Positioning resilience science more centrally in affirming LGBTIQA+ persons and communities

Adversity

To explore resilience, one must acknowledge adversity. The literature on adversity (e.g., stigma, discrimination, violence, hate crimes) and LGBTIQA+ persons abounds in South Africa and elsewhere (e.g., Breen et al., 2016; Follins et al., 2014; Herek, 2009; Judge, 2018; Judge & Nel, 2018; Lester, 2017; Levin & McDevitt, 1993; Marais et al., 2022; Meyer, 1995, 2003; Nel, 2007; Nel & Judge, 2008; Nel & Mitchell, 2019; Tankersley et al., 2021).

In South Africa, the country’s Constitution, founded on democracy, equality, tolerance, impartiality, and support for human rights, The Promotion of Equality and Prevention of Unfair Discrimination Act, and, most recently, The Prevention and Combatting of Hate Crimes and Hate Speech Bill, have brought some measure of legal protection, relief, support, and respite for sexually and gender-diverse persons. Despite these post-1994 remedies, LGBTIQA+ persons, perceived as ‘different’ and in some quarters ‘unAfrican’, continue to be exposed to pervasive socio-political violence, trauma, hostility, inequality, and oppression because of anti-social attitudes and criminal behaviours prevalent in the country (Breen et al., 2016; Marais et al., 2022; Nel & Judge, 2008). In contrast to adversity research, resilience studies in LGBTIQA+ persons’ lives are woefully absent from contemporary LGBTIQA+ literature, particularly in South Africa (PsySSA, 2013; Victor et al., 2014).

Resilience

According to Ungar (2021), resilience is a complicated multisystemic concept with many definitions, emphasising a shift in focus from disorder and breakdown in adversity to processes of adaptation, recovery or system-wide transformation. These processes are associated with change over time and produce a ‘preferred outcome for one or more systems or parts of systems’ (Ungar, 2021, p. 8).

The shift in focus now reflects the growing influence of developmental systems theory and the need to integrate knowledge about resilience to address multisystem threats (Masten et al., 2021). Thus, through multisystemic processes, resilience is the capacity of a dynamic system to adapt to challenges that threaten the way a system functions, survives, or develops in individuals and communities. This suggests the possibility of networked, multisystem protective factors working together (Masten et al.). All systems have the potential to show resilience. However, resilience will reflect the ability of multiple overlapping systems to interact well together under stress. Patterns of resilience are responses to the attribute of the stressors that a system experiences. The study of resilience is differentiated from fields like positive psychology, ecology, and population health, which include the factors that maintain normative functioning associated with expected patterns of growth and change (Ungar, 2021, p. 11).

Resilience, a natural human response typically arising as a positive adjustment during life’s challenges, is relational, collaborative, and ecological. In LGBTIQA+ persons, as in others, ineffective styles and responses of resilience and the subsequent mental ill-health can be mediated and prevented by range, depth, adaptability, and complexity of resilience. Range refers to the preferred cognitive styles of problem-solving behaviours, creative coping styles, and differences in resilience capabilities on a continuum from high adaptation to high innovation, depending on the context (Kirton, 2003). Depth explores and indicates reliance on culturally embedded wisdom, traditional values, personal interpretations, and perceived meanings for core resilience resources (Theron, 2016b). Adaptability entails how LGBTIQA+ persons may manifest diverse resilience (i.e., adapting to adversity) in social-ecological systems, undergoing unpredictable, or predictable change. Complexity refers to the multi-factorial intersections of sexually and gender-diverse persons with juxtapositions of race, culture, and social affiliations, among others. Such multiple tensions – range, depth, adaptability, and complexity of resilience – can affect LGBTIQA+ persons’ ability to navigate and negotiate for resources and mental health during adversity in the larger community (Judge, 2018; Nel, 2007; Tankersley et al., 2021).

A dynamic system can adapt and endure or recover from substantial changes that threaten stability, sustainability, or development (Masten, 2014). It is commonly understood as a positive dynamic process encompassing adaptation to significant adversity exposure (Luthar et al., 2000). Resilience is variable-focused, where factors exist on the ecosystemic levels of child, family, and community. Thus, resilience is a process, a dynamic system’s capability to adjust to disturbances that impend those system functions, viabilities, or developments (Masten, 2014).

