Void in the sphere of wisdom: a distorted picture of homosexuality in medical textbooks

Homosexuality is not a new issue in western medical literature; but an empathetic approach to it in the medical literature in India is a recent phenomenon (1, 2, 3). Equality in providing healthcare is not being practised, as evidenced by homophobia among doctors (4, 5), more so in the Indian sub-continent where religious and social biases contribute to denying proper healthcare to the homosexual – as well as the lesbian, bisexual and transgender – community. The attitudes of young medical students are more amenable to change, and can be better oriented towards providing equitable healthcare, irrespective of the sexual orientation of patients (6). Here the question arises: “What does our curriculum teach about sexuality issues?”

We highlight the misleading information given in the textbooks widely followed by the students of the West Bengal University of Health Sciences. The most affected subjects are physiology, psychiatry and forensic medicine. According to the physiology textbook, in puberty “there develops attraction to opposite sex.” (8). This clearly promotes heterosexuality as the only norm. Some forensic science textbooks state that homosexuality is an “offence”, homosexuals “may be psychologically imbalanced”, and they are “egoists”, who “disregard society” and pose a “social, moral and psychological problem”. (9) The term “crime of homosexuality” has been used and “treatment of homosexuality” has been suggested (9). Some books say “AIDS infection is commonly transmitted by unnatural sex acts with the homosexuals” (9) and call sodomy “a sexual offence” which is most popular and widely practised among homosexuals (10). This portrays same sex behaviour as an inferior form of sexuality. In spite of a long debate on the controversial term ‘gay bowel syndrome’ as it indicates a link between homosexual activity and gastro-intestinal disease, it is still referred to in a standard microbiology textbook (11). A widely followed textbook of psychiatry uses terms like “crossgender homosexuality” and “ego-dystonic homosexuality” (12).

We suggest substantial revision in the undergraduate medical syllabus and textbooks as these are the main sources of knowledge for doctors. If distorted information is provided from the start of their medical education, any seminars or discussions will be in vain. An unbiased discussion of concepts like sexual behaviour, orientation, identity, sex and gender are much needed. Specific diseases which affect homosexuals must be highlighted rather than providing the “treatment guidelines of homosexuality” (13). Policy makers, educationalists, authors and thoughtful readers must come forward to fill this void in the sphere of wisdom and forge a better patient-doctor relationship.