Her Mind
This is the script for the talk I was supposed to hold at the Her Mind event for the Karolinska Insititute. Unfortunately I could not make it due to a medical emergency, so I am instead sharing the script. I hope you find it useful.
The slides can be viewed in Googly Slides.
Intro
Hello everyone. My name is Olivia, and I am a transgender activist, public speaker, and software engineer. Today, I will be contributing to this event by highlighting what women’s mental health means for transgender women like myself. I will try to give a short rundown about what being trans means, how the world will likely treat you if you are trans, and what that means for your mental health.
A small disclaimer
I am not all transgender or queer people, and I am not here representing any organization today. What I am sharing here today are my observations and personal experiences, in the hopes that I can shine a light on a perspective of women’s mental health that might not be immediately obvious; the perspective of transgender women.
Oh, and also, I am not an academic. I just happen to sound like one sometimes, probably due to my unmedicated addiction to Wikipedia.
Empathy and curiosity
Whenever I hold a talk, I highlight that my two most important values in life are empathy and curiosity. I try to bring empathy to all my interactions, and I am constantly curious about the world. And when I come across something I don’t yet understand, I start with empathy in trying to understand it. My hope is that you can allow the same with the things I am about to present for you, since my assumption is that a lot of it might be new to you.
About being transgender
Now I could talk about this for approximately 14 hours straight, but since I only have 15 minutes, I’m obliged to keep this to the lightning version.
A transgender person is someone whose gender identity does not match the gender they were presumed to have based on the genitalia they were born with. This can mean a person born with a penis is actually a girl, and that a person born with a vulva is actually a boy. Conversely, the term for someone who is not transgender is cisgender.
Gender dysphoria
This incongruence of gender identity commonly leads to a condition called gender dysphoria - which is Latin for “bad feelings about gender.” This encompasses a wide range of scenarios that often lead to mental health issues. Here are a few of the different possible iterations of gender dysphoria:
Kinds of dysphoria
Physical dysphoria
A general feeling that the physical shape and characteristics of your body does not match your gender identity. For example, your primary sex characteristics like your gonads and genitalia, or secondary sex characteristics like broad shoulders or facial hair for trans women, or curvy hips and waists for trans men.
Social dysphoria
How people perceive you and your gender. This is where misgendering takes center stage. Misgendering is when someone uses a gendered pronoun like he or she for you, but uses one that does not match your gender identity. This might seem small, but it is very uncomfortable for trans people. This used to happen more to me, but along my transition it has mostly gone away.
Societal dysphoria
What roles you find yourself inhabiting in our society. The strongest of these are marital and parental ones, like mother, father, husband and wife. These can show up both before and after you transition. A trans woman who hasn’t come out yet might find a strange discomfort from being called a father. A transgender man who has given birth will struggle with how extremely female-gendered all resources around giving birth are. Furthermore, dating and courtship are highly gendered. One of my earliest memories of a dysphoric spike - a decade before I came out - was when I was doing couples dancing and I was told I was expected to lead rather than follow because I was being perceived as male.
Sexual dysphoria
Closely related to societal dysphoria, sexual dysphoria is centered around sex and sexual relationships. Genitals and gender are closely related, and a lot of sexual activity will likely involve your genitals at some point. If you’re pre-transition, this might lead to confusing and dysphoric feelings when having sex, which can reduce or even remove the pleasure sexual acts are supposed to bring. This can lead to adopting a sexual identity you don’t actually connect with, in attempts to find a solution to whatever is feeling wrong.
There are several more versions of gender dysphoria, and even the ones above could be covered with more detail than I can include here, but if you would like to know more, I very highly recommend the resource The Gender Dysphoria Bible.
Transitioning
The main way to treat gender dysphoria is by transitioning. A gender transition can entail many things, from smaller personal things;
Dressing and presenting more according to your gender
Training your voice to fit your gender
Asking people in your life to use a new name and pronouns for you
To bigger and more involved things;
Legally changing your name and gender
Hormone replacement therapy
Medical surgeries
No two transgender people will have the same journey, and not everyone will do all the things I just listed.
Healthcare
Some of the transitioning steps are things you can do on your own, but some of them require access to healthcare. How you present yourself to the world is something you yourself can control to a large extent, and it’s the first few steps that you do once you’ve come to the conclusion that transitioning is the right thing for you.
However, many of the bigger and later steps require medical intervention and surgeries, and that means being involved with the healthcare system. Unfortunately, trans healthcare is not in a great state anywhere. The systems we have in place are understaffed, underfunded, and overwhelmed.
When I applied to the trans clinic we have here in Stockholm, they told me it would be 18-24 months before any form of clinical evaluation could begin. I waited 39 months before I heard back. I had my last evaluation meeting with them last week, and I am currently awaiting their final evaluation whether I fit the diagnostic criteria for gender dysphoria or not.
My story is not uncommon. In most places of the world, the waiting lists are measured in years. In the last decade there have been some very clear improvements even here in Sweden, but in general it’s lagging behind and inadvertently suspending a lot of people in a form of suffering.
This brings me to my next section…
Data and census
Something that has always plagued those on the margins of society is that it is quite difficult to be recognized. Both in general by other people, but even more so by systems and governments. Queer people in general and trans people in particular have had a hard time making sure that systems count us.
