Irfan M Lone*
Master’s In psychology, Belgium
*Corresponding author: Irfan M Lone, Master’s In psychology, Hollandstraat 24, Antwerpen 2060 Belgium
Submission: October 13, 2020Published: December 08, 2020
ISSN:2637-773XVolume5 Issue4
In order to draw significant comparisons between the disparities in dealing with LGBT cancer patients in East and West, it becomes extremely essential for us, as clinicians and health care providers to understand the bigger picture of the LGBT Community in general. As we all know that in India we still have not been able to reach a point where all the people are accepted unconditionally; and when it comes to sexual orientation, we still face old taboos, socio-cultural and religious pressures, prejudice, and judgments in general. Moreover, while dealing with clients belonging to the LGBT community, clinicians also doesn’t have it easy. In India, we still do not approve same-sex marriages and the rights of the LGBT community are still not fully recognized, which puts this group on the lines of extreme vulnerability, both emotional and otherwise. On the other hand, the acceptance from family and friends, the government, and the general public and endless fear of ending up alone all life, makes things worse. However, thankfully the younger generation in India seems to be more accepting, possibly due to the social media explosion from last decade, or possibly due to easy access to worldwide web, mobile phones, and so on, and therefore, cultural and ideological exchanges with “online friends” abroad and also to some extent due to changing norms in Indian cinema.
On the other hand, however, in the west, specifically in Europe most of the countries give full rights and acknowledgments to all the individuals belonging to the LGBT group; they can get married, have children or adopt children and possess properties, dress the way they want to, be open and free and take pride in their sexual orientations, have equal opportunity in the job market and thus have normal married and committed life and so on, but this doesn’t mean that they don’t face challenges here. This community faces unique challenges here as well, sometimes more serious than anywhere else, but in the long run, these challenges are mostly practical and in most of the cases tangible and thus resolvable; besides the support from the government and political system and therefore society as a whole makes the situations and scenarios different here.
Both in India or west, any gay, lesbian, or anyone belonging to the LGBT community, after hearing “The Bad News of BIG C” experience the same emotions and shock waves, however as far as my experience in India goes, Indian patients feel these emotions to more extreme levels and their implications are highly significant. Fear of getting the sexual orientation disclosed after the diagnosis, fear of being judged by clinicians, and in extreme cases fear of being disowned by family and caregivers are the primary apprehensions or stressors that can profoundly impact the mental well-being and thus the quality of life of such patients. In some case, I have also seen that these fears significantly impact the decision-making process about treatment and therapies, (in such cases, the patients let
treating oncologists decide for them, “because if it helps to protect
my sexual orientation, it works for me, moreover doctors are the
experts to decide for my treatment”).
My experience in the field of psycho-oncology in India and
also the great opportunity to work in South -East Asia’s biggest
cancer hospital, I have had multiple clients, who were not out to
their families, but due to cancer diagnosis, there were situations
when they had to break the secret of their sexual orientation, which
was most of the times very difficult for me as a clinician to deal
with; given the fact that my role was highly essential in treatment
process, I should make sure that family is in peace with this truth
and accepts the patient as he/she is. The other side of the coin of
Clinical/professional difficulty was that this truth should only be
reviled to psycho-oncologist/ psychologist (in this case me), other
than the family (Mostly father and mother). In most of the cases,
even siblings should not know about this. Sexual orientation should
not be disclosed in any way with the rest of the treating team,
absolutely no body. The therapies with patient and family would
sometimes last for months, irrespective of socio-economic status,
or education of the family. Now for the family, there were two types
of catastrophes to deal with, the BIG ‘C’ and the Orientation of their
child. But in most of the cases both the parties would come to a
peaceful acceptance. Because “saving lives and treating Cancer is
Most essential and therefore priority at that moment. “Sexual
orientation can be dealt with later, “Because I know few of the
Baba Jis, they can surely help us”. These are the words of a father
of 24-year-old Rectum cancer Namit, who said he needs to disclose
the orientation before he gets started with cancer treatment. Namit
was studying for aviation and was an aspiring Pilot, had a long
term 4-year stable relationship with a guy called (Amar). Both the
families didn’t know about the sexual orientations of their sons, yet
Namit came out to his family after 3 weeks of knowing his cancer
diagnosis. Unfortunately, Namit passed away after 15 months of
his diagnosis, the disease was already in metastasis and it didn’t
respond to any sort of therapy. The last months and weeks were
hard for Namit and the family. (the names of the persons have been
changed for professional confidentiality)
On the other hand, however, in Belgium for example, LGBT
people are very open, as I discussed before, have an equal position
and opportunities in society. The issues and stressors are completely
different and unique than in India, however, the basic issues are the
same for any cancer patient, when he/she gets to know about the
cancer diagnosis, but here the fundamental basic issues revolve
round work, relationship, and logistics, which are more tangible
or practical, if we look at them in-depth and with a logical eye,
which doesn’t in any way mean that the shock and disbelief is not
experienced here by this group. The primary emotional issues in
Belgium according to my experience however are.
