1. The science
A 2013 study done at the Centre for Studies on Human Stress at the Louis H. Lafontaine Hospital, which is affiliated with the University of Montreal, has concluded that lesbians, gay men, and people who are bisexual (LGBs), if out to others about their sexuality, show lower stress hormone levels and fewer symptoms of anxiety, depression, and burnout as compared to peers who are not out. More specifically, the researchers measured what is called allostatic load - encompassing the corrosion caused by cortisol, a stress hormone, across the body’s systems - among participants in the study. LGBs who were out to family and friends showed lower levels of psychiatric symptoms and lower morning cortisol levels, two of the many measures that make up the allostatic load assessment. (Interestingly, though not the focus of this post, gay and bisexual men had lower allostatic load levels than heterosexual men.)
2. Why doesn’t everyone just come out then?
So what keeps people who identify as LGB (in keeping things within the scope of the study here) from coming out sooner - or coming out at all? The lead author of the study, Robert-Paul Juster, wisely points out that “[c]oming out might only be beneficial for health when there are tolerant social policies that facilitate the disclosure process.” Juster makes the important point that institutional support can play a significant role in the decision to disclose this aspect of one’s identity. If one’s job security, custody rights, access to healthcare, and other institutionally-adjudicated features of one’s life are threatened by disclosure, the practical decision might entail remaining in the proverbial closet.
He goes on: “Societal intolerance during the disclosure process impairs one’s self-acceptance that generates increased distress and contributes to mental and physical health problems.” Juster makes an important distinction here between a more pragmatic assessment of the institutional realities one must consider when deciding when and how to come out and the lived experience of existing in relation to those realities and what affect this has on how one feels. In other words, living in a society where one’s job security, one’s custody rights, one’s access to healthcare might be at stake if one were to come out is a very real source of anxiety, depression, and other emotional and physical symptoms that have detrimental short- and long-term health consequences.
Additionally, one might carry feelings of shame, disappointment, fear, disgust and attendant (and supporting) thoughts inspired by environmental homophobia and/or transphobia. These thoughts and feelings, while inspired by external factors, are oriented inward and are self-reflexive in the sense that they animate how one thinks of oneself. This impacts whether one feels proud, confident, happy about oneself, or disappointed, disgusted, depressed. Whereas the anxiety and depression outlined in the previous paragraph has to do with the enemy “out there” - the hostile features of reality outside oneself - the lived experience we’re exploring here involves the enemy “inside” - the destructive voices, values, and perceptions that one holds about and within oneself.
3. The role of therapy
So what role can therapy play in all this? First and foremost, therapy creates a space where issues related to coming out can be shared and discussed without judgment, but instead with support, compassion, and affirmation. In many cases, the absence of opportunity to talk with another person is a powerful part of the problem facing folks considering coming out. Without any sort of outlet, one is forced to contain related thoughts and feelings alone, an exercise that is at best draining and often unsustainable.
Therapy also offers an opportunity to explore and challenge those destructive voices, values, and perceptions that exist inside - the enemy within. Explore in the sense that it can be helpful to identify where those ideas come from (and, perhaps more importantly, who they come from). And challenge in the sense that those ideas need not be accepted as truth, even if they have in the past. Undertaking this process with an LGBTQ affirming therapist ensures that the work is collaborative, supportive, and affirmative. In other words, a therapist can create a safer space to be vulnerable about how one thinks and feels about oneself and to think through the impact of those thoughts and feelings.
Finally, a therapist can provide perspective in relation to how and when one decides - or doesn’t - to come out. This conversation would encompass talking through the practical and emotional implications of coming out - to whom? what would be gained? what would be lost? The purpose would be to think through and prepare for the different outcomes that might come to be. It is important to note that the role of the therapist in this context would not be to encourage or discourage one for choosing to come out. The decision to do so is ultimately something that must be arbitrated on one’s own. But the therapist would provide support with respect to considering the consequences of various courses of action, both emotional and practical, and how one would cope.
At the Gender & Sexuality Collective, we work with many clients at different stages of deciding whether to come out. We’re thrilled to see the science back up what we’ve witnessed: that coming out can provide tremendous relief from stress. But we’re also sensitive to the powerful reasons people have for choosing not to do so. Ultimately, our goal is to ensure that whoever is making the decision feels affirmed and supported throughout the process!