Resilience is found in competencies (protective factors) that can co-exist with risk factors – an interactive concept concerned with serious risk experiences and a relatively positive psychological outcome, despite those negative experiences (Rutter, 2006). Resilience goes beyond social competence or positive mental health (both viewed as protective factors). For resilience to occur, social competence must co-exist with risk. Some may have relatively good outcomes (protective factors) notwithstanding experiences of severe stresses or adversities (risk factors) (Rutter, 2013). The common threads of resilience include harnessing resources in sustaining overall wellbeing, self-efficacy, and cultural wisdom (e.g., Gunderson, 2000; Masten, 2014; Meyer, 2003; Panter-Brick & Leckman, 2013; Rutter, 2006; Singh, 2013; Theron, 2016a) and how one reacts to challenges determining whether large or small problems can lead to positive, neutral, or negative consequences.

According to Ungar and Theron (2020), there is more insight into the aspects predicting mental disorder than the processes and factors promoting positive development among persons exposed to adversity and often atypically high stress levels. Ungar and Theron state that this is best understood as the process of multiple psychological, social, biological, and ecological systems interacting in ways that help individuals to improve, regain, or sustain their mental wellbeing following challenges by one or more risk factors. Diverse fields including psychology, political science, genetics and human ecology indicate that resilience depends on a person’s thoughts, feelings, and behaviours, but, importantly, on the culturally available resources in stressed persons’ various environments. Regarding multisystemic resilience, though not explicitly aimed at LGBTIQA+ persons, Ungar (2021) states ‘The more the concept of resilience is described multi-systemically, the more useful it is when designing research and interventions that address the “wicked” problems that individuals and environments face’ (Ungar, 2021, p. 28).

In the next section we consider how general resilience science, summarised above, has been applied to LGBTIQA+ persons and communities, internationally, with a view of assessing applicability and possibilities this may hold for South Africa, with its peculiarities.

International perspectives on LGBTIQA+ resilience

Studies on resilience in LGBTIQA+ communities internationally, especially those considering their lived realities, seem sparse. According to Lyons (2015), citing various authors, there are, however, numerous narrative accounts related to resilience. For example, as a major protective factor for mental health challenges; the positive influence of accepting sexual identity and a sense of authenticity and freedom, personal development, and enduring emotional connections with others; and how building resilience can contribute to the prevention and treatment of mental health problems at both public health and clinical levels. However, Lyons states there are still gaps in resilience research among lesbians and gay men and, thus, by extrapolation, also those who identify as BTIQA+. For example, knowledge of the psychological and social factors of resilience among lesbians and gay men remains sparse, and strategies to build resilience need to be prioritised; available resources for dealing with life challenges may be unlike those in the broader population, mainly if there are challenges with access to support from significant others due to rejection or fear of discrimination from health and support organisations. Resilience-building interventions may also require alterations to accommodate stigma-related challenges, while resilience can be advanced through training.

Citing various authors, Levitt et al. (2016) indicate that researchers understand health concerns associated with being a sexually diverse individual and related discrimination experiences, but suggest the need to ponder the influence of stress in this grouping on their resilience strategies. In LGB persons, stress results from systemic factors that contribute to competing desires for authenticity and self-determination. Levitt et al. highlighted the insidious nature of stress in this population, particularly in the United States that lacks protective legislation; they also highlighted the adaptive strategies used to mitigate the effects. Resilience strategies include withdrawing from heterosexist social environments, concealing a sexually diverse identity, cultivating a marginalised identity, finding community, dismissing prejudice, or directly confronting it, approaching others for support or professional assistance, developing political consciousness, and striving for confidence and self-acceptance.

Levitt et al. (2016), explored the lived experiences of sexually diverse persons’ stress in a part of the United States without employment and services’ protections related to sexual orientation. The identified themes suggested that developing resilience comes at a cost where persons make choices informed by continual risk assessments. Also, whereas political advocacy and critique and self-acceptance reinforce resilience, these do not help overcome stressors. However, resilience is enhanced by integrating LGB persons with other identities to resist stressors that divide communities. Last, competing social pressures between inauthenticity and constrained self-determination elicit sexual diversity-related stress. Levitt et al. concluded that resilience is understood to lessen but not resolve the deleterious impact of stress on sexually diverse persons by positioning resilience as a choice between authenticity and self-determination.

