Doctors Treat Homosexuals by Jonathan Ned Katz, 1976

Introduction

from Jonathan [Ned] Katz, Gay American History: Lesbians and Gay Men in the U.S.A. (T.Y. Crowell, 1976), pp. 129-34, introducing a collection of treatment documents. 

The following chronological survey of documents relating to the medical treatment of homosexuals in America demonstrates that Lesbians and Gay men have long been subjected to a varied, often horrifying list of "cures" at the hands of psychiatric-psychological professionals, treatments usually aimed at asexualization or heterosexual reorientation. This treatment has almost invariably involved a negative value judgment concerning the inherent character of homosexuality. The treatment of Lesbians and Gay men by psychiatrists and psychologists constitutes one of the more lethal forms of homosexual oppression.

Among the treatments are surgical measures: castration, hysterectomy, and vasectomy. In the 1800s, surgical removal of the ovaries and of the clitoris are discussed as a "cure" for various forms of female "erotomania," including, it seems, Lesbianism. Lobotomy was performed as late as 1951. A variety of drug therapies have been employed, including the administration of hormones, LSD, sexual stimulants, and sexual depressants. Hypnosis, used on Gay people in America as early as 1899, was still being used to treat such "deviant behavior" in 1967. Other documented "cures" are shock treatment, both electric and chemical; aversion therapy, employing nausea-inducing drugs, electric shock, and or negative verbal suggestion; and a type of behavior therapy called "sensitization," intended to increase heterosexual arousal, making ingenious use of pornographic photos. Often homosexuals have been the subjects of Freudian psychoanalysis and other varieties of individual and group psychotherapy. Some practitioners (a Catholic one is quoted) have treated homosexuals by urging an effort of the will directed toward the goal of sexual abstinence. Primal therapists, vegetotherapists, and the leaders of each new psychological fad have had their say about treating homosexuals. Even musical analysis has reportedly assisted a doctor in such "cure." Astrologers, Scientologists, Aesthetic Realists, and other quack philosophers have followed the medical profession's lead with their own suggestions for treatment.[1]

Such negative treatment history is made more obscene by the early existence and discussion of an alternative—a form of treatment aimed at helping homosexuals feel good about—and give active, unsublimated expression to—their sexual-affectional attractions. This dissenting tradition is exemplified in the following survey by the "adjustment therapy" advocated by the homosexual emancipation pioneers Magnus Hirschfeld and E. I. Prime Stevenson, and that described by A.A.Brill.

This survey of treatment history is based largely upon doctors' reports of their own work, upon the relevant writings of early homosexual emancipationists, and upon a taped interview with a homosexual victim of shock treatment. Most of these documents are excerpted from medical journals (ironically, now one of the richest sources for Gay history research). These journal articles, even more than medical books, reveal doctors communicating with each other on a privileged, "insider" basis. Here they discuss the results of their latest "experiments"; they counsel each other against undue "pessimism" concerning "cures"; they caution each other that the display of "too much sympathy" for homosexual patients inhibits their desire to become heterosexual. Occasionally a doctor urges law reform, particularly that type which would increase the authority of the psychiatric-psychological establishment in matters concerning homosexuality.

The treatment of homosexuality by medical practitioners is of relatively recent origin, and is closely tied to the conceptualization of homosexuality as a medical-psychological phenomenon, a "mental illness." This conceptualization is itself a fairly recent inven- tion: European discussion of homosexuality as a medical phenomenon dates to the early 1800s. Before that time, ecclesiastical authorities conceived of homosexuality as essentially a theological-moral phenomenon, a sin. Next, legislative bodies declared it a legal matter, a crime. The historical change in the conception of homosexuality from sin to crime to sickness is intimately associated with the rise to power of a class of petit-bourgeois medical professionals, a group of individual medical entrepreneurs, whose stock in trade is their alleged "expert" understanding of homosexuality, a special-interest group whose facade of scientific objectivity covers their own emotional, economic, and career investments in their status as such authorities. At its time of origin, the medical practitioners' concept of homosexuality as a sickness may have been a liberal and humane advance over the conception and punishment of homosexuality as a crime. In 1976, psychiatrists and psychologists are among the major ideologues of homosexual oppression.

Research is now starting to trace the exact historical process by which these medical businessmen (for they are mostly males) acquired the power to define the character of homosexuals—and to trace that political movement by which Gay people are beginning to redefine themselves, struggling for power over that society which affects their lives. Today, Gay liberationists are challenging the long-accepted, medically derived notion that homosexuality is essentially a psychological phenomenon—any more than it is a political, economic, or historical one. They are disputing that view by which the complex human phenomena of homosexual behavior, emotion, life-style, culture, and history are reduced to mere psychology. Neither homosexuality nor heterosexuality, they argue, is encompassed by the psychological. Calling for the reconceptualization of homosexuality in broad, humanistic, and social terms. Gay people are today beginning the work of reconceptualizing themselves.

