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Viewpoint
1 Transgender Health Research Lab, School of Psychology, University of
Waikato, Hamilton, New Zealand
Corresponding author:
Kyle K. H. Tan, Transgender Health Research Lab, School of Psychology,
University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
E-mail: ktkhresearch@gmail.com
It’s Time to Consider LGBTQ-Affirmative
Psychology in Malaysia
Kyle K. H. Tan1
Abstract
International studies have revealed stark mental health inequities affecting lesbian, gay, bisexual, transgender, and queer (LGBTQ)
people. While there is increasing awareness of higher prevalence of mental health difficulties among LGBTQ people in Malaysia,
this issue has often been viewed through a cisheterosexist (cisgenderism and heterosexism) lens that criminalizes, pathologizes,
marginalizes, and/or delegitimizes noncisgender and nonheterosexual forms of identities. Informed by LGBTQ-affirmative psy-
chology, this viewpoint aims to scrutinize the common misconceptions surrounding the living experiences of Malaysian LGBTQ
people; these include poor mental health among LGBTQ people, victim-blaming narrative of sexual violence, LGBTQ is a mental
illness, and LGBTQ is a Western influence. This viewpoint draws on empirical and theoretical research, as well as international
guidelines, to debunk these misconceptions. Recommendations are also provided for psychology practitioners and researchers
to embark on the journey to supporting Malaysian LGBTQ people in a culturally safe manner.
Keywords
LGBT, LGBTQ, cisgenderism, heterosexism, Malaysia
Journal of Psychosexual Health
1–6
© The Author(s) 2021
Reprints and permissions:
in.sagepub.com/journals-permissions-india
DOI: 10.1177/26318318211060484
journals.sagepub.com/home/ssh
Introduction
In this viewpoint, I use the umbrella term “lesbian, gay, bisex-
ual, transgender, and queer or LGBTQ” to refer to people
whose sexual orientations and/or gender identities or expres-
sions differ from the conventional social norms of being het-
erosexual (people who are attracted to a different gender than
their own) and cisgender (people whose gender corresponds
to their sex assigned at birth). The multiethnic Malaysian
LGBTQ population also encompasses people who adopt
culture-specific LGBTQ identities such as mak nyah and
tongzhi (同志) that carry intricate sociocultural meanings.1
Rather than merely equating these culture-specific terms with
English definitions, a culturally appropriate lens should be
used to affiliate these terms with historical (eg, reclaiming
identities that have been long subjugated by colonizing cul-
tures), political (eg, advocating for normalization of identities
that have referred in a derogatory manner), and social (eg,
connecting with other LGBTQ members who share similar
identities) connotations.1 To date, no agencies (including the
Department of Statistics) have examined the demography of
LGBTQ people in Malaysia; so as a consequence, the preva-
lence of this population is not known.
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-
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(https://us.sagepub.com/en-us/nam/open-access-at-sage).
This viewpoint aims to address common LGBTQ
misconceptions in Malaysia and highlight the roles of
psychologists (including practitioners and researchers) in
improving the health and well-being of this marginalized
population. In light of the surge in number of Malaysian
research pathologizing the living experiences of LGBTQ
people,2 this viewpoint draws on LGBTQ-afrmative
psychology3 to challenge the societal bias, prejudice, and
discrimination against people of diverse sexuality and
gender. The LGBTQ psychology adopts an inclusive
and interdisciplinary approach by working with LGBTQ
psychologists and cisgender and heterosexual allies from
psychology, sociology, law, public health (to name a few) to
empower LGBTQ people who have been long affected by the
historical, social, and legal contexts of marginalization.
