Insight, Advice - Mind, Body and Family, Mar '14
By Dr. Tirthankar Guha Thakurta
By Dr. Tirthankar Guha Thakurta
On February 8, 2014, the West Bengal
chapter of the Indian Psychiatric Society organized an interactive event in
Kolkata to clarify their stand on homosexuality (see A Mental Boost! in the
February 2014 issue of Varta). Among a host of issues debated, one was the use of
reference books with outdated information on gender and sexuality by students
of the MBBS course, the future doctors of India. Varta decided to delve deeper
into the matter, and Dr. Tirthankar Guha Thakurta brings you the first in a series
of articles that analyse the content of some standard reference books.
Why are some (read many) Indian doctors
homophobic?
Well, I would rather say the reasons are
mostly the same as those that make a homophobe out of any other person. But,
for doctors, there are additional triggers that often make them a confident and
proud homophobe who can diagnose, treat and prevent homosexuality!
The five and a half years of drilling
through the sexually immature but otherwise updated medical curriculum makes
most bookworms what we can call a ‘professional homophobe’. Here’s a look at what
has been the status of discourse on gender and sexuality and related topics
over the last 10-15 years accounting for the insensitivity of some doctors to the
issues of lesbian, gay, bisexual, transgender and other queer people.
The first year of the MBBS syllabus exposes
a student to the knowledge of human anatomy, physiology and biochemistry. The
scope of a detailed study of gender and sexuality is while discussing human
physiology. The physiologists, however, rarely discuss sexuality beyond the
chapters of human reproduction. Each physiology book essentially contains a
chapter on the ‘reproductive system’, but there are no chapters on the ‘sexual
system’. The discussion of sexuality beyond procreation is unthinkable when the
books are so skewed in their sexual perceptions.
Some popular reference books by Indian
authors further state that puberty is characterised by the development of
“attraction to the opposite sex”, and in males by “love for contact sports like
football, wrestling, boxing and war games”. They further state: “Male
aggression is also a sign of puberty”. These lines are quoted from the book Concise
Medical Physiology, 4th edition, 2002, authored by Prof. Dr. Sujit K.
Chaudhuri, MBBS, PhD, Ex-HOD of Physiology, Medical College, Kolkata. A similar
view is echoed by the book Essentials of Medical Physiology, by Prof. Dr. Anil
Baran Singha Mahapatra, MD, HOD of Physiology, Bankura Sammilani Medical
College, Bankura, West Bengal.
The first year thus acts as the first dose
of hetero-normativity for most medical students. In the next year, a major
booster dose is provided by chapters on ‘sexual offences’ in the context of
discussing forensic medicine. This subject establishes a link between medicine
and law. The legal impact on medicine is evident when we find that almost all
forms of sexual acts other than penile-vaginal intercourse, and all forms of
sexual attraction other than heterosexual are called sexual perversions! The
average medical student mugging up the question bank of the board examinations
of the last few years finds questions on this chapter often repeated in the examinations
and learns the topics religiously to score high marks.
Let us take a look at some excerpts from
the book The Essentials of Forensic Medicine and Toxicology, 21st edition,
2002, by Dr. K. S. Narayan Reddy, MD, DCP, PhD, FAMS, FIMSA, FAFM, FAF Sc.,
FIAMS; Professor of Forensic Medicine, M. R. Medical College, Gulbarga; Retired
Principal, Osmania Medical College, Hyderabad. This book by Dr. K. S. Narayan
Reddy is considered a standard reference by most medical college professors. Here’s
what chapter 17 titled Sexual Offences says:
Excerpt 1: Pg 338, Classification (of Sexual
Offences):
(I) Natural offences –
1) Rape
2) Incest
3) Adultery
(II) Unnatural offences –
1) Sodomy
2) Tribadism
3) Bestiality
4) Buccal coitus
(III) Sexual perversions –
1) Sadism
2) Masochism
3) Necrophilia
4) Fetishism
5) Transvestism
6) Exhibitionism
7) Masturbation
8) Voyeurism
9) Frotteurism
10) Undinism
It is ‘funny’ to note that sexual offences can
be ‘natural’ as well – all provided they are heterosexual in content and penile-vaginal
in execution. Second, who is going to report consensual sodomy or buccal
coitus, if voyeurism itself is a perversion cum offence? And that masturbation
is a perversion reminded me of a popular joke: “If you ask people whether they
masturbate, 99% will say yes and 1% will lie!”
Excerpt 2: Pg 349
“In India, a class of male prostitutes
called Eunuchs act as passive agents in sodomy . . . among them there are two
groups (1) Hijrahs and (2) Zenana, who live separately. The Hijrahs are those
who have been castrated, usually before puberty . . . the genitalia of Zenana
are intact”.
Where on earth did the author get such
grossly inadequate ideas about the community structure of Hijras? (For anyone
interested in basic information about the Hijra community, a good starting
point can be Human Rights Violations against the Transgender Community,
People’s Union for Civil Liberties, Karnataka, 2003 – Editor).
Excerpt 3: Pg 351
“Female homosexuality is known as tribadism
or lesbianism . . . many lesbians are masculine in type, possibly because of
endocrine disturbances and are indifferent towards individuals of opposite sex.
