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What is the real message in these two articles its world picture? Combining the Abstract with the main body of the work, the first article concerned reflections on the experience of 29 patients in respect of the circumstances, over 50 years or more, relating to the referral pathway for change of sexual orientation, the process of treatment and its aftermath. We need to know whether all psychiatry and the patients spoke in those terms.

At the time all the professionals were asked for their opinions and for care and there is no reason to suppose that they were not in good faith - to whom did they say, in those terms, that that was what they were going to do? Throughout the paper the authors have been unable to exclude all references to psychological symptomatology and patienthood. They are unable to avoid describing the distress patients felt by their attraction to their own sex.

Many complained they lacked parental affection, and they complained of anxiety. There is then an over sympathetic, and undoubted, trivialisation in the detail provided by the authors from patients, often accompanied by a sense of indignant exasperation that this or that matter should even have been contemplated - and just that suspicion of homosexual entertainment constantly resurfaces. Some, when they confided in others, said they were usually met by silence, condemnation and rejection; but what did one expect the ordinary world to feel about the symptoms of an alternative sexuality and its effect on his life and others?

The authors say isolation drove several as young adolescents to take relief in experimentation with adults, so paedophilia was a major risk. That is clearly still the case today. It is instructive that the patients themselves willingly even desperately subjected themselves to all sorts of treatments and were prepared to pay for them.

They expected to gain. Some underwent electric shock treatment for up to two years. Some treatments reflect a range of inspired psychiatric imagination as one might expect in areas of professional ignorance when the patient asked for help. A series of selected anecdotes is provided but seems centred on adverse and prejudicially risible outcomes on being sent for treatment. In one case the doctor sexually abused him; in another, the patient states that doctors physically assaulted him; and another that his name was given to his family sic ; and that the brother of a third had died from the side effects of his treatment; another that, although very much in love with his wife, he had wasted her life; and another that he had no gay friends who had feelings of a lack of self worth, which would seem to the ordinary practitioner constantly in the back and front of the minds of all such patients.

For many it failed because it increased the sense or emotion of isolation and shame. Treatment, it will be agreed, was and is difficult, no doubt because the patients take pleasure in the existence of the condition and prefer to deny its existence as an aberrant entity - not the rarest of patient responses in the wide fields of psychiatric aspiration and failure. One may argue that there are negative consequences of defining any psychiatric syndrome as an illness.

The patients may well rightly think there is no treatment. In the conclusions there is no consideration of the pathology. The frank statement that same sex attraction or as it might have been described in the past, localised disorder of mental balance and consequent disorder of reproductive physiology is not sufficient to merit the definition term illness in its ordinary form is misconceived and subtly pusillanimous, and certainly not made out.

And if this view is supported, it shows the social and political pressures which may cause clinicians to abrogate the duty of care and leave the condition sanitised as the patient wants. What it also does show is the lack of understanding of the condition, particularly as an illness, and the appropriate practice. The second article suffers from much the same range of criticisms when it discusses the experience of the professionals who treated homosexuals in Britain since the s.

Even from the story which the authors lay out in the body of this article, this is artless and biased2. We learn too that social context influences sexual behaviour, and that this had not been previously appreciated by professionals. Unfortunately there is the case that this had been appreciated only too well over generations. In the main body of work the authors caricature the NHS effort and the various failings of the professionals in their careers, for example lacking awareness and being inexperienced.

I find it impossible to believe in spite of all the failures that physicians across the country pursued their craft as quacks, unconcerned about the outcome or the purpose of what they were doing, or that they had no personal or unit guideline, whether written or unwritten, to refer to, and that everything was done in bad faith and shame. Immediately after comments by some that they felt guilty about their treatments, which they thought were a form of punishment, even shameful, we learn, and the authors learnt, that an unquantified small minority maintained that same sex attraction is an illness and is associated with psychopathology, and another unquantified few voiced concern that treatment would nowadays be denied, because in one case he saw homosexuals who were very uncomfortable with the whole gay scene.