Mental Health: A Social Problem Associated with the Lesbian, Gay, Bisexual, and Transgender Rights in America

Lesbian, gay, bisexual, and transgender (LGBT) individuals often hail from different ethnicities, social classes, religions, and ethnicities. This group of individuals is associated with numerous social problems. These problems are driven by denial of human and civil rights, discrimination, societal stigma, and violence, among other factors. Subsequently, they affect not only the individual but also the community at large. For instance, discrimination has been linked to increased rates of suicide, substance abuse, and psychiatric disorders (Russell & Fish, 2016; Brechwald & Prinstein, 2011). Numerous factors drive mental health concerns among LGBT individuals. These include bullying, fear of rejection by family and community, anti-LGBT narratives in the media and places of worship amongst other spaces, and lastly, the stress that is associated with a hidden and stigmatized identity (Russell & Fish, 2016). Therefore, the role of anti-LGBT messages and actions cannot be overstated in exacerbating mental health issues in this group. A clear link exists between a person's acceptance or rejection by family members and his or her long-term physical and mental health. Likewise, LGBT individuals are more likely to experience substance abuse, depression, suicidal thoughts, and anxiety compared to their non-LGBT colleagues. Against this backdrop, this paper seeks to explore mental health, a social problem that is associated with LGBT rights in America.

Mental Health and Lesbian, Gay, Bisexual, and Transgender Rights in America 

Background 

In recent decades, there has been increased attention on the LGBT movement not only in America but also across the world. This has been exemplified by a rise in scientific and public awareness of LGBT issues and lives. The genesis of this increased awareness was anchored on sociocultural shifts in the conceptualization of gender and sexual identities. This was coupled with the 1970s emergence of the pro-LGBT movement and advent of diseases associated with the lifestyle such as HIV/AIDS in the 1980s. The initial research and public attention to the LGBT movement focused on mental health. Specifically, studies around the issue in the 1980s focused on increased suicidal rates among gay youth. Building on this, the last two decades have been characterized by unprecedented changes in public attitudes towards LGBT individuals and associated concerns (Russell & Fish, 2016). Likewise, research from numerous fields has also emerged, creating a solid foundation for the existing knowledge of mental health amongst LGBT individuals.

Lesbian, gay, bisexual, and transgender individuals select their gender and sexual identity labels based on how personally meaningful these labels are. In this context, sexual identities are based on peoples emotional, sexual, or romantic behaviors and attractions (Rosario et al., 2006). These attractions are likely to vary from one person to another. Also, the experiences of the group and meanings of LGBT has to be conceptualized as an intersection of various dominant social, cultural, ethnic, and personal identities (Kuper et al., 2014; Desai, n.d.). Generally, mental health patterns have been seen to be situated intersectionally. In particular, the patterns vary across gender and sexual identities as well as across ethnic, racial, social class, and cultural identities. Two critical tensions characterize the discourse on LGBT and mental health. On the one hand, various social changes influence the social acceptance of LGBT individuals and their associated issues. On the other hand, concerns about the mental health of this group have increased. Thus, the increase in mental health concerns among LGBT individuals is a social problem that cannot be ignored.

The scope over the Last 30-50 Years 

The American LGBT rights movement emerged in the 1950s. This was informed by the formation of Daughters of Bilitis and Mattachine Society in California (Associated Press, 2019). The former was a lesbian group. The first protest for gay rights took place in 1965 outside the White House. This protest was organized by Frank Kameny, a Government astronomer who was dismissed from work for being gay. In 1961, Kameny had presented his anti-discrimination case to the country's Supreme Court, but the justices refused to hear the appeal. Members of the Mattachine Society successfully staged what was called a ‘sip in' in New York in 1966 in protest to the laws that required bars not to serve alcohol to lesbians and gays (Associated Press, 2019) . It is subsequent to this protest that such terms as ‘gay liberation' and ‘gay pride' emerged. By 1969, all states except Illinois had outlawed gay sex. Likewise, psychiatric experts deemed homosexuality a mental disorder. Consequently, most LGBT individuals hid their identities so as not to lose their friends and jobs. However, an uprising of this group in New York resulted in a clash with the police around Stonewall Inn, a popular bar. This confrontation was a crucial catalyst in the global expansion of LGBT activism (Dwyer, 2014).

