Abigail was only fourteen years old when her family first took her to a hospital to ‘cure’ her, sometime in 2014. At a psychiatric and rehabilitation hospital in Kerala’s Tirur, Abigail was administered medication and electric shock in the name of Sexual Orientation Change Efforts (SOCE), or what is widely known as ‘conversion therapy’ or ‘reparative therapy’ by certified doctors and medical staff. “They did not tell me why I was being treated so harshly. They thought they could beat the femininity out of me,” says Abigail, a transgender woman. More recently, in February 2022, she was again subjected to ‘reparative interventions’ at a hospital in Kerala’s Kunnamkulam. “I sent an SOS message and was able to get out because of some community intervention,” says Abigail, who now lives in Bengaluru, away from her family.
In September 2022, the National Medical Commission (NMC) banned ‘conversion therapy’ and categorised it as professional misconduct. The NMC also wrote to all State Medical Councils, empowering them to take disciplinary action against medical professionals who conduct this kind of therapy. But conversion therapy continues in many hospitals, under the smokescreen of various established medical practices. In an interview given to TNM in July 2023, Sumayya Sherin and Afeefa, a lesbian couple from Kerala, spoke about the pseudoscientific treatment methods of conversion therapy that claim to ‘cure’ homosexuality, that Afeefa was subjected to at a prominent hospital in Kozhikode.
The legal move to ban practices that interfere with a person’s gender and sexuality was set in motion in 2021 by Justice Anand Venkatesh of the Madras High Court in S Sushma v. Commissioner of Police, where a lesbian approached the court seeking protection from their families. The court declared that any attempts to medically ‘cure’ or change the sexual orientation or gender identity of LGBTQIA+ persons should be prohibited. The court also directed action against professionals involved in any form of conversion therapy, including the withdrawal of their medical licence.
Despite these interventions, conversion therapy continues - not just through manipulative medical methods but also spiritual, psychological, religious, and other pseudo-scientific elements. What is enabling this is the lack of a comprehensive legal definition for conversion therapy leaving it only as a ground for disciplinary action against doctors, and not the basis for criminalisation of the practice. The loopholes for perpetrators and facilitators to get away with these illegal practices are many.
In 2020, 20-year-old Anjana Harish died by suicide in Kerala following alleged conversion therapy that her family forced her into, and the case was widely reported in the media. Soon after, Queerala, an organisation working to help Malayali queer communities, along with a trans man who is also a victim of conversion therapy, approached the Kerala High Court, asking the court to define conversion therapy and form guidelines to be followed by medical practitioners in the state.
Rajashree Raju of Queerala tells TNM that though the NMC regulations may have created a fear of consequence among doctors, the lack of a definition is a major hurdle in criminalising conversion therapy. “It has been over two years since we filed the petition before the Kerala HC. We decided to do that because post Anjana’s demise we received many distress calls from queer individuals asking for support. But we were unable to help many of them and felt we should move legally so that there will be more scope for us to intervene in such cases,” she says.
Another conspicuous detail to note here is that doctors and hospitals that continue to do conversion therapy do not call it by the name anymore. For example, in Afeefa’s case, she wasn’t told by the doctor or the hospital that they were trying to ‘convert’ her. When she sought police intervention and asked to see her partner Sumayya, they told her that she seemed anaemic and injected her, after which she says she was sedated for two days. She only recalls a counsellor telling her that homosexuality is a disorder in a conversation.
In Abigail’s case, she recalls being injected with what she thinks are testosterone shots, because she noticed increased body hair growth after. These kinds of hormone treatments per se are not illegal and hence, when LGBTQIA+ individuals are administered these with the intent to convert them, most often doctors get away with it because as such there is no illegality unless proven otherwise. Even if the survivor manages to prove it, there is no specific law that applies to try such doctors. The maximum that may happen is the doctor is warned, especially if it is a hospital that is aware of such therapy being provided.
