Adam W. Fingerhut, professor and chair of psychology, and Anna Muraco, professor and chair of sociology offer their thoughts on LGBTQ+ mental health.
Dr. Fingerhut writes:
As I think about the LGBTQ+ community and mental health, I find myself wearing my cap as a psychology Ph.D. but also indulging as a lay historian, as the story of LGBTQ+ mental health is in many ways linked with historical changes in beliefs about and attitudes toward LGBTQ+ people.
For example, prior to 1973, homosexuality was considered a mental disorder and listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the “bible” of psychiatric illnesses. At the time, mental health practitioners and those in the larger society falsely assumed that the increased prevalence of depression and anxiety among sexual minority individuals and the presence of these individuals in psychiatric institutions served as proof that homosexuality itself was a sickness. Of course, this conclusion fails to account for the very real stigma that sexual minority individuals have faced in our society and the deleterious consequences that prejudice and discrimination can have on an individual’s health and well-being.
In the 1990’s, Ilan Meyer, a social psychologist and psychiatric epidemiologist, put forth the minority stress theory, which suggests that exposure to unique stressors related to minority sexual orientation (e.g., discrimination) results in poorer mental health and increased risk for stress-sensitive mental health issues (e.g., anxiety and depression). Much data now exist supporting this theory and showing clear links between such stressors as interpersonal discrimination, institutional discrimination, stigma, and internalized homophobia, and increased risk for mental health problems.
As we have entered the 21st century, public attitudes toward LGBTQ+ individuals have shifted radically leading to greater acceptance. Additionally, we have witnessed legal and policy changes that now allow LGBTQ+ individuals access to important social institutions from which they have historically been barred. The most salient of these is the right for same-sex couples to marry, which came only recently as a result of the 2015 U.S. Supreme Court decision in Obergefell v. Hodges. These shifts have led scholars, including Meyer himself, to question whether minority stress and its relation to mental health remain relevant. In fact, in a post-Obergefell paper published in 2016, Meyer posed the following question: “Does an improved social environment for sexual and gender minorities have implications for a new minority stress research agenda?”
The reality, however, is that despite improved social attitudes, mental health issues seem to persist. Using data from a nationally representative sample collected between 2013 and 2014, Cochran, Björkenstam, and Mays (2017) showed that LGB men and women were significantly more likely than their heterosexual peers to show high levels of psychological distress and to report that this distress interfered with their lives. Recent data from the Generations Study, a multi-wave, multi-method study utilizing a national probability sample of LGB individuals from three distinct age cohorts, similarly demonstrate this (Meyer et al., 2021). Guided by minority stress theory and the idea that improved social environments should lead to less stress exposure and to fewer mental health problems, the researchers hypothesized that younger LGB individuals, growing up in a more accepting world, should report better outcomes in terms of both stress exposure and mental health than their older peers. But the data suggested otherwise: Those in the younger cohort (ages 18-25) reported higher levels of everyday discrimination and internalized homophobia compared to those in the middle cohort (ages 34-41) and older cohort (ages 52-59), and they also reported the highest levels of psychological distress.
When I first saw the results of these studies, I admit that I was both surprised and saddened. Here I offer a few potential explanations for the findings. First, the move toward more acceptance in the social environment is very recent, and the positive consequences of these shifts may not be felt immediately and therefore may not yet be showing up in the population and in the data that have been collected. Second, the recent gains in access to rights are perhaps being met with backlash, and the persistence of health disparities may reflect the truth that full equality has not been attained.
Many current legislative and legal battles highlight this fact. I point to a recent court case originating in Florida as an example. In 2017, the city of Boca Raton and the county of Palm Beach enacted legislation banning licensed clinicians from using conversion therapy, or talk therapy aimed at changing a client’s sexual orientation, for minors. Practitioners of conversion therapy sued, claiming this was a violation of First Amendment rights. Despite much psychological evidence demonstrating that 1) homosexuality is a normal variant of human sexuality; 2) conversion therapy is not proven to change sexual orientation; and 3) conversion therapy is linked with harmful mental health consequences for clients including anxiety, depression, and suicidal ideation, the 11th Circuit Court of Appeals overturned the Florida ordinances. Finally, health disparities may persist for the simple fact that LGBTQ+ people will always be a minority group in society, and with that comes feelings of token status and isolation.
As a gay man, I have been very fortunate to exist in spaces that are, for the most part, hugely accepting of me, my marriage to my husband, and the beautiful nuclear unit we have created with our daughter. At the same time, we are (to my knowledge) the only two-dad family in her left-leaning California public school of 500 children in 2021. This fact is always salient to me and creates a hypervigilance that others in the context do not experience.