2 Journal of Psychosexual Health
Cisheterosexism in Malaysia: Debunking
Misconceptions
To date, jurisdictions that criminalize same-sex conducts, and
gender identity and/or expression of transgender people, still
exist in Malaysia. These comprise the federal legislation
(ie, Section 377A of the Penal Code (Act 574)) that penalizes
carnal intercourse “against the order of nature” such as anal
sex in same-sex relationships, and Sharia laws that regulate
normative expressions of sexuality and gender among
Muslim.4 Criminalization of LGBTQ identities since British
colonial rule has led to the rise of cisheterosexism among
Malaysians.5 Derived from “cisgenderism” and “heterosex-
ism”, the term “cisheterosexism” denotes prejudices that
pathologize (perceive LGBTQ people as mentally disor-
dered), marginalize (privilege cisgender and heterosexual
people), and delegitimize (reinforce that sexuality and gender
are binary concepts) noncisgender and nonheterosexual forms
of expression, role, and identity.2 Cisheterosexism is evident
across various levels of Malaysian LGBTQ people’s life,
ranging from individual (internalization of negative societal
attitudes toward one’s own LGTBQ identity), interpersonal
(unfair treatment, rejection, and victimization), to institu-
tional (discriminatory laws and noninclusive policies).6
Cisheterosexism is also prevalent in the eld of
psychology.7 It is concerning that psychologists who are in a
position to contribute to improved well-being of marginalized
groups and inuence policies in institutional settings,8 may
perpetuate cisheterosexism in their own practices. In a quali-
tative study of 28 LGBTQ young people in Malaysia, partic-
ipants reported distrust toward mental health professionals’
competency in LGBTQ care and avoidance of services due
to fear of being stigmatized.9 Corroborating nding of low
knowledge level on supporting LGBTQ clients was observed
in a study that interviewed 15 Malaysian counsellors, and
recommendations were made to provide specic education
and guideline for counsellors for who are interested in deliv-
ering LGBTQ-afrming services.10
Below, I summarize 4 common misconceptions derived
from Malaysian studies utilizing a cisheterosexist lens, and
draw on local and international empirical evidence as a basis
of argument.
1. LGBTQ people have poor mental health?
Through interviews with 6 Malaysian LGBTQ
people, researchers from a study claimed that people
with depression and anxiety are likely to identify as
LGBTQ.11 To support their inference, the researchers
cited statements from an Australian mental health
organization, Beyond Blue, that reported elevated
risks of depression, anxiety, and suicidality among
LGBTQ people compared to those identifying as
cisgender and heterosexual. Whilst it is an estab-
lished fact that LGBTQ people experience mental
health inequities, there is a need to understand the
antecedents of mental health difculties as related to
cisheterosexism.12
Cited by more than 10,500 times to date (source:
Google Scholar; October 2021), Meyer’s minority
stress theory13 posits that LGBTQ people encounter
minority stress due to their marginalized social
position. Minority stressors may manifest as stigma
and discrimination, which are not experienced by those
in privileged position (ie, cisgender and heterosexual
people), and can have specic negative effects on the
mental health of LGBTQ people. Recently, psychology
scholars have expanded on the utility Meyer’s theory
by positioning cisheterosexism as the origin of
minority stress14 and incorporating a biopsychosocial
framework15 to examine the adverse biological effects
(eg, sleep disturbance and immune dysregulation)
resulting from minority stress. Although no Malaysian
studies to date have examined mental health effects
of minority stress of LGBTQ people, a large-scale
quantitative study in Singapore (which share similar
sociocultural context with Malaysia) has revealed
a strong association between discrimination based
on LGBTQ identities and suicidal ideation.16 With
the overwhelming evidence demonstrating negative
mental health effects of cisheterosexism, it is crucial
for psychologists to be prudent when seeing LGBTQ
clients and recognize that minority stress is one of the
contributors for mental distress.
