This is a recording and annotated transcript of a presentation given at the 2016 Lancaster Disability Studies Conference. Dr Sarah Carr is Associate Professor of Mental Health Research at Middlesex University London, and Vice-Chair of the National Survivor User Network (NSUN), England. This includes the slides which were shared but also additional knowledge resources to supplement the presentation.

 

Speaker Introduction

That’s me! Well, yeah, one of them could be me. Thank you very much for having me speak to you today. My name is Sarah Carr. Notionally, I’m an Associate Professor of Mental Health Research at Middlesex University, London. I am also active in the The National Survivor Users Network. Just before I start, I’d like to sort of say two things.

 

I’m very conscious that I’m with an audience who are partly sociologists, so I’m going to probably use contested language, some of it to do with sexuality, and some of it that has its historical place and how people self-identified at the time. So when I say “Gay Liberation movement,” that was how it was in the 60s and 70s.

 

 

 

 

Situating the Speaker

I also would like to sort of situate myself, where this comes from. I’m trying to situate myself and my experiences in mental health services. This is a bit of an effort to situate those outside the history of medicine and psychiatry in a more radical history. So my title is “Everything You Make Freak.” I didn’t add the other bit, “Will Infect and Make You Weak,”…

 

 

 

 

… and this is a poster from some 1990s UK queer activists who probably unintentionally formed counter-narratives to a lot of psychiatric stories that were told about us. They used the fear of madness and moral disease as tropes in their radical campaigning. This group of people was active in Manchester and Leeds and was called Homocult. If you Google them and use Google Images, you will find that that’s one of the milder versions of the posters that they put up around those cities in sort of ’92-’93.

 

 

 

 

Radical Campaigning

So they were creating a subversive association with disease and disorder, and they presented queers as a challenge to moral authority and a threat to social control. But this approach wasn’t welcomed by some in the lesbian and gay community who didn’t want to be associated with those considered to be abnormal, deviant, or, in this case, the undead – ‘undead persons’, because they wanted to be seen as normal, clean, tidy, and worthy citizens.

 

And just as a side note, when I put this poster up on campus, some of my fellow members of what was then called GaySoc took it down as fast as I could put it up. There was already a kind of binary going on where some of us didn’t mind being associated with disease, deviancy, and abnormality, while others really didn’t want it at all.

 

 

Interconnections Between Mad and Queer Studies

In their discussion, Helen [Spandler] is going to speak about the interconnections and tensions between Mad and Queer studies. Spandler and Carr highlight the connected issues of what’s considered normal and abnormal in terms of normativity and heteronormativity. Both disciplines focus on the critique of institutions and the construction of normativities, and I think this is what Homocult is playing with in these quite radical campaigns.

 

 

 

 

Historical Context

And critiques of psychiatry and psy-experience are obviously central to Mad Studies but have also surfaced during the history of the Gay Liberation movement, and later what would become queer activism. So does the history of Gay Liberation activism, therefore, intersect with Mad People’s History or Mad Studies? The service user movement, the Survivor Movement and the Gay Liberation movement were kind of developing some parallel discourses and critiques of psychiatry. They may have become slightly different civil rights movements, but did they reach some of the same conclusions about psychiatry?

 

 

Historical Pathologization of Homosexuality

Just to put the framework around this, historically, homosexuality or same-sex attraction, which has historically intersected with gender nonconformity, were indeed conflated in psychiatric practice and seen as mental illnesses in themselves. Same-sex attraction was a mental illness according to the DSM [Diagnostic and Statistical Manual). In this presentation, I’m going to trace some of the historical records and documentation of the Gay Liberation Anti-psychiatry political movement and some of the direct activism that went on in the 60s and 70s, some of which even preceded the Stonewall riots.

 

 

 

 

Arguments Against Pathologization

The Gay Liberation movement in both the US and the UK constructed very reasoned arguments against the pathologization of same-sex attraction and its classification in the Diagnostic and Statistical Manual, which also amounted at times to a broader and more radical critique of the discourses and disciplines of psychiatry. They argued that psychiatry was subjective, political, and about moral control. They also employed disruptive direct action tactics and threats of violent disorder to get what they wanted from the American Psychiatric Association and allied medical organizations.

