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Depuis la dépathologisation de l’homosexualité par les sociétés savantes en santé mentale, la formation des psychothérapeutes sur les minorités sexuelles comporte des lacunes. On préconise souvent de traiter les patients issus de ces minorités comme tous les autres. Or, le développement identitaire de ces personnes comporte des particularités qu’il est nécessaire de connaître pour adapter les évaluations et les interventions psychothérapeutiques comme il se doit. Le présent article propose un cadre théorique, des outils d’évaluation et des pistes thérapeutiques pour accompagner une personne issue d’une minorité sexuelle qui consulte un professionnel en santé mentale.

Les concepts de non-binarité de genre, de construction sociale des rôles de genre, les dimensions distinctes de l’orientation sexuelle (attirance émotive, attirance physique, comportement et identité sexuelle), l’indépendance des attirances envers un sexe et envers l’autre, l’impact et les manifestations de l’homophobie ainsi que le processus identitaire sont décrits dans le présent article. Une attitude d’ouverture quant à la diaspora sexuelle est prônée afin d’accueillir le patient et de lui permettre une exploration ouverte dans un cadre thérapeutique sécurisant et sans danger.

Les différentes facettes à explorer lors de l’évaluation de la sexualité sont énumérées. Des pistes de traitement psychoéducatif, cognitif et psychodynamique sont proposées, entre autres : déconstruire les mythes pour réduire l’homophobie ou la transphobie, panser les blessures narcissiques et relationnelles dues à l’homophobie, analyser le pour et le contre d’un mode de vie authentique, avec ou sans « sortie du placard » ou coming out. L’apport des interventions familiales et des thérapies de groupe est aussi exposé.

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Objective To propose a theoretical model and clinical approach to sexual minority patients who consult mental health professionals

Methods Clinicians at the McGill University Sexual Identity Center (MUSIC) who have been treating patients from various sexual minorities for more than 15 years present useful theoretical constructs of gender and sexuality as well as guidelines for the evaluation and treatment of patients consulting for discomfort or confusion surrounding their sexual orientation, their gender identity or both, based on both the current literature and their clinical experience.

Results The notions of non-binary construction of gender, of social determinism of gender roles and expression, and of gender creativity are presented. Sexual orientation is divided into four most commonly used dimensions (emotional attraction, physical attraction, behaviour and identity); the fluidity of these and their potential non-concordance are described. The fact that attraction to one gender is independent of attraction to another gender is highlighted. An attitude of openness to all forms of gender expression and sexual orientation constellations is encouraged to allow the patient free exploration of the several facets of their sexuality.

Various domains to explore in evaluating sexual orientation and gender as well as therapeutic avenues are proposed. Areas to enquire about include: mental, physical and social experiences of gender, eroticism and sexual fantasies towards all genders, emotional attraction towards them, sexual and romantic experiences, comfort and certainty about one’s identity and about disclosing it.

Psychoeducation can be used to teach about sexual diversity and to assess the risks and benefits of coming out to self, family, friends, co-workers or strangers. Cognitive strategies can be undertaken to debunk homophobic and transphobic myths which may fuel poor self-esteem. Psychodynamic approaches can be used to heal the narcissistic wounds of homophobia that may lead one to be mistrustful of authority figures or to suppress sexual feelings when emotional attachment becomes important. Some of these dynamic patterns are rooted in past reactions to parental homophobia and the compromises sexual minorities made as children in order to preserve their relationships with their parents. For youth coming out in present times, family support is crucial to well-being and can be enhanced through family therapy. In mixed orientation couples, couple therapy can help both spouses adapt to the coming out of one of the partners and find a new partnership. Group therapy is useful for many of the above issues particularly as it provides a sense of community which is often lacking in minority groups, especially when individuals and their families do not share the same minority status.

Conclusion With the proposed framework and an attitude of openness to sexual diversity, clinicians should feel competent to treat sexual minority patients.

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Des travaux pionniers développés au cours des dernières décennies permettent de concevoir les notions de sexe, de genre et d’orientation sexuelle de façon à dépasser le traditionnel modèle binaire. De manière générale, les professionnels de la santé et des services sociaux tardent toutefois à prendre acte de ce changement de paradigme qui fait une large place à la diversité humaine, et beaucoup moins à la marginalisation ou à la pathologisation des différences. Dans le présent article, seront notamment présentés les travaux d’Alfred Kinsey, de Sandra Bem et d’Anne Fausto-Sterling, portant respectivement sur l’orientation sexuelle, le genre et le sexe. Il sera proposé d’inclure leurs contributions (et celles de leurs successeurs) dans un modèle tenant compte à la fois de la diversité et de la fluidité susceptibles d’être présentes dans les identités et les expressions de soi relatives au sexe, au genre et à l’orientation sexuelle.

