A few months ago, I received an unusual call from a mental health practitioner in New Delhi. We’d spoken often over the past years about issues regarding inclusion and mental health, but this call was somewhat different. The practitioner told me how a new patient of theirs was told by a friend that their psychiatrist had asked them to go on a trip alone. The practitioner then found out that the psychiatrist had made sexual advances towards many other patients.
Psychiatrists, like other doctors, are bound by the Hippocratic Oath, part of which reads, “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasure of love with women or men, be they free or slaves.”
“The doctor-patient relationship in psychiatry especially is a very confidential one, so we rarely get to know exactly what happens,” Renu Addlakha told Re:Set. Addlakha, a professor at the Centre for Women’s Development Studies in New Delhi, specializes in sociology of medicine, mental illness, and has authored several books on intersections between disability, law, gender, and sexuality.
“The patient is in a vulnerable situation so sometimes develops attachments, especially in private practice. The psychiatrist is in a more powerful position, and very often psychiatrists in our country are men, so chances of abuse of various types, sexual as well as emotional, are high.”
“It happens because of a deep rooted sense of misogyny”
Addlakha explained the precariousness of the situation, as the abuser doesn’t make the misconduct public, and the patient’s credibility is doubted due to a psychiatric diagnosis, even if they try to make it public. If a victim is able to marshall the legal system and approach the right authorities, her credibility, cognitive stability and emotional vulnerability comes under the scanner because she sought help for her mental health. Oftentimes, even her family won’t believe her.
“It’s a very contested space, because how do you formulate consent in this type of relationship?” Addlakha said. “And then how do you prove consent? In my research in a psychiatric facility in Delhi, I found this patient who had written about abuse in her diary at the hands of her doctor in the government hospital. But chances of stories like that coming out are very low.”
In 2016, the Indian Psychiatric Society acknowledged the existence of sexual misconduct amongst mental health professionals, and issued a set of guidelines for them to abide by. This was done despite there being little to no national data on the subject.
A 2010 study from Karnataka found that sexual violations by doctors were common and in the survey of mental health practitioners, over 50% of the respondents said they had a sexual boundary violation which had not been investigated.
Ratnaboli Ray, a trained clinical psychologist and mental health activist, has been working with people with mental health conditions and or psychosocial disability for over 20 years. In this time, she has also worked with those who have been abused while in mental health institutions in West Bengal.
“It happens because of a deep rooted sense of misogyny,” Ray told Re:Set. “A mental health establishment is a patriarchal establishment. The power is in the hands of professionals who are mostly men. And therefore within institutions there’s a climate where women are looked down upon — especially women patients. Therefore, when you’re operating within the larger climate of misogyny, you run an enormous possibility of sexual misconduct.”
Ray added that the victim’s narrative is doubly invalidated, first because they have a mental illness and second, because they’re a woman.
“You have to keep talking to the victim and you have to be trustworthy”
The legal system too, in such cases, is complex to navigate, because one has to read several laws to safeguard the interest of victims. In a mental health institution, laws like Rights of Persons within Mental Institution, Right to Protection from Cruel, Inhuman and Degrading Treatment under Article 21, which has been incorporated in the Mental Healthcare Act, the Sexual Harassment Act, and the Disabilities Act are used. Redressal in private nursing homes too uses the same above-mentioned laws. And lastly, in private chambers of mental health professionals, one has to look at the Sexual Harassment and Disabilities Acts.
“If the case of sexual misconduct happens in an institute, the authorities constitute a special committee to look into it,” Ray explained. “Sometimes in the institution, an NGO is brought in to conduct the inquiry. If the case happens in an OPD, then the family looks into it.”
In such institutions, the abuse can extend to even the facility’s support staff. Ray remembered a case in an institution in Bengal where the woman was sexually abused by a security guard of the mental institution she sought treatment in. After she raised the abuse, the security guard first flatly denied it. Upon further questioning, he said the victim, “wanted it” and had seduced him, after which he gave into it.
After the inquiry, he was stripped off his role.
“You have to keep talking to the victim and you have to be trustworthy,” Ray said. “There will be incoherences, but you have to be diligent.”
“And people on the committee must be clued into understanding the intersectionality between gender, psychiatry and sexuality, otherwise you cannot do justice for the role.”