d. Behav. Ther. & Exp. Psychiat.

Vol. 3, pp. 23--30.

Pergamon Press,

1972.Printed n GreatBritain.

SEPTAL STIMULATION FOR THE INITIATION OF HETEROSEXUALBEHAVIOR IN A HOMOSEXUAL MALE*

CHARLES E. MOAN and ROBERT G. HEATHDepartment of Psychiatry and Neurology, Tulane University School of Medicine

Summary--A

24-year-old male, overt homosexual, repeatedly hospitalized for chronicsuicidal depression and found to have temporal lobe epilepsy, underwent a program ofseptal stimulation which resulted in subjectively reported and behaviorally observed statesof pleasure, euphoria, relaxation, confidence, and sexual motivation. These responses weresubsequently used to initiate heterosexual arousal and behavior. The findings have im-portant implications for the treatment of some psychological disorders.PLEASURE has long been known to be a primaryreinforcing condition for acquiring and estab-lishing behavior in animals and man. Theydevelop the particular responses that arefollowed by states of pleasure. The knowledgethat these states can be important positivereinforcers has led to significant applications inpsychotherapy, as witness the large number ofstudies reporting the effectiveness of variousoperational forms of pleasure in altering or"counterconditioning" undesired human be-haviours. Over the past several years consider-able interest has also fastened on the fact thata pleasurable response can be induced by directactivation of the brain and raised hopes thatthis might be applied to the treatment ofdisordered human behavior.In 1952, at a symposium on depth electrodestudies in animals and man, investigators atTulane University School of Medicine firstdescribed 26 patients' pleasurable responses tostimulation of specific deep regions of the brain,initially observed with electrical stimulation toseptal region (Heath, 1954). Subsequently,techniques were developed for intracranial self-stimulation and the study of what appeared tobe reward and aversive areas of the brain inanimals (Olds, 1960; Olds, 1962; Olds andMilner, 1954; Olds and Olds, 1964). Thesewere incorporated and modified by the Tulaneresearchers in human studies, enabling them toextend their scope to man (Bishop

et al.,

1963;Heath, 1954, 1963, 1964; Heath and Guerrero-Figueroa, 1968). Following an initial observa-tion that there were pleasurable experiencesaccompanying electrical stimulation of the deepstructures of the brain, they found that therewere positive and negative reinforcing propertiesof such stimulation and that there were effectivestimulus parameters and brain "reward" areasin man. In particular, they found that stimula-tion of the septal area consistently resulted in apleasurable response and frequently induced anassociated sexual motive state. Considering thefindings of these investigations it seemed logicalto employ pleasure-yielding septal stimulationas a treatment modality for facilitating theinitiation, development and demonstration ofnew and adaptive behaviors. The purpose ofthis study, therefore, was to explore the possi-bility of using it to bring about heterosexualbehavior in a fixed, overt homosexual male.This was but one phase of the therapeuticprogram undertaken to deal with the complexsymptomatology of this individual who hadconsistently failed to respond to other treatmentapproaches and was a most serious suicidalrisk.*Requests for reprints should be addressed to Robert G. Heath, Department of Psychiatry and Neurology, TulaneUniversity School of Medicine, 1430 Tulane Avenue, New Orleans, La. 70112.23

24 CHARLES E. MOAN and ROBERT G. HEATHCASE HISTORY

Background.

Patient B-19 is a 24-year-oldsingle, white male of unremarkable gestationand birth whose immediate family consists ofparents, age 55, and a sister, 19. The father,described by the patient as a tyrannical, abusiveand demanding individual given to excessivedrinking and episodic anger and violence,reportedly considers his son to be a deeplydisappointing young man who was a failure andcoward during childhood and adolescence. Themother is characterized as an extremely with-drawn, rigid and emotionally controlled woman,whose embrace B-19 cannot recall. Rather,she serves to mediate between him and hisfather, is given to excessive complaining abouther surroundings and circumstances and con-sistently approaches the patient for solutions toher marital conflicts. In contrast, he reportsconsiderable affection for his sister, with whomhe states he can share his confidences, anxietiesand disappointments.The educational background of B-19 ischaracterized by nine major residential andschool changes and by the early manifestationof behavioral and disciplinary problems whichresulted in three expulsions from school andtwo examinations by child specialists by age 11.From first grade on, he consistently experienceddifficulties in interacting with other boys andactively sought to avoid contact and competitionwith them, while becoming increasingly aggres-sive and punitive toward his female peers. Thesebehaviors resulted in his being teased, pickedon and ostracized by his classmates. Indesperation, he was sent to an all-male parochialschool where he experienced further rejectionand isolation and turned to individual pursuits,interests and reveries. High school began witha psychiatric referral because of an inability toget along with his peers and increasinglypoor grades. He dropped out after 3 yearsand took a part-time job as a stock clerk beforemilitary enlistment, which resulted in a psychi-atric discharge after 1 month due to "homo-sexual tendencies". Seven months were thenspent working in a factory followed by 2 yearsas a "drifter" travelling idly around the country,engaging in numerous homosexual relationshipsand being supported financially by homosexualpartners.

Symptomatology.

