As a child and adolescent psychiatrist, I deal with the LGBTQ (lesbian, gay, bisexual, transgender and queer) population on a regular basis.

In my practice, I see youth with different sexual orientations or gender identities who find themselves living in severe social and mental health crises in the crucial years of their development.

I had been treating Sara* for depression and anxiety for a few months with medication and therapy, but with limited success. Her psychiatric history includes multiple suicide attempts, self-harm behaviour and illicit drug and alcohol use.

It was much later in therapy when she described her core issue as a struggle with homosexual impulses. She is afraid that her religious family and community may reject her because of her sexual non-conformity.

Another patient John*, a female-to-male transgender, recently came out to his family about his gender identity. It caused massive conflict, and his mother has refused to accept him as her son.

John came to see me because of his ongoing anxiety symptoms. He thought that he was ready to get the medical and surgical treatment for a gender reassignment and adopt the gender of his desire. But his mother refused to pay for any medical and surgical treatment, giving consent to see a psychiatrist only.

Kabir*, who went to medical school with me, confided in me a few years ago, as a friend and professional, about his homosexuality. He reported that he lived under constant fear and uncertainty in Pakistan; torn between social norms and internal sexual desires that made him feel depressed, as well as anxious and guilty about himself.

He had two choices: to be himself or to conform to someone else's idea of normality.

He married under social pressure and lived with the tormenting agony of acting against his nature. He described it as a splitting of his soul, like a chariot being pulled in opposite directions.

His marriage soon ended on a sour note. To avoid future social pressure, he moved to the West so that he could restart his life where he could be himself.

One of my very dear friends from childhood committed suicide last year. As a psychiatrist, it left me baffled. How was I not able to prevent the death of a young person who was so full of life? While doing the psychological autopsy of Karamat*, I wondered if his sexual orientation was linked to his suicide. We never had any conversation about this, but now, I would put it very high on the list of risk factors for his suicide.

Looking back, it seems that like many other LGBTQ community members, he was hiding his identity to escape the stigma, discrimination, bullying and sexual abuse that can arise from coming out to a society which is not open and sensitive to sex/gender variation.

In Pakistan particularly, society tries very hard to box LGBTQ persons into gender and sexual conformity and expects them to play socially assigned gender roles.

Also read: Being queer was not always a crime in Pakistan

In my practice, part of psycho-education is to teach LGBTQ children and their families that they are born this way and that homosexuality is not considered an illness; it’s a variant of normal human behaviour. It is not contagious and people do not learn this behaviour from their peers or families.

It is important to learn about any stress or bullying faced by these children because of their alternative lifestyle, and prevent it. Every effort should be made to provide support and safety for these children and to help them and their families accept rather than reject — or worse, expect to change — their child’s sexual orientation.

The once popular effort that tried reparative therapy on homosexuals has been rejected by all the established and reputable American medical, psychological, psychiatric, and professional counselling organisations because of its lack of efficacy and its severe side effects, including suicide and self-harm behaviour.

In a recent episode on an immensely popular television talk show, Satyamev Jayate, Bollywood icon Aamir Khan invited people with alternative lifestyles, along with their significant others and family members, to discuss the problems faced by people with different sexual orientations.

They shared their stories of depression, anxiety, shame, and guilt before coming out; followed by how much they felt loved and cared for by their families and friends after they openly talked about their identity. The show was a revolutionary moment in support of the lesbian, gay, bisexual, transgender and queer community in South Asia.

Unlike some of the experiences in my practice, where coming-out was celebrated, things are almost always the opposite in Pakistan. Often, there is extreme violence e.g. earlier this year in Punjab, six men were shot dead in two different incidents of discriminatory killing. The male predators met their victims on online-dating websites and had sex with the victims before killing them.

Also read: Serial killer from Lahore 'wanted to teach homosexuals a lesson'

In an effort to educate the public in Pakistan, an author wrote a pictorial children’s book in Urdu, “My chacha (uncle) is gay”. The book is not available on the bookshelves of Pakistani book stores but it is available online. It is certainly a major breakthrough in children’s education about gender variance and the acceptance and celebration of diversity.

Unfortunately, such efforts are few and far apart. What else can you expect, given that in the current laws of India and Pakistan (inherited from the British, Article 377), alternative lifestyles are called an “unnatural offense.”

Famous writer, Vikram Seth in his poem, “Through love’s great power” summarises the LGBTQ community’s struggle to find love and freedom and fight the prejudice in India.

I feel these lines hold equally true in Pakistan as well...

Through love’s great power to be made whole

In mind and body, heart and soul—

Through freedom to find joy, or be

By dint of joy itself set free

In love and in companion-hood:

This is the true and natural good.

To undo justice, and to seek

To quash the rights that guard the weak—

To sneer at love, and wrench apart

The bonds of body, mind and heart

With specious reason and no rhyme:

This is the true unnatural crime.

*Names have been changed to protect identities

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