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An Interview with Ilan Meyer, Ph.D, on the Effects of Stress on Minority Mental Health

David Van Nuys, Ph.D. Updated: Aug 17th 2009

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Ilan Meyer, Ph.D.In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Ilan Meyer, Ph.D., Associate Professor of Clinical Sociomedical Sciences at Columbia University, about his research on the effects of stress on the mental health of minority populations. For the past 10 years Dr. Meyer has studied public health issues related to minority health. His areas of research include stress and illness in minority populations, in particular the relationship of minority status, minority identity, prejudices and discrimination, and mental health outcomes in sexual minorities, and the intersection of minority stressors related to sexual orientation, race/ethnicity, and gender.

David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

On today's show we'll be talking with Dr. Ilan Meyer about his research on the effects of stressors on the mental health of minority populations. Dr. Ilan Meyer is associate professor of clinical sociomedical sciences at the Mailman School of Public Health at Columbia University. His academic background is in social psychology, psychiatric epidemiology, and sociomedical sciences. For the past 10 years he's been studying public health issues related to minority health. His areas of research include stress and illness in minority populations, in particular the relationship of minority status, minority identity, prejudices and discrimination, and mental health outcomes in sexual minorities, and the intersection of minority stressors related to sexual orientation, race/ethnicity, and gender.

Now, here's the interview.

Dr. Ilan Meyer, welcome to Wise Counsel.

Ilan Meyer: Thank you, I'm glad to be here.

David: Well, some time back I interviewed Effie Malley about her work with suicide prevention among lesbian, gay, bisexual and transgender youth. And she recommended you as an important researcher in the LGBT literature. So maybe we should start out with you telling us a bit about your background and how you got into this work.

Ilan Meyer: Okay, my background wasn't a direct route. I originally planned to study clinical psychology, as I think many people who start in psychology. Actually, before that, I planned on not studying anything; I was going to work in the community and I worked as a caseworker in a clinic with mentally ill, mentally retarded individuals. This was shortly after I finished my undergraduate education in psychology at Tel Aviv University. And then I realized that I do need to get higher graduate school and I started with a social psychology program with the intention of later moving on to clinical psychology. It was really a general psychology program. But while I was there, at the New School for Social Research in New York, I became interested in stress research, and that was through a professor who taught there and who was very influential in how my career ended up moving from clinical psychology to what I do now, which is really stress and mental health.

David: So did you end up getting a Ph.D. in social psychology then?

Ilan Meyer: Did I?

David: Yes.

Ilan Meyer: I was then, actually, in a master's program in psychology. I was working full time at that clinic I mentioned, and I was studying at night in psychology - what I thought would lead me to a clinical psychology degree. It turned out at it ended up being a master's degree because then I moved to Columbia University. So I was first doing a psychology program, kind of trying to figure out what I wanted to do, and that's when I came upon Shlomo Breznitz, who was a professor there. And he taught stress and health and I became very interested in that. That was in 1984-86.

And at the same time, there was this new epidemic, HIV AIDS - well, we didn't know it was HIV; it was not even barely called AIDS then. So I became interested in trying to understand something about the relationship between stress and health, and thinking about this AIDS at the time. And when I first started doing these studies, I remember looking for information about AIDS and the only AIDS that was in the catalogs that we used at the time to find articles, was about hearing aids. It was not even a term yet. So I got into that.

Then I heard about a study conducted at Columbia University, and that study was of the impact of the AIDS epidemic on New York City gay men, and it was done by John Martin. And I read about the study and, because I was interested in stress and health, I contacted this researcher and that ended up where I came to Columbia to the School of Public Health. I didn't know anything about public health before that. So that's how I got to my area, really, although I never focused on AIDS. I was part of that study that John Martin did, who himself died from AIDS a few years afterwards.

So I moved to Columbia; I studied in the School of Public Health in what is called a Subcommittee, which is an interdisciplinary program in social psychology and public health. And I also did a pre-doctoral fellowship from the NIH on psychiatric epidemiology. So that's my education in psych epi, and social psychology and public health. And that's how I began to do what I'm doing to date.

