Suicidio LG Submited (Tomicic Et Al, 2018)

Journal of LGBT Issues in Counseling
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Adolescence and Suicide: Subjective Construction of the
Suicidal Process in Young Gay and Lesbian Chileans
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Journal: Journal of LGBT Issues in Counseling
Manuscript ID Draft
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Manuscript Type: Research
Adolescence, Suicide, Gay and Lesbian, Qualitative Research, Internalized

Keywords:
Homophobia
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URL: https://mc.manuscriptcentral.com/lgbtic Email: chaney@oakland.edu

Page 1 of 40 Journal of LGBT Issues in Counseling
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5 Adolescence and Suicide: Subjective Construction of the Suicidal Process in Young Gay
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Journal of LGBT Issues in Counseling Page 2 of 40
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Abstract
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The association between suicide risk and sexual minority is understood from the
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8 perspective of the social determinants of health. This consideration requires the
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10 development of a culturally sensitive knowledge. The aim was to characterize the
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12 subjective construction that young gay and lesbian people make about their experience of
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having lived and survived a suicidal process. Qualitative interviews were conducted and
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15 analyzed as elaborations about life events. In the accounts of the participants we identified
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17 hostile contexts associated with suicide, trajectories associated with homosexual
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19 identification processes, and milestones relating to victimization experiences as part of
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21 intentionality and rationality of suicide.
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5 A review of the research conducted over ten years in LGBT (lesbian, gay, bisexual,
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7 and transgender) populations concluded that, in general, self-identifying as a sexual
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9 minority (Tomicic et al., 2016) –being exposed to stigmatization, discrimination, and
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gender victimization– is by itself a predictor of suicidal tendencies (e.g. Pereira &
12 Rodrigues, 2015; Walls, Freedenthal, & Wisneski, 2008). Specifically, evidence shows that
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14 LGBT adolescents constitute a major risk group, given that they often encounter
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16 discrimination, violence, and humiliation due to their sexual orientation or gender identity
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18 (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009; Cáceres & Salazar, 2013; Pineda,
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19 2013; Puckett et al., 2016). Due to this situation, compared to their heterosexual peers,
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21 sexual minority young people continue to experience significant health disparities. These
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young people report differentially higher rates of anxiety, depression, suicidality, low self-
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25 esteem, and substance use (IOM-US, 2011; Hatzenbuehler, Phelan, & Link, 2013; Poteat,
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Aragon, Espelage, & Koenig, 2009; Tomicic et al., 2016). Regarding suicidality, it has
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28 been consistently demonstrated that lesbian, gay, bisexual, and queer/questioning young
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30 people report higher levels of suicidal ideation attempts and completions than heterosexual
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32 young people, which represents the most concerning disparity for this population (Austin &
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34 Goodman, 2017; Cochran & Mays, 2013; Goodenow, Szalacha, & Westheimer, 2006;
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35 Mustanski, Garofalo, & Emerson, 2010; Russell & Joyner, 2001; Poteat et al., 2011;
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37 Russell & Toomey, 2012).
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39 Specifically, estimates of suicide prevalence in homosexual young people range
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from 2.5% to 30%. In comparison, among sexual minorities, the odds of attempting suicide
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are approximately two to seven times higher than among heterosexuals (King et al., 2008;
44 Haas et al., 2010). A Rhode Island-based study demonstrated that 10% of sexual minority
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46 adolescents, as compared to just over 3% of heterosexual teens, reported suicide attempts

