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Being gay and growing up in Bangalore in the late seventies was a curse…. I approached a psychiatrist, assuming he would help me. ‘It’s all in the mind’, he said. My bouts of depression (which I now realise arose from bottling up my gay orientation), he glibly informed me, was a disease called schizophrenia. ‘Your gayness is the cause of delusions and hallucinations.’ He prescribed Orap and Serenace which are powerful neuroleptic medications. The nightmare began in earnest, lasting fift een years, ravaging body and soul, rendering every living moment an excruciating torment, a journey through hell. I failed my courses and I took an overdose of Orap, hoping to die. I was rescued and given shock therapy, which played havoc with my memory for over two years. I had to discontinue college. Efforts to reason with my shrink were shot down perfunctorily. Instead he prescribed a weekly dose of Semap. None of these medicines ‘cured’ me. When all else failed, the shrink suggested I get married. To prepare me for marriage, my shrink had more (mis)prescriptions. Out went Orap and Semap and in came an antiepileptic medication, to ‘enhance sexual performance!’
Excerpt from My Story cf. Gay in the Garden City, Radha Thomas, The Bangalore Monthly Update, September 1998.
Who is the homosexual in India today? In law, a criminal committing unnatural sexual offences; in religion, a sinner who violates God’s laws; and in medicine, a mentally ill person who needs treatment. These three systems of knowledge—law, religion and medicine—deeply impact our understanding of homosexuality in India. The story of one gay man, quoted above, is actually representative of a large number of others— whether gay, lesbian, bisexual ox transgender—who have been put through the moral grinders of an oppressive society due to their sexuality or gender identity.
These powerful ways of understanding the ‘truth’ about homosexuality are, however, increasingly being questioned in India through the emergence of a queer movement. The gaps in knowledge, the underlying contradictions and assumptions within these discourses, as well as the pervasive and near invisible heterosexism, are all increasingly being exposed. Just as the queer discourse questions the incoherence of a century-old anti-sodomy law within the framework of constitutional freedoms; just as voices that affirm both their faith and their sexuality challenge a religious discourse that refuses them space, questions are today being asked about the ‘objectivity’ and ‘neutrality’ of the medical discourse that declares the desires of homosexual people as abnormal and pathological.
In this essay, we will concentrate on trying to understand the ways in which homosexuality has been understood within the medical discourse and how this attempt to define, understand and ultimately control the homosexual has been questioned by the rise of the queer rights movement. …
… [The] classification of homosexuality as a mental illness under the Diagnostic and Statistical Manual (DSM II) came under increasing pressure. Finally in 1973, after years of bitter dispute, the Board of Trustees of the American Psychiatric Association (APA) approved the deletion of homosexuality as a mental disorder. The APA also passed a far-reaching civil liberties resolution, which clearly opposed discrimination against homosexuals and called for repeal of anti-sodomy laws.
The APA, noted, ‘…whereas homosexuality in and of itself implies no impairment in judgement, stability, reliability, or vocational capabilities, therefore, be it resolved, that the American Psychiatric Association deplores all public and private discrimination against homosexuals in such areas as employment, housing, public accommodation…’ (ibid.: 137).
Following this historic development, the opponents of the decision asked for a referendum on the decision by the entire membership of the APA. Through this democratic process, the APA by a majority vote of 58 per cent who supported the decision of the APA versus 37 per cent who opposed it decided that homosexuality was not a mental disorder (ibid.: 148). Thus in the entire controversy over the inclusion of homosexuality as a mental disorder, the scientific basis of classification was itself exposed to ridicule as it showed that the inclusion of homosexuality was as political a position as its deletion. …
… Homosexuality in India was never a medical category, and neither the subject of furious debates as it was in the United States of America. Within India, medical categories were themselves more complex, with ayurveda, unani and homeopathy as more traditional systems of medicine positioning themselves in opposition to allopathic systems. Outside the framework of all these systems of medicine there exist various faith healers, godmen and peddlers of miracle cures for a whole series of ailments. Particularly in the area of sexuality, these informal systems of medicine undoubtedly serves the needs of a majority of the Indian population.
The ‘treatment’ of homosexuality is located within this complex field of competing systems of medicine. However, the most well-articulated position with respect to the treatment of homosexuality encompassing both theoretical viewpoints and treatment protocols remains the domain of Western medicine. Historians of Western medicine in India have seen the very introduction of Western medicine into India as a part of the colonial project of pacification and control of the Indian subject. The disease of plague for example was seen as providing the rationale for the segregation of the European from the Indian.
