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Homosexuality, or the attraction to the member of the same-sex, is viewed in different angles

by different people. To date, the issues surrounding homosexuality still instigates uproars of

debates, revolts, etc., regularly. Homosexuality, with concrete evidence, seems to be present

since the time of the ancient civilizations. However, heterosexuality, or the attraction to the

member of the opposite sex, has been the entrenched norm put upon by society’s standards. And

ultimately, homosexuality was rebuffed as an abnormal and unorthodox stigma.1

In 1952 that the publication of the American Psychiatric Association’s (APA) first edition of

Diagnostics and Statistical Manual, Mental Disorders (DSM-I) homosexuality was categorized

as a sexual deviation. Specifically, sexual deviations are categorized under the Sociopathic

Personality Disorder in DSM-I, a label describing individuals who are ill in terms of current

societal norms. Sixteen years following the first publication, the second edition (DSM-II) was

released. Albeit homosexuality still categorized as a sexual deviation, DSM-II had made slight

modifications concerning its explication. Sexual deviation was then associated to individuals

whose sexual interests were not heterosexual but rather towards the sexual acts not associated

with sexual intercourse. Specifically, sexual deviations were categorized under Personality

Disorders. It was later in December 1973 that the Board of Trustees of the APA had reached to

an agreement, by voting, to reclassify homosexuality’s taxonomy as a sexual orientation

disturbance in the DSM-II due to cultural information, biological deductions and invalidation of

psychiatric and clinical examinations. At this point, the new amendments gave way to the fresh

perspective that homosexuality was only deemed as a mental disorder if it was personally

disturbing and distressing to the individual.1

1
Harold I. Kaplan, MD and Benjamin Sadock MD, Comprehensive Textbook of Psychiatry
Fourth Edition. (Baltimore, Maryland, USA: Williams and Wilkins, 1985), p. 1056.
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At the time of the issue before the reformation of the DSM-II, various gay activist groups

turned up during APA meetings. The issue involved the classification of homosexuality as a

mental illness and its association with sexual deviations. The upshot of the constant arguments

between the activists and the APA was a dynamic discourse between their representatives.2

A decision to remove homosexuality in its current diagnostics was subsequently made.

However, a faction of the APA members were displeased with the decision and acted to arrange

a referendum. It was perhaps a first that a medical diagnosis in DSM-II’s nosology had reached

to the voting of the APA membership. Ultimately, the decision of the APA was sustained.

However, the debates hadn’t ceased form the end of the voting, especially during the time for the

composition of the upcoming DSM-III. The 1973 uproar was widely known to public but the

events that followed after the voting remained exclusively inside the APA.2

The debates and revolts continued. Nevertheless, they reached ending upon the publication of

the DSM-III. The term “ego-dystonic homosexuality” was introduced and categorized under

psychosexual disorders of the DSM-III.2 And by psychosexual disorders, it means that ego-

dystonic homosexuality damages the relationship between a man and a woman. But the true

rationalization of not considering homosexuality a disorder sets apart the ego-syntonic and ego-

dystonic homosexuality.3 Ego-syntonic homosexuality is not a source of stress for the individual

and not deterring as the individual does not seek to change his sexuality. Ego-dystonic

homosexuality, in contrast, is a source of distress for the individual and is deterring his lifestyle.4
2
Ibid., p. 1057.
3
James Benjamin MD, Virginia Kaplan, Synopsis of Psychiatry; Behavioral Sciences/Clinical
Psychiatry Ninth Edition. (Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2003),
p. 697.
4
David Rosenhan, Abnormal Psychology. (New York: W.W. Norton and Company, 1952), p.
480.
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The standard attributes of ego-dystonic homosexuality are the craving to procure or expand

heterosexual interests to enable the individual to establish heterosexual interactions. Another one

is that the homosexual blatancy and urges are unwanted, therefore causing this to be a source of

distress. Thus, it is then considered that ego-syntonic homosexuality as an exclusion to the list of

psychosexual disorders.5

Ego-syntonic homosexuals are content with their sexual preference with no desire to alter it

are not manifesting psychopathic symptoms, and works efficiently in love or career. Ego-

dystonic homosexuals, conversely, are not content with their sexual preference and distressed by

this. They manifest symptoms of depression, anxiety, guilt, humiliation and loneliness. They also

fail miserably in love and career.6

The difference of the homosexuality and ego-dystonic homosexuality is reasonably simple.

