A Narrative Review on Indian LGBTQ+ Community: Adapting Trauma Informed Care for this population
V. Sharma, R. K. Suri, G. K. Suri, E. Ralhan, R. Sharma, S. GunturuIntroduction
India has a complex relation with concepts of gender and sexuality. While a third gender or nature has been recognized since ancient time, India decriminalized homosexuality only in 2018, after waking up from its colonial hangover. Existing stigma in Indian society results in complex trauma and high psychiatric morbidity.
Objectives
We explore the challenges faced, mental health struggles and resources available to the LGBTQ community through this narrative review. Additionally, we suggest adaptations to trauma and dissociation informed therapy to ideally support the Indian queer community.
Methods
We searched PubMed using keywords “LGBT India mental health”, “LGBT Trauma psychotherapy”, and “LGBT India”, yielding 174 studies. Inclusion Criteria: relevant English original or meta-analytic studies from India. Exclusion criteria: non-English, non-Indian, inaccessible studies. After duplicate removal, abstract screening and full text analysis, a total of 37 studies (6 studies- LGBT Statistics, 13 studies- struggles of LGBT Indian community, 11 studies- mental health impact, 9 studies- available resources, and 7 studies- trauma and dissociation informed therapy) were included for this narrative review (Figure 1).
Results
Familial, communal and police violence against the LGBTQ+ still exists in India. Stigma, microaggressions, homophobia, re-traumatization in healthcare causes complex PTSD and other psychiatric disorders (Figure 2). Government, non-profit and community-based interventions are lacking. Individually-tailored, socially-sensitive trauma-informed therapy would be ideal for the Indian queer community. ‘Narrative exposure therapy’ creating culturally empowering narratives, ‘Mentalization-based therapy’ reducing internalized stigma, ‘Prolonged exposure group therapy’ building a support system, ‘Milan family therapy’ combating negative stigma and ‘somatic therapy’ reclaiming one’s body, would help adapt existing western trauma and dissociation informed therapy models for the LGBTQ+ population in India (Figure 3).
Image 1: Long description.