An interview with guest-editor, Dr. Debanjan Banerjee
Doctor Debanjan Banerjee contributed a qulitative study on sex and sexuality in old age entitled “Love in the Later Years…”: Perceptions of Sex and Sexuality in Older Indian Adults — a Qualitative Exploration.
Debanjan Banerjee, Consultant Geriatric Psychiatrist, Apollo Gleneagles Multispecialty Hospitals, Kolkata, India; Vice-chair, Advocacy and Public Awareness Committee, International Psychogeriatric Association (IPA).
Maria Dolgaleva from the Consortium Psychiatricum team talked with Dr. Debanjan Banerjee about the article, the issue in general and why this theme is so important nowadays.
MD: First of all, I would like to thank you on behalf of the journal for your contribution to the issue on Old Age Psychiatry, as well as for encouraging the distinguished President of the World Psychiatric Association (WPA), professor Afzal Javed, to participate and write a special editorial note. Could you tell us about your experience as a guest-editor and the idea to create a thematic issue dedicated to geriatric psychiatry?
DB: Thank you for having me. Let me take this opportunity to thank the entire editorial team of Consortium Psychiatricum: the chief editor doctor George, doctor Olga Karpenko, Elena, the editorial assistant, for making this issue possible. I think it was a very important teamwork.
The idea of this issue came first when I was listening to doctor Olga present about one of the issues of CP in the last 2020 WPA Congress. I was also a presenter there and when I heard her present and when I had a look at the issue on the website I found it very interesting: it was a very young journal and it was doing pretty well. The issues were quite much thematic, they included papers by different authors across the globe, on different topics in psychiatry. I think at that time the journal was running for a year and a half. That’s how it all started. So I thought why not have a special issue on Old Age Psychiatry, geriatric psychiatry, because this is an area which is very initiate and not covered in many general psychiatry journals. That was the start of the process. I contacted doctor Karpenko and we had a detailed correspondence over quite some time, we made the idea about the issue and what it’s going to cover, what are the topic and subtopics of old age psychiatry that we are planning to include and even that day I didn’t know that our efforts were going to materialize so well and that it was going to come ahead in print today. It was a wonderful experience for me as an early career psychiatrist and editor of other journals. It was also a great learning experience for me, because I looked at it through the lens of being a geriatric psychiatrist myself, somebody early in my career in the field of mental health and of course a great editorial experience.
There are several aspects that I would like to highlight. First, reaching out to eminent figures like, as you mentioned, the distinguished president of WPA doctor Afzal Javed, doctor Carlos (Augusto de Mendonça Lima), chair of the section of old age psychiatry, who contributed a very important policy article and was very excited about the issue, doctor Kiran Rabheru, the chair of the Steering group of the International Longevity Centre Canada (ILC) and the chair of Advocacy and public awareness committee of the International Psychogeriatric Association which I’m also a part of. Then, of course, working with researchers from other parts of the world, from Russia, from India, from other countries. It was interesting discussing with them about the prospect of an independent issue which is only focused on the Old Age Psychiatry, something which will be helpful for clinicians as well as for researchers interested in this field. And that’s not to mention the editing experience, because I think your team was fantastic and helped me in every possible aspect. Doctor George was extremely encouraging and we could collaborate with authors throughout the period. We had the timeline of six months and the issue was on time, we managed to have 12-13 articles including original research, policies, editorials, reviews, and I’m glad I could contribute as an author myself as well and I think this will really serve as food for thought in having separate issues on geriatric psychiatry again and other thematic issues with Consortium Psychiatricum. It was a fantastic experience and I look forward to doing it again.
MD: It is a truly multidimensional work indeed and what all of you have managed to do is admirable. Before proceeding to our main topic of discussion, I know that you contributed to a couple more articles for the issue. Perhaps you could comment on what they are about and what is important to know about them.
DB: Firstly, again, I’m glad that I could contribute to this thematic issue on Old Age Psychiatry. I was very impressed by the timeline, the quality of the review and the multiple rounds of discussions with the editorial team which was really helpful, at least for my own articles.
So, as an author I have three publications in this issue. The original research is related to sexuality and sexual experiences in old age. There is also a commentary which was co-authored by doctor Henrique Pereira from Portugal and is entitled “Healthy Longevity Among the LGBTQIA+ Population: From Neglect to Meeting Their Needs”. The third one was a conference report about the World Psychiatric Association, Indian Psychiatric Society, SAARC Psychiatric Federation and Asian Federation of Psychiatric Associations joint panel discussion organized by the International Psychogeriatric Association entitled “Voices from South Asia Regarding Older People’s Mental Health Advocacy and Services''. It was co-authored by the other panelists that include doctor Afzal Javed, the president of WPA, doctor G Prasad Rao, the president elect of the Asian Federation of Psychiatric Societies and the current president of Indian Association of Geriatric Mental Health, doctor Gautan Saha, the ex-president of Indian Psychiatric Society and the current president of SAARC Psychiatric Federation and doctor Sudarshan Narsingh Pradhan from Nepal who is the immediate past president of SAARC Psychiatric Federation.
