Issue 10 / 25 March 2013

FIFTY years ago US poet Allen Ginsberg in his poem America proclaimed “America I’m putting my queer shoulder to the wheel”, and today he is not alone.

However, homosexuality, in the context of societal attitudes and prevailing social norms, remains a deeply contentious and divisive issue, imbued with political, legal and religious undertones.

As a barometer of change, it is notable that in a relatively socially progressive country such as Australia, the last state to decriminalise homosexuality was Tasmania in 1997.

As medicine reflects the sociocultural milieu in which it functions, homosexuality has a chequered history in the medical profession. The pathologising of homosexuality is not a concept found in the murkiest annals of medical history, but is a relatively recent phenomenon.

In recent years, there have been concerted efforts to eradicate the stigma associated with sexual orientation within the medical profession and in the community. The submission by the Australian Medical Student’s Association (AMSA) to the International Federation of Medical Student Associations of a draft policy calling for governments worldwide to legalise same-sex marriage is yet another step in that direction.

The changing attitude in the medical profession has been driven by overwhelming evidence refuting homosexuality as an inherent psychopathology, by evolving social norms and by the recognition of the potential for psychological harm caused by homophobic stigma and discrimination. Studies have shown that homosexuals suffer higher rates of depression, anxiety and suicide than their heterosexual peers.

The cause for marriage equality has previously been championed by the American Psychiatric Association in its 2005 position statement, which acknowledged the positive influence civil marriage equality would play in enhancing the physical and mental health at all stages of childhood development by providing long-term spousal and family support.

Likewise, in its 2002 position statement on Sexual Diversity and Gender Identity, the AMA recognised the diversity of the modern family construct and emphasised the importance of a non-judgemental attitude from medical professionals. It said that, from a social determinants perspective, legal recognition of same-sex unions and families would help facilitate health care equity within the community.

A recent study confirms the need for equity, with same-sex cohabiters reporting poorer health than their different-sex married counterparts.

The AMSA championed this position in its exemplary submission to the senate inquiry into marriage equality, again demonstrating the pivotal role the medical profession can play in advocating for the wellbeing and health of society through actively advocating for equity, non-discrimination and social justice.

The medical profession is held in high regard in society and embodies care and compassion underpinned by the rigour of scientific objectivity, so if it pathologises or stigmatises homosexuality the impact is profound and enormously dangerous.

Therefore advocacy for marriage equality by medical organisations like AMSA and the AMA, among many others, is a welcome step. Hopefully this will mean that the fears and reservations about interacting and openly disclosing their sexuality with the medical community by this still very vulnerable and marginalised group will be reduced.

Today, we, as a society, and using logic, rationale and empathy, must decide on this particular issue, which toys with a person’s basic human rights and compromises our sense of justice and equality, because by our actions today we will be scrutinised and held accountable by the society of tomorrow.

Equality, free of hatred and full of acceptance, has been a long time coming. Let’s not wait for it any longer.

Mr Souvik Kumar Das and Ms Sophie Hale are medical students at the University of Sydney.

Posted 25 March 2013

15 thoughts on “Souvik Kumar Das

  1. Kate Stewart says:

    Excellent article. We members of the medical profession must champion equal rights for all groups in our society, and decry state-based discrimination whereever we find it, as recognition of individual rights and freedoms really are the basis of health. This is why the 150-strong group of medical professionals who call themselves “Doctors for the Family”, who signed their names to a submission to the Senate inquiry into same-sex marriage in 2010 calling for a continuation of current discriminatory policies, should collectively hang their heads in utter shame. These well-educated doctors cannot claim ignorance or stupidity as a rationale for demonising a whole group of Australians, those who identify as LGBT. Yet the selective quoting of studies on their website that apparently support their contention that, for example, children do worse in same-sex headed families, would (and does!) put a first year medical student learning critical reasoning skills to shame.
    It is great that the AMA and AMSA have shown their support for marriage equality.

  2. Anonymous says:

    Call a homosexual union by another name. Marriage is for heterosexual couples and has been so for millenia. All the arguments above point to recognition which can be achieved without changing our language.

  3. anonymous says:

    The authors suggest that the profession should (rightly)avoid pathologising homosexuality and therefore champion same-sex marriage.
    This is a ludicrous proposition.