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48 severe enough to warrant medical attention (Jiang, Perry, & Hesser, 2010). As a group,
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50 LGBT young people experience greater levels of suicidal ideation and behavior than their
51 heterosexual peers (Suicide Prevention Resource Center [SPRC], 2008).
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53 Only a handful of studies on risk detection in LGBT adolescents have been conducted in
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55 Chile. An exploratory study carried out by León, del Río, and Chaigneau (2012) with
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57 lesbian adolescents residing in the country’s capital revealed a higher rate of psychological
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difficulties in them than in their heterosexual peers and in those questioning their sexual
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5 orientation. For its part, Todo Mejora [It Gets Better] Foundation conducted a nationwide
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7 survey in 2016 aimed at learning about the bullying and school abuse experiences of LGBT
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9 children and adolescents in 2015. This instrument revealed that over 50% of LGBT
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students had been victimized at school due to their sexual orientation or gender identity and
12 that 76.2% of students who had experienced more regular victimization linked to their
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14 sexual orientation reported high levels of depression (Infante, Berger, Dantas, & Sandoval,
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16 2016). A study performed by the Movement for Homosexual Integration and Liberation
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18 (Movilh, 2008) found that 40% of students, 55% of teachers, and 31% of parents or tutors
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19 had met at least one person who had been discriminated against at school due to their
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21 sexual orientation or gender identity. In addition, it has been reported that 39% of students
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attending public primary and secondary schools in Santiago have heard of at least one case
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25 of discrimination by school officials and/or teachers against a LGBT person (Movilh,
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2012). Convergently, studies conducted in Chile by the Pan American Health Organization
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28 and the United Nations Organization for Education have reported that 42.1% of non-
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30 heterosexual young men (between 18 and 24 years old) report having been the victims of
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32 frequent homophobic bullying and that 68% of LGBT boys and girls living in Chile report
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34 the presence of homophobic and transphobic bullying in schools (Cáceres et al., 2011).
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35 The association between sexual minority populations and suicide risk has
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37 commonly been approached from the point of view of the social determinants of health
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39 (Logie, 2012). In this regard, it has been pointed out that LGBT populations have a high
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prevalence of mental health problems associated with stigmatization and discrimination.
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Specifically, the Minority Stress Model (Meyer, 2003; Meyer, Schwartz, & Frost, 2008;
44 Meyer, Frost, & Nezhad, 2015) has provided a way of understanding how belonging to a
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46 minority that is discriminated against, such as lesbian and gay young people, is related to
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48 worse outcomes in terms of mental health problems such as depression, substance abuse,
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50 social isolation, conflicts with peers, and victimization, all of which increases individual
51 suicide risk factors. This model identifies four minority stress processes that can be
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53 categorized as either distal or proximal. External events, such as victimization and
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55 homophobic discrimination, are regarded as distal stress processes, heterosexist attitudes
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57 such as “assumed heterosexuality” and the problematization of sexual diversity are
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considered to be intermediate stressors, and the internalization of sexual stigmatization and
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5 the concealment of diverse gender identities and sexual orientations are examples of
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7 proximal stressors (Gillis & Cogan, 2009; Michaels, Parent, & Torrey, 2016). In this
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9 regard, its has been demonstrated that sexual orientation itself does not lead to suicidality
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among LGB young people; rather, environmental reactions to non-heterosexual orientations
12 increase suicide risk in this population (Michaels et al., 2016; Savin-Williams & Ream,
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14 2003; Tomicic et al., 2016). For example, the higher levels of psychiatric symptomatology
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16 and suicidality in LGBT young people is linked to the negative reaction of parents and the
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18 loss of friends due to the revelation of their sexual orientation (Diamond et al., 2011;
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19 Padilla, Crisp & Lynn, 2012; Shpigel, Belsky, & Diamond, 2015). For its part, a study
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21 conducted in the United Kingdom showed that discriminatory experiences in children and
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adolescents belonging to sexual minorities increase perceptions of shame and the use of
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25 individual coping strategies, which results in an increased risk of displaying self-destructive
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behaviors (McDemontt, Roen, & Scourfield, 2008). Also, studies employing the Minority
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28 Stress Model (Meyer, 2008) have reported that LGBT young people who perceive rejection
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30 from their support groups may internalize this attitude and transform it into self-destructive
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32 actions, which makes this population especially vulnerable (Blais, Gervais, & Hérbet, 2014;
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34 Kelleher, 2009).
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37 The Present Study
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39 Upon the basis of the information presented above, three intertwined problems can
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be identified: the high prevalence of suicide in Chile (DEIS, 2010; MINSAL, 2013), the
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progressive growth of the adolescent and young population as an at-risk group for suicidal
44 conduct, and, within this group, male and female adolescents and young people belonging
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46 to a sexual minority as a high-risk group for suicidality –a risk that has been shown to be
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48 socially determined. This is a problem that has yet to receive sufficient visibility in the
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50 production of scientific knowledge in Chile and South America.
51 With regard to the study of the subjective experience of suicide, in line with the
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53 conclusions of studies conducted by the World Health Organization’s SUPRE-MISS and
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55 EURO agencies (Bartolote et al., 2005), researchers have stressed the need to conduct
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57 studies that approach this phenomenon upon the basis of the meanings that suicidal
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behavior has for individuals. That is, studies that focus on the ways in which individuals
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5 who currently have or have had experiences of suicidal ideation and/or behavior interpret
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7 themselves, their actions, and their environments (Hjelmeland & Loa Knizek, 2010). From
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9 this perspective, suicidal behavior is regarded as a continuum that ranges from the
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emergence of the feeling of hopelessness to the completion of suicide and includes
12 ideation, planning, and suicide attempts (Blanca & Guibert, 1998; Ventura-Juncá, Carvajal,
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14 Undurraga, Vicuña, Egaña, & Gariba, 2010). Also, the suicidal process is regarded as an
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16 intentional act which has meanings and which is always situated in a cultural context
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18 (Hjelmeland, 2011). Therefore, regarding sexual orientation and gender identity as a
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19 determinant of health in general terms, and specifically as a risk factor for suicidal ideation
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21 and suicide attempts, makes it necessary to generate culturally-sensitive knowledge about
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this health issue. Doing this should improve our understanding of the issue, thus
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25 strengthening our assistance and prevention efforts aimed at specific social and cultural
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groups –in this case LG adolescents and young people.
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28 Consequently, the purpose of our study was to characterize the subjective
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30 experiences of young gay and lesbian chileans who have survived a suicidal process.
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34 Method
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37 A multiple-case design was used to perform a qualitative analysis of narrative
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39 interviews conducted with lesbian and gay young people who have experienced and
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survived a suicidal process with the purpose of performing an interrelated, systematic, and
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in-depth exploration of the subjective construction of their experiences (Stake, 2006). Also,
44 this study is a narrative research based on the assumption that the stories of suicide
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46 processes told by lesbian and gay young people convey meanings in themselves, because
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48 stories function as a basic human means of organizing and communicating life experiences
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50 (McLeod, 2010).
51 This article presents the analyses of a sample of young people who self-identify as
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53 gay and lesbian taken from a larger research project, funded by the National Health
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55 Research Fund [Fondo Nacional para la Investigación en Salud (FONIS)] of the State of
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Chile. It involves 30 qualitative interviews with young people who self-identify as lesbian,
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5 gay, bisexual, or transgender.
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9 Participants
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Eight young people (four females who self-identify as lesbian and four males who
12 self-identify as gay) participated in this study (see table 1). Their ages varied between 20
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14 and 24 years at the time of the interview, between 11 and 21 years when “coming out”, and
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16 between 14 and 21 years at the beginning of their suicidal processes. Regarding the latter,
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18 the participants represented a variety of suicidal behaviors: initial suicidal ideation (1),
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19 serious suicidal ideation (1), a suicide attempt (4), and severe suicide attempts (2). Five of
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21 them were undergraduate students and three were working. Almost all of them have had a
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romantic relationship with a same-sex couple and only one was living alone.
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25 The ethical protocol for this research was approved by the ethics committee of
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Universidad Diego Portales and informed consent forms were signed by all participants,
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28 who allowed their interviews to be used for research purposes and related publications.
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32 [Insert Table 1 here]
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35 Research Team
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37 The research team was led by the two first authors: a clinician with a PhD in
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39 Psychology and a vast experience treating people during suicide crises (CM) and a holder
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of a PhD in Psychology with a long experience conducting research with qualitative
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methods and data analysis procedures (AT). Two of the authors (FA and JR) have extensive
44 experience in sexual diversity and gender-related topics: (FA) is the director of the Chilean
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46 foundation “CulturaSalud” (Culture and Health) and (JR) was the coordinator of the mental
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48 health department of the “Todo Mejora” foundation (It Gets Better) as of this writing. FL is
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50 a child psychiatrist and IL a family therapist; also, both postgraduate students working as
51 research assistants –pursuing a PhD and a Master’s degree respectively. For their part, CR
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53 and CG are young clinical psychologists who also work as research assistants.
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57 Procedures
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Data collection. The participants were invited to enroll in the study through an
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5 advert on the websites of the associated institutions Todo Mejora and CulturaSalud, as well
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7 as on social networking sites (Facebook, Twitter, and WhatsApp). This advert presented the
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9 title and purpose of the study, making explicit the inclusion criteria used: adolescents and
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young people who self-identify as LGBT, aged 18-24 years, and who had had suicidal
12 thoughts, made suicide attempts, and/or or displayed suicidal behaviors between ages 12
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14 and 23.
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16 Semi-structured narrative interviews (Kvale & Brinkmann, 2009) were conducted
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18 by AT, CM, FA, FL, JR, and CG. An interview script was designed for this study. The
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19 opening question for the interview was: “Why did you decide to participate in this study?”
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21 This question was aimed at understanding the interviewees position when telling their
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story, thus establishing its ending, and to initiate the narration of their experience as a
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25 flashback: “I’d like you to describe in greater detail the process you experienced; tell me
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about your experience of having considered suicide or attempting to do so.” Together with
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28 each interviewee, we structured into a coherent story the multiple stages, milestones,
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30 causality attributions, and references to cultural and social imperatives surrounding their
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32 experiences of going through a suicidal process. During the interview, three topics were
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34 explored as they were mentioned in the participants’ narratives: (1) Attributions of
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35 causality regarding the suicide process experienced and its “engines” (e.g. What situations
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37 do you think contributed to your decision to consider suicide?; (2) Requests for help (e.g.
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39 Did you ask for help at any point? What type of help? Whom did you contact? What
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expectations did you have regarding the help you would receive?; and (3) Reasons for
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living (e.g. What do you think made you “survive” or stop considering suicide? To name
44 and refer to suicidal behavior, we prioritized the terminology used by the interviewee (e.g.
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46 taking one’s life, disappearing, dying, etc.).

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48 All interviews were audio-recorded and transcribed verbatim. Interviewees were
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50 assigned a pseudonym to safeguard their anonymity; also, the information provided by
51 them was edited to make it generic (e.g. street, city, university instead of the proper name
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53 used) and thus keep it from somehow revealing their identity.
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55 Analysis procedures. The narrative interviews conducted were analyzed by
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57 combining and simultaneously applying the analytic operations described by two
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qualitative approaches and using them to generate a new model called “Discovery-Oriented
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5 Biographical Analysis (DOBA)” (see Duarte, Fischersworring, Martínez, & Tomicic,
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7 2017). With this model, we sought to examine the organization, interpretation, and meaning
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9 of the interviewees' experience.
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One of the analytic operations performed is the open coding procedure of the
12 Grounded Theory approach (Charmaz, 2006; Corbin & Strauss, 2008). This procedure
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14 consists in the development of concepts and categories obtained from the data analysis. In
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16 order to do this, we approach the interpretation of the various fragments of the interview
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18 transcript with two analytic questions: What is the text talking about? and What does it say
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19 about it? The answer to the first question makes it possible to generate a concept or
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21 category, while the answer to the second question (i.e. what does it say about it?), applied
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to the same fragment of the transcript, allows us to develop the concept or category
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25 previously generated in terms of its properties or dimensions. Regular meetings were held
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with all members of the research team to triangulate the analyses and reach intersubjective
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28 agreement regarding the categories, concepts, and properties developed (Flick, 2007).
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30 The other analytic operation is the narrative organization of the categories
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32 developed during the open coding procedure. This was done with the Model of
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34 Construction of the Self in Biographical Narration (Piña, 1988, 1989). This analytic model
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35 regards narratives as the product of the subjective I which organizes, interprets, and
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37 signifies life events. To reconstruct the subject’s narrative in an interview, this model
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39 proposes the identification of contexts, stages, milestones, causality attributions, and
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references to moral imperatives in the narrative and their later organization into a narrative
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structure. Using this model to analyze the categories, concepts, and properties developed in
44 the open coding of each interview, we reconstructed a unique narrative that conveys a
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46 shared experience regarding their suicide process.

