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

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.