One of my clinical interests is the mental health of people who identify as lesbian, gay, bisexual and transgender. It is also one of my research interests, but unfortunately I haven’t been able to conduct any research into the area yet (hopefully that will happen post-qualification). We know broadly speaking, that people who are LGBT tend to experience stigma and prejudice, that HIV, for example, can result in psychological difficulties and that young LGBT people are more likely to self-harm and to attempt suicide. Mental health services are also not always set up to listen to the experiences of sexual minorities. It all says much about mental health provision, and it doesn’t say a lot that is positive, to be frank.
Happily, there is less stigma surrounding sexual orientation these days, but it’s patently obvious that all is not rosy. Nevertheless, sexuality is at least now debated in the mainstream media without too much vitriol. I came across two articles last week, both in broadsheets. One was about the prevalence of sexual assault on the gay scene; the other was about notions of ‘campness‘ and internalised homophobia. I found Strudwick’s article more thought-provoking, I must confess, but that’s because I have debated what it means to be ‘camp’ several times with several people. Strudwick’s writing revealed something that had previously been unknown to me. So far so good. But both articles made me think.
Strudwick and Jones are both gay men, and both their pieces were about gay men, which is fair enough. Reading them, though, I realised how much more ‘visible’ gay men, and gay male ‘culture’ (as though it is a homogeneous beast) is. Neither piece acknowledged females, but, then, why should they, necessarily? They were specifically about gay men and their experiences. I wouldn’t expect gay men to write about gay women, particularly, but I found the notion thought-provoking nevertheless. The fact is, I don’t know that I’ve ever come across any articles in the mainstream media which address these topics amongst women. I realised that I have no idea whether there is sexual assault amongst gay women. I don’t know whether ‘butch’ and ‘femme’ are seen positively or negatively, or whether they are tinged with shame or homophobia. I don’t know if there is an ‘ideal’ for gay women. I know that I have seen women who are gay or bisexual professionally and that for some sexuality has been something that they wanted to discuss, in the same way that some gay or bisexual men have wanted to do so. But other than that, I am pretty ignorant. So I asked someone I know and had a look at the research findings. And what, you may ask, did I learn?
I learned that if you search for ‘lesbian mental health’ on Google Scholar you get this. You get pages and pages of results talking about lesbian and gay populations, and lots about lesbians, gay men and bisexual folk, but, of the first sixty, results, only half a dozen or so focus exclusively on gay women. Most relate to victimisation, satisfaction with mental health services or, in one case, compared gay women to their heterosexual sisters. Most of the papers were from the 1980s and 1990s; the most recent was published in 2008.
This struck me as extraordinary. We know that gay people often have a tough time, not because they are more vulnerable to mental health problems per se, but because we live in a culture in which they continue to face stigma and oppression. We know that up to 10% of the population identifies as non-heterosexual (the precise figure depends on the survey). If you search for ‘gay men mental health’ you get 350 000 Scholar results; all of which talk about gay men. Yet my search for data relating to gay women turned up 109 000 results; the majority seeming to be about all gay and/or bisexual people. Is it the case that gay women are happily immune to the difficulties which seem to be prevalent amongst gay men? Perhaps, but I wouldn’t be so sure. Is it the case that female sexuality, often glossed over across academic disciplines has been also woefully neglected in mental health? Quite possibly. The absence of research into the are certainly suggests that’s a possibility. And the critical question for me, as a clinician, is what does this mean for gay women who are struggling with their mental health, whether or not it is related to their sexuality? Gay women are rather more invisible in popular culture than their male peers, but there’s little mention of it; much less any outcry. We create mental health services targeted at gay men and the problems they may present with. I don’t know of a single similar NHS service for women; and as far as I’m aware, provision in the voluntary sector isn’t much better. If the research isn’t there, we don’t know what the problems are, if any. If we don’t know that we can’t provide appropriate services. But it’s also about value and whose voice is worth hearing; whose story is worth exploring. I don’t know if the mental health of gay women is something enough clinicians and academics are concerned about. There are cultural and historical reasons that have resulted in gay men’s mental health being studied and it is a good thing that we have made progress in that area. But it is possible to be gay without being a man and I don’t think we’ve got to grips with what that can mean for people; the way that being a gay woman is often akin to being a minority within a minority. Being a minority, of any kind, is rarely easy. If there are gay females out there who could benefit from input from mental health professionals, but who are not getting it, the fault is ours. But by that token, responsibility for doing something about it also rests with mental health professionals, and that will require us to start valuing the experiences of a group which has been heretofore neglected in both the scientific literature and in our collective professional mindset.