Minority stress: the load those around you do not see

Friday lunch with colleagues. The conversation turns to the weekend and someone across the table asks: “What about you, have you got a girlfriend?” The question is friendly, with no ill intent. The man it is aimed at has a partner at home, another man, whom he has lived with for nearly four years. In the three seconds before he answers, he runs through everything: who is sitting at the table, what the boss said last time about a certain news story, whether he will still be invited for a beer after this, whether he even has the energy today. Then he says, “Not at the moment,” and asks who else wants coffee.

Nothing bad happened. Nobody insulted him, nobody denied him anything. And yet that answer cost him something that the colleague who had mentioned, a minute earlier, that she was off to the seaside with her husband did not have to spend. There may be ten such three-second moments in a week, several hundred in a year. Psychology has a name for this invisible work: minority stress.

In this post I would like to explain where the concept comes from, what it is made of, why it does not apply to one group of people only, and what can be done about the load. One thing I want to say plainly at the outset: nothing in this post suggests there is something wrong with you. It is about what happens to people in an environment where they constantly have to assess whether they are accepted.

What minority stress is

We all know stress: a deadline at work, illness in the family, bills. Minority stress is what comes on top of that, simply because you belong to a group that part of your surroundings regards with distrust, mockery or hostility. The American researcher Ilan Meyer, who described the concept most thoroughly, emphasised three features of this kind of stress.

• It is additional. It does not replace ordinary worries; it is added to them. A person has the job, the bills, and this as well.
• It is lasting. It does not come from a single event but from relatively stable social conditions. That makes it closer to chronic stress than to a one-off shock.
• It is social in origin. It does not arise in a person’s character or body, but in the relationship between that person and their surroundings.

The third feature is the heart of the matter. For a long time the reasoning ran the other way: if gay, lesbian and bisexual people have more anxiety and depression, the problem must lie in the orientation itself. The minority stress model turned that explanation round. Orientation is not the cause of distress. The cause is what a person experiences because of it, and what they have good reason to fear.

What the research shows

In 2003 Meyer published a review in Psychological Bulletin that became one of the most frequently cited texts in the field. In it he pooled the results of population studies and calculated that gay, lesbian and bisexual people were about 2.5 times more likely than heterosexual people to have had a mental disorder at some point in their lives. These were mainly mood disorders, anxiety disorders and substance use problems.

The figure needs to be read carefully, in both directions. First: higher likelihood does not mean a majority. Most people from minorities do not have a mental disorder, just as most people in general do not. Second: the difference is not small and cannot be waved away. Something is causing it. Meyer’s answer was that it is caused by the excess stress that stigma, prejudice and discrimination bring.

A piece of history belongs here too. The American Psychiatric Association removed homosexuality from its list of mental disorders in 1973, and the World Health Organization did so in 1990. The profession concluded decades ago that this is a variation of human sexuality, not an illness. Research on minority stress added the other half of the picture: if it is not an illness, where does the extra distress come from? From the way people are treated.

From what happens to what you carry inside

Meyer arranged the stressors according to how close they are to the person. At one end are things that happen outside and that anyone can see. At the other are things a person carries inside and nobody sees.

The external part is the easiest to understand: a rejected flat application, a remark in the street, a relative who offers an opinion at every visit, and in the worst cases violence. It also includes small, everyday things, each too minor on its own to respond to, which together make up an atmosphere.

The internal part is more insidious, because it operates even when nothing is happening outside. Meyer described three forms: expectation of rejection, concealment and internalised negative messages about one’s own group. All three are understandable responses to real experiences. All three also come at a cost. Let us take them in turn.

Concealment: protection that comes at a price

Concealment is not lying out of weakness. It is often an entirely reasonable decision: in an environment where disclosure would mean losing a job, a home or contact with family, silence is protection. Nobody on the outside has the right to judge when someone should “finally say it”.

It is true, though, that concealment is not free. In 2007 the psychologist John Pachankis described what goes on in a person who hides a part of themselves that their surroundings stigmatise. He described four levels. In thought: constant checking of who knows what, what I told whom, whether the two stories match. In emotion: anxiety, shame, guilt about not being honest with people you love. In behaviour: managing impressions, avoiding company where questions might come up, withdrawing from closeness. And in the view of oneself: the sense that people like you only because they do not know you.

That last point seems to me the hardest. A person who conceals often cannot take in even the good they receive. Praise, affection, friendship all pass by, because they are addressed to a version of you assembled for others. Pachankis points to something else as well: a stigma that cannot be seen cannot be shared with others who carry it until you find them. A person in hiding is therefore often convinced they are the only one.

