Mental Health and Queerphobic Sentiments: The Continued Pathologisation Of Queerness

Mental Health and Queerphobic Sentiments: The queer community has had a long and arduous relationship with what identity can look like for them. This is specifically true in the context of how systems accept or “allow” the societally palatable ideas of identification.

Having to fight for acceptance and inclusion - indeed, just the right to exist and to identify as themselves - something that has consistently occurred as a result of systemic marginalisation, has led to a need to examine what these systems look like, and the power they hold to shape the realities of the people who must live under it.

While this power disparity is most clearly observed and commonly discussed in the context of judicial and legal systems, the history of discrimination and dehumanising LGBTQ+ individuals is also rooted in other sociological systems of power, including the field of medicine. Particularly when viewed through the frame of diagnostics, the healthcare industry (including mental health care) becomes not one of protecting those who need help, but a system that enables disenfranchisement through the very structures it strives to uphold over time. This form of consistent exclusionary practice lends itself to exclusionary diagnostics in both how conditions are identified, named and recorded, and also in who receives this diagnosis in the first place. 

In the context of mental health, queerphobic sentiments make themselves known in formalized forms of diagnosis in several ways. In one form, several older versions of diagnostic manuals (the most noted example of this being the DSM) have pathologized queer identities as specific mental illnesses that require therapeutic intervention or change. This propels a vicious cycle where systemic validation of the “difference” as an illness furthers instances of discrimination instead of instances of support. Furthermore, it creates a barrier to accessing healthcare in the first place - by othering the identity of an individual itself, as if highlighting that the queerness of an individual is something that can be changed to be made more acceptable - as if there is a cure to make queer identities and lives more palatable to bigots.

There is some resistance displayed towards these diagnostics through identifying the biases that exist in the very human “experts” that create these discriminatory standards in the first place. However, a majority uncontested use of these diagnostic manuals is indicative of how pathologizing queer identities by individuals in positions of power and privilege often goes unchecked and unquestioned.

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In another form, psychiatry as a medical discipline has a history of conflating the association between queer identity and mental illnesses. Rather than looking at the relationship as one that has systemic correlations (and origins in stigmatization), the relationship is commonly perceived as being causal in nature. This furthers the discrimination and stigamization faced by the community, while cyclically allowing for the monolith of the ‘queer identity’ to be pathologized further.

The system of oppression that ends up being created in the healthcare system (particularly illustrated in the context of mental health here) leads to a deep mistrust in the queer community towards accessing these systems as spaces of support. The system instead becomes yet another facet of society that disregards identity in the forms that it can take, and instead dictates the forms that they think identity /should/ take, rooted in this context around the word ‘normal’ and the forms that “normal people” should take.

Any system of mental health that attempts to support the queer community needs to take this difficult history into consideration - and account for the very systems of distrust that it put in place in the first place. To win over support and trust from the queer community, the very least that needs to be done is the acknowledgement and respect of identity as a non-negotiable. The second step in the process needs to be the facilitation of an understanding of identity that centres queer lived experiences, and not the assumptions about the community through the lens of the oppressors who created the systems in the first place.

Another acknowledgement that needs to be made in the context of the medical and psychosocial healthcare industry is one of access. While identity intersections inform access to these structures in the first place, queer (affirmative) mental healthcare is almost wholly inaccessible, aside from a select few large cities, where the conversation then shifts to a lack of affordability and other systemic barriers that just morph and take up new forms. Even in these cities, there are no guidelines, no governing bodies, and no regulation in what should be a humane system of care. To this end, it is imperative to reimagine what mental health care can and should look like, to create access that acknowledges the systems of oppression that precede it and is responsive to the same.

Aishwarya Srinivasan is a social psychologist and cognitive anthropologist, with a background in cognitive science, evolution, social behaviour, and mental health. Their research is rooted in interdisciplinarity and allows for the viewing of social contexts from multiple lenses. The views expressed are the author's own.