The LGBTQI+ community faces particular issues in relation to institutional discrimination. Within psychoanalytic history and the 100 year history of our Trust LGBTQI+ has seen many changes, from the legalisation of homosexuality to the establishment of gender clinics. The relationship has not always been easy and there is much to learn from our past.
The Tavistock Clinic was founded in 1920 and the Portman in 1933, but often too much importance can be given to the founding of a group, because of the impression that something starts at the moment it comes into existence. There is a dynamic interplay between professional practice on the one hand, and beliefs and social structure on the other. As a medical organisation we came into existence within a certain context and role in society. The Tavistock and Portman may not want to see itself as part of a general normative discipline, but the ‘psy-sciences’ more widely have played their part in policing the boundaries of behaviour.
LGBTQI+ are often bundled together in a way that suggests that they are natural bedfellows, but this has more to do with a common history of social and legal marginalisation than a natural fit. In terms of persecution under the law homosexuality has perhaps the longest history.
In Britain the Buggery Act of 1533 made male homosexuality a capital crime, which it remained until 1861. In spite of this loosening of the law homosexuality still remained illegal for another hundred years, until being partially legalised in the Sexual Offences Act 1967.
During the 19th century, as with the ‘great confinement of the poor’ in France, every social problem in Britain was overshadowed by the Poor Law Amendment Act of 1834, which made institutionalisation the preferred solution not just for poverty, but insanity and breaches of morality. Again, it was not until the middle of the 20th century and the 1959 Mental Health Act that people were no longer allowed to be committed to the asylum for being labelled ‘morally defective’ (a category of ‘mental deficiency’ that was applied to those who engaged in sexual or criminal behaviours that were disapproved of by authorities).
During the 19th century science also turned to the question of sexuality. Early writers such as Richard von Kraft-Ebbing and Henry Havelock Ellis began to classify sexual behaviours and shifted notions of sexuality from being something that you did to something that you are. Similarly, in psychoanalysis, Freud made sexuality a core component of identity. Although in theory Freud’s writing opened up the concept of bisexuality and detached notions of sexuality from the biological/genital, in practice the psy-sciences as applied through disciplinary institutions tended towards viewing same sex attraction as a pathology.
It was within this legal and moral context that the Tavistock and Portman clinics came into being.
During World War 1 Hugh Crichton-Miller was part of the integral school, which included WHR Rivers. Their work with shell-shocked soldiers led them to challenge the notion that all neurosis was produced by sexual factors and develop a working hypothesis for treating trauma. Although this work developed from the compassionate treatment of men ‘broken down, either from the emotional strain associated with trench life or from the… chronic apprehension of danger’ (as Hugh Crichton-Miller put it), there was another side.
The poet Siegfried Sassoon, after being awarded a Military Cross, was said to have thrown it in a river and written a ‘Soldier’s Declaration’ against the war, which was read out in Parliament and published in ‘The Times’. Threats were made to reveal Sassoon’s homosexuality and court martial him and colleagues. He was committed to Craiglockhart under WHR Rivers, in an attempt to silence him. Thus almost from the outset psychology in Britain had a very direct a role in social and political control.
During the period that it was illegal, references to same sex attraction were often by connotation and suggestion. For example, just after the end of World War 1 JR Rees was asked a question on a psychiatric problem about ‘two men in trouble’ by a fellow GP. JR Rees had no idea about psychiatry and sought advice from Hugh Crichton-Miller. This meeting of these two key figures was an important precursor to the founding of the Tavistock Clinic, and although not stated outright that this meeting related to same sex attraction, it seems to be the connotation.
More explicitly, the early relationship between the Tavistock and Portman clinics came about as the result of treating homosexuality. In the early 1930s a handcuffed prisoner serving a sentence for homosexual offences was brought three times a week to the Tavistock Clinic by two uniformed warders. This gradually led to more criminals being seen at the Tavi and in turn led to uncomfortable situations in the waiting room and complaints from the Tavi’s ‘law-abiding’ patients.
