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PAPERS: Glenn Smith, Annie Bartlett, and Michael King Treatments of homosexuality in Britain since the 1950s—an oral history: the experience of patients BMJ 2004; 328: 427 [Abstract] [Full text]

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The new outcasts

Chris J Lovitt   (20 February 2004)

Well done but 1 small error

Christopher Anton   (22 February 2004)

Behaviour changing = a bad thing?

Jamie S Robertson   (23 February 2004)

A step in the right direction

Justin Varney   (24 February 2004)

The (mis)uses of pscyhiatry

Jay Sarkar   (24 February 2004)

Is homosexuality a perversion?

David Barnes   (24 February 2004)

Editing Rapid Responses

Chris Lovitt   (25 February 2004)

"Treating" lesbians and gay men: A response from the British Psychological Society Lesbian & Gay Psychology Section

Peter Hegarty, Sonja Ellis, Gareth Hagger-Johnson, Peter Hegarty, Martin Holt, Darren Langdridge, and Elizabeth Peel   (14 April 2004)

Homosexuality is a treatable obsessive-compulsive-addictive disorder.

George Hill   (16 April 2004)

Re: Homosexuality is a treatable obsessive-compulsive-addictive disorder.

Brian Morgan   (17 April 2004)

The new outcasts 20 February 2004
Chris J Lovitt, Public Health SP Trainee SW Kent PCT- TN13 3PG Send response to journal: Re: The new outcasts	An excellent article that should be seen as part of a reconciliation process between society, medicine and lesbian, gay and bisexual people. Mind have produced an outstanding resource “lesbians, gay men and bisexuals and mental health” which provides invaluable information- as well as detailing recent abusive counselling and psychotherapy http://www.mind.org.uk/Information/Factsheets/Diversity/Factsheetlgb.htm In the early 90's I used to volunteer on the Aberdeen Lesbian and Gay Switchboard and I recall receiving three calls from people who had undergone electro-shock therapy in the recent past and from one young man who was undergoing it at the time. I was totally horrified at the extent to which family and religious pressure was seemingly the main driver in trying to cure healthy people by the application of totally inappropriate "medical" treatments. The UK has changed dramatically, for the better, and now some degree of legal protection is afforded to gay, lesbian and bisexual people. However I cannot help but wonder whether people who cross dress (transvestites) are the new outcasts with a range of treatments applied designed to "cure" them of something that society disapproves. I hope that lessons learned from the recent past of how “medicine” inappropriately treated “homosexuals” will better inform how we treat people whose only disease is not to conform to society’s norms. Chris Lovitt Public Health Specialist Trainee SW Kent PCT, Sevenoaks Hospital, Hospital Rd., Sevenoaks TN13 3PG Competing interests: None declared
Well done but 1 small error 22 February 2004
Christopher Anton, Private Birmingham B20 3LE Send response to journal: Re: Well done but 1 small error	Dear Editor Well done for publishing this research which describes the horrors inflicted on gay men during the last century in the name of medicine, but one slight error has crept in. It was the Criminal Law Amendment Act 1885 (not Criminal Assessment Act) which criminalised all sexual activity between men. This bill had originally been introduced to raise the age of (heterosexual) consent from 13 to 16. It was hijacked by Henry Labouchere (in much the same way as gay rights bills still are by religious groups) who introduced the clause to criminalise homosexual activity just before the bill's 3rd reading, and it was accepted without any debate. Alan Turing, one of the pioneers of computing, was convicted under this Act. He committed suicide after treatment to try and cure him of his homosexuality. Although homosexuality was partially decriminalised in 1967, this nonsense was only removed from statute law by the Sexual Offences Act of last year. Competing interests: None declared
Behaviour changing = a bad thing? 23 February 2004
Jamie S Robertson, 3rd year medical student University of Glasgow Send response to journal: Re: Behaviour changing = a bad thing?	"Our study shows the negative consequences of defining same sex attraction as a mental illness and designing treatments to eradicate it. It 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" In 2004, few would advocate physical abuse as any kind of therapy, and rightly so. But what about behaviour-changing therapy in general? Homosexual activity is accepted in society; ergo, 'treating' the underlying psychology is obviously not popular. But what about bestiality? Paedophilia? Rape? All crimes, and detested within society; and yet, apparently, we should do nothing to rehabilitate the individual to stop it from happening again. In an era when most people want criminals to be rehabilitated in some way, rather than just flung into prison for a month, the author's views surely fly in the face of a society that wants to actively eradicate truely harmful psycological (and thus behavioural) tendencies. Competing interests: None declared
A step in the right direction 24 February 2004
