Prejudice

Dear Sir

Dr Denman (‘Prejudice and Homosexuality’, BJP Vol 9 No 3) takes me to task, amongst other things, for being prejudiced. Many of her points are well argued. With the benefit of hindsight I wish now I had written that ‘some’ rather than ‘many of those who had acquired the virus…’ etc. Over-generalization is one of the besetting sins of the clinicians attempting to write about their work. The talk on which the article was based was first given in 1989. My current views on psychoanalytic psychotherapy in the treatment of people with borderline or narcissistic personality disorders affected by HIV were presented at the 1993 Berlin World AIDS Conference (Ratigan 1993a).

As an out gay psychoanalytic psychotherapist running an HIV service in a department of genito-urinary medicine, I see patients either for consultation or treatment, who all have major mental health problems, most of which predate their testing positive and usually have their roots in infancy or childhood, otherwise they would be seeing a counsellor or health adviser. By far the majority of the HIV patients I treat are gay men, reflecting the epidemiology of the condition in England and Wales. Many have chosen or asked to see or been referred by consultant physicians to another gay man for therapy. I do also see numbers of heterosexual men and women only a minority of whom are drug users. I am unaware of clear psychopathologies that can be attributed to patient category. What I do think though is that we all seek in sexual union, amongst other things, the resolution or repetition of the early infant/mother relationship. This puts us all at risk as the virus is no respecter of so called ‘risk categories’ and especially those who have the most vulnerable psychic cores. Reading Dr Denman I began to wonder if I had been imagining the severity of the disturbances of the patients I see in my HIV clinic.

I do not think we serve our patients, profession or truth by pretending that, for whatever reason, there