The practice is usually indulged in by women who are mental degenerates or
those who suffer from nymphomania (excessive sexual desire) . . . lesbians who
are morbidly jealous of one another, when rejected may commit homicide, suicide
or both”.
Let us spend one minute in silence to pray that
the damage caused by this misinformation being read by thousands of medical
practitioners can be undone in some way. Tribadism is a specific act of
female-to-female sex – it is not synonymous with lesbianism. The author does
not know that “masculine type” is a gender role aspect that is not determined
by hormones. He probably never heard that biological sex, gender identity and
sexual orientation are three different aspects of life.
The other statements regarding mental
degeneracy and nymphomania are products of his sexually imaginative (read
biased) mind, and not supported by any contemporary scientific evidence. In
fact, the opposite was well established years before this edition was written.
And did I hear homicide and suicide? I can recall a C-rated Bollywood
production!
In the same semesters of the second year of
the MBBS course, the popular microbiology reference books relate sexually
transmitted infections (STIs), including HIV, with “homosexual acts” and
imprint a conscious and sub-conscious pathologization of homosexuality in the
minds of the medical students.
Now we have well-marinated and well-baked homophobes-in-the-making
entering the third year of the MBBS course. This is where they encounter a
subject called community medicine. This subject deals with the social and
cultural aspects of diseases and their preventive measures. The reference books
on this subject are not homophobic so to say, but often use the terms ‘homosexual’,
‘MSM’ and ‘high risk populations’ interchangeably.
Terms such as MSM (men who have sex with
men or males who have sex with males), which were once coined to conduct
epidemiological studies, become a label in the minds of the students. They begin
to believe that gay men are those men ‘whose only job is to have sex with other
men’. They also learn that ‘gay sex’ is a ‘high risk’ sexual activity. In
summary, they become aware of the ‘dangers of homosexuality’, while
heterosexuality remains imprinted in their minds as the ‘default’, ‘normal’ or
‘safe’ sexuality.
In the final year of the MBBS course, they
meet two major branches of medical science – general medicine and paediatrics. Reference
books on general medicine and paediatrics are usually updated. Some of them
specifically state that homosexuality and bisexuality are not diseases. Some
prefer silence. Some retain the popular reference of homosexuality to STIs and
HIV. But the problem starts with some outdated references on psychiatry. These
books retain outdated information on gender and sexuality and even go ahead to
prescribe behaviour therapy to ‘cure’ homosexuality.
Here are excerpts from A Short Textbook of
Psychiatry, 6th edition, 2006, Dr. Niraj Ahuja, MD, MRC Psych, ex-teaching
faculty of psychiatry at several medical colleges:
“Ways to treat a homosexual individual who
seeks a change in sexual orientation:
i. Psychoanalytic psychotherapy
ii. Behaviour therapy – aversion therapy
(rarely used), covert sensitisation, systematic desensitisation (if there is
phobia of heterosexual relationship)
iii. Supportive psychotherapy
iv. Androgen therapy (occasionally)”
At this point of time, the average medical
students (who prefer mugging up the answers to questions asked in the
examinations of the last few years) find questions on sexuality rare in the board
examinations. So they engage their attention on the more ‘important’ topics
that will make them good students and better doctors. If at all they come
across the newer developments in the fields of gender and sexuality, the older
and earlier knowledge often hinders unlearning.
After a year of internships (with no scope
of discussing gender and sexuality in detail), we get a judgmental,
hetero-normative, presumptive, homophobic, biphobic and transphobic doctor at
our service – wrapped in a white coat and ready for delivery (to society)!
Read the second article in this series here – Editor.
Read the second article in this series here – Editor.
Confused? Disturbed? Just inquisitive? Write in
any query on the mind, body and family to vartablog@gmail.com,
and Dr. Tirthankar Guha Thakurta, teaching faculty at a Kolkata-based medical
college, will be happy to answer them – with due respect to confidentiality.
This is awesome !. The right answer to many who were behaving naive !
ReplyDeletethank u sir for showing us the light
ReplyDeleteThank you Shuvojit.
ReplyDeleteHugs for my student dj.
Great read Sir, awareness must be made at some point or the other and really practical, important aspects of a "social taboo" must be discussed like the questions you've posed and the points that you've made.
ReplyDeleteThank you Shahrukh. :-)
ReplyDeleteAwesomely put words, sir, and much needed under current circumstances. I have never been ur student, but always an admirer. Respect :D!
ReplyDeleteDipayan
MCK
Thanks Dipayan..
Deleteand hugs.. :-)
The author of these books are spreading misinformation....cannot they be asked ( or forced) to remove such misinformations from their next edition ?
ReplyDeleteThank U sir :) hope our UG medical books will be updated at sometym or da other in future :) We need to take da initiative.
ReplyDeleteBodhibrata
MCK
Dear Anonymous, yes! We can surely ask. And we will. Please keep in touch through Varta for the activity- updates.
ReplyDeleteAnd thanks Bodhibrata!
Offences committed by the dominant section of society are natural. Medical education indeed ! Very close to Macaulay.
ReplyDelete