Homosexuality, by definition, is the attraction for the same-sex. Ego-dystonic homosexuality is

homosexuality, however the individual is bothered by the vulnerability of heterosexual arousal,

the strain of acquiring heterosexuality, and the riddance of homosexual impulses. The reason,

perhaps, that causes the ego-dystonic homosexual to feel horrified of being homosexual may be

of his own wishes to have children and a typical family. The ego-dystonia may also have been

developed from the strain put up by society’s norms.6

According to a survey conducted during the 1973s outbreak, common perspectives of

homosexuals are “sexually abnormal,” “perverted” and “mentally ill.” In opposition to this sort

of rejection, it is hard to keep one’s level-headedness.7


5
Kaplan and Sadock, loc. cit.
6
Rosenhan, op. cit., p.481.
7
Ibid, p. 482.
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Seeing that ego-dystonic homosexuality is a disorder, a source of distress, it is only

appropriate for the individual to seek treatment. However, it is advisable that that treatment

should not be coerced, especially for homosexuals who are content with their own sexuality, the

ego-syntonic homosexuals. Ego-syntonic homosexuals should not be referred for treatment.

There are various approaches for treatment that the individual can consider. Their choice of

treatment, however, is not of their own choice. Some of these treatments vary according to the

individual’s present level of sexual responsiveness and behavior. For instance, homosexuals who

are critical and threatening, anti-androgen therapy is a suitable therapy.8

It is also best to estimate and scale the individual’s prognosis, the prediction of the outcome

of disease. Unlike with diseases, prognosis is easily processed depending on the manifested

physical symptoms of the patient. But in the case of disorders, certain observations should but

painstakingly put into account.

As with other psychosexual disorders, in which erotic and sexual aspects are the main focus,

arousal and sexual liberation strengthens and evens out the modification of the disorder and

regresses the motivation for changes. Even if the sexual orientation is ego-dystonic

homosexuality, the truth that their lifestyle is restrained by their undesired sexuality allows the

chance of overcoming it to become more challenging. The chance of good prognosis relies on the

assessment formulated in compliance with the standard attributes of ego-dystonic homosexual.7

Simple personality structures, invalidating of defense mechanisms and pairing egoistical

strengths are factors that are most likely contributors to a less promising prognosis no matter

how effective the mode of treatment is. Factors that bear indicators of a promising prognosis are;

8
Kaplan and Sadock, op. cit., p. 1063.
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supple personality structures, less tampering of defense mechanisms and higher degrees of

achievement, tolerance and perceptiveness. In conferring about the prognosis, it is needed to first

consider the aim of the treatment. And whatever the aims are, it is not to be determined by the

treating physician but by the patient. As mentioned earlier, there are various forms of the

treatment but the type of treatment employed to the individual is dependent on the similar

component used to construct the diagnosis and prognosis.9

The treatment of the homosexuality encompasses issues directed towards the treating

physicians. The issues are utterly ethical, chiefly about the physician to assent or refuse to treat

the homosexual. According to Silverstein, Davison and Begelman, the pressures to convert into

heterosexuality make it a point that the cause of their desire to be treated is hardly a choice made

by the homosexuals’ own will.10 It has also been implied that the mere existence of this sexual

orientation conversion therapies is a hint of the condoning of the biases against homosexuality.

These therapies were fashioned because there are physicians who are deeply concerned about

ego-dystonic homosexuality. The literature on the treating homosexuality is meager. Ironic,

though, the articles and books promoting to discourage homosexuality are rich in numbers.

It was because of these reasons that it has been suggested that the treating physician should

refuse treatment even if the treatment is of a personal and willing choice. Several gay activist

groups were pleased with this, considering their advocacy in the belief that homosexuality per se

is not a psychosexual disorder.11


9
Ibid.
10
Gerald C. Davison, John M. Neal, et. al., Abnormal Psychology Fifth Edition. (New York:
Jon Wiley and Sons, Inc., 1990), p.630.
11
Rosenhan, loc. cit.
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According to those in opposition for homosexuality treatment, the desire to become

heterosexual is not an upshot of the persecution and rejection of the society. The desire to

become heterosexual is forced and involuntary and, therefore, should be left unheeded.

Conversely, others disagree, under the belief that the individual’s own suffering is an upshot of

society’s prejudices and rejection.12

The treatment of homosexuality is not simple. Homosexuality is not an unadulterated erotic

behavior; it is also an identity, a lifestyle, a vessel containing something precious to the

individual and something stemmed from deep experiences. Homosexuals usually come to

treatment on behalf of someone else, for themselves, but never for their homosexuality. The

degree of these alleged motivations would determine the outcome of the treatment.13

Traditional psychotherapy seems to provide little success in the treatment of homosexuality.

