Treatment of homosexuality during apartheidBMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7480.1415 (Published 16 December 2004) Cite this as: BMJ 2004;329:1415
- Robert M Kaplan, forensic psychiatrist ()
Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function, produced by a certain arrest of the sexual development. It is a great injustice to persecute homosexuality as a crime—and a cruelty too.1
In the 20th century, doctors were repeatedly accomplices in state repression, brutality, and genocide. The most notorious examples of medical complicity in state abuse are the Nazi doctors who participated in genocide and the Japanese doctors who practised biological warfare.2 Included among the former were psychiatrists, who in carrying out Hitler's euthanasia programme on their patients seem to have been in a state of complete moral disarray.
Involvement of psychiatrists in state repression has if anything escalated since 1945, the most extensive example being the use of psychiatric treatment for suppression of dissenters in the Soviet Union. Similar practices arose in other east European states, China, and Cuba. Recently there have been claims of psychiatric abuse of detainees at Guantánamo Bay.3
During the apartheid years in South Africa, medical personnel were involved in abuse of prisoners,4 the most well-known case being the death in custody of Steve Biko.5 From 1969 to 1987, psychiatrists of the South African Defence Force were implicated in serious abuses, stemming from attempts to cure homosexual conscripts.6 The South African Defence Force regarded homosexuality as subversive, and severe penalties were prescribed, although attitudes were often inconsistent.
The long history of medical treatment to convert homosexuals to heterosexuals reached a peak in the seventies. The results were unconvincing, if not hopeless, and experience showed that neither patients nor therapists found it satisfactory.7 8 With removal of the definition of homosexuality as an illness from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1973,9 interest in treatment faded and it would be thought the matter was of interest only to historians.
These developments had little influence on psychiatrists in the South African Defence Force. Militarisation of the white population escalated after the establishment of universal conscription in 1967. Conscript ranks were screened for homosexuals by doctors and chaplains. Threatened with punishment if they did not comply, they were admitted to the secretive Ward 22 at 1 Military Hospital, Voortrekkerhoogte, Pretoria. In later years, homosexual women were also selected.
Subjects were first given crude behaviour therapy. This consisted of exposure to black and white pictures of naked men while receiving electric shocks, then viewing Playboy magazine centrefolds. The shock was so intense that in one case the subject's shoes flew off.10
Homosexuals were indiscriminately grouped in the psychiatric ward with drug abusers, conscientious objectors, the politically unreliable, and the seriously mentally ill. They were often subjected to narcoanalysis, showing an ominous similarity to psychiatric re-education in the Soviet Union. Others were chemically castrated with massive doses of hormones. Drug addicts were threatened with transport to remote Greefswald (later Magaliesoord), regarded as little less than a forced labour camp.
Accounts exist of suicide during treatment and after discharge. The most well known is Jean Erasmus, who killed himself after providing detailed information about the programme.
The next stage in treatment went beyond any justifiable basis. Recurrent allegations have been made that between 1969 and 1987 approximately 900 men and women had gender reassignment surgery, the only known example of such operations being performed in military hospitals.10 11 They were given new identity documents, discharged from the military, and told to cut themselves off from family and friends.
The casualty rates were high. Patients died during surgery, and some were discharged before reassignment was completed, with extra surgery required. Preoperative or postoperative assessment was not done, informed consent was not obtained, and expensive hormone regimens were needed to maintain appearance. Patients later petitioned the military for compensation to pay for hormones or surgery.
The rationale for giving homosexuals reassignment surgery, in complete ignorance of the scientific literature on transsexualism, can only be described as repulsive. It was based on the simplistic belief that male homosexuals were sissies, female homosexuals were tomboys, and surgery would end their preference for the same sex by allowing them to fulfil their projected role in the opposite sex. The only conclusion that can be reached is that the psychiatrists involved were not only woefully and balefully ignorant but functioned as an extension of the military ethos.
Rumours of these activities circulated for years,12 but details of the programme first came to light at hearings of the Truth and Reconciliation Commission with submission of The Aversion Project, a detailed investigation of treatment of homosexuals in the South African Defence Force by a coalition of groups, including the Medical Research Council.13
In 1995, the Medical Association of South Africa issued a public apology for past wrongdoings.14 The South African Society of Psychiatrists does not concede that major abuses were perpetuated from within its ranks.15 Until there is a full and open investigation of medical abuses in the South African Defence Force, psychiatry in South Africa will remain compromised. To maintain credibility, offenders must be brought to justice and a regulatory system established to ensure such atrocities do not occur again. Anything less will be a serious injustice.
Competing interests None declared.