Gay, Lesbian, Bisexual, and Transgender Mental Health

Type of psychology:Multicultural psychology; psychopathology; psychotherapy

Homosexuality was once considered a psychological disorder, but it was removed from the American Psychiatric Association’s manual of disorders in 1973. Society’s views of sexual orientation are varied, with some people seeing homosexuality as a choice and others as an inborn trait. Many of the psychological issues faced by gay and lesbian people are directly correlated with the prejudice and discrimination they face. The study of homosexuality and mental health has been influenced by negative and stereotypical views of homosexuals.

Introduction

Sexual orientation is frequently defined as a person’s emotional, romantic, or sexual attraction to another person. Sexual orientation can be viewed on a continuum, with heterosexuality at one end, homosexuality at the other end, and bisexuality in the middle. Individuals who are attracted to same-sex partners are generally referred to as gay or lesbian. Individuals who are attracted to opposite-sex partners are considered heterosexual, and individuals who are attracted to both men and women are referred to as bisexual. Sexual orientation can be a source of psychological and cultural identity for some individuals. For example, individuals who openly identify themselves as gay may consider this identity to be an important part of who they are. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are often grouped together and referred to as the gay community.

Sexual orientation is different from gender identity. Whereas sexual orientation refers to romantic or sexual attraction, gender identity refers to roles society views as being appropriate for men or women. Gender identity is influenced by culture and socialization processes that change over time. It includes attitudes, cognitions, belief systems, gender roles, and norms for men and women as determined by culture and society. It is not directly related to sexual orientation.

The term “homosexual” was once used as a clinical term that defined same-sex attraction as a mental illness. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (2nd ed., 1968, DSM-II) used this term to describe a mental illness, although the association changed its position on homosexuality in 1973. Homosexuality was determined to be a normal sexual variant and not a mental illness, and the term was removed from further editions of the association’s manual.

Historical Overview

Historically, homosexuality has been accepted and rejected within different cultural groups at various points in history. In ancient Greece, homosexual acts between adult men and adolescent boys were considered acceptable. Judaism and Christianity viewed sodomy as a “crime against nature” and sinful behavior punishable by law. Like the ancient Greeks, some American Indians had a more flexible view of sexual orientation. Among some tribes, gay people were viewed as members of a “third gender” and were accepted. These tribes believed gay and lesbian people to have both male and female spirits. Evidence suggests that throughout history homosexuality has existed in various cultures around the world, including pre-Columbian tribes in Latin America, some tribes in Africa, and groups in China, Rome, Persia, the Middle East, South Asia, and Central Asia.

In societies in which homosexuality was considered an abomination, individuals who were suspected of engaging in homosexual acts were publicly ridiculed, socially ostracized, and even murdered. For example, in Nazi Germany, gay people were placed in concentration camps, subjected to painful medical experiments without anesthesia, and murdered. The Nazis believed that gay people could not contribute to the “master race” because they did not reproduce.

Homosexuality was not studied empirically until the twentieth century. Alfred Kinsey, a human sexuality researcher, developed a scale (later known as the Kinsey scale) that measured sexual orientation on a continuum from 0 (exclusively heterosexual) to 6 (exclusively homosexual). He felt that there were many individuals who could not be classified as exclusively heterosexual or homosexual. Kinsey and his associates’ large-scale surveys were the first source of information about the prevalence of homosexuality in the United States in the 1950s. Kinsey’s studies and subsequent research have highlighted the number of individuals who have had same-sex sexual experiences but do not consider themselves to be gay.

Because gay and lesbian people have a history of being discriminated against, many hide their sexual orientation. The term “coming out” or “coming out of the closet” describes a voluntary process by which gay or lesbian people publicly reveal their sexual orientation. Coming out is both a risk and a challenge because gay and lesbian people can face discrimination and rejection by their families and communities.

