MPIPP Newsletter
Vol. 2, Issue 6
MPIPP UPDATE
It
has been a busy month as
MPIPP is continuing its
outreach efforts to
provide mental health
research information to
different organizations.
National Institutes of
Mental Health
—
Judith Kovach, Ph.D.,
made a presentation at
the annual meeting of
National Institutes of
Mental Health Outreach
Partners. She focused on
MPIPP's goal to
disseminate accurate
research-based
information about the
mental health impact of
discrimination and
stigma to the LGBT
community. In addition,
she made a presentation
on the Know Us
Project that is
being developed by
MPIPP.
Macomb Community College — Sara Van Wormer, M.A., was one of two presenters at Macomb Community College for a staff and faculty in-service training entitled LGBT 101. Sara was invited back to make another team presentation about LGBT safety issues on campus at the college's annual Institutional Development Day on April 1st. The college president and other influential college administrators and faculty attended the session. MPIPP has been invited to stay involved as changes take place at the college, as well as for further speaking engagements coming up this Fall.
TRANSGENDER ISSUES: IDENTITY AND EXPRESSION
As American culture inches its way towards a more LGBT-inclusive society, there still appears to be considerable confusion about issues associated with transgender identity and expression and the life experiences of transgender people.
In 2008, the American Psychological Association (APA) Task Force on Gender Identity and Gender Expression completed its three-year task to document much of the current research on transgender issues and make policy recommendations.
According to the APA Task Force, "Transgender is an umbrella term used to describe people whose gender identity (sense of themselves as male or female) or gender expression differs from that usually associated with their birth sex" (APA, Appendix C).
Transgender Mental Health Issues — The Report of the APA Task Force on Gender Identity and Gender Variance (APA, 2008) says "Transgender people experience the same kinds of mental health problems that nontransgender people do. However, the stigma, discrimination, and internal conflict that many transgender people experience may place them at increased risk for certain mental health problems" while adding, "support from peers, family, and helping professionals may act as protective factors" (p. 10).
The report also clarifies, "Many not only experience an inner sense of not belonging but also harassment and discrimination, including verbal and physical abuse and reduced access to education, employment, housing, medical care, and other social services. A disproportionate number of violent and sometimes lethal acts are directed against transgender and other gender-variant people" (p.10).
Therapy — In the Task Force report, the APA urges psychologists to become better prepared to work with transgender people. Often transgender people - or those who have gender-based issues - consult mental health professionals for depression, anxiety, a sense of isolation, and concern for personal safety. In addition, mental health consultation is often a requirement of hormone therapy and surgery for those who elect to make a gender change via surgery.
Discussions — The APA Task Force Report provides useful discussions of issues within the broad transgender community from terminology (p. 28) to discussions of research and organizations consulted (pgs. 19-24). The report also frankly discusses problems associated with diagnosis (using the DSM IV criteria often required by insurance) juxtaposed against the issues that being gender-variant is not a "gender identity disorder" but rather a definition that continues to reinforce stigma (p. 26). The concern for transgender youth and the problems they face is consistent throughout the report.
Medical care, insurance, and surgical procedures — Transgender people often require specialized health care services ranging from managing psychosocial mental health issues to expensive surgery to transition. Access to appropriate care can be a challenge due to frequent exclusions in health insurance policies. However, as noted by the APA Task Force, "Which transition-related surgical procedures persons undergo during gender transition is an individualized decision, based on a variety of factors, including personal priorities, the balance of risks and benefits, financial resources, and access to health care" (p. 35).
Suicide — Suicidal ideation is a significant mental health concern for transgender people. Studies have shown that up to a third of transgender people are struggling with substance abuse, depression and suicidal thoughts or attempts (APA, 2008).
The Transgender Law Center & National Center for Lesbian Rights, in a 2002 San Francisco study documents that as a result of workplace discrimination, verbal and physical harassment and lack of access to safe and affordable housing:
-
35% of those transgender people studied noted suicidal thoughts and ideations; and
-
47% reported of those studied making at least one suicide attempt.
One study (Clements-Nolle, 2006) showed that approximately 33% of all transgender youth have attempted suicide.
Violence — Understandably, violence and concern for personal safety can lead to depression and anxiety. How prevalent is violence against transgender people? One study (Badgett, Lau, Sears. & Ho, 2007) showed:
-
Over 40% have experienced some form of physical abuse or violence;
-
80% have suffered verbal abuse or harassment; and
-
almost 50% feel unsafe at any given time.
Another study (Lombardi, Wilchins, Priesing, & Malouf, 2001) of transgender people found 25% report experiencing a physically violent incident.
