Mental Health Issues and the University Student

11 Clash of Cultures: LGBT Students

In the last two decades, universities have attended to the increasing diversity among their students, which has led to greater acceptance of and attention to the needs of students from minority sexual orientations: lesbian, gay, and bisexual students. Transgender students, whose concerns center more on gender identity than on sexual orientation, are usually included within the LGBT categorization , even though their needs or issues may differ. The generation currently in college has grown up with greater visibility and acceptance of LGBT people, with openly gay celebrities like Ellen DeGeneres and Clay Aiken, samesex marriage legal in some states, recent acceptance in the military of openly gay troops, and films and TV shows that normalize the lives of LGBT people. More and more universities feature classes and even majors that focus on LGBT studies, “queer studies,” or related disciplines. Yet research suggests that LGBT students continue to face greater discrimination and harassment on campus than do other minority groups, and that even open prejudice against LGBT students continues to be socially acceptable in a way that other prejudices no longer are.1 Continued clashes in our society over LGBT rights, and the great variability in how acceptable these issues are within various smaller communities, affect the emotional well-being of emerging adults. Highly publicized tragedies, such as the death of Tyler Clementi Chapter 11 Clash of Cultures LGBT Students Clash of Cultures: LGBT Students  87 because of bullying based on his sexual orientation, have drawn attention to these problems. But even in the absence of such extreme situations, LGBT students may adjust somewhat differently to college and present with mental health concerns that diverge from those of their heterosexual peers.2 For those of us working with emerging adults, providing compassionate, affirming care can have a tremendous effect on these students. Sexual Orientation Bruce is a 19-year-old white freshman from Alabama who comes to the counseling center complaining of depression. He endorses low mood, anhedonia, frequent crying, and a tendency to isolate himself from his peers, but he denies any neurovegetative symptoms. His concentration suffers only “sometimes,” and at first he’s vague about when. He’s been excelling academically. On the intake paperwork, he omits the demographic portion regarding sexual orientation and is vague in answering questions about relationships and social supports. He then asks whether any medicines can reduce sexual desire. The psychiatrist gently probes for details of the desire he wishes to avoid and of his sexual experiences. Bruce quietly admits that he’s been attracted to men for years now, but as the son of an evangelical Christian minister, he fears it would destroy his family if he came out. He hastens to explain that he is also committed to the religious community in which he grew up, and is loath to lose their good opinion as well. He did attend a program at the university’s LGBT center during orientation and felt further confused because he didn’t identify with some of the more activist stances that other students took. It’s only when he starts to think about how he might resolve this conflict in his life that he starts to obsess, and his concentration lapses. Lately he’s felt hopeless about ever being happy since he “can’t” be gay. At those times he’s experienced helplessness, guilt, and suicidal thoughts. His fear of eternal damnation scares him away from both suicide and exploring his sexuality. Given the highly emotionally charged clashes in our culture over gay rights, and the seemingly irreconcilable divide between some religious groups and the notion of whether sexual orientation and gender identity are “choices” or biologically predetermined, working with a student like Bruce can bring up confusion , fear, and counter-transference. What happens when a student’s multiple identities clash? In attempting to remain culturally aware and sensitive, we 88  Clinical Challenges might want to respect Bruce’s commitment to his religion as well as his physiological and psychological need to be true to his sexual orientation. As licensed professionals (physicians, psychologists, clinical social workers, nurses), we must turn to our evidence-based knowledge and the ethical codes of our discipline— along with the principle of “first, do no harm”—to help students caught in such seemingly impossible inner conflicts. Bruce is clearly suffering. He doesn’t meet all the criteria for a major depressive episode, but he could have another depressive disorder or dysthymia...