People often question how social justice and mental health relate. On the occasion of celebrating Pride Month and the 50th anniversary of the Stonewall uprising in New York City, it seems like a great opportunity to demonstrate this relation.
Up until 1973 “Homosexuality” was an actual diagnosis on the Diagnostic & Statistical Manual of Mental Disorders (DSM; Drescher, 2015) when it was removed from its second edition and finally not included in the third and subsequent publications. The decision came in the midst of controversy between those who pathologized homosexuality and those who believed it was normal. Activists from marginalized sexual and gender diverse groups argued that psychiatric theories pathologizing homosexuality contributed to the social stigma and marginalization they experienced and many psychiatrists and mental health professionals agreed (Drescher, 2015).
Gender beliefs have been inherent in this controversy, particularly because mental health professionals often conflated sexual orientation and gender identity (American Psychoanalytic Association, 2019; Drescher, 2015). Gender beliefs are based on a binary understanding of gender, categorizing individuals as “female” or “male” since before birth. Binary understandings of gender are so strong that it wasn’t until 2013 that the former “Gender Identity Disorder” diagnosis was renamed and reconceptualized as “Gender Dysphoria” within the fifth and latest version of the DSM (American Psychiatric Association, 2013). The change came as an attempt to focus diagnosis and treatment on the conflict between the gender assigned at birth and the gender that individuals identify with, rather than focusing on the gender identity of the person as the pathology.
Despite the institutional changes to de-pathologize diverse sexual orientations and gender identities, conversion therapy aimed at changing these identities, is still practiced in the U.S. and its territories. The mental health impact of this treatment is devastating. Research has consistently found that sexual and gender diverse individuals who have undergone this treatment are more than twice as likely to attempt suicide, compared to those who did not (Trevor Project, 2019). As part of the 2019 Trevor Project’s National Survey on LGBTQ Youth Mental Health 34,808 youth from marginalized sexual and gender identities 13-24 y/o across the U.S., were surveyed. Findings suggested that 42% of all respondents and 57% of transgender and non-binary youth who underwent this treatment reported attempting suicide in the last year. Among all respondents, regardless of having undergone conversion therapy or not, 20% attempted suicide and 39% seriously considered suicide, in the last 12 months. These statistics significantly increased to 33% and over 50%, respectively, when considering only those who self-identified as transgender or non-binary (Trevor Project, 2019). Other studies have found that youth from marginalized racial and ethnic groups who also self-identify with marginalized sexual and gender identities, are more likely to attempt suicide (Williams Institute, 2014).
The American Psychoanalytic Association recently issued an “overdue apology” to individuals from marginalized sexual and gender identities for their past views pathologizing these identities (American Psychoanalytic Association, 2019). From a social justice perspective of mental health, it is critical for us as mental health professionals to acknowledge the role that we have had contributing to discrimination and trauma. Let’s use the social power inherent in our profession to work towards undoing past harm and promote diversity and inclusion!
American Psychiatric Association. (2013). Gender Dysphoria. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm14
American Psychoanalytic Association (2019). News: APsaA issues overdue apology to LGBTQ community. Retrieved from http://www.apsa.org/content/news-apsaa-issues-overdue-apology-lgbtq-community
Drescher J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral sciences (Basel, Switzerland), 5(4), 565–575. doi:10.3390/bs5040565
Trevor Project. (2019). National Survey on LGBTQ Youth Mental Health. Retrieved from https://www.thetrevorproject.org/trvr_press/landmark-study-finds-39-percent-of-lgbtq-youth-and-more-than-half-of-transgender-and-non-binary-youth-report-having-seriously-considered-suicide-in-the-past-twelve-months/
Williams Institute. (2014). New study: LGBT youth more likely than heterosexual youth to attempt suicide. Retrieved from https://williamsinstitute.law.ucla.edu/press/press-releases/21-july-2014/