(p. 45) Lesbian, Gay, and Bisexual Service Members
Approximately 70,000 active duty service members in the US military are lesbian, gay, or bisexual (LGB), and 1 million US military veterans are estimated to be LGB (Gates, 2010a, 2010b). Exclusionary policies that restricted LGB service members from serving openly were in place for many years; however, LGB service members served covertly since the origination of the military (Burks, 2011). Although the Don’t Ask, Don’t Tell (DADT) policy has been repealed, LGB individuals in the military continue to encounter a number of unique stressors and issues, from discrimination in the workplace to laws impacting the benefits available to their partners. This chapter provides a history of the policies in the military that prohibited LGB service members from openly serving, and it discusses the challenges that remain for service members, clinicians, and practitioners in a post-DADT military.
History of Exclusionary LGB Policies in the Military
The US military has a long-standing history of excluding LGB service members from serving openly. Although specific regulations addressing homosexuality did not always exist in the military, evidence of both the service of gay military personnel and discharges for homosexuality has been documented as far back as the Revolutionary War (Shilts, 1993). The Articles of War of 1916 addressed the issue of homosexual behavior for the first time in Article 93, which stated that exclusion (p. 46) was limited to “assault with the intent to commit sodomy” (Burelli, 1994). In 1920, the regulations were modified to state that the act of sodomy itself was considered a crime and punishable by imprisonment (Shilts, 1993).
Prior to the 1970s, the exclusionary policy was based on support from the fact that homosexuality was categorized as a mental disorder by the American Psychiatric Association (APA). Although homosexuality was removed as a mental disorder in the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973, the military’s exclusionary policy continued. Johnson and Buhrke (2006) explain that the military justified exclusion for nonmedical reasons through Department of Defense (DoD) directive 1332.14 (Department of Defense, 1982), which indicated that homosexuality was incompatible with military service. The policy stated that the presence of LGB individuals in the military would seriously compromise military missions, reduce morale and unit cohesion, and increase risk for security breaches.
For many years, gay service members received a disproportionate percentage of undesirable discharges issued by the US military (Shilts, 1993). Shilts explains that in 1961, approximately 40% of all of the Navy’s undesirable discharges were issued to service members who were thought to be gay. Shilts cites a study of 400 gay veterans that found that only 1 in 6 of the discharged gay soldiers had been exposed because they had committed indiscretions that were brought to the attention of their commanding officers. Instead, 54% had been reported by someone else, often someone under investigation, whereas another 29% had identified themselves as gay, in most cases as part of a standard military interrogation. During the 1970s, several high-profile court challenges to the military’s regulations on homosexuality occurred but with little success.
From 1980 to 1990, approximately 17,000 service members were separated from the US military based on their sexual orientation (Burks, 2011; Jones & Koshes, 1995), sometimes with less than honorable discharges. Discharges that are not designated as honorable can have detrimental implications on the lives of the members who receive them. Service members who receive undesirable discharges are often denied subsequent Veterans Affairs (VA) benefits, including health care coverage, disability compensation, and educational benefits such as the GI bill. In addition, other than honorable discharges can make it very difficult to find employment in the civilian workforce.
In contrast to DoD directive 1332.14 (Department of Defense, 1982), a substantial amount of subsequent research in militaries throughout the world provided no evidence that combat missions are negatively affected or that unit cohesion declines when LGB individuals serve openly (Herek & Belkin, 2005; Johnson & Buhrke, 2006). As a result of these findings and the burgeoning of a more inclusive environment, the federal government enacted the DADT policy in 1993. DADT allowed LGB individuals to serve in the military as long as they did not disclose (p. 47) their sexual orientation and there was no evidence of homosexual activities or behaviors. Under DADT, superiors were disallowed from investigating a service member’s sexual orientation unless there was credible evidence of homosexual behavior. DADT also prohibited military personnel from discriminating against or harassing LGB service members. Homosexual activity was still prohibited in the DADT policy, and service members were subject to involuntary separation from the armed forces if they were identified as homosexual.
Although DADT did allow for LGB persons to serve in the military, according to Johnson et al. (2015), “the message regarding sexual orientation was clear: Stay in the closet or face discharge” (p. 109). Under DADT, thousands of LGB service members were forced to continue to keep their sexual orientation a secret and risked being discharged if their sexual orientation was disclosed. Due to the inability to directly ask service members about their sexual orientation, questionable tactics continued to be employed to identify gay service members (“Progress where you might least expect it,” 2014). Burks (2011) explains that although DADT was intended to be more inclusionary and implemented as an effort to end discrimination on the basis of sexual orientation, “it likely resulted in a more covert but nonetheless equally discriminatory policy” (p. 605).
