Social maxims come in 2 flavors.  I’ll use an example because any attempt to explain in abstract terms may appear clear as Mississippi mud.

Consider the maxim that says, “Your character is judged according to the company you keep.”  I think it’s pretty safe to say that the vast majority would agree it’s sound advice.  I’m not so sure those in agreement also agree upon its interpretation. One interpretation reflects a version of conservatism rooted in fear; another reflects compassion rooted in understanding.

I’ve had friends diagnosed with mental illnesses and still do. They’re some of the most loyal friends I know.  Not only are they loyal, they’re often very intelligent.  The stereotypical “koo-koo” fits the modern comic and some politicians far more than it does those who genuinely live with mental illness.  Your next door neighbor may battle mental illness and you may not even realize it unless that neighbor confides in you.

Why do I bring this up on a transgender blog?  Simply this: far too often, and in contradiction with the consensus of the psychiatric community, many people presume mental illness upon transpeople only upon the fact of their living openly as transpeople.  Those who make this presumption often turn out to be religiously intolerant Conservatives who want to remove transpeople from public life altogether, either temporarily or permanently, depending upon the disposition of their self-appointed “authority”.

On account of this self-appointment they’re inclined to refuse any business or association with a transperson.  It follows in the spirit of a ditty often recited among Christian youth in the 1970’s, “I don’t smoke… I don’t chew… and I don’t go with girls who do.”  And, of course, that goes double for those girls they equate with the ostensibly phony-baloney character, Max Klinger of the M*A*S*H television show.¹

Let’s assume for now that we transpeople are all mentally ill just for argument’s sake.  How does such a charge relate to how we treat mental illness generally?

 While we make this assumption for now, let me ask you another question.  Are you… well… NORMAL?  Don’t answer too quickly or I’ll consider you to be rash.

 

ABUSE OF DATA

This exercise in logic is worth pursuing because we’ve seen so much abuse of mental health data by those parties who want to claim that transition somehow “causes” mental illness.  For that matter, beliefs concerning transpeople and people with mental illness often become a “chicken-or-the-egg” proposition. Are we mentally ill because we’re transgender or are we transgender because we’re mentally ill?

You’d think that the armchair psychiatrists would make up their minds on this.  The typical response?  “I don’t know and I don’t care.  I just want you to be off the streets.”

Fine.  I can take that response for what it is.  It’s a statement of disinterest in the well being of others.

Some others say, “It takes a nut to know a nut, so I don’t want to know you.”

Fine.  I can take that response for what it is too.  It’s a statement of closed-mindedness based upon unqualified sloganism. The problem with slogans is that they’re so readily accepted as genuine maxims even if completely untrue and few are willing to test the verity of their slogans.

But it often doesn’t end there.  Some say, “Well, that Swedish study says transition causes transpeople to be mentally ill.”  But when I ask what “that Swedish study” is, they can’t tell me because they don’t know.

Fine.  I can take that response for what it is as well.  It’s a statement of rumor and ignorance.

Not only is it a statement of rumor, but I also know what the source of that rumor is.  “That Swedish study” was titled, Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden.  It was led by Dr. Cecilia Dhejne and published in 2011 by the Karolinska University Hospital.  I also know what that study concluded and it didn’t conclude what people often claim it concluded.²

Did their study show sharply elevated incidence of morbidity as suicide and criminal behavior among post-operative patients?  Yes it did.

Did their study conclude that transition caused this sharply elevated incidence of morbidity?  No it did not.

In fact, here’s what it concluded, stated verbatim:

 

“Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, [sic] and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.”³

 

Dr. Dhejne noted 2 groups they had studied over terms of several years: the first group covered the years 1979-1988 when very little infrastructure for trans health care existed and in which scarcely anyone spoke out concerning discrimination against transpeople.  The second group covered the years 1989-2003 when this situation had much improved.  The statistics published in this study didn’t differentiate between the 2 groups.  They were simply presented as an aggregate.  Dr. Djhejne told Transadvocate in 2016, “Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period 1989–2003.”⁴

It makes sense to improve post-operative care for transpeople.  Trans activists have long called for this.  Of course, those statistics concerning morbidity are statistics which the researchers compared to the general population.  Does this mean that every post-operative person is mentally ill as a categorical principle, based upon this study?

Nope.  The study didn’t attempt such a claim.  Many transitioning people do just fine after surgery.  They don’t get into trouble with the law.  They don’t indulge in drugs. They die of natural causes. In other words, transpeople aren’t categorically mentally ill because we’re transgender.

Since Dr. Dhejne’s statement about what should be considered a significant difference didn’t appear in the published study, it’s easy to see how anti-transgender polemicists seized upon that study to make it a feature of their propaganda through the misuse of data.  They took a legitimate study and twisted it into a red herring designed to further harm transpeople.  That’s the worst kind of rumor-mongering.

