Madness, Sexuality and Legacies of Strategic Sanism


In July 2018, the British government issued an LGBT action plan. This came in response to the results of a nationwide survey of LGB and T people which indicated that, among many other things, 5% of LGB respondents had been offered conversion therapy and another 2% had received it. This prompted the government to include the outlawing of conversion therapy in Britain in their 75-point action plan for improving the lives of LGB and T people. There is overwhelming evidence that LGB and T people are at higher risk of experiencing mental distress, developing mental health and addiction problems and of self-harm and suicide than the general population. In Britain we are also likely to experience discrimination within mental health services. Given this situation, why have service user and survivor activists in Britain been relatively quiet about this form of psychiatric oppression in general and this specific campaign to ban conversion therapy?

LGBT organisations and mental health professional groups have been at the forefront of campaigns to outlaw conversion therapy and provide better mental health services for LGB and T people in Britain. In 2014, the Department of Health requested that the UK Council for Psychotherapy, along with a number of other mental health professional bodies, issue a consensus statement on ‘conversion’ or ‘reparative’ therapy. They were clear that it is unethical and wrong to offer “a treatment for which there is no illness.” This position originated from the mental health establishment and LGBT activists. So is there question about survivor activism on LGB and T mental health and treatment? To date there has been little engagement between the survivor and LGBT movements despite a shared interest in critiquing and resisting the normalization project of the psy disciplines — that is, psychiatry and psychology’s clinical categorization of what is ‘normal’ and ‘abnormal’ or ‘healthy’ and ‘sick’. A common and intersectional position is yet to be developed between the two movements and their organisations.

Why might this be? Myself and Helen Spandler have been conducting an archive study about the treatment of female homosexuality in UK mental health services from the 1950s. This builds on our previous work in this area and we hope it will make a contribution to the intersecting histories of LGBT and Mad oppression. Our research has prompted us to wonder, along with US historian Regina Kunzel, if the present situation may have been influenced by the tactics of 1960’s and 70’s lesbian and gay activists in their campaigns to declassify homosexuality as mental illness.

Campaigns to depathologise homosexuality involved, as Kunzel says, “efforts to distance homosexuality from the stigma of mental illness.” For example, during the 1960’s and 70’s lesbian and gay rights activists who campaigned for declassification presented themselves as ‘Gay, Proud and Healthy’, essentially arguing that ‘gay is normal and healthy’ as opposed to ‘gay is abnormal and sick’.  Whilst this strategy may be an understandable reaction to pathologisation, despite their best intentions, were these activists falling into a psychiatric binary trap in their campaigning arguments about who should be classified as ‘sick’ or as ‘well’? In 1965, leading American Gay Liberation campaigner Franklin Kameny wrote of this tension in the lesbian magazine The Ladder, saying:

If we allow the label of sickness to stand, then we will have TWO battles to fight — that to combat prejudice against homosexuals per se, and that to combat prejudice against the mentally ill — we will be pariahs and outcasts twice over. One such battle is quite enough.”

Similarly, in Britain, to avoid psychiatric disqualification and advance political credibility, activists such as Jackie Forster from the Minorities Research Group also promoted homosexuals as mentally normal when she wrote, “we are not sick . . . our sexual orientation does not impel us to behave in such a way to injure or distress others.” Despite the momentously important outcome of this campaigning — the declassification of homosexuality as a mental illness — this tactic implied that people with mental health problems are abnormal or dangerous and that LGB people who experience mental distress should be strategically marginalised for the greater cause.

At the 1971 American Psychiatric Association convention, Kameny and other US gay liberation activists who were seeking to remove homosexuality as a mental illness from the Diagnostic and Statistical Manual (DSM) forced the organisers to let gay men and women speak for themselves on a panel called, ‘Lifestyles of the Non-Patient Homosexual’. Here, it is important to highlight the conceptualisation of the ‘non-patient’ homosexual. At the time much of the research on homosexuality was done on ‘patient populations’, which was seen as making gay people seem more ‘sick’, but in defining the ‘non-patient homosexual’ had gay liberation activists constructed a ‘sanist’ entity in their bargaining? Was the performance of psychological normalcy a condition of the liberation of LGB people from psychiatry?

