Bisexuality and Mental Health

(originally posted on tumblr)

This post was all super relevant when I started it a couple of months ago. We’ve moved on in our topics since then, but this kept sitting in my drafts and I wanted to finish it. So here you go. I could have done more weaving in between sections to make it flow a bit more, but I’m really bad at that and really tired tight now. But that just makes it a shorter read, so yay?

Before we start, though: warning for general discussion of mental illnesses and therapy, and for mention of biphobic violence and sexual violence. Also, the article I’m basing this on is cissexist. It only ever mentions men and women and I am unsure but skeptical as to the treatment of binary identified trans people in the studies it’s based on. (The article makes no mention of this, which usually means we can assume the worst.)

In the wake of Shiri’s awesome graphics campaign, discussion started up again about why bisexuals top so many of the most horrible charts. I wanted to write something about mental health issues and bisexuality, because they are both part of me, but I struggled to find out what.

That’s when I stumbled across an article on exactly this thing. I’d like to share some parts with you, the ones that I found especially relevant, in what I hope is a more easily accessible way than reading an academic article.

The article is “Mental Health Services Experiences of Bisexual Women and Bisexual Men: An Empirical Study" by Emily H. Page, which appeared in Journal of Bisexuality, Vol 4, Numbers 1-2 (here’s a link to the pdf of the article, I think it’s publicly available but let me know if you want me to email you the file). The italics in the quotes are from the original text,bold text emphasized by me and I have changed the formatting a bit here and there to make it easier to read (just line breaks and bullet points for statistics.)

The author is described in the book as a psychotherapist in private practice in the Boston area and Co-Chair of the Committee on Bisexual Issues in Psychology of the Society for the Psychological Study of Lesbian, Gay and Bisexual Issues (Division 44) of the American Psychological Association, among other things.

She starts with a review of the research in this field. Predictably, most studies haven’t considered bisexuals separately from LG people, but:

Two studies have distinguished between responses of bisexual participants and lesbian and gay participants (Lucksted, 1996; Moss, 1994). Both studies found that bisexual participants experienced greater degrees of heterosexual bias from their providers than did lesbian and gay participants. This difference has additional importance in light of recent findings in which bisexual responses were higher for anxiety, depression, suicidality and negative affect than lesbian, gay, and heterosexual responses. In particular, Jorm et al. (2000) found that, compared to lesbian, gay, and heterosexual participants, the bisexuals in their sample experience more “current adverse life events, greater childhood adversity, less positive support from family, [and] more negative support from friends…" These authors suggest that this disparity in psychosocial stressors is due, in part, to the dual prejudice that bisexual women and men experience: prejudice against bisexuality as well as prejudice against homosexuality.

[…]

Since research suggests that bisexual women and men may have greater mental health challenges and may be receiving less effective and potentially even more harmful services than those of other sexual orientations, it is important to learn more about the specific mental health care experiences and needs of bisexual women and bisexual men.

I mostly chose this quote to go, here, this is what is at stake. We’re doing very badly in the area of mental health and we’re not getting the help we should be getting.

So what are the issues we bisexuals dealing with? According to this report:

Participants’ reasons for seeking mental health services included:

• depression (40%);
• family or relationship problems (19%);
• post-traumatic stress disorder (10%);
• anxiety (7%);
• issues connected to participants’ sexual identity (6%);
• an addiction (4%);
• issues connected to participants’ gender identity (3%);
• a suicide attempt (2%);
• and small proportions of additional reasons (10%).

I initially wanted to emphasize some of these reasons but really, they’re all really important and relevant.

Depression is something we see in a lot of bisexuals, certainly most of the ones I know. I’m not sure if anyone has written about why so many of us get depression. I would imagine that feelings of isolation would contribute, along with all the other things we have higher rates for.

Family or relationship problems: we’ve all heard countless stories, I think, about people whose families can’t accept their sexuality. It surprised me that so many bisexuals sought therapy specifically for this reason, though. But then, do abusive relationships fall into this category? I think they probably do.

