How Silence Can Make You Sick

Confronting Health Disparities Among Lesbian, Gay, Bisexual And Transgender Youth

This article in Science Daily gives an overview of the state of health care for LGBTQ youth. In it they make an important point.  Often, in articles on LGBT youth and health it is emphasized that LGBT youth have a higher incidence of substance use, mental health concerns and suicide.  What authors often fail to point out is that this is due to victimization and social stigma — homophobia — in our culture.  Without this distinction, some readers can and do conclude that health problems with LGBTQ youth are due to some kind of inherent “sickness” that comes with being LGBTQ. Instead, Science Daily opens by saying:

Research indicates that the social stigma that surrounds lesbian, gay, bisexual, and transgender (LGBT) teens leads to a variety of health risks such as substance use, risky sexual behaviors, eating disorders, suicidal ideation, and victimization.

An editorial in the September issue of the Journal of Adolescent Health calls on clinicians and health researchers to lead the charge in improving the health and well-being of U.S. LGBT teens. Clinicians can start by providing LGBT teens with high-quality, preventive care in a regular, private, and confidential environment. Health researchers can start by including information on sexual orientation and gender identity in health surveys and assessments.

However, receiving good health care requires more than just not having a negative reaction to a patient’s sexual orientation.  Science Daily refers to a study in the Journal of Adolescent Health: “Healthcare Preferences of Lesbian, Gay, Bisexual, Transgender, and Questioning Youth”. This study uncovered that LGBTQ youth want the same health care as others do.  In fact, if they do not disclose their sexual orientation, it is often because no one asked:

Recent findings, from research by Dr. Schuster and others, have suggested that many clinicians do not know their patients’ sexuality in part because clinicians are not creating opportunities for teens to disclose it. (emphasis mine)

Rather than homophobia, this silence can be termed hetrocentrism, the tendency of our culture to assume that all people are heterosexual, that all relationships are heterosexual and that if non-heterosexual people do exist, we don’t really need to address their concerns.   It is often not done with malicious intentions and in fact, a certain number of people who acted in heterocentric ways would also say that they’d be very welcoming to a patient who revealed a non-heterosexual identity.  However, as these studies point out, LGBT youth will not receive the health care they need to address their issues as long as this silence persists.

Here are some ways that the silence can present itself in a health care setting:

The Outright Omission

Doctor before gynecological exam: So, do you have a boyfriend?

Bisexual girl: Um. No.

The Heterosexual Suggestion

Nurse: Are you dating right now?

Gay guy: Nope

Nurse: Don’t worry, the girls will come around; a handsome guy like you.

The Confusing Sex Question:

Doctor: Are you having sex? Do we need to talk about birth control?

Lesbian girl: (who might say that she is having sex, but context is now birth control, which she doesn’t need) Nope.

The Embarrassing Series of Questions

Nurse: Are you having sex?

College Girl: Yes, I am

Nurse: Are you using birth control?

College Girl: No

Nurse: Oh, are you trying to get pregnant?

College Girl: Nope

Nurse: OK, you do realize that if you’re having sex and not using birth control….

The Offhanded Comment

Doctor: How’s school going?

Bisexual guy: Great, I’m getting all A’s & B’s this semester.

Doctor: Ah, keeping your eye on your grades, and not the girls, huh?

Bisexual guy: I guess so.

These questions or comments might be well meaning, but can have the effect of shutting a young LGBT person down.  LGBTQ folks and especially youth are always scanning the environment for a sign that the person they will be speaking with will understand and accept their identity. The patient might think “Oh, this person doesn’t want to know that I have a boyfriend, and not a girlfriend.”  In other circumstances, important information may not be given because the answer to “do you have a boyfriend” is “no” leading the health professional to believe that the youth is not having sex, when they are.

All of these same questions apply to the client-therapist relationship.  A therapist seeing a young person may ask similar questions and fail to offer their LGBTQ youth client the full benefit of therapy due to assuming heterosexuality.

It is crucial that all practitioners in health professions use careful language to elicit open answers from youth about their sexual orientation.  It is more than a matter of making youth feel comfortable, it is about getting crucial information to them and countering our culture’s tendency to silence LGBTQ people.


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