Did US Psychiatrists Really Agree That Gays Were Nuts?

i-688d28ff8ba0b4be056711def5369ac9-Dykes_on_b_m1195507.jpgOver at Respectful Insolence, a lot of people have been discussing the relationship between skepticism and scientific consensus, a topic I brought up recently. And commenter Alvaro has pointed out a kind of counterexample, to whit, that the consensus among US psychiatrists had defined homosexuality as a psychiatric condition up through 1974. This is classic Michel Foucault territory, and I think Alvaro’s point is interesting and apt. Being gay isn’t always easy in an at best semi-tolerant society, but it sure isn’t something that calls for treatment.

Reading up a little, I found something that surprised me. Wikipedia has a meaty article on the issue, demonstrating that there was no consensus among US psychiatrists about gays being nuts prior to about 1953, and only a very weak one after that date.

To begin with, Alvaro’s chronology is slightly off. In 1953, the Diagnostic and Statistical Manual of Mental Disorders Mk. I defined homosexuality as a mental disorder. So did the first (1968) edition of DSM II. But already in 1973, the trustees of the American Psychiatric Association voted unanimously to remove homosexuality from new printings of the DSM II. The following year, amid great controversy, 58% of the APA membership confirmed this decision by vote. So, if we accept the DSM as a direct reflection of the consensus in psychiatry (which is highly debatable), then we only need to discuss a period of 15 years from 1953 to 1968.

In science, no answer can ever be better than the question you ask. My reply to Alvaro is that the issue here is really how “psychiatric condition” was defined in the 50s and 60s. If the definition was something along the lines of “non-standard behaviour and/or mental states that impair a person’s functioning in society”, then gayness clearly did fit the bill. Because it is, statistically speaking, non-standard, and it did pose problems for people living in the even less tolerant US society of the time.

So my take on this issue is that from 1953 to 1968, US psychiatrists may not generally have been very gay-friendly; but their consensus that gayness was something they should try to treat was probably not just a result of homophobia. Many psychiatrists did feel that something must be wrong in the brain of a person who doesn’t want to bonk people of the opposite sex. But they were also asking, “Is being gay a problem for our patients?”. And in the mid-20th century US, it would be hard to argue that it was not. It’s still a problem, because society is intolerant of non-standard lifestyles. What US psychiatrists agreed upon only about 20 years after DSM I was that gayness could not productively be handled as a psychiatric issue, despite the fact that it resides in the brain. In fact, defining gayness as a mental health issue just made the problem worse for the patients through social stigmatisation. Besides, gayness can’t be treated and most gay people don’t want to become straight. This sets it emphatically apart from unequivocal psychiatric diagnoses such as depression and anxiety.

(On a lighter yet kind of sad note, let me mention that the “gays are nuts” perspective survived in unexpected places long after 1968. The 1985 role-playing game Teenage Mutant Ninja Turtles & Other Strangeness has a table that the game master uses to determine a diagnose when a character goes insane for some reason. One of the “afflictions” such a character can be hit with is homosexuality.)

As I’ve said before, in my opinion, a real skeptic accepts scientific consensus. But the 1948 Kinsey report had documented a very high incidence of homosexual behaviour in US men. Therefore, the psychiatrists who drafted the DSM I knew that gay sex was not an unusual aberration among the brain-damaged, but something that a large part of the healthy population was doing for fun. I don’t believe there was any scientific consensus that gayness equalled madness in the 1960s. Apparently, however, a consensus remained that gayness was the business of psychiatrists because it was a problem for many people. And this latter is sadly still the case.

[More blog entries about , , , , , , ; , , , , , , , .]

Advertisements

Psycho Killer Not Psycho Enough

Back in June I posted a translation of a remarkable opinion piece written by two senior psychiatrists, commenting on their examination of a mentally ill man who had just committed his second murder. Today the papers report that Socialstyrelsens Rättsliga råd (“The judicial council of the social directorate”) has found the man insufficiently crazy to qualify for forced psychiatric treatment. This is bad news, because it means that he will likely be sentenced to jail, and Swedish jail terms for murder being surprisingly brief, he will probably be out again before long.

