Sickness or sin?

Sickness or sin? Attitudes towards homosexuality in the Middle East.

by Brian Whitaker, author of 'Unspeakable Love'

Text of a lecture at the Lebanese Psychological Association, Beirut, 26 May 2006.

My initial research into this subject was triggered by an event in Egypt five years ago when police raided the Queen Boat, a floating nightclub on the River Nile which was popular with gay men. More than 50 men were rounded up and their arrests, along with the resulting trial, and the accompanying publicity ruined many of their lives and careers, all in the name of moral rectitude.

Althought the Queen Boat case was my starting point, it soon became clear that the criminalisation of homosexuality was only one part of a much bigger problem which results from the underlying social and religious taboos. Use of the law to persecute gay people is certainly an important issue but in practice the number of people who are jailed or otherwise punished for same-sex activity is relatively small. The social and religious taboos, on the other hand, are a problem for all gay and lesbian people in the Middle East- and especially young people at the age when they are beginning to realise that their sexual feelings are different from those of their friends.

Many of them keep these feelings secret but if they tell their relatives - or if their relatives find out - it can result in a family crisis which often involves recourse to doctors or psychiatrists.

I'd like to begin with three case histories which I came across while researching my book. The first one is rather long, but I think it's very revealing.

It concerns Ghaith, a Syrian, who was studying fashion design in Damascus when the family crisis happened. He told me had known that he was gay for a long time but had never allowed himself to even think about it.

In his final year at college he developed a crush on one of his male teachers.

"I felt this thing for him that I never knew I could feel," Ghaith said. "I used to see him and almost pass out.

"One day I was at his place with a lot of guys and girls. We were having a party and I got drunk. My teacher said he had a problem with his back and I offered him a massage. We went into the bedroom. I was massaging him and suddenly I felt so happy. He was facing down on the bed so I turned his face towards my face and kissed him.

"He was like ... 'What are you doing? You're not gay.'

"I said: 'Yes, I am.'

"It was the first time I had actually said that I was gay. After that I couldn't see anybody or speak for almost a week. I just went to my room and stayed there, I stopped going to school, I stopped eating, I stopped doing everything. I was so upset at myself and I was going ... 'No, I'm not gay, I'm not gay, I'm not'."

Ghaith decided to entrust his secret to a female cousin who lives in the United States.

"I called her and told her: 'I really don't know what to say. I'll understand if you never speak to me again, blah blah blah, but I'm gay'."

"She was laughing and she told me that it's not something you have to be ashamed of. It's who you are and you should be proud of yourself.

"So next day, after a week on my own in my room, I went to school and told my friends. They were mostly cool about it and some of them said 'Yeah, we knew', but one said: 'I really think you should see a shrink'."

To reassure his friend, Ghaith agreed.

"I went to this psychiatrist and before I saw him I was stupid enough to fill in a form with the whole info about who I was, with my family's phone number.

"I told the doctor I had come just to prove to my friend that it's not a sickness. He was very rude and we almost had a fight. He said: 'You're the garbage of the country, you shouldn't be alive and if you want to live, don't live here. Just find a visa and leave Syria and don't ever come back.'

"Before I reached home he had called my mum, and my mum freaked out. She gathered all my straight friends and two of my uncles, and my sister and her husband. When I arrived home there were all these people in the house. My mum was crying, my sister was crying, and I thought somebody had died or something. They put me in the middle and everybody was judging me.

"I said to them: 'You have to respect who I am, this was not something I chose,' but it was a hopeless case.

"The bad part was that my mum wanted me to leave the college. It was my final year and I was first in the class. I said: 'No, I'll do whatever you want.' After that, she started taking me to therapists. I went to at least 25 and they were all really, really bad. Really bad. They did all sorts of medical tests, like hormones and things, and they always made you masturbate into this little container."

"The bad part was that my mum wanted me to leave the college. She was right in a way, because the college had changed me - it had opened my mind. Before that I was a typical Syrian guy but then I stopped behaving like the others. In Syria, everybody has to be a stereotype. If you don't have a big moustache and short hair it's always a problem.

"Anyway, my mother threatened she was going to stop paying the college and I said: 'No, I'll do whatever you want.' It was my final year and I was first in the class and doing very well. After that, she started taking me to therapists. I went to at least 25 different therapists and they were all really, really bad. Really bad. They did all sorts of medical tests, like hormones and things, and they always made you masturbate into this little container.