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Pioneering work conducted over the past decades used to design sex, gender and sexual orientation in order to go beyond the traditional binary model. In general, professionals in the health and social services, however, are a little bit slow to take note of this paradigm shift making more space for human diversity, and much less to the marginalization or pathologizing of differences. In this article, the work of Alfred Kinsey, Sandra Bem and Anne Fausto-Sterling will be especially presented, respectively on sexual orientation, gender and sex. It will be proposed to include their contributions (and also those of their successors) in a model taking into account both the diversity and the fluidity that may be present in identities and self-expressions related to sex, gender and sexual orientation.

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Le but de cette étude était de comparer l’association de l’intimidation avec l’idée suicidaire, la planification et la tentative de suicide, chez les élèves hétérosexuels sans attirance ou comportement envers le même sexe, les élèves hétérosexuels avec attirance ou comportement envers le même sexe et les élèves non hétérosexuels. Un total de 1852 élèves âgés de 14 à 18 ans, de 14 écoles publiques et privées de Montréal ont été interrogés anonymement. Les éléments du sondage ont évalué les dimensions de l’orientation sexuelle, les comportements à risque pour la santé, le harcèlement et les paramètres de suicide. En analyse multivariée, le groupe de référence était les élèves hétérosexuels sans attirance ou comportement envers le même sexe et n’ayant subi aucune intimidation. Lorsque les élèves avaient été victimes d’intimidation, ils étaient plus susceptibles d’avoir des idées suicidaires (rapport des chances [RC] = 2,11, intervalle de confiance [IC] 95 % = 1,52 à 2,92), mais pas plus susceptibles d’avoir eu des tentatives de suicide. Les élèves non hétérosexuels étaient deux fois plus susceptibles d’avoir des idées suicidaires lorsque non victimes d’intimidation (RC = 2,35, IC 95 % = 1,24 à 4,48) et quatre fois plus susceptibles lorsque qu’il y avait eu intimidation (RC = 4,44, IC 95 % = 2,26 à 8,72). De même pour les tentatives de suicide, elles n’étaient pas à risque accru sans intimidation, mais elles étaient presque trois fois plus nombreuses lorsqu’il y avait intimidation (RC = 2,87, IC 95 % = 1,43 à 5,78). La principale conclusion de cette étude est que la différence de risque suicidaire entre les élèves victimes et non victimes d’intimidation était de loin la plus grande chez les élèves ayant une identité non hétérosexuelle.

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Context Bullying is a known risk factor for suicidality, and suicide is the second leading cause of death for adolescents. Both are increased in sexual minority youth (SMY). As SMY are comprised of youth who self-identify as gay, lesbian, bisexual (GLB) or who have same-sex attractions or behaviors, our previous finding that different subgroups have different risks for suicidality is understandable. Given that the difference was along sexual identity lines (GLB vs heterosexual SMY), the analysis of bullying data in the same subgroups was felt to be important.

Objective To compare the association of bullying and suicide among heterosexual students without same-sex attractions or behaviors, heterosexual students with same-sex attractions and behaviors, and students with gay, lesbian or bisexual (GLB) or unsure sexual identities.

Design The 2004 Quebec Youth Risk Behavior Survey (QYRBS) questionnaire was based on the 2001 Center for Disease Control Youth Risk Behavior Survey, and included items assessing the three dimensions of sexual orientation (identity, attraction and behavior), health risk behaviors, experiences of harassment, and suicidal ideation, plans and attempts.

Methods A total of 1852 students 14-18 years of age from 14 public and private high schools in Montréal Québec were surveyed anonymously during the 2004-2005 academic year.

Main outcome measure Self reports of suicidal ideation, suicidal plan and suicide attempts in the last 12 months.

Results In all, 117 students (6.3%) had a non-heterosexual identity (GLB or unsure) and 115 students (6.3%) had a heterosexual identity with same-sex attraction or behavior. Bullying occurred in 24% of heterosexual students without same-sex attraction or behavior, 32% of heterosexual students with same-sex attraction or behavior, and 48% of non-heterosexually identified students. In multivariable analysis, the common risk factors of age, gender, depressed mood, drug use, fighting, physical and sexual abuse, and age of initial sexual contact were controlled. The reference group was heterosexual students without same-sex attraction or behavior and no bullying. When these students were bullied, they were more likely to have suicidal ideation (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.52-2.92) but not suicide attempts. Non-heterosexual students with no bullying were twice as likely to have suicidal ideation (OR = 2.35, 95% CI = 1.24-4.48) and four times as likely when bullied (OR = 4.44, 95% CI = 2.26–8.72). Similarly for suicide attempts, they were not at increased risk when not bullied, but they were almost three times as likely when bullied (OR = 2.87, 95% CI = 1.43-5.78). Heterosexual students with same-sex attraction or behavior were never more likely on any of the suicide measures compared to the reference group, even when bullied.

Conclusion This study was the first to show that adolescent students with a non-heterosexual identity will have a disproportionate increase in their suicide parameters when subject to harassment, but that heterosexually identified students with same-sex attraction or behavior did not have an increased risk over heterosexually identified students without same-sex attraction. This suggests that same-sex attraction and behavior on their own are not contributory to suicide risk, and that the efforts of future research as well as public health efforts may be better served by examining the interface between sexual identity and the school, family, and larger culture that surrounds the sexual minority youth. Longitudinal studies looking at the interplay between all these factors are needed.

