Abstract
Discrimination towards the LGBTQIA+ community has an impact on mental health that is described using the minority stress theory by Meyer. The authors are mental health professionals in India who hypothesize that in India, families are the dominant source of minority stress. They explain how in India's collectivistic framework, families are cis-hetero-patriarchal and contribute to distal stress through direct and indirect violence and proximal stress through forcing concealment, internalized homo and trans-negativity, perceived rejection, and internalized guilt. LGBTQIA+ individuals in India use three pathways to manage minority stress: living within the script (i.e., heterosexual marriages and dual lives), subverting the script (i.e., trying to fit queer relationships in a societally acceptable framework), or rewriting the script (i.e., choosing to live alone, having families of choice, and practising non-traditional relationship structures). Legal provisions that aid and inhibit these are discussed. Ways to build community resilience are suggested.
TopIntroduction
While there is no systematic data about the number of LGBTQIA+ people in India, one estimate suggests that they may form 3.8% of the population, which was 45.4 million people in 2011 (Kealy-Bateman, 2018). The World Global Value Survey of 2006 suggested that India falls in the middle compared to other countries with respect to acceptance of homosexuality, and attitudes have become more positive over time; however, prejudices still abound, with 64% of individuals surveyed stating that homosexuality is never justified (Badgett, 2014). In a national public health consultation, the community was identified as one of 12 that had the most health inequities in India (Ravindran & Seshadri, 2018). In a review of research articles about the LGBTQIA+ community from 2009 to 2019 conducted by us, we found that while prevalence rates of mental health conditions among LGBTQIA+ individuals varied across studies, these were generally much higher than population estimates (Wandrekar & Nigudkar, 2020).
Minority Stress Theory
The minority stress theory by Meyer (1995, 2003) provides a useful and widely accepted paradigm to explain the vast differences in mental health outcomes for cis-heterosexual and queer individuals. The theory states that queer individuals experience mental health conditions due to the stigma, prejudice and discrimination they experience because of belonging to a minority group that is termed as minority stress. Minority stress is unique to minority groups and is additional to general stressors that are experienced by all, chronic as it is related to relatively stable social and cultural structures, and socially based in that it stems from social processes and structures rather than the individual (Meyer, 2003).
Minority stress is a combination of distal and proximal stressors (Meyer, 2003). Distal stressors are external societal events of harassment, violence, discrimination, erasure, that can be conceptualized as enacted stigma experiences i.e. actual experiences of homonegativity. These are independent of personal identification with the minority status. Proximal stressors include three factors- felt stigma or the expectation of rejection i.e. the belief that they will be met with homonegativity, internalized stigma/ homonegativity, and concealment of one’s sexual orientation due to the above. Often, these stressors interact with each other, i.e. enacted stigma when combined with internalized stigma leads to more distress. Meyer also outlined individual and group processes that help mitigate the impact of minority stress and protect individuals from mental health conditions. These include resilience and coping (individual as well as group factors), and social support. Characteristics of minority identity may also be effect modifiers in minority stress processes, such as the prominence and valence of the identity and its level of integration with other identities in an individual’s life (Meyer, 2003).
Significant research worldwide has lent support to the minority stress theory (Meyer, 2003). It was initially proposed keeping sexual minority individuals in mind but has now been expanded to the LGBTQIA+ community in general with minority stress models encompassing trans-negativity (Rood et al, 2016). In India, research suggests that Indian LGBTQIA+ individuals experience a lot of stigma, and stigma leads to mental health conditions (Wandrekar & Nigudkar, 2020). Researchers tested and found support for the Adapted Minority Stress Model, where sexual minority stigma, gender non-conformity stigma and HIV stigma together contribute to higher rates of depression (Logie et al, 2012).
In this chapter, we focus on the mental health impact of discrimination using the paradigm of this Minority Stress Theory. In particular, we argue that birth families as institutions are the major locus of minority stress for Indian queer individuals. We use research in India as well as our experiences as queer mental health professionals providing group and individual psychotherapy for queer individuals to support our argument. We also explore how legal provisions for the community are tied in with this.
Key Terms in this Chapter
Mental Health: Mental health refers to cognitive, behavioural, and other emotional well-being. It is used to describe how people think, feel, and behave. Occasionally, the term is used to mean the absence of a mental disorder.
Family: Family is a group of people related either by consanguinity (by recognised birth) or affinity (by marriage or relationship). The purpose of the family is to maintain the well-being of its members and of society. Ideally, families offer predictability, structure, and safety as members mature and learn to participate in the community.
Minority Stress Theory: This theory describes well documented chronically high levels of stress faced by members of stigmatised groups who are usually the minority in the society.
LBGT: The term LGBT is an acronym for lesbian, gay, bisexual, and transgender. IN use since the 1990s, the initialism, as well as some of its common variants, functions as an umbrella term for sexuality and gender identity.