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48 Along with the analytic operations described above, case summaries were generated
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50 and titles representing the main plot of each one of the narrations were created (see table 2).
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53 Results
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55 By applying the DOBA to the narratives of the suicidal processes of the eight
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57 lesbian and gay participants, we were able to rebuild what seems to be a recurrent
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experience of members of sexual minorities when facing and surviving a suicidal process.
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5 We organized this recurrent experience by describing multiple aspects of it, which are
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7 temporally combined –diachronically and synchronically– to give an account of the
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9 motives and intentions that are associated with and surround suicidal behavior, constructed
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as a “hopeless Future as a Homosexual” (see figure 1). These eight aspects are (a) Difficult
12 Family Histories, (b) Acceptance-Rejection Tension, (c) Homophobic Violence and
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14 Internalized Homophobia, (d) Stigma and Hypervigilance, (e) Available cultural points of
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16 reference involved in the process, (e) Triggers, (f) The help coming from the adult world,
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18 and finally (g) The position adopted when giving us their testimony.
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19 In addition, cases were assigned a title summarizing their most salient aspect, taken
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21 from each participant’s experience of dealing with and surviving a suicidal process (see
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table 2).
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[Insert Table 2 here]
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34 The following section presents each of the elements that configure the description
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35 of the recurrent experience of suicide as narrated by the interviewees. These elements are
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37 described in detail and illustrated with interview excerpts labeled with the title assigned to
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39 each case and noting the participants’ sexual orientation.
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Difficult Family Histories
44 In all of the narrated experiences analyzed, we observed what we have labeled
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46 “Difficult Family Histories”, either due to the presence of conflicts at the family level and
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48 the existence of threatening parental figures –real or imagined– or due to the presence of a
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50 hostile family climate regarding sexual diversity.
51 Seven of our interviewees describe difficulties and conflicts at a family level that
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53 match risk factors generally associated with suicide. These difficulties and conflicts can be
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55 grouped into four categories: i) a complicated parental break-up with the child acting as a
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57 go-between (1), ii) parental distancing, negligence, or abandonment (2, 5, 6), iii)
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alcoholism or drug consumption by a parent (1, 6), iv) a restrictive, highly demanding
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5 family environment (2, 3, 7, 8).
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7 Additionally, five of the eight cases analyzed (2, 3, 4, 5, 8) show the presence, at a
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9 family level, of homophobic tendencies that could express themselves in many ways, from
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discriminatory discourse to a direct rejection of the narrator’s homosexuality. Some of the
12 interviewees report aggressive or stigmatizing comments (1, 2, 3, 5, 6, 8); others describe
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14 discrimination, heteronormative vigilance of their gendered expressions, and a direct
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16 rejection of their sexual orientation by parents and siblings (2, 3, 5, 8) (for instance, in one
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18 of the cases a mother asks the narrator to avoid being noticeably homosexual); others even
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19 relate tragic or disappointed reactions by parents to the revelation of their children’s
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21 homosexual orientations, going as far as attempting, in an explicit or implicit way, to
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convince them to attend a sort of “conversion therapy” (for instance, insisting that the
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25 narrator should consult a psychologist to get help with this “issue”).
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For instance, one interviewee notes how “off-the-cuff” comments from their loved
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28 ones, in this case his brother, contribute to the generation of a hostile and threatening
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30 family environment regarding their homosexual orientation:
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“…My brother, before going off to Spain, used to say the nastiest things: ‘If I had a
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35 gay son, I would kill him’. Things like that, harsh things.’” (The Secret, Gay)
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“She [my grandmother] told me: ‘I love you, I don’t care, I love you, you are
40 my grandson, nothing else could matter… I prefer that you are this way
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42 [homosexual] instead of a thief, a rapist, or something else…’” (If I Had Been
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Heterosexual, Gay)
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47 Some interviewees narrate scenes which, in an everyday and almost harmless way,
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49 reveal that their families become an environment where the fulfillment of heteronormative
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mandates is monitored, where diverse sexual orientations and gender expressions have no
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52 place or are discredited and stigmatized. This can be observed in the following excerpts
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54 taken from interviews with a gay young man and a lesbian young woman:
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3 “Still today, when they [my family] speak about homosexuality they kind of
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5 goof around, my cousins, my brothers, my uncles, they joke like… You are not
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7 as much of a man, it is a very common joke, like, if a man lets a woman take
8 charge, they joke like if you were less of a man.” (I Will Go to Hell, Gay)
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12 “(…) and then when I was in high school – when I was in secondary school, my
13 parents thought my romantic relationships weren’t good because I had to be the
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15 same as all my friends and all my friends had ‘hetero’ relationships, they all
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went out with boys and everything (ha) and they had steady boyfriends and
18 everything, and I, like, every time I tried it didn’t work” (Fear of Rejection,
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20 Lesbian)
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23 These difficult relational histories constitute the background of the tension between
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25 acceptance and rejection of the narrator's diverse sexual orientation.
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29 Acceptance-Rejection Tension
30 Acceptance-rejection tension is connected both with others, mainly parental figures,
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32 and with the self. In all the cases that were analyzed, fear of rejection appears to be the
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34 main effect of this tension.
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36 On some occasions, this fear of rejection is based on behaviors and beliefs that
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patients identify in their parents and family contexts, a fear that is confirmed in their
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39 attempts to reveal their homosexual orientation. For instance, the following fragments show
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43 either explicitly or implicitly, when they are discovered:
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46 “(...) I had accepted that I was going to finish college and I was never gonna see my
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48 parents again, you know? I was gonna have to live my life somewhere else, start
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from scratch, because that was the only way out (...) I had come to terms with the
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51 idea that they were gonna reject me and I didn't want to experience that either (…)
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53 My mother found out that I liked a girl and it was very chaotic, horrible… It was
54 difficult, because her reaction was to ask me how could I do this to them, after
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56 everything they had done for me, as good parents, giving me everything I needed,
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58 after supporting me, how could I repay them in this way... I was very scared because,
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3 for me, the fact that I could feel something for another woman was stigmatized.”
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5 (The Imperfect Daughter, Lesbian)
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8 “yes, yes, I think it was like that fear that they'd found out I was gay. Actually, at the
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10 beginning I never thought about telling my parents, I always said “okay, it doesn't
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matter, I'm not gonna tell my parents, I'm gonna go far away, maybe to another
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13 country, and I'm gonna have my gay life there and they won't find out”. But as a
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15 family we're kind of really united, there's a lot of love, I can't see myself far away
16 from my parents, so those were like unrealistic thoughts” (…) but they took it badly
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18 in the emotional side –it’s not like they said to me get out of the house or anything
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20 like that as in some cases– but they were really hurt emotionally, they cried –I’d
21 never seen my dad cry– they didn’t go to work, they talked a lot, and mainly they felt
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sorry for me thinking that I was gonna have to deal with this society, maybe
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discrimination, all those things; much of that was true, I thought were right with
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26 respect to many things, but I didn’t tell them, it’s like I always wanted to give them
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27
28 more encouraging answers… right, I was trying to convince them of something that
29 not even I was convinced of” (Condemned to Solitude, Gay)
30
ev
31
32
33 On other occasions, this fear of rejection is more a fantasy than a reality: narrations
34
contain less evidence based on patients’ concrete experiences in their relationship with their
ie
35
36 parents; also, when their homosexuality is revealed, they find that their fear was unfounded.
37
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38
39
40 My parents have always worried about me and they’ve always overprotected me (…)
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41 and I felt they kinda expected a lot from me and in that regard I couldn’t be their one
42
43 hundred percent perfect daughter you know? (...) I’d always wanted to be the perfect
44
daughter I had excellent grades and everything and it was all great and that was
45
ly
46 something that didn’t fit you know? (…) So that was like the lifestyle I knew, so I
47
48 was scared of being seen as something bad, I thought everyone would see it as a bad
49 thing, so I assumed that they would reject me automatically I mean (...)
50
51 I still have my school friends, they’ve always been with me and they know I’m gay
52
53 you know? And they never judge me they never have, at the beginning there was sort
54 of an explosion like they asked me ‘is it true?’ they weren’t like ‘I knew all along’
55
56 but it was like ‘good, it doesn’t really matter’, so it was never much of an issue. It
57
was the same with my parents, later they all said ‘it doesn’t matter, you have to be
58
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13
1
2
3 happy’, mo mom now says ‘as long as you fulfill your dreams and have someone
4
5 who respects you and loves you, now you need to get your degree and find your own
6
7 happiness, I can’t force you to be with someone, it’s your own life’, my dad said the
8 same, he tells me ‘it’s all fine’ (Fear of Rejection, Lesbian)
9
10
11
12 In various ways, this tension between acceptance and rejection results in the
13
14
concealment of the narrators’ sexual orientation –thus making it difficult for them to
Fo
15 develop their own identity in a way that integrates their sexuality. Likewise, it is associated
16
17 with making tremendous efforts –at a huge emotional cost– to hide that part of their
18
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19 identity, which, as a correlate, lead to progressive isolation, manifested through fantasies of
20
21 escaping to other cities and breaking all family ties as strategies for avoiding the rejection
22 that they fear so much. Furthermore, in seven of the eight cases analyzed, fear of rejection
ee
23
24 (1, 2, 3, 4, 5, 7, 8) –real rejection of their sexual orientation or even the fantasy of being
25
26 rejected over and over again in the future– was the main cause leading to suicide.
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27
28
29
30
Homophobic Violence and Internalized Homophobia
ev
31 It is also possible to trace, in at least seven of the eight narrations, experiences of

32
33 homophobic violence in the form of violent discourses, symbolic-institutional violence,
34
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35 transgressions of intimacy, and homophobic bullying. For example, the narrations

36
37 implicitly shape the notion that homosexuality is something that must be “treated”,
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38 “discussed”, corrected, or repaired –through therapy with a counselor or a psychologist.