A related experience is familiar to people who change into someone else at work every day; I wrote about it in The professional mask: the cost of being someone else at work. The difference is that you take the professional mask off in the evening. With minority stress, the question of whether you may take it off remains open at Sunday lunch too.

Expecting rejection, and a body on guard

Someone who has met with mockery or rejection a few times learns to look ahead. Before entering a new room, they read the faces. They listen to the kind of jokes being told. They notice the sticker on a car, the comment under a news story, the tone in which someone says a certain word. This is not oversensitivity. It is learned caution that was once useful and therefore stayed.

The body, however, does not distinguish this caution from real danger. We call the constant readiness hypervigilance: muscles tense, sleep shallow, attention divided between the conversation and the watching. In 2009 Mark Hatzenbuehler set out to explain the routes by which stigma “gets under the skin”. He described three: more difficulty regulating emotions, above all more rumination; more isolation and less support in relationships; and darker beliefs about oneself and the future. These are the same routes by which anyone slides into anxiety and depression. The difference is that stigma places an extra load on them. There is more on rumination in Rumination: the scientific name for spinning thoughts.

A short exchange between two friends shows how this sounds in everyday life (composed, not a real person):

“Why didn’t you bring Tina to the picnic? Everyone would have loved to meet her.”
“I know. It would probably have been absolutely fine.”
“So?”
“I’d have spent the whole week wondering who would say what. Then the whole picnic watching who was looking at us and how. And then three more days wondering whether it really was fine or they were just being polite. It was easier to come on my own.”

There is no enemy in this conversation. There is only a calculation that someone else would not need to make. And that is exactly why those around her do not see the load: from the outside it looks as though she came to the picnic alone because she wanted to.

When the message from outside becomes an inner voice

The third internal form is the quietest. A growing child hears how “those people” are talked about long before knowing they are one of them. Jokes in the school corridor, remarks at the television, silence at the family table. When they later work out who they are, the verdict on themselves is already prepared. The profession calls this internalised stigma: negative messages from the surroundings that a person turns against themselves.

It rarely shows as open self-dislike. More often it shows as discomfort around people who are “too visible”, as a need to be better, more diligent and less of a nuisance than others, as a sense that you somehow have to pay for your presence. Beneath it lies shame: not the feeling that you have done something wrong, but that you are wrong. I described how this emotion works, and why it is so hard to say aloud, in Shame: the emotion that whispers “There is something wrong with me”.

It matters to know that internalised stigma is not proof that the message is true. It is proof that you heard it often enough and early enough.

Not just one minority

The model grew out of research with gay, lesbian and bisexual people, but the idea is not tied to them. In 2012 Michael Hendricks and Rylan Testa adapted it for work with transgender people, where the experience of not having who you are recognised by those around you is added to the rest. Long before that, and alongside it, researchers were studying what discrimination does to the health of ethnic minorities. In 2009 David Williams and Selina Mohammed reviewed the research on racial discrimination and health, and in the same year Elizabeth Pascoe and Laura Smart Richman showed in a meta-analysis that perceived discrimination is linked to poorer mental and physical health across very different groups.

A similar dynamic will be recognised by an immigrant who wonders before a job interview whether to mention where they are from, and whose experience I turned to in Losing your homeland: moving abroad and quiet grief. It will be recognised by a member of an ethnic or religious minority, a person with a disability, a person with a mental disorder who does not mention it at work. The groups are not the same and their experiences should not be lumped together. What they share is three things: a part of you that your surroundings value less, a constant assessment of where it is safe, and a tiredness others do not see.

Some people belong to more than one minority at once. Then the loads do not simply add up; a person may find they are not fully at home in any of their communities.

An exercise: a vigilance map

Minority stress is hard to reduce while it is diffuse and nameless. This exercise does not remove it, but it makes it visible. It takes about fifteen minutes and you need a sheet of paper.

1. Draw three columns. Head the first “here I can be whole”, the second “here I weigh things up”, the third “here I hide”.
2. Sort people and places. Work, close and extended family, friends, the neighbourhood, the gym, the doctor. Each goes in the column that fits best. Do not think about where it ought to belong, but about how it really is.
3. Next to each entry in the second and third columns, write the cost. What does it take out of you there? Preparing answers in advance, tension in the shoulders, tiredness after a visit, feeling lonely among people.
4. Write what hiding protects you from there. Your job, peace at the table, safety. This is just as important a piece of information as the cost. Concealment that protects you from real harm is not a mistake to be corrected.
5. Choose one small thing. Not coming out to everyone. Perhaps one more hour a week in the first column. Perhaps one person from the second column with whom you could check whether they already belong in the first.

