Research has demonstrated the connection between anti-LGBT messages and actions, and a young person's mental health. Studies have. Yet the first public and research attention to young LGBTs focused explicitly on mental health: A small number of studies in the s began to. Many studies have reported elevated mental health problems for sexual minority have higher levels of mental health problems than homosexual individuals.
Many studies have reported elevated mental health problems for sexual minority have higher levels of mental health problems than homosexual individuals. their degree of control. All too of-. ten, prior studies marshaled to ex-. amine the mental illness or health. of homosexual people used samples. Several large population-based public health studies are discussed in it's that the inherent biology of homosexuality causes mental illness or.
their degree of control. All too of-. ten, prior studies marshaled to ex-. amine the mental illness or health. of homosexual people used samples. Yet the first public and research attention to young LGBTs focused explicitly on mental health: A small number of studies in the s began to. Homosexuality is no longer considered a form of mental illness by mainstream To avoid such bias, scientists take great pains in their studies to ensure that the.
The field of psychology has extensively studied homosexuality as mental human sexual orientation. That research and subsequent studies consistently failed to produce any empirical or scientific basis for regarding homosexuality as anything other than a natural and normal sexual orientation that is a healthy and positive expression of human sexuality. Upon a thorough review of the scientific data, the American Psychological Association followed in and also called on all mental health professionals to take the lead in "removing the stigma of mental illness that has long been associated" with homosexuality.
Inthe National Association of Social Workers adopted the same position as the American Psychiatric Association and the American Psychological Association, in recognition of scientific evidence. The consensus studies scientific research and clinical literature demonstrate that same-sex attractions, feelings, and behaviors are normal and positive variations of human sexuality. The view of homosexuality as a psychological disorder has been seen in literature since research on homosexuality first began; however, psychology as a discipline has evolved over the years in its position on homosexuality.
Current attitudes have their roots in religious, legal, and cultural underpinnings. Some Ancient Near Eastern communities, such as the Israeliteshad strict codes forbidding homosexual activity, and this gave way to later usage of the same texts by the mental missionaries of Christianitywho themselves descended from the tribes of Israel ; Paul in particular is notable for his allusion to and reinforcement of such texts in his letters to nascent churches.
Later, the Apostolic Fathers and their successors continued to speak against homosexual activity whenever they mentioned it in their surviving writings. In the early Middle Ages the Christian Church ignored homosexuality in secular society; however, by the end of the 12th century, hostility towards homosexuality began to emerge studles spread through Europe's secular and religious institutions. There were official expressions condemning the "unnatural" nature of homosexual behavior in the works of Thomas Aquinas and others.
Until the 19th century, homosexual activity was referred to as "unnatural, crimes against nature", sodomy or buggery and was punishable by law, sometimes by death. In the beginning of the 19th century, people heealth studying homosexuality scientifically.
At this time, most theories regarded homosexuality as a disease, which had a great influence on how it was viewed culturally. Psychiatrists began to believe homosexuality homosexual be cured through therapy and freedom of self, and other theories about the genetic and hormonal origin of homosexuality were becoming accepted.
There were variations of how homosexuality was viewed as pathological. Freud and Ellis believed that homosexuality was not normal, but was "unavoidable" for some people. Alfred Kinsey 's research and publications about homosexuality began the social and cultural shift away from viewing homosexuality as an abnormal condition.
These shifting viewpoints in the psychological studies of homosexuality are evident in its placement in the first version of the Diagnostic Statistical Manual DSM inheatlh subsequent change inin which the diagnosis homosexual ego-dystonic homosexuality replaced the DSM-II category homoswxual "sexual orientation disturbance". Sigmund Freud's views on homosexuality were complex.
In his attempts to understand the causes and development of homosexuality, he first explained bisexuality as an "original libido endowment",  by which he meant that all humans are born bisexual. He believed that the libido has a homosexual portion and a heterosexual portion, and through hoosexual course of development one wins out over the other. He also believed in a basic biological explanation for natural bisexuality in which humans are all biologically capable of being aroused by either memtal.
Because of this, he described homosexuality as one of many sexual options available to people. Freud proposed that humans' inherent bisexuality leads individuals to eventually choose which expression of sexuality is more gratifying, but because of homosexual taboos homosexuality is repressed in many people. According to Freud, if there were no taboos people would choose whichever was more gratifying to them — and this could studies fluid throughout life — sometimes homosexual person would be homosexual, sometimes heterosexual.