Rajashree says this is why conversion therapy must be separately legislated upon. “There is no legal order or legal document that really defines what conversion therapy entails, and we feel that if a law bans it, the order would define it, say what is punishable and how to pin criminality on those who practise it. Without that, doctors can only be subjected to disciplinary action or brought to court for extortion, kidnapping, assault, or whatever other charges apply,” she explains.
Murugan Muhilann, a survivor of this kind of therapy, says his family had taken him to a doctor who kept extorting money from them under the promise of ‘converting’ Murugan. “We went to a doctor’s clinic in Chennai’s T Nagar and at first, he didn't say anything, just ordered some tests, including an abdomen Doppler test to check my penile function. He never told me what the test was. They gave me a pill to swallow and I agreed because I was under immense pressure from my family. It was humiliating and extremely conflicting for me. My mother is not so educated and she trusted what the doctor said. He kept telling her he could ‘cure’ me and kept telling me “it's okay”, but insisted I do some sessions with him. This was very expensive. And later we realised he was extorting me and my family, ” he says.
Murugan also says that his mother had to pledge her gold to pay the doctor and that it cost her most of her savings simply because the doctor kept reassuring her that he could stop Murugan from being gay. “When doctors give such promises, desperate families believe them. I was also only 22 years old and to me, everything was confusing,” he adds.
Cases like Murugan’s where doctors loot families in the process of offering this pseudoscientific ‘remedy’, can only be tried before a court for extortion and not exactly for the attempt to convert one’s sexual orientation because of the lack of a legal definition, Rajashree explains.
Chennai-based advocate G Sathiya also points out that even in the Madras HC judgement by Justice Anand, conversion therapy is defined through references from foreign medical journals. “The NMC circular to State Medical Councils banning conversion therapy is the document that comes closest to saying what kinds of acts or methods can constitute conversion therapy in India. But even this is exclusive because it lays down what conversion therapy is but does not address how even established medical and psychological treatment modules like talk therapy, Cognitive Behavioural Therapy (CBT), or any kind of ‘cleansing’, ‘healing’, or psycho-religious rituals also constitute conversion therapy,” she says.
L Ramakrishnan, a queer rights activist from the NGO SAATHII, explained to TNM how the NMC’s ban on conversion therapy has indeed made many doctors refrain from administering it, but he also said that someone he knew was referred for CBT under the assurance of being ‘cured’ of his sexual orientation. Sathiya says that counselling and therapies have evolved to include the use of even performing arts like dance, music, theatre, and other activities. This creates more ambiguity, making reparative therapies thrive under many guises in the absence of punitive provisions.
“The current NMC ban only addresses doctors and medical practitioners who the medical councils have jurisdiction over. We live in an era where there are many online counselling courses that enable people to start sessions without due registration or monitoring. So what happens to those who use activities like natural healing, toxin cleansing, retreats, or even social media influencing for conversion therapy or to enable a positive attitude towards such therapy? This is why we need legislation that puts down what the course of action is and targets this practice in particular, taking into consideration all its possible manifestations under the guise of recognised medical or psychological practices. We can only fix accountability if we do this,” she says.
The lack of guidelines or a definition is not the only problem that makes it difficult to put an end to conversion therapy. Queerphobia, skewed social morality, and the lack of systemic will to consider the mental health of queer individuals beyond just reparative interventions further complicate the situation, disadvantaging queer lives.
Though doctors must not carry their personal biases into their professional interactions, Dr Hema Tharoor, senior consultant psychiatrist, at Alwarpet’s Apollo Spectra Hospitals, says that this is hardly the case in many situations. “The first thing is for someone to feel safe with a doctor or a mental health practitioner to come and speak about orientation and other things. But the problem is that there is still a lot of homophobia among the fraternity of medicine and this is irrespective of them being mental health professionals. There is a huge trade-off between their personal morality and their medical training,” she says.
