Sadhana Vohra is a psychotherapist in private practice in New Delhi, India. She divides her time between long hours at her busy urban practice and holidays with her two dogs and housekeeper at her delightful mud house in a village in the hills, so she can be sure that she is taking good care of her own mental health. In this interview with Radhika Chandiramani, she speaks about the linkages between mental health and sexuality, and speaks about how mental health is key in building “joyful lives from (a) sense of connection with other humans.”
Radhika Chandiramani: In your therapy practice of the last 20 plus years, what sorts of linkages have you seen between mental health and sexuality in the real lives of real people?
Sadhana Vohra: When I started practicing in New Delhi in October 1992, I found that the only people who would talk comfortably about sex were middle-aged men who would refer to it in an oblique manner, but within the context of a sense of entitlement. Sex was seen as an essential topic, not to be talked about openly, but necessary for the male’s ‘natural’ needs. Women, fewer, would also come in to complain about their spouse’s inability to have penetrative sex, but again this was within the context of a ‘biological’ need for children.
And, of course, there is more openness now but there continue to be people who see their access to sex as an entitlement and do not see anything coercive in emotionally overpowering their spouse or partners into providing sexual engagement. Obviously, all of this plays directly into people’s emotional make-up. Abusive people do not come to see me mostly. It is people who are at the receiving end of this coercion who come to me and are usually loath to begin to complain of this sexual abuse; a further indication of their sense of disempowerment which affects their psychological life severely.
But there are other kinds of stories as well. A successful businessman came to see me about five years ago and he was agitated and frustrated with his life situation, yet embarrassed and hesitant to talk to me about his problem. He had been married for a long time and the couple had grown-up children, but he had not had sex with his wife for many years and he felt deprived of what he saw as a ‘normal’ life. His wife and he were emotionally estranged but stable in their marital commitment although she did not wish for physical closeness. I think he came to see me because he wanted me to give him permission to seek an extra-marital relationship, which obviously is not my place to do. He even said that he was so depressed that he had considered killing himself. He came to see me twice and refused to get into any other issue that might have helped him deal with the decisions he was inadvertently making: to stay married in spite of his unhappiness within the marriage; and his placing the frustrations in his life within the sexual frame alone. He was intelligent and articulate but he just wanted to be told that it was alright for him to go out and have sex.
As I think back about this person, I wonder if he was already going to sex workers when he came to me. Perhaps not. He seemed to be stuck between the family values he had grown up with and the clash he was experiencing with his great need to connect sexually with another person. I know of many other such people who have chosen to go to sex workers, albeit with guilt. In my experience men who go to sex workers – I have not come across a woman who does (but this might be because of the nature of my clients and not a statement to derive conclusions from,) mostly feel guilt around it. They experience the sex worker as not ‘into’ the act and resent her acting in a ‘clinical’ manner. Yet it is easy for many people in this society to isolate the sexual act from the relational and the emotional aspects of it. Although, I find that all people seek these aspects and are usually bitter about having to do without.
I have also had women come in who have gotten into non-satisfying sexual liaisons in their effort to satisfy their needs to be acknowledged, loved, and held. Obviously, these relationships end in recriminations and hurt.
I try not to judge the ways in which people search for their happiness — my job is to walk with them, metaphorically speaking, so that they are able to make sense of why they do what they do in order to learn to make decisions that are progressively more constructive for them. Within an adult’s life, sexual connection or a partnering relationship holds great power; in fact, I would say, the primary power that one has to negotiate around. Figure out how to deal with it, or figure out how to deal without it. The people who come to me are struggling, or they would not need to come in, but their somewhat simplistic and fantastical assumptions about what allows for happiness obviously impact their sexual behaviour, actions, and acting out. As people get better over time, I find that their decisions within this relational and sexual arena become more integrated and more responsible.
RC: Have you seen any changes over the years? Do you think that as a society we encourage sexual wellbeing? Or do you think that our societal set up endangers our mental health as well as our sexual expression?
SV: I have found over the years that people have begun to speak increasingly more easily about their sexual lives. The issues are more overt now. In my understanding, this has to do with the changes that are taking place in our Indian society. What I now see is that the more confident a client, the more comfortably they are able to refer to the sexual part of their lives, whatever their understanding of this part might be.
So there are two aspects here. The society has become more open about sexual matters, and as people become more confident in themselves they talk about the issues within their sexual lives. What is pivotal is that people’s understanding of their sexuality (especially the younger people’s) has expanded to seeing this as a recreational, relational, and normal activity to be talked about openly. Not so much about the psychological aspects of their sexual life as it relates to their greater understanding of themselves and their partners, but as a socially permitted activity. I do not see that the larger society is at a place where people are optimally comfortable, in a mental health-enhancing way, with their sexual health. So, although I see an improvement, we have a ways to go before reaching that place of psychological comfort in integrating one’s sexual interests with other aspects of one’s personality.
There continues to be a constriction in the thinking and acting within the area of sex. People are conditioned to make do without sex and so they do not even wish to get into the subject, preferring to ignore this part of their life. Although in India, as in every other place, sex is used to sell almost anything in the marketplace, openly, or in surreptitious ways. Because it is all around us it also becomes intimidating to our own sense of okay-ness as desirable and desiring humans. People, and not just users of mental health services, have to come to terms between themselves and this, practically abstracted activity. And I have frequently heard people talk of it as an ‘indulgence’ and not as a wonderfully satisfying human activity that it really is. Happy people are comfortable with their sexual choices and decisions. They are able to build joyful lives from that sense of connection with other humans.
