‘The problem must be simply one of management. One cannot speak of cure’. Attitudes towards homosexual patients at Jordanburn Nerve Hospital in 1930s

Please note that the historic case notes include homophobic and queerphobic views.

In this blog, I will cover the treatment received by a patient who was diagnosed as 'homosexual' at Jordanburn Nerve Hospital (JNH) in the 1930s while also exploring the contemporary views and attitudes held by JNH psychiatrists towards homosexuality.

P/PL7/B/J/001 photo of the exterior of Jordanburn hospital, with nurses on the porch by the beds, c. 1920s.

Homosexuality was included in the World Health Organization’s list of the International Classification of Diseases (ICD-9) in 1977 and wasn’t declassified as a mental health problem until 1990. In Scotland, homosexuality was finally decriminalised almost ten years earlier in 1981. Edinburgh in 1930s was a rather hostile place if you were queer, as William Merrilees 'War on Homosexuality' would suggest (here is an excellent blog post about this disturbing part of Edinburgh's history). 

Jordanburn Nerve Hospital opened in 1929 to treat voluntary patients (also known as ‘informal patients’, voluntary patients give their consent to receiving in-patient treatment at the psychiatric hospital) in the early stages of mental illness. Over the last few weeks, I have read most of the case notes relating to men who were diagnosed as ‘homosexual’ within the JNH admission register (1929 – 1964). I was struck by one man, David (not patient’s real name), who was admitted several times throughout 1930s, suffering from severe depression and suicidal thoughts. The diagnosis column of every one of his admission entries, is populated by the word ‘homosexuality’.

LHB7/38/1 The JNH admissions register (11 Apr 1929–21 Mar 1951), note the word 'homosexuality' under the 'Diagnosis' column - just underneath 'Melancholia' and 'Mental Depression'. 

When David was first admitted, a psychiatrist recorded his impressions of his case and writes about potential ways to ‘cure’ homosexuality.

LHB7/CC1  Case notes detailing the psychiatrist's impression of David's case. The JNH psychiatrist notes that David identified himself with the female sex at an early age. He goes on to theorise that this may be due to an 'endocrine or chromosomal factor'. 

The psychiatrist also mentions that 'several attempts have been made to combat homosexuality by grafting healthy testicular tissue either of man or monkey into the patient with favourable results'. The case notes reference the work of Eugen Steinach (1861 - 1944), an Austrian physiologist who studied the relationship between hormones and sexuality. Steinach also sought to develop a “cure” for homosexuality. During the inter-war period, Stienbach conducted a testicular transplantation on a homosexual man using the testes of a heterosexual man - allegedly “curing” the patient of his homosexual tendencies.  
Image courtesy of the Wellcome Collection. 

The psychiatrist states that: ‘We have no means of telling just how much of his condition is organically and how much is psychologically determined and even though the latter be the more important such an authority as Havelock Ellis states that he knows of no case in which an analysis was successful in changing a homosexual condition into a heterosexual one.’

 Havelock Ellis (1859 – 1939) was a sexologist who wrote the first, serious and comprehensive textbook on homosexuality (which he called ‘sexual inversion’) in 1897. The book sought to present homosexuality not as a vice nor a crime (not even necessarily a disease) but as a natural part of human sexuality with Ellis even advocating for homosexual practices to be made legal.
Image courtesy of the Wellcome Collection.

Within the case notes relating to homosexual patients the idea of ‘constitutional’ or ‘acquired’ homosexuality is often put forward. Below is a transcript where the JNH psychiatrists are discussing another patient, George – to whom they are decidedly more sympathetic. Interestingly, the psychiatrists draw comparisons between David’s case and George’s. 

LHB7/CC1 - extract from case notes. JNH staff discuss the patient George as well as their views on homosexuality. They are supportive of George marrying in the future and seem to believe that his 'anxiety state' is caused by homosexuality. Prof Henderson makes a case that there is a link between constitutional and environmental factors which may then result in homosexuality. To illustrate his point, he states that people who have a 'predisposition to crime' who may also live under poor environmental conditions, can then 'set the train alight' (i.e they may become criminals). 

