LGBT

Mental illness has always been difficult to define, as the boundary between a disorder and normality is blurred. While training to be a psychiatrist, I had been warned about becoming an agent of the state, enforcing treatment on those whose behaviour is deemed undesirable by society. I did not fully appreciate the idea of medicine lying alongside moral condemnation and the criminal system until I met James.

James had not answered the door or phone calls for more than a week. His nurse had put notes through his door and received no reply. He is a man who had often thought of committing suicide and it was feared that he had done just that. It was decided that the police should be contacted and his door forced open; however, after much knocking on windows and doors, he answered.

James, now in his sixties, has good reason to be wary of psychiatric services: from the age of 21 he was subjected to brutal and dangerous treatments for his condition. The treatments included insulin-induced comas, electroconvulsive therapy and injections to induce nausea. The condition doctors were attempting to treat was homosexuality.

An extract from his initial referral to hospital in 1960 reads: "This boy's father came to see me this morning in great distress and told me the following story. Since the age of 12 or 13 his son has been mixed up with men of the town in the habit of homosexual practices. The father got to know what was going on and did his best to stop it, but when he failed he thought the best thing to do was to remove his son from the situation.

"At the age of 17 he therefore enlisted in the army. This was an unfortunate step for his habits did not change and in a comparatively short time he was in trouble with the police and about a year ago appeared in court and was sentenced to 18 months imprisonment. He was officially discharged from the army on medical grounds."

He had served 12 months in Wormwood Scrubs in London alongside notorious gangster Ronnie Kray and atom spy Klaus Fuchs. The prison psychiatrist concluded that "his homosexuality was the result of an excessive shyness which made him unable to form relationships with girls" and recommended hospital treatment on release from prison.

Homosexuality was decriminalised 40 years ago but it remained a psychiatric condition, as defined by the World Health Organisation, until 1990. As it was a medical disorder, attempts were made to cure it. An article in the British Medical Journal in 1958 stated that "homosexuality differs little from other perversion such as fetishism in which the sexual impulse is transferred to inanimate objects like corsets or the hood of a perambulator", and thought arguing otherwise would "encourage the view that homosexuality is incurable".

James remembers not wanting to be homosexual as his father, with tears in his eyes, left him at hospital. He felt prison had been a terrible experience and now he saw people being wheeled back to the ward from electro-convulsive therapy moaning and groaning. He too was to receive this treatment, and recalls: "It was like something from a monster movie - the couch, the green light, the doctor standing there with the electrodes, two or three nurses. I said hold on a minute, no'. They grabbed me, threw me on the couch, strapped me down, no injection to calm me and then the bang." The bang was the effect of the treatment.

ECT involves passing an electric current across the brain to induce an epileptic fit. It is still used today, albeit with a much improved and safer technique using anaesthetic and muscle relaxants, and is an effective treatment for depression. It can no longer be given to a patient able to decide against treatment without their consent.

There are also reports of aversion therapy, electro-convulsive therapy and even lobotomy being used. Insulin coma therapy was first introduced to psychiatry in 1933. Patients were fasted and then a coma was induced using large doses of insulin. This coma was reversed using glucose solution or sugary tea poured down a tube through the patient's nose and down to the stomach. There are no clear figures for mortality but estimated rates range from 0.5% to 10%. It is no longer used.

James recollects "Insulin coma therapy was a strange thing. You were taken away from the hospital and there were sort of outbuildings, just sheds, up the top of the hill. You had to fast and they took you, about half a dozen of us, up in the van and then you went into a room, they gave you an injection. I remember you came out of it very violent."

The most commonly used treatment from the early 1960s to early 70s for homosexuality was aversion therapy. The techniques used in aversion therapy were electric shocks or drug-induced nausea. Typically, a patient would be given a photograph of a male and be allowed to continue to look at or remove the image. If the subject continued to look at an image of a male he would receive an electric shock.

An article from 1969 in The British Journal of Psychiatry describes one method used: "The patient is asked to produce erotic male fantasies whilst looking a pictures of males. Painful electric shocks were delivered whenever an erection developed to a certain level. This was repeated at 15-second intervals unless the erectile response was falling. The strength of the shock was adjusted for each patient."

In 1962 a case report from the British Medical Journal describee successful treatment using apomorphine-induced nausea. After nausea was induced "a strong light was shone on a card where there were nude or near nude men. He the patient was asked to select one which he found attractive, and it was suggested to him that he re-create experiences which he had had with his current homosexual partner.

"A tape was played twice every two hours over the period of nausea. This began with an explanation of his homosexual attraction along the lines of father-depravation, reinforced by his first homosexual experiences, a learned pattern thus being established. The adverse effect of this pattern on him and its consequent repercussions was then described in terms ending in words such as sickening', nauseating' etc. followed by the noise of vomiting."

James tells us of his aversion therapy: "It really upset me. You were taken to a room and they would give you beer and whisky. They had a projector in the room and they showed me photos of boys, naked boys. First they werenae naked and they would say what do you think of them?' "And it would go on like this and gradually the film would get more dirtier and it would develop to him swimming naked, and then they would give me and injection and I was sick. This went on for a full week and I don't think you actually ate because you did not feel like eating you were so ill."

Many clinicians now regret giving these treatments. Some argued that homosexuality was illegal, people were asking for help and at the time people did not question the morality of the treatment. By the 1970s, doctors were questioning the efficacy of treatment and the belief that a person's sexuality could be changed.

At the 1972 American Psychiatrist Association annual meeting one psychiatrist spoke out against homosexuality being labelled a disease. He appeared in disguise, using a voice distorting microphone, for fear of losing his job. He opened his speech with the words: "I am a homosexual. I am a psychiatrist," and went on to say that "as psychiatrists who are homosexuals, we must look carefully at the power which lies in our hands to define the health of others around us. In particular, we should have clearly in our minds our own particular understanding of what it is to be a healthy homosexual." John Fryer, who revealed his true identity only in 1994, died in 2003.

After leaving hospital, James worked for two years in a local factory and found casual seasonal work in hotels. He worked as a kitchen porter and had his most significant love affair with an apprentice chef, but the relationship ended along with the summer season.

He has not worked or had a relationship for many years. He is reluctant to socialise as he wishes to keep his homosexuality secret. He still feels his homosexuality is in some way wrong.

James holds hold no bitterness against psychiatry, and of his time in hospital says: "When I went into the hospital I needed help. I needed an answer to the question could I be cured?' and they proved that I couldn't, so I'm grateful to them for that."

From: The Herald, Scotland, Written by: JON MACKLIN, 13 May 2008

http://www.theherald.co.uk/features/features/display.var.2265814.0.Pride_and_punishment.php