Lesbian, gay, bisexual, and transgender (LGBT) culture varies in many ways from other cultures, due to the fact that there is not an explicitly shared geographic origin, language, or faith. Rather, LGBT culture is unique in the sense that it widely varies by location, and identity of the LGBT individual. Furthermore, an individual who identifies as LGBT may not necessarily identify with LGBT culture. This is due to many factors, including physical distance from a larger LGBT community, an unfamiliarity of or lack of knowledge about LGBT culture. Further, an LGBT individual may not have disclosed their sexuality, or may prefer to remain unidentified with their sexuality, due to a fear of stigma or other various reasons. Globally, the history of recorded LGBT relationships dates back to ancient civilizations.
The earliest documents of same-sex relationships derive from Ancient Greece. Many documents from this time period appear to portray a society in which same-sex relationships were not only a formal practice but a fundamental aspect to a man or woman’s life. Concentrating on America, the timeline of LGBT history in America dates back prior to European colonization, when a number of indigenous communities were reported to respect roles for LGBT and gender-nonconforming individuals. In the 18th and 19th century prior to the American Civil War, a majority of Americans resided in rural areas, where homosexuality was a taboo and rarely seen or discussed notion. During this time period, homosexuality (a term not invented until 1868 by Karoly Maria Kertbeny) fell under the category of “sodomy” to encompass all forms of nonproductive sexuality. While same-sex relationships were considered illicit and illegal by law, there are many recorded cases of individuals from earlier centuries engaging in LGBT relationships. There are many documented examples of “romantic friendships” between men in the 1700s, as evidenced by a letter from Alexander Hamilton to his friend John Laurens, in which he writes “I wish, my dear Laurens, that it might be in my power, by action, rather than words, to convince you that I love you.” (“U.S. LGBT Timeline,” 2008).
The first American defense of homosexuality was published in 1908, which argued that homosexuality was inherited and should not be faced with hatred. Around this time, mainstream society was slowly becoming aware of the development of LGBT culture. Homosexuality began to occasionally arise in films and music in the early 20th century. As recognition increased, however, persecution and discrimination increased as well. Following World War I, LGBT individuals continued to be arrested through state sodomy laws. In the late 1930’s, life for LGBT individuals became increasingly difficult, as many were forced to hide their culture and identities. Laws were passed to declare homosexuality to be a mental illness that must be cured. In 1948, Alfred Kinsey published Sexual Behavior in the Human Male which looked scientifically at human sexuality to determine that roughly 10% of adult males and 5% of females were predominantly homosexual for at least three years of their lives (Kinsey, 1948).
During the 1950s and 60s, the LGBT movement began to develop, and many organizations for LGBT rights were slowly created. The sexual revolution began in the mid-60s and was quickly followed by the Gay Liberation movement in the late-60s. On June 28th, 1969, the police raided the Stonewall Inn, an LGBT bar in Greenwich Village. What followed were numerous violent altercations between LGBT individuals and police officers, resulting in what is now known as the Stonewall riots. Stonewall is now considered a cultural turning point for LGBT rights in America. Following the liberalism of the late 60s and 70s and the conservatism that led the 1980s, the LGBT community was marked by the emergence of HIV, with the epidemic being regularly connected to gay men. The conservative movement generated an anti-gay movement that was combatted both politically and socially. As the rates of AIDS related deaths not only increased but grew to include heterosexual and widely recognized individuals, the public began to express more sympathy and tolerance for the LGBT community. The 21st century saw increased LGBT activism, with the California Supreme Court’s approval of same-sex marriage in 2008 being met with both national applause and protests. On June 26th, 2015, the U.S. Supreme Court legalized same-sex marriage in all 50 states. Starting in the late 2000’s, much attention was given to homophobic bullying of LGBT children and teenagers, with countless initiatives launched to implemented improved school environments.
Currently in the U.S., there are many subcultures that exist within LGBT culture. The LGBT community, while extremely unique and varied, shares common characteristics such as pride and diversity. A study from 2017 revealed that approximately 4.5%, or 11 million, of adults in the U.S. identify as LGBT (Newport, 2018). This study further found that, while LGBT-identification rates for older generations of adults remained relatively stable throughout the years, the millennial generation showed a 40% increase in “yes” responses to the question, “Do you, personally, identify as lesbian, gay, bisexual, or transgender?” from 2012 to 2017. This is most likely due to an increased social and individual acceptance of the LGBT population among younger generations. Culturally, this corresponded to data found in a 2013 Pew Research Center study, which found that 92% of LGBT adults believe that societal acceptance of LGBT culture has increased in the past decade (Pew Research Center, 2013).
