Aversion therapy: A personal account

The summer of 1965 was the end of my first year of reading psychology at the University of Durham. During that year, I learned what happened to rats in mazes, dogs in boxes and monkeys in cages. I was taught that the role of the psychologist was to observe behaviour because behaviour could be seen… only that which could be seen could be measured, and only that which could be measured could be reproduced and judged valid. Behaviour and its measurement were the order of the day in the struggle to make psychology a respectable, empirical science. Feelings, intuition and introspection were not on the agenda. To become a 'proper' Psychologist, I had to abandon the subjectivity of feelings and emotions and become an objective observer.

I had expected so much from psychology and gained so very little. I chose it because I was interested in thoughts and emotions. I wanted to understand more about my own personal experiences as a woman and a lesbian. I wanted to understand anxiety, despair and depression. By the end of the summer of 1965, psychology had successfully constructed a behaviourist paradigm to guide my psychological conceptual development and understanding. Ironically, it was during that summer that I underwent aversion therapy. 

A vital significance

Aversion therapy was a desperate attempt to change my sexual preference and end the nightmare of who I was. I thought I saw a means of ridding myself of the powerful, all-consuming lesbian feelings that I held secret inside whilst showing my family and friends a successful, heterosexual woman. I was very unhappy, very isolated and increasingly unable to see a future for myself.

It was many years later in 1985, whilst completing a Master's degree in Women's Studies that the words of Wendy Clark in her Feminist Review article: 'The Dyke, the Feminist and the Devil' perfectly articulated my psychological and emotional situation as I willingly sat in a chair, looking at pictures of women and receiving electric shocks:

When one's identity is secret and stigmatized it takes on a particular and vital significance … If there is a part of you that is hidden; if that hidden part appears to have been defined by others not privy to it; if that part of you is in direct and immediate opposition to the social and cultural mores of society, then the question of identity and self becomes much more important, if not all-consuming. 

My only lesbian experience had been with a school friend the previous year. We both applied to Durham University but she was not accepted and chose to attend the University of Manchester in the city where we lived. Our distress was compounded when our parents discovered our relationship. Her father was furious and instructed her to end it. My mother was kind and asked me if I wanted to see a psychiatrist. I went to Durham and she went to her GP who referred her to Crumpsall Hospital where Philip Feldman, a psychologist,  and Malcolm MacCulloch, a psychiatrist, were working on a 'treatment' known as aversion therapy. She was encouraged and supported in this by a young man whom she later married. Her aversion therapy was regarded as a success but an opportunity to discuss with her the details of what she experienced at Crumpsall Hospital never occurred.

My school friend persuaded me to meet Feldman and MacCulloch at Crumpsall Hospital in North Manchester. By then I had a good idea of the behavioural principles involved and in some way their term 'behaviour disorder' seemed less offensive than 'sexual perversion' which I had previously believed. They explained to me that the 'treatment' was designed to make the fullest possible use of the extensive knowledge available about the psychology of learning. They seemed keen for me to be involved in their experimental 'treatment', offering me a job as a receptionist in the Department of Psychiatry for the summer to make it easy for me to be in the hospital and access the treatment room when necessary. They introduced me to the Clinical Director of Psychiatry, Doctor Northage J. De Ville Mather, who spoke encouragingly of Feldman and MacCulloch's 'treatment'. 

As a working-class girl, brought up to please and seek approval, particularly male approval, I was intensely flattered by these three important doctors. In my psychological vulnerability, I willingly agreed to undergo their aversion therapy 'treatment' of sexual deviations in order to divert my lesbianism to heterosexuality.

I was unaware that the 'treatment' programme was to be the subject of a series of academic articles and in 1971, edited in a book by Feldman and MacCulloch entitled Homosexual Behaviour: Therapy and Assessment. The book was enthusiastically reviewed in the July 1972 issue of the British Journal of Psychiatry by John Johnson, who began his comments with 'Behavior therapy for the treatment of sexual deviation has been one of the therapeutic success stories of the past decade. In this volume, Feldman and MacCulloch describe their systematic development of the principle of anticipatory avoidance conditioning applied to the treatment of male homosexuality.' 

