The Medical History of the LGBTQI+ Community
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The history of the LGBTQI+ community and the medical discourse has been a complicated one. The medical history of our community, while providing a peek into the development of the discourse around sexuality, provides another crucial insight. We learn that science and biology, often having strived to invalidate our existence, are neither objective fields of study nor are they immune from larger social and cultural influences, as many proponents of the sciences like to think.
One might be tempted to assume that gender and sexual minorities, stigmatised in earlier periods, have gained acceptance in a world that has become progressively open-minded. This linearity is challenged by Michel Foucault, a French philosopher, in his seminal study 'The History of Sexuality' where he makes the development of the discourse of sexuality his main focus. He suggests that homosexuality had a very legal and acceptable status back in Ancient Greece. In coming centuries, the discourses around sexualities changed due to a combination of factors and the developments in power structures. On the European sub-continent, the most influential change came about with the spread and adoption of Christianity during the Roman Empire with male homosexuality being deemed fully illegal in 533 AD. While the laws were not equally instated in every region, homosexuality did become a taboo in most European regions due to gradual Christian encroachment. Along with religion, the need to maintain patriarchal structures was another reason that homosexuality was unacceptable since it challenged the hierarchy of power possessed by cisgender, heterosexual men. For a more in-depth discussion, I would recommend reading 'When the Goods Get Together' by Luce Irigaray where she goes into the latent relations between homosexuality, heterosexuality, ‘female bodies’ and capitalist structures of the present. Our interest, however, lies in the nineteenth century when the question of sexuality gained great traction and eventually came to be classified as a medical issue.
The nineteenth century witnessed the emergence of sexology and sexologists. Sexology was the ‘science that sought to know the name and nature of diverse desires and sexual types’ (Bristow 6). Sexology was primarily influential in bringing to wider public knowledge new identity related terminologies. Its aim was to classify, analyse, and study various "sexual perversions", which it often codified under the categories of disease. Though problematic and insensitive in its attempt to classify and treat ‘sexual deviancies', it did open up a stimulating debate around the topic of sexuality that more conservative sections of society would rather not have heard (Bristow 15). Sexology can be considered a predecessor to the psychoanalysis of Freud and Lacan since most modern scientific inquiries continue to follow research approaches established under the tradition of sexology.
The terms homosexuality and heterosexuality first entered the English lexicon in an 1892 translation of, Psychopathia Sexualis, by Austrian sex researcher Richard von Kraftt-Ebing. The value of labels has been highlighted time and again, with developing terminology around sexualities finally providing people with a language to communicate their identities. Karl Heinrich Ulrichs (1825-1895), a Hanoverian legal official, was a pioneer in the field, dedicating most of his life to justifying the naturalness of same-sex relations way before the term ‘homosexual’ came into existence. Inspired by Plato's 'Symposium', Ulrichs created his own system of classification of the different sexualities, even attempting the classification of different genders. In contrast, Freudian psychoanalysis describes sexualities as being a result of early childhood trauma or inner conflict. Western society witnessed the proliferation of similar theories that attempted to prove homosexuality to be a devolution or degeneracy. The Darwinian evolutionary theory is still quite widely used to disprove homosexuality on the grounds that evolution and homosexuality are incompatible. This has, funnily enough, created the ‘Darwinian Paradox’ which cannot reconcile Darwin’s evolutionary theory of living beings inheriting genes that best aid in the survival and reproduction of a species (Darwin and Knight) and the gays. Though as it turns out Freud already had an explanation a hundred years ago, that is humans are not essentially reproductive beings. Eroticism and sexual desire extend well beyond the scope of reproductive capacities of sexually mature adults (Freud 1964, XXIII: 152). Dare I say, evolution is not all utilitarian and definitely not homophobic.
It will take a long time for psychoanalysis to come out of the shadow of Freud. Nonetheless, a number of studies have contributed to the consistent presence and persistence of the LGBTQI+ community within the field of medicine. The first Kinsey report in the mid twentieth century, Sexual Behaviour in the Human Male (1948) brought together statistical detail to show that 37 percent of the adult male population in the United States had achieved orgasm through homosexual contact. A similar report by Shere Hite The Hite Report: A Nationwide study of Female Sexuality caused sensation when it revealed that most American women did not reach an orgasm through heterosexual intercourse. However, interspersed through the statistical and scientific detail is the history of the actual community which was doing its best to survive in a vitriolic homophobic society. In the 1960s the homosexual community was to suffer through the AIDS epidemic which ravaged the lives of so many people of the community and can only be glimpsed today through the poems and works of the Beat generation, such as the hauntingly beautiful poem The Man with the Night Sweats by Thom Gunn and the works of Jack Kerouac. Living in the shadow of the Government of America which demonised them and a social attitude which blamed the epidemic on their ‘degeneracy’, it is no surprise that the LGBTQI+ community came to distrust medical institutions. Up until very recently, hormone therapy and electric shock aversion therapy were still considered legal means of curing homosexuality.
While we may appear to have come a long way, reality differs significantly. In the Indian society, few can confess their true sexual identity to one's parents or friends without risking one's lives, even in urban centres lauded for being progressive. Prejudices and discrimination don't just saturate our reality but are also institutionalised. Legal texts, despite claiming progressiveness, validate only three genders, the label ‘transgender’ being an umbrella term for a staggeringly large number of the Indian population. One would also be remiss to forget that it was merely three years ago that the transgender community finally acquired protection of rights through the Transgender Persons Act 2019, a law that remains deeply flawed. As it stands, a transgender person needs to go through sex-affirming surgery and must produce a medical report to prove their gender in order to get a transgender certificate. The law does not permit transgender people to declare their self-perceived gender identity without going through surgery. Not to mention, the crime rate against transgender people is still sky high. Even today, people cannot claim insurance when it comes to their transgender medical bills in USA, one can only imagine the state of transgender care in India. In India where gynaecologists to this day shame their patients on their sex life we still have a very long way to go. For a glimpse into the life of the transgender community, I would recommend reading Seven Steps Around the Fire by Mahesh Dattani and The Truth About Me: A Hijra Life Story by Rēvati.
Bristow, Joseph. Sexuality. 2nd ed., Routledge, 2011. Routledge.
Darwin, Charles, and Andrew Knight. “The Origin of The Species.” The Origin of The Species, https://www.vliz.be/docs/Zeecijfers/Origin_of_Species.pdf.
Freud, Sigmund. The Standard Edition of the Complete Psychological Works of Sigmund Freud: (1900) the Interpretation of Dreams (First Part). Creative Media Partners, LLC, 2015.
Aditya is a Literature student currently pursuing their Masters from University of Hyderabad. Their main interests lie in Gender and Queer Studies which they constantly intermesh with Psychology, Literature,and their own writings.