Influencia de la opresión internalizada sobre la salud mental de bixesuales, lesbianas y homosexuales de la Ciudad de México

• Autores: Luis Ortiz Hernández
• Localización: Salud mental, ISSN 0185-3325, Vol. 28, Nº. 4, 2005, págs. 49-65
• Idioma: español
• Enlaces
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• Dialnet Métricas: 16 Citas
• Resumen
  • español

    Los bisexuales, las lesbianas y los homosexuales (BLH) se enfrentan a diversas formas de exclusión social debido a que en la mayoría de las sociedades se valora de forma negativa su orientación sexual (OS). Estudios realizados en países industrializados han mostrado que las formas de prejuicio que enfrenta la población BLH pueden tener efectos negativos en su salud mental ya que, en comparación con los heterosexuales, presentan prevalencias más altas de consumo de alcohol y otras drogas, ideación e intento de suicidio y trastornos mentales. Aunque representan un avance sustancial, estos estudios no permiten explorar los mecanismos por los cuales la opresión lleva a una mayor morbilidad en la población BLH. A pesar de que en Latinoamérica cada vez más académicos y políticos se preocupan por esta problemática, aún es incipiente el conocimiento que se tiene sobre las condiciones de salud y enfermedad de los BLH. Considerando lo anterior, el objetivo de este estudio fue analizar los efectos que tiene la internalización de la opresión por parte de la población BLH en el riesgo de presentar los daños a la salud mental.

    Para comprender de qué forma incorporan los BLH la opresión en su subjetividad, se pueden utilizar tres conceptos: homofobia internalizada, percepción del estigma por homosexualidad y ocultamiento. La homofobia internalizada se presenta cuando los BLH incorporan en su autoconcepto los significados negativos, los prejuicios y los estereotipos asociados con la homosexualidad y la transgresión de los estereotipos de género (TEG), lo que provoca que tengan actitudes y reacciones negativas hacia su propia homosexualidad, la homosexualidad de otros, su TEG y la de otros. Debido al vínculo simbólico entre TEG y homosexualidad, es importante que en la definición de homofobia internalizada se incorpore la actitud negativa a la TEG. La percepción del estigma por homosexualidad se refiere a las expectativas que tienen los BLH sobre las posibles actitudes y reacciones que pueden tener otras personas debido a su OS. En el ocultamiento, los BLH modifican su apariencia física y sus comportamientos con el fin de invisibilizar su homosexualidad o las expresiones que considera TEG. Se realizó un estudio observacional, transversal y analítico. Entre septiembre y noviembre de 2001 se aplicó un cuestionario a 506 BLH que acudieron a organizaciones e instituciones de distinta naturaleza ubicadas en la Ciudad de México, a las cuales acuden diversos ¿subgrupos¿ de BLH. Una parte de la población fue contactada por medio de redes personales del autor y una lista de correos electrónicos de un grupo de socialización. El cuestionario fue completado por los mismos sujetos. Por medio del cuestionario se evaluaron las tres formas de opresión internalizada (homofobia internalizada, percepción del estigma y ocultamiento) y cinco daños a la salud (percepción del estado de salud, ideación suicida, intento de suicidio, trastornos mentales y alcoholismo). Para estudiar la asociación de las tres formas de opresión internalizada con los daños a la salud, se calcularon razones de prevalencias e intervalos de confianza a 95%. La percepción del estado de salud no se asoció con ningún indicador de homofobia internalizada. Los BLH que tuvieron niveles altos en la escala de homofobia internalizada, experimentaron culpa por su OS o tuvieron una actitud negativa hacia la TEG, presentaron mayor riesgo de ideación suicida, intento de suicidio y trastornos mentales; la escala de homofobia internalizada y la actitud negativa hacia la TEG también se asociaron con el alcoholismo. La vergüenza por TEG incrementó la probabilidad de presentar ideación suicida y trastornos mentales. La escala de estigma no se relacionó con ninguno de los daños estudiados. La expectativa de reacciones negativas de los familiares y de los compañeros de trabajo o escuela se asoció con mayor riesgo de percepción de estado de salud malo o regular, ideación suicida y trastornos mentales. El miedo a que se conozca la OS se relacionó con mayor riesgo de experimentar ideación suicida y trastornos mentales. Conforme aumentaba el número de amigos que conocían la OS (indicador de ocultamiento), mayor fue la probabilidad de presentar trastornos mentales, pero menor la de experimentar alcoholismo. El aumento en el número de compañeros que conocían la OS se relacionó con menor riesgo de alcoholismo. Evitar mostrar afecto a la pareja del mismo sexo se relacionó con mayor riesgo de presentar alcoholismo. Los riesgos de ideación suicida, intento de suicidio y trastornos mentales fueron más elevados en las personas que hacían lo posible para ocultar su OS. Los BLH que trataban de no TEG tuvieron mayor probabilidad de presentar ideación suicida, trastornos mentales y alcoholismo. Las personas que sólo TEG cuando estaban con amigos BLH tuvieron mayor riesgo de presentar alcoholismo.

