Dr Heath’s ‘gay cure’ and other mad science

In the first of two articles, Robert Colville exposes the scandal of the neurosurgeon who tried to retrain brains with massive electrical shocks

For the first hour, they just talked. He was nervous; he’d never done this before. She was understanding, reassuring: let’s just lie down on the bed together, she said, and see what happens. Soon, events took their course: they were enjoying themselves so much they could almost forget about the wires leading out of his skull.

The year was 1970, and the man was a 24-year-old psychiatric patient. The woman, 21, was a prostitute from the French Quarter of New Orleans, hired by special permission of the attorney general of Louisiana. And they had just become part of one of the strangest experiments in scientific history: an attempt to use pleasure conditioning to turn a gay man straight.

The patient – codenamed B-19 – was, according to the two academic papers that catalogued the course of the research, a “single, white male of unremarkable gestation and birth”. He came from a military family and had had an unhappy childhood. He had, the papers said, entered the military but had been expelled for “homosexual tendencies” within a month. He had a five-year history of homosexuality, and a three-year history of drug abuse: he had tried glues, paints, thinners, sedatives, marijuana, LSD, amphetamines, even nutmeg and vanilla extract. He had temporal lobe epilepsy. He was depressive, suicidal, insecure, procrastinating, self-pitying and narcissistic. “All of his relationships,” wrote his doctors, with an unsparing lack of sympathy, “have been characterised by coercion, manipulation and demand.”

In 1970, B-19 ended up in the care of Robert Galbraith Heath, chair of the department of psychiatry and neurology at Tulane University, New Orleans. Heath’s prescription was drastic. He and his team implanted stainless steel, Teflon-coated electrodes into nine separate regions of B-19’s brain, with wires leading back out of his skull. Once he had recovered from the operation, a control box was attached which enabled him, under his doctors’ supervision, to provide a one-second jolt to the brain area of his choice.

Before being given control of the electrodes, B-19 had been shown a film “displaying heterosexual foreplay and intercourse”. He reacted with anger and revulsion. But then the stimulation sessions started, delivered via the button that felt most pleasurable to him. Over the next few days, he found that it could arouse him, and he would press the button to stimulate himself “to a point that, both behaviorally and introspectively, he was experiencing an almost overwhelming euphoria and elation and had to be disconnected, despite his vigorous protests”. He would hit the button up to 1,500 times over a three-hour session. “He protested each time the unit was taken from him,” said one of the papers, “pleading to self-stimulate just a few more times.”

Ten days into his treatment, the doctors suggested that B-19 watch the porn film again. “He agreed without reluctance ... and during its showing became sexually aroused, had an erection, and masturbated to orgasm.” He started talking about wanting to have sex with women – and so Heath got permission to hire what he later referred to as a “lady of the evening”. “We paid her $50,” he said. “I told her it might be a little weird, but the room would be completely blacked out with curtains.”

She certainly did her job, guiding B-19 through the process and encouraging him to gradually build up his confidence. “As the second hour began, she relates that his attitude took an even more positive shift to which she reacted by removing her bra and panties and lying down next to him. Then, in a patient and supportive manner, she encouraged him to spend some time in a manual exploration and examination of her body.” Despite his initial shyness, he ended up having such a good time that – much to his doctors’ delight – he often paused before the moment of orgasm, in order to prolong his pleasure.

B-19 features in two 1972 papers: Septal stimulation for the initiation of heterosexual behaviour in a homosexual male, by Heath and his colleague Charles E Moan, and Pleasure and brain activity in man, by Heath alone, which set out – apparently for the first time – what happens to human brainwaves during orgasm. The papers are extraordinary: at once academic and pornographic, clinically detached and queasily prurient. And they prompt all sorts of questions. Who was this Dr Heath? How on earth did he come to carry out this experiment – and get permission for it? And did it really, you know, work?

In the course of trying to unravel these questions, I read Heath’s papers, interviewed his former colleagues, and travelled to New Orleans to see where he worked and to watch the videos in which he reminisced about his career. And what I found was something more remarkable than I could have imagined – the story of the man responsible for some of the strangest, boldest and most controversial experiments of the 20th century, yet who has been almost entirely written out of scientific history.