Though mental health disparities exist and persist and the legal landscape remains troubling, I would be remiss (especially during Pride month!) if I simply ended the story here. To begin, despite the existence of health disparities, research shows that the vast majority of LGBTQ+ people are thriving and doing just fine in terms of mental health. Furthermore, even in the face of marginalization, LGBTQ+ people find meaning in and positive aspects to their minoritized experience. In work I did with Ellen Riggle, Sherry Rostosky and others, LGB individuals were able to point to the positive aspects that came from their sexual minority identity (Riggle et al., 2014). Several themes emerged from participant’s responses. For example, they reported that being a sexual minority allowed them to: challenge social norms and live authentically; be deeply involved in community; and have purpose through the fight for social justice.
These themes and the larger point that LGBTQ+ folks are resilient in the face of stigmatization were also made salient to me in a 2008 study I conducted examining LGB individuals’ reactions to the campaign for Proposition 8, a ballot measure that was ultimately passed and stripped same-sex couples of the right to marry in California (Maisel & Fingerhut, 2011). Quantitative data showed that participants were feeling high levels of many negative emotions such as anger and nervousness, but were also feeling high levels of positive emotions such as pride. Answers to open-ended questions similarly revealed that participants were finding the positive even in the face of being targeted. For example, one participant stated that “[Proposition 8] has made me more involved in my community and the desire to fight for something I think is a right.” Another participant wrote that “[Proposition 8] has brought many of us in my own lesbian/gay circle closer together in discussion.”
Our understanding of sexual and gender minority mental health has evolved over time and must continue to do so, especially as we embrace life beyond the binary and identity as an intersectional phenomenon. In truth, I am not certain how, when or if mental health disparities linked with sexual and gender minority identity will vanish. Much work remains; at the same time, as we enter Pride month, I am more aware than ever that strength, creativity, and connectedness are at the heart of LGBTQ+ identity and community, and for that I am incredibly grateful!
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Dr. Muraco writes:
June is Pride month. This year, many retail outlets (I see you Target and IKEA), entertainment sources, and governmental entities are celebrating LGBT Pride. One June 1, 2021, there was a Presidential Action called “A Proclamation on Gay, Lesbian, Bisexual, Transgender, & Queer Pride Month[i],” which begins: “The uprising at the Stonewall Inn in June, 1969, sparked a liberation movement — a call to action that continues to inspire us to live up to our Nation’s promise of equality, liberty, and justice for all. Pride is a time to recall the trials the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) community has endured and to rejoice in the triumphs of trailblazing individuals who have bravely fought — and continue to fight — for full equality.” Referenced in the White House statement are the Gay Liberation Movement and the Stonewall Riots in 1969, which were a series of protests at the Stonewall Inn in New York City against police harassment in gay spaces.
Police and other forms of harassment also plagued older gay and lesbian adults living in Los Angeles during the 1960s and 70s. For my current book project, “Aging Under the Rainbow,” I interviewed 53 LGBT adults age 50 and over who lived in the greater Los Angeles area, in order to understand their experiences now that they have reached the second half of their lives. One of the Latinx lesbians I interviewed who was in her early 80s noted that she visited gay-friendly establishments (i.e., bars and coffee houses) before she turned 16 years old. She found a home with other gay and lesbian people in these spaces, but also was arrested several times for violating the “masquerading” law, (wearing men’s clothing) and was repeatedly harassed by local law enforcement, often spending weekends in jail. An 88-year-old black gay man shared that in the 1970s, he was “entrapped” by police when he was arrested for soliciting sex in a park bathroom; given that he was also a high school teacher, he was terrified that he would lose his job if the school district if found out. His concern was well-founded, given that the Briggs Initiative that would have banned lesbian and gay people from teaching in California public schools appeared on the 1978 ballot; while the proposition was defeated, many LGBT people came of age in a context where their livelihoods were legally threatened by various arms of the state. Then an epidemic, that was at first, largely ignored by state actors, AIDS, threatened entire generations of gay men. From Stonewall to AIDS, many contemporary LGBT adults age 50 and older in the U.S. lived under this specter of state threat, illness, and death.
Yet, research shows growing acceptance of LGBT people, lessening stigma, and younger ages of coming out (Russell & Fish, 2016). Younger cohorts of LGBT adults have experienced greater social and legal acceptance including the state sanctioning of same-sex marriage and inclusion of LGBT history in California Public Schools. But there is also persistent legal backlash that threatens transgender rights and adoption laws by same-sex parents in some U.S. states, as well as increased rates of violent hate crimes, especially against trans-people of color.
What does this all mean for current cohorts of later life LGBT adults, who have been the focus of my research for the past decade? Many later-life LGBT adults are thriving economically, socially, and physically and have hearty social networks that they have developed through their professional lives and civic engagements. Others are experiencing immense struggle. Some in my study were presently or previously housing insecure and lived on public assistance or fixed incomes. Many have physical and mental disabilities, some related to long-term HIV and others due to psychological conditions. Some of these same people are socially isolated without anyone to call if they need support. Most do not have biological children. Many focus on their pets as their primary companions. A few admitted that they did not have end of life paperwork completed because they had no one to name as their power of attorney.
