In an important article on describing competencies for psychologists who work with older generations of gay Americans, Hillman & Hinrichson described the challenges approximately 3 million older gay and lesbian people confront as they seek medical care in the US.
Fear of stigma and outright discrimination in a variety of health care,
institutional, and social service settings are well documented
among aging lesbian and gay adults (Fredericksen-Goldsen et al.,
2011; Metlife Mature Market Institute & The Lesbian and Gay
Aging Issues Network of the American Society of Aging, 2010),
including those who live in what one would expect as more
socially progressive, urban areas (Hinrichsen, 2010; Thurston,
This fear of discrimination from health care providers means that one in four elderly LGBT adults do not disclose their sexual orientation to their doctors, neighbors, or social communities. As a result of non-disclosure, quality of life and quality of healthcare can be significantly diminished.
Part of what makes this article so effective and vivid for the reader is an emphasis on the role of history on different cohort groups.
"All LG adults over the age of 50 lived through a time when their sexual orientation was labeled immoral, illegal, and pathological."
Yes, as a person getting closer to 50 I already knew that, but Hillman and Hinrichsen provide illustrative reminders of what life was really like when the generation just before mine was growing up.
For example, the oldest LG elders came of age in the 1950s when President Eisenhower’s, 1953 Executive Order #10450 called for homosexuals to be fired from government jobs, and McCarthy’s congressional hearings of 1954 sought to expose homosexuals as well as other “subversive elements” including communists. Few LG individuals openly professed their status out of fear of discrimination and violence, as individuals found engaging in same-sex behavior could be and were sent to prison or mental hospitals.
[Younger] baby boomers came of age during the advent of the gay rights movement which was catalyzed by the 1969 Stonewall riot in New York City. These baby boomers grew up with the American Psychiatric Association’s (1973) announcement thathomosexuality was no longer regarded a mental disorder, the 1974 election of Kathy Kozachenko, the first openly gay or lesbian U.S. public official, and the repeal of many states’ laws that criminalized homosexual behavior.
I know that I carry around with me a full bag of memories of coverage from the early days of the AIDS epidemic in the 1980's. I vividly remember the covers of Time magazine and the roar of condemnation from religious leaders on television sets. The harassment became more personal when I came out on my college campus in 1987. Pictures of AIDS patients were taped to my dorm room door, I received threatening phone calls, and printed letters in the college newspaper suggested gathering gays on an island and dropping bombs. This was considered sane commentary at the time. The result of that news coverage and the effect it had on the community around me still make me think twice about coming out to new people I meet. However, as rough as I had it, I find it disturbing to think what it must have been like to come of age during the time of Eisenhower's executive orders and McCarthy's hearings. I can't imagine the intense psychological impact of hearing derogatory messages on the nightly news and the ensuing conversations in dorm rooms or family living rooms.
Older LG populations today, as a result of earlier discrimination, tend to prefer living independently and in their own residences for as long as possible. This population also tends to rely on friends rather than family for care and assistance with tasks like driving to medical appointments or after surgery car. Even so, 1 in 5 older LG adults reports having no one to call in a time of need or emergency.
Hillman and Hinrichsen finish with a list of recommendations for practicing psychologists that can make their practices more welcoming, more inclusive, and more aware of the issues impacting gay and lesbian patients as they age. There are little things that mean a lot like using gender neutral intake forms that allow for a caregiver other than a recognized spouse. The authors also suggest some bigger recommendations:
Psychologists themselves must examine their own attitudes toward both older and LG adults, particularly if coming from a culture or religious affiliation that does not affirm an LG orientation (Pachankis & Goldfried, 2004). Therapists also are advised to provide training for staff and post a nondiscriminatory statement that equal care will be provided to all clients regardless of their age, sexual orientation, ethnicity, race, religion, physical ability and attributes, and gender identity.
The article is a great reminder that it's not at all easy to know what it's like to be in someone else's shoes. This population's reality included events I can only imagine, and this article really woke me up to some issues I had not previously considered.
Source: Hillman, J., & Hinrichsen, G. A. (2014). Promoting an affirming, competent practice with older lesbian and gay adults. Professional Psychology: Research and Practice, 45(4), 269-277. doi:10.1037/a0037172