Justin Varney, SpR Public Health Greenwich Primary Care Trust Send response to journal: Re: A step in the right direction	I think this paper brings a new voice to a practice that had been hidden in the closet of medical history and Lovitt is right to suggest that this openess may start a path to reconcile the psychiatric and gay populations. However it is worth noting that some schools of psychotherapy still view homosexuality as an aberation capable of cure and that there are several targeted religious programs of intervention that are a hair breadth away from aversion therapy. In response to the rapid response discussing homosexuality in the same context as rape it is worth noting that rape, bestiality and paedophilia are all crimes because they involve the abuse of victims unable or unwilling to give consent. Homeosexuality, relates to sexual orientation and as with heterosexuality, in terms of sexual acts relates to consensual intercourse between consenting adults. The paper is published at an interesting time. Moves at the United Nations to engage Sexual orientation into the anti-discrimination sections of the human rights act are being put foreword by Brazil and blocked by the Vatican. Liberalisation of civil partnerships both in the Uk and the USA have been met by legal challenges from the fundamental extremes and the Gender recognition bill which aims to give more rights to post- operative transgender people bounces between the two Houses in Great Britain. Although society has progressed significantly to recognise cultural diversity in all it's forms, medicine is perhaps amongst the slowest of professions to move to meet the demands of the new millenium's population mix. Removal from the medical coding is a step in the right direction, however the real challenge lies in facing up to the responsibilities of being doctors and health care professionals and delivering a standard of care that is accessible and appropriate to all. For mental health professionals, accepting that homosexuality is no longer a disease but is part of an individual that has credance and validity is one step. Delivering care in a way which recognises the rights of same sex partners and the cultural needs of lesbians and gay men outlined over 6 years ago in Diagnosis Homophobic (http://www.pacehealth.org.uk/homophobic.html) and re-iterated in the reccent Mind docment refered to by Lovitt, reflect the moves which are still waiting to be made. Competing interests: None declared
The (mis)uses of pscyhiatry 24 February 2004
Jay Sarkar, Specialist Registrar in Forensic Psychiatry Shaftesbury Clinic, Springfield University Hospital, London, SW17 7DJ Send response to journal: Re: The (mis)uses of pscyhiatry	I found the two articles by Smith et al (BMJ 2004;328:427, doi:10.1136/bmj.37984.442419.EE) and King et al (BMJ 2004;328:429, doi:10.1136/bmj.37984.496725.EE) a timely reminder to all about how psychiatry can be (mis)used to perpeturate prevailing societal values and attitudes by attaching labels of 'mental disorder' to behaviours deemed unacceptable by societies. Very early during my training as a junior resident in psyhiatry in India I was involved in giving aversive 'treatment' to a man with homosexual tendencies. At that time homosexuality was a mental 'disease' in terms of its how the International Classification of Diseases, 9th revision (ICD-9, World Health Organization, Geneva, 1978) conceptualised it. Whilst I unsuccessfully attempted to 'treat' the man with low voltage faradic current applied to his forearm under supervision of senior behaviour therapists, and discharged him , ostensibly 'cured' of his condition, within months of doing so arrived the latest revision of classifications, the ICD-10 (World Health Organization, Geneva, 1992). This version no longer found homosexuality to be a disorder and this change in its status was reflected in practice too as 'treatment' thereafter in the hospital where I worked seemed to be made available only to those requesting it and only if they found the thoughts and urges ego-dystonic. Happily I was never again required to provide a 'treatment' which I sincerely doubted would ever work given its simplicity, painful though it must have been. Throughout its history, psychiatry has seen the socio-political environments of the time both aiding the creation of, as well as leading to annihilation of certain psychiatric labels. An understanding of hysteria grew in a climate of the anticlerical political movement of the late nineteenth century in France, where representatives of a tradition of enlightenment and education battled against the forces of the aristocracy and the clergy (p7, Herman J. Trauma and Recovery. New York: BasicBooks, 1992). Similarly, precursors of the diagnosis of post-traumatic stress disorder; shell shock and rape trauma syndrome (Burgess AW, Holstrom LL. Rape trauma syndrome. American Journal of Psychiatry 1974; 131: 981-986), were studied in the social and political contexts of the collapse of a cult of war, and the feminist movements of Western Europe and North America, respectively (p9,Herman J. Trauma and Recovery. New York: BasicBooks, 1992). Conversely,although in a similar vein, homosexuality as a diagnosis and hysteria as a term (World Health Organization, Geneva, 1992) have exited nosological systems due to greater social acceptance of the former and increasing denouncement of the latter as a term of derogation. We now live in times where increasing public concern and preoccupation with risk of harm has driven the government to devise ways and means to reflect this. The proposed reforms to the Mental Health Act 1983(http://www.rcpsych.ac.uk/college/parliament/MHBill.htm)include detention of those with drug and alcohol dependence, and sexual deviance, two categories of psychiatric conditions that were excluded from the aegis of the Mental Health Act 1983. There will also be requirement for psychiatrits to preventively detain these people if they are deemed to pose a risk to the society (often based upon a past history of violence), thereby turning such professionals into some of sort of social policemen. As a profession we need to guard against forces that attempt to use a branch of medicine for socio-political purposes and resist all such attempts by drawing lessons from history which these timely articles remind us of. Competing interests: None declared
Is homosexuality a perversion? 24 February 2004
