Sometime in 1962 or 1963, a thirty- five- year- old man presented at Ban- stead Hospital, a psychiatric institution in Sutton, Surrey, England. He came to Banstead as a consequence of having read, a short time previ- ously, an article in a Sunday newspaper that referred to the successful aversion therapy that Dr. Basil James, the registrar of Glenside Hospi- tal in Bristol, had undertaken with a forty- year- old homosexual man. Exactly what the newspaper reported, or even which newspaper it was, has not been recorded, but an account of James’s work is available in an article he published in 1962 in the British Medical Journal. James presents his single case study as an unqualified success: his patient, exclusively homosexual, as indicated by his scoring a perfect 6 on the Kinsey scale, was judged “in all respects a sexually normal person” twenty weeks after the termination of his eight- day treatment. Some ten years earlier, this same patient had been hospitalized for three months, during which he had been subjected to psychotherapeutic treatment and doses of stil- boestrol, a drug intended to suppress his sexual appetites. Considering this regime “worse than useless,” he broke it off and, had he not been ad- mitted to the hospital a decade later, following a suicide attempt from a major barbiturate overdose, he would have been unlikely to have made himself available for further medical intervention. When the principles of aversion therapy were explained to him, he remained “frankly skepti- cal” but agreed nevertheless to receive the treatment. Despite his initial low expectations, after treatment he shared his doctor’s assessment of his cure. No longer attracted to men, he was reported to have found the treatment “fantastically successful” and expeditious. His relationships with his family had been repaired; he had acquired a steady girlfriend, with whom he made out regularly, a few times being brought to orgasm in heavy petting sessions with her; he had even taken up writing in his
spare time, producing “several short stories, some of which [had] been accepted by publishers, and . . . a full- length novel.”2
What was the clinical treatment credited with bringing about this transformation? For thirty hours, James’s patient was kept in a darkened room and, every two hours, injected with apomorphine, in order to in- duce nausea, and dosed with a heavy- handed shot of brandy. Each time he reported feeling nauseous, a strong light was directed at a display card to which were glued “several photographs of nude or near- nude men.” He was asked to pick one that appealed to him and elaborate a fantasy about the man, drawing on recollected scenes with his current boyfriend. Across the next few nauseous episodes, James would repeat aspects of this fantasy out loud to his patient. Moreover, for every subsequent two- hour period, a recorded message was played that narrated details of the patient’s case history and individual homosexual etiology—his “father deprivation,” for example, and his early erotic experimentations— before emphasizing his social degradation in graphic language that segued to a soundtrack of someone vomiting. After thirty hours the patient devel- oped acetonuria (a large amount of acetone within his urine), presumably as a consequence of not being allowed anything to eat, and the treatment was suspended for a day. The second bout of treatment followed a simi- lar course, except that the recorded message now concentrated only on the negative consequences of the patient’s homosexual behavior, “again ending histrionically,” and ran this time for thirty- two hours, before the patient again succumbed to acetonuria. The following night the patient was woken every two hours and made to listen to a different recorded message, one that took a confidently hopeful and even a “frankly con- gratulatory” tone in describing the immeasurably improved circum- stances the patient could have anticipated if “his homosexual drive had been reversed.” Across the next three days, he was injected with tes- tosterone propionate every morning and invited, should he feel sexu- ally stirred, to withdraw to his own room, which had been decorated in anticipation with a different display card presenting “carefully selected photographs of sexually attractive young women” as well as a record player and the records of a female singer “whose performance [was] gen- erally recognized as ‘sexy.’”3
Having read whatever details of this treatment were conveyed in the 2. James, “Case of Homosexuality Treated by Aversion Therapy,” 769.
popular press, the man who requested admission to Banstead Hospital for psychiatric care was reported to have arrived “demanding aversion therapy.”4 With no heterosexual sexual history, the patient reported an erotic career of opportunistic homosexual engagements, occasional but increasing exhibitionism directed at young boys and a rich masturbatory life enhanced by homosexual fantasies. Having resigned from his job and subleased his flat, he was admitted within the month, placed under the care of Dr. Seagar, a consultant physician, and referred for behavior therapy. Initially the treatment consisted of the patient being held in a small, dark room that communicated with an adjacent one that housed a small team of psychologists. He was “supplied with tissues” and asked to masturbate in the dark to whatever fantasy he chose, keeping his eyes open at all times. He was instructed to say “now” as soon as he felt his or- gasm was inevitable, at which point a psychologist, listening via a basic intercom system, flicked a switch to turn on a light in the patient’s room that illuminated “a picture of an attractive, scantily dressed female,” which remained on until the patient duly said “finished.”5 After eleven similar trials using eleven different images, this stage of the treatment was deemed a failure, because the patient still visualized homosexually inflected scenarios while masturbating.
