Health is defined as both the positive, functional elements of our life and the sicknesses that we face. We will close both in this unit.
Sickness
Stevens (1992) summarized the prevailing view of LGB pathology from the past: “Until the 1970s, lesbians were characterized by the medical profession as sick, dangerous, aggressive, tragically unhappy, deceitful, contagious, and self-destructive…Their encounters with health care systems were fraught with the ideological construction of lesbianism as a sin, a crime, and a sickness.” Fortunately, things have improved from when the below video was created:
Sickness
Stevens (1992) summarized the prevailing view of LGB pathology from the past: “Until the 1970s, lesbians were characterized by the medical profession as sick, dangerous, aggressive, tragically unhappy, deceitful, contagious, and self-destructive…Their encounters with health care systems were fraught with the ideological construction of lesbianism as a sin, a crime, and a sickness.” Fortunately, things have improved from when the below video was created:
Critical Health Psychology
- LGBTQQI people can face extreme forms of discrimination.
- The Critical Health Psychology theory challenges the “victim blaming” associated with traditional biopsychosocial models.
- To understand anyone’s health, an assessment should include economic wealth, ethnicity, culture, education, genetics, gender, drug/alcohol use, past abuses, and a myriad of other features.
Minority Stress
Minority stress model calls attention to the chronic stress that sexual and gender minorities may experience as a result of their stigmatization
Life course perspective looks at how events at each stage of life influence subsequent stages
Social ecology perspective emphasizes that individuals are surrounded by spheres of influence, including families, communities, and society
From The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (March 2011). Institute of Medicine of the National Academies.
Minority stress model calls attention to the chronic stress that sexual and gender minorities may experience as a result of their stigmatization
Life course perspective looks at how events at each stage of life influence subsequent stages
Social ecology perspective emphasizes that individuals are surrounded by spheres of influence, including families, communities, and society
From The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (March 2011). Institute of Medicine of the National Academies.
Suicide
This mixed-methods study is an exploration of the perceived distresses critical to the development of suicidal ideation and suicide attempts among lesbian, gay, bisexual, transgender, and questioning adults (18 and older) from their own perspectives and not compared to the heterosexual perspective. A triangulated mixed-methods design was used. In the study the Psychache Scale (Holden & Mehta, 1998), the Gay Identity Questionnaire (Brady & Busse, 1994), and the Suicide Ideation Scale (Rudd, 1989) were used to test the theory that psychache (unbearable psychological pain) is positively correlated with homosexual identity formation, suicidal ideation, and suicide attempts for participants responding to a Web-based survey. Thirty participants responded to the Web-based survey, 3 of whom granted in-depth interviews. This study found a positive correlation between psychache and suicidal ideation. In addition, it found, through in-depth semi-structured interviews, that sexual orientation is an identity; it influences how one might view himself and herself, and that the other-effect, or how others might view a person based on his or her sexual orientation can influence the development of suicidal ideation and suicide attempts.
Crain-Gully., D. r. (2011). Psychache and coming out lesbian, gay, bisexual, transgender, and questioning (LGBTQ) adults at risk of suicidal ideation and suicide attempts: A mixed-methods design. Dissertation Abstracts International, 71,
Virtually every study that compares LGBT (or people who are questioning, use other labels, or resist labels) to exclusively heterosexual and cisgender individuals, finds higher rates of depression, substance abuse, and suicidal behaviors.
