Thanks for translation and/or review to Vivek and Janani (Tamil), Rucha Satoor, Dharmakirti Sumant and Radhika Murthy (Marathi), Ruhaan Ali and Shyam B. (Hindi), Dadapeer Jyman and Naren Pai (Kannada). Assamese, Bengali and other translations are in progress.

Note: This article and its translations are community-created and owned resources, and may be shared widely, so long as the link to the original article https://new2.orinam.net/locked-down-safety-self-care-queer-trans/ is included in the republished posts. Updated versions and additional translations will be updated at this URL.

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LOCKED DOWN IN THE TIME OF COVID-19:
SAFETY AND SELF-CARE FOR QUEER AND TRANS PERSONS

The lockdown induced by COVID-19 has caused many of us to be stuck in abusive households with our natal families, or feel otherwise isolated.  We have compiled some tips for safety and self care during these difficult times. These are not intended to be exhaustive. 

1. We may feel even more isolated and vulnerable now than before the lockdown. Being in close contact with our friends and support systems, if at all possible, can help us.
2. In case there are other (less hostile) family members in the area we can explore the option of going and staying with them.
3. Some of us may be at home and have no option to leave. In that case it may be good to try and avoid escalation of issues, such as those around gender/sexuality or marriage.
   If topics of marriage do come up, we can reassure ourselves that the lockdown will prevent  parents from taking us to meet potential partners or inviting prospective grooms or brides at this point in time.  
4. In case of risk of physical threats, we should try to stay as close to the exit door and far away from objects that can be used to assault/harm as possible.
5. If we  have a smartphone,  we can send our location to people we rely on, via WhatsApp or other means. It will help others to reach us in case of emergency.
6. It’s a good idea to keep some cash and our important  official documents handy with us (examples include Aadhaar, PAN, Voter identity card, passport, copy of ration card, Trans Welfare Board identity card, workplace-issued ID, bank passbook, academic certificates, etc.).
   
7. For those of us who experience gender dysphoria, this can be particularly severe if family members force us to dress in ways conforming to assigned gender. Avoiding looking in the mirror may help a little in reducing our distress. If we have photos of ourselves in our gender presentation and preferred clothing, we may consider looking at these. It also helps to have a presence on online platforms where we can be ourselves, such as Second Life and peer WhatsApp groups.  More options for gender dysphoria- related support and interventions will become available after the lockdown.

 
SELF-CARE TECHNIQUES

This section is based on our experiences as community members, peer counselors and/or therapists.

Anxiety and fear during the pandemic can be accompanied by restlessness, agitation and reactiveness, all of which may be temporary or may add to more long-term anxieties. In times of crisis it is immensely important to be aware of our energies, notice our restlessness, anxiety, fear, etc.  

These feelings and emotions are valid and yet, are quite likely to be difficult to deal with. They will come and go multiple times a day. To manage these, so that we experience their full range but prevent ourselves from reacting, here are some suggestions:

DURING A DIFFICULT INTERACTION

• If we are able to convey to the person(s) around us that we need to step away, it will give us an opportunity to go to a safe place (bedroom, veranda, bathroom, terrace).
• If stepping away is not an option, we can try to ground ourselves [for e.g. by holding on to an object or squeezing a piece of clay] and focus on processing and responding carefully, rather than reacting spontaneously in a way that we may regret later.
  
• If we do end up reacting impulsively, it is important to remind ourselves that we are going through hard times, and to be easy on ourselves.  When we find ourselves back in a safe space, that may be a good time to introspect and figure out how to proceed in future.
• We need to find ways to remind ourselves  that the lockdown is a temporary situation, such as marking the duration of the lockdown on a calendar.
• Distracting ourselves with other tasks or activities can help.  However, we need to remember that shelving the difficult emotions may cause them to return later at unexpected times. The subsequent sections “Returning to a place of calmness” and “General practices for emotional well-being” outline  some ways to express our emotions so they don’t pile up.

RETURNING TO A PLACE OF CALMNESS 

Once we are able to step away from the interaction that was stress-inducing, here are some ways in which we can return to a state of calmness. Each of us can find a technique that works best for us.

• Holding on to an object, article of personal value or toy can offer us  a sense of comfort and safety. Sometimes it helps to just keep some clay or atta in the hand and keep squeezing. 
• Listening to our favorite music or reading a favorite author can help.
  