The second stage of the treatment was a variation on the first. The provocative pictures of physically appealing women were still illumi- nated continuously once the patient signaled he was about to come and until after he announced his orgasm, but also this time randomly, for one- second intervals throughout the masturbatory process, with an in- creasing frequency so that by the fifth and final trial of this kind the image was illuminated more often than not. This stage of the treatment was also considered a failure and broken off when the patient consis- tently reported using homosexual fantasies when the light was out and, during periods of illumination, limiting his attention to those parts of the image, such as naked buttocks, that he was able to incorporate with- out much difficulty into a homosexual scenario. The third stage of the treatment maintained the random illumination of the images of women as described above but alternated this with another set of trials orga- nized around photographs of naked men that the patient supplied from his personal collection. At random intervals as he stood masturbat- 4. Thorpe, Schmidt, and Castell, “A Comparison,” 357.
ing, but always within half a second to a second of an image of a naked man being illuminated, consistent with principles of variable interval- variable ratio reinforcement, a “painful electric shock” of 120 volts was administered to the patient’s bare feet via a customized rubber mat con- nected to a hand- operated generator that was given two sharp cranks from the adjacent room.6 Each trial took ten minutes; during this time, nine electric shocks were randomly administered, coinciding with one of the forty times an erotic photograph of a man was illuminated. The trials were usually managed in consecutive runs of five, although sometimes this was raised to ten, with the patient customarily receiving forty- five shocks in an hour.
The effects on the patient were immediate. Every time the light came on, his breathing became labored and he reported sensations of shock regardless of whether one had been administered. During the first trial following the shock treatments in which he was again exposed to pic- tures of women, and despite being assured that no shocks would be ad- ministered, he reported a marked reluctance to fantasize homosexually and visualized heterosexual encounters 60 percent of the time. After the third trial, he reported heterosexual fantasies 100 percent of the time. After the fifth trial, and once the picture of the woman was permanently illuminated, the patient was temporarily incapable of orgasm, although, as the clinicians note with some sense of achievement, “he was also un- able to use homosexual fantasy.”7 By the tenth trial, he was reliably able to have an orgasm while looking at constantly illuminated erotic images of women. “He soon began to report that he was masturbating away from the department either to pictures, which he provided himself, or to female fantasy, sometimes using images of female patients whom he had met on the ward.”8 When compared to the unmitigated success claimed in relation to James’s patient after little more than a week of treatment, however, the results in the Banstead case were less decisive. After 100 trials with electric shocks, thirty- eight were considered “positive,” and the patient was discharged less because his behavior had been success- fully modified than because he had come to the end of his agreed three- month residency.9 Eight months later, he wrote to report on the progress 6. Thorpe, Schmidt, and Castell, “A Comparison,” 359.
7. Thorpe, Schmidt, and Castell, “A Comparison,” 359. 8. Thorpe, Schmidt, and Castell, “A Comparison,” 360. 9. Thorpe, Schmidt, and Castell, “A Comparison,” 360.
of what the clinicians described as “his new found heterosexuality.”10 Although he was still able to masturbate and achieve orgasm using heterosexual fantasy, he had not been successful in advancing any of his erotic trysts with women as far as sex. Confident that this was a tempo- rary situation, he “had decided to wait until he would meet the right girl and fall in love,” continuing meanwhile to have occasional sexual en- counters with men. There had been a couple of exhibitionist incidents “but whereas before treatment he had only considered young men and boys, he now considered persons of both sexes. This occurred only in hot weather of which there was not much in an English summer.”11
While one notable aspect of the Glenside and Banstead case studies is their discrepant outcomes, another is the marked differences in their treatment design. Although it might be presumed that the man who pre- sented at Banstead did so in expectation of receiving similar treatment as had been administered to the man at Glenside, their treatments, de- spite both being therapeutic articulations of behavioral principles, were experientially quite different. Most obviously, at Glenside the aversive stimulus was chemical (the injections of apomorphine), whereas at Ban- stead it was faradic (the 120- volt shocks). Moreover, the treatment at Glenside began with aversive therapy, whereas this was only “resorted to” at Banstead after two cycles of positive conditioning had failed to have any effect on the patient’s behavior.12 At Glenside, the use of photo- graphs was supplemented with tape- recorded messages; at Banstead, only visual stimuli were used. Whereas the report on the Glenside case implied the possibility of some masturbatory practice on the part of the patient, who was invited to retire to the privacy of his room should the regular shots of testosterone prick his fancy, in the Banstead case—for the first time, as far as I have been able to discover—masturbation to orgasm was a central part of the treatment design.
