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Dr. Ilan Meyer sworn in.

Dusseault asking about educational background.

Meyer: BA Columbia U, Psych, MA, New School, Columbia U, psychiatric epidemiology. Study of mental disorders, causes of mental disorders. Risks for mental disorders. Very much like infectious disorders. PhD, Columbia U. 1993. Department Sociomedical Sciences, department brings together people from various social sciences to study public health problems. Doctoral dissertation, prejudice and pride, minority stress and health in gay men. Associate Prof at Sociomedical Sciences at Columbia. Co-Chair steering committee for school of public health. Chair, MPH, curriculum committee. I probably have some other committees that I am on. First appointment in 1994, full time in 1996.

Dusseault: Work you’ve done over 20 years.

Meyer: Social epidemiology. Relationship between social factors and health patterns. Mental health outcomes.

Walker: Area of study is area of social factors and mental health outcomes.

Meyer: Most directly lesbian, gay, bisexual populations, african-americans, asthma, HIV, homosexuals and mental health. Many presentations, most in CV. Over 40 listed there. Funding, currently Robert Wood Johnson Health Policy Investigator, NIH, NLM, NYS Department of Health. Awards, most recently for distinguished scientific contribution APA. Reviewed manuscripts and guest editor. American Journal of Public Health on lesbian and gay and transgender public health. Successful issue, first issue to sell out. Edited, or co-edited another journal. Special issue Social Science and Medicine, with two colleagues, prejudice and stigma and their impact on public health. Edit book on LGBT public health issues. Both peer reviewed and editorial articles. 44 peer reviewed articles on CV, maybe 12 other types, commentaries and so forth. 3 courses, research methodology, how to conduct surveys. Two seminars, one is called prejudice, stigma, and discrimination as social stressors, gay and lesbian issues in public health.

[Dusseault and Cooper put together list of all exhibits, Walker says, “thank you for facilitating that.”]

Dusseault: Is it true that each document document you’ve relied on to formulate opinion in this case. Deposition testimony. Do you intend to offer any opinions in this litigation.

Meyer: Work I’ve been doing. 3 elements. 1) Nature of stigma on G&L populations wr to Prop 8 as example of stigma. 2) Describe model of minority stress. Model I am accredited with offering. Will describe social stressors affect G&L pops. 3) Effects of those stressors on mental health.

Dusseault: On what do you base.

Meyer: Study of last 20 years. Opinion is based on many research articles. Some I’ve conducted, many more conducted in field over many years.

Dusseault: Define stigma.

Meyer: Have to be brief. Group in society has some kind of attribute seen as negative, this attribute is attached to persons believed to have it, because of having this attribute, devalued. In example of sexual orientation, identified as negative attribute, G&L people as a whole, identified by that identity, whole person is devalued. Stigma has been applied to many other pops.

Dusseault: What is structural stigma?

Meyer: Origins of stigma. Mechanisms that enact stigma. More solid structures in society. Institutions. The law, and any other institution central in our society.

Dusseault: Explain more the way that laws can be structural stigma.

Meyer: Laws may foster or block access to particular institutions. Of course here we’re talking about marriage. Of course the law has a role in who can access this institution.

Dusseault: Once structural stigma in place, how does it affect people.

Meyer: Determines access people have to those institutions. People internalize certain goals. Career, marriage, two important examples. Stigma would determine the access people have to those desired goals.

Dusseault: Has research found stigma attached to G&Ls?

Meyer: Intimate relationships and the way they’ve been portrayed. Stereotypes that gay people incapable of intimate relationships, undesiring of intimate relationships. The way it has been portrayed as well as in a more organized way in social institutions. Intimate relationships marriage, husband and wife, other intimate relationships, one’s children and one’s community. In all of them, described as social isolate, not as good citizens, participating in society in the same way. That’s what stigma does. In particular for G&L example, nature of being gay about who you choose to be with.

Dusseault: One of docs you’ve relied on in your opinoins.

Meyer: Chapter from book published in 60s and was very popular book. Everything you’ve always wanted to know about sex but were afraid to ask. Different chapters to educate public about sexuality, this chapter about male homosexuality.

Dusseault: Read text into record.

Meyer: May I explain something about this. Q&A format. Author goes through explaining issues as if someone asking him.

Dusseault [reads from book]

What about all the homosexuals who lived together happily for many years.

“Happy” remains to be seen. Bitterest argument between husband and wife is passionate love sonney by comparison with a dialogue between a butch and his queen. Live together? Yes. Happily Hardly. [Teddy has full quote in comments]

Meyer discussing when stigma is formulated: What they’ve learned in childhood. Affects everybody, but affects in very strong way someone who is coming out and is gay.

