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LGBT mental health and well being

IDAHOT 2016 global focus issue : Mental health and well being

 

International Day Against Homophobia, Transphobia and Biphobia 

Focus issue 2016

“Mental Health and Well Being”

 

 

Background and rationale

Around the late 19th Century when scientists started developing theories around sexual identity and behaviour, homosexuality, and later gender variance, was to be overwhelmingly defined as the result of chemical imbalances or mental deficiencies. The psychological approach has largely been instrumental in creating a vision of homosexuality and transgenderism as abnormal, hence inferior, dangerous and incapacitating.

The psychology arguments have since then been used towards the persecution of sexual and gender minorities. The connection engineered by leading scientists in the late 19th and 20th century, between mental illness and homosexuality became so influential, it enabled the rise of state-led criminalization crusades against same-sex behaviour

Specifically, the “psychiatric” argument has been used for justifying psychiatric “treatments” of LGBTIQ individuals, with the aim of ‘reforming’ or ‘curing’ them from their disease. Among the practices developed to “cure” patients of their homosexuality are electro-shock therapies, sterilisation, hormone treatments, brainwashing, confinement to psychiatric institutions and in the case of Lesbians and Bisexual women, rape.

There is nevertheless a growing international consensus moving away from this position on sexual orientation.

In 1973, the American Psychiatric Association declassified homosexuality as a mental disorder. The American Psychological Association followed in 1975 by adopting a policy statement: Discrimination Against Homosexuals, in support of the action taken by the American Psychiatric Association and taking a stand against discrimination.

The World Health Organization (WHO) published on May 17th 1990 a revised version of the International Classification of Diseases Manual, in which homosexuality was not considered a mental disease any longer. This is the reason why, every year since 2004, the International Day against Homophobia, Transphobia and Biphobia is celebrated worldwide on May 17th.

In a landmark special statement in 2016, the World Psychiatric Association has strongly condemned any attempt to conflate homosexuality with a mental disorder

For gender identity, the picture is by far not as positive.

Most medical professionals still consider Trans identities to be linked to mental disorders. “Gender identity disorder” (GID) or equivalent mental health diagnoses are mandatory in almost all countries for Trans people to access gender affirming treatment and diagnoses and other medical and social preconditions are required to access legal gender recognition. While some form of diagnosis remains necessary to access necessary health care, to keep this diagnosis within the mental health categories contributes to the stigmatisation and social exclusion of trans people, without contributing to their physical or mental well being.

While there is growing recognition that sexual and gender diversity is not linked to mental health, there is also increased recognition on the effects of stigma and discrimination related to sexual orientation and gender identity or expression on the mental well being of sexual and gender minorities. There is particularly an increased recognition that the stresses created by stigma, inequality and harassment can cause LGBTQI people to be at a heightened risk of psychological distress. These effects are also induced by the invisibility (the “closet”) to which sexual and gender minorities are forced by social rejection and violence.

This is often referred to as minority stress, a term used to describe the mental health consequences of stigmatisation, social exclusion, discrimination and harassment of minority groups.

Minority stress also expresses itself through self-stigma, defined as a set of concerns that negatively impact self-acceptance, self-perception, self-efficacy, self-esteem and self-confidence.

Since 2004, reports drafted by UN Special Rapporteurs on the right of everyone to the highest attainable standard of physical and mental health and well being have contributed significantly to addressing the mental health and well-being needs and challenges of LGBTIQ individuals, both in terms of pointing to the negative correlation between criminalization and mental health, and also by bringing attention to the stigmatization and discrimination against LGBTIQ individuals occurring in healthcare facilities, and the harmful effects it has on their mental health and well being.

The impact of this social and physical violence against sexual and gender minorities is particularly visible on children and young people, as was highlighted during past editions of the IDAHOT which focused on LGBT Youth or on Homo/Transphobic Bullying. Research has particularly highlighted alarmingly high suicide and suicide attempts rates in young people experiencing harassment.

Still, even where the professional consensus is well established, resistance takes place within the profession.

It is also important to take into account that even in societies which have officially moved away from the pathologisation of sexual orientation and gender identity, the assumption that same-sex attraction and gender expressions are mental illnesses remains one of the main underlying drivers of social stigmatisation and exclusion of sexual and gender minorities, even when it is not explicit or even unconscious. The mental illness argument is for example a major driver in beliefs that LGBT can’t be good parents, that discrimination in certain professions is acceptable, that the mental development of children can be affected by LGBT people, etc.

Approaches to advocacy

The focus issue of mental health and well being offers activists many entry points for action.

Among these:

Pushing for the depathologization of transgender identities

A group of international transgender health experts, under the lead of GATE, has been developing different alternative models to facilitate access to healthcare coverage without stigmatising diagnoses.

