Understand Queer, Bisexual, and Gay Men's Mental Health

Queer men share similar mental health challenges to heterosexual men, but there are several notable differences that require consideration, reflection, and care.^[1]

Let’s delve into these differences, as well as some first steps, to better understand and navigate the mental health impacts of the challenges queer men face (including gay, bi, and men who have sex with or are attracted to men).

THERE IS NOTHING WRONG WITH BEING QUEER

There is a longstanding history in the mental health field of focusing on what’s wrong and abnormal with queer men. This stigmatizing focus increases prejudice and discrimination because it makes queer men the problem instead of focusing on understanding the unique problems queer men have and why.

Therefore, to shift attention toward increasing acceptance and empathy, the focus in this article is not on what’s wrong with queer men, but instead on recognizing and better understanding the experiences and challenges of queer men.

RECOGNIZING UNIQUE EXPERIENCES AND CHALLENGES

Compared to men who identify as heterosexual, some of the most common experiences and challenges queer men face are:

Depression: Queer men are twice as likely to experience depression, low self-esteem, and other mental health challenges.^[1]
Suicidality: Suicide attempts are 2-4 times more common among queer men.^[2]
Substance use: Harmful use of alcohol, tobacco, and other drugs is two times more likely for queer men.^[3]
Body image: Queer men also report greater dissatisfaction with their physical appearance (especially muscle size) based on objectification and pressure from the media to conform to particular appearance standards.^[4]
Trauma: Finally, queer men are at greater risk of experiencing traumatic events, where trauma is defined as overwhelming experiences that leave lasting psychological effects and impacts.^[5]

UNDERSTANDING AND REFLECTING ON THESE CHALLENGES

Mental health challenges and their causes are complex and understanding them requires careful consideration and reflection. There is a growing body of research suggesting that the simple act of reflecting on mental health experiences and challenges may play a role in feeling better.^[6]

Here are some of the main issues queer men face and questions we can reflect on:

INTERNALIZING PREJUDICE

Internalized prejudice (e.g., homophobia or biphobia) means that others’ negative attitudes become part of the attitudes, thoughts, and beliefs about oneself.

Internalized prejudice plays a key role in why queer men experience depression and contemplate suicide.^[7] Avoiding making friends with other queer folks, not seeking out queer environments, disliking queer-themed movies, and self-censoring “gay” behaviours or body language can all be signs of internalized prejudice.

Everyone has some form of internalized prejudice, regardless of their sexual identity or orientation.

What obvious and less obvious signs of internalized prejudice can you think of in yourself and others?

SHAME

Shame is the sense that there is “something flawed” about oneself. Shame is one of the reasons why some queer men keep aspects of their sexuality or identity a secret. It goes hand-in-hand with internalized prejudice and the effects of trauma, and it tends to worsen health and mental health challenges.^[5]

Addressing shame is a key part of learning to better navigate challenges. You can better understand shame by reflecting on:

What aspects of yourself do you criticize or dislike the most?

LONELINESS

One of the great costs of internalized prejudice and shame is loneliness, which is not only significantly more common in queer men than heterosexuals, but also has similarly toxic effects on mental health as shame.^[8,9]

Loneliness, like shame, is a feeling that can be the result of social avoidance and social withdrawal. For many, avoidance and withdrawal are attempts at coping (e.g., avoiding relationships to avoid prejudice and shame).

A key question to contemplate here may be:

What are effective ways of coping with prejudice and shame (rather than socially withdrawing)?

MISTAKING SOCIAL PROBLEMS AS ONE’S OWN PROBLEMS

Without even knowing it, many queer men blame themselves for problems that are actually much bigger cultural or socio-political problems. We could call this “individualizing” social problems. For example, there would be no “closet” without prejudice, because without prejudice, queer men wouldn’t have to keep aspects of themselves a secret.

Think about:

“If low self-esteem and other mental health challenges are linked to social problems like prejudice, who really has the ‘problem’?”
“Could this lead to mistaking social problems (like ignorant or prejudiced attitudes) as one’s own problems?”
“Might you mistake bigger social problems as one of your ’personal’ challenges?”

LEARNING TO BETTER NAVIGATE CHALLENGES

Reflection, understanding, and insight are cornerstones of learning to better navigate challenges and creating more meaningful lives.^[10] Here are some possible next steps:

RECOGNIZING AND REFLECTING ON CHALLENGES

One of the first steps in addressing challenges is to recognize and acknowledge them. This is a bit like switching on the light in a dark room before being able to make sense of what’s there and maybe clean it up or change things.

Being aware of and understanding feelings, thoughts, desires, attitudes, etc. is a pre-wired human capacity.^[6] In many ways, this is the foundation of being able to improve our mental health, reflecting on our experience, and addressing mental challenges. We try to make sense of ourselves and others all the time, but we can make it more effective by reflecting on our experiences more deliberately and consciously.

Below are some specific ways in which to harness the power of reflection.

Decoding emotional data

Think of shame and loneliness (and emotions in general) as data. They carry information and serve other vital human functions (especially communication between individuals). To lessen the power that difficult emotions have over us, we have to better understand what the data mean or what they are trying to tell us.