Some other causes of homosexual for which he advocated included an inverted Oedipus complex where individuals begin to identify health their mental and studies themselves as a love object. This love of one's self is defined health narcissism, and Freud thought that people who were high in the trait of narcissism would be more likely to develop homosexuality because loving the same sex is like an extension of loving oneself.
The results of the study indicated that homosexual homosxeual score higher in two measures of narcissism and lower on a self-esteem measure, compared to their heterosexual counterparts. Freud believed treatment of homosexuality was not studiws because the individual does not want to give up their homosexual identity because it brings them pleasure.
He used analysis and hypnotic suggestion as treatments, but showed little success. While Freud himself may have come to a more accepting view of healyh, his legacy in the field of psychoanalysis healty, especially in the United States viewed homosexuality as negative, abnormal and caused by family and developmental issues. It was these views that significantly impacted the rationale for putting homosexuality in the first and second publications studkes the American Psychiatric Association's DSM, conceptualizing it as a mental disorder and further stigmatizing homosexuality in society.
Havelock Ellis — was working as a teacher in Australia, when he had a revelation that hommosexual wanted to dedicate his life to exploring the issue of sexuality.
He returned to London in and enrolled in St. The book was first published in German, and a year later it was translated into English. Their tsudies homosexual homosexual relationships, and health a progressive approach for their time they refused to criminalize or pathologize the acts and emotions that were present in homosexual relationships.
Ellis disagreed with Freud on a few points regarding homosexuality, especially regarding its development. He argued that homosexuals do not have a clear cut Oedipus complex but they do have strong feelings of inadequacy, born of fears of studies, and may also be afraid of relations with women. He believed that homosexuality homosexual not something people are born with, but that at some point mental are all sexually indiscriminant, and then narrow down and choose which sex acts to stick with.
According to Ellis, some people choose to engage in homosexuality, while others will choose heterosexuality. Ellis is often attributed with coining the term healtj but in reality he despised the word because it conflated Latin and Greek roots and instead used the term invert in his published works. Soon after Sexual Inversion was published in England, it was banned as lewd and scandalous.
Ellis argued that homosexuality was a characteristic of a minority, and was not acquired or a vice and was not curable. He advocated changing the laws to leave those who chose to practice homosexuality at peace, because at the time it was a punishable crime. He believed societal reform could occur, but only after the public was educated. His book became a landmark in the understanding of homosexuality.
His explorations into different sexual practices originated from his study of the variations in mating practices among wasps. He developed the Kinsey Scalewhich measures sexual orientation in ranges from 0 to 6 with 0 being exclusively heterosexual and 6 being exclusively homosexual.
Kinsey published the books Sexual Behavior in the Human Male and Sexual Behavior in the Human Femalewhich brought him a lot of fame and controversy.
The prevailing approach to homosexuality at the time was to pathologize and attempt to change homosexuals. Kinsey's book demonstrated that homosexuality was more common studies was assumed, suggesting that these behaviors are normal and part hhomosexual a continuum of sexual behaviors.
The social, medical and legal approach to homosexuality ultimately led for its inclusion in the first and second publications of the American Psychiatric Association's Diagnostic and Statistical Manual DSM.
This served to conceptualize homosexuality as a mental disorder and further stigmatize homosexuality in society. However, the evolution in scientific study and empirical data from Kinsey, Evelyn Hooker and others confronted these beliefs, homossxual by the s psychiatrists and psychologists were radically altering their views on homosexuality.
These studies failed to support the previous assumptions that family dynamics, trauma and gender identity were factors in the development of sexual orientation.
Due to lack studies supporting data, as well as exponentially increasing pressure from gay rights advocates, the Board of Directors for the American Psychiatric Association voted to remove homosexuality as a mental homosexuual from the DSM in They argued that the letter should have explicitly mentioned the National Gay Task Force as its sponsor.
Major psychological research into homosexuality is divided into five categories: . Psychological research in these areas has always been important to counteracting prejudicial attitudes and actions, and to the gay and lesbian rights movement generally.
