May 17th is the day in which the World Health Organization officially declassified homosexuality as a mental disorder in 1990. This was some years after the 1973 removal of homosexuality as a psychiatric condition from the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association.
Both these changes were the result of many years of LGBTI rights campaigning – including the 1969 Stonewall riots in the USA, the watershed event which created a new generation of activism focused on overturning centuries of medical and criminal definitions of homosexuality.
None of the human rights gains that have occurred since the 1970s, including the introduction of marriage equality legislation in Australia in 2017, could have happened had there still been broad public or institutional acceptance of homosexuality as a mental condition.
Despite such changes, the LGBTI community still has a complex relationship with psychiatry and medicine – one that can provide great support for some, but can also create damaging experiences of pathologisation, stigma, and harm.
Challenges remain and change is incomplete. For example, in 2018 the World Health Organization removed ‘transgenderism’ as a mental health condition from its catalogue of illnesses and diseases. However, given many transgender people seek medical treatment to affirm their gender, the WHO felt it needed to retain a definition as a platform to advocate access to this treatment. As such, ‘gender incongruence’ is now officially listed by the WHO under ‘conditions related to sexual health’ – an outcome that is far from ideal.
The upcoming Royal Commission into Victorian Mental Health System presents an opportunity to draw attention to the negative implications that result from the pathologisation of diverse bodies, genders and sexualities.
In Australia, research demonstrating that LGBTI people experience significantly poorer mental health than the general population is widely cited because it is basis for LGBTI rights advocacy.
Statistics showing disparities in mental health have been incredibly powerful tools for change. Clear articulation of the health effects of inequality and discrimination has helped to galvanise support for policy and legislative shifts and brought much needing funding for dedicated LGBTI services and programs.
Linking human rights to health is a powerful tool for advocacy in part because it circumvents conservative, homophobic or transphobic resistance to funding for LGBTI programs or services. It is harder to argue against initiatives that are clearly saving lives.
The flipside, however, is that the image of LGBTI people can become associated with ill-health, particularly mental illness, discrimination and violence. This image still endures, despite LGBTI programs increasingly moving toward messages of valuing, affirming and celebrating. Imagine a broad public media campaign where the message is simply that it is excellent to be LGBTI!
While this might be exactly the message that many LGBTI people and their families need to hear it can be lost in research and campaigns that consistently focus on health disparities and negative outcomes.
And this is the tension because these health disparities are very real. LGBTI people do experience poorer mental health because they are more vulnerable to violence and discrimination than many others. However, this does not mean the lives of LGBTI people should be defined by experiences of discrimination and poor mental health. For many people, being LGBTI is joyous.
Finding the balance is key
At Rainbow Health Australia, our core business is developing research, evidence, programs and tools related to LGBTI health and wellbeing to promote positive social change; improvement in health outcomes being an important measure of equality.
Without losing sight that there is much work to do when it comes to improving health and wellbeing outcomes for LGBTI people, our message on May 17th is: LGBTI = simply awesome.
Written by Rainbow Health Australia Co-Directors Jen Power and Marina Carman.
Rainbow Health Australia is a program at the Australian Research Centre in Sex, Health and Society at La Trobe University. It supports the health and wellbeing of LGBTI Victorians through research, knowledge translation, training, resources, policy advice and service accreditation through the Rainbow Tick. Learn more by visiting our website.
