*Lesbian, Gay, Bi/Pansexual, Trans, Intersex, Queer, and Questioning
Increasingly, different corners of the LGBTIQQ communities have seen an alarming increase in healthcare disparity. The various professional roles placing me among the most invisible and oppressed communities, personal and professional observations, and growing community outcry and outrage led me to the decision to introduce this multi-part series entitled, Diversity and Disparity in LGBTIQQ Health. This series will cover topics such as The Queer Umbrella, Race and Ethnicity, Poverty and Class, Culture – which will include Religion, Geographic Divides, and Generational Difference – Age, Sizeism, and Disability.
Before we can discuss these fairly broad topics of Diversity and Disparity, we need to establish some basic, introductory concepts at the heart of diversity and the disparity rampant throughout the LGBTIQQ communities, politics, and the healthcare system.
Terms Matter. Words Matter.
At least once a week, I receive calls from fellow therapists usually calling for referrals to other clinicians more aware of trans concerns because a trans person has just shown up at their door. When I check out their websites, however, often they will bill themself an "LGBT therapist" of some kind. Yet when faced with an actual person of trans experience, they find themselves nable to provide basic therapeutic service.
What message do you send when you as a clinician, guided by ethics and laws of your profession, put forth language on your public materials that you have competency in a particular area that you in fact do not possess? Better to refer a client than treat someone you feel in good conscience you could not see, but better still to avoid using language casually and without care for consequences.
If you call yourself an “LGBT specialist,” and do not have sufficient competency in any of the letters of the above acronym, do not list it, or preferably, get competency. This follows for all specialty areas, for any provider in any of the healing professions. (Ask yourself what constitutes competency.)
Words have the ability to further clarify an idea, experience, history, or identity. While words cannot fully encompass the complexity of a person’s experience, honoring our history, struggles, communities, clients, and fellow Beings requires that we continue to grapple with our everchanging understanding, the words that we use, and more importantly, those which individuals use for themselves. A small sample of common identifying terms used within the LGBTIQQ umbrella:
- Cisgender / Cis
- Gender Nonconforming
- Bisexual / Pansexual
- Gender Non-Conforming
- Mixed Race
Do any of these terms threaten, anger, befuddle, alarm, concern, confuse, or amuse you? Any of them seem more suited for research, academia, or some elitist queer, ivory tower? Contrary to what many
may think in LGBTIQQ mental and medical health, often far removed from the communities they serve, real people, from different classes, different levels of oppression and privilege, different educational
levels, and different cultures and identities, use these words, and more, everyday.
The struggle to acknowledge or closely approximate a community or individual experience through our language
ostensibly works at crosspurposes with ease of communication. Nevertheless, we have a mandate to use accurate words without sacrificing individual dignity. We have a responsibility, even if faced with momentary inconvenience, to use our wits and creativity to acknowledge, prioritize, and honor the human experience. (What mandate, you may be asking yourself. Good question.)
The excuses that have arisen throughout history and that still make their way through the rumblings of the layers of politics in health and inter/ intra-community have never shown themselves to have lasting merit; excuses like, “We’re too much for ‘them’ to handle right now,” “We’ll get to your needs later,” or, “That sounds too academic, too inaccessible, they wouldn’t understand,” come from fear, internalized ___- phobia, and shortsightedness. History tells us that allowing fear of calling possibly negative attention to ourselves, or “making waves,” stop us from including anyone in our communities, particularly our most vulnerable members, does no one good. Some examples:
- Gay men excluded and ridiculed dykes (and often still do).
- The feminist movement excluded queer women.
- Gay men and lesbian women shunned trans and gender non-conforming folks, when such individuals actually started and bore the brunt of the modern LGBT Rights Movement.
- Mono-sexually identified individuals (lesbian, gay, and heterosexual) denied the existence of and then derided bisexual and pansexual folks (and still continue to).
- Mental/medical health needs of genderqueer/gender nonconforming individuals and community too often are disregarded for “the larger trans narrative.”
- People of Color (POC) remain invisible, nominalized, patronized, and tokenized throughout queer space.
- Our elders and our youth, especially those in deep poverty, as far as basic health care and human rights are concerned, do not exist.
And as a result, how often does “LGBT” in reality mean “rich gay white (cis) male?”
“Inaccessible?” There was a time when “LGBT” sounded “too academic,” too scary, or too out of reach for the everyday person. Some people, yes, even on the Coasts, still ask for clarification. Our changing and evolving societal understanding, in turn informs our ideas of “normal.” Take race, for an example. Tracing commonly used terms for African- Americans throughout the decades demonstrates how acceptability, nuance, and understanding all change with time.
Coined words and nomenclature enter common vernacular through active use. If we continue to allow our fear of the threat of this invisible lowest common denominator stop us from honoring the individuals and communities which trust us, and from which we come, how will they trust us to serve them?
When it comes to health disparity, or any disparity, does inclusivity not make more sense than exclusivity?
Appearance Does Not Equal Identity.
While tempting to equate physiology, fashion, stance, style, and mannerisms with identity, we do a disservice to individual experience, especially with underprivileged and oppressed communities within the LGBTIQQ umbrella. How you look does not equal who you are. Some examples:
- Racial and Ethnic Identity, especially when taking into account mixed race, intergenerational issues, and the human and political constructs behind race, have less to do with skin color, physical structure, hair color, and facial features than historical and sociological complexities.
- Gender Identity, Gender Expression, Masculinity/Femininity, and Maleness/Femaleness, certainly do not depend on one’s karyotype, physiology, height, hair length, internal or external structures, clothing, sexual preference, sexual proclivities, facial features, or mannerisms.
- You cannot tell based on outward appearance, body shape, perceived racial attributes, or facial traits a person’s health, level of disability, age, or medical history.
While we all try to see the good in others and ourselves, how often do we think in terms of them, those people, or not like me?
The barriers to basic human rights and the disparities in health care take the form of insidious thoughts and ideology that come down to the other not being “____ enough,” or “too____.” When we start seeing ourselves as “____-er than thou,” when we start thinking in the I/Thou dichotomy rather than the global We, we draw lines of distinction, of otherness finer and finer, increasingly arbitrary and random, based on fear and chaos.
The very nature of privilege, advantages one group enjoys over others, or exemptions gained from certain burdens due to arbitrary and perceived distinctions, makes the bearer unaware that they possess it. Privilege happens systemically and contextually. Examples of privilege include white, male, cis, rich, passing, heteronormative, monogamous, vanilla, and so forth. Be aware that belonging to one or more minority groups does not grant immunity from the hazards of privilege. For example, gay white cis heteronormative men might belong to a sexual minority but might also benefit from passing privilege (in this case, appearing straight), racial privilege, and male privilege.
Examine your life and yourself. Ask questions. Be vulnerable, and share your vulnerabilities. Acknowledge that people with privilege have the luxury of exposing vulnerability in a measured environment such as a classroom or group discussion, but those without privilege, the disempowered, poor, and oppressed – your fellow Beings – experience that vulnerability in some form or another all the time.
Know the difference between empty platitudes like “I accept everyone,” “I view people as people, not as labels,” “There’s only one race – the human race,” and actually knowing the individual histories, cultures, values, philosophies, genders, experiences,
feelings, pains, and joys of those whom you claim to accept.
How are issues of class, poverty, race, education, religion, culture, ethnicity, age, disability, gender, size, and geographic divide unknown or invisible to you? How do you experience privilege in your life?