This article has been a little more difficult to go about writing than some of the others. It’s a subject which I am still coming to terms with in my own head. After so many years, writing about it so plainly felt alien. But this month being Pride month, it felt important to highlight this often overlooked crisis among the LGBT community.
It’s no secret that LGBT people are at higher risk of mental health problems. Recent studies show that LGBT people in England are two to three times more likely to experience psychological problems than heterosexuals. While around 25% of the general population experience mental illnesses, 40% of the LGBT community will suffer a mental illness at some point in their life: 42% of gay men, 70% of lesbians, 66% of transexual people, and the figures for bisexuality can be even worse (all according to MIND). Overall, LGBT people have higher rates of anxiety, depression, addiction, self-harm, suicide – and eating disorders. There is an epidemic of mental illness which isn’t talked about enough, either in LGBT communities or the wider conversation about mental health. For things to get better, this has to change.
For perhaps obvious reasons, I’ll focus this article on the prevalence of eating disorders. The figures are just as shocking. While gay men account for about 5% of the population, they make up 42% of males with eating disorders. Nearly half of all men with eating disorders are gay. If that’s not a crisis on epidemic levels, I don’t know what is. The figures for gay women and bisexuals are less easy to come across, but they too are disproportinately represented amongst the population suffering from eating disorders.
I spent ten months on an eating disorder ward. During that time, I couldn’t help but notice a worrying trend and wonder why the LGBT population was so over-represented in that setting. What was going on? But I only really needed to look at myself and some of the contributing factors to me developing anorexia.
During treatment on Ward 6, the Yorkshire Centre for Eating Disorders, I (finally) came out as gay. If you really want to recover from an eating disorder, you have to dig down into the roots of the illness, you have to understand the factors feeding the disorder and start to resolve those internal tensions. I realised that my sexual orientation was a large part of the reason for the development of the anorexia. Eating disorders, like many mental illnesses, are the result of internal stressors and traumas which cause the brain to stop functioning normally. Very often in cases of anxiety, depression, eating disorders, you can find a reason or multiple reasons why the brain is doing what it’s doing. For example, it might be a past trauma, it might be strong perfectionist traits, it might be low self-esteem, internal or external stress and pressure etc. (By the way, just because you might be able to identify a contributing reason, doesn’t make that illness any less debilitating or difficult to recover from, but it does make recover that much more possible).
Reading academic articles and mental health posts online, most tend to attribute the high number of LGBT people with mental illness to homophobic bullying, general low self-esteem, social isolation, fear of rejection and low social status. That’s all true. But it’s all quite obvious, and stated like that, not very meaningful. So, I’m going to attempt to sum up my own experience in the hope that it will help others to understand the causes of mental illnesses and the prevalance of especially eating disorders among LGBT people.
I grew up in one of the most white, heteronormative areas I can think of. Being gay was just not a thing. There were no role models to follow, not even on the media in those days. Happiness and success was following that normal life-plan of finishing school/uni, getting a job, meeting someone who you would marry and then settle down and have kids with. So, as you can imagine, being attracted to the same sex did not fit into any of that. A key cause of mental illness is social isolation. In many studies, researchers have found that subgroups and minorities in a population are more likely to develop mental illnesses due to the ‘unfavourable social, economic and environmental factors’. That’s basically a posh way of saying that, as humans, we need people. And we have the innate need to be open and honest and free with people and in the relationships we build. We’re a social being. But when you don’t feel like you fit in or belong, when you have a secret you can’t share with anyone, when you feel the need to suppress a large part of you for years on end, you are not fulfilling those very human, social needs. And that’s unhealthy, and dangerous. The sense of social isolation, of being odd, of not fitting in, of having to hide who you really are, of not liking a large part of what makes you you, is really damaging.