LHB7/CC1 - extract from case notes. According to Dr Jones, George 'is in such contrast to the usual homosexual. The usual homosexual has nothing approaching an anxiety state about his condition'. According to Prof Henderson, however, homosexual men do have 'a definite feeling of remorse... when they find themselves in awkward situations, when they see themselves getting into the hands of the police, or coming into undue publicity'. 

Prof Henderson describes George as ‘being more an acquired than a constitutional homosexual’. The idea that a man's physical appearance could be evidence as to whether or not he was a constitutional or acquired homosexual is demonstrated through Dr Munro comments on George’s physical appearance:‘the narrow shoulders and broad pelvis - rather the constitutional homosexual type’. Dr McInnes, on the other hand, believes George to be an acquired ‘type’: ‘because it is in the constitutional type that you do get this attitude of superiority’. This perceived ‘superiority’ is recorded within another document in which Dr Jones comments on David’s own feelings regarding his sexuality:

LHB7/CC1 The JNH Psychiatrist records David's attitude towards his sexuality: 'He feels that his attachments have been something out of the ordinary, and one feels that he thinks them better than the more usual heterosexual attachments'. 

Within David’s case notes there is a transcript of a staff meeting which included Professor Henderson and Dr Jones, other JNH staff and the patient himself. After a brief interaction with David, the transcript notes ‘Exit Patient’ and the seven doctors proceed to discuss his case while also sharing their thoughts on the ‘issue’ of homosexuality. 

LHB7/CC1 - extract from case notes. JNH staff discuss the patient David as well as their views on homosexuality. Prof Henderson states that 'there are at the same time people who say "Oh well homosexuality is a thing that is natural to a certain group of people". Should we sanction it and allow it to go on? I feel that it is dangerous problem so far as the State is concerned to accept a point of view such as that, both for the individual and the race'. 

LHB7/CC1 - extract from case notes. Dr Spence states that 'these people are a social menace. But if you are going to put all homosexuals into mental hospitals, you will need a great many more mental hospitals than we have at present!'. Dr Jones comments that David 'doesn't want to get better'. 

LHB7/CC1 - extract from case notes. Dr Denholm Young offers her view on homosexuality stating that: 'I don't see why the man is such a danger - as long as he lives with a homosexual man. It would prevent two women being unhappy, since they are not fitted to marry. They would not harm anybody else, and if this physical relationship gives them relief, and helps them to get on with the work - why not? If the idea that it is a danger to the rest of the community is that it might spread in the community - well, I don't see how it could'. 

Portrait of David K Henderson 

Sir David Henderson, who was the physician superintendent of the Royal Edinburgh Hospital from 1932 – 1954, discusses the approach psychiatrist should have towards homosexuality, namely that they shouldn't sanction it. When asked whether David is the sort of man who would go after homosexual boys, or if he would harm 'normal boys', Henderson replies that he would harm 'normal' boys. He goes on to say that 'a person who preys on others like that should not be altogether at large in the community. One has no idea who will be affected, or how. He is a danger, a man of this active type'. 

Henderson’s feelings towards the ‘condition which serves no biological purpose’ remained consistent throughout his tenure at Jordanburn as can be seen in this section on homosexuality within Henderson and Gillespie’s Textbook of Psychiatry.

Henderson and Gillespies's Textbook on Psychiatry For Students and Practitioners (1962). The section on 'homosexuality' (under the section on bestiality) is found in the chapter on 'sexual anomalies' along with masturbation, Scoptophilia and Exhibitionism, Transvestism and Fetishism. The full textbook is available here: https://edin.ac/3M71tCg

Dr Jones discusses his anxiety around discharging David – he would like to help David using ‘more heroic measures’ and states that ‘to be in a mental hospital for life is worse than unsuccessful castration’.

These more heroic measures involved the Physiologist Dr Bertold Wiesner (1901 – 1972) who at the time was head of Sex Physiology at the University of Edinburgh's Institute of Animal Genetics.