Substance abuse — Studies across North America have indicated that alcohol and drug use are common among transgender people. Research revealed that a lack of educational and job opportunities as well as low self-esteem were important factors contributing to drug and alcohol abuse (Clements, Wilkinson, Kitano, & Marx, 1999).
Discrimination in employment and housing — A 2002 study found nearly 50% experienced employment discrimination, more than a third suffered from discrimination in a place of public accommodation and nearly a third had been the victim of discrimination in housing (Transgender Law Center & National Center for Lesbian Rights, 2002).
A UCLA School of Law study found that up to 56% reported of transgender people being fired, 47% were denied employment, a third were harassed and 1 in 5 were denied a promotion based on their gender identity (Badgett, Lau, Sears, & Ho, June, 2007).
Gender-designated facilities (such as restrooms, athletic facilities, college dormitories, group homes, shelters, prisons, etc.) pose additional barriers or potential danger for transgender people.
The APA Task Force emphasizes (p. 40), "While it is true that some transgender people feel that it is part of their identity to be openly transgender, others feel that it is more consistent with their posttransition gender identity to simply blend in. We would not want to imply that one way of actualizing one's gender identity is better than another."
Few studies have focused on attitudes toward transgender people, although one study indicated that once people personally know a transgender person, their attitudes shift in a positive direction (Kendel, Devor, & Strapko, 1997).
This finding leads to hope, encourages discussion, and further supports the need for a program like the KNOW US PROJECT that is being developed by MPIPP.
American Psychological Association, Report of the Task Force on Gender Identity and Gender Variance, August, 2008. http://www.apa.org/pi/lgbt/resources/policy/gender-identity-report.pdf
Badgett, L., Lau, H., Sears, B. & Ho, D. Bias in the Workplace: Consistent Evidence of Sexual Orientation and Gender Identity Discrimination, June, 2007. http://www.law.ucla.edu/williamsinstitute/publications/Bias%20in%20the%20Workplace.pdf
Clements-Nolle K. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51 (3), 53-69. (NOTE: Abstract only, article available for purchase: http://www.informaworld.com/smpp/content~db=all~content=a904294096)
Kendel, M., Devor, H., & Strapko, N. (1997). Feminist and lesbian opinions about transsexuals. In B. Bullough, V. Bullough, & J. Elias (Eds.), Gender blending (pp. 146-159). Amherst, NY: Prometheus.
Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2001). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42(1), 89-101.
Transgender Law Center & National Center for Lesbian Rights, Trans Realities: A Legal Assessment of San Francisco's Transgender Communities, 2002. http://www.transgenderlawcenter.org/trans/pdfs/Trans%20Realities%20Final%20Final.pdf
Amy
Hunter is a columnist
for "The Bilerico
Project" and "The
Scavenger". She also
sits on the board of
directors for two LGBT
advocacy organizations.
Amy was also recently
asked to join the
Kalamazoo Community
Foundation's awards
committee for their
"LGBT Equality Fund"
where she will screen
proposals and recommend
funding levels for area
educational and
community outreach LGBT
programs.
Amy Hunter invited MPIPP to address myths and misperceptions about transgender people, and worked collaboratively with MPIPP to ensure delivery of important psychological data and research on discrimination against the transgender community. Amy feels Sara Van Wormer's presentation at the public hearing became the model for combating negative stereotypes during the ordinance campaign. Amy says, "I can state unequivocally that MPIPP played a crucial role in the successful passage of Ordinance #1856, thus providing legal protections against discrimination in housing, employment and access to public facilities in Kalamazoo for Gay and Transgender people." Amy was also a speaker at this year's MPIPP conference.
According to Amy, "Nothing speaks louder than our stories. When you combine that raw emotional power with research-based facts, the result is authentic and powerful." Amy recommends that LGBT people, "Offer your stories, as well as your energy. In particular, we need to keep pushing hard to get Transgender and Transsexual persons in the full public view.
Not only does it go against the instincts of Trans-people to be public about their lives, it can be highly dangerous too. Indeed, I myself have been stalked, threatened with violence and even rape. It is not surprising then, that many Trans-people want nothing more than to blend-in with everyday society. While I would never denigrate that impulse, blending-in and remaining silent does nothing to further protections for all of us and in particular, the Trans-person who is not able to 'just' blend-in."
Amy continues, "Speaking only for myself, but as a Trans-woman whose transition occurred successfully in full public view, I believe that I carry a responsibility to broaden the path for those who will follow. It is important for me to remember that my heroes were not inadvertent — they were (and are) people willing to carry the enormous burdens and danger of full disclosure. They are people — who understand that mainstreaming cannot occur without personal sacrifice."
