Lesbians, Gay Men and Bisexuals and Mental Health Factsheet
People are defined as lesbian or gay men if they are attracted to people of the same gender.
Since the pioneering Kinsey reports into human sexuality in the late 1940s, many now accept the idea that sexual identity is fluid and exists along a continuum. Some are heterosexual or, at the other end of the continuum, homosexual, but most of us are to a greater or lesser extent bisexual. If sexuality is ‘fluid’ in this way, it could be argued that individuals should not ‘fix’ their identities by declaring themselves gay, lesbian or heterosexual. The problem with this position, as Crouan points out, is that it can be used to deny gay persons the power to define themselves and establish an identity.
It can be psychologically important to establish an identity, especially if you belong to a minority group.
'Homophobia', which was first used as a concept by the psychologist George Weinberg in the late 1960s, is the hatred, intolerance and fear of lesbian, gay and bisexual people. It has been defined as "The fear of feelings of love for members of one's own sex and therefore the hatred of those feelings in others. The belief in the inherent superiority of one pattern of loving and thereby its right to dominance." 
While there is a need for a word to describe anti-gay attitudes, there are conceptual problems with the term ‘Homophobia’. The ‘-phobia’ suffix suggests an irrational fear, something which is beyond our control. But we can recognise our own homophobic attitudes and overcome them – we are all responsible for our own prejudices. And there is the implication that the homophobic person wants to avoid, to remove himself from the object of his fear. But many homophobic people actually seek out gay people to assault and/or harass them.
There are four interrelated types of Homophobia: personal, interpersonal, cultural and institutional.
As we grow up we are taught the values of our society. In our homophobic, discriminatory culture, we may learn negative ideas about homosexuality. Like everyone else, gay people may be socialised into thinking that being homosexual is somehow ‘wrong’. This can lead to feelings of self-disgust and self-hatred. This personal form of Homophobia is also known as 'internalised Homophobia'.
'Interpersonal Homophobia' refers to behaviour between individuals. Hatred may be expressed by telling jokes, name calling or even physical violence. Families often pressurise their members to conform to the beliefs deemed to be acceptable. Anything outside this is often rejected. Peers may be uninterested in hearing about relationships between persons of the same sex.
'Cultural Homophobia' refers to the norms and social values which portray heterosexuality as superior to homosexuality. For example, most mainstream films feature characters in heterosexual relationships.
Institutional Homophobia (also called ‘heterosexism’)
Many of our social and economic institutions promote heterosexuality as the 'norm', as being superior to homosexuality. For example, in terms of inheritance laws, our legal system offers protection to the 'traditional' nuclear family, but not to same-sex couples. This is a form of 'institutional Homophobia'.
The Power to Discriminate
"We recognise the cumulative effect of discrimination in all our social systems – housing, employment, the judiciary and the mental health services."
Mind Equalities Group 1994
The majority culture has the power to discriminate against gay persons. As shown above, many of our social, economic and cultural institutions are 'homophobic' in that they reflect the idea that heterosexual relationships are normal and mainstream, and any other lifestyles are deviant and 'abnormal'.
Ultimately, the media has the power to decide what information reaches the public and how it is presented. The popular press has been responsible for many instances of negative stereotyping of gay men and lesbians. When homosexuality is portrayed, lesbians, gay men and bisexuals are often stereotyped as sick, unbalanced, unhappy, etc. Lesbians have been portrayed as humourless and ugly. Gay men are characterised as effeminate and weak.
Some religions have taught their followers that certain groups of people are inferior, including lesbians, gay men and bisexual men and women.
The education system helps teach us what our culture considers 'normal'. From 1986, 'Section 28' effectively stopped local authorities providing information on gay issues to school children. This notorious section of the Local Government Act prohibited local authorities in England and Wales from 'promoting' homosexuality. The Act prevented "a local authority from giving financial or other assistance to any person for the purpose of publishing or promoting homosexuality as an acceptable family relationship, or for the purpose of teaching acceptability in any maintained school". It also labelled gay family relationships as 'pretend'.
While the Act technically only applied to local authorities, it had the effect of making teachers wary of providing any information about homosexually, including homophobic bullying and abuse. After a sustained public debate, Section 28 was overturned by the Labour Government in 2003.
The Legal System
While our legal system continues to reflect the idea that heterosexuality is the 'norm' and to uphold the ‘traditional’ nuclear family, there have been some significant recent changes in legislation which have increased the recognition and rights of gay people.