 

THE ASYLUM

Years ago one of my roommates began the process of transition.  One evening in 2003 she called me on the telephone.  She had spent 5 months in a mental ward in Los Angeles.  She said in a rant: “This is terrible!  This is hell!  If I knew it would be this bad I wouldn’t have transitioned!”

I said, “That’s the difference between you and me.  I knew it would be hell and transitioned anyway.”

So did those psychiatric professionals who treated my former roommate force detransition?  Nope. But they did prohibit using her female name and pronouns while committed.  It came down to revisiting her reasons for transition, offering her an out.  Naturally, any patient with gender dysphoria has the right to transition.  The same also has the right to detransition or even to re-transition as some detransitioners do.  Her treatment didn’t represent forced detransition.

So what’s the reality of the so-called “unreality” of the trans experience?  There’s a profound difference to consider.

We who were (or are) afflicted with gender dysphoria also understand too well what our physical reality is: that the bodies we have pre-transition don’t match our internal sense of gender.  Very likely this impacts the opinions other people have concerning our gender.  Those opinions may take the form of, “He’s too pretty to be a man!” or possibly, “He’s a fake— I don’t know why, but he’s gotta be a fake!”  Those perceptions don’t deny what a person’s physical body may be, whether representing one’s own perceptions or the perceptions of others.

However, if one assigned “male” at birth senses that internal “femaleness” and conscientiously denies they ever inhabited is a male body at all, that’s when we find real evidence of dissociation with reality.  See the difference?

Given this differentiation, we can’t categorically say that we’re transpeople because we’re mentally ill either.

 So if these professionals released my former roommate, why do armchair psychiatrists decide we all must be mentally ill and committed to an asylum?  Clearly it has nothing to do with accepted psychological practices.  Instead it must pertain to preconceived opinions.  That’s a position rooted in unstudied prejudice carried to a genuinely pathological malice.

So with a clear mind I say to the pathologically malicious, “You need help.  Really, you do.”

 

THE STIGMATIZERS

In 2002, Patrick W. Corrigan and Amy C. Watson submitted a thought-provoking article titled Understanding the impact of stigma on people with mental illness.  It appeared in World Psychiatry, the official journal of the World Psychiatric Association.

They called out the fact that people with mental illness face a double burden.  Not only do they have to deal with the symptoms of the illness itself but also the stereotypes and prejudices foisted upon them by those who don’t understand mental illness.  This is what embodies stigma and may be external (what they call “public stigma”) or internalized (what they call “self-stigma”).⁵

They cited 3 issues of stigma:

1. Stereotype: Negative belief about a group of people or about one’s self as part of that group. Examples include “dangerous”, “incompetent”, or “weak character”.
2. Prejudice: Agreement with a negative belief or emotional reaction.  Examples include “fear”, “anger”, and if internalized include “low self-esteem” and “low self-efficacy.”
3. Discrimination: Response to prejudice as behavior. Examples include “avoidance”, “withholding help”, “denying employment”, or “denying lodging.”  When internalized, one may not bother to pursue employment or housing opportunities.⁶

They also cited some common themes in attitudes that prejudices generate:

1. Fear and exclusion: The belief that people with mental illness should be fired and therefore kept out of local communities.
2. Authoritarianism: The belief that people with mental illness are irresponsible, so all decisions should be made by an authority.
3. “Benevolence” (actually a pseudo-benevolence): The belief that people with mental illness are like little children who must be cared for.⁷

These attitudes carry a behavioral impact through discrimination that takes 4 forms:

1. Withholding help
2. Avoidance
3. Coercive treatment
4. Segregated institutions.⁸

The solutions they propose are threefold:

1. Protest
2. Education
3. Contact⁹

Sound familiar?  It should.  It’s exactly what trans-activists have been doing for years.  But similarities don’t stop there.

Consider an article from 2017 from Laura Greenstein writing for the National Alliance on Mental Illness (NAMI).  She described 9 ways to combat stigma, using similar language to what Corrigan and Watson used years earlier in World Psychiatry:

1. Talk about mental health openly
2. Educate yourself and those around you
3. Be conscious of language
4. Encourage equality between physical and mental illness
5. Show compassion for those with mental illness
6. Choose empowerment over shame
7. Be honest about treatment
8. Let the media know when they’re stigmatizing those with mental illness
9. Don’t harbor self-stigma¹⁰

That’s pretty much what we do as trans activists, isn’t it?

While the severely mentally ill may experience such dissociation that they must spend time in a mental health facility, medical and psychiatric practices have advanced to where most can live regular lives in their communities— if the rest of us will let them.   The idea, “Once a sicko, always a sicko” isn’t productive when it comes to incarceration in a mental ward.

So if permanently committing all people with mental illness isn’t proper psychiatric procedure, what does that say about those people who advocate doing so?  It means those advocates of exclusion want to override what’s been proven to be effective.  They seek to override out of their own pathological fear and anger— and that kind of anger becomes a self-corroding hatred sooner or later.  This is the kind of pathology that drives those who insist that transpeople categorically are mentally ill.

