Episode 12: Queerness and Mental Health

Queer people have more mental health problems than their hetero friends. Why? Is it because there’s something bad about being gay? Or is there a problem with the way we think about sex and sexual identities?

(Transcript)

Mental health is notably lower for individuals who identify as lesbian, gay bisexual, transgender, or queer. There’s a complicated history between queerness and mental health, and understanding the connection could be insightful beyond minority populations.

Until 1973, homosexuality was categorized by the American Psychiatric Association as a mental disorder.  With the publication of the second edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1973), this categorization was no longer included.  However, debates over the nature of homosexuality in relation to mental health continued both among professionals and in the general population.  The legacy of homosexuality-as-disorder is seen in its social stigma, deviant identity, or difference requiring explanation.  Homosexuality is but one example of a broad array sexual orientations and identities that make a minority appearance in human variation.

The Pathologization of Gayness

Some people used to assume that homosexuality was a mental disorder because of religious or moral reasons. It’s wrong, and so behaving in a “wrong” way must be a sign of disorder. As moral reasoning gave way to scientific reasoning, a new argument was that homosexuality must be a disorder because homosexuals are more anxious, depressed, prone to suicidal ideation, and so on. But this reasoning is problematic for two reasons. First, depression is already a disorder, so just because one this in associated with a disorder does not make the one thing a disorder also. That’s like saying that because married people are more depressed, then marriage is a disorder. Second, it’s kind of a circular argument because we know that putting the label of “mental disorder” on someone in itself creates stigma, depression, and anxiety.

But anyway, that’s in the past. Now, at least among mental health professionals, pretty much everyone agrees that homosexuality is a natural sexual variation and not inherently disordered.

However, that doesn’t change the fact that homosexuals (LGBTQ people in general) have higher rates of mental health problems. So what’s going on?

What Do We Know?

Ilan Meyer (2003) did a great job summarizing the research up to that point. He found that stress related to sexual minority status in lesbian, gay, and bisexual (LGB) individuals is consistently shown to correlate with mental health problems.  Lesbian women and gay men experience more physical victimization than heterosexual people, including as property crime, physical assault, or sexual assault.  They also experience higher rates of discrimination, and just as damaging, they perceive discrimination based on sexuality whether it is explicit or not.

LGB individuals often conceal their sexual identity in an attempt to avoid victimization; but they also may disclose their sexual identity to receive acceptance into a community or for a personal sense of integrity.  However, heteronormative external pressures also may lead to internalized homophobia, if only in subtle forms.  “It is unlikely that internalized homophobia completely abates even when the person has accepted his or her homosexuality,” Meyer states.

Studies have been done on transgender populations, too, with similar results. Bockting et al. (2013) recruited a sample of transgender people from websites, mailing lists, etc. and found that transgender people have significantly higher rates of depression, anxiety, and overall distress than average.

In more recent studies, researchers have been branching out from the traditional categories of lesbian, gay, bisexual, and transgender. One study, conducted by Borgogna et al. (2019), was able to divide subjects into many categories including transmen, transwomen, gender nonconforming, bisexual, gay/lesbian, questioning, pansexual, demisexual, asexual, and queer. A few of their respondents gave still other identifiers, but they had to limit their categories in order to make statistical sense of their results. And, as you can guess, they found that individuals in all these categories have higher rates of mental health problems than heterosexual individuals. Additionally, mental health disparities are greatest for “emerging identities,” that is, the new ones opposed to the traditional categories of LGBTQ.

Not a Monolithic Sexual Minority

So, these days researchers are starting to understand that not everyone in the LGBTQ umbrella is the same. They don’t have the same experiences, and they don’t have the same problems. That’s why researchers are finding more and more categories to put people into. Nonetheless, there are clear similarities. As I explained earlier, mental health differences are seen in all the different categories in this umbrella.

Much of the research into mental health disparities of sexual minority populations is built around the theory of minority stress developed by Meyer (2003).  This theory is built on the same idea as racial minority stress.  In much the same way as Black individuals experience unique and additive stressors related to their minority race, those who are the focus of this research experience stressors uniquely related to their minority sexuality.

There was one problem that Meyer saw, though: an apparent contradiction in the consequences of minority stress.  Black individuals do not experience higher rates of mental disorders, but LGB individuals do.  Both hold a minority position, and both experience stress because of it, but their outcomes are different.