 

 

Reflection on Protest

I am conscious that Lucy said protest is broken now, so I think it might be quite nice to think about when it wasn’t broken. But my question is really: did they go far enough? Well, I’m going to show you a picture now that kind of demonstrates the psychiatrist’s relationship with homosexuality that is one of the crudest demonstrations of how the discipline determines the normal and abnormal upon which it overlays a sickness and health discourse.  And we’re living with this complex legacy even today.

 

 

Case Study: Ethel at Willard Insane Asylum

Gay, lesbian, and bisexual people were locked up for the safety of themselves and the public, viewed as corrupting and disruptive, and to be segregated wherever possible. So this is a woman who was segregated; her name is Ethel. She was locked up in the Willard Insane Asylum in New York in the 1930s, and this is a note about her and Ethel had been a little bit naughty…

 

 

 

Ethel

 

 

“The patient was transferred from ward one to ward two. She is a manic of rather sarcastic type who is inclined to pout and grumble and find fault.  It was discovered yesterday that she and Miss X, another patient, had been in the habit of getting into bed together, probably at night, but they were found in bed together in the day time and said to be having a jolly time. When discovered by Miss McMahon, charge attendant of the ward, they giggled and chuckled and told her there was a place for her if she would like to get in.”

 

 

Reflection on Historical Treatment

So, it seems to me that she was simply locked up for being a sarcastic lesbian. “There for the grace of God go I”…  So Bayer, in one of the few monographs in the history of psychiatry and homosexuality, observed at this time that those afflicted were in constant danger of becoming insane, which required the protection of the asylum.

 

 

 

 

So people were locked up as a preventative measure, and this reflects Peter Beresford’s later observation about psychiatry in general and what happens to people who are non-conformist. Their processing in the psychiatric system is related not only to them being seen as defective but also frequently as dissident, nonconformist, and different in their values.

 

 

 

 

Fear of Psychiatry in Early LGBTQ Movements

So very early on in the 30s, in what you could argue was an emerging movement or community of lesbian and gay people, there was a very significant fear of psychiatry. The rather curiously named Parry Sex, who was an anonymous author of a 1932 essay called “In Defense of Homosexuality,” wrote, “Now that inverts have almost escaped the stake and the prison, they are threatened with a new danger of the psychiatric torture chamber.”

 

 

 

 

Behavioral Modification Techniques

Here you might not be able to see it very well, but that’s an extract from a catalog of behavior modification and aversion therapy equipment that was known as slide and emetic. You can see there’s a slide machine here, and this woman is drinking an emetic. What’s going to happen is she’s going to be shown some slides of pictures she finds erotically appealing, and immediately after, she’s going to vomit. So there’s a kind of reverse Pavlovian thing going on here. This is what happened in the NHS up until the 70s, so that’s just the reality of people’s experience in the psychiatric system.

 

 

 

Activism Against Pathologization

 

So back to what the activists were trying to do. The first Diagnostic and Statistical Manual of 1952 had homosexuality as a sociopathic personality disturbance. So same-sex attraction is a disease and sickness in and of itself, and homosexuals are inherently sick. This became the focus of a specific campaign in the US gay rights movement.

 

 

 

 

And one of the leaders of that campaign, indeed the leader of one of the movements, a man called Frank Kameny, in 1965, wrote in a lesbian-gay journal for Ladder an essay titled “Does Research into Homosexuality Matter?”. He said, “I feel the entire homophile movement is going to stand or fall upon the question of whether or not homosexuality is a sickness, and upon taking a firm stand against it.”

 

 

 

 

Increased Political Activity

So even pre-Stonewall, this kind of activity and increased politicization and increased militancy was happening, and it happened within a previously quiet conservative US lesbian and gay rights lobby.  And they were strongly influenced by the Black civil rights movement and also by ideas from the anti-psychiatry movement, particularly the idea that psychiatry is not an objective science but is actually a replacement for religious institutions that enforce moral conformity and the so-called experts are biased by conservative social and moral values.

