A psychiatrist's view point of being more inclusive.

1. Same Sex Relations: The Journey
Over Time
Devashish Konar MD
Consultant Psychiatrist
Mental Health Care Centre
Kolkata India
+91 9434009113
1PRESNTED AT LUMBINI, NEPAL AT SPF CONFERENCE

2. CASE VIGNETTE
• 50 year teacher
• 42 year businessman
• 19 year girl who decided to go for police job
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3. ORIGIN OF HOMOSEXUALITY: FOUR AREAS
OF RESEARCH
• Biological studies
• Cross cultural studies
• Psychological development
• Acquisition of gay and lesbian identities
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4. BIOLOGICAL MODELS TO EXPLAIN
HOMESEXUALITY
• Model Of Permissive Biological Effects
• Model Of Direct Biological Effect
• Model Of Indirect Biological Effect
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5. CURRENT RESEARCH
• Biological research on sexual orientation has been driven largely by
the prenatal hormonal hypothesis and has focused on the potential
role of prenatal androgens.
• Early androgen exposure clearly organizes the mating behavioral
repertoires of laboratory animals however, it is not clear how the
regulation of stereotyped reproductive behaviors in animals pertains
to sexual orientation in humans.
• Research into indirect genetic effects on sexual orientation is
currently lacking.
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6. POSSIBLE BIOLOGICAL CONTRIBUTORS
• The Prenatal Hormonal Hypothesis
• Neuroanatomical Sexual Dimorphism
• Neurophysiological Measures
• Anthropometric Characteristics
• Genetic Research
-Family and Twin Studies
-Linkage Studies
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7. HOW THINGS CHANGED
• In 1972, Heath published a study with Charles Moan that used deep brain
stimulation in a man referred to as B-19.
• This 24-year-old man had a troubled psychological and social background.
• His father was abusive and drank excessively.
• His mother was withdrawn and rigid. B-19 had no memory of ever being
embraced by her.
• He was expelled from schools three times by the age of 11.
• He then dropped out of school and had a few short-lived jobs.
• Then he enlisted, but was discharged because of “homosexual tendencies.”
• He was described as being hypochondriacal and paranoid.
• He became addicted to alcohol and drugs, but said that he did not receive
pleasure from them or from sex.
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8. PATH BREAKING DSM
• Heath and his team placed electrodes throughout B-19’s brain, including frontal, parietal, septal,
and hippocampal regions.
• Only electrical activity in the deep limbic regions produced pleasure.
• Dr. Heath saw an opportunity to “cure” homosexuality, which at the time was labeled as a
disease by the American psychiatry establishment. B-19 was shown 15-minute “stag” films of a
man and woman having sex while his brain was stimulated.
• To “test” the effectiveness of his treatment, a 21-year-old prostitute was brought to his room.
• B19 was able to have sex with her. After this treatment, he had a short-lived affair with a
married woman. He continued to have sex with men because (according to the researchers’
report) hustling was a quick way to make money.
• However, the doctors concluded that an important part of the study was the “effectiveness of
pleasurable stimulation in the development of new and more adaptive sexual behavior.”
• The next year, in 1973, homosexuality was removed from the list of diseases in the Diagnostic and
Statistical Manual of Mental Disorders.
• Studies such as those done with B-19 did not continue.
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9. BIOLOGICAL AS WELL AS SOCIAL DETERMINANTS
• Scientists hypothesize that a combination of genetic, hormonal and
social factors determine sexual orientation.
• Biological theories for explaining the causes of sexual orientation are
more popular, and biological factors may involve a complex interplay
of genetic factors and the early uterine environment.
• These factors, which may be related to the development of a
heterosexual, homosexual, bisexual or asexual or orientation, include
genes, prenatal hormones, and brain structure.
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10. BIOLOGY AT BEST CAN HAVE A PARTIAL SAY
• A meta-study by Hershberger (2001) compared the results of eight
different twin studies: among those, all but two showed MZ twins
having much higher concordance of sexual orientation than DZ twins,
suggesting a non-negligible genetic component.
• Bearman and Brückner (2002) "does not suggest genetic influence
independent of social context.“
• Although wide confidence intervals suggest cautious interpretation,
the results are consistent with moderate, primarily genetic, familial
effects, and moderate to large effects of the non-shared environment
(social and biological) on same-sex sexual behavior.
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11. GENETIC ASPECTS ARE ONLY ONE OF THE
MULTIPLE CAUSES OF HOMOSEXUALITY
• The most relevant here being chorionicity and amniocity. Dichorionic twins
potentially have different hormonal environments because they receive
maternal blood from separate placenta, and this could result in different
levels of brain masculinisation.
• Monoamniotic twins share a hormonal environment, but can suffer from
the 'twin to twin transfusion syndrome' in which one twin is "relatively
stuffed with blood and the other exsanguinated".