In the following documents, purely theoretical passages are generally deleted, for they tend to obscure the actual character of that treatment upon which this section focuses. These documents indirectly suggest the physical pain and mental anguish which treatment by medical practitioners has inflicted through the years upon countless anonymous Lesbians and Gay men, whom it was ostensibly designed to "help." A few of the treatment histories included describe severely disturbed, obsessive and compulsive in- dividuals. Most of these reports contain (inadvertent) hints of those antihomosexual attitudes which helped drive these people mad; some reports indicate quite clearly that treatment itself drove these lost souls deeper into insanity.

The medical treatment literature documents a history of horrors, one of which has been the way Gay people themselves were made the agents of their own violation and destruction. Treatment has been perpetrated, sometimes, upon acquiescent victims. The very act of entering treatment for one's homosexuality involved a negative evaluation of one's own, often basic, feelings. There is clearly a link between socially induced feelings of guilt and worthlessness, and the self-punishing behavior of some homosexuals reported in these documents. Numbers of these histories concern guilt-ridden, self-hating homosexuals, who have so internalized society's condemnation that they seek out cruel forms of treatment as punishment; they play what can only be termed a masochistic game, in which the doctor is assigned, and accepts, a truly sadistic (as well as remunerative) role. There is surely a link between self-punishment as an internally motivated individual act and punishment as an external legal sanction, between castration as an early form of legal punishment (as proposed by Thomas Jefferson, and enacted into law in Pennsylvania) and castration as an early form of medical treatment.

A connection between the legal and medical establishments is also evident when doctors prominent in the business of treating homosexuals are simultaneously employed by the penal system. Justice is literally on their side when these agents of the medico- legal establishment seek to "rehabilitate" homosexuals who have come into active conflict with the law. This law derives from religious concepts, and Judeo-Christian morality is frequently found in these medical texts, propagated in secularized, pseudoscientific terms, even though such strictures supposedly have no place in a society theoretically based on separation of church and state.

The question of doctors' responsibility is not answered satisfactorily by reference to patients' alleged voluntary and informed consent to treatment and their desire to "go straight." For despite the current popularity of a simplistic libertarian ideology, we are not always in touch with, and do not always know, our own deepest feelings and best interests. In ways Gay people themselves have not fully realized, we do not yet always know our own minds, we are not always immediately able to affirm our own deepest desires. In this respect the present author's own history is like that of many:

I entered analysis, voluntarily I thought, with the idea that my "problem" was my homosexuality, and my goal a heterosexual "cure," although even then I was wise enough to know I never wanted to be "adjusted" to a society which was itself des-perately in need of radical change. Paradoxically, my experience in therapy turned out to be an extremely good one, helping me to know and affirm positive parts of myself, among them my homosexuality. By accident I had found a therapist who helped people to find and be themselves, who did not view my "problem" as I did myself. But it was only with the development of the Gay liberation movement, and my own involvement in it, that it came to me, in a rather brief and mind-spinning few months, that I, too, was a member of an oppressed group. Only then, after perhaps ten years of therapy, and only as a result of this organized movement of Gay people, did I understand that I had earlier been socially pressured into feeling myself a psychological freak, in need of treatment. In entering therapy, my goal had, in truth, not been voluntarily chosen at all.

Therapists who do not help their homosexual patients to fully explore the possibility of homosexuality as a legitimate option have not helped to expand those individuals' freedom.

The treatment documents demonstrate that the conflict between Gay people and the psychiatric-psychological profession is of long-standing; it did not begin with the recent Gay liberation movement. Dr. Edmund Bergler's lecture (not excerpted) before the New York Psychoanalytic Society in 1942 provides evidence of those antihomosexual views which have led many Gay people to despise psychiatrists and psychologists— conflict of whose origin Bergler is blithely unaware. Bergler's report indicates no sensitivity on his part to the fact that the "ill-repute enjoyed by our therapy among homosexuals" might be due to those therapists' negative evaluation of homosexuals as "sick" (Bergler's term). Bergler has no awareness that recurring conflicts with his homosexual patients (reported by himself) just might have something to do with his own attitudes toward "perverts" and "perversion" (his terms). His characterization of homosexuals as "injustice" collectors, who provoke trouble upon themselves to justify self-pity, must have struck some homosexuals as a provocative way of blaming the victim—even before the rise of the Gay liberation movement. The great irritation Gay liberationists will no doubt feel while reading Bergler's account today is simply a more conscious, less ambivalent form of that same dislike experienced (according to his own report) by many of Bergler's patients. Even in pre-Gay liberation days some homosexuals must have resented, however ambivalently, Bergler's positive evaluation of their pain—based on his belief that a certain high level of guilt indicated a good prognosis for heterosexual reorientation. In Bergler's report, it is indeed odd to find a man supposedly concerned with the alleviation of mental suffering so positively gleeful about the guilt feelings of homosexuals. If, as Bergler points out, many Gay people in treatment with him displayed masochistic tendencies, then he was undoubtedly the sadist in those partnerships. Bergler's provocative comments do raise serious questions about masochism as a form of socially conditioned Gay self-oppression, and about the often sadistic treatment of Gay people by psychiatrists and psychologists.[1]