Age of Consent
Until relatively recently, it was a criminal offence to be in a male gay relationship. In 1885 all gay male relationships were declared illegal. Many gays served time in prison and there were many cases of blackmail. In 1957, the report of the Wolfenden Committee recommended the decriminialisation of male gay relationships. Some of the recommendations were brought into law a decade later in the 1967 Sexual Offences Act. For the first time, men over 21 were permitted to have sexual relationships with each other.
The Wolfenden Report and the resulting Sexual Offences Act 1967 did not refer to lesbians. In fact, lesbians have never been directly legislated against and relationships between women have never been officially illegal. However, the absence of legislation did not mean that lesbian relationships were more socially acceptable.
The age of consent for gay men remained at 21 (compared to 16 for heterosexuals) until 1994, when it was lowered to 18 after a fierce debate in the Commons and Lords. In 1999, the Labour Government introduced a Sexual Offences Bill equalising the age of consent. This was passed in the Commons, but was defeated in the House of Lords. The Government decided to use the Parliament Act, which gives the Commons the power to pass Bills that have been defeated in the Lords. A new Sexual Offences Act was passed and the equal age of consent became law in January 2001.
Rights for Same-sex Couples
Gay persons still face legal discrimination if they are in long-term relationships. Unlike heterosexual couples, if one dies the other may have no pension rights, may have problems inheriting property and will have no status as next of kin. The new Civil Partnership Act 2004 will give some limited recognition under the law to same-sex couples. From autumn 2005 (at the earliest), same-sex couples will be able to register as 'registered civil partners'. Among their new rights and responsibilities, the couple will have the right to a joint state pension, parental responsibility for each other's children, will be able to claim a survivor pension and will be recognised under inheritance rules.
Historically, lesbians, gay men and bisexual people have had no legal recourse if they have, for example, been dismissed from a job because of their sexuality. There is, as yet, no parallel to the Race Relations Act or the Sex Discrimination Act. This may change with the introduction in 2006 of the new Single Equality Commission, which will have responsibility for tackling discrimination on the grounds of sexuality as well as religion, race, age, sex and disability.
Many of us belong to several different communities. We may identify ourselves as being Black, gay and a woman, for example. As a result we may experience discrimination at several levels, perhaps racism and Homophobia. This is known as 'multiple discrimination'.
Lesbian, gay and bisexual young people face particular problems. They may not have access to information about their sexuality. At an age where conformity and acceptance is important, they may try to conceal their sexuality from their family and friends to avoid rejection. They may have already internalised a negative self-image and find it hard to accept themselves.
Young people who identify themselves as lesbian, gay or bisexual have been found to be more susceptible to bullying at school. A 1997 London survey of young gay, lesbian and bisexual people under 25 found that verbal abuse was common: nearly 90 per cent of females and 80 per cent of males reported verbal abuse. Nearly half of these incidents took place in an educational institution.A study in 2001 found that 82 per cent of gay men, lesbians and bisexuals had been verbally abused, and 60 per cent reported being physically attacked during their time at school. In the same study, 53 per cent of those participants who had been bullied had contemplated self-harm or suicide as a result of the violence experienced.
The experience of being bullied has a variety of effects on academic performance and future mental health. Ian Rivers has conducted research into bullying and its subsequent effects on the mental health of gay and lesbian young people. Fifty three per cent of participants said that they had contemplated self-harm as a result of being bullied. Forty per cent indicated that they had attempted self-harm or suicide on at least one occasion. In later life, some of those bullied said that they experienced nightmares or flashbacks related to the bullying. Others said that they tended to avoid social situations or large gatherings for fear of experiencing a panic attack.
Jan Bridget of the Lesbian Information Service has reviewed British and American research on lesbian and gay youth suicide. Her analysis reveals that lesbian and gay young people are up to six times more likely to attempt suicide than heterosexual youth, with the highest rates of suicide among those who are isolated from support.
The term 'older' actually embraces several different generations. Some people like to identify themselves as 'older' and others do not. The issues facing a 40-year-old lesbian or gay man are likely to be different from those relevant to a person of 80. Rigid categorisation can be disempowering and unhelpful.
Some older lesbians and gay men may have been subjected to psychiatric treatment in the past in an attempt to 'cure' them. This may have left them with a legacy of guilt and emotional damage. Many others will have stayed 'closeted' throughout their lives. Others were active with the gay liberation movement and the women's movement.