As I’ve written before, to my mind violent crime is a symptom of insanity.

Questions of the perpetrators’ sanity in cases of violent crime always have me shaking my head. To my mind, the ability to commit a highly violent crime is, in itself, a symptom of insanity for all societal intents and purposes. Insanity is defined by violent behaviour among other things. And as we have no sure methods of curing such insanity, we must simply keep violent madmen locked up and sedated indefinitely for safety’s sake. Whether this is called a jail sentence or a one-way commitment to a mental hospital is to my mind irrelevant.

My position is utilitarian: I don’t care much whether the criminal can be held philosophically responsible for the crime, and I see no point in society avenging itself on the criminal. My main priority is to minimise the risk of repeat offenses. (And many with me believe that jail time is highly counterproductive in this respect: it encourages repeat offences and a criminal career.)

A really drunk person is for society’s practical purposes insane. And people who get drunk and become violent rarely choose to do so only once. So we should keep them from drinking.

In the case of roid rage murders, we have the similar knowledge that certain individuals have taken steroids and gone nuts. This makes them a societal liability. We should make sure they don’t do it again.

Criminal “justice”, to me, should be seen as societal hygiene, health care and risk management.

[More blog entries about , , , ; , , .]

Psycho Killer

Last week a mentally ill man shot one policeman to death and hurt three other people when they came to apprehend him in his home in the Swedish town of Nyköping. This is a very rare and shocking occurrence in Sweden, where gun control is such that most people have never seen a handgun. Wednesday, an opinion piece about the case appeared in the main Swedish newspaper Dagens Nyheter. It was written by two senior psychiatrists, Henrik Belfrage and Göran Fransson, both of whom have examined the killer in the past. What they had to say is quite remarkable, and so I decided to translate a few bits.

“Dedicated forensic-psychiatric clinics should be given the overarching responsibility for evaluating threatening people with paranoid symptoms. The level of expertise and security in the public mental healthcare system is insufficient. Many psychiatrists simply do not dare to write a certificate of insanity for these people because they risk facing threats and violence.

As a consequence, there is currently hardly anyone even within the judicial system who dares report threats from mentally ill paranoiacs, because it is impossible to trust psychiatric forced care to act and accept its responsibility. The tragic police murder in Nyköping should never have had to happen. The killer’s paranoid and dangerous state had long been amply documented, and the question was no longer if something might happen, but simply when.

[…]

As early as in 1999 we reported the […] man as exceptionally dangerous. At that time, he suffered from a pronounced delusional syndrom, so-called kverulansparanoia, and several persons were receiving serious threats from him. Unfortunately he was in jail at the time, not a hospital, serving time. After he had knifed three unknown people, killing one, a psychiatric evaluation had classified his paranoia as a personality disorder (that is, not a mental illness), and this was not enough to sentence him to indefinite mental care. […]

Someone who is severely mentally ill should of course be certified as insane and entered into forced psychiatric care, particularly if they are dangerous to others. This is in our view where things are not working, and the fault is mainly with the forced psychiatric care system.

If a psychiatrist for some reason — insufficient expertise, or, which is unfortunately more likely, fear — cannot accept the responsibility of such an assessment, then the forced care system breaks down. Anyone who has previously been involved in a court case or a forced care evaluation regarding the patient ends up in a very precarious situation. To wit, the paranoiac suddenly receives a “certificate” that he is in fact not ill at all, which becomes proof to him that all previous assessments of him as mentally ill were erroneous and possibly motivated by spite. This calls for revenge. […]

It appears that most people within and without the judicial system are fully aware of the weaknesses in the courts and forced care system in cases like these. The threats we have received from the man in question included various affidavits from lawyers, doctors and others who certify that he did not receive a fair trial the last time, that he displays no psychiatric symptoms, that he has the signatories’ full support in his struggle against the authorities etc. Did these people write those documents because they really believed what they said?

