“Ew,” she says, and covers her eyes, “Look away!” My friend and I are watching a horror movie, and we have just seen two men kiss on screen for half a second. She scrunches up her face. “That was the worst part,” she tells me, despite this movie’s many gruesome scenes. Her grandma nods in agreement.
“Oh,” I think to myself, “I guess that’s a bad thing.”
I was a kid when this happened, and kids soak up everything. I didn’t yet know I wasn’t straight, and by the time I found out, I had many queer friends and knew that there was nothing shameful about being queer1. Nevertheless, experiences like this can build up and seep into one’s core, affecting the way they see themselves and their self-worth. Unfortunately, queer folks often experience these small (and large) rejections of their identities. Even when direct rejection is not present, it is common for media, everyday language, education, healthcare, and people’s assumptions to lack representation and acknowledgement of queer people’s existence. My sex ed class in high school focused largely on safe sex for straight couples, which left me wondering what was wrong with me that I didn’t find it relevant.
These experiences have an impact. Hearing over and over that you don’t matter and that you are bad can lead to chronic shame and insecurity, and shame is a major contributing factor to mental illness, suicide, and substance use2. In fact, a study found that 1 in 3 LGBT adults experienced mental illness in 2015, compared to only 1 in 5 non-LGBT adults3. A whopping 40 percent of transgender adults have attempted suicide in their lifetime, much higher than the less than 5 percent of the general U.S. population4. Another jaw-dropping study found that queer people living in communities that are more stigmatizing toward their queer identities actually die an average of 12 years earlier than queer folks in more accepting communities5. There are further struggles for queer folks with other marginalized identities, such as queer people of color. Despite a majority of queer adults of color experiencing significant mental health challenges, only 29 percent have received a diagnosis for a depressive disorder, compared with 39 percent of queer adults broadly. This shows a possible bias in diagnoses, unequal access to assessments (including barriers to health insurance), or other factors6.
These numbers show how prevalent mental health challenges are for the queer community, and suggest that there are many queer individuals amongst those seeking professional help for mental illness. Therefore, it is important that mental health professionals be educated in and supportive of the needs of queer people with mental illnesses. However, the mental health field has not always been kind to queer folks. Homosexuality (and later “sexual identity disturbance”) was listed as a mental disorder in the Diagnostic and Statistical Manual (DSM) until 1987, and in the World Health Organization ICD until 1992. Many non-straight people were subjected to “conversion therapy,” in an incredibly harmful attempt to turn them straight (this is not possible, as neither sexuality nor gender identity are a choice). “Gender identity disorder” (aka being trans or nonbinary) was classified as a mental disorder in the DSM until 2013, and in the ICD until 2019, just two years ago.
Thankfully, due to the efforts of many queer and allied activists, mental health care (in addition to other fields) is becoming more affirming of queer identities. Nevertheless, still today many queer people face challenges and unacceptance in seeking mental health care. I had one therapist refuse to respect my partner’s pronouns, and a queer acquaintance told me how their uninterest in male celebrities and clothes shopping was pathologized, taken to be part of their mental illness. These things are harmful both because they are rejections of people’s identities and because they put the focus in the wrong place, so that when someone truly does seek help for a real mental illness, they are not given treatments that will help them.
This might sound quite depressing, but there are concrete actions we can all take to both lower queer folks’ risk of mental illness (yay, prevention!) and to improve the experiences for those who seek professional mental health treatment. One of the biggest and simplest forms of prevention is to be outwardly affirming in the way that you use language. Try not to assume a person’s gender or sexuality. In any group setting, providing a space for people to (optionally) say their pronouns reduces chances of people being misgendered. Being misgendered can contribute to lowered self-esteem, which is a risk factor for mental illness7. In fact, respecting the pronouns of trans and nonbinary family members has been shown to cut their risk of attempting suicide in half8. Therefore, if asking or using someone’s pronouns feels awkward, keep in mind how much of a difference it makes. Also remember that things become familiar over time with practice, and give it a try knowing that it probably won’t feel awkward forever. If you do misgender someone accidentally (it happens), correct yourself and move on. Make a conscious effort to remember in the future but don’t apologize profusely in the moment, as that puts pressure on the other person to reassure you that it’s okay, which isn’t their job. If someone in your life comes out to you as queer, not straight, or not cisgender, consider seeking out support for yourself so that you can be there fully for the other person. You are completely allowed to feel however you feel as a result of them coming out, and if you find a place to process those things for yourself, you may feel that you can be more present and helpful to the other person (see below for some resources). If you work in a mental health-related field, educate yourself on queer identities so that your clients don’t have to. Most importantly, do not pathologize queer identities, and do not assume that someone’s queerness is related to their mental health struggles.
Above all, know that engaging and making an effort are so much better than staying silent for fear of messing up. Mistakes happen: no one is perfect, and everyone can learn and grow. But that growth cannot happen without engagement, practice, and conversation. Silence perpetuates the harmful status quo, while engaging, however imperfectly, is a step toward change. Thank you, and please see below for resources on how you can engage.
Amy G., Intern
Education on Queer Identities:
Statistics on Queer Communities and Mental Health:
Resources for Queer People of Color:
– National Queer and Trans Therapists of Color Network (has a directory and mental health fund): https://nqttcn.com/en/
Resources for Family, Friends, and Partners of Queer People:
– For partners/family/friends of trans/nonbinary people: https://www.transgenderpartners.com/resource-for-partners-2
– Parents, Families and Friends: pflag.org
Queer Mental Health Organizations:
– The Trevor Project: thetrevorproject.org
1My use of the word “queer” fits the definition offered by OutRight Action International (below, with slight adaptations):
“Queer is often used as an umbrella term referring to anyone who is not straight and/or not cisgender. (Cisgender people are people whose gender identity and expression matches the sex they were assigned at birth). Historically the term queer was used as a slur against LGBTQIA+ people, but in recent years it has been reclaimed by LGBTQIA+ communities.”
2See Weingarden et al. (2016): 10.1097/NMD.0000000000000498 , Vizin and Unoka (2015): https://www.researchgate.net/publication/281825601_The_role_of_shame_in_development_of_the_mental_disorders_II_Measurement_of_shame_and_relationship
3Study by the Substance Abuse and Mental Health Services Administration’s National Survey
on Drug Use and Health (NSDUH), 2015.
4According to the U.S. Transgender Survey, 2016.
5Study by Hatzenbuehler et al., 2014: 10.1016/j.socscimed.2013.06.005
6Data from The Human Rights Campaign’s page, “QTBIPOC Mental Health and Well-Being”: https://www.hrc.org/resources/qtbipoc-mental-health-and-well-being
7Study by McLemore, 2014: https://doi.org/10.1080/15298868.2014.950691
8Study by the Trevor Project, 2020