Dusseault: Are you familiar with Prop 8. Basic understanding.

Meyer: Voted by voters in CA< restricted marriage to man and woman. Excluded gay men and lesbians from marriage.

Dusseault: Is Prop 8 form of structural stigma.

Meyer: Law and constitutional part of law, very strong part of stigma.

Dusseault: In what way is Prop 8 structural stigma.

Meyer: Denies them access to marriage. We’re raised to think certain things we want to achieve in life. this Prop 8 says you cannot achieve this particular goal.

Dusseault: Does DP eliminate structural stigma of Prop 8.

Meyer; I’m talking about institution that has social meaning. I don’t refer to any tangible benefits. Not any tangible benes that accompany marriage. Symbolic meaning, social meaning of marriage. Young children do not aspire to be domestic partners. Marriage is a very common socially approved goal. This is a desirable and respected type of goal.

Dusseault: Do you have opinion where DP has similar social meaning?

Meyer; I don’t think it has the same social meaning. I don’t think it has any social meaning. It has values in terms of benes that people receive. Those benes not really relevant to my discussion of stigma.

Dusseault: Minority stress. I’ve written a lot of arguments about it. The types of stressors. Everyone knows what stress means. Types of events that happen to a person. Requires a person to adjust. Different types of stress, chronic stressors or employment stress.

[Meyer is a dark skinned person, tidy hair cut. Grey suit. Dusseault is tall, glasses. He has a habit of looking a way, or trying to look empathetic, but without maintaining eye contact, and sometimes looking up in the air.]

Dusseault: Acute stress. What does that mean?

Meyer: Beginning and end. Chronic, prolonged. Losing job acute, unemployment chronic. Other types of stressors. Daily hassles. Minor stressors. Daily kinds of hassles. Another type of stress, a little different, non-events. Nothing happens. If I had been working in my job for many years, but didn’t receive expected promotion, it was expected, but others expected. It’s something that is normative to happen at particular time. Marriage would be one of those expected events. If you ask little children, it’s the kind of thing they might tell you that would happen.

Dusseault: Are the stressors you’re talking about inputs?

Meyer: Outcome. Feeling distress because of something that happen. Try to assess the input, the stressor part, and the outcome, in this case, we studied health outcomes.

Dusseault: let’s go back to minority outcomes.

Meyer: Social arrangements, prejudice and discrimination. In my model any stress that is related to discrimination, minority stress. Losing job due to discrimination is a minority stressor. Different impact for those type of events. Allows us to assess and measure them in way that is more precise.

Meyer: Prejudice social stress and mental health in lesbian and gay populations. 2003. Psychological bulletin. Quite difficult to get published there.

[I get the sense that Meyer has no tdone a lot of expert testimony.]

Meyer: Has been referred to by many other researchers. several hundred have used this as a resource for their own research.

Dusseault: Minority stress, other than G&L?

Meyer: Idea are not all brand new ideas. Rely on many years of research. I did not invent research on life events as a source of stress. Term used in article I read about. By minority, I mean sexual minority. This refers to gay, lesbian, and bisexual. Quite specific to gays and lesbians. General theories apply in more general ways.

Dusseault: Particular processes in which minority stress manifest itself.

Meyer: What do we mean by prejudice have an impact on people. Processes that describe why that’s a stressor. 4 types of minority stress processes.

• Prejudice events
• Expectations of rejection and discrimination
• Concealing–not being out
• Internalized homophobia

Dusseault: How did you identify these processes?

Meyer: There has been work on each of those topics, I relied on them to bring together a model that is more concise. Work on internalized homophobia, put it together in this particular form to explain experiences of gay men and lesbians.

Dusseault: What do you mean by prejudice events.

Meyer: Types of stressors that are related to prejudice. Being fired due to discrimination. Prejudice events echo those 4 types of stressors, major acute, chronic stress, minor events (daily hassles), non-events. This is taking the same framework and using it in this context. It’s not that I just took this and copied this–I used a lot of research.

Dusseault: Prejudice events, different from stress events of rest of pop? More examples?

Meyer: Other types of events people experience: anti-gay violence. Hate crimes. These are the major events. Chronic stressors. Resulting from prejudice. I’ve collected data from 400 gay men and lesbians. Asked them about life events that happened over their life. There will be chronic things like harrassment. Harrassed at schools. That’s not an event unless it was an event. If somebody says somebody called me a name over an entire year. If someone jumped and attacked me, it’d be an event, in this case a hate crime probably. Those are the life events.

Dusseault: Do those differ in magnitude?

