Mental Health Issues

HOMOSEXUALITY AS AN ILLNESS

Historically, homosexuality has often been treated as a mental illness in need of a cure. Treatments include(d):

"re-education" through psychology
lobotomy
aversion therapy
hormonal treatment
locating the "gay gene"
"de-gaying" through prayer

Professional literature lagged behind the decision that homosexuality per se was not a mental illness e.g.

The British Medical Journal was still discussing the potential of different treatments for homosexuality in 1975
The World Health Organisation only declassified homosexuality as a mental illness in 1992

(In 1992 the Vatican put out a statement describing homosexuality as an "objective disorder")

These views still exist today in some quarters. Homosexuality continues to be referred to as a mental disorder in some still-used psychiatric texts and anecdotal evidence shows that this view is common in society in general and is still held by some mental health professionals. It must be remembered that many people working in this field had their views formed by opinions and attitudes that were prevalent 30 or 40 years ago.

The fact that a person is gay, lesbian or bisexual does not mean that they are suffering from a mental disorder. Evidence suggests that gay men, lesbians and bisexuals may suffer more mental distress than the general population, but that mental distress may develop for many different reasons. Lesbians, gay men and bisexuals do face additional and particular pressures from living in a heterosexist society. These pressures can be highly detrimental to mental health.

WHAT "PRESSURES" CAN LEAD TO MENTAL ILLNESS?

Discrimination

By the law. Until recently it was legal to sack people simply for being gay or lesbian. There were legal discriminations in terms of: age of consent; security of housing tenure; adoption; serving in the armed forces; criminal injuries compensation; funeral procedures; access to partners in hospital. It is only very recently that some laws have been changed to reduce some of these areas of discrimination
Religion. Some religions have taught their followers that certain groups of people are inferior.
The media. The media has power to decide what information reaches the public and how it is presented. The press has been responsible for many instances of negative stereotyping.
Heterosexism. Everyone is assumed to be heterosexual unless there is evidence to the contrary. Society is structured to support heterosexuality and heterosexuality is assumed to be superior. This attitude is still common amongst professionals working in the areas of counselling and psychotherapy.
The education system. The system also teaches which groups are superior and which are inferior. Gay, lesbian and bisexual issues are very rarely discussed. Section 28 of the Local Government Act referred to same sex relationships as "pretend families".
Groups. Families and peer groups often pressure their members to conform to beliefs deemed to be acceptable within the group. Anything falling outside of this is often rejected. The rejection may take many forms.

Internalised homophobia

Homophobia - the fear of feelings of love for one's own sex and the hatred of those feelings in others - may be experienced by gay men, lesbians and bisexuals about themselves. If people are continually told that they are inferior, abnormal, sinful, unacceptable then some people may come to believe it and may experience feelings of self-disgust. This can result in depression, emotional trauma or suicide.

EXAMPLES OF HOMOPHOBIA IN ACTION

Students reported their clothes being set alight and chemicals thrown on them in science lessons, being urinated on, burned with cigarettes while being held down, being dragged around the school playing field by the hair, being raped (Rivers, Young, gay and bullied: Young People Now, January 1996)
GAi Project Survey (Nottingham 1997) found that 65% of respondents had been victims of homophobic incidents (abuse, harassment etc) and in 25% had been victims of homophobic violence
82% of lesbians, gay men and bisexuals had been verbally abused and 60% physically attacked at school. (Rivers - the bullying of sexual minorities at school (2001) Education and Child Psychology Vol.18 no. 1)
19% of gay men attacked because of their sexuality; 12% had their property damaged because of their sexuality; 40% insulted due to their sexuality; 48% insulted at school because of their sexuality; 28% bullied at school because of their sexuality - in each case the figures were a little lower for lesbians (2000-2002 Warner, McKeown et al British Journal of Psychiatry no. 185)
64% of respondents had seen other students being homophobically bullied. 26% had been homophobically bullied themselves. !8% had witnessed teachers homophobically bullying students (3Consultancy Survey of 3 schools in Northamptonshire 2003)
47% of young LGB people in London had experienced harassment or physical abuse at school and 83% had been verbally abused (PACE survey 2003)
The "I Count" survey (Nottinghamshire 2003) found that 43% had experienced abuse, harassment or violence because of their sexual orientation. Nearly one third had experienced harassment at work in relation to their sexuality.

WHAT IS THE INCIDENCE OF MENTAL ILLNESS AMONGST GAY MEN, LESBIANS AND BISEXUALS?

