Its not my job to tell you its okay to be gay

Medicalisation of homosexuality: a queer critique

Arvind Narrain and Vinay Chandran Introduction Being gay and growing up in Bangalore in the late seventies was a curse approached a psychiatrist! assuming he would help me" # t$s all in the mind% he said" My &outs of depression 'which now realise arose from &ottling up my gay orientation(! he gli&ly informed me! was a disease called schi)ophrenia" #*our gayness is the cause of delusions and hallucinations"% +e prescri&ed ,rap and -erenace which are powerful neuroleptic medications" .he nightmare &egan in earnest! lasting fifteen years! ravaging &ody and soul! rendering every living moment an excruciating torment! a /ourney through hell" failed my courses and too0 an overdose of ,rap! hoping to die" was rescued and given shoc0 therapy! which played havoc with my memory for over two years" had to discontinue college" 1fforts to reason with my shrin0 were shot down perfunctorily" nstead he prescri&ed a wee0ly dose of -emap" None of these medicines 2cured$ me" 3hen all else failed! the shrin0 suggested get married" .o prepare me for marriage! my shrin0 had more 'mis(prescriptions" ,ut went ,rap and -emap and in came and anti4epileptic medication! to 2enhance sexual performance5$" 1xcerpt from My Story cf Gay in the Garden City, 6adha .homas, .he Bangalore Monthly 7pdate! -eptem&er 899:" 3ho is the homosexual in ndia today; n law! a criminal committing unnatural sexual offences< in religion! a sinner who violates =ods laws< and in medicine! a mentally ill person who needs treatment" .hese three systems of 0nowledge >> law! religion and medicine >> deeply impact our understanding of homosexuality in ndia" .he story of one gay man! quoted a&ove! is actually representative of a large num&er of others! whether gay! les&ian! &isexual or transgender! who have &een put through the moral grinders of an oppressive society due to their sexuality or gender identity" .he three systems contort and misrepresent perceptions a&out homosexuality" .hese powerful ways of understanding the #truth% a&out homosexuality are! however! increasingly &eing questioned in ndia through the emergence of a queer movement" .he gaps in 0nowledge! the underlying contradictions and assumptions within these discourses! as well as the pervasive and near invisi&le heterosexism! are all increasingly &eing exposed" ?ust as the queer discourse questions the incoherence of a century old anti4sodomy law within the framewor0 of constitutional freedoms< and /ust as voices that affirm &oth their faith and their sexuality challenge a religious discourse that refuses them space! questions are today &eing as0ed a&out the #o&/ectivity% and #neutrality% of the medical discourse that declares the desires of homosexual people as a&normal and pathological" n this paper! we will concentrate on trying to understand the ways in which homosexuality has &een understood within the medical discourse and how this attempt to define! understand and ultimately control the homosexual has &een questioned &y the rise of the queer rights movement" After &riefly tracing the emergence and understanding of

Medicalisation of homosexuality: A queer critique

homosexuality in early 3estern medicine! we will focus on the ways in which issues of sexuality are understood &y ndian mental health practitioners! located particularly in Bangalore" @inally! we explore the ways in which the queer movement has and continues to challenge the construction of sexuality within medicine! showing how prevailing social norms and pre/udices against homosexual people are often the driving force &ehind #medical% diagnosis that deem their desires #a&normal"% How western medicine got to know the homosexual +omosexuality has a &iological &asis and if we find this &asis one can treat homosexuality" thin0 they will definitely find a treatment" @or example in some mental illnesses especially depression! if we treat the .A receptors using drugs! the patient feels &etter" -imilarly if you compare normal heterosexuals and homosexuals and do a neuro4imaging and see the difference in &iological parameters then one can pinpoint possi&ly two or three factors and try and change them" Dr. PE (Psychiatrist) n today$s world! young people have to fight &oth against peer pressure and the media! &oth of which are very strong" &elieve that people should &e free! &ut not free to commit suicide or to commit homosexuality" 3hen we tal0 a&out freedom! we should as0 the question! if =od would want you to do that particular act" CB (Counsellor) -odomy is illegal in ndia" Dr. CPB (Clinical Psychologist) .here are many traditions of thin0ing a&out sexuality in western medicine" .hese traditions have played a constitutive role in the emergence of the realm of #a&normal sexuality% as a recognised discipline of study" Bisciplines as diverse as sexology! psychology and psychiatry have produced thin0ing a&out the #a&normal% in sexual terms! contrasting it with the only accepta&le or #normal% form of desire >> within heterosexual marriages" +istorically! to understand the #normal%! one has needed to stigmatise #perverse% sexualities" As 3ee0s put it #the negative side of this classificatory enthusiasm was a sharp reinforcement of the normalthe de&ates over the causes of the perversions and the eager descriptions of even the most outrageous examples inevita&ly wor0ed to emphasi)e their pathology! their relationship to degeneracy! madness and sic0ness! and helped to reinforce the normality of heterosexual relationships"%8 .he founding father of the tradition of classifying sexual diversity as sexual a&normality was Viennese psychiatrist 6ichard Crafft41&&ing who! in Psychopathia Sexualis '8:9D(! viewed human sexual &ehaviour as a collection of loathsome diseases" #Beviations% from this #normal% pattern Crafft41&&ing viewed as perversions! including sadism! masochism! necrophilia! urolagnia! fetishism! nymphomania! satyriasis! homosexuality! voyeurism and exhi&itionism"A Bristow notes! #=iven the overwhelming quantities of evidence that Crafft41&&ing su&sequently produces on the topic of sexual perversion! Psychopathia Sexualis ma0es the distinct impression that the highest form of heterosexual love is menaced on all sides &y an epidemic of perverse sexual &ehaviours"%E .hough Craft41&&ing wrote his wor0 towards the end of the nineteenth century! his conceptual framewor0 of a&normal sexuality as opposed to
8 ?effery 3ee0s, Sexuality, 6outledge! 89:8" pF8" A 1dward M Brecher! +istory of human sexual research and study cf" Alfred M @reedman et" al" Comprehensive text&oo0 of Gsychiatry! 3illiams and 3illiams! Baltimore! 89FH! E ?oseph Bristow! -exualty ! 6outledge! Iondon! 899F! p"EJ"