Meyer: How big the event was. How much adaptation does such an event require. Losing a job is a very big event. Waiting on line is a very tiny magnitude. Hate crimes, they have a greater impact psychologically on victim, greater impact has to do not so much with characteristics, but social meaning of event.

Dusseault:What has research shown about who commonly perpetrates these events.

Meyer: Perpetrates, I talk about different levels, different causes of those events. Structural stigma. Context for events. An event is written in larger context. So those are the structural. And then are interpersonal events. Perpetrators might be state, but of course, it is also individuals who do something, in example of hate crime or sexual minorities. Quite distinct from other groups, when you think about groups, could be family members, siblings. We collected short narratives, quite dramatic in terms of what respondents reported had happened to them in the past. What was, I don’t want to say surprising, but distinctive, was how many families had perpetrated things like rape or homelessness. A whole range of perpetrators.

Dusseault: Every day hassles?

Meyer: We call those daily hassles, every day discrimination events. In same way that hate crime has social meaning attached to it. A minor event might have greater impact than another event that has no such meaning. The other one is representing social disapproval.

Dusseault: give us examples that research has called hasles.

[Walker looks bored.]

Meyer: I read plaintiff’s testimony given on Monday, I read it Tuesday, One of the things we hear over and over is filling out forms. You migut say, what’s the big deal of filling out form. The only way I can explain is it’s not about the form, it evokes a social disapproval, a rejection. it evokes memories of such events, including large events. So it is a minor hassle for most people. But for gay people I’ve seen this brought up many times. Other types of things. Being treated in unfriendly way by one’s parents. Would not be a nice thing for anybody. But for a gay person, social meaning of rejection. Relationship between social meaning.

Walker: You mentioned forms. What kind of forms.

Meyer: the testimony given here. What I meant was any kind of administrative forms, particularly where you have to fill in marital status. Gay person, there’s no place for me to put anything there. Either they would say “single” even though I’ve been in relationship for the past four years, I don’t want to get tinto this whol einformation. Crossing out things and writing in things. Obviously this is not very demanding, to cross out something and fill in something else. That would not be memorable event. Only reason bc of what it means. Social rejection.

Dusseault: You may have applications at a bank, or job application. Where there are boxes to describe status?

Meyer: Absolutely.

Dusseault: Hassles when traveling.

Meyer: very similar, not so much why it happened, but what it means. A clerk asking about king sized bed, area of great sensitivity, really talks to their rejection, to rejection of their family members.

Dusseault: does the fact you might ultimately get right sized bed, make it go away?

Meyer: There’s nothing really horrible about filling in form or explaining to clerk about mistake. It’s about “I’m gay and not accepted here.”

Dusseault: Non-events treated as prejudice events.

Meyer: when things like having childen don’t happen. Actual event, or non-event, but for G&L, not getting married would also have that social meaning. Stigma.

Dusseault: What, if anything, rel between Prop 8 and prejudice events as you describe.

Meyer: Quite obvious that Prop 8 blocks marriage event. It would be responsible for G&Ls not getting married. Explain why–I’m really not seen as being equal. My status is not respected by my state or my country. A block on the way to achieve desirable goal.

Dusseault: Katami describes rocks and eggs being thrown fence of patio at gay establishment, We couldn’t see who people were but we were definitely hit. I just accepted that as “well, that’s part of what we have to deal with.” Reaction to this?

Meyer: Very familiar event a gay person might report. Don’t mean to tell plaintiff that they are not unique, but they really are not unique. What struck me was not what you might notice. But that point about the very sobering moment. It’s the moment of registration. This is something I have to get used to ,who I am. He tries recognizing something about who he is as a gay person. This was related to hate. When we collect those narratives inmy resarch.

[Walker is looking at the screen with the testimony closesly, seems to be copying somethingdown from it. Dusseault is doing that staring away thing he does again.]

Meyer: What i don’t know is whether someone was hurt, would go to magnitude. Meaning was because of that sobering moment. “I am not the same as other people in society, someone can come and throw eggs at me, because I am gay.”

Dusseault: Often relayed by gay men or lesbians?

Meyer: Exactly.

Dusseault: Stier testimony. Doctor’s offices. I have to put a line through it and saying domestic partner and explaining what that is so our transaction can go smoothly.

Meyer: You have to ask why would a person remember that type of event. More than what has actually happened. IF there were some error, and she would have had to fix that, I don’t think she woudl have had to report that. It is the message that the forms echo about rejection. I’m not equal to most people who fill this form.

Dusseault: Expectations of rejection and discrimination.