In an integrative literature review, de Lira and de Morais (2018) state there is growing attention to resilience in LGB individuals. Their review of 39 articles published up to 2015 found that the dimensions of individual, family, and community-based resilience are studied in the quantitative, international, cross-sectional, empirical literature. Concurrently, the focus is on individual resilience, and there is a paucity of research on simultaneous interactions between the individual, family, and social contexts or the contributions to resilience. Nevertheless, their discussion indicates that the individual is key. Regardless of the importance of the interaction between individual and contextual characteristics in resilience, contextual characteristics are the individual capacity to use one’s relational skills and abilities to overcome adversity. De Lira and Morais conclude that the conceptual dimensions of resilience require further integration to ensure a more apt description of its systemic and relational nature. Integrating the three resilience dimensions should be considered for broader and more effective interventions and public policies for the LGB population. Thus, the individual, the family, and the community could be the focus. Furthermore, resilience, as a concept, is vital for future LGB research focused on strength-based approaches after decades of risk-based approaches and the focus on pathologies.

According to Follins et al. (2014), Black LGBT persons are more likely to suffer violence than other LGBT or heterosexual persons of any ethno-racial background. The literature is replete with descriptions about the challenges faced by Black LGBT persons, but their resilience capacity is given little attention. Owing to their ability to thrive and adapt when faced with myriad challenges, including related to gender identity, health disparities, and racialised sexual orientation, Follins et al. examined LGBT resilience and social science literature and the factors leading to Black LGBT persons’ resilience. The intersectional approach in their article explored the relationships among multiple modalities and dimensions of subject formations and social relations. A person’s core identity comprises various social statuses (e.g., ethno-racial identity, religious identity, sexual orientation, education level, socioeconomic status) that frame their experiences. Thus, intersectionalities significantly affect their experiences but also affect ‘patterns of privilege and disadvantage’ (Follins et al., 2014, citing Williams et al., 2012, p. 1256).

Using an ecological systems perspective to determine the factors that promote resilience in Black LGBT persons according to the literature, Follins et al. (2014) examined personal traits (African consciousness and coping skills) and socialisation factors (kin and religious and racial communities). They found that the participants in the empirical studies demonstrated adaptation and resilience in varying degrees despite oppression and adversity, along with ‘an acute awareness of how the multiple aspects of their identities continuously and simultaneously interact with one another and impact their experiences’ (p. 203). They concluded there are still challenges in researching this population in the United States, and there are thus opportunities for developing and implementing related culturally competent and affirming social and clinical services.

Owing to the paucity of systematic reviews of risk and resilience factors for mental health among TGNC persons under the age of 25, in contrast to the proliferation of research and guidelines focusing primarily on TGNC adults, Tankersley et al. (2021) evaluated 44 peer-reviewed articles that met inclusion criteria for a systematic review for methodological rigour and findings. Common risk factors for negative mental health variables included weight dissatisfaction, low self-esteem, verbal and physical abuse, social isolation, discrimination, poor peer relations, and age. The studies showed a tendency among adolescents and older children to report higher rates of psychological distress. Also, resilience-promoting factors for mental health included the ability to use one’s chosen name, belonging, parent connectedness, school safety, and social support. Using a minority stress and resilience-focused framework, and integrating the existing literature, Tankersley et al.’s review facilitated the promotion of psychological wellbeing for TGNC youth among clinicians and researchers.

Resilience, seen as an enduring constructive adaptation to one’s circumstances and environment during adversity (Watson & Tatnell, 2022, citing Luthar et al., 2000), could empower individuals to cope with discrimination. Higher trait resilience corresponds with positive mental health outcomes, while lower trait resilience with poor mental health outcomes (Watson & Tatnell, 2022, citing Hu et al., 2015). Also, in a study involving 330 adults (aged 18–30) from Australia’s LGBTIQA+ community, Watson and Tatnell (2022) examined non-suicidal self-injury (NSSI), psychological distress, discrimination, ‘outness’, and resilience. They found that identifying as LGBTIQA+ was associated with a greater risk for NSSI, and those individuals reported increased depression, anxiety and stress, and less resilience. Similarly, NSSI was associated with having to hide their gender identity in the workplace, but perceived discrimination, in general, was not associated with NSSI. Watson and Tatnell assert that developing resilience and social support in LGBTIQA+ persons could help tackle the mental health of LGBTIQA+ persons. Higher trait resilience thus would come into play.

