No topic has undergone as many changes and controversial discussions in the field of medicine, society and politics as homosexuality. Up until 1973, homosexuality was categorized as a psychiatric disease in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The International Statistical Classification of Diseases and Related Health Problems (ICD) continued to pathologize homosexuality even until 1991. At the same time the public policies towards homosexuality and same sex relationships have been seen as positive changes in many countries. However, there has also been a trend towards more negative attitudes and discriminatory policies, as can be seen in countries such as Russia and Uganda. Stigmatization and discrimination of homosexual people can range from subtle homophobia to public rejection, verbal and physical violence as well as criminal sanctions and even the death penalty. A serious lack of well-grounded discussions in the change-processes contributes to the ongoing pathologizing, criminalization and banishment of sexual and gender minorities
The medical community also continues to display forms of stigmatization and discrimination. A lack of knowledge concerning diagnostic and treatment issues, missing research and specialized services and even prejudices and homophobic attitudes are still common within the field. Access to medical and especially psychiatry services without discrimination and the necessary sensitivity and knowledge for the needs of patients with different sexual orientations is highly needed.
All these factors influence mental health. There is scientific evidence that people with non-heterosexual orientations have a higher rate of mental health problems such as major depression, suicidality, anxiety disorders or addiction.
Given this situation the provision of mental health services with specialized treatment opportunities and changes in the general medical system is highly needed. To foster this development, changes must address medical education and research, institutionalized services, and attitudes of the medical community and medical associations.
Therefore this special issue addresses some relevant issues concerning homosexuality and mental health. The first part will focus on diagnostic issues, new guidelines and the development of sexual orientation in young people. J. Drescher, member of the DSM-5 SubWork Group on Sexual and Gender Identity Disorders, provides an overview of the history as well as a future outlook on homosexuality and gender diagnoses in DSM and ICD. M. Plöderl gives an update on the current prevalence of mental health disorders in LGBT people. Insights in the development of new guidelines for the diagnosis and treatment of LGBT people in Italy as well as for transgender people in Germany are won through the articles of Nardelli et al. and Nieder et al., respectively. A. Güldenring offers a critical view on how the diagnostic procedures of DSM and ICD pathologize transgender people. The importance of attitudes of therapist towards LGBT patients is outlined in the article of M. King. The complexity of the development of sexual orientation in young people is described by R. Savin-Williams and K. Cohen.
The second section includes articles on attitudes towards people with different sexual orientations in various countries. Wu and Kwok insights Chinese attitudes towards sexual minorities in Hong Kong. Analyzing Bollywood cinema, D. Bhugra reflects on the changes in Indian society. Based on a study in Australia, A. Lyons addresses the importance of resilience for developing a positive identity in homosexuals.
The last two articles focus on the need for changes in medical associations, organizations and services. L. Mahler and G. Mundle describe the process of releasing a statement through the World Medical Association (WMA) declaring homosexuality to be a natural variation of human sexuality, therefore requiring no therapy, especially no “conversion procedures.” D. Bhugra et al. focus on the importance of access to psychiatric services without discrimination as well as different levels of intervention. Also they describe the organizational and individual changes which are needed to have medical and psychiatric services open and positive to all sexual orientation. The title of their article, “Sexuality and Mental Health: What next” can be seen as a next step, in which homosexuality is not an “outcast,” but instead simply part of human sexuality.
With this special issue on homosexuality and mental health, we hope to not only provide insight into the current state of the field, but also raise your awareness and your interest in these topics. The articles here have demonstrated first steps in changing attitudes, diagnostic issues and treatment possibilities. At the same time, they show the need for a continuous development of the medical system as well as society. We hope that this special issue can serve as an inspiration to continue the discussion within the medical field concerning the much needed changes in diagnostic processes, treatment possibilities, medical services and organizations as well as attitudes of medical professionals. It is worth noting that the World Psychiatric Association has set up a Presidential task force on the subject which will report next year on the mental health needs and training.
GUEST EDITORS
Götz Mundle
DGPPN, Section Sexual orientation and Identities, Germany, Center for Mental Health, Berlin
Lieselotte Mahler
DGPPN, Section Sexual orientation and Identities, Department of Psychiatry, University Charite, Berlin, Germany
Dinesh Bhugra
Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK