The purpose of this assignment is to discuss the psychological, sociological and social policy perspective of a case study and discuss the impact which it has on public health. The case study which I am going to be discussing involves a sixteen year old boy named Jason who lives with his parents in a wealthy suburb of a large city. He is experiencing confusion regarding his sexuality and thinks he may be gay. He doesn’t know how to approach the subject with his parents as his father has made homophobic comments previously. He is also spending increased amounts of time out of the house with his peers, consuming alcohol and smoking cannabis. His work at college is also suffering.
I am going to look at the key aspects of the case study. The key aspects which are crucial to this assignment are Jason’s confusion about his sexuality, his drug and alcohol abuse, the rebellion against his parents and homophobia, not just from his parents, but also from his peers and a brief history to make a clear picture of homophobia through the years.
Approximately 10% of the population is gay, lesbian, or bisexual (Robinson et al, 1994). However, among school-aged youths, only one to three percent identifies themselves in these categories (Kessel et al, 1998). It is estimated that 5-7% of the population may belong to a gay, bisexual and transgendered group (Keogh et
al, 2004). This could be due to confusion of sexuality or the difficulty surrounding “coming out” as a gay man or woman in society. The fears of “coming out” surround the ideation that they would be criticized and ridiculed by the community and their peers.
Within regards to Jason’s sexuality, confusion is a common thing surrounding people of this age, but can stem from early childhood and as early as infancy, as children are often pressured into gender roles, such as blue vs. pink. This type of behaviour is usually “drummed” into children’s head by their parents by repeatedly telling children things such as “girls like boys and boys like girls”. It is not common for parents to accept boys who show feminine traits, such as playing with dolls. Fathers pressure their sons into what they deem as acceptable games and behaviours such as playing football and rugby and being very rough and tumble, where as girls are expected to play house with the barbies and dolls and are told to be very girly and gentle.
People can become labelled as homosexual by other people and teased and taunted, even though the taunted person may feel heterosexual. If a young boy is doing something which others view as to be feminine, they can be labelled as a homosexual, often given taunts and remarks such as “gay boy”, “willy woofter” and “faggot”. Gender roles can influence peoples own opinions on others, such as men wanting to become nurses. Some people automatically assume that you must be gay if a man wants to become a nurse and it is a female’s role to become a nurse. However, research shows that Nursing is predominantly female, but has a growing population of male practitioners, with an increasing interest in the forensic field.
The teenage years is the time in which we begin to gain an identity and it is a distinct developmental stage in which dramatic neurological changes affect brain function and behaviour (Herman, 2005). Gay people who are scared to come out can often lead a self-destructive lifestyle in the hopes that people do not assume that they are gay and will carry on accepting them. Several models of gay psychosocial development describe the initial stages of awareness and confusion about same-sex attractions, followed by acknowledgment of homosexuality, disclosure to others, and eventual integration of sexual identity into a comprehensive sense of identity . This can be a distressing time and can cause confusion as to which sexuality is a person’s preference. Family relations are often painful, and gay adolescents are susceptible to loneliness, isolation, depression, and suicide (Radkowsky & Siegel, 1997).
The role of the parent is significant in helping to form an identity and self-esteem. The role of the parent as well as peers and their reaction to a disclosure of homosexual identity is significant in the formation of positive sexual identity and a strong sense of self-esteem (Coenen, 1998). Parents are role models in children’s lives and are who children aspire to be when they are growing up. All children expect their parents to be supportive of their choices in life and want to make their parents feel proud of them. Negativity towards homosexuality from parents can be very confusing for homosexuals, especially if they are yet to “come out” and become open about their sexuality. They may feel that they are letting their parents down and may become less than their parent’s expectations. Fears surrounding never having biological children can influence a homosexual person.
Adolescents have adapted their language and terminology in recent years. They are known to call homosexual people derogative names such as “faggot”, “queer”, “puffter” and “fudge packer” to name a few. This type of language is very demeaning and insulting, and also can be threatening and frightening. Harassment of gays is believed to be especially harmful during adolescence and young adulthood and is linked to the unusually high suicide rate among lesbian and gay youth (D’Augelli, 1992). The terms “fag” and “queer” have also begun to become normative names for heterosexual males to call each other as a bit of fun. The terms are reinforced through laughter and frequency of use. The use of such words may have an impact on homosexual peoples mental health and willingness to “come out”.
