HOMOSEXUALITY, INDIAN CONTEXT.
The shift in the understanding of homosexuality from sin, crime and pathology to a normal variant of human sexuality occurred in the last century. The American Psychiatric Association, in 1973, and the World Health Organisation, in 1992, officially accepted its normal variant status. Many countries have since decriminalised homosexual behaviour and some have recognised same-sex civil unions and marriage.
The new understanding was based on studies that documented a high
prevalence of same-sex feelings and behaviour 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 judgement, stability and vocational capabilities.
Psychiatric, psychoanalytic, medical and mental health professionals now
consider homosexuality as a normal variation of human sexuality.
Human sexuality is complex. The acceptance of the distinction
between desire, behaviour and identity acknowledges the multidimensional nature
of sexuality. The fact that these dimensions may not always be congruent in
individuals suggests complexity of the issues. Bisexuality, both sequential and
concurrent, and discordance between biological sex and gender role and identity
add to the issues. Medicine and psychiatry employ terms like homosexuality,
heterosexuality, bisexuality and trans-sexuality to encompass all related
issues, while current social usage argues for lesbian, gay, bisexual and
transgender (LGBT), which focuses on identities.
The prevalence of homosexuality is difficult to estimate for many
reasons, including the associated stigma and social repression, the
unrepresentative samples surveyed and the failure to distinguish desire,
behaviour and identity. The figures vary between age groups, regions and
cultures.
Medicine and science continue to debate the relative contributions
of nature and nurture, biological and psychosocial factors, to
sexuality. Essentialist constructs argue for biology and dismiss personal
and social meanings of sexual desire and relationships. On the other hand,
constructivists support the role of culture and history. While essential-ism
and construction-ism, on the surface appear contradictory, they may mediate
orientation and identity, respectively.
Anthropologists have documented significant variations in the
organisation and meaning of same-sex practices across cultures and changes
within particular societies over time. The universality of same-sex expression
coexists with variations in its meaning and practice across culture.
Cross-cultural studies highlight the limits of any single explanation of
homosexuality within a particular society.
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.
The argument that homosexuality is a stable phenomenon is based on
the consistency of same-sex attractions, the failure of attempts to change and
the lack of success with treatments to alter orientation. There is a
growing realisation that homosexuality is not a single phenomenon and that
there may be multiple phenomena within the construct of homosexuality.
Anti-homosexual attitudes, once considered the norm, have changed
over time in many social and institutional settings in the west. However,
heterosexual-ism, which idealises heterosexuality, considers it the norm,
denigrates and stigmatises all non-heterosexual forms of behaviour, identity,
relationships and communities, is also common.
In addition to the challenges of living in a predominantly
heterosexual world, the diversity within people with homosexual orientation
results in many different kinds of issues. Sex, gender, age, ethnicity and
religion add to the complexity of issues faced. The stages of the life cycle
(childhood, adolescence, middle and old age), family and relationships present
diverse concerns. In most circumstances, the psychiatric issues facing gay,
lesbian and bisexual people are similar to those of the general population.
However, the complexities in these identities require tolerance, respect and a
nuanced understanding of sexual matters. Clinical assessments should be
detailed and go beyond routine labelling and assess different issues related to
lifestyle choices, identity, relationships and social supports. Helping people
understand their sexuality and providing support for living in a predominantly
heterosexual world is mandatory. People with homosexual orientation face many
hurdles including the conflicts in acknowledging their homosexual feelings, the
meaning of disclosure and the problems faced in coming out.
Gay-affirmative psychotherapies have been developed, which help
people cope with the awareness of being same-sex oriented and with social
stigmatization. There is no evidence for the effectiveness of sexual conversion
therapies. 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.
The landmark judgement of the Delhi High Court, which declared
that Section 377 of the Indian Penal Code violates fundamental rights
guaranteed by the constitution, was in keeping with international, human rights
and secular and legal trends. However, the anti-homosexual attitudes of
many religious and community leaders reflect the existence of widespread
prejudice in India. Prejudice against different lifestyles is part of many
cultures, incorporated into most religions, and is a source of conflict in
Indian society.
There are few small case series in psychiatric literature
detailing homosexuality in males and its treatment with aversion
therapy. Heterosexual-ism and anti-homosexual attitudes among
psychiatrists and mental health professionals have been documented. The
international classification of diseases-10 category (F66) employed to code
egodystonic sexuality seems to be only employed in clinical practice only for
homosexuality, suggesting continued pathologization. It places the
responsibility on the individual without critically examining the social
context, which is stigmatising and repressing. The medicalization of
sexuality and the political impact of labelling and its role in social control
are often discounted. The ubiquitous use of disease models for mental disorders
is rarely questioned.
There is a dearth of Indian psychiatric literature that has
systematically investigated issues related to homosexuality. Data on
prevalence, emotional problems faced and support groups and clinical services
available are sparse. Research into these issues is crucial for increasing our
understanding of the local and regional context related to sexual behavior,
orientation and identity in India.
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 LGBT
people in India. The teaching of sexuality to medical and mental health
professional 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 needs to be sensitive to providing holistic care. A
positive and a non-judgemental 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 rights 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.
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.
Source : http://www.ncbi.nlm.nih.gov/
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