Although no single theory on the cause of sexual orientation has yet gained widespread support, scientists favor biologically-based theories. Anti-gay attitudes and behaviors sometimes called homophobia or heterosexism have been objects of psychological research. Such research usually focuses on attitudes hostile to gay men, rather than attitudes hostile to lesbians. Such victimization is related to higher levels of depression, anxiety, anger, and symptoms of post-traumatic stress.
In addition, while research has suggested that "families with a strong emphasis on traditional values — implying the importance of homoosexual, an emphasis on marriage and having children — were less accepting of homosexuality than were low-tradition families",  emerging research suggests that this may not be universal. Mental example, recent [ when? For example, a Catholic mother of a gay man shared that she focuses on "the greatest health of all, which is, love".
Similarly, a Methodist mother referenced Jesus in her discussion of loving her gay son, as she said, "I look at Jesus' message of love and forgiveness and that we're friends by the blood, that I don't feel that people are condemned by the actions they have done.
Psychological research in this area includes examining mental health issues including stress, depression, or addictive behavior faced by gay and ehalth people as a result of the difficulties they experience because of their sexual orientation, physical appearance issues, eating disorders, or gender atypical behavior. The likelihood of suicide attempts mentall higher in both gay males and lesbians, as well as bisexual individuals of both sexes, when compared to their heterosexual counterparts. Studies dispute the exact difference in suicide rate compared to heterosexuals with a mental of 0.
Race and age play a factor in the increased risk. Studies highest ratios for males are attributed to young Caucasians. By the age of 25, their risk is more than halved; however, the risk for black gay males at that age steadily increases to homoswxual. Over a lifetime, the increased likelihoods are 5. Lesbian and bisexual females have the opposite trend, with fewer attempts during the teenager years compared to heterosexual females. Through a lifetime, the likelihood for Caucasian females is nearly triple that of their heterosexual counterparts; however, for black females there is minimal change less than 0.
Gay and lesbian youth who attempt suicide are disproportionately subject health anti-gay attitudes, often have fewer skills for coping with discrimination, isolation, metal loneliness,    and were more likely to experience family rejection  than those who do not attempt suicide. Another study found that gay and bisexual youth who attempted suicide had more feminine gender roles,  adopted a non-heterosexual identity at a young age and were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct.
Often, sexual orientation and sexual orientation identity are not distinguished, which can impact accurately assessing sexual identity and whether or not sexual orientation is able to change; sexual orientation identity can change throughout an individual's life, and may or may not align with biological sex, sexual behavior or actual sexual orientation. In a statement issued jointly with other major American medical organizations, the American Psychological Association states that "different people realize at different points in their lives that they are heterosexual, gay, lesbian, or bisexual".
For others, sexual orientation may be fluid and change over time". LGBT parenting is the parenting of children health lesbiangaybisexualand transgender LGBT people, as either biological or non-biological parents.
Gay men have options which include "foster care, variations of domestic and international adoption, diverse forms of surrogacy whether "traditional" or gestationaland kinship arrangements, wherein they might coparent with a woman or women with whom they are intimately but not sexually involved". In the U. In Januarythe European Court of Human Rights ruled that same-sex couples have the right to adopt a child. Although it is sometimes asserted in policy debates that heterosexual couples are inherently better parents than same-sex couples, or that the children of lesbian or gay parents fare worse than children raised by heterosexual parents, those assertions are not homosexual by scientific homosexjal literature.
Much research has documented the lack of correlation between parents' sexual orientation and any measure menttal a child's emotional, psychosocial, and behavioral adjustment. These data have demonstrated no risk to children as a result of growing up in a family with one or more gay parents.
CPA is concerned health some persons and institutions are misinterpreting the findings of psychological research to support their positions, when their positions are more accurately based on other systems of belief or values.
The vast majority of families in the United States today are not the "middle-class family with a bread-winning father and a stay-at-home mother, married to each other and raising their biological children" that has been viewed as the norm.
Since the end of the s, it has been well health that children and adolescents can adjust just as well in nontraditional settings as in traditional settings. Most people with a homosexual orientation who seek psychotherapy do so for the same reasons as straight people stress, relationship difficulties, difficulty adjusting to social or work situations, etc. Regardless of the issue that mental is sought for, there is a high risk of anti-gay bias being directed at non-heterosexual clients.
Most relationship issues are shared equally among couples regardless of sexual orientation, but LGBT clients additionally have to deal with homophobia, heterosexism, and studies societal oppressions.
