Changing the LGBT Lived Experience

Shanti M. Pepper, Ph.D. is a psychologist and co-owner of

The Sage Center for Trauma and Wellness.

A Photo

A Photo

The increasing visibility of the lesbian, gay, bisexual, and transgender (LGBT) community is captured in literature, the media, and most recently in our legal system with the momentous SCOTUS decision. Some mental health professionals find themselves in conversations exploring how these new legal protections, for example, will change the face of LGBT mental health. Previous research consistently suggests that the LGBT community is significantly more likely to experience mental health problems like depression, anxiety, and substance abuse with one study finding this community to be affected 2½ times more compared to their heterosexual counterparts (Cochran, Sullivan, & Mays, 2003). A foundational study conducted by Herek, Gillis, Cogan (1999) found that when compared to heterosexuals, gay and bisexual men are 25% more likely to experience physical violence and lesbian women are 20% more likely. Equally appalling, individuals in the transgender community are more likely to report discrimination in almost all areas of their lives, including areas of health care, employment, housing, education, legal systems and within their family units. It’s also imperative to note that when dual stigma status exist, say for example for those gender variant individuals who are also racial/ethnic minorities, discrimination tends to be more severe. The research and literature is unequivocally clear in their findings suggesting that being LGBT, in and of itself, is not a mental health disorder but that individuals within the community experience external messages that range from implicit devaluing to explicit discrimination and/or violence. It is this societal stigma, oppression, and discrimination that contributes to LGBT mental health disparities.

Given the increased visibility and civil liberties, which many believe to be largely positive in nature, one might predict a decrease in future rates of anxiety, depression, substance use, and even PTSD in the LGBT community. The truth is, seismic changes are taking place across the country. One might venture to hope that this shift will reduce the amount of new HIV positive cases for the transgender community because many trans men and women are talking openly with their health care providers. Or maybe the levels of panic disorder will dramatically reduce when our LGBT brothers and sisters do not walk this earth in fear of losing their jobs or being attacked. One might also venture to believe that reversing the decades-long negative messages about God and self-worth will slowly melt away the isolation and depression that exists for many. All because the laws of the land are changing, right? It is this author’s belief that, unfortunately, more hard work is still ahead.

You see, an individuals’ heart, not just the country’s laws, is the real place where change occurs. A grandma quietly standing against her church’s teachings as she attends her grandson’s wedding to his partner of seven years. A father lovingly serving at the feet of his transgender teen daughter while she recovers from a breast augmentation, or “top surgery.” When a boss participates in the baby shower of his lesbian employee. The way each individual human values another individual, on a day-to-day basis, these are the “micro” events that shift perspective, that shift hearts, and that change the lived experience of LGBT individuals. The country’s historic decision to allow same-sex marriage is a macro-level change for our LGBT clients, and the weight of this decision is without words; the translation from felt emotion to expressed language does not currently exist. We are witnessing history, through joy and tear-filled eyes and yet, people’s hearts may take longer to change. Sadly, the safety of an LGBT individual may have more to do with the level of expressed hate or love in that community than any SCOTUS decision about marriage equality. As clinicians assisting our clients through this healing journey, we see the complex multi-dimensional factors that contribute to their health. Their biological predisposition, their social and cultural influences, their spiritual connectedness (or disconnectedness), and their experiences with oppression. Equality under the law is vital, it is indeed imperative for optimal health. Yet, there is a long road ahead by which clinicians will continue to help their clients repair these oppressive wounds created by the daily events of discrimination and hate.

This article falls on the heels of the month of June, which is LGBT Pride month and, coincidently PTSD Awareness month. This month calls us to honor the progress of our nation and of our profession while still moving forward so we may see those hopeful health changes described above. It is also an opportunity to reflect upon our lives, both as professionals and as humans walking this earth (noting these are not mutually exclusive identities, but in fact the same), and hearing the call to not only provide excellent clinical care but to see whose hearts may need to be changed. This may be your neighbors’, this may be your parents’ heart, but most importantly, the work may actually begin in your own heart. Every clinician, even those in remote rural areas, will work with an LGBT individual. Are you able to provide the excellent clinical care paired with the micro-level healing experiences (that are of the professionally appropriate variety) required for this community… or for any oppressed community? What is your comfort level with pronouns used to support the transgender community, talking with your LGBT clients about healthy relationships, job discrimination, advocacy, parental conflict, healing spiritually, and safe sex practices? These continue to be the issues facing the community and the truth is, the work of healing others almost always begins with the self. As frequently stated by one of my favorite teachers, Pema Chodron, “start where you are.”

Shanti M. Pepper, Ph.D. is a psychologist and co-owner of The Sage Center for Trauma and Wellness. She specializes in in the treatment of trauma, holistic approaches to mental health, and serving those in the LGBT community.