PTSD is an odd one, I am both shocked at how many bisexuals sought treatment for it and somehow also surprised that the number isn’t higher. I know we have appallingly high rates of sexual assault, which can lead to PTSD, but I also know that PTSD can go undiagnosed forever. So (on no scientific basis at all) I think there’s probably a huge part of the bi community that has PTSD, but most don’t have diagnoses or access to treatment.

The rest of the reasons given are represented in pretty small numbers, but I think it’s worth pointing that there isn’t a single thing listed up there that can’t be connected to some of the other stats we have on bi people and our lives.

Other findings in the report: 

(aka stuff I didn’t know where to put so here)

When asked to rate the helpfulness of a recent course of mental health services with their bisexual issues on a scale of 1-5, the average rating was halfway between 3 (neither helpful nor unhelpful) and 4 (moderately helpful).

When asked how accepting practitioners have been when told of the participant’s bisexuality, answers were:

• (1) extremely accepting (27%);
• (2) moderately accepting (62%);
• (3) neither accepting nor unaccepting (1%);
• (4) moderately unaccepting (8%);
• (5) extremely unaccepting (2%).

People with serious mental health problems reported a lower average acceptance rating (3.8) compared to people with moderate mental health issues (4.2) and were also slightly less likely to disclose their sexuality to their practitioners. This basically means that those of us most in need of help are less likely to get it in any meaningful way, and there’s probably some double effect of stereotypes of bisexuality and of mental illness going on here.

More men were seeking help for issues directly related to their bisexuality compared with women. The author suggests that this is because bisexual women (at least in the Boston Area, where this study was done) have more “nonclinical sources of support" ie. the bi women’s community. On the other hand, a higher proportion of women experienced what the report calls “more serious mental health issues".

Problematic Experiences Related to Bisexual Issues

I felt like this needed a section of its own because it’s hella important. According to the author, 66 out of 217 bisexuals in this study checked any of six listed examples of “biased interventions" (I assume they mean biphobic shit) that they had experienced. 

Of the 66 (30%) who responded, the two most frequently checked examples of bias were interventions in which the clinician invalidated and pathologized the sexual orientation of the client in one of two ways. Clinicians assumed that the client’s bisexuality was connected to clinical issues when the client didn’t agree, or assumed that bisexual attractions and behavior would disappear when the client regained psychological health. A greater proportion of those with more serious clinical issues experienced these examples of bias than did those with more moderate clinical issues.

And yeah, this is not surprising as it is part of a history as old as the word “bisexuality" in itself. But it is upsetting and I kind of get too emotional when I think about this to say anything clever about it.

Almost everyone in the study answered the free form question, "What do you think is the most important issue or problem you face in being both a mental health consumer and a bisexual?"

The most frequent themes in responses to this question were:

(1) invalidation of bisexuality, e.g., “I always felt like my therapist was humoring me when we discussed my bisexuality, like she thought it was a phase, despite that I’ve had long-term relationships with both sexes fairly consistently”;

(2) lack of knowledge about bisexual issues, e.g., “Finding practitioners who understand the oppression bisexuals get from other queers”; and

(3) interpretation of bisexual attractions or behaviors as unhealthy, e.g., “I feel I have the most difficulty with being bisexual and polyamorous when trying to find an appropriate therapist [i.e., one that doesn’t think these are symptoms of a problem].”

Some participants provided examples of (4) lack of skill in working with bisexual issues, e.g., “When I mentioned my bisexuality, she didn’t seem to know what to say, or any theory at all other than commonsense fake-seeming things to say”; and

(5) lack of proactive interventions, e.g., “My therapist didn’t even attempt to find out my orientation [assumed I was straight] and this made me scared to tell her.

I think there is very much a theme of bi erasure to this: People are assumed straight, bisexuality is assumed unreal, inauthentic, the symptom of mental issues. And in the absence of direct erasure, there is nothing. No knowledge about bisexuality and bisexual issues, no advice or anything. It’s painfully obvious that none of these people’s therapists have even asked themselves, “how can I specifically approach a bisexual patient in a helpful and respectful way?"

