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
Loren A. Olson, MD
Loren A. Olson, M.D. is a board-certified psychiatrist who obtained his medical degree from the University of Nebraska Medical Center in Omaha, Nebraska, in 1968. He spent four years in the United States Navy as a Flight Surgeon. After his discharge from the military, he completed a psychiatric residency at Maine Medical Center in Portland, Maine.
Awards and Recognitions
• His proudest professional achievement was the patient-nominated Exemplary Psychiatrist Award from the National Alliance on Mental Illness.
• He has received several awards for his writing.
• His book, Finally Out, won the IBPA Ben Franklin Award for BEST LGBT Non-fiction.
His clinical focus has been on the treatment of major mental disorders. His philosophy of treatment includes addressing biological issues, developmental experiences, and current life circumstances. He believes healing occurs when treatment is delivered with genuine warmth, accurate empathy, and unconditional positive regard for everyone.
Associations and Clinical Membership
• Dr. Olson is a Distinguished Life Fellow of the American Psychiatric Association.
Publications and Books
• Dr. Olson’s essays in Psychology Today have been accessed over one million times. He has also written for The Advocate, Huffington Post, Medium, and many other local and national newspapers.
• He has just released another book, Finally Out: Letting Go of Living Straight
Dr. Olson is married to his life-partner Doug, of thirty-four years. Before Doug’s retirement, they raised grass-fed beef on their farm in Iowa. He has two daughters and six grandchildren from his previous marriage. They all continue to expand their definition of family.
Dr. Olson considers himself to be an expert in retiring, “I’ve done it so many times.” During his current “retirement,” he continues to practice psychiatry part-time and writes extensively for various platforms.
Oh but you do have all of the qualifications you need to express your opinion. You are a human being, no greater or lesser than the rest of us. Social harmony will only happen when we begin to listen to each other, and I am so happy to have heard from you.
I agree with the professor and I got no issues with LGBT population but I do have an issue with some of them
who dictate terms to the rest of the society or insult the others of their race or color or even the talents. This happened
in once in Dutch TV show. One Mr. Gordon (who is Gay)a so called celebrity in a panel of judges repeatedly racially insulted a young talented Chinese origin singer then I think it’s high time to put him back in his place. We all got to accept none is superior to another. Live and let live. I got no qualifications to match any one of you but I believe in social harmony.
I find the stellar abuse of objective protocol appalling, Mr Olson. As a psychiatrist you are supposed to be more inclined to stating things factually, and instead your choices of presumptive descriptors leads the reader into the forest of illogical social justice warrior insanity.
One example, is the contention that by not allowing transgender kids to use bathrooms not designed for their biology… You state it as “he was rescinding President Obama’s directives to protect transgender schoolchildren”…
“To Protect Transgender Children”….
How about protecting all the well adjusted, stable children who as young, developing adolescent’s are horrified to have a boy (yes that is what he is if he has a penis…it’s an easy check…) undressing with them when they are in the pre-teen / early teen stages???
When do everyone else’s rights, y’know… those of the sane, start to count?
Instead of advocating therapy for these self perpetuating delusions of gender, and proposing treatments to help these poor individuals work through whatever trauma / imbalance or combination thereof, that afflicts them, you jump on the liberal-socialist “let’s create another special interest group of victims”.
Unfortunately, “reality” has imposed a very clear divisor… even down to the genome, this is physically verifiable, down to about 5 possible gender dispositions (M [xy] / F [xx]/ Hermaphrodite / chromosomal arrangement contrary to their phenotypic sex — example, XX males or XY females). Any other “belief” “perception” or whatever descriptor becomes popular on the lefitst side, is simply nonsense.
“Feelings” are not FACTS… they are mental constructs that are interpretations based on our starting beliefs and to a degree our neurochemical balance at that point in time.
Time to stop riding the socio-political train of subjectivism and start being clear.
Your professional standing gives you power… use it responsibly to present what is true instead of what is politically advantageous at this disfunctional point in history.
Well, James, let’s start with the obvious: You seem angry about my essay. Would you agree? That would seem to be a fact. But wait! Feelings aren’t facts, you say, but only mental constructs based on our “starting beliefs.” So, if I follow your reasoning, your anger then comes not from the essay but was a construct that grew out of your starting beliefs. I think your comments make very clear just what your starting beliefs are.
Let me re-state the most important fact in the essay: Transgender boys and girls, men and women, kill themselves at eight times the rate of the general population. That is not some “socio-political train of subjectivism.” Those are objective facts. Another important fact is that suicide rates are higher in communities that are not accepting of people that are different.
Your discussion of chromosomes is a discussion about anatomical sexual identity. Gender is something different. Gender is the perceived or self-identified masculinity or femininity of a person. It is a psychological construct, not an anatomical one. Having a penis is not a ticket to masculinity, nor is having a vagina a ticket to femininity. Determining the features of anatomical sex is many times a fairly easy check (although not always such as in the case of intersex children). Gender is a far more complicated matter. No external markers exist for gender.
In my work as a psychiatrist, feelings are facts. I believe it is an indisputable fact that you are angry with me. Sometimes people have feelings that are not justified by their circumstances; others may consider them invalid, but the person who feels them, owns them. They are his/her reality. His/her facts.
Suicide grows out of a feeling of hopelessness. It may seem like a reasonable conclusion to someone when risks and outcomes aren’t predictable and where the solution may not be optimal but it is the only solution that is acceptable. It is my job as a psychiatrist to give them hope, to help them see that there are alternatives. It is definitely not my job to tell them, “You’re crazy for feeling that way.” Plenty of others are more than willing to do that. Please don’t assume that you know what my job is better than I do.
I am quite aware of my power as a professional and my ability to influence people’s thinking. That is precisely reason I chose to write this essay. Unfortunately, nothing I have said will influence your opinion. You are stuck in your “starting beliefs.” This essay is not for you. It is for those who are intellectually curious and want to understand those who may be different from themselves, to help them understand and accept them.
Bravo, Dr. Olson, for an astute and restrained response to what I perceived as an angry rant.
Mr. McAliffe, it is a little strong to say “The LGBTXYZ (aka LGBTQABCDEFHIJKM – no N for normal – OPRSUVWXYZ) movement is an attack on nature. It is worse to change it into a one sided political religion and movement.
Best we accept folks as they are with tolerance and space. Best they keep out of screaming in our face and running to the US Supreme Court with every little nit pick. I have lived with all for my entire life with no problem except for “activists”.
Crisis of suicide? Let’s add context of the numbers of other folks who have contemplated and accomplished suicide. I resent the statement “… highest among identity politics groups…”. We are all people and in this together. Accept people as they are.
Comment will held for moderation