LGBT perspective of grief, an essay by Liz Gleeson
Here is an essay I wrote a couple of years back. It’s worth sharing here as there’s plenty of food for thought!
In an ideal world, the themes associated with lgbt bereavement would not vary greatly from non-lgbt, but in Ireland the gap is still wide and this essay aims to highlight some of the themes that are still very relevant to some members of the lgbt community when faced with bereavement.
The run-up to the marriage equality referendum that was recently held in Ireland was very much an eye-opener to attitudes towards lgbt in the general population and a stark reminder that, whilst our society has made some great advances towards equality for all, there is still a very real and prevalent stigmatization and discrimination towards people who identify as lgbt.
These prejudices are apparent throughout society, including in healthcare, and it is my intention here, to name some of the themes that were highlighted by Higgins and Glacken (2008, 2009) that same-sex couples mayexperience when dealing with bereavement, to explore some of the patterns that emerge and to look at ways that may be helpful in positively dealing with bereavement and minimizing secondary distress for lgbt people. It is important to note, the issues faced by lgbt people are as a result of stigmatization and marginalization and are not intrinsic to sexual orientation. Whilst the issues raised in this essay may not be the experience of all lgbt people, studies show (Glacken & Higgins 2008/09) that there are recurring themes that happen to a significantly large percentage.
It may be useful to mention that this author writes from personal experience as well as academic knowledge.
Approximately 8% of the Irish population identify as lgbt (My World Survey, 2012). Coming up to the referendum in April 2015, it would have been easy to assume that this one was a ‘no brainer’, of course people would vote ‘yes’ for this human rights issue, why should a referendum even be necessary?
But as media outlets started to share articles about same-sex marriage, what it means to be transgender in Ireland, should children have the right to a mother and a father, the prejudicial comments that were seen coming from the general public and the ‘no’ campaign were genuinely shocking and reveal a significantly hostile social environment.
Research has shown that 80% of lgbt people have experienced verbal abuse because of their sexual orientation, 60% homophobic bullying, 27% have practiced self-harm, 18% have attempted suicide and 50% had seriously contemplated suicide over their lifetime. 77% felt that their healthcare provides did not have sufficient knowledge or sensitivity to lgbt issues and only in 44% of cases were healthcare providers aware of their patients lgbt identity.
It is important to remember the context of this prejudiced point of view; loving someone of the same sex was considered an illness until 1990, a punishable crime until 1992 and is still considered a sin by the Catholic Church. That’s a whole lot of stigma to be waded through and this stigma will take time to change.
There is increased mental health risk among LGBT people (due to marginalization, stigmatization and discrimination) and bereavement can cause decrements in mental health (Doka), therefore lgbt people require attention to their specific mental health needs, particularly following a bereavement.
Possible Experiences and Common Themes
There is a presumption of heterosexuality in general healthcare which often exerts a pressure on a patient to have to overtly convey the nature of their relationship. It can be extremely distressing for a person to have their relationship go unacknowledged at a time of huge emotional pain, as well as a contributing factor to decrements in health and compounding the likelihood of developing complicated grief. An Irish study found that less than 50% of healthcare providers were aware of their patients LGBT identity.
Past losses can compound current losses:
o (many older lgb people will have lived through multiple losses through AIDS in the 80s and 90s), possibly resulting in survivor guilt, ptsd or anxiety.
o Some lost the love and acceptance of families.
o Many lgbt people emmigrated, thus incurring loss of home and country.
o Some lgbt are only out to a select portion of their family and friends and so disenfranchised grief may be experienced (Doka, 1989).
o Many people come out later in life and often regret lost time or hiding such an integral part of themselves for so long.
It is more common among older lgbt to be less ‘out’ than younger people. Generally, it is also quite common to have one partner who may be out and another who isn’t which can lead to further stigmatizing and marginalizing the already vulnerable bereaved person.