Eliason, M. (2011). Introduction to special issue on suicide, mental health, and youth development. Journal Of Homosexuality, 58(1), 4-9. doi:10.1080/00918369.2011.533622
Here is a video of a female-to-male person describing what it was like when he started contemplating suicide:
This mixed-methods study is an exploration of the perceived distresses critical to the development of suicidal ideation and suicide attempts among lesbian, gay, bisexual, transgender, and questioning adults (18 and older) from their own perspectives and not compared to the heterosexual perspective. A triangulated mixed-methods design was used. In the study the Psychache Scale (Holden & Mehta, 1998), the Gay Identity Questionnaire (Brady & Busse, 1994), and the Suicide Ideation Scale (Rudd, 1989) were used to test the theory that psychache (unbearable psychological pain) is positively correlated with homosexual identity formation, suicidal ideation, and suicide attempts for participants responding to a Web-based survey. Thirty participants responded to the Web-based survey, 3 of whom granted in-depth interviews. This study found a positive correlation between psychache and suicidal ideation. In addition, it found, through in-depth semi-structured interviews, that sexual orientation is an identity; it influences how one might view himself and herself, and that the other-effect, or how others might view a person based on his or her sexual orientation can influence the development of suicidal ideation and suicide attempts.
Crain-Gully., D. r. (2011). Psychache and coming out lesbian, gay, bisexual, transgender, and questioning (LGBTQ) adults at risk of suicidal ideation and suicide attempts: A mixed-methods design. Dissertation Abstracts International, 71,
Virtually every study that compares LGBT (or people who are questioning, use other labels, or resist labels) to exclusively heterosexual and cisgender individuals, finds higher rates of depression, substance abuse, and suicidal behaviors.
Eliason, M. (2011). Introduction to special issue on suicide, mental health, and youth development. Journal Of Homosexuality, 58(1), 4-9. doi:10.1080/00918369.2011.533622
Here is a video of a female-to-male person describing what it was like when he started contemplating suicide:
One of the best videos on suicide and gay issues is called Trevor. This video led to the Trevor project. The Trevor project led to Its Get Better. It's a powerful illustration of what it is like to feel as if no one understands or accepts you.
Gay Marriage and Health
Hatzenbuehler et al (2012) found, “In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean= 5.00 vs mean = 4.67; P = .05; Cohen’s d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen’s d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen’s d = 0.41), compared with the 12 months before the law change.”
Hatzenbuehler, M. L., O’Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2012). Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. American Journal Of Public Health, 102(2), 285-291. doi:10.2105/AJPH.2011.300382
Hatzenbuehler et al (2012) found, “In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean= 5.00 vs mean = 4.67; P = .05; Cohen’s d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen’s d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen’s d = 0.41), compared with the 12 months before the law change.”
Hatzenbuehler, M. L., O’Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2012). Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. American Journal Of Public Health, 102(2), 285-291. doi:10.2105/AJPH.2011.300382
Gay Men
AIDS
Prevention programs usually rely on white, western understandings of disease, sex, and sexuality.
According to the CDC, Gay males account for nearly half of the approximately 1.2 million people living with HIV in the United States. And one in five gay males is infected with nearly half of those (44%) unaware of their HIV infection.
http://www.cdc.gov/nchhstp/newsroom/docs/2012/CDC-MSM-0612-508.pdf
The higher risk may also stem from the fact that men are more likely than Lesbian women to engage in risky behaviors.
In many gay communities, attraction is based on physical appearance. Because of this, gay men tend to have lower BMIs than non-gay males.
AIDS
Prevention programs usually rely on white, western understandings of disease, sex, and sexuality.
According to the CDC, Gay males account for nearly half of the approximately 1.2 million people living with HIV in the United States. And one in five gay males is infected with nearly half of those (44%) unaware of their HIV infection.
http://www.cdc.gov/nchhstp/newsroom/docs/2012/CDC-MSM-0612-508.pdf
The higher risk may also stem from the fact that men are more likely than Lesbian women to engage in risky behaviors.
In many gay communities, attraction is based on physical appearance. Because of this, gay men tend to have lower BMIs than non-gay males.
Lesbian Health
On its own, Lesbianism may be the least physically dangerous form of sex.
However, given that Lesbians face substantial discrimination and higher rates of poverty, they may face higher rates of prostitution, drug use, alcoholism, rape, or other issues.
