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.