By A Mani and Sayani Basak
Everyone in India faces social stigma when it comes to mental health issues. However, women face a lot more of it due to patriarchal norms, social conditioning, and misogyny built into in the system. Lesbian, trans, and queer women specifically may have to deal with oppression arising from genderism, heteronormativity, and transphobia. Let’s look at what these words mean, and how they play out for us in the Indian society.
Sex or Gender?
Sex of a person, from a modern scientific perspective, is best seen as a tuple of parameters corresponding to hormonal, brain, clinical, chromosomal, and physical sex, epigenetics and more.
Gender is a plural term that refers to gender identity, expression, and gender as a social construct (Serano, 2016).
Gender identity of a person is their innate sense of gender. Some studies show that it is strongly influenced by hormonal exposure during prenatal development (Diamond, 2006). There are studies that also relate gender identity to brain structure, hormones in brain, and other modern biological markers of sex (Spizzirri, 2018), (Diamond, 2006), (Reed, 2016). In fact, gender identity may be said to be determined by unchangeable connections within the human brain subject to certain assumptions. Gender theorists have argued that gender is socially constructed.
Cisgender refers to individuals who identify with the gender they were assigned to at birth.
Gender diverse is an umbrella term to describe non-cisgender people.
A trans woman is a person who identifies as a woman or as a transgender woman but had been assigned a different gender at birth. Some people do use the term ‘queer women‘ to refer to all non-straight women, but this usage is not accepted universally even within the LGBTQIA community.
In the Indian situation things play out quite differently. People belonging to indigenous cultural and professional identities (that include gender diverse people), abbreviated by ‘Indcpgids’ in what follows, are less understood because of myths, and disinformation ((Dutta 2013)). Indcpgids (pronounced ind-si-pi-gids) such as Hijra, Thirunangai, Kinnar, and Kothi (that are based on culture, class, caste, sexuality and gender) do not necessarily fall under concepts of gender identity. Let’s have a closer look.
The socially-ostracised Hijra community, that has its own language, rituals, rules and occupational preferences. The community consists of castrated males, binary/non-binary trans women, intersex people, cis-men and even cis-women.
They are groups of gay men from lower socio-economic classes who may indulge in occasional cross-dressing.
They may be a trans woman or a transgender person or even a woman with congenital adrenal hyperplasia – an inherited condition which leads to excess of male hormones. Thirunangais usually belong to lower socio-economic classes.
A Unique Problem
A number of studies, originating in India, use the term ‘transgender’ to refer to all Indcpgid people. This is referred to as the sloppy gender problem. Indcpgids have played a major role in the context of struggles for LGBTQIA rights in India. Most of them are poor, and have had limited access to formal education. Because homosexuality was criminalised till recently in the country, no major quantitative studies on the mental health issues of lesbians have been conducted.
LTQ Women and Mental Health Issues
Also known as depressive disorder, this is a common but serious medical illness that negatively affects a person’s feelings, thinking and actions. Symptoms experienced can be
- extreme sadness or depressed mood
- loss of interest in previously enjoyed activities
- sleep disorders
- loss of energy or fatigue
- feelings of worthlessness or guilt
- impaired ability to concentrate
Typically, it is treated through medication, counselling and lifestyle changes.
Anxiety is an emotion characterised by feelings of tension, worried thoughts and physical changes like increased alertness and blood pressure. It is a necessary response for survival. An anxiety disorder, on the other hand, is characterised by excessive uncontrollable and overwhelming worries (over relatively unknown threats, fear) and possibly disorganised thoughts. Such disorders are often the result of long-term exposure to rejections, bullying, discrimination, isolation and harassment.
These creep in when a person feels they are no longer able to cope with an overwhelming situation. Every year on an average 1,00,000 people commit suicide globally making it a serious public health issue. Mental health issues like major depression, anxiety, post-traumatic stress disorder often significantly found to be correlated with committing suicide. Suicidal tendencies may be accompanied by negative thoughts associated with self-hatred, hopelessness, isolation, withdrawal, lack of belongingness and feeling like a burden to others (Weir, 2019). Such feelings are often associated with oppressed lesbians, trans and queer women in unsupportive or hostile environment. Comprehensive care that addresses strategies for handling such suicidal tendencies (possibly through supportive counselling) is recommended by mental health experts precisely because of the overwhelming nature of the situation.
In a survey, conducted by the National Centre for Transgender Equality (NCTE, 2016) with over 28,000 respondents, it was found that 40% of trans people had actually attempted suicide at some point of time in their life and over 48% had experienced abuse because of their gender. The figure is larger in the Indian context (it would be improper to suggest an exact figure on the basis of small sample studies). Some indicators can be found in (Kisha, G. 2012) and studies mentioned in (A Mani, 2019b). Harassment takes on different forms such as verbal abuse, physical attacks, and sexual abuse. A large percentage (over 40%) of trans people in India discontinue their academic courses due to the regular harassment.