  4. Peter kennedy says:

    It’s true that as you say “Studies have shown that homosexuals suffer higher rates of depression, anxiety and suicide than their heterosexual peers.” They have NOT shown, as you mischievously imply by your preceding sentence, that these problems are “caused by homophobic stigma and discrimination”.

    The push for purporting to re-define marriage to embrace the absurdity of so-called same-sex marriage, has nothing to do with “equality” much less good health care. It is all about trying to not only normalise, but COMPEL universal endorsement of, behaviour which has been abundantly shown to be both physically and psychologically harmful to individuals and to society. You are right, future generations will look back on our time with disgust when they read how supposedly responsible people argued for this absurdity.

  5. Evan Cameron says:

    Peter, Google scholar is a free service that allows you to search reasonable quality literature. Skimming abstracts I was unable to find anything supporting your view. Indeed, interventions aimed at reducing the psychological impact of stigma improved patient outcomes.

  6. Sue Ieraci says:

    It’s clear that marriage equality isn’t the only factor affecting the mental health of non-heterosexual people, but it is likely to be one influential factor. Referring to same-sex marriage as “so-called” and “absurdity” might be another. We are talking about allowing two adult individuals to have the same sort of civil marriage as the everyone else – there is no compulsion to approve, normalise, or compel anything of others. SPecifically, churches are not proposed to be required to marry non-heterosexuals, though some already do. And yet nobody is compelled to approve or normalise anything that heterosexual couples do – whether it be extra-marital sex, domestic violence or any other specific behaviour. Nobody else’s marriage affects one’s own, does it? I concur with the suggestion that de-stigmatisation is likely to improve the mental health of the stigmatised.

  7. Michael King says:

    I find it frustrating that debates such as this so frequently descend into emotive name-calling. I object to the epithet “homophobic” that is applied to anyone who disagrees with the Gay lobby. By definition a phobia is an irrational fear. I find it insulting that I am assumed to have an irrational fear of homosexual people just because I don’t automatically accept the tenets so loudly proclaimed by activists.

  8. Ian Jones says:

    It doesn’t seem all that long ago that the “progressives” were insisting that marriage was an old fashioned, out dated institution. Now everyone wants to get on the bandwagon. I suspect it’s not all about equality but pushing other agendas.

  9. Kate Stewart says:

    Ian Jones,
    It doesn’t seem all that long ago that the “conservatives” insisted that interracial marriage wasn’t allowable, citing stigma for the resulting children of the marriages as a reason. Luckily for many, the conservatives didn’t manage to stop progress then, and they won’t now.

  10. Peter Kennedy says:

    Evan: are you seriously suggesting that “homophobic stigma and discrimination” is the cause of the fact that active homosexuals as a group (even in places like the Netherlands where the levels of such discrimination and stigma are negligible) have far higher rates of all STDs, suicide, murder by sexual partners and other domestic violence, depression and other mental illnesses? Any psychiatrist will tell you that depression and suicide is far more frequently about what is happening endogenously inside the patient’s mind rather than any social stigma or any pathological hatred/fear expressed by others. In fact many depressed people and suicides have been surrounded only by love and acceptance by others.

    Sue: you seem very confused. You claim that “there is no compulsion to approve, normalise, or compel anything of others” yet in the same breath you condemn me for “Referring to same-sex marriage as “so-called” and “absurdity” claiming that I am damaging people’s mental health by doing so.
    So-called “same sex marriage” is not only contrary to common sense (the very suggestion that it was possible would have been universally considered utterly ridiculous to our Western culture until 20 years ago, and to every other human culture that has ever existed), it is legally impossible. If you try to bully me into not expressing my opinion of it now, what will you and your fellow would-be-dictators be like when and if it ever became purportedly legal?
    And yet you applaud some churches which you claim are purporting to marry same sex couples; if so they are clearly breaking the law.
    And why do you bring religion into it anyway? I don’t belong to any religion and this question has nothing to do with anyone’s religion or lack thereof. It’s about the fact that marriage is the basis of all human societies and it can’t be re-defined, certainly not by any parliament, court of law, or religious organisation.
    Domestic violence is illegal. And if you think that extra-marital (hetero)sexual activity has not been normalised in our society you must be living under a rock.