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Les normes traditionnelles de genre prescrivent l’adéquation de l’expression de la masculinité et de la féminité au sexe anatomique de naissance. Les personnes qui présentent des variations dans l’expression de genre sont sujettes à diverses formes de réactions sociales suggérant la réprobation (des regards désapprobateurs aux violences physiques) susceptibles d’influencer négativement leur santé mentale. Trente-sept jeunes se décrivant comme trans ou en questionnement sur leur identité de genre ont été recrutés dans le cadre de l’enquête sur les Parcours amoureux des jeunes de minorités sexuelles du Québec. Leurs expériences de victimisation parentale et de victimisation basée sur la non-conformité de genre ainsi que des indicateurs de santé mentale (détresse psychologique, estime de soi) ont été mesurés. Afin de comparer les expériences de victimisation et l’état de santé mentale des jeunes trans, ils ont été appariés à 37 garçons et 37 filles cisgenres sur la base de leurs caractéristiques sociodémographiques. Des analyses de prévalence et un modèle acheminatoire ont été réalisés. Les résultats mettent en évidence que les jeunes trans sont plus susceptibles de présenter des scores cliniques de détresse psychologique et de faible estime d’eux-mêmes que leurs pairs cisgenres. La violence verbale parentale et la victimisation basée sur la non-conformité de genre influencent négativement l’estime de soi, ce qui en retour augmente la probabilité de vivre de la détresse psychologique. Les résultats appuient l’importance des interventions de soutien à la diversité sexuelle et de genre.

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Introduction Trans youths are more likely to experience negative social and parental reactions suggesting reprehension, from disapproving looks to physical violence. While victimization increases the likelihood of poor mental health outcomes, little is known about potential mediating factors between mental health and victimization. Self-esteem is one of the factors that may mediate the impact of homophobic victimization on mental health. Yet, data on trans youths are scarce.

Objectives The objectives of this paper are: 1) to compare trans youths to cisgender heterosexual male and female youths regarding two different forms of victimization (victimization based on gender nonconformity and parental verbal abuse), self-esteem, and psychological distress, as well as 2) to test a path model of the impact of these two forms of victimization on self-esteem and psychological distress.

Methods Data for this study are drawn from the Quebec Youths’ Romantic Relationships survey. Data were collected among youth aged 14 to 22 years old recruited either in schools or online. Thirty-seven participants endorsed being trans or questioning their gender identity. They were paired to 74 cisgender heterosexual youths (37 male and 37 female) using propensity scores based on socio-demographic characteristics.

Results Results showed that verbal parental abuse and victimization based on gender nonconformity were more prevalent among trans participants. Parental verbal abuse and victimization based on gender nonconformity were both directly and negatively associated with self-esteem (explained variance: 36%). Sexual status explains 19.6% of the variance of parental victimization and 50.6% of the variance of victimization on the basis of gender nonconformity. A higher self-esteem was associated with decreased psychological distress (explained variance: 66.9%). Moreover, parental verbal abuse was also directly associated with higher psychological distress. Although there was no direct relationship between trans status and psychological distress and self-esteem, its total indirect effects on these two indicators of mental health and wellbeing status were significant (p-value < 0.001), suggesting that the impact of sexual status on them is mediated by the victimization.

Conclusion This study showed the high vulnerability of trans youths to poor mental health and wellbeing outcomes because of the victimization they experience. The results highlight the importance of preventing victimization based on sexual-minority status and to educate people, including parents, to sexual and gender diversity.

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Cet article explore les connaissances les plus récentes sur l’expérience des jeunes trans et de leur famille, et propose des pistes d’intervention pour les professionnels travaillant directement ou indirectement avec ces populations. La première partie de l’article étaye le contexte sociopolitique dans lequel grandissent les jeunes trans. Cette discussion est suivie d’une recension des écrits sur les connaissances relatives à l’expérience des jeunes trans et de leur famille. Finalement, l’article propose deux pistes d’intervention à privilégier pour travailler avec ces populations, et ce, dans une perspective de travail transaffirmative. Notamment, on y propose de réapprendre le genre et de comprendre la complexité des parcours et expériences des personnes transgenres, ainsi que de promouvoir l’autodétermination et le soutien des familles vers l’atteinte de leurs besoins.

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This article explores the most recent knowledge on the experiences of trans youth and their parents. The article also explores best practices for professional who work with those families. Finally the article proposes two main principles of intervention to work with those populations, highlighting the importance of a transaffirmative perspective. In particular, it is proposed to challenge the current way of understanding gender and to appreciate the complexity of the various trajectories young people may take. Furthermore, we suggest focusing the intervention on promoting self-determination of the young person as well as to support families so they can better meet their child’s needs.

Objectives To provide comprehensive review of current knowledge on the experience of parenting a transgender youth, and to propose some reflections on directions for working with those families.

Method Written as a theoretical paper, this article employs a systematic literature review to identify promising interventions with families who support a transgender youth.

