Peter Goldie
Approximately 3.8% of the United States population self-identify as members of the LGBT community, which consists of lesbian, gay, bisexual, and transgender individuals (Gates, 2011). The LGBT community-at-large is at an increased risk of a variety of mental health issues (Williams & Mann, 2017), including suicidal ideation (Blosnich, Bossarte, & Silenzio, 2012; Russell & Joyner, 2001), substance use disorders (Gilman et al., 2001; Lock & Steiner, 1999), and other anxiety and mood disorders (Gilman et al., 2001). Research suggests that these negative outcomes are often explained by experiences of discrimination, which are rooted in a lack of acceptance of the LGBT community among the general public (Herek, Gillis, & Cogan, 1999; Rodgers, 2017). For instance, more than half of lesbian, gay, and bisexual individuals report feeling stigmatized, and about 20% have experienced sexuality-related hate crimes (Herek, 2009). Furthermore, transgender individuals and people of color are disproportionately represented as victims of homicide (National Coalition of Anti-Violence Programs, 2017), thereby denoting the importance of intersectional and marginalized identities (e.g., class, race) that shape experiences of violence and oppression among the LGBT community (Crenshaw, 1991).
Furthermore, research suggests that discrimination manifests in both overt and covert forms, both of which are psychologically damaging (Tarquin & Cook-Cottone, 2008). Whereas overt discrimination consists of verbal abuse and physical violence (Bhui et al., 2005), covert discrimination – which includes microaggressions (Hatzenbuehler & Pachankis, 2016), whispers (McNeil et al., 2012), and social exclusion (Tarquin & Cook-Cottone, 2008) – manifests in more subtle and implicit ways (Bhui et al., 2005; McNeil, Bailey, Ellis, Morton, & Regan, 2012). Past research, however, has yet to differentiate the effects of LGBT oppression as a function of its overt and covert forms. In order to better equip practitioners in tailoring treatments or interventions that mitigate the negative effects of discrimination, this paper explores how overt and covert discrimination psychologically impacts LGBT-identifying individuals.
Overt Discrimination Against LGBT People
LGBT individuals face various psychologically destructive forms of overt discrimination (Hunter, 2007). For instance, certain forms of physical violence against LGBT individuals (e.g., attempted assaults with weapons) have increased in recent years (Dworkin & Yi, 2003), thereby increasing individuals’ risk for anxiety and depression (Bebanic, Clench-Aas, Raanaas, & Nes, 2015). The risk of experiencing rumination and feelings of loneliness is also heightened by exposure to violence, which creates an environment for LGBT people characterized by toxic levels of stress (Hatzenbuehler & Pachankis, 2016; Herek, 2009). Greater exposure to toxic stress, in turn, is particularly problematic as it leads to the release of unsafe levels of cortisol known to weaken the immune system and increase one’s susceptibility to infections (Lundberg, 2005). In fact, chronic stress is likely to detrimental for LGBT children, as it may disrupt the growth of key brain structures such as the HPA axis (Kaufman & Charney, 2001).
Experiences of overt discrimination in the home setting may also be a source of chronic stress, especially as LGBT individuals tend to lack strong family support systems (Martinez & McDonald, 2016). LGBT siblings are at a greater risk of being physically abused and kicked out of the home (Hunter, 2007), thereby contributing to disproportionately high rates of homelessness in LGBT youth (Corliss, Goodenow, Nichols, & Austin, 2011; Cray, Miller, & Durso, 2013). Once homeless, LGBT people fare poorly, attempting suicide more often than their non-LGBT counterparts (Van Leeuwen et al., 2006). As such, it is clear that overt forms of discrimination extend across various environments and pose significant implications for LGBT individuals.
