Trans Health Advocates Think Outside the Lines
On November 9, pioneering advocates for health service access for trans people gathered for the 2012 Trans Conference: Outside the Lines held at the California State Polytechnic in Pomona to discuss issues surrounding mental health support. Dr. Jack Drescher presented the keynote speech, questioning whether gender identity disorder should be removed from the DSM-5 as a disorder.
"It is argued that this disorder shouldn't be a diagnosis at all, and should be removed in the same way homosexuality was removed some time ago. It's about stigma but it's also about getting access to care. Trans people need medical treatments like hormone therapy or surgery and they can't access this without a diagnosis that their doctor can assign," Drescher explained, noting that in France, they moved this diagnosis from the ICD's 'Mental Disorders' section to the 'Rare Diseases' section.
"That's a possibility for the future, but right now trans people need doctors, insurance companies and hospitals to provide care from a point of necessity," he said. "It's a very complex problem. The care is under-funded, certainly, but you can't even get care without a diagnosis."
As a member of the American Psychological Association's Diagnostic and Statistical Manual (DSM-5) Workgroup on Sexual and Gender Identity Disorders and the World Health Organization's Working Group on the Classification of Sexual Disorders and Sexual Health for the International Classification of Diseases (ICD-11), Drescher seemed to question the necessity for keeping Gender Identity Disorder in both publications as a diagnosis of the transgender experience.
Founder and director of the Los Angeles Transgender Center and marriage and family therapist Marie Keller provided a discussion of how to approach the trans experience as a mental health provider. She argued that there should be a clamor to remove the disorder diagnosis from the DSM and ICD and consider gender transition as more akin to pregnancy or menopause, which are not considered to be diseases but periods of physical change.
"There are other cultures in the world in which there are five or more genders and no binary concept," said Keller. "We here have a very unimaginative system at the moment and we all see things through the lens of a reality created by that culture. I feel it reduces the negativity and suggests other possibilities for our own future understanding of gender."
Keller admitted that the psychology community holds what she sees as a "great wound" for the history of pathologizing trans people. This has set up a situation, she fears, in which the transgender need relief from the stress of their lives but do not feel safe to seek out therapy. In her own work she provides family therapy to promote understanding between trans people and their family members. Through the L.A. Transgender Center and a partnership with a local trans-friendly sperm bank, she provides information on building a new family.
"Trans people are as different from each other as people with brown eyes. The only reason they get grouped together is because they’re discriminated against as a group," Keller explained. "We pathologize a lot of mental and emotional difficulties unnecessarily because of the medical model we work under. You have to be seen as sick in order to get medical treatment. The insurance companies need a code on their forms in order to pay out."
Willy Wilkinson works with health service providers, educational institutions and social justice organizations to develop access to health services for trans people. He focused on providing information on how service providers can approach those with non-binary identities with respect. At the forefront, he argued, is using appropriate names and pronouns and asking appropriate questions in order to make trans people feel safe, accepted and understood.
"There are three areas to transition-related health care: mental health care, hormonal treatment and surgeries. Surgeries are the hardest element of care to access," described Wilkinson, noting the expense, lack of insurance coverage and high level of expertise required from surgeons who can perform face, chest and genitalia surgeries. "Many trans people have to travel outside of California for procedures. There are a lot of barriers to access what are highly necessary health care needs. This is a huge mental health issue -- getting surgery can mean life or death for some."
San Fran at Forefront of Trans Provisions
Wilkinson highlighted the good work of the Healthy San Francisco program that provides health care for the uninsured. Exclusions for transitional surgeries have been removed from their provisions. In San Francisco too, government employees now have access to the full range of trans health care as medical necessities. This makes the northern Californian city the first in the U.S. to implement such progressive strategy.
All of the speakers at the event investigated the complex intersection between surgeries a trans person wants for themselves to feel congruent and the surgeries they feel they must have to be accepted socially and avoid discrimination.
"I discuss this with my clients," said Keller. "We may ask, is it their personal unease about their body that drives the decision or is it social anxiety? The problem is, we won’t know this and they won’t know this until we allow trans people the space and freedom to live without judgment."
Nancy Tubbs is the director of the University of California, Riverside’s LGBT Resource Center. She discussed how in January 2012 she organized the first T-Camp, an inter-campus retreat for trans people in the San Bernadino Mountains. The University of California was the first college system to provide all trans health care services to its students, starting two years ago.
Tubbs also instigated with her students the TransFigures Poster Project. Although the campus honors Trans Remembrance Day by displaying 300 images of murdered trans people, the students desired a campaign that showed the faces of those trans people who are thriving. Tubbs has set out an action plan for other colleges and organizations that want to take up the project and present their own positive trans stories.
"It was a mission to get away from the world and explore our gender identities in a supportive space," said Tubbs of T-Camp. "The only other people there were the camp staff. We wanted to create a community that was as gender inclusive as possible. On our campus, and many campuses, trans people are not visible and so if you’re going through that experience you can feel very alone. Trans people can be prone to blame themselves for their situation. We teach that the problem isn’t you, it’s the world."
For more info, visit www.capsportal.org/events/