Meyer: means exactly what it says. Interesting process that occurs in populations. THey know about prejudice that exists in society. Needs to maintain vigilence that would guarantee their safety. A gay couple walking down the street. In my experience regardless of how firnedly, have to monitor kind of affection they show each other. It’s not something them about indivs but bc they are presenting as gay. One type of vigilence. You have to watch, third eye monitoring environment. Many people don’t have to think about that.

Dusseault: Does the expectation go away if the rejection doesn’t happen?

Meyer: Another interesting thing. Nothing really has to happen. Not only that the persons involved in environment, may not hold any negative attitudes. What I represent may trigger in somebody. It doesn’t have to be anything specific. Being in job interview and having to monitor what you say. You’re expecting that. In addition to issues of safety. Issues around social intercourse. It could be embarrassing or awkward. Swallow minor incidences of prejudice. Move on bc they don’t want to get into it. anticipation. When someting happens, anticipation.

Dusseault: What if someone concerned about this just stays inside, doesn’t go out.

Meyer: Quite a punishment.

Dusseault: Relationship bet Prop 8 and this expectation.

Meyer: Prop 8 sends message not to be respected. Not equal. That’s in addition to achieving literal aims, sends message about values, constitution itself. Would encourage or is consistent with holding prejudicial environment.

Dusseault: Concealing.

Meyer: One more concept. Coping. Part of the stress process. How does stress affect outcome. Concealing means not revealing I’m gay or lesbian. Relationship with coping. People conceal usually as coping mechanism. So they’re not fired from their job. If you’re in USM, you have to conceal by law. Many ways that this kind of concealment are stressful. All of this comes from lit not specific to this topic.

Dusseault: Briefing identify what those ways are.

Meyer: Concealment requires strong cognitive effort. Stress involved with concealing. You have to really work hard on this. It’s not that easy.

[Dusseault now nodding enthusastically]

Meyer: a very difficult type of thing. If you’re in military, you live your life there. People talk about girlfriend. Gay people have been known to change pronoun, say “yeah, my girlfriend,” when they really mean boyfriend. It’s a lot of work keeping track of that. Responses, they say this is private hell. The cognitive work.

Dusseault: Does the person who conceals lose benes he or she might receive if express true self.

Meyer another way concealment stressful. Concealing prevents you from expressed emotion. Use of this with cancer patients, expressing something intimate helpful psychologically, hiding something. Also authneticity, living authentic life. People feel better presenting themself as who they are.

Dusseault: Does concelment interfere with ability to get support.

Meyer: Beneficial ways, through social support. Affiliation with gay community. If you go to community center. You get certain benefits from being thatin that environment. If you’re concealing, you’re not going to walk into gay community center. May be health services that targeted to G&L pops. That too may be something that person who conceals would be able to benefit from.

Dusseault: One point I want to clarify. Can concealment be absolute in nature.

Meyer: It could be. It doesn’t have to be that. If they conceal at work, they may have some friends they confide with. Reason you conceal is significance of derision. No tjust a simple issue.

Dusseault: Believe testimony from one plaintiffs on Monday, knowing he was gay, but didn’t come out.

Meyer: Sounds like he recognized or feared that if he were to express this about himself, would lead to discrimination. To losing relationships. I presume this is what the person expected.

Dusseault: Connection between concealment and Prop 8.

Meyer: Prop 8 part of stigma. When I talked about effects of Prop 8, not only affect gay people, not just damaging about gay people sends message that it’s valued by constitution to designate them different class of people.

Dusseault: [more testimony] Chris Perry. “I have to decide if I want to come out everywhere I go.”

Meyer; Demonstrates several of the things I already mentioned. need to decide whether it’s worth it to get into whole thing. Repetition of it. In so many contexts. Word that most jumped at me in this is “exhausting” because it has a special meaning in stress research. One of earliest examples of stress research. Seyle. General adaptation syndrome. Echos what I was describing. In his words the end of hta twas exhaustion. Result of stress process was exhaustion. He studied animals and in many cases resulted in death.

Dusseault: Internalized homophobia.

Meyer: A word discussed in different forms. Used existing lit. Internalized homophobia discussed a lot. Learned in socialization process. Not only gay men and lesbians. Natural thing is to reflect that everything I’ve learned abou being gay, it’d be quite devastating, to young or not young person. If they believed that was what was in their future.When I use homophobia, I use it as akin to racism. It’s a word that is recognizable, in dictionary. Found it just as good a word as some other words that had been proposed.

Dusseault: Possible self.

Meyer: Not exactly within context. Another theory I have used. Related to what people feel right now. Having more optimistic notion of future. Opposite, feeling that you will be blocked from achieving goals, lower self of well-being.