Jason’s father’s negative and homophobic comments regarding homosexuality, will make Jason believe that a disclosure of “coming out” could push his father and peers away. Hetrosexuality is seen as superior to homosexuality and bisexuality. It is a theory which has been around since the mid 1930’s to 1940’s, around the time of the war. This is a view which has been apparent in many households. This may be the reasoning behind Jason’s dads homophobic comments. Other theories surrounding this may be due to the 1980’s when there was a huge outbreak of HIV and AIDS, which was put to blame on the gay community. This theory still stands today, as many people still believe that many gay people in society carry the AIDS and HIV virus. This repulses many heterosexual people, and leaves them susceptible to bullying and harassment of gay people.
This rejection or suspected rejection can have huge ramifications on a homosexual person’s mental health. Rejection is usually noted to be because people do not have enough education about homosexuality, and feel that heterosexuals and homosexuals should not work with each other through teens or throughout adulthood. Lack of support and proper discussion surrounding homosexuality is a leading cause of homophobia, and it is usually fear which makes people comment negatively.
White and Cash (2003) state that men in general are regarded as problematic because they are less inclined to consult health professionals than women.
It has been reported that GLB youth are 2-3 times more prone to attempt suicide than their heterosexual counterparts and as many as 20% to 35% of gay youth have contemplated suicide. Thirty percent of completed suicides are gay or lesbian youth (Gibson et al 1986)
This is also the time in which teenagers tend to experiment with their sexuality. This could lead to promiscuity, which can have devastating effects on a person’s sexual and physical health if not practiced safely. An example of such effects are, such as, Chlamydia. Chlamydia can be transmitted vaginally, anally or orogenitally (Wakley et al, 2003). According to RCN, High instances of Chlamydia for men can occur for those with new sexual partners, multiple partners or those who do not use a barrier method such as a condom. If Jason were to be having sexual relations with numerous partners to experiment with his sexuality, without using barrier methods, he may catch a sexually transmitted disease (STD) such as Chlamydia which I previously mentioned, or, if Jason were to already have an STD, he could spread that disease around if it was to go unnoticed.
If Jason was not to experiment his sexuality and had only previously had long relationships using protection such as condoms, this does not mean his risk of catching an STD is lowered. Nice released some guidelines in 2007 which stated that the main groups at risk of STD’s are men who have sex with men (NICE 2007). In 1997, the government removed sexual health from their list of national priorities, which has led to an increase in STD’s, STI’s and HIV and AIDS among men who have sexual intercourse with other men.
It also states that behaviour which increased the chances of STD’s was misuse of alcohol or other illicit substances. This may be because, when people are taking illicit substances and or drinking excessive amounts of alcohol, they tend to lose their inhibitions and “act out” in a way which could be described as inappropriate and care free. This often leads to “one night stands”, which can also lead to absent mindedness or carelessness when it comes to using a method of protection against such infections and diseases during sexual intercourse. Research has shown that substance abuse is a major problem during adolescence and homosexual youth may be at increased risk due to negative social attitudes concerning homosexuality (Shifrin ; Solis, 1992). This may be to either “fit in” with their peers, or it may be used as something which they feel they can depend on to help numb the pain and anguish of being a gay member of the community.
Research on adolescent gay and lesbian populations has found that they engage in more maladaptive coping mechanisms such as self-destructive activities than their heterosexual peers (Grossman ; Kerner,1998; Peters, 1997). This could also include the way in which Jason seems to be using alcohol and cannabis as a crutch to try and forget about his homosexuality, which he deems as an obstacle in his path of growing and developing to adulthood. Adolescents such as Jason, who cannot legally access alcohol, may be pushed into inadequately supervised and marginalized subcultures which also increase the likelihood of exposure to substance use and other high-risk situations (Jordan, et al 1997).
Other research which was carried out was conducted on 14-21 year olds by Rosario et al (1997) which showed that 59% of males were partaking in the abuse of illicit substances, particularly cannabis. When this was compared to the results of homosexual males, the results were 4.4 times higher than the heterosexual male. Rosario goes on to discuss the possibility that the reasoning behind the higher rates of misuse may be to use substances to escape the stress of negative societal attitudes and feelings of unhappiness created by the stigma of homosexuality.
I believe that the reasoning behind Jason’s alcohol and substance misuse may be a way of Jason rejecting his homophobic tendencies and feelings, to try and “fit in” with his peers who appear to be openly heterosexual. No information was given as to whether they were homophobic peers, but research shows that this is a high probability. Jason may be rebelling in such a way as he believes it is what heterosexual people do and how they behave. He may also begin to resent other homosexual people if he does not seek help.
