Or why Transgender children & teens deserve Psychotherapeutic support rather than judgement and why their parents deserve to be admired and respected.

Is suicide amongst Transgendered people increasing or are cases of self destruction simply being reported more often? It seems I was no sooner finishing writing about the death of Trans teen Leela Alcorn when yet another similar tragedy breaks into the News

Blake Brockington 

Blake-Brockington-x400d18 is being mourned after committing suicide on Monday night. Blake, an 18-year-old student at the University of Carolina, Charlotte, became homecoming king of East Mecklenburg High School a year ago after he raised more funds than 12 other senior royalty hopefuls, ultimately gathering over $2,500 out of the school’s total $3,200 for the school’s charity of choice, Mothering Across Continents — an organisation working to build a school in South Sudan.

Brockington’s death is the sixth reported suicide of a trans youth in America alone this year, in an “epidemic” that trans advocates say sees far more casualties than are noted by media. Whether this “epidemic” is confined to the USA we can’t know. We do know that the number is too high everywhere. What we also know is that despite an increase in the numbers of Transgender people, and even though society is more aware and supposedly more tolerant, the experience of being Transgender still presents a huge challenge to those individuals and their families singled out to confront the dilemma presented by an incongruence between mind and body.

A full report on Blake Brockington’s untimely death may be found here

So why does a young person seemingly in the bloom of youth, even if that youth is blighted by the experience of an unhappy gender identity, take their own lives? The answer quite simply is that changing gender roles is still one of the biggest changes any human being can make. Furthermore, the clinical support available to trans people and young trans people in particular is often inadequate and all too often unavailable.

 

Clinical Treatment

Young people in the UK if they are given a referral by their GP or local medical practitioner will likely be referred to The Tavistock Clinic.  However numbers are increasing year by year and according to the charity Gires, the number of people presenting for treatment is doubling every six years. Whilst they do a difficult job as best they can, waiting times for for both new patients and those needing follow up support at the Tavistock are under pressure and the time between subsequent appointments is consequently being stretched. The problem for clinicians is that Gender Dysphoria, as the condition formerly known as Gender Identity Disorder, is now known, is a self diagnosed condition. It could be argued that anyone showing up for treatment has Gender Dysphoria otherwise why would they be there in the first place? Therein lies the first challenge as Gender Dysphoria isn’t by definition a condition; the word dysphoria simply means the opposite of euphoria. So what then is the clinician expected to do? When Gender Identity Disorder was removed from DSM V (Diagnostic and Statistical Manual of Mental Disorders) and replaced by Gender Dysphoria, the move was intended to mark a shift away from pathology towards an identity.

That’s all very well but then how does the medical world support an individual who by definition isn’t ill yet desires and often needs medical intervention?

harryb2

Harry Benjamin

Since Harry Benjamin set out recommended Standards of Care for Transgendered individuals back in the 1960s, treatment pathways for people presenting for treatment have changed very little, this inspite of the apparent shift from pathology to identity albeit a recent shift. Essentially, the onus is still on the patient to prove his or her suitability for hormone treatment and surgery. The clinician (often a psychiatrist or psychologist) is thereby relegated to the role of gatekeeper. The big question is still “How can I prevent this person from making a mistake?” Where then is the treatment? Now we meet the real challenge. What form should that treatment take?

The Role of Psychotherapy

My doctoral research is reaching it’s conclusion and aside from the fact it has confirmed what I already knew from speaking with Trans people over the years, i.e. that a large number of patients or clients are unhappy with the treatment they receive. Many describe being treated as an object rather than a person and an even larger number describe the treatment as an obstacle rather than as a support.

More of this in my next blog lest this trope will be morph into a clinical research paper. For now, suffice it to say that I believe we have a long way to go to improve the clinical treatment of Transgendered people.

How then does this apply to a young person on his or her way to school feeling like an alien in a world they struggle to identify with in a body they are at best ill at ease with and at worst a vehicle they find foreign and repugnant? Firstly, society needs to recognise that not everyone fits neatly into the gender roles assigned at birth. If we provide a safer place for people to explore their gender expression without fear of judgement, they will more easily find a role and an expression they feel comfortable with.

So what role for the clinician? My contention is that people need space to explore their feelings and gender identity without fear of judgement and/or being denied treatment. Not enough space is provided to help young or older individuals for that matter to come to terms with who they are or where they fit on the gender spectrum. Whilst we continue to pressurise young people to confirm to our stereotypes they are likely to feel isolated and without hope. Whilst they feel isolated and without hope they will continue to seek an exit door rather than a place in a world that feels alien to them.

The Impact on parents, friends & Families

So what then of parents and families? I never cease to be inspired by the love, courage and determination displayed by most of the parents I meet. True, I tend to see those who by definition are loving and supportive but nevertheless they fight a daily battle to support their children in schools, with clinicians and with the community they live in. Often a community that fails to understand what the family is going through. Mermaids is the UK based charity which is often a refuge if not a beacon of light for parents, families and young people struggling with their gender identity. It probably is no exaggeration to proclaim that without this organisation many young people would simply not survive and parents would be struggling to find a sympathetic ear. As well as offering their own support the charity provides signposting to the relevant services and organisations who can help the family when that help is needed.

For families and the individual themselves we all as a society have to create a space where people can explore and find their place on the gender spectrum. If we embrace their diversity we may eventually stop waking up to the news that another young person has found life too difficult and too painful. We can only hope.

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