Research Round-up: Why Is Bisexual Mental Health So Poor?

MPOTY_2014_Helping_someone_get_treatment_for_mental_health_issuesBisexuals face many problems, including higher than average rates of interpersonal violence (IPV) and homelessness, but at top of that list is mental health. In a Biscuit poll in February 88% of respondents reported having had mental health problems at some point, with 37% reporting saying that theirs were severe.

But this is only just scratching the surface, as a 2010 study conducted by the San Francisco Human Rights Commission found bisexuals to be around six times more likely to have mental health problems than heterosexuals. The study also incorporated data from a 2002 study published in the British Journal of Psychiatry, which reported that rates of mental health issues amongst bisexual people were significantly higher than those amongst lesbians and gay men.

My partners and I constantly argue over whether our mental health is a function of our bisexuality, vice versa, or unrelated. – Phil

A YouGov poll from 2015 found that one in five people identify as something other than completely gay or completely straight, which is a significant chunk of the population, so this is quite a serious issue.

But why do so many bisexuals have mental health problems? If sexuality was the issue in and of itself surely you’d expect the mental health of gay men and lesbians to be equally poor. The sad truth is that the issues faced by bisexuals are what impact on our mental health, rather than bisexuality itself.

One of the first decisions that people make when they identify as bi is whether to come out. A study of the mental health of behaviourally bisexual men conducted by Columbia University in 2013 found that greater concealment of their sexuality correlated with more symptoms of depression and anxiety. However, for those who did choose to come out this disclosure seem to help and wasn’t associated with good mental health.

A 2015 study by the London School of Hygiene and Tropical Medicine also found that bisexual women were less likely to be out than lesbians, and were also less likely to be in a relationship. Out bi women were, the study found,  less likely to experience sexuality related discrimination than lesbians in general, but more likely to experience it from their friends.

Another study, published in 2014 in the American Journal of Community Psychology, looked at LGBT youth. There is no data specific to bisexuals (only 5% of articles with the key word ‘bisexual’ have bi-specific data) but things don’t bode well for younger bisexuals. The study found that the benefits that came with coming out (like of greater resilience and higher self-esteem) were counteracted with higher levels of victimisation and leading to increased negative outcomes such as lower grades at school.

This doesn’t make happy reading; it appears that you’re damned if you do and damned if you don’t with regards to coming out. But why is the world so hostile to bisexuals?

As well as facing homophobia for our same sex attractions, bisexuals face biphobia from all corners because breaking the gay/straight dichotomy is something that many find unsettling. Biphobia from within the LGBT community is particularly hurtful as it’s something that we’re supposed to be part of.

Although biphobia most commonly manifests in being told that you’re either gay, straight or lying (along with a multitude of other bisexual myths), it can extend to hate crime. Research published in the Journal of Sex Research shows that similar numbers of bisexuals and monosexual people have faced crimes against their person or property due to their sexuality. The research also found that biphobia was rife, with a study cited that found attitudes towards bisexuals were more negative than for any other included in the survey except IV drug users.

Furthermore, a 2014 study published in Archives of Sexual Behaviour – and many other like it – have found that participants  utilise harmful stereotypes in their evaluation of bisexual men. Compared to heterosexual and gay men, bisexual men were seen as confused, untrustworthy, less able to maintain long term relationships and less inclined towards monogamy.

imagesBiphobia can affect you whether you’re out or not – if you’re out you may find yourself the direct target of it, if you’re not then just knowing how biphobic the world is can make you feel unsafe. The daily grind of microaggressions (which are slights, snubs and insults, both intentional and unintentional, which give hostile or negative messages to someone based on their membership of a marginalised group) can really wear you down, and make you less mentally resilient.

A stable sense of identity is something that’s also important for good mental health. Many of us have a strong sense of self when it comes to other aspects of our identity, but being bi can often be confusing (especially when first coming out) due to the lack of positive bi role models out there.

Role models exist, which is good, but they’re often not reported as being bi. Bonus points for when there are stories about them being bi and this is being used as criticism. – Vicky Syred

A lack of positive role models can make it hard for someone newly identifying as bisexual feel comfortable about their sexuality, and can lead to internalised biphobia.

