How Medicine Treats Disabled Trans People

In an article for SpoonieHacker, I talked about how medicine treats disabled trans people, and this conversation is something everyone can benefit from reading.

How Covid-19 Is Affecting The Transgender Community…

An extract from a talk I did for the University of Nottingham for Transgender Day of Visibility (31/3/20), detailing some of the extra complications that exist for the trans community around this pandemic.

Please note, I use certain language in this video that is ingrained but not ideal – It’s interesting how when we’re tired and stressed we use less skilful words, for example:

• Trans people being on a “journey” is an unhelpful cliché.
• Most trans people who were assigned female at birth would prefer to refer to their upper body with the word “chest”.
• Gender incongruence has superseded the term gender dysphoria, according to the World Health Organisation, and is generally preferred in-community, although not by everyone.

Trans kids won’t be okay until non-binary is accepted

Another article published in Beyond the Binary:

Transgender children have been in the news spotlight recently, with unhelpful and misleading “debate” and sensationalised headlines. The impact this will have had on trans children and their families is considerable.

As a therapist who has mainly worked with children and young people, and a trans trainer for schools and colleges, all children’s welfare is very important to me. Because of their isolation and marginalisation, trans kids are particularly vulnerable to bullying, abuse, and poor mental health outcomes. We need to discuss trans kids, and the discussion needs to be well-informed. Read more

World Mental Health Day

CN: mental illness, police, suicide, abuse

Mental Health is something I’ve been mulling over a lot recently. My own, and other people’s. It’s particularly relevant to the trans community, not because being trans is actually a mental illness, they have proved it isn’t. But because incidence of mental ill health is common in the trans community for the obvious reasons that we have less social support, are more likely to be abused and traumatised, and experience homelessness and other life stresses that can cause or exacerbate mental health problems.

My own health has been shaky this past couple of years. The stress of myself and my partner going through transition; our changing relationships with a lesbian community we were very much involved with; the discovery that once trusted friends are deeply transphobic; the experience that coming out as trans has fundamentally altered how people view me professionally and severely derailed my career; the backing off people have done as they’ve seen my increased need for support and haven’t necessarily felt up to the job. All these have played their part.

Alongside this is complex trauma that goes way back: like many trans children, and other children who are obviously different, I had a really bad start in life. And I’m autistic, a difference I share with many trans people, and one that also tends to marginalise you and leave you prey to abusers.

Because my particular mental health issues do not have easy medical fixes and are poorly understood, I’ve tended to avoid doctors for my mental health and turned to therapists, who have substantially helped me. Being a therapist myself, I’ve had access to supportive environments most people can only dream of, but I’ve often had to keep the extent of my inner turmoil close to my chest in a world that sees mental health in very “us and them” terms.

Perhaps that’s why I felt a chill in the air when I came out as trans and found myself experiencing pretty blatant discrimination in multiple professional arenas. Because many associate trans people with mental illness, and because mental illness carries a stigma.

And here’s the thing; one of the biggest strains of all on mentally ill people is the effort it takes to hide our distress because the world refuses to accept, support and hold it.

Care in the community?

For the last few weeks I’ve been dealing with a young woman in my street becoming increasingly paranoid and psychotic.

A regular round of police and ambulances, both of which cost and neither of which help. I’ve had to intervene several times in midnight screaming matches at hapless and hopeless public servants or ill equipped friends and relatives.

I have a knack for calming her and she now sees me as a safe person so is knocking on the door regularly and popping notes through the door which are alarming and bizarre. There is a grain of sense in everything, of course, and a true sad story going back a long way. Like most ill people her mind isn’t disturbed simply from a chemical imbalance, faulty genes or poor personal choices but years of trauma for which she’s had no support.

While I am in no doubt that she currently needs medication and probably hospitalisation for her psychosis, kindness and listening work a kind of magic on her. If only she had been listened to and supported more during her traumatic childhood maybe things would be different now. But now, helping her is not so easy.

So often I find that people who show resilience to life’s trials actually had support from somewhere. It’s that which makes the difference. Humans really cannot function without other humans supporting them, whatever our individualistic society likes to think. But we withdraw support from others quite quickly when things get tricky, scared that people will “take too much” and oblivious to the fact that if we act generously, as if we have an abundance of time and care, people often feel resourced and find their own resilience again, whereas if we keep pushing them away, well they keep experiencing a deficit and their need will be never ending.

Of course, there are some for whom the deficit they have had from others over decades means we may never be able to make up for it. This neighbour, and many in the trans community who have turned to me for help are examples of the enormous social deficit some people experience.

In the absence of social structures designed to meet need with genuine care, we spend a fortune on substandard care and have the police standing as care in the community. An abundance of people whose job it is to listen could obliterate the loneliness, isolation and marginalisation that lead to people falling prey to harmful and abusive people or to self-soothing behaviours that in the end make things worse, such as substance misuse.

Meanwhile our prisons are full of mentally ill people, and a large proportion of trauma and deaths at the hands of police happen to mentally ill and disabled people. Police and prisons are an expensive and entirely unhelpful resource for what is a healthcare and social issue.

More support, early intervention and warm, person centred care for those who need it, would save us millions and more importantly make our communities happier places for all.

Understanding resilience comes through vulnerability, not strength

This requires a fundamental philosophical shift: Support makes people and communities more resilient. Shouldering too much without help can make you crumble. The idea that “mollycoddling” makes people weak is a popular but dangerous myth.

So often people think they’ve not had support and have “got through” on their own but some support is invisible – sometimes it’s generally socially supportive attitudes to your circumstance, a difficulty that’s understood or portrayed favourably in the media rather than one that’s taboo or dealt with badly.

As primates, we really do very badly on our own, we are so fundamentally social. And as social creatures, evolved to collaborate and work collectively, our capacity for mutual support is what makes us awesome. Crowning achievements like the NHS show just what we can be, and chipping away at the edges of this service until we have people who need inpatient care sleeping in police cells and police acting as expensive and untrained care workers, well this does not just affect the individuals who are suffering, it puts stresses on whole communities and increases the cost of police and prisons. In effect it is the very opposite of the old adage “a stitch in time saves nine”. Saving money on mental health can work out very expensive indeed.

Withholding our care does not toughen people up, in fact quite the reverse. Yes, many people with mental ill health need medicine, and many need walks in the woods and exercise as certain internet memes insist.

But what we all need most is human support and empathy, and there is no substitute for this. That cannot be found in a forest or a bottle, but it is nevertheless an abundant resource.