    Kate: I’m not aware of anyone in history outside of South Africa (1960s to 1980s) and certain SE States of the USA where “interracial marriage wasn’t allowable”. But nobody has ever claimed it is impossible, as is the case with so-called same sex-marriage. By definition there cannot possibly be any resulting children so your claim about stigma towards such children is nonsensical. As for labelling people who don’t want to redefine marriage as “conservatives”, in fact it is the conservatives in the UK and elsewhere who are attempting to force this absurdity on the people against their will.

    And it doesn’t seem that long ago that the so-called “progressives” were telling us that the State has no business what consenting adults of the same sex do in private. Now they’ve done U-turn and they claim the State has a duty to endorse and celebrate it as the basis of human society.

  11. Chris Middleton says:

    I disagree with the authors of this opinion piece. This is not a medical issue, it is a social and political issue. Firstly, there is no discrimination against same-sex couples under Australian law. Changes to Commonwealth law in 2008 saw 85 items of legislation amended to recognise same-sex couples including those pertaining to property, superannuation, social security and family law.

    Secondly, same-sex couples are clearly not equivalent to heterosexual couples as their union is incapable of producing children. This does not mean that they are inferior; it just means they are different. We deal with different things and different people in different ways every day because they are different not because we are making value judgements. This is not an equality issue no matter how much proponents of same-sex marriage would want us to believe that.

    Finally, as for the medical implications referred to in the above article, there is no good evidence that the poorer health of homosexuals is in any way due to inability to marry each other, nor that health outcomes are improved overall in those jurisdictions where the practice has been legalised.

    The AMA should not take a public position on “same-sex marriage”.

  12. Peter Doyle says:

    The AMA is a representative organization whose business is about health care, and which should represent the members views.

    Policies should be approved by a significant number of members before they are adopted.

    I am a member of the AMA and I agree with most of the position statements in this document, but I do not agree with positions 6.5 and 6.6 which support equal opportunity policies and legislative recognition of same sex unions.

    At no time have I been canvassed by the AMA about this position statement, and I have only just become aware of it.

    Furthermore, it is my opinion that the AMA has no business taking a position on these matters, which have to do more with social (and perhaps moral) stances than with quality of health care.

  13. James Lawler says:

    Great article guys!
    1. Yes we are suggesting that stigma and discrimination is part of the social determinants which cause the LGBTI population to have poorer health outcomes. This is infact what the evidence is suggesting, despite your assertions that it is due to genetic/internal factors. Marriage equality would go some way to rectifying this.
    2. You state that any psychiatrist would tell me that these factors are from inside the patient’s mind, and not due to social discrimination. However, if you read the article again you would see that the American Psychiatric Association actually was one of the first medical bodies to support marriage equality for exactly this reason. Your comment that “any psychiatrist will tell you…” is clearly not guided by psychiatrists but by your own pre-existing views.
    3. Same-sex marriage actually was occuring in ancient Rome and China, again you’ve assumed something which is wrong.

    I’m sorry if you feel like there has been name-calling directed at you, but as you can see your arguments are based on false claims. My question to you – if same-sex marriage was to be implemented, what would you feel are the negative social/health effects which you or those around you would be subject to? I would think there are none which are evidence-based.

  14. Peter Kennedy says:

    James, it is interesting that because you and others promoting this absurdity base their “arguments” on emotive unfounded assertions and your personal feelings, you assume that those opposing it must do the same. I certainly never claimed that legislating such absurdity would hurt my feelings or have negative social/health effects on me. My arguments are based on objective factual data only. I can’t see any name-calling directed at me here. My statement about psychiatrists is perfectly correct as you would know if you have any knowledge of psychiatry. I certainly did not say “that any psychiatrist would tell me that these factors are from inside the patient’s mind, and not due to social discrimination”, this ludicrous absolute and specific assertion is a straw-man you have created.

    It is a matter of record that the American Psychiatric Association’s position on thus is a result of political manipulation. I would hate to think that such political manipulation is controlling the public statements of the leaders of our own AMA.
    Certainly homosexual activity occurred in ancient Rome and China and almost every other society, however so-called same-sex marriage has never occurred before anywhere, despite the groundless assertions of those making creative re-interpretations of history for political motives.

  15. Dr Janelle Trees says:

    Thank you for doing the research and writing this, Souvik and Sophie. I am appalled that colleagues in our caring profession would consider it controversial.

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