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Brian Feinstein Q&A: Sexual Orientation-Related Stress & LGB Health

Brian FeinsteinBrian Feinstein, a 2015 recipient of Stony Brook University’s distinguished doctoral student award, is completing his degree in clinical psychology. His research  focuses on lesbian, gay, and bisexual (LGB) health with an emphasis on risk and protective factors related to psychopathology. He has received funding from the National Science Foundation, the Society for the Psychological Study of Social Issues, and the American Psychological Association of Graduate Students. He is  currently completing a  one-year clinical internship at the University of Washington  School of Medicine. After graduation, he will begin a 2-year post-doctoral fellowship in the Department of Medical Social Sciences at Northwestern University Feinberg School of Medicine. He will continue his program of research focused on LGB health as well as begin a new focus on HIV prevention.

Stony Brook University Graduate School (SBU GS): Why did you start pursuing this particular line of inquiry – why psychology, and why the focus on LGB health?  

Feinstein: I’ve always been interested in psychology and human behavior; even in middle school and high school the books and movies that interested me were very much rooted in understanding why people do things, and why people are different from one another. So it was always a natural interest of mine.

My interest in LGBT health in particular is very much rooted in my personal experience as a gay man, and the different struggles I experienced finding my way through adolescence and young adulthood. I saw people from so many different backgrounds in the LGBT community, and their different struggles and strengths – and how that impacted them – became a very central interest of mine. 

SBU GS: You mentioned being interested in books focused on human behavior – do you have any favorites?  

Feinstein: I’m very much interested in memoirs, so a lot of what I read was nonfiction accounts of people’s experiences with different types of mental disorders. A few standouts include Elizabeth Wurtzel, the author of Prozac Nation, and several other memoirs about her experience with major depression and addiction; her work was really influential in solidifying my interest in depression, in particular, and substance use – and seeing how the two impact one another. Marya Hornbacher is on this list as well; she’s written about her struggles with bipolar disorder as well as various addictions and eating disorders. And, probably the most influential for me, is Kay Redfield Jamison; she’s a clinical psychologist who’s written about her own experiences with bipolar disorder. She has a really nice insight into her personal lived experience with the disorder and how her own experience of mental illness has impacted her personal and professional life. 

SBU GS: What has been challenging about your work? 

Feinstein: When I first started graduate school one of the most challenging things was simply finding mentors who were interested in LGBT issues. That’s something that’s been changing over the past five or six years that I’ve been in school, and it’s been really nice to see that happen in a relatively short period of time. But when I was initially applying to doctoral programs, there were really very few people in clinical psychology who were studying LGBT populations. My adviser Joanne Davila had started approaching the topic, but her research was focused on adolescent depression and how that related to romantic and sexual experiences. So one of the things that this led me to do was to really reach out to other people in the field and develop professional relationships with faculty at Stony Brook who had a secondary interest in LGBT issues and also faculty outside of Stony Brook. 

Perhaps the biggest challenge, however, is the difficulty finding people to participate in research on minority populations facing social challenges and stigma. Some of my colleagues are able to use the human subject pool through the Psychology Department, where undergraduate students participate in experiments and research for course credit. That was never a possibility for me because when we did assessments of how many participants in the pool identified as sexual minorities, it was a relatively small number that wouldn’t have allowed for sufficient samples. So my work has either used online recruitment to find people across the country or used existing databases that may not have exactly the kinds of information I wanted, but that have the population I’m looking for. For my dissertation I was able to recruit a decently sized sample from Manhattan, but that also required a lot of travel back and forth from Long Island to Manhattan, as well as funding to pay participants. So I think there are still a lot of challenges around finding people who identify as sexual minorities to participate in research, particularly for younger researchers who may not have the financial resources or funding to compensate participants. 

SBU GS: It’s shocking, isn’t it, that these populations seem to be understudied? 

Feinstein: Even to me it was a bit of a surprise. But one thing that I’ve come to realize over the past six years is that there were pockets of people doing similar research, but in different disciplines.

  SBU GS: What experiences, outside of your coursework or direct research area, have you found most valuable to your work?  

Feinstein: In the summer of 2013 I participated in a month-long training institute in LGBT population health research at the Fenway Institute – one of the largest health care providers in the Northeast for LGBT populations – and co-sponsored by Boston University School of Public Health. The institute brought people at either the senior graduate school level or early professional level together from different disciplines who were all interested in LGBT health research.

