Ratnaboli Ray is a mental health activist, trained psychologist, and the founder of Anjali Mental Health Rights Organisation that works with the government on rehabilitation and reintegration processes focusing on persons with mental illness and psychosocial disability. Ratnaboli says that it became clear to her “that the dream of systemic reforms would remain a pipe dream unless civil society’s ambivalence about persons with psychosocial disability is challenged and the issue of the rights of this particular constituency is firmly established in the popular psyche.” Shikha Aleya speaks to Ratnaboli about wellbeing and sexuality in the context of mental illness and psychosocial disability and uncovers the role of hypocrisy and biases as well as positive stories of sexual expression.

Shikha Aleya (SA): Wellbeing is a key concept in the WHO definition of mental health. Please share your understanding of ‘wellbeing’ in the context of mental health. What part does sexuality have in the discussion on mental health and wellbeing?

Ratnaboli Ray (RR): The first thing I would want to tell you about wellbeing is that there is no one definition; it depends on the person defining it. Everyone has their own version and idea of wellbeing. And this can change over time, as we learn, unlearn and relearn. So you are the master of your own definition of wellbeing. Let nobody else decide it for you. Sexuality plays a large part in mental health as well as wellbeing. Sexuality and expressing sexuality must be a free choice. Whether or not I want to express, exercise and experience my sexuality should be my autonomous decision alone. What I choose to do with it should be about how I see myself, not how someone else expects me to be. Society or an individual should not prescribe what I do with my sexuality. To do something that does not come naturally to me is a direct violation of my rights, and affects my wellbeing too.

A key concept which has gained prominence emphasises life satisfaction as the key indicator of wellbeing. Viewed as a cognitive component, life satisfaction was seen to complement happiness, the more affective, feeling-oriented dimension of positive functioning. Included in this theoretical framework of wellbeing are six distinct components of positive psychological functioning. Briefly, they are:

• self-acceptance – a sense of continued growth and development as a person
• personal growth – the belief that one’s life is purposeful and meaningful
• purpose in life – the possession of quality relationships with others
• positive relationships with others – the capacity to manage effectively one’s life and surrounding world like family, workplace, etc
• Coping with the environment
• Autonomy or self-determination

I feel that there are problems with this classification. Not only is it not exhaustive, it does not mention people’s personal, subjective sense of whether their lives have purpose, whether they have the ‘free’ choice to determine and exercise their purpose, whether they have the opportunity to realise their potential and desires, the quality of their relationships with others, and if they feel in charge of their own lives.

Relying / borrowing from a ‘strengths’ perspective, as opposed to a pathology-based discourse of sexuality, we must include the recognition that people have an assortment of unique sexualities. People – read women – with psychosocial disabilities/ mental health conditions are capable of drawing from their existing strengths to resolve problems and be happier and more fulfilled, including developing their sexual identities and expressing their sexuality. Sexuality, then, is concerned with how people are, or can be, fulfilled with their unique sexualities and sexual expression, which contributes to their overall wellbeing.

SA: Viewing it from this perspective, in your experience engaging with people on issues of stigma and rights, what are the most common attitudes you have encountered when sexuality enters the discussion?

RR: There are actually many kinds and nuances of attitudes that I have encountered. It also depends on who exactly you are having that conversation with. If you are talking to caregivers/family members, a standard response will be, “Let her stay in the hospital for a few days and get well first, then we’ll see about”… (silence, unspoken)…“Oh you mean marriage? All this is just frivolity. This kind of behaviour was there before as well, that’s why we admitted her…let her get married then all this will be taken care of.”

If a woman exercises her ‘free’ choice and autonomy to express her sexuality, that too will be considered a symptom of mental illness. Most of our conversations regarding sexuality happen with participants at Anjali; that’s the first point of dialogue. We are keen to facilitate their autonomy vis-à-vis sexuality. However, even if we prepare them to be independent, a relentless fear of incarceration pushes them towards being the ‘good wife’, ‘good daughter’, and ‘good daughter-in-law’ and fulfilling their husband’s needs, parents’ needs, and parents-in-law’s needs, no matter consent and comfort. When I say that we prepare them to be independent in terms of sexuality, I don’t mean that we have prescriptive answers for them. I can recall one of our participants who went back to her husband after two years and went to the beach town of Digha with him for a second honeymoon. She came back happy, and became pregnant. So her psychiatric medication had to be stopped and our support was intensified.

Also, there are other issues that come up. If they say they don’t like to have sex, don’t like the way they are touched, that their partner(s) stinks of alcohol – how does one respond? There is no correct response, is there? We have to be silent; we have to be with the person. There are no ready-made answers to these issues.

