When these words were uttered in 1972 at the annual meeting of the American Psychiatric Association (APA) in Dallas, the medical group still considered homosexuality to be a mental illness. The man who stood up and made this proclamation did so wearing a Richard Nixon mask and oversized suit to protect his identity — that’s how dangerous the admission felt. The short but shocking speech, given by Dr. John Fryer, then known only as Dr. H. Anonymous, helped galvanize support within the APA to declassify homosexuality as an illness. Gay people finally got their “instant cure,” as one headline described it, in December 1973, when the APA voted to remove homosexuality from its Diagnostic and Statistical Manual of Mental Disorders. Freed from the mantle of being considered mentally ill, LGBTQ+ people over the ensuing decades would gain the ability to qualify for government security clearance, serve openly in the military, and marry their partners, among other key rights. “Psychiatry helped take away the ability of other organizations — the military, churches, boards of education — to discriminate against gay people by claiming they have a medical disorder,” says Jack Drescher, MD, a clinical professor of psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons in New York City and the author of Psychoanalytic Therapy and the Gay Man. “They removed the medical and psychiatric rationalizations for discrimination.”
New Challenges for LGBTQ+ People
Despite these hard-won victories, the LGBTQ+ community today faces potential new challenges to maintaining their rights, with the overturning of Roe v. Wade — its now-shaky privacy protections later secured other major LGBTQ+ rights — alongside a rising tide of anti-transgender legislation. This climate of uncertainty, amid an increase in bias crimes and an uneven patchwork of LGBTQ+ protections across the country, is impacting the community’s mental health, particularly among teenagers and young adults. Studies have shown that if there’s something going on in wider culture that’s discriminatory or demeaning for LGBTQ+ people, it can have an effect on the mental health of LGBTQ+ people, Dr. Drescher says. Two in three LGBTQ+ youth — and 85 percent of transgender and nonbinary youth — cited debates over anti-transgender legislation as having a negative impact on their mental health, according to a poll by Morning Consult for The Trevor Project, a suicide prevention organization for LGBTQ+ youth. The pandemic has accentuated preexisting mental health challenges for LGBTQ+ adults and youth alike, according to Sean Cahill, PhD, the director of health policy research for Fenway Health in Boston, which seeks to optimize health and well-being for sexual and gender minorities and those affected by HIV. “There’s a mental health crisis affecting youth in America,” Dr. Cahill says, adding that it is disproportionately affecting LGBTQ+ youth. “Things that were problematic before the pandemic have gotten worse during the pandemic.” A recent survey of LGBTQ+ college students found that nearly half were either not out to their families or not accepted by them. As colleges shut down during the pandemic and students had to return home, 6 in 10 experienced anxiety and depression as a result.
External Stresses Cause Higher Rates of Mental Illness for LGBTQ+ Youth
The specific mental health risks for LGBTQ+ youth are driven mostly by external forces, according to Jonah DeChants, PhD, a research scientist for The Trevor Project. LGBTQ+ youth must deal with issues around coming out, bullying, and discrimination based on their sexual orientation or gender identity, while their straight peers do not. LGBTQ+ youth “are not inherently prone to mental health challenges and suicide risk because of their sexual orientation or gender identity,” Dr. DeChants says. “Rather, they are often placed at higher risk because of how they are mistreated and stigmatized in society.” Ayiti-Carmel Maharaj-Best, MD, an assistant professor of family medicine and community health at the University of Pennsylvania’s Perelman School of Medicine and a clinician in Penn Medicine’s LGBTQ Health Program in Philadelphia, says that many of her patients are recovering from a “lifetime of trauma. Some have high rates of depression, anxiety, and PTSD.”
Anti-LGBTQ+ Activism Takes a Toll
Dr. Maharaj-Best’s transgender patients struggle with not only gender dysphoria (the experience of living in a body that doesn’t feel like it’s your own and doesn’t match your identity) but also personal safety issues, given the high rates of violence against trans people. This reality is challenging enough, given a general lack of anti-discrimination protections, but a spate of anti-transgender legislation around the country has made it worse. “I have heard patients talk about the weight of the burdens that it adds to them, just for being who they are, and people feel like they shouldn’t even exist,” Maharaj-Best says. “I think that can have a really toxic effect over a lifetime, and the chronic stress really takes a toll on people.” Experiences of discrimination and victimization can exacerbate anxiety, depression, and suicidal thoughts, among other negative mental health outcomes. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health found that 45 percent of LGBTQ+ youth seriously considered attempting suicide in the past 12 months, including more than half of transgender and nonbinary youth. For LGBTQ+ youth who were physically threatened or harmed, experienced discrimination, or had to undergo conversion therapy, the rate of attempted suicide was twice as high, compared with those who didn’t suffer from anti-LGBTQ+ victimization, according to The Trevor Project.
Positive Experiences, Positive Outcomes
At the same time, the risk of youth attempting suicide can be cut by over 40 percent just by having parents and caregivers treat their LGBTQ+ identity with respect, according to new data from The Trevor Project. “When parents are able to provide an environment where kids growing up believe in themselves and feel loved and accepted for who they are, that is incredibly protective over the course of a lifetime, compared to kids who don’t have that,” Maharaj-Best says. For trans people in particular, problems with anxiety, body image, and even substance abuse can improve when they feel supported and have access to appropriate medical care. “It doesn’t erase a lifetime of trauma, but the difference is pretty remarkable at times,” Maharaj-Best says. “It’s also important to remind everyone else what we can do to make it better,” Maharaj-Best adds. “If we could be kind to people and allow people to live freely as they are and accept them for who they are without judgment, we could save ourselves so much of this trouble.” Despite their many challenges, most LGBTQ+ young people manage to rise above their circumstances. “Most young people in the LGBT community don’t experience high rates of mental health and substance abuse,” Cahill says. “They do well in school and succeed in their lives. We want to reduce disparities in how they are treated and support people experiencing these challenges but also understand that people have inner strengths and agency and despite those challenges, still do great things.”
Coping Tips
Here are some tips and strategies for LGBTQ+ people who have anxiety, depression, or other issues relating to their sexual orientation or gender identity. Find your community. Whether with family or friends, in person or online, finding your place in the world is key for LGBTQ+ people to cope with anxiety and stress. Seek out supportive learning environments. So-called “safe” schools that have inclusive curriculum and gay-straight or gender-sexuality alliances help make LGBTQ+ youth feel safer and less likely to experience victimization. Look for supportive medical care. Find a trusted primary care provider who can connect you with the resources you need and respect your identity. Ask for help when you need it. Look for support groups, either online or in person, or consider talk therapy to unlearn negative feelings you’ve absorbed consciously or unconsciously. The Trevor Project offers trained crisis counselors 24 hours a day, seven days a week, and its Resource Center features a range of educational materials and mental health resources. Unplug from the news. If you find that the headlines are increasing your levels of stress and anxiety, take a break.