39
40 Also, some of the interviewees (1, 6, 7, 8) experienced the social pressure to expose their
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42 sexual orientation with the statement “you have to say it”. The following fragment makes
43
44 this pressure explicit in the actions of psychologists who, by breaching their confidentiality
45
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agreement, institutionally inflict homophobic violence:

46
47
48
49 That's when they told [my mom], I never said I actually was [a lesbian] and I never
50
51
denied it to the psychologists, but they like had clearly seen that I actually um and
52 they told her. My mom came crying into my room one day and she tells me ‘they
53
54 said this and that to me, I want to know if it's true’ and I told her ‘I have no idea
55 what that is, I don't know what a homosexual is, but that's right, I prefer to be with
56
57 women, I like to caress them, I like to kiss them and I'm repulsed by men’ and then
58
59
60
14
1
2
3 she started crying and everything and like that's when the whole process started (Shit
4
5 Happens, Lesbian).
6
7
8 For their part, five interviewees (1, 4, 5, 6, 7) describe homophobic bullying experiences as
9
10 well as violence and hate in public settings:
11
12
13
14 The situation in my class deteriorated greatly because they started making fun of me,
Fo
15 everyone found out and the bullying became bad, really bad. I started feeling very
16
17 isolated, nobody talked to me, I was very, very lonely (...) It started there, the moral
18
judgment started there in front of the class, that it was not right, that it was like
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19
20 immoral, dirty, things like that (The Secret, Gay).
21
22
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23
I was walking down the square one day, going to a friend's house, I was with my best
24
25 friend, and someone got off a truck and he started slapping me in the face, and then
26
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27 my friend got involved, she started chasing him away and all, it was her dad [my
28 girlfriend's] and he told me to stay away from his daughter and started to yell lots of
29
30 things at me (...) that I shouldn't be disgusting, that I couldn't do those things, that
ev
31
32 men and women were meant to do that, that he didn't want to see me with his
33 daughter anymore because I had sort of made him go crazy and lots of things like
34
ie
35 anti, like really homophobic (Shit Happens, Lesbian).

36
37
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38 On the other side of the coin, some of the cases display signs of internalized homophobia.
39
40 They can be traced (a) in stereotyped and disqualified images of homosexuality which take
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42 part in the initial confusion and in the tension between acceptance and rejection of the
43
44 narrators' sexual orientation; (b) in feelings of guilt and in fantasized scenes in which love
45
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is not possible for a homosexual person; and (c) in the establishment of a deep feeling of
46
47 hopelessness.
48
49
50
51 ...that's what I felt, I hated myself at some point, because it was like ‘why do I act
52 this way if I don't have to be this way?, why do I do this?’: I hated myself, or I don't
53
54 know if I hated myself, but I didn't like who I was (I Will Go to Hell, Gay).
55
56
57
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15
1
2
3 I never had the chance to ask anyone, you know? There was nobody who could tell
4
5 me ‘well there’s nothing wrong with that calm down live your life you have to and if
6
7 you define yourself as a lesbian it won’t be so awful you’ll be able to deal with life
8 anyway’ –it’s like I felt it was almost a disability that I’d have to carry on my
9
10 shoulders my whole life, you know? Like I was gonna have ‘lesbian’ written on my
11
forehead and I’d have many doors closed on my face, I don’t know if that’s the case,
12
13 but I’m struggling so it won’t be like that so the same prejudices I created won’t play
14
Fo
15 against me because I was prejudices I mean I didn’t but as a lesbian I wondered what
16 people would say and I couldn’t accept myself I denied myself I lived a double life
17
18 (P.’s Double Life, Lesbian)
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19
20
21
22
Stigma and Hypervigilance
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23 In order to deal with homophobia and internalized sexual stigma, the young people
24
25 interviewed become engaged in a process of “hypervigilance” in which the stigma
26
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27 associated with their own sexual orientation prevails. So, to a larger or smaller extent, they
28
29 mention a permanent state of exploration and vigilance of their surroundings and of
30 themselves in search of signs of hostility or security. This state of susceptibility appears in
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31
32 their narrations as a chronic source of anxiety or anguish, contributing to a progressive
33
34 degree of emotional wear.
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35
36
37
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It was like very tiring for me to have to think every day, I don't know... I went
38
39 to the mall and I found some clothes I liked and I said, “okay, are these normal
40
‘straight’ clothes? I mean, is this tracksuit fine? Or maybe if I choose this t-shirt
On
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42 it will be a bit like showing I'm gay”, or, I don't know, in a conversation, “is my
43
44 thinking gay or maybe it's ‘straight’?” I preferred to keep those things to myself
45
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[so that] it wouldn't be noticeable (Condemned to Solitude, Gay)