Results Because families of transgender children and youth experience difficulties both on personal and social levels, many of which are coming from social stigmatization and lack of knowledge about their experience, it is proposed that practitioners work toward interventions that not only facilitate families support, but also works toward a more just and inclusive society by broadening access to services and by challenging oppressive structures that contribute to the difficulties experiences by children, youth and their families.

Conclusion The paper proposes that practitioners working with families of transgender children must be guided by an reviewed conception of gender and an understanding of the multiplicity of contexts that may affect the person’s trajectory, as well as promoting self-determination and supporting families in meeting their needs.

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Cet article explore le rôle modérateur du soutien parental dans les relations entre la victimisation homophobe, l’homophobie intériorisée et la détresse psychologique chez des jeunes de minorités sexuelles (JMS), que l’on dit aussi lesbiennes, gais, bisexuels ou en questionnement. Il vise à 1) documenter la prévalence des différentes formes de victimisation homophobe vécue par les JMS, et ce, selon le genre et l’âge ; et 2) explorer l’effet modérateur du soutien parental dans la relation entre la victimisation homophobe, l’homophobie intériorisée et la détresse psychologique. Un échantillon de 228 JMS âgés de 14 à 22 ans, non exclusivement hétérosexuels, recrutés en milieu communautaire dans le cadre de l’enquête sur le Parcours amoureux des jeunes (PAJ) du Québec a été analysé. L’impact de la victimisation homophobe, du soutien parental, de l’homophobie intériorisée sur la détresse psychologique est exploré par un modèle de régression linéaire avec effets de modération et de médiation. Le rôle modérateur du soutien parental est confirmé dans la relation entre la victimisation homophobe et la détresse psychologique. Ces variables peuvent constituer des leviers pour prévenir les effets négatifs des préjudices homophobes sur la santé mentale des JMS.

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Introduction Sexual-minority youths (SMY) report high rates of psychological distress such as depression, anxiety and suicidal ideation (Burton, Marshal, Chisolm, Sucato et Friedman, 2013; Williams & Chapman, 2011). Several studies confirm that the poor mental health outcomes are partly related to their high likelihood of experiencing homophobic victimization (Blais, Gervais, Boucher, Hébert & Lavoie, 2013; Taylor & Peter, 2011; Hughes, McCabe, Wilsnack, West & Boyd, 2010; Chamberland, Richard & Bernier, 2013). Whereas the development of a positive sexual minority identity is crucial for the mental health of SMY (Chamberland, Richard & Chevrier, 2011; Rosario, Schrimshaw & Hunter, 2011; Luhtanen, 2002), the victimization they experience put them at risk of internalizing societal homophobia and heterosexism (Meyer, 2003; Hatzenbuehler, 2009). It is important to identify variables that may influence the impact of distal and proximal factors that impact SMY’s mental health.

Objectives The objectives of this paper are 1) to document different forms of homophobic victimization experienced by SMY, according to gender and age, and 2) to test the potential moderating effect of parental support in the relationship between homophobic victimization, internalized homophobia and psychological distress.

Method Data come from 228 SMY aged 14 to 22 years old recruited through online means as part of the Quebec Youth’s Romantic Relationships Survey. The impact of homophobic victimization, parental support, and internalized homophobia on psychological distress is explored by a linear regression model including moderated mediation effects.

Results Results show the relationship between homophobic victimization and psychological distress as well as indirect significant relationship through internalized homophobia. The moderated mediation analysis also confirms the moderating role of parental support in the relationship between homophobic victimization and psychological distress. Thus, at equal level of victimization, participants with low parental support experienced more psychological distress. However, parental support did not lessen the impact of victimization on internalized homophobia. The linear regression model explains 22.5% of the variance in psychological distress and 6.6% of the variance of internalized homophobia.

Conclusion The results emphasize the importance of continuing efforts to prevent homophobic behaviors and attitudes among school staff, parents as well as employers and colleagues in the workplace. Given their key role, parents must also be educated and trained to support their gay, lesbian, bisexual or questioning children.

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Le processus identitaire par lequel passe une personne d’une minorité sexuelle inclut plusieurs phases, dont la confusion, la prise de conscience d’un homoérotisme, la comparaison avec des pairs hétérosexuels et homosexuels, le deuil des privilèges sociaux reliés à l’hétéronormativité et enfin l’acceptation et l’intégration de son orientation sexuelle minoritaire. Il arrive que la détresse occasionnée par la réalisation d’être autre que ce que l’individu, sa famille et la société avaient prévu amène la personne à consulter un professionnel de la santé. Les pratiques actuelles en cette matière proscrivent toute thérapie de réorientation et encouragent plutôt le professionnel à aider l’individu dans son acceptation de sa minorité sexuelle. Or, il arrive quelques fois que des individus sans aucun homoérotisme consultent pour une détresse reliée à un questionnement identitaire sexuel. Cet article propose une série de cas de jeunes hommes qui ont demandé de l’aide pour accepter leur orientation sexuelle mais qui n’avaient pas l’érotisme pour soutenir leur questionnement pourtant persistant. Le diagnostic de trouble obsessionnel compulsif (TOC) a été posé et traité. Comme il y a peu dans la documentation scientifique décrivant cette forme de TOC, ces illustrations cliniques servent à décrire le phénomène et à dégager quelques pistes diagnostiques et thérapeutiques, et ce, afin d’éviter de confondre le TOC sexuel avec une détresse reliée à la non-acceptation d’un érotisme homosexuel.