"In Syria they think the only reason why you would be gay is that you're over-feminine, that you're having problems with your hormones ... that you're trans-sexual, basically. I told them, 'No, I don't want to be a woman, I'm a man.' It's very difficult but I totally understand. I used to be aggressive against gay people myself - maybe because I was gay and not admitting it.

"One day we were having a family dinner and I had to go to see another therapist. My brother-in law offered to drive me there. While we were in the car he said, 'You know, I married your sister because she's from a good family and she has a good reputation. I don't care about you or what you do, but if I ever hear anyone say my brother-in-law is gay I'm going to divorce your sister'. I felt sad for my sister more than anything else, and she would have been stupid enough to blame me for the divorce if it happened.

"After what my brother-in-law had said, I decided to stop resisting. I said 'Khallas! I cannot do this any more. Nobody is remotely trying to understand me.' I started agreeing with the psychiatrist and saying 'Yes, you're right'. I was going there every day and soon he was saying 'I think you're doing better'. He gave me some medicine that I never took. I have no idea what it was, but he used to charge a big bill.

"So everybody was fine with it after a while, because the doctor said I was doing OK, and because I was lying to the doctor. But I don't think anybody was convinced 100%."

As soon as he graduated, Ghaith left home and left Syria. Six years on, he is a successful fashion designer in neighbouring Lebanon, though he visits his family occasionally. He feels that the experience has affected his mother and sister in different ways. His sister - once very traditionally-minded - has become more understanding while his mother, who was once a very open person, never talks about his sexuality. "I've tried to open the subject a few times but it never worked out," he said. "My mum is in denial. She keeps asking when I am going to get married: 'When can I hold your children?' In Syria this is the way people think. Your only mission in life is to grow up and start a family, then raise your children so they can start their own family. There are no real dreams. The only Arab dream is having more families."

* * *

Sahar, a lesbian from Beirut, described her experience: "My mother found out when I was fairly young - around 16 or 17 - that I was interested in women, and she wasn't happy about it," she said. Sahar was being treated for depression at the time and her university-educated mother decided to change the therapist. "The previous one was sympathetic. Instead, she took me to a very homophobic therapist who suggested all manner of ridiculous things - shock therapy and so on."

Sahar thought it best to play along with her mother's wishes - and still does. "I re-closeted myself and started going out with a guy," she said. "I'm 26 years old now and I shouldn't have to be doing this but it's just a matter of convenience, really. My mum doesn't mind me having gay male friends but she doesn't like me being with women. I've heard and seen much more extreme reactions. At least I wasn't kicked out of the house."

* * *

Salim, an Egyptian, was 20 when his family asked if he was gay. He said yes, and they bundled him off to see the head of psychiatry at one of Egypt's leading universities. Salim told the professor that he had read about homosexuality and knew it wasn't a mental illness, but the professor disagreed. "An illness," he replied, "is any deviation from normality."

The professor offered Salim a course of psychiatric treatment lasting six months. "He told me he couldn't say what the treatment would be until he knew more about my problem," Salim said. "I asked how he knew it would take six months, and he said that's what it usually takes. I turned it down."

Six months' psychotherapy may be pointless, but there are far worse alternatives. Stories abound in Egypt and other Arab countries of sons with homosexual tendencies being physically attacked by their families or forced to leave home. Ahmed told of a friend whose father discovered he was having a homosexual relationship and, after a beating, sent him to a psychiatrist.

"The treatment involved showing pictures of men and women, and giving him electric shocks if he looked at the men," Ahmed said. "After a few weeks of this he persuaded a woman to pretend to be his girlfriend. His father was happy for a while - until he found a text message from the boyfriend on his son's mobile phone." The beatings resumed and the young man fled to the United States.

* * *

Whether a gay Arab is considered mad or bad - as a case for psychotherapy or punishment - depends largely on family background. "What people know of it, if they know anything, is that it's like some sort of mental illness," said Billy, a doctor's son in his final year of studies at Cairo university. "This is the educated part of society - doctors, teachers, engineers, technocrats. Those from a lesser educational background deal with it differently. They think their son was seduced or lured or came under bad influences. Many of them get absolutely furious and kick him out until he changes his behaviour."

