APA Responds to Indonesian Psychiatrists for Stance Against LGBT Individuals

Recent statements by the Indonesian Psychiatric Association (IPA) in which the organization appears to classify gay, lesbian, bisexual, and transgender (LGBT) people as mentally ill, are counter to scientific understanding and could encourage violence and discrimination against LGBT individuals.

That’s what APA CEO and Medical Director Saul Levin, M.D., M.P.A., and APA President Renée Binder, M.D., told the IPA in a letter outlining the most recent scientific findings regarding the development of sexuality and gender. The March 8 letter, addressed to Tun Kurniasih Bastaman, M.D., the president of the IPA, was in response to statements by the IPA appearing in Indonesian and Western news reports.

“With all due respect to you and to the Indonesian people, we advise that classifying homosexuality and gender expression as intrinsically disordered will only lead to coercive ‘treatments’ and violence against those who pose no harm to society and cannot change who they are,” Levin and Binder said.

“[T]he latest and best scientific research shows that different sexual orientations and gender expressions occur naturally and have not been shown to pose harm to societies in which they are accepted as a normal variant of human sexuality,” they wrote. “In fact, research shows that efforts to change an individual’s orientation—so-called ‘conversion therapy’ or ‘reparative therapy’—can be harmful and are linked to depression, suicidality, anxiety, social isolation, and decreased capacity for intimacy. For these reasons, APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify people who are lesbian, gay, bisexual, or transgender as intrinsically disordered.

“We respectfully submit that the individuals within IPA who ushered through these changes in classification may have misunderstood the significance of recent scientific findings, which show that multiple factors, including both biological and environmental contributors, play roles in sexual orientation and gender identity. In short, one’s orientation is not a choice.”

A February 24 article in the Jakarta Post reported that “the leading Indonesian psychiatric body has classified homosexuality, bisexuality, and transgenderism as mental disorders, which it says can be cured through proper treatment.”

The article cited IPA member Suzy Yusna Dewi, M.D., as saying, “We really do care about [LGBT individuals]. What we are worried about is, if left untreated, such sexual tendencies could become a commonly accepted condition in society.”

Western news outlets have also reported the IPA assertions. A February 22 article in the London Guardian reported that “the Indonesian Psychiatric Association said transgender people ‘can be categorised as persons with mental disorders,’ which it said ‘may cause suffering and obstacles in functioning as a human being.’ ”

The Guardian also reported that the IPA said homosexuals and bisexuals were in danger of developing a psychiatric disorder unless they “maintain their mental health by guarding their behaviour, habit, healthy lifestyle, and increasing their ability to adapt to their social environment.”

The IPA’s statements come amid reports of increasing violence against LGBT individuals in Indonesia and elsewhere in the Islamic world.

In their letter, Levin and Binder emphasized the science behind sexuality and gender, citing five peer-reviewed reports that underscore the involvement of genetics and/or intrauterine hormonal influences in their development.

For instance, Levin and Binder cited a 2007 Finnish study in the Archives of Sexual Behavior involving 3,261 Finnish twins aged 34 to 43 years. “Quantitative genetic analyses showed that variation in both childhood gender atypical behavior and adult sexual orientation was partly due to genetics, with the rest being explained by non-shared environmental effects.”

The authors of the Finnish study also drew on a Dutch study of gender atypical behavior (GAB) in 7- and 10-year-old twins and later sexual orientation, which found that genetic factors account for 70 percent of the variance in GAB for both boys and girls and that this phenomenon was substantially linked to homosexuality.

Additionally, Levin and Binder cited a 2011 review by Belgian researcher Jacques Balthazart, Ph.D., published in Endocrinology that concluded that “homosexual subjects were, on average, exposed to atypical endocrine conditions during development” and that “significant endocrine changes during embryonic life often result in an increased incidence of homosexuality.”

Levin and Binder stated, “In addition, genetic and hormonal factors generally interact with environmental factors that have yet to be determined, though neither faulty parenting nor exposure to gay individuals causes homosexuality. The preponderance of opinion within the scientific community is that there is a strong biological component to sexual orientation and that genetic, hormonal, and environmental factors interact to influence a person’s orientation. There is no scientific evidence that either homosexuality or heterosexuality is a free-will choice.”

They concluded: “It is important to recognize that there is no evidence that attempts to change people’s sexual orientation have ever been successful, even when the subject sincerely wants to change. In 1973, based upon a review of scientific research, the American Psychiatric Association determined that homosexuality is not a mental disorder and removed it from DSM. It is the position of APA that there is no rational basis, scientific or otherwise, upon which to punish or discriminate against LGBT people.” ■

A blog on this issue by Levin with a link to the March 8 letter can be accessed here.