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A Review of “The LGBT Casebook”

I started writing this review after listening to a morning radio program on the Canadian Broadcasting Corporation in which Robert L. Spitzer was interviewed about his decision to recant and apologize for his deeply flawed research supporting “reparative therapy” as a way of curing homosexuality. The study had tremendous impact on the psychiatric profession and on the lives of gay and lesbian people seeking help. I was heartened to be writing a review of a book published by a psychiatric press of note, which will contribute to another sort of repair, this time of our profession’s understanding of the developmental challenges encountered by queer people in every stage of their lives. Population health tells us that certain groups face specific risks and challenges, not caused by their differences but rather by the sociocultural forces that shape and even construct their identities and attitudes toward seeking health care. The LGBT Casebook effectively brings home this message by representing the diversity that exists within sexual minorities. We are reminded not to think of gender or sexual orientation as binary or even fixed and that some people reject labels based on their sexual activities or romantic drives. We are also reminded that where you live, what religion you grew up with, your ethnicity, and your exposure to neglect, bullying, trauma, or legislative discrimination will shape your self-esteem and your acceptance (or disavowal) of your sexuality. We are then invited to reflect on how these various forces might also deeply influence the way one internalizes and understands a psychiatric diagnosis. Early chapters of the Casebook define key concepts such as homophobia, heterosexism, sexual orientation versus identity, and gender role versus identity while mapping what is different for lesbian, gay, bisexual, and transgender (LGBT) people as they grow from childhood to adolescence, construct (or re-examine) relationships with partners and family, become parents themselves, and navigate the challenges of aging. Coming out is a lifelong act and the risk of rejection (and violence) never really goes away. This helps readers to contextualize with compassion certain population health risks already documented for gays and lesbians such as alcohol and substance abuse, HIV infection, and sexual and physical abuse, and to