
The purpose of this blog is to stimulate thought and discussion about important issues in healthcare. Opinions expressed are those of the author and do not necessarily express the views of CMDA. We encourage you to join the conversation on our website and share your experience, insight and expertise. CMDA has a rigorous and representative process in formulating official positions, which are largely limited to bioethical areas.
Scapegoating the Church for LGBT Suicide and Stigma
June 27, 2019
by Andrè Van Mol, MD
Health statistics for people who identify as GLBTQ+ are recognized as poor compared to the general population. Finding causation for those negative statistics in stigma and the religious groups that allegedly promote it is the ideological zeitgeist. California Assemblyman Evan Low just introduced non-binding resolution ACR-99 Civil rights: lesbian, gay, bisexual, or transgender people, which states, “The stigma associated with being LGBT often created by groups in society, including therapists and religious groups, has caused disproportionately high rates of suicide, attempted suicide, depression, rejection, and isolation amongst LGBT and questioning individuals;” and it isn’t the only time “religious groups,” “pastors” or “religious leaders” are mentioned in the text condemning “conversion therapy.” It’s conceptual and factual error and ultimately hurts sexual minorities. Blame shifting does that.
Suicidal Behavior
If religious convictions are a major contributor to stigma and suicide, one would expect much lower rates of such in nations with relatively fewer people of orthodox faith. But a 2006 study from the Netherlands noted, “This study suggests that even in a country with a comparatively tolerant climate regarding homosexuality, homosexual men were at much higher risk for suicidality than heterosexual men.” A 2011 Danish study asserted, “The estimated age-adjusted suicide mortality risk for RDP [same-sex registered domestic partnerships] men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married.” GLBT-identified individuals in Canada and Northern Europe enjoy government support and subsidy, celebration from liberal (and failing) churches and a public coerced into silence by hate-speech codes, yet their suicide rates remain alarming.
Suicidality in the LGB-identified, adults or minors, has been shown to not be uniformly improving even as society becomes more affirming. Furthermore, the Wang paper from 2015 found that the high rate of attempted suicide in sexual minorities was not explained for by psychological disorders or discrimination. Stigma just wasn’t it.
Three reports in the last five years suggested that the “trans” suicide attempt rate was over 40 percent (Haas 2014, James 2015, Toomey 2018), results which were trumpeted by activists in the media. All three reports used convenience sampling.
University of California, San Francisco (UCSF) epidemiology expert and former male-to-female transitioner Hacsi Horváth realized the researchers in each of these surveys sabotaged their efforts by not using appropriate methods to obtain truly representative sampling. Specifically, statistical generalizations cannot be made from convenience sampling, which is what they all used, as Horvath explains well. Horvath details that the William’s Institute, and LGBT “think tank” which also produced and promoted the Haas report in 2014, was contracted by the state of California to use appropriate survey methods and found the trans-identified suicide attempt rate was 22 percent. That is comparable to rates for people with psychological illness, bullying victims and general LGB-identification. So, bad rates, but not uniquely so.
So, what are causative factors for suicidal behavior? There is no one causative factor. Life is multi-factorial. Nonetheless, certain contributors stand out. Horvath cites a study (Nock 2013) showing about 96 percent of U.S. adolescents attempting suicide demonstrate at least one mental illness. Here I would add a 2003 study showing that 90 percent of people (adults and adolescents) who completed suicide had unresolved mental disorders. The Nock study concluded that “the core responsibility of doctors in trying to reduce suicide rates remains the identification and treatment of mental disorders.”
Returning to Horvath, he continues, “Around 5% of all youth suicide can be attributed in part to discussion and media coverage of other suicides (Kennebeck 2018).” That contagious example of publicized suicide is called the Werther effect, a copycat phenomenon; whereas, the Papageno effect is the reduction of suicide rates prompted by the public example of a suicidal individual who finds a way to live on.
Intimate Partner Violence
A major contributor to the elevated suicide statistics in sexual minority adults is literally found closer to home, namely intimate partner violence. A 2014 Australian study reported that a leading reason for suicide among “LGBTI” individuals was stress from romantic partners rather than societal rejection. The CDC’s 2010 findings from its ongoing National Intimate Partner and Sexual Violence Survey (NISVS) stated that sexual minorities experience intimate partner violence at rates equal to or greater than non-sexual minorities. A 2010 ScienceCodex article was titled “Gays and lesbians twice as likely to endure Intimate Partner Violence as heterosexuals….”