A point made repeatedly by young gay Arabs in interviews was that parental ignorance is a large part of the problem: the lack of public discussion about homosexuality results in a lack of level-headed and scientifically accurate newspaper articles, books and TV programmes that might help relatives to cope better. The stigma attached to homosexuality also makes it difficult for families to seek advice from their friends. Confronted by an unfamiliar situation, and with no idea how to deal with it themselves, the natural inclination of parents from a professional background is to seek help from another professional such as a psychiatrist. In Egypt this is a common middle-class reaction to a variety of behavioural "problems". One (heterosexual) Egyptian recalled that his parents had sent him to a psychiatrist because he regularly smoked cannabis. The treatment failed, but he went on to become a successful journalist.

Psychotherapy in Egypt doesn't come cheap. There's also no evidence that it "cures" anyone. Contrary to prevailing medical opinion elsewhere in the world, the belief that homosexuality is some form of mental illness is widespread in the Middle East, and many of the psychiatrists who treat it do nothing to disabuse their clients.

It is now 16 years since the World Health Organisation removed homosexuality from its list of recognised illnesses and, at least in the west, sexual reorientation (or "reparative") therapies are rejected by most mental health organisations but supported by some evangelical Christian groups. Treatment is not permitted in Britain, though it is offered by some therapists in mainland Europe. In the United States, the only treatment approved by the American Psychiatric Association is "affirmative therapy", which aims to reconcile clients with their sexuality. For other forms of treatment, clients must sign a consent document acknowledging the APA's view that sexual reorientation is impossible and that attempting it may cause psychological damage.

The medical approach in Egypt can be very different. In 2001, at the height of the Queen Boat case, al-Ahram al-Arabi - which has close links to the Egyptian government - quoted Dr Ahmed Shafiq about ways of "curing sexual perversion".

Dr Shafiq, described as a "professor of surgical medicine", stated that the most successful method "has been cauterising the anus, which, by narrowing the anus, makes it more painful for the passive homosexual to be penetrated, which makes the active homosexual also unable to penetrate, and causes the sexual encounter to fail."

Psychiatric treatments described to me in Egypt ranged from counselling to aversion therapy. Futile as this may be in terms of re-orientating the client, it is not necessarily a total waste of time and money: One gay Egyptian cited the cases of several friends where failed therapy had helped to convince parents that their son would not change, and thus persuade them to accept his sexuality.

In contrast to their perplexed parents, gay youngsters from Egypt's professional class are often well-informed about their sexuality long before it turns into a family crisis. Sometimes their knowledge comes from older or more experienced gay friends but mostly it comes from searching the internet. This of course requires basic computer literacy, access to the internet and fluency in English (or possibly French) and is therefore only available to the better educated.

"If it wasn't for the internet I wouldn't have come to accept my sexuality," Salim said, but he was concerned that much of the information and advice provided by gay websites is addressed to a western audience and may be unsuitable for people living in Arab societies. Many of these sites carry first-person "coming-out" stories from westerners who found the experience positive, or at least not as painful as they expected. The danger of this, Salim explained, is that it encourages Arab readers to do the same - and the results can be catastrophic, especially if they have no access to support and advice when relatives and friends respond badly.

* * *

Of course, doctors and psychiatrists are not the only ones that gay people and their families turn to for advice. Many consult priests or imams.

Here is a letter posted on a Muslim website, IslamiCity.

"Dear Imam," the letter begins, "I fear Allah, and believe in him so strongly that I cry when I pray ... my problem is homosexuality."

The writer continues:

"I pray to Allah that I am dead for having these uncontrollable feelings, I do not want to be gay, I try to change, but all this seem to be bryond [sic] my capability. For many years I've prayed to Allah to correct me, I really prayed very Sincerely with a clean heart, but I am only the same since I was a young boy ... If i ever commit an act with another man, should not I be killed? I must admit, i have, and I wish I am dead. In such a situation, (and since we do not live in a Muslim state where islamic law should be upheld) should I not kill myself and therefore [be] upholding the law and MAY BE getting forgiveness from Allah.. I know suicide is not allowed, but in a case like mine, and being well aware of some islamic laws, shouldn't we have an exception and allow suicide?"

