What’s a healthy interest in sexuality?
In his famous 1963 study Stigma: Notes on the Management of Spoiled Identity, Erving Goffman, the Canadian sociologist, examined “the situation of the individual who is disqualified from full social acceptance”. His observation that “shifts have occurred in the kinds of disgrace that cause concern” has been confirmed by the shifting status of one of the stigmatised identities considered in his study – that of homosexuality.
Despite their long record of pathologising homosexuality, doctors are soon going to be required, under guidelines issued by NHS England, to inquire into and record the sexual orientation of their patients. According to the Manchester-based LGBT Foundation, which has promoted this initiative, this should improve the healthcare of gay people, who are “disproportionately affected” by poor mental health, substance abuse and sexually transmitted infections.
The transformation in the status of homosexuality has, indeed, been dramatic. I recall as a medical student in the Seventies seeing gay men being subjected to behaviour therapy to “cure” their deviant sexuality. Homosexuality was no longer a crime in Britain after 1967, but it was still – until 1974 – regarded by the protocols of US psychiatry as a disease. In the late Eighties, homosexuality was condemned by some prominent authorities as a sin for which Aids was a form of divine retribution.
Over the past 20 years, homosexuality has generally ceased to be regarded as a “disgrace”. Popular TV shows, such as Queer as Folk, Queer Eye for the Straight Guy and Gogglebox, have presented gay lifestyles as not merely socially acceptable but as culturally superior.
Workplace discrimination is illegal, and civil partnerships and gay marriages have become commonplace. No doubt prejudices still exist, but, far from enjoying official approval, these are universally condemned and prosecuted.
Some GPS have protested – rightly, in my view – that monitoring patients’ sexual orientation is intrusive and offensive. I am surprised that there have not been more complaints from activists.
Documentaries commemorating the 50th anniversary of the partial decriminalisation of homosexuality featured excruciating accounts of older gay people who, as adolescents, were marched by their parents into surgeries for various forms of aversion therapy. It is ironic that, whereas the early gay liberation movement campaigned against the medicalisation of homosexuality, its successors seem keen to invite medical surveillance and regulation of the lives of gay people.
Autism in spotlight
One group of patients that might benefit from greater medical intervention is people with autism. Recent studies have confirmed high levels of anxiety and depression and other mental health problems. They have also revealed that suicide is a major contributor to a high death rate and reduced life expectancy.
Research led by Dr Sarah Cassidy at the University of Coventry has found that individuals who have not been diagnosed as autistic, but manifest autistic traits, are more likely to end their lives. Published last week, her study suggests that feelings of depression, of being excluded from society, and of being a burden are contributory factors. Given that many adults who meet diagnostic criteria for autism have not yet been diagnosed, could this help to explain the increased risk of suicide? What can be done to prevent this?
The research charity Autistica has announced a series of mental health research projects on topics such as anorexia, anxiety and depression. Next month, they will launch a campaign calling for improvements to mental health services for autistic people, increased research into autism-specific interventions and therapies and increased recording of data for autistic people.
WHO dunnit
The appointment – and dismissal – of Robert Mugabe, Zimbabwe’s president, as a “goodwill ambassador” for the World Health Organisation has done nothing to improve its tarnished reputation.
Given that Mugabe has presided over the collapse of his country’s health service and pursues his personal medical treatment abroad, his appointment by Dr Tedros Adhanom Ghebreyesus, the recently elected first African WHO director-general, seemed designed to vindicate his election slogan: “Let’s prove the impossible possible”. The rapid withdrawal of Mugabe’s appointment under a storm of criticism means we will never discover how his celebrity status could complement that of WHO goodwill ambassadors, such as Craig David, the British singer and rapper, and Amitabh Bachchan, the Bollywood film star.
In April 2009, Margaret Chan, Tedros’s predecessor, declared that “all of humanity was under threat” from a swine flu pandemic that turned out to be more benign than the familiar seasonal flu. Meanwhile, the WHO has been criticised over its response to ebola in West Africa and cholera in Yemen.
In recent years, it has faced a stream of allegations of bureaucratic incompetence and corruption. The Mugabe episode confirms that it risks acquiring a status similar to that enjoyed by Fifa in relation to world football.