Diversity / People of Color
After completing this module the participant will understand how social and cultural factors influence psychosocial development and identity formation.
- Appreciate how men and women can have different psychosexual life paths and understandings of their LGB identity;
- Understand how racial, ethnic and class groups may conceptualize sexual identities in radically different ways;
- Appreciate how religious upbringing and beliefs can seriously complicate an individual's adjustment to his/her sexuality.
- LGBT identity:
- Can interact with other aspects of cultural identity in complex ways.
- Does not describe an aspect of cultural identity.
- Always takes on more importance than ethnic identity.
- All of the above.
- Members of a racial or ethnic minority who are gay:
- May face double discrimination by the majority community.
- May have difficulty finding possible role models.
- May feel they have to choose a primary identity.
- All of the above.
- Religious LGBT people:
- Must remain celibate to retain their faith.
- May experience conflicts between their faith and their LGBT identity.
- Must abandon their faith in order to successfully come out.
In an American Psychiatric Association white paper outlining a research agenda for the DSM-V, Alarcon et al. (2002) outline three different strands of association between culture and psychiatric diagnosis:
- a comparative cultural psychiatry developed from the vantage point of asylums and colonial psychiatrists, leading to so-called culture-bound syndromes;
- a study of illness behavior and diagnoses in non-white groups within multicultural societies, leading to studies of migration, acculturation, and associated traumas; and
- a recognition and analysis of psychiatric knowledge and practice as the outcome of social, cultural, economic, political, and historical factors.
Using this framework, the study of the mental health of all lesbian, gay, and bisexual (LGB) people clearly falls into the realm of cultural psychiatry under the third strand.
When thinking about diversity within the LGB community, there are broad, influential factors that affect identity. These may include diverse cultural ideas about gender roles, conceptions about the place of family, family structure and family expectations, geographical location, and the influence of religion (Garnets & Kimmel 2003). While it is important for psychiatrists to have knowledge about issues within each major community (Cabaj and Stein 1996) a categorical approach may be limiting, and paradoxically may reinforce cultural stereotypes. It is difficult, after all, to speak of specific commonalities between disparate members of the same ethnic group— for example, a married Mexican migrant farm worker who has sex with men on the side and a third-generation Latina graduate student planning a gay wedding ceremony in Toronto.
In addition, when formulating research questions, a common mistake is to assume that gays are a homogeneous group, overlooking not only race and ethnicity as mediating variables, but also age, gender, socioeconomic status, etc (Herek et al. 2003). Often, "the gay community" being studied consists of gay, white men. This not only leads to conclusions that are difficult to generalize or cannot be generalized, but also limits the scope of research questions. One reason for a paucity of literature on gay people of color, for example, is researchers' lack of recognition of diversity within the gay community. This is not only a problem in research on gay populations, but in research on racial and ethnic minorities. For example, researchers, looking at alcohol dependence in the Native American population, may omit questions about sexual orientation, thereby not only contributing to the invisibility of gay and lesbian people of color, but also missing possible confounding factors and complex interactions.
In addition, terms like "gay" or "lesbian" are culture-bound. Most models of sexual identity formation with stages of coming out are a largely white, western phenomenon (Cass 1996). Ethnic minorities who researches may categorize as "gay," "homosexual" or "bisexual" may not necessarily identify themselves as such. For some LGB individuals, identification with another group may be a more important determinant of their identity than their sexual identity. It is helpful for the clinician to understand the diverse meanings of sexual orientation within these groups. With the above caveats in mind, this module draws attention to some of the issues related to race, gender, ethnicity, religion socioeconomic status, disability and geography.
Race & Ethnicity
An individual's racial or ethnic identity plays a powerful role in social belonging and group affiliation (Chan 1995). LGB individuals who are black, Latino, Asian, Pacific Islander or Native American are members of a "double minority." Members of a "double minority" can have interpersonal and familial issues, as well as intrapsychic conflicts, that affect the successful development of an affirmative identity and self esteem.
Disclosure of one's homosexual or bisexual orientation can sometimes leads to a negation of one's racial or ethnic identity, either from one's racial or ethnic group (e.g. "There are no gays in our community, therefore you are not Black, Asian, Arab, etc.") or from the larger gay community (e.g. "Your race does not matter, you are gay, you are one of us"), or both. Consequently, LGB people of color can face alienation, discrimination, or both from the LGB community and from their ethnic community of origin. Some members of LGB racial minorities may feel forced to choose one identity over the other. In addition, LGB people of color may not necessarily derive the same psychological benefits from "the gay community" as white gays, e.g. social support, visible role models, acceptance for "who you are," and at times may even experience racism within the gay community (Garnets and Kimmel 2003) .
Men and women will have very different experiences of being gay or bisexual because sex and gender are profound determinants of identity. Prejudice against women can have an impact on a lesbian's development. While lesbians and gay men may share common psychological qualities and interests, this assumption must be tempered with the recognition that lesbian psychology and development may relate as much to female psychology and development as it does to the psychology of being gay.
