People with mental illnesses who are incarcerated face a near-total denial of their sexual rights

The illustration is set against a dark, bluish-black background with leaves spread all over. On the left is a mugshot of a person, who has close-cropped hair. The person has a flower tucked behind their left ear.

The consequences of dismissing the sexual rights of people with disabilities in institutions are dire.

In 2012, I witnessed a woman masturbating in a mental health facility in New Delhi.

That simple act repulsed me, because she was considered ‘crazy’ – her hair was cropped short, and she wore a patient’s uniform, further labelling her. The nurses laughed, some others watched. Later, as I processed that event, I questioned my own repulsion. Was it because we consider people with mental illness as childlike, and therefore asexual? Was it because she was doing it in public? Or was it because mental health patients are not considered to be people at all?

My answers shamed me – perhaps it was all of the above. As I started to explore the rights of people who are incarcerated – not just in asylums, but also prisons, I started to ask questions – what are their reproductive and sexual rights? What is the global scenario, and what is happening in India? And do these answers differ for people based on their gender and sexuality?

The UN Convention for the Rights of People with Disabilities (UNCRPD) calls for several rights and freedoms which aim for the inclusion of people with disabilities, and to protect their human rights and dignity. The article relevant to this conversation states that:

‘Discrimination relating to marriage, family and personal relations shall be eliminated. Persons with disabilities shall have the equal opportunity to experience parenthood, to marry and to found a family, to decide on the number and spacing of children, to have access to reproductive and family planning education and means, and to enjoy equal rights and responsibilities regarding guardianship, wardship, trusteeship and adoption of children (Article 23).’

Although India agrees in word (the government has ratified the Convention), the reality is dire. The Mental Health Care Act 2016 (as passed by the Rajya Sabha on 8 August 2016) explicitly aims ‘to align and harmonise the existing laws’ with the UN Convention. However, the sexual and reproductive rights of the disabled, especially the mentally ill, are not considered important. Policy makers, activists and the carers of the disabled do not press enough for these, and the mentally ill do not have a loud enough voice. Further, the sexual rights of men and women with mental illnesses who are incarcerated are not discussed to any adequate degree.

In addition, when sexuality is part of the conversation, it is framed in terms of sexual violence, and its possible consequences such as unwanted pregnancies. This line of thinking can have grave consequences. For example, in 1994, 11 women with psychosocial disability underwent forced hysterectomies in Pune without their consent.

To date, guardians and parents stealthily take their daughters to hospitals and get them sterilised; getting consent is not even considered necessary. In addition, mentally ill persons are often considered hyper-sexual and this is considered funny by so called ‘normal’ people.

As for Indian prisons, imprisonment often causes mental illness, which largely goes untreated. Access to partnered sex, which facilitates social connection and intimacy, and which may help the person fight depression, anxiety and other conditions, is lacking. In 2015, the Punjab and Haryana High Court held that conjugal rights or artificial insemination in prisons were fundamental rights. Despite this, there is no real information on whether those incarcerated in prisons are able to access these rights.

I have not come across any statistics for mental asylums, but of course, rape and abuse, as well as instances of inmates getting intimate with each other, and masturbation are reported. A Human Rights Watch report published in 2014 reveals horrifying statistics and the need for urgent change:

The prevalent mindset is that people with disabilities, particularly women and especially those with intellectual or psychosocial disabilities, are incapable, weak, and lack the capacity to make any meaningful decisions about their lives. Institutions to which they are sent are overcrowded and poorly managed: all women and girls with psychosocial or intellectual disabilities currently or formerly living in institutions interviewed by Human Rights Watch experienced forced institutionalisation; most faced a range of abuses in institutional care, including neglect, physical or verbal abuse, and involuntary treatment.’

The sexuality and sexual rights of women in general are not discussed in India from the point of view of pleasure. Instead, a host of organisations work on women’s sexual rights from the point of view of maternal well-being and reproductive health. Perhaps this is because there is the (justified) sense that if people are struggling for basics like food, water and shelter, then sexual rights take a backseat. But this also has a direct and adverse impact on the rights of people with disabilities.

As Pramada Menon, a queer feminist activist says, people in institutions are primarily seen as ill bodies that need to be salvaged so that they can live a ‘normal’ life, but this idea of normal doesn’t encompass sexual well-being. This is because sexuality is considered a luxury, not a necessity.

Pramada also speaks of sexual access in incarceration—do we mean access to someone else or to the self? If fantasising and masturbating were considered, would it be okay to think of the people they meet the most, their doctor or care staff? This would be considered out of bounds, so even the fantasies of those who are incarcerated are regulated!

She adds, ‘I often think about how one is to do this work since even the understanding of who the person is varies greatly across class, education, sexual and gender identities and expressions, caste, experiences of abuse and more.’

Bhargavi Davar, Founder of Bapu Trust in Pune, talks about what incarceration consists of: ‘Captivity could mean both physical captivity and chemical captivity; it could also mean captivity by creating a “control command” environment wherever a person lives. By now, we know that a ‘mental institution’ is not just a physical structure, but rather, a pervasive mentality.’

‘Control over sexuality occurs in a myriad ways: ‘treatment’ for ‘sexual deviance’; gatekeeping over the decisions of people ‘transitioning’ from one sex to another using the bogey of ‘incapacity’; psychiatrising the perceived ‘promiscuity’ of adult survivors of child sexual abuse; and of course the coercion involved in forcing needless treatments, including psychiatric medication, electro-convulsive therapy and involuntary commitment into a mental asylum,’ she adds.

Jayasree Kalathil, a researcher and activist focusing on the mental health issues of minority ethnic communities in the UK built on Bhargavi’s comments as she shared her experience of ‘sexual deviance’ and psychiatry:

‘Psychiatry, psychology and mental health services definitely take on the role of morality and normality police when it comes to sexuality and sexual rights. I believe that one of the diagnoses – borderline personality disorder – was given to me because of my sexuality. Historically, in places where western psychiatry holds sway, women have been diagnosed and locked up for being “promiscuous”, loving other women, having sex outside culturally permitted patriarchal arrangements or for generally flouting sexual moralities imposed upon them. Psychiatry and associated disciplines have been, and continue to be, a means to control sexuality and sexual behaviours.’

‘The very fact that you may experience mental distress or are psychosocially disabled means that your right to sexual and reproductive rights are thwarted,’ she adds.

Pramada and Bhargavi both also mention their concerns with the side effects of treatment, ‘What about those people whose sexual drive has been reduced because of the medication, how does one talk of reclaiming their reproductive health, sexuality and sexual energies?’ asks Pramada. Is this something even entering conversations?

In a conversation I had recently with a doctor at a major hospital in New Delhi, I was told their facility was not an asylum, as I called it, but a psychiatric hospital. A visit to the facility now reveals gardens, rehab rooms, an outdoor gym, and more. But underneath it all, the same principles of Victorian, colonial asylums where ‘lunatics’ are imprisoned, desexualised and looked upon as entertainment persist.

In those times, speaking of the notorious Bethlem Royal Hospital in London, people even paid a penny to come and watch people in cages managed by ‘keepers’. The keepers today, here in India, are the same. The names have changed. The nurses and attendants still carry a stick. People are still chained. And sexual rights remain a dream. Or a fantasy.

Featured image credit: Upasana Agarwal