- Trupti Soman
Mental health is a state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and are able to make a contribution to their community. The spectrum of mental health is considered to be a part of the larger public health system. Despite this, it is often neglected alongside the built stereotypes and stigma surrounding it in many religious and cultural contexts around the world.
Recent studies on the mental health scenario in India portray a bleak picture. A study conducted by the National Commission on Macroeconomics and Health in 2005 reported that nearly 5% of India’s population suffers from common mental disorders, such as depression and anxiety. As per the review of epidemiological studies conducted in 2000, the prevalence of mental disorders in India was 70.5 per 1000 in rural and 73 per 1000 in urban population.
Mental health is often perceived within the context of Indian mainstream narratives. Such narratives are highly concentrated in urban centers, and have mental health practitioners coming from certain power positions of caste and class. These practitioners are not always sensitive to context specific distress, as they come from different social locations. There is an additional question about those who are pushed to the margins? Marginalized communities exist in many pockets of India and many of them come from a variety of different social constructs such as class, caste, gender and others.
One of the communities living in the peripheries of society are the Lesbian Gay Bisexual Trans Queer Intersex Asexual and other sexualities, sexes and gender identities (LGBTQIA+) persons. Access to resources and services that a cis heteronormative population takes for granted, such as renting a flat, is a privilege that someone from the LGBTQIA+ community will find obstructed, particularly if their appearance is visibly non-normative. When you are not sheltered by layers of privilege, navigating everyday life can be a complex but invisible struggle, and aggravates the feeling of marginalization. A side-effect of such marginalization is diminished mental health.
These marginalities exist not only in terms of sexual orientation, but are multilayered and have intersections within them. A person who identifies with a non-normative sexuality, is not simply an individual from the LGBTQIA+ community, but is also someone who has various other extensions to their personhood such as caste, class, tribe, religion, and other social categories that they belong to.
A 2007 article by Ilan H. Meyer looks at the stress and stressors that the LGB population have to face only on the basis of their sexuality, and how it affects their mental health. Comparing the LGB population with the heterosexual population and with the help of research, he concludes that prejudice and non-acceptance from the larger part of society subjects the LGB population to greater mental stress in comparison to the heterosexual population. He proposed a Minority Stress Model explaining the higher prevalence of stress in the LGB population with two views on it: a subjective view (which focuses on the individual and their means of coping with stress) and an objective view (which focuses on the environment causing stress). This focuses on how the individual copes, and how the environment around them affects their coping mechanisms. He suggests that while dealing with stress and minority stressors in the LGB population, mental health professionals, researchers and policymakers are recommended to use the minority stress model to attend to the full spectrum of interventions, resilience resources for these individuals to improve the health outcomes.
This model can be used to look at the larger context of social locations an individual comes from, and identify the stress they face especially if they belong to minority groups in a diverse country like India.
It moves beyond symptoms and diagnosis.
It asks questions about representation & intersectionality,
and
It analyses what is considered as mental illness and who is a mental health practitioner along with which population avails these services.
The rates of depression, anxiety, and suicide are far greater in LGBTQIA individuals . The rates of suicidal ideation and attempts in trans people are extremely high. This shows a significant health gap and a true health inequity that is reversible. This is not a symptom of being LGBTQIA but an imposition by society.
Setting this context of how mental health and marginalization has shaped up to be and by viewing it from the lens of a person's social context, it has become an important point to analyse how queer affirmative practice’ is addressed.
Unpacking Queer Affirmative Practice
Simply defined, Queer Affirmative Practice is a therapeutic practice that is linked to the identities of lesbian, gay, trans, bisexual, asexual and other multiple sexual and gender identities, and it extends a positive affirmation to their lives, distress, relationship and their being in general. It is a modification of the existing model to include issues and stressors that an LGBTQIA+ individual faces in a heterosexually constructed world, can be applied to any of the therapeutic models that mental health practitioners use in their work.
Queer Affirmative Practice means that a practitioner acknowledges the marginalization and mental health issues that an individual faces due to their identity, and works on them. It addresses the structural issues that people from the community face and addresses various issues like transphobia, biphobia, homophobia, and other related discrimination that those from the LGBTQIA+ community face.
Often there is a lot of masking and hiding with regards to what a person feels due to their identity, which normative clinical practice fails to address. Queer Affirmative Practice provides a space for affirmation for the person’s identity. It does not merely diagnose them with a disorder or look at a list of clinical symptoms and ascribe them to the person. Queer Affirmative Practice fills in this gap by providing representation, and offering a safe space to address the layers of exclusion and their effect on their mental health, as well as the other social problems that an LGBTQIA+ person faces, along with their individualised distress.