The patient exhibits adistinct preoccupation with his body image andis given to extreme somatization characterizedby multiple vague and fluctuating complaintsregarding suspected changes in facial dimensions,loss of libido and hormone imbalance, agitationand fatigability, and various conditions of dis-comfort in his head. In addition to thesehypochondriacal traits he demonstrates con-siderable paranoid ideation, which often exceedsthe limits of reality. Such thinking is highlightedby a marked fear of the future, a dramaticdread of inflicted physical pain, a daily expecta-tion of dying and deliberate avoidance ofpeople, especially men. Hypersensitive to criti-cism and unreasonably self-conscious in public,he feels sealed off and alienated from society ingeneral. Paradoxically, however, he cannottolerate being ignored and is generally disdain-ful, arrogant and grandiose in his presentationof knowledge and expresses hostility for gainingattention and recognition. Regarding the dis-comforts of these conditions, he conceives ofhimself as a "special" person who will berewarded by God for the endurance of presenthardships. The extent of his paranoia fluctuatessituationally, but is often of true psychoticproportion.B-19 is also distinguished by marked apathy,chronic boredom, lack of motivation to achieveand a deep sense of being ineffectual, inadequate,worthless and inferior. He avoids making anyplans, has no meaningful feelings for others,and complains of having no talents worthmention. He is a severe procrastinator, gives upeasily and obsesses on his personal problems tothe point of incapacitation. Depression andsuicidal rumination are reportedly his dailycompanions. Further, he feels that he will neverfind happiness or peace of mind and that hislack of masculinity and intellectual power causehim to want to end his life. Complaints are alsopresent of an alteration in his ability to

SEPTAL STIMULATION FOR THE INITIATION OF HETEROSEXUAL BEHAVIOR 25experience pleasure, where he states that he isbored by everything and left constantly blasr.Having initially turned to alcohol, drugs andsexual acting out for pleasure and stimulation,drugs no longer produce a high or euphoria andhe gets no "kick" out ofsex--"not even mastur-bation". He does have a three-year history of drugabuse, which ran a course punctuated by alcohol,amphetamines, barbiturates, major and minortranquilizers, the sniffing of chemical agents andsolvents, marijuana, and nutmeg. Addictionand preference were for amphetamines, whichgave him a "lift", confidence, energy andelation. With continued usage, however, alcoholand drugs, even in greater frequncy and dosage,failed to produce the desired effects and resultedin severe depression and a state he referred to as"brain pollution".For the past 5 years he has exhibited fixed,overt homosexual behavior but has never in hislife experienced heterosexual relations of anykind. He prefers to be the dominant individualin anal intercourse, with fellatio being toleratedbut not necessarily sought. He is most attractedto and jealous of handsome, well-built and-dressed, intelligent and masculine men; though,he is far more comfortable when lovemaking iswith effeminate males. Those with whom hehas had sexual relations over any consistentperiod of time have been several years olderthan he and characteristically of marginalemotional stability. He describes himself ashaving been "sexually precocious", experi-encing erotic feelings toward his sister whenbathed together as children, having begun "wetdreams" at age 5 or 6 (which he elaborates as asense of pleasurable relief when he wet the bed),and having very actively indulged in masturba-tion since age 12 (still a preferred behavior).Homosexual encounters began at this time, aswell as wide reading in the area of sexualdeviations and perversions. There has neverbeen an active interest in females, though headmits that he is somewhat aroused by picturesof women in various degrading and pitiablepositions. In no way does the patient himselfphysically manifest effeminate mannerisms,gestures or movements.

Hospitalizations, Evaluations and Examina-tions.

Following two previous psychiatrichospitalizations of approximately 5 monthseach and initiated by suicidal depressions,

B-19

was examined and admitted to the TulaneService of the Department of Psychiatry ofCharity Hospital of New Orleans. Physical andneurological examinations were within normallimits, as were the results of urinalyses and bloodchemical determinations. Psychological evalua-tion indicated bright normal intellectual func-tioning (WAIS Verbal Score 118, PerformanceScore 104, Full Scale Score 113) and an unusuallyhypersensitive and obessive-compulsive indi-vidual who experiences chronic depression of adegree which leaves him functionally dis-organized, confused, discontent and bitter. Histolerance for frustration is extremely low, andhe responds quickly with suspicion, anger,impatience, querulousness and vindictiveness.Psychiatric examination indicated that thesymptom complex exhibited by the patient wasconsistent with temporal lobe epilepsy. Con-ventional scalp EEGs showed an abnormalitycharacterized by bitemporal slow-wave activity,maximal on the left. Paroxysmal delta activityalso appeared over the right temporal region,with Chlorolose activation. Pneumoencephalo-gram was normal.TECHNICAL PROCEDURE ANDAPPARATUSOperative procedure and stereotaxic implanta-tion of electrodes followed techniques previouslydescribed (Heath

et al.,

1968). The patient wasunder general anesthesia, with visualization ofthe ventricular system by air and pantopaque.Stainless steel Teflon-insulated electrodes 0.003in. diameter, each with three to six leadsseparated by 2 ram, were implanted into thefollowing brain regions: right mid septal, righthippocampus, left and right amygdalae, rightanterior hypothalamus, right posterior ventrallateral thalamus, left caudate nucleus, and attwo subcortical sites within the left lobe of the