LGBTQ identity and its relationship to disability has also been analyzed by academics. LGBTQ identities have been pathologized as mental disorders by some groups, both historically and in the present. Alternatively, some activists, scholars, and researchers have suggested that under the social model of disability, society's failures to accommodate and include LGBTQ people makes such an identity function as a disability.
Rates of disability
In general, studies have found that LGBTQ populations report higher rates of disability than the general population.
In studies looking at populations in the United States, LGBTQ populations report higher rates of disability compared to the heterosexual and cisgender majorities.
According to the Movement Advance Project in 2019, an estimated 3 to 5
million lesbian, gay, bisexual and transgender people in the United
States have a disability.
In a 2020 study of Australian LGBTQ people, 38% of respondents reported having at least one disability.
In China, a rough estimate of cantong, or LGBTQ people with disabilities, is about 5 million people.
Academic theory
Academics writing about queer theory and disability studies
have drawn from one another's work, as both examine what society deems
as normal and how those people outside of that definition are treated. For example, theorist Robert McRuer has used Adrienne Rich's idea of compulsory heterosexuality to examine how society might also perpetuate "compulsory able-bodiness". In Feminist, Queer, CripAlison Kafer's
"engagement with the intersections of gender and cripping time is never
stronger than in the instances where she makes explicit the mainstream
responses to gendered disability narratives".
Street Transvestite Action Revolutionaries (STAR), a group founded by Marsha P. Johnson and Sylvia Rivera, worked both to support trans and gay people and disabled people.
STAR called for the end of non-consensual psychiatric incarcerations of
LGBTQ individuals, something Johnson had experienced in her life.
In the late 1970s, disabled attendees and groups were recorded at San Francisco Pride.
In the 1980s and early 1990s, the case of Sharon Kowalski was taken up by both disability and gay rights activists.
Kowalski, a lesbian, had become disabled after a car accident, and her
father had been awarded custody of her. Her father then moved Kowalski
to a nursing home five hours away from her partner, Karen Thompson, and
prevented Thompson from visiting Kowalski. In a victory for both groups
of activists, the Minnesota Court of Appeals ruled that Thompson be made Kowalski's legal guardian, in line with Kowalski's wishes.
In June 2014, the White House hosted a panel on LGBT issues and disability.
Medical care
Until 1973, homosexuality was included in the Diagnostic and Statistical Manual of Mental Disorders.
Although many gay liberation activists celebrated its removal, others
were blase or wary about aligning the wider community with psychiatric associations or providers. Before its removal, both anti-psychiatric and gay liberation activists had used homosexuality's inclusion in the DSM as leverage to criticize psychiatry as a whole.
In the late 1970s, Bobbie Lea Bennett became the first trans woman to have her gender-affirming surgery covered by Medicare. Bennett, as a wheelchair user with osteogenesis imperfecta,
was already covered by the policy, which forced the courts to decide
whether the surgery was considered a "legitimate medical treatment"; up
until this point, transgender activists trying to have their surgeries
covered under the policy had to argue that being transgender, in and of
itself, was a disability.
The Americans with Disabilities Act of 1990 (ADA) made disability a protected class
in the United States. However, the law purposefully excluded
homosexuality, bisexuality, and "[t]ransvestitism,
transsexualism...[and] gender identity disorders not resulting from
physical impairments" from the act's definition of disability. This exclusion has led to some cases in which prosecutors have argued that gender dysphoria is a "gender identity disorder" that therefore cannot be accommodated under the ADA. In 1998, Bragdon v. Abbott confirmed that HIV
was considered a protected disability under the ADA, which has been
used to protect HIV-positive individuals in years since, many of whom
are members of the LGBT community.
In 2017, Kate Lynn Blatt became the first trans woman who was
allowed to sue her employer under the ADA for not accommodating her
gender dysphoria.
Challenges
LGBTQ individuals with disabilities are subject to higher rates of childhood bullying and lack of comprehensive sex education.
LGBTQ individuals with disabilities who are assisted by family or
caregivers may have more difficulty finding time to be intimate with or
have sex with their partners. Those who live in group homes might similarly have difficulties with maintaining privacy within relationships.
People who cannot drive or require assistance while traveling may have
more limited opportunities to attend LGBTQ support groups, community
spaces, or events.
Limited travel opportunities may lead some disabled LGBTQ people,
especially those living in socially conservative areas, to pursue
online or long-distance relationships.
Discrimination
Medical care
In some cases, medical providers or other authorities will use a transgender person's disability status to deny them gender-affirming care, using the argument that the person is not capable enough to give informed consent for such care. Similarly, people may deny LGBTQ self-identification on the basis of someone's disability, particularly intellectual disability.
Alternatively, LGBTQ individuals may avoid seeking needed medical care, such as STI testing, or accessing disability services because of prejudiced comments or treatment by their healthcare providers.
Those who do seek medical care, but do not disclose their identity, may
have adverse health consequences when their identity is not taken into
account by their physicians.
LGBTQ individuals with disabilities that need in-home care may be
especially vulnerable, as they may be less likely to have family that
can care for them, and nurses or other hired caregivers may make
prejudiced or uneducated statements to their patients.Some individuals may choose to change their appearance or behavior so as to appear straight or cisgender to caregivers.
For people who are unsure of their sexual or gender identity,
caregivers or assistants may be unwilling to discuss the topic with
their client.
Interpersonal relationships
Both
LGBTQ people and people with disabilities face high rates of sexual
assault compared to the general population; for people who are both
LGBTQ and disabled, the statistics are even higher.
Employment
Limited opportunities for employment may drive some disabled LGBTQ people to remained closeted at work, to avoid being fired. For disabled individuals who are out, their disability and LGBTQ identity may further limit job opportunities.
A 2020 study of American lawyers found that nearly 60% of
respondents who were both LGBTQ and disabled reported having experienced
discrimination in the workplace related to their identities.
Intercommunity issues
A
common complaint among disabled LGBTQ people is that the LGBTQ
community does not discuss disability, and the disabled community does
not discuss queer identities. This is particularly an issue among the
LGBTQ movements in countries such as China and Nepal.
Within the LGBTQ community, accessibility remains an important issue. Not all LGBTQ community spaces, for example, have accessible buildings or parking, sign language interpretation, Braille signage, or TTY services.
LGBTQ events, such as Pride events and marches, may have routes which
are difficult to navigate for those in wheelchairs or using mobility
devices, or spaces that are too overwhelming for those with sensory
sensitivities. Lectures, gatherings, or film screenings may lack sign language interpretation or closed captions.
This may be further complicated by limited budgets that organizations
or groups have, leaving little funding to better cater to disabled
people.
Ableism more widely is also an issue within the LGBTQ community.
LGBTQ people with disabilities have also expressed that a focus in the
community on appearance can lead to disabled people feeling excluded or
undesirable as partners. Attitudes that disabled people are inherently asexual are also still prevalent.
Within disabled communities, homophobia and transphobia remain as important issues.
Related organizations
Multiple
organizations have been founded that specifically aim to serve those in
the LGBTQ community with disabilities. International organizations
include Blind LGBT Pride International.
In the U.S., these include Services & Advocacy for GLBT Elders (SAGE). In the U.K., these include Brownton Abbey, Deaf Rainbow UK, ParaPride, and Regard. In Australia there is Inclusive Rainbow Voices (IRV) and Rainbow Rights & Advocacy.
In media
Disabled LGBTQ characters in movies and television tend to be rare; a 2021 report by GLAAD found zero such characters in any major American movie releases that year. Their 2022 report found only 27 characters - 4.5% of all counted LGBTQ characters - who were also disabled. However, some movies and television shows featured disabled and LGBTQ characters do exist, such as Margarita with a Straw (2014), about a bisexual student with cerebral palsy, Queer as Folk (2022), which features a wheelchair-using side character, and Special (2019), a series about a gay man with cerebral palsy. Such characters have also been included in some children's shows, including The Dragon Prince (2018), which has a recurring Deaf lesbian character, and Dead End: Paranormal Park (2022), which has an autistic bisexual protagonist.