It is apparent to me that the best form of action would be to introduce more history and information on homosexuality into schools to create a better understanding for children from an early age. More information for the gay community, like help groups and sexually transmitted Infection testing and information on safe sex. NICE guidelines (2007) state that having one to one structured discussions with individuals at high risk of STIs, or arrange for these discussions to take place with a trained practitioner. Some support in drugs and alcohol awareness for the gay community, as it has become more clear from the articles which i have read, that it seems the gay community are at a higher risk of taking illegal substances and misusing alcohol than any other group, therefore, it seems sensible to focus some more attention on the gay community and offer support.
Councelling would be very beneficial for Jason and his mother and father, as it may be a place in which Jason could express himself with the support of a health professional, who may be able to help jason’s father understand the term homosexual and their lifestyle.
It appears that times have moved on favourably for homosexuality, although it is still viewed as a taboo subject for peers and parents who are still ignorant to the subject. Jobs such as Nursing, are still considered to be a female job, even though the Nursing profession is gaining more and more male staff each year. Doctors are also regarded as a male job, but female doctors are also on the rise. Gender roles exist within society, this will probably never change. We are not likely to ever change this.
More education regarding homosexuality and gender roles would be beneficial for children within schools.
Support from people with a mental health background would become useful, as it also seems that the gay community suffer with their mental health.
Health professionals trained in sexual health could make any services which are already implemented, more widely known and accessible, and maybe set-up drop-in clinics to discuss situations, in areas which people may feel safe to go to. Possible help could come from previously “outed” men or women to come into classrooms, or support groups to talk about their experiences as a gay member of the community and their difficulties and obstacles which they may have had to overcome. It seems support like this can spur homosexual people on to gain the strength to also “come out” and form their sexual and personal identity with the world and live as an accepted member of not just the gay community, but the community as a whole.
Nurses continue to play a crucial role in helping to deliver the Department of Health’s 10-year National Strategy for Sexual Health and HIV (DH, 2001) and the Government’s White Paper, Choosing Health (DH, 2004)
Herrman JW (2005) The Teen Brain as a Work in Progress: Implications for Paediatric Nurses. Paediatric Nursing 31(2): 144-8
Wakley G, Cunnion M, Chambers R (2003) Improving Sexual Health Advice. Radcliffe Press, Oxford
National Institute for Health and Clinical Excellence, 2007 (http://www.nice.org.uk/nicemedia/live/11377/31898/31898.pdf) last accessed: 15-09-2010
DuRane, R.H., Knowchuk, D.P., ; Sinal, S.H. (1998). Victimization, use of violence,
and drug use at school among male adolescents who engage in same-sex sexual behavior. Journal of Pediatrics, 132, 113-118.
Garofalo, R., Wolf, R.C., Kessel, S., Palfrey, J., ; Durant, R.H. (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics, 101, 895-902.
Shifrin, F., ; Solis, M. (1992). Chemical dependency in gay and lesbian youth. Journal of Chemical Dependency Treatment, 5, 67-76.
Rosario, M., Hunter, J., ; Gwadz, M. (1997). Exploration of substance use among lesbian,gay, and bisexual youth: Prevalence and correlates. Journal of Adolescent Research, 12(4), 454-476.
Sullivan ; Wodarski. (2002). Social alienation in gay youth. Journal of Human Behavior in the Social Environment, 5(1), 1-17.
Radkowsky, M.,;Siegel, L. J. (1997). The gay adolescent: Stressors, adaptations, and psychosocial interventions. Clinical Psychology Review, 17(2), 191-216.
Grossman, A. H., ; Kerner, M. S. (1998). Self-esteem and supportiveness as predictors of emotional distress in gay male and lesbian youth. Journal of Homosexuality, 35(2), 25-37.
Gibson, P. (1989). Gay male and lesbian youth suicide. Report on the Secretary’s Task Force on Youth Suicides, 3, 110-142. Washington, D.C.: U.S. Department of Health and Human Services.
Jordan, K.M. (2000). Substance abuse among gay, lesbian, bisexual, transgender, and questioning adolescents. School Psychology Review, 29(2), 201-206.
Department of Health (2004) Choosing Health: Making Healthier Choices Easier. DH, London.
Keogh P, Weatherburn P, Henderson L, Reid D, Dodds C, Hickson F (2004) Doctoring Gay Men: Exploring the Contribution of General Practice. Sigma
D’Augelli, A.R. (1992). Lesbian and gay male undergraduates’ experiences of harassment and fear on campus. Journal of Interpersonal Violence, 7, 383-395.