46
47
48
49 In some cases (1, 2, 7, 8), hypervigilance regarding the stigma is transformed or resolved
50
51 via the construction of a double life, simultaneously meeting the heteronormative
52 expectations of their environment and those associated with living in accordance with their
53
54 sexual orientation, but at a high emotional and psychological cost.
55
56
57
58
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16
1
2
3 The thing is my friends are all ‘good’ girls I mean (…) they all had boyfriends,
4
5 they all did things the right way, they were really feminine [cries], I’m like that
6
7 too, but I had this thing that didn’t fit in (ha) (…) and I would defend those girls
8 they said things like ‘oh, look, that girl is a ‘lesbo’ (…) and I would say ‘it
9
10 doesn’t matter, let her be’, but I’m telling you at the same time I didn’t want to be
11
singled out I didn’t want any fingers pointed at me you know? (Fear of Rejection,
12
13 Lesbian)
14
Fo
15
16
17 Available Cultural References Involved in the Suicide Process
18 Interestingly, in the narrations, cultural points of reference are not only present but also
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19
20 participate at different moments of the suicidal process. These points of reference,
21
22 materialized by means of mass media images, amplify the participants’ fear and
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23
24 hopelessness. Furthermore, some of the interviewees mention religious points of reference,
25
26
of the Catholic religion specifically, in which homosexuality is condemned as a sin, causing
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27 guilt that could be expiated. In the following fragment, one of the participants narrates how
28
29 he connects with the possibility of dying due to being homosexual after watching a film at
30
school.
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31
32
33
34 They brought the movie Brokeback Mountain... these two homosexual
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35
36 cowboys… I was left devastated after the movie, because I was feeling very
37
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38
sensitive and the movie talked about love and many other things, at the end one
39 of the actors is murdered, he's murdered due to his homosexuality. So, okay, I
40
On
41 was feeling terrible and then I fell into a deep state of depression, sadness, crying,
42 and, alone in the classroom I took all the pills I found in the first-aid kit (...) I
43
44 think that when I saw that move the theme of romanticism, of love, was already
45
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46 in the air, right? Love between two people, in ninth grade I didn't have that
47 contact with anybody, and okay, at the end of the story one man is killed because
48
49 he's homosexual. Right, I think that at that point, that was like “so this can happen
50
51
to me, I can die because of this”. It was, okay, like “I don't know what I'm doing
52 here, I mean, if I'm going to die in any other way I'd rather die now” (If I Had
53
54 Been Heterosexual, Gay)
55
56
57 Triggers of the Suicidal Process
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17
1
2
3
In the eight stories analyzed, the way in which the identity development process,
4
5 homophobic violence, internalized homophobia, stigma, and hypervigilance are connected
6
7 with the suicidal process can be determined by analyzing the suicidal trigger. This trigger
8
9 can be a specific event (trigger by impact), but it could also be a small event that functions
10
11
as “the straw that broke the camel’s back” (trigger by overflow). In the first case, a specific
12 event interrupts the process of discovery, acceptance, and integration of the participant’s
13
14 diverging sexual orientation; this would apply, for example, when a school friend of the
Fo
15
16 narrator were to tell the whole class that he/she was gay, in which case it would also
17
18 become apparent that his/her mother will eventually find out. In the second case, a minor or
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19 circumstantial event would confirm, for the narrator, the increasing impossibility and
20
21 hopelessness that he or she associates with life as a gay or lesbian person:
22
ee
23
24
25 For a start I wasn’t going to school anymore ‘cause I had lost my scholarship, I
26 didn’t have any chances to return to school because the tuition was really
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27
28 expensive. I thought I had lost everything, my granny- who was a strong support
29
30
for me- my career, my partner, my whole future and life. I really didn’t want to see
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31 or talk to anybody, and on that same day I arrive from a party, open Facebook and
32
33 see a message from my ex (…), I didn’ t want anything else, I closed everything, I
34 didn’t care anymore, everybody was asleep, so I started popping pills, pills, pills, I
ie
35
36 had a few shots of alcohol so pills, shots, pills, shots until… I really would have
37
w
38 kept on taking pills if I hadn’t collapsed, passed out (Shit Happens, Lesbian).
39
40
On
41 In this mental, relational, and sociocultural context, suicide as an idea, intention, and/or
42
43 action seems to materialize and express the fatigue and hopelessness that the young person
44
45 feels in connection with developmental tasks which have been interrupted or hindered –or
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46
47
which he/she has given up trying to fulfill: mostly those of affirming one's identity and
48 establishing romantic relationships.
49
50
51
52 Well, what happens is that maybe due to my history, when I was feeling quite
53 distressed by this issue [homosexuality] my closest friends realized that I wasn't
54
55 feeling okay (...) um like many times I thought like the solution to this issue was
56
57 suicide, and that time it's like I said, okay, I have to put an end to this because I'm
58
59
60
18
1
2
3 not doing what God wants, I'm going to make my family feel bad, sad, terrible, it's
4
5 for the best that I'm simply not here. If I'm not here anymore I'll stop sinning,
6
7 maybe God will forgive me for having committed suicide because I had a good
8 justification and maybe my family will be sad, but at least they will find peace
9
10 because I'll no longer be there with my [homosexual] way of life... at least they
11
won't have to suffer the shame of accepting [me] (I Will Go to Hell, Gay).
12
13
14
Fo
15 In some of these cases, we can observe a hopelessness that is derived from depression
16
17 caused by an accumulation of experiences of rejection, discrimination, and other issues. In
18
other cases –which could be considered to be harder to tackle– this hopelessness is more
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19
20 permanent, linked as it is with the impossibility to achieve an identity and a place in one’s
21
22 society and family or personal legitimacy as a gay or lesbian person.
ee
23
24
25 …life in the case of gay people –or in my case, actually– won't be the same as for
26
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27 other people, I'll probably never have a stable relationship and I actually still think
28
29 that way about gay people (...) it's very unlikely that I'll have a stable partner and
30 when I grow up probably, I don't know, when I'm forty I'll be alone, I'll live alone
ev
31
32 (...) those thoughts bring me down sometimes (Condemned to Solitude, Gay).
33
34
ie
35 Help Coming from the Adult World

36
37 In this process, the help coming from the adult world, both from the spheres of the school
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38
39 and of mental health care, is described as rather clumsy and as something that at times
40
deepens the problem. This is partly due to the fact that, in the experience of these young
On
41
42
43
people, the problem is situated by the adult world as one that concerns their sexual
44 orientation, thus contributing to the context of gender victimization. Particularly, in at least
45
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46 five of the eight cases, the psychologists' actions are described as discriminatory, ignorant,
47
48 and characterized by interventions that do not help the patient and which even amplify their
49
50 problems. We also observed that many of those interventions do not take into account
51 specific themes and motives that preoccupy sexually diverse people. In this context, the
52
53 possibility of receiving help from a mental health professional is affected by the activation
54
55 of hypervigilance:
56
57
58
59
60
19
1
2
3 It's frustrating not being able to find a clear answer because I also think that this
4
5 phenomenon, becoming aware that you are homosexual, and starting to get
6
7 depressed is very likely to keep others from finding out and if someone finds out
8 it's like the problem gets worse. Putting a psychologist in the middle of all this also
9
10 makes you (I experienced that) deal with it as if it was another threat, I mean it's
11
like the psychologist came to treat you as if you were sick” (The Secret, Gay).
12
13
14
Fo
15 So I never felt supported by the psychologist. Like I don't know, like they dealt with
16
17
the issue of impulsiveness, like learning to relax, lots of things like alternative
18 therapies and all that but there was nothing... in fact, she knew practically nothing
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19
20 about me. I thought about the things I had to tell her before going, you know? Like
21 okay, if she says this to me okay, I'm gonna be indifferent, I'm not gonna talk about
22
ee
23 this topic or I'm gonna act as if it didn't matter, you know? (...) [like a]
24
25 predetermined speech, like what she'd like to hear and what I was gonna tell my
26 parents (P.’s Double Life, Lesbian).
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27
28
29
30 For their part, some interviewees narrate actions and interventions that reveal a lack
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31 of specific competences that is frequent among those who work with homosexual
32
33 people:
34
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35
36
37 Well, they forced me to go to a psychologist. I had a very bad experience with that
w
38 psychologist. In fact she made me decide whether I was a lesbian or “straight”, and I
39
40 actually back then I didn't know what I was... I was experimenting, I was living, I
On
41
was discovering and I wasn't. And I was also very scared, because for me it was sort
42
43 of stigmatized, the issue of having feelings for another woman (The Imperfect
44
45 Daughter, Lesbian).
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46
47
48 For example, I don't know, the first psychologist I went to, I told her ‘I'm sick of this
49
50 life because, I don't know, it's not the same to walk around holding hands with a man
51 without people looking at me and criticizing me like they would if I was with a
52
53 woman’ and she'd say ‘no, that's not completely true, you can still do it’ (…) she
54
55 downplayed everything (Condemned to Solitude, Gay).
56
57
58
59
60
20
1
2
3
Testimonial Positioning
4
5 Finally, in all the cases we observed a subjective movement, a change in the narrators'
6
7 positioning that reconciles them with their sexual orientation and allows them to
8
9 progressively integrate –and maybe reconstruct– their identity, and which is experienced as
10
11
a constructive movement for themselves and for their environment. We call this movement
12 “Testimonial Positioning”, that is, a psychological and identity-related place from which
13
14 they can share their “testimony” of an experience of suffering that transforms them, helps
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15
16 them to grow as individuals, completes them in their subjectivity, and which, eventually,
17
18 can become a comforting legacy for others:
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19
20
21 Afterwards, well, I think my parents still don't fully accept it because they have
22
always hoped maybe that this will go away even though they don't say it but it
ee
23
24 doesn't bother me so much anymore because I've already accepted myself, you
25
26 know? I'm really sure of what I believe in, what I feel, what is happening to me,
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27
28 what I want. It's like I'm taking a stand in this struggle... actually, I am, because we
29 recently formed a sexual diversity collective in my faculty and we are working on
30
that” (The Imperfect Daughter, Lesbian)
ev
31
32
33
34 “today I think that all the rejection of sexual diversity is due to the idea that we can
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35
36 choose our sexual orientation, [it was useful for me] to realize that I cannot choose
37
w
to be homosexual, heterosexual, whatever (…) I think that idea is fundamental for