Some LGBTQ magazines have specifically addressed a disabled audience, such as the magazine Dykes, Disability & Stuff, from Madison, Wisconsin, which was founded in the late 1980s and was published until 2001. More general LGBTQ magazines have also addressed disability; lesbian magazine Sinister Wisdom, for example, made "On Disability" the theme of their Winter 1989/1990 issue.
Sexuality and disability is a topic regarding the sexual behavior and practices of people with disabilities. Like the general population, these individuals exhibit a wide range of sexual desires and adopt diverse methods of expressing their sexuality. It is a widespread concern, however, that many people with disabilities do not receive comprehensive sex education,
which could otherwise positively contribute to their sexual lives. This
stems from the idea that people with disabilities are asexual in nature
and are not sexually active. Although some people with disabilities
identify as asexual,
generalizing this label to all such individuals is a misconception.
Many people with disabilities lack rights and privileges that would
enable them to have intimacy and relationships.
When it comes to sexuality and disability there is a sexual discourse
that surrounds it. The intersection of sexuality and disability is often
associated with victimization, abuse, and purity, although having a
disability does not change someone's sexuality, nor does it change their
desire to express it.
For physical disabilities that change a person's sexual functioning, such as spinal cord injury, there are methods that assist where needed. An individual with disabilities may enjoy sex with the help of and physical aids (such as bed modifications), by finding suitable sex positions, or through the services provided by a sex worker.
History
Much
of the sexual biases in the United States are traced back to Puritan
ethics. Issues on the acceptance of sexuality and disability root back
to 2000 years. The review of history on sexuality in philosophy,
religion, and science leads to the modern day views on sexuality and
disability. Religious institutions were the first entities to combat
sexuality. They believed that sex was a sin and should not be practiced
unless it was done with intents of reproducing. Then doctors began
developing medical views on sex. Sexual pleasure was deemed a sickness.
The taboo around sexuality being a disease and sin restricted many
people from expressing their sexuality, especially people with
disabilities.
After much groundbreaking research, it was not until the 20th
century that sex and pleasure became normalized. With the normalization
of sex, pleasure became the main focus. Healthy sex meant a good
performance that led into an orgasm. If a person was not able to orgasm
during sex they were seen as inadequate for sexual intercourse.
With this a sex therapist would help the individual explore oral sex,
and clitoral orgasm. When a person with a disability is not able to
achieve an orgasm it was not seen as problematic, because they did not
have sexual desires. The neglect on the sexual lives of people with
disabilities roots from the idea that they are child like and asexual.
Because people with disabilities do not fall under the category of being
sexual, there were no resources for them to seek sexual assistance.
Over the years sexually disenfranchised groups were working
towards sexual acceptance for all people, including queer and disabled
communities. The work of these groups began to open doors for people
with disabilities to become more expressive of their sexuality. Even
with these new found opportunities, sexual pleasure for people with
disabilities remained unspoken of.
Self-image
Having
a disability may sometimes create an emotional or psychological burden
for the individual with disabilities. They may feel inhibition about
pursuing relationships, fearing rejection on the basis that they have a
disability. Self-image
may suffer as a result of disfigurement, or lack of confidence. A New
York disabled dating service manager explains, "Sexuality, travel,
mobility, pain: Everything takes on a different dimension." In The Ultimate Guide to Sex and Disability,
Miriam Kaufman points out that attempting to hide a disability or
minimize its existence is ultimately an added burden, encouraging
readers to "come out" to themselves as having a disability, to accept
their disability.
There is often fear associated with the intersection of sexuality
and disability. Many people with disabilities embody a fear of being
rejected due to the way they look. This hypersensitivity causes the
individual with disabilities to keep interactions platonic. Author of
Sex and Disability Robert McRuer studied a man with disabilities. McRuer
gave insight on the individuals sexual and non-sexual encounters. This
man had a belief that crossing the line into sexual encounters meant it
would cause severe bodily harm for him. During a sexual encounter, the
man felt very uncomfortable and could not cross the sexual boundary.
This was due to his fear of being judged. This is an issue common in
some people with disabilities. The "evaluative gaze" coming from others
causes people with disabilities to feel judged and uncomfortable in
their own bodies.
It is a common misconception that people with disabilities are insecure
and have a negative self-image. A study was done on 7 adolescents with cerebral palsy,
to assess their self-image. Of the group there were 3 girls and 4 boys,
ranging between 12 and 17 years old. A personality inventory was
conducted and the results came out to be positive. The group of
adolescents with disabilities viewed themselves very positively, rating
their self-image higher than norm groups. After the inventory, the
interviewer Lena Adamson wrote this conclusion in her "Brief
report—Self-image, Adolescence and Disability", published in the American Journal of Occupational Therapy:
The
following conclusions are made: Further studies on self-image and the
psychosocial development of adolescents with disabilities should (a)
focus on the social interaction outside their immediate families, and
(b) continue to use and develop methods where these adolescents can give
voice to their own experiences and opinions.
In contemporary society
Individuals with disabilities are rarely regarded in society as sexy
or believed to be sexually active. When sex and disability are linked,
it is common for marginalization to occur. Many people shy away from the
idea that individuals with disabilities can have sex. This is due to a
lack of information on the subject. Popular scholarly texts on
disability rarely discuss sex, conversely disability is rarely discussed
in the field of sexuality studies. Disability studies is a new field,
it is just recently beginning to have a voice in the scholarly
communities. Cultural theory on HIV and AIDS is one area of study that
has broadly considered disability and sex. Since the AIDS epidemic, the
queer community have been including physically and intellectually
disabled individuals in their activist interventions. Even with these
efforts, the correlation between sexuality and disability are not
discussed in disability studies.
In society, it is widely believed that women with disabilities
are asexual. One reason for this belief is that Individuals with
disabilities are seen as eternal children.
Others see the intertwine of sex and disability as an acrobatic act. It
is difficult for many people to imagine an individual with a disability
having sex, because of the restricting impairments.
Viewing women with disabilities as asexual has issues. In contemporary
United States, women with disabilities are not viewed as physically
attractive because society does not view them as sexually desirable.
This results in women with disabilities to be limited and constrained in
their capacity to love and be loved.
In the United States, pleasure and sex have been largely ignored,
especially when it comes to individuals with disabilities. Medical
facilities, public schools, and religious groups have created a "don't
ask don't tell" policy when it comes to sex education. The United States
government has spent over 500 million dollars funding a program that
restricts public schools from teaching sex in the classroom.
The idea that sex is meant for reproduction can be damaging to
the sexual lives of individuals with disabilities. Because some
disabilities restrict an individual from having children, the idea of
this person having sex is eliminated. Additionally, the hereditary
nature of certain disabilities may make caregivers of disabled adults
uncomfortable allowing them to engage in sexual activity. There also
exists a history of forced sterilization of disabled people, such as the Buck v. Bell case legalizing the practice in the US and the Law for the Prevention of Hereditarily Diseased Offspring mandating disabled people be sterilized in Nazi Germany.
Sexual activity
General
The mechanics of sex
may be daunting, and communication, experimentation, medication and
manual devices have been cited as important factors for sexual activity
where disability is involved. Additionally, recognition of the pleasure
that is derived from sexual activity beyond penetration and intercourse
is also highlighted. For example, changes may take place in a person's sexuality after spinal cord injury; sensitivity to touch can increase above the lesion location in someone with a spinal injury. From research undertaken by the Christopher and Dana Reeve Foundation, orgasm was achievable for 79% of men with incomplete spinal cord injuries and 28% of men with complete injuries.