Bertold married the obstetrician Mary Barton and together they managed a Fertility Clinic in London during which time Bertold’s sperm was used to artificially inseminate women - it was alleged that he was the biological father of over 600 children.

It appears that Dr Jones contacted Wiesner due to Wiesner’s work around endocrinology, believing that David’s homosexuality, as well as his identification with the female sex, was due to some kind of hormonal, or endocrine, issue.

When Dr Jones initially contacts Wiesner he described David as ‘a man who, as long as he can remember, has identified himself with the female sex. This man is a passive homosexual who wishes to play the female role in the sexual sphere’. According to Dr Jones, homosexuals who, like David, display ‘physical signs of femininity’, are more difficult to change. Whether the change he refers to is from gay to straight or whether he means change in the sense of an alleviation of mental suffering is unclear but I feel the former is more likely. He does refer to other cases of homosexuality responding fairly satisfactorily to psychotherapy (again, I’m not sure if the positive response to psychotherapy refers to the men feeling better about themselves or if they somehow became straight). Dr Jones goes on to write about the ‘hopelessness’ of the situation stating that he had ‘seriously considered the question of castration. Professor Henderson, however, vetoed the idea’ (in one of the case notes Dr Jones writes that the patient himself considered castration, however, the ‘uncertainty of the psychological effect of such a procedure, the ethical aspect and the physical caused this to be abandoned’). Jones continues: ‘I am convinced that there is more than the psychological factor here, I think I am justified in approaching you as to the possibility of any glandular therapy being beneficial in this case’. The letter indicates the patient was, at this time, ‘intensely miserable’ and ‘prepared to try anything’.

LHB7/CC1 Extracts from case notes: Wiesner agrees that 'castration in a case of this description would be of no objective advantage' and scraps the idea of a 'rational glandular therapy', writing that 'we do not know enough about the factors which direct the sex drive, even though we can state that these factors are of a chemical nature.' Wiesner agrees to carry out some tests stating that 'it is of great value to investigate at least some such cases with the methods usually applied in hormonic analysis'.

LHB7/CC1 - extract from case notes. Dr Jones relays his conversation with Dr Wiesner regarding David's treatment. In it, he mentions 'an extract' which was to be administered to David with the idea of stimulating 'the staticula secretion' and so counteract the female tendency.' 

LHB7/CC1 - extract from case notes. Wiesner's secretary send one bottle of 'gondatropic extract' which was then injected into David in order to 'counteract the female tendency'. 

It would seem that these extracts made no difference to the patient as Dr Jones sends a letter to Wiesner saying that the extract which Wiesner sent was almost finished but that the‘situation remains as difficult as before’.

LHB7/CC1 extract from case note

Wiesner writes back to say that there would be no benefit in continuing the treatment and states that ‘there remains one desperate remedy’ which he asks to discuss with Dr Jones on the phone as it is ‘rather involved’.

LHB7/CC1 extract from case note

What this remedy is can be gauged from a later document written by Jones. 

LHB7/CC1 - extract from case notes.  It would seem that Wiesner did not find any abnormality in the hormone content of David's blood. Wiesner debunks the effectiveness of testicular grafts for 'curing' or 'treating' homosexuality, instead believing that the 'direction of the sexual drive is dependant upon the anterior pituatory hormone'. He also stated that 'a certain control of the sexuality of rats is now possible by the use of anterior pituatory hormone or the surgical removal of the anterior part if the pituatory'. Wiesner also believed that in 'the next year or two it might be possible by the use of anterior pituatory hormone to control the sex drive sufficiently to make such a case socially adaptable'. 

The location of the Pituitary Gland (mispelt 'pituatory' in Dr Jones' case notes).

Wiesner therefore proposes two modes of treatment: the first being deep x-ray therapy of the sella turcica (where the pituitary gland is located). Wiesner admits this method is ‘not very scientific in that we did not understand exactly what might happen’. The second, ‘as advocated by Hirschfeld, no scientific method should be tried at all and the patient should be encouraged to practice overtly his aversion’. 