Beginning with the Banstead case as the first recorded instance in which orgasm is key to a behavior- modification program, this chap- ter analyzes the use of orgasm in behavior- therapy treatments for men, concentrating particularly on those designed to reorient homosexually inclined subjects toward heterosexual objects. The chapter draws pri- marily on Anglo- American clinical literatures from the late 1950s, when 10. Thorpe, Schmidt, and Castell, “A Comparison,” 360.
11. Thorpe, Schmidt, and Castell, “A Comparison,” 360. 12. Thorpe, Schmidt, and Castell, “A Comparison,” 359.
behavior therapy began to solidify as a coherent set of possible treat- ments for a range of erotic behaviors deemed deviant or antisocial, to the mid- 1970s, when gay- activist opposition to behavior- reorientation programs fundamentally transformed the ethical grounds on which such treatments could proceed.13 It is easy—and, as I noted in my opening paragraph, necessary—to dismiss these attempts to modify sexual orien- tation as viciously skewed to the normative. From the present moment, the critique of this aspect of the behavior- therapy project is sharpened by the jumble of affects that mediate the relatively short historical period between now and then. For even as we take the measure of the historical difference that separates our current moment from one in which many of those who tended to consensual or harmless nonheterosexual erotic exchanges or acts were compelled, whether by civilian or military court order, social pressure, or more obscure but no less brutalizing forms of self- management, to make themselves intimately available to the insinu- ating forces of psychotherapeutic intervention, that temporal distance readily contracts to a seeming simultaneity in which sexual- behavior- modification programs, particularly ones that depend on aversive con- ditioning, stand as evocative figures for those too familiar scenarios of erotic injustice that continue to flourish even in contemporary neoliberal societies ostensibly characterized by self- governance and relatively un- regulated social, and hence erotic, economies. So for reasons both his- torically and currently pressing, there is clear value in persisting with the queer- affirmative critique of the everyday cruelty of these sexual- reorientation projects, a cruelty more pointed for taking empiricism and objectivity as its alibis.
It is now axiomatic to critique midcentury behavior- therapy inter- ventions in erotic response for their bludgeoningly confident casting of normative heterosexual practice as a sexual and social ideal. The monu- mentality of this common understanding, however, might prevent a more finely grained discernment of the simultaneous operation across the field of clinical behavioral practice during this period of different knowledges, admittedly underformulated and imperfectly operational- 13. Such opposition contributed substantially to the American Psychiatric Asso- ciation’s declassification in 1973 of homosexuality as a mental disorder. For authori- tative accounts of the American history of the declassification of homosexuality as a mental disorder, see Bayer, Homosexuality and American Psychiatry, and Drescher and Merlino, American Psychiatry and Homosexuality.
ized. Such knowledges, however partial, indicate ways of apprehending or conceptualizing the sexual that are frequently incompatible with those that underpin the heterosexual presumption for which erotic behavior therapy is properly critiqued. In what follows, I bracket any further consideration of the presumptive heteronormativity of mid- twentieth- century behavior therapy in order to trace across a set of case studies the uses to which orgasm is put in clinical practice designed to increase the incidence of erotic behavior deemed normal.14 Far more interesting than demonstrating the fundamental wrongheadedness of erotic- behavior modification is the possibility that its blighted project might offer up, in spite of itself, radical perspectives on sexuality that still struggle to get any effective purchase on everyday understandings of the sexual. Or- gasm proves central to this endeavor. Not only key to the therapeutic design of the case studies, orgasm is also a handy figure for getting at a set of unresolved questions around how the clinicians think of sexuality in behavioral terms. What relation does orgasm have to sexual behav- ior, for instance? Is it itself a sexual behavior? Or is it rather a means of getting a controlling purchase on sexual behavior? What relation does orgasm have to erotic orientation? Is it somatic evidence of a particu- lar orientation? Or is it a behavior that iteratively constitutes orienta- tion? Given the emphasis on erotic fantasy for orgasm- oriented behav- ior modification, what relation does orgasm have to ideation? Far from being answered in the clinical literature, these and related questions are not even posed. In putting these questions, then, this chapter returns to midcentury erotic- behavior modification to suggest that its potentially radical understanding of sexuality might be retrospectively realized via the recognition that a behaviorist approach to sexual practice has unex- pected affinities with queer critical paradigms.