New Delhi: Waging a battle within to identify one’s own gender can take years and a huge toll. Even more overwhelming can be the revelation of this self-realisation to the world outside, be it one’s own family or the society at large. The uncertainty of what comes with this public knowledge of something so private can test the mental, emotional strength of even the most resilient. But for those from the LGBTQIA+ community this struggle is the ultimate reality and there is no escaping it unless by concealing one’s true self, which can be even more traumatic. Add to this the burden that many from the LGBTQIA+ community have to endure, years of abuse, humiliation, neglect, rejection, discrimination and loneliness.
The need for focussing on mental health and wellbeing assumes a whole new meaning and importance for someone from this community. But this need goes beyond the usual scope of treatment. A psychiatrist also plays a huge role in the lives of a queer person when they take the life altering decision to medically adopt their secondary gender and alter the gender assigned to them at birth through what is called the Gender Affirmation Surgery.
In our Pride month’s special, team Banega Swasth India speaks with Dr Rajeev Mehta, Vice Chairperson, Senior Consultant, Department of Psychiatrist, Gangaram Hospital, New Delhi to understand the role of a Psychiatrist in a queer person’s life to provide them with their desired healthcare treatment. Here’s what we discussed:
Understanding Gender Dysphoria
First thing first, Dr Rajeev Mehta explained about the term Gender Dysphoria, he said,
Sometimes, when a biological male identifies more as a female or vice versa and faces constant distress with the sex assigned at birth, as it does not match the person’s identity, it is termed as Gender dysphoria. People with gender dysphoria often feel that they were born in the wrong gender. As a result, to fix this feeling, Gender Reassignment Surgeries, sometimes called Sex Reassignment Surgeries, is performed to transition individuals with gender dysphoria to their desired gender.
Not All Qualify For Gender Reassignment Surgeries
Highlighting how do the doctors qualify a person for Gender Reassignment Surgery, Dr Mehta said,
When the patient first comes to us, the first thing we have to see is whether he or she is actually suffering from Gender Dysphoria or they are doing it for some other purpose. Many a times, we have seen, when parents don’t have a male child, they want their girls to become one. So, when a queer person comes to us for their treatment, we have to rule out all possibilities.
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Dr Mehta listed down few measures Psychiatrists usually take to identify a person suffering from Gender Dysphoria. He said,
– We track their journey from childhood
– We observe their behaviour, their social conduct, their attire
– We see what pronouns they are using to describe themselves in the first round when they come for a session
– We, usually ask them to communicate with us in a local language or Hindi to understand their stand as in English the pronouns are not used, usually
– Then, we try and verify their history with someone who is staying with them, either from childhood or from past 6 months
– We also ask them to show us their photographs, for us to understand their disconnect with the body, usually photos are the deciding factor as it reflects a person’s identity
Dr Mehta further said that once identified as a person who is suffering from Gender Dysphoria and someone, who really needs to undergo a treatment, we Psychiatrists usually weigh in mental health comorbidities that the person maybe experiencing. Dr Mehta said,
These people have an array of mental health issues – from depression to anxiety, drug abuse, you name it, and they will have it. Before, we give them a clearance for the surgery, we have to make sure the mental health related issues are corrected.
Dr Mehta also said that in the entire process, doctors have to rule out the possibility of other diseases in which a person thinks that they are of other genders, for example in Psychophobia Psychosis. Dr Mehta added that doctors have to see their cognitive, financial capabilities as well and understand their social support system and occupation.
Sharing an instance with us, Dr Mehta added,
I remember, I had a case with my colleague, wherein a singer wanted to be transformed as a male. So, when she started with the treatment and started taking hormone therapy, she was able to get her desired sexual characteristic, but at the same time, she lost her profession. So, futuristic vision has to be there and should be the deciding point.
Paperwork Needed For Gender Reassignment Surgery
Explaining the certificates and clearances needed, Dr Mehta said,
A certificate is basically a clearance that states yes the person is suffering from Gender Dysphoria and not any other disease and is fit to undergo the surgery.