There is limited research to know what this group may need. But many African American women present with HIV concerns.
Although men are more likely to contract HIV, we should be focused on the unique concerns of women, too.
On its own, Lesbianism may be the least physically dangerous form of sex.
However, given that Lesbians face substantial discrimination and higher rates of poverty, they may face higher rates of prostitution, drug use, alcoholism, rape, or other issues.
There is limited research to know what this group may need. But many African American women present with HIV concerns.
Although men are more likely to contract HIV, we should be focused on the unique concerns of women, too.
Mental Health
Ego-dystonic sexual orientation (still in the International Classification of Diseases).
An egodystonic condition. The World Health Organization lists egodystonic sexual orientation in the ICD-10, under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO describes it thus:
The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.
Read more: http://dictionary-psychology.com/index.php?a=term&d=Dictionary+of+psychology&t=Egodystonic+sexual+orientation#ixzz2WhmFV3Q7
This is no longer in the DSM because anything can be egodystonic. I could be egodystonic tall, but we wouldn't treat that as a mental disorder.
Gender Dysphoria in the DSM-5 is still pathologized. They discussed removing it as a "mental disorder" but they decided that this could result in fewer insurance companies paying for services.
Such diagnoses create stigmatization for LGBTQ people in mental health settings.
Ego-dystonic sexual orientation (still in the International Classification of Diseases).
An egodystonic condition. The World Health Organization lists egodystonic sexual orientation in the ICD-10, under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO describes it thus:
The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.
Read more: http://dictionary-psychology.com/index.php?a=term&d=Dictionary+of+psychology&t=Egodystonic+sexual+orientation#ixzz2WhmFV3Q7
This is no longer in the DSM because anything can be egodystonic. I could be egodystonic tall, but we wouldn't treat that as a mental disorder.
Gender Dysphoria in the DSM-5 is still pathologized. They discussed removing it as a "mental disorder" but they decided that this could result in fewer insurance companies paying for services.
Such diagnoses create stigmatization for LGBTQ people in mental health settings.
Transsexuals
The physical health issues for transsexuals span many years.
It’s best to see these stories from individuals.
Here is a good introductory video to the health of female to male transsexuals:
The physical health issues for transsexuals span many years.
It’s best to see these stories from individuals.
Here is a good introductory video to the health of female to male transsexuals:
Here is a good video for male to female transsexuals.
Intersex
When to have corrective surgery. One of the biggest controversies regarding this population is attempting to "fix" them before their gender identity is clear. It is strongly recommended that physicians and parents avoid any surgical corrections until the child is able to request such services. This will be very clear from the video.
Community Identity. Individuals who do not have a group identity are more vulnerable to depression and anxiety. Isolation may help explain why LGBT people face significantly higher rates of depression.
The Intersex Society of North America (ISNA) is devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female.
We have learned from listening to individuals and families dealing with intersex that:
When to have corrective surgery. One of the biggest controversies regarding this population is attempting to "fix" them before their gender identity is clear. It is strongly recommended that physicians and parents avoid any surgical corrections until the child is able to request such services. This will be very clear from the video.
Community Identity. Individuals who do not have a group identity are more vulnerable to depression and anxiety. Isolation may help explain why LGBT people face significantly higher rates of depression.
The Intersex Society of North America (ISNA) is devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female.
We have learned from listening to individuals and families dealing with intersex that:
- Intersexuality is primarily a problem of stigma and trauma, not gender.
- Parents’ distress must not be treated by surgery on the child.
- Professional mental health care is essential.
- Honest, complete disclosure is good medicine.
- All children should be assigned as boy or girl, without early surgery.
Affirmative Therapy
Therapists should (Langdridge, 2007)
Therapists should (Langdridge, 2007)
- Interrogate their own LGBTQ feelings
- Not enter into therapeutic arrangements which imply that LGBTQ Identities are pathological or undesirable.
