India’s apex professional body of psychiatrists, the Indian Psychiatric Society (IPS), has once again registered its support for decriminalisation of homosexuality. The press statement, dated July 2, 2018, is timed in support of the Supreme Court hearings challenging the constitutionality of Section 377, scheduled to begin on July 10, 2018.

In January 2014, shortly after the Supreme Court’ in Koushal (11/12/13) reversed Delhi High Court’s Naz Foundation verdict of 2009, the IPS made its first statement (Rao and Jacob, 2014) supporting decriminalisation in an editorial of its official journal, the Indian Journal of Psychiatry. In a stinging critique of the Koushal verdict, editors Dr. T. S. Sathyanarayana Rao (JSS Medical College, Mysore) and Dr. K.S. Jacob (Christian Medical College, Vellore) wrote:

“The judgment goes against the grain of the Supreme Court’s own jurisprudence on advancement of fundamental rights and freedoms of all people, especially those who face marginalization in society… There is a need to seek an interim stay on the operation of the judgment, as the judgment has caused immense prejudice to all adult persons who engage in consensual sex. This is particularly true for those from the Lesbian, Gay, Bisexual and Transgender (LGBT) community who had become open about their sexual identity since the High Court judgment and are now at risk of prosecution under criminal law.”

They concluded:

“It is also time for social groups and professional associations to clearly state their positions and demand a review of the flawed verdict. The Indian government and its Parliament now have an opportunity to leave a lasting legacy of progress and should act immediately to seek a repeal of Section 377. The 19th century law has no place in a 21st century democracy.” – Rao and Jacob 2014.

In 2016, Rao et al. (2016)  called out the mental health establishment for their weak response to the Koushal verdict:

“…India’s Supreme Court issued a ruling against human rights by reinstating the law that bans gay sex in 2013. The response from mental health and legal establishment to this manifest bigotry was weak. The hesitancy of the establishment to clearly support LGBT rights exposes their subscription to prevailing societal prejudices.” 

They went on to repeat their call for decriminalization:

“Medical and legal fraternities should support the need to decriminalize same–sex orientation and behavior and to recognize LGBT rights to include human, civil, and political rights. The recognition of people’s humanity also advocates the legal recognition of same-sex relationships, anti-bullying legislation, anti-discrimination laws in employment and housing, immigration equality, law for an equal age of consent and laws against hate crimes, thus providing enhanced criminal penalties for prejudice-motivated behavior and violence against LGBT people”. – Rao et al. 2016.

The July 2, 2018 statement by IPS, issued in anticipation of the Supreme Court hearings scheduled to commence July 10, 2018, are a welcome and timely iteration of its official stance.

Besides the matter of decriminalization, the matter of conversion therapy (attempts to change sexual orientation and gender identity) by psychiatrists and other medical/mental-health professionals in India requires urgent attention. The IPS itself has published articles on “treatment” of homosexuality in its journal (e.g. Sakthivel et al. 1979, Pradhan et al. 1982), through electro-shock therapy and other means. It was not until 2012 that the practice of conversion therapy was questioned (Jacob and Rao 2012, Kalra 2012 ):

“There is no evidence for the effectiveness of sexual conversion therapies.[2,3] Such treatments also raise ethical questions. In fact, there is evidence that such attempts may cause more harm than good, including inducing depression and sexual dysfunction. However, faith-based groups and counsellors pursue such attempts at conversion using yardsticks, which do not meet scientific standards. Clinicians should keep the dictum “first do no harm” in mind. Physicians should provide medical service with compassion and respect for human dignity for all people irrespective of their sexual orientation.” – Rao and Jacob 2012.

Despite such strong statements against conversion therapy, homophobic and ambivalent attitudes continue to be expressed by psychiatrists who are members of the Indian Psychiatric Society: see Dr. Indira Sharma’s statement [responses here] and the interview of Dr. Raju referenced here.

The constitution of IPS’ LGBT Mental Health Task Force in 2017,  the meetings in Bhubaneswar (2017), Mumbai (2018) and Delhi (2018), and the media statement by current President Dr. Ajit Bhide, are moves in the right direction.

We hope that IPS will continue on its mission to advance inclusion by taking action against mental health professionals who practise conversion therapy for changing sexual orientation or gender identity, and condemn this unethical and unscientific practice with the same certainty with which they have supported decriminalization, regardless of the outcome of the current constitutional challenge to 377.

References

Kalra G. A psychiatrist’s role in “coming out” process: Context and controversies post-377. Indian J Psychiatry 2012;54:69-72. Available online at http://www.indianjpsychiatry.org/temp/IndianJPsychiatry54169-8323335_230713.pdf

Mehta, S. Looking into minds wired differently. Times News Network; Feb 3, 2014. Online at https://timesofindia.indiatimes.com/city/visakhapatnam/Looking-into-minds-wired-differently/articleshow/29788494.cms?referral=PM

Orinam. Open letter to Dr. Raju, General Secretary, Indian Psychiatric Society. Feb 5, 2014. Online at https://new2.orinam.net/drraju-ips/

Orinam. Letter to World Psychiatric Association: Feb 3, 2014. Online at https://new2.orinam.net/letter-world-psychiatric-association-feb-3-2014/.