Hema also says that queerness is treated harshly by many doctors including the use of methods like hypnosis and heavy medications, apart from magico-religious acts. She says that the NMC’s ban on conversion therapy fails to ensure that there are sensitisation mechanisms that trickle down to the individual doctor to educate them and pull them out of their own biases about LGBTQIA+ lives.
“Most often, doctors, psychologists and counsellors play the family card, or emotionally manipulate queer individuals into thinking that if they do not submit themselves to a ‘treatment for a cure’, their lives will be extremely difficult going forward. Being queer in our society in itself is difficult on many levels, and such medical interventions latch on to this sense of shame and fear that families have. Unfortunately, this also makes many individuals believe they have to change themselves. This may be why many do not feel safe to open up or come out of it, reducing the documented cases of conversion therapy,” she adds.
Vasu, a trans man who left his family after prolonged harassment about his gender identity, says that doctors did rely on their morality and not science when he was taken for reparative therapy. “My elder brother’s wife is a nurse. I think she consulted some doctors before my family took me to one. I told the doctor that I have been feeling some changes in myself from a younger age but I did not have the courage to express it. I slowly began expressing myself after understanding more about my identity and my family began questioning the changes in my behaviour. After that, I told them about my gender identity, but they did not accept me. Only I knew the changes that I was experiencing. The doctors then spoke to my brother’s wife and told her that these changes are not usual. They also told her that I was doing this probably because I was mentally disturbed. Then they injected me with something,” he recalls. He also mentions having had very rude responses from the police after approaching them for help.
Hema says that there is a lack of sensitisation among mental health professionals. In theory, they may know that this is normal, and they must not be biased, but wherever they are getting trained, if these are not taught or talked about, it allows this ignorance to persist.
“Some queer individuals present with Obsessive Compulsive Disorder (OCD), where they constantly doubt their sexuality. This, and other kinds of psychological stress or behavioural roadblocks come with the overwhelming fear of living a queer life, and sometimes becomes entangled with other psychological stress factors,” Hema adds. But many doctors use this as an opportunity to conduct reparative interventions, like in the case of Vasu.
Rajashree says that sensitisation of doctors and police personnel remains incomplete without the state first acknowledging the issue, pointing out that in response to Queerala’s petition to the Kerala HC, the state government made extremely disappointing claims. “The state said there is no proof for conversion therapy being conducted in Kerala because they have not received formal complaints. This was after Anjana Harish died by suicide after alleged conversion therapy and the case garnered wide media attention. When you refuse to address the problem, how do you ensure that you sensitise those who allegedly administer it as well as state machinery like the police who further stigmatise queer persons who approach them for help?” she asks.
Sathiya also agrees with Rajashree and says that in Tamil Nadu, an eleven-member committee has been formed following Justice Anand’s judgement to frame and finalise the LGBTQIA+ policy for the state. “Queer individuals are being given sedatives, high dosage antidepressants, and treated with no humanity across hospitals. But if we continue to rely only on them to come forward and complain, we won’t be able to help them at all. I hope this committee defines conversion therapy and pins specific accountability on those who perform and enable it. Legislation should also be pressed for, no doubt,” she says.
This must also be read with the Union government’s responses to the marriage equality petitions that are now awaiting judgement from the Supreme Court. The government has raised quite many claims that are moralistic and extremely opposed to the fundamental rights enshrined in the Constitution, further putting the welfare of LGBTQIA+ individuals in ambiguity. Though the Madras HC passed a progressive judgement on conversion therapy asking for a ban, critics also ask why the court did not take suo motu criminal cognisance of it and instead, directed medical councils to take disciplinary action.
In effect, it seems that though the NMC’s ban on ‘conversion therapy’ has some effect on medical practitioners and families who offer and enable it, for it to really benefit LGBTQIA+ individuals, we need more legal and state-led will that goes into the welfare of queer individuals and does not only limit the issue to therapy.
This reporting is made possible with support from Report for the World, an initiative of The GroundTruth Project.