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Objectives In synthesizing a homosexual or bisexual identity, an individual may go through different stages before coming to a positive healthy identity. It is likely that there will be a period in which homosexual yearnings will be unwanted. Sometimes this distress leads the person to consult a health professional. Conversion therapy has been proven both ineffective and harmful and therefore has been ethically prohibited by all major psychiatric and psychological associations. The responsible clinician will attempt to assist the individual in his acceptance of his sexual minority. Occasionally individuals without homoeroticism consult because of distress related to sexual identity questioning which poses a different problem for clinicians especially if the situation goes unrecognized. The objective of this paper is to describe homosexual obsessive compulsive disorder (HOCD) and distinguish it clinically from the normal process of sexual minority identity formation in western culture.

Methods A literature review yielded very few descriptions of homosexual OCD. A retrospective chart review of all patients seen in the last 3 years at the McGill University Sexual Identity Centre was conducted to identify all the cases of OCD. Six cases were found, 4 of which were of HOCD and are presented. Similarities between cases are highlighted.

Results All cases were young men with relatively little relationship and sexual experience. Most were rather shy and had some other obsessional history in the past though often at a sub-clinical threshold. Obsessional doubt about their orientation was very distressing and did not abate over time as would normally occur with a homoerotic individual. The four patients who had an obsession of being gay despite little or no homoerotism are presented in detail. They all presented mental compulsions, avoidance and physiological monitoring. Continuous internal debate trying to prove or disprove sexual orientation was a ubiquitous mental compulsion. They all spent a majority of time monitoring their physiological reactions to members of both sexes to check for arousal. They attempted homosexual activity and were disgusted by it, yet this did not end their questioning. They avoided relationships with the opposite sex, being either too anxious to initiate, or too conflicted to maintain them. The obsession with being gay seemed like a horrific thought symptomatic of homophobia, however the level of horror was out of proportion to the patient’s overall level of homonegativity suggesting that the horror came mostly from feeling like their core identity was threatened.

Conclusion HOCD can present in ways similar to normal homosexual identity formation. A thorough exploration of eroticism towards both sexes as well as prior history of subclinical anxiety should help distinguish the two. Treatment of HOCD should combine education about sexuality and OCD as well as usual OCD treatments such as relaxation techniques, cognitive restructuring, mindfulness training and pharmacology.

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Malgré les avancées législatives en matière d’égalité au travail pour les minorités sexuelles et de genre (MSG), les données disponibles permettent de constater la persistance des discriminations en milieu de travail envers les personnes lesbiennes, gaies et bisexuelles, et surtout, envers les personnes transsexuelles/transgenres. Cet article, basé sur une revue de la littérature, explore les liens entre les différents vécus de discrimination en milieu de travail et leurs impacts sur la santé mentale chez les MSG et chez différentes sous-populations : hommes ayant des relations sexuelles avec d’autres hommes, femmes non hétérosexuelles, parents lesbiennes et gais, et personnes trans. De plus, l’article explore certains facteurs de protection et de risque individuels et systémiques qui interviennent dans cette relation, entre autres le dévoilement de l’orientation sexuelle ou de l’identité de genre et le soutien organisationnel. Finalement, la littérature sur la discrimination en milieu de travail et la santé mentale des MSG met en lumière l’importance, dans le contexte actuel, des approches intersectionnelles et des études sur les micro-agressions. Pour terminer, l’article discute les implications pour les milieux de pratique, de recherche et de travail tout en formulant plusieurs recommandations.

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Despite legislative advances in terms of workplace equality for sexual and gender minorities (SGM), available data ascertains the persistence of workplace discrimination of lesbian, gay, bisexual, and especially of transgender/transsexual employees. This article, based on an extensive literature review, explores the relationship between different types of workplace discrimination experiences and their impacts on the mental health of SGM and of different sub-populations: men who have sex with men, non-heterosexual women, lesbian and gay parents, and trans people. Furthermore, the article explores certain individual and systemic protection and risk factors that have an impact on this relationship, such as coming-out at work and organisational support. Finally, the existing literature on workplace discrimination and mental health of sexual and gender minorities highlights the importance, in the current legal and social context, of intersectional approaches and of research on homo- and trans-negative microaggressions. The article ends with a discussion on the implications for practice, research, and workplace settings, as well as with several recommendations for these settings.