Covert Discrimination Against LGBT People
While more subtle than overt discrimination, experiences of covert discrimination are equally problematic for LGBT people (Tarquin & Cook-Cottone, 2008). For example, lesbian, gay, and bisexual people commonly experience covert discrimination in the form of microaggressions, which are subtle and often unconscious actions which communicate hostility and devalue members of minority populations in a variety of different ways (Nadal, Whitman, Davis, Erazo, & Davidoff, 2016). LGBT individuals commonly experience microaggressions in the form of statements that deny the presence of homophobia or transphobia in contemporary society, or that negate a gay person’s homosexuality, both of which invalidate the oppression faced by members of the LGBT community (Sue et al., 2007; Swann, Minshew, Newcomb, & Mustanski, 2016). Stress stemming from microaggressions toward LGBT people, in turn, is associated with mental health concerns such as depressive symptoms (Swann et al., 2016). Furthermore, microaggressions often increase LGBT individuals’ feelings of distress and disrupt the healthy development of a sexual identity (Hong, Woodford, Long, & Renn, 2016). It must also be noted that microaggressions affect specific subgroups of the LGBT community (e.g., bisexual people) and LGBT people of color in different ways (Balsam, Molina, Beadnell, Simoni, & Walters, 2011; Nadal et al., 2016). For example, a transgender lesbian black woman will likely face a more severe set of microaggressions than a cisgender gay white man will.
Furthermore, social exclusion is another form of covert discrimination which has been suggested to have destructive effects on LGBT individuals’ mental health (Tarquin & Cook-Cottone, 2008). In fact, it is common for others to avoid LGBT individuals, especially after they come out (Corrigan & Matthews, 2003). This often leaves LGBT people feeling alienated and lonely, diminishes their self-confidence (Corrigan & Matthews, 2003; Tarquin & Cook-Cottone, 2008), and can increase their risk of developing issues related to depression, anxiety and substance abuse (Lock & Steiner, 1999).
A similarly alienating form of covert discrimination is the lack of representation of LGBT characters in both American (Gomillion & Giuliano, 2011) and global (Santos, 2016) media. Research suggests that gay, lesbian, and bisexual people are negatively affected by media invisibility and often feel excluded from society (Gomillion & Giuliano, 2011). Furthermore, such discrimination may lead to the internalization of heterosexism even among LGBT individuals; this internalization, in turn, has been demonstrated to be associated with depression, anxiety, substance abuse, stress, and personal devaluation (Herek, 1998; Lock & Steiner, 1999; Newcomb & Mustanski, 2010). Furthermore, research demonstrates that there is a dearth of positive images of queer people of color in particular (Lopez, 2015); thus, for this group within the LGBT community, the negative effects of racism compound onto the heterosexism experienced more broadly among the LGBT community. Nevertheless, while the lack of media representation for the community is damaging, it is promising that there have been an increasing number of, and diversity in, LGBT characters in recent years (Kelso, 2015).
Conclusion
In sum, research suggests that the various forms discrimination that LGBT people face are severely psychologically damaging (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009). While overt and covert forms of discrimination manifest differently, the detrimental effects they produce share several similarities (e.g., increased risk for developing anxiety and depression). Understanding that these outcomes are common across overt and covert discrimination can inform the development of comprehensive interventions. For example, recognizing that both forms of discrimination often lead to depression and anxiety in LGBT individuals might prompt researchers to recommend responding to experiences of discrimination using cognitive-behavioral therapy, which has been suggested to mitigate such symptoms (García-Escalera, Chorot, Valiente, Reales, & Sandín, 2016). Future research should also identify protective factors for LGBT individuals who have experienced discrimination. For instance, interpersonal support might mitigate the problematic effects of heterosexism and discrimination (Hong et al., 2016), and represents a promising area for future intervention research. However, intervention and treatment for LGBT individuals must be supported by additional research on the the combined effects of heterosexism and racism, ableism, classism, and other forms of discrimination that affect LGBT individuals who are also part of other minority groups (Huang et al., 2010).