Wiesner mentions Magnus Hirschfeld (1868 – 1935) who was a German physician and a LGBT rights activist who set up the Institut für Sexualwissenschaft ('Institute of Sexual Research') in Berlin in 1919.

It's worth mentioning that JNH staff would adopt hormonal treatment on homosexuals at JNH later on in 1940s as Roger Davidson wrote in his paper Psychiatry and homosexuality in mid-twentieth-century Edinburgh: the view from Jordanburn Nerve Hospital:

In the late 1940s, Professor Henderson had collaborated with Derrick Melville Dunlop, Professor of Therapeutics at the University of Edinburgh, on research at the Royal Infirmary into the use of hormones in the treatment of homosexuality, following American reports of advances in this field. A group of JNH’s patients ‘who had proved resistant to psychiatric treatment and who were anxious to have their homosexual tendencies reformed’ had been referred to Dunlop. However, the results of the treatment had proved ‘completely negative’, although the therapy was claimed to have induced ‘marked feminine changes physically in practising sodomites.

During David’s first stint at JNH he decides to leave, and his case notes reveal the psychiatrist’s thoughts on his future wellbeing stating that although his ‘agitation’ has subsided ‘the outlook in a case like this is extremely grave’. The perceived gravity, according to the psychiatrist, was due to David’s ‘type’ of homosexuality which prevented him from ever becoming heterosexual. David’s hope for the future ‘lay in his ability to resign himself to such a situation and sublimate his energies’. 

What strikes me about this case is the psychiatrist believing that David will probably never get better because there was no chance he could ever ‘recover’ from his homosexuality. In the mid-1950s David was referred to JNH once more and the psychiatrist who examined him described him as a ‘long-standing homosexual, with features of inversion going well back into childhood’. In his mind, an ‘emotional adjustment seems barely possible in a man of his age with such history. The problem must be simply one of management. One cannot speak of cure.’ 

LHB7/CC1 extract from case note ater David's first admission. 'Patient left today of his own accord. He was advised to stay longer but this he refused to do'. 

The psychiatrisation of homosexuality is an extremely disturbing and poignant part of queer history. David was just one of the homosexual men who sought professional help for their mental health. It is deeply unsettling to read that, instead of getting the mental health support they much needed, the professionals they turned to would scrutinise and pathologise their sexuality. It is also upsetting to read the psychiatrist’s insistence that if these patients would simply ‘change’ or ‘manage’ their sexuality they could alleviate some of their mental suffering. 

The Lothian Gay and Lesbian Switchboard (the UK’s first gay helpline and Scotland's first gay charity) collection often provides some light and optimism when it comes to queer history and counteracts the disturbing and biased voice within some of our historic institutional records. 

The Lothian Gay and Lesbian Switchboard (LGLS) was a key source of support to LGBT+ people across Scotland and the UK. They campaigned and advised on sexual health, mental health, and equality issues, and worked with the NHS and Scottish Government in health education and social and economic research. LGLS provided a listening service and in-person befriending service to people struggling with issues or difficulties relating to their sexuality. Volunteers were available to listen to callers concerns as well as provide practical information, which included passing on details of gay-friendly organisations, counselling professionals, and sexual health advice.

The helpline was established after the gay rights organisation, the Scottish Minorities Group (SMG, founded in 1969) received a request from the Samaritans, who wanted to refer their clients to a specifically LGBT+ organisation. SMG also conducted an inquiry in their opening year, which looked into the views of people who were likely to be concerned with the gay community (including psychiatrists, social workers and clergy) to find out more about the social needs of homosexuals. The results confirmed that loneliness and isolation was the major problem facing homosexuals in Scotland at that time.

The below document found within the LGLS collection, dated 1978 (30+ years after David’s first admission, and a year after homosexuality was added to WHO’s list of International Classification of Diseases), shows how the Scottish Minorities Group were invited to provide a one-day workshop to staff at the Royal Edinburgh Hospital on Sexual Attitude Reassessment - which included a session on homosexuality. 

GD61/5/2/1 a one-day workshop on Sexual Attitude Reassessment held at the Royal Edinburgh Hospital, 27/05/1978.