• If we have a dog or pet, petting it can be soothing.
• We can practise some form of breath work to cope with emotions – focusing on deepening and lengthening the breath: such as  three seconds inhale, one second pause, three seconds exhale, trying to increase the duration of the exhalation to a few more seconds than that of the inhalation.  While doing this breath work, we focus on the sensation of the breath, how they feel in the body, etc. More information and links are in the ‘Other Resources’ section of this document.

GENERAL PRACTICES FOR EMOTIONAL WELL-BEING

• Starting the day with useful activities and chores can keep our minds occupied and give us a sense of control and fulfilment.  These activities could include exercise, cleaning, washing clothes, arranging rooms: anything that does not need too much thought. While engaging in these activities, it helps for us to keep our focus on the task at hand, and address any challenges that arise in a problem-solving/strategizing manner. For example, while cleaning or  arranging items on shelves, we focus on where to keep what, what items can be kept together, etc. 
• Productive activities such as studying, working, learning  a new language or skills can also help give us a sense of accomplishment.
  
• Noticing sensations (sigh, smell, touch, taste, hearing) while engaging in these activities helps us remain in the present moment. When we become aware that our thoughts have gone to the  future or past, worries, etc., we can bring the mind back using the sensations of the present.  
• An additional benefit of these activities is that they can help us build our safe space and limit difficult and potentially hostile interactions with other people.
• It helps greatly to make breath work (as described in the previous section) a part of  our daily routine.
  
• Physical exercise along with breath work or other kinds of meditation help us to release pent-up energy of any kind in the body.  Good cardio- and weight training can be done at home even if there is very limited physical space. Many video links are available online: some are linked in the ‘Other Resources’ section below. 
• Writing,  sketching, painting,  music, are some of the ways that help us to express our emotions.  
  • An example of  a writing exercise is to set aside a desired time period to write continuously without taking pen off paper.  While writing, if nothing comes to mind, we can just write “can’t think of anything.“ 
  •  Another example of a writing exercise would be to create stories featuring us in the way we see ourselves.

AUTHORS AND CITATION

This document emerged from discussions during a SAATHII-organised Zoom webinar on  LGBTIQA+ crisis response held on March 21, 2020, and subsequent discussions on the LGBTQIA+ 4 Mental Health WhatsApp group. The author list is arranged alphabetically by last name. Our suggested citation format is: 

Balasubramanian1,  S., Banerjee2, S.,  Borah3, R.,  Raju2, A., Ramakrishnan4, L., and A. Sarkar4 (2020).  Locked Down in the Time of Covid-19:  Safety and Self-care for Queer and Trans Persons. https://new2.orinam.net/locked-down-safety-self-care-queer-trans/

• Shyam Kamala Balasubramanian is with the Orinam collective, and based in Coimbatore
• Shilpi Banerjee and Avanish Raju are with Being Myself Clinic in Gurugram
• Rituparna Borah is with Nazariya: a Queer Feminist Resource Group, Delhi
• Amrita Sarkar and L. Ramakrishnan are with SAATHII in Delhi and Chennai, respectively

COMMUNITY SUPPORT

Every  Saturday, Nazariya QFRG organises zoom calls with queer women and trans* persons to check in about their mental well being. Do write to nazariya.qrfg@gmail.com to know more about these meetings.   Similar online meetings for LGBTIQ+ persons are being organised by Good As You  in Bangalore (https://www.facebook.com/goodasyoublr)   and Orinam  (orinam.net@gmail.com) in Chennai. SAATHII offers information and peer support via helpline@saathii.org

OTHER RESOURCES 

Books, Articles and Manuals
Banerjee, Shilpi and Raju, Avanish (2018). Stress Toolkit. Being Myself Clinic, Gurugram. Online at https://new2.orinam.net/stress-toolkit/

Great Good Science Center (undated)  Mindful Breathing. University of California at Berkeley. Online at https://ggia.berkeley.edu/practice/mindful_breathing

Kabat-Zinn, Jon (2013) Full Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness.  Bantam Books, New York. ISBN-10: 9780345536938, ISBN-13: 978-0345536938

Videos on Mindfulness

Kabat-Zinn, Jon (2020)  Mindfulness, Healing, and Wisdom in a Time of COVID-19. Online at https://www.youtube.com/watch?v=r2efOoRF_pw

Segal,  Zindel (2016) Three-Minute Breathing Space. Online at  https://www.youtube.com/watch?v=amX1IuYFv8A&feature=youtu.be

Kabat-Zinn, Jon (2011) The Healing Power of Mindfulness: talk at Dartmouth College. Online at https://www.youtube.com/watch?v=_If4a-gHg_I