Medicalisation of homosexuality: A queer critique

loo0ing at the a&ove as an example of &enign sexual diversity! remains remar0a&ly resilient and continues to influence a&normal psychology text &oo0s even in twentieth century Bangalore"D 3hen Craft41&&ing$s thin0ing is specifically applied to homosexuals it results in conclusions such as the one arrived at &y Bei&er" Bei&er! after a study of 8JJ homosexuals and 8JJ heterosexuals! concluded that homosexual orientation was a result of a pathogenic family with a domineering mother and a detached or a&sent father" Bei&er in his study went on to pathologise various aspects of homosexual existence" +e noted that! #Because of its pathological status! the possi&ility of esta&lishing a sta&le and intimate homosexual relationship is precludedhence there is ceaseless! compulsive! anonymous cruising%K .his conclusion &y psychoanalysts resulted in efforts to treat this pathological condition" 1arly efforts at treatment included the use of surgical techniques" @or example! -tienach in 898F was the first to use a surgical technique to #cure% homosexuality" +e performed a unilateral castration on a homosexual man! and then transplanted testicular tissue from a heterosexual man into the castrated patient! in the hope that he would &e cured" #At least 88 men were operated on from 898H to 89A8" .he experiments were not successful"%H n 89HA! 6oeder introduced a new surgical technique" -ince then FK men considered sexually a&normal have &een su&/ected to hypothalamotomies" Most of these men had either &een imprisoned or involuntarily committed to medical institutions"F Apart from these surgical experiments there was also the attempt to treat homosexuality using hormones &ased on the theory that #homosexuality means that the men are inadequately masculine and the women are overly masculine"% +owever the therapeutic method! which achieved a culturally hegemonic status in the 3estern world! was what is today called &ehavioural therapy" Behavioural therapy was &ased on the wor0 of physiologist Gavlov who showed that repeated exposure to a certain stimuli in a certain environment could succeed in eliciting a &ehavioural response from a patient" +is wor0 showed that 2previously neutral environmental stimulus 'e"g" a &ell( when temporarily preceding a naturally occurring automatic response 'e"g" salivation in the presence of food( could acquire the power to elicit the automatic reaction after many such pairings >> in simple terms! if you heard a &ell immediately &efore seeing food often enough! the sound of the &ell would then ma0e you salivate in expectation of the food" .his phenomenon was later descri&ed as #classical conditioning% and a num&er of the current treatment strategies used &y &ehaviour modifiers are derived from the principles of classical conditioning"$: 3hen &ehavioural therapy was applied to the treatment of homosexuality it too0 the form of exposing! say! a male patient to male nude pictures and su&/ecting the patient to a
D As recent as three years ago! a text &oo0 on a&normal psychology prescri&ed &y Bangalore 7niversity for graduate and postgraduate studies noted in the Chapter on sexual perversions! #it is a wrong notion with some persons that homosexuality is characteristic of only children and adolescents" n fact! this perversion may &e found in any person at any age and in &oth the sexes" nnocent children and adolescents pic0 up this ha&it through association with perverted persons" +omosexuality in women may &e found in those who are either unmarried! widows or deserted &y or separated from their hus&ands on certain grounds" -uch women see0 partnerships with other such women who also desire their sexual gratification through the same process% -" G" Chau&e! A nor!al Psychology" Ia0shmi Narain Agarwal" Agra" 899K" pDE:4DE9" K 6onald Bayer! +omosexuality and American psychiatry! Basic Boo0s ! New *or0! 89:8 ! pDH" H Charles -ilverstein! Gsychological and Medical .reatments of +omosexuality! c". ?ohn C =onsiore0 et.al" ! #o!osexuality$ %esearch i!plications "or pu lic policy ! -age! Iondon! 8998! p 8JF" F &id" : LMichel +ersen et. al" ! +istorical perspectives in Behaviour Modification: ntroductory comments ! cf" ! Grogress in Behavior Modification ! Vol 8 ! Michel +er)en 1d" ! et. al" ! Academic Gress ! New *or0! 89FK! p" A"