David Barnes, Retired Home, SG12 8RE Send response to journal: Re: Is homosexuality a perversion?	What is the real message in these two articles (its world picture)? What is to be concluded for today’s practice (reliability)? Is there sufficient purpose for the outcome of this “research” and what are its theoretical grounds (epistemology)? Combining the Abstract with the main body of the work, the first article concerned reflections on the experience of 29 patients in respect of the circumstances, over 50 years or more, relating to the referral pathway for change of sexual orientation, the process of treatment and its aftermath. The authors infer that the full objectives of these matters were, in the 1960s and 1970s, simply dealt with by use of the provocatively laconic ‘treatments to change homosexuals into heterosexuals.’ Without evidence, this general allegation smacks of a convenient distortion of reality. As it stands, it is no more than the authors’ dismissive opinion. We need to know whether all psychiatry and the patients spoke in those terms. At the time all the professionals were asked for their opinions and for care and there is no reason to suppose that they were not in good faith - to whom did they say, in those terms, that that was what they were going to do? Throughout the paper the authors have been unable to exclude all references to psychological symptomatology and patienthood. They are unable to avoid describing the distress patients felt by their attraction to their own sex. Many complained they lacked parental affection, and they complained of anxiety. There is then an over sympathetic, and undoubted, trivialisation in the detail provided by the authors from patients, often accompanied by a sense of indignant exasperation that this or that matter should even have been contemplated - and just that suspicion of (homosexual) entertainment constantly resurfaces. Male 1 described the “vituperative filth” which appeared in the newspapers of the time; but this was a description of how he confirmed and volunteered, in his own terms, his own practices and emotional life. Some, when they confided in others, said they were usually met by silence, condemnation and rejection; but what did one expect the ordinary world to feel about the symptoms of an alternative sexuality and its effect on his life and others? The authors say isolation drove several as young adolescents to take relief in experimentation with adults, so paedophilia was a major risk. That is clearly still the case today. It is instructive that the patients themselves willingly even desperately subjected themselves to all sorts of treatments and were prepared to pay for them. They expected to gain. Some underwent electric shock treatment for up to two years. Some treatments reflect a range of inspired psychiatric imagination as one might expect in areas of professional ignorance when the patient asked for help. A series of selected anecdotes is provided but seems centred on adverse and prejudicially risible outcomes on being sent for treatment. In one case the doctor sexually abused him; in another, the patient states that doctors physically assaulted him; and another that his name was given to his family (sic); and that the brother of a third had died from the side effects of his treatment; another that, although very much in love with his wife, he had wasted her life; and another that he had no gay friends who had feelings of a lack of self worth, (which would seem to the ordinary practitioner constantly in the back and front of the minds of all such patients). There is no real surprise that half of the ‘informants,’ as they are sometimes called, were still continuing to receive (and presumably seeking) ‘psychological help’ (presumably treatment), at the time of interview. The purpose of the help is not admitted but is inconsistent with the view of all ‘participants’ that homosexuality is not an illness and treatment had no direct benefits. For many it failed because it increased the sense (or emotion) of isolation and shame. The euphemisms ‘Change of sexual orientation’ or ‘same sex attraction’ ill-describe the whole symptom complex or its effect on the mental health of the affected individuals and their families, but the authors see the syndrome merely as participants’ responses to complex personal and social ‘pressures’. Treatment, it will be agreed, was and is difficult, no doubt because the patients take pleasure in the existence of the condition and prefer to deny its existence as an aberrant entity - not the rarest of patient responses in the wide fields of psychiatric aspiration and failure. One may argue that there are negative consequences of defining any psychiatric syndrome as an illness. The patients may well rightly think there is no treatment. In the conclusions there is no consideration of the pathology. The frank statement that same sex attraction (or as it might have been described in the past, localised disorder of mental balance and consequent disorder of reproductive physiology) is not sufficient to merit the definition term illness in its ordinary form is misconceived and subtly pusillanimous, and certainly not made out. And if this view is supported, it shows the social and political pressures which may cause clinicians to abrogate the duty of care and leave the condition sanitised as the patient wants. What it also does show is the lack of understanding of the condition, particularly as an illness, and the appropriate practice. The second article suffers from much the same range of criticisms when it discusses the experience of the professionals who treated homosexuals in Britain since the 1950s. In particular was the claim in the Results in the ABSTRACT that the professionals developed ‘treatments to make homosexuals into heterosexuals’. Even from the story which the authors lay out in the body of this article, this is artless and biased2. We learn too that social context influences sexual behaviour, and that this had not been previously appreciated by professionals. Unfortunately there is the case that this had been appreciated only too well over generations. In the main body of work the