Pradhan PV, Ayyar KS, Bagadla VN. Homosexuality: Treatment by Behaviour Modification.  Indian J. Psychiatry 1982; 24(1), 80-83 . Available online at http://www.indianjpsychiatry.org/temp/IndianJPsychiatry24180-783487_214548.pdf

Sakthivel LM, Rangaswami K, Jayaraman TN. Treatment of homosexuality by anticipatory avoidance conditioning technique. Indian J Psychiatry 1979;21:146-8. Available online at http://www.indianjpsychiatry.org/temp/IndianJPsychiatry212146-8345459_231054.pdf

Sathyanarayana Rao TS, Jacob KS. Homosexuality and India. Indian J Psychiatry 2012;54:1-3. Available online at http://www.indianjpsychiatry.org/temp/IndianJPsychiatry5411-8150695_223826.pdf

Sathyanarayana Rao TS, Jacob KS. The reversal on Gay Rights in India. Indian J Psychiatry 2014;56:1-2. Available online at http://www.indianjpsychiatry.org/temp/IndianJPsychiatry5611-7294761_201547.pdf

Sathyanarayana Rao TS, Rao GP, Raju M, Saha G, Jagiwala M, Jacob KS. Gay rights, psychiatric fraternity, and India. Indian J Psychiatry 2016;58:241-3. Available online at http://www.indianjpsychiatry.org/temp/IndianJPsychiatry5611-7294761_201547.pdf

Figuring out answers to such questions, living and working in a world that is often unfriendly and sometimes outright discriminatory, can mean a life lived in the shadows. For the Indian LGBTQIA+) community (Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual and other), in addition to the social and familial prejudices, the legal framework is oppressive, leaving little room to find safety and protection. Conflicts between one’s internal reality and the way the world is, can be a source of major distress [1]. We are aware of many instances of suicide and suicide attempts among community members that were prompted by such distress.

While support groups and queer-friendly counsellors do exist in India, particularly in the metros, there is a need for more support including channels of trained peer supporters in the community.

Peer Support may be defined as the help and support that people with lived experience of a minority group are able to give to one another [2]. It may be social, emotional or practical support but importantly this support is mutually offered and reciprocal, allowing peers to benefit from the support whether they are giving or receiving it. It is built on the premise of empathy and personal experience.

Peer support and professional mental health support can complement each other through two-way referrals [3]. Increasingly, LGBTIQA+ community groups are receiving referrals from psychiatrists and counseling psychologists who ask their clients to reach out to such groups to obtain peer support and reduce their sense of isolation.

With the goal of building a strong peer support system in mind, a group of organisations and collectives based in Bangalore and Chennai, including professional counsellors, peer supporters and diversity/inclusion professionals, have taken the following
steps:

1. Initiated 3-4 hour workshops  for LGBTIQA+ community members and allies to orient them on peer counselling principles: The workshops have been conducted in Bangalore (January 7, 2018) and Chennai (February 25, 2018) so far. Participation is capped at 20 per workshop, and is open to those with prior exposure to providing peer support, as well as those who would like to engage in the future. Workshops are multilingual and held in accessible venues. At present they are funded by community donations and a participant fee (sliding scale, including waiver, available).

2. Building a referral network of peer support individuals: A WhatsApp^TM group has been created with all the peer supporters who attend the workshop and agree to be part of the network, to ensure that there is an ongoing effort to reach out to people who could benefit from support. The group also intends to function as a safe space for people to exchange best practices around peer support and build their capability as peer supporters.

Organising entities include InnerSight, Diversity Dialogues, and Orinam. The Chennai workshop was co-organised with Nirangal and focused on the role of peer counselling within the larger crisis support framework. Reading materials created to help build understanding around peer support may be downloaded from https://test.orinam.net/wp-content/uploads/2018/03/Feb25_2018_LGBTIQA- Peer-
CounsellingHandouts.pdf

Note: These community-initiated workshops are not the first of their kind. To our knowledge, previous workshops of this nature have been organised in Chennai (2008, 2009), Kochi (2016) and Imphal (2017). The present set of workshops has been motivated by an increase in individuals seeking support, mobility of individuals especially among southern states – that calls for a referral network of peer counsellors (in addition to those involved in crisis intervention), and several reported instances of suicide and suicide attempts in the past year.

References

[1] Natarajan, Mahesh. 2017. Coming out vs Fitting in: Mental health and the LGBT person in India. White Swan Foundation. Online at
http://www.whiteswanfoundation.org/article/coming-out- vs-fitting- in-mental- health-and-the-lgbt-person-in-india/

[2] Mental Health Foundation. year unknown. Peer Support. Online at https://www.mentalhealth.org.uk/a-to-z/p/peer-support

[3] Pattojoshi, A., BB Pattanayak, and L. Ramakrishnan. 2017. LGBT Mental Health: The Way Forward.The Odisha Journal of Psychiatry 2017 issue: pp. 2-8. Online at http://odishajp.com/wp-content/uploads/2017/12/JOURNAL-BOOK-2ND-EDETION-NOVEMBER-2017-16-Version.pdf

This talk was part of ‘TransForm: Transgender Rights and Law‘ conference, organized by the Centre for Law and Policy Research (CLPR),  on December 14-15, 2016, and held at the Indian Institute for Human Settlements, Bengaluru.

Orinam thanks Gee for consent to share this on Orinam, and CLPR for making this available in the public domain (see TransForm site for links to other talks).

To respond to claims by some African governments that science supports criminalisation of homosexuality, the Academy of Science of South Africa (ASSAF), in collaboration with the Uganda National Academy of Sciences (UNAS), assembled a thirteen-member panel of scholars across multiple disciplines such as paediatrics, epidemiology, HIV medicine, behavioural science, psychology, anthropology, ethics and gender studies to review the current literature in their respective fields of expertise.

The resulting report “Diversity in Sexuality: Implications for Policy in Africa”, published in May 2015, answers most of the arguments used to stall decriminalisation of homosexuality and to pathologise LGBT people as mentally ill or deviant.

It needs to be read by all law-makers and parliamentarians responsible for keeping Section 377 on the books in India. The report is also essential reading for policy makers associated with the Ministry of Health and Family Welfare, Indian Council of Medical Research and Medical Council of India. It consolidates all the evidence needed for these bodies to work together and stop ‘conversion therapy’ by medical professionals, still a rampant practice in the country.