Medicalisation of homosexuality: A queer critique

mild electric shoc0 so that the patient would &egin to lin0 the imagery to feelings of pain" .his was followed &y techniques wherein one tried to increase the pleasure in heterosexuality" ,ne of the methods used was orgasmic reconditioning which #involves mastur&ation to 2deviant$ imagery! with a heterosexual image su&stituted /ust &efore e/aculation" .he appropriate image is then gradually su&stituted at an earlier stage of the mastur&atory sequence until it &ecomes its sole content" Case studies have demonstrated the usefulness of this technique for increasing heterosexual arousal in su&/ects see0ing treatment for homosexuality"%9 3hat is interesting to note is that there is a gap &etween the diagnosis and the proposed treatment" -tudies in the aetiology of homosexuality have pointed to everything from the pathogenic family! to lac0 of heterosexual contact as the cause" +omosexual orientation is seen as a product of a deep psychic process! &ut the proposed treatment 'in the form of &ehavioural therapy( addresses homosexual orientation as a mere question of &ehaviour" t seems inexplica&le how! if something is so deeply rooted and pathological as homosexuality was &elieved to &e! it was still considered possi&le to &ring a&out change &y treating it as a &ehavioural pattern" Questioning homosexuality as a sexual perversion t was not till the emergence of the gay and les&ian movement that the hegemonic status of the pathology paradigm was seriously ruptured" t was the &eginning of gay militancy after the -tonewall riots in 89H98J! which resulted in a dramatic transformation of the existing social milieu surrounding homosexuality" 3hile previously homophile organi)ations requested inclusion and stressed a gradualist approach! -tonewall changed the nature of gay activism" As one of the activists noted! #3e consider the -tonewall riots to mar0 the &irth of the gay li&eration movement! as that was the first time that homosexuals stood up and fought &ac0"%88 .his new culture of militancy found a worthwhile target in the psychiatric treatment of homosexuals" =ay activists used various strategies to question the framewor0 of pathology" &irstly! activists arrived at a more political understanding of the cultural power of psychiatry" Gsychiatry was no more seen as a science &ut rather an ela&orate &ody of 0nowledge! which had replaced religion as the ar&iter of social values" .he critique of psychiatry$s inclusion of homosexuality in fact drew upon a wider critique of the very process of the medicalisation of social life" t drew upon anti4psychiatrist wor0 such as that of .homas -)as) who in their wor0 went on to #expose the ways in which psychiatry had assumed the social function previously performed &y religious institutions" As a guarantor of the prevailing social ethos! he argued! it sought to redefine deviations from ethical! political and legal norms &y first the invention and then the expansion of the concept of mental illness"%8A Secondly! the authority of psychiatry to spea0 on &ehalf of a silent population was questioned" =ay activists such as @ran0 Cameny questioned the right of psychiatrists to spea0 on their &ehalf" Cameny quite simply asserted that! #3e are the true authorities on homosexuality whether we are accepted as such or not"% 8E .his viewpoint was ta0en forward
9 Celly B Brownell et" al" ! .he Behavioral treatment of sexual deviation ! cf" Michel +er)en! Grogress in &ehaviroral modification! 1d" ! et" Al" ! Academic Gress ! New *or0 ! 89FK" pH8E" 8J ,utside a &ar called the -tonewall! in New *or0! the riots mar0ed the first time that patrons of a gay &ar fought &ac0 against policemen who tried to raid the &ar! a common practice with gay &ars at the time" 88 6onald Bayer! +omosexuality and American psychiatry! Basic Boo0s ! New *or0! 89:8 ! p9E" 8A &id" pKD" 8E &id" :A"

Medicalisation of homosexuality: A queer critique &y repeatedly asserting the right of homosexuals to spea0 in forums of psychiatrists where homosexuality was the o&/ect of discussion! and deny narratives that portrayed them as deviants" 'hirdly! the critique of pathologisation tapped into a cultural current! which was de4 lin0ing procreation from pleasure" .he hegemonic status of the ideology of sexuality as procreation was questioned &y the rise of the feminist movement" &inally, the critique was successful only &ecause the strategy &uilt upon the new culture of fighting &ac0 as opposed to reasoned speech" Activists disrupted the functioning of Gsychiatric conferences! through sit4ins and what were called #)aps%" Conferences were disrupted with gay activists ta0ing the microphone and denouncing psychiatry as the enemy incarnate" Bayer concludes! #.o those who had so &oldly challenged the professional authority of psychiatry it was clear that only the threat of disorder or even of violence had &een a&le to create the conditions out of which such a dialogue could occur" .hat lesson would not &e forgotten"%8D Shift in the classification of homosexuality Bue to the factors outlined a&ove! the classification of homosexuality as a mental illness under the Biagnostic and -tatistical Manual 'B-M ( came under increasing pressure" @inally in 89FE! after years of &itter dispute! the Board of .rustees of the American Gsychiatric Association 'AGA( approved the deletion of homosexuality as a mental disorder" .he AGA also passed a far4reaching civil li&erties resolution! which clearly opposed discrimination against homosexuals and called for repeal of anti sodomy laws" .he AGA noted! #whereas homosexuality in and of itself implies no impairment in /udgement! sta&ility! relia&ility! or vocational capa&ilities! therefore! &e it resolved! that the American Gsychiatric Association deplores all pu&lic and private discrimination against homosexuals in such areas as employment! housing! pu&lic accommodation%8K @ollowing this historic development! the opponents of the decision as0ed for a referendum on the decision &y the entire mem&ership of AGA" .hrough this democratic process! the AGA &y a ma/ority vote of K:M who supported the decision of the AGA versus EFM who opposed it decided that homosexuality was not a mental disorder" 8H .hus in the entire controversy over the inclusion of homosexuality as a mental disorder! the scientific &asis of classification was itself exposed to ridicule as it showed that the inclusion of homosexuality was as political a position as its deletion" .he position adopted &y B-M V should &e understood in the context of the various AGA statements made since 89FE! which have &een supportive of gay and les&ian civil rights" Among the most recent is a 899: statement regarding so4called reparative therapies" t states that #the American Gsychiatric Association opposes any psychiatric treatment! such as 2reparative$ or 2conversion$ therapy which is &ased upon the assumption that homosexuality per se is a mental disorder or &ased upon the a priori assumption that the patient should change hisN her sexual homosexual orientation"% n specific regard to the issue of civil unions! in AJJJ! the AGAOs Board of .rustees voted to affirm that! #.he American Gsychiatric Association supports the legal recognition of same sex unions and their associated legal rights! &enefits! and responsi&ilities"%8F
8D &id" p"8JD" 8K ( id" p8EF" 8H ( id" p 8D:" 8F http:NNwww"finnqueer"netN/uttu"cgi;sP88HQDFQA

Medicalisation of homosexuality: A queer critique Mental health and homosexuality in the Indian context: owards a history

