Queerly invisible: LGBTQ people of color and mental health
This special issue of the Journal of Gay and Lesbian Mental Health on LGBTQ People of Color (POC) and Mental Health features a series of articles originally presented as a symposium at the American Psychiatric Association Annual Meeting in Atlanta in May 2016. This was the first APA meeting to ever explicitly feature a symposium on the mental health of LGBTQ people of color. Titled Queerly Invisible: LGBTQ People of Color as Psychiatrists and Patients, the symposium discussed the mental health needs of LGBTQ POC from adolescence to old age, from the perspectives of LGBQ psychiatrists of color.
Weeks after we presented this symposium, LGBTQ-POC were to attract national visibility under the most tragic of circumstances. In the Pulse Nightclub shooting, Omar Mateen opened fire on the predominantly Latinx patrons of a gay club, killing 49 and injuring 53 others before being shot dead by Orlando police. Apart from being one of the deadliest mass shootings in American history, this terror attack was notable for being perpetrated by an LGBTQ POC (conflicted as he apparently was about his sexuality) against other LGBTQ POC. Months later, following the somewhat unexpected election of Donald Trump to the U.S. presidency, a wave of racist, homophobic, and xenophobic attacks saw many minority individuals living under fear of persecution, discrimination, and uncertainty.
This special issue could not be timelier. In a world of increasing uncertainty and insecurity, where the local and the global meet, where cultural values and sexual desires collide, where deep divisions in society arise, where discrimination is not only increasingly acceptable but enshrined in legislation, this collection of articles is now more relevant than ever.
First, Kali Cyrus examines the stress of being a multiple minority using the minority stress theory. She reviews some of the literature on the stress experienced by LGBTQ POC and discusses that, while there is overwhelming evidence that LGBTQ and racial/ethnic minorities experience poorer mental and physical health outcomes, the evidence that there is a cumulative effect for LGBTQ POC is less compelling. She suggests that the multiple stressors, microaggressions, and traumatic experiences endured by this population could provide some resilience against additionally worse mental health outcomes compared with White LGBTQ individuals or heterosexual cisgender racial/ethnic minority individuals. At the same time, research specifically focusing on LGBTQ POC is still in its infancy, precluding any firm conclusions about additional psychiatric morbidity in these multiple minority individuals.
Next, Matthew Dominguez discusses how cultural formulation can inform the care of LGBTQ POC. He notes that the major explanatory models of psychopathology largely originate from White, heterosexual, cisgender men and, as a result, may be less appropriate for capturing and formulating the struggles experienced by LGBTQ POC. Dominguez further suggests that clinicians pay close attention to identities (of which there may be many) that patients bring as a starting point to build rapport, validate, and understand their patients, as well as to minimize pitfalls from language errors, when working with a population who may be primed to react negatively to language errors which may be perceived as purposeful. He also describes how the power dynamics that occur when members of non-dominant groups interact with members of dominant groups may play out in the clinical arena. Dominguez highlights a number of other considerations and discusses how these can be applied to treatment planning and formulation of LBTQ POC.
Then, James Murphy and Rashad Hardaway discuss special considerations for working with LGBTQ adolescents of color. Adolescence is a time of identity formation, the emergence of sexuality and sexual identity, and the adolescent’s sexual desires or gender identity may conflict with their own cultural values. This is particularly true for many LGBTQ youth of color, and as young people continue to come out at an earlier age than in the past, we can learn more about the needs of this population. One of the difficulties, of course, is that many of the adolescents who struggle the most may not identify openly as LGBTQ, and thus it becomes harder to study this population. For obvious reasons, our understanding of LGBTQ adolescents of color is limited to those who already identify as LGBTQ.
Finally, Seon Kum explores the challenges that older LGBTQ people of color face, and the intersection of ageism, racism, and homophobia. Older LGBTQ people in general do not receive much attention or research interest, and this is truer still for LGBTQ POC. As Kum describes, these individuals may feel less comfortable disclosing their sexual orientation or gender identity to physicians, having encountered a lifetime of discrimination, and potentially growing up in an era where they would have been pathologized for identifying as LGBTQ. He outlines how many of these individuals may feel that they have to go “back in the closet” if they need to rely on institutional settings such as nursing homes in later life. Lastly, Kum describes the loneliness that has characterized the lives of many older LGBTQ POC, which may be compounded further in later life.
This year’s winner of the 2017 JGLMH Outstanding Resident Paper Award is the review article “PrEP: A Review for Mental Health Professionals” (Pereira, Goschin & Ashley 2016). It will be familiar to JGLMH readers as it was previously published in last year’s special issue on PrEP. Congratulations goes to Luis F. Pereira, Chief Resident at Mount Sinai Beth Israel Hospital in New York City who received $500 and financial assistance with travel to San Diego, California to present his paper at the AGLP Annual Meeting.
A strong runner-up in this year’s submissions was Jason L. Garner’s case report of brief psychodynamic psychotherapy treatment of a heterosexually married gay man with borderline personality traits, titled “Organizing the Closet,” included in this issue.
Also in this issue, we feature two original research reports:
William Goedel, DeMarc Hickson, and Dustin Duncan present their research on gay and bisexual men who use geosocial-networking smartphone applications, looking at their level of identification with the gay community. This trait has been shown in past research to correlate with better mental health.
Peter Ceglarek, José Bauermeister, and co-authors report on an interesting study examining the effects on mental health of breaking up a romantic relationship in a large cohort of young gay and bisexual men. While one might predict an association between negative appraisals and depression, they also found an interesting association between negative and positive appraisals and anxiety. This may due to a healthy process of reflecting on the relationship and breakup.