authors caricature the NHS effort and the various failings of the professionals in their careers, for example lacking awareness and being inexperienced. They discuss that whereas the NHS had thought the matter real, relevant and deserving enough of care to set up 5 clinics in the major cities in the UK, some of the professionals identified had now (conveniently) prejudged that the topic of their work was no longer relevant or they (conveniently) feared media attention, in some way; that one electrician who had developed electric shock equipment participated in the research; and that while in his first year, one psychologist claimed ‘more or less, all (he) ever did was shove electricity down homosexual patients’; others described how they often worked with scant regard for ethics; and one that you never thought about the morality of what you were doing; and that treatments were used throughout the country without ethical guidelines; the mental health nurse thought they had to become electrifying geniuses; and that talking to patients compromised aversion therapy treatments; that the work of one leader in the field was publicly compared with brain washing (and presumably he’d never heard that criticism, ever before, about his job). I find it impossible to believe in spite of all the failures that physicians across the country pursued their craft as quacks, unconcerned about the outcome or the purpose of what they were doing, or that they had no personal or unit guideline, whether written or unwritten, to refer to, and that everything was done in bad faith and shame. I can believe that the authors’ description will give comfort to those who wish to denigrate the service, to those homosexuals who believe they are fully normal and intent on altering the conscience of society, and to those who wish to conform to a politically correct scene. The actual numbers of professionals holding opinions are omitted, and it must have been quite a blow to the authors to learn that a minority, not numbered, regarded treatment as effective, and others, unquantified, that it was possible to curb homosexual behaviour, (although most, also unquantified, doubted the treatment’s efficacy). Immediately after comments by some that they felt guilty about their treatments, which they thought were a form of punishment, even shameful, we learn, and the authors learnt, that an unquantified small minority maintained that same sex attraction is an illness and is associated with psychopathology, and another unquantified few voiced concern that treatment would nowadays be denied, because in one case he saw homosexuals who were very uncomfortable with the whole gay scene. All this approach is forgotten in the Discussion where we learn that assumptions about public morality and professional authority can lead to the medicalisation of human differences, which are (conveniently) not specified in detail, although regarded by the authors as mental pathology (at the top of p430), and that this leads to the infringement of human rights. The authors’ view is that most professionals say that same sex attraction is compatible with psychological health, whilst within a few lines in a Conclusion they say “... (homosexuality is) what we, (presumably including they themselves), regard as mental pathology,” and social and political assumptions serve as a warning for future practice. It is certainly a warning that psychiatry comes to heel in those circumstances. Now either homosexuality has a mental pathology or it doesn’t. These authors should make up their minds. It affects and destroys the formulation of reproductive health at all levels. It undermines and betrays the sexual purpose itself. The alternative view that the rights founded on the intuitive conscience of patients, their families, and health in society, are infringed by the authors’ statement of denial among the professionals of the nature of this self-evident psychiatric pathology, does not appear We are also expected to believe that social and moral attitudes can determine what is regarded as “pathology”. The meaning to be given to the word determine appears to be ‘bring to an end’. This is most unfortunate since, conveniently again, the authors say they had little opportunity to interview leading psychoanalysts, a particularly crucial undertaking one would have thought to allow them to establish at least their medical attitudes and what they think they are doing and why; and whether homosexuality is indeed a serious disorder of variable genetic penetrance with serious repercussions, and its psychiatric existence quite independent of the views of any lay organisation. 1. Public Knowledge. John Ziman (1967). C.U.P. 2.One would not say though one could, that cosmetic surgery clinics are really clinics designed to make the ugly beautiful, or surgery is a craft designed to inhibit squawking due to pain. FINALLY, pursuing Ziman’s theory1 that the goal of science is a consensus of rational opinion over the widest possible field, it is easier and proper to examine the articles to show what rationality they do and do not reveal. OUR IGNORANCE IN PSYCHIATRY Primarily of course we needed to know what homosexuality is, as distinct from is best thought of as, or whether these authors indubitably think it is psychiatrically normal. We know from extensive literature written by a practitioner that they claim it as a perversion. Is it? How are we to deal with those who do recognise their own mental condition as abnormal? Does it not show a host of psychoneuroses which make it instantly recognisable by ordinary people on the street? What is going on psychodynamically in the minds of homosexuals during their public demonstrations and parades, who reveal bizarre conduct and dress and flagrant immature fantasy life? Why is it not a psychopathy? All the above sounds very much like the setting of an illness but these matters still remain obscure unfortunately. THE COMIC