Insight, Advice - Mind, Body and Family, Mar '14
By Dr. Tirthankar Guha Thakurta
By Dr. Tirthankar Guha Thakurta
On February 8, 2014, the West Bengal chapter of the Indian Psychiatric Society organized an interactive event in Kolkata to clarify their stand on homosexuality (see A Mental Boost! in the February 2014 issue of Varta). Among a host of issues debated, one was the use of reference books with outdated information on gender and sexuality by students of the MBBS course, the future doctors of India. Varta decided to delve deeper into the matter, and Dr. Tirthankar Guha Thakurta brings you the first in a series of articles that analyse the content of some standard reference books.
Why are some (read many) Indian doctors homophobic?
Well, I would rather say the reasons are mostly the same as those that make a homophobe out of any other person. But, for doctors, there are additional triggers that often make them a confident and proud homophobe who can diagnose, treat and prevent homosexuality!
The five and a half years of drilling through the sexually immature but otherwise updated medical curriculum makes most bookworms what we can call a ‘professional homophobe’. Here’s a look at what has been the status of discourse on gender and sexuality and related topics over the last 10-15 years accounting for the insensitivity of some doctors to the issues of lesbian, gay, bisexual, transgender and other queer people.
The first year of the MBBS syllabus exposes a student to the knowledge of human anatomy, physiology and biochemistry. The scope of a detailed study of gender and sexuality is while discussing human physiology. The physiologists, however, rarely discuss sexuality beyond the chapters of human reproduction. Each physiology book essentially contains a chapter on the ‘reproductive system’, but there are no chapters on the ‘sexual system’. The discussion of sexuality beyond procreation is unthinkable when the books are so skewed in their sexual perceptions.
Some popular reference books by Indian authors further state that puberty is characterised by the development of “attraction to the opposite sex”, and in males by “love for contact sports like football, wrestling, boxing and war games”. They further state: “Male aggression is also a sign of puberty”. These lines are quoted from the book Concise Medical Physiology, 4th edition, 2002, authored by Prof. Dr. Sujit K. Chaudhuri, MBBS, PhD, Ex-HOD of Physiology, Medical College, Kolkata. A similar view is echoed by the book Essentials of Medical Physiology, by Prof. Dr. Anil Baran Singha Mahapatra, MD, HOD of Physiology, Bankura Sammilani Medical College, Bankura, West Bengal.
The first year thus acts as the first dose of hetero-normativity for most medical students. In the next year, a major booster dose is provided by chapters on ‘sexual offences’ in the context of discussing forensic medicine. This subject establishes a link between medicine and law. The legal impact on medicine is evident when we find that almost all forms of sexual acts other than penile-vaginal intercourse, and all forms of sexual attraction other than heterosexual are called sexual perversions! The average medical student mugging up the question bank of the board examinations of the last few years finds questions on this chapter often repeated in the examinations and learns the topics religiously to score high marks.
Let us take a look at some excerpts from the book The Essentials of Forensic Medicine and Toxicology, 21st edition, 2002, by Dr. K. S. Narayan Reddy, MD, DCP, PhD, FAMS, FIMSA, FAFM, FAF Sc., FIAMS; Professor of Forensic Medicine, M. R. Medical College, Gulbarga; Retired Principal, Osmania Medical College, Hyderabad. This book by Dr. K. S. Narayan Reddy is considered a standard reference by most medical college professors. Here’s what chapter 17 titled Sexual Offences says:
Excerpt 1: Pg 338, Classification (of Sexual Offences):
(I) Natural offences –
(II) Unnatural offences –
4) Buccal coitus
(III) Sexual perversions –
It is ‘funny’ to note that sexual offences can be ‘natural’ as well – all provided they are heterosexual in content and penile-vaginal in execution. Second, who is going to report consensual sodomy or buccal coitus, if voyeurism itself is a perversion cum offence? And that masturbation is a perversion reminded me of a popular joke: “If you ask people whether they masturbate, 99% will say yes and 1% will lie!”
Excerpt 2: Pg 349
“In India, a class of male prostitutes called Eunuchs act as passive agents in sodomy . . . among them there are two groups (1) Hijrahs and (2) Zenana, who live separately. The Hijrahs are those who have been castrated, usually before puberty . . . the genitalia of Zenana are intact”.