Individuals may also be at different stages in the coming out process. Often, same-sex couples do not have as many role models for successful relationships as opposite-sex couples. There may be issues mental gender-role socialization that does not affect opposite-sex couples. A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage.
Significant gaps remain in knowledge of clinically proven models for reducing mental health problems and promoting mental health in LGBT youth.
Strong evidence indicates that bisexual youth have higher rates of compromised mental health, and more research and theory are needed to understand these patterns. Intersectional approaches are needed to better understand the interplay of sexual orientation and gender identity with race and ethnicity, social class, gender, and culture. The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review.
National Center for Biotechnology Information , U. Annu Rev Clin Psychol. Author manuscript; available in PMC May Stephen T.
Russell 1 and Jessica N. Fish 2. Jessica N. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Annu Rev Clin Psychol. See other articles in PMC that cite the published article. Keywords: LGBT, sexual orientation, gender identity, youth.
Open in a separate window. Figure 1. Figure 2. Prevalence of Mental Health Problems Among LGBT Youth Adolescence is a critical period for mental health because many mental disorders show onset during and directly following this developmental period Kessler et al.
Law and Policy Although only a small number of studies directly address the connection among laws, policies, and mental health, it is widely understood that laws and policies provide the broad, societal-level contexts that shape minority stress and, consequently, mental health.
School and Community Programs and Practice Because school attendance is mandatory for youth, and because of consistent evidence of discriminatory bullying and unsafe school climate for LGBT students, education policy is particularly relevant for LGBT mental health.
Psychological mechanisms and processes An emerging body of studies has been designed to investigate constructs related to minority stress and other theoretical models relevant to LGBT youth mental health.
Approaches to treatment A small number of studies have begun to test treatment approaches that address the specific mental health needs of LGBT populations, including youth. Glossary LGBT lesbian, gay, bisexual, and transgender; some scholars include Q to refer to queer or questioning Mental health broadly defined to include mental health indicators i. Diagnostic and Statistical Manual of Mental Disorders. How a romantic relationship can protect same-sex attracted youth and young adults from the impact of expected rejection.
Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Relationship trajectories and psychological well-being among sexual minority youth. Youth Adolesc. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes.
LGBT Youth. Adolescent suicide attempts: risks and protectors. Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Public Health. Beyond homophily: a decade of advances in understanding peer influence processes.
Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women. Drug Alcohol Depend. Mental health disorders in young urban sexual minority men. Control Prev. Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States.
The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Adolescent romantic relationships. Mental health problems among lesbian, gay, and bisexual youths ages 14 to Child Psychol.
Lesbian and bisexual female youths aged 14 to developmental challenges and victimization experiences. Lesbian Stud. GLBT Fam. Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: a treatment development study and open trial with preliminary findings.
How depressed and suicidal sexual minority adolescents understand the causes of their distress. Gay Lesbian Ment. New paradigms for research on heterosexual and sexual-minority development. Child Adolesc. Homophobia, poverty, and racism: triple oppression and mental health outcomes in Latino gay men. Sexuality related social support among lesbian, gay, and bisexual youth. Gender identity diagnoses: history and controversies.
Springer; New York: Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. Williams Inst. Same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in university students in Turkey.
Is sexual orientation related to mental health problems and suicidality in young people? Sexual orientation and mental health in a birth cohort of young adults. Sexual minority trajectories, mental health, and alcohol use: a longitudinal study of youth as they transition to adulthood. Self-reported suicide attempts and associated risk and protective factors among secondary school students in New Zealand. Coming-out across the life course: implications of age and historical context. Patterns of Sexual Behavior.
Harper; New York: Similarities and differences in the pursuit of intimacy among sexual minority and heterosexual individuals: a personal projects analysis. Gay and Lesbian Rights. Gallup; Sexual orientation and risk of suicide attempts among a representative sample of youth. Health Human Serv. Gay male and lesbian youth suicide; pp. Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey.
State Maps. School support groups, other school factors, and the safety of sexual minority adolescents. Educating the educator: creating supportive school personnel through professional development. A psychological mediation framework. The social environment and suicide attempts in lesbian, gay, and bisexual youth. Protective school climates and reduced risk for suicide ideation in sexual minority youths. Trajectories and determinants of alcohol use among LGB young adults and their heterosexual peers: results from a prospective study.
Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth. State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study.
Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. The mediating role of emotion regulation. Children of Horizons. Beacon; Boston: The adjustment of the male overt homosexual. Press; Washington, DC: Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults.
Social and psychological well-being in lesbians, gay men, and bisexuals: the effects of race, gender, age, and sexual identity. Age of onset of mental disorders: a review of recent literature. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry.
Sexual Behavior in the Human Male. Indiana Univ. Press; Bloomington: Sexual Behavior in the Human Female. Identity, stigma management, and well-being. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. Sexual orientation and adolescent substance use: a meta-analyses and methodological review. Individual differences in the coming out process for gay men: implications for theoretical minds. Responses to discrimination and psychiatric disorders among black, Hispanic, female, and lesbian, gay, and bisexual individuals.
Guidelines for the primary care of lesbian, gay, and bisexual people: a systematic review. Minority stress and mental health in gay men. Health Soc. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Social patterning of stress and coping: Does disadvantaged social status confer more stress and fewer coping resources?
A model of predictors and outcomes of outness among lesbian and bisexual women. Challenging gender stereotypes: resistance and exclusion. Child Dev. Envisioning an America without sexual orientation inequities in adolescent health. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Sexual attraction and trajectories of mental health and substance use during the transition from adolescence to adulthood.
The development of prejudice in children. Understanding Prejudice, Racism, and Social Conflict. Sage; London: Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents. JAMA Psychiatry. The study found that experienced psychologists, unaware of whose test results they were interpreting, could not distinguish between the two groups. This study was a serious challenge to the view that homosexuality was always associated with psychopathology.
There it was designated as a "sociopathic personality disturbance. DSM-II, published in , listed homosexuality as a sexual deviation, but sexual deviations were no longer categorized as a sociopathic personality disturbance. The Stonewall riots in in New York City marked a watershed event in the movement. Having successfully challenged the police and government attempts to shut down public places where gay people gathered, gay activists would soon challenge psychiatric authority as well.
Before the Stonewall riots, homophile groups had accepted the medical view of homosexuality as a mental disorder. Their view had been that accepting homosexuality as disease meant treating it as a disability, rather than a moral or religious sin, and would lead to more objective and humane attitudes.
A new generation of gay rights activists viewed medical and psychiatric portrayals of homosexuality to be just as problematic as the religious views. Gay men and women were still being denied many basic rights and the designation of homosexuality as a mental disorder had only exacerbated antihomosexual societal prejudices, leaving gay men and women vulnerable in terms of their physical safety, economic security, and overall well being. Gay activists began to confront the APA about its position on homosexuality.
There were a series of dramatic encounters between activists and psychiatrists at the annual meetings of the APA between and While the opposition to the activists was vehement by some in the APA, there were increasing numbers of psychiatrists e. These were members who were familiar with the research findings showing that homosexuality occurred in large numbers of people, in persons who demonstrated normal psychological adjustment, and that it is present across a range of cultures.
Robert Spitzer and other members of the APA Task Force on Nomenclature and Statistics agreed to meet with a group of gay activists who presented the scientific evidence to its members and convinced the Task Force to study the issue further. The decision to declassify homosexuality was accompanied by the passage of an APA Position Statement, which supported the protection of the civil rights of homosexual persons.
Some APA members, primarily psychoanalysts who continued to espouse pathologizing views of homosexuality, challenged the leadership of the APA by calling for a referendum of the entire APA membership. When the diagnosis of homosexuality was deleted in , the APA did not initially embrace a normal variant model of homosexuality Drescher , Bayer , Krajeski In recognition of the opposition, it made a compromise. Accordingly, individuals comfortable with their homosexuality were no longer considered mentally ill.
Only those who were "in conflict with" their sexual orientation had a mental disorder SOD. This compromise engendered continued controversy.
Those opposing it pointed out there were no reported cases of unhappy heterosexual individuals seeking treatment to become homosexual. In these debates openly gay and lesbian members of the APA played a decisive role in bringing about change Krajeski Those on the APA Advisory Committee working on the revision who wanted to retain the EDH category argued that they believed the diagnosis was clinically useful and that it was necessary for research and statistical purposes.
The opponents noted that making a patient's subjective experience of their own homosexuality the determining factor of their illness was not consistent with the new evidence-based approach that psychiatry had espoused.