Emotional data can tell us a lot about our needs, desires, wishes, wants, boundaries, fantasies, and a whole lot more. For example, if shame means that you are embarrassed about being attracted to men, this might give you some clues about internalized prejudice at work (e.g., the story that “There is something wrong with me”). Having decoded shame this way, you can then try to recognize and change the stories you tell yourself, replacing internalized prejudice with what you actually believe and value (e.g., “I value self-respect”).

Focusing on relationships

Most mental health challenges tend to be linked to relationships in some way. But as much as relationships can be the cause of trauma and hurt, they can be essential in better navigating and overcoming challenges. For example, human connection and belonging is one of the best remedies and antidotes to shame and loneliness. Strengthening relationships therefore is a key ingredient in creating healthy and meaningful lives. Knowing where to start can be difficult here, but talking with a psychotherapist can be a very useful first step.

Examining avoidance

Avoidance is a common attempt at coping with challenges, including prejudice, shame, or the effects of trauma. But often avoidance comes at a steep cost. For example, if we rely on social withdrawal to cope with prejudice and shame, we may suffer costs like loneliness and poorer health and mental health.

Unhealthy substance use is one possible avoidance strategy, which often starts as an attempt at coping. Finding less costly coping mechanisms can be an important part of better navigating challenges and growing in meaningful ways.

Recognizing “individualizing” social problems

Finally, it is easy to assume that one’s depression, suicidal symptoms, or body image challenges are solely one’s own problem or perhaps even one’s own fault (this is what is meant by “individualizing”). But individualizing problems may also be an example of internalized prejudice, where queer men assume they are the problem because that’s what they learned.

Seeing problems only on the “inside” may also be a way of avoiding feeling powerless over the impact of social problems like prejudice. But queer men have the power to take their healing journeys into their own hands, and this could mean not shouldering all of the burden alone.

Next Step

Learn about common negative thinking patterns and how to reframe them into healthier ones.

Rewiring Negative Thoughts Course

Guest Author:

Dr. Joachim Sehrbrock is a licensed psychologist, founder and director of Alethea Services, and Clinical Assistant Professor in Psychiatry at the University of British Columbia (UBC). He has been working clinically with queer men for close to two decades and has taught, as well as published, on various topics related to queer men’s mental health.

References:

Bromberg, D. J., Paltiel, A. D., Busch, S. H., & Pachankis, J. E. (2021). Has depression surpassed HIV as a burden to gay and bisexual men’s health in the United States? A comparative modeling study. Social Psychiatry and Psychiatric Epidemiology, 56(2), 273-282. https://doi.org/10.1007/s00127-020-01938-1
Salway, T., Ross, L. E., Fehr, C. P., Burley, J., Asadi, S., Hawkins, B., & Tarasoff, L. A. (2019). A systematic review and meta-analysis of disparities in the prevalence of suicide ideation and attempt among bisexual populations. Archives of Sexual Behavior, 48(1), 89-111. https://doi.org/10.1007/s10508-018-1150-6
Kerridge, B. T., Pickering, R. P., Saha, T. D., Ruan, W. J., Chou, S. P., Zhang, H., Jung, J., & Hasin, D. S. (2017). Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug and Alcohol Dependence, 170, 82-92. https://doi.org/10.1016/j.drugalcdep.2016.10.038
Frederick, D. A., & Essayli, J. H. (2016). Male body image: The roles of sexual orientation and body mass index across five national U.S. studies. Psychology of Men & Masculinity, 17(4), 336-351. https://doi.org/10.1037/men0000031
Scheer, J. R., Harney, P., Esposito, J., & Woulfe, J. M. (2020). Self-reported mental and physical health symptoms and potentially traumatic events among lesbian, gay, bisexual, transgender, and queer individuals: The role of shame. Psychology of Violence, 10(2), 131-142. https://doi.org/10.1037/vio0000241
Luyten, P., Campbell, C., Allison, E., & Fonagy, P. (2020). The mentalizing approach to psychopathology: State of the art and future directions. Annual Review of Clinical Psychology, 16(1), 297-325. https://doi.org/10.1146/annurev-clinpsy-071919-015355
Munn, M., & James, D. (2022). Internalized homophobia and suicide ideation among sexual minority adults: The serial mediation of core self-evaluations and depression. Archives of Sexual Behavior, 51(7), 3417-3430. https://doi.org/10.1007/s10508-022-02316-5
Gorczynski, P., Paul, & Fasoli, P., Fabio. (2022). Loneliness in sexual minority and heterosexual individuals: A comparative meta-analysis. Journal of Gay & Lesbian Mental Health, 26(2), 112-129. https://doi.org/10.1080/19359705.2021.1957742
Salway, T., Ferlatte, O., Gesink, D., & Lachowsky, N. J. (2020). Prevalence of exposure to sexual orientation change efforts and associated sociodemographic characteristics and psychosocial health outcomes among canadian sexual minority men. Canadian Journal of Psychiatry, 65(7), 502-509. https://doi.org/10.1177/0706743720902629
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