Amongst the darker annals of the history of psychiatry has been its position on homosexuality. As human sexuality began to be scrutinised with a scientific temper in the 19th century, it soon became abundantly clear that homosexuality was no different from heterosexuality in the sense that they were both examples of the diversity of human sexual orientation. Indeed even Freud, who once viewed homosexual behaviour in adults as the result of “arrested” psychosexual development, wrote towards the end of his life that “homosexuality is nothing to be ashamed of. It cannot be classified as an illness; we consider it to be a variation of the sexual function”.
Yet, for the better part of a century, psychiatrists pathologised homosexuality, categorising it as an example of a sexual deviance in diagnostic manuals, and attempting to “cure” people of this “disorder”. This stance adopted by a discipline of medicine offered a scientific veneer to justify the religiously-inspired prejudice against a significant minority of the population. Of course, the practice of medicine (since before modern times) has often colluded with tyrannical forces to legitimise unjust causes, best illustrated by the reconfiguring of the desire of slaves to escape their appalling conditions in the 19th century by conjuring the diagnosis of drapetomania. This was supposedly a “disorder of slaves who have a tendency to run away from their owner due to an inborn propensity for wanderlust”, which conveniently reassured slave-owners that it was not their unmitigated cruelty which was to blame.
This medical legitimisation of prejudice was a major contributor to the stigma against homosexuality. Soon after the 1969 Stonewall riots in New York City, gay and lesbian activists disrupted the 1970 and 1971 annual meetings of the American Psychiatric Association, trying to shame the profession into abandoning its collusion with the religious obsession for controlling human sexuality and adopting a genuinely scientific position on the issue. Ultimately, the removal of homosexuality from the Association’s diagnostic manual in 1973 was the result of a concerted campaign by a coalition of gay activists and scientists who would not allow the denial of the fundamental sexual rights of homosexuals on the basis of a fraudulent medical condition.
However, the vote by the Association’s Board of Trustees to remove homosexuality from the diagnostic classification (yes, this issue was voted upon, a telling indication of the scientific process of this professional society!) was met with fierce resistance by many practitioners, especially from the psychoanalytical community who still dominated the practice of psychiatry. As a result, homosexuality continued to be considered a condition worthy of “treatment” if it was “ego-dystonic” (meaning that the homosexual person was distressed by his sexual orientation and wanted it to change). This, of course, was a sort of a deal with the “hardliners” and indicated that the profession was only prepared to dilute its entirely spurious pathological perspective. It took another 17 years, marked by a continuing shift in the profession to acknowledge the mounting evidence that homosexuality was a fundamental and enduring aspect of the person, and could not be modified by any therapy (just as, for example, you cannot change your heterosexual orientation), before the World Health Organisation (WHO) removed homosexuality from its International Classification of Diseases.
It would not be an understatement to claim that the removal of homosexuality as a medical disorder has not only been a major victory for compassion and science but, in stripping the moral brigade of the scientific rationalisation for their poisonous hate, also fuelled radical social reforms in many countries around the world which have slowly, but surely, accorded a slew of sexual rights to homosexuals on par with straight people. India now stands on the threshold of joining this growing comity of nations which will not tolerate discriminating against tens of millions of its own citizens when the curative petitions to strike down the infamous Section 377 of the Indian Penal Code, inherited from the British who have long since dumped their own legislation, is reviewed again by the Supreme Court. In a legal saga which began in 2001, our highest Court has the unique opportunity to put into practice its landmark ruling declaring individual privacy, of which sexual orientation is the exemplar, a guaranteed fundamental right.
As one amongst a number of psychiatrists who have consistently supported the petition to remove Section 377 on the grounds that it had no scientific merit, I do however need to acknowledge that there is a significant body of evidence which does, in fact, show a strong relationship between homosexuality and mental health. And this evidence shows compellingly that mental health problems, in particular mood and anxiety disorders and suicide, are more frequently encountered in homosexual persons. The primary reason is the consequence of the stigmatisation and discrimination experienced in daily life, enshrined in the law.
Indeed, in this respect, Section 377 is not only in contravention of the fundamental right to privacy, but also of the rights to health and life itself. Just as any form of exclusion presents a risk factor for mental health problems, there is no doubt that the existing law directly contributes to misery, mental illness and premature mortality. This is the only mental health-related argument, which is relevant when the Supreme Court deliberates on whether this country will, 28 years after the WHO did, accept that homosexuality is neither a mental disorder nor a sexual deviance, but a fundamental, inalienable, part of human diversity.
(The writer is the Pershing Square Professor of Global Health at Harvard Medical School and is affiliated with the Public Health Foundation of India and Sangath)