A culturally competent psychologist involves being
cognizant of the social marginalization context of
Malaysian LGBTQ people. Hence, the association of
poor mental health and LGBTQ identities should be
understood based on existing models of mental health
difculties related to cisheterosexism.13-15
2. Childhood sexual violence leads to LGBTQ?
Based on a quote extracted from gay participant
on his high libido and childhood sexual victimization
experience, a Malaysian study of 5 LGBTQ participants
insinuated that childhood sexual victimization is a
factor for people identifying as LGBTQ.17 Not only
that the conclusion drawn was highly premature, the
researchers also wrote in a language that could be
construed as victim-blaming (ie, suggesting LGBTQ
people are at fault for the sexual harm that befalls
them). Further scrutiny of that particular study
found that there was no approval granted from an
ethics committee nor was carried out in consultation
with any LGBTQ groups in Malaysia.15 On the
other hand, another Malaysian qualitative study of
33 gay men reported that participants commonly
described homosexuality as inherent (nature) and that
interpersonal (eg, friends and family members) and
institutional (eg, school environments) factors (nurture)
play crucial roles in healthy development of LGBTQ
identities.18 International population-based estimate
Tan 3
indicates that the LGBTQ population is a diverse
entity with increasing number of people situating their
identities across spectrums of sexuality and gender
diversity. For instance, a national probability survey
of transgender people reported a higher percentage
of young people identifying as nonbinary (including
genderuid and genderqueer) and those of older age
groups were more likely to use binary transgender
identities (trans man and trans woman).19 Therefore,
a narrow conceptualization of sexuality and gender,
especially from a cisheterosexist perspective, is likely
to lose its applicability over the years.
It is not uncommon to come across victim-blaming
narratives around LGBTQ people in Malaysia.
Psychologists should be provided with LGBTQ-
afrmative resources and trainings to improve our
ability to discern evidence-informed LGBTQ research
from those that attempt to blame LGBTQ people for
their experiences of sexual violence.
3. LGBTQ is a mental illness that should be curbed?
Lack of interventions from parents, religious
authorities, and educational institutions have also
been cited as reasons underlying the proliferation of
Malaysian people identifying as LGBTQ.11,17 However,
the notion that LGBTQ identities are pathological and
ought to be rectied stands in contrast with LGBTQ-
afrming approaches that support LGBTQ people in
developing a positive sense of self. Efforts to revert
LGBTQ people’s sexual orientation and/or gender
through religious counseling, aversion therapy, and
other methods that hinder LGBTQ people from taking
medical and social steps to afrm their identities,
are commonly known as “conversion therapy.”20,21
International studies with large samples of LGBTQ
people have uncovered the association between
exposure to conversion efforts and heightened risk of
suicidal ideation and suicide attempts,20,21 providing
empirical evidence that conversion efforts may cause
mental distress and psychosocial morbidity. Some of
the most crucial domains of social support with known
protective inuences on LGBTQ people’s mental health
are family members, friends, and signicant others
that can include people from LGBTQ and religious
communities.12 International LGBTQ research also
found those surrounded by supportive social networks
were less likely to be affected by minority stress and
cisheterosexism.14 All psychologists have the ethical
responsibility to promote the mental health and well-
being of marginalized groups (including LGBTQ
people),8 and we should critically scrutinize research
that seeks to cause harm. In this instance, psychologists
should question the moral intent of researchers who
urged those in close social ties of LGBTQ people to
perform conversion efforts which have little scientic
credibility in altering sexuality and gender.
Internalized cisheterosexism (also sometimes
known as internalized homo/transphobia) is the
feeling of self-hatred and shame that some LGBTQ
people may develop within themselves following
the negative societal attitudes.13,14 Negative self-
perception of LGBTQ identity should not be muddled
with LGBTQ people being confused with their
identities, although some do continue to question and
explore their sexuality and gender across lifetime.3
The level of LGBTQ-inclusiveness that a country
portrays, plays a key role in determining LGBTQ
people’s self-acceptance toward their identities.
Also evident in a cross-cultural quantitative study of
gay men in Australia and Malaysia, the researchers
found that the latter group had a higher level of
internalized homophobia.22 This nding is perhaps
unsurprising, given that Australia has legalized
same-sex marriages and banned conversion practices
in certain states, whereas these privileges were not
enjoyed by Malaysian LGBTQ people. For researchers
suggesting that LGBTQ people may wish to “return
to normal life” due to internalized cisheterosexism,11
psychologists should reect on minority stress theory
that elucidates internationalized cisheterosexism as
a proximal stressor arising from distal stressors (eg,
societal rejection of LGBTQ identity).