1. If the relationship or commitment or partnership will
continue after cancer diagnosis.
2. Identifying and accepting the role changes in relationship
(from a partner, lover or husband and so on to care-giver)
3. Managing Logistics, for example with work and family life.
4. Body image issues among younger patients (the younger
the patient, the stronger the intensity)
5. Negative implications on dating and sexual behaviors
after diagnosis
6. Disparities in self-image
However, after the treatment gets started, gradually the
information and knowledge of cancer diagnosis, treatment, and
prognosis (prognosis, mostly in European patients, because in
the east, specifically in India patients are not yet told about clear
prognosis, but it has improved over the past decade) sink in and
these issues come to peace, which I have experienced and observed
with Indian counterparts, lasts even longer and in most of the case
go along the whole trajectory of the cancer journey and sometimes
even after treatment.
To a great extent, the solutions to these fundamental issues are
directly correlated to the quality of caregiving and social support.
The diagnosis of cancer also brings a great deal of challenges in
the family stricture, dynamics, and “Normalcy.” Given the fact
that caregiving can be a delightful gift one can offer to change the
picture of the cancer journey; on the other hand, it can be extremely
irritating and can profoundly impact the quality of life of the
caregiver. Burnout, verbal assault, irregularities in professional and
social life, mood disorders, chronic and acute stress, and fatigue
are the basic issues reported globally by caregivers, irrespective of
cultural or religious backgrounds. In India, the primary caregivers
are family (Parents) and is seen more structured and organized
when it comes to caring for LGBT patient, but in Europe (Belgium)
the primary caregiving is offered by partner or lover or husband/
wife (if the patient is committed, legal partnership or married)
family and friends follow the line. But if the patient is single due
to any reason, primary caregiving is provided by family (including
parents and siblings), followed by friends. In Belgium, both
heterosexual and the LGBT cancer patients enjoy their social lives,
even during the treatment of cancer, and thus going out, meeting
friends and family, organizing small feasts, and so on doesn’t make
them feel that they need care all the time, which on the other hand
in India, patients are mostly forbidden to go out in gatherings and
thus are confined to home or in hospital, which makes them feel
and believe that they are sick, thus need care all the time. This,
in turn, puts the caregivers in India generally on a spectrum of
unique challenges ranging from mood disorders, fatigue to clinical
depression.
Psychologists and Psycho-oncologists need to be extremally
empathetic and possess a non-judgmental attitude, especially
in India. Clients belonging to this community must feel safe and
secure, to first bring the issues about sexual orientation on the
table and secondly, to feel a sense of deep trust and respect with a psychologist to resolve challenges concerning orientation alongside
the cancer therapies. Such cases should not be considered
as “glittering and rainbow disco lights decorating the ceilings”
(by this, I mean a psychologist should never highlight in their
professional profile, with laughter, pride and fun, that these cases
were or are being dealt by him/her). But this doesn’t mean that
such cases should be regarded as special ones, rather they should
be considered highly sensitive and extremely confidential.
Indeed, Special education focusing on LGBT and cancer could
certainly uplift the sensitivity of such cases, make clinicians more
aware of this group of patients, and likewise make them more
confident and practical in dealing with such patients. Other clinical
professionals including, nurses and oncologists along with primary
caregivers, families, and close ones could also be sensitized over
this subject, which in turn will ultimately reflect that “we do not
discriminate them in health care and we do our best to take care of
them as One Clinical Team”.
Some of the common issues reported by LGBT survivors after
the completion of cancer treatment in no particular order in
Belgium are:
Long-term psychological Distress with or without comorbid
another DSM diagnosis
a) Depression and loneliness
b) High intensity of Body Image Issues
c) Uncertainty in existing relationships or starting a new
serious committed relationship.
d) Intense feelings of physical and sexual undesirability
e) Apprehension to openly participate in dating behaviors
f) Inconsistency with job profiles.
(The above-mentioned issues go in line with Indian context,
which gives me an impression that these issues are at the core in
every society when we focus on LGBT and cancer as a whole)
There is a lot to offer in terms of breaking the stigma about LGBT
and cancer, however, I feel it falls in the broader and huge domain
of Sexual Orientation and socio-cultural and religious norms and
belief systems in India or any society in general. Yet on the other
hand, as Clinicians and oncology professionals we form a big group
together and if we, as a big group open our hearts and hands to
serve and care for them with compassion, that would be already a
great start and the legacy would be build up in our professionalism,
and possibly other professionals will be inspired and they will
also follow the steps and ultimately, we will create a society where
everyone is loved, respected and given ultimate care they deserve,
irrespective of caste, color, religion or orientation.
Besides, we need to start exploring the area of LGBT and cancer,
to formulate some special guidelines for handling and care for this
super special, yet highly vulnerable group.
"If cancer never discriminates people, why should we as clinicians do so; let's pledge to defeat cancer with love and compassion."
© 2020. Irfan M Lone. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.