LGBTQ+ Mental Health: Revisiting the past to understand the present
Recalling and naming the collective oppressed history of LGBTQ+ people is essential for understanding why mental health difficulties exist disproportionately for this group
My name is Dr Brendan J Dunlop (he/him) and I am a Highly Specialist Clinical Psychologist and Clinical Lecturer in Clinical Psychology. I am motivated to reduce mental health inequalities for marginalised groups, especially LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, and others) people, with a consideration for wider systems, structures and stories that impact upon health and wellbeing.
February is LGBTQ+ history month. Thinking about LGBTQ+ history is important for many reasons. These include understanding how marginalisation and victimisation previously operated, so that we can prevent it from happening again. Another equally important reason is to help us understand why LGBTQ+ people experience disproportionate levels of mental health difficulties and distress when compared to heterosexual and/or cisgender (i.e., those whose sense of personal identity and gender corresponds with their birth sex) people. To this end, we must recount the history of how people and groups, policies, institutions, and laws, as well as social stories, have influenced the mental health and wellbeing of LGBTQ+ folk.
In this short blog, I will detail just a handful of historical events that have had a ‘trickle down’ influence on mental health and wellbeing today. I will include the implicit or explicit message this sent (or sends) to LGBTQ+ people, and in turn the potential mental health consequences.
To start, let’s think about the criminalisation of homosexuality in the United Kingdom. Until partial decriminalisation in 1967, being gay was a crime. The explicit message this sent to gay people was that you, and what you do, are inherently and morally wrong. Imagine receiving the message that a central component of your identity was wrong? The mental health consequences of this law and the subsequent message it sent are that of internalised shame, reluctance to engage with authorities (e.g., not seeking medical attention) and difficulties with mood (such as feeling low, anxious or angry).
Another example of a harmful law/policy that has a trickle-down effect is Section 28 of the Local Government Act (1988). This section of the Act stated that local authorities could not ‘promote’ homosexuality in schools or other learning environments. The implicit and explicit message here was that homosexuality is wrong and it should not be spoken about. The consequences here were multiple. Children and young people could not see themselves represented in others. Homophobia and bullying were rife. It is therefore no wonder that young LGBTQ+ people felt shame after experiencing such abuse, bullying and interpersonal trauma.
In the 80s and 90s, the AIDS (acquired immune deficiency syndrome) crisis hit. This was dubbed by the media and other organisations as ‘the gay plague’, as HIV (human immunodeficiency virus) disproportionately affected gay men. This social story had far-reaching messages and implications. The prevailing narrative was that if you were gay, you were going to die. Furthermore, implicit and explicit messages were that, as someone on the ‘fringes’ of society, it was not in society’s interests to put effort into curing this disease and saving you. The mental health consequences of the AIDS crisis were wide ranging and included a reluctance to seek help due to shame and fear of rejection, anger, trauma, family rejection, grief from the death of friends and loved ones, and, for some, suicide.
So-called ‘conversion therapies’ (any form of treatment or psychotherapy which aims to change a person’s sexual orientation or to suppress a person’s gender identity) have historically been used by some healthcare and religious groups to ‘cure’ homosexuality or gender identity differences. The banning of this is still being debated. Similar to my first example about the criminalisation of homosexuality, the message inherent within so-called ‘conversion therapies’ is that the very core of you needs to change. Shame, trauma, loss of trust in authorities, anger and self-harm/self-punishment are likely to have been mental health consequences of such a practice.
For transgender (people whose gender does not match their sex-assigned at birth), non-binary (people whose gender identity is not ‘man’ or ‘woman’) and gender-diverse people (umbrella term for people that experience differences in expression and experience of gender), structures and systems perpetually retraumatise. Whether it is lack of legal recognition on state-issued documents, to ‘debating’ trans rights, to the endless waits for gender clinic appointments. The implicit message within these behaviours and lack of equity is that these folk are not worthy of attention.
This marginalisation, rejection and erasure of gender-diverse people serves to maintain the ‘status quo’ of heteronormativity (where binary gender identity and heterosexuality are assumed to be the default position), and binary gender identity (i.e., those who identify as either man or woman). As you might be able to make a guess at by now, this has a very real impact on the mental health of these people within the LGBTQ+ community. Difficulties with mood, with trusting others, and with self-worth, could all be mental health consequences of oppressive and harmful systems and structures.
The impact of such historical (and current) events and practices influence the way that both heterosexual/cisgender and LGBTQ+ people appraise the LGBTQ+ community. Implicit messages and stories over the years may have consciously or subconsciously influenced the way in which people respond to those that have a different sexuality and/or gender identity. This leads to present day discrimination, bullying, marginalisation, rejection, abuse, erasure, epistemic injustice, lack of legal protection and recognition, lack of healthcare awareness, unsupportive systems and actively harmful policies and laws. It is therefore no wonder that LGBTQ+ today experience disproportionate levels of mental health difficulties such as substance misuse, mood difficulties and suicidality when compared to other groups.
For the purposes of this short blog, I have necessarily made the broad connection between history, messaging/social stories and mental health consequences. Of course, as humans, we are complicated people and there are often other mechanisms or factors that contribute to this picture. Understanding, however, how ‘minority stress’ related to people and groups, policies, institutions, and laws, as well as social stories, impacts upon the mental health and wellbeing of LGBTQ+ people is essential for identifying areas of change. Whether these changes are top-down policy changes, changes in the way systems operate so they are more inclusive, or challenging discrimination at an individual level, there are multiple things that can help to improve the mental health and wellbeing of this particular minoritised group of people.
If you want to know more about how history and external influences play a part in impacting the mental health and wellbeing of LGBTQ+ people, including practical ways to improve mental health, you can find out more in The Queer Mental Health Workbook: A Creative Self-Help Guide Using CBT, CFT and DBT. This self-help resource can be used as your personal mental health resource and includes lots of activities tips, tricks and strategies to improve your mental health, or think about your identity and relationships in context. It isavailable now for pre-order here.