TUESDAY, June 6, 2023 (American Heart Association News) -- As rainbow flags flutter in the June breeze for Pride Month, many LGBTQ+ people will feel tension in the air.

"It's been a really rough go for LGBTQ Americans" of late, said psychiatrist Dr. Natalia Ramos, an assistant clinical professor at the David Geffen School of Medicine at the University of California, Los Angeles.

In the wake of universal stressors such as the COVID-19 pandemic and the economy, the news has been full of anti-gay and anti-transgender actions from the highest levels of state and local governments. "I think even for those of us that are not based in states that are directly impacted right now, it's hard to miss out on the extremely negative discriminatory messaging that's going on against LGBTQ people," Ramos said.

Which means this year's pride celebrations could be an opportunity for LGBTQ people and those who love them to get a much-needed mental health boost from social companionship and public affirmation. But fittingly for an event that is associated both with exuberance and defiance, there's a spectrum of ways to approach it, experts say.

Jessica Halem, senior director of Eidos, the LGBTQ+ health initiative at the University of Pennsylvania in Philadelphia, calls today's social and political climate the best of times and the worst of times. "I've been in LGBT health for 20 years," she said. "We've never had so much momentum, interest, support and public recognition," even as states enact laws that target LGBTQ people and some pride events are being shut down.

"That's the part that gives us a little bit of whiplash," Halem said. "And of course, none of this is good for my heart health."

Ramos, who is medical director of UCLA's EMPWR clinic, which emphasizes well-being and resilience in LGBTQ+ people, said toxic stress of the type caused by homophobia and discrimination can indeed be a health risk. "It's a weighty thing to be experiencing constant stigma and messaging against you and/or people you love."

A 2020 scientific statement from the American Heart Association emphasized that stress is thought to be a significant factor in health disparities for LGBTQ people. They also are at higher risk for social isolation, which has been linked to issues with mental and heart health.

Pride Month celebrations might, therefore, be healthy, Ramos said. "In general, we know that social connectedness, social cohesion and finding meaning in your identity and your values are all very positive experiences for our mental well-being and our physical well-being as well."

Halem, who was the first LGBTQ director at Harvard Medical School, said "being isolated breeds shame. And shame is the internalization of stigma." It's impossible for an LGBTQ person to avoid hearing negative messages and absorbing their toxicity. "But you have to actively release it. That is why we dance. That is why we listen to loud music. That is why we sing. That is why we wear wacky clothes. We have to release that shame."

Pride Month traces its roots to the 1969 Stonewall Uprising for gay rights in New York City. Over the years, it's been celebrated in ways both serious and silly.

"You know, it's funny, because some of us old-timers probably started to take pride celebrations for granted," Halem said. "We were a little like, 'Oh God, not one more party. Not one more rainbow boa.'"

Now, she's tuned in to the way those celebrations are a way to witness "the huge diversity of experience, expression and lives within the community."

Halem, who has performed as a standup comic at pride events nationwide, said she'd felt the power of such gatherings firsthand.

At pride celebrations large and small, she said, "you will always see an incredible range of bodies, couples, hairstyles and clothes. I mean, just to see how people live in their queer bodies, just to see people embody queer joy, to see transgender people, to see old gay people. It's just …

"It heals," Halem said.

Ramos said "there's an immense potential positive effect on well-being for folks that are marginalized" if they experience a sense of community. "Seeing ourselves in public discourse and public media in positive ways also is very helpful for mental health, even if you're not directly experiencing the pride events in person."

But she said it would be naïve to assume that a pride month, week or weekend could counterbalance all of the negative social and political stressors people are encountering right now. People might also have safety concerns about large gatherings.

"Realistically, a lot of folks think there's a kind of performative aspect of pride where it's confined to one weekend or one month, while all of these life stressors are never-ending," Ramos said.

Some pride parties end up centered on alcohol in unhealthy ways, she said. Others focus on family and community or emphasize activism. So, in some areas, people can pick and choose the most comfortable setting for celebrating.

Social connectedness doesn't have to involve marching in a parade, Ramos said. "Hanging out with friends, chosen family, in small get-togethers – whatever floats your boat – can be really meaningful."

Halem said LGBTQ events, like LGBTQ people, come in all varieties. "Back in the day, we only had smoky bars and a couple of softball leagues. Today, you can find meetups in parks. You could find Dungeons & Dragons gay night. I'm going to a trivia night at a church basement."

If your favorite type of event doesn't exist, it's easy to start something over social media, she said. Go to an online forum such as a local LGBTQ-oriented Facebook group, Halem said, and say, "'I'm looking for other introverts to do a gay puzzle night.' I guarantee you, you'll have 20 people show up."

Pride activities also are a great way for friends and family to show support, Ramos said. People who aren't sure how to best be an ally can always ask. But, she said, "you don't want to just reach out to your LGBTQ friends during Pride Month. You want to be maintaining the relationships, checking in, being mindful and thoughtful year-round, especially when there's a lot of stuff going on around us."

LGBTQ allies who want to show their support in person need to be thoughtful in choosing an event, Halem said. "You should go to a pride parade and cheer people on and hold a sign saying, 'Another mom for gay rights! I love my transgender kid!'" But after that, "you don't have to go to the dance club."

Overall, she said, even small validations of LGBTQ people – including self-validations – matter.

The world is full of loud, cruel voices, Halem said. "For me, the antidote, and the way to celebrate this month, is to practice love, joy and affirmation towards ourselves and others."

Pride, she said, "sounds like an event I go to. But it's a feeling that I can cultivate in myself first."

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved.

By Michael Merschel, American Heart Association News