Author’s note: This article is a tribute to the spirit of resistance that Pride Month is supposed to embody. Like the brick that became a metaphor of resistance in the Stonewall Riots, this piece intends to be a brick thrown at the conversion culture that permeates mental healthcare systems in India in subtle and stark ways and how that disproportionately adds to the distress of queer lives.
‘MHP’ is short for ‘mental health professional’ and I shall be using it time and again in this article.
Conversion constitutes an umbrella of unscientific and queer-phobic malpractices that are imposed on queer clients by MHPs to ‘cure’ their queerness and restore them to the socially coveted path of compulsory cis-heterosexuality. There has been a recent furore in the mental health activist fraternity of India over the death (read: ‘institutionalised murder’) of Anjana Harish, a young bisexual woman from Kerala who was subjected to unethical and illegitimate conversion practices. These conversion attempts were forced on Anjana as evidenced by one of her viral Facebook videos which also incidentally describes her altercations with her family vis-à-vis her sexuality.
The incident was met with organised virtual protests by rights-based mental health organisations, queer rights networks and independent professionals. The multiplicity of voices in disfavour of this malpractice yielded position statements of condemnation from reputed professional bodies of India, working in the field of mental healthcare such as the Indian Association of Clinical Psychologists (IACP) and Association of Psychiatric Social Work Professionals.
It is disheartening to see that so far no affirmative policy framework for queer mental health has been drafted across systems of mental healthcare in India. This perpetuates the activist-professional divide when it comes to addressing queer mental health, as the claims of justice and equity-based healthcare that are raised in queer mental health activism seldom trickle down to ground realities of the MHPs’ chambers. The onus of breaking this divide also seems to lie solely on the activists or on people navigating activist-professional spaces simultaneously. The Queer Affirmative Counselling Practice programme run by the Mariwala Health Initiative in India is a case in point.
If we look at the trajectory of conversations around queer mental health in India, the scenario is pretty dismal. In Sept 2018, Section 377 of the Indian Penal Code was partly read down by the apex court of the country, decriminalising consensual same-sex relationships while explicitly vouching for addressing systemic discrimination by upholding fundamental rights and dignities of queer individuals.
The Mental Healthcare Act of 2017 prohibits discrimination on the basis of gender identity and/or sexual orientation. It particularly harps on voluntary admissions to registered mental health establishments. It also holds patient autonomy and consent sacrosanct for treatment delivery. These legal underpinnings can be utilised to counter conversion practices. However, this does not explicitly speak in disfavour of conversion attempts of LGBT+ individuals. If the law is late in holding out promise to queer individuals, psychiatry has not come even remotely close to a significant debut yet.
In 2018, sometime before the curative petition on Section 377 was to be heard by the Supreme Court, the Indian Psychiatric Society lent its support to the depathologization of homosexuality. It is interesting to note here that because the Mental Healthcare Act of 2017 had already prohibited discrimination on the basis of sexual orientation, depathologization was a logical given and did not add to the discourse in any way – it was, at best, a tokenistic gesture. More importantly, homosexuality was depathologized globally in the early 1990s. The IPS’ public stance on the normalisation of homosexuality in 2018 only reflects the regressive orientation of Indian psychiatry and its allied disciplines towards homosexuality.
By extension, it is frightening to think of the modalities of mental healthcare and treatment that queer individuals in India are exposed to in the absence of systemic normalisation of their identities, let alone affirmative guidelines of praxis. Until Anjana’s death in 2020, there had not been any public advocacy in this regard from the IACP. It also seems plausible that IACP’s anti-conversion stance would not have seen the light of day without substantial pressure from various rights-based initiatives and practitioner Tejas Shah’s open letter to the body.
It is disheartening to see that so far no affirmative policy framework for queer mental health has been drafted across systems of mental healthcare in India. This perpetuates the activist-professional divide when it comes to addressing queer mental health, as the claims of justice and equity-based healthcare that are raised in queer mental health activism seldom trickle down to ground realities of the MHPs’ chambers. The onus of breaking this divide also seems to lie solely on the activists or on people navigating activist-professional spaces simultaneously.
In an age of heightened information access and awareness, it is only rudimentary to reiterate that homosexuality is a normal variant of sexuality, or that transgenderism is not a pathological condition. It clearly does not do much for the queer client who often already knows this thanks to rigorous activism-driven awareness work by the queer community and the experience of belonging to affirmative queer spaces. Psychiatry and allied systems in India clearly need to do better when it comes to mental health advocacy for queer clients.
