Sexual Orientation Is a Spectrum

Homosexuality has been taboo in Iran society for decades, long before the Islamic Revolution of 1979. With the emergence of the new regime however, conditions for Iran's lesbian, gay, bisexual and transgendered community deteriorated significantly, as the revolutionary authorities introduced legal punishments for gay sex and cultivated a climate of homophobia that turned prevailing attitudes into a national culture of hostility. As part of our series on Iran's LGBT community, we turn to Dr. Ehsan Habibpour, a psychiatrist based in the United States with experience dealing with LGBT issues, to better understand the challenges gays and lesbians face in Iran and to distinguish between facts and commonly held myths about sexual orientation.

How does modern psychology view homosexuality?

The consensus is that sexual orientation is a spectrum, from fully heterosexual to some heterosexual tendencies, on to fully homosexual. There have been multiple studies of sexual preference among humans and overall the understanding is that this is a spectrum and different people fall on different parts of the spectrum.

What do you say to people who say people choose to be gay, or that maybe they developed homosexual tendencies as a result of sexual abuse during childhood? Is there any validity to these arguments? Are people born gay?

I think there's a lot of debate about the reasons for different sexual orientations. There is no clear consensus over the dominant factor. We all know that sexual orientation, as well as many other aspects of human behavior, are shaped by multiple components; the biological component, the psychological component, and a person’s relationship with their social environment. A combination of these three can contribute to a person's sexual orientation as well as other phenomena related to mental health. 

Can sexual orientation be changed through therapy?

It has happened. Prior to 1973, and even after, there have been psychotherapists and psychiatrists who have attempted that, and there's been some success, i.e. 6% in a sample of about 100-150 homosexuals that were converted, but the reliability and validity of those studies have been questioned. So it has been done, but it's no longer common practice.

What would you say to a mother or father in Iran who has come to you looking for a cure to the homosexuality of their child?

I would explain to them that homosexuality is something that's no longer considered a disorder, and we need to understand this more with the child and family, and invite them to discuss this in a therapeutic setting. We need to discuss the concerns, the worries, and the anxieties involved, as well as giving the child or adolescent the chance to process these in an environment that's confidential, secure, and open to different opinions. 

You mention homosexuality is no longer considered a disorder. When did this shift take place in the psychiatric community?

The American Psychiatric Association removed it as a disorder from the Diagnostic Statistical Manual (DSM) in 1973 and there's been arguments following the removal, but it's nevertheless been removed from all classifications of illness and disorder, including by the International Classification of Diseases (ICD), which is published by the World Health Organization (WHO).

What are some of the potential consequences of asking a gay person to fake being straight? Is suppression harmful?

It has been proven that it is harmful. It causes significant mental disorders such as depression and anxiety disorders. We have remarkable statistics showing a higher risk of suicidal behavior and attempts at suicide within this community, for different reasons. Holding sexual orientation in secret and bullying are factors that cause a significant emotional burden on individuals and is a major stressor that can cause or trigger different mental disorders.

What is homophobia?

It's an emotional reaction toward an unknown phenomenon that evokes a lot of conscious and unconscious feelings and anxieties. I think more often rather than being intentional or aggressive, it's an internal reaction to a novel phenomenon that some are uncomfortable discussing or having experiences with, and once they're exposed to it they react in an often anxious way. 



There appears to be some confusion between homosexuality and transexuality in Iranian society and in government, with homosexuals often being encouraged to go through sex change operations. Is this a wholly incorrect approach?

I think this approach comes out of confusion about sexual orientation. The medical society is still trying to understand the issue, and so is Iranian society. My understanding is that in Iran they do evaluate patients comprehensively and give the evaluation a fair amount of time by teams of physicians, psychiatrists, and psychologists, before they go ahead with the procedures, but at the same time there's a risk that some people might choose to, because of social pressure, take that route because it might be more tolerated. But again, going back to the spectrum we discussed earlier, there's a lot of overlap, and there's still a great lack of scientific knowledge and confusion, so at times the overlaps can create mistakes or problems.

What sort of mental pressures do the LGBT community face? What are the psychological consequences for those living in Iran?

The impact is results from holding on to a secret that they’re not comfortable sharing. They can often be afraid of other people's emotional reactions to them, particularly reactions from family, close friends, classmates, or colleagues. That can induce a lot of undeserved anxiety. The consequences can include bullying, isolation, and withdrawal from society, as well as from their parents, depending on how they respond. As a result it becomes a significant risk factor with possible mental health consequences.

How would you respond to people who invoke religious arguments against homosexuality (i.e. God created Adam and Eve, not Adam and Steve)?

Well, religion of course holds strong opinions and significant influence in societies, and debates from theological standpoints have a significant impact on the way we think, interact and deal with these kinds of subjects, but I believe religion has been open to modifying and understanding new phenomena and redefining concepts. The Pope for example recently spoke progressively about this issue, and in Iran we've had changes in opinion toward transexuality. So the hope is that we continue to see this sort of progress in the future.