In a context of reflection on diversity and inclusion, which are essential pillars of a democratic society, psychiatrist and psychotherapist Bernardo Rahe gave lectures at the Neuro 2026 event. His experience in caring for transgender people served as a basis to discuss the neurological effects generated by continuous exposure to stress.
Rahe warned that when difference meets prejudice, various negative experiences result. He detailed these manifestations, which include stigma—the association of individuals with stereotypes and labels—discrimination, which implies unequal treatment, bullying, which causes repeated victimization, rejection, which distances or suppresses the feeling of belonging, and barriers, which can impede or hinder access and participation.
The specialist emphasized that even if an act of prejudice lasts only a few minutes, the anticipation of its recurrence can affect a person daily. Rahe underlined the importance of listening to patients' experiences, arguing that lived experience provides scientific information, and that listening does not negate the scientific method.
The psychiatrist explained how stress resulting from prejudice impacts mental health, dividing the factors into distal stressors (external), such as violence, institutional barriers, rejection, and bullying; and proximal processes (internal and relational), such as identity concealment, hypervigilance, internalized stigma, and expectation of rejection.
The outcomes associated with these factors include anxiety, depression, isolation, exhaustion, and reduced help-seeking behavior. The phenomenon known as 'Masking' represents an invisible cost in attempts to ensure acceptance and safety. Rahe observed that although it may appear to be good adaptation or high functionality, what is masked is often constant effort, exhaustion, and lack of support.
Rahe drew attention to statistical data, mentioning that the estimated prevalence of Autism Spectrum Disorder (ASD) in the general population is between 1% and 2%. However, among those treated for gender dysphoria or incongruence, this percentage reaches 11%. He contextualized the confrontation of diversity against prejudice again:
- Neurodivergent people face sensory barriers, implicit rules, inadequate communication, and infantilization.
- The LGBTQIA+ population deals with identity invalidation and rejection within a system that imposes cisheteronormativity, meaning it considers cisgender identity and homosexuality as the only legitimate and natural ways of existing.
To conclude, Rahe outlined two paths: a risk path, composed of internalized stigma, isolation, anxiety, depression, hypervigilance, exhaustion, masking, and discrimination; and a protection path, which includes autonomy, well-being, participation, accessibility, adaptations, positive identity, and listening. He concluded that true overcoming does not lie in appearing less different, but rather in preventing difference from being transformed into a lesser value.