No, of course not. They wrote them out of fear for themselves. Everyone knows that unless you play along with the paranoiac you risk becoming the victim of threats and violence. In this case it is also amply documented that a great number of authority representatives, doctors, district attorneys and others have been receiving serious threats from the man for years. How many police reports? None. No-one dares.

[…]

Anyone who had been in contact with this man in recent years knew that he would in all likelihood break out in homicidal violence one day. This was obvious. Nevertheless, in the eight years since we filed our assessment, he has never received forced care. A young policeman with his entire life in front of him became the man’s victim. Him, instead of one of us who are on the man’s hate-and-death list. It feels terrible to us, and it is a great defeat for the judicial system and the forced mental care system.

[…] the professionals in question should not have to live under constant threat because the forced care system is not acting against severely ill and dangerous people. Nor should these ill people be left without the care they so clearly need.”

Update 1 July: Here’s another opinion piece by the husband of a Swedish psychologist who was stalked and threatened by a former patient. She repeatedly reported the man to the police, but he finally murdered her in 2006 on the stairs to her office. The killer has since been deemed too insane to deserve a lifetime in prison, but too sane to receive indefinite forced psychiatric treatment. Instead, he serves a ten-year prison sentence, which in Swedish practice means five years.

[More blog entries about , , , , ; , , , , ]

Are Humans Polygamous?

[More blog entries about , , , ; , , , .]

i-d3001ca5c2ca37fa00a08933390cc23f-image020.jpgThe nature vs. nurture debate will always be with us poor cultured apes. Only very rarely can we lay the blame for our behaviour on genetic programming. A typical issue is that of monogamy.

I happened upon two bloggers (here and here) who argue that humans are polygamous (“everybody’s built to screw around”), or at least polygynous (“men are built to screw around”), by nature. They base this assertion on the results of research showing that a) somewhere between a percent and a third of all babies show genetic evidence of having been sired by someone else than their officially alleged progenitor, b) the pupils at one high school proved amazingly promiscuous over a 6-month period. The bloggers also taught me a cute acronym for adultery: EPC, “extra-pair copulation”.

Now, I find all this very interesting, but as always with evolutionary psychology, I wonder what kind of truth claims these statements about human “nature” really are.

Humans are air-breathers, no doubt about it. Humans are diurnal creatures. Humans are omnivores. All these are reasonably uncontroversial biological claims about humans. But can we say with the same kind of certainty that humans are polygamous? I think that’s pretty close to saying that humans are Mozart fans by nature or that humans like hamburgers by nature. Beyond the basics, it’s actually very hard to disentangle nature and culture.

Humans choose, and that means we’re responsible. Very few wives would accept “My genes made me do it” as an excuse when they catch their husbands cheating. And the research I mentioned suggests that most women actually choose to get impregnated by their steady partners, no matter how friendly the mailman is. It strikes me as an odd interpretation to suggest that the reason that most babies are sired by their mom’s steady partner is that culture conditions women (against their nature) to turn down the friendly mailman. I’d like to suggest another interpretation: humans have free will, and some screw around a lot, some very rarely, and some not at all beyond the officially sanctioned serial monogamy that most cultures cultivate.

I’m a happily married man myself — second marriage. I still look fondly at women in the street, but given all the grief and hassle an EPC would cause, I limit myself in practice to frequent and enthusiastic IPC. Does this mean that I am a polygynous ape acting against my nature? I’d say it means I’m a human who’s pretty happy with the social mores favoured by his culture. But culture isn’t forcing me to be monogamous, and my genes couldn’t force me to be polygamous. I choose. And if you saw my wife, you’d realise that my choice is a pretty easy one.

Is Psychotherapy Superstition?

[More blog entries about , , , , , ; , , , , , .]

i-05cfec2c51d4843178210358518a6ab8-freud.jpg

I recently had a book on popular psychology recommended to me and found it absolutely dire. And today’s paper reports that most of Sweden’s university programs for psychotherapists have been found to be substandard and will be closed down unless they improve dramatically. This has inspired me to write something about late 20th century psychotherapy, a.k.a. humanistic psychology, a movement that has been a background presence for much of my life.
Continue reading