So in 1931 JA Hadfield (one of the seven founder members of the Tavistock Clinic) became one of seven founding members of the Institute for the Scientific Treatment of Delinquency, beginning a relationship that led to the founding of the Portman Clinic. JA Hadfield was responsible for coining its initial name, the ‘Psychopathic Clinic’, and he was one of their initial staff. As well as being on their Scientific Committee and Education Committee, he took with him a notable student from the Tavi, Wilfred Bion, who was also a founding member of staff at the Portman.
The Portman developed a long history of working with homosexuals, based on willing co-operation, with treatment focused on acceptance and adjustment and helping the patient come to terms with issues of mental health relating to social marginalisation. Although this was initially in the context of criminality, staff at the Portman soon began to see homosexuality quite differently.
The Portman, with its strong links to the legal and judicial systems, became an important institution in terms of advocating a change in the law. Immediately after World War 2 Edward Glover issued a pamphlet calling for penal reform. Then, in the mid-1950s, the government established the Wolfenden Committee to look into homosexuality and prostitution. The Portman prepared and submitted a report to this committee on the 113 relevant cases they treated over a one-year period. In 1956 both Edward Glover and Denis Carroll, from the Portman, appeared before the Wolfenden Committee to argue that that homosexuality should not be illegal, could not be classified as a disease and that ‘there was no answer to homosexuality save tolerance on the part of the intolerant anti-homosexual groups in society’.
The Wolfenden Report, was published in 1957. It recommended that ‘homosexual behaviour between consenting adults in private should be no longer a criminal offence’, but it took 10 years for the government to implement these recommendations in the Sexual Offences Act 1967.
During the 1980s tensions around psychoanalytic views on homosexuality resulted in Stonewall protesting in the Tavistock Centre car park. Stonewall were protesting because the Institute of Psychoanalysis had invited anti-gay American analyst, Charles Socarides, to lecture there, and Brendan McCarthy, the then Institute of Psychoanalysis president, was a member of staff at 120 Belsize Lane though in the Child Guidance Training Clinic rather than the Tavi.
Towards the end of the 20th century equalities became a much bigger issue for government institutions as a whole. In 1999 the MacPherson Report found strong evidence of institutional racism in the police after the investigation into the killing of Stephen Lawrence. As well as making 67 direct recommendations it initiated a wider change of perspective that led to the Equality Act 2010 which made it against the law to discriminate against anyone because of:
- age
- gender reassignment
- being married or in a civil partnership
- being pregnant or on maternity leave
- disability
- race including colour, nationality, ethnic or national origin
- religion or belief
- sex
- sexual orientation
The Act also included a public sector equality duty, which meant that as part of the NHS, the Tavistock and Portman had to consider all individuals when carrying out our day-to-day work – both delivering services and in relation to our employees.
Although race equality work had begun in the early noughties, Louise Lyon was key in tackling equality in relation to sexual orientation. In 2014 she contacted Stonewall for their advice and help in becoming a Stonewall Health Champion. We were particularly keen to address the historical legacy of same sex attraction being viewed as a pathology within some traditions of psychotherapy. We wanted to find ways to make it clear that this was not the contemporary view and not one we supported.
Stonewall helped us develop an LGBT and Friends staff network. In relation to our patients, we realised that we needed to collect more data on our patient population, to find out whether or not our services were reaching the LGBT population and, if so, whether or not they are helpful.
This work has continued and more recently expanded into our student population, where 81% of applicants identified themselves as heterosexual, which is significantly lower than the 93.2% proportion of the UK population. In carrying out more research into our student population and equalities, it’s emerged that our application forms only list male and female as gender options. This is being rectified for the next academic year.
We are currently collecting data on all aspects of the student journey from recruitment through to award against a number of protected characteristics including sex and sexuality. These will then be analysed to identify good practice and areas for development within Equalities Action Plans.
Louise Lyon, who retired in 2019, commented, ‘We still have a long way to go, but I think that working with Stonewall helped us build solid foundations, and helped us feel confident that while we have much to do, we have made steps forward of which we can feel proud.’