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 saddening inadequacy has numerous reasons in a country with an attitude and mindset so regressive towards mental health that immorality takes a peculiar turn when prejudice comes in the way. India is taking heavy steps to walk towards seeing a day that is free of persecution but it seems like way too long a shot for a country that has itself muddled in a bog of ideologies fighting with each other to gain dominance.
It’s time we talk about this unnerving situation where a therapist denies treatment to a person or shame him/her for having contradictory views about society, politics, gender roles or sexual orientation. The range extends covering almost the entire marginalised community. A plight of such inauspicious incidents have taken a big toll on the LGBTQIAA section as well as on women and its horrendous effects are fair to observe. What’s more shocking is that none of such occurrences get reported or have a way to report them and the zilch coverage by any sort of media speaks of their shady state.
Undoubtedly, this derogatory circle is bigger than our reach when caste-discrimination continues to infiltrate even primary healthcare. A survey titled The Untouchability of Rural India found that in 21.3% of villages dalits were restricted to enter private medical care centers. The same report gave a horrific statement about dalit women in Uttar Pradesh where they 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 these people.
The pool of this new faced bigotry is spread across the world with no country completely free of it but developing nations like India suffers the worst. With people bounded and beheld by religious beliefs and a zealous passion for culture and tradition, any form of professional advice or reform is vulnerable to contamination. One prominent reason why such quandaries take place more often in India is because of the way people perceive education. They lie in that grey area between taking medical education too seriously and too lightly.When people make tiny compromise in what they have learned with the beliefs they carry everywhere, the outcome is wide. So much so that it conceals the truth.
A recent bill is on its way to the Governor of the state of Tennessee (U.S) which will allow therapists to deny therapy to homosexuals as well as others belonging to the LGBTQ community. The attachment also says –
“The measure is part of a wave of legislation across the country that opponents say legalizes discrimination against lesbian, gay, bisexual and transgender people. ”
Specific guidelines are provided by the American Psychological Association (APA) for the psychological treatment of Lesbian, Gay and Bisexuals. These set of guidelines were adopted in 2011 and include a straight-up group of directions for professionals to follow. They have sections titled- attitude towards homosexuality & bisexuality, relationships and families, issues of diversity, economic and workplace issues, education and training & research.
Despite the availability of such guidelines, and despite a growing body of evidence suggesting LGBT youth are at higher risk for major depression, generalized 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]
For a country undergoing such a state of wrongful complexity, the trail of therapy sessions gone wrong adds a major contribution. One of these horrendous experiences is shared by a friend who 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)
When it comes to mental health care, women in India go through a burrow of “suggestions” and treatment methods that are polluted by the system of patriarchy. They place their trust in the therapists sitting in front for their expertise and get double-crossed for having an “unusual outlook” of life. It happens when compromised mindsets take over the professional disposition of a care provider. Topics like sex, clothing or not wanting to live “by the rules” are often shunned and advised over by layers of slut-shaming, body-shaming, victim-blaming and forcing women to live their lives as regulated by “Indian values”. It ends up leveling up the depression one has already been caged in.
Carelessness can also be observed. Being told to look at the less fortunate lives to overcome depression or adding spirituality to overcome stress, are some of such ill treatments that are thrown around like paracetamols. Another heart rending story speaks for itself –
“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)
While the minorities in India are still fighting for basic human rights, mental health care has become a very significant part of social justice. There have been some valid discussions about why therapists should talk about politics with their clients in order to expand the circumference of dialogue that has some affect on the patients’ mental state. NGOs and support groups can work as a strong medium to generate this much needed flexibility and open-mindedness.
The target needs to account for people whose social, cultural, political, sexual and religious views that define them as a person are far different from the views of their therapists. And the ultimate focus needs to be towards abolishing the fear of being ponderously judged because of such differences that further results in maltreatment.
Having biased professionals in the field swells the problem not just for the emerging mental health care but also the on-going battle for social justice. Knowledge is a necessity and a rational attitude towards the client’s personal issues is what counts as positive. Definite inclusions of aspects related to minority-issues within courses and training, genuine knowledge about topics like feminism and caste, LGBTQ psychology and information about other excluded groups based on demographics can be considered as safe solutions.
I’m not implying, that there aren’t any guidelines about the importance of being non-judgmental while pursuing mental health, I’m questioning their credibility as being nothing more than textbook topics. A master’s program in psychology at the Ambedkar University, Delhi is a clear illustration- Psychosocial Clinical Studies aspires to combine human psychology with structural and political processes that come together in the formation of human subjectivity. It serves a sensibility of privileges and allows critical thinking and rationality to blend in with clinical psychology and psychotherapy. Programs like this are very rare but there is a strict need of them especially in India where privilege ignorance becomes a persona.
Gay affirmative psychotherapy has been a tremendous step in helping LGBT clients accept and conform to their sexual orientation, what we need now is to have the regular psychologists comprehend this acceptance. Donald Clark, the first openly homosexual psychologist provides introspective particulars on this. In one of hisextended interviews he said,
“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 first came into discussion in the 1960s when women psychotherapists driving the feminist movement in the United States modified their protests against sexism being spewed towards women seeking help. In India it’s another salient necessity- to include feminism based therapy for women who have to conceal or fake the actual sources of their illness because of the fear of being suggested nothing but patriarchal norms. A blog by Laura. S. Brown PhD will brief you how it all works.
When bigotry impedes mental heathcare it not only further worsens the condition of the patient but also pesters humanity as a whole. We are just at the starting line towards the imperative journey of providing affordable and accessible mental health care to those in need and we surely don’t want to bring social discrimination along with us on this one.