With an exercise like this, a person often sees for the first time how much work they do every week without ever counting it. That alone can bring some relief: the tiredness acquires a reason.

Where this explanation falls short

The minority stress model is useful, but it has limits, and an honest account has to mention them.

First, it does not explain everything. A person who belongs to a minority also has a childhood, attachment, losses, a temperament and a body. Their depression may be linked to stigma, but it may be linked to grief, to the thyroid, or to a relationship that ended. If we explain every difficulty by minority status, we once again reduce the person to a single characteristic, only this time with good intentions.

Second, the model can unintentionally paint a picture made of wounds alone. Most people from minorities lead full, connected lives. Meyer himself built sources of resilience into the model: support from those close to you, a sense of belonging to a community, and the pride that grows from having come through something hard. Many people take from these experiences a sharpened sense for others, and friendships that come close to family in their strength.

Third, the link between openness and wellbeing is not simple. It does not follow from research on the cost of concealment that everyone should tell everything everywhere. In a dangerous environment, caution is wise. How to think through coming out to those closest to you is the subject of Coming out to your family as an adult: when you tell them who you are.

And fourth, not every sensitivity to rejection is minority stress. Some people react very strongly to the slightest sign of disapproval for quite different reasons; one such explanation is offered in Rejection sensitive dysphoria (RSD): the sensitivity we rarely name.

What helps

Because the source of the stress is social, a large part of the remedy is social too. The strongest protective factor that recurs in the research is belonging: people among whom nothing needs explaining. For one person that is a circle of friends, for another a community. In Slovenia, counselling and support for LGBTIQ+ people is offered, for example, by the association Legebitra in Ljubljana. For people from other minorities, cultural associations, faith communities or groups of people with the same experience play a similar role.

The second thing is a single person who knows. Pachankis’s account of concealment suggests why: someone who has nobody who knows has nobody who could confirm that they are accepted as they are. The step from “nobody” to “somebody” is therefore often bigger than the step from “some” to “everyone”. The third is naming. Once you know that the tiredness after a family lunch is the result of three hours of vigilance and not of your being unsociable, you stop looking for the fault in yourself.

If the load is growing into hopelessness or thoughts that life is not worth living, do not wait. In Slovenia, the Samarijan confidential helpline is available 24 hours a day on 116 123, the Klic v duševni stiski helpline between 7 pm and 7 am on 01 520 99 00, and in an emergency call 112.

What you are entitled to expect from therapy

Therapy cannot change the environment you live in. It can, however, be a place where vigilance rests for an hour, and where it becomes possible to untangle which part of what you carry is yours and which was placed on you. I described why such a place differs from ordinary conversations in A safe space: why the therapy room differs from every other conversation.

There are some things you may expect from a therapist without negotiation. That they do not treat your orientation or gender identity as a problem to be solved. That they do not try to change it; in 2009 a task force of the American Psychological Association concluded, after reviewing the research, that such efforts are unlikely to succeed and can cause harm. That they do not push you into a disclosure you are not ready for. And that they do not assume everything you bring is connected with belonging to a minority. If you find yourself, with a therapist, in the role of the one who has to explain and reassure, that is a sign to keep looking. There is help with choosing in How to choose a therapist who is right for you.

I am a marriage and family therapist in training under supervision, and I am not a specialist in work with minorities. What I can tell you is how I see it: who you are and whom you love is not something to be corrected in a session. The subject of the conversation is how you are living with it in a world that is not always kind to you. Sessions are held in person in Ljubljana, and I also work with English-speaking clients. If two of you carry the load, you can read about how it shows up in a relationship in Same-sex couples in therapy: what is the same and what is different.

What to remember

• Minority stress is an additional, lasting load that comes from how your surroundings relate to the group you belong to, not from who you are.
• It is made up of external events (discrimination, insults) and internal processes: expecting rejection, concealment and internalised negative messages.
• Concealment is often reasonable protection, but it costs: vigilance, tiredness and the feeling that people do not know you.
• The model also applies to ethnic, religious and other minorities, but it does not explain every difficulty and does not mean you are damaged.
• What helps most is belonging, at least one person who knows, and a place where you do not have to weigh your words.