Bergler's antihomosexual views are typical of many other doctors, few of whom show any sign of seriously questioning their own motives, feelings, and fundamental assumptions in treating homosexuals. Their basic system of values has remained quite simple and unchanged through the years. America's psychological establishment has quite simplemindedly propagated the absolute virtues of heterosexuality, marriage, monogamy, parenthood, and the most traditional, narrow definitions of femininity, masculinity, and of male and female roles. The doctors' reports are characterized by a complacent, middle-class sensibility, a smug philistinism. This moralizing is most evident in the earliest documents quoted—those from the end of the nineteenth century and the start of the twentieth. At that time, doctors un-self-consciously invoked morality—God, country, family—in describing their treatment of homosexuals. More recent documents usually replace such overt moralizing with quieter, often unspoken, hidden evaluations, expressive of a technocratic consciousness focused on getting a job done, a new heterosexual created. Doctors have increasingly turned to technical language and jargon to disguise and suppress their own emotions and underlying values. Although secularization has transformed the rhetoric, mystification remains.

The focus here is on treatment—actual medical practice—rather than on either of the two other major areas of medical discourse on homosexuality: its alleged nature, its supposed cause. These character assessments and etiological discussions have often been of a highly abstract, theoretical, and speculative character, disassociated from any social reality. The literature on treatment, on the other hand, conveys what was actually done to, and even experienced by, Lesbians and Gay men. The diverse theories of the alleged character and cause of homosexuality, and their relation to particular forms of treatment, do need to be studied in social-historical perspective—an important task for the future. Here, the doctors' causative theories may often be inferred from the type of treatment they prescribe. Aversion therapy, for instance, rests upon the tenets of behavioral psychology holding that homosexuality is a learned response, capable of being unlearned. This concept is only distantly related to the more complex notion of those psychoanalysts who regard sexual orientation as the outcome of early experience, especially within the family, by which social norms and role models come to influence the undefined psyche of a child. Opposed to both these views are various physiological theories of causation, now generally regarded as outmoded, according to which homosexuality is either treatable by biological means, such as hormones, or is an unalterable, hereditary trait. It is now becoming clear that the causation of homosexuality cannot be understood apart from the causation of sexual orientation of every variety (including heterosexuality, bestiality, and object fetishism)—if the subject is to be studied at all. Past interest in the subject was almost always motivated and obscured by either pro- or antihomosexual views: the cause of homosexuality is inborn, it was argued, therefore homosexuals should be free of legal harassment or medical treatment; or homosexuality is a "bad thing," which understanding might make alterable. Contemporary Gay liberationists emphasize that study of the cause and cure of heterosexuals' seemingly obsessive antihomosexuality should have higher priority.

Except for their vested interest in incomprehension, it should not be too difficult for even the most obtuse psychiatrists to understand that to characterize homosexuals as products of arrested emotional development, or to propagate any such all-encompassing negative judgment, is to perpetuate an oppression that has caused Gay people much mental anguish. By the suffering they have caused, the damage they have done, psychiatric-psychological professionals have revealed their own moral character. There is a special obscenity about bigotry in the guise of "help," antihomosexual pronouncements in the name of "mental health," or similar prejudice from religious authorities in the name of morality. The early Puritans were at least open about their hate; homosexuals were "abominations," to be punished by death. Simple. Clear. Contemporary puritans are less candid. Today, Gay liberationists are doing what they can to delegitimize those "experts" who have done their best to delegitimize them. The psychiatric-psychological profession's collective responsibility for causing homosexuals years of pain invalidates its claim to speak as a humane and moral authority on the subject of homosexuals' "mental health." It might begin to rehabilitate itself by publicly recognizing its own role in Gay oppression and by using its very real power to call for the immediate, universal repeal of all laws criminalizing sexual activity between consenting persons, as well as for civil rights legislation to protect individuals discriminated against on the basis of sexual or affectional orientation.