Videos on Physical Fitness

Lewis, Lita (2018) 30-Minute HIIT Cardio Workout with Warm Up – No Equipment at Home | SELF. Online at https://www.youtube.com/watch?v=ml6cT4AZdqI  

Fitness Blender (undated) Free Workout Videos. Online at https://www.fitnessblender.com/videos

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

According to Dr. Mathew Varghese, professor and head of psychiatry at NIMHANS, there are only about 4000 psychiatrists, 1000 psychologists and 3000 mental health social workers in India. This stark inadequacy, given the population of our country, is compounded by the widespread social stigma attached to mental health issues. Both act together to prevent individuals from accessing the care they need. As if these were not enough, we have to contend with yet another obstacle: negative attitudes of providers towards sexual and gender minorities, women and members of other marginalised groups.

It’s time we talk about this unnerving situation where a therapist denies treatment to a person or shames them for having contradictory views about society or politics, or for their departure from socially imposed gender roles, identities, or normative sexual orientations. Such prejudice targets many marginalised communities, and continues to take a big toll on LGBTQIA+ people, as well as on (cis, heterosexual) women.  Shockingly, very few of these occurences of blatant discrimination get reported in the media.

Pervasive prejudice among healthcare continues to target patients based on caste. For instance, a survey on untouchability in rural India found that Dalits in over 21% of villages were restricted from entering private medical care centers. Dalit women in parts of Uttar Pradesh were barred from receiving health care during pregnancy. A concern for mental health sounds too far-fetched when even basic medical services are denied to the community. Given this bleak scenario, it seems hardly surprising that sexual orientation and gender would be exempt from the prejudice.

Homophobia, transphobia, and misogyny are worldwide phenomena. However, they seem most vicious in societies and communities bound by religious beliefs and traditions that fiercely uphold the patriarchal norm, and dismiss any alternate way of life. This is by no means restricted to India. In August 2016, the Governor of the state of Tennessee (U.S) passed a bill allowing therapists to deny therapy to individuals from the LGBTQ communities. This bill is part of a wave of bigoted legislation across the US that seeks to institutionalise discrimination against LGBT people, such as North Carolina’s Bathroom Bill.

Guidelines such as those of the American Psychological Association (APA) for psychological practice with lesbian, gay, and bisexual clients, adopted in 2011, lay down best practices based on clinical research and experience. They cover social attitudes towards homosexuality as bisexuality, relationships and families, issues of diversity, economic and workplace issues, education and training and research.

Despite the availability of such guidelines, and despite a growing body of evidence suggesting LGBT youth are at high risk for major depression, generalised anxiety disorder, substance abuse, suicidal behavior, sexual risk taking, and poor general health care than their heterosexual counterparts, mental healthcare providers in India and elsewhere treat homosexuality and bisexuality as aberrant conditions to be condemned, or pathologies to be “cured” [see work by Vinay Chandran and Arvind Narrain, and Ketki Ranade]

“I was talking about my nightmares to my therapist and while in the middle of that I accidentally told him that I am a bisexual and out of nowhere he just slapped me and asked me to go away. The incident did make me badly depressed, took a toll on my health and everything. I already have ADD and OCD and that’s what I was seeing the therapist for. So the depression just doubled from there and although now I have overcome it slightly, it still keeps on running in my head.” – Vinay (Name changed)

Such prejudice on the part of mental health professionals is not restricted to LGBT people. Heterosexual women are subjected to a barrage of suggestions and treatment methods that are polluted by the system of patriarchy. Those seeking professional help for issues such as depression get pathologized if they do not choose to live “by the rules”. They are slut-shamed, body-shamed, victim-blamed and coerced to conform to traditional “Indian values”. Such treatment, besides being grossly unethical, ends up vitiating the depression one has already been caged in.

Carelessness can also be observed. Being told to look at the less fortunate lives to overcome depression or adding spirituality to overcome stress, are some of such ill treatments that are thrown around like paracetamol. These heart-rending experiences by two women speak for themselves:

“I have borderline personality disorder. Got diagnosed at a very young age and was taken to several psychologists and psychiatrists. While some gave me heavy doses of medication without hearing me out properly, others gave me huge lectures on morality about how my lifestyle and opinions are very wrong for a ‘girl’ and how I am difficult and should be more passive. I had been in an abusive relationship for a long time and my previous psychologists slut-shamed me for having sex with that person out of marriage and kept calling me “psychotic” all the time” – Shruti (Name changed).