And I started with the stress model, thinking about how stress affects people's health. And, because I was interested in mental health, I looked at things like mental disorders. In working with John Martin on his study, which was focusing on AIDS but he was a social psychologist as well and it had a lot of social psychological aspects to it, I looked at some of the aspects of the mental health outcome while he was looking on mostly AIDS related issues.

David: Okay. Now, I see on your website that you served as director of something called Project STRIDE. Is STRIDE an acronym?

Ilan Meyer: It's actually not. It's a research project; we called it STRIDE. It kind of came out of the word stress and identity, but it really was just a word that one of my research workers… we brainstormed about what to call the project. It was a project that I am the principle investigator to. It was a study funded by the NIMH, and the data collection is completed but we're still writing papers on that.

David: Yes, tell us about that research project: who the subjects were and what you were trying to find out, etc.

Ilan Meyer: This research project was kind of a combination of a lot of the work that I've done up to then. One of the things that I've done is developed a model that some people call the "theory of minority stress." And the idea behind this model is that mental health is caused, in part - of course, there are many causes of mental disorders - but mental disorders and mental health are caused, in part, by social conditions; and looking through a stress model, which suggests that people's experiences in the world affect their health, applying this model to all kinds of minority groups or disadvantaged social groups, as I call them - so that would include gay, lesbian, bisexuals versus heterosexuals; it would include blacks and Latinos or other ethnic minorities versus whites; it would include women versus men, and so forth. And the idea is that the disadvantaged social status leads to exposure with all kinds of stressors.

Now, "stressors" is also a big term that has many definitions, but one easiest way to think about it is life events, events that happen to people. And, of course, everybody has events; all people have stress in their lives. The idea of minority stress or social stress is that people who are socially disadvantaged experience more bad things and, in large part, those bad things that they experience are caused by prejudice and discrimination against the group. So, for example, if a black person is not hired or not promoted as much as his counterpart that would be an event - like not being hired, or being fired, or not being promoted - that is caused by social stress.

And the stressful experience, we know, of those kinds of events varies among people, but I guess the research question was: could that lead to mental disorders in people in general? So that would mean that people who were in social disadvantages, if they have more stress exposure because of personal discrimination, would they therefore have more mental disorders? Some mental disorders, like the ones that we look at in the psychiatric epidemiological studies, are usually the large ones, which is mood disorders, anxiety disorders, substance abuse disorders. So the question is: does what happened to you lead to or cause mental disorders; and do some populations have higher risk for those things because of their social position?

David: Yeah, that's very clear.

Ilan Meyer: So this was the theory.

David: Who were the subjects?

Ilan Meyer: So around this, I designed this study and the study included 524 men and women who were New York City residents. And they were people who were in those different groups that we can identify based on this, so that we can test this theory. So they were gay and lesbian bisexual versus heterosexual; they were women versus men; and they were black and Latino versus white. And we looked at those three disadvantaged statuses and to what extent those disadvantaged statuses are related to an increase in stressors as the theory would say, and to what extent, if they do have those increases in stressors, do they, in fact, lead to certain mental disorders. And, by the way, we also looked at suicide, which is probably how you heard about it.

David: Yes.

Ilan Meyer: In addition to looking at mental disorders. So this was the question. In addition to that, we looked at things related to identity. Now, that complicates this whole equation a little bit more. So, I said before, there are socially disadvantaged groups; socially disadvantaged groups are also groups that do things for themselves. This is something that we all are familiar with, you know, since the great liberation movements in the United States and before that. So if you talk about gay and lesbian people, to one side of the equation they, you can say, suffer from the effect of prejudice and discrimination. On the other side of this equation, they also do a lot of things to cope with those types of stressors, and that would include what I refer to sometimes as a minority coping or a group level coping. So that is things, for example, of changing values and norms - or reframing values and norms. So, for example, for gay people, one of the stereotypes that gay people learn early on is that gay people are lonely, that they don't have families; and a lot of this discussion is changing now, as we speak, with all this debate about marriage. But, you know, even 10 years ago there was very little of that in the public domain.