- Recognize LGBTQ oppression
- Deprogram internalized stereotypes
- Explore feelings of anger, sadness, and isolation.
- Encourage finding a support group
- Support consciousness-raising activities.
- Encourage developing a value-system.
- Lessen guilt and shame about being LBGTQ
- Affirm their identity.
Helping someone find a surgeon. It would be a good idea to explore some of the surgical sites to assist someone in finding a surgeon. This is often a stressful and difficult activity, especially if the individual's health insurance does not cover the procedures (which is the norm).
I would recommend going to Susan’s Place as a starting point: http://www.susans.org/ Try to imagine that you would be selecting a surgeon for yourself or others. Try to imagine how incredibly this difficult would be to decide the one person who could affect the rest of your life.
I would recommend going to Susan’s Place as a starting point: http://www.susans.org/ Try to imagine that you would be selecting a surgeon for yourself or others. Try to imagine how incredibly this difficult would be to decide the one person who could affect the rest of your life.
Friday Project
ASSIGNMENT DUE: International policies paper.
There are two tricks to this assignment. First, pick a country that either speaks English or Spanish. If you want to study another country, just be sure that there is plenty of information published about their treatment of gays and lesbians.
The other trick is to find peer-reviewed literature about a general topic, even if it does not relate to the country. For example, say you wanted to study Egypt. The Muslim Brotherhood has been cracking down, and it is likely that gay and lesbian couples will face additional prejudice in the coming era. Although you could probably find a few newspaper articles on this topic, you aren't going to find many peer-reviewed articles. So, use the newspaper articles to get oriented about what is happening, and then use the peer reviewed articles to discuss things like, 1) Islamic issues related to LGBT, 2) LGBT issues in the Middle East, 3) Counseling and psychotherapy issues in Egypt, 4) Immigrant issues for Egyptians, etc. The point is to use the available literature to help you delve deeper into the material and to extrapolate to larger constructs.
ASSIGNMENT DUE: International policies paper.
There are two tricks to this assignment. First, pick a country that either speaks English or Spanish. If you want to study another country, just be sure that there is plenty of information published about their treatment of gays and lesbians.
The other trick is to find peer-reviewed literature about a general topic, even if it does not relate to the country. For example, say you wanted to study Egypt. The Muslim Brotherhood has been cracking down, and it is likely that gay and lesbian couples will face additional prejudice in the coming era. Although you could probably find a few newspaper articles on this topic, you aren't going to find many peer-reviewed articles. So, use the newspaper articles to get oriented about what is happening, and then use the peer reviewed articles to discuss things like, 1) Islamic issues related to LGBT, 2) LGBT issues in the Middle East, 3) Counseling and psychotherapy issues in Egypt, 4) Immigrant issues for Egyptians, etc. The point is to use the available literature to help you delve deeper into the material and to extrapolate to larger constructs.
Discussion Question
Topic: What advantages are there in identifying as LGBTQQI as a young person?
There are a few things I am hoping you will do with this topic. I want you to discuss the advantages of coming out early in life (versus middle age). We tend to think of the coming out process as traumatic, but it is likely to be easier if you do not have to give up a lifetime of an identity. So, there could advantages to future families (e.g., not going through divorce), parents (getting used to the idea early), and even for future success of identity (e.g., trans kids who do not undergo their gender-assigned puberty will pass better as adults). Keep thinking through these types of issues and see what other things you can devise.
Topic: What advantages are there in identifying as LGBTQQI as a young person?
There are a few things I am hoping you will do with this topic. I want you to discuss the advantages of coming out early in life (versus middle age). We tend to think of the coming out process as traumatic, but it is likely to be easier if you do not have to give up a lifetime of an identity. So, there could advantages to future families (e.g., not going through divorce), parents (getting used to the idea early), and even for future success of identity (e.g., trans kids who do not undergo their gender-assigned puberty will pass better as adults). Keep thinking through these types of issues and see what other things you can devise.