38
39 preventing suicide maybe, to realize that you are not to blame for this and that you
40
should feel confident of who you are –of who you are, not of what you're doing– I
On
41
42 think that's fundamental (The Secret, Gay).
43
44
45
ly
46 It was a major change, very very important, (…) a change a change in my life - yes yes
47 it was heavy it was quite a long and painful process but I think it was fruitful and that's
48
49 when I decided to be more political well and to join a foundation to work for young
50
51
people, for people who went through this and who did not find support in their in their
52 age group, so we can do some peer work with them, I don't know – I joined Fundación
53
54 Iguales, and at Fundación Iguales I was already studying political science precisely to
55 change policies, I don't know, it was a whole mentality already; that's why I told you
56
57
58
59
60
21
1
2
3 that it often defines me; sexuality defined many aspects of my life (If I Had Been
4
5 Heterosexual, Gay).
6
7
8
9
10
11
12
13
14
Fo
15
16
17
18
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19
20
21
22
ee
23
24
25
26
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28
29
30
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31
32
33
34
ie
35
36
37
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38
39
40
On
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44
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47
48
49
50
51
52
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1
2
3
Discussion
4
5
6
7 This study sought to explore the way in which a group of lesbian and gay young people
8
9 biographically reconstruct how they experienced –and survived– a suicidal process. We
10
11
have organized this discussion around four core aspects that summarize the results
12 presented and allow us to discuss them.
13
14 The first element that stands out is the way in which certain “general” suicide risk factors
Fo
15
16 acquire a “specific” form in the case of lesbian and gay young people. The narrations
17
18 analyzed display hopelessness, a general risk factor for suicide (see Nicolopoulos, Shand,
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19 Christensen, & Boydell, 2017) that adopts a very particular form in the interviewees.
20
21 During their suicidal process, the possibility of an encouraging future, of personal
22
fulfillment, is interrupted due to the mere fact of having a diverse sexual orientation. At a
ee
23
24
25 very basic level, this attitude towards the future is obstructed by a homophobic
26
environment and its inclusion into the participants’ self, in the form of internalized
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27
28 homophobia. In this regard, we observe that normal personal development tasks, such as
29
30 the construction of a positive personal identity and the establishment of romantic
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31
32 relationships, are interrupted or hindered by adverse events linked to prejudice against
33
34 homosexuals or homophobic discrimination.
ie
35 The above is in line with international research that indicates that LGB young people are at
36
37 a higher risk for suicide if they reveal their sexual orientation at an earlier age (Remafedi,
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38
39 Farrow, & Deisher, 1991), possibly because they are exposed to discrimination due to their
40
sexual orientation for a longer period and while their identity is less solid. Also, it has been
On
41
42
43
reported that, for these young people, seemingly minor and trivial experiences of rejection
44 and discrimination linked to stigmatization accumulate over time (i.e. trigger by overflow),
45
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46 which results in serious consequences for their mental health (Meyer, Ouellette, Haile, &
47
48 McFarlane, 2011). Microaggressions such as those described by the young people
49
50 interviewed in this study convey and imply the erasure of their diverse identity and sexual
51 orientation (Nadal, 2008; Sue et al., 2007). As pointed out by Meyer (2003), continuous
52
53 exposure to such stressful events –either open discrimination or microaggressions– makes
54
55 the mental health status of sexual minority people worse than that of their heterosexual
56
57 peers.
58
59
60
23
1
2
3
In connection with the above, and following Savin-Williams and Ream (2003),
4
5 Bronfenbrenner’s (1979) ecological model can be used as a framework to organize the
6
7 components of suicide risk as well as the factors that protect and promote psychological
8
9 well-being in lesbian and gay young people. These components, as the experiences of our
10
11
interviewees have shown, can be located in various levels of the system: the immediate
12 microsystem (e.g. family rejection, homolesbophobic bullying), the mesosystem (e.g.
13
14 psychological care system, school system), and the macrosystem (e.g. heteronormative
Fo
15
16 social imperatives and cultural points of reference leading to hopelessness). This view of
17
18 risk factors involves considering how generic risk factors interact with specific ones
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19 associated with this social group, for instance, the way in which individual vulnerability to
20
21 mental health problems is affected by specific stressors of sexual minorities.
22
A second element that must be highlighted is the link between identity construction,
ee
23
24
25 internalized homophobia, hypervigilance, and the suicidal process. Our analysis suggests
26
that the connection between these conditions and the suicidal process lies in the events that
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27
28 trigger it. As the results presented reveal, either by impact or overflow, in all cases the
29
30 content of the trigger is related to the interviewee’s diverse sexual orientation. LGB
ev
31
32 research shows multiple ways in which issues linked to sexual diversity influence mental
33
34 health processes that eventually lead to suicidal behavior. Thus, in the case of what we have
ie
35 called trigger by overflow, stress related to stigmatization can lead to isolation, internalized
36
37 homophobia, and, in consequence, to a reduction in social support (Hatzenbuehler, 2009,
w
38
39 Link, Struening, Rahav, Phelan, & Nuttbrock, 1997). Also, as noted by Pachankis (2008)
40
and as we observed in the interviewees’ narrations, concerns regarding rejection and
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42
43
negative opinions can lead young people to avoid close relationships because they fear that
44 their stigmatized identities will be discovered. In the mid and long term, this strategy
45
ly
46 provides them with relief and protection, but causes an increasing feeling of loneliness,
47
48 isolation, and social anxiety.
49
50 Closely linked to the above, a third aspect that stands out in the results is that the
51 participants’ doubts regarding their right to exist in the world appear to “set in motion” the
52
53 suicidal process. Thus far, we have observed that doubts, or in some cases certainty that
54
55 being homosexual is morally bad and/or entails harm to loved ones –especially parents–
56
57 leads young people to put into question this fundamental right. Specifically, internalized
58
59
60
24
1
2
3
homophobia and hypervigilance of stigma appear to be signs of these doubts, and therefore
4
5 triggers of the suicidal process, in this regard, the chronicity of the stressors encountered
6
7 emerges as the main source of hopelessness, a construction linked both to depression and
8
9 suicide (Russell & Joyner, 2001). In addition, family is a context where doubts regarding
10
11
one’s right to exist as a homosexual person can be strengthened. In several of our
12 interviewees, the discovery of their homosexuality by family members in a context of
13
14 imagined or real rejection was the event that precipitated, as a trigger by impact, the suicide
Fo
15
16 process. In this regard, Ryan et al. (2010) showed that LGB young adults who had
17
18 experienced high levels of family rejection were 8.4 times more likely to report having
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19 attempted suicide during adolescence and 5.9 times more likely to display depressive
20
21 symptoms than peers from families with low or moderate levels of rejection. Thus, a
22
supportive family environment is important when trying to reduce suicide risk in young
ee
23
24
25 people with a diverse sexual orientation, among other reasons because such support can
26
attenuate the effects of sexual orientation-based victimization (Poteat et al., 2011, Rivers,
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28 2011).
29
30 Finally, a fourth noteworthy element in our results relates to the question of how diverse
ev
31
32 sexual orientations can be integrated in interventions aimed at providing help in cases such
33
34 as those examined in this study. When we talked about the effective help coming from the
ie
35 adult world, our interviewees emphasized the need for a reliable environment where
36
37 victimization experiences are acknowledged, not minimized or ignored. Interviewees also
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38
39 refer to the usefulness of a discourse that challenges stigmatization and state that it is urgent
40
and necessary to clearly manifest that these issues originate in discrimination and
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42
43
homophobic violence, and not sexual orientation. In this regard, Ryan et al. (2010) point
44 out that mental health care and medical providers can help young people and their families
45
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46 identify supportive behaviors that can protect them from risk factors and promote a healthy
47
48 psychological development. Such behaviors include talking to young people about their
49
50 LGB identity, assist them when they are mistreated due to their diverse sexual orientation,
51 and offer them an adult role model, as a lesbian or gay person, that reveals a possible future
52
53 to them (Morrison & L’Heureux, 2001).
54
55 However, other studies have shown that the factors that hinder LGB young people’s access
56
57 to psychological and psychotherapeutic care include the fact that few professionals
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25
1
2
3
specialize in treating people with a diverse sexual orientation (Bidell, 2016; Grant, Mottet,
4
5 Tanis, Harrison, Herman, & Keisling, 2011; Rutherford, McIntyre, Daley, & Ross, 2012)
6
7 and that some therapists harbor explicit or implicit prejudices and negative attitudes
8
9 towards sexual minorities (Bidell, 2016; Bidell & Stepleman, 2017).
10
11
Although all interviewees provided relatively similar stories, eight cases may be
12 insufficient when assessing how representative our results are within the lesbian and gay
13
14 population. Other sociocultural factors, such as social status, living in an urban or a rural
Fo
15
16 area, or belonging to a gender activism or sexual diversity organization, may increase
17
18 intersectionality, thus adding nuance and richness to the results highlighted here (e.g.
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19 Lardier, Bermea, Pinto, Garcia-Reid, & Reid, 2017) . In addition, future analyses should
20
21 take into account the gender variable, because the constructions of the suicide experiences
22
of these young people may vary depending on sociocultural strictures linked to gender
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24
25 identities; for instance, those related to the binary and stereotyped division of roles and
26
expressions of the female and male genders. Nevertheless, and despite the limitations
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28 noted, we consider that the cases analyzed and the results presented, as a shared experience,
29
30 suggest a perspective that is both complex and situated. That is, it shows how general and
ev
31
32 specific risk factors for suicide, along with the stress processes that affect minorities, are
33
34 linked with the biography and the singular experiences of LG young people who have
ie
35 survived a suicidal process (Morrison & L’Heureux, 2001; Savin-Williams & Ream, 2003).
36
37 This perspective, though limited in terms of its generalizability to the population of
w
38
39 homosexual young people, is extremely generative when attempting to identify possibilities
40
for suicide prevention and related interventions in these cases, both at the micro and the
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macro levels of the socioecological system.
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6 Table 1. Participants’ Characterization
7 ID Title SO Age Activity Suicidal Process
Fo
8
9 1 THE SECRET Gay 22 University student Severe suicide ideation (14
10
years old)
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12 2 P’S DOUBLE LIFE Lesbian 23 University student Suicide ideation and
13
14 attempt (15 years old)
15
16
3 CONDEMNED TO
SOLITUDE
Gay
ee23 University student Suicide attempt (19 years
old)
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17
18 4 I’LL GO TO HELL Gay 24 Public administration Suicide ideation (16 years
19
20 worker old)
21
22
5 IF I HAD BEEN Gay 24
ev
Works on subjects related Three attempts (14 years
iew
23 HETEROSEXUAL to sexual diversity old), the last of which was
24 serious
25
26 6 THESE THINGS HAPPEN Lesbian 23 University student Suicide attempt (14 years
27
On
old)
28
29 7 FEAR OF REJECTION Lesbian 20 University student Suicide attempt (17 years
30
old)
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31
32 8 THE IMPERFECT Lesbian 23 Public administration Severe suicide attempts,
33
34 DAUGHTER worker hospitalization
35
36
37
38
39
40
41
42
43
44
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46 URL: https://mc.manuscriptcentral.com/lgbtic Email: chaney@oakland.edu
47
48
Table 2. Case Summaries