Ageism within society has meant that older people are generally seen as unattractive and socially boring. The 'gay scene' is no exception and is more often than not geared towards younger people. Despite the lack of social opportunities generally, some older lesbians and gay men have long-established support networks. Others will be more isolated, perhaps due to the deaths of partners and friends, lack of mobility, or simply because they have lost touch with others.
Some organisations working with older people fail to take into account the fact that a service user may not be heterosexual. Sheltered housing and residential care is usually mixed-sex and geared towards heterosexuals, driving some older lesbians and gay men to get together to discuss the alternatives.
Black and Minority Ethnic Communities
Black lesbians and gay men face double oppression because of their race and their sexuality. Some feel they have been forced to choose between the gay and the Black and minority ethnic cultures. Black communities can be homophobic, in the same ways white ones can be.
Anne Hayfield points out that when Homophobia occurs within Black communities this can mean that an individual is cut off from support networks of family and friends, which are important to enable a person to develop a positive Black identity and to counter the racism faced on a daily basis. Black lesbians and gay men therefore have to consider the importance of 'coming out', weighing the possible loss of family and community support against the gains.
Black lesbians, gay men and bisexual women and men also face discrimination from organisations that exist to support them. It seems that Black issues are often ignored within political/campaigning groups and in social/support groups, as well as out on the 'scene'. Anne Hayfield claims that Black lesbians have often been refused admission to lesbian spaces and have been subjected to racism from white lesbians.
Quibilah Montsho, a Black lesbian poet and survivor who was wrongly diagnosed as mentally ill and forced into hospital against her will, believes that as many as 60 per cent of Black lesbians in this country have had, or will have, some experience of the mental health system. She says that it is impossible for a Black lesbian to complain of sexism, racism and/or Homophobia in a psychiatric setting because complaining may be interpreted as an aspect of paranoid psychosis. This psychosis is seen to be suppressible, either by increasing the dosage of medication or prescribing additional drugs. In these circumstances it is unlikely that a Black person will feel safe to 'come out' within the mental health services. Montsho also makes the point that because of language and cultural differences the service user/survivor can be misunderstood and further labelled as defensive or uncommunicative.
People with Disabilities
Lesbians, gay men and bisexual women and men with disabilities, like all people with disabilities, are not expected to have any sexuality at all, let alone an attraction to people of the same sex. Disabled people have generally been pressurised to play down their sexuality, both in wider society and in residential settings. Where the issue of sexuality is raised, most people with disabilities are assumed to be heterosexual.
Of course, the gay community is also affected by the discrimination against disabled people that exists in society generally. Gay people are also responsible for sometimes regarding people with disabilities as asexual and genderless. Gay, lesbian and bisexual events and venues are often difficult to access for people with disabilities.
Some lesbians, gay men and bisexuals may be dependent on heterosexual carers. This makes the process of declaring their sexuality risky. Some individuals rely on vital support networks and may be afraid of losing this support because of Homophobia. This places considerable pressures on the individual.
People with HIV/AIDS
Some gay men encounter fear, harassment and/or discrimination on the grounds that they could be HIV positive or have AIDS. There is a common myth, encouraged by sections of the media, that most gay men are HIV positive. The reality across the world is that HIV is predominantly affecting heterosexual people, although in the West, gay men have been the first to develop HIV-related illnesses in significant numbers.
Since the early 1980s, HIV and AIDS organisations have paid particular attention to the emotional needs of people with HIV and AIDS. The Terrence Higgins Trust, for example, runs a helpline and offers counselling for anyone 'with or concerned about HIV or AIDS’. Some mental health professionals have specialised in the mental health needs of people with HIV and AIDS. Such services have generally had a strong input from gay men and are less likely than mainstream mental health services to be discriminatory. The impact of AIDS has also raised awareness of the need for bereavement support that acknowledges the grief of gay partners and friends.
The Lesbian, Gay and Bisexual Community and Mental Health
There is no doubt that, within our culture, discriminated groups are over-represented within the mental health system. Black women, working class women and young Black men, for example, are far more likely to be given neuroleptic drugs and ECT than white, middle class professionals.
The issue of minority communities and mental health is a complex one. There is no doubt that the mental health system continues to discriminate, and that people from the minorities are more likely to be labelled as being ‘mentally ill’ because they may not conform to what the majority culture believes is ‘normal’. The majority culture has, after all, the power to define mental illness. But, at the same time, the experience of being discriminated against can contribute to mental distress.