies. This was challenged in the 1960s with the rise of experimental psychology. Behavioural treatments were imported from Britain to the USA, and this research sought to produce a different kind of evidence. It relied upon experimentation involving a greater number of participants, control groups, and physical measurements of arousal. Sexual orientation itself shifted from the mind to the body.

At the same time, however, all attempts at reorientation were coming under fire. Homosexuality was removed from the influential American reference work of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. The next section of The Straight Line is centred around the work of Robert Spitzer, the psychiatrist who is credited with this removal and who then provoked enormous controversy three decades later by researching and reporting on the occasional efficacy of the same reorientation treatments he had helped to condemn. Spitzer is used to illustrate the extent to which the meaning and measures of orientation shifted over this period: Waidzunas argues that Spitzer’s own opinions and methods remained unchanged, while the meaning and measurement of orientation did not. In the 1970s, his view of homosexuality as ‘suboptimal’ but not an illness was both radical and essential to the rewriting of the DSM, as was his willingness to engage with the views of gay activists on the margins of the psychiatric profession. By 2010, those on the margins were the advocates of reorientation, and his readiness to rely upon self-reports from the ex-gay community was roundly criticised on evidentiary and ethical grounds. Although his findings were used as proof that orientation could be changed, pro-reorientation campaigners no longer spoke of illness but grounded their arguments instead in the language of human rights and religious freedoms. The question of how to define and measure orientation remained contested, though, as debate surrounding the measurement and alteration of sexuality continued.

Subsequent chapters provide an account of a new ‘middle way’ in the 2000s, including the APA’s influential position statement on conversion therapy for homosexuality. The APA came down firmly on the side of sexual orientation as immutable and located in the body, physiologically measurable, and unsuitable for treatment. Reflecting the compromises and adjustments made by the ex-gay movement and their opponents in search of their ‘middle way’, the APA also acknowledged that sexual identity, rather than orientation, could be changed by psychological treatment. This was only appropriate for individuals for whom a homosexual identity could not be reconciled with other aspects of their life, such as a religious identity, the APA report emphasised. This distinction between orientation and identity had emerged from debates between ‘ex-gay’ groups, grappling with the nature and meaning of a lifelong change in sexuality, and ‘ex-ex-gay’ activists, who were sympathetic towards deeply held religious beliefs and promoted respect for the decisions of those who sought treatment. Separating orientation and identity allowed for the possibility of same-sex attraction to remain while a heterosexual lifestyle was pursued, and made space for physiological testing to measure arousal, or orientation, alongside self-reporting to assess the individual’s sexual identity. Here, Waidzunas brings out the rich and complex interactions between different groups, as meanings and evidence were carefully negotiated.

The final chapter moves our attention to Uganda at the time of an Anti-Homosexuality Act, passed there in 2014. This offers an interesting contrast to the USA: social workers rather than psychiatrists and psychologists were key figures in the debate around homosexuality, and although reorientation therapies were accepted in theory, criminalisation and the extent of hostility towards gay people meant that it had not been put into practice. Importantly, homosexuality was frequently defined not simply as same-sex attraction, but as behaviour invariably involving child abuse and the spread of HIV. As a result, campaigners did not debate how sexual orientation might be measured or caused, but rather, focused on increasing and enforcing criminal penalties on the one hand, and offering covert grassroots support and education for and about LGBT issues and people on the other. Would it help campaigners against the Anti-Homosexuality Act to adopt an essentialist argument, to present sexual orientation as innate and immutable, Waidzunas asks? This closing chapter brings to the foreground one of the underlying issues that The Straight Line addresses: on what basis should LGBT rights arguments be founded? The opportunity to present any case about sexual orientation – acquired disorder, inborn state, natural variation – depends upon legal, political, professional and intellectual structures, and each one creates its own opportunities and limitations alike.

These books illustrate the potential for harm within any rigid model of acceptable gendered and sexual behaviour. They also highlight that scientific authority is far from neutral, that it can be used in unexpected ways, that such uses will themselves have unintended outcomes. Alternatives to criminal penalties aiming to cure rather than punish are not necessarily preferable; arguments in favour of greater tolerance on the basis of biology leave tolerance on other grounds out in the cold. As Waidzunas remarks in his closing pages, recognising the limits of science is not to condemn its achievements. Rather, such recognition might allow us to step away from rigid binaries and universals of all types, and towards reflection, dialogue, and thoughtful enquiry. Science, after all, is not the only way of knowing.