Have you ever felt trapped in a predicament in which you thought there was no possible good outcome? I have. I was a successful psychiatrist, married for 18 years with two young daughters, but tormented with a decision about coming out as gay. The more I struggled with the decision, the more anxious I became. Although I never considered suicide, other mature adults—and there are many—confronting the decision to come out attempt suicide at about three times the rate of the general population, sometimes making multiple attempts. My predicament lasted a relatively short time, and once I made the decision to come out, my anxiety disappeared.

 

The transgender suicide predicament

The dominant psychiatric belief has always been that suicide is the result of a mental disorder, and recent adverse life events are known to increase the risk and perhaps form the trigger for suicide. Dr. Saxby Pridmore, an Australian psychiatrist, described “predicament suicide,” which occurs when an individual without a mental disorder completes suicide to escape intolerable circumstances. To some extent, all suicides are a response to a predicament, but the idea of predicament suicide still has some currency when applied in a limited sense to cases where there is no mental disorder.

People who are transgender have a much harder struggle than I did. Many trans children become aware of their predicament long before they understand the concept of gender or are aware that their opposite-sex interests will result in significant disapproval. It doesn’t take long for them to begin to experience strong opposition and violence. Often, a trans individual experiences multiple, daily acts of intolerance or violence, beginning as early as preschool and continuing across a lifetime.

I recently interviewed a middle-aged trans female just beginning her transitioning from male to female. She always wanted to be female. At age four, her alcoholic father caught her dressing in girls’ clothing and in a fit of drunken rage, he threw her against the wall, causing injuries that required her prolonged hospitalization. Because of that violence, she lived a secret life. As an adult, she had a successful career, married, and had children, burying her interest in being a woman except when secrecy could be assured. Her predicament frequently led to thoughts of suicide.

Acts of violence are not single incidents. Mental health issues and experiences of harassment, discrimination, violence, and rejection may interact to produce a marked vulnerability to suicidal behavior in transgender and gender non-conforming individuals.

I work as a psychiatric consultant in a clinic that does gender-reassignment treatments, and stories like this trans woman’s are common. I am often asked to give a psychiatric opinion of whether a person is psychiatrically stable so that gender-reassignment surgery can proceed. In most cases, I find no evidence of a psychiatric disorder or only symptoms related to a lifetime of abuse.

Although at higher risk for anxiety, depression, and suicide, many of these transgender men and women show a remarkable resilience to having been rejected by family and peers, harassed, traumatized, and abused. Many of their psychiatric symptoms disappear once they have accepted that “I am what I am; I don’t care what anyone thinks.” Shame cannot survive in the presence of people who accept these individuals. One person who had lived as a woman for a year after having undergone hormonal treatment requested surgery and said,

“I have no illusions that I will be a beautiful woman. I just want my outsides to match my insides.”

Findings published in a report called “Suicide Attempts among Transgender and Gender Non-Conforming Adults,” indicate that 46% of trans men and 42% of trans women have attempted suicide, a public health crisis for the estimated 150,000 trans teens and 1.4 million trans adults. The prevalence of transgender suicide is highest among the young, the economically disadvantaged, and the less educated and ethnic minorities. It is also higher for those who are thought by others to be gender non-conforming, even if they are not told. For those who have an underlying mental condition, suicide prevalence is even higher.

Related Content: Suicide in America: Understanding the What and Why

Politics and religion

As a candidate for president, Donald Trump said that transgender people should use the bathroom they were more comfortable with. He appeared to support the Obama administration’s decision to inform schools receiving Title IX federal funds that they must allow students to use restrooms and changing rooms consistent with the gender with which they identified. He claimed to be sympathetic to the LGBTQ community and made a commitment to protect us from violence.

President Trump lost credibility when he reversed his position and in a brief letter announced that he was rescinding President Obama’s directives to protect transgender schoolchildren. The decision was couched in terms of deference to the primary role of states and local schools to establish educational policy. An editorial in the Los Angeles Times suggested, however, that Trump’s decision was influenced largely by religious conservatives who provided significant support to Trump and long have stirred up hysteria over the imaginary danger to children posed by policies that allow transgender children to use facilities of the gender they identify with, even if it doesn’t match the one on their birth certificates.

A recent article on the Gospel Coalition website states, “The sexual revolution has so subverted public opinion and Christian-influenced morality that teachings about sex that were previously considered immoral or even unthinkable eventually found their way into the classroom as school policy. But a quicker and more effective route to societal change is to simply reverse the process: force an issue to become school policy and eventually opposition to it will become unthinkable. That is the shift that is being attempted today on the issue of transgenderism in schools.”

This article goes on to say that people might choose “their own sex” to benefit themselves. “But as history has shown, people respond to incentives. If men can gain an advantage by saying they are women, many will do so. To claim otherwise is to be completely unaware of humanity’s sinful nature.”

Although we don’t really know why some people are transgender, the explanations for this complex issue are often found in a combination of genetic, psychological and cultural factors. The statements by the Gospel Coalition ignore the pain that goes into the decision to transition and the violence to which these people are exposed, treating the matter as if transitioning will help gain one admission to a favored college or a peek over the top of a bathroom stall.

The LGBTQ community is in for a bumpy ride. Trump supports the First Amendment Defense Act, which is quite like a law passed by Vice President Mike Pence in 2015 when he was the governor of Indiana. It would allow business owners to deny services to LGBTQ customers based on their belief that marriage is solely between one man and one woman.

That legislation was cosponsored by then Alabama senator and now attorney general Jeff Sessions, who has consistently opposed pro-LGBTQ legislation throughout his twenty years in Congress. He voted in support of a constitutional ban on same-sex marriage, against providing workplace discrimination protections for LGBTQ people, against repealing the military’s “don’t ask, don’t tell” policy, and twice against expanding the definition of hate crimes to include attacks on people because of their sexual orientation and gender identity. He has supported a law that would allow state laws to override federal laws about same-sex marriage. The Human Rights Campaign, in its annual scorecard of how lawmakers fare on LGBTQ issues, year after year has rated Sessions at zero.

Education Secretary Betsy DeVos, a conservative Christian, originally supported President Obama’s policy of protection for trans teens but, apparently, under pressure from the new administration, has reversed her position and now says it is an issue for states and local schools to decide.

On March 28, the Supreme Court will hear oral arguments in a lawsuit filed by Gavin Grimm, a transgender high school student, a boy seeking to use the boys’ restroom at his Virginia high school. In ruling for Grimm, a federal appeals court had relied on the Obama administration’s interpretation of Title IX. With the Trump administration’s change of policy, the justices might send the case back to the appeals court.

 

The bottom line

What some have seen as an epidemic of people seeking to transition from one gender to another is not a real change in incidence but a change in visibility of a hidden population. If recent policy changes by the Trump administration are activated, trans children and adults will be driven back into hiding, where they will once again be faced with a huge predicament. It appears that this is only the beginning for the entire LGBTQ community.

Related content: Older Gay Men and the Risk of Suicide