Title: Aversion Therapy
Author(s): Council on Scientific Affairs
Affiliation: The American Medical Association
Citation: Council on Scientific Affairs of the American Medical Association, “Aversion therapy,” Journal of the American Medical Association, vol. 258, no. 18 (November 13), 1987, pp. 2562-2565.
The purpose of aversion therapy is to reduce unwanted or dangerous behavior by pairing it with unpleasant sensations or punishment. It is based on principles of learning theory and behavior modification. Although extensive physiological and animal research has been done to refine its use, its use remains controversial on ethical grounds. Aversion therapy has been the focus of debate for many years among educators, mental health practitioners, and medical professionals.
Aversion therapy has been used to shift sexual orientation away from homosexuality towards heterosexuality. In 1935, Max first reported using electric shock for this purpose. After four months, he claimed the procedure was successful “95% of the way.” Freund used caffeine and apomorphine to induce nausea in his treatment of 67 homosexual men. A five-year follow-up study showed effectiveness was poor to mediocre.
In 1963, Thorpe required a patient to stand barefoot on an electrical grid which produced controlled electric shocks. He reported successful treatment after 4000 sessions. His attempt to replicate this failed when a second patient discontinued treatment after two days. In another study, Thorpe reported success using electric shock on three men, but his work was challenged by Feldman for methodological problems, subject selection, and lack of follow-up.
Other researchers have used covert sensitization to attempt conversion from homosexuality to heterosexuality. One review of the literature expressed cautious optimism about this approach, stressing the need for more controlled studies.
Maletzky & George advocate the use of covert sensitization assisted by the use of valeric acid, a noxious smelling substance. Although they report excellent results, further research is needed. One researcher found disagreement between self-reports of sexual arousal and penile measurements, calling into question the validity of these studies.
Investigations of the effectiveness of aversion therapy with other behaviors such as pedophilia, exhibitionism, and transvestitism have paralleled those for homosexuality. Most studies have used apomophine-induced nausea or amphetamine-induced sleep deprivation. One early treatment using emetine was discontinued when the patient developed toxic myocarditis as a result. Other researchers have used electric shock, preferring it to nausea-inducing methods as less unpleasant, more easily controlled, and having fewer side effects.
Covert sensitization has also been used for pedophilia. Results of electric shock and covert sensitization have been similar to those of nausea-inducing methods.
In general, very few controlled studies with multiple patients have been conducted. While a literature review suggests that covert sensitization seems useful in treating deviance, the literature contains mostly uncontrolled studies so that firm conclusions cannot be drawn.
Note: Two months after this statement was published, a letter from Stanley E. Harris, MD, University of Southern California, Los Angeles, was printed in the journal (vol. 258, no. 18—November 13, 1987, pp. 2562-2565). Harris wrote that treatment for homosexuals should aim to relieve distress not increase it with electric shock, nausea, or noxious odors. He noted that the Council’s statement made no mention of iatrogenically induced despair, depression, and sexual dysfunction many patients suffer when aversion therapy fails to work. He wrote that patients often need therapy to recover from the stress resulting from the aversion therapy.