The first thing you have to understand about Bob Heath is his charisma. If you were casting a movie and looking for someone to play the scientist-hero, he would be the first and last name on your list. In every profile, every interview, the topic of his presence came up: he was Gary Cooper or Cary Grant or Gregory Peck in a crisp white lab coat. “He looked like a god – and carried himself like one,” says his former colleague Marilyn Skinner.

The second thing is that he was talented – perhaps too talented. He was board-certified in both psychiatry and neurology. He was a qualified psychoanalyst. He could treat a patient, diagnose a mental illness, read an EEG and dash off a paper, all before heading off to the country club for a round of golf.

The third thing is that the one true love of his life wasn’t a woman, but an area of the brain. Imagine a line that goes through one ear and out the other. Now take another line that runs dead centre from the top of your skull and down through your tongue. Where the two meet is what Heath labelled the septal area, although scientists today would probably call it the nucleus accumbens. For Heath, it was the seat of pleasure and emotions that he thought would allow him to unlock the human brain.

Born in 1915 in Pittsburgh, Heath trained as a neurologist, before being drafted into service as a military psychiatrist in the Second World War. He rapidly aligned himself with the new breed of biological psychiatrists – scientists who argued that what were traditionally thought of as diseases of the mind were often actually diseases of the brain and could therefore be cured through surgery, not therapy.

There was already some obvious evidence for this, in the shape of the way that patients’ behaviour changed after prefrontal lobotomy. This was the most widespread form of what was known as psychosurgery – the surgical treatment of mental illness. Yet even though the procedure, which involved chopping away the connections to much of the brain’s frontal lobe, was growing in popularity, Heath and his colleagues at Columbia University rightly viewed it as crude and ineffective. They decided to compare it with a much less invasive alternative, which they called topectomy: this involved targeting and removing specific areas of the cortex, in order to avoid wider damage to the brain.

Heath had already developed a particular interest in schizophrenia, which he viewed as the single greatest challenge in mental health, affecting roughly 2 per cent of Americans. He noticed that such patients seemed largely unaffected by either lobotomy or topectomy; since these procedures targeted only the most immediately accessible part of the brain, the cortex, he concluded that their symptoms must be more deep-rooted.

So Heath began his investigations of the subcortex (literally, “the part below the surface”). And one particular area – the septal region – appeared particularly promising. When it was damaged or destroyed in cats and monkeys, they started behaving in a startlingly similar fashion to people with schizophrenia: their emotions were dulled, they lost their ability to experience pleasure (a phenomenon known as anhedonia), and they generally seemed to be removed from reality.

This reinforced Heath’s burgeoning conviction that schizophrenia was a biological, not a psychological, problem: something “dependent upon a defect in basic machinery, rather than a complication of environment”, as he would later write. By implanting electrodes into the deepest parts of the brain, he could not only examine how this machinery operated, but also – he hoped – jolt it back into life.

There was just one problem. Heath could – and did – carry out all the tests he wanted on animals, but he couldn’t test his theories on humans: not so much for ethical reasons as because his colleagues at Columbia weren’t interested in the subcortex. Then, on a trip to Atlantic City, he found himself lying on the beach next to a man from New Orleans. He was the dean of Tulane University’s medical school, and he was looking to set up a psychiatry department. He’d heard good things about a guy called Bob Heath. I’m Bob Heath, said Bob Heath. And so they started to talk.

For the 35-year-old, the job at Tulane was an irresistible opportunity. New Orleans was an academic backwater. But it had something very special: in the words of his future colleague Arthur Epstein, “a big sprawling beautiful hospital, containing some of the sickest patients you will ever see”.

This was Charity Hospital, a vast, brutalist 1930s edifice through which the poor and sick of New Orleans flowed in their thousands. Heath was open about the fact that it was this endless supply of potential patients – or, as he put it, the “tremendous amount of clinical material” – that attracted him to the job, because it gave him the chance to realise his outsize ambitions. He moved to New Orleans in 1949: within a year, he had persuaded Charity’s governors to budget up to $400,000 to set up a 150-bed psychiatric unit on the third floor, which would enable him to tackle a waiting list for psychosurgery that was already ten months long.