 

 

Opposition to Biological Pathologization

They began with angry opposition to the specific biologization of homosexuality, which at times developed into a broad critique of psychiatry itself as a discredited branch of medicine. In 1965, they said there’s no valid evidence that homosexuality is a sickness, disturbance, or pathology. Frank Kameny, in 1965 as well, was very assertive in saying, “We are right; those who oppose us are morally and factually wrong. We are the true authorities on homosexuality, whether we are accepted as such or not.”

 

 

 

 

Manifesto of the Gay Liberation Front

 

And just popping over the pond in 1971, similar discussions were going on as the Gay Liberation Front was kicking off. This is their 1971 manifesto, and again they focused on, alongside several other social institutions, psychiatry as one of the social institutions that oppresses and silences gay men and women. I think these two extracts from the manifesto speak for themselves and speak to us today:

 

“One way of oppressing people and preventing them from getting too angry about it is to convince them and everyone else that they are sick. There has hence arisen a body of psychiatric theory and therapy to deal with the problems and treatment of homosexuality.

 

The psychiatrist commands such credence and such income, it’s surprising if we remember their hysterical disagreements of theory and practice in their field and the fact that in formulating their opinions, they rarely consult gay people. In fact, so far as it’s possible, they avoid talking to them at all because they know that such confrontation would wreck their theories.”

 

 

 

 

Activist Reflections

 

 

So back to America now, and these are the two leading activists: that’s Frank Kameny, and that’s Barbara Gittings. In reflections upon the activism at the time, Barbara Gittings said in an interview in 1993: “Psychiatrists were one of the three major groups that had their hands on us. They had a kind of control over our fate in the eyes of the public for a very long time. Religion and law were the other two groups that had their hands on us. So besides being sick, we were sinful and criminal, but the sickness label infected everything we said and made it difficult for us to gain any credibility for anything we said for ourselves. The sickness issue was paramount.”

 

 

 

 

Importance of the Sickness Label

So you can see the concern here was something about the psychiatric disqualification that undermined the lesbian and gay civil rights movement at the time, and it was very important to override control of destiny from psychiatry. Okay, I’m going to go on to the exciting bits of direct action.

 

Anyway, they got together with countercultural allies—feminists and people from the anti-war movement—from 1968 to 1972. They disrupted the American Medical Association Convention, the American Psychiatric Association Convention, and the Association for the Advancement of Behavior Therapy, during which they distributed a flyer entitled “Torture Anyone?”.  They later coordinated careful disruptions and interruptions, where protesters shouted over and argued with speakers who were pro-pathologization or promoted aversion techniques.

 

 

Notable Direct Action Examples

One of which was somebody who grabbed a microphone at the American Medical Association in 1968 and said, “We interrupt this program and psychiatric propaganda to bring you a message from Gay Pride.” But by 1971, they’d convinced the American Psychiatric Association to allow gay men and women to speak for themselves on the panel. The panel was called “Lifestyles of the Nonpatient Homosexual,” and I think it’s quite known to be the term “nonpatient homosexual” for later on, but they were still kind of active and threatened to destroy stalls selling aversion therapy and behavioral control equipment, and the companies quickly dismantled those stalls.

 

 

The 1972 American Psychiatric Association Convention

So moving on to the 1972 convention, this is such a scary photo from the history of psychiatry. This is the panel where Gay Liberation activists started to look to gay psychiatrists as allies. That gay psychiatrist’s name is John Fryer, and he appeared on the panel as Dr. Anonymous, a psychiatrist in a mask, because that was the only way he felt he could talk as a gay man who was also a psychiatrist. So they began to talk to psychiatrists, gay psychiatrists. I wonder if this was a turning point in their campaign in several ways.

