Peer Support Practice
Living as a queer person in a heteronormative world means that LGBTQIA+ persons face oppression, discrimination, a lack of social acceptance, invisibility and violence. This is faced in not just everyday life but also reflected in social structures such as school, law, transport and the medical establishment (Shah, Merchant, Mahajan and Nevatia, 2015). It is only in 2018 that the Supreme Court decriminalised homosexual acts by reading down Section 377 of the Indian Penal Code. The rights of trans persons continue to be denied with the introduction of problematic laws such as the Transgender Persons Bill 2018.
This is seen clearly in psy disciplines - LGBTQIA+ persons have been pathologised and stigmatised on account of gender and sexuality. There is a shared, largely violent history & legacy of psychiatry with LGBTQIA persons. The Diagnostic and Statistical Manual of Mental Disorders I, 1952, classified LGB sexualities as sexual perversions. Homosexual men were criminalised, incarcerated or administered aversion therapy (Carr and Spandler, 2019). Women were also administered with aversion such as ECT, chemical emetics and other punishments. Homosexuality was removed from DSM II in 1973 and from ICD in 1990 (Dreshner, 2015). The diagnostic label of gender identity disorder (GID) was renamed gender dysphoria in DSM 5 in 2013 to tackle the stigma associated with the term disorder. Intersex persons continue to be deeply marginalised by the psy-complex. Closer home, In 2013-2014, the Indian Psychiatric Society continued to describe homosexuality as unnatural and advocated treatment with an aim to ‘convert.’
Luckily, the Mental Health Care Act 2017, foregrounded the right to access mental healthcare, by mandating equality and non-discrimination for all persons with mental illness. No person with mental illness can be discriminated against on the grounds of gender, sex, sexual orientation, caste, class, disability, religion, culture, and social or political beliefs. This was quoted when the Supreme Court ruled on Section 377 in 2018.
However, the MHCA 2017 and the striking down of Section 377, are legal changes, social dynamics are still at play. Living as a queer person in a heteronormative world comes with unique life stressors. Oppression, discrimination, a lack of social acceptance, internalized homophobia, invisibility, harassment, relationship issues and difficulties with self acceptance—exact a toll on mental health and wellbeing (Greene, 2007). As a result, research suggests that LGBTQIA persons are at increased risk for suicidal behavior, depression, anxiety disorders, substance abuse, and body image issues (Shelton and Delgado-Romero, 2011). Mental distress is further magnified when supportive social networks or LGBTQIA-specific resources aren’t available or easily accessible (Willging, Israel, Ley, Trott, DeMaria, Joplin and Smiley, 2016).
The reality is Mental Health Practitioners (MHPs) are largely cisgender, heterosexual, savarna. All these identities have power and privilege associated with them which affects the practitioner-client relationship. From curricula to praxis, many practitioners reflect the social codes and norms of heterosexuality. This prevents LGBTQIA+ persons from accessing mental health care and gender affirmative processes. The question of how to adequately support LGBTQIA+ communities is critical.
One answer lies in Queer collectives, who have fulfilled this role for decades—providing social support to their members and challenging heteronormative practices—doing untiring work and foregrounding lived experience and knowledge from the margins. This peer-support work is as crucial to LGBTQIA+ well being as formal, traditional mental health work. Peer Support work for LGBTQIA+ foregrounds lived experience as valid and vital knowledge. In this case, ‘expert knowledge excluding the knowledge from the margins is incomplete. This peer work is therefore not just about the experience of support, but also about being understood by someone who has had a similar life experience.
At MHI, we believe that the mental health ecosystem must work to challenge dominant heteronormative constructs in multiple ways. Through equipping practitioners but also emphasizing peer support - therapeutic work with a political frame of reference - a different worldview based on voices from the margins. Thus, MHI has launched a workshop module for peer support practice (PSP) within the lgbtqia+ community created by K Ranade, S Chakravarty, P Nair and G Shringarpure, as queer MHPs - uses knowledge from the margins with empathy, ethics and structure. This module thus challenges a top-down hierarchy of psy expert and clinical paradigms. PSP includes skills to work with support seekers, ethics around power, boundary setting, perspective building and self care practices. Trainings have been completed in Kolkata and as we move to a South-Asia based training in Delhi, we hope that linkages between MHPs and Peer Support Groups for LGBTQIA+ continue to be strengthened.
“Peer Support work for LGBTQIA+ foregrounds lived experience as valid and vital knowledge”
1 Shah, C., Merchant, R., Mahajan, S., & Nevatia, S. (2015). No outlaws in the gender galaxy. Zubaan Books.
2 Carr, S. and Spandler, H. (2019). Hidden from history? A brief modern history of the psychiatric “treatment” of lesbian and bisexual women in England. The Lancet Psychiatry, 6(4), pp.289-290.
3 Drescher J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral sciences (Basel, Switzerland), 5(4), 565–575. doi:10.3390/bs5040565
4 Greene, B. (2007). Delivering ethical psychological services to lesbian, gay, and bisexual clients. In K. J. Bieschke, R. M. Perez, & K.A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients(2nd ed., pp. 181-199). Washington, DC: American Psychological Association.
5 Shelton, K., & Delgado-Romero, E. A. (2011). Sexual orientation microaggressions: The experience of lesbian, gay, bisexual, and queer clients in psychotherapy. Journal of Counseling Psychology, 58, 210-221.
6 Willging, C. E., Israel, T., Ley, D., Trott, E. M., DeMaria, C., Joplin, A., & Smiley, V. (2016). Coaching mental health peer advocates for rural LGBTQ people. Journal of gay & lesbian mental health, 20(3), 214–236.