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La plupart des gais et lesbiennes aînés ont été marqués dans leur trajectoire de vie par des expériences de discrimination et de stigmatisation reliées à leur orientation sexuelle. Ces expériences négatives peuvent avoir eu des impacts sur leur parcours de vie et sur leur santé mentale. Même si, actuellement, la majorité des aînés gais et lesbiennes ont et maintiennent une bonne santé mentale, il ressort des études que les personnes non hétérosexuelles sont plus à risque de développer certains problèmes tels que l’anxiété, la dépression, les idéations suicidaires et la consommation excessive d’alcool et d’autres substances. Cet article présente les facteurs pouvant fragiliser la santé mentale des aînés gais et lesbiennes, soit la victimisation et l’exposition à diverses formes de préjudices au cours du parcours de vie, la gestion continue du dévoilement ou de la dissimulation de l’orientation sexuelle, le degré d’homophobie intériorisée ainsi que la solitude ; et les facteurs potentiels de protection tels que les capacités de résilience, le réseau social et le soutien social. Cet article conclut sur les implications quant à la prise en compte des besoins propres aux aînés gais et lesbiennes. Des recommandations sont mises de l’avant dans une perspective de reconnaissance des enjeux touchant les aînés gais et lesbiennes, et d’amélioration des services qui leur sont offerts.

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Most gay and lesbian elders have experienced discrimination and stigmatization related to their sexual orientation in their life trajectory. These negative experiences may have had an impact on their life course and on their mental health. Even if the majority of gay and lesbian older adults actually have and maintain good mental health, studies show that non-heterosexual people are at a greater risk of developing certain difficulties, such as anxiety, depression, suicidal thoughts and excessive consumption of alcohol and other substances. This article presents the factors that may weaken the mental health of older gay and lesbian people, such as victimization and the exposure to various forms of prejudice in their life course, the continuous management of the disclosure or dissimulation of their sexual orientation, the degree of internalized homophobia, as well as loneliness; and also presents the potential protective factors, such as building resilience, social networks and social support. This article concludes by illustrating the implications concerning the specific needs of the gay and lesbian elders. Some recommendations are also formulated with regards to recognizing the issues affecting gay and lesbian older adults as well as improving the services that are offered to them.

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Contexte Dans la société polynésienne/tahitienne, il existe une condition sociologique et anthropologique appelée RaeRae ou Mahu. Un RaeRae est un homme se comportant et se considérant comme une femme. Les RaeRae et Mahu sont des bons exemples de transsexualisme ou de transvestisme liés à la culture. Être Mahu a une signification culturelle, reconnue dans l’histoire de la société polynésienne, et n’est pas le synonyme d’une condition médicale ou psychiatrique. Être RaeRae, c’est pousser la transformation jusqu’à l’éventuelle hormonothérapie et la chirurgie, en conservant le rôle social traditionnel du Mahu mais en étant susceptible d’être influencé par les rencontres avec les phénomènes de prostitution et d’homosexualité à risque.

Revue de la documentation scientifique et méthode Recherche dans différentes sources (MedLine, PsycINFO, google scholar), y compris les thèses universitaires (source DUMAS) avec 20 références françaises et anglophones au total.

Résultats et contenus Nous décrivons le phénomène, le contextualisons et décrivons les hypothèses socioculturelles. Nous retenons une référence liée à une connaissance implicite des rituels polynésiens en particulier sur les sacrifices : ce qui permettait aux Mahu de ne pas subir le sacrifice dont les victimes étaient des hommes. Une discussion générale doit être envisagée autour du DSM-5 avec l’entité du transgenre. La description contribue à une réflexion sur les limites qu’il y a à considérer le genre comme binaire plutôt que comme un continuum non régi par la médicalisation et la psychologisation d’un élément de culture, identifiable d’ailleurs dans d’autres espaces culturels, dont ceux des Amérindiens.

EN :

Background On numerous islands of the Pacific, under various names, there are people considered to be neither men nor women but half-men/half-women. In French Polynesia, there is a sociological and anthropological condition called RaeRae or Mahu. A RaeRae is a man who behaves as and considers himself to be a woman. RaeRae and Mahu are good examples of culture-bound transsexuality or cross-dressing. Being Mahu has a cultural meaning, recognized in the history of Polynesian society, and cannot be considered as a medical or psychiatric condition. Being RaeRae extends the transformation to possible hormone therapy and surgery; the traditional social role (education, tourism) of Mahu is retained but in some cases is influenced by prostitution and at-risk homosexuality.

Bibliographic sources and method We conducted a literature search using several medical, social, and anthropological bibliographic sources (MedLine, Google Scholar, PsycINFO, DUMAS). We used the terms RaeRae, Mahu, Polynesian androphilia, and Polynesian sexuality. We found 20 articles and theses. Some articles discuss a very similar condition in Samoa (fa’afafine). In addition, Mahu seems to be a derogatory term for a male homosexual or drag queen in the Hawaiian Islands.