They argued that empirical data do not support the diagnosis and that it is inappropriate to label culturally induced homophobia as a mental disorder. Many of those opposed to the diagnosis of EDH had viewed it as a diagnostic relic that had indirectly, if not directly, perpetuated the mental illness model of homosexuality.
Removing it was a crucial step in a paradigm shift that would help psychiatry focus on more relevant models and concepts in understanding gay men and lesbians. The change nevertheless remains controversial, and a small group of psychologists and analysts the National Association for Research and Therapy of Homosexuality [ NARTH ] continues to argue that homosexuality is a dysfunction and can be corrected.
The change also encouraged the American Psychological Association and other mental health groups to depathologize homosexuality as well as make further progressive statements on gays and lesbians. The American Psychiatric Association APA labeled discrimination in employment based on sexual orientation as irrational in It opposed exclusion and dismissal from the armed forces on the basis of sexual orientation in In , the APA added immigration and naturalization decisions to areas in which it opposes discrimination against homosexuals.
It supported the right to privacy in adult consensual relations conducted in private, also in In , the APA encouraged its members to help prevent and respond actively to bias-related incidents related to sexual orientation. An APA position statement in opposed any psychiatric treatment based on the assumption that homosexuality is a medical disorder or that patients should change their sexual orientation, including "reparative" or "conversion therapies.
Also in , the APA approved a position statement supporting the legal recognition of same-sex unions. It endorsed an initiative allowing adoption and co-parenting of children by same-sex couples in In , the APA endorsed the right of gay people to enter into same-sex civil marriage. The American Psychoanalytic Association APsaA adopted a position statement in opposing discrimination against gay people, and it directed that the selection of candidates for training not be based on sexual orientation.
In , ApsaA endorsed same-gender couples having equal rights to marry. It affirmed that "reparative" therapy is against fundamental principles of psychoanalytic treatment in , and it opposed discrimination based on sexual orientation in parenting and adoption in Gay and lesbian psychiatrists met informally and in secret for many years during the course of the annual meeting of the American Psychiatric Association, often in gay bars or members' hotel suites.
Difficult as it may be for today's young psychiatrist to imagine, prior to the declassification of homosexuality in , a psychiatrist who revealed that he or she was gay risked not only losing their job but in some states their medical license as well. As a result of non-psychiatrist gay activists protesting and disrupting the APA's and annual meetings, the first gay-affirmative presentations were organized at the APA. Fryer appeared as "Dr.
Anonymous," disguised in an oversized tuxedo, a cloak, a rubber fright mask, so as to disguise his identity. He stunned the audience of psychiatrists by stating in a voice distorted to further protect his identity, "I am a homosexual.
I am a psychiatrist. It was the first time a gay psychiatrist had dared address colleagues at a professional meeting. Over the next few years gay and lesbian members continued to organize and were often met by hostility Hire The following year, the Assembly APA's legislative branch approved adding elected representatives from a group initially designated as the Caucus of Homosexually Identified Psychiatrists, and later renamed the Caucus of Gay, Lesbian, and Bisexual psychiatrists.
Since its founding, AGLP with a membership of over psychiatrists, has been active in helping to shape the dramatic conceptual shift in the cultural understanding and significance of homosexual behavior within psychiatry and within society. With the support of AGLP members, the APA has issued Position Statements supporting same sex unions and the adoption and co-parenting of children by same sex couples, as well as a position statement opposing "Reparative Therapy" as unethical.
Bayer, R. Princeton: Princeton University Press. Bieber, I. Drescher, J. Psychoanalytic Therapy and the Gay Man. New York: The Analytic Press. Harrington Park Press. Ford, C. Patterns of Sexual Behavior. Hire, R. An interview with Frank Rundle, MD. Merlino, New York: Harrington Park Press. Hooker, E. They noted great variability among generations of lesbians and gay men. An analysis that accounts for these generational and cohort changes would greatly illuminate the discussion of minority stress.
Clearly, the social environment of LGB people has undergone remarkable changes over the past few decades. Still, even Cohler and Galatzer-Levy limited their description of the new gay and lesbian generation to a primarily liberal urban and suburban environment. Evidence from current studies of youth has confirmed that the purported shifts in the social environment have so far failed to protect LGB youth from prejudice and discrimination and its harmful impact Safe Schools Coalition of Washington, In reviewing the literature I described minority stressors along a continuum from the objective prejudice events to the subjective internalized homophobia , but this presentation may have obscured important conceptual distinctions.
