My client is disabled and queer: The importance of developing an intersectional lens
Jeff Driskell, PhD, LICSW and Elspeth Slayter, MSW, MA, PhD,
Salem State University School of Social Work
Many social workers have worked hard to be more aware and inclusive of queer clients and colleagues in their work – along with facing their heterosexism and homophobia. This does not take away from the fact that the profession has often gone along with societal views and actions that pathologize and even criminalize people who are sexually diverse or gender diverse (Mulé, 2016). Increasingly, social workers are also working to learn more about the disability communities and to face their ableism and sanism as well. This is despite decades of research documentation of how ableism and sanism play out in social work spheres (Kiesel, DeZelar & Lightfoot, 2018). However, we don’t often think about these communities as connected, often due to social workers’ ableist assumptions about disabled people’s sexuality and sexual orientation (Ballan, 2008). In the spirit of taking an intersectional approach in our social work practice, this essay addresses the intersections of three social identities – disability, gender identity and sexual orientation – as it relates to doing our best to do better work.
So what do we know about this intersection from the existing literature? Let’s start with numbers. We know that 8% of the U.S. adult population identifies as lesbian, gay, bisexual, transgender, questioning/queer, intersex, agender/asexual (LGBTQIA+) (Human Rights Campaign, 2021). Among U.S. adults, we know that 27% of the population is disabled (Varadaraj et al., 2019). We also know that in LGBT communities, specifically, people are more likely to experience disability than they are in the general U.S. population and among people who identify as heterosexual (Movement Advancement Project, 2019; Fredriksen-Goldsen et al., 2012). Additionally, we also know that LGB adults with disabilities, in particular, are often much younger than disabled heterosexual adults (Fredriksen-Goldsen et al., 2012). Looking just at the national transgender population, we know that nearly 40% of this group are disabled (James et al., 2016). Furthermore, we know that sexual minorities have both higher prevalence rates of mental health conditions (Cochran 2003, et al.) and poorer physical health outcomes (Conron, 2010; Flentje, 2020) as compared to their heterosexual counterparts. These data points suggest significant intersections between the queer and disability communities.
To provide some context for this discussion, we know that since the onset of the disability rights movements, access to community spaces and community inclusion has increased for disabled people. And while we have a federal disability civil rights law (The Americans with Disabilities Act of 1990) that technically prohibits discrimination against disabled people in employment, schools, etc., sexual rights have not been a core part of this work. Disability scholar Tom Shakespeare (2000) documents that sexuality has historically been ignored in society and sometimes in the disability community. Further, Shakespeare notes that addressing the topics of sex and sexual orientation may be very intimidating for disabled people, who have often lived in isolation and/or experienced abuse (Shakespeare, 2000). Despite this, disability civil rights movements – and especially the disability justice movement – have resulted in this community’s increased rejection of sexual oppression (Liddiard, 2018). One of the indications that we are doing better on this is the fact of the presence of an entire journal named Sexuality & Disability although social work education is simultaneously noted for being behind the curve on these topics as well (Ballan, 2008).
While coming out as queer is a documented challenge, for disabled people, coming out can look different given the oppression experienced by both communities (Stoffelen et al., 2018; Brownworth & Raffo, 1999). For example, interviews with disabled queer young people revealed that coming out decisions were complex due to both ableism and heteronormativity (Toft, 2020). Some research documents that often, queer and disabled people don’t come out to family, which points to the need for a circle of supports in one’s community (Samuels, 2003). It is important to note that the phrase ‘coming out’ typically refers to queer communities, but people with hidden disabilities also have to consider coming out (Kattari & Beltran, 2019; Spangenberg, 2018). Of this the coming out experience, one neurodiverse gay man, notes “I was afraid to be seen as gay because I already was being bullied … and I knew being ‘the gay kid’ could only worsen my situation” (Ascher, 2018). Scholars in this area note that when disabled queer people do actually come out, they may experience both invisibility and even erasure from either or both communities, which can lead to feeling isolated (Kattari & Beltran, 2019). And of course, after coming out and identifying as a queer, disabled person, experiences of queer and disability oppression in the community are well-documented across all spheres. As reflected in the data, these compounding stressors can have significant health implications for disabled and queer people.
So what can social workers do about these realities? In addition to practicing self-awareness/reflection and unlearning their ableism, able-bodied privilege, homophobia, heterosexism and often heteronormative focus, they can be guided by learning about theories. I argue that the roots of the work, in this case, involve not only getting comfortable working within the context of sexual orientation, gender orientation, and disability but also using theory to guide their practice. To unpack this topic as it relates to your practice, breaking down and learning about these theories is critical. Specific to this argument, crip theory, queer theory, and minority stress theory can support you in this learning process.