Johnson either failed to notice or regarded as unimportant the inclusion of two females in the experiment. Perhaps the most chilling words in the review for me were: 'The electrical circuitry used in applying this treatment is in itself complex and is a credit to the ingenuity and capacity for improvisation which the authors have shown in developing the technique.' The review concluded: 'The authors have produced a work of considerable value and practical application. This technique for the treatment of homosexuality would have been applauded by the doyens of sexual psychopathology.'

It would seem that at the time, psychology's contribution to the understanding of lesbian sexuality was to support and consolidate the paradigm of sickness, perversion and pathology that surrounded it.

The 'treatment'

Several weeks after my meeting with Feldman and MacCulloch, I found myself sitting in a chair, looking at a blown-up photograph of an unknown, semi-clad, sexualised female, waiting to receive an electric shock. The electric shock itself was not severe but still painful. What was more unpleasant was the anxiety and fear of waiting for the shock, the anxiety and fear that they were systematically trying to link with the female form on the screen. Their particular technique was a refinement of previous ones where the subject received a shock each time the same-sex photograph appeared. For me, three things could happen; I could receive a shock immediately after the photograph appeared; I could receive a shock after 30 seconds or there could be no shock at all.

They had discovered that this technique created far more anxiety and fear than the original one. The final refinement was that by pressing a button I could even avoid the shock entirely by replacing the female photograph with one of a man. I could avoid the physical violence of the electric shock and the emotional violence of the acute anxiety by choosing a man. Feldman and MacCulloch named this Anticipatory Avoidance Learning.

In my feedback to Feldman and MacCulloch after the first couple of sessions, I made two points. Firstly that the photographs of the semi-clad, sexualised females that were probably straight from Page 3 of The Sun newspaper held no sexual attraction for me whatsoever. In retrospect, their use of these particular images only betrayed their ignorance of female sexuality in general and lesbian sexuality in particular. They said far more about how men have sexually objectified women than about lesbianism as a broad, all-embracing affirmation of women in an emotional as well as an erotic sense. The second point I made was that I was beginning to dislike John Pinschof, the male therapist who was administering the 'treatment' and giving me electric shocks. Taken aback by this experimental oversight, they allocated the remainder of my 'treatments' to Valerie Mellor, a probationer psychologist at Crumpsall Hospital. Mellor had published in Acta Psychiatrica Scandinavica with Feldman and MacCulloch, and with James Orford, on The Application of Anticipatory Avoidance Learning to the Treatment of Homosexuality-Developments in Treatment Technique and Response Recording.

Two decades later, as a qualified Educational Psychologist working for Manchester City Council, I came across Valerie Mellor professionally on a number of occasions. On one of these occasions, we met to discuss a safeguarding case with which we were both involved. I reminded her where we had met before and told her I was delighted that the electric shocks she had administered had made no difference whatsoever to my sexual preference. She said that she knew and the conversation ended. Looking back, I would have liked her to tell me that she was sorry.

Healing

I received approximately 20 sessions of electric shocks as part of a 'treatment' designed to destroy my lesbian feelings and create heterosexual ones. Neither Feldman nor MacCulloch made any attempt to help me accept my sexual orientation. Instead, they advised me to change my patterns and habits of thinking. They told me not to focus on women, not to engage with women, not to even look at them, but to turn my thoughts, both social and sexual to men, to make them the centre of my attention. There was some irony in this in that I had already achieved the outward appearance of heterosexuality with partners whose company I mainly enjoyed but towards whom I was not emotionally or sexually attracted. Behaving in a heterosexual way was something I had achieved prior to the aversion therapy.  Feeling heterosexual was shockingly difficult.

Instructed not to look at women, only at men, and to consciously suppress any lesbian identity that might begin to emerge, became increasingly difficult. I suppressed my attraction towards one of my friends throughout my second and third years at Durham until the energy required for this became physically, psychologically and emotionally exhausting. Finally, in 1967, I presented myself back at Crumpsall Hospital feeling I had nowhere else to go. Feldman and MacCulloch had already moved to work at the University of Birmingham but I saw Doctor De Ville Mather who diagnosed a reactive depression and arranged for me to be admitted to the Hospital's psychiatric ward. I was prescribed Ativan, an anti-depressant and Sodium Amytal, a sedative that is no longer prescribed. I remained there for three weeks and was discharged back to Durham, drugged and dulled by the medication. 