At the outset let me extend my thanks to all my co-authors for contributing to this issue.
So, to give you a brief about the first paper, the one on “Healthy Longevity Among the LGBTQIA+ population”, you know, this comes from a personal interest in sexual health and in working with sexual and gender minorities. I am also the deputy editor of a journal called “Journal of psychosexual health” which is published by the SAGE and as a result of that I interact with many authors who have interest in psychosexual health and sexual medicine. So I thought why don’t we intersect the themes of geriatric psychiatry and sexual health, especially with regards to the LGBTQIA population who age, especially in the later life. It is a population which is already marginalized, stigmatized, have a lot of unmet needs which are furthered with the COVID-19 pandemics and particularly so with the age, because aging brings in a lot of its own unique challenges which are perhaps more for this vulnerable group. So what myself and doctor Pereira tried to do, was to give a brief glance at what are the different challenges, the different aspects that people aging in this community feel. The lesbian, gay, bisexual, trans, queer, intersex or asexual community. There can be a lot of different challenges, including ageism, sexual stigma, self-stigma, sexual identity stigma an so on. Today, when we are talking, we are talking in the United Nations Decade of Healthy Aging which is 2021-2030. The Decade enablers are making efforts to combat ageism, create age-friendly environments for all age groups and promote an integrated and holistic care. In that line I think this commentary discusses how, as health professionals, we can optimize opportunities for physical, mental and sexual health in the LGBTQIA+ population, how we can provide them with a better quality of life and how the inclusion is important to make them aware of the sexual and reproductive rights. All of these can actually promote healthy aging which is a very important preventive and promotive strategy for mental health.
Coming to the Conference report, it was something very close to my heart. In fact, this discussion was a part of the last year’s IPA Older adults mental health awareness week, which was the first-time initiative that we organized last year. I should also share with you that we have the same initiative that starts on October 1st, considered The International Day of Older Persons and it extends to the 10th of October which is the World Mental Health Day. All of you are invited to attend the event, it’s virtual and it will be available on the IPA website.
So, this discussion was initially conceptualized as a South Asian discussion, a part of the world which not only houses a significant amount of population but also faces rapid population aging. And we had all the key leaders from the SAARC group, doctor Afzal Javed himself representing WPA, as well as from one of the South Asian countries and other dignitaries office bearers in the respective societies. So what we predominantly discussed was the geriatric services in this area of the world, you know, how the different organizations can collaborate with the guidance of IPA and WPA on promoting training, hand holding with respect to geriatric psychiatry, what are the unique challenges that these countries face with regard to population aging and mental health of older adults and what is the way forward and that was not only a highly acclaimed discussion, but which received a very positive feedback around the world. So all of us got encouraged to write down the proceedings of this discussion as a report and we thought that what better than to have it published in the thematic issue on old age psychiatry and once again I thank all the office bearers in the South Asian region who contributed to this event report not only highlights the challenges but also calls for and urgent collaborative action not only from a biomedical approach but also focusing on human rights and dignity based mental care for older adults in this part of the world which is indeed extremely important and I should also mention here that we have an IPA Congress coming up in the month of November which will available on the website. and welcome to this year’s Older Adults’ Mental Health Awareness Program as well! We’ll be having a similar South Asian discussion this time so we look forward to seeing you.
MD: Thank you so much for the invitation, sounds very promising. I think it brings us to the article which is our main point of interest today. Sex and sexuality in old age. Maybe you can say a few words about what’s unique about this study and why you chose this particular subject matter. What makes you care about it?
DB: See, the thing is, as I told you, that my interests are in sexual medicine, as well as in geriatric psychiatry. So I decided to see where these two intersect. In India, where I’m from, and in some of the other South Asian countries sexuality in older age is looked upon as something either non-existing or which is stigmatic. In fact, a very popular misconception considers older people as asexual, which is extremely damaging for their dignity, to their privacy, to their confidentiality and also to their sexual and reproductive rights. We all will age. And sexuality is something which concerns a very important aspect of our life. Sexual health is indeed necessary for having a proper mental health and psychosocial well-being.
The first thing which is unique about the study is that it is the first study conducted not only in India but to the best of my knowledge in the SAARC region in general, which looks into direct lived experiences of older adults regarding sexuality. I am a big fan of qualitative studies, you know, no offense to quantitative studies…of course they both have their own niche, opportunities, advantages and their own challenges. However, being trained as a qualitative researcher and spending a significant time in qualitative research, I feel there are certain things that are abstract, they are lived experiences, understandings of a conceptive depth which can only be achieved through a qualitative research. Especially this area, sexuality, is like pain or like motherhood. It’s something that you cannot simply gauge through a scale. It needs a detailed discussion with the participants and what can be better than directly bringing it to people who we’re interested in? Rather than us making a biased judgement about what they want and what they need, we thought of going to the older people themselves and trying to understand what are the challenges they face, how do they perceive sexuality and what are their unmet needs in terms of sexual health. As I said, it’s a quite a stigmatic subject even to talk about in the popular media, movies etc.
