Dickinson, a senior lecturer and associate professor in mental health nursing, is deputy head of the Department of Mental Health in the Nightingale School of Nursing at King’s College London. His dissertation topic became a full-length book, Curing Queers, focused on the use of aversion therapy to ‘cure’ homosexuality and sexual deviancy from the 1930s through the mid-70s.
Administered by mental health nurses in psychiatric hospitals across the U.K. beginning in 1935, aversion therapy used chemical, electrical, and psychological techniques to ‘treat’ male homosexuality and transvestism. The practice continued until about 1974, when the American Psychiatric Association removed homosexuality from its diagnostic manual as a category of mental illness. It wasn’t until 1990, however, that the WHO stopped classifying homosexuality as a mental illness.
Dickinson, a nurse historian who’s teaching the graduate course Cross-disciplinary perspectives on lesbian, gay, bisexual, trans*, queer (LGBTQ) & psychiatric histories this semester, will offer a keynote address at UVA Nursing’s May 10 LGBTQ+ Healthcare Symposium: Embracing Inclusion and Diversity in Caring for the Whole Person.
How’d you decide to become a nurse?
I sort of fell into it. I had planned to go along a corporate route, studying retail management after my A-levels, but during high school got a job in a nursing home for people with dementia. I loved that job. I loved the patients. I loved how every day was different, and how you got to be creative in your care.
Dementia patients couldn’t have been easy.
It was a challenging population, but I quite liked it. You have to be more imaginative, more dynamic. It isn’t just, ‘Give them this drug,’ or, ‘This is how you cure it.’ Mental health nursing is often seen as the poor relation to nursing; it scares people because there’s no right or wrong answer, no exact method. We talk about the therapeutic use of self in mental health, and really, we use ourselves, and our emotional intelligence. It’s an incredibly rewarding career; I wouldn’t choose anything else. Certainly not retail!
How’d you get the idea for your dissertation, and, ultimately, Curing Queers?
I’d been on holiday, having just finished my master’s, and was reading for pleasure a book about the gay history of Britain, and in it was a sentence that said something like, ‘During the 1970s, gay men underwent psychiatric treatments to cure them.’ No footnote, no reference. That’s always a good sign as a historian because it suggests there’s nothing written about the topic. I emailed the author, who encouraged me to pursue the subject, and then found a nurse historian to be my advisor.
How did you find people who’d both received and administered aversion therapy?
It’s thought that about 1,000 people received aversion therapy in the U.K. … so finding people to talk to who were still alive was difficult. But I managed to track them down by putting adverts in LGBTQ magazines. Nurses were easier to recruit. The nurses who administered these treatments were retired, but because nursing is an intergenerational profession, I’d find grandchildren who’d asked their grandparents who were nurses if they’d done the work, and I got contacts that way. In all, I interviewed eight former patients and 17 nurses.
Aversion therapy involved chemicals, electrical shocks, humiliation, deprivation, and worse. What was it like hearing what patients faced?
It was incredibly emotive to hear these stories, and often upsetting. Patients were angry, upset, the treatments were unpleasant, and the nurses had a great deal of contrition about what they’d done. Most, though, said it was quite cathartic for them to speak about it.
You have empathy for both sides.
I think it’s really, really important to not pass judgement on the nurses. [At the time] culturally, legally, there were things going on that made this practice OK. Newspaper articles would describe how disgusting, evil and perverted gay men were, and promoted this ‘therapy’ as a cure. Keep in mind, too, that homosexuality was illegal in the England and Wales until 1967 (Scotland and Northern Ireland would have to wait until the 1980s), and the American Psychiatric Association, which publishes the DSM, until 1974, considered it a mental illness. The World Health Organization didn’t reconsider this until 1990.
This was the framework nurses worked under. Doctors had all the answers; nurses did as they were told. And the majority of patients put themselves forward for the treatments.
We can all look back and go, ‘I never would have done that,’ but that’s too simplistic. There are some things today we do and we will look back in 30 years and say, ‘God, we did that?’ and be shocked.
Curing Queers came out in 2015. What are you working on now?
My current book project is Nursing a ‘Plague.’ It’s a look at HIV and AIDS care before antiretroviral medication. I’ve interviewed nurses who cared for people with HIV and AIDS between 1981, the year the U.K. reported its first AIDS case, which then was called GRID (Gay-Related Immune Deficiency), through 1996, when the evidence for antiretroviral medication became explicit and HIV became a manageable chronic disease.
There were limited scientific treatments for HIV and AIDS in those early days, so nurses had to rely on their ‘artistic’ nursing skills to creatively craft care for people with HIV and AIDS. In their quest to become nurse scientists, nurses can sometimes forget how important the art of nursing is in their quest to be nurse scientists. With these nurses, when they didn’t have a science, they had to be really innovative in their care. They dealt with many very young patients who were dealing not only with the physical and psychological aspects of HIV & AIDS, but also the social death the disease created. The nurses made people with HIV and AIDS feel safe; they were less rigid. With the stigma attached to the HIV ward, there was a lack of surveillance, so it created this environment in which nurses, often free from direct managerial oversight, could dictate care and boundaries with ease. Nurses re-counted that they would often watch out for the nurse administrator while patients smoked or pets were brought onto the ward to comfort their dying companion. Couples would often lie in bed together behind closed doors or curtains with no questions asked as to how far intimacy went. One nurse took a patient for a ride on the back of a motorbike a few days before the patient died, as it was something he had always wanted to do. Meanwhile other nurses discreetly palmed clean needles for IV drug users. These were places where nurses said, ‘Do you know what? We need to break the rules a little bit.’ I have conceptualized that they were ‘care-crafting.’
Nursing is both an art and science. But because targets and quantifiable procedures and routines often drive nurses, their creativity can be quashed. Some nurses consider themselves nurse scientists; I consider myself a nurse artist. And I think that’s something we should promote as well.
Why is it important for your nursing students to understand this particular history, do you think?
We have to understand that all our patients come with their own histories, their own sets of challenges that they’ve lived through. That’s particularly true for LGBTQ patients. It’s really, really important that we understand what they’ve lived through to enable us to empathize, celebrate their diversity and make their care as inclusive, respectful and valued as possible.
We need to be mindful that society can move backwards as well as forwards. What makes it go backwards is people in power with regressive ideologies and values to whom the masses listen and don’t critique. That’s why as a nurse educator, I believe it’s important to encourage self-efficacy and agency in the next generation of nurses to enable them to voice their concerns and question those in authority.