Since LGBTI people are at a higher risk of developing mental disorders than heterosexual people, it is important to know how to support them, how to support them without discrimination and stigma, two feelings that the community has always experienced. Not only are LGBTI people more likely to be victims of isolation, rejection and discrimination in society - it is also important to remember that this stigma extends throughout the medical profession. Indeed, medicine is still largely marked by patriarchy and homophobia to this day. We must therefore deconstruct these stereotypes and prejudices that lead to marginalization and highlight the mistakes of the past in order to provide good care for LGBTI patients.
Several studies have shown that social and medical support helps LGBTI people. Indeed, young trans people who have socially transitioned have similar mental health to cisgender children (Durwood et al, 2016), which proves that social and medical support for young trans people can improve their mental health and reduce the high suicide rate in this population. Indeed, trans people who have benefited from a puberty blocker have less than a 30% risk of suicidal ideation (Turban et al, 2020).
It is therefore essential, in order to support people in the LGBTI community, to know how to follow them, accompany them in therapy. It is also important to get up to date: in addition to the advancement of psychological practices, knowledge about sexuality and gender identity has been able to bring a more modern vision of gender, previously described in a very binary way by the medical profession. Patients' demands are changing, so we must adapt quickly.
For example, the classic transgender model previously called "transsexual" which therefore implied a change in biological sex was analyzed to conclude that transgender people were not necessarily all looking for surgical sex reassignment but rather that they had a fluid image of genders. These changes also lead, by rebound, to changes in therapeutic practices. People ask less to "change sex" and also ask for less reconstructive surgeries. The problem that seems to appear first is the societal image, to be able to live in peace in society, without judgment or discrimination. New behaviors and new demands going in the direction of gender variety call for a more individualized approach, centered on the subject, rather than the application of a standardized protocol of sexual reassignment and psychological help through the transition. The role of the therapist is therefore also changing, in perpetual evolution. The patient expects support in self-acceptance.
Accept all individual experiences, feelings, without necessarily talking about transition. Accepting fluidity has become one of the key points of medical and therapeutic support.
To properly support LGBTI people, we must therefore think inclusively, think differently. Practices such as person-centered therapy, constructivist sexology, as well as the many training courses to specialize in the trauma experienced by LGBTI people are all recent advances in the medical and psychological worlds that can allow us all to receive patients while being educated, informed and trained.
The impact of poor social and medical support on mental health shows the importance of fighting discrimination and LGBTIphobia in a structural and transversal manner, obviously through the medical profession and more particularly through mental health professionals who have for a long time induced or worsened the trauma experienced by the people concerned.
Thus, it is necessary to improve the care of LGBTI people facing psychological difficulties. An intersectional approach would also make it possible to understand mental health problems related to socio-economic factors that simultaneously refer to gender, social class and ethno-racial belonging. The issue of discrimination suffered by the people concerned, particularly in access to employment and care, through daily violence, should also be taken into account, to better understand the structural dimension of mental health.
In general, mental health deserves to be investigated further in connection with sexuality and gender. If taking into account the issue of gender in medicine is important, we can conclude that taking into account gender non-conformity as well as sexual orientation would make it possible to have knowledge of all the socio-cultural factors that
Chloé ROSATI,
Psychopraticienne
Sources:
Genre et santé · Inserm, La science pour la santé. (s. d.). Inserm. https://www.inserm.fr/dossier/genre-et-sante/
Gaudette, Y. (2023). L’intervention transaffirmative en santé mentale. Nouvelles Pratiques Sociales, 33(1), 254‑272. https://doi.org/10.7202/1095948ar
Médico, D. (2014). Cahiers critiques de thérapie familiale et de pratiques de réseaux, 109-137. https://www.cairn.info/revue-cahiers-critiques-de-therapie-familiale-2014-1-page-109.htm
1970 : quand l’homosexualité était un symptôme psychiatrique. (s. d.). ina.fr. https://www.ina.fr/ina-eclaire-actu/1970-quand-l-homosexualite-etait-un-symptome-psychiatrique
Schmidt, N. (2023, 25 janvier). Hétérosexuels et homosexuels ; : histoire d’une lente évolution vers l’égalité. Observatoire des Inégalités. https://inegalites.fr/Heterosexuels-et-homosexuels-histoire-d-une-lente-evolution-vers-l-egalite
Meredith Wadman (12 septembre 2019) « New study reveals risks of transgender ‘conversion therapy », Science. https://www.science.org/content/article/new-study-reveals-risks-transgender-conversion-therapy
Stein TS (1996). A critique of approaches to changing sexual orientation. In: Textbook of homosexuality and mental health (ed. R.P. Cabaj & T.S. Stein). American Psychiatric Press, Washington, DC.
Lange, T. M. (2020). Trans-affirmative narrative exposure therapy (TA-NET) : A therapeutic approach for targeting minority stress, internalized stigma, and trauma reactions among gender diverse adults: Practice Innovations. Practice Innovations, 5(3), 230‑245. https://doi.org/10.1037/pri0000126
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