The findings of the aforementioned 2014 study from the Archives of Sexual Behaviour showed that few people had explicit knowledge concerning bisexual stereotypes, but they still evaluated bisexuals with reference to those stereotypes. As bisexuals are not particularly visible as a group, it was suggested that that knowledge was drawn from indirect sources (such as general beliefs regarding human sexuality) but it wasn’t necessarily acknowledged by participants that these ideas might be stereotypical or offensive. As it turned out, those most prejudiced towards bisexuals tended to have less explicit knowledge regarding stereotypes.

When we do suffer from mental health problems our bisexuality and lack of visibility can affect our access to treatment.

Being erased and experiencing biphobia in medical, including mental health, settings lowers our standard of care. – Nicole

A study published by the British Association for Counselling and Psychotherapy in 2007 found that over 25% of therapists seen by bisexual clients had assumed that sexual identity was relevant to the goal of therapy when the client didn’t agree, and it also found that the reasons LGB people seek talking therapies were largely similar to those of non-LGB people ie not related to their sexuality. The study also found that a minority of therapists had tried to convert bisexual clients to being gay or straight! Additionally LGBT-specific awareness training for health professionals largely focuses on the ‘L’ and the ‘G’, meaning that when we are able to access treatment it doesn’t always meet our needs.

For those of us with other intersections of identity (eg race, disability, gender, social class, age) it can be even worse.

I’m in a constant state of anxiety when existing as a black bi person in LGBT spaces – racism, biphobia, fatphobia and ableism. These all add up and make me feel like it’s not worth the effort to socialise – this adds to isolation and depression. I guess I’m saying my mental health is far worse for being out as a bi person. It stinks, but it’s true. – Applewriter

Intersectionality is where someone is a member of multiple marginalised groups and the disadvantages they face as a result. For example, if a person is both of a minority ethnicity and queer this may affect their access to queer spaces as a result of institutional racism (eg publicity for groups may not be targeted where they are likely to see it; if they attend an event they may feel excluded if the majority of attendees are white); it may also impact on the way that they are treated (eg someone who is bisexual and disabled may be excluded from disability communities on the basis of being bi if they are trying to access spaces that happen to be biphobic). Microaggressions have a cumulative effect and are bad enough of if you’re a member of one marginalised group; if your marginalisation intersects various groups then the effect is increased several fold. This results in feelings of exclusion and alienation.

So what can be done to improve our mental health?

Combat biphobia – Biphobia occurs on a scale from hate crime through to microaggressions. It needs to be challenged, not just by bisexuals but by our allies and the organisations that claim to represent us. To improve our outcomes services that we use need to educate themselves on bisexuality, step away from stereotyping us and try to eradicate institutional biphobia.

Increase visibility – We need positive bi role models so that newly identified bisexuals can have someone to look up to and feel less conflicted about their sexuality – this means accurately reporting people as bisexual when they identify as such, and not conflating bisexuality with negative stereotypes in media reporting.

Recognise intersectionality – Flavia Dzodan said ‘My feminism will be intersectional or it will be bullshit.’ Likewise bi activism needs to be intersectional so that we don’t exclude and further alienate those effacing multiple oppressions as they are particularly susceptible to poor outcomes regarding mental health.

Don’t erase us – Don’t include bisexual people within samples of lesbians and/or gay men as this may result in overstating the risks faced by LG people, and ignoring the risks faced by bisexuals.

Treat us with care and sensitivity – the Bisexuality Report published in 2012 by the Open University recommended that health service providers should be aware of the necessity of sensitivity when providing services for the bisexual population.

Spend money on us – The B in LGBT stands for ‘bisexual’, but given the amount of money spent on bi projects in the UK (practically £0 in general and absolutely £0 when it comes to government funding) you’d think it stood for ‘blank’. The Bisexuality Report recommended that there should be assurance from healthcare providers that funding streams were available specifically for provision to bisexuals and their unique needs. Additionally, if LGBT organisations could channel money into combatting biphobia and increasing bi visibility that would help our lot greatly.

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Cat Rocks

Cat is in her mid 30s (and is rapidly approaching her late 30s at an alarming rate) and has identified as bisexual for longer than she cares to remember. In between working, being a parent, knitting and battling a Frijj addiction she occasionally finds time for writing and other forms of activism.

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