Minority stress (Meyer)
The idea that people in a stigmatized sexual minority carry extra, chronic stress on top of ordinary life stress, and that this stress explains much of their higher rates of depression, anxiety and substance use. Meyer separates distal stressors, things that happen to a person (rejection, discrimination, violence), from proximal ones that go on inside (expecting rejection, hiding, and turning society’s negative view on oneself). His 2003 model also includes coping and community support, which can soften the effect.
What drives it
The stress does not need a fresh insult every day. Scanning the street before taking a partner’s hand, rehearsing a pronoun before a work dinner, bracing when a relative brings up the news: each costs a little, and the costs add up. For identification it moves the question from ‘what is wrong with me’ to ‘what have I been carrying’, and it counts the setting as part of the cause. Hatzenbuehler’s later framework adds that the stress works through routes that affect anyone, such as trouble managing emotion, strained relationships and negative thinking.
How it shows
Work
Deciding at each new job whether to put the wedding photo on the desk. Saying ‘my partner’ on Monday mornings while colleagues say ‘my husband’. Feeling wrung out after a client lunch that had nothing hard on the agenda.
Relationships
Letting go of a partner’s hand when a group of men comes round the corner. Holidays planned around which relatives can be visited together. A fight at home after a day of small slights that neither person names.
Self
Notice how often you check a room, a sentence or a face before you say who you are, and how tired you feel after days with a lot of that checking.
What tells it apart
Generalized anxiety: Generalized anxiety spreads worry across many topics. Minority stress is more likely when the vigilance tracks particular settings (the family dinner, the new office, a small town) and eases in places where being gay, lesbian or bisexual is ordinary.
Rejection sensitivity: General rejection sensitivity expects rejection from anyone, for anything. The minority stress version is tied to the identity, and it may show up only when sexuality could come into view.
Major depression: Depression can grow out of minority stress, and the two often occur together. The lens is more likely to help when low mood rises and falls with time spent in hostile settings, though a depression that has taken hold can run on its own whatever started it.
A test
Ask the person to list the settings of an ordinary week and say how much of themselves they edit in each. If distress tracks the editing and the hostile news, and stays lower where they edit nothing, minority stress may be part of the picture.
Questions to carry
- Where was I this week when I checked the room before I spoke?
- What do I carry home from those places that I don’t carry from others?
Go deeper
- Read: The Velvet Rage, Alan Downs, 2005, second edition 2012. Written for gay men by a clinical psychologist, from his practice and his own life. He traces adult shame back to a boyhood of feeling different and sets out three stages of moving out of it. It is widely read and many readers say it named something for them. The stages come from his clinical work and haven't been tested in studies that we found. A related idea, that some gay men make up for stigma by achieving, was tested later by Pachankis and Hatzenbuehler (2013). It says little about women, bisexual or trans people.
- Study: Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence, Ilan H. Meyer, Psychological Bulletin, 2003. The paper that set out minority stress. Using meta-analyses of earlier studies, Meyer found higher rates of mental disorders among lesbian, gay and bisexual people than among heterosexual people. He explained the gap by stress from stigma: prejudice events, expecting rejection, hiding, and internalized homophobia, with coping that softens some of it. It is a review and a model, and later studies tested its parts. It covers lesbian, gay and bisexual people. Hendricks and Testa adapted it for trans people in 2012. The full text is free to read.
How strong the research is
moderate. A review with meta-analyses by Ilan Meyer (Psychological Bulletin, 2003) found higher rates of mental disorders in lesbian, gay and bisexual people than in heterosexual people. A later review of 25 population studies (King and colleagues, BMC Psychiatry, 2008) found about twice the rate of lifetime suicide attempts and at least 1.5 times the rate of depression and anxiety, though only one study met all four of its quality marks. In a US national survey (Hatzenbuehler and colleagues, American Journal of Public Health, 2010), mood disorders among LGB people rose 36.6% and generalized anxiety 248.2% between the 2001 to 2002 and 2004 to 2005 waves in states that voted to ban same-sex marriage, with no significant rise among LGB people in states without a ban. Most evidence for the stress pathways is cross-sectional. In two Swedish twin studies (Frisell and colleagues, Psychological Medicine, 2010, and Donahue and colleagues, American Journal of Public Health, 2017), adjusting for discrimination and victimization shrank the gap, and comparing people with their own twin shrank it further or nearly removed it, which the authors read as shared genes or family environment explaining part of the difference.
Where it comes from
Virginia Brooks, Minority Stress and Lesbian Women, 1981. Ilan Meyer, ‘Minority stress and mental health in gay men’, Journal of Health and Social Behavior, 1995, and ‘Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence’, Psychological Bulletin, 2003. Mark Hatzenbuehler, ‘How does sexual minority stigma “get under the skin”? A psychological mediation framework’, Psychological Bulletin, 2009
On the family tree: Ilan H. Meyer