On the question of suicide at least, the advice from IslamiCity's imam is very clear. "Two wrongs don't make one right," he says. "While homosexuality is wrong, it doesn't justify suicide under any conditions or circumstances."

But the imam has little to offer by way of help beyond urging repentance:

What you should do is to truly repent to Allah, the Merciful, the Gracious, and pledge to Him never to get involved in any homosexual acts anymore. If medical or psychological counselling helps, then get it, but know that Allah is the Curer, and the Qur'an is your best companion. Give charity, pray, make dua', and Allah will not leave you alone. You have got to believe in the infinite amount of Mercy Allah provides to His servants, and you should also realise that He forgives, if He wishes, all types of sins, except the sin of disbelieving in Him. Therefore, don't lose hope in Him and write us anytime you want ...

In reply to other questions, the imam says that homosexual feelings are not in themselves sinful. "What is sinful in homosexuality is the actual sexual act between the couple of a similar sex."

A person who feels attracted to someone of the same sex should keep quiet about it, the imam says. He should ask God to help him to get rid of the feeling and also seek medical advice to "correct it through appropriate means".

This, broadly speaking, is as much support as a gay Muslim is likely to get from a mainstream Islamic scholar. IslamiCity's imam may be unrealistic in expecting that "the problem" can be overcome with help from God and "corrected" by medical intervention but his tone is calm and not unsympathetic. There are many others who take a much harder line, denouncing gay people as "paedophiles and AIDS carriers" and likening homosexuality to alcoholism, drug addiction or a "cancer tumour" that must be eradicated in order to preserve society.

In contrast to IslamiCity, IslamOnline website describes homosexuality as "the most heinous" sin in Islam and "one of the most abominable"; a sin so "enormous in intensity and gravity" that it must be punished both in this life and the next. These are not casually-aired views; they come with a stamp of religious authority. IslamOnline is one of the largest Muslim websites and to ensure that none of its content "violates the fixed principles of Islamic law", everything is vetted by a scholarly committee. The head of the committee is the popular Sunni cleric, Yusuf al-Qaradawi.

According to Qaradawi, in a fatwa for IslamOnline, "this perverted act is a reversal of the natural order, a corruption of man's sexuality, and a crime against the rights of females.

"The spread of this depraved practice in a society" he says, "disrupts its natural life pattern and makes those who practise it slaves to their lusts, depriving them of decent taste, decent morals, and a decent manner of living."

This seems to be a fairly new development in Islamic teaching, and it's probably a reaction to gay activism in the west. Traditional Islamic teaching sees nothing particularly sinful about having homosexual feelings; it's only when people act upon those feelings that the question of sin arises.

However, that traditional distinction between acts and feelings is blurred in the discussion at IslamOnline, where homosexuality is described as both a "perverted act" and a "devilish lifestyle".

Qaradawi spells this out clearly when he writes: "Almighty Allah has prohibited illegal sexual intercourse and homosexuality and all means that lead to either of them" - a phrase that dramatically extends the boundaries of forbidden territory.

Thus, in the words of IslamOnline, homosexuality is not just "a prohibited act" but "an assault on the humanity of a person, destruction of the family, and a clash with the aims of the Divine Legislator, one of which is the establishment of sexual instincts between males and females so as to encourage the institution of marriage and procreation." Muslims who experience same-sex attractions therefore have no alternative but to try to acquire the right instincts and become heterosexual: "It is their responsibility to know how they can orient this craving".

To support the argument that homosexuality and "all means" that lead to it are sinful, IslamOnline claims that sexual orientation is a choice - and therefore something that can be corrected. For a man who "was sexually abused in his childhood and now ... only likes sex with males", it recommends the following treatment:

If he is a Muslim, he is left with no choice but to change ... Let him convince himself that the pleasure that he derives from such an abominable behaviour is in reality nothing but pain and suffering in the long term. So instead of associating this behaviour with pleasure, let him learn to associate and link it with pain; so every time he is tempted to do it, let him picture the pain and suffering of hell fire. By repeatedly going through this exercise, he will eventually come to abhor and shun this behaviour altogether.