This should not be confused with the idea of the clinician merely being LGBTQIA+ friendly, as they are open to such clients but do not include practices that would help them work on the issues and problems that individuals face due to their identity. Instead, Queer Affirmative Practice manages to deconstruct the power hierarchies that exists between a mental health practitioner and a client as the space between both is also political.
In the process of trying to understand how Queer Affirmative Practice in mental health stands up today, especially in terms of advocacy, representation especially with the United Nation’s Convention on the Rights of Persons with Disabilities’ motto being
I asked two questions to three queer individuals coming from different sociopolitical contexts.
How do you view queer affirmative practice considering your social context?
Do you feel represented?’
Here's what they had to say:
Ajay Meherchandani, 29, Mumbai
"Basically I am a Sindhi, and Sonara is the subcaste. It is a variation of the upper caste in many ways. Caste identity is not the same in Sindhi society as it is in other communities. I was not aware of my own location in many ways, until I started studying sociology and engaged with friends.
With reference to queer affirmative practices, I feel like it depends on accessibility. In my personal experience, I have gone through psychotic breaks, around two or three times. In those times, my family could afford psychiatrists. The first psychiatrist I went to, she was an upper caste but not queer affirmative. It took me a change of two psychiatrists to find queer affirmative psychiatrists.
From my location, I am from an upper-class family. My father is retired, but I could still afford the slew of change in psychiatrists. I don’t think many people can afford to do this.
Second is that my place of living also helped me to access these people, as well as my social capital in terms of friends helped me find psychiatrists and therapists. Coming from my upper class, Hindu, cis gendered gay male location, it was considerably easy for me to find help. I also found out about queer affirmative therapy from friends coming from similar circles."
Anonymous, 22, Ahmednagar
"I feel like my therapists were never from my social backgrounds, or I never felt represented. I was able to find a queer therapist. But even then, my social identity like class and caste, or my background as I come from a small village and moved to Pune, a metropolitan city, I always felt like that the person did not empathize much with my social identity.
I was seeing them for my issues with my gender identity, but then, I realized it is not just my issues about my gender identity, but also with other social identities I carry with myself. I think that was the reason why I was not able to talk about real issues I had.
My therapists always came from a privileged background than me, I am not saying it just like that, but they evidently were from a higher class and caste. So, I always had an inferior position in the conversation, and my social identity affected my mental health. I always felt like it would have been better that I would have seen with a therapist who could understand that part of my identity too. It wasn’t gender identity for me, but due to a lack of representation, there was a heteronormative angle to my existence."
Suvlaxmi Gurmayum, 23, Imphal
"Coming from Meitei community, even in Manipur, the word counselling seems alien, especially when I go back five to seven years back. Now things are seeming to be a bit better in a government sense.
52 practitioners for hundreds, thousands of people. There might be four queer affirmative practioners in this.
In the sense of queer affirmative counselling, how accessible is it in general? Most do not have the basic knowledge, and secondly, they might just go for ‘normal’ counselling. Especially by not knowing about queer affirmative counselling, they might get the wrong idea about counselling when they are facing gender identity issues, or get misdiagnosed. I myself have been coming to terms with my sexuality in the pandemic. The counselling I went to before, it was not queer affirmative.
I kind of hid the fact that I was attracted to men as well as women, I tried my best not to bring that up. I intuitively felt like my counsellor would not be able to help me, or answer my questions. I dodged all kinds of questions around my sexuality.
In terms of representation, there is not enough. I think there can be more done in terms of furthering the practice.‘ There is a need to analyse whether the same old pattern of upper caste, upper class, cis gendered mental health practioners and practices being the majority represented and used in the realm of Queer Affirmative Practice.
There is a need for diversity and representation in India's mental health landscape, not just for the sake of it, but also for greater well-being and an enhanced understanding of what distress means for the person. It is not just to diagnose someone with symptoms and unidimensionally use the clinical perspective of mental illness but also what mental health means for each community. It is essential that there are more LGBTQIA+ individuals as mental health professionals, not just for representation, but also for participation as it opens up a space which is understanding and is able to reflect on the marginalization of the individual due to them being from a particular community. More LGBTQIA+ individuals need to come up from different communities for making the field of queer affirmative practice diverse and inclusive. This would ensure that every person who needs help is able to get the same without having to mask their identity or avail services which are not sensitive to their social location as well as the distress that comes from it.
Trupti Soman is a Mental Health Advocate at Nolmë Labs. Mental health and queer issues are their guiding factors. They have always been enthusiastic about reading and understanding new things, and are currently pursuing their Masters in Social Work. When not reading or working on something, they binge-watch series and write posts on their own struggle with poor mental health, hoping to reach out to others.