Kunzel believes that one of the key problems lies with the campaigners’ use of a “single axis of oppression relying on the spoiled health of others” where “health is not just a desired state or self-evident good, but an ideology that mobilises a set of norms, prescriptions and hierarchies of worth.” Cat Fitzpatrick and Jijian Voronka writing on contemporary campaigns to depathologise trans identities and lives have urged trans activists to be careful not to “imitate gay activists in throwing mad people under the bus in the interests of respectability.” To paraphrase the lesbian feminist writer Adrienne Rich who wrote about the oppressive power of ‘compulsory heterosexuality’, do LGB people and communities also experience the oppressive power of ‘compulsory sanity’?

Given this legacy and context, it seems necessary to ask about the relationship of UK survivor movement’s to LGB survivor history and to the contemporary social and political struggles of LGB and T communities with psychiatry, therapy and mental health. The UK survivor movement has not had a prominent role in campaigning against the contemporary religious revival of therapeutic treatment for homosexuality, or in criticizing the homophobic treatment of LGB people in mental health services. There still isn’t an adequate critique of the oppressive power of heteronormativity as it relates to the ‘psy’ disciplines (as well as in society itself) from within the movement. Those who identify as lesbian, gay, bi or queer and mad inhabit an intersectional space between the two movements, and can be marginalised in both. However, we may now be entering into a new era of queer survivor activism and politics in Britain. There are an emerging number of survivor activists, many of them younger women, many of whom identify as queer and feminist, who are challenging the ‘borderline personality disorder’ and ‘emotionally unstable personality disorder’ labels. Activists are calling the labels misogynist ‘character slurs’. If you are non-heterosexual you may well be at higher risk of being given these labels. One of the diagnostic criteria is having ‘unstable’ self-image or sense of self, interpreted by some clinicians as being indicated by sexual orientation and gender identity. New and important questions about the psy establishment’s definitions of ‘normal and abnormal’ and ‘sick and well’ are being asked.

In 1965, Kameny said that gay liberation campaigners “must argue from a positive position of health.” There are now highly compelling reasons for collaborations to argue from a critical position on health, as conceptions of health rely on clinically, socially and culturally constructed normativities that continue to oppress and exclude. Regina Kunzel reminds us that “Disability and Mad Studies help us understand health not simply as an assertion of pride over stigma, but also as a project of normativity and exclusion.” Helen Spandler and Meg-John Barker have discussed some of the complexities and commonalities between the two radical disciplines of Queer and Mad Studies to explore potential shared visions between the two. Importantly, they explain that “both Queer and Mad Studies critique dominant and culturally-accepted ways of being ‘normal’ . . . they question dominant understandings and constructions of what it means to be psychologically or sexually normal . . . they both share the idea that ‘normativities’ are kept in place through binary oppositions, where one side is privileged over the other.” Given the contemporary and intersectional struggles that exist for LGBT people who experience mental distress or receive a diagnostic label, the survivor movement and LGBT communities in Britain can stand in open solidarity to construct and argue from critical positions on health to challenge the power of psychiatrists and psychologists in determining ‘normality’ and ‘sanity’.

With thanks to Helen Spandler, Professor in Mental Health, University of Central Lancashire, UK.


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  1. Having gone through the mh system in San Francisco, at least this wasn’t an issue. The shrink I was seeing at the time, several of the therapists in “day treatment,” my voc rehab counselor and boss, and the senior staff attorney with whom I worked in legal mediation, were all gay, as were about 50% of the people around me, in all tiers of the system and in general. In SF, that’s the norm.

    Same Earth, different worlds.

    God I wish people would wake up. This labeling-mania is obviously based on fear, ignorance, and hate. That is what is bad for the world and its inhabitants.