Historically, LGBTQ people have been medicalized
through Diagnostic Statistical Manual (DSM) and
International Classication of Disease (ICD) which
are diagnostic tools widely used by professionals in the
elds of psychology and psychiatry. Homosexuality
is no longer listed as a mental disorder in the latest
version of DSM-5 and ICD-11.23,24 The American
Psychiatric Association made a symbolic change
to replace “gender identity disorder” in DSM-IV
with “gender dysphoria” in DSM-5 to shift away
from the framing of transgender identity as a mental
disorder.23 In attempts to dissociate transgender
people with mental disorders, the World Health
Organization moved the ICD-11’s classication of
“gender incongruence” for transgender people from
the “Mental and Behavioural Disorders” chapter to
the new chapter of “Conditions Related to Sexual
Health.24 Overseas psychology bodies such as the
American Psychological Association and the New
Zealand Psychological Society have also published
statements asserting that identifying as LGBTQ is not
a form of mental illness.25
The misconception that LGBTQ phenomenon can
be mitigated through conversion efforts from peers,
parents, and religious leaders does not align with
the latest guideline provided by international bodies
such as the American Psychiatric Association and the
World Health Organization.23,24 Part of the role of a
psychologist is to actively update ourselves with the
4 Journal of Psychosexual Health
latest evidence-based guideline, and these include
challenging pathologizing narratives around LGBTQ
(eg, suggest that LGBTQ can be cured) and providing
services that recognize the self-determination of
LGBTQ people in identifying their own health needs.
4. LGBTQ is merely a Western inuence?
A few research has suggested that LGBTQ is a
Western inuence that has little relevance to the
Muslim-majority Malaysian context.11,17 The claim
that LGBTQ is only a recent phenomenon in Malaysia
was refuted by early Malaysian research that pointed
out that LGBTQ people have had a long history
of residing in Malaysia. In fact, there was a period
(before 1983) when transgender people were presented
options to undertake gender-afrming surgeries in
Malaysia without a repercussion of being detained.26
It should be noted that this viewpoint has no attempt
in undermining the freedom for Malaysians to practice
preferred religions, although religious practices should
not be used as a medium to justify cisheterosexism
and persecute LGBTQ people.27 International Human
Rights Standards, such as the Yogyakarta Principles,
acknowledges that all individuals have the basic
right to freedom from criminalization and sanction
regardless of their sexual orientation, gender, and
sex characteristics (Principle 33).27 On this basis,
all Malaysian LGBTQ people should be provided
opportunities to ourish which include adequate access
to social determinants (eg, LGBTQ-competent health
care) through an equity lens.2 A scholar proposed
that current laws criminalizing Malaysian LGBTQ
people stem from intersecting religious, historical, and
political imperatives; the multitude layer of inuences
perhaps explains the slow progress made in the
LGBTQ decriminalizing movement in this country.28
Often, the Malaysian public is sensitized to the
deleterious Western inuence in promoting LGBTQ-
afrmative practices by disrupting traditional family
values and religious teachings. This misconception
ought to be contested as it reinforces a cisheterosexist
framework of understanding sexuality and gender and
risks further stigmatizing the human rights of LGBTQ
people who constitute an already marginalized
population in Malaysia.