Behavior modification is the monopolizer in the treatment of this condition. One of the more

widely used behavior modification techniques is the aversion therapy. Aversion therapy is not

the sort of therapy that only consists of a single procedure. An application of procedures is

employed to the individual in the therapy. Aversion therapy has been widely used since before

the 1960s. But reports show that the utility of aversion therapy on homosexuals has a dramatic

decline as the decades elapse. Aversion therapy is not exclusively employed to homosexuals.

Aversion therapy is also employed to alcoholics, druggies and sex offenders.14

Despite aversion therapy having arrays of procedures, they all have a sole concept;

chastisement. First, an unwanted and lethal stimulus (called aversives) is delivered when a
12
Ibid.
13
Kaplan and Sadock, p. 1063.
14
Henry Roediger III, Elizabeth Deutsch Capaldi, et. al., Psychology. (St. Paul, Minnesota:
West Educational Publishing, 1996), p. 680.
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behavioral response (the homosexual arousal) is at its peak. This delivery of the aversives is

abrupt and is done when arousal is manifested, in psychological terms they call it pairing.

Notionally, the arousal is repressed when something unwanted intervenes. Subsequently, the

individual would perceive his homosexuality as unpleasant and unwanted due to the effects of

the pairing of his homosexuality with some other unpleasant stimulus. A blending of blue and

yellow creates green, coalescence occurs in the process like in the pairing. As a result, the

individual feels, for the therapy’s namesake, aversion for his behavior.

Several techniques are utilized in aversion therapy. But not all forms of the techniques are

applied for the treatment of homosexuality. Only those techniques that are suitable for treatment

are used. All the techniques all have similar objectives through similar means, that is to decrease

the individual’s homosexual behavior and responsiveness through aversive or disgusting means.

For evaluation of the patients’ improvement in achieving heterosexual responsiveness, a penile

erection meter or a clitoral erection meter is employed. The usual “mediums” used to provoke

arousal in patients are photographs, slides, videos and even real-life situations or demonstrations.

One of the more widely used techniques is the aversive relief therapy. The most common type

of aversive for this therapy is the use of electric shocks. An example of this application is

provided in Mears and Gatchel’s Fundamentals of Abnormal Psychology, about a male

homosexual patient of the aversive relief therapy. The patient was shown explicit photographs of

the same-sex. Before the actual therapy, the client was cautioned that he would receive electric

shocks while viewing the photographs. But he can find “release” if he presses the button that

removes the photo and stops the electrocution. After pressing the button, an explicit photograph,

this time that of the opposite sex would be seen. The idea here is that the photograph displaying
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the female would be considered as a reward and escape of distress because it can get rid of the

aversive event.15

The chemical aversion therapy involves the employment of emetics. Emetics are agents that

induce vomiting. The common use for emetics is to spew out any consumed poison.16 Emetic

takes its effect on the medulla oblongata and stomach.17 Apomorphine is the most common type

of emetic for the therapy. The common symptoms of the drugs are nausea and vomiting. But the

usage of drugs makes chemical aversion therapy as a precarious technique. These drugs or

emetics risks overdoses and allergic or violent reaction in the patient. This is why this therapy

must only be administered by professionals. This technique must only be employed in medical

backdrops like laboratories and hospitals to ensure safety protocols are adhered. The emetics

should also be used sporadically as to not cause its physical drawbacks. Lab tests should be

conducted to ensure the client’s immunity for the administered emetic. And the processes

involved in the therapy are plain similar to the concept of pairing, only that the lethal stimuli

used are emetics.

Smell sensitization employs the pairing of the homosexual responsiveness with an obnoxious

odor. For example, a patient may be sexual aroused but this is abruptly paired with gases that

horribly reeks.

The shame aversion therapy employs embarrassment to the homosexual for his homosexual

conducts. A public of people are present during its process to embarrass the patient. In this

therapy, the patient would perform homosexual acts while being by those people. The lethal

stimulus here is the humiliation of the patient, the social censure.

