Diagnosed with nonexistence: How bias deprives medicine of integrity

A person’s identity is contingent upon a motley of circumstance; the way we perceive each moment in time’s passing accumulates, molding a sense of self so that we can claim a space in the intersection of a tangible and philosophical universe.

Consciously or not, it’s an arduous task that each one of us undertakes in order to make sense of life’s perpetual flow around us.  Sometimes that flow is interrupted by a shortcoming or an insult delivered to us — we question where we stand and who we are, but eventually this dribble returns to its original state – life goes on.

Until it doesn’t.

The most basic sense of self that we have been taught from a young age is gender, something that we are locked into and yield to the authorities of our doctors and parents without question.  These are people who love and support us unconditionally, increasingly often with the condition that we don’t debate this ideal of self-dom.  The immediate instinct to reject someone who doesn’t accept the ordainments of society is a reactionary characteristic, and the insistence of those we should trust, including loved ones and medical professionals that our anguish is imaginative creates a lavishly monochromatic quality of life for too many.

When I was in a treatment facility for anorexia, I became friends with someone for whom I inadvertently became witness to the emotional exploitation of their private adversities.  P was transgender, and from the first day of her admittance to the facility her toils with her identity, and the obstinacy of society to reject it, were thrown in her face.

Ubiquitously, eating disorder facilities require a naked weigh-in and urine sample at the start of each day.  On that first day, I saw P’s morning supplies marked with two names; one I did not recognize and her name in quotes.  I was horrified, and a friend and I irately brought this injustice to the staff so that they might correct it.  They had placed her real name in quotes and insisted upon the validity of her given gender by placing that name before the latter, without the undermining punctuation.

This was the most tangible contention I witnessed P go through, but behind the scenes a war was waging:

If I was to receive any support, I would have to use my voice in a way that ‘earned’ the sympathy that would motivate other staff or peers into speaking on my behalf. Expressing my ‘feelings’ was not enough, I had to be convincing. Anorexia and social anxiety go hand in hand for me, so the very illness that I was in intensive treatment for also prevented me from receiving the same fair treatment enjoyed by the other patients.

P and I revisited the details of this treatment, where the circumstances surrounding aforementioned ‘weigh-ins’ was reiterated:

I was weighed alone, by a woman, after the cisgender patients had all gone. You can probably guess that I would feel excluded by this. The act of it served to reinforce the idea that in my gender I am only an imposter, alone in my ‘belief’ that I am as much a woman as any other. Yet it is not as if the woman who weighed me in meant to say any of these things to me, and in fact I know that these members of the staff were unhappy with having to carry out this process in this way. It is in this way that an institution itself can be transphobic.

The full weight of her experience slapped me in the face; the entire time that she was struggling alongside the rest of us to overcome the deadliest mental illness suffered, her healing process was sabotaged by the inflexibility of the people who were supposed to help her.  Likewise, another close friend revealed to me that she “hasn’t seen a doctor since 2013” out of fear that she will have this painful experience of being called an imposter.  My heart tightened; our loved ones are being denied basic human rights centered around a chronic illiteracy.  But how damaging can the stubbornness and genuine incomprehension truly be?

Suicide attempts among the transgender community is a heartbreaking 41%, pole-vaulting the 4.6% of the general population in the United States.  This jumps to 50% when they reveal to the people they trust that they identify as non-conforming or transgender, and when medical professionals reject their pleas for treatment based upon this alignment it leaps to 60%.  What kind of society is willing to kill its neighbors and loved ones just because they don’t understand?

On my journey towards understanding what my friends endure, I’m grateful to Dr. Paul R. McHugh, an established and highly respected psychiatrist-in-chief for Johns Hopkins Hospital.  His statements on the transgender and anorexic community have created a concise and accessible ‘Cliff Notes’ of illiterate hatred that is truly impressive.  Claiming that transgenderism is a “mental disorder” and that “people who promote sexual reassignment surgery are collaborating with and promoting a mental disorder”, he has pointed to this identification as a “disorder of ‘assumption’”.  He even paralleled it with anorexia, saying “It is a disorder similar to a ‘dangerously thin’ person suffering anorexia who looks in the mirror and thinks they are ‘overweight’”.  This suggests that the years of intense treatment and hospitalization; the arduous hours of research and cross-checking; the professional advisement of world-renowned doctors and therapists and the myriad credible papers and studies done on anorexia are invalid.  I was surprised to find that my history of trauma and abuse had nothing to do with my disease, and that anorexia is a two-dimensional vanity, contrary to the staggering amount of aforementioned literature on the subject. Overwhelming evidence directly contending Dr. McHugh’s opinions – oddly demanding themselves as fact – substantiates the connotation that personal belief is actively undermining the integrity of the medical community and literally killing patients in need.  We live in a disturbing reality where established professionals are casting aside the morals Medicine prides itself on to promote an agenda of unwarranted acrimony.

Thanks to professionals like this abusing their resources and standing in the community, the standard of care that transgender individuals receive is inhumane.  Although there are people like my friend P that are able to persevere past this insistence upon repudiation of the most basic of human rights, this incessant insistence upon a reality where loved ones and complete strangers are rallying together to grab you by the shoulders and tell you that you aren’t valid, that you are a poseur, this flow of life begins to ebb; marginalized, you desperately reach for the values most intrinsic to who you are, when suddenly society grabs this out of your hands and rejects you completely.  At the most basic sense of self that contemporary society has advertised, you are told you no longer have a claim; you don’t fit this mold; without this foundation for identity, you no longer exist.

As stated by Trans Lifeline, an organization dedicated to providing a support line to an unjustly tyrannized community:

Even if an individual is stabilized past the period of impulse, the underlying factors of institutional and structural barriers leading to suicidality remain.

Typical mental health resources, including individual providers and clinical settings, are often at a loss to address these underlying factors. This arises both from discrimination against and discomfort with transgender people and issues, and from the structure of typical mental health resources to treat mental health as purely a personal, individual issue.

P’s experience and Dr. McHugh’s statements represent a trenchant account of what is happening on a large scale; a toxic culture of nonacceptance that is pitting friends and family against one another, and eroding a respectable profession into a morally and scientifically devoid debris. When an organization or individual labels themselves as a pro-health foundation but structurally undermines recovery — buttressing the original strife with a vengeance — we have to acknowledge that something is inherently wrong and change our approach to one that replaces opinion with credible knowledge and exchanges judgement for nurturing.  To clear the rubble of ignorance and misinformation, to stop the slaughtering of our loved ones, we can look to Martin Luther King Jr. for guidance; that “Hatred cannot drive out hatred, only love can do that.  Don’t give in to hatred, don’t give in to fear, instead live lives of love.  That doesn’t mean love those who love like you, who look like you, or who worship like you.  It just means ‘love’.”

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