Oral sex and manual sex
are other alternatives where penetration is not possible or not wanted,
and wedge devices can be used to aid with positioning—wedges can be
used as an aid in sex generally. Sex toys may be used as assistive devices as well; for example, vibrators
can be used to provide extra stimulation and in circumstances where
hand mobility is impaired. Other supportive devices include manual
stimulation pumps, for erection promotion and maintenance, and "sex
furniture", whereby rail or clamp enhancements, or specialised designs
facilitate sexual activity.
Writer Faiza Siddiqui sustained a serious brain injury that led
to a decrease in her sexual drive and the loss of her ability to orgasm,
with the latter most likely the result of damage to Siddiqui's
hypothalamus. Siddiqui explained her learning process in relation to
sexual activity following the accident in a 2013 article:
I had to clear away all the thoughts I had about my imperfect body ...
Since then, I've started to feel less shame about my unresponsive body
... My brain can't concentrate on as many things anymore, so I have to
focus more on every little twinge and the lightest of touches. Surely
that's going to mean better sex? I can't say that the sex is exactly
better – I can't be on top anymore – but I'm learning that it doesn't
really matter ... I had to grow up. Growing up is something that we're
all having to do.
Some people with a spinal cord
injury are able to "transfer their orgasm" using sexual energy to any
part of the body that has sensation. For example, Rafe Biggs acquired a
spinal cord injury in 2004. Through his work with a sexologist he
discovered during a massage that when his thumb was being massaged; it
felt very similar to his penis.
It was through this experience that he learned that he could transfer
his orgasm, using tantric energy, to his penis. Kenneth Ray Stubbs also
has a spinal cord injury and is able to use tantric bodywork to obtain
an "orgasmic feeling".[16]
If a person is able to use sexual energy correctly then they would be
able to experience an orgasm in any part of the body that is capable of
feeling sensation.
Fetishes and BDSM
Sexuality for people with disabilities is often linked to fetishes and "freakish excess".
Abasiophilia
is when an individual's sexual arousal is dependent on a sexual partner
with a disability. The obsession is most common for people with
disabilities who wear leg braces.
Apotemnophilia is when an individual amputates their own limb for
sexual pleasure. A case research done in the Journal of Sex Research
states "Apotemnophillia is related to erotization of the stump and to
overachievement despite a handicap." Little is known about the
relationship between sexual pleasure and amputated limbs. This is due to
the fetish being fairly new. Apotemnophilia was first introduced to the
public in the magazine Penthouse
in late 1972. The fetish was brought up by a young man with a
disability who practices this fetish. After reading his accounts some
editors of the magazine related with this feelings and published his
story.
Some individuals who have this fetish, have made successful
amputation attempts. For those who want to be amputated but do not have
the means or strength to do so, are able to get professional assistance.
Devotism is the sexual attraction someone has for a person with disabilities
Sex and disability does not only have an unattractive connotation.
Sex and Disability writer Robert McRuer found that Devotism had
renewed self-assurance in a group of women with disabilities. He writes
"Women who had felt profound shame about their bodies reported
significant gains in their self-confidence after discovering devotees."
This empowerment has led to positive changes in the women's behavior.
It has been reported by Robert McRuer that because of this some women
with disabilities are more confident in their self-image and do not hide
their disabilities as they previously have.
People who have a devotism fetish are referred to as Devotees.
Robert McRuer argues that devoteeism relies on disgust and desire. The
description of the devotees' desire come from an ableist assumption that
disabled bodies are disgusting. It is typical for a devotees to view
themselves as the only people who are sexually attracted to amputees.
This belief establishes a ground for Devotees exceptionalism.
BDSM
is a topic in the sex and disability culture. It has been described as
empowering for people with disabilities because of their acceptance of
non-normative bodies. BDSM could be used as a way to control pain for
people with chronic pain. Bob Flanagan
used BDSM to help him cope with his Cystic Fibrosis. His ability to
control his own pain excited him as he was known to push himself as far
as he could. "I was making a mockery out of something serious that had
happened to me," said Flanagan when making light of his pain related to
Cystic Fibrosis. Flanagan was an artist. He was a writer, an actor, and
also created a traveling museum exhibit called "Visiting Hours" that
showed the intersectionality of Cystic Fibrosis and sadism and
masochism. In the exhibit, "Visiting Hours",
museumgoers would experience an environment that was a combination of a
children's residential hospital and a BDSM torture chamber. The purpose
of this exhibit was to portray Flanagan's pain through a pleasurable
lens showing that BDSM could offer some sexual healing.
Women and girls with disabilities are a common focus in fetishism
due to their immobility. This makes them especially vulnerable to
sexual abuse.
Sex work
In
February 2013, it was reported that citizens with disabilities in the
Netherlands were eligible for a government-funded scheme that provided
funds to cover up to 12 occasions of sexual service per year.
During the same period, Chris Fulton, a campaigner in the UK with
cerebral palsy and muscular dystrophy, called upon the UK government to
also provide financial support for sexual services for people with
disabilities. Fulton explained:
The idea is to give people with disabilities more of a choice. There's
still a lot of stigma attached [to people with disabilities having
relationships] from research I've done and experiences I've had. I think
it would be good to bring the Dutch scheme over here to take away that
stigma about people with disabilities having sex. But it's not just
about that. It's about people with disabilities being accepted when they
have relationships ... It needs to be brought out into the open in a
managed and constructive way.
In early 2013, former brothel
owner Becky Adams spoke with the media about her intention to open a
non-profit brothel exclusively for people with disabilities in the UK,
which, if launched in 2014, will be the nation's first legal initiative
of this nature. Adams stated that she will invest £60,000 into the
brothel following a stroke in 2009—Adams explained that after the
stroke, her "eyes were suddenly opened. I was utterly unaware that such a
big group was suffering so enormously." If she is approved for a
permit, Adams plans to open a two-room service in Milton Keynes, near London, that will be staffed by sex workers and assistants.
Adams also founded the Para-Doxies service in 2012, which
connects people with disabilities throughout the UK with sex workers—at
the time, Adams ran the service on a completely voluntary, non-profit
basis. In April 2013, the service was receiving over 500 enquiries a
week from men, women and couples, and was struggling to cope with the
demand.
A 2011 Australian documentary directed by Catherine Scott, Scarlet Road,
explores another aspect of sexuality and disabilities through the life
of a sex worker who has specialized for 18 years in a clientele who have
disabilities. In 2012, the topic was highlighted in a fictional film based on the real life experience of writer Mark O'Brien. The Sessions portrays the relationship between O'Brien, who survived polio as a child, and a "sexual surrogate" to whom he loses his virginity. A member of the British Polio Fellowship states that post-polio syndrome, which affects polio survivors later in life, is a little-known condition that could have been explored in the film.
A survey conducted by the Disability Now magazine in 2005
found that 19% of female participants would see trained sex workers,
compared with 63% of the male respondents. Tuppy Owens,
sex therapist and disability professional, explained in 2013 that
disabled women "don't trust male sex workers to be honourable".
LGBT people with disabilities face double marginalization.
Individuals with disabilities are often either viewed as nonsexual or
hypersexual. Because of these misconceptions it is hard to find queer
people with disabilities portrayed in healthy sexual lives. During the recent decades, scholars have been working to include disabilities studies into queer theory,
with the intentions of normalizing disability in queer and LGBT spaces.
Queer and disabled liberation starts with the rejection of historic
ideas on sexuality and disability.
It is also rare to have a queer person with disabilities
portrayed in media. Some movies and literature do exist for the queer
disabled communities such as:
Akers, Michael D. (director). 2012. Morgan (film). United Gay Network
This movie is about a bicyclist who gets in an accident and becomes
paraplegic. After the bicyclist recovers from his injuries, he comes to
terms with his sexuality and falls in love with a man.
Alland, Sandra (filmmaker). 2013–2014. I'm Not Your Inspiration (documentary film series)
This is a short documentary series documenting the lives of queer and trans people with disabilities.
This is a film about a young Indian woman with cerebral palsy
who relocates to America for her undergraduate education. The movie
follows her complex romantic relationship with a blind woman.