Managing to graduate, I spent the next three years in Manchester, qualifying as an Educational Psychologist. I continued trying to behave heterosexually but my commitment had become tired and threadbare. Accidently I bumped into a woman from my College in Durham about whom it was whispered she was a lesbian. Fearful of my instructions to focus solely on men, I had ignored her whilst at Durham. She introduced me to a small lesbian community. I immediately felt more comfortable, more lively and 'at home'. That year I met my partner, a woman with whom I was to live for the next 20 years.

My memories of the electric shocks and the messages that were drummed into me about behaving heterosexually gradually receded. I felt psychologically and emotionally stronger. The despair and depression had disappeared. It was almost 20 years later during my time at Bradford University doing a Master's degree in Women's Studies that these long-buried emotions were re-awakened. It was in the mid-80s at the height of the Second Wave Feminist Movement, a time of consciousness-raising and discovery. The connections between what had happened to me at Crumpsall Hospital and my unfolding understanding were made slowly and laboriously. The exercise was mainly an intellectual one. The emotional connections, however, were made suddenly and painfully. They were made as I read the final paragraph of Judy Grahn's poem/prose: The Psychoanalysis of Edward the Dyke, in 1978's The Work of the Common Woman:

Edward rolled to the floor. 'I am vile! I am vile!' Doctor Knox flipped a switch at his elbow and immediately a picture of a beautiful woman appeared on a screen over Edward's head. The Doctor pressed another switch and electric shocks jolted through her spine. Edward screamed. He pressed another switch, stopping the flow of electricity. Another switch and a photo of a gigantic, erect male organ flashed into view, coated in powdered sugar. Doctor Knox handed Edward a lollipop.

For the first time, I saw with great clarity the meaning of the physical violence and the emotional violence that had been committed against me. The tears I wept helped to heal the damage. Other healing came from the feminist theory and knowledge that helped me to join up the fragments that until that point had not made much sense. The grounds for battle were no longer inside me, they were outside in a patriarchal and heteronormative society. At the age of 40, I was finally free from the shame and self-doubt that had hovered throughout most of my adult life.

Truth and reconciliation

In 2022, Helen Spandler and Sarah Carr published a paper in History of the Human Sciences entitled 'Lesbian and Bisexual Women's Experiences of Aversion Therapy in England'. The paper presents the findings of their study of the history of aversion therapy as a treatment technique used in the English mental health system to convert lesbians and bisexual women into heterosexual women. The authors carried out an intensive exploration of published psychiatric and psychological literature together with lesbian, gay and bisexual archives and anthologies. In all, they identified just 10 examples of young women who received aversion therapy in the 1960s and 1970s.

As a result of their searches, they found references in the medical literature to four women being subjected to anticipatory avoidance therapy at Crumpsall Hospital in North Manchester in the mid-1960s, published in the British Medical Journal in 1967 as 'Aversion Therapy in the Management of 42 Homosexuals'. The authors of these articles and the managers of the aversion therapy were the psychiatrist Malcolm MacCulloch and the psychologist Philip Feldman. It was unclear whether four women or two women were involved in the 'treatment', but what was clear was that I was one of the women referred to in their article – and referred to as a success.

Some four years ago, I met Helen Spandler and was able to discuss with her at length my experience of aversion therapy at Crumpsall Hospital. Details of this discussion are included in her paper. In an earlier paper, published in the Mental Health Review Journal in 2017 with M. McKeown, Spandler explores the case for a 'truth and reconciliation' approach to psychiatric (and psychological) harm, a process that would start by 'acknowledging the mistakes of the past and involve carefully and truthfully documenting this history'. Such an approach, they argue, could help to prevent future wrongdoing and 'begin to heal the harm caused by the psychiatric and psychological mistreatment of minorities'.

