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The latest issue of the Indian Journal of Psychiatry (April 3, 2012) has a lead edit written by T S Sathyanarayana Rao, editor, and K S Jacob, who is on the editorial board, arguing for the need for the profession in India to stop treating homosexuality as a disease. This is a breakthrough in a way, since there is a feeling among psychiatric bodies and journals in India that criminalising homosexuality might be wrong, but it was still a treatable disease.


Illustration/Amit Bandre

“Many countries have since decriminalised homosexual behaviour and some have recognised same-sex civil unions and marriage; with India decriminalising homosexuality and legalising gay sex among consenting adults on July 2, 2009. This path breaking event motivated us to write a paper to help the public understand the fact that homosexuality is not a disease and is just another form of sexuality in human beings,” said Dr T S S Rao in a telephonic interview from Mysore.

Excerpts from an interview:

Q: What defines a person’s sexuality and how is it proved that homosexuality is not a disease?
Ans: A person’s sexual orientation is based on a lot of parameters. In fact, it has been researched and proved that every individual has a homo and heterosexual quality in them. The Kinsey Scale and the Klein Sexual Orientation Grid are tools that have been developed to measure the sexuality of a person based on his/her sexual activity and history. The Kinsey Scale, also called the Heterosexual-Homosexual Rating Scale, uses a scale from 0, meaning exclusively heterosexual, to 6, meaning exclusively homosexual. Sigmund Freud has also said that all human beings are born without any defined sexuality.

Q: Do people and parents go to psychiatrists to change their orientation? Are they told to ‘cure’ a person of this disease?
Ans:  Unfortunately, the views of our society have not changed much and there is a phobia of homosexuals. We get cases where people come to a psychiatrist to get cured of this disease ‘homosexuality’ as they feel abnormal. It is a pity to see persons blaming themselves for something that is not a disease or a crime. It is just an alternate form of being and that is what we tell them.

Q: Does a large part of the psychiatric community still believe that homosexuality can be cured? If yes, then what are the methods they use to ‘cure’ such individuals?
Ans:  No, we don’t believe that homosexuality is a disease so the idea of curing it is out of question. Gay-Affirmative psychotherapies have been developed, which help people cope with the awareness of being same-sex oriented and help with social stigmatization. On the other hand, there is no evidence for the effectiveness of sexual conversion therapies, which raise many 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 and should be condemned and banned.

Q: Do you think there should be a law against sexual conversion therapies as they are devoid of scientific backing?
Ans:  Yes, there should be a law against it. Attitudes and behaviours can’t be modified and there is no method available that helps people change their sexuality. It is in fact a problematic situation. People should be happy with their orientation. It leads to a lot of distress at times owing to the pressure from society, family etcetera. The person in distress comes to us to seek treatment to change his/her sexuality. It should not be so. They should be counselled to the fact that they are completely normal, just different from the majority and there is nothing abnormal about them.  Dr Rao says in conclusion, “Human sexuality is complex and diverse. As with all complex behaviours and personality characteristics, biological and environmental influences combine to produce particular sexual orientation and identity. We need to focus on people’s humanity rather than on their sexual orientation.” 

Excerpts from the paper ‘Homosexuality and India’
The shift in the understanding of homosexuality from sin, crime and pathology to a normal variant of human sexuality occurred in the late 20th century. The American Psychiatric Association, in 1973, and the World Health Organization, in 1992, officially accepted its normal variant status. Many countries have since decriminalized homosexual behavior and some have recognized same-sex civil unions and marriage.

Studies
The new understanding was based on studies that documented a high prevalence of same-sex feelings and behavior in men and women, its prevalence across cultures and among almost all non-human primate species. 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.

Research
Classical theories of psychological development hypothesize the origins of adult sexual orientation in childhood experience. However, recent research argues that psychological and interpersonal events throughout the life cycle explain sexual orientation. It is unlikely that a unique set of characteristics or a single pathway will explain all adult homosexuality. There are few small case series in psychiatric literature detailing homosexuality in males and its treatment with aversion therapy. Heterosexism and anti-homosexual attitudes among psychiatrists and mental health professionals have been documented.

Prejudice
Despite medicine and psychiatry arguing that homosexual orientation is a normal variant of human sexuality, mental health fraternity and the government in India are yet to take a clear stand on the issues to change widely prevalent prejudice in society. The fraternity needs to acknowledge the need for research into the context-specific issues facing Lesbian Gay Bisexual Transgender (LGBT) people in India. The teaching of sexuality to medical and mental health professionals needs to be perceptive to the issues faced by people with different sexual orientations and identities. Clinical services for people with such issues and concerns need to be sensitive to providing holistic care. A positive and a non-judgmental attitude will go a long way in relieving distress. Professional societies need to increase awareness of these issues, transfer knowledge and skill and provide opportunities to increase the confidence and competence of mental health workers in helping people with different sexual orientations and identity. Psychiatrists and mental health professionals need to be educated about the human right issues and possible abuses. The emphasis should not just be on education but also on a change of attitude. The development and dissemination of clinical practice guidelines is also essential. 

About the Indian Journal of Psychiatry
The Indian Journal of Psychiatry is the official journal of the Indian Psychiatric Society. This scientific journal is a quarterly that publishes original work in all fields of psychiatry. The April issue is accompanied by a supplement that contains the abstracts of the academic content of the annual national conference of the Society. The article on 'Homosexuality and India' has been published in the April issue of the journal as the editorial and is written by Dr T S S Rao and Dr K S Jacob.

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