1
2
3
4
5
6
7
Fo
8
9
10
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11
12
13
14
15
16 ee
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18
19
20
21
22
ev
iew
23
24
25
26
27
28
29
30 On
ly
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
1
47
48
ID Title Summary of suicidal process

1
2 1 The secret The interviewee directly links suicidal ideas to the discovery of his sexual orientation: when
3 he feels sexually attracted to a man, he immediately believes it is wrong. This happens in 7th
4 grade, when he falls in love with a teacher and later with a classmate. When he tells this
5 classmate, he suffers a forced revelation and a period starts during which he suffers
6 homophobic bullying in his classroom daily. This has a direct impact on his mood, but this is
7 not singled out by the interviewee as a trigger of his suicidal thoughts. Instead, he mentions
his fear that his mom will “find out” as the main propeller of suicide planning; when, due to
Fo
8
9 problems at school it becomes evident that sooner or later his mother will discover his
10 homosexuality, the suicide process is triggered.
He spends a month thinking about committing suicide; after this experience, he doubts his
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11
sexual orientation for four years. At this point, in tenth grade, one day he has a revelation of
12
sorts in which he realizes that his sexual orientation is real. From this moment onwards, he
13
manages to explore and accept his sexuality more openly, and is dares to reveal his sexual
14
15
16
2 P’s double
life ee
orientation to his mother.
The interviewee discovers her homosexuality at 15 years of age when she realizes that she
does not like men as much as her female classmates, which troubles her. Back then, she
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17
thought that what was happening to her was bad and that her future would be bad too; she was
18
unable to adapt her family’s religious and ideological beliefs (Catholic and right-wing) with
19
her diverse sexual orientation. In that context, she thought about her problems and concluded
20
21
22
ev
that the only solution was to “stop existing”. She met her first girlfriend online. Despite her
fears, she eventually tells her mother. She supports her, but takes her to a psychologist to
make sure it is not “a stage of confusion”. She describes her relationship with her girlfriend as
iew
23 “stormy”: they lived far from each other, her girlfriend’s family did not know she was in a
24 lesbian relationship, and, upon discovering this, they forbid her from contacting and talking
25 with P on the phone. In this context, P’s girlfriend finishes the relationship several times and
26 breaks P’s heart when she finds out that she had cheated on her with a man. This breakup
27 leads to the interviewee’s first suicide attempt: to sleep for days and feel no more anguish, she
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takes several hypnotic pills. After being hospitalized, she breaks up for good with her
girlfriend, devotes her time to her studies, and moves to the capital city to enroll in her
university program of choice. She does this hoping that she will be able to live her
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31 homosexual orientation freely in Santiago. Nowadays, she is stable and content with her
32 sexual orientation, but she can only express her sexuality away from her city of origin; she
33 states that this is still a taboo subject in her family and that, because she fears prejudice, she
34 prefers to keep it a secret from people in her city.
35 3 Condemned The interviewee ascribes his distress and his suffering to the hard process of accepting himself
36 to solitude –of “coming out of the closet”. In this regard, he notes that he felt a permanent fear of other
37 people finding out he was gay, particularly his parents. He made great efforts to keep his
38 secret and always tried to “look heterosexual”. This effort appears to be key to his suicidal
39 process: he states that the fear, pressure, and isolation linked to not revealing his secret caused
40 much emotional fatigue.
41 When he finally decides to tell his parents, they “suffer after hearing the news”. They both
42 suggest him that he can change. His mother encourages him to meet women he finds attractive
43 and his father suggests conversion therapy, which does not work out. At this point, he
44 attempts suicide. This event directly results in the revelation of his sexual orientation to other
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family members and friends. To this day, the interviewee thinks that, if he had been
1 heterosexual, he would not have had the mental health problems that he experienced nor
2 would he have attempted suicide; however, he also reports noticing some progress in himself
3 due to opening up more regarding this issue, Nevertheless, he still feels that he has not fully
4 accepted his orientation.
5 I’ll go to Hell The interviewee comes from a rural area (countryside) and describes his family as
6 conservative and middle-class. He attends a Catholic school and reports having been a strong
7 believer; for instance, he states that he was an acolyte in the school parish for several years.
Fo
8 At school, he witnesses two scenes of sexual stigmatization. First, two female classmates
9 publish a picture kissing on the Fotolog website. At the end of the year, they are expelled. The
10 interviewee presumes that this picture was the reason for this measure and suspects his
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11 classmates are lesbian. The second stigmatization event that he observes concerns other two
12 classmates who are seen hugging in town. They are summoned to a meeting with their parents
13 and the school principal, after which one of them leaves the school, but it remains unclear if
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they were expelled or if their parents took this decision. The interviewee thinks that, in this
15 case, the suspicion that they were lesbians was also the reason for making a problem out of
16 this situation.
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17 Simultaneously, he experiences the process of discovering his homosexual orientation
18 privately and in absolute loneliness. He is tormented by the idea that he will go to Hell due to
19 his orientation; also, he is certain that the discovery of his homosexuality would be terrible for
20 his family and that he would be completely rejected. He thinks that suicide is the best
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solution, as the sin of being homosexual is more serious than that of taking his own life, and
that his parents will suffer less than if they found out they had a gay son. Thus, he decides to
iew
23 attempt suicide by taking some pills. On the day of his attempt, a classmate sees him cry and
24 asks him what is wrong. She listens to him and tells him she is going to help him. This
25 support is hugely important for the interviewee. This classmate tells the “cool” counselor-nun
26 about his problem, and she conducts several support meetings with him. He never tells her
27 that he is feeling bad, but he never tells her that he is okay either. Years later, he visits a Jesuit
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priest who runs a service for LGBT people and their families. On an interview, he tells him
that his homosexual orientation is fine and that the Church was wrong and that it was the
Church that had to change. After this conversation, he begins a progressive process of
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31 acceptance. At university, he finds an environment of high acceptance, where nobody was
32 rejected.
33 He has a long homosexual romantic relationship. His partner is strongly rejected by his own
34 family, which is also staunchly Catholic. When he came out of the closet, he was forbidden
35 from leaving the house for a whole summer. The interviewee came out of the closet with his
36 whole family; however, his father still does not know anything. He accepts himself now, with
37 no major contradictions, and wants to become a LGBTQ activist. Even though he is critical of
38 the Church hierarchy, he wants to recover his faith.
39 4 If I had been The interviewee notes that he first recognized his homosexuality when he was 11 years old.
40 heterosexual His family adopted a tolerant attitude, supporting him but openly manifesting their displeasure
41 and demanding that he try to conceal his homosexuality.
42 Nevertheless, the interviewee states that it is not his home that is his main problem, but his
43 peer group. He affected by homophobic violence at school and starts to feel out of place,
44 lonely, marginalized, humiliated, and hopeless. He first attempts suicide after watching the
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movie “Brokeback Mountain” at school: in it, he sees a reflection of all his fears, which
1 reinforces his idea that he will always be marginalized and will never be able to experience a
2 loving relationship. Later, he tries to commit suicide after falling in love with a classmate