NEUROSIS Do the homosexual comedians believe that their audiences are laughing with them or at them? Are homosexuals not the butt of widespread discriminatory jokes? In their defect of expression of speech and constant anal innuendo is there not a world in which they tragically appear trapped? Is a life of comedic expression of lavatorial humour a normal occupation? The authors leave the answers to all these questions in the positive. THE RELATIVES Is mutual regard and family cohesion a good thing? Does the syndrome ever destroy family cohesion and balance? If it does what are the psychodynamics of this rejection? How do we deal with the relatives who are unable to accept patients’ conduct as normal behaviour? Is it wise for homosexuals to live on the outside of the normal emotional relationships and purposes investing the species? In advising us, the articles give no clear guidance on these matters either. This work suffers from lack of unambiguous communication. There are no grounds for consensibility of new reliable knowledge suitable for intersubjective validation. Nothing is added to the grounds for our current knowledge. THE MEDICAL POLITICS So did the American Psychiatric Association get it wrong? I am afraid they did. Wholly wrong. This condition is characteristically a psychiatric disease; symptoms and signs litter the scene. It would not be the only one for which there is no satisfactory treatment. To treat it as normal betrays our trust. The perversion, as claimed, needs understanding and some sympathy but never medical sanitisation. The current practice within BBC and ITV of maximising public exposure to the condition wherever and whenever possible in broadcasts merely exacerbates the ridiculous. One cannot be inured to so obvious an abnormality. We are being brainwashed in our turn. Not all the people will be misled. Now that psychiatrists in these articles appear to reject the obvious, have they joined the laughing stock of a ‘politically correct’ brigade who wish to be seen cool, with it and modern? There is a pusillanimity about the conclusions of these articles. APPENDIX The authors appear to be in some confusion over the date of legal risk of prosecution for homosexuality (sodomy and gross indecency) for consenting persons as agent and patient in private. This ceased by 1957 following Wolfenden (the consent of the AG being required in doubtful cases), and I can find none of these recorded since 1957. Those who sought treatment for homosexuality for legal reasons, as described in the articles might have been involved in something improper additionally. The formal decriminalisation was certainly enacted in SOA 1967 and the acts more precisely defined in 1994. Buggery with animals is still unlawful but the rationale for this is still obscure especially in light of these articles and today’s social environment. For legal purposes the following outline for an undergraduate thesis was prepared in 1999 and in view of the importance of the subject I append it so that lay people, patients or not, who chance to read these notes are in a position to understand the straightforward factual matters relating to the problem looked at from a wider perspective, which I hope was unbiased. 21.12.99 IS THIS MATTER FINALLY SETTLED? Male homosexual practice was for a long time felonious in England. It had been generally loathed and punished by longish terms of imprisonment. In criminal law their Lordships might readily be heard in judgement in such cases to express no uncertain view as to its negative influence on society. Looking back it seems that the recent acceptability of homosexuality as a normal or preferable mode of conduct at least in this country is only based on the conclusions of the Wolfenden1 report of the Departmental Committee on Homosexual Offences and Prostitution of 1957. This chose to overlook any analysis of abnormality of the condition. Sir John Wolfenden had been a headmaster of public schools for 15 years. A noteworthy member of that enquiry team was the Lord Chief Justice of that time. Soon after publication of the report, the psychiatric condition2 of homosexual perversion was erased from the statute list of criminal activity. The report is also noteworthy for the other areas into which it refused (or was unable) to comment or draw any conclusions although various doctors and a whole raft of organisations and other individuals (including policemen with strong views) were questioned. Generally it became clear that, treatment not being effective, the condition was relegated to a personality defect classification, much as the psychopaths are today, of being beyond the capability of doctors to cure, even where the patient was (outwardly) willing to subject himself to treatment. Accordingly, it was not blameworthy. According to libertarian propaganda, society is said to have developed, or become less censorious and more understanding. There is no doubt though that, prior to Wolfenden, the concept of males engaging with each other in sexual activity had spiritual, ethical and physical repugnance. Why does it not have such today? What does society have to ignore or conceal to allow such a radical change? There is no analysis of this in the Wolfenden report itself, so it bears re-examination, when in particular its apologists3 freely and acceptably describe themselves as ‘perverted’ and its practitioners might even find themselves in Government and indeed in charge of ‘Culture’. It is difficult to write on this subject in an unbiased manner, but certain fixed points can be elucidated and these may be divided briefly into the subjective field of psychology, then a review of the anatomically and physiologically observable purpose of distinct organs, and finally the associated psycho-pathology (the associated syndromes of observable mental illness), together with other accompanying physical illness. (Subheading) PSYCHOLOGY Even prior to the frank