I’m more or less running out of things to say here and in a way, what I found the most interesting about this whole thing was the quotes from the bisexual participants in the study. You can feel the frustration, the pain and the anger there. So I’m just gonna put a looong quote here are then wrap up.

Participants in this study strongly urged their clinicians to validate their bisexual orientation and identity as legitimate, healthy per se, and equal in standing to lesbian, gay and heterosexual orientations.

[…]

Descriptive written responses of this study illustrate the impact on clients of invalidating or pathologizing bisexuality. One respondent wrote that a session created “more stress than I had gone in with (though the stress had nothing to do with how I felt about my sexuality, he just made me very angry at how he treated me) … this counselor did not even accept the POSSIBILITY [sic] that bisexuality even exists.” Another said her clinician “saw it [her bisexuality] as ‘illness’/or a medicatable situation, rather than inquiring more and finding the dilemma that ‘causes’ my feelings of distress.” A third respondent wrote simply: “We DO exist!”

The emphasis on basic validation of their sexual orientation by the participants in this study contrasts with findings from prior research on lesbian and gay clients’ psychotherapy experiences. In the prior studies, lesbian and gay participants rated training in skills specific to lesbian and gay issues and general therapeutic skills more highly than a practitioner’s role in validation of their sexual orientation as real and healthy per se (Lebolt, 1999; Liddle, 1996; Morgan & Eliason, 1992). This may be a reflection of how publicly invisible bisexual issues still are compared with societal awareness of lesbian and gay issues.

And this is where I get completely emotional because damn it, we’re still stuck on this stage where we’re trying to get our therapists to see that bisexuality isn’t the problem or even a symptom of it, and how the hell are we gonna get better if we’re have to fight this out with our therapists? If sessions end up making us feel worse?

So I guess to sum this up, this is how things are in one of the best places in the world to be a bisexual person in. Things are pretty fucking dire. Does anyone know of any groups working with this? If not, does anyone wanna join me and start some kind of bi mental health action group?

About the Idea of Monosexual Privilege and the Monosexual Privilege Checklist

Some context on this: the idea of monosexual privilege has been a hotly debate subject among bisexual people on tumblr. This post came on the tail end of a loooong debate involving a lot of people and a lot of different views. For more background: read these posts by Shiri Eisner, this post by pareia, and these discussions on tumblr.

This is the post as it appeared on my tumblr on Jan. 26, 2013.

I’m adressing this post to the people I argued with yesterday over the concept of monosexual privilege and in particular to Shiri Eisner, as the creator of the monosexual privilege checklist. It is based on yesterday’s discussion and today’s clarification from Shiri Eisner on the intent behind the checklist.

I would like to make it clear that I write this as a bisexual woman who is very interested in bisexual politics and devotes a lot of time to thinking and writing about it. My stake in this is that I would like to see bisexual politics that are revolutionary, that speak to our experience as bisexuals, that are well thought out and well reasoned and useful tools for bringing down the binaries – in short, I want the same as you. So please do not dismiss my arguments here as privilege-denial, or as internalized monosexism.

While you see two different axes of oppression, one straight-queer and one monosexual-bisexual, I (and others, but I can only speak for myself in this post) see only one straight-queer axis of oppression with different consequences for the different oppressed groups and a degree of horizontal hostility as a result of that.

In one of my many, many, many posts on the subject of monosexual privilege yesterday, I said the following:

So far, I have seen no examples of monosexual privilege that is generally available to gay people. Some of it is available to white middle-class cis gay people who conform to heteronormativity, some of it is available to gay people only in LGBT spaces. The former is an example of the privileged group extending privilege to a select few of the non-privileged as a reward for buying into their ideology, the latter does not count as it is a subspace separate from mainstream society.

This got buried in a wall of text and nobody responded to it so I’m putting it in its own post and bolding it. I will add that another category exists: rights that the gay community had to fight tooth and nail to have, which we don’t have yet because our problems haven’t been prioritized. I would argue that hard-won rights (especially those that are relatively recently acquired and only in a specific set of countries) have no place on a privilege checklist. If necessary, I am willing to go through the checklist point by point and show that each of them belongs in one of these categories.

