LGBT, diversity not disease

In July 2016, Jakim launched a five-year action plan meant to “curb” LGBT behaviour, titled “Pelan Tindakan Menangani Gejala Sosial Perlakuan LGBT 2017-2021”. The plan was drafted based on the notion that an LGBT person is an abnormality, pathology and social ill.

In Malaysia’s healthcare system, the pathologisation of LGBT persons is evident from a set of guidelines released by the health ministry in 2017 on addressing people with “gender health problems” in public clinics (also referred to in the guidelines as Gender Identity Disorder).

The consequences of pathologising LGBT persons, especially in the healthcare system, are severe.

To pathologise means to acknowledge a specific condition as a disease. Diseases are defined as an abnormal medical disorder or condition that negatively affects the structure or function of an organism. Pathologising LGBT people implies that non-normative sexualities and genders are a disease. This assumption is not only inaccurate; it is discriminatory and has a profound, negative impact on them.

There is an abundance of scientific research evidence that illustrates the diversity and spectrum-like nature of sexuality and gender. This diversity is not exclusive to humans. It is also present in a large variety of animals such as lions, giraffe, penguins, dolphins and sheep.

In isolation, having a non-normative sexuality or gender has not been found to result in negative functioning or conditions in both humans and animals alike. It does not kill or impair a person’s ability to live. While homosexuality and being a transgender person were historically pathologised, improved understanding of sexuality and gender facilitated their recent depathologisation in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases.

Furthermore, external factors (such as the lack of acceptance among family and society) were found to be the cause of negative states and functioning among LGBT people, due to internalised homophobia, transphobia, self-hate and violence.

Perceiving them as a diseased population dehumanises, rejects and reduces an LGBT person’s individuality and complexity to sexuality or gender. Coupled with unsupportive and stigmatising social surroundings, it is no surprise that these factors bring about adverse health outcomes, particularly among those who are LGBT.

In general, LGBT persons are found to be 2.5 times more likely to have a history of mental disorders than non-LGBT persons, including depression, anxiety and post-traumatic stress disorders. They are twice as likely to live with a mental disorder and show higher rates of suicide, psychological distress, risky behaviours (eg. unprotected sex), low self-esteem, social isolation, self-harm and unhealthy coping mechanisms (eg. smoking, substance use).

These mental disorders or conditions are strongly associated with the stigma and discrimination they face.

Pathologisation of LGBT persons also enables and encourages conversion therapy. Such so-called therapy is actually traumatic and has been found to induce severe, long-term harm to a person’s mental health, including guilt, hopelessness, relationship strains, social isolation, poor self-image, and post-traumatic stress syndrome.

It has also been found to worsen overall well-being, self-esteem and mental health, while reinforcing self-hatred and social alienation.

An LGBT person’s access to healthcare can also be affected. Public health services are often the only available option for many, due to high fee charges from private healthcare services. But due to expectations of micro-aggressions, discrimination and prosecution (especially among Muslims who are LGBT), many become fearful of accessing the health services they require.

Their fears are not unfounded: recent local research shows that medical doctors who hold stigmatised views and feelings towards transgender people expressed greater intention to discriminate against them.

Greater intent to discriminate increases the likelihood of discriminatory behaviour. This results in many healthcare professionals asking invasive questions and acting withdrawn or even hostile towards LGBT patients.

To truly nip the problem of such discrimination in the bud, the notion that being LGBT is a pathology must end.

Non-normative sexualities and genders must be acknowledged as what they truly are – a simple diversity of sexuality and gender, and therefore a completely normal, natural phenomenon.

All relevant health guidelines and policies should be reviewed and amended accordingly to ensure they are LGBT-affirmative, inclusive and adhere to international human rights and evidence-based frameworks.

These reviews must be made in consultation with local LGBT activists and community members. Health professionals should be trained in sexual orientations, gender identities and expressions. Conversion therapy, especially those supported by the state, must cease.

Our healthcare system is responsible for protecting the well-being and needs of all persons, regardless of background and status.

Pathologising LGBT persons goes against the creed and ideals of the health profession to do no harm, and to put the patients’ needs at the forefront with openness, compassion, humility and understanding.

Jade See is a research officer with the Galen Centre for Health and Social Policy.

The views expressed are those of the author and do not necessarily reflect those of FMT.