We reproduce below the Executive Summary of the report. The full report may be downloaded from the Academy of Science of South Africa (ASSAF)  website.

EXECUTIVE SUMMARY

Although two-thirds of countries in the world no longer outlaw lesbian, gay, bisexual, transgender and intersex (LGBTI) relationships, same-sex relationships are still illegal in 76 countries. In the recent past, new laws have been passed in Russia, India, Nigeria, Bu-rundi, Cameroon and Uganda and are being contemplated in other countries to further prohibit same-sex relationships or the so-called ‘promotion of homosexuality’. There is evidence that such new laws precipitate negative consequences not just for LGBTI persons and communities, but also for societies as a whole, including the rapid reversal of key public health gains, particularly in terms of HIV and AIDS and other sexual health programmes, increases in levels of social violence, some evidence of reduced economic growth, and the diversion of attention from sexual and other violence against women and children.

Partly because those arguing in favour of criminalising sexual and gender diversity have made explicit appeals to science, this report examines the extent to which science sup- ports any of the arguments that proponents of these new laws make. Drawing on recent scientific evidence and, where possible, on systematic reviews, the report seeks to pro- vide an up-to-date overview of the state of the current biological, socio-psychological, and public health evidence and assess how this supports, or contests, the key arguments made in favour of new laws. This report considers the following questions:

1. What is the evidence that biological factors contribute to sexual and gender diversity? To what degree is the wide diversity of human sexualities explained by biological factors?
2. Do environmental factors such as upbringing and socialisation explain the diversity of human sexuality?
3. Is there any evidence for same-sex orientation being ‘acquired’ through contact with others, i.e. through ‘social contagion’?
4. What evidence is there that any form of therapy or ‘treatment’ can change sexual orientation?
5. What evidence is there that same-sex orientations pose a threat of harm to individuals, communities, or vulnerable populations such as children?
6. What are the public health consequences of criminalising same-sex sexual orientations and attempting to regulate the behaviour/relationships related to some sexualities?
7. What are the most critical unanswered scientific research questions regarding the diversity of human sexualities and sexual orientations in Africa?

Global bodies, such as the World Health Organisation (WHO) declassified homosexuality as an illness or disorder in 1990 and there is now a wide global consensus among scientists that homosexuality is a normal and natural variation of human sexuality without any inherently detrimental health consequences. In this context governments have a duty to consider scientific perspectives and draw on the most current scientific knowledge when creating policy and enacting laws. In terms of sexual orientation, significant and even path-breaking research in a variety of fields has taken place in the recent past. Much of this research is not widely known to policymakers yet, nor is it in the public domain. This report aims to bring the most recent replicated and respected global research to the attention of policymakers.

Examining the biological factors, including genetic, neurohormonal and other factors, the report concludes that contemporary science does not support thinking about sexu- ality in a simple binary opposition of hetero/homosexual and normal/abnormal. Rather, it favours thinking in terms of a range of human variation, very little of which can justifi- ably be termed abnormal. As variation in sexual identities and orientations has always been part of a normal society, there can be no justification for attempts to ‘eliminate’ LGBTI from society. Efforts should rather be focused on countering the belief systems that create hostile and even violent environments for those who are made to feel alienated within societies that privilege male power across political, social and family domains.

The panel concludes that there is substantial biological evidence for the diversity of hu- man sexualities and for sexual orientations in particular. Studies have found significant linkage between male sexual orientation and regions of the X chromosome, though the exact manner in which gene expression impacts on sexual orientation remain to be determined. Familial patterns with regard to same-sex orientation, particularly in men suggest a strong likelihood of biological elements. In addition, although limited in number, some pedigree studies, tracing thousands of female relatives of heterosexual and homo- sexual men, found convincing evidence that female relatives of homosexual men have increased fecundity, i.e., on average, they bear more children compared to female rela- tives of heterosexual men. This may provide a key to the major evolutionary paradox of presumed reduced fecundity because of the relatively high prevalence of same-sex- attracted men in every society.

Although less well studied, there is also considerable evidence for a biological component for same-sex orientation in women and for bisexuality.

Socio-behavioural research demonstrates unequivocally that both heterosexual and ho- mosexual men feel that they have/had no choice in terms of their sexual attraction. The majority of women who experience same-sex attraction also express a lack of a sense of choice in their sexual orientation, although there is evidence for much greater fluidity in sexual orientation among women of all sexual orientations.

The study explores – and finds lacking – evidence to support the contention that the way parents bring up their children, or the relationships formed between children and parents, impact on sexual orientation. While family environment may shape other elements of sexuality and the way sexuality is expressed, and while construction of gender and sexual identities have strong social and cultural components, there is little evidence that orientation is directly correlated to family upbringing.

This report explores but could find no evidence that sexual orientation can be acquired through contact with LGBTI persons. Instead, the panel found substantial evidence that tolerance of same-sex orientation not only benefited LGBTI persons but impacted positively on public health, civil society and long-term economic growth in societies across the spectrum of economic development. ‘Peer pressure’, although a powerful influencer of young people’s behaviour, has not been shown to influence same-sex activity or the development of same-sex sexual or bisexual orientations.

The panel explores a wide variety of sources and studies and could find no evidence link- ing LGB sexual orientation or transgender people with the ‘recruitment’ of young people through childhood sexual abuse. Given the high prevalence of childhood sexual abuse in Africa, the protection of all children should be paramount. As there is no evidence that adult sexual orientation is correlated with abuse in childhood, this false connection should no longer be used to justify the marginalisation of LGBTI persons.