“My first psychiatrist told my parents that, being 24 years old, I should have been married by now and have started a family of my own, as my unmarried status was the root of my depression. He ignored when I said that I’ve very low emotional quotient and it’s very difficult for me to recognize feelings. The second one repeatedly kept asking if there was violence at home and how do I know that I get anxiety attacks. He mocked me in every session. When I informed him about the side effects I have been having from the prescribed drugs, he asked me not to blame the drugs. I then refused to respond to his queries. Finally, he rudely asked me and my parents to leave.” – Priyanka (Name changed)

While minorities in India are still fighting for basic human rights, access to unstigmatized mental health care has become a very significant part of the demand for social justice.  NGOs and community  collectives working on feminist and LGBTIQ* issues can advocate with mental health professionals to generate this much needed flexibility and open-mindedness .

More broadly, therapists have to learn to work non-judgmentally with clients whose social, cultural, political, sexual and religious views may diverge widely from their own. Having biased professionals in the field not only impacts provision of much-needed quality mental health care , but also impedes the ongoing battle for social justice.

Knowledge, sensitivity and a rational attitude towards the client’s personal issues are essential. There is a dire need to include minority, feminist and LGBTQ* issues within academic courses and training. These should include detailed and culturally relevant content on how minority stress and institutionalized prejudice impact women, those of marginalised castes, LGBTQ*,  and other excluded groups.

Such courses are few and far between: the MA program in Psychosocial Clinical Studies at Delhi’s Ambedkar University, and courses in gender and sexuality at Tata Institute of Social Sciences serve as examples. Their importance cannot be overstated, especially in a country where privilege ignorance is so widespread.

LGBT-affirmative psychotherapy has been a tremendous step in helping LGBT clients accept their sexual orientation and/or gender identity. What we need now is to have the regular psychologists comprehend this acceptance. Donald Clark, the first openly homosexual psychologist, says the following in one of his extended interviews:

“Gay people do not grow up in gay families. The vast majority of the time, they do not have any support around who they are. There is nothing comparable in the human experience. It is as if the gay child is the result of having an egg from outer space planted in the uterus of the mother.”

Feminist therapy has its roots in the interventions by women psychotherapists during the U.S. feminist movement of the 1960s. Such feminist therapeutic approaches need to be adapted for the Indian cultural context.

When bigotry of the kind described in this article impedes psychological therapy and other mental health care, it not only worsens the condition of the patient but holds back humanity as a whole. We need affordable and accessible mental health care for those in need, and we surely don’t want to bring social discrimination along with us on this one.

Credits: An earlier version of this article appeared on the Nirmukta blog.

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.

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.

I loved my cousin brother Raghu*. I liked to think I was the one in the family he was closest to, the one he would confide in, seek advice from.

Well, not close enough, evidently.

One morning, three years ago, Raghu called me on the telephone. Without preliminaries, he announced to me that he loved men, not women, and hung up just as abruptly. This, just weeks after he had become father to a baby boy, and a year or so after his marriage.

Later that day, Raghu, all of 26, ended his life in the south Madras flat where he and his family lived.

I wish I could say I had suspected something like this was brewing when he made that call to me, the call that was to be our last conversation. I hadn’t.

Love and forgiveness. I wrestle with these each day. Through love, one can overlook others’ faults, however significant they may be. Through forgiveness, one seeks peace.

Raghu, I wish I could forgive you easily for ending your life, leaving your wife and infant son behind, casualties of the choices you made. Forgiving you remains a struggle, though I try. Questions race through my mind all the time. Why could you not have thought about your preferences beforehand, and avoided drawing her into your life? Did we, as a family, make it so difficult for you to admit your different orientation? Or, was it your desire to conform, to not hurt your parents, that drove you to consent for marriage in the first place? What of the hurt that engulfed everyone when you chose to depart?

Raghu, wherever you may be now, I still love you, my brother. Your difference did not matter to me then, nor does it now. I wish you happiness wherever you may be. And I continue to try to forgive.

To the readers of this note, I ask that you live and let live. If you have a sibling, child, friend or other loved one who has a different orientation, please do not let this difference come in the way of your love for them.

And if you are yourself differently oriented from the so-called mainstream sexuality, be strong in your convictions. Going against family expectations may cause some grief, but that is nothing compared to the devastation resulting from the choices that Raghu – and I fear there have been many like him through the ages – felt compelled to make.

*name changed

This piece is based on a note submitted by an Orinam reader, and is being posted on Sept 10, World Suicide Prevention Day. If you or someone you know is depressed or suicidal, please seek help. Some crisis support resources are here.