Pride Month Feature: Mental Health and Science of LGBT(QIA+) Individuals

by Yorick Peterse

In 1973, new psychological insights, scientific evidence, and most importantly, a strong societal pressure from the LGBT community, led the board of the American Psychiatric Association (APA) to abandon homosexuality as a mental health disorder. Fifteen years later, in 1987, all diagnoses related to same-sex attraction were finally removed from its manual in 1987. Notably, a transgender identity is still regarded as a psychiatric disorder by the APA and World Health Organization today, although this is debated and might be abandoned in the future.

Despite not being considered inherently ill because of one’s sexual orientation, a disproportionate number of LGBT individuals suffer from psychiatric diseases such as depression and mood disorders, anxiety, post-traumatic stress disorder, substance abuse and suicidal thoughts or attempts. Here, it is important to note that virtually all studies did not include sufficient QIA+ individuals to draw any conclusions for that part of the community. The increased occurrence of mental health issues in LGBT persons is often explained by the minority stress model, which posits that people belonging to a minority experience unique and chronic stress directly related to their minority identity, in this case sexual orientation or gender identity. Three sources are distinguished for this stress: direct discrimination and victimization by others, the individual’s own expectation about being discriminated against and the resulting vigilance of that person to avoid negative situations, and last, a person’s self-directed negative feelings about their sexuality/gender identity, also known as internalized homophobia.  

With this model in mind, one can think of ways to minimize stress experienced by LGBTQIA+ individuals. In a supportive and tolerant environment, discrimination occurs less frequently, people feel more free to be themselves, and institutionalized expectations about how one “should be” are less rigid. Indeed, a number of studies have shown that LGBT persons living in supportive environments experience lower levels of depressive and anxious symptoms, as well as suicidal ideations, whereas an unsupportive or discriminatory environment is associated with more psychological problems. A supportive environment can take many forms, but notable examples are acceptance by family, friends and colleagues; actively being part of the LGBTQIA+ community; Gay-Straight Alliances (GSAs) in high schools and LGBTQIA+ societies in universities or at the workplace; and law and policy directed at preventing and punishing discrimination and promoting equality, including same-sex marriage.

In the light of awareness, being informed about the scientific facts related to LGBTQIA+ issues can contribute to an environment of tolerance and support. As a full review of all scientific evidence related to sexual orientation and identity is far beyond the scope of this article, the focus will be on some key psychological and biological facts that might help increase the understanding and acceptance of LGBTQIA+ persons.

For instance, on a societal level, the landmark studies by Kinsey in the 1940s and 50s (conducted among cis-gendered men) revealed that 46% of men reported to have had homosexual attractions and 37% had engaged in homosexual behaviour - far more common than previously assumed. Additionally, homosexual behaviour occurs in many non-human species, and its acceptance in human societies is dependent on the culture and historical context. Furthermore, in sexology, the trichotomy of hetero-, homo- or bisexuality is often regarded not informative enough, and replaced by more dimensional scales for sexual attraction, behaviour and thoughts/fantasies. Together, these findings indicate that homosexual attraction is actually quite common, and can therefore hardly be considered as “abnormal”. For gender identity,  the number of people born as “intersex” (when the biological sex which cannot be classified as clearly male or female) is also much higher than many people think (1.7% according to one estimate), and as much as 0.4% of the population has a non-binary gender identity.

On a biological level, both gender identity and sexual orientation are mostly determined during prenatal development. Sexual behaviour is in turn largely “activated” by a renewed surge in sex hormone levels during puberty. Usually, a person with sex chromosomes XX develops a uterus and vagina, and identifies as a woman, whereas with XY chromosomes testes and a penis develop, and a person identifies as a man. However, the interplay of the sex hormones, chemicals and (until now largely unidentified) genes that determine sexual development can deviate from the “normal pathways”, and importantly, sexual differentiation of the sex organs and of the brain takes place at different time points during fetal development, allowing for a possible asynchrony between gender identity and the genitals of an individual and for the origination of a broader range of gender identities and a non-heterosexual orientation. For example, during fetal development, an absence or insensitivity of/for the hormones testosterone or aromatase lead to a brain differentiation usually associated to females, even in the presence of XY chromosomes. It should however be noted that there is a dimensional aspect to the “male or female brain structure”, and there are not two clearly distinct gender-related groups of brain structures.

In relation to sexual orientation, family and twin studies have shown that this is determined by genetics for more than 50%, and again sex hormones and chemical factors play a large role in this process. In contrast, there is no proof for any substantial influence of the postnatal environment on sexual orientation, and actually children raised by lesbian couples were found to be heterosexual as often as children of opposite-sex couples. With many genes, hormones and chemicals involved, it is understandable that any deviation in the sexual development process can lead to a different, or fluid, gender identity than assumed purely based on the sex chromosomes of a person, or in a non-heterosexual orientation.

In conclusion, after initially having contributed to the stigmatization of LGBTQIA+ individuals, psychiatric, psychological and biological science has long moved on and actually provides an evidential basis for creating understanding, and thereby tolerance and acceptance. Science has shown that gender identity and sexual orientation have a strong biological basis, and a diverse range of expression of both can occur under social, cultural and societal influences. Importantly, non-normative does not equal “abnormal” or “ill”. By being informed about this, stigmas, prejudices and discrimination can be reduced, creating an environment of lower stress, which in turn benefits the mental health of LGBTQIA+ individuals.

We certainly hope this is the case within the Max Planck Society, and that you as informed and highly educated individuals contribute to the spreading of an LGBTQIA+-friendly environment!

Suggested readings

  • Herek and Garnets. Sexual orientation and mental health. Annual Review Clinical Psychology (2007), vol. 3: 53–75
  • Kealy-Bateman and Pryor. Marriage equality is a mental health issue. Australasian Psychiatry (2015), vol. 23: 540-543.
  • Bao and Swaab. Sexual differentiation of the human brain: Relation to gender identity, sexual
  • orientation and neuropsychiatric disorders. Frontiers in Neuroendocrinology (2011), vol. 32: 214–226.
  • Joel et al. Sex beyond the genitalia: the human brain mosaic. PNAS (2015), vol. 112: 15468-15473.

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