Since 2009, the International Campaign Stop Trans Pathologization (STP) has called on putting an end to mandatory psychiatric monitoring leading the way (or not) to desired hormonal treatment and surgery. STP has also called upon stakeholders to push for the removal of ‘Gender Dysphoria’ / ‘Gender Identity Disorder’ categories from the international diagnoses manuals (DSM of the American Psychiatric Association and ICD of the World Health Organization). Revisions of the current International Classification of Diseases (ICD-10) are underway, which will allow for a new version of the International Classification of Diseases (ICD-11) to be approved by the World Health Assembly in 2017. In addition to STP and as part of this global campaign towards the depathologization of transgender individuals, GATE and TGEU are closely following this process with the goal of supporting depathologization of transgender identities and individuals, while retaining full access to transitional healthcare.

The World Professionals Association of Transgender Health – WPATH also calls for the depsychopathologisation of gender variance and urges “governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people”.

Opposing “conversion therapies” and specifically protecting young people

In some cases, “conversion therapy” is also referred to as “reparative therapy” or “ex-gay therapy/Ministry”. Secular and religious promoters of these therapies, often work together in their efforts to promote the harmful concept that an individual can change his or her sexual orientation or gender identity.

Instances of “conversion therapy” attempts still occur worldwide.

For example, while undercover in 2014, and although China removed sexual orientation from its list of mental disorders in 2001, a young sexual rights activist found it surprisingly easy to attain from a senior psychiatrist at a major hospital, advice on how to put him on the road to straightness: “Cold showers, jogging to run off the gay hormones,”[1] and nausea-inducing drugs. Following this experiment, China had its first court case against a “Gay Conversion” clinic. The Court ruled that the defendant, the Chongqing Xinyu Piaoxiang Psychological Counseling Center, should publish a public apology for its “conversion” practices and pay compensation to the plaintiff.[2]

In other places, progress on this front has been achieved:

Following the suicide, in December 2014, of 17-year-old transgender youth Leelah Alcorn, whose parents forced her to attend “conversion therapy”, U.S. President Barack Obama called for an end to psychiatric therapies aimed at changing people’s sexual orientation or gender identity. This trickled down into the U.S. Department of Health & Human Services releasing a 76-page report, entitled: “Ending “conversion therapy”: Supporting and Affirming LGBTQ Youth”.[3] The report concludes, “conversion therapy” perpetuates outdated views of gender roles and identities as well as the negative stereotype that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development.”[4] Moreover, the report clearly reaffirms that “none of the existing research supports the premise that mental or behavioral health interventions can alter gender identity or sexual orientation.”[5] To this day, despite the fearless pushback by promoters of “conversion therapy” (like NARTH, for example), California, Illinois, New Jersey, Oregon, and the District of Columbia have laws protecting children from “conversion therapy”.

Many movements are now looking at a federal ban[6]

“Conversion therapies” are often justified with the same arguments that have led the WHO to keep some mental health classification attached to homosexuality in the form of ego-dystonic homosexuality, making the removal of this category sometimes part of the approach to combat “conversion therapies”.[7]

Pathologizing homo/bi/transphobia?

As a reaction to labelling sexual and gender diversities as illnesses, some movements are advocating for homo/trans/biphobia to be identified as mental disorders. Ironically, this has something in common with the erroneous classification of homosexuality as a sickness prior to 1973. In both cases, a diagnostic label is used to stigmatize a disliked pattern of thought and behaviour. Using the label misrepresents what really is a subjective value judgment as a scientific, empirically grounded conclusion.

Moreover, by equating psychopathology with evil, it also reinforces the stigma that historically has been attached to mental illness.

Yet another problem with labelling homo/trans/biphobia a clinical disorder is that doing so frames heterosexuals’ hostility toward sexual and gender diversities as a purely individual phenomenon. This limits our ability to understand the social processes through which sexual and gender prejudices develop and are reinforced. It encourages us to focus on the prejudiced individual while ignoring the larger culture that stigmatizes homosexuality and gender variance.

This is not to deny that sexual and gender prejudices (like other form of prejudice) are observed in some people with severe psychological problems. But that doesn’t mean homo/trans/biphobia are themselves a pathology.[8]

Resources 

General

The International Psychology Network for Lesbian, Gay, Bisexual, Transgender and Intersex Issues (IPsyNet) consists of psychological organizations around the world working together to increase understanding of sexual orientation and gender diverse people and to promote their human rights and well being.

It provides a large list of resources on the issue, quoting that “LGB youth are four times more likely, and questioning youth three times more likely, to attempt suicide as their straight peers; 41 percent of transgender people have attempted to end their lives.”

