Saturday, June 20, 2015

Challenging queer ‘cures’

Insight, Jun '15
Psychiatrist Dr. Ujjaini Srimani, advocate Kaushik Gupta and social activist Bappaditya Mukherjee on how to tackle grievous, illegal and unethical attempts to ‘cure’ queer persons

Reshma is 19 and lives in Tangra, Kolkata (some markers of identity changed to maintain confidentiality). Reshma is a trans woman affected by relentless family violence because of her non-conforming sense of gender and attire – so much so that she has started contemplating suicide. Matters came to a serious head recently when she was beaten up by her brother and parents and threatened with eviction from home. This time she mustered the courage to report the matter to the local police station with assistance from Kolkata Rista, a Kolkata-based support forum for trans women. But she was in for a shock when the sub-inspector at the police station sided with her family members instead (though he did record a General Diary based on her complaint), and exhorted them to get her ‘treated’ for the ‘disease’ she was suffering from, even if force was required. If any doctor refused to treat her, he promised to speak to the doctor to ensure that Reshma got the ‘treatment’ she required to become ‘normal’ (euphemism for ‘heterosexual man’).

Fortunately, neither Reshma nor the NGO supporting her backed down. They promptly reported the matter to the higher level of police authorities, where they were better received. The erring sub-inspector was admonished for surpassing his brief and told to register an FIR against Reshma’s family members, following which he stopped insisting on ‘treatment’ for Reshma and instead warned the family members not to beat her up. Reshma’s parents agreed not to throw her out of home, but extracted a promise that she would tone down on dressing up flamboyantly and stop returning home late at night.

But for the supportive role played by higher level police officials, this case is not any different from others reported all over India by queer support forums where gullible (and often homophobic and transphobic) family members attempt a ‘cure’ for their queer sons and daughters, egged on by unscrupulous and / or biased health care providers and as in this case, also by over-zealous police officials playing moral guardians of society.

This scenario persists despite the stands taken by premier health organizations – the World Health Organization, American Psychiatric Association and our own Indian Psychiatric Society – which clearly state that a homosexual or bisexual orientation or a transgender identity is not a disease. Cleverly worded advertisements promising a ‘cure’ for homosexuality and transgender inclinations continue to appear in outdoor media like posters and leaflets pasted on walls and inside local trains, and even in newspapers and magazines. Again, this goes against the stand taken by the Advertising Standards Council of India – click here to read how a complaint against an advertisement from Visakhapatnam claiming a “cure for homosexual problems” was dealt with (see graphic above).

Artwork credit: Prosenjit Pal
Unfortunately, even if laws, policies and standards become progressive over time, some health practitioners either remain stuck in time attitudinally or financially exploit anxious family members (and sometimes queer individuals themselves) with the false promise of a ‘cure’ (read a recent India Today article on this issue here). Yet existing laws, polices and systems do provide some means to tackle the menace of bogus treatments for what are just variations in human gender and sexuality. Varta spoke to psychiatrist Dr. Ujjaini Srimani, advocate Kaushik Gupta and social activist Bappaditya Mukherjee to find out what queer individuals, their well-wishers and NGOs working on gender, sexuality and human rights can do to tackle attempts to ‘cure’ someone’s queerness and ‘set them straight’.

Varta: We know many families want their queer children to be ‘cured’ and ‘normalized’ through medical (and even pseudo medical means). In your experience, what complaints do the families usually come with? What do they seek in terms of ‘normalizing’ their children?

Ujjaini: The families of queer persons often ‘bring’ them to health care providers (with or without their express consent) for a ‘cure’ of their ‘illness’. They are usually brought at a young age during adolescence or young adulthood. Because of the culturally-sanctioned homophobia (as also biphobia and transphobia), most families believe same-sex sexual attraction and a transgender orientation to be abnormalities or perversions. Their usual concerns are around their children’s marriage and parenthood, social disapproval of their children, possible unemployment and other difficulties that might arise out of social ostracization.