Gender may influence the development of sexuality and sexual orientation differently in men and women. For example, there are differing expectations for men and women that may limit women's choices or lead to sex discrimination. Gender socialization of boys and girls profoundly influences the quality of their social interactions, and as a result, men and women generally behave in different ways. Consequently, a variety of features of same-sex relationships will be influenced by the gender characteristics of the partners. [See also the unit on Development.]
Religious institutions are passionately debating the meanings of homosexuality and its impact on the individual, the family and society at large. A growing number of religions are moving toward theological positions that tolerate and even actively embrace LGB individuals. Some religious groups are ordaining LGB priests, ministers and rabbis. Other, have reaffirmed their traditional opposition to open expressions of homosexuality. Regardless of an LGB individual's personal relationship to religion or his/her involvement with a specific religious group, s/he will be profoundly affected by religious teachings and beliefs about homosexuality.
LGB individuals have had exposure to a wide range of religious attitudes toward homosexuality. Some may maintain ties to their original communities of faith while others may have changed their religion. Many LGB individuals have left religious communities with disapproving or condemnatory teachings about homosexuality. Some have abandoned religious practices altogether. Others may work within their religious groups to try and change traditional, unaccepting attitudes about homosexuality. Many LGB individuals have sought reconciliation between their sexual identity and their spirituality within traditional religious groups; some have been successful in doing so. Others have moved to create new churches and spiritual settings that affirm their sexual identities and their relationships.
LGB individuals often internalize the antihomosexual attitudes with which they have been raised or to which they have been exposed since childhood. In some cases, this may inhibit their sexual identity development and their ability to develop relationships. LGB individuals from communities where social and religious activities are deeply intertwined may stop participating in religious activities altogether and become estranged from their families, or may identify with their religious identity and avoid any involvement with the LGBT community. Conflicts between religious beliefs and homosexual feelings are usually an important focus of the clinical work with religious LGB individuals.
Javier is a 17 year old first generation Mexican-American male born in San Diego. He has been aware of same sex attraction since fifth grade. Although he dated girls in junior high school, since then he has become more certain of his gay sexual orientation. However, this conflicts with his Roman Catholic upbringing. He is very close to his mother and is afraid she will be heartbroken if he does not marry and have children. He asks you if he will go to hell if he pursues his gay inclinations.
As with any client, the clinician has to be respectful of Javier's religious and cultural values. However, it is not the role of psychiatrists to get their patients to conform to religious dogma. The clinician might explore what Javier's core moral values are and if and how they actually conflict with his sexual orientation. Javier may not be aware that increasing numbers of gay couples are choosing to start families by adopting children (see parenting). He could also be referred Dignity--the gay Catholic community organization.
Socioeconomic Status, Disability, Geography
All these are additional factors that may influence a person's LGBT identity and connection to the wider gay community. For example, coming out as gay in rural Montana is markedly different from coming out in Manhattan. On the other hand, the internet may be blurring geographic boundaries and lessening social isolation for rural LGBT people. Physical disabilities may limit LGBT people's access to the larger gay community. However, subcommunities of support may exist, eg. The gay deaf community. Socioeconomic status interacts with other cultural factors as well, eg. Being a poor black gay man from the inner city poses much different challenges than being an upper middle class, Harvard-educated black man from the suburbs. For these groups as well as other cultural groups discussed above, it may be much harder to find or recognize positive role models in one's neighborhood or the media.
Betty is a 64 year old white woman living on social security. For twenty years she lived with her female partner in a trailer in rural upstate New York. The couple had met on the job and developed their relationship. To Betty's surprise, she had never considered herself a lesbian prior to meeting her partner. Five years ago, Betty's partner suddenly died. Betty now comes to treatment complaining of depression. She has no connection to the gay community and no family members are aware of the relationship she lost. In the past year her diabetes has resulted in loss of vision and Betty cannot drive. She feels increasingly isolated, helpless, and unable to move on from her grief. The clinician can help Betty by identifying bereavement as a primary diagnosis, which will frame her feelings of depression and validate the importance of the relationship with her partner. The clinician can help Betty explore whether disclosing her loss and therefore her same sex relationship to her family might provide her with additional support. The clinician can also point Betty in the direction of resources in the gay community, such as the local gay bookstore or SAGE so that she can begin to find a social network.
- Gay identity:
- is the same for men and women
- does not exist for African-Americans
- may vary in different countries
- is well accepted by middle class white families
- is condemned by all religions
- is incompatible with spiritual beliefs
- is more common among agnostics
- None of the above
- LGB people in rural areas
- must go to large cities to pursue their sexuality
- must repress their sexuality
- may use the internet to find community
- marry and secretly have gay relationships
- Religion is an aspect of diversity important to consider in evaluating