BMJ  2004;328 (21 February), doi:10.1136/bmj.328.7437.0-g

Editor's choice

Lessons from medicine's shameful past

In a week when we look to the future of human cloning, (pp 415, 421) we also look back at the lessons that medicine should learn from its past.

Almost 30 years ago, in Limits to Medicine, Ivan Illich wrote: "Medicine undermines health not only through direct aggression against individuals but also through the impact of its social organisation against the total milieu." He referred to this as social iatrogenesis, and two papers in this week's BMJ illustrate this phenomenon uncomfortably well (pp 427, 429).

"I felt totally bewildered that my entire emotional life was being written up in the papers as utter filth and perversity," confesses Male 1, one of 29 people in the United Kingdom who received "treatment" to change their sexual orientation in the 1960s and 1970s. People received treatment between 13 and 40 years of age, mostly in NHS hospitals. The most common treatment was behavioural aversion therapy with electric shocks. Male 4 states, "A psychologist was the man who administered the jolts to me," and Male 5 summarises the pointlessness of such treatment: "She [the psychiatrist] said, `I don't think we are going to get anywhere. To be quite honest, I never expected we would in the first place. You're going to have to go home and tell your wife that you're gay and start a new life.' Boom!" With statements like this, it is unsurprising that the authors are so grave in their conclusions: "[Our study] serves as a warning against the use of mental health services to change aspects of human behaviour that are disapproved of on social, political, moral, or religious grounds."

Perhaps more chilling is the second paper (p 429), which examines the experiences of the professionals who "administered and evaluated treatments for homosexuality." While one clinical psychologist confesses, "I feel a lot of shame," another says, "I thought they [homosexuals] were people who were disordered and needed treatment and psychiatric help. I still do."

So much for Judd Marmor's victory in declassifying homosexuality as an illness (p 466) and with such bigoted attitudes it is not difficult to see why services like the BMJ Careers discrimination matching scheme and the Advice Zone are needed. The former is a peer support system for doctors and medical students who have faced discrimination and the latter is a web based career related question and answer service covering over 80 topics, including discrimination. We have recently launched a dedicated Career Focus website which has a range of different search options (on Career Focus content), services, and links (see bmjcareers.com/careerfocus for more details).

We hope that these features will help support doctors and medical students in their career decisions and their working lives, whoever, whatever, and wherever they are.

Career Focus (rmacdonald{at}bmj.com)

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