Heath’s new position made him one of the most powerful men in the Louisiana mental health system. As well as Charity, he held positions at other New Orleans hospitals such as DePaul, Touro and the Veterans Administration Center, and later Tulane’s own private hospital. He maintained an experimental unit – at the state’s expense – at the East Louisiana Mental Hospital in Jackson, and was involved with another facility in Mandeville. If he needed healthy volunteers, he had free access to inmates at the state prison complex at Angola.

On top of this, there was his role within Tulane. Uniquely, his new department combined not just neurology and psychiatry – itself a reflection of his then-radical commitment to treating the mind and brain as linked – but also a psychoanalytic institute modelled on the work of his mentor Sandor Rado, who had argued for the key role of pleasure in motivating behaviour: Heath urged all of his colleagues to learn analysis, and to be analysed themselves. By 1970, the time of the “gay cure” experiment, there were almost 200 staff and medical students under his supervision.

In 1952, Heath and the colleagues he had recruited from Columbia and elsewhere revealed the first fruits of their work. At a scientific conference (written up as the 1954 book Studies in Schizophrenia), they described how they had honed their techniques, developing better and safer methods of implanting ever more electrodes and leaving them in for ever longer.

These electrodes had, they announced, uncovered “an abnormality in the septal region” – unusual brainwave patterns, seen during seizures, that were exclusive to schizophrenia. And their use of electrical pulses to stimulate the same area had had promising results with the initial 22 patients, 19 of whom were schizophrenic. (The others were two patients with terminal cancer and one with acute TB: Heath wanted to see whether septal stimulation would offer relief from their incurable pain.)

The tone of the reports – and of most of the observers’ comments – was upbeat. Professor Herbert S Gaskill of Indiana University, while admitting that the clinical results were not conclusive, praised the “breadth of vision and imagination which this research study has shown”, calling it “of inestimable value”.

Yet you do not have to read through many of the 600 pages of Studies in Schizophrenia to feel slightly different emotions. The type of electric pulse, Heath and co admitted, was “arbitrarily chosen” because it seemed to work on animals: “We are still by no means certain that it is the most effective way of influencing the circuit.” Among the first ten patients, “Two patients had convulsions… wound infection occurred in two cases.” Among the second ten, there were two deaths, both related to brain abscesses that developed following the operation. Some patients developed infections, others had convulsions. Patient 21 “tugged vigorously at his bandage and displaced the electrodes”. Patient 12 had two electrodes put in the wrong place.

When the electrical currents were activated, several of the patients had seizures. Patient 13 “complained of nervousness, urinary urgency and chills”. Patient 14 “developed a generalized terror, which appeared to be associated with his extreme apprehension and fear and which persisted for several minutes after stimulation”. Patient 16 “became quite agitated”, with her blood pressure spiking to 178/110. Patient 17 developed “marked cardiac arrhythmia”, and “in both stimulations, the patient’s eyes were seen to open widely, and she said she was afraid”. Patient 22 “expressed great fear, and at one point it took four or five people to restrain her”.

If these studies make uncomfortable reading, they make for even more disturbing viewing. Heath filmed many of his experiments over the years, showing the results to colleagues and visitors. After his death, the films were seen by neuroscientist Gregory Berns, while researching his book Satisfaction. He describes watching footage of patient A-10, a member of the Army whose erratic behaviour saw him diagnosed as a paranoid schizophrenic, and entrusted to Heath’s care in 1952.

The full description is harrowing. At one point, A-10 rakes his face with his hands, squirms, and complains of “going black in the head”, before curling into the fetal position and saying: “I can’t think of nothing when my brain is turning up like that. Oh, no ... before I pass out! I don’t want to pass out ... Oh, my brain!”

“Suddenly,” writes Berns, “the patient’s voice changes. He screams in a pitch so high it is uninterpretable. Then he starts tearing at his clothes, trying to rip off his shirt, and gets up from the gurney.

“The interviewer says, ‘You’re tearing at your clothes. Do you know you’re tearing at your clothes?’ On the verge of incoherence, in a falsetto voice, the patient screams, ‘I don’t care! I gotta do something! I don’t care. I don’t care!’ Pausing for a moment, he starts to get off the gurney again before yelling, ‘I’m gonna rip you up!’

