SPECIAL REPORT: SEXUAL AND GENDER MINORITIES
Sadly, psychiatry has a dark history when it comes to the treatment of sexual and gender minority (SGM) individuals. As a gay man, it was disappointing to recognize that our profession classified homosexuality as a mental illness until 1973. The field has similarly—and fairly, I should add—been criticized for inappropriately pathologizing transgender and genderdiverse people.
But I am also proud to say that our profession has made major strides in overcoming its past. The American Psychiatric Association (APA) and the American Academy of Child & Adolescent Psychiatry (AACAP) have unambiguously stated that gender diversity and homosexuality are not pathological, but rather manifestations of healthy diversity. These associations have clearly labelled attempts to force SGM people to be non-SGM (eg, conversion therapies) as dangerous and unethical. Instead, we have developed protocols that affirm SGM individuals. We have recognized that the primary drivers of mental health problems among SGM individuals are societal stigma and rejection. Along with this recognition, we have started to build evidence-based protocols to help SGM youth build resilience in the face of these unjust adversities.
Politicians have not caught up with the mental health profession. SGM individuals continue to face discriminatory public policies that negatively impact their mental health. One recent example is legislative attempts to outlaw gender-affirming medical care for transgender youth. Although this legislation was opposed by all relevant major medical organizations (the APA, AACAP, and the American Academy of Pediatrics, to name a few), politicians have aggressively pushed these bills forward. In Arkansas, one such bill just became law, putting young people in that state at high risk of mental health crises.
In parallel with these attacks on SGM individuals from politicians, society has seen a resurgence of attacks on SGM individuals broadly, particularly SGM youth. Transgender youth in particular have become targets—with high-profile media outlets pathologizing their identities. Many of us have seen this attitude trickle down to parents, who may come into the clinic noting that they have heard in the news or on television that they should not affirm their transgender children.
It is my hope that politicians and society at large will make the same shifts we made in psychiatry: recognizing that diverse gender identities and sexual orientations should be celebrated and affirmed, not pathologized and attacked. But I also believe that it is the responsibility of every psychiatrist to spread evidence-based information about these populations.
In this Special Report, we focus specifically on the mental health of SGM youth. I hope readers will be inspired by the cutting-edge science and evidence-based recommendations inside this issue. I encourage readers to integrate these lessons into clinical practice, and take an active role in ongoing societal and political discourse so that we can best support these young individuals. Given the history of harm that psychiatry placed on the SGM community, it is the least we can do to support this vulnerable and marginalized population.
Dr Turban is a fellow in child and adolescent psychiatry at Stanford University School of Medicine, Palo Alto, California, where he researches the mental health of transgender youth. He reports that he receives textbook royalties from Spring Nature, and from expert witness testimony for the ACLU and Cooley LLP. He has received pilot research award for Gender Psychiatry Residents from the American Academy of Child & Adolescent Psychiatry, support by industry donors (Pfizer and Arbor), and is on the Scientific Advisory Board for Panorama Global. ❒