So I got to see that even though there may not be a ton of people in clinical psychology specifically doing this work, there were people in sociology, public health, demography, social work, and social psychology – in all these different related disciplines who had similar interests. It made me realize there were a lot of us doing similar work and not necessarily communicating with one another about it. So it really expanded my sense of what is being done currently and what the possibilities are moving forward. And the experience provided valuable perspective because even though we were looking at similar things, we talked about them and thought about them in very different ways. The experience was just huge in my development. And it’s opened up a lot of great collaborations; many of us have started working together on different projects.

SBU GS: How has your time at Stony Brook helped equip you for success? 

Feinstein: It’s been fantastic. I had high expectations and high hopes for the clinical psychology program, and it’s done nothing but exceed those expectations. 

I have never doubted or questioned my decision to come to Stony Brook. It’s a program that really values training, and it always felt like my training was the number one priority of the faculty.

There are a few reasons that I chose Stony Brook. First, it certainly had a high reputation, and I knew it was among the strongest clinical psychology programs in the country. And I wanted to go somewhere that, at least by reputation, I knew was going to prepare me for the type of career that I wanted. 

I wanted an environment where people were doing really important work but where it wasn’t cut throat, where people were very collegial – and that’s the sense I got at Stony Brook that I didn’t necessarily get at other places. And that has held true throughout my experience: I’ve always felt very much at home at Stony Brook – there’s a warmth and sense of community throughout the department and program that I think makes the long hours and work smoother and easier.

And then the relationship with my advisor and mentor was really critical to me. The prospect of working with Joanne was the main reason I decided to go to Stony Brook. She was very supportive of the direction I wanted to go, and I knew I needed to work with someone who I had that connection with – if you’re going to have a successful six-year experience working with someone you really want there to be that foundation and connection.

I have never doubted or questioned my decision to come to Stony Brook. It’s a program that really values training, and it always felt like my training was the number one priority of the faculty – and they really wanted to make sure that I met my goals, whatever my goals were.

SBU GS: What are some of the key takeaways from your research you wish the general public understood?

Feinstein: One of the big messages is that often people see the letters LGBT as going together as though it’s just one large community. And while I think there are some benefits to tying all those groups together, at times it has been a disservice to some of the individual groups.

Historically, even though we would talk about LGBT people, it often really meant gay, white men. I’ve recently been looking at differences among women, people who identify as lesbian and people who identify as bisexual – and, even further, looking at people who identify as bisexual who are in relationships with men versus relationships with women – to understand some of the unique challenges that each of these different groups experience. While they all experience some similarities as sexual minorities being stigmatized in the broader society, there are also unique things that one group faces that another doesn’t.

For example, bisexual women who are in relationships with men experience a certain degree of invisibility within the community because, unless you disclose your sexual identity, you don’t have a marker of belonging to this community. People who are bisexual often get targeted from both the broader heterosexual society and also the gay and lesbian society as not fitting in either place. So that’s certainly one message that I’d want people to understand – that there are unique challenges associated with all of these sub-identities within the umbrella of LGBT.

Another thing I’d like people to understand is that while things have certainly gotten exponentially better in terms of the social climate and the political climate and the way that sexual minorities are treated – there’s still a lot of challenges that exist, particularly for certain types of people and particularly in certain areas. Explicit discrimination is certainly less common and less frequent than it was 10, 20, 50 years ago, but there lingers a stigma around identifying as a sexual minority, particularly if you identify as bisexual – and that’s even more true for men who identify as bisexual in certain parts of the country where people are living in more rural areas or where people are more religious. But it happens even in Manhattan where we like to think that there wouldn’t be much discrimination going on.

And discrimination isn’t the only type of stress that sexual minorities experience. Living someplace where you know you could be discriminated against or that there is this kind of stigma around this main part of your identity, people carry with them a lot on the inside – including past traumas – that contributes to the stressful day-to-day experiences that they have.

To some all of that up, I want people to understand that discrimination, while less prevalent than in the past is still, unfortunately, alive and well and that even as it decreases, the types of stress that sexual minorities continue to experience are varied, and reducing or eventually eliminating discrimination is not the only thing necessary to help LGBT people in recovering from past difficult and traumatic experiences. 

This interview has been edited and condensed. 

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