In addition to tailoring support to the experiences of discrimination among LGBT individuals, research must also identify means of decreasing heterosexism among society-at-large. School-based interventions represent one key means of reducing discrimination, by promoting LGBT tolerance among future generations while their attitudes towards the LGBT community are still developing. Interventions aimed at shifting beliefs about LGBT individuals are the most effective means of supporting the LGBT community, as they would prevent discrimination before it occurs rather than simply managing its negative effects.
References
Almeida, J., Johnson, R., Corliss, H., Molnar, B., & Azrael, D. (2009). Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38(7), 1001-1014.
Aronson, E., & Aronson, J. (2012). The social animal. San Francisco, CA: Freeman.
Balsam, K., Molina, Y., Beadnell, B., Simoni, J., & Walters, K. (2011). Measuring multiple minority stress: The LGBT People of Color Microaggressions scale. Cultural Diversity and Ethnic Minority Psychology, 17(2), 163- 174.
Bebanic, V., Clench-Aas, J., Raanaas, R., & Nes, R. (2015). The relationship between violence and psychological distress among men and women: Do sense of mastery and social support matter? Journal of Interpersonal Violence, 32(16), 2371-2395.
Bhui, K., Stansfeld, S., McKenzie, K., Karlsen, S., Nazroo, J., & Weich, S. (2005). Racial/ethnic discrimination and common mental disorders among workers: Findings from the EMPIRIC study of ethnic minority groups in the united kingdom. American Journal of Public Health, 95(3), 496-501.
Blosnich, J., Bossarte, R., & Silenzio, V. (2012). Suicidal ideation among sexual minority veterans: Results from the 2005–2010 Massachusetts Behavioral Risk Factor Surveillance Survey. American Journal of Public Health, 102(S1), 44-47.
Corliss, H., Goodenow, C., Nichols, L., & Austin, S. (2011). High burden of homelessness among sexual-minority adolescents: Findings from a representative Massachusetts high school sample. American Journal of Public Health, 101(9), 1683-1689.
Corrigan P., & Matthews A. (2003). Stigma and disclosure: Implications for coming out of the closet. Journal of Mental Health, 12(3), 235-248.
Cray, A., Miller, K., & Durso, L. (2013). Seeking shelter: The experiences and unmet needs of LGBT homeless youth. Washington, DC: Center for American Progress.
Crenshaw, K. (1991). ‘Mapping the margins’: Intersectionality, identity politics, and violence against women. Stanford Law Review 43(6), 1241-1299.
Dworkin, S., & Yi, H. (2003). LGBT identity, violence, and social justice: The psychological is political. International Journal for the Advancement of Counselling, 25(4), 269-279.
García-Escalera, J., Chorot, P., Valiente, R., Reales, J., & Sandín, B. (2016). Efficacy of transdiagnostic Cognitive-Behavioral Therapy for anxiety and depression in adults, children and adolescents: A meta-analysis. Revista de Psicopatología y Psicología Clínica, 21(3), 147-175.
Gates, G. (2010). How many people are lesbian, gay, bisexual, and transgender? Retrieved from https://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf
Gilman, S., Cochran, S., Mays, V., Hughes, M., Ostrow, D., & Kessler, R. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91(6), 933-939.
Gomillion, S. & Giuliano, T. (2011). The influence of media role models on gay, lesbian, and bisexual identity. Journal of Homosexuality, 58(3), 330-354.
Hatzenbuehler, M., & Pachankis, J. (2016). Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics of North America, 63(6), 985-997.
Herek, G. (1998). Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals. Newbury Park, CA: Sage.
Herek, G. (2009). Hate crimes and stigma-related experiences among sexual minority adults in the United States. Journal of Interpersonal Violence, 24(1), 54-74.
Herek, G., Gillis, J., & Cogan, J. (1999). Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 67(6), 945-951.
Hong, J., Woodford, M., Long, L., & Renn, K. (2016). Ecological covariates of subtle and blatant heterosexism discrimination among LGBQ college students. Journal of Youth and Adolescence, 45(1), 117-131.
