For those of us dealing with ongoing issues of trauma, depression, anxiety and psychosis, access to medical transition or simply, health care, is loaded with the specific stigma of mental illness. Folks with mental health issues share a history of being warehoused and incarcerated in “sanitariums,” with some still experiencing segregation in large institutions. There is an obvious overlap for trans folks who have been forced into the psychiatric system to attain approval for health care, in terms of experiences of persecution, being pathologized, systemic abuse, and involuntary treatment.
Many trans and Two-Spirit folks who experience serious mental health issues have trauma histories based largely in societal and familial responses to our identities. In other words, our mental health issues (most commonly anxiety and depression) are a direct result of the transphobia we experience in our everyday lives. Yet, in Ontario, you are required to proceed directly to the nearest mental health institution to receive a diagnosis of “Gender Identity Disorder” or "Gender Dysphoria" in order to get funding for surgeries. If you disclose your trauma history or mental health status, your access to health care may be denied or indefinitely delayed so that you are de facto refused access. You are paradoxically required to admit that your gender identity is an illness or disorder to be considered for treatment, while your mental health history may serve as a barrier to access.
Furthermore, you are asked to present your narrative as if it is an unbearable burden. It is not simply enough for you to know that you are trans and that access to care would be beneficial to you. In order to qualify for funding, or in many cases to attain primary health care in the form of hormone therapy, you are expected to meet a certain subjective threshold of dysphoria defined and assessed by cisgendered, Eurocentric, medical gatekeepers. Trans women of colour have spoken out about this idea of the ‘tragic trans narrative’ as the only possible narrative applied to them by mainstream society.
An emphasis on tragedy and pervasive, unrelenting, unbearable dysphoria by government and medical systems sets access to care contingent upon one’s ability to prove and display suffering related to their gender. Gender variant people are forced to (en)act a pathological existence, thus reinforcing societal beliefs that the only way to be trans is to be sick, wrong, confused, or broken. Ironically, the suffering trans folks face is largely due to the pervasive repression and degradation of our identities. If trans and gender variant people were supported to explore and accept ourselves from a young age, much of the suffering around internalized shame, feeling the need to hide one’s true self, being exposed to psychological and physical violence, daily microaggressions, rejection and erasure contributing to depression and low self worth would be absent.
The stigma and restricted access to decision making in trans health and embodiment is a major cause of suffering for many trans folks. Having trans people measured for degree of suffering is like using a transphobic measuring tool to gauge the unbearableness of transphobia. It is a systemic multiplication of transphobia under the guise of psychiatry, and oddly, increases the trauma and mental health issues that we may be forced to deal with.
Trans, Two Spirit and genderqueer folks who resist the ‘tragic trans narrative,’ and define and express our identities for ourselves, disrupt the medical system with our own truths. As well, trans folks who do not have a definitive end point of gender in mind, but nonetheless seek masculinization or feminization, can challenge medical service providers to drop the imposed binary narrative and see us in our full complexities.
We do this by authentically presenting our own stories in the manner that fits for us, using terms that we choose for ourselves, not altering our histories and understanding of our genders, and by seeking out and demanding medical practitioners and surgeons that listen to us. We continue the push for accessible, culturally appropriate primary health care, and we then share this information with those of us who do not have access. By doing so, we resist succumbing to psychiatrization for access and, instead, create opportunities for ourselves and others via whatever creative means we have available.
There is simply no reason that trans or gender variant identities must be pathologized (labelled as mentall illness) in order to have access to primary health care that is informed, supportive, and reflective of the needs of the individual seeking access. This does not mean that we abandon offering counselling and support for those who desire it, or that we make hormones accessible on demand. It means that we stop labelling trans folks as mentally ill in order to receive care.