One possible explanation for this is the minority community.  Black people are born into their ethnic community, and thus they may receive support and a bolstered sense of identity from their community throughout their whole lives.  On the other hand, people with a minority sexuality are not thought to be born into a sexual identity community.  If they become part of such a community at all, they must undergo a process of sexual development and discovery first.  Even then, because sexual identities are fluid and do not always align precisely with an individual’s experience, membership in a sexual minority identity community may not be guaranteed.

Meyer’s minority stress model presumes minority identity.  While sociologists excel at categorization and identification, an individual person’s experience does not necessarily match the same identifier.  When sexualities deviate from the normative, then stress is likely in some form, even if the deviation does not align with an alternate minority identity categorization.

Queer Theory From Grounded Theory

Grounded theory has the goal of looking at data without any preconceived notions of what they will show. Basically, start with the basic facts that are known to be true, and then build a theory from there.

Minority Stress

In this case, we see these various sexual minority identity groups having higher rates of mental health problems. Meyer saw this evidence, and he drew the comparison to racial minority groups. This theory makes a lot of sense, but it’s not perfect.

So let’s take a step back and look at the evidence in a different way. sexual identity groups are tricky things, because not everyone fits them perfectly. They’re just generalizations. Instead of saying that all these individuals identify with a sexual minority group (which might not even be true—for example not all men who have sex with men call themselves gay) what do all these individuals have in common?

Group-Norms

Vrangalova and Savin-Williams (2011) hint at an alternative to identity by measuring only whether an individual deviates from the norm, not whether they identify with a label aligned with deviation. They interviewed high school seniors about their mental health and asked them what age they were when they had their first sexual experience. They found that people who had sex at the “normal” time, meaning at the same time as their average peers, had the best mental health. People who did not have sexual experiences until later were more likely to have mental health problems.

In the concept of their study, they anticipated a normative sexual experience; and experiences that deviated from the norm were associated with poorer mental health.  This group-norms perspective may allow an understanding of the minority stress model that is independent from self-identity.  Their theory is able to see “minority stress” without subjects being categorized directly with a minority identity—and especially without having to self-identify into a non-normative categorization.

Sexual Identity Stress

Another study, by Sattler et al. (2017), provides another interesting variation on Meyer’s theory because it applies sexual identity stress to individuals of any sexual identity, not only minority sexual identities.  While it is clear that sexual minority populations experience a disproportionate level of these stressors, Sattler et al. (2017) finds that sexual majority populations experience them as well.  Furthermore, in their model, sexual identity stress explains all of the variation in mental health outcomes between majority and minority sexual identity groups, suggesting that there is nothing essentially different about sexual minority groups; rather, they simply experience sexual identity stress in varying levels.

Let me say that another way. Sexual stress explains the difference in mental health, not sexual identity. According to their data, it doesn’t matter what a person’s sexual identity is. What matters is how stressful their experience is of their sexual identity. For example, someone who is picked on for being straight can be depressed as a result, in the same way that someone who is picked on for being gay can be depressed.

Queer Theory

So where does this lead, then? We can follow this evidence right into queer theory. A fundamental aspect of queer theory is that it rejects binary classifications.  For the queer theorist, it is not only insufficient to add more categories to better define difference, it is antithetical.  This applies directly to categorization and labeling of sexual minority populations:

Queer theory posits that the identity categories of ‘lesbian’ and ‘gay’ are products of binary cultural systems of meaning reproduced by institutional and discursive practices. Sedgwick (1990) and Fuss (1991) elaborate on how homosexuality becomes the inferior partner in the binary by arguing that the homo/hetero binary operates in relationship to other unequal binaries such as male/female, rational/emotional, strong/weak and active/passive.

Semp 2011:71

Semp argues that the ubiquitous use of identity categories in social research limits our understanding of these populations and distorts knowledge where a subject does not understand his or her position in the same way as the researcher does (2011:71).

Part of this limitation is in how researchers recruit and survey participants.  Potential subjects would be excluded from many of the convenience samples used in the research analyzed here, because they were not part of an established club, organization, or identity group.  This limitation is especially significant with younger populations where sexual identity is still being developed.  Likewise, if a survey asks about sexual identity, it requires the subject to align with a particular identity group; this may not be the same as engaging in a particular sexual activity.

Another part, though, relates to how researchers theorize and interpret findings.  By naming categories, a researcher gives them an essentialist quality.  By studying homosexuality, for example, a binary relationship is implicitly created between heterosexuality—the normative state—and homosexuality—a deviant or aberrant condition that must be studied to be understood.  “The deployment of heteronormative assumptions in research risks underplaying the role marginalisation and homonegative experiences play in the lives of queer people and risks adding power to the arguments of those who pathologise homosexuality” (Semp 2011:71).