Amy, what makes you happy?
"To know that in some way, no matter how small, I have contributed to the betterment of the lives of others."
What accomplishment(s) are you most proud of to date?
"My contributions to the passage of Kalamazoo's non-discrimination ordinance, in particular, the re-drafting of its language to strengthen protections for transgender persons."
Who are your heroes and why?
Martin Luther King
Mara Kiesling, Executive
Director, National
Center for Transgender
Equality (NCTE)
Lynn Conway, Transsexual
pioneer and activist
What are some of your favorite quotes?
"There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep man in everlasting ignorance — that principle is contempt prior to investigation." — Herbert Spencer
"Doing the same thing over and over and expecting different results — that is the definition of insanity." — Albert Einstein
"In the end,
what have we to offer
that is of any lasting
value,
but our honest selves?"
—
Amy Hunter
MPIPP
VOLUNTEER: Andre Wilson
Photo:
Janice Levy
©
2009
Andre Wilson is a senior associate with Jamison Green & Associates, a transgender training and policy consulting company. He has a M.S. in Environment and Behavior Research and is also pursuing a Master of Social Work degree in Policy and Evaluation.
Andre worked with MPIPP last year on several issues related to transgender health. He also met with others from MPIPP to work on intervening to provide background information for the successful Kalamazoo ordinance campaign.
According to Andre, "Having the discussions through MPIPP also provided a forum for sharing insights about transgender issues with my colleagues."
When asked about how others can volunteer, he offered: "I don't think of this work as 'volunteering'. As someone trained in Social Work, our Code of Ethics clearly extends our responsibility as professionals well beyond our individual clients or patients: we are each responsible for engaging in efforts to change those social or political structures which may stand as barriers to health and well-being in our clients' lives." Andre and others worked with the NASW Michigan chapter "to change the national NASW Code of Ethics so that it now includes 'gender identity or expression'. Among other things, this means that our ethical obligations now explicitly extend to working for policy change to end discrimination against transgender people."
Andre also frankly discusses his personal journey and the medical and emotional issues of being a transgender person.
"I'd been involved since the late 1970s in equality efforts, including efforts to achieve equal benefits and access to health coverage for unmarried partners (of any sex). For most of that time I was an out lesbian and my thinking and advocacy tended to be gay and lesbian centric. But in my mid-forties I finally came to terms with being transsexual. Encountering barriers to accessing needed health care led to the determination to make a difference for others, and to a career shift."
"In recent years, I've been particularly focused on improving health care access for transgender and transsexual individuals."
Andre adds, "The medical process which helps bring the external physical characteristics and the individual's internal experience of their body into alignment has been around since the middle of the last century. Medical providers qualified in this area work with transgender patients to identify the best treatment plan, and for many of these the "sex confirmation" process (also known as "sex reassignment") will make a profound difference in their health and well-being. Conversely, others who are unable to access such treatment will suffer cruelly and needlessly across their lifespan. This kind of suffering leads to severe stress, (also anxiety, depression, suicidal ideation) and impacts health and wellness. Indeed, treatment is so effective that individuals often report significant improvements (and lowered overall health costs) in remarkably short periods. Despite the clear necessity and effectiveness of the recognized treatment protocols, pervasive ignorance continues to result in deep stigma against transgender individuals."
"One of the things we see in medical care is that 'access' is largely a function of reimbursement," Andre continues. "Although sex confirmation services are routinely covered in many other countries (because they are recognized as medically necessary and efficacious), many health plans in the USA have built-in separate exclusions for such treatment or procedures. In fact, these exclusions too often are interpreted in ways that extend well past transgender transition-related care, and result in denials of many types of routine or urgent care for the transgender person."
"Many people don't have personal experience of seeing a transgender client or loved one — a sibling or friend — come alive as a result of transition. So a lot of my work involves helping insurance carriers and benefits administrators come to understand the basic underlying medical issues, including both the difference treatment makes as well as the high short- and long-term costs to the transgender individual and their families (and the insurance plans!!) of withholding medically necessary treatments."
Andre, what makes you happy?
"Today, being alive makes me happy, because today I have a connected self who can feel alive . . . such a gift. As I say that, I am amazed thinking back to my life pre-transition, less than a decade ago. I lived 43 years with depression that never abated despite treatment of various kinds. Until the very early days of my transgender transition, and specifically the start of cross-sex hormone replacement therapy, I was depressed every day, and suicidal on most days. I did not know what "un-depressed" felt like. I lived with an internal battle: trying to repress or ignore the self who knew I was male, or experiencing the extreme disjuncture of dysphoria. I didn't have a core self, and as a consequence didn't know what 'happy' felt like."