I should thank doctor TS Sathyanarayana Rao who is not only my mentor but also a very important contributor in this paper and also JSS university and the JSS Medical College and Hospital and the JSS Academy of Higher Education and Research for the ethical approval and guidance in the study process that was finally successful and today we see it in print. Our idea was to have not a very large sample size but to go to certain people who are willing to discuss their experiences. Similar studies are being conducted in different parts of the world and this has actually helped to shape policies. With this kind of framework in mind we conducted very in-depth interviews with 20 participants who were aged above 60 years. What we really were interested in looking at, is how they perceive sexuality, how it is related to aging, how they conceptualize sexuality with increasing age, what meaning it carries for them. The description, the definition of intimacy in literature changes with aging. It doesn’t mean that they turn asexual, but how the elderly perceive sexuality is very different. We also wanted to know what barriers they face when they try to discuss it with the healthcare professionals.
I would like to keep this as a teaser, though, because if I speak too much about it, people will not really go to the paper and read it. It is an open-access paper, which is one of the great features of CP, so I believe many will come across it and it will spark further research into this neglected field. It may definitely ring a bell in the policy makers and healthcare workers to consider this as an important area of shaping policies.
MD: Absolutely! Thank you so much for sharing. I’m not a scientist myself to judge, but what you said about the qualitative research is really thought-provoking. And I was deeply touched while reading the sincere stories of some of the respondents that you interviewed. I think it’s really important to hear what people really feel and experience.
DB: Sometimes it can also very challenging. We managed to get these 20 gentlemen and ladies with a lot of difficulties because people are not very open to discuss these issues. One of the important themes that came up in the paper was self-stigma. When you really face this reaction coming from society, be in in movies, books, popular discourse, media discussion… Aging is associated with something which is decaying, something which is no longer beautiful, no longer attractive. As a geriatric psychiatrist, as a person, who has taken care of my parents and my grandparents, I feel that dignity is not something which changes with age. At least when I age, I don’t want my experience to be totally taken away from me. So I think it’s important that we create a world where we like it when we age.
MD: Dignity is something we all are endowed with, our birthright, and it cannot be taken away.
DB: It is not something that can be granted
MD: Exactly. To conclude, maybe you would like to give some advice or even send an appeal to the healthcare workers, policy-makers, share what you think can be done to help?
DB: With the very limited capacity that I have, let me use this forum to do my best. For one thing, thanking you for the fact that this discussion is happening today.
Worldwide, the population is aging rapidly. In fact, based on the WHO estimates, by 2050 the number of older individuals above 60 will more than double. We have achieved much better control of infections, which is great, but probably now it’s time to shift our attention to non-communicable diseases. There are so many things that affect old people: dementia, mental health disorders, vascular risk factors, diabetes, hypertension, arthritis, chronic pain.
But first things first, we need to battle ageism. According to the recent WHO Global report on ageism, almost 50% of individuals worldwide have some sort of ageist stereotypes. We will all age, that is an inevitability. So if we do not take a step today and start acting, 20 years down the line we are not going to live in a world which we feel secure in. I believe it is urgent for all the health workers, policy makers, everybody around there, all of us, to be sensitive towards the care of older persons. Whenever we see them, in primary, secondary tertiary health care level, it doesn’t matter, let us be sensitive to their needs. Spend five minutes and listen to them. Think that they might cognitive issues, sensory problems and sometimes they have a lot to share: loneliness, isolation, problems with communication, digital literacy, all of these are very important considerations. It’s not going to change in one day. But perhaps if today we take a stand and try to make sure that whatever interventions we have, services, commissions in healthcare and in policy are geared towards older persons, we will succeed. If I’m framing something, I should understand that this also needs to help creating an age-friendly environment, an anti-ageist society. It’s not just about a biomedical approach. I think like any other specialty it’s biopsychosocial approach. And then along the way, if we are sensitive to this issue, we can actually turn the world into an age-friendly place.
And lastly, human rights do not depend on age. So as a person, as a member of the IPA, as a vice-chair of the Advocacy and public awareness committee, let me join in this call for all the healthcare workers, involving geriatric and older persons care, let us call for an international United Nations convention on the rights of older persons. We need an international framework as a legal standard to prevent human rights violations in older people. We can no longer wait for things to get worse. COVID-19 has already shown high rates of elder abuse and marginalization in senior citizens. It is very important how we think, how we act. So let’s start acting now.
MD: Thank you so much, what you shared today is so encouraging and gives so much hope! If we had more people like you, this world would be a much better place.
DB: You know, my opportunities are very very limited. Sitting here, in this corner of the world, I only have something to do in my personal capacity. But if this message reaches out worldwide, if it snowballs into something bigger, if it is heard by many people, even the trainees, who are being educated in medicine, nurses, other healthcare professionals, this is going to be a global, collaborative action. There’s so much of tremendous efforts that the WPA, the IPA, the GAROP, the ILC and many other organizations are putting in. My work here is only as a messenger, nothing more…