+omosexuality in ndia was never a medical category! which was a su&/ect of furious de&ates as it was in the 7-A" 3ithin ndia! medical categories were themselves more complex! with ayurveda! unani! and homeopathy as more traditional systems of medicine positioning themselves in opposition to allopathic systems" ,utside the framewor0 of all these systems of medicine there exist various faith healers! god4men and peddlers of miracle cures for a whole series of ailments" Garticularly in the area of sexuality! the informal system of medicine undou&tedly serves the needs of a ma/ority of the ndian population" .he #treatment% of homosexuality is located within this complex field of competing systems of medicine" +owever the most well articulated position with respect to the treatment of homosexuality encompassing &oth theoretical viewpoints and treatment protocols remains the domain of western medicine" +istorians of western medicine in ndia have seen the very introduction of western medicine into ndia as a part of the colonial pro/ect of pacification and control of the ndian su&/ect" .he disease of plague for example is seen as providing the rationale for the segregation of the 1uropean from the ndian" Comparatively there has &een little discussion on the history of the mental health field in ndia" t is this context of a limited critique that we need to locate the #non4discussion% around the clinical category of ego4dystonic homosexuality" .he ndian medical esta&lishment! )i*.! .he Medical Council of ndia! the ndian Medical Association and the ndian Gsychiatric Association! has adopted the 3+, system of classification of mental and &ehavioural disorders 0nown as CB48J '899A(" .his system distinguishes &etween ego4 syntonic and ego4dystonic homosexuality and specifically mentions ego4dystonic homosexuality! &isexuality and heterosexuality as psychiatric disorders" n ego4dystonic homosexuality! &isexuality or heterosexuality the gender identity or sexual preference is not in dou&t! &ut the individual wishes it were different and see0s treatment" n such a case! according to the 3+,! treatment is warranted" n ego4syntonic homosexuality! &y contrast! the individual is comforta&le with his or her sexual preference or gender identity and treatment is not warranted" Apart from the ego4syntonicNdystonic distinction! if a person faces pro&lems in maintaining a sexual relationship due to the person$s sexual preference or gender identity! then the CB48J classifies it as a sexual relationship disorder! which also warrants treatment" .here has &een no pressure on the mental health profession to re4evaluate the notion of dystonicity" .he following of the category of ego4dystonic homosexuality &y the ndian mental health profession is itself a testament to the power of discourse" +ow once a #truth% is produced &y a certain form of 0nowing that #truth% has a life of its own" 3e &ecome the servitors and defenders of that #truth%" Mental health professionals have &ecome the uncritical defenders of a category! which is the product of a certain history" .he 3est might have moved on due to the social pressure exerted &y the gay and les&ian movement! &ut ndian professionals remain hostage to the category which was implanted at a certain point in time! and today constitutes nothing &ut a historical residue impacting the very perception and treatment of homosexuality in ndia with long term implications for the lives of those with homosexual desires in ndia" !go"dystonic homosexuality: #hat do doctors mean $ #Anyway! aversion therapy causes less tissue damage than anal sex% Dr. CPB (Clinical Psychologist) .o figure out the contemporary meaning of #ego4dystonic% homosexuality! we interviewed a section of Bangalore$s mental health community" .he dominant opinion really

Medicalisation of homosexuality: A queer critique

"

flowed from an understanding of the diagnostic category itself" As one psychiatrist noted: 1go4dystonicity is a @reudian term and is to do with the lac0 of coherence of the self" .he dystonic patient is often deeply distressed over hisNher condition" As a psychiatrist! cannot ignore the patient$s distress" t is not my /o& to tell him that it$s o0ay to &e gay! &ut rather my duty to deal with the patient$s distress &y treating him" have to help the individual" Dr. PE (Psychiatrist) .he decision to #treat% flows from the understanding that there is a category of ego4 dystonic homosexuality" ,nce the category exists! then doctors diagnose the patient and if they find that he or she is ego4dystonic then there is no choice &ut to treat" .hrough this positivist construction of helplessness in the face of an already given category! which needs to &e followed! mental health professionals effectively a&solve themselves of any ethical responsi&ility" -ince they are following what already exists they are outside politics and decidedly neutral" t is hence not their responsi&ility to tell a person that it is o0ay to &e gay as their role is merely confined to addressing the person$s distress" .he question of whether the distress can &e dealt with &y ma0ing the person more comforta&le with himself or herself is not contemplated" .he underlying assumption leaves the primacy and inherent superiority of heterosexuality in the minds of the practitioners unquestioned >> the &est result for a patient is to ma0e himNher heterosexual! even if &riefly and as a conditioned response" .his opinion shows no understanding of the histories of the category of ego4dystonicity! instead preferring to ta0e the CB classification as their #truth%" +owever an even more &asic pro&lem arises! which is the very understanding of dystonicity itself" .he scientific character of dystonicity itself comes into dou&t! as Br" CGB 'Clinical Gsychologist( notes! #.he pro&lem is much more when the person is not distressed a&out homosexuality &ut a&out its consequences" -ince you cannot separate the individual from the society! the attraction leads to a pro&lem"% 3hat Br" CGB is articulating is the sheer difficulty in actually specifying what the distress associated with the clinical category of ego4dystonic homosexuality is" .he distress is often &ecause of the consequence of &eing homosexual i"e" lac0 of family support! no peer group approval etc" t has nothing to do with the a&stract supposedly scientific category of ego4dystnonic homosexuality! or an inherent discomfort with one$s sexuality! rather it is fear rooted in the lac0 of social acceptance >> a fear of violence! of alienation! and of pho&ia" n this context ego4dystonicity remains more a social category than a clinical category! and in diagnosing it as a disorder! it merely ma0es social homopho&ia seem accepta&le" he cause of homosexuality: % ceaseless etiological preoccupation he &uestion as to why are people homosexual exercised considera'le fascination among the interviewees( !veryone has an opinion on the &uestion( I feel that young people are 'eing trapped in )angalore* on the roads* in pu's* they are enticed 'y offer of food and drinks and once they get addicted then they feel there is no way out( here are so many young people who come to me* that it is really &uite shocking( In a meeting with gay activists* I told them that you are trapping people into homosexuality+ they kept &uiet 'ecause they knew it was the truth( ,) -,ounsellor. %t a particular age the person of the opposite sex appears very mysterious and there is no outlet in our society* so what people do is that to release