This study finds abundant and robust evidence that more repressive environments in- crease minority stress and impact negatively on LGBTI health. There is overwhelming evidence that this has a direct impact on the general population’s health, particularly in terms of HIV and AIDS, tuberculosis (TB) and other sexually transmitted infections (STI) reduction efforts. There are no known positive impacts on public health because criminalisation cannot stop people from feeling same-sex attractions and expressing same-sex orientations. Such legislation also cannot stop same-sex or bisexually-orientated people from having relationships, sexual and otherwise, with the wider population in any society.

The study explores and could find no evidence that same-sex orientation can be changed through ‘conversion’ or ‘reparative’ therapy. It highlights that 50 years of research have not found same-sex attraction to be inherently pathological or a malady of any kind. Studies have also not been able to show any particular social harm of consensual relationships between adults, nor any negative impact on broader communities. Given the documented dangers of such therapy and its direct conflict with medical ethics, these interventions are contra-indicated. Further, recognising the ineffectiveness of conversion therapy, we recommend the wide dissemination of this information especially to health professionals across Africa and beyond.

The study suggests that African health professionals and their associations should adopt affirmative stances towards LGBTI individuals. Psychosocial interventions and support particularly for adolescents are recommended to facilitate the adjustment of same-sex- orientated persons to the stress, stigma, shame and discrimination they may face and to affirm their choices and orientations.

This report concludes that almost all of the recent scientific research regarding human sexualities needs to be much more widely disseminated and discussed in public, and should indeed be drawn upon by policymakers when contemplating new legislation.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)** published by the American Psychiatric Association and considered the standard classification manual by medical and mental health practitioners all over the world does not classify homosexuality as any form of mental or psychosexual deviation.

Nor does it question forms of orientation or states it as something that needs “curing”. But I’m sure Delhi doctors are far too talented to follow any norm or even a standard classification system that would question their redundant cultural and social belief system – which of course, as it seems, is way above their medical knowledge and scientific grounding.

In a recent sting operation report by Mail Today, when a number of certified medical doctors claiming to cure homosexuality through electroconvulsive therapy, hormone replacement therapy, psychological counseling and many more deceptively formulated modalities, were exposed, it brought to light the hideously substandard quality of medical practitioners in India. And their scary lack of understanding not just of medicine and psychiatry but also of the human race as a whole.

Being a certified medical doctor and a psychotherapist myself, I wonder how in spite of years of training (and mind you, not two or three years, but more than six years – the average amount of time to become a doctor in India), can one still harbour and formulate such unscientific and preposterous theories about homosexuality. This only shows, how unexposed most doctors are, and validates the unscrupulous attitude and extorting tendencies of medical practitioners all over the country.

One Dr Vinod Raina who claims to have cured over 1,000 homosexuals through hormone replacement therapy, demanding Rs. 1.1 lakh per package, perhaps has no idea of the set guidelines under which HRT can be prescribed. The list of indications include post-menopausal women, osteoporotic patients, patients suffering from ovarian failure, or people – be it a heterosexual/homosexual/transsexual – having a physiological deficiency of androgen, testosterone, estrogen or progesterone. Homosexuality is, of course, not one among them, as it is nowhere classified under any hormonal or endocrine disorder. Not to mention the side effects of HRT, which includes cardiovascular disturbances, thromboembolism, and even breast cancer. Yes, males can have breast cancer too.

Then, going one step ahead, when sexologist Dr PK Gupta talks about the existence of “recessive gay gene” in parents that later become active in homosexual children, he doesn’t realise the faux pas he has already made of his great knowledge of genetics. It is to be noted that medical graduates are taught about advanced genetics (including recessive and dominant gene functioning) right in the first year of MBBS. And nowhere in the course of medical history is there genetic or biological evidence to homosexuality, let alone recessive or dominant. Though twin studies on tracing the “gay gene” were conducted for a long period, no substantial proof were ever found. Everything about the gay gene and its propagation is only a hypothesis.

Also, people visiting such quacks and fraudulent practitioners should know that the concept of a sexologist in India is very ambiguous. There are no fixed medical degrees that certify a doctor as a sexologist or a sex therapist in India. Also, the Medical Council of India does not recognise sexologists who do not have a postgraduate degree in Psychosexual Medicine, which in turn is a part of MD Psychiatry coursework.

But that isn’t where the quackery stops. It is without evaluation and inspection people are prescribed anti-psychotic drugs like Oleanz and given electro-convulsive therapies to cure them of their homosexuality. Oleanz (Olanzapine) in psychiatric practice is an anti-psychotic drug prescribed for severe forms of schizophrenia and bipolar affective disorders. Schizophrenia and bipolar, both are classified as organic mental health disorders according to ICD-10 (International Classification of Disease) – a standard system of coding diseases formulated by the World Health Organisation – and homosexuality doesn’t even fall under any organic criteria, which needs a proper, clearly defined physiological change in the brain or any other organ system.

Similarly, the practice of electroconvulsive therapy in India is highly controversial, as its mechanism of action is still not fully known and under set guidelines is used for severe depression, schizophrenia, mania, epilepsy or co-morbid psychiatric ailments only. It is deeply condemned among the medical community in various parts of the world as a violation of human rights.

It is a pity that people in Delhi, in spite of being generally aware than most other parts of the country, still lack basic scientific temperament. It is for this lack of knowledge that they still fall for the false claims made by such dubious doctors. Desperate parents, relatives and sometimes repressed gay men who who’d want to live a so called “normal” life still think that “conversion therapy” is real, whereas in truth there exists no such modality.

Have your say. You can comment here. It is high time people should realise that it is only and only pure quackery.

* This note was originally published as “Doctors who claim they can cure gays need shock therapy” [link] in the Daily O, and has been republished with consent of the editor.

