LGBT+ and your health; a student writes…

There are a lot of ways people like me – LGBT+ people – struggle in life due to society’s stigmatisation of us. Doctors and healthcare services, which exist to care for us, as for everyone, are invaluable and essential to the poor health that arises from these struggles, for complex reasons, so it is very important that healthcare challenges received ideas. The Student Health Service kindly invited me to write a blog on LGBT+ peoples’ issues relating to healthcare, which is definitely a really encouraging thing. I realised it was a difficult topic to be able to cover fully, but I’ve tried to bring together thoughts, evidence and memories that will hopefully be illuminating.

Firstly from my own life, I thought about the way being queer has affected me in terms of my health and the way I access healthcare. Lots of complicated thoughts came to my mind.

I’ve thought about the way, for example, in which fear of rejection for my orientation has prevented me from being ‘out’ to any therapist I’ve had. The effects of not being straight on my mental health have also been very strong, including the damaging shame and anxiety created by realising that I was not straight, as well as the issues it has created in my friendships and family relationships, including fear of rejection.

One time from my life also really stands out to me – I actually thought of when I was younger, of my experiences to do with gender expectations, and not fitting them. I am a woman, and someone who’s seen by others as a woman. However, as a teenager I developed facial hair- I didn’t realise that the feeling of shame about this supposed fault with me and my body, was actually a false shame put upon me from outside, and I didn’t realise I could push back with my own narrative and ideas about how my body should be – perhaps if the doctors I saw about this problem had questioned whether it was really something by necessity negative, I wouldn’t have been ashamed for so long. As I got older I realised that society has strict binary definitions of male and female that are so ingrained and hegemonic it’s easy for many of us to barely notice them. This dictates as wrong, and somehow lesser, those, for example, whose bodies don’t match these definitions. I am cisgender (I understand myself as a woman, and my body’s sex is considered as female), so it has been much easier for me that for those who are transgender, whom I know this gender binary affects very strongly.

How then can doctors help? How could my interactions with doctors have gone better? I’m not sure, and I think it’s a difficult task for doctors that want to help, to do so. I suppose two things to think of are the way in which our health is looked after specifically in relation to our gender, sex, sexuality etc, and of the way in which our general health is looked after, aside from these issues. I thought  that even if doctors simply take a stance of providing a respite from oppressive ideas, actively countering dominant ideas about LGBTQ+ people, that would be a very helpful thing.

I’ve only been able to speak about my own particular experiences here, so I’ve looked for examples and information to shed light on other ways in which LGBT+ affects people’s health. One thing that affects LGBTQ+ people disproportionately is mental ill health, and this was reflected in pretty much every piece of research I found.

The NUS research ‘Education Beyond the Straight and Narrow’ notes that Chakraborty “affirms that discrimination can be analysed as a predictor of mental disorders.”

The research also tells us that “42 per cent of LGBT respondents to the Youth Chances28 survey reported having experienced depression or anxiety, compared to 29 per cent of non-LGBT respondents”, and that this is linked to experiences of discrimination and harassment.

This NUS research talked about the very high rates of ill health, depression and anxiety for Trans students in particular, and this was strongly related to high levels of transphobia, unacceptably long waits for provision of treatment to transition, and stress and discomfort about seeing medical professionals due to dismissive or phobic attitudes.

I have also read, although not in this research in particular, about asexual people’s (people who do not or experience little sexual attraction) experiences of healthcare, including asexual identities being seen as problems or illnesses.

LGB+(Lesbian, gay, bi+) and T+ (Trans+) students were all more likely to consider dropping out than straight and cisgender students, with T+ students being proportionally most likely to consider dropping out due to health concerns, while LGB+ students being proportionally most likely to consider dropping out due to feeling like they don’t fit in (although both overlap significantly). This data reflects the complex nature of reality even more in that black LGB+ students, for example, had a higher likelihood of considering dropping out, suggesting lower levels of wellbeing that need to be considered.

Research also noted that mental health has an evidenced effect on physical health. This must be compounded by the fact that LGBT+ people report attending doctors less, or feeling put off or distressed by negative reactions by doctors, and this can be anywhere, from GP surgeries, to hospital emergency care.

So, in the end it seems to me that healthcare services often fail LGBT+ people if they have taken in societal biases and left them unchallenged, but I think they could definitely help in our lives if they are positive –because they’re at that central, delicate position in which people are going for help.

If you’re LGBT+, and uncomfortable seeing a doctor about something or uncomfortable to talk about something because you’re scared of being looked down upon, it can be hard. I thought that this quote (from the NUS research mentioned previously) was illuminating, even if it’s not directly related to health:

“I’ve had negative experiences or responses to being trans in every university building I’ve been in, including the students’ union (SU), but only in the SU have I ever been listened to about them and those experiences dealt with. So that makes me feel safer there than anywhere else.”

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Reflections on Body Image

Last month the Students’ Health Service had a visit from our local MP Stephen Williams, a member of the All Party Parliamentary Group on Body Image. He was interested to hear about our work with students with eating disorders, but we also talked through the challenges of being a student with a condition such as Body Dysmorphic Disorder, and the misuse of body building drugs such as anabolic steroids in some parts of our population.

Negative body image underlies much of the mental health work we do, whether it leads to low self esteem (which can itself lead to depression or self harm), anxiety, social phobia, and more obviously anorexia and bulimia.

The report highlights more positive ways to view ourselves and our bodies, such as the Health At Every Size movement, which focuses on health rather than weight/ Body Mass Index. This movement tries to encourage us to eat healthily and engage in appropriate amounts of physical activity and has been shown to lead to higher levels of self esteem, and better blood pressure and cholesterol levels.

Anecdotally the medical community is certainly becoming increasingly wary of using BMI as a ‘one size fits all’ measure, as we watch the generations increase in height and muscle mass. Even traditional children’s measurement charts have had doubt thrown over them, with a current study from the University of Worcester identifying healthy children as being incorrectly labelled ‘obese or overweight’ by the National Child Measurement Programme. This could then lead to those children developing neuroses about their height and weight in the future, in our ‘weight obsessed society’.

Fixating on a particular weight may not be the best approach for us, and it might be better to take a more holistic approach  with better health being the best outcome measure to aim for; focus on Fitness rather than Fatness, if you like.

If you are worried about your weight/ shape or health, then please do come and see us to talk it through. We are very used to discussing these issues, and I hope you will find us good at listening and keen to help.