Note: For the purposes of this post, I use multiple acronyms and terms to refer to members of the larger LGBTQIA+ community. I realize that these terms may not encompass all identities, but the stress experienced by minority groups applies to all sexual and gender minorities. There is a list of acronyms and terms at the end of this piece for your convenience.
It’s a heartbreaking sentence to hear as a therapist (and a member of the LGBTQ community), yet I’ve heard it from clients before: “Is there something wrong with me because I’m gay?” I talk a lot about stigma as it relates to mental health, but stigma can affect any group that is discriminated against in any way. The LGBTQ community is no exception.
From 1952 until 1973, homosexuality was listed in the Diagnostic and Statistical Manual of mental disorders as a “psychopathic personality disturbance”. Many mental health practitioners during this time viewed same-sex attraction as outside of the realm of normal, healthy behavior, seeing it as a defect that needed to be treated. Outside of the mental health community, being gay was generally viewed as a moral failing in our society at large. Being gay was criminalized (via sodomy laws) in every state until 1961, when Illinois became the first state to decriminalize sodomy (which refers to anal or oral sex, even between consenting adults). As of the time of this writing, sodomy laws are still existent in thirteen states. Although these laws are rarely enforced, the message is clear. Some members of our society still do not support us.
Anti-LGBTQ proponents sometimes cite the disproportionate rates at which LGBTQ folks are affected by mental health issues in order to explain their beliefs. It is true that “LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. High school students who identify as lesbian, gay, or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers, and 48% of all transgender adults report that they have considered suicide in the past 12 months, compared to 4% of the overall US population (NAMI, 2019)”. The statistics are staggering, so the response by those who wish to disenfranchise LGBTQ folks is obvious: there must be something wrong with us, right?
Wrong. All major medical and mental health organizations agree that same-sex attraction is a normal part of human sexuality. So if there is nothing mentally wrong with LGBTQ people, why do we experience mental health issues at an alarmingly disproportionate rate? According to the American Psychological Association, the answer lies in a concept called “minority stress”. Minority stress theory explains that the “disproportionate mental health issues experienced by LGBTQ+ folks are due to the stressors induced by a hostile, homophobic culture, which often results in a lifetime of harassment, maltreatment, discrimination and victimization and may ultimately impact access to care“ (American Psychological Association, 2019). In other words, being queer doesn’t have a negative impact on your mental health, but being discriminated against does. Those two things often go hand in hand, resulting in these alarming statistics.
“Access to care issues” refers to the reasons that people who identify as LGBTQ+ may not go to the doctor, or may not have access to healthcare they can afford. This can manifest in many ways. First, there is the issue of actual logistical or financial limitations to accessing care. For example, before marriage between non-cis-het couples was legalized, access to healthcare through one’s partner was extremely limited in our community. Job discrimination based on sexual orientation and gender identity (this type of discrimination is still legal in some states) may prevent LGBTQ+ folks from having healthcare through their workplace. Since you can be fired for being gay in many states, and fired for being trans in even more, LGBT folks are at a higher risk for unemployment and therefore at a higher risk for not having access to medical insurance through their workplace.
The other part of “access to care issues” are related to discrimination in healthcare settings that can be traumatic and prevent people from seeking care in the future to avoid further trauma or discrimination. Trans people are often misgendered or called by their dead-names in medical settings. Cis women in same-sex relationships are asked if they use condoms. On a personal note, this still happens to me at every yearly physical, even though I have been married to another woman for three years and have been going to the same clinic my entire adult life. Federal regulations do not allow a cisgender man who has had sex with another cisgender man within the past year to donate blood because of stereotypes about the prevalence of HIV/AIDS in the gay community (anal sex is more likely than vaginal or oral sex to transmit HIV, however, this can occur in a woman who has anal sex with a man just as easily as it can occur in a man who has anal sex with another man. Women who have anal sex with men are not prevented from donating blood). The list goes on.
It stands to reason that all of these issues with access to care would also contribute to higher rates of mental health issues. If people aren’t going to the doctor, they also aren’t receiving the necessary medications, treatments, and referrals that they may need to manage their mental health. Top this off with a good dose of minority stress, and you’ve got a recipe for mental health disaster.
To be clear, there is no uncertainty regarding the response to the initial question (is there any inherent mental health issue caused by being LGBTQ). The APA states in no uncertain terms: “Lesbian, gay and bisexual orientations are not disorders. Research has found no inherent association between any of these sexual orientations and psychopathology. Both heterosexual behavior and homosexual behavior are normal aspects of human sexuality. Both have been documented in many different cultures and historical eras. Despite the persistence of stereotypes that portray lesbian, gay and bisexual people as disturbed, several decades of research and clinical experience have led all mainstream medical and mental health organizations in this country to conclude that these orientations represent normal forms of human experience. Lesbian, gay and bisexual relationships are normal forms of human bonding. Therefore, these mainstream organizations long ago abandoned classifications of homosexuality as a mental disorder. (APA, 2019)”
This clear stance by all mainstream medical and mental health associations does not stop some from clinging to the idea that gay people need to be “fixed”. Conversion therapy, also sometimes called “reparative therapy” is still practiced in many religious settings, and often presented as legitimate mental health care despite the fact that “all major national mental health organizations have officially expressed concerns about therapies promoted to modify sexual orientation. (APA, 2019). There has been no scientifically sound research that has suggested that these therapies are safe or effective, and there has been evidence to show that they are likely to be extremely harmful (APA, 2019). These therapies also contribute to minority stress by reinforcing negative stereotypes and pathology related to being LGBTQ, without any actual evidence to back these claims.