reporting in Masters and Johnson4 it had been well know as a generality that most sex takes place in the mind. Genito-urinary physicians had always taught this, i.e. 98% above the waist the rest below. There is no sex without consciousness - practised it is thought in the ‘id’ - the most basic and here inescapable reproduction-orientated part of the personality, according to simple psycho-analytical theory. It is thus common psychiatric practice to enquire into the nature of such suppressible fantasies of individuals to determine what has been termed ‘orientation’. The fantasies will be characteristic - like an ECG - throughout life. Once established it is not possible to actively switch the gender of this sexual fantasy type permanently by will though it is easy to say so. Thus whatever the final pertinent object of the heterosexual fantasy activity of an individual, it will be at that point reproductive in purpose. A female will be involved and it will be normal. This interpretation is not available to wholly male activity. Male fantasies based on anal penetration are commonly reported and commonly exclusively practised. The disorders involved are quite abnormal in not only this loss of a natural purpose but also in the unfortunate practical realisation that the activity accords exactly with adverse public bar concepts*; it is at this point that the degree of such profound mental abnormality becomes obvious. It is very difficult to interpret the active forethought relating to this with any reference to genetic purpose at all. The activity cannot be said to have any other beneficial purpose in reproductive or Darwinian terms, either. It is destructive of it. It will be remarked that this activity is not unknown in the heterosexual population. Its prevalence there will also accord with the degree to which normal psychology has become disordered in such minds as well. Whether originating in nature or nurture, it is the degree of this personality defect which dictates its importance to the individual. It may overwhelm his thought processes. Where it becomes exclusively the active sexual purpose, (or nearly so), the illness assumes the mantle of psychosis. Its abnormality is denied by the sufferer, who in practice usually nurses and encourages it during exacerbations, and he refuses to change activity because of its pleasure to him. (Such non - beneficial behaviour is also found in some other psychopathic and manic-depressive psychoses). To co-working male observers the most serious disabling disadvantage is that at any one time he does not know and could only guess, had he notice of such inclination, what the homosexual is thinking about him. A mature female always knows what a male will be thinking. He is normally thinking this. (Subheading) ANATOMY5 and PHYSIOLOGYand INFECTION There will not nowadays be an experienced surgeon in practice who has not removed foreign bodies from the ano-rectum. Trauma to the same area by sexual violence is commonplace and the cause of post-coital bleeding. The transmission at this site of bacterial, spirochaetal and viral infections are now notorious. The treatment of some of these are particularly hazardous, world-wide and increasingly in many cases unavailing. The anatomy of the digestive tract pelvic organs will not support any normality of their functional use for genital purposes. Whereas the vagina is a thick walled tube designed to lubricate and functioning to receive the penis, as a conduit for fertilisation and for the expulsion of the foetus, the ano-rectum by contrast has no purposes with reproductive value in either sex. The rectum is thin walled with significant and fragile blood supply, all designed in its structural and directional anatomy simply to retain and facilitate the external passage of faeces. The detail of this much simplified account may be confirmed easily in anatomy textbooks. (Subheading) PYSCHO-PATHOLOGY A necessary consequence of the homosexual lifestyle is the breakdown in the dynamics of our traditional and historic family lifestyle, founded more or less on Freudian analyses. Procreation, the underlying basis of sexual activity, and a primary purpose of existence, may be rejected as a welcome lifestyle, and women become disparaged, unselectable as exclusive sexual companions. Common too is the observation that entrapment in homosexual lifestyle leads to inadequate short-term relational fecklessness in the victim and substantial spells of guilt, depression, anxiety, projection of immature thought and speech patterns. These are undoubtedly exacerbated by the abusive homophobic consequences expressed by the community at large, whose tolerance is skin deep to exposure to much instability or irrational activity in any individual for fear of fragmentation of healthy mindsets. Clearly, practising homosexuals in positions of responsibility are advantageously placed to seriously alter for the worse the dynamics of societal relationships, and social life of a more undisturbed and undistorted kind. On the other hand they are also in a position to maximise influence in employment matters, which is currently seen in the media, stage, university, and the book world. They will invariably seek support from, and provide support for, various political correctnesses and the other deviations to minimise resentment of their own activities. They are faced with an uphill struggle of persuading the public of their normality. A similar analysis may easily be made of the activity of the fantasy mind of the paedophile the sexual nature of which merges into purposelessness akin to that of the homosexual. It is difficult to see that these matters are finally settled. The fact that these simple observations need to be written out for the community to consider beggars belief. The acceptability of the consequences of homosexuality might be more fully realised politically. That there is no intrasexual purpose in homosexual