Of course, you could argue that this was a choice. I could have just accepted who I was and got on with it. But at the time, that just was not an option. Not only had I grown up in an area and culture where being gay just wasn’t visible, but being gay was openly criticised and mocked. From primary school, ‘you’re so gay’ was used to mock and insult people seen as weak or as not fitting in. While those who used the phrase were probably not even thinking, the constant use of the word negatively eventually instills in you the belief that being gay is wrong, it is something to be ashamed of. And shame is on the most powerful, damaging emotions in the human psyche.
So, as I became more aware of my sexuality, I became even less accepting of it. It’s not just explicit homophobia that is the problem, but the general lack of representation of the LGBT community (in a positive light) in the media and society in general which leads to a sense of isolation, shame, even guilt and fear of rejection. Things have, thankfully, been improving, but the figures of mental illness are still worryingly high.
This low status that gay/bi/trans people had in the environment in which I was growing up was translated to my own opinion of myself: I was somehow ‘bad’, ‘wrong’, an outsider. Studies have shown that low status groups are more prone to a sense of humiliation, of low self-esteem, insecurity, stress and anxiety. It makes sense, I suppose. Go back to more primitive times and low status meant you were lower down the food chain, so to speak. So it’s no wonder that lower-status groups are more prone to severe anxiety, depression, and eating disorders. Add to this low self-esteem the constant psychological stress of having to hide who you really are and of actually hating a large part of you, and that makes for a toxic mix. The fear of somehow being ‘outed’ increases anxiety, while the suppression of yourself causes depression due to isolation and a negative self-image. Shame, guilt, self-hatred are heavy and powerfully harmful emotions which, experienced over time, lead to a severe deterioration in mental health.
I responded to this constant mental stress with a mix of perfectionism and depression. The perfectionism was, in the long-term, just as damaging as the sense of shame, guilt and self-dislike. I threw myself into my school work in an attempt to make up for what I felt were my failings as a person. I’ve talked about the dangers of perfectionism before, so I won’t repeat myself too much. But, simply, it meant that on top of the already very negative self-image, I could never be good enough.
Now, the LGBT community isn’t just the victim here. There are serious problems which the community itself needs to address and which also contribute to poor mental health. There is masive pressure, especially amongst gay men, to look a certain way. It’s not just about being slim, but toned and muscular too. That’s just not a reality for most people. But, in a world which is still not fully accepting of homosexuality, the gay community doesn’t make it easy for someone to feel that they belong either. There is a pressure to look and act in a certain way which can alienate those who are not like that or not quite ready to embrace that. So, young gay men can often feel they don’t belong either in wider society or in the gay community, adding to that sense of isolation, of shame and loneliness which are so harmful. The gay community needs to take a hard look at itself and really start to address some of the pressures that it puts on people who just want to find somewhere to fit in. That rainbow flag is not always as colourful as people assume.
Young people questioning their sexual identity still face a mighty uphill struggle. The societal and cultural, and the subsequent mental pressures they face, are a dangerous mix that too often can lead to a decline in mental health. In 2015, I first started to show signs of the anorexia I was struggling with (although I didn’t know at the time). This was a result of years of low self-esteem, self-hatred anxiety, fear of rejection, fear of being myself, guilt, shame, social isolation, perfectionnism and the pressure and harm of neglecting an important part of who I am. The eating disorder, in many ways, was a coping mechanism. It was my brain’s way of trying to handle all the pressures and negative emotions by seeking something to control: food and weight. And it was effective: the more I starved myself, the less room in my head I had to think about all the complications and pressures that surrounded my personality and sexuality. And, as my body began to preserve energy by switching off key hormones, I actually felt ‘less gay’. But none of that mattered because, in the end, the eating disorder nearly killed me and robbed me of years.
Now I am on the othe side of the disorder, I can see what triggered it. I am one of the statistics about mental illnesses and LGBT people. But we need to see beyond the statistics and start to understand and fix the problems leading to such an epidemic of mental illness amongst the LGBT community. Pride month is for celebrating diversity, but we must remember how far we still have to go to really claim all the colours of the rainbow flag.