An example of the effectiveness of this approach can be seen in an investigation instigated by the University of Birmingham in 2021 into its involvement in the research and clinical practices that came under the heading of 'conversion/aversion' therapy, carried out by two members of its staff, namely M.P. Feldman and M.J. MacCulloch. The investigation was prompted by 'Chris' coming forward in 2020 to the BBC, reporting that he had experienced 'conversion therapy' in the mid-70s at the University of Birmingham.

A steering group, chaired by Professor Sarah Beck in 2021 and by Professor Elaine Fulton and Doctor Mo Moulton in 2022, was established. It included representatives from the School of Psychology, the Guild of Students and the Rainbow Staff Network. The report of the research, carried out and written by Dr Rebecca Wynter, entitled 'Conversion Therapy' and the University of Birmingham, c 1966-1983, was published in June 2022.

The report opens with a statement from the Vice-Chancellor: 'Today I formally acknowledge and apologise for the University's role in the historical research and practices detailed in this report and the harm that they caused… We understand the impact that conversion therapy has on individuals and unreservedly condemn this practice. We are unequivocal that conversion therapy is unethical, degrading and harmful.'

One of the observations of the report is that 'Talking with survivors in Manchester, Birmingham and beyond would help to develop knowledge of the ways in which the 'conversion therapy' of the 1960s and 1970s advocated by Birmingham scholars affected the lives of those with direct experience and people whose identities and activities were threatened by AA (Anticipatory Avoidance Therapy).'

My discussions with Helen Spandler, and the report from the University of Birmingham, have contributed significantly to my motivation to write this personal account of an experience that lingers with me, even after 55 years.

Pauline Collier

'I apologise unreservedly'

As a probationer clinical psychologist in Manchester in 1965-66, I took part in the aversion therapy programme described in the foregoing, moving and disturbing account of being on the receiving end of that treatment. I don't believe we met in person, but I want to personally apologise to you, and others who shared your experience, for what went on and what I contributed to. I hope, in doing so, that I speak for all those who were part of the programme, none of whom I am now in contact with and some of whom may no longer be alive.

The following is a piece I wrote for colleagues in the School of Psychology at the University of Birmingham, at the request of the Head of School, in 2021 at the time the University's investigation was being conducted. I am pleased for it to be seen more widely now.

In the mid-1960s, I was training to be a clinical psychologist and spent my final practical placement at a hospital in Manchester where there was a treatment programme using aversion therapy for homosexuality – a form of conversion therapy. I was assigned to work on the programme and I willingly did so. At the end of the placement, my supervisor gave me the opportunity to be a junior author on a paper and a chapter in a book the programme directors were writing about it, and I willingly accepted. Things were changing fast, including the law about homosexuality, and within a very few years that form of treatment ceased to be practised within the NHS, by psychologists or any other profession. As time went on and the rights of gay and lesbian people, and then LGBT people generally, were fought for and became better understood and appreciated, conversion therapy was increasingly seen, not just as out of fashion, but as part of the cruel, discriminatory climate that had existed at that time. The role of psychology in aversion therapy was seen more clearly for what it was – an unethical practice, an abuse of those who were treated and the wider group they represented, a misuse of psychology. To my knowledge, it has not been practised in clinical psychology for many years. The British Psychological Society has clearly ruled against its use.

After completing my final placement, I moved to London, to take up a research post in addiction, which became my main area of work for the rest of my career. It was and remains an absorbing topic and I confess that for a long time, I gave little thought to the conversion therapy I had contributed to during my training. But as time went on and I saw more and more people coming out and telling us about the hurt and discrimination they had experienced, I thought more about it and felt increasingly bad about it. It became clear to me that what I had taken part in at the very beginning of my career played a part in reinforcing an abusive climate in which gay and lesbian people had felt unable to acknowledge their sexuality openly and be proud of it. Their struggle to campaign for change, to create a new climate in which they could be proud of who they are and be free to express their love and to marry if they choose, has been one of the most courageous and effective in my lifetime. I only wish that when I was enthusiastically embarking on a career in psychology, we had been part of it, supporting it rather than colluding with the climate of the times that so badly needed changing. I feel ashamed of that aspect of 1960s clinical psychology and of the part I played in it. I apologise unreservedly.