3 who, he feels, will never reciprocate his feelings. He attempts suicide a third time after being
4 repudiated and rejected by his father due to his sexual orientation. After each attempt, he
5 connects with feelings of loneliness and hopelessness linked to the idea of a fatal destiny due
6 to his homosexuality. In connection with this, he often ponders “if I had been heterosexual,
7 none of this would have happened”.
Fo
8 Even though the adults around him accept him as gay, they provide confusing help. His
9 grandmother rejects his suicide attempts and just sees them as ways of calling others’
10 attention. A member of his school’s Catholic group notices that he is in a poor state and
rP
11 recommends him to consult a specialist. He goes to two psychologists, but these treatments
12 fail. A third one helps him change his perspective, mature, and become a change agent. “I’m
13 going to change by teaching History”, he tells himself, and becomes a positive leader in his
14 class, helps his classmates, and even becomes class president in 11th grade. From that point
15
16 ee
onwards, a major movement takes place in his school, as several boys come out of the closet
and he starts a relationship. He becomes a political activist, studies Political Science, and
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17 works at the city hall giving career guidance talks for LGBT adolescents and assisting
18 bullying victims.
19 6 These things The interviewee declares that, for her, discovering her sexuality was something
20 happen “unresearched” or “naive”: at around age 13, she starts feeling affection and displaying
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romantic behaviors towards women, without thinking that this could be regarded as
lesbianism. At school, she suffers institutional homophobic violence: she attends a prestigious
iew
23 school for girls and both the school’s psychologist and her teachers presume her to be a
24 lesbian without asking her. The interviewee reports having experienced a negative attitude
25 from school staff because, unlike her classmates, she was stigmatized, her privacy was
26 violated, and received psychological mistreatment. These problems at school coincide with a
27 major decrease in her academic performance and a depressive mood. She starts cutting herself
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superficially and eventually has to repeat the year. During this time, even though she does not
attempt to commit suicide, she frequently thought about disappearing.
In addition to the above, she associates the hardest moments of her life with her difficulties
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31 with one of her female partners. The interviewee narrates several episodes of emotional
32 overload in which, desperate due to their problems as a couple, and especially to keep her
33 girlfriend from harming herself, she hurts herself in front of her as a form of threat or
34 punishment. This initiates a cycle of torment and mistreatment that ends up in an episode of
35 physical violence where she is taken to hospital due to her partner’s blows. Once they break
36 up, she loses control, developing substance abuse problems and and engaging in risk
37 behaviors such as driving at a high speed or drinking to the point of passing out on the street.
38 Around this time, her grandmother dies. With her gone, she loses a major source of emotional
39 support and becomes unable to fund her university studies. She starts feeling her life is
40 pointless. She states that, at that point in her life, there was nothing to dissuade her from
41 committing suicide, a behavior that she describes as fundamentally impulsive. If she did not
42 die, she points out, it was because her body ended up “switching off” due to her drug and
43 alcohol use. Also, she believes that her grandmother took care of her from Heaven during all
44 that time.
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7 Fear of The interviewee reports that discovering and revealing her homosexual orientation involved a
1 rejection long and difficult process. When she discovers her diverse sexual orientation, she tries hard to
2 deny it, especially by attempting to establish romantic relationships with men. In addition, she
3 recalls feeling a lot of anxiety and pressure due to the possibility that her parents would reject
4 her when they found out she was a lesbian. She bases these rejection fantasies on the fact that
5 her father is a member of the armed forces and on the impression that both her father and
6 mother demand a lot from her. In addition, she feels that her parents regard her as a perfect
7 daughter, and considers at that time that her homosexuality does not match the image that she
Fo
8 has conveyed. At school, she describes a period of confusion regarding her sexual orientation,
9 during which she starts fearing that she will be discriminated against by her classmates if she
10 fails to follow the mandates of heteronormativity and the traditional roles of womanhood. She
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11 narrates how she started partying and drinking too much alcohol as a way to avoid these
12 problems and fears. In this context, as a university freshman, she tries to commit suicide. She
13 was partying, had drunk too much, and in an action that she describes as impulsive and
14
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desperate, she tries to get hit by cars on a high-speed highway. A friend helps her, tries to
15 dissuade her, and given the risk to her life, she calls the police and her parents. After this
16 attempt, she reveals to her mother and father that she is a lesbian. They support her, thus
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17 disproving her rejection fantasies. Her parents seek psychiatric help for her, and though she
18 does not understand how the process works, she considers that both the psychotherapy and the
19 medication have helped.
20 8 The imperfect The interviewee defines herself as a girl who always tried hard to be a perfect daughter: good
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daughter
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grades, good behavior, a first-rate university. Nevertheless, her desire to be with women put
her in a place of failure in front of her parents: she was certain that, if they discovered that she
iew
23 was a lesbian, she was going to disappoint them. Therefore, she starts regarding her lesbian
24 orientation as a disability. She spends two years lying and hiding her homosexuality to her
25 environment and to “the world” because of her belief –and certainty– that it is impossible to
26 reveal her diverse sexual orientation and be accepted. In this period, she suffers enormously,
27 becoming depressed and isolating herself, which harms her in her studies, her only area of
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safety regarding her parents. She suspends her university studies for a semester, which causes
her an overwhelming feeling of failure. In this context, and after a fight with her girlfriend,
she attempts to commit suicide. She is committed to a psychiatric hospital and the medical
ly
31 team there acts as a channel for her to communicate with her parents. When she finally
32 manages to tell them, her parents accept her and she starts her path of self-acceptance.
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Journal of LGBT Issues in Counseling

Journal: Journal of LGBT Issues in Counseling

Manuscript Type: Research

Adolescence, Suicide, Gay and Lesbian, Qualitative Research, Internalized

URL: https://mc.manuscriptcentral.com/lgbtic Email: chaney@oakland.edu

46 adolescents, as compared to just over 3% of heterosexual teens, reported suicide attempts

46 taking one’s life, disappearing, dying, etc.).

46 shared experience regarding their suicide process.

31 It is also possible to trace, in at least seven of the eight narrations, experiences of

35 transgressions of intimacy, and homophobic bullying. For example, the narrations

38 “discussed”, corrected, or repaired –through therapy with a counselor or a psychologist.

agreement, institutionally inflict homophobic violence:

35 anti, like really homophobic (Shit Happens, Lesbian).

[so that] it wouldn't be noticeable (Condemned to Solitude, Gay)

35 Help Coming from the Adult World

to be homosexual, heterosexual, whatever (…) I think that idea is fundamental for

27 Quebec (Canada). Ciência & Saúde Coletiva, 19 (3), 727-735.

38 homofóbico en instituciones públicas de Chile, Guatemala y Perú. Documento de

27 treatment development study with preliminary findings. Psychotherapy, 49, 62-71.

46 risk in lesbian, gay, bisexual, and transgender populations: Review and

35 Kvale, S. &Brinkmann, S. (2009). Interviews. Learning the craft of qualitative research

46 enfoque de género. Gobierno de Chile. Santiago, Chile. Retrieved from:

35 Psychology, 76, 306-317.

46 LGB Youth. Journal of Psychiatry, 18 (2), 14-168. DOI: 10.4172/Psychiatry.1000229

Table 2. Case Summaries

ID Title Summary of suicidal process

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