perverted activity and that it is not contrary to any reasonable assessment of any aspect of normality, still needs a full basic explanation prior to being actively supported in any legal sense so far. The legal profession and the psychiatrists might almost be thought conspiring in a response of rectitudinal inactivity, and that judges at the ECHR should ignore all these aspects must reflect sadly on their own psychological insights and balance, and experience. (Subheading) COMMENTARY This presentation is simply a statement of basic beliefs and conclusions which have been common in polite society for generations. It is not worked up as a full blown article and it is not fully annotated (though it could be). Now that it is proposed to remove subsidiary remaining controls and teach homosexuality in schools, following repeal of section 28 of the Local Government Act 1988 and lower the age of consent, some reminder of the basic psycho-sexual dynamics might be thought necessary before such change goes through on the nod. In their recent decisions, the High Court (Family Division), the Appeal Court, and the European Court of Human Rights seem unable to comprehend the detail of the conduct and associated mental considerations to which they have given support. And now an immature Parliament seems willing to follow suit, still further. If this conduct comes to assume normal attributes particularly continuing perspectives of normal health following such political promotion, then they inevitably will need defending in Court and office and university practice. This may be very difficult, even for money. But if so, and the analysis above is right , then arguably the country at large will not tolerate any significant close association with, or understanding of, homosexuals and we shall divide ourselves again into further strata in our too divided society. FOOTNOTES * of which one such describes their practice as ‘f****** into s***’ BIBLIOGRAPHY 1. Wolfenden Report (1957) Report of the Committee of Homosexual Offences and Prostitution (London: HMSO) Cmnd 247 2. Clinical Psychiatry. Slater & Roth 1970 3. TATCHELL Peter We don’t even want to march straight. 1985 4. Masters and Johnston HUMAN SEXUAL RESPONSE 1966 ISBN 0700000542 5. GRAY’S ANATOMY Ed Williams and Warwick, ISBN 0443053278 WC 1724 Competing interests: None declared
Editing Rapid Responses 25 February 2004
Chris Lovitt, Public Health SP Trainee Kent Health Protection Unit ME20 7NJ Send response to journal: Re: Editing Rapid Responses	Barnes posting on the 24 February 2004 is a clear demonstration of why there should be an editorial review of rapid responses. Barnes rapid response is long rambling demonstration of manifest homophobia- that conforms to practically every stereotype of the homophobe. But I am left with one question- how did this get through the editorial process? Any editor would have every justification in requiring Barnes posting to be:- shortened, more focused, exclude references to conspiracy theories ("homosexuals" in the BBC and ITV "brainwashing" the poor public by showing gay people on TV- oh please) and require the removal of the classic homophobes' obsessional reference to "fucking into shit" rather than the pathetic use of asterisks. The posting by Barnes does add much to the debate; more than anything as a demonstration of how irrational the fear of gay people can be amongst some sections of society. However this does not justify the manifest dereliction of editorial process. Chris Lovitt Competing interests: None declared
"Treating" lesbians and gay men: A response from the British Psychological Society Lesbian & Gay Psychology Section 14 April 2004
Peter Hegarty, Lecturer Department of Psychology, University of Surrey, Guildford GU2 7XH UK, Sonja Ellis, Gareth Hagger-Johnson, Peter Hegarty, Martin Holt, Darren Langdridge, and Elizabeth Peel Send response to journal: Re: "Treating" lesbians and gay men: A response from the British Psychological Society Lesbian & Gay Psychology Section	Dear Editor, The British Psychological Society Lesbian & Gay Section committee would like to respond to recent articles in the BMJ ‘lesbian, gay, bisexual and transgender health collection’. Smith et al. [1] conducted an oral history study of treatments to change same sex attraction in Britain from 1950 and King et al. [2] examined the motivations and experiences of professionals who developed and practiced these treatments. Hughes & Evans [3] highlighted that women who have sex with women form a small but important group and have specific health needs and ‘lack of awareness among healthcare professionals about these needs may lead to ill informed advice and missed opportunities for the prevention of illness’. While the Smith et al. [1] paper (on patients' experiences) has quite clear conclusions about the negative effects of supposed ‘conversion therapies’, the conclusions of the King et al. [2] paper (on professionals' experiences) are much more ambivalent. We are concerned that a small minority of health professionals still regards homosexuality as a disorder, needing treatment and psychiatric help. King et al. [2] could have done much more to highlight the implications of heterosexism within psychiatry and medicine for patients and for health professionals. For instance, the authors seem to suggest that although doctors/therapists may have subscribed to the view of homosexuality as pathological in the past, they were only following the prevailing 'social and moral attitudes' of the time. This ignores the powerful influence that medicine and psychiatry had in defining homosexuality as pathological in the public imagination and seems to exempt doctors from further reflection on the misuse of expert authority. A psychiatrist quoted by King et al. [2] said: ‘I still see guys who are predominately homosexual but are really uncomfortable with the whole gay scene. So I could see someone like that, if there was a