Mental health is a vital concern to the LGBTQ community, but it often goes ignored, or worse — stigmatized. Although the National Alliance on Mental Illness (NAMI) reports that people who identify as LGBTQ are three times as likely to experience a mental health condition like depression or anxiety, even within our own community, ignorance and discrimination against mental illness abounds.
“I tend to let my guard down around people I know are LGBTQ+ [because] they know about acceptance,” said Janet Weiss, 27, a pansexual Charlotte native who was diagnosed with bipolar disorder in her teenage years. “That’s why it can hurt so much more when one of these people I trusted turns out to be as blind and as cruel as any other ‘neurotypical’ — someone who doesn’t have mental illness or a learning disability or a brain injury; someone whose brain works the way it’s generally assumed it’s supposed to.”
No community and no individual is immune to holding preconceived notions about those different from themselves. LGBTQ people know the harmful effects of small comments — “that’s so gay” comes to mind — and the same is true of those with mental illness.
“Remember all the times you resented somebody’s assumption that they knew what was going on in your head or in your heart?” Weiss asks. “All the times you needed the people in your life to take your word for it that you know who you are? Show that same humanity to people like me. I don’t think it’s so much to ask that coming out as bipolar not be even more frightening than coming clean about my sexuality.”
But this stigma does exist, and it does impact both individuals with mental illness as well as the institutions that are meant to help them. The Mayo Clinic notes that when family, friends and community fail to understand, the personal effects can be enormous. Sarah Crouse, 25, knows this far too well.
“Internalization of heteronormativity led me to realizing later than I should have that I’m bisexual,” Crouse told qnotes. “[Similarly], the most serious obstacles that mental illness stigma has provided to me, personally, were self-made ones. Internalizing the idea that I should just be able to ‘get over’ my depression and anxiety led me to view my inability to do so as a personal failing, a sign of poor character.”
The way that outward intolerance turns inward is likely familiar to LGBTQ readers, even ‘neurotypical’ ones. How many of us have hated ourselves for our desires, when family or religious communities judged us harshly? This internalization is what Dr. Mike Freidman, a Manhattan-based clinical psychologist, calls “self-stigma.”
“Self-stigma will often undermine self-efficacy, resulting in a ‘why try’ attitude that can worsen prospects of recovery,” wrote Dr. Freidman for Psychology Today. “One research review of 22 studies that focused on barriers to care and mental illness determined that stigma and embarrassment were the top reasons why people with mental illness did not engage in medication adherence.”
Of course, “going off your meds” is usually not an effective way to combat a legitimate illness — and despite what far too many people claim, mental illness is legitimate. Saying “it’s all in your head” to someone with mental illness is parallel to telling a diabetic, “it’s all in your pancreas.” A chemical imbalance is a chemical imbalance, whatever organ it affects.
Licensed Clinical Social Worker Alicia Lightfoot of University Psychological Associates in Charlotte, N.C. points out that though many mental illnesses do improve from medicated treatment, there are other vehicles for support available. But without the community support that encourages a person to seek help, many neglect their mental wellness and emotional stability.
“Having good social supports that the individual can be vulnerable with, including lots of positive and affirming experiences, can help insulate and build resiliency when faced with societal stigmas,” Lightfoot told qnotes “Sometimes just having someone that you can be vulnerable with is healing within itself. Normalizing seeing a therapist or counselor as part of good self-care, just like going to a gym or yoga class, could be really helpful for a lot of people that struggle with reaching out for help.”
Normalizing mental self-care is challenging when even members of more tolerant communities seem prone to the same prejudices that prevent individuals from entering treatment.
“When one of us [in the LGBTQ community], in all earnestness, tosses off a word like ‘psychotic’ or ‘bipolar’ as if that constitutes a character flaw, it feels like a betrayal,” Weiss said. “Normality is relative. They know that no amount of self-recrimination can change who we are; the harder we fight to bend the crooked bits of ourselves into shape, the more damage we cause. They know that ignorance and malice too often walk hand in hand.”
Ignorance — and the related malice — can lead to something even more damaging. As with anti-LGBTQ legislation and policies implemented as a result of homophobic and transphobic stigma, that against mental illness has institutional results as well.
The Mayo Clinic notes that those with mental illness may have fewer opportunities for employment, suffer social alienation and have difficulty securing reliable housing. Even health insurance companies often don’t adequately cover treatment for mental illness.
“My income is below the poverty line, and I spend half of it on insurance co-pays,” said another LGBTQ person who chose to share thoughts anonymously and was diagnosed with bipolar disorder. “My medication, frequent therapist visits and the increased co-pays for specialists in psychiatry have literally forced me to apply for food stamps. But without that treatment, I’d probably be dead.”
Dr. Freidman reminds us that the isolation stigma incurs “is associated with poor mental and physical health outcomes and even early mortality — ‘the lethality of loneliness’.”
Lethal loneliness occurs frequently in a world where mass murderers are labeled “mentally ill” in the media without diagnosis; where parents in denial would sooner bring a struggling child to church than therapy; where significant others ask “why do you need pills? Don’t I make you happy?”
Individual, private struggles reach an even broader level when stigma is widely held even within healthcare providers and the halls of legislatures. The Centers for Disease Control and Prevention acknowledge that stigma leads to lower prioritization of government resources, and lower-quality care.
NAMI and other mental health advocates work tirelessly to combat stigma and its destructive effects. NAMI’s StigmaFree campaign asks that allies take the pledge: educate themselves and others; see the person, not the condition; take action on personal and legislative levels.
A person is not defined by their symptoms. Stereotyping based on diagnosis is still stereotyping, no matter what characteristic is being used. At best, dismissive comments about mental illness are insensitive. At worst, they are blatantly discriminatory.
“Telling a person with depression to try harder to cheer up makes as much sense as telling a lesbian to look harder for the right penis,” Weiss declares. “Someone with OCD is not a cranky neat freak. Someone with PTSD is not a coward. And I am no one’s punchline.”