Stigma, Discrimination, and Mental Health of Sexual

Stigma, Discrimination, and Mental Health
of Sexual Minorities in Japan
Anthony S. DiStefano, PhD, MPH
Center for AIDS Prevention Studies University of California, San Francisco
Purpose
This study describes the perceptions of lesbian, gay,
bisexual, transgender, and intersex persons regarding
how they are viewed and treated by mainstream (i.e.,
heterosexual, sexual majority) Japanese society, parity of access to human rights, and mental health issues
in their communities.
Methods
• This project is a sub-study that involved analysis
of targeted themes drawn from the dataset of a
larger ethnographic study conducted in Tokyo,
Kyoto, Osaka, Nagoya, Chiba, and
Ibaraki, Japan (DiStefano, 2005).
• In-depth, qualitative interviews
(n=36) and participant observation
(n=33) with persons who self-identified as a sexual minority were
conducted in Japan in 2003-04.
Nine (9) persons participated in
both the qualitative interviews and
participant observation, yielding a
combined, unduplicated sample of
62 individuals (N=62). Archival
research was also carried out.
Resulting qualitative data were
inductively coded and analyzed for
emergent themes and conceptual
connections.
Very few sexual minority participants believed
that Japanese society as a whole accepted them as
equal members.
Heterosexist Pressure
• Pressure to marry is omnipresent and weighs heavily.
• “Duty marriages” are
common:
– To fulfill obligations to
family.
– To become a bona fide
member of society.
• Pressure to have children.
P ro
tect
ion
Nondisclosure of
Sexual Minority Identity
Due to Stigma
Mod
erat
e
• They do not exist in Japan; everyone is
heterosexual.
• Even if they do exist, there are none in my life;
they don’t affect me.
• Sexual minority identity is just a fetish.
• Gay/bisexual men = feminine, cross-dressing
caricatures.
• Lesbians & bisexual women = category of pornography for men to enjoy.
• Promiscuous, threatening to sociocultural status
quo, against marriage and families, responsible
for HIV/AIDS.
• Stigma: “Abnormal,” “different,” “weird,” “sick,”
“disgusting.”
• They can be tolerated only when fictional, distant,
or hidden.
Coming Out
• Few disclose their sexuality to families, police,
health care providers, in the workplace, or at
school.
• Fears of: physical, verbal, & psychological abuse,
bullying, ostracism.
• Negative social consequences of coming out are
more severe for women, esp. financially.
Protection Against
Deliberate Physical,
Psychological, Verbal
Abuse (i.e., Bashing)
X
Low-Level Protection
Sig
nif
ica
nt
R
isk
Depression,
Anxiety,
Hikikomori (Social Withdrawal),
Neuroses,
Psychological Injury
• Laws and Policies
References
– No codified protections from discrimination.
– No same-sex marriage.
– Disparities in social benefits & human rights.
Hidaka, Y. (2000). Heterosexual role conflict and psychological distress among gay and bisexual men.
Adolescentology, 18(3), 263-272.
• Employment
– Held back from promotion, hostile work
environment, forced resignation.
Hidaka, Y. (2001a). Mental health and school-based verbal
abuse among Japanese gay and bisexual men, 129th
Annual Meeting of the American Public Health
Association. Atlanta, GA.
• Housing
– Few landlords will rent to 2 men.
• Healthcare
Hidaka, Y. (2001b). Milestone events among Japanese gay
and bisexual men, 109th Meeting of the American
Psychological Association. San Francisco, CA.
– Poor insurance coverage.
– Transgender & intersex patients are refused care; if
admitted, often guinea pigs for study.
– Insensitive, conservative providers; poor
communication.
– Lack of confidentiality.
• Education
– Lack of (non-pathologized) representation in classroom, texts, and reference books before mid-90s.
Japanese sexual minorities experience stigma and discrimination –both explicit and subtly obscured- which
are perceived to result in poor mental health outcomes.
Level of homophobia relative to other industrialized
societies was not measured, but a perceived lack of
equity in human rights was documented. A feasible
and non-paternalistic initial strategy to address disparities may involve increased mobilization of
grassroots community efforts (e.g., CBOs) to advocate for training on sexual minority issues in key sectors: health care providers, attorneys, social services
staff, police, and policymakers in relevant government
ministries.
Data collection was supported by the Japanese Government Ministry of Education, Science, and Technology. Analysis was supported by the National Institute
of Mental Health and the Center for AIDS Prevention
Studies, UCSF.
Discrimination
– Same restrictions vs. MSM as U.S. Red Cross.
Conclusions
Acknowledgments
DiStefano, A. (2005). Violence and self-harm among
LGBT people in Japan. Poster presented at the American Public Health Association 133rd Annual Meeting,
Philadelphia, PA.
• Giving Blood
At left: Traditional wedding at Meiji
Jingu Shrine, Tokyo
Repeated Experience
of Discrimination
Ris
k
Mainstream Society’s View of Sexual
Minorities
Hypotheses of Risk and Protection:
Perceived Associations Among
Stigma, Discrimination, Abuse,
and Mental Health
nifi
can
t
• Few studies have examined stigma and discrimination experienced by sexual minorities in Japan and
how these may be related to mental health.
• Existing research using exclusively gay and bisexual male samples indicates that general harassment, verbal abuse, and nondisclosure of sexual
orientation predict heterosexual role conflict,
which in turn predicts several negative mental
health outcomes (Hidaka, 2000; 2001a; 2001b).
Tokyo Lesbian and Gay Parade, 2005
Sig
Results
XX
Background
Tokyo