Relationships
Individuals
with disabilities access to sexual and emotional partners is restricted
by societies de-eroticization of their sexuality.
The experiences of individuals with disabilities has shown that the
basic human need to form close relationships is as relevant for
individuals with disabilities as it is for humans without a disability.
Furthermore, the social networks of people with disabilities can be
small and this restricts the ability to form new relationships.
Society's view of disability also puts pressure of individuals with
disabilities in finding relationships. Even though our society has made
great strides with creating a more accepting world, individuals with
disabilities are still seen as outsiders. Parents prevent their children
from asking individuals with disabilities questions which results in
them viewing people with disabilities as "other". While the majority of non-disabled people meet other people in public spaces there are many physical and social barriers.
The lack of access to public spaces, whether it be stairs; an absence
of menus written in braille; or no ASL interpreters; could make it
difficult and almost impossible for an individual with disabilities to
go out. Individuals with disabilities also participate in online dating.
Not only are there websites that are for online dating, but there are
also websites that are solely for people with disabilities finding
someone that is also disabled or someone that wants to date an
individual with disabilities.
Disability stereotypes add to the difficulty and stigma
experienced by individuals with disabilities. The following myths about
individuals with disabilities have been identified:
Individuals with disabilities do not need sex to be happy.
Individuals with disabilities are not sexually attractive.
Individuals with disabilities are "oversexed".
Individuals with disabilities have more important needs than sex.
Individuals with disabilities do not need sex education.
Individuals with disabilities cannot have real sex.
Individuals with disabilities, particularly those with intellectual
disabilities, should not have children and should not be allowed to have
children.
According to one survey, up to 50% of adults with disabilities are not in any sexual relationship at all. Online dating sites specifically aimed at individuals with disabilities have been founded to fill this void.
Misperceptions from the broader community has been raised as a
prominent issue for individuals with disabilities in terms of their own
relationships. The head of a disabled dating service explained in 2010:
"Like anyone else, people with disabilities have different preferences.
Someone with good mobility may prefer someone also mobile; others don't
limit at all." In a 2012 Sydney Morning Herald,
the mother of a man with cerebral palsy explained, "It's hard being a
parent and this [sexuality] comes up. People see them sitting in their
wheelchair think, that's it. They don't see what's going on in their
lives and Mark [son] would dearly love a relationship."
Oppression
There
is a long history of seclusion and segregation that has affected
society's view of people with disabilities. For years people with
disabilities have been segregated from society. People with disabilities
were often put in institutions against their will because they were
deemed "weak" and "feeble minded". While they were in the institutions
they would often experience compulsory sterilization a.k.a. forced
sterilization.
The types of sterilization would include vasectomies, salpingectomy,
and other types as well. None of these were considered dangerous to the
person in the institution. In 1927, the United States Supreme Court case of Buck v. Bell stated that it was permissible to sterilize some people with disabilities against their will. It also stated in the decision that that did not violate the Fourteenth Amendment to the United States Constitution. However, in Olmstead v. L.C., 527 U.S. 581 (1999), the Supreme Court of the United States held that under the Americans with Disabilities Act,
individuals with mental disabilities have the right to live in the
community rather than in institutions if, in the words of the opinion of
the Court, "the State's treatment professionals have determined that
community placement is appropriate, the transfer from institutional care
to a less restrictive setting is not opposed by the affected
individual, and the placement can be reasonably accommodated, taking
into account the resources available to the State and the needs of
others with mental disabilities."
According to a series of interviews taken place in Malta
investigating the sexual lives of men and women with intellectual
disabilities, most individuals reported that they felt oppressed by the
expectations from families and caretakers to not engage in sexual
activity or a relationship.
As a result of the study, almost all individuals expressed a desire to
be able to talk openly about their relationships and spend more time
away from the family. And while all people's sexualities are controlled
and limited by social norms, people with disabilities feel that they are
limited by further factors.
Another study in Texas explored the beliefs of the families and
caretakers of people with intellectual disabilities on their
sexualities. The results revealed that the majority of families and
caretakers of those with intellectual disabilities believed that those
with disabilities should not engage in sexual activity because of the
fear that they will be taken advantage of.
A resolution to the oppression that people with disabilities face when
it comes to sexuality is educating families on these findings and
educating disabled people on their own sexualities and life options.
Sexual harassment, assault, and domestic violence
People with disabilities are no less vulnerable than people without disabilities to harassment, assault, and domestic violence. People with disabilities are more vulnerable to sexual assault than the general public, being targeted due to the physical or mental impairments that they have. The American Journal of Preventive Medicine has published results of a survey that found that males with disabilities are 4 times more likely to be sexually abused.
Other studies have shown that for women with disabilities, "regardless
of age, race, ethnicity, sexual orientation, or class [they] are
assaulted, raped, and abused at a rate two times greater than women
without disabilities [... the] risk of being physically assaulted for an
adult with developmental disabilities is 4–10 times higher than for
other adults".
It is estimated that 25% of both girls and boys with disabilities will
experience sexual abuse before the age of 18. It is also estimated that
20% of these incidents are reported. These rates are much higher than
sexual abuse incidents pertaining to nondisabled children. There is a 1
in 4 chance that a girl with developmental disabilities will be molested
before the age of 18. This is 10 times higher than the nondisabled
population. During the California Committee on Abuse of Person with
Disabilities, national statistics estimate the sexual abuse on people
with disabilities as such:
By
combining national statistics with specific studies, estimate ranges
are as follows: between 39% and 83% of girls with developmental
disabilities, and between 16% and 32% of boys with developmental
disabilities will be subjected to sexual abuse before the age of 18
years. Incidence of sexual abuse among the population of persons with
developmental disabilities was estimated in 1985 by the California State
Department of Developmental Services to be 70%.
A majority of the predators are documented to be the father or
stepfather of the victim. This is especially true for females with
developmental disabilities. It is estimated that 10% of girls with intellectual disabilities are victims of incest.
Females are most likely to be victims of sexual abuse. Studies show 50%
of disabled females have experience multiple incidents of sexual abuse
and 80% of disabled males experienced 1 incident. The numbers for sexual
abuse are so high because the perpetrators are well known to the
individual, such as a parent, uncle, aunt, cousin, friend, caretaker or
sibling.
The statistics on sexual abuse for people with disabilities are
also high because staff and dependent parents are not adequately trained
in identifying sexual abuse. Many staff believe that sexual abuse must
be proven before it is reported. The issue with this is that certain
disabilities restrict the individual from expressing the experience.
Adults with training in identifying abuse are more effective in
protecting the child. Most programs focus on "stranger danger", which is
not effective because most sexual abuse assaults come from the
individual's inner circle.
Prevention
Several prevention programs against sexual abuse for people with disabilities exist in the United States.
Seattle
In Seattle, United States a program called Seattle Project trains
individuals with developmental disabilities to prevent sexual assault.
Minnesota
In Minnesota, the Department of Corrections created a prevention
program where children and adults with disabilities are trained in all
aspects of abuse prevention.
California
In California, there is the Waters Child Abuse Prevention Training
Act (WCBTA). This program attempts to provide all children with abuse
prevention. Each program caters to the child's age and learning level.
In Contra Costa County, California, the WCBTA focuses on the needs of
various disabilities and sexual abuse prevention. In Los Angeles County
Office of Education they have created a Preschool Abuse Prevention
Program for Children with disabilities. In this, teachers are instructed
to train students with disabilities on physical, emotional, and sexual
abuse.
Organizations
Australia
The subject of the Scarlet Road documentary, Rachel Wotton, also co-founded and helps run Touching Base,
an organization based in New South Wales, Australia that provides
information, education and support for clients with disabilities, sex
workers and Disability Service Providers. The organization has been
active since October 2000 following the formation of the founding
committee that consisted of disability and health organization
representatives. Wotton explains, "I am a sex worker and I make my money
from clients seeing me. Some clients just happen to have a disability."
Initially, the organization was receiving around one weekly phone call,
but by 2012, inquiries were daily.