Results and contents RaeRae and Mahu is broadly defined as men with sweetness [OK?] or women who are prisoners of men’s bodies. There is evidence of their presence and social functions in ancient times. The arrival of the missionaries and Christian morality resulted in the emergence of a new moral and sexual order. RaeRae and Mahu remain present and visible today. They are integrated into local professional and cultural life and are accepted, as long as their sexuality remains unspoken and invisible, which is more difficult for RaeRae. We describe the phenomenon and its context and the sociocultural hypotheses. We retain a reference connected to tacit knowledge of Polynesian sacrificial rites: Mahu did not undergo sacrifices the victims of which had to be men. A general discussion must be envisaged concerning the DSM-5, transgender identity and stigmatization. For instance, in Hawaii, people who identify as transgender continue to suffer high rates of violence, sexual assault and discrimination. The description contributes to an investigation of the limits of considering gender as binary; rather, it is a continuum not governed by the medicalization and psychologization of a cultural feature, which is also recognizable in other cultural areas including among the Amerindians. Studying RaeRae and Mahu in Polynesia means agreeing to confront the binary concept that structures and divides the world into two categories of gender and sex, male and female, just like grammatical gender in French. Examples from other cultures include the new half in Japan, muxe or muché among the Zapotecs of Tehuantepec, woubi in Côte d’Ivoire, femminielli in Italy, ladyboys or kathoeys in Thailand, natkadaw in Myanmar, hijra in India and Pakistan, khounta in Arab Islamic culture, and in Canada and the USA, agokwa among the Ojibwa, and ikoneta in the Illinois language. Mahu, or transgendered individuals and transvestites, were in fact viewed by the ancient Hawaiians as a normal element of the old social culture that preceded missionary days and American and French military missions. Mahu were not merely tolerated; they were regarded as a legitimate and contributory part of the ancient Polynesian community.

FR :

Cet article est le premier de deux articles explorant les liens bidirectionnels entre le concept d’adaptation et celui de neurosciences. Nous verrons tout d’abord dans cet article que les neurosciences peuvent être perçues comme ambitieuses et toutes-puissantes oscillant entre un danger réductionniste et déshumanisant ou bien cristallisant certains fantasmes de maîtrise. Nous verrons ensuite que la société s’adapte aux neurosciences en intégrant certaines méthodologies et certaines découvertes dans des domaines très variés, au point que nous pouvons nous questionner sur la neurosociété de demain. Ensuite nous verrons que la méthodologie des neurosciences est elle-même fréquemment remise en question et nécessite que chacun en connaisse les limites sans s’en tenir aux seules promesses. Après cela, nous verrons que l’adaptation vue comme une promesse d’un but déterminé et fini peut s’avérer rassurante mais est surtout improbable.

EN :

This article is a first article in a series of two articles exploring the bidirectional links between the concept of adaptation and of neuroscience. In this first article, first of all we will see that neurosciences can be seen as ambitious and all-powerful oscillating between a reductionist and dehumanizing threat or crystallizing some control fantasies. We will then see that society adapts itself to neurosciences methodologies and incorporate some discoveries in various fields so that we can ask ourselves about the neuro-society of tomorrow. Then we will see that the methodology of neurosciences themselves is frequently challenged and requires that everyone knows the limitations and not only stick to promises. After that, we will see that the adaptation seen as the promise of a determined and finite goal may be reassuring but is most unlikely.

FR :

La perspective biopsychologique systémique des émotions de base est un modèle heuristique permettant de mieux comprendre comment l’individu apprend à s’adapter à son environnement grâce aux différentes émotions qui se sont développées progressivement en même temps que la myélinisation des circuits neurohormonaux, de la naissance jusqu’à environ vingt et un ans. Ce sont ces mêmes émotions, agissant en complémentarité, qui vont permettre à l’individu de maintenir son équilibre tout au long de sa vie.

Cinq émotions de base ont été retenues, car dans la documentation scientifique, cinq circuits neuronaux associés aux émotions sont définis, soit les cinq circuits décrits par Panksepp : celui de l’agressivité (rage-colère), celui du stress (peur-surprise), développé par LeDoux, celui de la récompense (recherche-joie), développé par Tassin, celui de l’empathie (panique-tristesse), développé par Decety, et celui de la conscience (conscience-bonheur), développé par Damasio.

EN :

The systemic biopsychological perspective of basic emotions is a heuristic model that allows a better understanding of how people learn to adapt to their environment through different emotions that developed gradually along neurohormonal circuit myelination from birth until about the age of twenty-one. These same emotions, acting in complementarity, will allow the individual to maintain a balance throughout his life.

Five basic emotions were retained in line with the five emotions related to neuronal circuits, which are defined in the literature, and these are the five circuits described by Panksepp as follows: aggressiveness (Rage, angry), stress (Fear- surprise), developed by LeDoux, reward (Seeking-joy), developed by Tassin, empathy (Panic-sadness), developed by Decety, and consciousness (consciousness-happiness), developed by Damasio.

Several studies on myelination (Kinney, 1988, Parazzini, 2002, Deoni, 2012), Miller, 2012, and Welker, 2012) provide us with a scientific platform to determine the order of development of the neurohormonal circuits underlying basic emotions.

Neurohormonal circuits development begins at conception and will continue up until the age of 20-30 years. This article specifically addresses the first three years of life. It offers a systemic biopsychological perspective of basic emotions developed from the latest data in neuroscience. These informations have been integrated into a coherent whole that allows understanding the origin, the development and the functioning of basic emotions.

