Abstract
Dear Editor,
Sri Lanka is a South-Asian nation with a middle-income economy and a multireligious population of 21 million inhabitants. More than 70% of the population are Buddhists, followed by minority Hindus, Muslims and Catholics. The traditional male being ‘the breadwinner’ and female being ‘the caretaker’, ideologies are challenged with increased opportunities for women in paid work and higher education (Jordal, Wijewardena, Öhman, Essén, & Olsson, 2015). Sri Lanka, the country that produced the first elected female head of the state in the world in 1960, has nearly two-thirds of its university entrants being female today.
The lesbian, gay, bisexual and transgender rights remain stagnant since the colonial era and homosexuality is illegal in Sri Lanka (Jayasundara, 2000). However, male-to-male sexual contact has been found to be common and nearly two-thirds of men reported having engaged in this form of sexual behaviour during their lifetimes (Silva, Sivayoganathan, & Lewis, 1998). Culturally, virginity is highly valued for females leading to gender segregation in adolescent years (Jayasundara, 2000). Many boys do not continue this behaviour and function as heterosexuals in adulthood. Furthermore, homosexuality is stigmatized by the mainstream culture and persons with same-sex orientation face significant abuse during their lives (Nichols, 2014). The media portrayal of homosexuality in Sri Lanka has been mostly in a derogatory tone (Wipulasena, 2018). In addition, Indian cinema which is extremely popular in Sri Lanka is also known to depict homosexuality largely in a negative way (Bhugra, Kalra, & Ventriglio, 2015). This possibly influences the artistic expression of Sri Lankans as well.
Gay men and lesbians in other Asian countries have been reported to have higher suicidal ideation compared to heterosexuals. This is in the context of alienation associated with low tolerance of social differences in the community and perceived burdensomeness felt due to the sexual identity of these minority groups (Kim & Yang, 2015). There are no publications on psychiatric morbidity of Sri Lankan sexual minorities. However, according to the World Health Organization, Sri Lanka had the highest age-standardized suicide rate in the world in 2015, which was 34.6 for 100,000 in the population. Many of the suicides and acts of self-harm occur in the context of conflicts with intimates and family disputes. These are mostly unpremeditated and driven by feelings of anger, humiliation, frustration and desire to strike back against perceived wrongful treatment (Marecek, 2006). Considering the social discrimination faced by homosexual individuals in the Sri Lankan context, it is highly likely that they are faced with a higher burden of psychological distress and suicidality. These are rarely reported in media as experiences of harassment and suicidal attempts related to sexual orientation and being forced into heterosexual marriages (Equal Ground, 2016). Furthermore, homophobia is rampant and families may disown and force out homosexuals, leading to further alienation by society and they may opt for suicide due to unbearable distress (Immigration and Refugee Board of Canada, 2008). The illness model of homosexuality has been discarded decades ago (Gonsiorek, 1991). However, it is not uncommon to see parents demanding psychiatric treatment for homosexual orientation in their children in Sri Lanka.
According to De Silva (2003), homosexuality is not explicitly mentioned in any of the Theravada Buddhist discourses. However, the Buddha mentioned the wrongfulness of adultery, which involves subterfuge and deceit. It appears that in Buddhism, it is not the desired object that determines whether a sexual act is inappropriate or not, but rather the nature of the intentions involved. Theravada Buddhist countries such as Sri Lanka, Myanmar and Thailand did not have any legal statutes against homosexuality in the past (De Silva, 2003). Furthermore, Hindu religious texts such as Rig Veda and ancient sculptures in India depicted explicit homosexual acts (Agoramoorthy & Minna, 2007). As in India, the British made homosexuality a criminal offence in Sri Lanka in 1883 and it has existed under Penal Code 365A until the present day. Thailand has never been under colonial rule and homosexuality was decriminalized before many Western nations.
Europeans ruled parts of Sri Lanka from the early 16th century to the independence from the British in 1948. Many European countries who had considered homosexuality an offence in the past have legalized same-sex marriages now. Sri Lanka has been a Buddhist majority country for 2,300 years and maybe the time has come to embrace the core Buddhist values of equality again. Furthermore, in neighbouring India, a landmark ruling has been issued by the Supreme Court legalizing gay sexual relationships. This ruling overturns a colonial-era law, known as Section 377, under which gay sex was illegal. The Buddhist and Hindu values were introduced to Sri Lanka from India in the ancient times. Maybe this is a golden opportunity to follow the pathway of India again on restoring legal equality in sexual expression. In order to facilitate this, the psychiatrists with other health professionals need to make a collective recommendation to the Ministry of Justice in Sri Lanka.