Not all the medical treatment literature conveys quite so much in quite so little space as the following British report, dating to 1964, of aversion treatment, summarized succinctly by Weinberg and Bell:

Aversiontherapy was conducted with a male homosexual who had a heart condition. The particular form of aversion therapy involved creation of nausea, by means of an emetic, accompanied by talking about his homosexuality. The second part of the therapy involved recovery from the nausea and talking about pleasant ideas and heterosexual fantasies, which was sometimes aided by lysergic acid. In this case, the patient died as a result of a heart attack brought on by the use of the emetic.[3]

Notes

I wish to thank James D. Steakley for his help in compiling this part, and for writing a first draft of the general introduction and introductions to the documents. Responsibility for the final versions is my own.

1. The various treatment types mentioned are all documented in the following section and notes. Documentation of hysterectomy Part 3, "Passing Women," p. 276, 6o6n. 69. Primal therapy, Vegetotherapy, musical analysis, astrology, Scientology, and Aesthetic Realism are documented by Ralph Blair, Etiology and Treatment Literature on Homosexuality, The Otherwise Monograph Series, no. 5 (National Task Force on Student Personnel Services and Homosexuality, 1972), p. 36-37; also see Blair "Part II: Treatment," for a good, documented discussion and summary of the subject of treatment.

Some of the early medical documents suggesting surgical measures for masturbation, satyriasis, etc., are cited by Vern L. Bullough and Martha Voght in "Homosexuality and the 'Secret Sin' in Pre-Freudian America," Journal of the History of Medicine and Allied Sciences, vol. 28, no. 2 (April 1973), P- J 43-55; and G. J. Barker-Benfield, The Horrors of the Half-Known Life; Male Attitudes Toward Women and Sexuality in Nineteenth-Century America (N.Y.: Harper & Row, 1976), on sexual surgery, p. 82-83, 88-90, 91 ff., 97, 104, 120-32, 286-87, 292-93. Also see note 5 below.

One of the strangest treatment documents meriting further research is an extract from an address in 1866 by Dr. W. D. Buck, President of the New Hampshire State Medical Society: "A distinguished surgeon in New York city, twenty-five years ago [1841], said, when [Guillaume] Dupuytren's operation for relaxation of the sphincter ani was in vogue, every young man who came from Paris found every other individual's anus too large, and proceeded to pucker it up. The result was that New York anuses looked like gimlet-holes in a piece of pork." The apparent homosexual implications of this may be misleading. Buck goes on to say that the uterus, also, is being subjected to "surgical operations, and is now-a-days subject to all sorts of barbarity from surgeons anxious for notoriety." His statement is aimed at primitive abortion and birth control measures ("A Raid on the Uterus," New York Medical Journal, vol. 5 [Aug. 1866], p. 464). A brief biography of Dupuytren is in John Talbott, A Biographical History of Medicine (N.Y.: Grune & Stratton, 1970), p. 342-44. I wish to thank Stephen W. Foster and Dennis Lampkowski for help with this research.

2. Edmund Bergler, "Eight Prerequisites for the Psychoanalytic Treatment of Homo- sexuality," Psychoanalytic Review (N.Y.), vol. 31 (1944); see especially p. 255, 260, 266, 268-69, 277-79. 281-86. Also see Bergler's "Suppositions about the Mechanism of Criminosis," Journal of Criminal Psychopathology, vol. 5 (1943), p. 215-46 (espe- cially case 4, p. 235). Permission to reprint excerpts from Bergler's papers was denied.

3. Martin S. Weinberg and Alan P. Bell, Homosexuality; An Annotated Bibliography (N.Y.: Harper and Row, 1972), p. 287. The source of the case cited is "Fatal Emetine Poisoning from Aversion Treatment," Re W. T. (Westminster Inquest, Feb. 7, 1964), Medico-Legal Journal, vol. 32, no. 2 (1964), p. 95. The Weinberg and Bell bibliography contains a large, useful, alphabetical, annotated listing of books and articles dating from 1940 to 1968 on the treatment of homosexuals. The index provides a guide to types of treatment, and the introduction lists the various indexes and guides used in the compilation. Documents on various treatment forms through 1969 are listed and indexed in William Parker, Homosexuality; A Selective Bibliography of Over 3,000 Items (Me- Metuchen, N.J.: Scarecrow Press, 1971). The Institute for Sex Research provides mimeo- graphed bibliographies on "HomosexualityAversion and Behavior Therapy" (Nov. 1972) and "Homosexuality Therapy: Pre-1940" (May 1974).