Having this conversation with hospital authorities is different again. They think we are ‘radical’ people who are ‘corrupting’ their ‘wards’. Marriage is encouraged, any sexual expression outside it is a ‘symptom’ and not to be encouraged. Same-sex relationships are beyond their imagination. This holds true mostly for women. In men, hyper-masculinity is regarded as a good ‘normal’ thing and a healthy sign of recovery.

SA: So there are gender biases that seem to operate within families as well as in hospitals and out of them. In an online article, you pointed out that after discharge from hospital, the response towards a ‘recovered’ woman is very different from the response towards a ‘recovered’ man. Tell us more about the different kinds of biases you see operating.

RR: The first thing that happens is that a lakshman-rekha is put around a woman, featuring a list of conditions and don’ts. There is a lot of protectionism surrounding women in all realms of life. I don’t have to tell you that these protectionist measures are set by patriarchy – an insatiable need to control a woman lest she goes ‘astray’. Expression is not allowed, be it sexual or otherwise. I work with resource-poor people, a cast-aside, marginalised constituency. They have conditions set upon them at every step of the way. It’s important to understand what a vicious loop this can become, and how it can get internalised. Often, successful recovery and playing their ascribed societal role is maintained by concealing their previous diagnosis/condition. There are also very fundamental differences in quality of life for men and women, and how they are looked at upon their discharge from hospital straight away reflects and determines their quality of life. When I say quality of life, I do not mean happiness, because people confuse the two and use it interchangeably. But quality of life is more than that, especially for people with psychosocial disability – because in such cases people became socially isolated. One indicator of quality of life is how you are negotiating social spaces – friends, family, neighbourhood, and work spaces. This is largely missing in the lives of women after they have been discharged. They are looked at with pity, as if letting them come back home is an act of charity. How will they negotiate after this?

Secondly, there is the whole question of autonomy. The women’s movement teaches us that autonomy is the main goal – but for women with psychosocial disability, autonomy is a progressive goal, on a continuum. For men it is completely different.  When they have recovered – they are allowed to go out of the house, allowed to live on their own terms. Nobody questions their behaviour or looks at them suspiciously for the slightest hint of a symptom.  They needn’t always be accountable, or inform anyone about where they are going. Even if they have gone out and visited a sex worker, it will never be questioned. But for a woman to go out of the house and even talk to men, she will be looked upon as being of ‘bad’ character– an immoral woman! In Purulia (underdeveloped, deprived, almost barren, with severe hot weather, a district tucked away in a western corner of Bengal) where we are working on a new program – one of the families of a participant spoke of how they cannot bring her back home because she loiters, meets men, and drinks. When asked why they equate this with ‘mental illness’, their reply is that drinking is not culturally acceptable in their society and she should know better – reiterating the moral value that a woman should uphold. This is where we need to challenge the notion of respectability around sexuality. There cannot be a hypocritical binary around respectable and disrespectable sexuality.

SA: The hypocrisy emerges in this difference of approach based on gender. Are there non-medical, psychosocial roots to a lack of wellbeing that have to do with gender and that may have a cause-effect relationship with mental health? Where and how would you suggest opening up this conversation about mental health, wellbeing and gender across larger sections of society?

RR: I feel we must start having these conversations at home. That can make a whole lot of difference. And I don’t just mean parents having it with children, it can and should be the other way round too. As long as there is scope for healthy dialogue. Even children can raise these questions and should have a safe space to raise question. Breaking our construction of ‘the child’ is important.  – we need to question our own ideas about what we think childhood is and how we have socially made up the idea of ‘the child’. Innocence is not in conflict with knowledge about and experience in sexuality.

As activists and development professionals we must inculcate the significance of wellbeing into our work spaces, and keep reinforcing it with the people we work with, their families, the communities they live in, and make sure all these people are having these conversations with each other. We have to encourage spaces where women feel safe to talk, to share, and feel empowered. I mean spaces within the family. It could be cousins, a conversation with an aunt –anyone of a similar mindset. We have to deliberately, intentionally create these spaces within families, in offices, in organisations, in communities. Is it laziness that we do not work enough to create these relationships /support spaces? I don’t know.

We need to use an intersectional approach in our work on gender, sexuality and mental health. We need to substantiate the impact on mental health whether we are working with gender or with sexuality. This will bring out the ordinariness of mental health issues without pathologising them. We do not want mental health to be medicalised. I mean, everyday struggle or distress cannot be pathologised, and if they are, then stigma and discrimination will remain pervasive. Getting rid of fears, prejudices and stigma around mental health is crucial. This conversation cannot be limited to women only, otherwise they will go back home and face the same hurdles over and over. That is why community intervention is the need of the hour.

While we talk about intersectionalities, we must never forget sexuality, in all its facets. Sexuality is an important part of being human. I must add here that sexuality can be manifold. It really depends on the individual. Since we are trying to move away from heteronormative definitions of sexuality, the onus is on us to have conversations and action plans around other forms of sexuality and not impose our value judgements on the people we work with.