Now I should add that I am well aware that monosexual privilege is not claimed to originate in the gay community. However. If you construct a group of people as a privileged group by virtue of sexuality, it has to make sense to talk about that group as privileged by virtue of their sexuality. If what you describe as monosexual privilege is not available to everyone you define as monosexual, even when taking the other axes of oppression into account, it’s time to look at who actually holds the privilege in question. In this case, I think it clearly is heterosexuals. The reason why those of us who criticize the idea of monosexual privilege focus so heavily on lesbians and gays in relation to this is twofold. 1) We all agree that heterosexuals hold the privileges listed and 2) it is when we apply the concept of monosexual privilege to gays and lesbians as subsets of the proposed monosexual group that we see how little sense it makes to talk about them as monosexuals.

The monosexual privilege checklist was accepted by many, including myself, without critical thought. It speaks of the unique problems faced by bisexuals and it was such an emotional experience to see it all in list form that I didn’t initially question the chosen template, or its implications.
Since then, I’ve seen a lot of criticism of how prolific the format of the privilege checklist has become, how it’s used on all forms of oppression without taking into account whether the form of oppression in question actually fits the original model. This has become widespread and many people now don’t realise that when you create a privilege checklist, you are implying an underlying axis of oppression with your non-privileged group on one end and everyone else at the other. The format of the privilege checklist cannot and should not be divorced from this political analysis of oppression, or it is meaningless.

Think of the first privilege checklist, the white privilege checklist. It was created to show white people how they are privileged in ways they rarely even think about. Behind it is an analysis of racial oppression that shows white people as privileged over all other racial demographics. This is true regardless of how various non-privileged racial groups are oppressed in different ways, or receive varying degrees of provisional access to the privileges described, because whiteness is monolithic. Because regardless of intersecting gender, class or sexuality oppressions, it makes sense to speak of a relatively uniform white experience. Because I, as a poor person, a woman, a bisexual, a person with a mental illness, living in a country with a vastly different racial history and social dynamic from the US, I can still read the white privilege checklist and have my mind blown by all of the privilege I never realised I had. It works because although whiteness is mostly never considered by white people, white people are still a group with clearly defined membership, even though it mostly becomes clear through definitions of who isn’t white.

This is not transferable to the idea of monosexual privilege. There is no monolithic group of monosexuals. It is not a concept except in our minds as bisexuals. Heterosexuals may see gays and lesbians as less threatening on some levels (as expertly pointed out by Kenji Yoshino in his essay The Epistemic Contract of Bisexual Erasure) but they do not experience straights and gays as one group. There is no cohesion there as there is with whiteness. The extent to which gays and straights have common interests in the suppression of bisexuality is still, as Yoshino describes it, a subconscious contract between two groups with different motives, investments and privileges. It is still a contract between one privileged group and a minority. Intersectionality doesn’t even begin to explain the complete lack of cohesion in this supposedly privileged group.

So here is my problem. If the unique situation of bisexuals does not fit the privilege-oppression framework in the sense of bisexuals being oppressed by monosexuals, and if this framework is not even necessary in order to describe and explain the unique experience of bisexuals or the interests of gays and lesbians in bi erasure, why should we use it? It’s faulty, flawed, oversimplifying and unnecessary. It brings far more harm than good. And to be honest, it feels appropriative to me.
I’m not saying the list should be completely chucked. With a few changes, it could be a list of consequences of bi erasure. A list of specific oppressions for bisexuals under heterosexism. Shining a light on bi specific oppressions is a good thing, a necessary thing. It does not need to be a privilege checklist to do that.

Here is what I suggest: we can talk about bisexual erasure and biphobia as a consequence of heterosexism and sometimes an expression of horizontal aggression. We can even talk about monosexism as a subset of heterosexism in which bisexuality is specifically targeted for the threat it represents to heteronormativity. But if we talk about monosexism among gays and lesbians we should make clear that we are talking about internalized shit and attempts to make an oppressed group look more palatable to the privileged group (homonormativity).