Aversion Therapy: Painfully Redundant or the Only Solution?

Abstract: Aversion therapy is a type of behavior therapy that is designed to condition a patient into giving up an undesirable habit or behavior by associating it with an unpleasant, or averse, effect. The patient is exposed to a stimulus, which reflects the unwanted behavior, while simultaneously being subjected to a form of physical, mental, and/or emotional discomfort. Commonly used forms of aversion therapy are electric shock therapy and the use of prescription drugs. While some psychologists continue to use aversion therapy as a form of treatment for their patients, most contemporary psychologists raise a variety of ethical issues that surround both the short-term and long-term mental, physical, and emotional effects that patients face as a result of this treatment. This paper will describe the reasoning behind each side of the argument regarding the use of aversion therapy. It will also evaluate and compare earlier scientific research and more contemporary research in order to determine whether or not the use of aversion therapy is redundant, adverse, or a viable solution to specific psychological issues.

Scientific Controversy:

        Aversion is a strong feeling of dislike or disgust towards something or someone. In 1930, psychologists began using painful stimuli on their patients who were addicted to alcohol in order to provoke a feeling of dislike towards alcohol and this could treat their addiction. This practice became known as aversion therapy, which is a type of behavior modification therapy that employs a form of stimuli that can cause uncomfort or pain in a patient and can help them unlearn harmful or socially unacceptable behavior (Elmer, 2019). Essentially, the patient is conditioned into associating the unwanted behavior with unpleasant or uncomfortable sensations. There are several forms of aversion therapy that are each subject to controversy among psychologists all over the world. The most commonly used forms of aversion therapy are the administering of electric shock on patients and the use of prescription drugs, such as disulfiram, that produce aversive side-effects.

        The vast majority of contemporary psychologists reject the use of aversion therapy and raise several ethical issues regarding it. Along with these psychologists, public opinion in recent years has shifted towards the idea that aversion therapy is simply inhumane and unethical. There is a plethora of scientific evidence that demonstrates how forms of aversion therapy can not only cause physical pain and trauma, but it can also increase anxiety in patients which can actually negatively interfere with the treatment process rather than helping the patients overcome a certain behavior (Britannica, 2018). Furthermore, contemporary psychologists view aversion therapy as ineffective and suggest alternative methods of treatment for patients. However, there are psychologists who view aversion therapy as the single most effective method of changing human behavior and despite its unethical foundation, practitioners continue to use it in various parts of the world. These psychologists use scientific data to argue that even though forms of aversion therapy induce pain, the ability of the therapy to terminate a patient’s harmful behavior triumphs over any possible negative effects. They believe that pain is required for treatment and it is not unethical for a patient to endure short-term pain for a positive result that is long-term (Elmer, 2019). Other psychologists who argue for the use of aversion therapy are simply culture driven as they believe that biological components of an individual’s identity, such as homosexuality, are actually behaviors that can be altered to fit societal norms through the use of aversion therapy. 

        The use of disulfiram is a form of aversion therapy that is commonly administered for the treatment of alcoholism. Disulfiram is essentially a drug that causes acute sensitivity to ethanol, which is a chemical compound in alcohol. Psychiatrists prescribe this drug to patients and instruct them to ingest it while they are also consuming alcohol. The drug then interferes with the body’s metabolization of alcohol which leads to uncomfortable symptoms such as flushing of the face, nausea, sweating, and heart palpitations (Elkins, 2017). Patients are then conditioned to associate the adverse physical side-effects with the consumption of alcohol and often avoid drinking alcohol to avoid these effects, which treats alcoholism. Although disulfiram is FDA-approved due to its effectiveness in the decrease of continued drinking behavior for people who are trying to recover from alcoholism, both psychologists and physicians disapprove of the use of this drug since it has been implicated in numerous reported cases of hepatic injury which can lead to liver failure and death (Britannica, 2018). According to the American College of Physicians, the body’s liver cannot properly metabolize both alcohol and disulfiram when taken at the same time but the treatment requires patients to do so. Long-term effects of disulfiram include coronary artery disease, epilepsy, and severe myocardial disease (American College of Physicians, 1989) . Furthermore, the efficacy of disulfiram is heavily debated. While the FDA initially approved the use of disulfiram due to early research on it by a Danish group of scientists in the 1940s who concluded that high dosages can reduce dependence on alcohol (Britannica, 2018), recent studies, such as that of Dr. Marilyn Skinner, shows that there is virtually no difference in the behaviors of alcoholic patients whether they are given a placebo or are given the drug. Earlier studies displayed apparent success with failure to monitor patients’ compliance and the absence of control groups, while Dr. Skinner’s study consistently monitored all patients and administered a placebo to a control group and this validates her conclusion that disulfiram is less effective than earlier studies once concluded (Skinner et al, 2014). A study by Dr. Wade Myers at Brown University explained how the use of disfularment on adolescents, which is an age group that this drug is popularly prescribed to, is more successful on candidates with relatively stable lifestyles. Adolescent males with alcohol dependence were prescribed disulfiram and it was concluded that the patients with relative stability in their personal lives showed limited short-term abstinence from alcohol consumption, while males with relatively unstable lives showed virtually no change in behavior (Myers et al, 1994). This effectively exhibits how the use of disulfiram is virtually redundant for certain populations. 