Medicalisation of homosexuality: A queer critique

sexual tension they adopt whatever is availa'le and get fixated on it( /eople do have friends of the same sex and they can care a lot a'out each other( )ut development of interest in the opposite sex is natural( However* if they get fixated* then they continue with their homosexual 'ehaviour( #e try finding out what age these feelings start$ #hat is the aetiology$ #hen did this orientation 'ecome a fixation$ 0r( ,/) -,linical /sychologist. 1Homosexuality doesnt do any good1the homosexual himself was not the pro'lem 'ut his condition was due to poor parenting( /eople who feel they are homosexuals and want to change should come in early to cure the pro'lem1if a homosexual is happy then theres no pro'lem* 'ut if they arent then I will help them( 0r( ,% -,ounsellor. he answers themselves illustrate the way the issue of aetiology has 'een ela'orated 'y existing discourses( %mong the most powerful influences has 'een the discourse of psychiatry with the theories of homosexuality resulting from a pathogenic family( hus the 2homosexual fixation3 is explained 'y the lack of normality in the family environment* which could include the 2victim3 suffering from child sexual a'use( % further theorisation contends that the fixation* which interferes with the normal route of sexual development* might 'e the result of a particularly Indian context* where the two sexes are rigorously separated( here is also the link 'etween early childhood experience and pleasure* which could lead to a homosexual orientation 'eing made( 4inally the homosexual orientation is linked to the trapping of young 'oys 'y people who are already homosexual( #ithin this discourse there is a vigorous resistance to the idea that homosexuality could 'e natural and an insistence of an active 2recruitment policy3 'y homosexuals themselves( #hatever might 'e the diverse discourses from which these ideas of origin come* what is clear is that the very focus on producing these forms of knowledge a'out the aetiology of homosexuality is itself a process of sta'ilising a form of heterosexism( he very production of homosexuality as an o'5ect of knowledge* leaves heterosexuality as a neutral position 'eyond the pale of study( %s 0avid Halperin notes* 21)y constituting homosexuality as an o'5ect of knowledge* heterosexuality also constitutes itself as privileged stance of su'5ectivity 66 as the very condition of knowing 66 and there'y avoids 'ecoming an o'5ect of knowledge itself* the target of possi'le criti&ue(378 he homosexual as pervert: 0octors speak out 3hat are the ideas! which form part of the very way the physician thin0s; 3here do these ideas come from; .hese ideas come from not only what the what the medical field has to say! &ut also as importantly! it is constructed &y the ideas prevalent in the discourse of the law and of religion" .he value systems! ways of thin0ing of the doctor &ecomes of crucial importance particularly when a heterosexual doctor is treating a homosexual patient" Very often! there is a wide gap &etween what the heterosexual person sees as #right &ehaviour% and what the homosexual person$s &ehaviour is" .o give a few examples of what doctors in Bangalore thin0 a&out homosexuals: Homosexual people* 'ecause of the societal pressure* do not have relationships which last long( hey change their partners fre&uently( hey have issues of how to deal with the pain of 'reak ups etc1there are those
8: Bavid +alperin! Saint+ &oucault 'o,ards a gay hagiography! ,xford 7niversity Gress! ,xford! 899K! p"DF"

Medicalisation of homosexuality: A queer critique

who go to seek sexual satisfaction 'y paying others for sex( 0r( /% -/sychiatrist. .he entire issue of multiple partners can create depression! feelings of re/ection! /ealousy when &rea04ups happen! as there is no support within the group for partners who experience this form of re/ection" Dr. PD (Psychiatrist) feel that gays also have other pro&lems such as depression! personality disorders etc" -ome of these are due to a lifestyle with multiple sexual partners" Dr. CPA (Clinical Psychologist) n the narratives a&ove! the &eliefs a&out unsta&le and distressing homosexual relationships first constructed &y western psychiatrists! in the early twentieth century find voice through the experiences of counsellors in Bangalore" Multiple partners! cruising for sexual contact! short4term relationships! re/ection and depression! are all mentioned in passing as pro&lems that homosexual people have to face without exception" .here is little or no questioning of the social pressure &ehind the cause for many of these so4called unsta&le components of homosexual relationships" Additionally conservative notions of relationships '&oth from religious roots or otherwise( as &eing monogamous! single4partner! marital and procreative only! permeates unconsciously through these assumptions" .he one fact assumed at the start &y these mental health practitioners is that heterosexuality is the o&/ective of all sexual development" .hat &eing a heterosexual is the #natural% thing" And that people are homosexual &ecause of unhealthy fixations! same4sex experimentation! same4sex sexual a&use and peer pressure" *et again! the norm of heterosexuality is &eyond question! and its primacy requires no explanation" 1verything outside heterosexuality &ecomes #different%! and therefore! suspect" 3hat is different must &e explained in ways that does not threaten the norm! and hence difference &ecomes pathologised! and accepta&ly classified as a&normal under the all4legitimising &anner of medicine" @rom this assumption to move into classifying heterosexuality as superior to any other form of sexual desire or attraction also seems inevita&le" .he following example spea0s a&out how the counsellor! a sexologist! views the differences &etween homosexuality and heterosexuality! with an analogy a&out cycles and scooters" t is automatically assumed that pleasure through heterosexual sex is &etter! li0e riding a scooter! in fact" n another case! a patient told me that he was standing in a &us and another man with his erect penis po0ed him" told him that he should not feel guilty that he had en/oyed" instead told him that he was going to have &etter and &etter en/oyment once he got more and more involved with girls" f you are riding a cycle you are happy /ust riding it" But once you 0now that a scooter is &etter than cycle you would prefer to ride it" Dr. SB (Sexologist) Counselling processes that involve religious sanctioning &reeds a whole host of assumptions a&out the ideal man or woman and ideal relationships that disavow any effort to experience sexuality differently" Coupled with #scientific%$ theories of poor parenting! fixations and ha&it forming homosexual experiences! and the connections with + V and other sexually transmitted infections! the counsellors attempt to paint homosexuality as an undesira&le as well as dangerous condition" consider homosexuality a0in to an addiction li0e alcoholism and drug a&use" And many &oys and young men! &ecause of homosexual sex! have sexual diseases li0e A B-! and some &oys wear colostomy &ags &ecause of anal