15
Frederick Mears and Robert Gatchel, Fundamentals of Abnormal Psychology. (Chicago:
Rand McNally College Publishing Company, 1979), p. 304.
16 “
Emetic.” Encarta Premium. CD-ROM. National Bookstore. 2006.
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The electric aversion therapy is almost as similar as the chemical aversion therapy. But the

electric aversion therapy’s lethal stimulus is electrocution. The computability of the effects in

aversion therapy is significant for treatment success. And the employment of electric shocks is

preferable due to its computability. Electric shocks can easily be controlled, by switching it on

and off, and lowering or heightening the electricity levels, compared to the uncontrollability of

using drugs and obnoxious smells. In a comparative study, Tanner tried to prove the

effectiveness of higher degrees of electricity to that of lower degrees. A 5mA strength of

electricity is compared to degrees ranging from 3mA to 4.5mA. In this experiment, 26 male

homosexuals were involved. The homosexuals were each randomly grouped in either to of 5mA

or 3mA to 4.5mA. The results were that the 5mA group showed much more improvement than

the other groups. However early flight from the therapy occurred more in the 5mA group. From

this experiment, the conclusion is that electricity shocks must only be employed at an adequate

degree. The main aim of the electricity shocks is to postpone and destroy the homosexual

arousal. It should not be for the purpose of bringing pain and torment to the patients.18

And covert sensitization, which focuses on provoking arousal through the patient’s fantasies.

There are three forms of the covert sensitization; the employment of electric shocks or nauseants,

orgasmic reconditioning and masturbatory satiation. The employment of electric shocks or

nauseants should not be confused with the chemical and electric aversion therapies. Granting the

processes involved are similar to the two therapies the provocation of arousal is through

fantasies, not through the usual “mediums” like photographs and videos. Orgasmic

reconditioning involves the patient masturbating. He does this while recounting his sexual
17
K. Matsumoto, M. Yoshida, et. al., “Effects In Vitro and In Vivo by Apomorphine in the
Rat Corpus Cavernosum,” British Journal Pharmocol. Volume II, No. 146, (2005), p. 259.
18
Harold Leitenberg, Handbook of Behavior Modification and Behavior Therapy. (New
Jersey: Prentice-Hall, 1976), p. 278-280.
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fantasies aloud. As he reaches climax, he switches to a more acceptable (heterosexual) scene for

the fantasy. And masturbatory satiation, the homosexual continues to masturbate even after

reaching orgasm several minutes ago— a painful task. He does this while recounting fantasies

aloud and then the pairing would be delivered.19

Aversion therapy is not an all-around cure for homosexuality. Sometimes other techniques or

therapies are melded with the aversion therapy to experience its full-effect. An example of this

method is provided by a report given in by Barlow and his co-workers of a 17-year old male

transsexual.20

This patient had always wanted to be a female. He would cross-dress, and his attitude was

dominantly effeminate. But because of this attitude, he is made fun of by people. Though he

badly wanted to change his gender, he agreed to go into therapy to change his sexual orientation.

The first attempt in the therapy was to incorporate more masculine mannerisms into the patient,

such as walking, sitting and standing. This was achieved with the aid and supervision of a male

therapist. His participation in the therapy was documented. He was heavily lauded for his

successful attempts. As his performance in the therapy improved, the jeering of other people had

markedly disappeared. Because of this, the young man was beginning to enjoy his “manly

image.”20

The client also had apparent meager social skills. Behavioral techniques were utilized, and

feedback was used to improve his social skills. He was also given voice retraining since he had

obtained a womanish voice before his therapy, which later proved to be a success. By the end of

this step, the client was having an increase in his confidence and interaction with both sexes.20
19
Rosenhan, p.495.
20
James Coleman, James Butcher, et. al., Abnormal Psychology and Modern Life. (Glenview,
Illinois: Scott, Foresman and Company, 1984), p. 476-477.
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Improvements were further fortified after a fantasy-retraining program. Here, the client was

incorporated to have heterosexual fantasies. However, the diagnosis in his documented

assessments showed that the client was now “psychologically” a male homosexual. The next

step, then, consisted of increasing the clients’ response to heterosexual oriented materials and to

decrease his homosexuality. This was achieved via a simple procedure that conditioned the

client’s arousal and orgasm with heterosexual stimuli, and this program proved to be a success.

But according to the documented diagnosis, the client had now shifted into bisexual. There

remains the obstacle of repressing the homosexual constituent to be able respond to heterosexual

stimuli. This was achieved through electric aversion therapy and covert sensitization. After two

years, a follow-up checkup was conducted and it was revealed that the client was now going to

college and dating women.21

Aversion therapy does have its drawbacks or disadvantages, which may range from its risks to

its ineffectiveness. One thing, a considerable amount of homosexual patients are reported to have

not finish their therapy. In other words, the patients commit an early flight from the therapy. It

may originate from their fear and wariness of being electrocuted, drugged or all other repulsive

techniques used on them. Usually, patients who flee from therapy are relived of escaping the

“nightmares” and, possibly, the therapist whom they blame for their torment. Though some

patients are determined to endure and finish through the processes.

