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  世界精神醫學會對於性別認同與同性性傾向、性吸引和性行為之立場聲明

 
2016/7/29

  背景

由於最近在許多國家出現性傾向議題的爭議,世界精神醫學會(World Psychiatric Association, WPA)認為:有必要提出對於同性性傾向、性吸引和性行為(舊稱同性戀)的澄清。

和其他國際組織一樣,世界精神醫學會認為:性傾向是與生俱來的,由生物、心理、發展和社會等因素所決定。

在50多年前,金賽(Kinsey)等人於1948年就提出:人與人之間的性行為具有多樣性。他描述了就當時的時代背景來說令人驚訝的現象:超過10%以上接受訪談的對象有同性性行為。隨後的族群調查發現:約有4%的人具有同性性傾向(例如:男同性戀、女同性戀和雙性戀傾向)。另外0.5%的人的性別認同與出生時的生理性別不同(例如:跨性別)(Gates, 2011)。整體而言,上述人口數目超過2億5千萬人。

精神科醫師應有社會責任,經由倡議來改善社會的不平等,其中包括性別認同和性傾向相關的不平等。

儘管歷史中不幸地對於少數性別和性傾向曾抱持汙名與歧視,但過去數十年來,現代醫學已經不再視同性性傾向和性行為是病態(American Psychiatric Association, 1980)。世界衛生組織(World Health Organization, WHO)也已將同性性傾向視為人類性行為的正常展現(WHO, 1992)。聯合國人權理事會於2012年聲明重視女同性戀(Lesbian)、男同性戀(Gay)、雙性戀(Bisexual)和跨性別者(Transgender)(合稱LGBT)的權益。在國際疾病分類(The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, ICD-10)和美國精神疾病診斷和統計手冊第五版(Diagnostic and Statistical Manual of Mental Disorders, 5th ed., DSM-5)這兩個主要的疾病診斷和分類系統,也已不將同性性傾向、性吸引、性行為和性別認同少數者視為病態(WHO, 1993; APA, 2013)。

有相當多研究證據顯示,性行為和性的流動性取決於諸多因素(Ventriglio等人,2016)。而且,許多研究明確指出:在LGBT族群中雖然有較高的精神疾病罹患率(Levounis等人,2012;Kalra等人,2015),一旦他們的權利和平等受到保障,這些疾病的比率就開始下降(Gonzales, 2014;Hatzenbuehler等人,2009和2012;Padula等人,2015)。

各種多元性傾向和性別認同的人都有資格去尋求治療方案,來幫助自己活得更舒適、減輕苦惱、處理社會結構中種種的歧視、更接納自己的性傾向或性別認同。這樣的原則適用於任何對自己的性傾向和性別認同感到苦惱的人,也包括異性戀取向者。

世界精神醫學會堅信治療需要有實證基礎,而目前並沒有明確的科學證據能證明性傾向可以被改變。更何況,所謂「對於同性戀的治療」可能會滋長對於同性戀的偏見和歧視,因此這些治療具有潛在的危害性(Rao和Jacob, 2012)。對於不被視為疾病的性/別少數有任何「治療」的意圖,是全然違反倫理的。

行動
  1. 世界精神醫學會認為:女同性戀、男同性戀、雙性戀和跨性別者,要被視為、且應當被視為社會中重要的一份子,具有和其他公民完全相同的權利和責任,包括平等接受醫療照護、以及在文明社會中擁有相同的權利和責任。
  2. 世界精神醫學會認為:同性情慾的展現是普遍存在於各文化的。在客觀層面而言,同性性傾向本身並不會造成心理功能的障礙、或是判斷力、穩定性或職業能力的缺損。
  3. 世界精神醫學會認為:同性間的性吸引、性傾向和性行為皆屬於人類性行為的正常範圍,也認為:人類的性、性傾向、性行為和性生活方式是多因素共同造成的結果。世界精神醫學會確認:企圖改變性傾向的「治療」都是缺乏科學療效的,而且強調:這些所謂「治療」會帶來傷害和不利影響。
  4. 世界精神醫學會明瞭:社會上對於具有同性性傾向和跨性別認同者,存在著污名化和伴隨而來的歧視,並認為:他們所面臨的困難是造成他們苦惱的重要原因,因此需要提供適當的精神健康支持。
  5. 世界精神醫學會支持:有必要對於同性性傾向和性行為、以及跨性別認同者除罪化,並確認:LGBT族群應具有的權利包括人權、公民權和政治權。世界精神醫學會並支持以下各項性別和性傾向平等行動:反霸凌入法;設立就學、就業和居住的反歧視法律;移居的權利平等;法律上行使同意權年齡的平等;和設立制止仇恨犯罪的法律,以增加因偏見而施加在LGBT族群的暴力犯罪刑責。
  6. 世界精神醫學會強調:需要進一步研究和發展具有實證支持的醫療及社會介入方式,以增進女同性戀、男同性戀、雙性戀和跨性別者的精神健康。
WPA Position Statement on Gender Identity and Same-Sex Orientation, Attraction, and Behaviours