The historical trends of social acceptance of LGBT individuals in the United States (U.S) indicate that in 1977, about 43% of American adults reckoned that lesbian or gay relations, so long as they involved two consenting adults, ought to be legalized. Interestingly, this figure had gone up to 66% by 2013 (Gallup, 2015). In line with the changing attitudes, social acceptance of LGBT individuals has been increasing with time. For instance, the age at which LGBT individuals ‘come out' or share their gender or sexual identities to others has decreased. This average age has changed from 20 years in the 1970s, 16 years in the 1990s, and 14 years in the 2000s (D'Augelli et al., 2010). The growing social acceptance has allowed LGBT individuals to understand and accept themselves in the context of intensified publicity. Currently, these individuals ‘come out' in their youth when they are likely to face strong peer opinion and influence, and therefor victimization (Brechwald & Prinstein, 2011). Also, the age at which most youths come out coincides with a developmental period that is characterized by intensified social and interpersonal regulation of sexuality and gender, as well as homophobia. Due to this historical and social context, mental health is a challenge for LGBT individuals irrespective of the increased social acceptance.

Before the 1970s, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA) deemed homosexuality a sociopathic personality disturbance (Russell & Fish, 2016). However, studies on the psychological similarities between gay and heterosexual men as well as the prevalence of same-sex sexuality aided in changing the attitudes of the psychological community. These studies also motivated APA to, in 1973, cease considering homosexuality a mental disorder. The past 50 years have seen a change in the psychological discourse on same-sex sexuality. This is from the narrative that homosexuality is linked with poor mental health towards one geared towards exploring the social determinants of mental health challenges amongst LGBT individuals. One notable theory that has offered the foundational framework for developing a comprehensive understanding of mental health disparities amongst the minorities is the minority stress theory.

According to the minority stress theory, sexual minorities such as LGBT individuals experience chronic and distinct stressors that are associated with the group's stigmatized identities. Key aspects of this stigmatization include victimization, discrimination, and prejudice (Miller, n.d.). Coupled with everyday stressors, these elements are likely to affect the well-being and mental health of LGBT individuals disproportionately. Meyer (2003) highlights three key stress processes. Firstly, there are external or objective stressors. These include institutionalized or structural discrimination as well as the direct interpersonal interactions of prejudice or victimization. Secondly, they entail an individual's expectations that rejection or victimization is bound to occur, coupled with the associated vigilance. Lastly, there may be an internalization of various negative attitudes.

Addressing Mental Health Challenges amongst LGBT Individuals 

Individuals struggling with their gender identity and sexual orientation are bound to hesitate seeking help from mental health providers. This is chiefly due to fear of making their LGBT status known to people who may be unsupportive. As a result, health care providers should not rely on the affected LGBT individuals to share the severity or nature of their mental health conditions. Therefore, one of the most profound steps in addressing mental health challenges amongst LGBT individuals is having general practitioners with comprehensive training in identifying and responding to the initial signs of mental health concerns in LGBT individuals. This is a crucial step in mitigating the detrimental impacts of such mental health challenges as depression, among others. There is also a need to recognize other structural barriers that affect response to mental health challenges amongst LGBT individuals. Notable among these include LGBT-centric training of the health care providers, lack of monetary incentives in the treatment of LGBT individual, inadequate access to treatment services, failure and sloppiness in dealing with the intersection between substance abuse and mental health issues, and lastly, a general lack of adequate information on the health needs of LGBT individuals.

A multifaceted approach is necessary for dealing with the mental health issues associated with LGBT individuals. To start with, all medical training programs ought to revise their curricula so as to incorporate materials that touch on LGBT patients. Closely associated with this is the need to support medical education programs that foster LGBT cultural competency, particularly for providers in the public health program. Moreover, there is a need to develop LGBT cultural competency training modules, policies, tools, and goal in consultation with stakeholders from the LGBT community. All government-funded medical facilities should embrace this move while public health service personnel should be subjected to cultural competency training on how to serve the LGBT community.