Where on earth did the author get such grossly inadequate ideas about the community structure of Hijras? (For anyone interested in basic information about the Hijra community, a good starting point can be Human Rights Violations against the Transgender Community, People’s Union for Civil Liberties, Karnataka, 2003 – Editor).
Excerpt 3: Pg 351
“Female homosexuality is known as tribadism or lesbianism . . . many lesbians are masculine in type, possibly because of endocrine disturbances and are indifferent towards individuals of opposite sex. The practice is usually indulged in by women who are mental degenerates or those who suffer from nymphomania (excessive sexual desire) . . . lesbians who are morbidly jealous of one another, when rejected may commit homicide, suicide or both”.
Let us spend one minute in silence to pray that the damage caused by this misinformation being read by thousands of medical practitioners can be undone in some way. Tribadism is a specific act of female-to-female sex – it is not synonymous with lesbianism. The author does not know that “masculine type” is a gender role aspect that is not determined by hormones. He probably never heard that biological sex, gender identity and sexual orientation are three different aspects of life.
The other statements regarding mental degeneracy and nymphomania are products of his sexually imaginative (read biased) mind, and not supported by any contemporary scientific evidence. In fact, the opposite was well established years before this edition was written. And did I hear homicide and suicide? I can recall a C-rated Bollywood production!
In the same semesters of the second year of the MBBS course, the popular microbiology reference books relate sexually transmitted infections (STIs), including HIV, with “homosexual acts” and imprint a conscious and sub-conscious pathologization of homosexuality in the minds of the medical students.
Now we have well-marinated and well-baked homophobes-in-the-making entering the third year of the MBBS course. This is where they encounter a subject called community medicine. This subject deals with the social and cultural aspects of diseases and their preventive measures. The reference books on this subject are not homophobic so to say, but often use the terms ‘homosexual’, ‘MSM’ and ‘high risk populations’ interchangeably.
Terms such as MSM (men who have sex with men or males who have sex with males), which were once coined to conduct epidemiological studies, become a label in the minds of the students. They begin to believe that gay men are those men ‘whose only job is to have sex with other men’. They also learn that ‘gay sex’ is a ‘high risk’ sexual activity. In summary, they become aware of the ‘dangers of homosexuality’, while heterosexuality remains imprinted in their minds as the ‘default’, ‘normal’ or ‘safe’ sexuality.
In the final year of the MBBS course, they meet two major branches of medical science – general medicine and paediatrics. Reference books on general medicine and paediatrics are usually updated. Some of them specifically state that homosexuality and bisexuality are not diseases. Some prefer silence. Some retain the popular reference of homosexuality to STIs and HIV. But the problem starts with some outdated references on psychiatry. These books retain outdated information on gender and sexuality and even go ahead to prescribe behaviour therapy to ‘cure’ homosexuality.
Here are excerpts from A Short Textbook of Psychiatry, 6th edition, 2006, Dr. Niraj Ahuja, MD, MRC Psych, ex-teaching faculty of psychiatry at several medical colleges:
“Ways to treat a homosexual individual who seeks a change in sexual orientation:
i. Psychoanalytic psychotherapy
ii. Behaviour therapy – aversion therapy (rarely used), covert sensitisation, systematic desensitisation (if there is phobia of heterosexual relationship)
iii. Supportive psychotherapy
iv. Androgen therapy (occasionally)”
At this point of time, the average medical students (who prefer mugging up the answers to questions asked in the examinations of the last few years) find questions on sexuality rare in the board examinations. So they engage their attention on the more ‘important’ topics that will make them good students and better doctors. If at all they come across the newer developments in the fields of gender and sexuality, the older and earlier knowledge often hinders unlearning.
After a year of internships (with no scope of discussing gender and sexuality in detail), we get a judgmental, hetero-normative, presumptive, homophobic, biphobic and transphobic doctor at our service – wrapped in a white coat and ready for delivery (to society)!
Confused? Disturbed? Just inquisitive? Write in any query on the mind, body and family to firstname.lastname@example.org, and Dr. Tirthankar Guha Thakurta, teaching faculty at a Kolkata-based medical college, will be happy to answer them – with due respect to confidentiality.