Resilience, thus, is generally viewed as a positive adjustment to adversity, contingent on complex multi-level negotiations between individuals with few protective factors and resources and the social reciprocation processes that can supply helpful resources from LGBTIQA+ allies’ socio-cultural ecosystems (Gunderson & Holling, 2002). Disruptors to psychological wellbeing and mental health can be understood as either protective factors or risk factors (e.g., Rutter, 2006, 2013). Individuals might naturally perceive various challenges such as social injustice, loss, marginalisation, violence, economic deprivation, oppression, neglect, and sexual abuse, as risk factors impinging on their quality of life and mental health. Quixotically, some LGBTIQA+ persons’ perceptions of these same challenges might view these events as pivotal periods in their life-course development as positive challenges and protective factors.

The core of resilience is to sustain survival in the human species. It is often operationalised as internal individual-level attributes and external community-level resources, as documented in the LGBTIQA+ context (Shilo et al., 2015). According to Ungar and Theron (2020), it is necessary to acknowledge the multifaceted interactions across systems that predict those who will do well and use this understanding to advance mental health interventions. Of significance is that LGBTIQA+ persons have the potential creativity and internal resources to deal with their difficulties and problems (PsySSA, 2017; Victor et al., 2014).

There is a need for further exploration regarding resilience in LGBTIQA+ communities through the four aspects of their lived experiences, namely spatiality (lived spaces), corporeality (the lived body), temporality (lived time), and relationality (lived human relations) (Van Manen, 1990) to augment related research in South Africa for psychology professionals (PsySSA, 2017; Victor et al., 2014). Knowledge about their life-world stories regarding resilience in adversity and how their lived-world experiences of violence, discrimination, and oppression helped them find effective resilience strategies could be worth exploring further, mainly because such resilience enquiry may well evolve into later resilience research.

Having considered how resilience science has been applied to LGBTIQA+ persons and communities, internationally, we now assess applicability and concrete possibilities this may hold for South Africa.

Guideline 1: non-discrimination

Includes reference to the South African Constitution and Bill of Rights, National Action Plan for the Protection and Promotion of Human Rights, African Commission on Human and Peoples’ Rights, internationally recognised sexual rights, and South African ethical rules of conduct for health practitioners; and so on.

This guideline seems to correspond well with what Levitt et al. (2016) highlighted in respect of the insidious nature of stress in the LGBTIQA+ population, particularly in contexts that lack protective legislation related to sexual and gender diversity.

Guideline 2: individual self-determination

Includes reference to the South African Professional Conduct Guidelines in Psychology that state that the client/patient ought to control and determine the course of their own lives. Includes the ability to seek, consent to and/or refuse treatment, as well as the right to coming out (or not disclosing) and/or living in stealth; and so on.

In this regard Lyons (2015), citing various authors, reported narrative accounts related to resilience, including the positive influence of accepting sexual identity and a sense of authenticity and freedom. However, in LGB persons, stress results from systemic factors that contribute to competing desires for authenticity and self-determination (Levitt et al., 2016). Accordingly, resilience strategies among others include withdrawing from heterosexist social environments and concealing a sexually diverse identity, and striving for confidence and self-acceptance. Whereas self-acceptance reinforces resilience, it does not help overcome stressors (Levitt et al). Indeed, competing social pressures between inauthenticity and constrained self-determination elicit sexual diversity-related stress. Importantly, Levitt et al. concluded that resilience is understood to lessen but not resolve the deleterious impact of stress on sexually diverse persons by positioning resilience as a choice between authenticity and self-determination.

Guideline 3: enhancing professional understanding

Includes the importance of appropriate language and conceptualisations; differences in academic categorisations and individual real-life experiences; conflation of ‘sex’ and ‘gender’ in popular discourse; constraints of social forces and socialising agents; importance of acknowledging diversity and fluidity; acknowledging the client is best placed in guiding which identity options and pronouns to use; and so on.

Tankersley et al.’s (2021) review indeed highlighted that resilience-promoting factors for mental health in TGNC youth included the ability to use one’s chosen name, while Follins et al. (2014) emphasised the importance of culturally competent and affirming social and clinical services.