Although many subgroups of LGBT share different characteristics, the Pew study found many cultural factors that were similar throughout communities. Of the 1,197 LGBT adults represented in the survey, 39% reported rejection by a friend or family member due to their sexual orientation. A striking 58% reported being the subject of slurs or jokes regarding their orientation or sexual identity. In regard to their coming out experience, lesbian, gay, and bisexual adults reported that 12 years old was the median age in which they began to question their sexuality, while the median age in which they knew for sure was 17 years old (Pew Research Center, 2018). The Pew study found that, compared to the general public, the LGBT community is reportedly, “more liberal, more Democratic, less religious, less happy with their lives, and more satisfied with the general direction of the country,” (Pew Research Center, 2018). On average, the LGBT community was found to be younger than the general public, with a lower family income. Politically, there are many issues that are important to a majority of LGBT individuals, such as equal employment rights, HIV/AIDS prevention and treatment, adoption rights, health insurance coverage of transgender health issues, and adoption rights. 48% of survey respondents reported having no religious affiliation, and 29% reported feeling unwelcome in their place of worship.
There are many stereotypical classifications that exist within the LGBT community, broken down by gay male culture, bisexual culture, lesbian culture, transgender culture, as well as queer or questioning culture. These categories can be due to sexual attraction, individual interests and ideas, and overall exposure to different aspects of LGBT culture. As previously stated, however, it is very common for LGBT individuals to not adhere to or belong to common characteristics to one specific LGBT culture. It is important to remember that there is intersectionality within the LGBT community. This intersectionality refers to the fact that LGBT individuals exist within multiple cultural communities, and that the overlap of these communities (i.e. race, class, SES, gender, religion, ethnicity, and sexual orientation) impact how you internalize culture and how you express your cultural identity.
As care providers, there are many cultural considerations to keep in mind when working with a member of the LGBT community. One major consideration is using the appropriate pronoun and terminology for the LGBT individual you are working with. Gender identity and pronoun use is not only an extremely important sign of respect, but it increases communication and ultimately builds a strong client-clinician relationship. An easy and non-invasive way to collect gender identity information is to provide space on an intake form for clients to identify their name and pronoun. Another way is to simply ask the client, “Which pronouns do you prefer?” As the SLP, you can lead the way by introducing yourself and the pronouns you use and lead the way for your client to do the same.
Overall, there is a need to increase clinical cultural competency of the LGBT community, particularly for transgender clients. A study from Hancock and Haskin (2015) found that, while this is within our scope of practice, 51% of SLPs in their study reported not knowing how to describe transgender communication therapy. The individuals who are receiving voice and communication services deserve culturally and clinically competent SLPs who are confident in their ability to provide service to this population. As SLP’s, we must ensure that we are getting an above adequate education and clinical experience with the LGBT community and the specific communication services they may require. This can begin by educating yourself on LGBT culture and seeking out opportunities to improve one’s cultural competency.
Another important cultural consideration to keep in mind when working with the LGBT community is how to address bullying and violence. According to a national Youth Risk Behavior Survey in 2015, 34% of LGB youth were bullied on school property, and 28% were bullied online or electronically. These experiences with bullying and violence can have an extremely negative impact on children and young adults, with 29% of LGBT youths attempting suicide at least once in the prior year. As SLPs, we can help create a safe space for our clients by assigning the speech therapy room as an “LGBT Safe Space,” as well as being extremely transparent about a zero tolerance policy towards bullying and homophobia. You can utilize your role as an SLP to educate and lead positive conversations about the LGBT culture and community to increase understanding and awareness. Overall, the most important thing to remember when working with the LGBT community is that your client has the right to “competent, considerate, and respectful care in a safe setting,” (Gandolfi & Kaurich, 2018, slide 12). As an SLP, you must educate yourself in order to ensure you are culturally competent when working with this population in order to provide the best possible care to improve their overall quality of life.
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