25-65% of gay people seek counselling at some stage of their lives (Man, Lyndsay (1994) Journal of the British Association for Counselling vol. 5 no.1)
Levels of alcoholism are over twice that in the general population. Reasons suggested include using alcohol and drugs as a means of coping with depression and the pivotal role of bars in gay social networks (Herbert, Hunt & Dell (1994) Journal of Rehabilitation)
Young gay men were 13.9 times more likely to attempt suicide than their heterosexual peers (Bagley and Tremblay (1997) Suicidal behaviour in Homosexual and Bisexual males)
6 population based studies since 1997 showed rates of attempted suicide between 20 and 42% amongst gay men, lesbians and bisexuals (Remafedi (1999) Archives of General Psychiatry. American Medical Association 56)
53% of those bullied at school because of their sexuality had contemplated self harm or suicide and 40% had attempted self harm or suicide (Rivers - the bullying of sexual minorities at school (2001) Education and Child Psychology Vol. 18 no. 1)
18% of respondents had attempted suicide; 66% had experienced depression (Respondents to the Nottinghamshire "I Count" survey - 2003)
Young gay men are 5.6 times more likely to injure themselves without suicidal intent than young men in the general population (Hutchinson, Porter, Le Voil (2003) Findings from a study of suicidal thoughts amongst young gay men and bisexuals in Edinburgh)
43% had mental disorder, 31% had attempted suicide (respondents to survey - Rates and predictors of mental illness in gay men, lesbians and bisexuals - Warner, McKeown, Griffin et al (2004) British Journal of Psychiatry)

EXPERIENCES OF GAY MEN, LESBIANS AND BISEXUALS AS USERS OF THE HEALTH SERVICES

Nursing staff share the homophobia prevalent in society and this is carried over into their practice (Royal College of Nursing working party 1990)
It was found that all the counsellors surveyed had worked with lesbian and gay clients, but none had received any specific training related to counselling these clients. 50% of lesbian and gay clients reported discontent with their experiences of counselling (Man, Lyndsay (1994) Journal of the British Association for Counselling vol. 5 no.1)
There is widespread evidence of homophobia amongst doctors (McColl Homosexuality and medical health services: Editorial BMJ Feb.1994)
73% of lesbian, gay or bisexual mental health service users reported experiences of prejudice, discrimination, harassment and even physical and sexual violence (MIND: Without Prejudice 1997)
It is surmised that 77% of mental health nurses were either moderately or severely homophobic (Wells, Homophobia and Nursing Care, Nursing Standard 12, Oct 1997)
Lesbians feel unable to disclose their sexuality to health care professionals due to homophobia and heterosexism (Carr, Scoular et al British Journal of Family Planning 25 - 1999)
It is particularly difficult for school nurses to tackle homophobia where school policy is not supportive (Mahoney, A Law for bullies, Nursing Times 96, 2000) 99% of schools have anti-bullying policies, but only 6% refer to homophobic bullying (Stonewall)
There is considerable anxiety and fear of stigmatisation in relation to disclosing ones sexuality in the context of primary care services (Cant Primary Health Care Research and Development 3: 2002)

But

Nottingham Primary Care Trusts were rated 9^th in the top 100 best employers for lesbians and gay men (Stonewall: January 2005)

COMING OUT

Coming out is not a single-step process. Usually, it involves acknowledgement of one's sexual identity first to oneself and after that to other people. Usually, the involvement of "other people" is also a step-wise process: it often begins with acknowledgement to other people who are known to be gay or lesbian, then to a few friends who are assumed to be heterosexual and gradually to more and more people. For some people coming out goes through all these stages, for some it stops somewhere along the route.

Coming out is generally seen as a process by which lesbians, gay men and bisexuals challenge internalised homophobia and increase the self-esteem which will help develop healthier ways of dealing with oppression. It can be seen as an important political statement in the context of living in a heterosexual society. It has been suggested that it is important to understand the processes many people go through in moving from a negative to a positive identity both for the people who are oppressed and those trying to help.

LESBIANS, GAY MEN AND BISEXUALS FROM BLACK AND MINORITY ETHNIC COMMUNITIES.

This group of people will face multiple oppression. To all the factors listed previously we can add racism and cultural conflicts - with inevitable consequences on stresses which may affect mental health.

Quibilah Montsho believes that up to 60% of black lesbians will have had some experience of the mental health system during their lives. She describes psychiatry as both racist and homophobic and what is classed as mental illness is defined and controlled by straight white men. She talks of the difficulty for a black lesbian to complain of sexism, racism and/or homophobia in a psychiatric setting because complaining may be interpreted as displaying an aspect of paranoid psychosis. She makes the point that because of cultural and language differences, the service user can be misunderstood and labelled as defensive or uncommunicative. (Behind locked doors: Talking Black, Cassell, 1995)

It is important not to stereotype people from the same ethnic group. Although there are similarities, there will also be many differences. However, a substantial number of black and ethnic minority people are British-born and have grown up living in two cultures.

Many black and Asian LGB people identify strongly with their communities and this helps to deal with the racism of the dominant culture which they experience. The concept of coming out as an individual does not easily fit into the value systems of themselves, their families and their communities.

Coming out may result in an additional burden to the level of discrimination they already experience. Rita Brauner (Issues in Therapy with LGBT clients OUP, 2000) argues the following point. While coming out to one's family may be crucial to the psychological health of, say, a white gay man, it may be equally crucial to the psychological health of say, an Asian gay man, not to come out to his family. Coming out may mean being cut off from family and community support.

Earlier it has been mentioned that the second step of coming out is often that of being open about one's sexuality to other lesbians or gay men. Black and ethnic minority LGBs often face racism from LGB organisations that would be expected to support them, such as LGB social/support groups. The commercial gay scene is certainly not free from racism. Black and Asian lesbians and gay men often say that they are perceived as being lesbian and gay within their own communities, but as Black or Asian in the general gay scene.