KEY POINTS
Heterosexism is the attitude or belief that heterosexuality is the only normal and natural expression of sexuality.
Research shows sexual orientation microaggressions experienced by gay, lesbian, and bisexual people could be directly linked to PTSD symptoms.
While LGBTQ+ people have increased rates of substance use problems, they only make up 1 percent of clients in mainstream treatment programs.
In describing heterosexism—the attitude or belief that heterosexuality is the only normal and natural expression of sexuality—I often use humidity as an analogy.
Heterosexism isn’t something you can necessarily always see. However, for members of the LGBTQ+ community, heterosexism is like humidity in that it’s thick, murky, heavy, and absolutely something that we can feel. In an article about the impact of microaggressions on sexual minorities, the authors wrote: "Sexual orientation microaggressions reflect heterosexism and long-held societal biases that continue to have a negative impact on the lives of individuals who are not heterosexual. The daily effect of this type of microaggression is an increase in marginalization, isolation, and devaluing of the lives of sexual minorities (Sue, 2010 as cited by Platt & Lenzen, 2013)."
When most of us think of homophobia and transphobia, we often think of a verbal or physical attack. Derogatory language, bullying, or assault is what usually comes to mind. However, homophobia and transphobia can also be subtle, conscious, or unconscious and are buried in heterosexism.
In the study of trauma, mental health professionals usually classify trauma into two categories: physical trauma and emotional trauma–sometimes known as “big T trauma” and “little t trauma.” Physical, or “big T,” trauma includes domestic violence, sexual assault, death, a natural disaster, or the experience of war. “Physical trauma is more recognizable than emotional trauma, which provides a possible explanation for why more emotionally related experiences with trauma are overlooked in the research” (Goodwin, 2014). Emotional, or “little t,” trauma, is still a highly distressing event, but it doesn’t fall into the more widely recognized physical trauma category—for instance, a non-life-threatening injury, verbal abuse, bullying or harassment, or the loss of significant relationships.
Although this classification of trauma may make physical trauma appear to be more severe than emotional trauma, the effects of emotional trauma, especially if they’re ongoing, are just as harmful. “Emotional trauma is primarily responsible for the impact of trauma on individuals’ mental health and quality of life,” wrote the author of a study on the effects of homophobic-related trauma for LGB men and women (Schneider et al., 2012, as cited in Goodwin, 2014). For many years while teaching social-emotional learning (SEL) to LGBTQ+ youth, bartending at a popular gay bar, and working as an LGBTQ+ advocate, I had seen homophobia and transphobia as the main culprit of people’s pain. However, it wasn’t until I attended a conference for mental health professionals that I came to understand how the microaggressions LGBTQ+ people experience on a daily basis, including heterosexism and not being fully seen, are themselves trauma. In a 2013 qualitative study by Platt and Lenzen, the authors revealed seven themes of sexual orientation microaggressions among gay, lesbian, and bisexual people (GLB). The seven themes were: endorsement of heteronormative culture; sinfulness (morally deviant); overt homophobia; heterosexist language/terminology; over-sexualization; under-sexualization; and microaggressions as humor. To be clear, each of the seven themes was a consistent experience found among GLB people, and the research showed how each of the themes experienced by gay, lesbian, and bisexual people could be directly linked to PTSD symptoms based on the DSM-IV-TR checklist (Goodwin, 2014).
And while the study showed that heterosexism is just as important a predictor of PTSD symptoms among people who are GLB (Bandermann & Szymanski, 2014), heterosexist discrimination does not meet the threshold for Criterion A in the DSM-5 as hate crimes do.
In addition to PTSD symptoms, heterosexism is linked to psychological distress in general (Bandermann & Szymanski, 2014). What’s more, the internalization of heterosexist-related microaggressions is a cause for increased rates of drug and alcohol use among people who are GLB.
Although research shows that LGBTQ+ people have increased rates of substance use problems, they only make up approximately 1 percent of clients in mainstream treatment programs (Amico & Neisen, 1997; Finnegan & McNally, 2002, as cited in Rowan & Faul, 2011). This speaks to the effects of LGBTQ-related microaggressions and underscores how heterosexism operates societally. What's more, LGBTQ+ people don’t have access to the same levels of care as non-LGBTQ+ people suffering from addiction—often a result of the very thing preventing them from seeking treatment.
Something important to consider is that even though “LGBTQ” is often used together as one acronym, each group in the LGBTQ+ community has unique experiences related to their identity. More research needs to be done on heterosexism and how it impacts bisexual, transgender, and gender non-conforming individuals. While gender and sexuality aren’t the same and shouldn’t be conflated, heterosexism still impacts gender minorities.
Be Mindful of Who Is in the Room
It’s not possible to be socialized in a dominant heterosexist culture and not somehow absorb heterosexist-infused beliefs. As such, it can be easy to automatically, consciously, or unconsciously make assumptions about our clients' identities. And while the majority of the population is heterosexual and cisgender (statistically speaking), there is much to be said about the spectrum of gender and sexuality.
Not long ago, I had an appointment with my dentist of four years. We were chit-chatting and catching up, and she happened to mention that she and her wife were going out of town to visit some friends. It suddenly occurred to me that after all these years, I had never considered that she could be a lesbian.
Beneath heterosexism lies homophobia and transphobia. Unconsciously assuming my dentist was heterosexual is a perfect example of the heterosexist glasses that we can all sometimes unknowingly wear.
Not everyone who seeks mental health services will be heterosexual, and not all LGBTQ+ clients are aware of the extent to which heterosexism impacts their lives. Further, not all clinicians are aware of the connection between heterosexism, trauma, and being a sexual and/or gender minority.
When we consider the possibility that our clients might be LGBTQ+, it helps disrupt heterosexism and prevents sexual and gender microaggressions.
By understanding the link between heterosexism and LGBTQ-related trauma, mental health professionals can work together to decrease the clinical implications of heterosexism among LGBTQ+ people–both inside and outside of the therapy room. We also create space for our clients to be seen and known fully.
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