Medicalisation of homosexuality: A queer critique

%&

tears+omosexuals who came to change o&viously felt there was a deficit in their lives compared to heterosexuals condoms and safer sex are also dangerous" CB (Counsellor) *et another form of &elief a&out homosexuals expresses itself in the notion of homosexuals who articulate their identities as #flaunting% it or #wearing it on their sleeve%" ,ne doctor we spo0e to felt distur&ed &y this and said that heterosexuals don$t wear their sexuality on their sleeves" .he pro&lem we have had in our hospital is that it &eing a teaching institute we have presentations on homosexuality" have always felt we should loo0 at it o&/ectively and not get too carried away &y activism" 1ven in our hospital we have some people who wear their sexuality on their sleeve" .his feel is unnecessary! as heterosexuals do not assert their sexuality all the time" Dr. CPA (Clinical Psychologist) .his calls attention to the many su&tle ways in which heterosexism expresses itself" n a culture in which heterosexuality is the norm! even the slightest questioning of the #norm% provo0es resistance" .he fact that heterosexuality always flaunts itself though every conceiva&le discourse! and heterosexuals ceaselessly flaunt their identities! &ecomes invisi&ilised! when heterosexuality is the very standpoint of the spea0ing su&/ect" n one rare self4reflective interview! a psychiatrist provided a glimpse into where all these opinions were coming from: Many heterosexual doctors are often very uncomforta&le with the issue of homosexuality and when they deal with homosexuals! there is distaste and an anger! which gets expressed" .he expression hides under the la&els of ego4 dystonicity" Many doctors often moc0 homosexuals! they feel they are threatened &y homosexuals &ecause the sexual difference has some affinity with themselves" t is distasteful 'for heterosexual doctors( to deal with homosexuals 'spea0ing personally( and it ta0es some preparation &efore one is even willing to &e compassionate" Dr. PA (Psychiatrist) 3hat emerges is that there is no o&/ective space which these professionals can claim to spea0 from" .heir statements emerge from the medical discourse as well as &eing formed &y their own notions of what homosexuality is and who homosexuals are" 3hat is the &ac0ground &elief which underlies every shade of opinion expressed a&ove is that heterosexuality! marriage! family! and procreation are the natural o&/ectives of the development of each individual" .hese &eliefs are the very formative ground out of which mental health categories on homosexuality have emerged and continue to influence treatment options" he contemporary treatment of homosexuality: % state of shock 3e have examined the way the discourse of the physician operates when it comes to treating homosexuals" .he deep4rooted &eliefs of physicians are in some ways a product of the medical discourse and in other equally powerful ways emerge from discourses such as law 'homosexual acts as an offence( and religion 'homosexuality as a sin(" -uch &eing the powerful social influences which construct #homosexuality% what does the physician do; 3hat happens! when the discourses of law! religion and medicine come together to treat the homosexual; .here are three modes &y which homosexuals are treated in Bangalore" &irstly, there is the mode of prescri&ing &ehavioural therapy including #shoc0% therapy" @or example:

Medicalisation of homosexuality: A queer critique

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In -the leading mental health institution in this city. they have 'ehavioural therapy in which they try to suppress the homosexual response 'y shock therapy( hey show pictures of homosexual activity and then give the person a mild shock( hey show pictures of oral sex* on seeing which the patient feels happy* and then give him a shock( he idea 'eing that the person associates shock and not pleasure with the activity( I 'elieve in 'ehaviour modification* the positive way( #hat I do instead is to show a series of pictures of heterosexual activity( ,om'ined with this I teach him how to enhance pleasure 'y the use of lu'ricant( I try and introduce him to the idea that a woman feels nice and the pleasures of living together and how sex is the root cause of that( I give him an idea of what is the vagina and how one can mastur'ate with lu'ricant so that the organ slides into the vagina( I create a sense of anticipation a'out the vagina so that when he finally encounters a vagina he feels pleasure( My o'5ective is to replace the feeling of pleasure in homosexuality 'y pleasure in heterosexuality( his is what I call replacement therapy( 0r( S) -Sexologist. he idea is to decrease interest in homosexuality and increase interest in heterosexuality( hat apart* we use treatments like orgasmic reconditioning 66 which is 'asically a treatment to redirect a persons stimulus for pleasure( 4or example* if a person can 'e made to think of a woman instead of a man at the moment of orgasm then we succeed in reconditioning their pleasure in the female direction( #e make the person get an erection with physical stimulus* the person is then made to imagine a person of the opposite sex and made to mastur'ate( #e start 'y showing pictures of the same sex 'ut move towards replacing it with pictures of the opposite sex( %s an ad5unct to orgasmic reconditioning we also use aversive therapy -79 to :9 sessions.( #e may follow up with 'ooster sessions* which may 'e for four to five days consecutively( 0r( ,/) -,linical /scyhologist. here seems to 'e a widespread understanding that homosexuality is a 'ehaviour and one can get patients to stop exhi'iting that form of 'ehaviour through aversive therapy* positive reconditioning* orgasmic therapy and various other ways in which sexual pleasure is sought to 'e changed( he violence of the process of 'ehavioural therapy has its roots in its very 'eginnings( he comprehensive text'ook of psychiatry notes that* in an experiment conducted in /avlovs very la'oratory it was discovered that* 21%s usual* the unconditioned stimulus was food powder and the unconditioned response was salivation( In this case the conditioned stimulus was a mild electric shock on the dogs skin* which might 'e expected to elicit defensive reactions competing with salivation(( Still* the conditioning was going well up until the point when the shock was administered to one new location after another on the animals skin( #hen this was done* conditioning 'roke down* and the animal developed a lasting distur'ance of its overall 'ehaviour(3 7; he 2violence3 of the process lies not only in the physical pain of a mild aversive shock which increases in intensity going up to 79amps* 'ut in the exposure of ones deepest fantasies to the clinical ga<e of 5udgement( he fantasy is the su'5ect of the doctors ga<e as pleasure is then monitored* cali'rated and 5udged( he patient gets the approval of the
89 Bonald C 6outh! #ippocrates Meets De!ocritus$ A #istory o" Psychiatry and Clinical Psychology ! p"AA" cf" ! Alfred M @reedman! et" Al" !" Comprehensive text &oo0 of psychiatry ! 3illiams and 3illiams Co! Baltimore! 89FH ! G" AA"