In the absence of grateful testimonials on the effectiveness of this remedy, IslamOnline turns for additional support to the National Association for Research and Therapy of Homosexuality (or Narth). Narth is a fringe psychiatric organisation in the United States which promotes "sexual reorientation therapy". Although Narth's approach has some backing from Christian and Jewish conservatives in the US, it is rejected by all the main professional bodies, including the American Psychological Association (150,000 members) and the American Psychiatric Association (35,000 members) - both of which removed homosexuality from their lists of recognised mental disorders in the 1970s and now regard efforts to "cure" it as liable to do more harm than good.

The American Psychological Association states:

Human beings can not choose to be either gay or straight. Sexual orientation emerges for most people in early adolescence without any prior sexual experience. Although we can choose whether to act on our feelings, psychologists do not consider sexual orientation to be a conscious choice that can be voluntarily changed ...

Even though most homosexuals live successful, happy lives, some homosexual or bisexual people may seek to change their sexual orientation through therapy, sometimes pressured by the influence of family members or religious groups to try and do so. The reality is that homosexuality is not an illness. It does not require treatment and is not changeable ...

Some therapists who undertake so-called conversion therapy report that they have been able to change their clients' sexual orientation from homosexual to heterosexual. Close scrutiny of these reports however show[s] several factors that cast doubt on their claims. For example, many of the claims come from organisations with an ideological perspective which condemns homosexuality. Furthermore, their claims are poorly documented. For example, treatment outcome is not followed and reported over time as would be the standard to test the validity of any mental health intervention. The American Psychological Association is concerned about such therapies and their potential harm to patients.

Conveniently for IslamOnline, the theories and therapies favoured by Narth meet its ideological needs. In a series of articles under the heading "Homosexuality in a changing world: are we being misinformed?", the website's health and science editor, Dr Nadia el-Awady, looks at the development of sexual orientation, research into homosexuality, therapy, etc, in what is described as "an Islamic and a scientific light". Adopting "the fact" that homosexuality is a matter of choice as their premise, the articles rely almost exclusively on material from Narth and its supporters. There are no fewer than 26 links from Dr Awady's articles to Narth's website, and just one each to the websites of the American Psychological Association and the American Psychiatric Association.

Readers of Dr Awady's articles, if they are unfamiliar with the debate in the United States, might easily form the impression that Narth reflects the scientific consensus while the mainstream professional bodies are mere dissenters.

It may be worth mentioning that the cures for homosexuality proposed by IslamOnline are very similar to the cures that other Islamic scholars offer for a variety of alleged behavioural problems, including masturbation and left-handedness.

Giving advice to a relative of a left-handed child, Sheikh Muhammad al-Munajid, a Saudi cleric, points out that left-handedness is bad because Satan eats and drinks with his left hand. He urges the relative to make the boy change his ways or seek medical help:

Try to get him used to eating with his right hand and keep on advising him and reminding him to do so. You could seek the help of psychiatrists, because some of them may have some useful ideas. We ask Allaah to give you strength.

Many Islamic websites describe masturbation as an abominable or wicked act. The Islamic Voice website states that "its harms are great and it has disastrous consequences as established by doctors."

Several websites give identical lists of the "proven" medical effects which - besides damage to the eyesight and sexual organs themselves, include disruption of the digestive system, inflammation of the testicles, damage to the spine ("the place from which sperm originates"), and "trembling and instability in some parts of the body like the feet".

In addition, they say, there is a weakening of the "cerebral glands" leading to decreased intellect and even "mental disorders and insanity". Furthermore, "due to constant ejaculation, the sperm no more remains thick and dense as it normally occurs in males." This results in sperm which is not "mighty enough" to make a woman pregnant or produces children who are "more prone to disease and illness".

The source of all this medical information, according to Islamic Voice, is Abd al-Aziz bin Baz, the late Grand Mufti of Saudi Arabia.

The problem in many parts of the Middle East is that such rubbish from religious authorities often passes unchallenged by medical professionals. One reason is that the clerics have a public platform for their views which the professionals usually lack. In some countries, the professionals are also fearful that if they do speak out they will be denounced as unbelievers.

During one of my visits to Egypt I asked a gay activist: "If one thing could be done to make life easier for gay and lesbian Arabs, what would it be?"

His answer surprised me, but he said he would start with the medical profession. It is impossible, he said, to find a psychiatrist in Egypt who is willing to state openly and in public - regardless of their private opinion - that homosexuality is not a disease.