        Another form of aversion therapy that is highly controversial is the use of electrical stimulation devices (ESDs), which essentially administer painful electric shocks on a patient  through electrodes that are attached to their skin, following cues that stimulate unwanted urges or behaviors (Cherry, 2020). Electric shocks are usually deployed to decrease self-injurious or aggressive behaviors by patients with developmental or intellectual disabilities. For example, individuals with conditions such as autism can have difficulty to process distressing emotions and become frustrated, which can cause them to harm themselves or others (Britannica, 2018). In a 1964 study that was conducted by Dr. Ralph McGuire at the University of Edinburgh, about 60% of patients who were given electric shock treatment associated the pain from the electric shock to the unwanted behavior and were able to decrease the prevalence of this behavior or stopped showing it all together. He concluded that the electrical stimulus as an aversive consequence would make it much easier and effective to link the stimulus and the response to change in behavior (McGuire, 1964).  

        However, recent studies and opinions from contemporary psychologists question both the efficacy and ethics of electric shock treatment. Several psychologists and physicians argue that there are long-term effects of the electric shocks such as memory loss and anxiety. In a study by Dr. Glenda Macqueen at the Cumming School of Medicine, subjects were given a variety of learning and memory tests and it was found that subjects who had electric shock treatment in the past performed significantly worse on the tests than those had never received the treatment before (MacQueen, et al 2007). This actively displays how electric shock treatment can harm brain functionality. According to studies at the University of Michigan, about 30% of patients who faced exposure to electric shock therapy were diagnosed with various anxiety disorders due to the physical and emotional distress that the painful shocks cause (Britannica, 2018). This distress and pain is essentially what often causes outrage amongst both the medical community and the public regarding the ethics of the use of electric shock therapy. Medical professionals and members of the public often agree that children should not be subject to electric shock treatment since they cannot give consent to experiencing the pain. Disability rights advocates also agree that it is unethical to force a neuroatypical individual to experience the pain and other side effects of electric shock without their full understanding or consent (Kent, 2020). In March 2020, the United States Food and Drug Administration officially banned the use of ESDs to treat neuroatypical patients with self-injurious or aggressive behaviors due to a medical consensus that harmful behaviors should not be subject to further physical pain and could instead be managed through positive reinforcement, such as the teaching of appropriate skills and use of rewards (Kent, 2020). 

        Although aversion therapy was originally used to discourage a variety of physically harmful behaviors, in 1940, American psychoanalyst Sandor Rado believed that it could be used as a so-called “treatment” for homosexuality. He concluded that through careful programming of behavior modification, which includes electrical shock treatment, an individual would be able to unlearn feelings of attraction towards the same sex and then “revert” back to heterosexuality which was deemed the “biological norm.” Although Rado and his followers claimed that about 50% of their patients were “cured” of their homosexuality, the majority of these patients were rendered asexual in response to aversion therapy (Britanicca, 2018). As a result, contemporary psychologists, such as Nathaniel McConaghy, reviewed these outcomes as similar to that of desensitization. This means that any emotional responses to the idea of homosexuality were mostly or completely diminished due to repeated exposure to the aversive stimulus, which was usually electric shock (McChonaghy et al, 1983). In essence, a patient’s sexuality did not “revert” back to hetersexuality as Rado had originally planned for his patients, but rather the patients became desensitized to sexuality entirely and the treatment is deemed ineffective with regards to its original purpose. 

        Furthermore, contemporary psychologists believe that since many of Rado’s patients who were given electrical shock therapy for homosexuality actually seeked the treatment themselves because they viewed their sexuality as morally wrong, their change in sexual desire may have resulted from internalized self-hatred and a desire to be accepted by society. Thus, psychologists conclude that the outcomes of Sandor Rado’s use of aversion therapy on homosexual individuals were simply a result of desensitization or a placebo effect due to the patients’ genuine desire to change their sexuality (Britannica, 2018). In 1994, both the American Psychological Association and the American Psychiatric Association declared the use of aversion therapy to “treat” homosexuality as dangerous and ethical codes against it were established in 2006. While attempting to alter an individual’s sexuality is a violation of professional conduct in the United States, psychologists in countries that are less progressive in regards to homosexuality, specifically those that are non-secular or socially driven by religion, often declare homosexuality as a disease and use aversion therapy, specifically electric-shock therapy, as a form of treatment (Britannica, 2018). 

        While the use of aversion therapy was once deemed effective and socially acceptable, recent research that utilized more advanced and organized resources provides reliable data that proves how the use of aversion therapy is not as effective as psychologists in the past once thought. It is almost redundant in many cases since there are alternative methods to treat patients with unwanted behaviors including talk therapy, positive reinforcement, and prescribed medications that do not produce the same adverse side-effects of aversion therapy. The contemporary world focuses heavily on the ethics behind medical practices and this reflects the beliefs of the majority of today’s psychologists who argue against the imposition of pain and long-term side-effects on their patients. Furthermore, societal standards and individual values in many places of the world have evolved to accept behaviors, which were once deemed morally wrong, as simply elements of one’s identity that cannot be biologically altered. Only behaviors that are physically and emotionally harmful for an individual should be altered in the safest possible manner, which is not aversion therapy but rather one of its alternatives. 

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