 

 

 

 

 

 

Presentation of Activist Claims

 

 

This was the stall they showed at the 1972 American Psychiatric Association Convention. They were presenting themselves and their case, and they’re being gay, proud, and healthy. “Gay is good,” was one of their slogans. But there remains a question as to what extent this was understood as being gay, normal, and healthy—meaning that the campaign was falling back into the binary psychiatric trap. In 1973, the American Psychiatric Association committee on the literature finally decided to delete homosexuality as a mental illness from the next copy of the DSM.

 

 

The Shift in Psychiatric Discourse

 

 

So were all gays suddenly cured? only the ones who are normal in psychiatric terms.  So it was okay to be gay, but it wasn’t okay to be gay and mad. Now, if you were gay, you had to opt for normalcy; you needed to be the non

 

…and I know I haven’t got much time, but I’ll read out what the American Psychiatric Association resolution they passed because I find it amusing: “Whereas homosexuality in and of itself implies no impairment in judgment, stability, reliability, or vocational capabilities, therefore be it resolved that the APA deplores all public and private discrimination against…”

 

 

Continued Pathologization of Non-Normative Identities

But they did include another category. Of course they did. So they included this one: “Sexual orientation disturbance for individuals whose sexual interests are primarily towards people of the same sex who are disturbed by, in conflict with, or wish to change their sexual orientation.” So they opted to still have the option to intervene there.

 

 

Current Psychiatric Classifications

What I was going to do—and I have one minute—is to say that although homosexuality is removed as a disorder itself in the ICD-10, there are five F66 sexual orientation and gender identity categories that still allow for the option of the psychiatric characterization of non-gender conforming people and people who are attracted to the same sex.

 

 

 

Concluding Questions

So really, my question is: in order to be normal and healthy as LGBTQ people, must we also be sane? Are we required to be sane? Must we be psychologically normative in order not to be heteronormative? As Jeanette Winterson said in her second part of her biography, “Why be happy when you could be normal?”

 

 

 

 

 

Final Reflection

So my concluding remark—and I’m going to appropriate Jasna’s divorce analogy from this morning—is that I think we need to go further than the Gay Liberation amicable separation from psychiatry to a divorce from psychiatry completely and ask the question: do queers now need mad studies for the sake of their self-acceptance, community well-being, and global rights? Because we are globally continuing to live psychiatrized lives.

 

 

 

 

Questions and Discussion

Okay, I’m going to take questions now. I’m mindful that we sort of drifted at the beginning, so if you could keep your questions as brief as possible, I’d appreciate that.

 

 

Contestations in Current Politics

And I’m going to take a bit of a risk here. This split between Radical Feminists and Queer Theorists historically leads us to today where some of those tensions are still around in the mad movement. For example, is something considered transphobic or is something considered like a radical feminist critique?

 

This idea that just don’t be mean—I think some things are actually… how do we decide what’s diversity of thought and what’s oppressive? That’s a contestation I think… I personally think that. For example, this question this morning about whether anyone can call themselves a prostituted woman if that’s their self-identity, or if the correct term these days is sex worker because it’s oppressive to use the word “prostituted.” To me, that actually goes back to the Rad-Fem-Queer historical split.

I think these are contestations that mean it’s really hard to not do violence. Whatever you do, however you enter this field, somebody is going to be harmed because of the way that they think is invalidated by other people. I also think this idea about ‘just don’t be mean’, it overlooks structural violence because it means that if you’re the one being unkind, what if you’re actually responding, naming or calling out something that is structurally unkind?

 

If I say “fuck off” to someone who’s actually sexually harassing me, but in a really nice way, do you know what I mean? I’m being mean, and that’s how women get rapped for saying “fuck off.” There’s a fine line between critique and violence that I think is really challenging for our field at the moment because I think we’re all about the diversity of thought, but some diversity of thought is oppressive or offensive to other people and yet how do we keep open space for diversity ?

 

 

Response to Question

Yeah, it’s a great question. I mean, that’s deceptively simple because I do think about that phrase, “Do whatever you need to do, just don’t be mean,” and even though I know what you’re saying, and I think we see this particularly in trans politics at the moment for example the trouble that … has got into recently around transphobia.

