A majority of us would have experienced what it feels like to be left out, at least once in a lifetime. It could be not being chosen to play in a sports team, not being given a role in a school drama, being the last one to finish food during breaks, being the last one in a running race, having to sit alone in a cafeteria, and any other situation, irrespective of the cause of being subjected to it. Take a pause, and recall. How did we feel to be left out? To be ridiculed for not ‘fitting in’? To be labelled as an outcast only on a superficial basis with no solid reasons at all? Not a pleasant feeling, isn’t it? Many of us would recall feeling uncomfortable and hurt, something that none of us would want to spend the rest of our lives feeling.
When we were in school, most of us belonged to the middle category. There would be a set of students who were overachievers in academics, and there were a set of students who were supremely good in athletics, but a vast majority of us found ourselves in between – achieving decently in academics but not in the ranker’s list, or doing well in sports but not brilliant enough to get selected for competitions. And that is where we would be perpetually under the mindset and societally influenced label of being “not good enough”, or being the middle ones, or never being able to conform to the set standards of “best” in the society. It is obviously not a happy place to be in, and to spend a lifetime in that category, can be quite stressful.
Trans persons in India sadly share a similar plight. They are constantly told that they don’t ‘fit in’ the societally approved constructs of the male-female binary, they are regularly rattled with insensitive comments and are subjected to feelings of ignorant hate, they are those who are struggling to be ‘good enough’ on a daily basis, they have to fight each day to live; not because they suffer from any physical illness, rather because they are victims of unruly social norms and rigid stereotypical attitudes. To be surviving in a social atmosphere and surrounding like this, these situations are a definite breeding ground for serious mental health problems.
Understanding Related Terminologies
Before we shed light upon their specific mental health and related conditions, it is important for us to understand a few terminologies with respect to trans-persons population. ‘Sex’ refers to the classification of an individual as male or female based on their biology. ‘Gender’ refers to the state of being male or female with reference to social and cultural differences. ‘Gender Identity’ refers to a person’s perception of having a particular gender, which may or may not correspond with their birth sex. ‘Intersex’ refers to individuals born with physical characteristics that do not fit into typical binary notions of male or female bodies. ‘Cisgender’ refers to individuals who identify their gender as that of their assigned birth sex. ‘Transgender’ usually refers to individuals who identify their gender as that of the opposite sex and not their birth sex. There are two major categories – Transmen and Transwomen. Transman refers to an individual who was assigned the sex of a female, but identifies as a male. Transwoman refers to the individual who was assigned the sex of a male, but identifies as a woman. The term transgender is moreover an umbrella term and includes a few other gender related categories. ‘Sexual orientation’ refers to a person’s sexual identity with respect to the gender to which they are attracted. Sexual orientation of an individual bears no relevance to the gender an individual identifies with. Over the years, LGBTQ+ has developed as a community, and is an acronym for Lesbian, Gay, Bisexual, Trans, Queer/Questioning, and others. It refers to a population of people united by having gender identities or sexual orientations that differ from the heterosexual and cisgender.
What does literature say of Mental Health issues amongst trans persons in India?
In India, the concept of trans persons is popularly understood in the form of the ‘Hijra’ community. In an article published in 2017 in The American Journal of Psychiatry, titled ‘Understanding the Mental Health of the Hijra Women of India’, Dr. Vikas Jayadev highlights the plight of hijras in India, with respect to their physical as well as mental health concerns. It emphasises the lack of research and literature with regard to this population. The article comprises of the available literature and sheds light on the serious and troubled conditions of people belonging to this community, physical health problems relating majorly to high rates of HIV, and including mental health problems like depression, anxiety, self-harm, suicidal tendencies, and substance abuse. “Aside from poor sexual health, this patient cohort experiences perceived and internalized stigma, isolation, discrimination, and victimization that predisposes them to mental health issues” writes Dr. Vikas.
“The American Psychological Association pointed out in its March 2016 report on the impact of discrimination, that adults who are LGBT and have experienced discrimination have average stress levels of 6.4, compared to 6.0 for LGBT adults overall. Among adults who are non LGBT, stress levels are 5.5 for those who have experienced discrimination and 5.0 for non LGBT adults overall” as quoted in the December 2016 report titled ‘Why transgender people experience more mental health issues?’, on the Psychology Today website.
A study from Boston, published in 2015 in the Journal of Adolescent Health, reported that 180 transgender youth had a two-fold to three-fold increased risk of psychiatric disorders, including depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, when compared to a control group of youth.
A review written in 2014 on research about suicide and the transgender population found “an unparalleled level of suicidal behaviour among transgender adults”.
Overall, the transgender population is majorly affected by mental health problems like depression, anxiety, suicidal ideation and self-harm. The statistics and information though not full proof are yet staggering and alarming. There is always some form of stigma attached to seeking help for mental health troubles, and add to that the severe stigma attached to belonging to the trans community, imagine the trouble for them to reach out for help and if at all they do, the chances of being mistreated or not treated at all.
Transgender individuals were for a long period of time considered to be pathologically ill. It is in the latest Diagnostic and Statistical Manual –V that the diagnosis of ‘gender identity disorder’ was replaced with ‘gender dysphoria’. The medical fraternity worldwide no longer refers to being transgender as an illness, rather a choice and way of living. This all is nice and fine on paper, but the harsh reality that still haunts is the misguided and ignorant views of others regarding people belonging to this community.
One Future Collective is the outreach partner for the Trans Diamond Festival. This article series, across platforms, is a result of the ongoing effort of Make Room India and One Future Collective to discuss issues of the transgender community and build an ecosystem towards strengthening the trans rights movement in India.
by Bansri Mehta
Bansri Mehta is a volunteer researcher at One Future Collective.*
Photo by Dmitry Bayer on Unsplash