    Los resultados del estudio mostraron que la población BLH tiene problemas de salud importantes como la ideación y el intento de suicidio y el alcoholismo en el caso de las mujeres BLH. Además, las tres formas de opresión internalizada (homofobia internalizada, percepción del estigma por homosexualidad y ocultamiento) se asociaron con mayor riesgo de presentar ideación suicida, intento de suicidio, trastornos mentales y alcoholismo. Estos hallazgos se pueden aprovechar para prevenir los daños a la salud de la población BLH.

  • English

    Bisexuals, lesbians, and homosexuals (BLH) face diverse forms of social exclusion because their sexual orientation (SO) is viewed negatively in most societies. Studies performed in industrialized countries have shown that prejudices faced by the BLH population may have a deleterious effect in their mental health because, in comparison with heterosexuals, they present a higher prevalence of consumption of alcohol and other drugs, suicide attempts, suicide ideation and mental disorders. Meyer has pointed out in those studies that comparing BLH and heterosexual morbidity may only allow for the documentation of the existence of negative effects of heterosexism and homophobia on BLH health. Although this means a substantial advance, it does not allow for the exploration of mechanisms through which oppression leads to higher morbidity in the BLH population. It must be added that most of these studies are not guided by a conceptual framework which explains in detail the differences in mental morbidity between heterosexuals and BLH.

    Despite the fact that in Latin America increasingly more academics and politicians are worried by these problems, knowledge about health and disease conditions in BLH is still incipient. In a literature review it was evinced that almost all the researches performed in Latin America have been centered in the HIV/AIDS infection and other sexually transmissible diseases or traumatisms derived from certain sexual practices in homosexual and bisexual males. It was concluded that more studies are necessary about mental health in the BLH population in which bisexual and lesbian women are included, because they have been studied with less frequency than homosexual and bisexual males.

    Considering the above, the objective of this study was to analyze the effects of internalization of oppression on the risk of presenting mental health damages in the BLH population.

    The oppression of BLH is caused by three dominant norms deriving from the gender system: a) Heterosexism, which is the ideological system that denies, derides and stigmatizes any form of behavior, identity, relation or community different from the heterosexual ones. b) The adherence to gender stereotypes, according to which males must be masculine and women must be feminine. Culturally, homosexuality is equaled to the transgression of gender stereotypes (TGS): homosexual males are thought of as feminine and lesbians as masculine, although in reality this does not always the case. That is why many BLH have suffered diverse forms of violence because in infancy and adolescence they were feminine males or masculine women. c) Androcentrism consists in the subordination or inferiority of feminine before masculine, that is, the features, attitudes and values considered as masculine are evaluated positively and the individuals who have them possess a superior status, while the symbols defined as feminine are scorned. Androcentrism explains why homosexuality is more punished in males than in females.

    BLH, just like heterosexuals, grow up and live in a society structured in terms of the dominant norms of the gender system. This causes that BLH internalize the dominant values of the gender system. To understand how BLH incorporate oppression in their subjectivity, one may recover the concept of habitus which is defined as a system of categories of perception, thought and action. To be able to evaluate the habitus of the oppressed in BLH it is proposed to “deconstruct” it in three concepts: internalized homophobia, perception of the homosexual stigma and hiding. Internalized homophobia occurs when BLH incorporate in their self-esteem the negative meanings, the prejudices and stereotypes accrued to homosexuality and TGS, which causes them to have neg ative attitude towards their own homosexuality, the homosexuality of others, towards their TGS and that of others. Due to the symbolic link between TGS and homosexuality, it is important to incorporate the negative attitude towards TGS in the definition of internalized homophobia. The perception of the stigma due to homosexuality refers to the expectations of BLH about possible attitudes and reactions that other persons may have due to their SO. By hiding, BLH modify their physical appearance and their behavior with the goal to make invisible their homosexuality or the expressions considered TGS.

    An observational, cross-sectional and analytical study was performed. Between September and November of 2001, a questionnaire was applied to 506 BLH attending various organizations and institutions in Mexico City visited by different “sub-groups” of BLH. A part of the population was contacted through personal networks of the author and a list of e-mail addresses of a socialization group. The questionnaire was completed by the subjects themselves. Through the questionnaire, the three forms of internalized oppression were evaluated (internalized homophobia, perception of stigma and hiding) and five risks to health perception of the health status, suicide ideation, suicide attempts, mental disorders and alcoholism). To study the association of the three forms of internalized oppression with health damages, prevalence ratios were calculated with confidence intervals of 95%.