So, to what extent does being affiliated with a group - so having a gay identity, for example, and being connected with other gay people - to what extent does that buffer or ameliorate some of the bad effects that you can get from prejudice and discrimination experiences? So if I'm connected with my community, do I learn different values, different norms, that reaffirm who I am, that give me more hope for the future, and so forth; and, therefore, also ameliorate or buffer some of the effects of stress leading to better mental health outcomes? So we looked at all of this combination of causes and interaction factors: so we look at the stress, the coping, and the outcome of mental health in those three groups. And I include women versus men, even though, of course, women are not a minority group, but they're disadvantaged and there are some similarities in terms of some of the stereotypes and potential discrimination. But each of those groups - race, ethnicity, gender, and sexual orientation - are very different; they're very different issues around it. But we did look at all three of those, how they interact and what it looks like in terms of patterns of mental disorders.

David: Well, it sounds like a very complex study, and I understand that you're still mining the data. What have some of the main findings been so far?

Ilan Meyer: Well, one of the interesting things to me - and this is not totally something new or that I've come into the study with questions about - so one thing that, to me, is very interesting - and I'll answer your question more directly - is the fact that there are these different patterns when you look at the three different disadvantaged groups; that what you see in regard to sexual orientation in lesbian, gay, bisexuals versus heterosexuals, is not always similar to what you see, for example, with regard to race/ethnicity, for blacks versus whites; even though the theory behind it suggests that this is something that is common, that there's some social patterning of disease - this is the sociological, psychosocial theory behind it - but the evidence does not seem to support it so nicely, so fully.

So some of the findings that we had, for example, is when we look at the stress exposure. So we wanted to study each aspect of this theory, because a lot of the elements of the stress theory, especially when it comes to this social stress, are often assumed but not tested. And we wanted to test carefully the entire process. So the first hypothesis - you know, it's a pretty big hypothesis, there are a lot of different studies around that - is do disadvantaged groups, in fact, have more stress? Are they actually exposed to more stress? And that's already a complicated question, because then you ask, what does more stress mean? Does it mean more of one type of stress? Does it mean some kind of totality of stress exposure? What would that be? So there are a lot of both conceptual and measurement issues that you need to think about and answer before you can even do that.

So our approach to that was to look at what people called the broad spectrum of stress exposures. So I gave you an example before of a life event as one exposure of stress, but there are other types of stressors, for example, chronic stressors. So a life event might be losing your job, but being unemployed is a chronic stressor. So we looked at the range of those exposures to stress and assessed on those groups that I mentioned before - that is gender, sexual orientation and race/ethnicity - whether there are differences in exposure to stress that are predicted by the social stress theory, which would be that the disadvantaged group has more stress than the advantaged group.

And what we found was interesting. Regarding race/ethnicity, we found that, indeed, black and Latino - in this case they were lesbian, gay, bisexual blacks and Latinos - they had more stress than the whites and the heterosexuals, that is, the white gay and straight. We found that the gay and bisexual and lesbian people, compared to heterosexual, had more stress but only some types of stressors. They had more stressors which we would call objective stressors that we were able to identify by looking at what happened to them - and I can tell you a little bit more about how we determined that. But they were not as good at calling those stressors out, so when we asked them questions about what is called an "everyday discrimination scale," which is about being exposed to unfair treatment, the white gay, lesbian, bisexuals were not able to tell us about those things; whereas the blacks and Latinos were. So that's a difference by race/ethnicity.

But all of them had, in fact, experienced more stressors when we looked at those stressors and assessed them. So those were what we would call the objective stressors; those are the big life stressors such as being raped, being abandoned as a child, being homeless, things like that. So those are the things that we were, not asking their opinion, but asking them for certain facts. So their opinion, their assessments [unintelligible] for the whites versus blacks and Latinos. In terms of gender, we found that men and women did not have different levels of overall stress - and this is something that is also found in the general literature. So I'm giving here, like, three lines of stories and it can be complicated without showing you any pictures.