** Nor does International Classification of Diseases (ICD) of the World Health Organization,

Preface: In activism, as in science, results are rarely attributable to a single event or person.  In the case of the Indian Psychiatric Society’s public statement on homosexuality, it is likely that many events and activist efforts resulted in this response: media coverage of homophobic statements by Immediate Past President Dr. Indira Sharma that provoked public outrage, the protests by IPS members and resignation from IPS of psychiatrists in Kolkata in protest against IPS’ not taking a public stance, the dissemination of results from a Samapathik Trust survey carried out at the IPS annual meeting in Pune last month, and ambiguous messages carried in a ToI interview of the General Secretary in Visakhapatnam that elicited further communication to IPS.

Many individuals, LGBT and heterosexual, health professionals and lay persons, have written to the IPS and to the World Psychiatric Association (WPA) seeking public clarification of their stance.

We reproduce below one such letter, written to the President, World Psychiatric Association on Mon, Feb 3, 2014, three days before IPS made a public announcement of their stand. We also present the follow-up responses from WPA and IPS.

We invite other individuals and groups who have made similar interventions to share them for the public record, to enable us archive these moments in the history of LGBT activism in India.

Dr. Indira Sharma’s homophobic comment: A petition from scientists, professionals and other concerned individuals

February 3, 2013

Prof. Dinesh Bhugra
President Elect
World Psychiatric Association

Dear Professor Bhugra,

We write to you as scientists, professionals and concerned individuals who are members and allies of the lesbian-gay-bisexual-transgender communities in India.

We are deeply concerned by the homophobic remarks made by Dr. Indira Sharma, Immediate Past President of the Indian Psychiatric Society and current President (as per IPS website http://www.ips-online.org/) of the SAARC Psychiatric Federation. At a panel discussion on homosexuality and Section 377 that was part of the recently concluded 66th Annual National Conference of IPS held in Pune this January, Dr. Sharma, who is a child psychiatrist, termed homosexuality as unnatural, and followed this up with comments to a leading national daily newspaper stating:

“The manner in which homosexuals have brought the talk of sex to the roads makes people uncomfortable. It’s unnatural. Our society doesn’t talk about sex. Heterosexuals don’t talk about sex. It’s a private matter,”… “There are some who are comfortable, but there are many who are not. The latter should realize they can get help (from psychiatrists). Some of them may even be able to change their orientation,” Sharma said. She added that those comfortable with their orientation should be made aware that their behaviour was causing a lot of uneasiness in society.  – Homosexuality is unnatural, leading psychiatrist says [Iyer, 2014].

Our concerns around her statements at the conference and to the press stem from the following:

 (i) Dr. Sharma’s views – coming from a child psychiatrist –   go against the grain of current scientific and psychiatric opinion, can cause immense harm to potential clients, and will infuse false hope among parents and family members of lesbian, gay and bisexual children that homosexual orientation is responsive to medical intervention. It has been well documented that anxious parents in India drag their children to psychiatrists to “cure” any symptom of gender-nonconformity or homosexual behaviour, and there exist several unscrupulous clinicians who use everything from anti-depressants to electro-shock therapy to try and reduce the clients’ same-sex desire [Chandran, 2013]. We are apprehensive of the potential harm to the mental health LGB youth that is likely to result from her statements.

 (ii) As a spokesperson of the Indian Psychiatric Society, Dr. Sharma’s opinions run counter to the Society’s views as articulated in compelling editorials by Professors Rao and Jacob in the official journal Indian Journal of Psychiatry, in which the authors argue for psychiatrists to understand homosexuality as just another variant of human sexuality, and to desist from attempts to change sexuality [Rao and Jacob, 2012, 2014]

(iii)  As the SAARC Psychiatric Federation, of which Dr. Sharma is reportedly the President, is affiliated with the World Psychiatric Association, we believe her publicly aired professional views do major disservice in misrepresenting psychiatric opinion on the issue, jeopardising WPA’s mission to advance psychiatry and mental health across the world.

(iv) In the current Indian socio-legal context,  our LGBT communities are struggling to sway the obsolent colonial legacy that is our sodomy law in the direction of justice, by battling the Supreme Court verdict on Section 377. Notwithstanding the fact that a team of mental health professionals has filed a review petition urging the Supreme Court to reconsider its decisions, we fear that front-page newspaper pronouncements of the kind made by Dr. Sharma risk fortifying popular prejudice with the appearance of scientific support – which is both false and misleading.

Out of this concern, we wrote a mail to Indian Psychiatric Society and the present President has clarified via email  that Dr. Sharma’s view is her own and the society does not endorse it [Orinam, 2014]. However, we are yet to see a public statement or press release to this effect.

We are thus writing to you in hopes that WPA and SAARC Psychiatric Federation would consider taking a public stand on the ‘naturalness’ of homosexuality and on “curative”/”reparative” therapy, and that such a stand is made available to the public and LGBT communities in India. A letter to the Editor, TOI, or a statement in a professional journal, bulletin or website,  will help a lot.

