One of the biggest lessons I’ve learned as an LGBTQ+-affirming therapist who specializes in gay men’s identity is how much minority stress continues to cause clinically significant negative health outcomes for LGBTQ+ people.
I’ve also learned that fostering resilience is directly linked to a decrease in symptoms and maladaptive coping mechanisms.
Research shows the most common mental health disorders often experienced in the LGBTQ+ community are
Substance use disorders
Depression and anxiety are 1.5 times higher in LGBTQ+ individuals than in heterosexual individuals. Further, there is a higher likelihood of mood and anxiety disorders among LGB people compared to heterosexual individuals. Research also shows LGBTQ+ individuals have rates of substance abuse two to three times higher than the general population in the United States.
An important distinction to make is that most of all the “disorders” researchers found among LGBTQ+ people are connected to trauma. We cannot fully address gay men’s mental health without exploring trauma.
When we think of trauma, most of us think of rape, murder, death, a catastrophic event, or a natural disaster. And while these are unequivocally traumas, a trauma is also experienced as a daily microaggression, such as homophobia, bullying, and time spent in the closet. Any child who has experienced the closet has known shame—and shame itself is trauma.
The Effects of Trauma
Addiction rates are higher for LGBTQ+ people than the overall population. Compared to their heterosexual peers, LGB youth are 90 percent more likely to use substances. The Adverse Childhood Experiences (ACE) study shows how exposure to emotional, physical, or sexual abuse and household dysfunction during childhood, compared to those who had experienced none, led to a four- to twelvefold increase in the risk of alcoholism, drug abuse, depression, and suicide attempts.
Recently, a newly sober client told me that while he’s a 40-year-old adult gay man, he’s never been able to have “sober sex.” The shameful messages he internalized as a child about his identity still show up in how he relates to himself and other gay men.
For that reason, increased rates of gay men turn to drugs and alcohol to anesthetize the toxic shame they consciously, and unconsciously, feel about their sexuality. In fact, it’s not uncommon for gay men to feel an incongruence between sex and love and intimacy. Many of my clients who use crystal meth describe their experience with the drug as “washing the shame away.”
One client, who has never been able to have sex without drugs, talked about his “longing to be in a relationship.” In helping him understand his drug use, I reflected to him that crystal meth has been a bridge to help him get close to the very thing his heart desires: connection. It’s just that the trauma he experienced in his childhood around his identity has prevented him from being able to explore sex and sexuality without the presence of toxic shame.
During a recent conversation with an HIV specialist, I asked him for his perspective on HIV stigma and why it still exists. He said, “Because societal homophobia still exists.” He told me that while there has been tremendous progress with regard to medication and treatment, many people who test positive for HIV still face unnecessary stigma, which, he said, “Keeps HIV-related shame alive.”
HIV may not be the same illness today as it was 30 years ago, but societal stigma around HIV/AIDS is still pervasive. Currently, the highest level of risk for HIV belongs to gay men between the ages of 17 and 29. Crystal meth, often correlated with HIV acquisition, is a silent epidemic among gay men throughout communities across the United States.
For my clients interested in sobriety or minimizing their substance use, I help them explore three important areas:
Understand what the substance is for.
Explore the substance from the perspective of a relationship.
What is the story you’re telling yourself about the substance and the reasons why you drink/use?
Resilience as an Intervention
When discussing the impact of minority stress among LGBTQ+ people, resilience must also be considered. Despite the challenges that gay men continue to face in an overwhelmingly heteronormative and homophobic society, they also have incredible resiliency.
There are numerous factors that affect resiliency, but one that is often overlooked in books targeted to gay men is religion and spirituality. Religion and spirituality can serve as an area of resiliency for LGBTQ+ individuals, families, and couples. Both religion and spirituality provide coping strategies to deal with difficult experiences and assist people with making meaning out of pain and trauma.
In fact, the process of creating congruence between identity and faith of choice is a resilience-building process.
What I’ve learned in working with people from all backgrounds is that the more challenges a person has faced, the more resilient they can become. By no means am I implying that the trauma LGBTQ+ people experience is good. The familial homophobic trauma I’ve heard about would break your heart. What I am saying is that the people I work with who have faced the most adversity are often the wisest and most empathetic.
The level of our personal development is determined by how much we can transform challenges and share the lessons of transformation with others. We don’t need to experience challenges to arrive at our purpose. When we can find purpose in our challenges, though, we create transformation—not only in our individual lives but also in the lives of our communities.