The long term historical and political context has influenced the present mental and physical health conditions and in the past decade, both the Institute of Medicine and the National Institutes of Health identified LGBT populations as health disparate and underserved. Specifically, LGB populations are at higher risk for disability, poor mental health, psychological distress, suicidal ideation, and mental health disorders like anxiety and depression, than their heterosexual counterparts (Fredriksen-Goldsen et al., 2014). Some of the factors that can mitigate mental health risks are social contact and social network size; community organizations like the L.A. LGBT Center have senior-specific services like support groups and social events to promote intergenerational connections, but they are not sufficient to meet the great need. While necessary legal progress has expanded the civil rights of LGBT people, the decades of legal oppression and stigma has left an indelible imprint. LMU’s focus on the promotion of justice and the call to identify with those who have lived in the margins of society gives us the opportunity to collaborate and connect with later life LGBT people, not only during Pride month, but throughout our everyday lives.
Footnote:
i I typically use LGBT and not LGBTQ to discuss lesbian, gay, bisexual, and transgender people because with studying older adults, some bristled at the term “queer” because it had been used as a slur throughout their lives; for sampling purposes, we omitted the Q (Queer) from the term in order to gather data from as many people as possible. Additionally, some studies specifically focused on same-sex oriented people (LGB) and did not include transgender people in the study, which is why LGBT and LGB are the terms used. There are many potential issues with treating LGBT as fixed identities, including trans people in the grouping, etc., and I am aware of these concerns, but they are beyond the scope of this very short piece.
LGBTQ+ Mental Health Resources (available for download here)
National Suicide Prevention Lifeline
Available 24 hours. Languages: English, Spanish.
800-273-8255
National Queer and Trans Therapists of Color Network
NQTTCN is a healing justice organization committed to transforming mental health for queer and trans people of color (QTPoC)
C.O.L.O.R.S.
Colors LGBTQ youth counseling center provides free LGBTQ-affirmative counseling and healing psychotherapeutic services to youth under 25 and their families in the greater Los Angeles area.
Address: 400 Corporate Pointe, Culver City, CA 90230
Phone: 323.953.5130
Email: info@colorsyouth.org
Mental Health Apps
Retrieved from National Alliance on Mental Illness, LGBTQI:
The LGBT National Help Center
Offers confidential peer support connections for LGBT youth, adults and seniors, including phone, text and online chat.
The National Center for Transgender Equality
Offers resources for transgender individuals, including information on the right to access health care.
The Trevor Project
A support network for LGBTQ youth providing crisis intervention and suicide prevention, including a 24-hour text line (text “START” to 678678).
SAGE National LGBT Elder Hotline
Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE)
Delivers educational and support resources for LGBTQ individuals, as well as promotes competency on LGBTQ issues for counseling professionals.
The Gay and Lesbian Medical Association’s Provider Directory
A search tool that can locate a LGBTQ-inclusive health care provider.
OIA Buzz
- Celebrate Pride, 24/7 and 365 : View our LGBTQ+ Pride Month Hub.
- OIA is getting a new name. In President Snyder’s recent letter, Honoring George Floyd Through Progress and Action (May 25), he announced:
“I am grateful for the high level of ownership and DEI engagement from units across LMU, and we will continue to seek your partnership as we recruit our next executive leader for diversity, equity, and inclusion. In approaching this search process, I recently sought advice on the question of whether the “Office of Intercultural Affairs” remained appropriate nomenclature for our time. After consulting with VP Jennifer Abe, senior leaders, board members, and constituency groups, I have decided that LMU will rename the Office of Intercultural Affairs the “Office of Diversity, Equity, and Inclusion” and will advertise for the position of vice president for Diversity, Equity, and Inclusion in our upcoming search. This aligns with language from the commitment in our strategic plan and provides a more contemporary and comprehensive description of the role and office. I am pleased to share that José Badenes, S.J., associate provost for Undergraduate Education and professor of Spanish, will serve as chair of the search committee.”
In the upcoming weeks, Intercultural Affairs will transition to be called Diversity, Equity, and Inclusion.
- Sign up for Cultural Consciousness Conversations, a yearlong dialogue with a cohort of staff, administrators, and faculty from diverse backgrounds and perspectives. From September to May, this group explores topics of discussion that prompt self-reflection, new social contexts, and education. Ask members from the previous cohorts about their experiences, and share the web page with others in your office who may be interested!
- In Six Words gets to the heart of our community’s struggles and fight against the unjust and unequal experiences that plague our society, in hopes of sparking conversation, understanding, and empathy. LGBTQ+ Pride is about more than just identity. June stories will highlight the lesbian, gay, bisexual, trans, and queer community around issues of dignity, new perspective, expression, joy, advocacy, and so much more. View stories and submit yours