In Peter Tatchell’s website, there was one reported death incident of an aversion therapy

patient. The patient’s name was Billy Clegg-Hill, a 29-year old gay. But the authorities had

verified and labeled his death as due to “natural causes.” Thirty four years later, the coroner who

21
Ibid.
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had examined Clegg-Hill verified that he actually died from coma and subsequent convulsions

caused by excessive shots of apomorphine. During his treatment, he had been shown explicit

photos of men and was then shot with apomorphine, making him seriously ill. The doctors’

grounds were to link Clegg-Hill’s homosexuality with the nausea for him to feel revolted of his

homosexuality, and to ultimately convert him. The autopsy reports imply an apparent medical

negligence. That is, when Clegg-Hill was ill, there were no actions taken to moderate his

condition.22

In the same web article, teenage gay, Peter Price, who was forced into therapy after his

mother discovered his gayness. During his therapy, he was forced to lie on bed strewn with his

own excrement and vomit while viewing explicit photos of men while hearing an over voice

through tapes saying crude languages that insulted his sexuality. Price then decided to flee from

the therapy. Twenty-five years later, Price was still gay as he was before the therapy.22

The American Psychological Association has declared aversion therapy as a precarious and

lethal form of treatment in 1994. As of 2006, aversion therapy is in infringement of the codes of

conduct and professional guidelines of the APA. The employment of aversion therapy is also

considered illegal in some countries. Contrary to the previously reported successes in aversion

therapy, four studies have shown that aversion therapy has an average success rate of 0.5%. That

is, the failure rate of aversion therapy in those studies is 95%.23

According to the Encyclopedia of Homosexuality, most practitioners of aversion therapy

maintain that they act only at the request of the patient.24


22
Peter Tatchell, “Aversion Therapy Exposed,”
www.petertatchell.net/psychiatry/aversion.htm.
23
“Aversion Therapy and Homosexuality,”
www.http://en.wikipedia.org/wiki/Aversion_therapy#Aversion_therapy_and_homosexuality/.
24
“Aversion Therapy.” Encyclopedia of Homosexuality. Garland Publishing, 1990, p. 101.
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Aversion therapy also marks a substantial possibility that their effects are not that full and

accomplished. And in most cases, aversion therapy fails to incorporate heterosexuality in the

patient. As a result, the patients would turn out bisexual or a tentative heterosexual. Also, while

in a laboratorial or clinical backdrop, the patient may show progresses during the therapy but he

may not be able to respond much to heterosexual stimuli while outside therapy.

There is also a drawback in both chemical aversion therapy and aversive relief therapy.

That is, when patients achieve erection while viewing photos or videos of the opposite sex, they

may not achieve erection with an actual woman. So it is important not to neglect to incorporate

social skills during therapy.

One major drawback in aversion therapy is the risk of being impotent, being sexually unable,

and asexual, being sexually disinterested. Aversion therapy’s employment of the aversives occur

most especially when erection and arousal is at its summit. While aversion therapy centers on

eliminating homosexual urges and responsiveness, there entails the risk of literally eliminating

any sexual urges and responsiveness. The patients would be revolted to have any erections at all.

And this would lead to impotence and asexuality, instead of the goaled heterosexuality.

But most of its drawbacks are substantially of emotional concern. The pain caused during the

therapy often generates trauma in the patient. The tampering of one’s physical limits also pushes

through one’s emotional territory.

Aversion therapy is much abysmal if it is coerced. Coercion to take aversion therapy sessions

only misguides and further degenerates their condition. Aversion therapy is only recommended

for ego-dystonic homosexuals who wish to change their homosexuality. It is discourage to be


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employed on ego-syntonic homosexuals who, from the very beginning, are content with their

homosexuality and has no desire to convert to heterosexuality.

Aversion therapy, while encompassing probabilities of risks and vanity, is actually a good

type of therapy in treating homosexuals. But before an individual enters this treatment he should

first contemplate on the possibilities of pain and trauma, the doubts and certainties he has for his

therapist and the institution or clinic and, of course, how much keen he is to be treated through

aversion therapy.