The Raj Still Lives On, Long Live The Queen!

Even though India keeps celebrating its independence from the British every year, and laws like the Mental Healthcare Act 2017 came into effect on 29 May 2018, a legislation cited in the British Journal for Psychiatry as setting a standard for the rest of the world to emulate, what happens in practice and on the ground is far from what the state dictates.

Recently, India revised its outdated MBBS curriculum after 20 years, and the Medical Council of India has even ‘patented’ it.

However, the Raj is alive and well in the tenets it lays down — for instance, lesbianism, adultery and transvestism being taught as sexual offences and perversions in forensic and psychiatry competencies. This in the era of Section 377 finally being decriminalised, and adultery no longer being a crime, with the very recent striking down of a 158-year-old colonial law in September.

Future medical doctors are still being taught the old, repealed Mental Health Care Act of 1987. There is no mention of the new Mental Healthcare Act 2017. In addition, competencies framed by the solo physiatrist (PMR specialist) still mention outdated terms like ‘differently abled’ and are heavily based on the medical model of disability, says Dr Satendra Singh, activist and medical doctor at the University College of Medical Sciences in New Delhi, expressing his disappointment with the progress or lack thereof in the MBBS curriculum revision.

In my own work in mental healthcare advocacy, I am constantly speaking about the UNCRPD or Rights of Persons with Disabilities Act. Neither is even mentioned in the curriculum and the controversial MCI guidelines for admitting persons with disabilities were even challenged in the High Court and Supreme Court, but later overruled.

Says Singh, it is not difficult to guess that there were no doctors with disabilities to frame this competency-based medical education curriculum.

Adds Dr Indrajit Khandekar, professor and in-charge of thet Clinical Forensic Medical Unit at the Mahatma Gandhi Institute of Medical Sciences, ‘All our suggestions have been ignored. As this curriculum was drafted more than 4-5 years back, there are some obsolete entries. It should have been updated before releasing this version.’

He went on to condemn the MCI as he said it was misleading the nation and the criminal justice system by producing incompetent doctors. ‘This competency based curriculum was drafted in 2014. It was not made public in spite of our repeated requests. The MCI even refused to give a copy of it after a right to information request. Even the final version was not made open for comments by experts. Why did the MCI keep such secrecy about the curriculum? Although I was invited to advise the MCI on the curriculum, they have ignored most of the suggestions given by us and in our public interest litigation.’

Dr Bhargavi Davar, founder of the Bapu Trust in Pune, points out that wandering, mendicant activities, renunciation, begging, etc., were criminalised by the British centuries ago. ‘Such people were “incapacitated” by law, and could be shunted into asylums or other such institutions. Those laws were never repealed. The Lunacy Act, and associated acts are used to bring the homeless into asylums. The home ministry also had those provisions, including a universal provision for trans-institutionalisation (which means that if a mental asylum is not able to house a person, any other similar institution can be used to incarcerate them).

‘The powers given to any and all kinds of quasi judicial authorities meant that magistrates, police officers, railway officers, corporation officers, and commissioners of different kinds could send someone to an asylum or similar place, to whisk away a person. NGOs working with the homeless too act as quasi-authorities, using vans to forcibly “round up” people and take them into closed-door shelters. Some may have a magistrate visiting their facility routinely, to write off the right to liberty and right to consent. Once so rounded up, you will know what happens to consent for any kind of treatment!’

Shreya Ila Anasuya, part of the Mumbai based nonprofit Point of View, says, ‘What’s happened with the revised MBBS curriculum shows that no amount of progressive legislation will change things in the actual lives of people, unless it is implemented. The medical profession has a problematic history of disempowering those who seek healthcare, and particularly those forced occupy marginalised spaces in society.

‘It has reinforced injustice for so long, and with recent changes in legislation there is really no excuse for the revised curriculum to contain extremely offensive, outdated and harmful directives. Being queer and trans needs to stop being criminalised and this cannot happen without the medical profession being sensitised to issues of gender and sexuality.’

Dr Harshit Sharma, a research scholar in psychiatric neuroscience writes that stigma leads to disparities for minority groups like the LGBTQIA+ communities and others. He writes about the ‘Minority Stress Model’ in which members of sexual or gender minority groups may face stressors such as discrimination and violence.

‘Data shows poor mental health outcomes in these populations including suicide ideation, sexual risk taking and more. These negative attitudes, including physicians’ homophobia, can put off LGBTQIA+ or disabled persons from accessing healthcare. The opinions and practices of medical practitioners need to change. Even now, you keep hearing of conversion therapy, psychotropic medication and even religious texts being used to ‘normalise’ sexual behaviour. The WHO has issued a statement condemning such therapies, that they ‘constitute a violation of the ethical principles of healthcare and violate human rights.’

Despite this darkness, there is hope in the artwork and activism by transwoman, activist and medical student Trinetra who is a fierce voice for the young trans community of India, making a difference in their lives by documenting her journey from being Angad to Trinetra.

Dr Satendra Singh is forever fighting for change and is conducting a conference end November in New Delhi, with the University of Chicago Medical School in disability-inclusive compassionate care with the real stakeholders — disability rights activists, doctors with disabilities and health professional educators. He hopes to frame the right disability competencies which can help future doctors in compassionate care.

Over seventy years after independence, India is still struggling to shed layers of the Raj. Whether in colonial practices, outdated laws still gathering mould, waiting to change, or in the romanticism of celebrating posh accents and the right kind of English, we have a long way to go in reclaiming the diversity that makes India rich, and embracing the idea that all shades of bodies, minds and sexuality are normal, that a rainbow coloured world just is more beautiful.