The American Psychological Association has developed a full briefing page for this year’s IDAHOT, containing many great resources

Policy brief on self stigma – http://youthvoicescount.org//application/files/2015/04/YVC-POLICY_BRIEF-SELF_STIGMA-smallsize.pdf

A useful article from The Advocate on this issue

A large list of  items elated to  the psychological impacts of anti-LGBTQ political actions by psychologist Glenda M. Russell

The World Psychiatric Association’s 2016 statement condemning the conflation of homosexuality with a mental disorder contains a list of useful references. See also BBC coverage of this statement

On the history of homosexuality and mental health

The History of Psychiatry & Homosexuality

http://www.aglp.org/gap/1_history/

American Psychological Association

http://www.apa.org/pi/lgbt/resources/index.aspx

Changes in the Classification of Homosexual Behaviour

http://www.academia.edu/1154979/Changes_in_the_Classification_of_Homosexual_Behavior

http://www.behaviorismandmentalhealth.com/2011/10/08/homosexuality-the-mental-illness-that-went-away/

On the depathologization of transgender identities

International Day of Action for Trans Depathologization / 24 October:

http://www.stp2012.info/old/en/news#call_to_action2015

International Campaign Stop Trans Pathologization:

http://www.stp2012.info/old/en

TGEU Campaign with a special focus on Depathologizing Gender Diversity in Childhood:

http://tgeu.org/take-action-depath/

Blueprint for the provision of comprehensive care for trans people and trans communities in Asia and the Pacific:

http://static1.squarespace.com/static/53cf9459e4b0a5929855f337/t/5613e795e4b0664e55678cde/1444145045387/Asia+Pacific+Trans+Health+Blueprint.pdf

World Professional Association for Transgender Health:

http://www.wpath.org/

Critique and Alternative Proposal to the “Gender Incongruence of Childhood” Category in ICD-11

WHO Bulletin proposing the deletion of categories referred to sexual orientation: http://www.who.int/bulletin/volumes/92/9/14-135541/en/

More and more guidelines on Trans Health avoid classification as mental disorders: The American Psychological Association this year adopted Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, the Australian Psychological Society has Transgender Practice Guidelines (member access only), the British Psychological Society has Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients (purchase only) and the Psychological Society of South Africa has Sexual and Gender Diversity Position Statement: Introduction, Rationale and Context

On opposing “conversion therapies”

Substance Abuse and Mental Health Services Administration, Ending “conversion therapy”: Supporting and Affirming LGBTQ Youth. HHS Publication No. (SMA) 15-4928. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015 :

http://store.samhsa.gov/product/SMA15-4928

Movement Advancement Project, USA:

http://www.lgbtmap.org/file/policy-spotlight-conversion-therapy-bans.pdf

Queer Comrades, China:

http://www.queercomrades.com/en/news/china/gayconversioncase/

“Cures that Kill”, Documentary about turning gay people straight in China:

http://www.timeoutbeijing.com/features/Books__Film/11768/Documentary-Cures-that-Kill.htm

Political Research Associates: “The Ex-Gay Movement in Latin America”:

http://www.politicalresearch.org/wp-content/uploads/downloads/2013/04/Ex-Gay-Movement-in-Latin-America.pdf

Truth Wins Out, a lead US based organisation fighting “ex-gay” myths and lies.

http://www.huffingtonpost.com/entry/why-do-some-gay-mormons-still-seek-out-conversion-therapy_560aec6be4b0dd8503098753

http://www.huffingtonpost.com/entry/gay-conversion-therapy-survivors_5625556ee4b0bce34701c45d?ir=Gay%2BVoices&section=gay-voices&ncid=newsltushpmg00000003

 

footnotes

[1] “Unreported World: China’s Gay Shock Therapy – review”, Sam Wollaston, The Guardian, 10 October 2015 (http://www.theguardian.com/tv-and-radio/2015/oct/10/unreported-world-chinas-gay-shock-therapy-review-channel-4 )

[2] Victory for Plaintiff in China’s First “Gay Conversion” Case – See more at: (http://www.queercomrades.com/en/news/china/gayconversioncase/#sthash.dw3M0i2E.dpuf )

[3] Substance Abuse and Mental Health Services Administration, Ending “conversion therapy”: Supporting and Affirming LGBTQ Youth. HHS Publication No. (SMA) 15-4928. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

[4] Idem. (p. 1)

[5] Idem. (p.11)

[6] http://www.huffingtonpost.com/2015/05/19/conversion-therapy-ban_n_7322828.html

[7] http://newsroom.ucla.edu/releases/experts-urge-who-to-stop-classifying-sexual-orientation-issues-as-disorders

[8] http://www.beyondhomophobia.com/blog/#sthash.IgtE8hrK.dpuf

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