SA: Talking about these issues and breaking the silence around them is indeed very important. In fact, wasn’t it only last year that at the ‘Pleasure, Politics and Pagalpan’ national conference on sexuality, rights and psychosocial disability organised by Anjali and ARROW, one of the key challenges identified by participants was the issue of silence around both sexuality and mental illness? Once we acknowledge sexuality as integral to our life experiences, how would this impact our understanding and construction of support and rehabilitation?

RR: This is a very difficult question. We at Anjali focus on social inclusion, not just rehabilitation. Within social inclusion there is a need to acknowledge sexuality, but when we start working with the participant, acknowledgement of sexuality comes much later, after establishing trust, respect and mutuality. The stories have always been of abuse, violence, and deprivation of rights, love, affection, stories of skin hunger. So recognition of sexuality is via negative experiences. In a mental hospital where the residents don’t have a decent standard of living, we feel hesitant to bring up the issue of sexuality, romance, love – because we have to be mindful as to how these conversations will trigger many other stories and pent-up feelings which would need intensive hand-holding support. So a lot depends on our relationship with the participant. Some have voluntarily shared information about love and romance that has happened within the institution. The dilemma for us is how to respond to these stories? There was a girl who worked in the Anjali canteen and built a relationship with a labourer. We could tell there was opportunity for romance. When she confided in us, I wasn’t sure how to react. We knew he was contractual labour and after the contract he would leave. We had to tell her to remember this was not a long-term thing. Had we discussed this with her medical officer, she would have been stopped from coming to work at Chai Ghar (the canteen), and her medication would have been increased, to keep her ‘in control’.

Potential is plenty, but it takes time to manifest into action. So, while acknowledgement is key, we lose precious time in only being accepting and doing nothing more. I feel action must go hand in hand with acknowledgement. In September this year, we are organising an international conference on mental wellness in communities, along with another NGO, Sangath, that works in the mental health field. The purpose is to engage with grassroots field experiences around mental health as processed and shared by barefoot mental health counsellors from across the country. So the attendees, professionals and practitioners from the mental health sector, NGO workers, government teams, and others, will participate in a learning process that questions and challenges the established assumptions they may hold. A vital component of the conference agenda is understanding and shifting gender and sexuality issues to a space of possibilities and innovative ideas in the wellbeing discourse.

SA: This brings me to my final question. Have you come across positive, affirmative narratives of sexuality and relationships in the context of dealing with mental illness?

RR: Yes, several. I produced a film this year called Love In The Time Of Madness, which presents how two women chose to express their desires and sexuality and refused to be passive bystanders in their own lives. Both these women had faced incarceration, and had been judged cruelly for their sexual autonomy. Both of them are feisty and challenge their diagnosis every day. One of these women is smart and outgoing and wouldn’t take anything passively, so as punishment she was put into Pavlov Hospital by her family. Once she enrolled in our program, she improved and there was no stopping her. When she left the mental hospital, she went home and created a Facebook account, met a man online, fell in love and got married. Some of my feminist friends have been wary of this fairy tale ending. But the decision is her own. The other woman in the film talks fondly of her desires, acknowledges her sexuality and hopes to fulfil it some day. She talks about her several encounters with men on her train journeys. On camera she told us that she once met a ‘fair, round and hamsome’ (handsome) man on a train. What was beautiful was that she acknowledged her attraction towards him. She had no self-stigma, neither did she harbour any fantastical hopes; she was happy with that feeling. She owned that. This brings me back to what I was saying about conversations. If I as an activist and professional did not talk to them explicitly about the need to accept and own one’s desires, these women would have continued living a doubly self-stigmatised life.

We have also developed a workbook on sexuality, meant for women. It is called ‘Ei Amader Prem Kahini’ in Bengali, (My Book of Love). This book has been created for women who have lived in institutions and/or have psychosocial disability. We know from our experience that their sexual expression gets thwarted for many reasons, medication being one, and rigid, patriarchal hospital rules being another. This blunts cognition, which in turn blunts imagination. Therefore, our workbook aims to acknowledge their sexuality and facilitate sexual expression.  In this book we have included conceptual issues like, identity, consent, pleasure and privacy, and talked about the body, orgasm and so on. These topics are interspersed with poems, short prose, mini stories and suitable, flowing illustrations all of which will act as prompts to invigorate their fantasies. The workbook has been created with support from CREA and will be released and disseminated soon.  See, whenever people speak about sexuality, they speak of violence; that seems to be the only recognised form of sexuality in the lives of people with mental health conditions. But there are so many happy, sexy, lovely, delicious stories in there.

इस लेख को हिंदी में पढ़ने के लिए यहाँ क्लिक करें।

Cover Image: Ratnaboli Ray