In March 2014, former Australian High Court judge Michael Kirby became a patron of the organization, joining four other inaugural patrons: Eva Cox,
Professor Basil Donovan, Associate Professor Helen Meekosha, and NSW
Local Government elder statesman Peter Woods. Following his appointment,
Kirby stated: "If you deny sexual expression to human beings, cut them
off from that aspect of their personalities and of their happiness, then
you end up with a lot of very frustrated and very unhappy people", and
he praised Touching Base for recognising that people with disabilities
need "to have opportunities for sexual expression".
People with Disability Australia has developed a sex and relationship education workshop for people with intellectual disabilities.
United Kingdom
TLC Trust
The TLC Trust provides a web-based service that facilitates the
provision of sexual services—sex workers, therapists, and teachers—for
people with disabilities, including a phone call appointment-booking
service for those people with speech impairments or care workers who are
unable to organize such services for clients due to the policy of their
employer. The TLC Trust was founded in 2000 at a Sexual Freedom
Coalition Conference and the website was initially run by James Palmer, a
man with disabilities. The organization has garnered praise from sex
educator and performance artist Annie Sprinkle, and academic and writer A.C. Grayling.
Outsiders
Founded by Owens, Outsiders is primarily an international social club
for people with disabilities, but the organization also runs the Sex
and Disability Helpline, a telephone support service for people with
disabilities that is staffed by both people with disabilities and health
professionals.
Outsiders is supported by the Outsiders Trust, which consists of a
board of trustees that assists with the management of matters such as
finances and projects.
Sexual Health and Disability Alliance (SHADA)
The Sexual Health and Disability Alliance, also founded by Owens, was
first started to provide a forum in which all of the UK's disability
helpline operators, and others, could meet and discuss their work. The
individuals who were initially involved state that they were "eager to
improve the sex-positive work we do" and the Alliance was eventually
formalized in 2008 with a mission to "bring together health
professionals who work with people with disabilities to empower and
support them in their sex and relationship needs."
The Alliance does not charge a fee for those interested in becoming
members and meets biannually in London. It held its first conference in
2009 at the Royal Society of Medicine.
The Disabilities Trust
The Disabilities Trust is over 30 years old and is a leading
charitable organization in the UK. It states that it provides
"residential and day services to meet the needs of individuals with
Autism, Brain Injury, Physical Disability and Learning Disability", as
well as helping people to live at home in the community. The Trust has
produced written information on sexuality and disability, which are
freely available on the Internet.
United States
Reach Out USA
Reach out USA is an advocacy organization that focuses on the
relationship between disability and LGBT (gay, lesbian, bisexual, and
transgender) concerns. The group's goal is to influence disabled
communities to be more aware of the LGBT communities, and LGBT
communities and organizations to be more accountable and welcoming of
disabled communities. Reach Out USA also helps out with other topics
such as mental illness, suicide, depression and much more.
Queerability
Queerability is an LGBT and disabled rights advocacy group that is
run by LGBT people with disabilities who hope to increase visibility to
the community. The goal of this group is to ensure that the voices of
LGBT people with disabilities are heard. The organization gives them a
large social platform to express themselves. Queerability does not only
advocate for the rights of LGBT disabled communities, but also provides
educational sources pertaining to the individuals sexuality and
disability. Some of the sources they provide include: How to Meet, Date,
and Have Sex When You're Disabled, Practical Sex Tips for people with
disabilities, Good Sex Positions for Disabled Sex, Talking About
Sensitive Topics and more.
France
The idea of sexual support emerged in 2007, when a conference on "Physical dependence: intimacy and sexuality" was organised by Marcel Nuss.
The Strasbourg conference is co-organised by Handicap International,
the Association des Paralyés de France (APF), the French Muscular
Dystrophy Association (AFM) and the Coordination Handicap et Autonomie
(CHA).
In France there are several structures that now provide training
for sex assistants: the Swiss association Sexualité et Handicap Pluriels
(SEHP), the Association for the Promotion of Sexual Support (APPAS),
founded by Marcel Nuss,
which is organising its first training cycle in 2015, and the
association Corps Solidaires, which brings together certified sex
assistants.
The field of psychology has extensively studied homosexuality as a humansexual orientation. The American Psychiatric Association listed homosexuality in the DSM-I in 1952 as a "sociopathic personality disturbance,"[1] but that classification came under scrutiny in research funded by the National Institute of Mental Health.
That research and subsequent studies consistently failed to produce any
empirical or scientific basis for regarding homosexuality as anything
other than a natural and normal sexual orientation that is a healthy and
positive expression of human sexuality.[2] As a result of this scientific research, the American Psychiatric Association removed homosexuality from the DSM-II in 1973. Upon a thorough review of the scientific data, the American Psychological Association
followed in 1975 and also called on all mental health professionals to
take the lead in "removing the stigma of mental illness that has long
been associated" with homosexuality. In 1993, the National Association of Social Workers
adopted the same position as the American Psychiatric Association and
the American Psychological Association, in recognition of scientific
evidence.[2] The World Health Organization, which listed homosexuality in the ICD-9 in 1977, removed homosexuality from the ICD-10 which was endorsed by the 43rd World Health Assembly on 17 May 1990.[3]
The consensus of scientific research and clinical literature
demonstrate that same-sex attractions, feelings, and behaviors are
normal and positive variations of human sexuality.[4] There is now a large body of scientific evidence that indicates that being gay, lesbian, or bisexual is compatible with normal mental health and social adjustment.[5]
Historical background
The view of homosexuality
as a psychological disorder has been seen in literature since research
on homosexuality first began; however, psychology as a discipline has
evolved over the years in its position on homosexuality. Current
attitudes have their roots in religious, legal, and cultural
underpinnings. Some Ancient Near Eastern communities, such as the Israelites, had strict codes forbidding homosexual activity, and when Christianity began, it adopted their Jewish predecessors attitudes surrounding homosexual activities. Among the New Testament authors Paul in particular is notable for his affirmation and reinforcement of such texts in his letters to nascent churches. Later, the Apostolic Fathers and their successors continued to speak against homosexual activity whenever they mentioned it in their writings. In the early Middle Ages the Christian Church
ignored homosexuality in secular society; however, by the end of the
12th century, hostility towards homosexuality began to emerge and spread
through Europe's secular and religious institutions. There were
official expressions condemning the "unnatural" nature of homosexual
behavior in the works of Thomas Aquinas and others. Until the 19th century, homosexual activity was referred to as "unnatural, crimes against nature", sodomy or buggery and was punishable by law, sometimes by death.[6]
As people became more interested in discovering the causes of
homosexuality, medicine and psychiatry began competing with the law and
religion for jurisdiction.
In the beginning of the 19th century, people began studying
homosexuality scientifically. At this time, most theories regarded
homosexuality as a disease, which had a great influence on how it was
viewed culturally.[7]
There was a paradigm shift in the mid 20th century in psychiatric
science in regards to theories of homosexuality. Psychiatrists began to
believe homosexuality could be cured through therapy
and freedom of self, and other theories about the genetic and hormonal
origin of homosexuality were becoming accepted. There were variations of
how homosexuality was viewed as pathological.[6] Some early psychiatrists such as Sigmund Freud and Havelock Ellis
adopted more tolerant stances on homosexuality. Freud and Ellis
believed that homosexuality was not normal, but was "unavoidable" for
some people. Alfred Kinsey's
research and publications about homosexuality began the social and
cultural shift away from viewing homosexuality as an abnormal condition.
