According to Dr Mathew Varghese, professor and head of psychiatry, NIMHANS: there are about 4000 psychiatrists, 1000 psychologists and 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. I’m talking about this unnerving situation where a therapist/psychiatrist declines helping a person just because he/she belongs to a marginalised community. A plight of such heavily inauspicious incidents for numerous reasons, have taken a big toll on the LGBTQIAA community the most as well as on women and its horrendous effects are fair to observe. What is more shocking is that none of such occurrences gets reported and there is no way to report them. I, while researching couldn’t find a single article that talks about this issue in India.
This derogatory circle is bigger than our reach and it still involves caste-discrimination in providing health care. According to a survey named The Untouchability of Rural India , in 21.3% of villages, dalits were restricted to enter private medical care centers. The same report gives a horrific statement about dalit women in Uttar Pradesh where they do not receive health care during pregnancy. For Dalit women if basic medical care becomes such a colossal obstacle, think about the mental health care that we haven’t even come to think of.
Actually, the pool of bigotry is spread out in lumps across humanity with cases all over the world, but India sees the worst of it because the pool gets even bigger here as people are bound to be biased towards our beliefs and more staunch towards our culture that comes from a series of mythological/religious scriptures and classist/casteist living standards. One prominent reason why such quandaries take place more often in India is because of the way we perceive education. We lie in that grey area between taking medical education too seriously and taking it too lightly. We don’t go cold hearted but we compromise what we have learned with the beliefs we carry everywhere and their outcomes. So much so that the actual results go unnoticed in the darkness of subjection.
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.
The issue takes a darker and a much more devious form in India for the community, for women and for every other person who happen to go a little off track from the masses. A study conducted by a research fellow, Ketki Ranade for the Health and Population Innovation Fellowship at the Population Council of India, LGB youth are at greater risk for major depression, generalised anxiety disorder, substance abuse, suicidal behaviour, sexual risk taking and poor general health care than their heterosexual counterparts. The same report also suggests a 20%-40% suicide attempt rates among lesbian and gay youth.
For a country undergoing such a state of erroneous complexity, the trail of discriminatory incidents is quite long. One of these horrendous experience is shared by a friend who says:
“ I was talking about my nightmares to my therapist and while in the middle of that while discussing one such nightmare 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.”
When it comes to mental health care, women in India too go through a terrible burrow of suggestions and treatment methods that are polluted by the snippets of patriarchy. Often times they place their trust in the person sitting in front for their credibility but get double-crossed. Reason could be the compromised inner mindsets that takes 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 slutshaming, victim-blaming and forcing women to live their lives as regulated by the patriarchal system. Carelessness can also be observed in the treatments provided. 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 just like paracetamols. A case narrating one such incident says:
“I have borderline personality disorder. Got diagnosed at a very young age. 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 slutshamed me for having sex with that person out of marriage and kept calling me a “psychotic” all the time”
India is still fighting over the basic human rights for people and mental health care becomes a very significant part it. There have been some discussions about why therapists should talk about politics to initiate a larger circumference of dialogue that affects the mental state of their patients, but not so vociferously. NGOs and support groups can work as a strong medium to generate flexibility, but there is a greater need to add knowledge to the procedures. Organizations like the RCI (Rehabilitation Council of India) and IACP (Indian Association of Clinical Psychologists) need to understand that having bigoted people in the field only swells the problem further. Solutions can begin right from the emergence with the inclusions of definite guidelines within the education system. There is an immediate requirement of researches and surveys to get information and to know the amount of people belonging to the marginalised communities being affected, just because they are persecuted. Basic and precise grasp on feminism included within the courses and training would help take a huge step. It will also help in removal of misunderstandings regarding the subject.
Moreover, programmes could be restructured in order to cure expertise of partiality too. A Master’s programme in Psychology at the Ambedkar University, Delhi is a clear illustration. The programme is titled MA in Psychology (Psychosocial Clinical Studies) and aspires to combine human psychology with structural and political processes that come together in the formation of human subjectivity. It also serves a sensibility of privileges and allows critical thinking and rationality to blend in with clinical psychology and psychotherapy. Programmes like this are very rare but there is a strict need of them especially in India where privilege ignorance becomes a persona.
When bigotry impedes therapy it not only contaminates the procedure of providing help, but also derogates humanity. Statistics are a definite requirement and so are the remedies. 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 the acception. Don Clark, the first openly homosexual psychologist provides introspective particulars on this, in his extended interview (Do read this!) he says,
“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”
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 therapy. 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 patriarchal norms. A blog by Laura. S. Brown, PhD will brief you how it all works. It also makes us understand how badly we need to implement this within the system, within educational courses as well as within training. We are just at the starting line in providing affordable and accessible mental health care to those in need and we surely don’t want to bring persecution along with us on this one.