Health Care Professionals And Lost Generation Of Transgenders

In several posts on this blog, I have mentioned some of the difficulties transgender people have in getting appropriate medical and psychiatric care.  One of the main reasons is, of course, the high percentage of trans people who are poor, uninsured and even homeless.

As bad as the situation is now, it was much worse during my youth.  The poverty and homelessness, and the lack of insurance, probably were even bigger problems for trans people thirty or twenty years ago than they are now.  However, there was yet another factor that made it difficult, or even impossible, to get the necessary therapies and treatments, and helped to create a lost generation of transgender people. 

That factor is a trait of a particular group of people--the ones who were, in essence, "gatekeepers."  I'm talking about medical as well as psychiatric professionals.  They, like nearly everyone else, were inculcated with their culture's notions of gender and sexual norms.  That is to say, nearly all of them believed in the "male-female" gender binary and the normalcy of being a heterosexual.

What that meant, of course, is that nearly all such professionals were deeply homophobic to one degree or another, whether consciously or not.   (I will admit that I shared much of that homophobia.)  So, for example, a female-to-male transgender who wanted hormones and surgery could not give even any indication of sexual attraction to women.  She also had to exhibit what were considered "feminine" traits and desires.  Worst of all, she had to commit herself to living a life of denying her past.  In other words, she had to re-invent her life as that of a woman growing up to become a girl, in the name of "passing."

Victoria Brownworth has written, "Passing never works; the lie distances you from those who aren't a party to it.  Society may reward the lie, may even demand it, but the passing person is punished for passing--either by being caught in the lie or believing it.  Every closet is a prison, whether it is a construct of sex or class. Passing kills; it annihilates who we are and keeps us from who we could be."

About the only beneficiaries of this emphasis on "passing"--which is to say, living in an enforced closet--were the Four Horsemen of our community:  AIDS, drugs, suicide and violence.  They all reached staggering proportions during the 1980's.  Although good, let alone exact, statistics on trans people from that period are nearly impossible to find, I would guess that an even larger percentage of trans people died from those causes than are claimed by them now.  In a literal sense, they are the reasons why we have a lost generation of transgender people.  But even the survivors of that generation--who include me--had to endure decades of depression, isolation and, in many cases, substance abuse, as a result of not seeking the care we needed until much later in our lives.  That left us as isolated from each other as all of those transssexuals who "passed", or tried to, were from each other.  The result was that, really, we didn't have a community for at least a decade, and could therefore not offer each other the advice, mentorship and other help we so desperately needed.

In other words, even those of us who wouldn't begin our transitions for another two or three decades had to live with the same lie as those who told doctors, psychiatrists, endocrinologists and surgeons what they wanted to hear.  They, of course, told those lies because the health professionals themselves believed, if not the lies themselves, then in the homophobia that made them necessary.  Those of us who survived are still dealing with the aftermath, and will probably do so for the rest of our lives.

What The DSM-V Won't, And Can't, Address

Yesterday I discussed, briefly, the possible implications and effects of removing "transgender" from the list of mental disorders for the upcoming DSM-V.

As I mentioned, this de-classification of us as mentally ill may not turn out to be an entirely good thing unless other changes are made.  In the post, I talked about the fact that some medical and psychiatric care is available to us on the premise that our identity is a "disorder". The good news is that while changing such a circumstance won't be easy, it can at least be done through a few very specific actions, such as changing some health care, governmental and insurance policies.

On the other hand, there's another problem that will take longer and could prove even more difficult:  changing the attitudes of some health professionals and others on whom we depend.  While efforts to educate them about homosexuality have eliminated or lessened at least some of the homophobia found among such professionals, there is still some bigotry against non-heterosexual people.  And, where there's homophobia, there's usually even more transphobia.

Fortuanately for me, I have not experienced transphobia from health care professionals since the time, early in my transition, a group of nurses at the New York Eye and Ear Infirmary mocked me when I came in for an appointment.  I was ready to walk out and file a complaint when the doctor with whom I had the appointment walked in, apologized for the nurses' behavior and treated me with courtesy and respect.  While that incident turned out well and I have not had difficulty with health care professionals since then, many other trans people are not so fortunate.

As an example, a trans man I know told me about an LGBT health fair he attended.  One of the presenters was a doctor with a large number of transgender patients.  In fact, he was my first doctor when I started my transition.  According to this friend--and others who attended that fair--this doctor disparagingly compared trans people to Michael Jackson and even said, in essence, that there's not much that can be done to help trans people; all anyone can do is to medicate them.

Now, if a doctor with transgender patients can make such comments, you can only imagine how much transphobia still exists, even if it's less openly expressed.  It can be mitigated, of course, through education:  Some aspiring doctors are learning about trans issues as part of their training.  Others are doing residencies or internships with clinics and other institutions that serve large numbers of LGBT people.  And, of course, some experienced doctors and nurses are open to change, or weren't bigoted to begin with.  But while I am confident that others  can and will change, de-classifying us in the DSM-V won't be enough.