Conclusion

A podcast is a great place to ask questions. It’s not necessarily the best medium for providing answers. We’ve learned a lot from the significant research into sexual identity groups, like how a lesbian woman’s experience is different from that of a straight woman. But what if we didn’t limit ourselves to thinking within those categories? What if we take a broader view of sexual subjectivity—not by adding more categories, but by seeking to understand sexual dynamics throughout society, in light of group norms and social scripts?

Sexual variation can be observed in many individuals regardless of self-identified (or researcher-imposed) categorization.  When that variation deviates from socially established normativity, a common experience of sexual minority status can be observed, and common stress patterns result.

I’m a firm believer that we’re all a little queer. You don’t have to be gay to be a little different, a little bit outside of the norm, in one way or another. After all, sexual normativity is a practically impossible standard. If the mental health challenges that researchers have observed are not exclusive to LGBTQ communities, but rather they can be applied to anyone who is not a perfect model of normativity, then this problem might be seen in a very different way. Maybe it’s not a problem of being gay, or some other sexual identity. Maybe it’s a problem of how our entire culture approaches sexuality, forcing people to adhere to a myth of normativity or be subjected to shame, stigma, marginalization, and ostracism.

Thanks for listening.

References

This episode is based on a research paper I wrote for school. Below is the full list of references for the original paper. Acknowledgements, also, to a Wikipedia entry and the LGBTA Wiki for identifying the flag images in the video version.

• American Psychiatric Association. 1973. Diagnostic and Statistical  Manual of Mental Disorders. 2nd edition. American Psychiatric Association.
• Bockting, Walter O., Michael H. Miner, Rebecca E. Swinburne Romine, Autumn Hamilton, and Eli Coleman. 2013. “Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population.” American Journal of Public Health 103(5):943–51. doi: 10.2105/AJPH.2013.301241.
• Borgogna, Nicholas C., Ryon C. McDermott, Stephen L. Aita, and Matthew M. Kridel. 2019. “Anxiety and Depression across Gender and Sexual Minorities: Implications for Transgender, Gender Nonconforming, Pansexual, Demisexual, Asexual, Queer, and Questioning Individuals.” Psychology of Sexual Orientation and Gender Diversity 6(1):54–63. doi: 10.1037/sgd0000306.
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• McDermott, Elizabeth, Elizabeth Hughes, and Victoria Rawlings. 2018. “Norms and Normalisation: Understanding Lesbian, Gay, Bisexual, Transgender and Queer Youth, Suicidality and Help-Seeking.” Culture, Health & Sexuality 20(2):156–72. doi: 10.1080/13691058.2017.1335435.
• Meyer, Ilan H. 2003. “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence.” Psychological Bulletin 129(5):674–97. doi: 10.1037/0033-2909.129.5.674.
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• Puckett, Jae A., Brian A. Feinstein, Michael E. Newcomb, and Brian Mustanski. 2018. “Trajectories of Internalized Heterosexism among Young Men Who Have Sex with Men.” Journal of Youth and Adolescence 47(4):872–89. doi: 10.1007/s10964-017-0670-z.
• Rutherford, Kimberly, John McIntyre, Andrea Daley, and Lori E. Ross. 2012. “Development of Expertise in Mental Health Service Provision for Lesbian, Gay, Bisexual and Transgender Communities: Development of Expertise in LGBT Mental Health.” Medical Education 46(9):903–13. doi: 10.1111/j.1365-2923.2012.04272.x.
• Sattler, Frank A., Johanna Zeyen, and Hanna Christiansen. 2017. “Does Sexual Identity Stress Mediate the Association between Sexual Identity and Mental Health?” Psychology of Sexual Orientation and Gender Diversity 4(3):296–303. doi: 10.1037/sgd0000232.
• Semp, David. 2011. “Questioning Heteronormativity: Using Queer Theory to Inform Research and Practice within Public Mental Health Services.” Psychology and Sexuality 2(1):69–86. doi: 10.1080/19419899.2011.536317.
• Vrangalova, Zhana, and Ritch C. Savin-Williams. 2011. “Adolescent Sexuality and Positive Well-Being: A Group-Norms Approach.” Journal of Youth and Adolescence 40(8):931–44. doi: 10.1007/s10964-011-9629-7.
• Wahl, David W. 2020. “Speaking through the Silence: Narratives, Interaction, and the Construction of Sexual Selves.” Doctor of Philosophy, Iowa State University.