These shifting viewpoints in the psychological studies of homosexuality
are evident in its placement in the first version of the Diagnostic Statistical Manual (DSM) in 1952, and subsequent change in 1973, in which the diagnosis of ego-dystonic homosexuality replaced the DSM-II category of "sexual orientation disturbance".[7] However, it was not until 1987 in DSM-III-R that it was entirely dropped as a mental disorder.[8]
A 2016 survey of the European Union Agency for Fundamental Rights found that many medical professionals in countries such as Bulgaria, Hungary, Italy, Latvia, Poland, Romania and Slovakia
believe that homosexuality is a disease and that such interpretations
continue to exist in professional materials. This goes against Council of Europe Recommendation 2010(5) which recommends that homosexuality not be treated as a disease.[9] As of 2018, homosexuality was popularly considered a disease in Lebanon.[10]
Freud and psychoanalysis
Sigmund Freud's views on homosexuality
were complex. In his attempts to understand the causes and development
of homosexuality, he first explained bisexuality as an "original libido
endowment",[11] by which he meant that all humans are born bisexual. He believed that the libido has a homosexual portion and a heterosexual portion, and through the course of development one wins out over the other.
Some other causes of homosexuality for which he advocated included an inverted Oedipus complex
where individuals begin to identify with their mother and take
themselves as a love object. This love of one's self is defined as
narcissism, and Freud thought that people who were high in the trait of
narcissism would be more likely to develop homosexuality because loving
the same sex is like an extension of loving oneself.[12]
Freud believed treatment of homosexuality was not successful
because the individual does not want to give up their homosexual
identity because it brings them pleasure. He used psychoanalysis and hypnotic suggestion as treatments, but showed little success.[13]
It was through this that Freud arrived at the conclusion that
homosexuality was "nothing to be ashamed of, no vice, no degradation, it
cannot be classified as an illness, but a variation of sexual
function".[14] He further stated that psychoanalysts "should not promise to abolish homosexuality and make normal heterosexuality take its place",[11]
as he had concluded in his own practice that attempts to change
homosexual orientations were likely to be unsuccessful. While Freud
himself may have come to a more accepting view of homosexuality, his
legacy in the field of psychoanalysis,
especially in the United States viewed homosexuality as negative,
abnormal and caused by family and developmental issues. It was these
views that significantly impacted the rationale for putting
homosexuality in the first and second publications of the American
Psychiatric Association's DSM, conceptualizing it as a mental disorder
and further stigmatizing homosexuality in society.[7]
Havelock Ellis
Havelock Ellis
(1859–1939) was working as a teacher in Australia, when he had a
revelation that he wanted to dedicate his life to exploring the issue of
sexuality. He returned to London in 1879 and enrolled in St. Thomas's Hospital Medical School. He began to write, and in 1896 he co-authored Sexual Inversion with John Addington Symonds.
The book was first published in German, and a year later it was
translated into English. Their book explored homosexual relationships,
and in a progressive approach for their time they refused to criminalize
or pathologize the acts and emotions that were present in homosexual
relationships.[15]
Ellis disagreed with Freud on a few points regarding
homosexuality, especially regarding its development. He argued that
homosexuals do not have a clear cut Oedipus complex but they do have
strong feelings of inadequacy, born of fears of failure, and may also be
afraid of relations with women.[16]
Ellis argued that the restrictions of society contributed to the
development of same-sex love. He believed that homosexuality is not
something people are born with, but that at some point humans are all
sexually indiscriminate, and then narrow down and choose which sex acts
to stick with. According to Ellis, some people choose to engage in
homosexuality, while others will choose heterosexuality.[16] He proposed that being "exclusively homosexual"[17]
is to be deviant because the person is a member of a minority and
therefore statistically unusual, but that society should accept that
deviations from the "normal" were harmless, and maybe even valuable.[15]
Ellis believed that psychological problems arose not from homosexual
acts alone, but when someone "psychologically harms himself by fearfully
limiting his own sex behavior".[16]
Ellis is often credited with coining the term homosexuality but in reality he despised the word because it conflated Latin and Greek roots and instead used the term invert in his published works. Soon after Sexual Inversion
was published in England, it was banned as lewd and scandalous. Ellis
argued that homosexuality was a characteristic of a minority, and was
not acquired or a vice and was not curable. He advocated changing the
laws to leave those who chose to practice homosexuality at peace,
because at the time it was a punishable crime. He believed societal
reform could occur, but only after the public was educated. His book
became a landmark in the understanding of homosexuality.[15]
Alfred Kinsey
Alfred Charles Kinsey (1894–1956) was a sexologist who founded the Institute for Sex Research, which is now known as the Kinsey Institute for Research in Sex, Gender and Reproduction.
His explorations into different sexual practices originated from his
study of the variations in mating practices among wasps. He developed
the Kinsey Scale,
which measures sexual orientation in ranges from 0 to 6 with 0 being
exclusively heterosexual and 6 being exclusively homosexual.[18] His findings indicated that there was great variability in sexual orientations. Kinsey published the books Sexual Behavior in the Human Male and Sexual Behavior in the Human Female,
which brought him both fame and controversy. The prevailing approach to
homosexuality at the time was to pathologize and attempt to change
homosexuals. Kinsey's book demonstrated that homosexuality was more
common than was assumed, suggesting that these behaviors are normal and
part of a continuum of sexual behaviors.[7]
The social, medical, and legal approach to homosexuality ultimately
led to its inclusion in the first and second publications of the
American Psychiatric Association's Diagnostic and Statistical Manual
(DSM). This served to conceptualize homosexuality as a mental disorder
and further stigmatize homosexuality in society. However, the evolution
in scientific study and empirical data from Kinsey, Evelyn Hooker,
and others confronted these beliefs, and by the 1970s psychiatrists and
psychologists were radically altering their views on homosexuality.
Tests such as the Rorschach, Thematic Apperception Test (TAT), and the Minnesota Multiphasic Personality Inventory
(MMPI) indicated that homosexual men and women were not distinguishable
from heterosexual men and women in functioning. These studies failed to
support the previous assumptions that family dynamics, trauma, and
gender identity were factors in the development of sexual orientation.
Many psychologists have differing opinions about same-sex relationships.
Some think that it is not healthy at all, some support it, and some
cannot support it because of their own personal religious beliefs.[19]
Due to lack of supporting data, as well as exponentially increasing
pressure from gay rights advocates, the board of directors for the
American Psychiatric Association voted to declassify homosexuality as a
mental disorder from the DSM-II in 1973, but the DSM retained a
diagnosis that could be used for distress due to one's sexual
orientation until the DSM-5 (2013).[20]
Major areas of psychological research
Major psychological research into homosexuality is divided into five categories:[21]
What causes some people to be attracted to his or her own sex?
What causes discrimination against people with a homosexual orientation and how can this be influenced?[22]
Does having a homosexual orientation affect one's health status, psychological functioning or general well-being?
What determines successful adaptation to rejecting social climates?
Why is homosexuality central to the identity of some people, but
peripheral to the identity of others?[23]
How do the children of homosexual people develop?