Queer theory is based on the notion that queer is a political identity and social location that is a moniker which has been adopted by people who experience oppression based on their sexual orientation (Sullivan, 2003). Goulden & Katz Kattari (2022, p. 11) note that challenging heteronormativity as well as the ‘othering’ of queer identities (Steyn & Van Zyl, 2009) is central. Further, this theory is a “vague and indefinable set of practices and (political) positions” that challenges normative behavior, how we understand the world, and social identities (Goulden & Katz Kattari, 2022, p. 11; Greteman, 2017, p. 43-44). This can be paired with social workers’ embrace of ‘crip theory.’ Crip theory is helpful to draw on in practice with queer, disabled people. This theory challenges the separation of what is defined as ‘normal’ and that which is ‘abnormal’ (McRuer, 2006). Goulden & Katz Kattari (2022, p. 7) note that “this phenomenon is named compulsory able-bodiedness in crip theory – the expectation that normalcy is something everyone wants to achieve.” This theory lays a foundation for understanding the intersection of disability and sexuality. Goulden & Katz Kattari (2022, p. 9) point out that “crip theory modifies the pathological discourse from undesired bodies to make room for thinking about the crip body as desirable and fulfilling.” Using ‘crip’ as a verb, Goulden & Katz Kattari (2022, p. 10) note that to “crip” social work practice as well as how we understand sexuality “is to expose discourses of compulsory able-bodiedness, even in contexts not explicitly focused on disability…. It is vital within social work practice to refrain from assuming what sexuality and sex mean for disabled clients, as these vary widely.”
While minority stress is derived from other theories on stress, it has significant implications in understanding its impact on disabled and queer communities. Minority stress theory supports the notion that the stress associated with being a sexual minority is the result of discrimination and stigmatization (Meyer, 1995). Meyer’s (2003) position on the health implications associated with minority stress are the result of both distal and proximal stressors. As such, he conceptualizes stress to include both distal stressors (i.e., objectively measurable events such as prejudice or discrimination events or conditions) and proximal, or internalized, stressors (i.e., expectations of prejudice and discrimination, concealment of sexual orientation, and internalization of societal stigma. It’s this framework for understanding minority stress which provides an overlap with crip and queer theory.
Minority stress theory has three main components all of which makes stress experiences chronic in nature (Meyer, 1995). First, beyond general life stress, minority individuals experience additional stress due to their minority status. Second, the source of stress is fueled by social structures such as ableism and heterosexism. Last, beyond interactions with a majority or dominant group, institutions, and larger social structures influence stress. For example, the creation of discriminatory social policies (Meyer, 2003).
In summary, by drawing on lessons from theory for application to practice, as well as our profession’s commitment to reflective and reflexive practice, social workers have the capacity to lift up their queer disabled clients, colleagues and community members. Let’s start seeing, hearing and listening to queer disabled people in our efforts to fight oppression, foster empowerment and foment social change.
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 According to the Columbia Journalism Review (2019), ‘queer’ was originally a derogatory term for people with same sex partners or people who have sex with their same gender. This term has been reclaimed in a prideful way. More recently, the term has been embraced by many in the non-heterosexual community as a term of pride.
 Ableism is defined by activist and scholar Talila Lewis (2022) as “a system of assigning value to people’s bodies and minds on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence and fitness. These constructed ideas are deeply rooted in eugenics, anti-Blackness, misogyny, colonialism, imperialism and capitalism. This systemic oppression leads to people and society determining people’s value based on their culture, age, language, appearance, religion, birth or living place, ‘health/wellness’ and/or their ability to satisfactorily re/produce, ‘excel’ and ‘behave.’ You do not have to be disabled to experience ableism.”
 Sanism refers to how people living with mental health issues have been thought of as ‘incompetent, not able to do things for themselves, constantly in need of supervision and assistance, unpredictable, violent and irrational’ (Slayter & Johnson, 2022).
 I approach this writing this as an ally/co-conspiritor with the queer communities, and as a member of the disability communities who acknowledges that I always has more to learn. This writing reflects my personal knowledge about these communities (from personal interaction) as well as the knowledge I have gleaned from the social work literature base. I am open to critique and dialogue about this writing.
 Prevalence data about the LGBTQIA+ populations are potentially inaccurate due to the limited understanding of gender and sexually diverse populations in research and the use of problematic or incomplete measures (Bragg, 2020). In part this has to do with the conflation of gender, sex and sexual orientation).
 This data point only includes people identified as lesbian, gay, bisexual, and transgender.
 This data point only incudes people identified as lesbian, gay and bisexual.
 The disability justice movement centers the priorities and approaches of people who are most historically excluded, such as women, people of color, immigrants, imprisoned individuals, and LGBTQIA+ people (Berne, no date). This movement notes that disability, race, and ethnicity are not separable; they are entwined with gender identity, gender expression, sexual orientation, socioeconomic status, age, body size, immigration experiences, caste, etc.
 In the disability communities, ‘crip’ is considered to be an inclusive term that can represent all disabilities, which are broad in their diversity. ‘Crip’ is not only used to describe a disabled person (a within community word use only) but it can also be a verb, i.e. ‘cripping’ focused on revealing able-bodied assumptions as well as exclusion. Crip theory considers impairment as more than an “unwelcome presence” (Shildrick, 2009, p. 32).
 Johnson, Singh & Slayter (2022, p. 10) note “Reflectivity is about unearthing the actual truth embedded in what professionals do, versus just what they say they do (Schön, 1983, 1987). Reflexivity, by contrast, is the ability to look inwards and outwards to recognize how society and culture impacts practice as well as how we ourselves influence practice. The reflective and reflexive social work practitioner, social workers will want to ask “How do I create and influence the knowledge about my practice that I use to make decisions?””