 

What I think we need to do is to keep the dialogue open about what constitutes meanness within certain contexts because they are all context-based. What is mean in one context isn’t going to be mean in another context. In the context where you’re telling someone who is touching you up to “fuck off,” that isn’t mean. I’ll leave it there.

 

I think that there’s a kind of issue that I struggle with in the classroom, teaching people who go and work with people in the psychiatric system about the need to consider people’s humanity and sexual diversity and diversity of gender expression, who absolutely fundamentally disagree with that because of their religious beliefs.  And that’s a conversation that just isn’t happening in classrooms. That’s just my observation.

As an aside, Ive recently done a piece of research I’ve done recently about teaching people who are trained to go into health and social care in higher education institutes and how easy it is for the people who are teaching them to talk about sexual diversity and to talk about gender diversity.

 

And the things that people come out with in the classroom are just shocking, and the chief teachers don’t know what to do about it because they are kind of stalled by not wanting to offend the people who are being offensive. I have a colleague who’s a gay man who has to absorb quite a lot of what we would understand as verbal violence because it’s his job to teach people and to guide them. He has to go to hell—not directly because sometimes he strategically comes out, sometimes he doesn’t—but he has to absorb a lot of abuse.

 

I mean, that’s an observation from where I am. There’s a lot of silence and tension around, yeah, religion and sexual and gender diversity needs. This discussion needs to happen, at least in the classroom, because you’re teaching people, and people are actually quite dangerous.

 

Inquiry on Madness and Responsibility

So what I think… I mean, this was a question for you: is madness the ultimate most important? But really, do we deal with it in many different ways? I just want to say my view, what I think makes that difference is… I don’t know how to express this, but I feel it takes responsibility away from us. It’s very normal to talk about us, talk about our behavior, etc. I think more than other groups…

 

I don’t know, but this is my feeling. We are more than the others. Denying it is part of the discussion, and we… as people—I mean, I never say we as people—but I think madness invites others to take responsibility for us, and I think that’s very… and that needs to change. We have different senses in this, so maybe it’s not about madness, not about madness as the most threatening difference we have to deal with. Maybe it’s about how it we have been treated, and maybe we need to… I start talking about this. I think we’ve been the most silent…

 

 

Current Global Context

I mean, I totally agree that we… I suppose my talk took too long, and I sort of cut off at the end when I was going to talk about the problems with the ICD-10 and the upcoming ICD-11 and things more globally around gender identity and the psychiatrization of gender nonconformity as well as alternative sexual orientations. I think I see the situation as being within psychiatry. I think in February the Indonesian Psychiatric Association has re-pathologized homosexuality.

So the story is ongoing on a global scale now. Absolutely, I think single issue, as it was then historically, it’s probably not the way to go now because it is so big and it’s globalized…

 

 

Final Thoughts on Diversity and Complexity

[Helen Spandler] I can’t do your question justice, but the question you raised about whether madness is the ultimate difficulty to accommodate… I don’t know, actually. I think that’s my point about limits working at different levels, and we all have our own different limits at a personal level.

 

There are certainly other forms of difference that are probably a lot more tricky to accommodate—people who have sexual attraction to children—and certain things I feel a lot less comfortable around than others. We have to accept also that we’re talking about human diversity. The Mad Movement has historically kind of said, “Okay, we’re only dealing with these sorts of mad people.”

 

Those sorts of mad people are, you know, the criminal justice system and whatever. Unfortunately, we can’t sort of… it’s difficult to make… at the end of the day, we have to talk about human diversity and increasingly non-human diversity too because that’s the other issue here is, you know, we’re only talking here still about human rights and talking about non-human rights as well. That’s a whole other talk.

 

I don’t know. I certainly think some expressions of things that might be considered madness are more difficult to be around than others, and I think that’s a tricky thing to talk about, but I’m not sure it’s the ultimate…probably not…but it depends.

To find more of Sarah Carr’s work please visit:

orcid.org/0000-0002-5301-9456