Psychological research in these areas has always been important to counteracting prejudicial attitudes and actions, and to the gay and lesbian rights movement generally.[21]
Although no single theory on the cause of sexual orientation has yet gained widespread support, scientists favor biologically based theories.[24]
There is considerably more evidence supporting nonsocial, biological
causes of sexual orientation than social ones, especially for males.[25][26][27]
Discrimination
This section needs expansion. You can help by adding to it. (May 2008)
Anti-gay attitudes and behaviors (sometimes called homophobia or heterosexism)
have been objects of psychological research. Such research usually
focuses on attitudes hostile to gay men, rather than attitudes hostile
to lesbians.[21] Anti-gay attitudes are often found in those who do not know gay people on a personal basis.[28] There is also a high risk for anti-gay bias in psychotherapy with lesbian, gay, and bisexual clients.[29]
One study found that nearly half of its sample had been the victim of
verbal or physical violence because of their sexual orientation, usually
committed by men. Such victimization is related to higher levels of
depression, anxiety, anger, and symptoms of post-traumatic stress.[30][full citation needed] Through the 2015 U.S. Transgender Survey, which was conducted by the National Center for Transgender Equality,
transgender people of color were found to face disproportionate
discrimination because of their overlapping identities. These forms of
discrimination included violence, unreasonable unemployment, unfair
policing, and unfair medical treatment.[31]
Research suggests that parents who respond negatively to their
child's sexual orientation tended to have lower self-esteem and negative
attitudes toward women, and that "negative feelings about homosexuality
in parents - decreased the longer they were aware of their child's
homosexuality".[32]
In addition, while research has suggested that "families with a
strong emphasis on traditional values implying the importance of
religion, an emphasis on marriage and having children – were less
accepting of homosexuality than were low-tradition families",[33] emerging research suggests that this may not be universal. For example, recent[when?] research published in APA's Psychology of Religion & Spirituality journal by Chana Etengoff and Colette Daiute[34]
suggests that religious family members can alternatively use religious
values and texts in support of their sexual minority relative. For
example, a Catholic mother of a gay man shared that she focuses on "the
greatest commandment of all, which is, love". Similarly, a Methodist
mother referenced Jesus in her discussion of loving her gay son, as she
said, "I look at Jesus' message of love and forgiveness and that we're
friends by the blood, that I don't feel that people are condemned by the
actions they have done." These religious values were similarly
expressed by a father who is a member of the Church of Jesus Christ of Latter-day Saints who shared the following during his discussion of the biblical prohibition against homosexuality: "Your goal, your reason for being, should be to accept and to love and to lift up ... those in need no matter who they are".[22]
Mental health issues
Psychological
research in this area includes examining mental health issues
(including stress, depression, or addictive behavior) faced by gay and
lesbian people as a result of the difficulties they experience because
of their sexual orientation, physical appearance issues, eating
disorders, or gender atypical behavior.
Psychiatric disorders: in a Dutch study, gay men reported significantly higher rates of mood and anxiety disorders than straight men, and lesbians were significantly more likely to experience depression (but not other mood or anxiety disorders) than straight women.[21] A research paper from the American Journal of Community Psychology
states that individuals who face multiple forms of oppression tend to
find their hardships more difficult to manage. In this study, it is
noted that LGBTQ+ people who are disabled have reported struggling more
with their oppressed statuses.[35]
Physical appearance and eating disorders: gay men tend to be more concerned about their physical appearance than straight men.[36][full citation needed] Lesbian women are at a lower risk for eating disorders than heterosexual women.[37]
Gender atypical behavior: while this is not a disorder, gay men may
face difficulties due to being more likely to display gender atypical
behavior than heterosexual men.[38] The difference is less pronounced between lesbians and straight women.[39]
Minority stress:
stress caused from a sexual stigma, manifested as prejudice and
discrimination, is a major source of stress for people with a homosexual
orientation. Sexual-minority affirming groups and gay peer groups help
counteract and buffer minority stress.[7]
Ego-dystonic sexual orientation: conflict between religious identity and sexual orientation can cause severe stress, causing some people to want to change their sexual orientation.
Sexual orientation identity exploration can help individuals evaluate
the reasons behind the desire to change and help them resolve the
conflict between their religious and sexual identity, either through
sexual orientation identity reconstruction or affirmation therapies.[7]
Ego-dystonic sexual orientation is a disorder where a person wishes
their sexual orientation were different because of associated
psychological and behavioral disorders.
Sexual relationship disorder: people with a homosexual orientation in mixed-orientation marriages may struggle with the fear of the loss of their marriage.[7]
Sexual relationship disorder is a disorder where the gender identity or
sexual orientation of one of the partners interferes with maintaining
or forming of a relationship.
The likelihood of suicide attempts is higher in both gay males and
lesbians, as well as bisexual individuals of both sexes, when compared
to their heterosexual counterparts.[40][41][42] The trend of having a higher incident rate
among females encompasses lesbians or bisexual females; when compared
with homosexual or bisexual males, lesbians are more likely to attempt
suicide.[43]
Studies dispute the exact difference in suicide rate compared to
heterosexuals with a minimum of 0.8–1.1 times more likely for females[44] and 1.5–2.5 times more likely for males.[45][46] The higher figures reach 4.6 times more likely in females[47] and 14.6 times more likely in males.[21]
Race and age play a factor in the increased risk. The highest
ratios for males are attributed to young Caucasians. By the age of 25,
their risk is more than halved; however, the risk for black gay males at
that age steadily increases to 8.6 times more likely. Over a lifetime,
the increased likelihoods are 5.7 times for white and 12.8 for black gay
and bisexual males. Lesbian and bisexual females have the opposite
trend, with fewer attempts during the teenager years compared to
heterosexual females. Through a lifetime, the likelihood for Caucasian
females is nearly triple that of their heterosexual counterparts;
however, for black females there is minimal change (less than 0.1 to 0.3
difference), with heterosexual black females having a slightly higher
risk throughout most of the age-based study.[21]
Gay and lesbian youth who attempt suicide are disproportionately
subject to anti-gay attitudes, often have fewer skills for coping with
discrimination, isolation, and loneliness,[21][48][49] and were more likely to experience family rejection[50]
than those who do not attempt suicide. Another study found that gay and
bisexual youth who attempted suicide had more feminine gender roles,[51]
adopted a non-heterosexual identity at a young age and were more likely
than peers to report sexual abuse, drug abuse, and arrests for
misconduct.[51]
One study found that same-sex sexual behavior, but not homosexual
attraction or homosexual identity, was significantly predictive of
suicide among Norwegian adolescents.[52]
Government policies have been found to mediate this relationship
by legislating structural stigma. One study using cross-country data
from 1991 to 2017 for 36 OECD countries established that same-sex
marriage legalization is associated with a decline in youth suicide of
1.191 deaths per 100,000 youth, with the impact more pronounced for male
youth relative to female youth.[53]
Another study of nationwide data from across the United States from
January 1999 to December 2015 revealed that same-sex marriage is
associated with a significant reduction in the rate of attempted suicide
among children, with the effect being concentrated among children of a
minority sexual orientation, resulting in about 134,000 fewer children
attempting suicide each year in the United States.[54]
Coming out: many gay, lesbian and bisexual people go through a "coming out"
experience at some point in their lives. Psychologists often say this
process includes several stages "in which there is an awareness of being
different from peers ('sensitization'), and in which people start to
question their sexual identity ('identity confusion'). Subsequently,
they start to explore practically the option of being gay, lesbian or
bisexual and learn to deal with the stigma ('identity assumption'). In
the final stage, they integrate their sexual desires into a positive
understanding of self ('commitment')."[21] However, the process is not always linear[55] and it may differ for lesbians, gay men and bisexual individuals.[56]
Different degrees of coming out: one study found that gay men are
more likely to be out to friends and siblings than to co-workers,
parents, and more distant relatives.[57]
Coming out and well-being: same-sex couples who are openly gay are more satisfied in their relationships.[58]
For women who self-identify as lesbian, the more people know about her
sexual orientation, the less anxiety, more positive affectivity, and
greater self-esteem she has.[59]
Rejection of gay identity: various studies report that for some
religious people, rejecting a gay identity appears to relieve the
distress caused by conflicts between religious values and sexual
orientation.[7][60][61][62][63]
After reviewing the research, Judith Glassgold, chair of the American
Psychological Association sexuality task force, said some people are
content in denying a gay identity and "there is no clear evidence of
harm".[64]
Often, sexual orientation and sexual orientation identity
are not distinguished, which can impact accurately assessing sexual
identity and whether or not sexual orientation is able to change; sexual
orientation identity can change throughout an individual's life, and
may or may not align with biological sex, sexual behavior or actual
sexual orientation.[65][66][67]
Sexual orientation is stable and unlikely to change for the vast
majority of people, but some research indicates that some people may
experience change in their sexual orientation, and this is more likely
for women than for men.[68]
The American Psychological Association distinguishes between sexual
orientation (an innate attraction) and sexual orientation identity
(which may change at any point in a person's life).[69]
In a statement issued jointly with other major American medical
organizations, the American Psychological Association states that
"different people realize at different points in their lives that they
are heterosexual, gay, lesbian, or bisexual".[70] A 2007 report from the Centre for Addiction and Mental Health
states that, "For some people, sexual orientation is continuous and
fixed throughout their lives. For others, sexual orientation may be
fluid and change over time".[71]
Lisa Diamond's study "Female bisexuality from adolescence to adulthood"
suggests that there is "considerable fluidity in bisexual, unlabeled,
and lesbian women's attractions, behaviors, and identities".[72][73]
LGBT parenting is the parenting of children by lesbian, gay, bisexual, and transgender (LGBT)
people, as either biological or non-biological parents. Gay men have
options which include "foster care, variations of domestic and
international adoption, diverse forms of surrogacy (whether
"traditional" or gestational), and kinship arrangements, wherein they
might coparent with a woman or women with whom they are intimately but
not sexually involved".[74][75][76][77][78] LGBT parents can also include single parents; to a lesser extent, the term sometimes refers to parents of LGBT children.