Between 1993 and 2009 (when DADT was in effect), 13,000 service members who served honorably were discharged against their will on the basis of their sexual orientation (Burks, 2011). Although DADT was implemented to protect LGB service members, LGB service members continued to be discharged from the military. LGB service members in the DADT era experienced intense social and personal stress, isolation, discrimination in employment, harassment, and distrust in the military (Johnson et al., 2015). Serving in the US military during DADT as an LGB service member meant that one had to be on guard, vigilant about what information one shared and in constant fear about being exposed. Working in an environment in which one had to keep secrets in order to not jeopardize one’s career and in which one could not benefit from the same support and services afforded to one’s heterosexual peers took a serious toll. The psychological health and well-being of LGB individuals serving in the military during DADT were negatively impacted by heterosexist societal attitudes, internalized homophobia, stigma, victimization, and concealment of LGB identity (Burks, 2011; Meyer, 1995; Moradi, 2006, 2009; RAND, 2010).
2011: Repeal of DADT
On September 20, 2011, DADT was repealed through a historic piece of legislation with The Don’t Ask, Don’t Tell Repeal Act of 2010. Federal policies now allow LGB service members to openly serve and prohibit separation from the armed services based solely on sexual orientation. The repeal of DADT was significant for the US military and LGB service members. There has been progress for LGB service members in other areas as well. For example, the Supreme Court recently struck down Section 3 of the Defense of Marriage Act (DOMA), which denied (p. 48) more than 1000 federal benefits and protections to legally married same-sex couples (Miller & Cray, 2013). Although LGB service members can now serve openly, and their spouses have also been recognized by the DoD, there are still residual social and structural impacts of DADT. A number of important challenges and issues still remain for LGB members of the US military.
Challenges Remain in the Post-DADT Military
In a military context that is influenced by heterosexism and a history of mandating secrecy about sexual orientation, the repeal of DADT has strong implications for increases in rates of discrimination, victimization, and harassment (Burks, 2011; Johnson et al., 2015). The DoD continues to make significant progress toward the inclusion and protection of LGB service members, such as the recent update to its military equal opportunity program to protect service members against discrimination because of sexual orientation. However, discriminatory policies continue to exist in the military. According to Miller and Cray (2013), opponents of LGB equality continue to make considerable efforts to undermine the military’s steady march toward inclusion and respect.
Despite the repeal of DADT and increased visibility, LGB service members may also be at heightened risk for victimization and harassment based on sexual orientation. Incidents of sexual assault and sexual harassment have been reported to be pervasive in the US military before the repeal of DADT (Street, Kimerling, Bell, & Pavao, 2011), and with an increase in hate-based crimes toward LGB individuals in the civilian population, it has been estimated that the repeal of DADT could lead to a potential spike in sexual orientation-based harassment and victimization (Burks, 2011; Ciarlante & Fountain, 2010; Johnson et al., 2015). An increase in rates of harassment and victimization could place LGB service members at risk for developing a number of psychological problems associated with traumatic experiences, including depression, anxiety, substance abuse, and posttraumatic stress disorder. Since the repeal of DADT, the opposite of what was speculated has occurred as service members have been supportive, readiness and morale in the military have not been negatively impacted, and an increase in harassment and victimization is yet to be observed. Although the initial military climate appears generally supportive, LGB service members are still affected by serving under a history of exclusionary policies.
It has been well documented that LGB individuals are at greater risk for developing problems with mental health due to experiences of stigmatization, discrimination, and victimization. Specifically, a number of population-based studies have established that LGB individuals have higher prevalence rates of depressive, anxiety, and substance abuse disorders (Boehmer & Case, 2006; Cochran, 2001; Wilder & Wilder, 2012). Research also indicates that LGB individuals are at a significantly higher risk for suicidality than their heterosexual counterparts: It is estimated that LGB individuals are three to five times more likely to attempt suicide than heterosexual individuals (Wilder & Wilder, 2012).