Dusseault; Does internalized homophobia lead to lowered concept of possible self.

Meyer: Certain attitudes, stereotypes. If you internalize that, you think, this is who I’m going to be. Part of that is about how do I see my future. Who will I become? Some gay youth have a harder time thinking of possible self.

[Meyer is increasingly gesticulating with his hands.]

Meyer: They might think [referring back to book earlier] that it’s not possible for gay couples to have good relationships.

Dusseault: Another example of testimony, from Chris Perry.

I never really let myself want [marriage] until now, never let myself want it, everyone tells you you’re never going to have it.

Meyer: Person recognizing within herself, as lesbian, some of the things relevant to other people, such as marriage, do not apply to me. Can’t hope for that. Presumably, her being plaintiff, she began to believe she might get access.

Dusseault: Third and final opinion. Health. Sitigma, minority stress gay or lesbian, stigma have on health outcomes.

Meyer: As I mentioned earlier, entire stress process to study health, determinants of health and disease. Literally hundreds of studies that study different aspects of this. There has been shown experience of this kindn of outcomes. Mental disorders. Anxiety disorders. Mood disorders. Substance disorders. General distress or feeling, blue. There are a variety of outcomes. Health behaviors associated with stress. Excess smoking, eating behavior, drinking. True for general stress literature. As well fo rgay and lesbian populations. Point being that G&L pops exposed to more of this stress, which is unique and additive, and therefore that excess risk as we call it epidemiological research, associated with excess disease. We’ve studied well-being. Also been studies that show excess in suicide attempts, particularly in youth.

Dussseault: Does the research show that stigma contributes to higher incidence to these adverse consequences in G&L than pop at large.

Meyer: Look at excess risk. There’s been pretty consistent findings that show excess disorder in G&L pops as compared to hetero.

Dusseault; Want to be sure we’re being clear on a couple of points. Are you saying being GorL associated with mental–

Meyer: No not at all. Excess risk is associated with excess disorder. Because it is excess, leads to more exposed to the risk. Never expected that everyone exposed to risk is diseased. Even people exposed to extreme stressors (like war) doesn’t mean all of them are going to be affected. Excess relationship, patterns of disease, more of this risk and more of this disease.

Dusseault: Are you saying that all or even most G&L people suffer from soem kind of disease?

Meyer: Analogy would be when we look at smoking and lung cancer. Do people that smoke have more lung cancer, it does not a fact that everybody that smokes gets lung cancer. Most G&L not disorder. Excess in pop as compared to hetero.

Dusseault: Would inceidences be less if we could find a wya to reduce sitgma?

Meyer; When people have more they have more of the disorder.

[Walker now making notes on something]

Meyer: we see that some people have more of those life events, more of the outcome, maybe depression. Other people didn’t have that exposure. Indicates more of those stressors, more disease.

Dusseault: Healthy people two thousand ten?

Meyer; We call that Healthy people Twenty ten.

[A much needed chuckle all around, particularly between Teddy and me, since he wrote a post on calling it 20-10]

Meyer: working now on healthy people 20-20.

[Excerpt up: The issues surrounding personal, family, and social acceptance of sexual orientation can place a significant burden on mental health and personal safety.]

Meyer: Section from Healthy People 20-10, one of our nation’s goals to reduce disparities in G&L pop as compared to hetero.

Dusseault: Chart: Coping resources, social structure, stress, health outcomes.

Meyer: very schematic way of showing causal chain. Stress and coping resources not randomly assigned to people in society. Social structures. If you’re employed, you can get fired from your job, if you’re not employed, you cannot get fired. When we show social studies, stigma leads to exposure to specific stressors, I dsecribe here, both general and prejudice related. Everyone experiences general stressors. There’s added prejudice related stress. Coping resources, protective role of coping. There’s a lot more behind each of those boxes. A lot more can be said about coping. What it shows is how this process affects outcomes.

Dusseault: How mental health outcomes owuld improve if Prop 8 were not law.

Meyer: I do [almost apologetic] Consistent with everything I’ve said, relevance of social structures, and findings that show when people exposed to more stress they fare worse than when exposed to less stress. If CA, and it also has to do with proscriptive elements, that the opposite of that clearly would send positive message. You are welcome, your relationships are valued. We don’t approve of rejection of you as a gay person. That has a very significant power. We all know law in state is important part to creating social environment. Clearly not only thing that determines. Certainly a major player, major factor.

Dusseault: Nothing further.

10 minutes

Walker: we seem to be following a little behind our schedule so we can get everything in we anticipated getting in.