Thanking you,

Sincerely yours,

Dr. Abhijit Majumder, Early Career Fellow, Institute for Stem Cell Biology and Regenerative Medicine, Bangalore.
Dr. L. Ramakrishnan, Solidarity and Action Against The HIV Infection in India (SAATHII), Chennai
Dr. Mohinish Shukla, Assistant Professor, Dept. of Psychology, UMass
Boston, Boston, USA
Prof. Jyotsna Dhawan, Scientist and Ex-Dean, Institute for Stem Cell
Biology and Regenerative Medicine, Bangalore.
Dr. Rajnish Rao, Postdoctoral Researcher, Bernstein Center for Computational
Neuroscience,Humboldt University of Berlin, Berlin, Germany.
Dr. Ipsita Pal, Fellow, John Hopkins University, USA
Dr. Aditya K. Sengupta, Avesthagen Ltd, India.
Dr. Hari Easwaran, Asst. Professor, Oncology, Johns Hopkins University,
Baltimore, MD, USA
Dr. Venkatesh Acharya, Senior Designer Engineer, Texas Instuments, USA.
Dr. Vineet Gaur, Postdoctoral researcher, International institute of
molecular and cell biology, Warsaw, Poland.
Dr Gurjot Singh, Project Associate, Divecha Centre for Climate Change,
Indian Institute of Science, Bangalore.
Dr. Subhojit Sen, Ramalingaswamy Fellow, Center for Excellence in Basic
Sciences, Mumbai University, Mumbai, Maharashtra, India.
Dr. Rajeeb K Swain, Ramalingaswami Fellow, Institute of Life Sciences, India.
Shishir Thadani, Retired Telecom Consultant, Former Manager Quality
Assurance and Product Support, Siemens Santa Clara, CA
Dr. Nishad Matange, Research Associate, Division of Biological Sciences,
IISc, Bangalore.
Dr. Ramkumar Sambasivan, Scientist, InStem, Bangalore.
Dr Ritwick Sawarkar, Group Leader, ETH-Zurich, Switzerland and Max Planck
Institute of Immunobiology and Epigenetics, Germany.
Deepanjan Saha, City Planner, Delhi Development Authority, Delhi.
Manish Gautam, External Consultant, Indian Institute for Human
Settlements, Bangalore City Campus, Bangalore.
Nabil Khan, Harvard Divinity School, USA.
Kaveri Rajaraman, Center for Neural and Cognitive Sciences, Central
University of Hyderabad
Karthik Rao Cavale, PhD Student, MIT, USA.
Asha Gopinathan, Consultant, GenSci-e-Tech, Trivandrum, India.
Bodhisatwa Chaudhuri, PhD Student, Centre for Neuroscience, IISc
Varun Pattabhiraman, Research Scientist, Amazon.com
Anuj Menon, PhD Student, JNCASR, Bangalore
Pronoy Rai, Teaching Assistant & PhD Student, Department of Geography, and Unit for Criticism and Interpretive Theory, University of Illinois, IL, USA.
Devesh Radhakrishnan, PhD candidate, Department of Chemical and
Biomolecular Engineering, University of Delaware, Newark, DE.
Shinjini Basu, Project Assistant, Centre for High Energy Physics, IISc
Mrinmaya Sachan, PhD Student, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA
Nimisha Agarwal, PhD scholar, National Institute of Advanced Studies,
Bangalore
Vinodh Ilangovan, Graduate Student, Max Planck Institute for Biophysical
Chemistry, Goettingen, Germany.
Shantanu Kumar, software developer, Netherlands.
Srinivas Muktha, R&D Engineer, Bangalore.
Sheeraz Ahmad, PhD student, University of California, San Diego.
Ayan Roychowdhury, PhD Student, Mechanical Engineering Department, IIT Kanpur.
Manas Modi, Interaction Designer, User Experience team, Flipkart.com,
Bengaluru.
Sumit, UG student at IIT Roorkee, CSI-V, Roorkee, Uttarakhand, India-247667
Abhinav Aggarwal, UG student at IIT Roorkee, CSI-V, Roorkee, Uttarakhand, India-247667
Abhinav Rajagopalan, UG student at IIT Bombay, Powai, Mumbai, Maharashtra, India
Shreekant Deodhar, PhD Student, Center for Ecological Sciences, Indian
Institute of Science.

References:

Chandran. Vinay. 2013. From judgement to practice: Section 377 and the medical sector. Indian Journal of Medical Ethics. Vol X No. 4 October-December 2013 http://www.issuesinmedicalethics.org/174co198.html

Iyer, Malathi. 2014. Homosexuality is unnatural, leading psychiatrist says. Times of India. Jan 21, 2014 http://articles.timesofindia.indiatimes.com/2014-01-21/india/46410477_1_orientation-dr-indira-sharma-ips

Orinam. 2014. IPS clarifies: Dr. Indira Sharma’s View on Homosexuality is Not the Official View. Orinam blog Jan 22, 2014. https://new2.orinam.net/indira-sharma-homosexuality/

Sathyanarayana Rao T S, Jacob K S. 2012. Homosexuality and India. Indian J Psychiatry [serial online] 2012. 54:1-3. http://www.indianjpsychiatry.org/text.asp?2012/54/1/1/94636

Sathyanarayana Rao T S, Jacob K S. 2014. The reversal on Gay Rights in India. Indian J Psychiatry [serial online] 2014. 56:1-2. http://www.indianjpsychiatry.org/text.asp?2014/56/1/1/124706

Postscript: We reviewed an immediate response from the WPA President-Elect stating that he has “forwarded it to the WPA secretariat so that this can be discussed at length at the next Executive Committee. These matters are led by the President of the WPA, Professor Ruiz, who is aware of the situation.” Professor Bhugra further suggested the petitioners  write to the President of the Indian Psychiatric Society and Chair of the Medical Council of India.

A follow-up letter by Dr. Majumder to the IPS President, on  February 5, 2014, following the General Secretary’s TOI interview, fetched the following response “We will be stating IPS statement soon (before evening). Thanks for the mail.I am sure that the prevailing issues would be sorted out.”

On February 6, 2014, the IPS official statement was released.

The Indian Psychiatric Society has just posted the following statement by Dr.T.V.Asokan, President, and Dr. N.N.Raju, General Secretary, on their website http://www.ips-online.org,

“Based on existing scientific evidence and good practice guidelines from the field of psychiatry, Indian Psychiatric Society would like to state that there is no evidence to substantiate the belief that homosexuality is a mental illness or a disease. IPS will issue a more detailed statement in due course of time”.

Thanks to IPS for this official clarification, which was much needed in light of contradictory statements made in January/February 2014 by some of its office bearers (see here and here).