 

THE COMPANY YOU KEEP

Let’s look again at how “your character is judged according to the company you keep.”

If our company is designed to confirm and to advance stereotypes, prejudice, and discrimination, then how can anyone other than ourselves be judged as anything but hateful?  If, however, our company is designed to reach out and strengthen those whom the hateful tear down, wouldn’t others judge us as “compassionate” unless those judges come from groups who seek to advance stereotypes, prejudice, and discrimination?

It comes down to what emotions and beliefs we choose to facilitate.  How we view others with mental illness reflects what’s in our own hearts, whether they be full of fear or compassion; and those we think to be hopeless often embody a beautiful universe within.

So whether, if we follow our supposition that we transpeople are categorically a bunch of incorrigible sickos, our treatment must follow in proper course with other plans for mental health.  That objective is no longer to impeach the unpopular and isolate them indefinitely, but to restore and affirm.  If the majority of those with mental illness can live regular lives, there’s no reason transpeople can’t do the same.  Those who insist on perpetuating stigma aren’t helping anybody, especially themselves.

So this gives good reason to do lunch with someone you think is a nut.  Maybe that other person isn’t as “nutty” as you think.  You may find that other person to have amazing insight, a beauty you hadn’t seen because your prejudices blinded you.  You may realize that you might not be so “normal” after all, whatever “normal” is supposed to be.

Certainly when it comes to transpeople, some have made great contributions to the world:  like Dr. Alan Hart, a transman who developed X-rays as a diagnostic tool for tuberculosis…¹¹ like transwoman Wendy Carlos who invented the synthesizer and changed music worldwide…¹² like Lynn Conway whose electronic engineering proved indispensible for modern computing.¹³ Nome of them look like the stereotypical mentally ill incompetents stigmatizers try to make us all out to categorically be.  We can cite many others with amazing stories worth telling.  Open your hearts and listen to these worthy stories.

Meanwhile, those of us who are transgender should look beyond our own civil rights.  We need to recognize and advocate for the rights of individuals facing issues of mental health, for the issues they face are quite often analogous to our own.

So let’s do lunch.  Make mine vegetarian.

_____________________

 For information on mental illness, please visit the website for the National Alliance on Mental Health at www.nami.org.

_____________________

REFERENCES:

 Featured Image: A little girl draws representations of her confusion and darkness on the walls and floor. But look closely. Do you see the swirls she has drawn as if they’re extensions of Vincent Van Gogh’s painting titled, A Starry Night? Public domain image by Jennifer Mathis, (Flickr) superimposed upon A Starry Night (Wikimedia Commons).

1. Witnessed by the author at Ozark Bible College (now Ozark Christian College) in Joplin MO in 1977 when she was a missionary student there.
2. Lynnea Urania Stuart. “A Presumption of Evil” Transpire (June 24, 2017, accessed December 14, 2018) https://lynneauraniastuart.wordpress.com/2016/06/24/a-presumption-of-evil/.
3. Dhejne, Cecilia; Lichtenstein, Paul; Boman, Marcus; Johansson, Anna L.V., Långström, Niklas; and Landėn. Mikael.  “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden” PLOS (February 22, 2011, accessed June 18, 2016) http://dx.doi.org/10.1371/journal.pone.0016885.
4. Williams, Cristan. “Fact Check: Study Shows Transtion Makes Trans People Suicidal” Transadvocate (Accessed June 18, 2016) http://transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm.
5. Patrick W. Corrigan and Amy C. Watson. “Understanding the impact of stigma on people with mental illness” World Psychiatry (February 1, 2002, accessed December 12, 2018) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/.
6. Ibid.
7. Ibid.
8. Ibid.
9. Ibid.
10. Laura Greenstein. “9 Ways To Fight Mental Health Stigma” NAMI (October 11, 2017, accessed December 12, 2018) https://www.nami.org/Blogs/NAMI-Blog/October-2017/9-Ways-to-Fight-Mental-Health-Stigma.
11. Ari Mejia. “Alan L. Hart” OutHistory (accessed December 14, 2018) http://outhistory.org/exhibits/show/tgi-bios/alan-l-hart.
12. Natasha MadDonald-Dupuis. “Meet Wendy Carlos: The Trans Godmother of Electronic Music” Vice (August 11, 2015, accessed December 14, 2018) https://www.vice.com/en_us/article/53agdb/meet-wendy-carlos-the-trans-godmother-of-electronic-music.
13. (n.a.) “Introducing Lynn Conway, Prof. of Electrical Entineering & Emoputer Science, Emerita, University of Michigan, Ann Arbor” (University of Michigan Website accessed December 14, 2018) http://ai.eecs.umich.edu/people/conway/BioSketch.html