• 10q26 showed highly significant maternal loading, thus further supporting
the previous family studies.
• Dean Hamer and Michael Bailey suggest that genetic variation in each of
these regions contributes to development of the important psychological
trait of male sexual orientation.“
• Researchers have pointed that the evidence of genetic influences should
not be equated with genetic determinism.
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12. PRENATAL HORMONAL PROGRAMMING
• A 2010 study, Garcia-Falgueras and Swaab asserted that "the fetal brain develops
during the intrauterine period in the male direction through a direct action of
testosterone on the developing nerve cells, or in the female direction through the
absence of this hormone surge”.
• In this way, our gender identity (the conviction of belonging to the male or female
gender) and sexual orientation are programmed or organized into our brain
structures when we are still in the womb.
• There is no indication that social environment after birth has an effect on gender
identity or sexual orientation.
• More research is needed in order to understand the requirements and timing of
the development of the Ovine Sexually Dimorphic Nucleus and how prenatal
programming effects the expression of mate choice in adulthood.
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13. ENVIRONMENT IN WOMB
• The early fixation hypothesis includes research into prenatal development and
the environmental factors that control masculinization of the brain.
• Some studies have seen pre-natal hormone exposures as the primary factor
involved in determining sexual orientation.
• This hypothesis is supported by both the observed differences in brain structure
and cognitive processing between homosexual and heterosexual men.
• One explanation for these differences is the idea that differential exposure to
hormone levels in the womb during fetal development may change the
masculinization of the brain in homosexual men.
• The concentrations of these chemicals is thought to be influenced by fetal and
maternal immune systems, maternal consumption of certain drugs, maternal
stress and other factors.
• This hypothesis is also connected to the fraternal birth order research.
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14. EXOTIC BECOMES EROTIC THEORY
• Daryl Bem, a social psychologist at Cornell University, has theorized that the influence of
biological factors on sexual orientation may be mediated by experiences in childhood.
• A child's temperament predisposes the child to prefer certain activities over others.
• Because of their temperament, which is influenced by biological variables such as genetic factors,
some children will be attracted to activities that are commonly enjoyed by other children of the
same gender.
• Others will prefer activities that are typical of another gender.
• This will make a gender-conforming child feel different from opposite-gender children, while
gender-nonconforming children will feel different from children of their own gender.
• According to Bem, this feeling of difference will evoke psychological arousal when the child is near
members of the gender which it considers as being 'different'.
• Bem theorizes that this psychological arousal will later be transformed into sexual arousal
: children will become sexually attracted to the gender which they see as different
("exotic").
• This theory is known as Exotic Becomes Erotic theory.
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15. LONGITUDINAL COURSE
• 63% of both gay men and lesbians reported that they were
gender nonconforming in childhood (i.e., did not like activities
typical of their sex), compared with only 10–15% of
heterosexual men and women.
• There are also six "prospective" studies—that is longitudinal
studies that begin with gender-nonconforming boys at about
age 7 and follow them up into adolescence and adulthood.
• These also show that a majority (63%) of the gender
nonconforming boys become gay or bisexual as adults.
• There are very few prospective studies of gender
nonconforming girls.
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16. COMMON SOCIAL CONCENSUS AND IT’S
INHERANT CONTRADICTION
• If biological we must learn to accept and give the comfort zone in the
society.
• Mature society should accept what ever is biological.
• ? Antisocial personality
• ? Violence
• ? Pedophilia
Is the society kind enough to accommodate
all biologically different people or it looks after
the interest of the majority?
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17. NATURE VERSUS NURTURE
• Genetic Family Studies
Twin Studies
- Identical twin
- Fraternal twin
Linkage Studies
• Hormonal During Prenatal period
• Bringing up Intimate Mother
Distant father
As with any
other issue in
Psychiatry
ultimately we
end up with
Nature Nurture
Theory
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18. I AM PROUD TO BE GAY, DECLARES TIM COOK
Coming out and meaning of disclosure
CEO, Apple Inc.
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19. STRIKE THE BALANCE TO BE POLITICALLY CORRECT
• Inclusiveness may be essential for any society.
• Activism may not always be as productive.
Ethical society needs to adopt
expansion of the boundaries
without disturbing the
harmony.
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20. IN A FIRST, VATICAN TALKS OF ‘WELCOMING’ HOMOSEXUALS
MONDAY, OCT. 13, 2014
Talking of Inclusiveness
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21. POPE FRANCIS ON MAN-WOMAN UNION
“An anthropological fact that can not be qualified based on ideological notions
important only at one time in history”. Distancing from activism for Homosexuality.
17th NOV. 2014
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22. ACTIVISM SOMETIMES MAY BE COUNTERPRODUCTIVE
FOR THE SOCIETY
• ? Same sex marriage
• ? Rearing children
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23. THANKS
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