In the 2000 U.S. Census,
33% of female same-sex couple households and 22% of male same-sex
couple households reported at least one child under eighteen living in
their home.[79]
Some children do not know they have an LGBT parent; coming out issues
vary and some parents may never come out to their children.[80][81]Adoption by LGBT couples and LGBT parenting in general may be controversial in some countries. In January 2008, the European Court of Human Rights ruled that same-sex couples have the right to adopt a child.[82][83] In the U.S., LGBT people can legally adopt, as individuals, in all fifty states.[84]
Although it is sometimes asserted in policy debates that
heterosexual couples are inherently better parents than same-sex
couples, or that the children of lesbian or gay parents fare worse than
children raised by heterosexual parents, those assertions are not
supported by scientific research literature.[2][85]
There is ample evidence to show that children raised by same-gender
parents fare as well as those raised by heterosexual parents. Much
research has documented the lack of correlation between parents' sexual
orientation and any measure of a child's emotional, psychosocial, and
behavioral adjustment. These data have demonstrated no risk to children
as a result of growing up in a family with one or more gay parents.[86] No research supports the widely held conviction that the gender of parents influences the well-being of the child.[87]
If gay, lesbian, or bisexual parents were inherently less capable than
otherwise comparable heterosexual parents, their children would present
more poorly regardless of the type of sample; this pattern has not been
observed.[88]
The vast majority of families in the United States today are not
the "middle-class family with a bread-winning father and a stay-at-home
mother, married to each other and raising their biological children"
that has been viewed as the norm. Since the end of the 1980s, it has
been well established that children and adolescents can adjust just as
well in nontraditional settings as in traditional settings.[97]
Psychotherapy
Most
people with a homosexual orientation who seek psychotherapy do so for
the same reasons as straight people (stress, relationship difficulties,
difficulty adjusting to social or work situations, etc.); their sexual
orientation may be of primary, incidental, or no importance to their
issues and treatment. Regardless of the issue for which psychotherapy is
sought, there is a high risk of anti-gay bias being directed at
non-heterosexual clients.[29]
This section needs expansion. You can help by adding to it. (October 2009)
Most
relationship issues are shared equally among couples regardless of
sexual orientation, but LGBT clients additionally have to deal with
homophobia, heterosexism, and other societal oppressions. Individuals
may also be at different stages in the coming out
process. Often, same-sex couples do not have as many role models for
successful relationships as opposite-sex couples. There may be issues
with gender-role socialization that does not affect opposite-sex
couples.[98]
A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage.[99]
Therapy may include helping the client feel more comfortable and
accepting of same-sex feelings and to explore ways of incorporating
same-sex and opposite-sex feelings into life patterns.[100]
Although a strong homosexual identity was associated with difficulties
in marital satisfaction, viewing the same-sex activities as compulsive
facilitated commitment to the marriage and to monogamy.[101]
Gay affirmative psychotherapy is a form of psychotherapy
for gay, lesbian, and bisexual clients which encourages them to accept
their sexual orientation, and does not attempt to change their sexual
orientation to heterosexual, or to eliminate or diminish their same-sex
desires and behaviors. The American Psychological Association (APA) and
the British Psychological Society offer guidelines and materials for gay affirmative psychotherapy.[102][103]
Practitioners of gay affirmative psychotherapy state that homosexuality
or bisexuality is not a mental illness, and that embracing and
affirming gay identity can be a key component to recovery from other
mental illnesses or substance abuse.[102] Some people may find neither gay affirmative therapy nor conversion therapy
appropriate, however. Clients whose religious beliefs are inconsistent
with homosexual behavior may require some other method of integrating
their conflicting religious and sexual selves.[104]
The American Psychological Association
recommends that if a client wants treatment to change their sexual
orientation, the therapist should explore the reasons behind the desire,
without favoring any particular outcome. The therapist should neither
promote nor reject the idea of celibacy, but help the client come to
their own decisions by evaluating the reasons behind the patient's
goals.[105] One example of sexual orientation identity exploration is sexual identity therapy.[7]
After exploration, a patient may proceed with sexual orientation
identity reconstruction, which helps a patient reconstruct sexual
orientation identity. Psychotherapy, support groups,
and life events can influence identity development; similarly,
self-awareness, self-conception, and identity may evolve during
treatment.[7]
It can change sexual orientation identity (private and public
identification, and group belonging), emotional adjustment (self-stigma
and shame reduction), and personal beliefs, values and norms (change of
religious and moral belief, behavior and motivation).[7] Some therapies include "gender wholeness therapy".[106]
The American Psychiatric Association
states in their official statement release on the matter: "The
potential risks of 'reparative therapy' are great and include
depression, anxiety, and self-destructive behavior, since therapist
alignment with societal prejudices against homosexuality may reinforce
self-hatred already experienced by the patient. Many patients who have
undergone 'reparative therapy' relate that they were inaccurately told
that homosexuals are lonely, unhappy individuals who never achieve
acceptance or satisfaction. The possibility that the person might
achieve happiness and satisfying interpersonal relationships as a gay
man or lesbian are not presented, nor are alternative approaches to
dealing with the effects of societal stigmatization discussed. APA
recognizes that in the course of ongoing psychiatric treatment, there
may be appropriate clinical indications for attempting to change sexual
behaviors."[107]
The American Psychological Association aligns with this in a
resolution: it "urges all mental health professionals to take the lead
in removing the stigma of mental illness that has long been associated
with homosexual orientation"[108]
and "Therefore be it further resolved that the American Psychological
Association opposes portrayals of lesbian, gay, and bisexual youth and
adults as mentally ill due to their sexual orientation and supports the
dissemination of accurate information about sexual orientation, and
mental health, and appropriate interventions in order to counteract bias
that is based in ignorance or unfounded beliefs about sexual
orientation."[109]
The American Academy of Pediatrics advises lesbian, gay, gynandromorphophilic, and bisexualteenagers
struggling with their sexuality: "Homosexuality is not a mental
disorder. All of the major medical organizations, including The American
Psychiatric Association, The American Psychological Association, and
the American Academy of Pediatrics agree that homosexuality is not an
illness or disorder, but a form of sexual expression. No one knows what
causes a person to be gay, bisexual, or straight. There probably are a
number of factors. Some may be biological. Others may be psychological.
The reasons can vary from one person to another. The fact is, you do not
choose to be gay, bisexual, or straight."[110]
Developments in individual psychology
In contemporary Adlerian
thought, homosexuals are not considered within the problematic
discourse of the "failures of life". Christopher Shelley, an Adlerian
psychotherapist, published a volume of essays in 1998 that feature
Freudian, (post)Jungian and Adlerian contributions that demonstrate
affirmative shifts in the depth psychologies.[111] These shifts show how depth psychology can be utilized to support rather than pathologize gay and lesbian psychotherapy clients. The Journal of Individual Psychology,
the English language flagship publication of Adlerian psychology,
released a volume in the summer of 2008 that reviews and corrects Adler's previously held beliefs on the homosexual community.
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