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BOOK REVIEW |
Director, Gerontology StudiesProfessor and ChairDepartment of Sociology & AnthropologyHoly Cross CollegeWorcester, MA 01610
Lesbian, Gay, Bisexual, and Transgender Aging: Research and Clinical Perspectives, edited by Douglas Kimmel, Tara Rose, and Steven David. Columbia University Press, New York, 2006, 303 pp., $45.00 (cloth).
Gerontologists and clinicians working with older adults are aware that the aging experience of racial and ethnic minorities often differs from the majority population's experience of aging. Enough research has been published and enough clinical experience has been presented in case conferences for professionals to know at least bits and pieces about how, for example, the aging experience of Asians and African-Americans can be unlike the experience of people from European-backgrounds. The same professional communities, however, are often much more ignorant of the ways older lesbians, gays, bisexuals, and transgender people experience aging and manage later life. Ironically, the elder lesbian, bisexual, gay, and transgender (LBGT) population in the United States is estimated to be 3 million. If that is accurate, it is as large as the elder U.S. population of African ancestry and three times the size of the U.S. elder Asian population. And if so, our collective ignorance about LGBT aging cannot be attributed to insignificant size of the existing population of sexual minorities who are 65 or older.
Why is it that we do not know much about LBGT aging? The answer is disturbingly simple. Heterosexism has been hegemonic. It remains deeply embedded in American cultural beliefs about normalcy, perceived as necessary to the integrity of social institutions (e.g., the U.S. military, the Catholic Church), and affirmed whenever men and women of any sexual orientation marginalize LGBT issues. Among gerontologists, for example, when samples of older adults have been gathered, rarely is the sexual orientation of the participants recorded. Heterosexuality is presumed. When it isn't, and a research protocol directly asks about sexual orientation, most often the LGBT men and women are excluded from data analysis on the logic that their numbers are too few to be representative. Interestingly, ethnic/racial categories are included in the analyses. Social gerontology textbooks designed to introduce college undergraduates to the study of aging now integrate the aging experiences of ethnic/racial minorities into discussions of employment and retirement, families and caregiving, or health care utilization and needs. But information about LGBT aging is most often not available. Likewise, medical and nursing students are rarely alerted to the health care concerns of LGBT peoples, such as male-to-female transsexuals' need for regular prostate exams, or most female-to-male transsexuals' need for regular pap smears. Providers of health care still bring heterosexism into their workplaces, often times by only asking if the patient is married rather than more explicitly asking "Are you partnered, and are you sexually active?" Intended or not, heterosexism remains commonplace in geriatrics and gerontology, and it is a significant part of the LGBT aging problem. Men and women within the LGBT communities age on the margins of public consciousness, or interest.
The juggernaut of heterosexism in geriatrics and gerontology is, however, being challenged. For some time scholars—e.g., Raymond Berger, Douglas Kimmel, Barbara McDonald, Jean Quam, Gilbert Herdt, Marcy Adelman, John Lee—have been trying to raise professionals' consciousness about LGBT aging and their efforts are succeeding. Information about LGBT aging offers innovative thinking about the aging enterprise and a finer understanding of processes of aging for all older adults. The meetings of the Gerontology Society of America and the joint conference of American Society on Aging and the National Council on Aging annually have a greater number of presentations and workshops that address LGBT aging than in the past. Johns Hopkins University Press will soon be releasing a handbook on GLBT aging, Springer Publishing Company already has a handbook-type collection (Herdt & de Vries, 2004), the Haworth and Harrington Park presses publish a number of research journals about LGBT communities, The Gerontologist recently published two review essays of some of the current work (Thompson, 2004, 2006), and as the remainder of this review essay notes, an important new handbook-type collection was recently published by Columbia University Press.
Lesbian, Gay, Bisexual, and Transgender Aging: Research and Clinical Perspectives, edited by Douglas Kimmel, Tara Rose, and Steven David, brings together 15 substantive chapters, and a bibliography listing 317 articles or books on LGBT aging. The bibliography is intended to be a complete list of the LGBT aging literature. It isn't, but it is a great resource. Inadvertently omitted, for instance, are some references cited in the earlier chapters—e.g., Roger Brown's (1996) memoir Against My Better Judgment, and Kimmel's (1996) textbook Adulthood and Aging).
The collaborative work in Lesbian, Gay, Bisexual, and Transgender Aging should certainly encourage greater sensitivity to what it means to age in America, and thus not just within LGBT populations. Kimberly Balsam and Anthony D'Augelli's chapter on the victimization of older LGBT adults, for instance, is not restricted to addressing elder abuse within the LGBT communities. Their discussion of LGBT victimization as having an "add-on" quality (pp. 111–112), or how transgender men and women may not be welcomed in domestic violence shelters (p. 116), makes more transparent the societal problem and the inadequacy of the nation's downstream rescue programs for abused elders. The chapter also flags how gender stereotypes may cause all older men to not acknowledge their victimization because it runs counter to embodying masculinity, and then how gay and bisexual men might be less inclined to seek help because they anticipate victim-blaming and insensitive treatment. The practical advice Balsam and D'Augelli offered to clinicians to assess older LGBT people's risk of future victimization, especially by caregivers, applies to older heterosexuals current safety as well.