Orinam and other community groups look forward to working with IPS to sensitise mental health professionals on LGBT issues, advocate for inclusion of these issues in the undergraduate and relevant postgraduate medical curricula and in-service training, and to end unethical/unscientific practices of “conversion” therapy that continue to exist in all parts of India.

Dr N N Raju
Professor and Medical Superintendent
Government Hospital for Mental Care (GHMC)
Visakhapatnam, Andhra Pradesh

Dear Dr. Raju,

First, our hearty congratulations on your becoming the first psychiatrist from Andhra Pradesh to be  elected General Secretary of the Indian Psychiatric Society (IPS).

We read the recent interview “Looking into minds wired differently” in the Times of India [Sulogna Mehta, TNN Feb 3, 2014], in which you have stated:

“Homosexuality is a grey area, entailing confusion and complexity, and black and white comments can’t be made on it. Globally doctors are divided on whether to label it normal or a deviation from the norm as genetics, environment and peer pressure contribute to it. However, homosexuals are not criminals, even though legally or morally they are considered wrongdoers. As of now, the IPS, consisting of around 5,000 registered psychiatrists, is working on finding out the majority opinion among psychiatrists regarding the classification and management of homosexuality.”

Respected Sir, we draw your attention to the fact that the Indian Psychiatric Society, of which you are now the General Secretary, has published not one but two editorials [2012, 2014] in its official journal IJP, confirming that homosexuality is a normal variation of human sexuality, and citing primary research that demonstrates that “people with homosexual orientation [do] not have any objective psychological dysfunction or impairments in judgment, stability and vocational capabilities”. In writing this, IPS has echoed the position of the World Health Organisation, World Psychiatric Association and psychiatric associations in a number of countries.

Homosexuality is not a disease to be “classified and managed”, as you appear to have suggested. The ignorance of psychiatrists on this issue, on the other hand, may well be.

We hope that you, in your capacity as General Secretary of IPS, will push for a public position statement by the Society that homosexuality is not a mental disorder, such as the one recently issued by LPS. Such a statement would not be contingent on “majority opinion” of the members as though they were voting on a logo design, but on the Society’s acknowledgment and endorsement of scientific consensus, dating back to 1973.

We further ask that the IPS issue a general directive to its members to cease attempts to “manage” homosexuality through practices as ECT and aversion therapy.

We remain optimistic of your and IPS’ timely attention and response in this matter.

Sincerely yours,

Orinam team, Chennai
orinamwebber@gmail.com

p.s.  Please refer to the open letter signed by healthcare professionals in India, calling for greater sensitivity and non-judgmental approaches on the part of the medical establishment towards lesbian, gay, bisexual and transgender people.

Dr.Indira Sharma (Image Source: IPS-online.org)

In a shocking development, on Jan 21, 2014, the Indian Psychiatric Society’s immediate past president, Dr. Indira Sharma, told the Times of India that homosexuality is “unnatural.”  Her comments  sparked outrage among LGBT people, their allies and many healthcare professionals.

Dr. Abhijit Majumder, who specializes in stem cell research and is a visiting fellow in the National Centre for Biological Sciences, Bangalore,  wrote to the Indian Psychiatric Society asking for a clarification on Dr. Sharma’s comments. He received a response from the President of Indian Psychiatric Society clarifying that Dr.Sharma’s comments are her personal view and they don’t represent IPS’s official stance on the issue.

Email from Dr. Abhijit Majumder:

Respected President IPS, Dr. Indira Sharma, Prof. TSS Rao and Dr. Mallik,

As you may have noticed that in today’s Times of India (TOI), a new report has come which states that Dr. Indira Sharma has termed homosexuality as unnatural (“Homosexuality is unnatural, leading psychiatrist says”, TOI Jan21st 2014). As par the news report, Dr. Sharma has told over telephone, “The manner in which homosexuals have brought the talk of sex to the roads makes people uncomfortable. It’s unnatural. Our society doesn’t talk about sex. Heterosexuals don’t talk about sex. It’s a private matter.” She has also added, “Some of them may even be able to change their orientation”.

However, in the editorial of your official publication, it has been mentioned time and again that homosexuality is NOT unnatural. To quote, “Investigations using psychological tests could not differentiate heterosexual from homosexual orientation. Research also demonstrated that people with homosexual orientation did not have any objective psychological dysfunction or impairments in judgment, stability and vocational capabilities. Psychiatric, psychoanalytic, medical and mental health professionals now consider homosexuality as a normal variation of human sexuality. It suggested that much of the distress faced by people with same-sex orientation is due to difficulties they face living in our predominantly heterosexual world.” (Sathyanarayana Rao T S, Jacob K S. The reversal on Gay Rights in India. Indian J Psychiatry 2014;56:1-2).

The above mentioned article in your official publication also states that “We should voice our concerns against the Supreme Court verdict. It is also time for social groups and professional associations to clearly state their positions and demand a review of the flawed verdict.”

On this apparently contradictory views coming from the editor of official publication and last President, I would like to humbly ask,

1. What is the official stand of IPS on homosexuality? Do they consider it unnatural or a “normal variation of human sexuality”?
2. What is your stand on Dr. Sharma’s comment that sexuality can be changed using psychiatric help? Do you differ in your view from APA which states that conversion therapy causes more harm than it helps and there is “no scientific proof that sexuality can be changed using therapy”?
3. How is it possible to “voice our concern” as suggested by the editorial of your official publication, without talking about sex in the public discourse which Dr. Sharma has found “unnatural” and thus to be avoided?
4. Do you think that the TOI reporting of Dr. Sharma’s statement is going to cause more “difficulties they (LGBTQ) face living in our predominantly heterosexual world”?

Although you do not owe an answer to me, I feel that a clear stand will help many of us to understand the field better. As at present, homosexuality is a matter of national debate, a clear stand from Indian Psychiatric Society will help all the stakeholders as well as our national policy makers to form their opinion and decision.