I have given much thought to trying to understand how it was that the profession I was entering could have supported conversion therapy in those days and how it was that I could so willingly have taken part in it as a trainee. I have come to the conclusion that the answer to those questions comes in two parts. One was simply hubris. Clinical psychology was an emerging specialty in the 1960s, primitive in comparison with how it is now. The academic side of my training was dominated by behaviour modification, based to a large extent on what had been discovered about animal conditioning and learning. Our teachers imparted to us their enthusiasm, conveying the notion that behaviour was never fixed and could always be changed. In many ways, this was a very positive message and the movement was an exciting one to be part of. But it over-reached itself in the form of unethical practices such as conversion therapy. I was a gullible student, caught up in and unquestioning of my teachers' enthusiasms. There are lessons to be had there for students at all times in all places.

The second part of the answer concerns our failure to find out about and reflect on what was going on in the world outside the narrow confines of our discipline. We were willingly ignorant of the bigger picture. At least I was and I assume my supervisors must have been too. I was so wrapped up in the details of psychological theory and practice, that I didn't know, or ask, about the law, campaigns to change the law, about social attitudes surrounding sexuality, or reflect and debate about the ethics of what was going on. I should have done.

It would be disingenuous of me to claim that I used my psychology later to campaign against conversion therapy or for sexual rights, although I have encouraged students and others to research and write on the subject. My main contribution of relevance here concerns the branch of psychology known as 'community psychology'. I am proud of having introduced it into the clinical psychology training programmes I was responsible for at Exeter and later at Birmingham, of having for some years been editor of the first UK journal on the subject, of having been one of the pioneers of it in Britain, and taking a lead in creating the European Community Psychology Association and the Community Psychology Section of the British Psychological Society. What is distinctive about community psychology, and why the conversion therapy of the 1960s would not have been possible had community psychology been on the curriculum then, is its insistence on seeing the bigger picture. It requires its adherents to see beyond individual behaviour, to learn about the broader attitudes, norms and laws and the structures of power within which individuals live their lives, and to reflect on professional practice from that broader perspective.

I look back with shock and shame on the aversion therapy programme I took part in as a trainee in the 1960s. I apologise for my part in it. I am also pleased to say that it no longer plays any part whatever in professional psychology in the UK, nor could it.

Jim Orford
Emeritus Professor of Clinical and Community Psychology
University of Birmingham

The darker aspects of psychology's past

We found Pauline's account very moving to read. It is a poignant reminder of the regrettable role that psychology has historically played in pathologising sexual diversity and the harm caused by the psychological mistreatment of LGBT+ people. 

We are keen to better understand and uncover the role that the BPS may have played in such therapy. With that in mind, there are two recent developments to share with you.

Firstly, the BPS has a Challenging Histories group that reports to the Ethics Committee. This is an interdisciplinary group that includes BPS members, psychiatrists and historians reviewing some of the darker aspects of psychology's past. You can expect to read more about that work in the pages of The Psychologist in due course. 

Secondly, the BPS has recently been successful in getting funding for a PhD studentship to look at the history of the BPS when it comes to race and LGBT issues.

Our intention is that these activities will allow us to better understand and acknowledge the mistakes of the past and will lead to more informed statements and apologies in the spirit of truth and reconciliation.   

We are also aware that whilst this account describes 'conversion therapy' of the 1960s and 70s, other forms of so-called 'conversion therapy' continue to be practised in a range of contexts. Pauline's experience of how psychologically and emotionally exhausting it is to suppress one's LGBT+ identity resonates with the accounts of those who have experienced conversion therapy more recently, as outlined in a recently published government report. The British Psychological Society unequivocally opposes conversion therapy practices.

Dr Adam Jowett
Chair, Equality, Diversity and Inclusion Board
Dr Debra Malpass
Director of Knowledge and Insight

Update: Read responses from subsequent issues, plus more on aversion therapy from across the BPS website.