Highlighting the time period for certification and documentation, Dr Mehta said,
It is done generally in one or two sittings, provided, we have the proper material to understand their case. This can be done clinically and also through physiological assessments, in which there are various scales. But personally, I think, clinical assessment is good enough. Sometimes people go for physiological assessments just to be sure that they have not missed any disorder.
Dr Mehta explained the certificate is needed by the LGBTQIA+ Community for Hormone Replacement Therapy and as well as for top and bottom surgeries. He added,
Different surgeries require different certificates. For example, if a person needs to undergo top surgery and HRT, then only one Psychiatrist certificate is needed. For people, who wish to undergo bottom surgery as well, two Psychiatrist certificates are needed. Ideally, people undergoing surgeries need to be under clinical observation by a Psychiatrist for long. Treatment just doesn’t mean medication it also means therapy sessions.
Things To Know Before Starting Gender Reassignment Treatment
Explaining what type of counselling is provided to the community before they are given the certificate by a Psychiatrist, Dr Mehta said,
They need to be told that this is an irreversible process. We ask our patients, to go and live their life in the desired gender for some time previous to the surgery and hormone treatment. We ask them to change their name, we tell them to explore both private and public environment being the gender they want to be for some time. This way, they can be made comfortable in their desired gender role, which they have to adopt any which ways after the surgery. Also, this will help them prepare for all kind of challenges and situations, which they may face after the surgery is done.
Challenges For Anyone From LGBTQIA+ Community Wanting To Change Their Sex
Talking about the challenges and what someone from the LGBTQIA+ Community should expect before they kick-start their sex change journey, Dr Mehta said,
We should be sympathetic to this community. Understand that they are the sufferers. In the past, they have suffered a lot, they have lost their families and have been bullied too. There is also a lot of sexual abuse among these people. All the challenges that general public face they all also face, but what they face is in large number. Depression, anxiety, drug abuse are some of the outcomes of the challenges that this community face. They are vulnerable, in minority and they have very low support system. And that’s why they need counselling and should be under Psychiatrist’s observation.
Lastly, talking about the expectations, Dr Mehta said,
Know that the Gender Reassignment Surgeries are irreversible. Once done, you cannot change it. LGBTQIA+ Community should be ready that their friends and family group may change after the surgery is done. They should also know that they cannot become a biological parent after the surgery. Lastly, the treatment and surgeries are costly, they should be ready to bear that cost and know that their financial stability may change.
A Pride Month Message From A Psychiatrist
Dr Mehta said that there is a dearth of professionals in India who are experienced to handle the LGBTQIA+ community. Highlighting how doctors and professionals can help treat the community, he said,
No body is willingly LGBTQIA+, nobody is willingly gender fluid. This is a genetic makeup of a person, understand it is a natural phenomena and treatment should be done in the same manner as of the rest of the population. LGBTQIA+ community should be accepted everywhere without any terms and conditions. My suggestion for healthcare professionals will be that be sympathetic towards them, lend them an ear, understand them, call them with their correct pronoun. Lastly, understand the topic as much as possible and keep all judgements away.
Dr Mehta signed off by saying that Indian society can become inclusive once the information regarding LGBTQIA+ Community is in India’s curriculum. He said,
Education is very important. Everyone should be sensitised towards this topic since the beginning. Gender diversity should be a part of India’s school curriculum and not just medical curriculum. It is high time we stop limiting genders only to male and female.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – theLGBTQ population,indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the currentCOVID-19 pandemic, the need for WASH (Water,SanitationandHygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fightmalnutrition, mental wellbeing, self care, science and health,adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues likeair pollution,waste management,plastic ban,manual scavengingand sanitation workers andmenstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India wheretoiletsare used andopen defecation free (ODF)status achieved as part of the Swachh Bharat Abhiyan launched byPrime Minister Narendra Modiin 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.