David: Yes.

Ilan Meyer: But, basically, what we're seeing is that, regarding gender, the expectations of social stress theory that the disadvantaged group - in this case women - would have more exposure to stress is not verified, not by our studies and actually not by many other studies. Regarding race/ethnicity and regarding sexual orientation, we do find evidence that the gay, lesbian, bisexual, in fact, do have more stress, more exposed to bad things defined in different ways; and the same thing is true for ethnic minorities.

And then we look at the outcome of mood disorders, anxiety disorders and substance abuse disorders. And there we found that, indeed, the gay, lesbian, bisexuals have higher rates of disorders than heterosexuals. This is something that has been found by many, many studies so far, including national studies and national probability studies, so it's not totally surprising, but it was verified again. And we see that the relationship between stress and mental health, as the theory predicted, is in fact supported by this study.

However, regarding the black and Latinos, we found an interesting finding. Again, this is a finding that is not unique to this study so I wouldn't tell you anything that is so unique that I would suspect were it actually valid. So this seems to be valid because it's been shown with other populations in general studies. So blacks and Latinos have more stress, but they don't have more mental disorders. So that's very bewildering, again, from the social stress perspective, because you question whether your theory is correct: if they have more stress and the stress is a cause of disorders - which is what this whole study is about - then how come they don't show more disorders?

And that's where the issue of coping and social support comes that I mentioned earlier, which is also part of the stress theory. So one explanation for that is that something about being black and Latino and being gay, actually, in some way protects you from greater stresses that you experience as a gay and bisexual person, and that therefore there does not show increase in the mental disorders that you see in the whites.

So, as you see, there are a lot of findings that are somewhat within the general theory; you can see where they're going. But there are also a lot of challenges to the general theory that makes you more and more intrigued. And that's where we begin to look at some of the relationships with identity and identification with your community; and to what extent there's some protective factors that help against mental disorders.

David: I'd like to ask you a question at this point about stressors, and I think maybe you've hinted at this. The stressor is external and yet we know from cognitive behavioral psychology and other sources that how stressful an objective event is depends, to some extent, on how it's framed or what the person tells himself or believes about that external event. So that two people could have the same external event befall them, yet one person might find it very stressful because of how they've coded it for themselves, and another person might be able to just dismiss it.

Ilan Meyer: Right, and that's a hugely important and difficult question in many ways, but it's a question that, basically, I would say, has two kind of philosophical orientations in the stress research literature. One is what you might refer to as the Lazarus and Folkman model of stress: they focused on stress in the way that you just described, which is, really, what is stressful is what the person appraises as stressful. So in order to know if something is stressful, you really need a subjective assessment of the person. So you and I can have a similar experience and I would find it stressful because of the way I understood it, the way I appraised it. And you might not find it stressful because of either the way you understood it differently, or maybe because you had better coping abilities, or many other reasons. So this is the Lazarus and Folkman definition of stress, and that's what I would call a subjective stress definition.

Against that there is another kind of, I call it, philosophical approach that views stress that something that should be assessed more objectively. And according to this view, if something bad happens people may have different responses to it, but we define it as stressful because it requires some kind of adaptation by the person. And this is really kind of the original stress definition that started in the '60s and '70s with Holmes and Rahe, who did studies on, basically, life events. They counted how many events happened to you and they showed - and, again, this literature has a long history and complicated history - but at least the theory was, the more events you have, the more adaptations you required; and regardless of whether you appraise at positive or negative, they really didn't care about that. Just the fact that you need to cope with things, even if you're successful with them, that need to cope is itself the stressful process.