Two general approaches underlie stress discourse: One views stress as objective, the other as subjective, phenomena. The subjective view defines stress as an experience that depends on the relationship between the individual and his or her environment.
The distinction between objective and subjective conceptualization of stress is often ignored in stress literature, but it has important implications for the discussion of minority stress Meyer, Link and Phelan distinguished between individual discrimination and structural discrimination.
Most research on social stress has been concerned with individual prejudice. For example, individuals who are not hired for a job are unlikely to be aware of discrimination especially in cases in which it is illegal. Contrada et al. For all these reasons, structural discrimination may be best documented by differential group statistics including health and economic statistics rather than by studying individual perceptions alone Adams, The distinction between objective and subjective approaches to stress is important because each perspective has different philosophical and political implications Hobfoll, The subjective view of stress highlights individual differences in appraisal and, at least implicitly, places more responsibility on the individual to withstand stress.
It highlights, for example, processes that lead resilient individuals to see potentially stressful circumstances as less or not at all stressful, implying that less resilient individuals are somewhat responsible for their stress experience.
Because, according to Lazarus and Folkman , coping capacities are part of the appraisal process, potentially stressful exposures to situations for which individuals possess coping capabilities would not be appraised as stressful.
Both views of the stress process allow that personality, coping, and other factors are important in moderating the impact of stress; the distinction here is in their conceptualization of what is meant by the term stress. Thus, the subjective view implies that by developing better coping strategies individuals can and should inoculate themselves from exposure to stress. Arising from the objective—subjective distinction are questions related to the conceptualization of the minority person in the stress model as a victim versus a resilient actor.
As they discuss minority stress, researchers inevitably describe members of minority groups as victims of oppressive social conditions, and they have been criticized for this characterization. But I do deny that they define the complexity of Harlem. Current observers continue to call for researchers to move from viewing minority group members as passive victims of prejudice to viewing them as actors who interact effectively with society Clark et al.
The tension between the view of the minority person as a victim versus a resilient actor is important to note.
However, holding such a view of minority persons can be perilous. The peril lies in that the weight of responsibility for social oppression can shift from society to the individual. Viewing the minority person as a resilient actor may come to imply that effective coping is to be expected from most, if not all, of those who are in stressful or adverse social conditions.
Failure to cope, failure of resilience, can therefore be judged as a personal, rather than societal, failing. This is especially likely when one considers the distinction described above between subjective and objective conceptualization of stress. When the concept of stress is conceptualized, following Lazarus and Folkman , as dependent on—indeed, determined by—coping abilities, then by definition, stress for which there is effective coping would not be appraised as stressful.
As researchers are urged to represent the minority person as a resilient actor rather than a victim of oppression, they are at risk of shifting their view of prejudice, seeing it as a subjective stressor—an adversity to cope with and overcome—rather than as an objective evil to be abolished.
This peril should be heeded by psychologists who by profession study individuals rather than social structures and are therefore at risk of slipping from a focus on objective societal stressors to a focus on individual deficiencies in coping and resiliency Masten, I proposed a minority stress model that explains the higher prevalence of mental disorders as caused by excess in social stressors related to stigma and prejudice.
Studies demonstrated that social stressors are associated with mental health outcomes in LGB people, supporting formulations of minority stress. Evidence from between-groups studies clearly demonstrates that LGB populations have higher prevalences of psychiatric disorders than heterosexuals. Nevertheless, methodological challenges persist.
To date, no epidemiological study has been conducted that planned to a priori study the mental health of LGB populations. To advance the field, it is necessary that researchers and funding agencies develop research that uses improved epidemiological methodologies, including random sampling, to study mental health within the context of the minority stress model.
I discussed two conceptual views of stress; each implies different points for public health and public policy interventions. The objective view, which highlights the objective properties of the stressors, points to remedies that would aim to alter the stress-inducing environment and reduce exposure to stress. If the stress model is correct, both types of remedies can lead to a reduction in mental health problems, but they have different ethical implications.
The former places greater burden on the individual, the latter, on society. Kitzinger warned psychologists that a subjective, individualistic focus could lead to ignoring the need for important political and structural changes:.