Background Recent controversies in many countries suggest a need for clarity on same-sex orientation, attraction, and behaviour (formerly referred to as homosexuality).
Along with other international organisations, World Psychiatric Association (WPA) considers sexual orientation to be innate and determined by biological, psychological, developmental, and social factors.
Over 50 years ago, Kinsey et al (1948) documented a diversity of sexual behaviours among people. Surprisingly for the time, he described that for over 10% of individuals this included same-sex sexual behaviours. Subsequent population research has demonstrated approximately 4% of people identify with a same-sex sexual orientation (e.g., gay, lesbian, and bisexual orientations). Another 0.5% identify with a gender identity other than the gender assigned at birth (e.g., transgender) (Gates 2011). Globally, this equates to over 250 million individuals.
Psychiatrists have a social responsibility to advocate for a reduction in social inequalities for all individuals, including inequalities related to gender identity and sexual orientation.
Despite an unfortunate history of perpetuating stigma and discrimination, it has been decades since modern medicine abandoned pathologising same-sex orientation and behaviour (APA 1980) The World Health Organization (WHO) accepts same-sex orientation as a normal variant of human sexuality (WHO 1992). The United Nations Human Rights Council (2012) values Lesbian Gay Bisexual and Transgender (LGBT) rights. In two major diagnostic and classification systems (International Classification of Diseases (ICD-10) and DSM-5), same sex sexual orientation, attraction, and behaviour and gender identity are not seen as pathologies (WHO 1993, APA 2013). There is considerable research evidence to suggest that sexual behaviours and sexual fluidity depend upon a number of factors (Ventriglio et al 2016). Furthermore, it has been shown conclusively that LGBT individuals show higher than expected rates of psychiatric disorders (Levounis et al 2012, Kalra et al 2015), and once their rights and equality are recognised these rates start to drop (Gonzales 2014, Hatzenbuehler et al 2009, 2012, Padula et al 2015)
People with diverse sexual orientations and gender identities may have grounds for exploring therapeutic options to help them live more comfortably, reduce distress, cope with structural discrimination, and develop a greater degree of acceptance of their sexual orientation or gender identity. Such principles apply to any individual who experiences distress relating to an aspect of their identity, including heterosexual individuals.
WPA believes strongly in evidence-based treatment. There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful (Rao and Jacob 2012). The provision of any intervention purporting to “treat” something that is not a disorder is wholly unethical.
Action

  1. The World Psychiatric Association (WPA) holds the view that lesbian, gay, bisexual, and transgender individuals are and should be regarded as valued members of society, who have exactly the same rights and responsibilities as all other citizens. This includes equal access to healthcare and the rights and responsibilities that go along with living in a civilised society.
  2. WPA recognises the universality of same-sex expression, across cultures. It holds the position that a same-sex sexual orientation per se does not imply objective psychological dysfunction or impairment in judgement, stability, or vocational capabilities.
  3. WPA considers same-sex attraction, orientation, and behaviour as normal variants of human sexuality. It recognises the multi-factorial causation of human sexuality, orientation, behaviour, and lifestyle. It acknowledges the lack of scientific efficacy of treatments that attempt to change sexual orientation and highlights the harm and adverse effects of such “therapies”.
  4. WPA acknowledges the social stigma and consequent discrimination of people with same-sex sexual orientation and transgender gender identity. It recognises that the difficulties they face are a significant cause of their distress and calls for the provision of adequate mental health support.
  5. WPA supports the need to de-criminalise same–sex sexual orientation and behaviour and transgender gender identity, and to recognise LGBT rights to include human, civil, and political rights. It also supports anti-bullying legislation; anti-discrimination student, employment, and housing laws; immigration equality; equal age of consent laws; and hate crime laws providing enhanced criminal penalties for prejudice-motivated violence against LGBT people.
  6. WPA emphasises the need for research on and the development of evidence-based medical and social interventions that support the mental health of lesbian, gay, bisexual, and transgender individuals
 
 
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