"Today, many things make me happy. One of my favorite things is growing and picking black raspberries. These are native to Michigan, and grow like gangbusters. The berries have their own time: they come ripe and continue to ripen at their own pace. They start slowly . . . just a handful . . . then a bowlful . . . then a pie can be made. As June turns into July and July days wear on, the pace of the berries speeds up. Suddenly so many berries at once no one could eat them all, and the only recourse is making jam. The berries of mid-July are impatient: left unpicked even a day too long and flavor goes, two days and they either mold or shrivel and ruin even unripe adjacent berries."
What accomplishment(s) are you most proud of to date?
"I am proudest of accomplishments that I cannot claim as just mine. The first transgender advocacy work I did was through my union local, American Federation of Teachers Local 3550, representing 1700 graduate student employees at the University of Michigan. I went to the union members in April 2004 to suggest that for our upcoming contract we should get rid of the transgender exclusion in our health coverage. Little did I imagine that the following year would transform my life: that I'd spend the summer with a team of volunteers researching all our health insurance and related proposals, or that 6 months later union members would elect me as lead negotiator for our bargaining team."
"In the summer of 2004, no one I spoke with imagined that our union would achieve coverage of transgender-transition-related procedures (aka 'sex-reassignment surgeries'). No one had ever heard of a union in this country taking up the issue, let alone succeeding. In the early hours of April 1st 2005, when we signed our contract, we had not only succeeded but premiums didn't go up at all and we had traded nothing away for it: we won across the board pay increases for all and got closer to pay equity for the lowest paid workers than ever before in our 30 year history, we achieved better language and equity for international students, better child care subsidies for parents . . . in short, we had succeeded in leveraging positive changes for every single so-called 'minority' in our bargaining unit."
Who are your hero(s) and why?
"The people I admire are those who stand up and 'come out' against injustice, and keep going doggedly, even against great odds."
"But I don't really think about 'heroes' so much as smaller heroic acts: moments when individuals rise above narrow self-interest to accomplish something greater. However, I do think that often individuals are moved to do more because they are inspired by people they think of as heroes."
"Many transgender people have sacrificed enormously in fighting stigma. In a world where having one's transgender status known can mean loss of family, job, home, friends, health care and more, many are too fearful even to advocate for their own needs. Those who are open and out advocates for our community across multiple decades are few and far between."
What are some of your favorite quote(s)?
"Simplicity is a fiction for the privileged." Myself. ("The insight here is that the social world tends to be structured so that life is relatively simple for people who are privileged, those with financial means, those in the majority, and those who 'fit in' to social norms. This same world is therefore structured to make life considerably more complex for those who are not privileged. And by a cruel quirk, this structural inequality is largely invisible, especially to those with privilege who cannot understand why others find everything more complicated.")
Marge Piercy's poem, "To Be of Use" (and I've hacked at it here to shorten it . . .)
"I
love people who harness
themselves, an ox to a
heavy cart,
who pull like water
buffalo, with massive
patience,
who strain in the mud
and the muck to move
things forward,
who do what has to be
done, again and again.
[. . .]
"The work of the world
is common as mud.
Botched, it smears the
hands, crumbles to dust.
But the thing worth
doing well done
has a shape that
satisfies, clean and
evident.
Greek amphoras for wine
or oil,
Hopi vases that held
corn, are put in museums
but you know they were
made to be used.
The pitcher cries for
water to carry
and a person for work
that is real."
TRANSGENDER DISCUSSION GROUP TO MEET AT THE UNIVERSITY OF MICHIGAN
The University of Michigan Health System Comprehensive Gender Services Program is pleased to announce that a monthly support group and discussion space is now being offered for family and friends of transgender and gender questioning individuals.
The group, "Family and Friends on the Gender Continuum" provides an accepting space for family and friends of transgender people and gender questioning individuals to find support, community and connection with each other and to address questions, concerns, feelings and experiences with one another and with a member of the CGSP mental health team. Participant interests will direct the discussions.
The meetings are held on the third Tuesday of each month:
| DATES: | April 20, May 18. The support group will continue in the Fall after the Summer break. |
| TIME: | 5:30-7:00 PM |
| LOCATION: | 2025 Traverwood Dr., Suite A1, Ann Arbor, MI 48105 |
| ACCESS: | Wheelchair
accessible Open to the public |
| COST: | $10 per session |
| INFORMATION & REGISTRATION: |
www.med.umich.edu/transgender Or call Anita at (734) 332-0669 |