Abstract

INTRODUCTION

Homosexuality as a disorder has been removed from the psychiatric classificatory systems. This does not mean that homosexuality as a segment of human population has lost its importance. Its ramifications in various aspects such as its definitions, various epidemiological methodologies for assessment, forensic aspects, community living, and services for the members are attracting attention. It is not proposed here to discuss any of the areas; as they are competently written about by various authors.[1]

In this article, the core concepts in this area of lesbian, gay, bisexual, and transgender (LGBT) sexuality as defined by Becker and Perkins in the American Psychiatric Publishing Textbook of Psychiatry are applied to the ideas prevalent in the ancient Tamil land.[2] The Indian scenario, to an extent, has been covered in a previous article.[3] The complexities and confusion existing in this area of human behavior, including terminologies, are very great; especially those of the past; which makes our effort challenging, hazardous and probably inappropriate. We have used the Tamil equivalents and near equivalents from reputable Tamil lexicons and encyclopedias.[4] The terms selected are pedu and ali. The term ali means a person who is neither male nor female and also is referred to as the third sex. In ancient Tamil literature, the word pedu was used to describe both male and female persons. The male pedus were described to have many effeminate features such as gait, other bodily movements, high-pitched voice, prudery, lacking virility, beauty and fine feelings. The female pedus were said to have prominent secondary sexual characters of females along with marked hirsutism, with the features of completely feminine stride, pestering, murmuring music, being fed-up, blessing, or cursing. The literature is rather silent about their feelings of attraction to the other or same sex. The present popular term in Tamil aravaani has been covered (vide supra). The concept not only includes sexual attraction to the same sex but also defects in human sexual development, congenital and otherwise. The remarkable achievement of begetting a child with normal physical and mental development is mentioned by the classical Tamil poet Thiruvalluvar in the Thirukkural as follows:

Of all that men acquire, we know not any greater gain

Than that which by the birth of learned children men obtain.[5]

Another great Tamil poetess Avvaiyar mentions incomplete development of the sex as one of the congenital defects. This is found in her poem:[4]

If you ask what is rare Lord Muruga
It is rare to be born as a human being
Even if one is born as a human being
It is rarer to be free from being a hunchback or blind or deaf or hermaphrodite.

As the legend goes, this is Avvaiyar's reply to one of Lord Muruga's queries as to what is most rare. The period of this poem is rather difficult to ascertain as there are more than one Avvaiyars in the Tamil literature, the earliest being of Sangam age, and later ones probably belong to subsequent (Chola 10^th century) periods. This poem is from the Avvaiyar probably dating back to the Chola period c. 13^th century Chola empire (CE), when she was a contemporary of Kambar of Kamba Ramayana fame in the Chola court.

Another notable reference to ali (indeterminate sex) is by the great saivite saint Manickavachagar of the c. 9^th century CE in his Thiruvembavai written in praise of Lord Annamalai, the presiding deity of the sacred hill of Thiruvannamalai in Tamil Nadu:

In his presence, not only the sun, but also the stars lose their luster
He is all male, female and ali and also different from all these.

There is a description of a pedi koothu i.e. a dramatic performance by a hermaphrodite in Manimekalai (written by the 2^nd Century CE Buddhist poet Sathanar):

Then, a hermaphrodite's dance (pedi koothu) is watched by other interested spectators:[6]

The dancer had a curly beard and dark hair!
Coral red mouth and pearl-white teeth!
Bright wide eyes with red lines!
And wearing garland made of white conch shell,
Dark low eyebrows and crescent moon forehead
Fair hand like kantal and upright tender breasts!
Wide alkul and fair lean hip!
Wearing a skirt! Drawings on his shoulders
He was enacting a kuttu
Performed by Kaman son of him who measured the earth
In the street of Conakar of Vanan-Asura king.

The context is to the story of Prithyumnan, the son of Lord Krishna and Subhadra who goes to the capital city of the Asura King Banasura disguised as a hermaphrodite to beguile the Asura King to release his son Aniruddhan who is imprisoned in the royal harem of the King's daughter, Usha.