In his book Queer Data: Using Gender, Sex and Sexuality Data for Action, Dr. Kevin Guyan goes into deep detail about the problems with data and census collection when it comes to queer people. The first chapter is called Gaps and Absences and discusses the data that was never recorded. It brings up that when the British government invested more in census data after the end of the second World War - the big dub dub dos1, as it were - survey questions about sexuality were included. So, for essentially the first time ever queer people could be counted.
At face value, this is a good thing. Societal visibility and recognition in some way starts there - when the systems starts seeing the data. But, by this time in the 1940s and 1950s being a homosexual was still a crime. So while it was now possible to make yourself and your identity seen, it was at your own peril of both social exclusion and state violence to self-identify as someone who by definition breaks the law.
These same systems that have held queer people back have of course also effected other groups of people that are not wealthy white men. Dr. Guyan continues:
[…] it is vital to underscore how the efforts of lawyers, medical professionals and scientists in the nineteenth-century in defining, categorizing, and controlling sexuality were the product of patriarchal ideas of what was worthy of being counted.
These practices result in data sets that do not reflect true reality. Women, queer people, ethnic minorities, and anyone who isn’t a white straight man does not get accurate representation under these conditions. And while that might seem insignificant to an onlooker, that kind of numerical and statistical representation is what leads to actual political representation and therefore actual systemic change.
Politics
Unfortunately, this means we have to talk about politics. The world is currently a scary place in many ways, and doubly so if you’re a trans person. In the last few years, the world has taken a turn towards authoritarianism, and the places that have done so have used transphobic rhetoric as a political tool. This started in the U.S. around a decade ago, and they have since spread across the world.
After gay marriage was legalized in 2015 it only took a couple of months before so called “bathroom bills” started getting proposed. Those purported to “protect women from predators” by trying to police which public bathrooms trans people were allowed to use. This wasn’t very successful because the general public found that kind of policing to be quite uncomfortable for everyone. The target was then moved to “protecting children from harmful doctors”, by introducing legislation restricting or banning transgender healthcare for persons under the age of 18.
The purpose of these bills is to have a politically expedient scapegoat for the political right. It used to be gay people, but after the legalization of gay marriage, the political apparatus moved on to the next marginalized queer group; trans people. Even worse so with the bills targeting trans minors, since they don’t yet have the right to vote and therefore cannot politically defend themselves.
As a direct result of such political messaging, violence against trans people has increased. Rights to healthcare have been taken away. Laws criminalizing parents who give their children gender affirming healthcare have been put in place. Trans people have been forced back into the closet in fear of their own safety. The constant barrage of news of the things I just listed have a mental health effect on trans people regardless if they are directly affected or not.
Most of the things I just described are currently American phenomenons, but we’re seeing attempts to export it out and import it elsewhere. Luckily those attempts have yet to take root in places like Sweden, but the fear still lives with us that they one day might.
Conclusion
Earlier I hammered on about data and censuses because they are an important tool in politics. If there were more trans people representing the trans community on all political levels, our ability to fight back against the political apparatus seeking to utilize trans people as a scapegoat would be greatly increased. To get to that political representation, we need more data so that the system can recognize us.
Furthermore, the sorry state of trans healthcare is a direct effect of the lack of proper representation trans people have had over the last decades. Even at face value, the fact that the system is so overwhelmed by the amount of people seeking healthcare is a quite clear indication that the resources given to the healthcare system are not adequately scaled to the needs of the population. I believe there are more trans people than current data and censuses show, due to the gaps and absences I spoke of earlier.
The political situation and the healthcare situation are tied together, and as I’ve said a couple of times now, I genuinely believe that the systemic changes needed to improve all of this starts with representation in data. So, if there is only one thing you bring with you after hearing me talk today, please let it be this:
If you’re working with data collection or data processing in any way, please make sure that that you include trans, queer and marginalized identities. If you are unsure on how to do this, please reach out to your local LGBT organizations and they will be able to provide data and support to you. Here in Stockholm, those would be Transammans and RFSL. I’ll have links to them at the end.
Oh, and look into the works of Dr. Guyan. His body of work is an amazing resource on this topic. I’ll link his website at the end as well.
Gender euphoria
Now, I’m about to wrap this talk up and because I am a bubbly optimist, I want to end on a positive note. In contrast to gender dysphoria, we also have gender euphoria. This encompasses the inverse of gender dysphoria - feelings of happiness stemming from your relationship to your gender.
It’s the reason why we as trans people go through this arduous and gatekept process. It’s the reason why we risk severing ties with our friends and family to be true to the people we are.
This happiness can come from small things like people using your name and your pronouns correctly, to someone you don’t know correctly assuming your gender without you having to do anything in particular, to seeing yourself in a mirror and genuinely connecting with your reflection.
The euphoria is the best aspect of transitioning, and it is much under-discussed since almost all trans discourse is focused on misery. Therefore, I want to highlight that trans people that manage their dysphoria and have achieved gender euphoria are some of the happiest people you will ever meet. Regardless of how you quantify quality of life, be it productivity in society, a utilitarian sense of happiness, or whatever else - systemically helping trans people is a way to increase that. It makes lives better.
That’s why this is all worth fighting for, and that’s why I was on this stage today speaking to all of you. Thank you for your time.