To enhance access to mental health services to LGBT individuals residing in underserved and rural areas, there is a need to leverage technology. Including LGBT individuals in the healthcare sector is not only vital for workforce diversification but also crucial in promoting inclusiveness. It is essential for the government to establish LGBT-friendly health centers from where these individuals can seek help for mental health issues. To address the financial challenges associated with access to mental health services by this group, the government ought to offer financial reimbursement for such services while paying close attention to the at-risk LGBT individuals. There is also a need to avail federal funding in support of mental health prevention services that prioritize the LGBT community. Another essential strategy is to farther research on mental health while focusing on LGBT individuals. This is vital in fostering an elaborate understanding of the issue and the most appropriate response to it.

Key Concepts and their Relationship with Mental Health in the LGBT Community 

Several key concepts are vital in the discourse on mental health within the LGBT community. Notable among these include gender, sexual orientation, sexual behavior, and family values. Sexual orientation encompasses a person's object or romantic or sexual desire or attraction, and whether it is of similar or other sex that is relative to the person's individual sex (Katz-Wise et al., 2016; Barkan, 2013). The sexual orientation of LGBT individuals is either exclusively or partly focused on the same sex. Sexual orientation is closely related to gender identity. The two can be conceptualized as distinct elements of the self. In the context of gender identity, two groups emerge, which include transgender and cisgender. Transgender includes individuals whose present gender identity, as well as the sex assigned to them at birth, are inconsistent. Cisgender, on the other hand, includes individuals whose gender identity is consistent with their sex at birth. Ultimately, LGBT individuals have been seen to have higher risks of poor mental health compared to their cisgender and heterosexual counterparts.

Disparities by sexual orientation exist in health-related diagnoses, symptomatology, and risk behaviors. These disparities have been seen to persist over time and exist irrespective of the adopted definition of sexual orientation. Sexual orientation can be defined by romantic or sexual attractions, self-identification, or sexual behavior (Katz-Wise et al., 2016; Barkan, 2013). Self-identification may be bisexual, gay, lesbian, heterosexual, other identities, or a combination of different identities. Sexual behavior, on the other hand, entails a wide array of behaviors via which individuals express their sexuality (Sewell et al., 2017; Barkan, 2013). These could vary from solitary sex such as masturbation to partnered sex that could either be either intercourse, non-penetrative, or oral. Disparities by gender identity have been identified in which case transgender individuals are likely to experience poor mental health compared to their cisgender counterparts.

The mental health challenges of LGBT individuals are linked to the stress associated with stigma. This stress is conceptualized as stigmatization when driven by other persons. However, it can also be internalized in which case an individual victimizes himself or herself. Individuals may victimize themselves by harboring negative attitudes towards homosexuality. This is referred to as internalized homophobia or homonegativity. Besides interpersonal and internalized stigma, individuals may experience structural stigma (Katz-Wise et al., 2016; White et al., 2016). This refers to the stigma associated with societal level laws, policies, and norms. The most critical aspect in this regard is family rejection or acceptance. Both familial attitudes and support towards LGBT individuals influence well-being, disclosure, and self-acceptance, which ultimately determine the mental health status. Perceived acceptance of an individual's sexual identity by his or her family has been seen to result in increased levels of self-acceptance. Often, families struggle to balance their deeply held personal and religious values with their love for LGBT family members (Ryan et al., 2010). For instance, a family's high religious involvement is likely to be associated with low acceptance of LGBT family members. Nevertheless, acceptance at the family level reduces an individual's stress levels and protects him or her against mental health challenges.

Conflict Theory and its Relationship with Mental Health Challenges amongst LGBT Individuals 

Proposed by Karl Max, the conflict theory postulates that the society is often in a state of continuous conflict owing to competition for the limited available resources. Thus, social order is established through power and domination as opposed to conformity and consensus (Koskenniemi, 2004). Accordingly, the individuals with power and wealth often protect it through suppression of the powerless and poor. Also, groups and individuals in society work towards maximizing their benefits. Another important postulation of this theory is that a society's political and economic structures are responsible for creating social conflicts, inequalities, and divisions. Conflict theories are also conceptualized as social science views emphasizing a social group's material, political, and social inequality. These views may also critique the larger socio-political system. Sociologists reckon that some conflict theories play a crucial role in exposing the ideological aspects that inform the traditional thought.