It should be mentioned that the presentation of the antics of a hermaphrodite to draw the attention of the spectators is only a caricature; hence, the expression is one of the very much exaggerated features of the female with a marked hirsute visage. Such dance dramas are often performed by professional dancers are much in vogue in the country. Eleven varieties of koothu are described in the Tamil classics, which include seven by gods (Shiva, Vishnu, and Murugan), three by goddesses (Durga, Lakshmi, and Indrani) and one by the pedi which Kaman enacts. Among the eleven varieties mentioned, some of them are drunkards’ antics, dances by a lame person with a wooden leg and other folk dances.

This pedi koothu is also referred in the classic, Silappathikaram. It was an epic written by the the Tamil Jain poet Ilango, who was a close friend of Sathanar (the Tamil Buddhist poet who wrote the epic Manimekalai). This koothu is performed by the great dancer Madhavi, in the city of Puhar, in front of her lover Kovalan.[7]

Manimekalai also has many references to the transgender role. There is the description of the life of Arjuna spent in the city of the Virata King as a female for a year. This episode is the fulfilment of the curse given to him by the heavenly damsel Urvashi when Arjuna rejected her advances. Another instance is that of Amba who also assumes the male form as Sikandi before she could confront Bhishma to wreak her vengeance upon him for his refusal to marry her. Manimekalai also assumes the form of an aged male ascetic when she has to listen to the philosophies of the religious sects at Kanchi.[6] Such sexual transformations found in our literature could be compared to this day sexual reassignment surgeries and hormonal reassignments and categorized as divine reassignments.

Then, there is also the concept of Ardhanaareeshwara in Hindu mythology. Lord Shiva and his consort, Goddess Parvathi are seen to be complementary halves of one whole.[8] Parallels can be drawn between this ancient concept and current scientific knowledge of the potentiality of every human organism to develop into either male or female. Ancient Indian mythology also describe a king called Bhagiratha who was supposed to have born out of the union of two women.[9]

We are not sure about the numbers of the LGBT population in our country though the statistics are available for the USA. Kinsey's mid-century studies gave a prevalence of 10% in men and much lower in women. Jayarajan and Chandra (vide supra), studying large US populations in 2011, found 2–4% of males and 1–2% of females reporting their sexual identity as homosexual and also showed 1–3% of men and 2–5% of women reporting their sexual identity as bisexual.

The risks faced by this population are very high, the prevalence of HIV-AIDS and other sexually transmitted diseases such as gonorrhea, syphilis and human papillomavirus are common. This further leads to aggravation of the social stigma towards this population.[10] Various types of cancers and physical illnesses are high in this group. Psychiatric co-morbidity with anxiety and depression, suicidal ideation, and suicide and substance use disorders are quite common. In one US study, the prevalence of depression, panic attacks, and psychological distress in gay-bisexual men was more than that in heterosexual men.[11] A study carried out in Ahmedabad reported the prevalence of psychiatric morbidity was 52.9% in gay men.[12] A high risk of psychiatric illness (63.9%) in gay men was documented in another similar study in central Kolkata.[13]

CONCLUSION

Decriminalization of homosexual behavior has happened in many European countries and some African countries and some states in the USA. Closeting is very common in the LGBT community and “coming out” is rather uncommon. Psychiatrists who come into contact with them have to be absolutely nonjudgmental and understanding, with a high degree of confidentiality needed. The present status of homosexuality is hanging in fire in India after the Supreme Court's ruling of 11^th December 2013, upholding section 377 of the Indian Penal Code, and criminalizing adult consensual same sex contact. How the Indian psychiatric community is going to deal with these problems remains an open question. A 2012 issue of Indian Journal of Psychiatry carried an editorial on Homosexuality and India.[14] In it, the complexity and diversity in human sexuality was appreciated, and a shift in the understanding of homosexuality as a normal variation of human sexuality was propounded. Many Indian mental health professionals have appreciated and applauded this effort to have at least begun a dialog around the issue of alternate sexuality and the way psychiatrists in our country need to deal with it.[15]

Acknowledgments

REFERENCES