LGBT Health Awareness Week: Mental Health and “Tolerance”
As we mentioned before, this week is LGBT health awareness week in the United States. Today our topic is mental health, which is a complicated issue for LGBTQ folks, and not only because the Bible of Psychology, the DSM-IV, only recently (1986) removed homosexuality from its list of psychological disorders, and still pathologizes trans people as “suffering” from “Gender Identity Disorder.” Beyond this, however, the very act of living in a hostile culture is potentially psychologically damaging to LGBTQ folks. The LGBT health awareness website puts it well:
Living in a largely heterosexist, homophobic and transphobic culture can cause or exacerbate existing mental health problems among LGBT people.
Studies indicate that members of the LGBT community experience mental health problems, including stress related disorders, at a higher rate than the general population.
Even in the post Will & Grace world, LGBTQI folks are regularly subjected to cultural messages that suggest they need to be “tolerated,” that their sexuality or gender identity or body is a joke or disgusting, that they are not fit to have the same rights as their fellow citizens, that they deserve to be put to death. We might liken it, perhaps, to living with psychological abuse–but with a vast culture of perpetrators, rather than a single abusive partner or parent.
It’s crucial, then, that we continually push back against the homophobic and heterosexist messages of our cultures–not just because it’s “P.C.” (does anyone use that term anymore?), but because it’s the right thing to do, and it has enormous consequences for many, many people. And, importantly, we’re not just talking about being “accepting”–this way of thinking about it makes “open-minded” heterosexuals the heroes, as though they deserved a cookie for not being assholes. No, what we’re after is something bigger. There are different ways of thinking about what that “something” is, but to start, there’s the following scale of homophobic and queer-positive attitudes developed by psychologist Dorothy Riddle:
Homophobic Levels of Attitude
Repulsion: Homosexuality is seen as a “crime against nature.” Gays/lesbians are sick, crazy, immoral, sinful, wicked, etc. Anything is justified to change them: prison, hospitalization, behavior therapy, electroshock therapy, etc.
Pity: Heterosexual chauvinism. Heterosexuality is more mature and certainly to be preferred. Any possibility of “becoming straight” should be reinforced, and those who seem to be born “that way” should be pitied, “the poor dears.”
Tolerance: Homosexuality is just a phase of adolescent development that many people go through and most people “grow out of.” Thus, lesbians/gays are less mature than “straights” and should be treated with the protectiveness and indulgence one uses with a child. Lesbians/gays should not be given positions of authority because they are still working through their adolescent behavior.
Acceptance: Still implies there is something to accept. Characterized by such statements as “You”re not lesbian to me, you”re a person!” or “What you do in bed is your own business.” or “That”s fine with me as long as you don”t flaunt it!”
Positive Levels of Attitudes
Support: The basic ACLU position. Work to safeguard the rights of lesbians and gays. People at this level may be uncomfortable themselves, but they are aware of the homophobic climate and the irrational unfairness.
Admiration: Acknowledges that being lesbian/gay in our society takes strength. People at this level are willing to truly examine their homophobic attitudes, values, and behaviors.
Appreciation: Value the diversity of people and see lesbians/gays as a valid part of that diversity. These people are willing to combat homophobia in themselves and others.
Nurturance: Assumes that gay/lesbian people are indispensable in our society. They view lesbians/gays with genuine affection and delight, and are willing to be allies and advocates.
Beyond fostering such attitudes, the LGBT health awareness website rightly points out that our governments need to enact the right kinds of legislation and policy changes:
- Sexual and gender minorities should be specified and prioritized when funding, designing and implementing programs.
- Suicide prevention programs, pilots and demonstration grants need to focus on LGBT youth.
- Sexual orientation and gender identity demographic questions must be added to all population-based behavioral health-related surveys. Additionally, analysis of data for sexual orientation and gender identity will inform planning, program and policy development to best meet the mental health and substance abuse needs of the LGBT community.
Moreover, many of us who are not in a position to make policy decisions on the government level are able to change policies and practices in our own little corners of the world, in addition to our own attitudes and assumptions:
Individuals, organizations, and providers can help LGBT patients and families feel safe and welcome:
- Forms should be inclusive of diverse sexual orientations, gender identities and relationship status (e.g., questions are open-ended so patients can designate their own gender, sexual orientation and relationship status).
- Do not make assumptions about patients’ sexual orientation or gender identity.
- Become culturally competent through ongoing training and treat all people with dignity and respect.
- Know your available LGBTQ community resources; LGBTQ individuals who are supported report lower rates of emotional distress and substance use/abuse.
There’s no reason LGBTQ folks should suffer from mental health issues at a higher rate than the straight population; this is a culturally-created problem. Fortunately, this means that it can be changed–but doing so has required and will continue to require a lot of work.