In addition to the information output from the thalamus to the midbrain that set in motion the somatic nervous system there exist, according to Roberge (1998), two other brain information sources that are managed by the hypothalamus (the limbic system). These two information sources allow the refining of the behavioural responses and they favour the homeostasis of the organism. The first information source goes from the midbrain to the hypothalamus to activate the peripheral nervous system. The latter is divided into two: the sympathetic (norepinephrine) that accelerates the motor response and the parasympathetic (acetylcholine), which slows it down. These two systems work in tandem. As for the second release of information, it is endocrine, thus it will follow the hypothalamus-pituitary-adrenal axis to cortisol, the hypothalamus-pituitary axis to endorphin and oxytocin and the hypothalamus-pineal axis to melatonin. The different emotional behaviours result from one of these two sources of information or from a combination of these two and are then managed by the limbic system, which is in continuous connection with the neocortex.

In short, no specific centre totally controls human behaviour. Control is achieved through a group of brain structures and relays, permitting adaptive behaviour and maintenance of balance by means of permanent exchanges. Anger, for instance, is a survival emotion, which allows protecting one’s physical integrity. It is very useful as an immediate response in an emergency situation, but it can also be harmful if it is used extensively in all situations, giving way to conduct disorders. Thus, the other neurohormonal circuits will regulate anger.

Emotions are an integral part of human behaviour. They allow the individual to constantly adapt to the physical and social environment. This approach brings a new perspective to understand how each person maintains balance to avoid the onset of clinical disorders. The understanding of neurochemical mechanisms underlying basic emotions opens up the door to several clinical applications.

FR :

Le trouble de personnalité limite (TPL) est une psychopathologie sévère qui engendre une grande détresse personnelle et familiale et dont l’étiologie remonte à l’enfance. Les données empiriques appuyant une certaine stabilité temporelle des traits de personnalité de l’enfance à l’adolescence et à l’âge adulte, plusieurs auteurs soutiennent qu’il est possible d’observer chez des enfants et des adolescents des traits de personnalité pouvant être associés aux caractéristiques du TPL à l’âge adulte. Peu d’instruments permettent toutefois d’identifier chez les enfants et les adolescents des traits associés au TPL, d’où l’intérêt du Borderline Personality Features Scale for Children (BPFS-C). Basé sur une perspective développementale, cet instrument mesure les traits de personnalité limite chez les enfants de neuf ans et plus par un questionnaire autorapporté. Une première étude de validation de la version française de l’instrument démontre une cohérence interne très satisfaisante. Les corrélations entre les deux versions de l’instrument (en anglais et en français) sont significatives. L’analyse en composantes principales révèle un modèle en quatre composantes qui présente des similarités avec les quatre sous-échelles de la version anglaise, mais diffère quant à la répartition des énoncés appartenant initialement à la sous-échelle « problèmes d’identité » du BPFS-C. La poursuite de la validation de cet instrument permettrait d’identifier des traits de personnalité et des comportements associés au développement du TPL dans l’enfance et favoriserait la réalisation d’études prospectives afin d’augmenter les connaissances sur l’étiologie du TPL, ses manifestations et sa trajectoire au cours du développement.

EN :

Objectives The Borderline Personality Disorder (BPD) is a severe psychopathology related to great personal and family distress, which aetiology goes back to childhood. Empirical data supports a certain temporal stability of personality traits from childhood to adolescence and adulthood. Several authors argue that it is possible to identify in children and adolescents personality traits that could be associated with the characteristics of BPD observed in adulthood. However, only few instruments have been developed to assess child and adolescent traits associated with BPD. This article aims to present the results of the first validity study of the French version of the Borderline Personality Features Scale for Children (BPFS-C).

Method The French version of the instrument, which has been developed using translation/back-translation was administered to 262 children, aged 9 to 12 years old (M = 10.52; ÉT = 0.96), attending regular schools in Quebec (55.70% were girls). Forty-three bilingual children (M = 10.65, SD = 0.98; 60.50% were girls) completed the two versions of the questionnaire (English and French), on a one-week interval. In addition, 23 English-speaking children from Quebec (M = 10.42, SD = 1.12) completed the original version of the questionnaire.

Results The first validity study of the French version of the instrument shows a very satisfactory internal consistency. The correlations between the English and French versions of the instrument are significant. The principal component analysis revealed a four component model that have similarities with the four subscales of the English version, but differs in the distribution of items originally belonging to the subscale Identity problems of the BPFS-C.

Conclusions The results of the first validity study of the French version of the instrument are promising. However, further research is needed in order to demonstrate the temporal stability as well as the construct validity of this measure. The instrument should also be validated with children from a clinical population with a higher preponderance of biological and environmental risk factors associated with the development of BPD. Finally, it would be interesting to establish the standardized values of the instrument allowing clinicians to identify which scores can be considered normal and which may indicate a strong presence of borderline personality traits. The identification of personality traits and behaviours associated with BPD in children and adolescents could promote prospective research and increase knowledge about the aetiology, characteristics, and trajectory of BPD throughout child development.