treatment to make them heterosexual, to give it to them’. We suggest that research should focus on the reasons for such discomfort, and the implicit meanings on ‘gay scene’, rather than on sexual orientation itself. Reasons for the discomfort may offer valuable insights, and since sexual orientations are not illnesses, they cannot be treated. Regarding Smith et al. [1] who reported that 'Many participants felt they lacked parental affection during childhood and adolescence'. In the way they posit the statement Smith et al imply that somehow the two are correlational – that homosexuality is the result of bad parenting and is, by extension, deviant. Yet it is equally likely that a sample of heterosexual participants would also report that they lacked parental affection during childhood and adolescence. In line with Hughes & Evans [3] approach to non-discriminatory practices in the workplace (now supported by legislation), we welcome attempts to afford people the choice to disclose their sexual orientation in healthcare settings where this will improve the access to, or delivery of, appropriate patient care. We query the notion of women participating in high risk behaviours such as IV drug use and unprotected sex with homosexual or bisexual men acting 'as a bridge, transferring risk to women who exclusively have sex with women' [p.939]. We would advise extreme caution when discussing issues of responsibility. There is a long history of feminists critiquing the notion that certain kinds of women are a 'vector' or 'bridge' for HIV transmission - particularly sex workers [4][5]. The issue here is not just one of attributing agency, but also of privileging men's health over women's As a general point in regards to practice and research in this area we recommend that heteronormative language is not used in healthcare settings and in research. For example, ‘partner’ can be used instead of ‘wife/husband’, and ‘children’ instead of ‘offspring’. Moreover terms such as ‘incidence’, ‘prevalence’ or ‘risk factor’ should not be used to refer to homosexuality, since the origin of the frequent use of these terms in medicine, epidemiology and psychology can connote the presence of a disease where none exists. We hope that the articles in the collection and our comments serve to remind readers of the need for ethical practice with lesbian, gay and bisexual people. Yours faithfully, Sonja Ellis Gareth Hagger-Johnson Peter Hegarty Martin Holt Darren Langdridge Elizabeth Peel British Psychological Society Lesbian & Gay Section Web Site: http://bps.org.uk/sub-syst/lesgay/index.cfm Reference List [1] Smith G., Bartlett A., King M. Treatments of homosexuality in Britain since the 1950s - an oral history: the experience of patients. British Medical Journal 2004;328:427-9. [2] King M., Smith G., Bartlett A. Treatments of homosexuality in Britain since the 1950s - an oral history: the experience of professionals. British Medical Journal 2004;328:429-32. [3] Hughes C.,.Evans A. Health needs of women who have sex with women - Healthcare workers need to be aware of their specific needs. British Medical Journal 2003;327:464. [4] Treichler P. An epidemic of signification. In Crimp D, ed. AIDS Cultural Analysis/Cultural Activism., Cambridge, Mass ; London: MIT Press, 1990. [5] Patton C. Sex and Germs. Boston, MA: South End Press, 1985. Competing interests: Members of the British Psychological Society (BPS) Lesbian & Gay Section
Homosexuality is a treatable obsessive-compulsive-addictive disorder. 16 April 2004
George Hill, Retired Port Allen, Louisiana 70767, USA Send response to journal: Re: Homosexuality is a treatable obsessive-compulsive-addictive disorder.	Dear Editor: Smith et al. report a negative experience with traditional treatment of homosexuality.1 This is not surprising. There is evidence that homosexuality is not a sexual disorder at all. All attempts to treat homosexuality as a sexual disorder, therefore, are doomed to failure. There is, however, abundant evidence that homosexuality is an obsessive-compulsive-addictive (OCA) disorder and that it can be successfully treated with programs that treat the underlying emotional and spiritual problems that result in OCA behaviours. Not everyone wants to be cured; there must be a genuine desire to change behaviour. Several groups are helping many individuals to recover from homosexual obsession, compulsion, and addiction with a program of emotional and spiritual development. Such groups include NARTH, Exodus International, and Homosexuals Anonymous. Homosexuals, like alcoholics, have great resistance to entering treatment. Anyone who disagrees that homosexuality is a normal, healthy, alternative lifestyle is termed a “homophobe”, whatever that is. This letter, therefore, may attract abundant criticism. Nevertheless, successful treatment is now available for those who are determined to change their behaviour. George Hill Port Allen, Louisiana 70767 USA Reference Smith G, Bartlet A, King M. Treatments of homosexuality in Britain since the 1950s—an oral history: the experience of patients. BMJ 2004;328:427 Competing interests: None declared
Re: Homosexuality is a treatable obsessive-compulsive-addictive disorder. 17 April 2004
Brian Morgan, Freelance Journalist Cardiff CF11 6LF Send response to journal: Re: Re: Homosexuality is a treatable obsessive-compulsive-addictive disorder.	Please supply peer reviewed journal references to: "There is, however, abundant evidence that homosexuality is an obsessive-compulsive-addictive (OCA) disorder and that it can be successfully treated with programs that treat the underlying emotional and spiritual problems that result in OCA behaviours." This is not a criticism of the writer's opinion, only a request for references to help inform my friends. Brian Morgan Competing interests: I am of heterosexual orientation but proud to know friends who are: bisexual; homosexual; transvestite, OCD (or OCA) oriented.