Dr. Kapila Ranasinghe is a Consultant Psychiatrist, who for the last five years has been attached to the National Institute of Mental Health, which was formerly known as the Angoda Mental Hospital. He received specialised training in Couple and Sex Therapy at Maudsly Hospital in London, which is considered to be the premier hospital in psychiatry and psychotherapy.
He is also a lecturer in Couple and Sex Therapy, conducting training at many institutions including the Post Graduate Institute of Medicine, University of Colombo, Sri Lanka. Dr. Ranasinghe has published articles both in Sri Lanka and overseas on Couple and Sex Therapy. Yuga Diviyata Maga Penveema, authored by Dr. Ranasinghe in Sinhala is available in local book shops. He humorously says that there are specialists in Sexual Medicine but not in Homosexuality as it is not a disorder.
Q: There is a belief among some people that homosexuality and transsexuality are mental disorders. As a medical doctor, what is your opinion about this belief?
A: The sexual attraction of one individual to another individual can be shown on a spectrum. At one end of this spectrum, the majority of people are attracted to the opposite sex. This group is called heterosexuals. At the other end, there are people who are attracted to the same sex. They are called homosexuals. Some of them are attracted exclusively to the same sex. Between these two ends of the spectrum, there are bi-sexual people who are attracted to both sexes. The current scientific understanding is that all these are normal phenomena which you see in any population.
Hence homosexuality is not abnormal. Many factors including heritable factors contribute to it. We have evidence to say that from the beginning of human evolution to the civilized humans, there have been heterosexuals, homosexuals and bisexuals in human history. There is no recent evidence to identify homosexuals to be different from heterosexuals except that they are sexually attracted to the same sex. It is like being right-handed and left-handed. Because of ignorance and lack of scientific understanding, people continue to label people as homosexual or bisexual. There is no scientific argument to accept that homosexuality is a disorder. Such misconceptions come from religious beliefs. Major medical bodies like the American Psychiatrists Association has categorically said that homosexuality is not a disorder. Personally, I have never believed that is a disorder.
Q: What percentage of any country’s population is homosexual and transsexual?
A: A transsexual is a person born into one sex and later adopts an identity of the opposite sex. For example, a person born as a boy may later become unhappy about his gender and start behaving as a female. A homosexual is someone who has sexual activity with the same sex. He/she does not wish to be the opposite sex. These are two different conditions.
Although, in Sri Lanka, no surveys have been done on homosexuality, all over the world, a lot of surveys have been carried out. Figures from a survey done by Kinsy Institute in New York, which specialises in Sexual Medicine, show that in a population, sexuality varies from 1% – 3%. Among males, this variation is 1.5% – 3%. Among females, it is 1% – 1.5%. These are global figures exclusively for homosexuals. Depending on the culture, religion and society, the figure for bisexuals can vary between 5% – 7%. These could be relevant to any population.
It is very difficult to calculate figures for transsexuals. Transsexuality is expressed openly when there is sexual freedom in the country. It is slightly higher in countries where sexual rights are protected. The figures are less than 0.5%, which is minimal.
Q: What are the social and psychological problems faced by a person of a sexual orientation different to heterosexuality, or a gender identity not matching that person’s birth biology?
A: Bisexuality and homosexuality are different sexual orientations to heterosexuality. Just being a homosexual or a bisexual, a person would not experience psychological problems. He/she would have such problems because of social relationships and the nature of social attitudes. A conventional family background would reject a homosexual. This can affect his/her mental health and he/she can become desperate or depressed. Homophobia and social stigma can make life difficult to a homosexual. Comments made by others can make him/her anxious. He/she will suffer minor psychological problems as a result of interacting with people with prejudice. Pressures from religious organisations may affect their mental health and social functioning. Because same sex relationships are treated as abnormal, they break up and do not last long. When a homosexual grows old, he/she will find it difficult to live alone and will have a slight vulnerability to develop mental health problems.
Transsexuals have existed from antiquity. Indian culture has male-to-female eunuchs. These cross-dressing eunuchs have a place in society for hundreds of years. They are called to conduct rituals during house warmings and office warmings. They have special homes. In our society too, there had not been a substantial rejection for the third gender. In the harems of certain kings, eunuchs had served. Before the arrival of the European culture, we had a culture with appropriate sexual freedom in that era. Marriage was not compulsory. Living together was based on trust, understanding and sexual needs. When we were under the British, Victorian attitudes arrived in the country and colonial government made homosexual acts illegal. In the Royal British Army, homosexual acts were forbidden. Christian concepts contributed to these punitive attitudes.
In the Buddhist philosophy, there were no rules for relationships and marriages. In our country, we did not have sexual rules. There was only a taboo against sexual abuses. With the change of the economic system and family structure, pressure mounted on sexual minorities including homosexuals and transsexuals to marry. As the number of children in a family reduced, the existing child or two were compelled to marry on attaining adulthood. European countries who changed our attitude to sexuality are now open to civil and sexual rights. But we are still continuing outdated values. Just because a person is homosexual or transsexual, he/she will not experience mental problems. It is the rejection he/she faces from society that will make him/her frustrated and depressed.
Q. In your medical practice, how many homosexual and transsexual persons have you met? What have been your experiences about them?
A: I have seen a lot of homosexuals and about 50 transsexuals. I could be seeing more than other psychiatrists as I have specialized training. Some of these transsexuals cross dress only. Some of them have gender identity disorder. They are not happy with their born gender. It is not an illness. It affects them psychologically. It is very stressful for some one not to be comfortable with one’s body. They want to change their body shape and genitalia. We help them to go through the process of changing their sexual identity and achieving their desired sex.
To be continued next week.