Discrimination’s toxic effect on health

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Following the momentous Supreme Court gay marriage ruling, many likened this victory to certain milestones in the civil rights era. Comparing the discrimination experiences of LBGT communities to those endured by African-Americans, however, was sharply criticized by commentators ranging from the journalist Roland Martin to Republican presidential candidate Mike Huckabee.

The key difference, these critics say, is that gays and lesbians can hide their marginalized identities – and thus have the capacity to avoid the more harmful instances of discrimination – whereas African-Americans and other racial minorities cannot.

As someone who studies the effects of discrimination, I know that experiencing discrimination is harmful in important ways, no matter what identity is being targeted. In a paper published in Psychological Bulletin examining over two decades of research on discrimination and health, Elizabeth Pascoe of the University of North Carolina-Asheville and I found clear evidence that discrimination, particularly in more subtle forms, has a toxic effect on both mental and physical health, and that it doesn’t matter whether the discrimination was due to race, gender or sexual orientation.

We find two potential pathways for how experiencing discrimination compromises health. One path involves how our bodies respond to stressors over time. Stress, in most forms, doesn’t in fact make us sick. But certain kinds of stressors – ones that are uncontrollable and unpredictable – are particularly harmful to physical and mental health. Chronic exposure to stressful experiences can lead to elevated levels of the stress hormone cortisol, which increases risk for diseases as far ranging as heart disease, depression and diabetes.

The other path involves harmful behaviors. Our analyses suggest that those who experience discrimination often adopt behaviors such as overeating, excessive alcohol use and smoking. These behaviors seem to serve as adaptive coping responses to stress in the short-term. They feel good, are familiar and can provide comfort. However, when these behaviors become routine responses to stress, they can ultimately cause long-term harm.

Conventional notions of discrimination evoke images of violent acts or denial of access to opportunities or resources. But what is less well-known is the harm caused by subtle, chronic types of discrimination. Being treated with disrespect by a shopkeeper, feeling unwelcome in high-powered social circles or being devalued in school or the workplace are all aspects of the modern discrimination experience. These experiences are perhaps even more stressful because they often catch us off guard. In that way, they can be difficult to process and comprehend in the moment. The perpetrator can also easily disavow these kinds of behaviors, thereby limiting the opportunities to respond or otherwise take action.

It is true that some people choose to conceal their sexual orientation, because doing so provides a source of safety. However, in work from my lab and others, we’ve found that hiding a marginalized identity can extract its own costs. People who hide their identities, knowing that disclosure would invite discrimination, suffer from higher rates of depression and compromised immune systems.

Long after civil rights has brought racial equality to our laws, socially and culturally tolerated forms of discrimination – ranging from subtle to overt – have persisted to impose stress on racial minorities. And unfortunately, the recent Supreme Court victory will not end these forms of discrimination for LGBT communities. Even when concealment is an option, the evidence suggests hiding one’s identity confers some unique disadvantages as well. Understanding the range of harmful effects discrimination can have is a first step toward counteracting its sources.

Laura Smart Richman is an assistant professor of psychology and neuroscience at Duke University.