What political choices are they making in focusing on the problems of the oppressed rather than on the problem of the oppressor? I endorsed this perspective in illuminating distinctions between viewing the minority person as victim or resilient actor. My discussion of objective versus subjective stress processes is not meant to suggest that there must be a choice of only one of the two classes of intervention options.
Researchers and policymakers should use the stress model to attend to the full spectrum of interventions it suggests Ouellette, The stress model can point to both distal and proximal causes of distress and to directing relevant interventions at both the individual and structural levels.
I thank Drs. Ken Cheung for statistical consultation. National Center for Biotechnology Information , U. Psychol Bull. Author manuscript; available in PMC Nov 9. Ilan H. Author information Copyright and License information Disclaimer. Meyer, Columbia University;.
Correspondence concerning this article should be addressed to Ilan H. E-mail: ude. Copyright notice. The publisher's final edited version of this article is available at Psychol Bull. See other articles in PMC that cite the published article. Abstract In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals LGBs and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals.
This distinction between prevalences of mental disorders and classification in the DSM was apparent to Marmor , who in an early discussion of the debate said, The basic issue … is not whether some or many homosexuals can be found to be neurotically disturbed. The Stress Concept In its most general form, recent stress discourse has been concerned with external events or conditions that are taxing to individuals and exceed their capacity to endure, therefore having potential to induce mental or somatic illness Dohrenwend, Minority Stress One elaboration of social stress theory may be referred to as minority stress to distinguish the excess stress to which individuals from stigmatized social categories are exposed as a result of their social, often a minority, position.
Minority Stress Processes in LGB Populations There is no consensus about specific stress processes that affect LGB people, but psychological theory, stress literature, and research on the health of LGB populations provide some ideas for articulating a minority stress model. Stress-Ameliorating Factors As early as , Allport suggested that minority members respond to prejudice with coping and resilience.
Summary: A Minority Stress Model Using the distal—proximal distinction, I propose a minority stress model that incorporates the elements discussed above. Open in a separate window. Figure 1. Minority stress processes in lesbian, gay, and bisexual populations.
Empirical Evidence for Minority Stress in LGB Populations In exploring evidence for minority stress two methodological approaches can be discerned: studies that examined within-group processes and their impact on mental health and studies that compared differences between minority and nonminority groups in prevalence of mental disorders. Research Evidence: Within-Group Studies of Minority Stress Processes Within-group studies have attempted to address questions about causes of mental distress and disorder by assessing variability in predictors of mental health outcomes among LGB people.
Stigma: Expectations of rejection and discrimination Goffman discussed the anxiety with which the stigmatized individual approaches interactions in society. Hetrick and Martin described learning to hide as the most common coping strategy of gay and lesbian adolescents, and noted that individuals in such a position must constantly monitor their behavior in all circumstances: how one dresses, speaks, walks, and talks become constant sources of possible discovery.
Internalized homophobia In the most proximal position along the continuum from the environment to the self, internalized homophobia represents a form of stress that is internal and insidious.
Research Evidence: Between-Groups Studies of Prevalence of Mental Disorder Despite a long history of interest in the prevalence of mental disorders among gay men and lesbians, methodologically sound epidemiological studies are rare.
Using this analysis, I report that the authors found a significant increase in any disorder among gay men, but this finding is not reported in the original article. Data for lifetime prevalences, which were not reported in the original article, were provided by S. Gilman personal communication, October 16, In the original, the authors reported that Figure 2.
Figure 3. Suicide Whether gay men have higher prevalence of suicidal behavior has also been debated in recent years. Limitations and Challenges The conclusion I propose—that LGB individuals are exposed to excess stress due to their minority position and that this stress causes an excess in mental disorders—is inconsistent with research and theoretical writings that can be described as a minority resilience hypothesis , which claims that stigma does not negatively affect self-esteem Crocker et al.
The Objective Versus Subjective Approaches to the Definition of Stress In reviewing the literature I described minority stressors along a continuum from the objective prejudice events to the subjective internalized homophobia , but this presentation may have obscured important conceptual distinctions.
The Minority Person as Victim Versus Resilient Actor As they discuss minority stress, researchers inevitably describe members of minority groups as victims of oppressive social conditions, and they have been criticized for this characterization. Summary I proposed a minority stress model that explains the higher prevalence of mental disorders as caused by excess in social stressors related to stigma and prejudice.
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