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Minority Stress and LGBT/Q Health
Adapted from “Public Health Implications of Same-Sex Marriage,” Am J Public Health. 2011 June; 101(6): 986–990. William C. Buffie, MD. (Dr. Buffie has provided medical information for A Thousand Moms.)
One only has to consider the rash of recent teen suicides resulting from anti-gay bullying to begin to comprehend the magnitude of the public health problem faced by this country and its LGBT sexual minority. Despite the prevalence of same-sex households and campaigns to protect human rights, gay persons find the very nature of their being constantly debated within our legislative bodies, the courts, and the mainstream media. They are subject to ridicule and are commonly the targets of demeaning and derogatory slang terms or insensitive jokes. Their morality and value as human beings are frequently questioned by individuals and organizations ignorant or unaccepting of current medical and social science literature concerning the gay population….
Being cast in such a light strongly contributes to the phenomenon known as “minority stress,” which members of this community experience in their struggle for validation and acceptance in our heterosexist society.
LGBT individuals are constantly subject to subtle, inadvertent, or insensitive attacks on the core of their very nature, even by people who profess no disdain or disrespect for them.
Unique to the LGBT form of minority stress—as opposed to minority stress engendered by societal prejudice based upon race, ethnicity, gender, or disability—is that one's sexual orientation usually is invisible to others. As a result, in addition to being the target of overt discrimination, LGBT individuals are constantly subject to subtle, inadvertent, or insensitive attacks on the core of their very nature, even by people who profess no disdain or disrespect for them.
For instance, if someone has a lesbian colleague but doesn't know the colleague's orientation, an innocent question—such as asking her if she has a boyfriend, rather than asking “Are you seeing someone special?”—implies a judgment regarding what is “normal.” When the “other” is invisible, faceless, or nameless, it is common for those in power to ignore the reality of the other's existence and the challenges the other faces. This interplay of power and prejudice, whether overt or covert, constitutes the phenomenon of heterosexism. Similarities to the racism and sexism so prevalent during the civil rights movements of past generations are obvious.
This sexual-minority status, as explained by Riggle and Rostosky, is defined by a culture of devaluation, including overt and subtle prejudice and discrimination, [one that] creates and reinforces the chronic, everyday stress that interferes with optimal human development and well-being.
LGBT individuals, stigmatized by negative societal attitudes directed at the essence of their being, struggle on a daily basis to balance the dual dangers of publicly engaging their need for equality and validation and remaining closeted to find some calm through an escape from public scrutiny. Many gay persons internalize such discrimination and prejudice. Fractured social-support mechanisms and minority-stress–associated low self-esteem contribute to a high prevalence of self-destructive behaviors, such as substance abuse, suicide, and risky sexual behavior.
Institutionalized stigma and its attendant internalized prejudice (i.e., minority stress) stand at the forefront of this cycle, begetting higher rates of sexually transmitted diseases, depression, suicide, and drug use
Hatzenbuehler et al. studied more than 34 000 lesbian, gay, and bisexual participants and found empirical evidence of the negative health effects of discriminatory policies relative to marriage equality. They surveyed participants in 2001 and 2002 on a range of psychological health indicators, and they administered the same survey in 2004 and 2005, after 14 states approved constitutional amendments limiting marriage to opposite-sex unions. In the second set of responses, participants reported significantly higher rates of psychiatric disorders, with increases of 36% for any mood disorder, 248% for generalized anxiety disorder, 42% for alcohol use disorder, and 36% for psychiatric comorbidity. In the comparable control group from states without such amendments during the same time period, there were no significant increases in these psychiatric disorders.
Although causality may be difficult to establish, the association and prevalence of these disorders suggest that institutionalized stigma and its attendant internalized prejudice (i.e., minority stress) stand at the forefront of this cycle, begetting higher rates of sexually transmitted diseases, depression, suicide, and drug use—all of which, when combined with suboptimal access to health care and fractured family-support systems, eventually contribute to higher overall mortality as well as morbidity from various cancers, cirrhosis, hypertension, and heart disease….
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