The U.S. Department of Health and Human Services (HHS) offered a grant in 2013 for the prevention of domestic violence in LGBTQ individuals stating, “Domestic/intimate partner violence is a significant health problem among LGBTQ populations….” This should not be news to California legislators. In 2008, with a $50,000 grant from the Blue Shield of California Foundation, the Gay and Lesbian Medical Association launched the “LGBT Relationship Violence Project” to educate medical professionals about LGBT domestic violence.
Stigma
Stigma is popularly cited as a major cause of negative health outcomes for the GLBT-identified. The attraction is easy to grasp: it’s you guys and not me, the victim, and nothing in me needs to change.
A 2014 study by Hatzenbuehler entitled “Structural stigma and all-cause mortality in sexual minority populations” claimed an average life expectancy reduction of 12 years for sexual minorities living in areas with suspected prominent anti-gay sentiment. The publication was widely reported. Mark Regnerus’s team in 2017 tried to replicate the results of Hatzenbuehler’s work, and 10 different methods of statistical computation failed to do so. Retraction Watch carried the story. Social Science & Medicine eventually retracted the study, explaining that, “Re-analysis confirmed that the original finding was erroneous and the authors wish to fully retract their original study accordingly.” But citations of Hatzenbuehler’s false conclusions persist.
Mayer and McHugh’s comprehensive review of the scientific literature on sexuality and gender concluded this about stigma reports, “[I]t is important to note that due to the cross-sectional design of these studies, causal inferences cannot be supported by the data…In particular, it is impossible to prove through these studies that stigma leads to poor mental health, as opposed to, for example, poor mental health leading people to report higher levels of stigma, or a third factor being responsible for both poor mental health and higher levels of stigma.” In the executive summary we find, “More high-quality longitudinal studies are necessary for the ‘social stress model’ to be a useful tool for understanding public health concerns.”
Faith, It’s Not the Bad Guy
Some critics charge that any wish on the part of a person to reduce their same-sex attractions and behaviors reveals self-stigma. This attitude reveals a dismissive and ill-informed view of orthodox religious and conservative moral values—a stigmatization of its own.
Research titled “Same-Sex Attracted, Not LGBQ,” published this year by a team composed of progressive (GLBT-affirming) and conservative (change allowing) researchers, examined sexual minorities among Mormons who held progressive social values—those comfortably LGBQ-identified, came out and rejected conservative religious faith—as well as conservative sexual minorities who rejected LGBTQ identification, did not come out, and retained their conservative faith. Both groups experienced equal health benefits regarding depression, anxiety, flourishing and life satisfaction. That contradicts minority-stress expectations.
A 2017 study of sexual minorities found, “Surprisingly, no significant differences are found between mainline Protestants (whose church doctrine often accepts same-sex relations) and evangelical Protestants (whose church doctrine often condemns same-sex relations).” It also found, “LGBT individuals who identify as Catholic, agnostic or atheist, or with no particular religious affiliation report lower levels of happiness compared to mainline Protestants.” They lumped Catholics (a “studied one, studied ‘em all” error) while separating out mainline and evangelical Protestants, which, in my honest opinion, misrepresents orthodox Catholic happiness.
A study of black GLB-identified young adults asserted, “Participants who reported lower religious faith scores and lower internalized homonegativity scores reported the lowest resiliency, while those reporting higher religious faith scores and higher internalized homonegativity reported the highest resiliency scores.” So higher religious faith and a non-affirming view of same-sex sexual behavior bore higher resiliency, not suicidality.
A few people, both secular and religious, claim a 2009 Pediatrics Journal study showed LGBT youth in religious-condemning families had eight times the general youth population suicide rate. Dr. Caitlin Ryan of San Francisco State University, the study’s lead researcher, rebutted: “We did not say that LGBT youth from religiously condemning families were at an 8 times greater likelihood of dying by suicide.” It was LGBT youth that were “highly rejected.” What counted was not the family’s religious beliefs but the behaviors the families showed LGBT-identified children.
First Amendment Concerns
A public statement appeared April 22, 2014 on RealClearPolitics.com titled “Freedom to Marry, Freedom to Dissent: Why We Must Have Both.” It contained bold chapter headings including “Free Speech Is a Value, Not Just a Law” and “Disagreement Should Not Be Punished,” and it was signed by a raft of law professors, politicians, organizational heads and activists. What happened to that set of convictions? In its 2015 Obergell v. Hodges decision regarding same-sex marriage, the U.S. Supreme Court specified, “The First Amendment ensures that religious organizations and persons are given proper protection as they seek to teach the principles that are so fulfilling and so central to their lives and faiths, and to their own deep aspirations to continue the family structure they have long revered.”
Evidently, our legislators need reminding of both law and science as they rush to scapegoat people of faith—and stigmatize reasoned disagreement—as a primary cause of sexual minority suicidality and depression.