'Treatments' for 'sexual deviance', lessons for CFS?

[Esther12]

I'm starting this thread after having made a series of slightly OT posts in a thread about 'personality and CFS' research. I was just about to make another post there, but thought I'd move to a new thread instead. Most of the following has been taken from this thread, but I thikn can be understood in isolation: http://forums.phoenixrising.me/inde...hronic-fatigue-syndrome-a-controlled-s.19947/.

Coincidentally (or maybe not), I've just stumbled upon this piece from Peter Tatchell which discusses Isaac Marks's use of aversion therapy. Isaac Marks was a co-author on this early Wessely CBT RCT for CFS:

Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial.
Deale, Alicia; Chalder, Trudie; Marks, Isaac; Wessely, Simon
The American Journal of Psychiatry, Vol 154(3), Mar 1997, 408-414.


This description of Mark's approach does rather remind me a the biopsychosocial approach to the 'management' of the sick:

Outlining the circumstances under which the medical profession was entitled to use aversion therapy, he suggested that this should be when the "patient asks for help" or when "society asks to be relieved of the burden of an individual".

http://www.petertatchell.net/lgbt_rights/psychiatry/dentist.htm

He was a founding member of BABCP (British Association for Behavioural and Cognitive Psychotherapies), which Chalder now chairs.

Reading some of this old psychology of homosexuality stuff... it's really disgusting. A lot of the people involved went on to continue to be respected as researchers into this century.
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...

This section of John Bancroft's book seemed to have some lessons for CFS too:

Then, in the 1960s we entered the era of modern learning theory and the development of behaviour therapy or behaviour modification. Here the objective was not so much curing illness but modifying behaviour that was in some way unwanted. One of the more successful applications of this approach was the management of phobic anxiety, by means of a graduated exposure, combined with some form of relaxation (e.g. systematic desensitization).

Attention was also paid to the possibility of modifying sexual preferences, reducing, for example, fetishism, transvestism or homosexuality, a chapter in this history which is of particular significance to me as, for a few years, I was involved in it. Soon after completing my training in psychiatry, I collaborated with Isaac Marks and Michael Gelder in the treatment of fetishism and transvestism using electrical aversion therapy (Marks et al 1970).

Around that time, MacCulloch & Feldman (1967) and McConaghy (1970) reported success, at least in some cases, in reducing homosexual and increasing heterosexual responsiveness by means of aversion therapy... I was interested to see if I could replicate their findings, using what I believed to be a better aversive procedure.

I reviewed this literature, including my own research (Bancroft 1974; see Haldeman 1994 for a more recent review), coming to the conclusion that aversive procedures were ineffective, but more positive techniques to gradually increase the capacity for heterosexual response and behaviour without trying to suppress homosexual interest, may have some value in those individual who wanted to change... (paragraph spacing added for easier reading) [E12 edit: More can be found in the thread mentioned at the top - I disagree with moderators over how much of a book can be quoted without risking legal difficulties for PR]

Human Sexuality And Its Problems
John Bancroft
Churchill Livingstone, 1989 - Medical - 745 pages
http://books.google.com/books/about/Human_Sexuality_and_Its_Problems.html?id=Mgrxw_SZUg8C

There's more after that which is interesting too.

This guy's write up of himself sounds very like CFS quacks too:

A consistent theme in my research over the past 20 years has been the interaction between psychological/psychosocial and biological processes in reproductive and sexual behaviour.

http://www.kinseyinstitute.org/about/bancroft-cv.html
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However, I also came to realize that, by pursuing this behaviour modification, I was unintentionally reinforcing the medical pathologization of homosexuality.

If this 'insight' had been achieved through therapy, said therapy after at least 5 years would have failed every test of cost effectiveness.

The fact that exaggerating the extent to which cognitive and behavioural interventions can control an abnormal 'condition' will serve to increase the stigmatisation which surrounds those with this condition - it was true for homosexuality, and it's true for CFS. That those taking money for the provision of psychosocial care have forgotten to account for this social aspect to their approach reveals them to be utterly incompetent or else intentionally dishonest.

This piece is open access by Isaac Marks and John Bancroft (both mentioned earlier), on aversion therapy for sexual deviance: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1902433/?page=1

The CFS CBT RCT I Marks was involved in is available here: http://journals.psychiatryonline.org/data/Journals/AJP/3674/408.pdf

 

[Esther12]

This section of a recent editorial from the Lancet seemed relevant:

Ending LGBT conversion therapies
The Lancet
...

Conversion therapies are interventions that aim to change an individual's sexual orientation or gender identity to fit societal norms, typically using a combination of counselling and prayer. The practice is often targeted at adolescents, who might not have the legal authority to make their own medical decisions, and many of the organisations involved are faith-based, privately run, and unregulated.

The so-called therapies are largely discredited and are not condoned by any mainstream US psychiatric, paediatric, or psychological associations. Several US states, including New Jersey and California, have already made the practice illegal. The “therapy” is built on the assumption that homosexuality and non-binary gender identities are mental disorders that should be treated in the same way as alcoholism or gambling addiction. Therapists who advocate the practice insist that such identities are changeable and that the approach has successfully modified people's sexual or gender identity and behaviour in the past. However, a review for the World Bank showed that the practice is not just ineffective, but potentially harmful.

The most important factors for the mental health and wellbeing of LGBT young people are well documented to be the support and acceptance of family and friends. This support is all too often missing in communities that widely medicalise and stigmatise homosexuality and non-binary gender identities, leading to high rates of anxiety, depression, and suicidal ideation that could be prevented.

http://www.thelancet.com/journals/l...ternal/Family Medicine|General Surgery|Lancet

It's interesting reading criticisms of the way homosexuality was treated from current medical/psychiatric authorities, as it often seems to skirt around the problems with the research in this area.

To me, it seems that the problem was founded upon unwarranted claims of medical expertise justified by nonblinded trials which used self-report measures as outcomes, and served to promote stigmatising assumptions about the individuals who could supposedly be 'treated'. Acknowledging that would be rather awkward for a lot of people.

 

[Esther12]

More generally, promoting a view in society that people have more control over any aspect of their lives than is truly the case does create this oppressive pressure to do what it takes to be 'functional': find that treatment, adopt that behaviour, take those pills, alter those cognitions... whatever it takes to stop you from being what we don't like. You have to be willing to at least TRY...

The above point has been made so many times here, but I just had another conversation that made me think of it again after posting in this tread, and it does remind me of lots of things I've seen gay people complain about.