A walk-away conclusion from this chapter—older LGBT adults often face added adversity—is echoed in many of the other chapters. Arnold Grossman's chapter on the physical and mental health of older LGB adults summarizes findings from a national sample of lesbians, gays, and bisexuals aged 60 to 91. A key conclusion is that older LGB men and women face problems similar to heterosexual older adults, including poorer health and loneliness. But Grossman warns that older LGB adults also must manage the added risk of marginalization caused by hostilities toward homosexuals. Grossman poignantly calls attention to the dearth of research that incorporates questions about sexual orientation, gender identity, and sexual behavior; his purpose is to show that lesbian, gay, and bisexual elders seek health care providers who are responsive to LGBT health concerns and risks.
The separate chapters on older women's and men's sexuality become a worthwhile pair that provides a background for understanding the uniqueness, diversity, and complexity of lesbian and gay sexuality. In "Sexuality in the Lives of Aging Lesbian and Bisexual Women," Linda Garnets and Letitia Anne Peplau not only review lesbian sexual expression, they address how developmental milestones (e.g., the timing of coming out, and menopause) affect women's types of sexual activities and experience of sex. Garnets and Peplau call attention to the diversity among lesbians and how often people fail to recognize that many older lesbians have previously been in heterosexual marriages. When LGBT elders were young men and women, heterosexism was so normative that many LGBT people adopted heterosexual lives to avoid the stigma of being outed as homosexual. Similarly, in the chapter "Gay Men and Aging: Sex and Intimacy," Edward Wierzalis, Bob Barret, Mark Pope and Michael Rankins call attention to the gender scripts boys are offered from birth and thus how older gay and bisexual men "struggle with the vestiges of stigma and shame that were so evident in their youth" (p. 93). Because the gay community is not monolithic, but many microcommunities, gay and bisexual men's sexual expression is diverse and affected by many factors, such as whether the men are in long-term dyadic relationship or single, and the extent to which men who are invested in their bodies accept or resist the ways physiological aging affects sexual functioning. Both chapters urge clinicians to adopt a nonjudgmental approach and talk with their aging lesbian and gay clients about sexual behavior. Sexual activity is interpreted as "facilitative, an aid to better emotional and physical health, not as something bad" (p. 106).
Having lived with the victimization arising from a heterosexist culture, older LGBT adults typically have learned to compensate and, in turn, age successfully within their chosen families and with the support of LGBT-sensitive services. A cluster of chapters in this book markedly extend most gerontologists' and clinicians' understanding of retirement, grandparenting, and end-of-life-issues. Using comparative data on older adults in same-sex and heterosexual relationships, Steven Mock, Catherine Taylor, and Ritch Savin-Williams provide an engaging discussion of retirement planning, which is especially essential for sexual minorities who lack the societal and legal support that benefit married heterosexuals. Lesbians more often make their retirement plans interdependently with their partners. Older gays make plans independently. The chapter's key finding reveals that retirement plans among same-sex couples are an amplification of gender patterns. Heterosexual and lesbian women view planning as an extension of their couple relationship, whereas gays prepared for retirement more independently than all others. Nancy Orel's chapter on "Lesbian and Bisexual Women as Grandmothers" is also an engaging discussion of the social lives of lesbian grandmothers, who sometimes are their partners' co-grandmother and other times are step-grandmothers. The long-standing finding that the grandparent-grandchild relationship is an indirect one, with parents being intermediaries, is amplified for lesbian and bisexual grandmothers. Adult children's acceptance of the grandmother's sexual orientation is the primary determinant of lesbian grandmothers' opportunities to grandparent.
Three chapters reviewing "Legal Concerns of LBGT Elder" (Matthew Dubois), "End-of-Life Issues for LGBT Older Adults" (Dean Blevins and James Werth), and "Community Assessment Needs: Documenting the Need for Affirmative Services for LGB Older Adults" (Nancy Orel) become a thoughtful bookend to understanding the discrimination older LGBT adults must deal with. Older lesbians, gay, bisexuals, and transgender people face many barriers in the U.S. legal and health care systems that require conscious, thorough planning to ward off unexpected challenges to late life. Of course older heterosexuals also must address end-of-life issue such as living arrangements, identifying health care proxies, and developing living wills. But older LGBT adults must plan ahead much more thoroughly. For example, a 75-year-old gay man of today was entering midlife when the designation homosexuality was removed from the American Psychiatric Association's list of disorders. The same man is still having to navigate around discriminatory federal policies and state laws that do not recognize homosexual partnerships, as well as manage late life with the absence of affirmative community services (such as the openhouse program in San Francisco or New York City's SAGE, which are summarized in the final two chapters of this book).
Typical of edited collections, there is unevenness among the chapters in Lesbian, Gay, Bisexual, and Transgender Aging. Some chapters are galvanizing, because they are very well written and offer cutting-edge information. Cook-Daniels' chapter on "Trans Aging" is one example that grabbed me and taught me much. Some are valuable, thorough reviews that will unquestionably inform both the naïve and well-read, such as the lead chapter "Historical Context for Research on Lesbian, Gay, Bisexual, and Transgender Aging" (Kimmel, Rose, Nancy Orel, and Beverly Greene). Others are presented in a research article format and require a bit more wading through the study's method and/or descriptive findings. Despite its unevenness, this book ought to be in all college libraries. It also ought to be on the bookshelves of medical clinics and social service organizations that work with older adults. Throw a dart at the table of contents and select any one of the chapters for the foundation of a great brown-bag lunch discussion. You won't miss, but without the book being available you will miss out.
References
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