So, how do people get away with practicing “reparative” therapy? Well, for one thing, it isn’t illegal on a national level (it is banned in certain states and municipalities, but not all). While all mainstream mental health and health authorities have deemed the practice of conversion therapy to be harmful, there is no national legislature that prevents it. Religious freedom is often cited as a reason for allowing these therapies to continue, despite the clear danger that they present to LGBTQ+ people. You can read more about specific religions and their support (or lack thereof) when it comes to LGBTQ rights here.
So, what do we do with this information? If you have LGBTQ+ people in your life, show them and tell them that you support them. While minority stress can predict mental health issues, social support can protect from them. Speak out on the behalf of marginalized groups, and vote in favor of legislation that supports their rights. Speak out against religious institutions that discriminate against LGBTQ+ people. Ensure that you aren’t affiliated with these groups, and if you find that you are, speak up to spark change.
“Is there something wrong with me because I’m gay?” It is my hope that someday, I will no longer hear clients asking that painful question. We, as a society, clearly already know the answer. Now it is up to all of us to spread the word.
by Leora Mirkin, LCSW
TOOLS
If you’re trans or a gender minority and you need a therapist who will write a letter for hormones or surgery, don’t be afraid to ask upfront.
Tell people in your life who are part of the community that you support them, and show you support them by standing up for LGBTQIA+ rights.
While minority stress can predict mental health issues, social support can protect from them. Speak out on the behalf of marginalized groups, and vote in favor of legislation that supports their rights. The Human Rights Campaign, The Trevor Project, Glaad and PFLAG are some incredible orgs that you can get involved with. Find one whose mission you really support and donate some money or time!
Speak out against religious institutions that discriminate against LGBTQ+ people. Ensure that you aren’t affiliated with these groups, and if you find that you are, speak up to spark change.
If you are an LGBTQIA+ member, know you’re not alone. Connect with your local community organizations (such as OutReach LGBT Community Center here in Madison), flood your social media with positive role models and influencers so you feel less isolated. If you live in a rural area and you don’t have a community center, find support online.
If you’re looking for help as an LGBTQIA+ person, do your homework when reaching out to medical professionals…ask for a therapist who specializes in LGBTIA+ issues or go on Psychology Today where you can also find one. You can also look into Pride Counseling, affiliated with BetterHelp for LGBT people and you can request a therapist who is part of the community.
ACRONYMS AND TERMS USED IN THIS POST…
LGB: Lesbian, gay, or bisexual
LGBT: Lesbian, gay, bisexual, or transgender
LGBTQIA: Lesbian, gay, bisexual, transgender, queer, intersex, or asexual
Cis (short for cisgender): someone whose biological sex assigned at birth matches the gender they identify with
Cis-het (cisgender and heterosexual): someone who is not part of the LGBTQIA+ community
The “plus” symbol is sometimes added to the end of acronyms to acknowledge community members who may not identify with a specific letter in the acronym
Misgendered: being referred to using the pronouns that a person does not identify with
Dead-named: when a trans or gender non-binary person is referred to using the name they were give at birth (their “dead name”), rather than their chosen name
CITATIONS
American Civil Liberties Union. (2019). Update on the Status of Sodomy Laws. Retrieved from https://www.aclu.org/other/update-status-sodomy-laws.
American Psychological Association (APA). (2019). Sexual Orientation & Homosexuality. Retrieved from https://www.apa.org/topics/lgbt/orientation.American Red Cross. (2019).
Drescher J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral sciences (Basel, Switzerland), 5(4), 565–575. doi:10.3390/bs5040565
Faith Positions. Retrieved from https://www.hrc.org/resources/faith-positions.
LGBTQ Donors. Retrieved from https://www.redcrossblood.org/donate-blood/how-to-donate/eligibility-requirements/lgbtq-donors.html.CNN. (2019, December 4).
LGBTQ Rights Milestones Fast Facts. Retrieved from https://www.cnn.com/2015/06/19/us/lgbt-rights-milestones-fast-facts/index.html.Dentato, M. P. (n.d.).
The minority stress perspective. Retrieved from https://www.apa.org/pi/aids/resources/exchange/2012/04/minority-stress.Human Rights Campaign (HRC). (n.d.).
Mental Health and the LGBTQ Community. Retrieved from https://suicidepreventionlifeline.org/wp-content/uploads/2017/07/LGBTQ_MentalHealth_OnePager.pdf.Human Rights Campaign (HRC). (n.d.).
National Alliance on Mental Illness (NAMI). (n.d.). LGBTQ. Retrieved from https://www.nami.org/find-support/lgbtq.Wikipedia. (n.d.).
Sodomy laws in the United States. Retrieved from https://simple.wikipedia.org/wiki/Sodomy_laws_in_the_United_States.