When grief is disenfranchised, poor bereavement outcomes are more likely, because of missing out on appropriate support. (Hornjatkevyc & Alderson 2011).
Doka (1989) outlines three ways that a grief may be disenfranchised:
o The relationship is not recognised
o The loss is not acknowledged
o The griever is excluded
Financial loss & status loss (up to 2011, there was no recognition of same-sex unions in law; partners had to pay inheritance tax and could be legally excluded from the bedside of their partners as they weren’t recognized as ‘next of kin’). Only now, as recent as last month, can same-sex partners enjoy the legal protection of the institute of marriage.
Glacken and Higgins (2008/2009) identified the following four themes:
1. Tacit acknowledgement of relationship
2. Tacit exclusion of partner
3. Sculpting the distress – exacerbating the grief experience
4. Sculpting the distress – easing the grief experience
How can services for LGBT people be improved?
Healthcare professionals need to be aware of the diverse health needs of their diverse patient population; many health professionals lack knowledge and sensitivity around lgbt issues. Sexual identity is not just about who you have sex with. It is an integral part of our lives and shapes our families, relationships and identity as a person. To ignore, demean or dismiss someone’s sexual orientation or gender identity can significantly contribute to decrements in health.
It is important that a patient’s sexual orientation is not assumed; most lgbt people do not conform to the Hollywood stereotypes. Health professionals need to be aware of LGBT specific issues and know how to deal with them.
Do assume, however, that approximately 8% of your service users and staff are lgbt and use language that demonstrates openness. Explore and validate these assumptions.
Treat a same-sex couple as you would any couple, in terms of information, involvement, legal rights, etc. Help to create a supportive environment from a holistic perspective; taking into consideration the physical, emotional, social and spiritual wellbeing of the patient and partner, engender trust.
It is important to know that homophobic and transphobic bullying are real and prevalent issues in society and possibly in our services. Ensure that this is considered when developing policies and standards for services. Discrimination of any sort is inappropriate, cruel and illegal and must not be tolerated.
Tacit acknowledgement is not sufficient and as a healthcare provider, don’t be complicit in this. Healthcare professionals need to actively encourage lgbt people to be open and confident about their relationships and provide a safe and supportive environment for them to do so. Implying acceptance is not the same as openly acknowledging a relationship. When cues are offered, acknowledge them.
Health professionals should be aware of any personal prejudices or anti-gay bias they may have and address them in professional supervision; being homophobic is simply not an option in ethical healthcare practice and research shows that the attitude of the healthcare professional can either exacerbate or ease the grief experience.
It is important also, to be mindful of not taking the opposite approach of openly declaring a person’s sexuality and ‘outing’ someone who may not be comfortable with that; the lead must be taken from each individual and what is right for their specific situation. Don’t’ assume that everyone is comfortable talking about their sexuality or gender identity and don’t facilitate forced disclosure.
Treating all patients the same is not the same as ensuring that each patient has their needs met. Know the difference and offer quality care that meets each individuals needs.
Service needs to be provided that acknowledges and respects everybody’s specific values, belief and experiences and doesn’t discriminate because of sexual orientation or gender. If you have images of couples in your premises, ensure that same-sex couples are also represented. Display leaflets that address gay and lesbian grief and know where and how bereavement support groups for lgbt people can be accessed (most have a heterosexual bias); actively work against exclusion, marginalization and invisibility, all of which exacerbate the psychological distress of bereavement.
Sensitive caring practices and supportive staff attitudes can help to constructively ease the distress of the bereaved, prevent disenfranchised grief and halt feelings of isolation and marginalisation. Being compassionate, choosing to connect emotionally and being present to someone in their most difficult moments is a gift that all grieving people deserve.
I conclude with this quote from Anne Hathaway:
“there are people who’ve said that I’m being brave for being openly supportive of gay marriage, gay adoption…. With all due respect, I humbly dissent. I am not being brave, I’m being a decent human being… love, is a human experience, not a political statement”