They are also bothered about family dishonour leading to possible difficulties to be faced by other children and family members, for example a child’s marriage can become difficult to negotiate if the sibling is labelled as ‘homosexual’. Even for the parents who know that variations in gender and sexuality are normal, the constant pressure from relatives, friends and neighbours makes it very difficult for them to handle the child. Trans persons, especially trans women, are stigmatized because of their socially unacceptable ‘cross-dressing’ and feminine demeanour. The ‘guardians’ expect the health care providers to examine and investigate the ‘minor’ (age wise or social location wise, wherein an adult is treated like a minor) to find out the ‘causative hormonal defect’ or the ‘brain abnormality’ in order to correct it. If that is not found or even attempted by the health care provider, then they want their children to at least be counselled to leave the ‘deviant path’ and ‘come back to normal life’. At times, health care providers are also ambivalent and work as moral guardians acting out of prejudices contributing to more confusion and phobia.

Bappaditya: The entire concern is pseudo clinical! There is no question of ‘normalizing’ any sexual preference, and any attempt to do so is violence and cannot be justified by any logic, science or any other field of study. When most parents seek ‘help’ to ‘cure’ their children, they essentially want them to stop mingling with other queer individuals, and eventually get into a heterosexual marriage – irrespective of their interest or willingness, which too is violence.

Varta: The first question may be seen as related to ‘demand’ for ‘cure services’. In terms of the ‘supply’ of such ‘services’ what is in practice in India today?

Ujjaini: Queer persons are often admitted to mental hospitals for a ‘cure’, and unofficial use of ‘shock therapy’, that is, electroconvulsive therapy (ECT) for aversion or conversion is also known. Experimentation with hormones or homeopathic and Ayurvedic medicines on trans persons without a prescription is done sometimes claiming it to be a ‘help’ for the ‘sufferer’. There are clinics for sexual problems where unknown treatment and counselling methods are applied. The potential for harm in such therapies and experiments can’t be overstated. Then again, both within and outside mental hospitals and clinics, health care providers sometimes over-prescribe medicines that may have side effects like sedation and slowing down of a person’s movements. They may verbally talk about ‘treating’ homosexuality or transgender inclinations to the family members and even queer individuals, but do not write so on the prescription. Rather they justify the over-prescribed medicines as necessary to control anxiety, anger or depression. This also provides them an escape route if challenged by anyone about the veracity of their ‘treatment’.

Families sometimes take their children to faith healers, astrologers, religious places or give them unknown Ayurvedic medicines. Many a times queer persons, out of pressure, frustration or internalized stigma, or for other reasons, land up in marriage and become parents. But very often they lead an unhappy life thereafter. It is understandable that their spouses may also suffer endlessly. The act of marriage and childbirth is often claimed by family, health care providers and so-called healers as indicators of ‘successful conversion’.

Varta: If an attempt to ‘cure’ a queer person takes place, whether from the family's side or a health professional’s side or both, what are the steps that can be taken by the person concerned and his or her well-wishers (friends and perhaps supportive family members)?

Ujjaini: Queer persons should first and foremost know that a homosexual or bisexual orientation, or a transgender identity, is nothing that needs to be ‘cured or normalized’ through any kind of treatment. These are already normal human traits in themselves. Only if an individual is suffering from depression, addiction or any other mental illness associated with non-acceptance of their sexual orientation or gender identity that treatment through counselling and / or medication may be needed – mind you, to treat the depression or the addiction, not to normalize the sexual orientation or gender identity!

Bappaditya: Second, they should reach out to supportive people within their families, friends and ‘safe spaces’ like NGOs that work to protect the health and rights of queer people [several such NGOs are listed in the Resources column of Varta]. They may take the support of these well-wishers to start a dialogue with their parents and other family members. The idea is not just to empathize with the family members about their concerns around safety and well-being, but also to explain the futility of trying to fix something that is not broken in the first place.

Ujjaini: Talking to the family members may or may not help, but queer persons facing ‘treatment’ attempts must keep records of any ‘treatment’ suggested or attempted. No form of medicines should be taken without a proper prescription that bears the name and qualifications of the health care provider and registration number provided by an authorized medical body. The prescription should have the health care provider’s signature with date, and they should also be asked for the reasons for prescribing medicines.

ECT, if advised, should be in writing and the health care provider must explain why it is needed. A written consent of the person to be administered ECT or a family member should be taken after attending to all the queries around ECT. It is important to know that ECT can be used rationally for some severe mental illnesses following an evidence-based protocol, but it can’t be used for aversion or conversion therapy in relation to one’s sexual orientation or gender identity.