In Indian psy-circles, there seems to be an archaic complicity with vestiges of past learnings, to historic pathologisation, to promises of a psychoanalytic and behaviouristic ‘cure’ for homosexuality, to internalised bigotry. All of this just goes on to perpetuate a ‘conversion culture’ that overtly or covertly looks at same-sex affinity as something to save the individual from. The client’s discontent with themselves and/or a family member’s appeals for ‘correction’ become grounds on which this complicity then flourishes and thrives.
The professional temptation to capitalise on queer vulnerabilities can be lethal. The fact that a market for conversion practices exists in the Indian context, both in terms of demand and supply, only underscores this haunting reality. The prevalence of this reality is like ‘the missing stair’; one that everyone notices but does not bring into public view. Conversion attempts can be easily dismissed as non-existent for systemic convenience, but they continue to resurface time and again like a ghost from the past – often in glaring newspaper headlines, community whispers, or as trauma experienced by impressionable queer minds that is later revealed to a sensitive professional.
My own experiences, in this regard, as a Clinical Psychology student and trainee have been no less telling. I remember a renowned psychoanalyst telling me in a personal capacity that transgenderism is a defensive protest against authority figures and can be reversed. At another time, I was told by a professor-MHP that a male child with gender-expansive play and ‘cross-dressing’ tendencies needs to be made aware of the role differences between boys and girls so that they do not become confused about their gender-role and identity.
In both these instances, gender non-conformity – which is often intimately tied to queer identification – is considered pathological by default, as something that demands correction. It seems to be the MHPs’ implied onus to save the child from the abominable indicators of queerness.
At the same time, rather hypocritically, classroom instruction highlights the fluidity of gender, the understanding of gender as a spectrum, the social construction of gender roles and the need to counter stereotypes. What is interesting to note is that those textbook recommendations contain explicit pathological references to alternate sexualities, and some even advocate for conversion. Rights-based directives and an affirmative orientation towards queer identifications based on social justice are missing in curricular realities. It is in these systemic inconsistencies that conversion thrives and lives on, rather than being unequivocally perceived as injustice.
In a class on developmental milestone screening of children and adolescents, a professor-MHP reiterated that sex differences in play do not hold much relevance in present times because homosexuality has been depathologized. However, it is not acknowledged at all that psychiatry has been historically wrong and unjust in pathologising something that is not pathological in the first place. The question of ‘relevance’ is therefore redundant. Moreover, the assumption that sexual fluidity in play could only be evidence of homosexuality – the focus on which is negatively connoted – instead of a developmental normal, speaks volumes.
‘Relevance’ was my major takeaway from that class and I heard it come up again in another class on personality assessment where ‘latent’ homosexual tendencies of the client were allegedly spared from screening since it was no longer ‘relevant’. This is also indicative of how psychiatry has the power to arbitrarily label pathologies as ‘relevant’ or ‘irrelevant’ according to the convenience and whims of its proponents.
Additionally, clinical psychology – which has almost become a non-pharmacological correlate of psychiatry – must also bear the burden for being an ally to such oppressive structures. The clinical psychologist makes an entry into the conversion market by providing non-pharmacological interventions in the nature of psychotherapies.
Rights-based directives and an affirmative orientation towards queer identifications based on social justice are missing in curricular realities. It is in these systemic inconsistencies that conversion thrives and lives on, rather than being unequivocally perceived as injustice.
Conversion practices are based on behavioural modification techniques, which, in turn, are guided by aversive conditioning (such as administering shocks to the client if they show arousal to homo-erotic stimuli). They also draw from talking therapies addressed by the psychoanalytic school of thought. Often, the client is asked to engage in heterosexual practices to ‘correct’ their behaviours and normalise it. Electro-convulsive treatment or psychiatric drugs, which fall under the purview of psychiatry, are also a part and parcel of conversion culture. Moreover, in most clinical mental healthcare setups, case formulation and psychological assessment rest with the clinical psychologist, who also provides the psychotherapy. On the basis of the clinical psychologist’s evaluation, drugs are administered by a psychiatrist. There is, therefore, an unspoken collaboration that permeates the clinical psychologist-psychiatrist dyad, and their interests certainly converge. The conversion market is not an exception either.
Considering the institutionalised power and hierarchy of psychiatrists within mental healthcare systems and their direct relation with pharmaceutical capital, it is not hard to see why clinical psychologists must observe a synergy to maintain the status quo and benefit from it.
Merely a few days after Anjana’s death, I got to know that the mother of a close acquaintance was assured a ‘cure’ for her son’s homosexuality by a psychiatrist. This was in the city of Kolkata. I am not even trying to imagine the situation in the suburbs and rural areas of the country.
Aritra Chatterjee is a trans-feminine trainee in Clinical Psychology in Kolkata, India. Their interest lies in cripping conventional systems of mental healthcare and unsettling complicit stakeholders.