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    • “This labeling-mania is obviously based on fear, ignorance, and hate” on the part of the “mental health” workers, who have odd delusions that “all distress is caused by chemical imbalances” in peoples’ brains. I presume that’s what you mean, Alex? If so, I agree.

      Sarah, I do agree, “the ‘borderline personality disorder’ and ‘emotionally unstable personality disorder’ labels … are … misogynist ‘character slurs’.” As is “histrionic personality disorder.” And today, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002).” It would be misogynists (although that does include both the male and the female “mental health” workers) who want to cover up child abuse and rape on a massive societal scale.

      Although, “Within individuals diagnosed with psychotic or affective disorders, [childhood trauma] reaches 82% (Larsson et al., 2012).” So those stigmatizations (“depression,” “anxiety,” “bipolar,” and “schizophrenia”) would also be primarily child abuse and rape covering up ‘character slurs.’

      Primarily men created the psychiatric system to be a child abuse covering up system, likely because it is primarily men who rape women and children. And the DSM is a child abuse and rape covering up system, by design. Our “mental health” workers can NEVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, unless they first misdiagnose them with the “invalid,” but billable, DSM disorders.

      I think all people should work together to end psychiatry’s current reign of error and terror, as well as their modern day psychiatric holocaust of innocents.

      The DSM deluded psychiatrists, and their DSM deluded “mental health” minion, are repeating the worst of history. Make it end.

      “We can’t solve problems by using the same kind of thinking we used when we created them.” And since the “mental health” workers won’t throw away their “BS” DSM “bibles,” obviously they are unable to change their way of thinking, so they’ll never solve the problems they created.

      Which include our society’s pedophilia and child sex trafficking run amok problems. Because covering up child abuse on a massive societal scale also functions as a way of aiding, abetting, and empowering the child molesters and traffickers. Which, by the way, is illegal.

      We are dealing with “the psychiatric destruction of America,” the unmentioned war within.

      The “power of psychiatrists and psychologists in determining ‘normality’ and ‘sanity’” needs to be taken away. The psychiatrists are insanely delusional people, who believe the only way to help a healing child abuse survivor, four years after the abuse, is to neurotoxic poison him. It’s the psychiatrists and psychologists who are insane.

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      • “’This labeling-mania is obviously based on fear, ignorance, and hate’ on the part of the “mental health” workers, who have odd delusions that “all distress is caused by chemical imbalances” in peoples’ brains. I presume that’s what you mean, Alex?”

        That is part of it, SE. Of course “chemical imbalance” is a completely false narrative which has led to mass delusion based on ignorance of humanity and how people function. Add to that the self-delusion that they think–insist, in fact–that they DO understand how things work, and you’ve got a dangerous delusion happening.

        I do think that ignorance breeds fear and arrogance breeds resistance to truth. Put it all together, and you have a group of professionals and an entire industry marginalizing their clients–who tend to speak their heart’s truth, that’s why they are there–which then turns into a negative projection because the clinician has failed to see that the client is a mirror of themselves. We are, after all, all connected.

        However, these labels create the illusion of “us and them,” meaning that we are not connected, but totally separate. That, in and of itself, is a huge mass delusion, and indeed, the “mental health” industry aggressively and blindly perpetuates it, it is their mainstay. Not only for financial gain, which of course is relevant, but also for their very fragile and needy (it always seems) egos.

        Clinicians LOVE to be worshipped, and if they are not, they’ll mask their self-hate by labeling the client (for starters, it can go much deeper and become seriously insidious gaslighting abuse). That’s how I’ve seen it for years, from grad school to going up and down the system. Many of my colleagues in training were some of the most aggressive marginalizers and truly bigoted, snobby, elitist people I’d ever met, all justified by labeling others. Keeps hard truth away from oneself, to fall unjustly and perilously on the unsuspecting. In this industry, that is criminal. There is fraud and malpractice all over this, widespread and systemically.