Controversy

American society is conflicted about the origin of sexual orientation. Some people believe that sexual orientation is determined by nature or biology from birth, while others believe that it is a choice. Historically, American society viewed homosexual acts as amoral and sinful, and some Americans still hold this view. Not surprisingly, the study of sexual orientation has often been influenced by the investigators’ personal beliefs. Subjective studies by those opposed to homosexuality were often used to justify violence and hatred against gay, lesbian, bisexual, and transgender individuals. Science suggests that sexual orientation is not determined by a single cause. Identical twin studies show that these genetically identical individuals tend to have the same sexual orientation, suggesting a strong genetic influence for this trait. However, it is generally accepted by the scientific community that biological, social, psychological, and cultural influences interact to produce sexual orientation. Scientists disagree about which of these factors most strongly influence sexual orientation.

Bisexuality

Bisexual people have rarely been studied as a group with a distinct sexual orientation, separate from gay or lesbian people. As a result, there are many misconceptions about bisexuality. Many view bisexual men as gay men who have not yet come out of the closet; bisexual people are also viewed as sexually promiscuous because of their attraction to both men and women. The limited research on bisexuality finds that bisexual individuals do not have to be attracted equally to men and women. Some bisexual individuals are more attracted to one sex than the other but still maintain an attraction to both. Bisexual individuals continue to be viewed with confusion and hostility from both the homosexual and heterosexual populations because bisexual people are often able to “fit in” with either community and hide their sexual orientation if they so choose.

Transgender

Gender or gender identity is a culturally and socially influenced concept that shapes an individual’s behavior, gender roles, and psychological identity as being male or female. Sex has often been narrowly defined as being male (XY chromosomes) or female (XX chromosomes). Individuals who are born with ambiguous genitalia are often referred to as intersexed or intersexual.

Transgender individuals have a gender identity that is inconsistent with their biological sex. These people have normal genitalia yet feel that they are actually a member of the opposite sex. They feel as if they are “trapped” in the wrong body and frequently seek gender identification with the opposite sex. The Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (rev. 5th ed., 2013) defines this condition as gender dysphoria ; this marks a change from the previous edition, in which the diagnosis was gender identity disorder. It can be seen in childhood, although individuals may not express their dysphoria openly until adulthood. The nonclinical term for this condition embraced by many individuals with gender dysphoria is transsexual. The criteria for this disorder are behaviors that indicate identification with the opposite gender and behaviors that indicate discomfort with one’s own anatomy and gender roles.

Some of the treatments for gender dysphoria are hormone therapy and sex reassignment surgery. However, not all transgender individuals seek this treatment or undergo it to the same degree.

Rates of Mental Illness

Those in the LGBTQ community have higher rates of suicide, depression, eating disorders, and substance abuse than do people in the general population. This is often attributed to the pressures of being gay or lesbian in a society that continues to actively discriminate against these communities. Coming out is a lifelong process because gay and lesbian individuals continually must determine if it is safe to reveal their sexual orientation in the environments in which they find themselves. Many LGBTQ people have lost social and familial relationships as a result of coming out, and this population continues to be frequent victims of hate crimes. Among young gay men, the use of “party drugs” such as cocaine and ecstasy is more common than in the general population. Gay men with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) often experience higher rates of depression and anxiety and substance abuse disorders than do their noninfected peers. Lesbians tend to have higher rates of alcohol use than their heterosexual counterparts.

A disproportionate number of LGBTQ people use mental health services. Most report using mental health services to cope with how society stigmatizes them and the strain this has on their relationships.

One controversial treatment for homosexuals is conversion therapy, which is aimed at changing an individual’s sexual orientation from homosexual to heterosexual. The assumption underlying treatment is that homosexuality is an individual choice, or a mental illness that needs to be treated. The American Psychological Association has opposed such treatments or therapies since 1998. In 2015, the Substance Abuse and Mental Health Service Administration recommended ending conversion therapy programs because of the harm they cause to children and adolescents. Although many US states have laws that prevent minors from being subjected to such programs, such laws do not apply to faith-based organizations, which are more likely to support conversion as a therapy or treatment. Research has found that conversion therapy has adverse effects on the mental and emotional health of members of the LGBTQ community, for example they attempted suicide more and had higher rates of depression and substance abuse.

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