The British Journal of Psychiatry
Transvestism and Fetishism: Clinical and Psychological Changes during Faradic Aversion
ISAAC M. MARKS, MICHAEL G. GELDER

Abstract

1. This paper reports changes in transvestism and fetishism during faradic aversion treatment, as shown by clinical reports, erections measured on a penis transducer, and attitudes on evaluative scales of the semantic differential. Faradic shocks were given to the arm while patients carried out their deviant behaviour in fantasy and in practice. A variable partial reinforcement schedule was followed.

2. The five patients treated had well-adjusted personalities and high motivation, and they were co-operative. Their deviant behaviour was accompanied by overt sexual excitement.

3. Erections during deviant behaviour ceased selectively as aversion was introduced into treatment.

4. Fantasy images of deviant behaviour were first suppressed and then partially extinguished as aversion proceeded. Deviant images became indistinct and transient, lost their pleasurable quality, and ceased to be accompanied by erections. Images which were not shocked did not show these changes.

5. Attitude changes with aversion fell broadly into three categories: those concerning the sexual deviations became selectively devalued, those about family remained stable, while other concepts fluctuated.

6. Attitudes and autonomic responses changed in the same direction at different speeds. Attitudes about sexually deviant objects changed most in the first few sessions of aversion before erections were completely extinguished. During partial relapse attitude reversal again preceded return of erections.

7. All sources of information—clinical reports, autonomic responses, fantasy images and attitudes—pointed consistently to the same pattern of change in each patient during treatment. Sexually deviant desires and practices diminished or disappeared. Most of this change was due to aversion, while repeated practice, embarrassment and other components of treatment played but a small part in producing this change.

8. Associated symptoms also changed as the main symptoms were treated. Masochistic desires disappeared completely, while trans-sexualist desires diminished as transvestism decreased. Certain symptoms seemed secondary to others in these patients.

9. Emotional reactions during treatment included short-lived anxiety, depression, irritability, hostility and embarrassment, which required skilled psychiatric management at times. Masochistic patients avoided shocks in normal fashion, and did not seek these painful stimuli as a fresh source of gratification.

10. Faradic aversion produced marked improvement in transvestism and fetishism over the short period studied, and can be a useful tool of clinical investigation which allows an experimental approach to the psychopathology of sexual deviation.