        I think it applies in general, however, that people tend to project pejorative labels on other people to keep themselves from identifying with their own shadow. “Mental health” inc. legitimizes this, as does academia, as does politics. These mainstream entities actually *set* the example for hate, fear, and division. I believe it is why we have so much suffering, all due to believing these liars and all of the false social narratives that have permeated our culture, and which are so harmful to so many, and to the greater good in general. These have led us down a treacherous path, all based on aggressively projected illusions which serve to divide, separate, and create fear. The truth shall set us free.

        It’s a mind trick, to project one’s shadow, and clients pay for it, obviously. My way of dealing with it was to throw it back to them and let them feel it and deal with that crappy, thick, dense energy. It wasn’t mine to begin with.

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  2. On my 1980 Mental Health Formulation of Schizophrenia (from my notes at Galway University Hospital Ireland).

    “Preoccupation with Homosexuality” was entered as a symptom of Schizophrenia. (….the doctor asked about little else).

    “Delusional perception” was recorded as another symptom (…the doctor had recorded me as living in the UK in the previous 6 months, whereas I had been living in Holland..)

    “Auditory Hallucinations” was recorded as another symptom (…I had been referring to “normal social thought inside of my head…”).

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  3. In 1843, Karl Marx was already describing this subdivision of civil society into myriads of small spheres that are fighting each other, and the way this elevates the rulers:

    “It is a case of describing the dull reciprocal pressure of all social spheres one on another, a general inactive ill-humor, a limitedness which recognizes itself as much as it mistakes itself, within the frame of government system which, living on the preservation of all wretchedness, is itself nothing but wretchedness in office.

    What a sight! This infinitely proceeding division of society into the most manifold races opposed to one another by petty antipathies, uneasy consciences, and brutal mediocrity, and which, precisely because of their reciprocal ambiguous and distrustful attitude, are all, without exception although with various formalities, treated by their rulers as conceded existences. And they must recognize and acknowledge as a concession of heaven the very fact that they are mastered, ruled, possessed! And, on the other side, are the rulers themselves, whose greatness is in inverse proportion to their number!”

    Below, he asks the question:

    “Where, then, is the positive possibility of a German emancipation?

    Answer: In the formulation of a class with radical chains, a class of civil society which is not a class of civil society, an estate which is the dissolution of all estates, a sphere which has a universal character by its universal suffering and claims no particular right because no particular wrong, but wrong generally, is perpetuated against it; which can invoke no historical, but only human, title; which does not stand in any one-sided antithesis to the consequences but in all-round antithesis to the premises of German statehood; a sphere, finally, which cannot emancipate itself without emancipating itself from all other spheres of society and thereby emancipating all other spheres of society, which, in a word, is the complete loss of man and hence can win itself only through the complete re-winning of man. This dissolution of society as a particular estate is the proletariat.”

    It does not matter whether you are homosexual, transsexual or otherwise. What matters is that you belong to the lowest class of society, because then you have no sphere below you that you could crush to raise yourself.

    Since a sphere has another sphere below it to hit it, it can not be revolutionary.

    It is not as blacks, homosexuals, transsexuals or anyone else, a revolution is possible, but only as human being, by people below all, who have no one to oppress.

    A Contribution to the Critique of Hegel’s Philosophy of Right, Introduction

    We find a similar design in Shakespeare’s Merchant of Venice:

    “Hath not a Jew eyes? Hath not a Jew hands, organs, dimensions, senses, affections, passions; fed with the same food, hurt with the same weapons, subject to the same diseases, heal’d by the same means, warm’d and cool’d by the same winter and summer as a Christian is? If you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? And if you wrong us, shall we not revenge? If we are like you in the rest, we will resemble you in that.”

    — Act III, scene I

    Although oppressed as a Jew, it is as a human being that Shylock claims his rights and deeds.

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    • Point taken.