Bappaditya: Parallel to all of this, queer persons must resist abuse and violence – physical, emotional, sexual – and legal steps should be taken whenever possible.

Varta: What can be done legally against the family and the health care providers? Under what laws or acts can one seek legal redress for forced and bogus treatment?

Kaushik: After a person attains the age of 18, they have the right to decide what to do with their life, except causing grievous hurt or death to themselves. They can’t be forced to undergo any medical treatment if they don’t suffer from unsoundness of mind, which impairs their ability to decide for themselves. Thus if the parents or anyone else forces an adult queer person to undergo a ‘treatment’ for their sexual orientation or gender identity against their will, they can lodge a complaint with the local police station about the criminal intimidation (threats) and physical hurt caused by their family members or others.

The police complaint can be lodged by the victim, their friends, an NGO or anyone who comes to know of such an illegal act. The criminal law can be set in motion by anyone and not necessarily only the victim. However, the complaint must be supported by cogent evidence or else it will fail.

A formal complaint can be filed also against the erring health care provider with the Medical Council of India. The complaint should be supported by a recording of the in-chamber conversation with the health care provider. If the health care provider has put out advertisements claiming a ‘cure’ for homosexuality or transgender inclinations, then copies of the advertisements should also be enclosed. If the Medical Council of India does not take any steps, the complainant can move an appropriate court to get a direction for effective steps. If there is sufficient material evidence, criminal complaints can also be lodged against the health care provider or clinic concerned.

One of the legal provisions under which health care providers making false claims through advertisements can be charged is the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954. While the ‘disease’ of a non-normative sexual orientation or gender identity does not fall within the schedule of diseases as mentioned in Section 3 of the Act, we can try to take help of Section 4 of the Act, which states: “Prohibition of Misleading Advertisements Relating to Drugs – Subject to the provisions of this Act, no person shall take any part in the publication of any advertisement relating to a drug if the advertisement contains any matter which a) directly or indirectly gives a false impression regarding the true character of the drug; or b) makes a false claim for the drug; or c) is otherwise false or misleading in any material particular”. However, the complainant has to prove with evidence that the said health care provider or clinic is guilty of making the aforesaid claims.

It is important to mention here that the law does not give any protection in the event the parents of a person above 18 years decide to throw them out of their house because of their sexual orientation or gender identity.

Varta: What roles can NGOs working with queer people play?

Ujjaini: Apart from reaching out to queer people victimized by family members and health care providers, NGOs must engage sensitive health care providers and medical bodies to hold interactive programmes with family members, health professionals from different fields of medicine (including all categories of mental health professionals), students of medicine and public health, medical and social researchers, faith healers, religious leaders and even quack medical practitioners. The participation of queer individuals should be facilitated in these interactions so as to generate greater sensitivity. The focus in these sessions should not be only on queer people who are adults, but also adolescents who have lesser agency to resist false treatment attempts.

Bappaditya: There is an immediate need to create a group of mental health professionals, lawyers, social activists, media persons and above all ‘treatment survivors’ to run a sustained social and legal campaign against the racket of false ‘cures’ for sexual orientations and gender identities that don’t meet the so called social norms.

Ujjaini: One of the most important functions that NGOs can perform is to enable queer individuals to focus on self-empowerment through education, livelihood skills and financial self-reliance. An independent existence can often by the best defence against the violations of one’s rights.

Note: The terms ‘health care provider’ and ‘health professional’ have been used in this article in an umbrella sense to cover mental health professionals like psychiatrists, psychologists and counsellors, as well as other health care providers – Editor.

Read more related articles in Varta:

Homophobia – An Emerging Disorder, Dr. Tirthankar Guha Thakurta, January 2014 issue

The Homophobic Doctor, Dr. Tirthankar Guha Thakurta, March 2014 issue

Psychiatry and Homosexuality, Dr. Tirthankar Guha Thakurta, April 2014 issue

Bappaditya Mukherjee is Founder and Chief Anchor at Prantakatha (Stories of Change from the Margin).

Kaushik Gupta is a lawyer by profession, a photographer by passion, and happy to answer your queries on legal matters around gender and sexuality. Write in your queries to, and they will be answered with due respect to confidentiality.

Dr. Ujjaini Srimani is a consultant psychiatrist based in Kolkata who engages in endeavours to bring about social change.

No comments:

Post a Comment