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doctor when he is successfully a'le to exhi'it the 2right3 kind of pleasure( #hen we speak of the clinicians ga<e* the ga<e not only functions to capture the homosexual 'ody in an em'race of power 'ut aims in fact to change desire under its relentless 5udgmentality( In 'ringing a'out this change the clinician 'ecomes =od in damning the very flow of human desire and changing its course to a more accepta'le direction( )y 'eing told that your desire needs to 'e changed* the patients sense of self and internal coherence instead of 'eing validated* is deeply challenged( %s one doctor noted* 'ehaviour therapy gives the patient a low sense of self"esteem as he is told through ver'al and physical means that what he feels and indeed what he is has to 'e changed( he tragedy lies in the fact that there remains a historical continuity that links the dog in /avlovs la'oratory and the homosexual in contemporary )angalore( Such is the power of the 'elief that is formed at the intersection of law* medicine and religion( Secondly* we also have the recent development of religion"'ased therapy in )angalore( his therapy* which offers homosexuals* through prayer and 'elief* the opportunity to 'ecome heterosexuals* gained prominence when !xodus International visited )angalore( %n organisation whose mem'ers have converted from homosexuality to assert heterosexual identities* !xodus International* with the help of local religious groups* organised a series of meetings to speak a'out how homosexuals can 'e converted through reparative religious therapy( heir practices are also endorsed internationally 'y another organisation called >%? H ->orth %merican ?eparative herapy for Homosexuals.* an association that 'elieves that homosexuality can 'e cured and offers aversion therapy( In the present context* we have faith"'ased support groups operating out of the office spaces of a religious group offering support for people to come out of homosexuality( ?ecent developments show that even founders of !xodus International now state that their programmes were 2ineffective1not one person was healed(3 hey stated that the programme often exacer'ated already prominent feelings of guilt and personal failure among the counselees+ many were driven to suicidal thoughts as a result of the failed reparative therapy:9( hirdly* one has to note that there are counsellors and doctors who do take a non" 5udgemental position towards homosexuality( #hen one tries to isolate the reasons for this position* how does one category of admittedly small num'er of doctors function outside the powerful discourses outlined a'ove$ Is it the nature of a singular pro"active empathy for patients or does the articulation of this position point to the 'eginnings of another discourse$ .here is a hint that it is really the emergence of a gay and les&ian voice that has resulted in the a&andonment of #treatment% of homosexuality" .here is also the understanding that the readings in the contemporary history of western psychiatry that has resulted in the ta0ing of a different stand" .he question of clinical practice! which shows that treatment does not wor0! is also hinted at" .hus one can note that there is the incipient formation of a counter discourse which questions the heterosexist assumptions of the discourses of medicine" he &ueer criti&ue: %n epistemological challenge
AJ =erald C" Bavison! Constructionism and Morality in .herapy for homosexuality! c". ?ohn C =onsiore0 et.al" ! #o!osexuality$ %esearch i!plications "or pu lic policy ! -age! Iondon! 8998! p 8K9"

