Can discrimination cause mental illness?

SUMMARY: Studies have shown gays are more prone to mental illness, and conservatives say it means gay brains are defective. But a breakthrough study suggests another cause: an unaccepting world.

Studies have shown that homosexuals are more likely to suffer from mental illness than straight people, and some conservatives think that proves gay brains are defective. But a breakthrough study suggests another possible cause: an unaccepting world.

"Lesbians and gays who feel discrimination are more likely to (suffer from) depression and anxiety," said Susan Cochran, a professor of epidemiology at the University of California at Los Angeles and co-author of a new study into gay mental health.

But Cochran cautioned that while there seems to be a link between discrimination and mental problems, it's not entirely clear that one causes the other.

Psychologists have argued for decades about what goes on in the minds of gay people, and homosexuality was officially listed as a mental illness as late as the 1970s. But only in the last few years have large psychological studies began to routinely ask questions about sexual orientation, Cochran said. That has allowed researchers to compare gay people not only to one another but to straight people as a whole.

In research published earlier this year, Cochran found that lesbians are more obese and heavier smokers and drinkers than heterosexual women. Alcoholism is often a sign of depression, and other studies have found that lesbians are more likely than straight women to abuse drugs and alcohol.

Studies have also discovered that gay teens are more suicidal than their straight counterparts, and gay men are more likely to be depressed and suffer from panic attacks.

Cochran decided to see if she could find out why gays are at higher risk. Her findings appear in the November 2001 issue of the American Journal of Public Health.

She looked at a 1995 study of more than 2,900 Americans aged 25-74. Of those, 73 said they were homosexual or bisexual.

Those people reported experiencing more discrimination than the others in the study. After statistical adjustment, three-fourths said they'd been discriminated against, and 4 in 10 said it was because of their sexual orientation, at least in part. "While (the discrimination) may seem somewhat obvious to those of us in the community who experience this day to day, I don't think this has really been documented before," Cochran said.

Those who reported discrimination were also more likely to report symptoms of mental illness. "There's a link," Cochran said, "but we don't know if it's causal. It may be that people in the middle of a depressive episode are more likely to feel they're discriminated against."

However, common sense suggests that discrimination will affect mental health, said Dr. Jerrold Polansky, a San Francisco psychiatrist and chairman of the education committee of the Gay & Lesbian Medical Association.

"Our internal view of ourselves is shaped very profoundly by the way other human beings treat us," he said. "If you live in a world where there's discrimination, bias and mistreatment by others, because of that, one's internal psychological state will be adversely affected."

Polansky acknowledged that any focus on the mental health challenges facing gays is a "double-edged sword" because critics may use statistics as an excuse to accuse the community of being mentally flawed.

"That's an old ploy," he said. "It's very easy to cause oppression in a group and then use the negative consequences of the oppression as a justification for continuing persecution."

For her part, Cochran said her research provides yet another reason to fight for equal rights. "If we want to do something to improve the mental health of lesbians and gay men, we may need to decrease discrimination," she said. "The burden for change is not just on the individual but also on society."