    A minority of the individuals surveyed evaluated their health status as bad and very bad (3%). Almost 40% of the population presented suicide ideation in the last year and 15% answered that at least once in the past year they had attempted suicide; in women the frequency of suicide attempts was higher (21% in women and 12% in men). Almost three out of ten individuals surveyed presented risk of suffering mental disorders, the prevalence being higher in women (33%) than in men (23%). A fifth of the population presented risk of alcoholism. With the AUDIT scale, an alcoholism prevalence of 21% in BL women was obtained; with the same scale in other populations of women in Mexico it has been found that the prevalence of alcoholism oscillates between 3.6% and 7%. It was observed that the frequency of alcoholism in BL women surveyed was up to seven times higher than that reported by other women.

    Almost 40% of BLH surveyed suffered guilt due to their homosexual feelings and behaviors, a fifth had negative attitudes toward TGS and four out of ten suffered shame because of TGS. Regarding the indicators of the perception of stigma due to homosexuality, more than half of the individuals surveyed referred that their family, schoolmates or co-workers could react negatively towards a gay or a lesbian and a little more than 40% reported they were afraid of people finding out about their SO. In 40% of the interviewed individuals, their heterosexual friends knew their SO, in 31% most of their co-workers or schoolmates were aware of it and in 45% of the cases most of their relatives were aware of it. Half of the surveyed individuals with a partner avoided showing him/her affection and a little more of 40% hid their SO. Half of the surveyed individuals tried to avoid TGS in front of heterosexuals and five of ten did it only when they were amongst their BLH friends. Concerning the differences by sex in the forms of internalized oppression, in bisexual and homosexual males those related to TGS were more frequent (negative attitude towards TGS, a shamed of it, tried to avoid TGS and only TGS when they were with BLH friends), while in bisexual and lesbian women the higher percentages were those related to SO (scale of perception of stigma due to homosexuality, expectation of negative reaction of family towards BLH, afraid people knew their SO and avoid showing affection to their partner). Likewise, among bisexual and homosexual males internalized homophobia was more frequent than in bisexual and lesbian women.

    The perception of the health status was not associated with any indicator of internalized homophobia. BLH presenting high levels in the scale of internalized homophobia suffered guilt due to their SO or had negative attitudes towards TGS, showed higher risk of presenting suicide ideation, suicide attempts and mental disorders. The scale of internalized homophobia and the negative attitude towards TGS were also associated with alcoholism. Shame due to TGS increased their probability of presenting suicide ideation and mental disorders.

    The stigma scale was not related to any of the damages studied. The expectation of negative reactions from their relatives, schoolmates or co-workers was associated with a higher risk of perception of bad or regular health status, suicide ideation and mental disorders.

    As the number of friends who knew the SO increased (hiding indicator), the greater the probability was of presenting mental disorders, but less than that of presenting alcoholism. The increase in the number of schoolmates or co-workers who knew the SO was related with a lower risk of alcoholism. Avoiding showing affection to their partner of the same sex was related with a higher risk or presenting alcoholism. The risks of suicide ideation, suicide attempts and mental disorders were higher in the persons that did all they could to hide their SO. BLH who avoided TGS had a higher probability of presenting suicide ideation, mental disorders and alcoholism.

    The results of the study showed that BLH population have important health problems such as suicide ideation and suicide attempts and alcoholism in the case of the LB women. Further, although there are differences between homosexual and bisexual males and lesbian and bisexual females regarding the most frequent type of internalized oppression, the three forms of internalized oppression (internalized homophobia, perception of the stigma due to homosexuality, and hiding) were associated with a higher risk of presenting suicide ideation, suicide attempts, mental disorders and alcoholism. These findings may be recovered to prevent health damages in the BLH population.

    The actions directed by governments towards the BLH population have been basically HIV/AIDS research and prevention programs in homosexual and bisexual males. These actions are the result of the magnitude of the problem and not because the existence of these sub-groups is recognized. However, this research has evidenced that besides the HIV/AIDS problem, BLH present other health problems such as suicide ideation and suicide attempts, mental disorders and alcoholism. Therefore, it is required that government institutions broaden the scope of the welfare and health programs directed towards the BLH population. Evidently, long term measures must be taken to eliminate prejudice against homosexuality and TGS, which may only be possible through modifications in the social institutions.