By Prateek Sharma
According to Dr. Mathew Varghese, professor
and head of psychiatry at NIMHANS,
there are about 4000
psychiatrists, 1000 psychologists and 3000 mental health social workers in
India. This
stark inadequacy, given the population of this country, is compounded by the
widespread social stigma attached to mental health, both acting together to
prevent individuals from accessing the care they need. As if these were not
enough, we have to contend with yet another obstacle that embraces a bigoted
attitude of mental health professionals towards sexual and
gender minorities- women and members of other marginalised groups.
It’s time we talk about this unnerving situation where a therapist denies treatment to a person or shames them for having contradictory views about society or politics, gender roles, identities, or normative sexual orientations. Such prejudice targets many marginalised communities, and continues to take a big toll on LGBTQIA+ people as well as on (cis, heterosexual) women. Shockingly, none of these occurrences of blatant discrimination get reported in the media and there lies no way to report them.
The recently passed Mental Health Care Bill induces
an element of hope. Clause 21(1)(a) states, “there shall be no discrimination
on any basis including gender, sex, sexual orientation, religion, culture,
caste, social or political beliefs, class or disability”. But the hassle still
remains as to which group of professionals are or aren't prejudiced and how
one evaluates that, because it shouldn't be on the expense of
a further deteriorating mental health of the person in question.
Pervasive prejudice among healthcare continues
to target patients based on caste. For instance, a survey on
untouchability in rural India found that Dalits in over 21% of villages were
restricted from entering private medical care centers. Dalit women in parts of
Uttar Pradesh were barred from receiving health care during pregnancy. A concern for mental health sounds too
much of a far-fetched approach when basic medical provisions are in denial to
the community. Given this
scenario, it seems hardly surprising that sexual orientation and gender would
be exempt from discrimination.
Homophobia, transphobia, sexism and misogyny
are worldwide phenomena. However, they seem most vicious in societies and
communities bound by religious beliefs and traditions that fiercely uphold the
patriarchal norm, and dismiss any alternate way of life. This is by no means
restricted to India. In August 2016, the Governor of the state of Tennessee
(U.S) passed a
bill allowing
therapists to deny therapy to individuals from the LGBTQ communities. This bill
is part of a wave of bigoted legislation across the US that seeks to
institutionalise discrimination against LGBT people, such as North
Carolina’s Bathroom Bill.
Guidelines such as
those of the American Psychological Association (APA) for psychological practice with lesbian, gay, and bisexual clients, adopted in 2011,
lay down best practices based on clinical research and practice.
Despite the availability of such guidelines, and studies that
have resulted in a growing body of evidence
suggesting LGBT youth are at higher
risk for
major depression, generalised anxiety disorder, substance abuse, suicidal
behavior, sexual risk taking, and poor general health care than their
heterosexual counterparts, mental healthcare providers in India and elsewhere
treat homosexuality and bisexuality as pathological conditions to be “cured”
[see work by Vinay Chandran and Arvind
Narrain, and Ketki Ranade]
A
friend says: “ I was
talking about my nightmares to my therapist and while in the middle of that I
accidentally told him that I am a bisexual and out of nowhere he just slapped
me and asked me to go away. The incident did make me badly depressed, took a
toll on my health and everything. I already have ADD and OCD and that’s what I
was seeing the therapist for. So the depression just doubled from there and
although now I have overcome it slightly, it still keeps on running in my
head.” – Vinay (Name changed)
Such prejudice on the
part of mental health professionals is not restricted to just LGBT people.
Heterosexual women are subjected to a barrage of "suggestions" and
"treatment methods" that are polluted by the system of patriarchy. Those seeking
professional help for issues such as depression get pathologized if they do not
choose to live “by the rules”. Women are
slut-shamed, body-shamed, victim-blamed and coerced to conform to traditional
“Indian values”. Such treatment, besides being grossly unethical, ends up
vitiating the depression one has already been caged
Carelessness can also be observed. Being told to look at the
less fortunate lives to overcome the ongoing depression or propagating
religiosity as treatment to surpass stress are some of such widely
performed ill treatments. These heart rending experiences by two women speak
for themselves –
“I
have borderline personality disorder. Got diagnosed at a very young age and was
taken to several psychologists and psychiatrists. While some gave me heavy
doses of medication without hearing me out properly, others gave me huge
lectures on morality about how my lifestyle and opinions are very wrong for a
‘girl’ and how I am difficult and should be more passive. I had been in an
abusive relationship for a long time and my previous psychologists slut-shamed
me for having sex with that person out of marriage and kept calling me a
“psychotic” all the time” – Shruti (Name changed)
“My first psychiatrist told my parents that being 24 years old, I should have been married by now and have started a family of my own as my unmarried status was the root of my depression. He ignored when I said that I’ve very low emotional quotient and it's very difficult for me to recognize feelings. The second one repeatedly kept asking if there was violence at home and how do I know that I get anxiety attacks. He mocked me in every session. When I informed him about the side effects I have been having from the prescribed drugs, he asked me not to blame the drugs. I then refused to respond to his queries. Finally, he rudely asked me and my parents to leave.” - Priyanka (Name changed)
“My first psychiatrist told my parents that being 24 years old, I should have been married by now and have started a family of my own as my unmarried status was the root of my depression. He ignored when I said that I’ve very low emotional quotient and it's very difficult for me to recognize feelings. The second one repeatedly kept asking if there was violence at home and how do I know that I get anxiety attacks. He mocked me in every session. When I informed him about the side effects I have been having from the prescribed drugs, he asked me not to blame the drugs. I then refused to respond to his queries. Finally, he rudely asked me and my parents to leave.” - Priyanka (Name changed)
While minorities in India are still fighting for basic human
rights, access to unstigmatized mental health care has become a very
significant part of social justice. NGOs and community collectives
working on feminist, LGBTIQ* or caste issues can advocate with mental health
professionals to generate this much needed flexibility and open-mindedness.
More broadly, Indian therapists must learn to work
non-judgmentally with clients whose social, cultural, political, sexual and
religious views may diverge widely from their own. Having biased professionals
in the field not only impacts provision of much-needed quality mental health
care but also impedes the ongoing battle for social justice.
Knowledge, sensitivity and a rational attitude
towards the client’s personal issues are essential. There is a dire need to
include minority, feminist and LGBTQ* issues within academic courses and
training. These should comprise of detailed and culturally relevant
content on how minority stress and institutionalized prejudice impact women,
lower castes, LGBTQ*, and
other excluded groups.
LGBT-affirmative
psychotherapy has
been a tremendous step in helping LGBT clients accept their sexual orientation
and/or gender identity Practiced mostly in the west this acceptance is a must
for the regular Indian therapists. Donald
Clark, the first openly homosexual psychologist,
says the following in one of his extended
interviews:
“Gay
people do not grow up in gay families. The vast majority of the time, they do
not have any support around who they are. There is nothing comparable in the
human experience. It is as if the gay child is the result of having an egg from
outer space planted in the uterus of the mother.There is nothing comparable in
the human experience. It is as if the gay child is the result of having an egg
from outer space planted in the uterus of the mother”
On a similar note, Feminist
therapy has
its roots in the interventions by women psychotherapists during the U.S.
feminist movement of the 1960s. Such feminist therapeutic approaches also need
to be adapted for the Indian cultural context.
When bigotry impedes psychological therapy and
other mental healthcare provisions, it not only worsens the condition of the
patient but also holds back humanity as a whole. In a country where privilege
becomes a persona, we are asking for an affordable and accessible mental
health care for those in need and it is demanding a separate
streak of struggle. It's high time to appear concerned for
there remains a limited time to fix such quandaries.
