From ‘Glad to be Gay’ to ‘Sad to be Gay’

New NHS guidelines risk re-medicalising homosexuality.

New NHS guidelines will instruct health professionals in England to ask patients aged 16 or over about their sexual orientation. The guidance applies to doctors and nurses, as well as local councils responsible for adult social care. NHS England claims the new instructions are necessary because lesbian, gay, bisexual and transgender (LGBT) people are apparently ‘disproportionately affected’ by health inequalities such as poor mental health, and are at a higher risk of self-harm and suicide.

Many within the LGBT community are in favour of the new guidelines. Paul Martin, chief executive of the Manchester LGBT Foundation (which worked with NHS England on the development of the new initiative), said: ‘If we’re not counted, we don’t count.’ This new monitoring, he argued, was a ‘hugely important step in the right direction’ towards addressing LGBT inequality in health and social care.

No patient will be forced to answer a question about their sexuality under the new rules. Yet some have rightly criticised what is arguably an unnecessary intrusion into people’s private lives. Dr Peter Swinyard from the Family Doctor Association said sexuality was mostly irrelevant to health outcomes or care, as it affects relatively few medical conditions. So why do doctors need to know our sexuality?

The main argument seems to be that gay people, particularly in a homophobic society, are more vulnerable to mental-health problems and therefore need specific attention. But this is a claim we need to question.

First, our society is nowhere near as homophobic as some would make out. No doubt there are still some instances of homophobia in the UK today, and this can negatively affect how people feel about themselves. But this does not compare to the experiences of the previous generation, who not only faced great public opprobrium for their sexuality, but state hostility, too. Today, instances of homophobia are likely to be condemned, not endorsed, by the state, public bodies and the vast majority of the population.

What’s more, earlier generations of gay activists rebelled against the notion that they were mentally ill, and rejected the pathologisation of homosexual desire. In 1972, the veteran gay-rights activist Peter Tatchell – at the time a leading member of the Gay Liberation Front – was physically assaulted and ejected from a talk given by the psychologist Hans Eysenck. Eysenck was promoting electric-shock aversion therapy as a ‘cure’ for homosexuality. This was not an unusual idea at the time – advocacy for such treatment was even promoted in the 1971 edition of the British Journal of Social Work (an indication of the way social work invariably reflects many of society’s prejudices). Adopting the slogan ‘Glad to be Gay’, grassroots campaigners challenged both the discrimination and medicalisation of their sexuality. Such campaigns, alongside changing social norms, influenced the decision by the American Psychiatric Association to remove homosexuality from the 1974 edition of its Diagnostic and Statistical Manual. At a stroke, millions of people were supposedly ‘cured’ of what was hitherto regarded as a mental disorder.

Forcing doctors to ask about their patient’s sexuality is wrong. The reasons behind mental illness are often far more complicated than the fact of someone’s sexuality. But today’s emphasis on mental vulnerability is not only indicative of the changing form of political campaigning, it also risks re-medicalising homosexuality as something that requires monitoring by doctors and social workers – albeit in a more palatable, pro-LGBT form. It is ironic that some within the gay community see this as progressive. Rather than being ‘Glad to be Gay’, the contemporary slogan seems to be ‘Sad to be Gay’.

Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University. His most recent book, Empowerment: A Critique, is published by Routledge. (Buy this book from Amazon (UK).)

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