February 09 2016

The sickness label

Associate Professor of Mental Health Research, Dr Sarah Carr, is currently involved in a research project to survey lesbian, gay, bisexual and transgender inclusion in higher education institutions’ health and social care curricula, with colleagues Alfonso Pezzella and Professor Trish Hafford-Letchfield.

As part of the LGBT History Month activities taking part at Middlesex University in February 2016, she details the long struggle to change the classification of homosexuality as a mental illness over nearly half a century.

For LGBT History Month 2016, it’s important to look back on the impact early lesbian, gay and bisexual activists and ancestors had on the world. One crucial contribution was to contest the psychiatric diagnosis and pathologisation of homosexuality.

Almost 50 years ago, in the wake of the Stonewall riots that marked the beginning of the gay liberation movement in the US, a group of radical British gay men and women were creating the Gay Liberation Front. Later, a direct challenge to psychiatry formed a key part of their 1971 manifesto: “One way of oppressing people and preventing them getting too angry about it is to convince them, and everyone else, that they are sick. There has hence arisen a body of psychiatric ‘theory’ and ‘therapy’ to deal with the problems and ‘treatment’ of homosexuality.”

At the time, homosexuality was classified as a mental illness. As the gay liberation movement grew in the US and Britain, activists campaigned tirelessly to remove homosexuality as a disease classification and as a mental disorder from diagnostic manuals.

The sickness label

The sickness label was used by a psychiatric system that strived to ‘cure’ gay people and to discredit lesbian and gay civil rights activists. In 2005, Barbara Gittings, one of the original campaigners in the US, recalled the oppressive power of psychiatry: “The sickness label infected everything we said and made it difficult to gain credibility for ourselves. The sickness label was paramount.”

Thanks to these pioneering activists, in 1973 the American Psychiatric Association finally recognised that being gay did not mean being ‘mentally ill’ and homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders. However, the option to diagnose someone with ‘sexual disorder not otherwise specified’ remained until 1994. Homosexuality as a mental illness itself was only finally removed from the World Health Organization International Classification of Diseases (ICD-10) in 1990 – incidentally, the same year a therapist was attempting to cure me of my ‘illness’.

Sadly, changes on paper do not always mean changes in mental health practice. Research in 2009 showed that 17 per cent of the 1,400 therapists surveyed had attempted to help patients reduce feelings of same-sex attraction. Findings from a 2015 study of risk and resilience in LGB and T mental health, with more than 2,000 people, showed that “participants reported that a lack of awareness and training means responses from medical or professional staff can feel inadequate. Inclusive resources, which reflect the lives and issues of young LGB and T people, are sparse outside of LGBT+ specialist services”.

The pathologisation legacy remains influential in mental health services, often making them inaccessible, oppressive or even unsafe for lesbian and gay people, or for people who are unsure about their sexual orientation. My research has shown that the lesbian and gay community may be suspicious of mainstream mental health services and many may choose not to engage with them when they are in distress.

Coming out alive

In 1999, Michael King and Annie Bartlett, researchers who explored gay people’s experiences of UK mental health services, concluded that “the conservative bias inherent in psychiatry and psychology has damaged the lives of gay men and lesbians and provided grounds for discrimination”.

When you know what went on in some NHS psychiatric hospitals until the 1970s you can understand what they meant: lobotomies, hormone treatment, chemical castration, electric shock and emetic aversion therapy. Anyone familiar with the life and death of Alan Turing will know that in 1952, he was charged with indecency when being gay was still illegal for men, and chose probation with hormone treatment instead of imprisonment.

Peter Price was a gay man who psychiatrists attempted to ‘cure’ with aversion therapy in the 1960s, using emetic drugs to make him sick when he was shown sexual images of men. His horrific ordeal is recounted in my 2010 article, ‘The Sickness Label’.

“For seventy-two hours I was injected, I drank, I was sick… I just had to sit in my own vomit and excrement… I was in a terrible state. What was going through my mind was not the fear of being gay; it was the fear of not coming out of the psychiatric wing alive.”

Fortunately, Peter did come out alive, but Mathew, a young gay man sent to a military hospital instead of the prison for having a sexual relationship with a man, did not. As his sister Colleen found out years later, Mathew had been given the emetic drug apomorphine and had died as a result.

“What he’d ended up dying of was dehydration and that had brought on a massive stroke,” she told me. “It’s what people die of in countries without much water when they’ve got diarrhoea and vomiting; it’s really bad care, why someone in the UK should actually die because of just vomiting.”

Or indeed because he loved men.

Refusing to play the game

“The plague of mankind is the fear and rejection of diversity… The belief that there is only one right way to live,” wrote the famous ‘anti-psychiatry’ psychiatrist Thomas Szasz in a 1973 critique of his own profession.

Unfortunately, some mental health services are still in the business of making sure people ‘play the game’, with certain therapists exploiting gay people’s internal conflicts about their sexual orientation (and sometimes faith), confusion about identity, or distress at rejection and discrimination, in order to make them ‘normal’. GPs are still sending gay people like me who experience mental distress for conversion therapy.

The exposure of the continued practice of forms of aversion therapy in mental health services prompted the British Medical Association to vote that the NHS should not fund ‘discredited’ and ‘harmful’ conversion therapy. Speaking for the motion, junior doctor Tom Dolphin said: “Sexual orientation is such a fundamental part of who someone is that to attempt to change it will just result in significant conflict and depression, and even sometimes suicide.”

Despite the fact that the World Health Organization ICD-10 removed homosexuality as a disorder in itself, it nonetheless contains contains five ‘F66’ disorder categories relating to sexual orientation and gender identity.

We need to keep questioning and challenging psychiatric theories about lesbian, gay, bisexual and transgender people

A recent review of these categories for the forthcoming ICD-11 in 2018 concluded that “from a human rights perspective, the F66 categories selectively target individuals with gender nonconformity or a same-sex orientation without apparent justification”.

Perhaps then, the last word should come from the 1971 Gay Liberation Front manifesto, as it still holds true today:

“That psychiatrists command such credence and such income is surprising if we remember the hysterical disagreements of theory and practice in their field, and the fact that in formulating their opinions, they rarely consult gay people. In fact, so far as is possible, they avoid talking to them at all, because they know that such confrontation would wreck their theories.”

We need to keep questioning and challenging psychiatric theories about lesbian, gay, bisexual and transgender people, because those theories can still lead to the broken minds and lives of many across the globe today.

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Tags: bixsexual, disease, gay, homosexual, human rights, illness, lesbian, LGBT, mental health, mental illness, NHS, psychiatry, therapy, transgender