So they're different approaches, and we actually use both approaches. We use both the subjective and the objective ways of thinking about stress, and of asking people about stress. So when we ask about events, one part of it we assessed independently of the person and not even about the person. It goes something like that: what would the average person experience in this kind of thing? Not how would it affect them in terms of their health outcome, but would that be something that requires a lot of adaptation, a lot of effort in coping? And if it does, then it's a stressful event regardless of whether they successfully coped with it, and even may not have experienced it themselves as stressful. And the reason that has benefit, that is sometimes counter-intuitive, especially for people who are more into subjective, humanistic psychology, and especially in therapy. In therapy you're dealing with one person, so that's the only perspective that matters, that person's perspective. But we're looking at population studies, you're interested in something additional to that; and in this case I was interested in the kind of average stress experience by people, regardless of whether they know that they're experiencing stress or not. So, for example, if I asked you - and again, the word "stress" has so many meanings that we don't even use it usually - but if I ask you, did you ever become homeless, I didn't then ask you whether that was stressful to you. I'm assuming a certain average stressfulness of something like that.

David: Sure.

Ilan Meyer: So that's the two different approaches, and each of them has benefits and disadvantages, of course. In some ways you can say, well, if I didn't experience it as stressful, then obviously it wasn't. And that's what we look at: we look to study to see whether those two different types of stress definitions work in different ways, and sometimes they do work in different ways, or not.

David: Are there questions that remain for future research?

Ilan Meyer: Oh, my goodness, yes. One of them is, actually, the one that we started with, which is the suicide. So one of, I think, the most interesting - well, not the most - but one of the fascinating findings that we found in terms of the epidemiological findings, is the really interesting difference between the black and Latino and white gay, lesbian, and bisexual respondent. So, I mentioned earlier that when we looked at the prevalence of mental disorders - again, those are depression or mood disorders, anxiety disorders and substance disorders - blacks and Latinos, but especially blacks, do not have higher prevalence than whites. Now, this is true, by the way, in the general US population as well, and it's one of those paradoxes that has occupied stress researchers: how is it possible that a group - in this case, let's say, blacks in the US - are undoubtedly exposed to prejudice and discrimination more so than whites, again, on average; how is it possible that you don't see this relationship in this population? So we didn't find that, as well, in the gay sample.

However, when we looked at suicide attempts we found the opposite pattern. So in the mood disorders, which are usually considered a precursor to suicide, we found that whites actually have higher rates than blacks and Latinos. In the suicide attempts, we find the exact reverse pattern; that blacks and Latinos - and this is more so Latinos - but blacks and Latinos had more suicide attempts than the white sample. And this is bewildering for many reasons. For one, that it is a different pattern from mood disorders, or other disorders, and suicide, which normally we think of as traveling together. We think of mood disorder, especially, as a precursor of suicide. So here you have a population that has higher mood disorders, lower suicide attempts; and a population with lower mood disorders, higher suicide attempts. In the case of Latinos it was, like, hugely different; like much higher. In the case of blacks it was somewhat higher, but it looks impressive. You look at it, it's like, what's going on here? Why do we see this reversal? But the other reason that it's interesting is that, in the general non-gay population, not only we don't see that, we see that blacks and some Latinos - we don't have that great studies - but certainly with blacks, we see lower rates of suicide. So here you have a population in the gay and lesbian sample that 1) it doesn't match the general non-gay population pattern, and 2) it goes against what we think normally about suicide attempts.

So this is the topic of the next study that I'm actually working on, a proposal right now for submission on July 5. And my theory on that goes back to the stress theory, and it goes back to some of the things that I've already noticed in the study. And that is that, perhaps, in the suicide attempts, what is going on is there's something other than mood disorder that has a very strong effect; and that something else is actually those stressful events.

What we've found - and I didn't do this analysis yet because it's a little complicated, I'll tell you why - but based on the impression of the data, the black and Latino respondents reported many quite horrendous life experiences around the time of their coming out, coming out meaning when they first realized that they were gay or lesbian and told somebody in their family, or somebody in the family found out about it. And what we found is that that was accompanied by a lot of bad things happening to them, such as being thrown out of the home, such as being raped, such as being harassed in school, such as being attacked - there's a lot of interest now about bullying, for example. A lot of those kids experienced that.

