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Rapid Responses: Rapid Responses published:
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Normal or abnormal behaviour? Medical or psychiatric disorder?
- AK. Al-Sheikhli. (30 January 2004)
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Re: Normal or abnormal behaviour? Medical or psychiatric disorder?
- Rita Pal (1 February 2004)
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Treatment of homosexuality in the South African Defence Force during the Apartheid years.
- Robert M Kaplan (20 February 2004)
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Reorientation is a possibility for some homosexuals
- Sarah C Glendinning (5 March 2004)
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Re: Reorientation is a possibility for some homosexuals
- Alan V Sheard (20 March 2004)
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AK. Al-Sheikhli., Psychiatrist. Medical Centre,2Manor Court Avenue,Nuneaton,CV11 5HX,UK.
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Dear Editor, It was interesting to read the paper of King,Smith,and Bartlett,Online First, Treatments of homosexuality in Britain since the 1950s--an oral history:the experience of professionals(BMJ 2004;0:379844967-0). My comment 1.It shows how legislation can affect the attitude of the public among which are the professionals (the medical, and psychiatric staff). 2.It shows that although some professionals consider the treatments were valid, many have doubts about efficacy and ethics. 3.I wonder whether we are dealing with one of the varities of sexual behaviour,abnormal sexual behaviour, medical or psychological disorder? 4.The study reminds me of Insulin coma and frontal lobotomy for the treatment of schizophrenia. Thanking you,
AK.Al-Sheikhli. Competing interests: None declared |
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Rita Pal, Editor NHS Exposed
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Homosexuality was in the past, much like whistleblowing is today. Psychiatrists are often guilty of judging behaviour - by normal or abnormal. The judgement ruler is usually their own background, prejudices, world view etc. That is my first criticism of some psychiatrists. There is a world view that everyone is different and some people should be allowed to be accepted without the stigma of a psychiatric diagnosis. It is interesting though that the more judgmental doctors look upon behaviour out of the ordinary to be a product of some form of personality disorder. There was a judgment recently on the front page of the BMA news where the privacy of doctors if judged as "eccentric" should be grounds for an alert letter. Now judges seem to be willing to make diagnosis of abnormality based on their own judgement. This judgment shows that we have not really moved from a 16th century view of "perceieved abnormal behaviour" judged very often as " mental illness". Homosexuality has a great deal of understanding in this day and age. Other forms of behaviour eg campaigning etc within the medical profession does not command that level of understanding. To campaign for better healthcare these days is clearly according to the GMC a product of abnormal behaviour although homosexuality is deemed acceptable. I suspect it is time psychiatrists looked upon products of their own prejudices before they take the time to judge an individualist within the ICD 10 code. Genetics exists for us to develop into individualists - not to remain clone doctors moulded by a profession that remains stuck in the 19th century :) or even further back! Dr Rita Pal Editor www.nhs-exposed.com Competing interests: None declared |
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Robert M Kaplan, psychiatrist 2500
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In their article, the authors reveal some of the personal views and experiences of medical and psychology professionals in the United Kingdom who attempted to make homosexual men and women heterosexual in the 20th century. These experiences however must rank as relatively mild compared to the appalling events in South Africa Defence Force [SADF] during the Apartheid years, known as the Aversion Project. There were horrifying revelations at the TRC. Over an 18 year period 900 men and women were coerced into having sex change surgery after the crude attempts at behaviour therapy failed. This atrocity, which must rank as one of the worst abuses in psychiatry since World War 2, went on with the full conivance of the military authorities who regarded homosexuality as an intolerable defect that had to be weeded out of the conscript ranks. Victims were often handed in for treatment after they had confessed to the regimental chaplain. Victims were discharged from the SADF with no support, in some cases with the surgical conversion incomplete. The psychiatrists who ran this system have not been brought to justice and one is reported to have a prestigious position in an overseas country. The South African medical establishment has many sins [such as the death of Steve Biko] to answer for during the Apartheid years. The failure to act, even retrospectively about these psychiatric abuses is quite inexcusable. Dr Robert Kaplan [Kaplan R. The Aversion Project – Psychiatric abuses in the South African Defence Force during the Apartheid Era. South African Medical Journal March 2001, 90-3;216-217.] Competing interests: None declared |
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Sarah C Glendinning, GP Retainee New Hall Lane Practice, Geoffrey Street, Preston PR1 5NE
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Editor Rhona MacDonald is wrong to suggest in the Editor's Choice column that only a bigot would believe that homosexuals might benefit from psychiatric help.(1,2) A recent paper by Professor Robert Spitzer(3)(who, incidentally, has a long track record of supporting gay rights, and was instrumental in getting homosexuality declassified as a psychiatric illness in the United States in 1973) suggests that it is possible for some gay people to reorientate themselves as a result of some form of "reparative therapy". The study was of 200 self-selected individuals who had undergone therapy at least 5 years previously. Structured interviews were used to assess homosexual feelings and behaviour in the year before therapy and in the year before the interview. The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the year before interview. Professor Spitzer comments that, although he was initially sceptical,in the course of the study he "became convinced of the possibility of change in some gay men and lesbians". Most participants reported finding the therapy helpful, and reported depression rates were much lower at the time of interview than before therapy. 1.MacDonald R. Lessons from medicine's shameful past. BMJ 2004;328:Editor's choice. 2.King M,Smith G,Bartlett A. Treatment of homosexuality in Britain since the 1950's - an oral history: the experience of professionals. BMJ 2004;328:429-432. 3.Spitzer RL. Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Archives of Sexual Behaviour 2003;32(5):403-417. Competing interests: None declared |
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Alan V Sheard, Retired Consultant in Public Health Not Applicable
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Re: Reorientation is a possibility for some homosexuals Professor Spitzer's study, referred to by Dr Glendenning, has been quoted by both critics and supporters of lesbian and gay people. It is therefore helpful to hear Spitzer himself talking in an interview he gave with Dr Raj Persaud on BBC Radio 4 recently. It can be heard at http://www.bbc.co.uk/radio4/science/rams/allinthemind_20040203.ram It's about 8 minutes, and ignore the first 2 minutes which are on a different topic. In this Spitzer says he had difficulty in finding 200 volunteers who had apparently changed their sexuality and it took him 2 years to do so. He concludes it is a rare situation.The vast majority of these volunteers came from religious organisations. His results showed that only 14% of the group had completely eliminated their homosexual feelings. He stresses that the survey was not a representative group and his results are not generaliseable to the gay community. In a separate article (in the Wall Street Journal) Spitzer has said he fully supports human rights for gay and lesbian people. I think that in view of the criticism of lesbian and gay people it is not surprising that some of them wish to change. The viciousness of this criticism may not be realised by people unfamiliar with some of the published mainstream conservative religious writing. Spitzer's survey does show that these religious critics are very influential, and bigotry is not too strong a word for this. It is striking that in spite of such societal pressures so few people do change their orientation to any significant degree. Spitzer in his talk comments that his survey may have harmed more people than it has helped. Primum non nocere. His findings do not alter the fact that there are many lesbian and gay people, religious or not, who do not wish to change, and would be incapable of changing. It should be remembered that the General Medical Council requires that doctors must not let their views about their patients' sexuality (or race, gender, economic circumstances etc) prejudice the treatment they provide or arrange ('Good Medical Practice', GMC 2001, p4). Competing interests: None declared |
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