Surely, Dr.Sharma has not said that homosexuality per se is unnatural as reported by TOI, but talking about it is.  However, the reporting by TOI about Dr. Sharma’s comment is going to cause a lot of distress among LGBT people and their family members.

Out of this concern, I would request The President, IPS to release a press statement if TOI has misreported Dr. Sharma’s comment or the comment made by Dr. Sharma is completely her personal opinion and IPS does not agree to that. If IPS chooses to endorse Dr. Sharma’s view, then I request the editors of IJP to rectify their editorial view.

Thanking you for your time and wish IPS all the very best.

With Warm Regards,
Dr. Abhijit Majumder
Wellcome Trust/DBT India Alliance Fellow,
National Centre for Biological Sciences,
Tata Institute of Fundamental Research,
Bangalore, India.

Response from Prof. T.V.Asokan, President, Indian Psychiatric Society:

Dear Sir,
Greetings.
Thanks for the information.
with ref to TOI article,I forwarded my response to e ips group that the view expressed by IPP was not the official view of IPS.Our Editor also responded to TOI by quoting previous articles of IJP.
Regards,
Prof.T.V.Asokan
President,
Indian Psychiatric Society

Recommended Reading:

• Mental health professionals oppose criminalization of homosexuality
• Professional views: Summary of Indian healthcare professionals’ view on homosexuality
• Campaign for Open Minds (CFoM) – Several healthcare professionals have joined Orinam in supporting non-discriminatory, appropriate, and ethical treatment and healthcare for LGBT people.

I’ll begin by quoting Jonathan Rodrigues who wrote this piece on suicide in The Hindu:

“Many teenagers die of failure of what I would call an ‘attempt to threaten suicide.’ Their main intention is to deliver a message or a threat demanding attention and love, but they eventually succumb to the tortures they force on their bodies. Suicidal behaviour whether attempted or threatened must be taken seriously and dealt with maturely. It should not be treated as taboo anymore. There is need for discussing the concept of suicide in schools and colleges.”

I come from Tuticorin, India. Growing up, I didn’t know of any gay people, let alone role models. I wasn’t out when I was in high school, but I got bullied for a host of other reasons. During my final years there, I felt lonely and aloof and  I sat through the day, imagining things to write about when I was at home. Computers were my escape from reality. I wrote about technology. I had a personal blog. I connected with tech enthusiasts from across the world. Although my life then was filled with purpose, I still felt alienated as I couldn’t find anyone like me in school. By the time I was done with high school, the awareness of my sexuality had existed in me for years and I was able to fully understand and accept my identity. I thought I was all set for the life ahead of me.

And then I moved out of my town to go to college. The first two years were fine. I made good friends along the way. Then, I fell in love with someone straight and that ripped my heart apart. That was my first real taste of rejection and it was painful emotionally and physically. At that age, love that isn’t reciprocal can make you want to kill yourself. I fell into depression in my last two years of college.

I thought I spent those years wandering around doing nothing, but in hindsight, I actually did a ton of things to put myself back together. I thought I’d share them with you, because you might find them useful when the going gets tough.

• I built a personal support system. I’ve never had trouble finding friends (despite my own bouts of loneliness in both high school and college). By the time I finished college, I was out to around 20 people, including my Dad. I did not plan on building such a circle, but it happened. I had a straight roommate who was also my 4 AM counselor. I had a classmate who was aware of my sexuality and offered reassuring advice when I needed it. Whenever I visited home, there was a childhood friend who stood by me. A lot of others were always there for me no matter what. I actually have a WhatsApp group for my best friends and that’s my go-to place for venting. I know it seems like overkill, and I am sure I’ve taken too much of their time, but truth be told, I wouldn’t have survived if they hadn’t listened to me. Trust me: you’ll also find people like them whose support is priceless.

• I jumped at every chance I got to socialize. Until college, I always kept to myself, and there’s nothing I enjoyed more than being alone and contemplating random things. But after my depression episode began, every time I got invited to hangout with my friends, I forced myself to go. I made sure I wasn’t alone and that helped me put off suicide. The idea is to surround yourself with people you love, and trick your brain from going down that road.

• I sought professional help. Though I tried everything I could, sometimes things went way out of control. I’d be depressed one day but feel deeply elated the next and I wondered if I was doing irreparable damage to my mental health. Just being with friends and leaning on them wasn’t enough, so I found an LGBT-friendly counselor in Chennai and sought her help. Although she didn’t have a magic wand, her advice helped and she connected me with organizations in the city that worked on LGBT issues.

• I read ‘It Gets Better.’ The book had real-life accounts of LGBT people from across the world. Granted, I’ve read a lot about queer issues online, but there’s something that stood out among the anecdotes in the book: ‘it doesn’t get better; you get stronger.’ I couldn’t agree more. I don’t think there was a huge change in public perception in India of LGBT issues; what changed was me. I’ve grown stronger. You’re might encounter homophobic laws like 377, but you’ll grow a thick skin and learn to deal with hate like I did. Just remember: what doesn’t kill you, makes you stronger

(On a side note: if you’re a parent or a friend of someone who is constantly feeling suicidal, I urge you to read this piece from March 2013 that was published in The Hindu. The real reasons why people try to do what they do, are clearly laid out in this article. I also suggest reading this comic on depression by Hyperbole and a Half because that I am sure it will resonate with you).

Orinam editors’ note: This is one of a series of articles on Orinam that discuss living and coping with depression. Also see Pink Me’s essay No Matter What Happens, and Vinodhan’s essays Storms Without Warnings and Spells and Charms.  For readers who would like to learn more about coping with depression, a guide on mental health for LGBT people developed by Ireland’s Health Service Executive mental health project is available here. Additional resources are being developed by Orinam and will soon be available here.