Comparatively there has been little discussion on the history of the mental health field in India. It is in this context of a limited critique that we need to locate the ‘non-discussion’ around the clinical category of ego-dystonic homosexuality. The Indian medical establishment, i.e., The Medical Council of India, the Indian Medical Association and the Indian Psychiatric Association, has adopted the World Health Organisation (WHO) system of classification of mental and behavioural disorders known as ICD-10 (International Classification of Diseases-10) (1992). This system distinguishes between ego-syntonic and ego-dystonic homosexuality and specifically mentions ego-dystonic homosexuality, bisexuality and heterosexuality as psychiatric disorders.
In ego-dystonic homosexuality, bisexuality or heterosexuality the gender identity or sexual preference is not in doubt, but the individual wishes it were different and seeks treatment. In such a case, according to the WHO, treatment is warranted. In ego-syntonic homosexuality, by contrast, the individual is comfortable with his or her sexual preference or gender identity and treatment is not warranted. Apart from the ego-syntonic/dystonic distinction, if a person faces problems in maintaining a sexual relationship due to the person’s sexual preference or gender identity, then the ICD-10 classifies it as a sexual relationship disorder, which also warrants treatment.
There has been no pressure on the mental health profession to re-evaluate the notion of dystonicity. The following of the category of ego-dystonic homosexuality by the Indian mental health profession is itself a testament to the power of discourse. How once a ‘truth’ is produced by a certain form of knowing, that ‘truth’ has a life of its own. We become the servitors and defenders of that ‘truth’. Mental health professionals have become the uncritical defenders of a category, which is the product of a certain history. The West might have moved on due to the social pressure exerted by the gay and lesbian movement, but Indian professionals remain hostage to the category which was implanted at a certain point in time, and today constitutes nothing but a historical residue impacting the very perception and treatment of homosexuality in India with long-term implications for the lives of those with homosexual desires in India.
Ego-dystonic Homosexuality: What do Doctors Mean?
To figure out the contemporary meaning of ‘ego-dystonic’ homosexuality, we interviewed a section of Bangalore’s mental health community. The dominant opinion really flowed from an understanding of the diagnostic category itself. As one psychiatrist noted:
Ego-dystonicity is a Freudian term and is to do with the lack of coherence of the self. The dystonic patient is often deeply distressed over his/her condition. As a psychiatrist, I cannot ignore the patient’s distress. It is not my job to tell him that it’s okay to be gay, but rather my duty to deal with the patient’s distress by treating him. I have to help the individual.
– Dr PE (Psychiatrist)
The decision to ‘treat’ flows from the understanding that there is a category of ego-dystonic homosexuality. Once the category exists, then doctors diagnose the patient and if they find that he or she is ego-dystonic then there is no choice but to treat him/her. Through this positivist construction of helplessness in the face of an already given category, which needs to be followed, mental health professionals effectively absolve themselves of any ethical responsibility. Since they are following what already exists they are outside politics and decidedly neutral. It is, therefore, not their responsibility to tell a person that it is okay to be gay as their role is merely confined to addressing the person’s distress.
The question of whether the distress can be dealt with by making the person more comfortable with himself or herself is not contemplated. The underlying assumption leaves the primacy and inherent superiority of heterosexuality in the minds of the practitioners unquestioned—the best result for a patient is to make him/her heterosexual, even if briefly and as a conditioned response. This opinion shows no understanding of the histories of the category of ego-dystonicity, instead a preference to take the ICD classification as the ‘truth’.
However, an even more basic problem exists: the very understanding of dystonicity itself. The scientific character of dystonicity itself comes into doubt, as Dr CPB (Clinical Psychologist) notes, ‘the problem is much more when the person is not distressed about homosexuality but about its consequences. Since you cannot separate the individual from the society, the attraction leads to a problem.’
What Dr CPB is articulating is the sheer difficulty in actually specifying what the distress associated with the clinical category of ego-dystonic homosexuality is. The distress is often because of the consequences of being homosexual, i.e., lack of family support, no peer group approval, and so on. It has nothing to do with the abstract supposedly scientific category of ego-dystnonic homosexuality, or an inherent discomfort with one’s sexuality, rather it is fear rooted in the lack of social acceptance—a fear of violence, of alienation and of phobia. In this context ego-dystonicity remains more a social category than a clinical category, and in diagnosing it as a disorder, it merely makes homophobia seem acceptable and inevitable.
This extract is from the essay ‘It’s Not My Jon to Tell You That It’s Okay to Be Gay’ by Arvind Narrain and Vinay Chandran, originally published in Because I Have a Voice, edited by Gautam Bhan and Arvind Narrain, New Delhi: Yoda Press, 2005, with permission from the publisher.