Implications for Psychologists
Generally, Malaysians have a low acceptance level toward
LGBTQ people, with one nationally representative study
reporting that 60.5% thought same-sex attraction was not
morally justifiable.5 As aforementioned, negative attitude
toward LGBTQ people stems from cisheterosexism that
criminalizes (through both secular and religious laws), mar-
ginalizes, pathologizes, and delegitimizes noncisgender and
nonheterosexual forms of identities. There are currently a low
number of LGBTQ-affirmative psychologists in Malaysia,10
and it is more important than ever to upskill psychologists in
the area of LGBTQ-cultural safety and competence to respond
to the increasing mental health needs among the Malaysian
LGBTQ population due to cisheterosexism and the resultant
minority stress. Cultural safety expands beyond culturally
competence that requires psychologists to have basic knowl-
edge in delivering LGBTQ-affirmative care (eg, working
with the input of LGBTQ people to identify their health
needs), and include an ongoing self-reflection that questions
power structures related to their own culture, prejudice, and
privilege that may affect quality of care.29 In the Malaysian
context, this means psychologists should be aware of how
their personal assumption is shaped by cisheterosexism and
how power differential between provider and patient can dis-
empower LGBTQ people from seeking timely and appropri-
ate care.9
The widespread cisheterosexism across various
Malaysian institutions has, however, presented immense chal-
lenges for psychologists to meet the goal of being culturally
safe and competent when providing care for LGBTQ people.
As a researcher endorsing LGBTQ-afrmative psychology,
I can understand the hesitancy for Malaysian psychologists
to take a similar stance in their own practices with LGBTQ
clients. In no way I am pressuring psychologists to put their
careers at stake for voicing out for the marginalized LGBTQ
population. Rather, I encourage psychologists to work closely
with local LGBTQ community organizations to identify best
practices when interacting with LGBTQ clients and provide
referral to other LGBTQ-competent specialists where neces-
sary. With the increasing cisheterosexist attitudes toward
Malaysian LGBTQ people, some LGBTQ organizations have
emerged to provide a counternarrative that afrms the lived
experiences of LGBTQ people.2 For instance, the SEED foun-
dation (a transgender-led organization) has collaborated with
the Galen Centre (an independent advocacy organization) to
create a guideline for health professionals in the provision
of trans-specic primary care in Malaysia.30 Meanwhile, it is
ne for psychologists to not know everything about LGBTQ
issues, as long as we maintain an open-minded attitude to
learn about the health needs of LGBTQ people and foster a
culturally safe relationship with LGBTQ clients.
Final Note
News of authorities targeting LGBTQ people and activists
are not uncommon in Malaysia. In 2021, Nur Sajat, a
Malaysian trans woman entrepreneur was charged under
Syariah laws for dressing as a woman at a religious event.31
The Nur Sajat’s case, followed by various state authorities
escalating restriction on LGBTQ people, exemplifies the
repressive climate based on cisheterosexism which has
spurred much fear among LGBTQ people to express their
identities openly in Malaysia. However, there are also exam-
ples of significant progress in combating persecution of the
Tan 5
LGBTQ community such as the overturning of the ruling of
“sex against the order of nature” on a Muslim gay man.32
Cisheterosexism that includes criminalization of LGBTQ
identities has detrimental effects on LGBTQ people’s mental
health. A recent review of existing Malaysian studies with
LGBTQ people reported limited research focusing on mental
health and well-being of this population.2 Specically, critical
literature gaps exist on the prevalence of mental health dif-
culties and the negative mental health impacts of minority
stress on Malaysian LGBTQ people. More contextually rele-
vant research on this topic is required so that we can advo-
cate for change at the local level. Psychologists should be
prepared to support graduate students (especially those who
identify as LGBTQ) who express interest in researching on
LGBTQ health. This includes helping students to understand
the effects of cisheterosexism on LGBTQ people’s mental
health and encouraging students to work in consultation
with LGBTQ community organizations. At times, there will
be voices that deter Malaysian researchers from exploring
LGBTQ health with claims of potential backlashes from anti-
LGBTQ groups or little changes that can be made to improve
situation for LGBTQ people in Malaysia. My counterargu-
ments for these sentiments are: If not now, then when?
Acknowledgments
The author would like to thank allies who have been advancing equi-
ty for the Malaysian LGBTQ population, including Chin Sheng who
has inspired me to write this viewpoint.
Declaration of Conflicting Interests
The author declared no potential conicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author received no nancial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Kyle K. H. Tan https://orcid.org/0000-0001-6831-7045
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