Lifelong stigma, prejudice and discrimination create a harsh and social stressful environment. This is the stress which includes
- experiences of prejudice events
- expectations of rejections
- being bullied
- constant need to conceal/hide oneself
- internalised homophobia
- constant struggle of coping within the heteronormative environment (Meyer, 2003), (Kelleher, 2009).
Lesbians, trans and queer women are always surrounded by these institutionalised forms of prejudice, discrimination and violence which destroys their everyday well-being and social support system.
This is a complex condition that owes its origin to both sociological and psychological factors in a given situation. It may be due to the person withdrawing or becoming isolated from their environment or other people. Most non-cis women suffer from alienation as being inhibited eventually from self and the external world which frequently rejects their identity within the societal norms. The fear of being alone and exclusion often makes them feel uncomfortable, uneasy leading in vulnerable conditions within the social environment. Such vulnerability evokes fear and threat, which might seem to be unknown or unclear causing mental health issues in everyday queer lives.
Non-cis people often spend many years being in the closet, trying to understand themselves amid heteronormative social structures. There’s a struggle between having to behave in “acceptable” ways and identifying with their true self. This conflict creates huge psychological burden on queer lives.
Most LGBTQI+ people from several parts of India experience adverse reactions when they come out of their closet. There’s usually little to no emotional support by parents. Families often reject and shame them thus increasing their risk of victimisation with significant long-term mental health consequences.
Previously referred to as gender identity disorder, this is typically experienced by trans women during their pre-transition state. In simple terms, it refers to the perception of mismatch between one’s sense of self and the internal and external parts of their body (in relation to gender identity and expression). It was regarded as a mental health issue in DSM-IV (till the year 2012) and was declassified subsequently. An interesting definition and classification of gender dysphoria can be found in this article (A Mani, 2014a) by one of the authors.
Factors that sustain mental health issues
Pressure from family, lack of compulsory sex education, and lack of sensitisation among academics, teachers and medical personnel are only some of the reasons why we experience mental health issues.
Indian patriarchy has been strongly influenced by colonialist practices of genderism, homophobia, heterosexism, and transphobia. A number of registered doctors in India actually believe that homosexuality is a mental illness and support abominations such as conversion therapy (Orinam, 2015) — this is despite the fact that the Indian Psychiatric Society officially stands by DSM-5 and ICD-11.
School and college often become spaces for harassment and bullying for lesbian, trans and queer women. In India, gender sensitive sex education is not compulsory even at college level. Most of us are never taught basics of consent and relationships. Conservative academics including lecturers and professors may be in denial or in the dark about these basics because of their own upbringing in patriarchal, sexist and misogynist cultures. Further feminist ideas on matters relating to gender, sex and sexuality are not well understood by all.
Toxic masculinity (including ideas of chivalry, normalisation of gendered violence, ‘boys will be boys’), for example, is poorly understood by men and conservative women. Further, gender and sexual harassment committees and policies are functional in only some universities because of poor implementation of UGC Regulation Act (2015), Visakha Guidelines (1997) and Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013. Despite such laws, many higher institutions of learning have limited the public spaces of women faculty and learners by implementing restricted time frames, surveillance on women’s dresses and even putting restrictions on their ‘out time’ from the Institutions. Such regressive rules can be found for example in the Benaras Hindu University, RKMU, Aligarh Muslim University, and St Xaviers College/University, Kolkata.
Hegemonic Brahminical patriarchy (Chakravarti, 1993) ensures lesbians, trans and queer women remain closete by typically limiting their everyday public, personal and private spaces. In cosmopolitan milieus like Kolkata, they tend to be less closeted due to frequent queer activism and visibility in the last two decades in the city. Apparently, lesbians in the social and legal sciences tend to fall in the ‘out and proud’ (that is ‘non-closeted’) category more often than those in other sciences. In fact, the population of ‘out and proud lesbians’ in mathematics research has been covered in this article by one of the authors. This state of affairs does say a lot about the conservative and insensitive attitude of substantial sections of the population towards LTQ women in the country.
All in all, in most family systems and public space, considerable stigma is attached to same-sex attraction. ‘Coming out’ in the face of persecution is difficult. All this in conjunction with prejudice, and genderism leads to mental health problems in sexual and gender minorities.
Other queer-friendly support groups:
A number of organisations that work with reproductive health needs for LGBTQI and can also connect one to queer-friendly mental health support:
1. Nazariya queer feminist collective-Delhi
2. NAZ foundation-Delhi
3. Ya’all Manipur-Imphal
4. Sappho for Equality-Kolkata
6. Humsafar Trust-Mumbai
7. Mariwala Health Initiative leads a training programme for Queer Affirmative Counselling practices and has a number of trainers to help LGBTQI members.
LGBTQ groups working with mental health:
8. Queerela, Kerala
9. TARSHI, Delhi
10. Varta Trust, Kolkata
References for the article can be found here.
Author bio: A Mani is a researcher in mathematics and logic. Sayani Basak is a scholar at TISS.
Acknowledgements: TLoS thanks Sayani Basak (co-author) and Sweta Pal at Sangath for the support groups mentioned above.
Illustration by Ipsa Jain.
Note from the artist: Escaping the clouds by accepting the colors of gender identity.