      I think what you are tackling here is the difference between self-determination and identity politics. With most of the categories you describe the bottom line is capitalism (though racism and sexism also constitute basic systems of oppression in and of themselves). Capitalism affects each oppressed sub-group differently, so it is not inconsistent for each group to have its own take — as long as it is recognized that the Mother of All Oppression is the capitalist behemoth that sets the preconditions for all our lives, and that individual cultural differences pale in the face of this.

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    • *transgender

      Most trans people are not transsexual.

      The author did not say that LGBT+ and queer people are in conflict with psychiatric survivors. She said that there is surprisingly little overlap between the activist communities, despite significant numbers of LGBT+ and queer people experiencing abuse and trauma, and thus, psychological distress.

      I’m not quite clear how your comment relates to the topic the author has written about. There is no conflict between these communities. Only a lack of communication, when better communication could help all LGBT+ and queer survivors and all psychiatric survivors.

      As a trans and queer person, I very much agree with what the author has said. There is not enough communication and interaction between anti-psychiatry activists, survivors and LGBT+ & queer people in Canada either.

      As a trans, queer abuse survivor, I hope this will change. I see evidence in my online and offline communities that there is movement towards more open communication between these groups happening already. I find that extremely heartening. I look forward to seeing these activist groups working increasingly in tandem, hopefully in the near future.

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      • There is no conflict between these communities.

        Which communities? The author was pointing out that all sorts of cultural offshoot groups are nonetheless affected primarily by capitalism, even when there are subordinate conflicts within those groups. Are you denying such conflicts?

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        • Oldhead, I was responding to Sylvain’s assertion that there is conflict between the LGBT+ and queer communities and psychiatric survivor communities. Rather, there is a great degree of overlap. I suspect Sylvain misread or misunderstood part of the original article in stating that.

          Quite frankly, there is more conflict between the self-identified queer community and LGBT+ people who object to reclaiming that slur than there is between LGBT+ or queer people and non-LGBT+ or -queer psychiatric survivors.

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    • I feel I must also point out that, moving as many people find Shylock’s speech, his character is ultimately an anti-Semitic trope, written by a goyische man in a time period during which Jews were still often believed to be witches, were blamed for poisoning wells to start plagues, etc.

      As a Jewish person, I hope you can appreciate my skepticism that Shylock’s monologue is a good example of a marginalized person demanding his personhood be recognized. After all, he isn’t a real Jewish man. He is a goyische man’s idea how what a Jewish man might be like, and from the 1500s on top of that.

      I assure you that a great many Jewish people have written much more truthfully and realistically about their experiences of systemic oppression. If you wish to use Jewish people to exemplify your point, please choose a real Jewish person’s words, rather than those of a fictional character written by someone who was not a Jew. Thanks.

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  4. Thank you for explaining so well this tragic distancing of LGBT activists from the stigma of “mental illness.” That activists are loathe to being perceived as “pariahs twice over” can also explain the strategic marginalisation of people with real or perceived psychosocial impairments by some in the disability community “for the greater cause.” In the long run, this distancing will harm all parties who, especially as oppressed people, are particularly vulnerable to being arbitrarily assigned stigmatising, dignity crunching and often life threatening psy labels.

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    • As someone who is trans, queer and mentally ill, I have personally experienced some of that harm from the larger queer and trans communities, as have a number of people I know who share those intersections of oppression. You’re so right—everyone loses when survivors are stigmatized, silenced and ignored. I deeply hope this will begin to change in the near future.

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  5. Hi Sarah,

    Awesome job. Upon reading this I listened to Green Day song called Holiday.

    Somebody I know got me onto that song. That’s a really great song Sarah. I get feeling well and talk sing it and laugh…sigh, deep sigh, don’t feel want to sniffle.

    Then a moment about the journey of persistence with this shall I say legacy.

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    • One of my favourite songs! And quite relevant, I agree.

      “Restless Heart Syndrome” also comes to mind. If you haven’t heard it you might like it too. It’s from their “21st Century Breakdown” album.

      You have good taste in music!

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