Huang, Y., Brewster, M., Moradi, Goodman, M., Wiseman, M., & Martin, A. (2010). Content analysis of literature about lesbian, gay, and bisexual people of color: 1998- 2007. The Counseling Psychologist, 38(3), 363-396.
Hunter, S. (2007). Coming out and disclosures: LGBT persons across the life span. New York, NY: Haworth Press.
Kaufman, J., & Charney, D. (2001). Effects of early stress on brain structure and function: Implications for understanding the relationship between child maltreatment and depression. Developmental Psychopathology, 13(3), 451-71.
Kelso, T. (2015). Still trapped in the U.S. media’s closet: Representations of gender-variant, pre-adolescent children. Journal of Homosexuality, 62(8), 1058-1097.
Lock J., & Steiner, H. (1999). Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey. Journal of the American Academy of Child and Adolescent Psychiatry 38(3), 297-304.
Lopez, L. (2015). A media campaign for ourselves: Building organizational media capacity through participatory action research. Journal of Media Practice, 16(3), 228- 244.
Lundberg, U. (2005). Stress hormones in health and illness: The roles of work and gender. Psychoneuroendocrinology, 30(10), 1017-1021.
Martinez, K., & McDonald, C. (2016). By the hands of our brothers: An exploration of sibling-to-sibling aggression for victimized heterosexual and sexual minority women. Journal of GLBT Family Studies, 12(3), 242-256.
McNeil, J., Bailey, L., Ellis, S., Morton, J., & Regan, M. (2012). Trans mental health study 2012. Scottish Transgender Alliance. Retrieved from http://www.scottishtrans.org/Uploads/Resources/trans_mh_study.pdf
Nadal, K., Whitman, C., Davis, L., Erazo, T., & Davidoff, K. (2016). Microaggressions toward lesbian, gay, bisexual, transgender, queer, and genderqueer people: A review of the literature. The Journal of Sex Research, 53(4-5), 488-508.
National Coalition of Anti-Violence Programs. (2017). Lesbian, gay, bisexual, transgender, queer, and HIV-affected hate violence in 2016. Retrieved from https://avp.org/wp-content/uploads/2017/06/NCAVP_2016HateViolence_REPORT.pdf
National Childhood Traumatic Stress Network. (n.d.). Effects of complex trauma. Retrieved from http://www. nctsn.org/trauma-types/complex-trauma/effects-of- complex-trauma
Newcomb, M., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(8), 1019-1029.
Rodgers, S. (2017). Transitional age lesbian, gay, transgender, and questioning youth. Child and Adolescent Psychiatric Clinics of North America, 26(2), 297-309.
Russell, S., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91(8), 1276-1281.
Santos, A. (2016). ‘In the old days, there were no gays’ – Democracy, social change and media representation of sexual diversity. International Journal of Iberian Studies, 29(2), 157-172.
Sue, D. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. Hoboken, NJ: John Wiley & Sons.
Sue, D., Capodilupo, C., Torino, G., Bucceri, J., Holder, A., Nadal, K., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for counseling. American Psychologist, 62(4), 281-286.
Swann, G., Minshew, R., Newcomb, M., & Mustanski, B. (2016). Validation of the sexual orientation microaggression inventory in two diverse samples of LGBTQ youth. Archives of Sexual Behavior, 45(6), 1289-1298.
Tarquin, K., & Cook-Cottone, C. (2008). Relationships among aspects of student alienation and self concept. School Psychology Quarterly, 23(1), 16-25.
Van Leeuwen, J., Boyle, S., Salomonsen-Sautel, S., Baker, D., Garcia, J., Hoffman, A., & Hopfer, C. (2006). Lesbian, gay, and bisexual homeless youth: An eight-city public health perspective. Child Welfare, 85(2), 151-170.
Williams, S., & Mann, A. (2017). Sexual and gender minority health disparities as a social issue: How stigma and intergroup relations can explain and reduce health disparities. Journal of Social Issues, 73(3), 450-461.