While visiting Karachi University a few months back for a fieldwork assignment, I had a rather peculiar run-in with a group of clinical psychologists. All of them were involved in clinical and rehabilitative projects and had recently banded together to start a small forum to teach people aspiring to enter mental health and also to disseminate specialised information among professionals. They felt that such knowledge was largely disaggregated in Pakistan.
This meeting was atypical for me since it was one of my first encounters with a group of well educated and professionally active psychologists who wanted to inject some vigour into the largely lethargic domain of mental health in the country.
One of the psychologists I talked to was working on a project in which he was the chief counselor for a group of HIV positive men – mainly sex workers. I found the topic quite novel and decided to question him further. Obviously when discussing the sex trade, it is pertinent to ask which genders are involved. When I asked him, he told me that he was working with MSM (men who have sex with men). When I asked him if he meant gay men, he brushed me off with a severe ‘no’.
Call me a skeptic, but I assumed that at least some men out of the several ‘MSM sex workers’ in Karachi must be gay. Here I define gay as being attracted to and engaging in sexual activity with the same gender out of natural inclination or choice.
This clinical psychologist, a counselor to the MSM, explained that such men do not exist in the country. Unfortunately for him, I had done some research of my own and therefore I provided him a personal account of several self-identified gay men that I had encountered in the country during my own research work. His response to that was simple, sneering, and not well thought-out:
“Gay men may exist in the upper elite class, but no men from the middle and lower classes would want to have sex with men.”
This man probably belonged to the middle class himself and obviously saw me as ‘the elite’. But much to my surprise, not one person out of this group of professional clinical psychologists and counsellors refuted his statement.
Finally a researcher, who was also a guest at the gathering, spoke up saying that homosexuality exists across the spectrum amongst all people and that it was a mistake to think otherwise. After a minor quibble, the discussion ended with neither side relenting their position.
For most people, this would be a simple belief-based argument, that people are allowed to believe what they may about the etymology of homosexuality – choice or nature – so long as they do not impress this belief on others. But the reason it is not acceptable for a psychologist to think this way is because homosexuality was removed from the list of mental illnesses from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973 and for an entire group of psychologists to be either unaware of this or unwilling to accept it, is outrageous.
Why is this a problem when no one explicitly said that homosexuality is a mental disorder?
It’s a problem because it is a counselor’s job to be judgment free so that his clients can express themselves in a way they are unable to do outside the safety of the counseling room. It is a place created for people to let out their fears so that the trained professionals can help their clients learn how to tackle their fears and problems. However, when a counselor has a negative attitude towards homosexuality or any ‘deviant’ sexuality for that matter, clients will either be incapable or unwilling to present their problems fully.
If the counselor is particularly adamant on stamping out certain sexualities, he/she may recommend conversion therapies which are aimed at rectifying all forms of sexuality till they match conservative heterosexual standards. These can further debilitate the mental health of their clients.
A recent article by the American Psychological Association states:
“Mental health professionals should avoid telling clients they can change their sexual orientation through therapy or other treatments, according to a resolution adopted by the APA’s Council of Representatives on Aug. 5 during APA’s 2009 Annual Convention.
There really is no evidence that orientation can change, (or that you can change) who you’re attracted to or who you fall in love with.
In addition, some participants in sexual orientation change efforts reported an exacerbation of distress and depression when such efforts failed”, she added.
“The task force also looked at how therapists can help people who are distressed by their sexual orientation in ways that do not attempt to change that orientation. Despite growing social acceptance of homosexuality, some people, particularly men from an evangelical or fundamentalist faith tradition, can’t reconcile their sexual orientation with their religious beliefs,” Glassgold said.
“Therapists can help by teaching such clients active coping skills, reconciling religious and sexual orientation identities and helping them develop social support networks so they feel less isolated.
When working with clients who want to change their sexual orientation, practitioners need to acknowledge and explore the stigma and bigotry still experienced by gay, lesbian, bisexual and transgender people.
The task force also found that coercive approaches to change teens’ sexual orientation—particularly involuntary residential programs—are “contrary to current clinical and professional standards,” she said. And parents should avoid programs that claim to prevent adult homosexuality by teaching gender conformity since there is no evidence for the effectiveness of such programs.
It’s really important for practitioners to try to increase parental acceptance of their children and encourage families to love their children despite any outcome of a child’s identity…There is evidence that parental rejection increases mental health problems in children,” Glassgold said.
My point here is not to sermonise about accepting homosexuality (though it may seem that way). It is simply to point out that psychologists have certain obligations to their clients and a code of ethics to follow.
By creating a hostile environment for his clients, this man was doing a disservice to them. In a country like Pakistan, one of the chief complaints of homosexual men would be intense feelings of guilt, conflict with religion and social denigration.
How can a counselor deal with the guilt brought on by these men who are enjoying emotional or sexual liaisons with other men, when he does not know about it?
Whether people opt for conversion therapies to engage in homosexual love affairs or sexual partnership, it is their choice. However it is the counselor’s responsibility to provide his clients with all the relevant information necessary to make educated choices and to remain as neutral as possible. The chief duty is to maintain the mental health of the clients, irrespective of any personally held beliefs.
I worry for Pakistan, where to my knowledge no certification as such is required to practice psychology and no checks are kept on professionals who are likely to have a drastic impact on clients. We need psychologists who understand that they form a part of a larger scientific community, and it is their duty to reflect on and act on the findings of this community.
If homosexuality is no longer categorised as a mental disorder and conversion therapies don’t work, then clients need to know that. If people have been able to lead successful lives being homosexuals then clients need to know that too.
by Muneeb Ahmed Khan
Source – The Express Tribune
Response to Muneeb Ahmed Khan:
My experience teaching 20+ Pakistani doctors about gender, sex, sexuality and STI clinical care in 1997 could not have been further from this response. The doctors were employed to work in ‘men’s sexual health’ for a US NGO including clinical work with male and transgender sex workers, men who have sex with men and gay men, so were possibly ‘sensitised’ to the issue already but they had never had this training before…even at medical school.
I was surprised about their ease with understanding and accepting the gender, sex and sexuality issues we discussed (and role played) given their less than conducive country and religious environment. Also, there respect when practicing examinations (supervised by me) on volunteer community members of (self identified ‘gay men’ and transgender) exceeded that exhibited in many South East Asian countries where I had done the same training. Several doctors told me latter that they segment their personal views from professional views ‘to ensure they can be the best doctor they can be’ and were very eager to learn more. It was very heartening to hear this.
Dr Chris Bourne MM (sexual health), FAChSHM l Head, NSW STI Programs
Unit & Senior Staff Specialist l Sydney Sexual Health Centre l Sydney
Hospital l PO Box 1614 l Macquarie Street l SYDNEY l NSW l 2001 l
Auatralia January 19, 2012