“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)
There are about 4,000 psychiatrists, 1,000 psychologists and 3,000 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. If these were not enough, we have to contend with the bigoted attitude of mental health professionals towards sexual and gender minorities, women and members of other marginalised groups.
It is 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 sexual orientation. Such prejudice targets many marginalised communities, and continues to take a big toll on LGBTQIA+ people as well as on cis or heterosexual women.
The recently passed Mental Health Care Bill holds out 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 problem lies in in pervasive prejudice among healthcare workers.
It starts with caste
Some 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 centres. Dalit women in parts of Uttar Pradesh were barred from receiving healthcare during pregnancy and concern for mental health sounds far-fetched when basic medical provisions are in denied. To expect adequate mental healthcare for sexual minorities seems even more of a stretch.
Homophobia, transphobia, sexism and misogyny are worldwide phenomena are, by no means, restricted to India. In August 2016, the governor of the US state of Tennessee passed a bill allowing therapists to deny their services 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 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, there is a growing body of evidence which suggests that LGBT youth are at higher risk for major depression, generalised anxiety disorder, substance abuse, suicidal behavior, sexual risk taking, and poor general health than their heterosexual counterparts, mental healthcare providers in India and elsewhere treat homosexuality and bisexuality as pathological conditions to be cured.
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 like depression or anxiety get pathologised 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 in.
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. The following experiences by narrated by two women speak volumes..
“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 recognise 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 unstigmatised 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 healthcare 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 gender identity. Donald Clark, the first openly homosexual psychologist, said 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.”
Similarly, feminist therapy has its roots in the interventions by women psychotherapists during the US 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. The demand for affordable and accessible mental healthcare for minorities needs a special focus and struggle before we waste more time in fixing the system.
A version of this article has appeared in Medium, Nirmukta and Orinam.