Real World Clinical Blog: The Health of Trans People
by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way
There is clearly a large and public debate about how the transgender community should be treated by society as a whole. By engaging in a dialogue about the use of bathrooms, we are publicly debating the basic human rights of the trans community. While this fact, in itself, is horrifying, it is also emblematic of the deep, complex issues in the trans community that are being squelched by policy debates being had by everyone but those who are suffering themselves.
As social workers, we are mandated to have a high level of competency when working with any marginalized community. Given the ways in which trans people are being particularly targeted at this time, our mandate grows considerably. Here are some ways to enhance our work with trans people, in order to lessen the burden of the persecution that continues to doggedly follow this diverse treatment population.
First, language matters. It matters a lot. That is important to know, because using precise and inclusive language is an intervention unto itself. The best way to talk about the trans community, at this moment in time, is to simply use the word “TRANS.” Transgendered and transgender don’t quite represent the intricacies of the community. The word transgendered suggests that there is a clear and discrete migration between gender identities that has a beginning, middle, and end. This is rarely the case. Although some do officially transition, the process of transitioning may be to a non-binary identity or may be experienced as nonlinear. Transitioning is rather intricate and lacks the simple directionality that the word transgendered suggests. The term transgender is preferable, but it is still not properly inclusive. This is because it is based, still, on a binary gender system that suggests that travel exists between genders, rather than landing on a genderqueer, or nonconforming, identity.
Second, the terms F (female) to M (male) or M (male) to F (female) are no longer suitable descriptors of the process of identifying as trans. First, the terms suggest that one was ever definitively male or definitely female. Instead, we now say AFAB (assigned female at birth) or AMAB (assigned male at birth). This means that because of the presentation of specific genitalia at birth, a gender was assigned. However, this gender is often a misassignment based on biological markers. The assumption that biological markers signify a specific gender identity is problematic, and it is what has led to the suffering of so many. To say that one’s presumed gender identity was a byproduct of an assumption, but not a felt identity, is the best way to conceptualize the trans experience.
While we have moved into a space, hopefully, of asking people what their “preferred gender pronoun” is, that language also falls short. The term “preferred” suggests that this is optional for people and simply something that they are selecting by choice. The pronoun that someone uses is not a preference, but a fact of their identity. When we mispronoun someone or use the term preferred, we are engaged in a microaggression that leaves our trans clients feeling unseen and misunderstood.
As many of us, as social workers, look toward becoming supportive allies of the trans community, we need to truly interrogate what it means to be an ally. As professionals who engage at all with diagnosis or even consult with the DSM, we are engaged in a system that oppresses the trans community. By being members of the mental health community, we are assigned a role in the medical treatment of the trans community. Many medical providers will not provide gender confirmation interventions (I am not saying gender reassignment, please note, because we are confirming authentic gender experiences, not reassigning gender) without the approval of a mental health professional.
WPATH, the World Professional Association for Transgender Health, suggests that medical intervention should be preceded by the documented presence of: well documented gender dysphoria, capacity for consent to treatment, and “well controlled” mental health. This puts us, as mental health providers, in the tricky position of gatekeeping for a population that ought to be treated as experts on their own lives. Furthermore, the suggestion that mental health suffering ought to be relieved before medical intervention confounds a lot of what we have come to know about how taxing it is to subsume an authentic identity.
If we cannot properly examine the way in which social work has been indoctrinated into a complex set of power dynamics, which often disenfranchise the trans population, then we can’t truly assume our role as competent practitioners. We are part of the machine that feels entitled to legislate what public restroom someone uses, despite the fact that we feel so removed from that specific debate.
Trans people are struggling to assert their most basic human rights. The fact is that no one feels comfortable using public bathrooms. The act of using one is inherently anxiety provoking for a host of both obvious and more subtle reasons. The fact that someone would have to enter this already uncomfortable situation with an additional fear of being either found out or misgendered highlights the very precarious position that trans people are in at this exact socio-cultural moment in time.
Next week, I will provide a closer look at the intricate clinical issues facing the trans community. (Now available here: The Mental Health of Trans People.)
Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She provides more of her clinical perspective and tips for developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.