Based on the conflict theory, the creation of social structures is anchored on conflicts between individuals of different resources and interests. These resources and interests are also influenced by the social structures as well as the unequal distribution of societal resources and power. Thus, conflict theory can be used in understanding queerness, the LGBT movement, and mental health issues associated with this group. In this regard, stigmatization and victimization of LGBT individuals are owed to the fact that their ways are seen to deviate from the acceptable social norms. However, these norms may be conceptualized as rigid social organizing categories that don't explain variations in conditions, behaviors, and attitudes of individual experiences (Renn, 2007). Thus, they are correlated to power distribution and the need to maintain a status quo. Consequently, mental health issues in the LGBT community can be traced back to the non-conformity of this group to the social norms and the reaction of the general populace to this phenomenon.

References 

Associated Press, (2019). 50 Years After Stonewall, LGBT Rights Are a Work in Progress. Retrieved from https://www.usnews.com/news/us/articles/2019-06-17/50-years-after-stonewall-lgbt-rights-are-a-work-in-progress 

Barkan, S. E. (2013). Social problems: Continuity and change . Flat World Knowledge, Incorporated.

Brechwald, W. A., & Prinstein, M. J. (2011). Beyond homophily: A decade of advances in understanding peer influence processes. Journal of Research on Adolescence , 21 (1), 166-179.

Brown, S. (n.d.). Demographic structure of society - sex, gender, and sexual orientation. Retrieved from https://www.khanacademy.org/test-prep/mcat/society-and-culture/demographics/v/demographic-structure-of-society-sex-gender-and-sexual-orientation 

D'Augelli, A. R., Grossman, A. H., Starks, M. T., & Sinclair, K. O. (2010). Factors associated with parents' knowledge of gay, lesbian, and bisexual youths' sexual orientation. Journal of GLBT family studies , 6 (2), 178-198.

Desai, S. (n.d.). Self-concept, self-identity, and social identity. Retrieved from https://www.khanacademy.org/test-prep/mcat/individuals-and-society/self-identity/v/self-concept-self-identity-social-identity 

Dwyer, A. (2014). Pleasures, perversities, and partnerships: The historical emergence of LGBT-police relationships. In Handbook of LGBT communities, crime, and justice (pp. 149-164). Springer, New York, NY.

Gallup (2015). Gay and Lesbian Rights. Retrieved from https://news.gallup.com/poll/1651/gay-lesbian-rights.aspx 

Katz-Wise, S. L., Rosario, M., & Tsappis, M. (2016). LGBT youth and family acceptance. Pediatric Clinics of North America , 63 (6), 1011.

Koskenniemi, M. (2004). What should international lawyers learn from Karl Marx? Leiden Journal of International Law , 17 (2), 229-246.

Kuper, L. E., Coleman, B. R., & Mustanski, B. S. (2014). Coping with LGBT and racial–ethnic ‐ related stressors: A mixed ‐ methods study of LGBT youth of color. Journal of Research on Adolescence , 24 (4), 703-719.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin , 129 (5), 674.

Miller, B. (n.d.). Prejudice and discrimination based on race, ethnicity, power, social class, and prestige. Retrieved from https://www.khanacademy.org/test-prep/mcat/individuals-and-society/perception-prejudice-and-bias/v/prejudice-and-discrimination-based-on-race-ethnicity-power-social-class-and-prestige 

Renn, K. A. (2007). LGBT student leaders and queer activists: Identities of lesbian, gay, bisexual, transgender, and queer identified college student leaders and activists. Journal of College Student Development , 48 (3), 311-330.

Rosario, M., Schrimshaw, E. W., Hunter, J., & Braun, L. (2006). Sexual identity development among lesbian, gay, and bisexual youths: Consistency and change over time. Journal of sex research , 43 (1), 46-58.

Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual review of clinical psychology , 12 , 465-487.

Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing , 23 (4), 205-213.

Sewell, K. K., McGarrity, L. A., & Strassberg, D. S. (2017). Sexual behavior, definitions of sex, and the role of self-partner context among lesbian, gay, and bisexual adults. The Journal of Sex Research , 54 (7), 825-831.

White, Y., Sandfort, T., Morgan, K., Carpenter, K., & Pierre, R. (2016). Family relationships and sexual orientation disclosure to family by gay and bisexual men in Jamaica. International Journal of Sexual Health , 28 (4), 306-317.

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