So my research question is: is it possible that those kinds of experiences, even in the absence of any mood disorder underlying there, would be a cause for suicide attempt? Because, again, just imagining what it might be like for a young person like that - most of the suicide attempts occur under age 20, so a teenager - what is it like to discover that you're gay or lesbian, to have these experiences occur to you, and what is your sense of your future? And whether that alone is a risk factor for the suicide attempts. That would be quite different from what we normally think of. So that's the topic of the study that I'm looking at. That is, by the way, an area that people are beginning to look at in general, not just in my study, about things other than mood disorders. But, to me, that's very interesting, where you see this almost reversal of patterns between mood disorders and suicide attempts.

David: Yes, that's very interesting. A topic that you've written about, that maybe is relevant to this discussion, is internalized homophobia. Tell us a bit about that.

Ilan Meyer: Well, in terms of homophobia, you asked me before about what I was calling objective and subjective stressors. I actually include among the stressors not just life events, but also other things that are at different levels of internalization, you might call, or subjectivity, you might say. So the life events are something that happens externally completely, and then you may or may not go through some kind of an appraisal process. But what I said in this minority stress theory is that there are other processes that might be more internal and may really rely on cognitive and affective kind of processes that are not directly related to what is happening to you on the outside, but still are very much connected to the social environment. And internalized homophobia is one example of that; there are others.

In this case, the person takes in, internalizes, notions about what it is like to be who you are - which is gay or lesbian. And, normally, people come out at some age; in other words, nobody is raised gay - although it seems that young kids are coming out earlier and earlier. When I was young, you didn't hear about a lot of people coming out in high school, but now that seems to happen quite a lot. But still, at some point somebody says to themselves or recognizes or realizes or names it - whatever the process might be and the different theories about what that is - that they maybe associate themselves with being gay or lesbian. And, again, they might not use those terms, by the way; those terms I'm just using as a generalization.

So what happens at that point where you recognize that, or you name this, or you identify that? And the question is: how do the social norms about homosexuality or about heterosexuality, about expectations, about the religious norms and values, how does that affect you when you begin to think of yourself as a gay or lesbian person? And internalized homophobia is when you internalize negative attitudes or negative values, and assign them to yourself. And we see a lot of examples of that, for example, from people who were raised in a very strictly religious environment, although it's not only a religious environment. But often they might be people who have gone to church and were told by their priest or preacher negative things about what it is to be gay, and then they think that they themselves might be gay, and then they think they're all those bad things and they're going to go to Hell. Or in a non-religious setting it is, again, very similar; it doesn't have to be a religious setting.

So internalized homophobia is just feeling negative things about who you are, about what your prospects for the future might be. I mentioned before, stereotypes about having family, the notion that, at least in the past - and it definitely has been changing, I hope that it's very different now and we do have some evidence that it is different - that you thought, well, if I'm gay, I'm never going to have a family, I'm never going to have children. And what does that do to a young person growing up? So that's the internalized homophobia part.

There are other elements of social stressors that can affect a person without anything actually happening directly or immediately to them. Another one of them is what I call "expectations of rejection," which is not about internalizing on your own self the homophobia, but expecting it from other people. And this is something that Gordon Allport, who talked about prejudice, talked about a lot - as did Erving Goffman, who talked about stigma. Allport actually called it "vigilance." It's the expectation that somebody else might harm you in some ways, and it's kind of like being on edge or being watchful all the time, which is a very stressful experience to be.

So one example of that might be when you're at work and you cannot tell anybody that you're gay, if you're gay. And you have to make up all kinds of stories about what you did this last weekend, and about your partner, and you have to change the gender of the partner. And there are a lot of studies in social psychology and cognitive psychology, actually, that show that this is a very stressful experience for people to kind of lead this double life. They've done studies, for example, with women with breast cancer who were, basically, trying not to tell anybody at work for fear that it might damage their prospect for other reasons. And it's just very, very stressful; actually the office there was referred to like a "living hell" kind of experience where you always have to think about how to disguise who you really are. So that's another experience of stress that I've talked about and that we measure, that vigilance thing. So these are the more, I would say, subjective or internalization aspects of the stressful environment.