Guideline 4: awareness of normative social contexts

Includes reference to, among others, related assumptions, and implications (also for health care provision) of hetero-cis-normativity and heterosexual and cisgender privilege.

Levitt et al. (2016), in particular, specified as resilience strategies withdrawing from heterosexist social environments, concealing a sexually diverse identity, dismissing prejudice or directly confronting it, approaching others for support or professional assistance, developing political consciousness, and striving for confidence and self-acceptance.

Guideline 5: intersecting discriminations

Includes a definition of intersectionality and application to, among others, practitioner awareness of the multiple intersecting identities of sexually and gender-diverse individuals, and the diversity of experiences among sexually and gender-diverse individuals. The use of cultural humility as a tool when working with cultures different from their own is recommended.

Multiple tensions – range, depth, adaptability, and complexity of resilience that can affect LGBTIQA+ persons’ ability to navigate and negotiate for resources and mental health during adversity in the larger community – are acknowledged (Judge, 2018; Nel, 2007; Tankersley et al., 2021).

In addition, Follins et al. (2014) reported that Black LGBT persons are more likely to suffer violence than other LGBT or heterosexual persons of any ethno-racial background. They purport that while the challenges faced by Black LGBT persons are well documented, their resilience capacity is given little attention. Accordingly, Follins et al. examined LGBT resilience and social science literature and the factors leading to Black LGBT persons’ resilience. They found that intersectionalities significantly affect their experiences but also privilege and general disadvantage.

Guideline 6: counteracting stigma and violence

Includes reference to a body of knowledge in respect of significant experiences (and fear) of discrimination, victimisation, and ill-treatment; institutionalised discrimination/oppression; associated vulnerabilities to mental health issues; hesitancy to access health care; and application to:

Watson and Tatnell (2022) emphasise that resilience could empower individuals to cope with discrimination and that developing resilience and social support in LGBTIQA+ persons could help with improved mental health.

Resilience strategies include withdrawing from heterosexist social environments, concealing a sexually diverse identity, cultivating a marginalised identity, finding community, dismissing prejudice or directly confronting it, approaching others for support or professional assistance, developing political consciousness, and striving for confidence and self-acceptance (Levitt et al., 2016).

Guideline 7: recognising multiple developmental pathways

Includes reference to a general movement away from imposed identities, to self-chosen identities; increased recognition of personal agency, human development variations, and attractions and identities that evolve over a lifetime; cultural and social contexts that change over time, including expectations of people at different stages of life, and needs of people that may differ across their lifespan.

There is, indeed, an increased need to combine knowledge and strategies to inform policies and practice to alleviate risk and encourage resilience in systems that shape human adaptation during the lifespan (Masten, 2018).

Guideline 8: non-conforming family structures and relationships

Includes acknowledgement that many LGBTIQA+ persons are parents (sometimes before coming out) or want to have children (own; via adoption, fostering, surrogacy), also lesbian- and gender non-conforming people and trans men; and requirements of reproductive treatment; and that psychology professionals need to understand the diversity and complexities of relationships within families of origin and families of choice and for people in different relationship configurations.

Numerous narrative accounts related to resilience, include, as a major protective factor for mental health challenges, enduring emotional connections with others (Lyons, 2015).

Guideline 9: the necessity of an affirmative stance

The required lens is that of a cultivated and ongoing sensitivity to and acceptance of sexual and gender diversity as normal, increased contextual awareness of factors impacting wellbeing, and empathy with the unique experiences of and acknowledging the diversity in and among LGBTIQA+ persons and communities. Also included is actively taking a positive view of LGBTIQA+ clients’ lives and that they may have the inventiveness and internal resources to cope with their challenges and difficulties.

Guideline 12: continued professional development

Stresses the importance of seeking continued professional development regarding sexual and gender diversity, including developing social awareness of the needs and concerns of sexually and gender-diverse individuals.

Diverse disciplines indicate that resilience among others depends on the culturally available multisystemic resources in stressed persons’ various environments (Ungar, 2021).

Strategies to build resilience need to be prioritised; available resources for dealing with life challenges may be unlike those in the broader population, mainly if there are challenges with access to support from significant others due to rejection or fear of discrimination from health and support organisations. Resilience-building interventions may also require alterations to accommodate stigma-related challenges, while resilience can be advanced through training (Lyons, 2015).