“Several hands come into view and hold the patient down, tying his hands. ‘Stop!’ the interviewer commands. ‘Stop!’ The patient stares into the camera and hisses, ‘I don’t give a goddamn. I’m gonna kill you. Let me up. I’m gonna kill you and rip you to goddamn shreds!’”

Even by the standards of the time, these experiments were radical and strange – and they duly caused an uproar. Heath and his acolytes later blamed this on the hostility of the American Psychological Association, in which the emotional rather than biological model of mental health was firmly entrenched (a popular theory on schizophrenia, for example, was it was caused by poor parenting – the “schizophrenogenic mother”). But as Heath admitted, his work also “caused a great deal of emotional upset to a lot of people at the 1952 meeting” – particularly the stimulation of “averse emotions of an intense degree”, such as rage or fear.

There was another problem: while the work had improved scientists’ understanding of the brain’s circuitry, it hadn’t actually done much to cure schizophrenia. Heath had been encouraged by the initial results of stimulating patients with electrodes: “If they were catatonic and mute, they would begin to talk; if they were very delusional, they would tend to come back towards reality to varying degrees.” But in the long term, the risk of damage from the electrodes’ implantation appeared to outweigh any benefits from the treatment: of the initial 22 patients, four who had had abnormal brainwave patterns showed improvement a few months later, but at least the same number who had had normal patterns developed “evidence of gross abnormality”. Also, although Heath did not acknowledge it, any improvement may have come about simply because the chosen patients were getting more attention from their doctors.

By 1955, Heath had stopped the study, on the grounds that “the lasting beneficial effects in the patient group ... have not been significant”. But this did not mean that he was done with his electrodes. He was just getting started.

He noticed that the same jolt to the septal area, in depressed but non-schizophrenic patients, resulted in an intense sensation of pleasure, almost ecstasy. Given the chance to stimulate themselves, some of his patients would do so hundreds of times an hour, just as rats did in similar experiments (and as patient B-19 later would). In one of Heath’s films, a man who has just tried to kill himself starts to smile when his electrodes activate, saying: “I feel good. I don’t know why. I just suddenly felt good.” He adds: “When I get mad, if I push the button I feel better ... that’s a real good button ... I would buy one if I could.”

Soon, Heath was coming up with all manner of uses for those buttons. In 1963, he reported that he was treating two new types of patient. One, with epilepsy, had 51 electrodes implanted into 17 separate brain sites in an attempt to disrupt seizures before they happened. The other, a 28-year-old nightclub entertainer with narcolepsy, was given a self-stimulation unit with three buttons, each linked via electrodes to a different part of the brain. Like B-19 later on, he quickly settled on the button connected to the septal area as his preferred option. If he felt himself falling asleep, he would push the button – or his friends would give him a jolt to wake him up. But he also learned another use for the button: to push it in a “frantic” fashion. “It built him up toward a feeling of orgasm that he was never quite able to consummate,” writes Peter Breggin in his book The Return of Lobotomy and Psychosurgery.

Heath’s was a time in which damaging or experimental procedures were commonplace: there were almost none of the controls or restrictions that we have today. But even so, his radicalism stood out.

Other doctors would implant a few electrodes for a few days; Heath implanted dozens, and left them in for years. Others experimented with animals; Heath experimented with people and animals both, feeding the findings from one set of tests into the next. Others tested the pleasure reflex under carefully controlled laboratory conditions; Heath handed patients the control boxes and set them loose to juice themselves as they saw fit. One of them ended up in Chicago, trying to sell himself and his hardware to the university for $5,000; another popped up in New York, whose police force called Heath on the grounds that he was the only one anyone could think of whose patients had wires coming out of their heads.

Heath was, in other words, a man of extraordinary curiosity – and in a position to follow his muse wherever it took him, or have one of his many subordinates do so on his behalf. While septal stimulation was the constant of his career, he engaged in an enormous variety of other work, publishing at least 425 papers.

Among these were his efforts to treat gay men by turning “repugnant feelings ... toward the opposite sex” into pleasurable ones – and similar work on “frigid women” – a subject to which we will return tomorrow.

This excerpt first appeared on mosaicscience.com and is republished here under a Creative Commons licence