May is Mental Health Awareness month. This is an issue that is very relevant when thinking about trans youth and it is important to be able to talk about mental health among trans people in an informed way.

In June 2021, The Williams Institute at UCLA School of Law published a 42-page paper titled, “LGBTQ People in the US: Select Findings from the Generations and TransPop Studies”. The lead authors were Ilan H. Meyer, Bianca D. M. Wilson, and Kathryn O’Neill. Among other things, the paper does talk about the Mental Health of the LGBTQ community and had enough subjects and data to really break down the findings.

The patterns that emerged were disturbing but not surprising. When it came to adverse childhood events, the subgroup of Gay/Bi/Queer Cis Men had the lowest incidence, and the subgroup of Transgender people had the highest. Respectively,  68% and  75%  reported childhood emotional abuse; 37% and 44% childhood physical abuse; and 29% and 45% childhood sexual abuse. Not surprisingly, the same horrific patterns emerged when looking at negative health outcomes such as: history of suicidal ideation (70% and 81%); suicide attempts (22% and 42%); and non-suicidal self-injury (32% and 56%).

To my mind, the fact that the pattern repeats just confirms what we already know; that victimization leads to poor mental health. Most of you probably instinctually understand the direct linear relationship between, stigma and poor mental health outcomes. Today I want to give you the vocabulary and concepts to help you talk to others about this in an intellectual way.

The concept that explains how stigma contributes to poor health outcomes is known as minority stress and it was first developed to explain the otherwise unexplainable reason that the African American community suffers higher rates of heart disease, diabetes, and other chronic health problems. Underlying the concept of minority stress are assumptions that stressors are unique (not experienced by non-stigmatized populations); chronic (related to social and cultural norms); and, socially based (social processes, institutions, and structures).

In simplistic terms the connection between stress and poor health is the result of the physiological impact of excess cortisol. Stress produces an increase in the production of cortisol (a stress hormone) which is adaptive in the short-term. However, prolonged increased cortisol levels caused by chronic stress can decrease in immune functioning, increase weight gain, and increase blood pressure, cholesterol and risk of heart disease. Sustained cortisol increases can also the brain and impair thinking, memory and learning.

Trans people experience minority stress due to layers of unique, chronic, and socially based factors. Having a horizontal identity is a unique experience, having internalized transphobia, and a lifelong secret is a chronic stressor, and daily social microaggressions take their toll.

A horizontal identity is one in which an individual did not inherit a trait from prior generations vertically in a family tree. In vertical identities there is support within the family from others who have experience coping with the marginalization by the larger culture. In a horizontal identity there is isolation.

Internalized transphobia is a result of societal pressures and a byproduct of a coming out process which typically involves early identity comparison and denial. By growing up in a culture where there are negative messages about being transgender, those attitudes get adopted.

Research has shown that having a secret is a burden. People who recalled, were preoccupied with, or suppressed an important secret estimated hills to be steeper, perceived distances to be farther, indicated that physical tasks would require more effort, and were less likely to help others with physical tasks.

And microaggressions are subtle behaviors – verbal or non-verbal, conscious or unconscious – directed at a member of a marginalized group that have a derogatory, harmful effect. And membership in a minority or stigmatized group can be stressful even when people do not experience any bias.

It is important to understand the ways in which transgender individuals experience stress and how that can result in mental health struggles because there is a resurgence of a narrative that is very different and presents transgender people as mentally ill, with a transgender identity as a symptom of said mental illness. This idea that transgender identity is a symptom of a mental illness because trans people do have such high rates of mental illness is a reemergence of an idea that was commonly held about homosexuals in the middle of the last century. Knowing where that myth came from and how it was dispelled can also be useful. The next installment of Illuminations will tell that story.


Dr. Antonia CarettoAntonia Caretto, Ph.D. is a fully licensed Clinical Psychologist and a graduate of the University of Michigan and the Alliant International University California School of Professional Psychology. Dr. Caretto’s 1991 doctoral dissertation research was on “Familial Homosexuality Among Women and It’s Relationship to Childhood Gender Role Non-Conformity and Adult Sex Role.”

Dr. Caretto has a solo private practice in Farmington Hills, MI, and gender identity development continues to the focus of much of her work.

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