(p. 49) Due to perceived risks associated with disclosure of sexual orientation, many LGB service members may resume with concealing their LGB identity despite the formal repeal of DADT. Research in civilian LGB populations suggests that greater degrees of outness and disclosure of sexual orientation are associated with better mental health and psychosocial functioning (Balsam & Mohr, 2007; Meyer, 2003). For example, in a study conducted by the Military Partners and Families Coalition, 55% of the LGB service members who were surveyed indicated that although DADT had been repealed, they still believed that coming out would put them at risk for some kind of negative reaction within the military community (Gleason et al., 2012). Despite the repeal of DADT, LGB service members continue to struggle with disclosure of their sexual orientation and experience psychological distress related to fear of being outed.
Due to a history of LGB service members being forbidden to share information about their sexual orientation, there is a lack of knowledge and scientific data pertaining to LGB individuals in the military. DADT created substantial barriers and significantly limited the participation of LGB service members in social science research. As a result, the prevalence and incidence rates of mental health disorders and victimization among active duty LGB service members are largely unknown. As the US military adjusts to the repeal of DADT, it is imperative to develop LGB-specific research in order to better understand the unique health care needs and effectively support and enhance the well-being of LGB service members.
Recent studies discuss a number of important considerations related to the unique health care needs of LGB service members in the post-DADT military. Biddix, Fogel, and Black (2013) remind us that prior to the repeal of DADT, disclosures of sexual behaviors to military health care providers could be used against LGB service members as grounds for discharge. Many LGB service members either avoided receiving needed health care or received treatment outside of the military health care system. Biddix and colleagues explain that perceived barriers to adequate health care continue to remain despite the repeal of DADT. They examined the comfort levels of 30 active duty gay and bisexual men in discussing sexuality and sexual health with military health care providers. Although all 30 participants indicated they understood that disclosure of their sexual orientation to a military health care provider could not be used against them as a reason for discharge or prevent career advancement since the repeal of DADT, only 70% of the service members indicated that they felt comfortable discussing their sexual orientation with a military health care provider without fear of punishment or discrimination. Biddix et al. also discussed the difficulties they experienced with recruiting participants for their study and explained that the long shadow of DADT may continue to make LGB service members feel uncomfortable participating in social science research.
In another study, Sherman and colleagues (2014) examined barriers to receiving and providing care among 58 LGB veterans and 202 VA providers. Almost 75% of the veterans reported that fears of receiving compromising care and discrimination due to sexual orientation served as deterrents to them accessing care. (p. 50) In addition, less than one-third of both veterans and providers viewed the VA as welcoming to LGB individuals. Interestingly, although providers in this study reported fairly high levels of comfort in discussing sexual orientation with their patients, 50% of them stated that they had not asked any of their patients about sexual orientation in the past year. More than 50% of the providers also indicated that they do not make any changes in their treatment plans once an LGB sexual orientation is disclosed. In addition, only 47% of the VA providers reported receiving professional training and education in LGB issues. In focus group discussions, veterans in this study recommended sensitivity training for staff on LGB issues in order to help providers be more respectful and aware of LGB-specific issues and risk factors. Johnson and colleagues (2015) also express concern related to culturally competent care and address the need for LGB-specific training in the post-DADT military. They explain that LGB service members may be at risk of receiving care from inexperienced active duty and civilian military psychologists who have not been adequately trained on LGB-specific issues and/or are not comfortable providing care to openly serving LGB service members.
Although the repeal of DADT signifies a significant shift in military culture toward inclusion of LGB service members, it is important to recognize that the long history of exclusionary policies in the military continues to impact LGB service members. It is important for providers to understand that the repeal of DADT does not necessarily mean all LGB service members will feel safe disclosing their sexual orientation. Military providers should also be aware that LGB service members are at increased risk for experiencing a number of unique stressors, including stigma, discrimination, violence, and rejection in a predominantly heterosexist culture. In addition, LGB individuals face barriers to accessing needed health care, and as a result, they may experience disparities in health outcomes. Recently published studies indicate that LGB service members in the post-DADT military continue to believe their care will be affected if they disclose their sexual orientation to a military health care provider. Recent studies also highlight the strong need for cultural competency and training specific to LGB health care in the military.
The opinions expressed in this article are the authors’ own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery.
The authors are employees of the US Government. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that “copyright protection (p. 51) under this title is not available for any work of the United States Government.” Title 17 U.S.C. §101 defines US Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties.
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