David: Yes, I also that you've done several studies in relation to issues surrounding abuse and eating disorders in gay populations. What have you found there?

Ilan Meyer: So, eating disorders is another interesting area, and it's actually a rare disorder. In the general population it's about 1%, and it's very hard to study in many studies because it's rare, so you need a large sample. So there's been a lot of theories that gay men are especially susceptible to eating disorders, and there have been several studies that show that they have related things, like symptomatology of eating disorders, meaning the symptoms, not necessarily the actual diagnostic category. Or that they have other types of things that could be related to it, like body image issues that may relate to eating disorders. But we used the study to examine whether the actual defined category of eating disorder is actually more prevalent in gay men than it is in heterosexual, as many studies speculated. So that was that study, and we did actually show that the prevalence was much higher than it was in the general population and than it was in the straight men in our study.

We also looked at some causes, potential predictors, of that; and sex abuse history was one of them that had been hypothesized to be a potentially distal cause of eating disorders, and we did find a relationship. Of course, we don't think that that's a sole cause or even if it's the most important cause, but in this paper we show that it's associated with that as a predictor; that people who had sex abuse were more likely to also have eating disorders.

David: Okay, well, your data is so rich, there's so much more that we could explore. I have to say, you're very courageous to tackle such complex issues and to approach them in such a complex way. I wonder if there are any final thoughts you'd like to leave our audience with, as we wind down here.

Ilan Meyer: Well, I guess you're right, this is a very complicated theory, and I think the only thing I would say, is that I hope people, both researchers and lay persons who think about it, they actually take the more complex approach to understanding it because it's really not an easy way to summarize all that. That's why I always try to stress that there are a lot of inconsistencies; it's not like we can say in one sentence, this is bad, this is good. But we do see, certainly, evidence that shows that what happens to people in their social environment is very important to how they feel, to their general health, to their wellbeing. And there are other studies where we looked at wellbeing outcomes and more positive kind of outcomes, rather than just negative outcomes; and we see similar patterns.

So it's important to think about that, and it's important to think toward the future, about what kind of interventions would come out of that. And I think the recent discussion about bullying, that I mentioned earlier, in the schools is a very important part of that because a lot of the events that I referred to, that we see now in our respondents, that they talk about - and we have narratives for, literally, thousands of events that happened to them - many of them do occur in school; and gay and lesbian people are subject to stressors like that, that could have really grave effects. And I think we haven't taken it seriously enough so far, so that's another area that I'm hoping to be able to influence by looking at some of those issues around youth. But, other than that, I guess I would encourage people to read more about it and, as you said, it's a very complex theory and it's a very complex set of evidence that we need to consider.

David: Well, Dr. Ilan Meyer, thank you so much for being my guest today on Wise Counsel.

Ilan Meyer: All right, thank you so much.

David: If nothing else, Dr. Meyer's research certainly suggests that more widespread tolerance and acceptance of minority differences would go a long way toward reducing the misery they often experience. You can learn more about Dr. Meyer's work, including the opportunity to read some of his research papers online, by going to the website at

You've been listening to Wise Counsel, a podcast interview series sponsored by If you found today's show interesting, we encourage you to visit, where you can add a comment or question to this show's web page, view other shows in the series, or simply page through the site, which is full of interesting mental health and wellness content. Access the show's page and show archive information via the podcast box on the home page.

If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.


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  • Meyer's professional homepage at Columbia University is devoted to his NIMH funded Project Stride, which is set up to explore the intersection of stress, identity and mental health.

About Ilan Meyer, Ph.D.

Ilan Meyer, Ph.D.Dr. Ilan Meyer is Associate Professor of Clinical Sociomedical Sciences, Mailman School of Public Health, Columbia University. His academic background is in social psychology, psychiatric epidemiology, and sociomedical sciences. For the past 10 years he has been studying public health issues related to minority health. His areas of research include stress and illness in minority populations, in particular, the relationship of minority status, minority identity, prejudice and discrimination and mental health outcomes in sexual minorities and the intersection of minority stressors related to sexual orientation, race/ethnicity and gender.

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