RC: You have been supportive of lesbian, gay, bisexual, trans and other queer clients as well as the movement calling for the repeal of Section 377. Not many therapists in India are so openly supportive. What has contributed to your being thus?
SV: I arrived at feminism early. My mother was the first woman’s rights activist I met. So, mine is a second-generation, less fraught, and therefore, less reactive feminism. In this I am fortunate. She protected me from a prejudiced system. Obviously, no protection is complete in such a situation — but I had an authority figure who repudiated the validity of the ubiquitous misogynistic assaults women of my generation faced and which succeeding generations of women continue to, perhaps in increasingly subtle forms.
My mother was an amazing woman, much smarter than I could ever expect to be. She experienced many emotional assaults from being a woman born in 1929, mostly which she was strong enough to identify as seriously unfair, and others that, because so much of this stuff gets internalised, she allowed to disempower her. But she continued to grow and evolve and empower herself through her experiences and through running a shelter and short-stay home for distressed women until her death in 2010.
It was she who supported my anger when I first experienced discrimination at age four. My paternal grandmother implied that I was not as valuable as a boy born in my place would have been. My mother’s intervention allowed me to dismiss any value I might have attached to my grandmother’s statement. But nevertheless, there was enough discrimination that I, born in 1956, had to contend with. It was my parents’ protection that encouraged me to continue to feel invincible. Because of this protection, I could use my energies to analyse my surroundings and arrive at abstract conclusions. It became clear as I went to school and then college that patriarchy was built on an arbitrarily developed hierarchy and that there were many areas where prejudice and discrimination had damaged people’s lives laying them to tragic waste. I witnessed all of these: the damage wrought by class and caste hierarchies, as well as the ridicule meted out to people who did not adhere to the dominant sexual style. There were rules about how females should behave and what clothes and styles they were allowed if they wished to be respected. Growing up I resented all of this.
I strongly felt that people who owned sexual preferences that contradicted this male-as-superior position were fighting the same battles as I was. Over time I sought out and became friends with people whose sexual preferences did not fit within the arbitrary prescription of a patriarchal system. As the number of my friends within these groups grew I began to understand the issues that LGBT groups face. It is clear to me that we need to actively discourage regressively rigid ways of understanding others to support constructive human life.
RC: Transpeople in India need a certificate saying that they have gender dysphoria or gender identity disorder in order to qualify for sex reassignment surgery. There is an international movement to do away with this. Would you be in favour of doing away with this criterion? Why or why not?
SV: I am totally in favour of doing away with this criterion. I have had many people come to me to get the certificate in order to be eligible for sex reassignment surgery. Initially, I used to follow the traditional method of trying to dissuade people from choosing this path, but soon I found this direction meaningless. It is not given to humans to determine how other humans must be. If someone wishes to live within a particular gender role why should mental health professionals use a set of arbitrarily arrived-at norms to determine if they should or not.
RC: As a feminist, do you feel that there have been times when your feminism has not been congruent with the tenets of psychotherapy as you practice it? How have you resolved those conflicts, if any? Or do you feel that there is a complementarity between the two that strengthens both?
SV: I have never found my feminist principles to clash with the work I do in providing psychotherapy. However, I have been at the receiving end of feminist friends’ assertion that what I do is not what is best for my clients.
There have been two streams of thought here. One that sees people in trouble and perceives them as needing concrete help and not detached psychotherapy. The second relates to feeling that psychology labels as pathological normal reactions to difficult surroundings. I realise that many times in people’s lives concrete help is needed. For instance, in refugee camps and in dealing with poverty, unemployment, and other such life situations. And we need appropriate systems to provide such concrete help. Psychotherapy is not appropriate here.
The second perspective demands that we as mental health professionals stay on guard against judging clients on the basis of our own value systems. Psychologists help people learn how to help themselves and it is the person’s own evaluation system that we work with. Sometimes humans internalise the self-negating messages from the people around them. In working within therapy people often discard such illogical labels that they have internalised.
Sometimes people misunderstand the work that I do. I have had a psychiatrist, two clients, and a few other people who have called me a ‘whore’, not at all trying to diminish me, but just calling a spade a spade, you know, (!) implying that I provide support for money. The truth is that I do not provide support. My job is to help people learn how to help themselves and the client’s actual shift towards taking care of themselves makes them feel better. That there is someone in front of whom they can tell all of their stories truthfully to themselves also helps. Every human likes to be in charge of their lives — in that, they make sure, as much as possible, that they get what they want and what they see as most meaningful to them. My job is to help them figure out how to shore up their navigation skills. And I do not see respecting humans’ rights to make their own choices as contradicting my feminist position. I experience that my clients value my detachment as implying that they are potentially strong within themselves.
RC: On a more personal note, what gives you hope and nurtures your resilience?
SV: I would imagine that I am nurtured by those things that nurture all humans: Our first relationships, which help us understand who we are within which we internalise a sense of happy encouragement; our sense of mastery within the world around us — and the knowledge that we can learn from our mistakes — that this is something given to all of us. In the day-to-day of living, I find that the quality of the relationships around me supports me most in my journeys. I do believe that the most powerful motivator for all of us humans is the knowledge that we are loved and respected. This allows confidence and excitement in the churning of ideas and in discoveries that life allows. The memory of such relationships is also potent in helping withstand disagreement and times of loss when there are forces that push towards instilling despair.
This interview was originally published in the April 2015: Mental Health and Sexuality issue of In Plainspeak.