Medicalisation of homosexuality: A queer critique

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n ndia! the three discourses of religion! science and law acting through prayer! therapy or punishment condemn homosexuals and homosexuality" .he queer movement has challenged these forms of intervention and tried to li&erate the homosexual voice from the power of these discourses" .he queer discourse is not only an activist intervention &ut has also challenged the epistemological intervention! which challenges the very foundations within which homosexuals have &een defined and treated" .he 0ey analytical category through which this challenge has &een mounted is the understanding of how the &asis of law! science and religion is heterosexist" .he critique can &e viewed as: 8( Challenging the framewor0 of heterosexism A( ,ffering a different epistemological framewor0 Challenging the "ra!e,or- o" heterosexis! 3hen it comes to violence against homosexuals the first conceptualisation was the notion of homopho&ia" 2=eorge 3ein&erg introduced the word #homopho&ia% into literature in 89FA in a pu&lication titled Society and the healthy ho!osexual" +e defined homopho&ia #as the dread of &eing in close quarters with homosexuals% which is consistent with the formal criteria for a pho&ia in psychological literature" @ive 0ey differences distinguish homopho&ia from a true pho&ia" @irst! the emotion classically associated with a pho&ia is fear! whereas homopho&ia is often characteri)ed &y hatred or anger" -econd! a pho&ia generally involves recognition that the fear is excessive or unreasona&le! &ut homopho&ic responses are often considered understanda&le! /ustified! and accepta&le" .hird! a pho&ia typically triggers avoidance! whereas homopho&ia often manifests itself as hostility and aggression" @ourth! a pho&ia does not usually relate to a political agenda! while homopho&ia has political dimensions including pre/udice and discrimination" @inally! unli0e homopho&ia! people suffering from a pho&ia often recognise that it is disa&ling and are motivated to change"$A8 ronically! the starting point of critique &y the queer movement was the use of the medical discourse to define those who hated homosexuals as suffering from a form of pho&ia" .his in turn led to the use of other medicalised categories such as #homosexual panic% as a defence accepta&le in a court of law when a heterosexual person murdered a homosexual man" 3e would argue that the medicalisation should not &e the approach used when we are loo0ing at structural modes of discrimination against homosexuals" .he word homopho&ia individuali)es and locates the #pro&lem% in a pho&ia which some people suffer from" +owever what happens in this analysis is that one forgets that the violence and discrimination suffered &y homosexuals is not the result of a #pro&lem% that some people suffer from! &ut rather the result of the way society structures heterosexuality and homosexuality hierarchically" f one uses a parallel analogy and says that the reason why men &eat their wives is &ecause they suffer from gender pho&ia! the ridiculousness of the use of the word homopho&ia &ecomes clear" .hus we need a structural conceptualisation of why homosexuals are su&/ect to discrimination on the lines of the use of the categories li0e racism and sexism" -imilarly! we must adopt a framewor0 for analysis that does not medicalise homosexuality &ut instead loo0s at how various epistemological framewor0s function with the assumption of heterosexuality" n this connection we would li0e to use the concept of heterosexism to understand how 0nowledge is constructed and how the 0nowledge paradigm frames and conditions the
A8 Bavid Glummer! ,ne of the &oys: Masculinity! homopho&ia and modern manhood ! .he +aworth Gress! 8999! New *or0 ! pE"

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violence to which queer people are exposed" +eterosexism operates &y constructing the homosexual as the o&/ect of study and hence the source of the #pro&lem%" 3ithin the medical discourse the o&/ect of study is ego4dystonic homosexuality! not heterosexuality with &ehavioural therapy &eing prescri&ed for homosexuality and not heterosexuality" ,f course! the question of whether heterosexuality is natural or normal is never posed with the assumption &eing that it is always heterosexuality which is the natural outcome of sexual development" .hus we see that the medical discourse as a system of 0nowledge ends up constructing homosexuality as the pro&lem there&y leaving heterosexuality as the location from which the study is conducted" .his form of construction of 0nowledge we would call heterosexism" +eterosexism as a framewor0 can &e used to understand not only the medical discourse &ut also the discourses of religion! law! and even popular culture" t is wider than #homopho&ia% as it is not /ust a pro&lem located in one individual! &ut is instead a way of loo0ing at the world" -o even violence has its roots in the structural foundations of heterosexism as we have shown! in the context of the medical discourse" 'o,ards a di""erent episte!ological "oundation .he medical discourse has traced the aetiology of homosexuality to medical causes" 3hat the queer discourse in ndia has done is to show how the concept of ego4dystonic homosexuality is a product of heterosexism" f such is indeed the understanding of what is homosexuality! then even the treatment of homosexuality will &e very different" .he queer community &elieves that the &est way of dealing with what the medical profession descri&es as ego4 dystonic homosexuality is &y exposing the heterosexist roots of the very category" 3hile this critique functions as questioning the very need of medical intervention! the queer community also intervenes to provide its own form of #therapy% for those characterised as ego4dystonic" .he very simple answer! which the queer community has come up with! is the formation of support groups for homosexuals" -uch spaces &y their very nature portray homosexuality as a lived reality for a certain num&er of people" " .his might &e the &est way of ensuring that dystonicity is exposed for the social category that it is" -upport groups and other services li0e drop4in centres! documentation! and research on homosexuality alongside counselling provided in N=,s in ndia have &een sites where the traditional understanding of homosexuality is &eing challenged" More and more individuals can access these support services through the visi&le queer movement and through the vast resources thrown up &y the nternet" 3hile the nternet now also provides some of the anonymity and connectivity that was once the mainstay of pu&lic places! several e4groups and e4mail lists have provided space for the articulation of and resolution of homosexual desire" -upport groups around ndia are strong sites of articulation of queer rights as well as spaces for &ecoming comforta&le with one$s own identity" n one sense support groups for homosexuals are spaces! which affirm identities and experiences without /udgment and moralism" By attempting to help its mem&ers gain some sense of individuality and self4 esteem through contact with others who have gone through similar experiences! support groups also function as self4help groups" A support group meeting provides many answers for the homosexuals participating in them" .he issues raised and discussed in a support group are the same ones that are raised with psychiatrists! clinical psychologists! and counsellors" ssues of self4identity! marriage pressures! coming out to friends and family! are spo0en of regularly in these meetings" Mem&ers of the group share their own experiences on these issues and there&y help others to reali)e that they are not along in the feelings that they go through" ?ust through the process of interaction with a diverse range of people ! new comers to the group realise that feelings of

Medicalisation of homosexuality: A queer critique

loneliness! guilt! depression are products of a dominant social morality" .he moment the isolation is &ro0en! and a sense of community forms! many of the pro&lems disappear" 3hile the same issues may &ecome pro&lematised and #treated% &y #neutral% counsellors and doctors! &y the very nature of its existence! support groups ma0e those who are anxious a&out their identities &ecome comforta&le with it in the face of similar experiences faced &y others" .he goal then is not to medicalise an emotion after having pathologised the person! &ut to loo0 at the person$s experiences as ordinary and normal and de4medicalise his emotions" .herefore the very idea of a support space is to do away with the need for medical intervention" t is argued that homosexuals can &est deal with the pro&lems of homosexuals" .o escape the ga)e of the clinician might &e the starting point of doing away with the category of ego4dystonicity" f counsellors have the humility to send homosexual clients to support groups of ordinary people! rather than professionalise and medicalise the lives of such ordinary people it might &e the starting point of the solution"