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DR. WALTER BOCKTING: Now, switching to transgender identity development; this is mainly based
on clinical experience. There has been some qualitative research that has informed this
as well, and coming out models that are well known for the development of a gay or lesbian
identity have been adapted for the development of a transgender identity. And you see here
the different developmental stages that transgender people may encounter, and you see that this
is heavily influenced really about coping with stigma and having gradually come to terms
and understand their gender identity. And we see that people are coming out or realizing
their transgender identity and actualizing this as at an earlier and earlier age, thanks
not only to greater visibility, but also thanks to medical interventions to adjust the body
to the gender identity that the person has at an earlier and earlier age.
Next slide. These then are some of the latest stages. I always say that transgender identity
development is a lifelong process, and even those people who pursue hormones and surgery
to change their body, I think in time find out that being transgender has an added value
to that, a unique experience; that transgender is a part of who they are, not all of who
they are, and that they have a unique perspective to bring to this world. So as time and time
goes on, the value of that I think emerges, which really helps people to return the shame
that they may experience as a result of stigma into pride and self esteem.
The next slide. Family and friends go through a similar process. They may be very concerned
about how the loved one might be treated in society, bringing this out or being genital
conforming. They also might worry about their own standing in the community. But what we
find that after an adjustment period that most families adapt to this very well. And
that children of transgender parents fare very well. And then having support from others
like them, which for example, that PFLAG provides, is incredibly important.
The next slide. Then switching to the mental health concerns, we did some research here
with the Minnesota community and compared the rates of depression of transgender people,
both trans men and trans women, to that of men who have sex with men and bisexually active
women. So we’re looking within the GLBT community and we found that 52 percent of
the trans participants reported depression as compared to 38 percent among men who have
sex with men, and 40 percent among bisexually active women. And we found that 47 percent,
a very high number of people, of transgender people considered or attempted suicide in
the last three years, which was compared to a third among the other two groups. So even
within the LGBT community there is an elevated prevalence of depression and suicidal ideation
and attempts along the transgender group.
The next slide. The way we think about this today is that these levels of depression and
suicidal ideation and attempts and other mental health concerns that disproportionately affect
this community is related to the stigma and the stress of living with gender nonconformity
or with transgender identity that our society is still not sufficiently accommodating. And
the concept of resilience is then what is a good adaptation in the face of those challenges.
And I’m going to share now some research that reflects on that.
The next slide. We did this Internet survey, and we assessed mental health in this study
with a standardized instrument, a shortened version of the systems checklist, SCL-90 for
those of you who are familiar with that.
The next slide. This is the sample for the mental health analysis. We had over 1,000
participants. About half was male to female and half female to male. The mean age was
33, but a wide range from 18 to 70. the majority was white, however, as this was an online
sample. This was a highly educated sample, but despite its high education, still a third
had an income under the poverty level.
Next slide. These are then the numbers on the stigma experience of discrimination that
people reported. And you see very high levels of verbal abuse related to being transgender,
difficulty getting a job, difficulty maintaining a job, problem accessing health services,
physical abuse, housing discrimination. And you see that it holds for both the trans men
and the trans women. There are a few differences, but both groups are subject to stigma and
to the minority stress associated with that.
The next slide, please. Then these are the numbers on mental health, this time of a much
broader sample across the country using the standardized instrument. And we found that
of the trans women 49 percent had clinical levels of depression, and 33 percent reported
anxiety; and for the trans men, it was 37 percent for depression and 33 percent for
anxiety. So this is high. This is higher than the average, the general population. But you
can also look at it, like two-thirds of trans men, for example, doesn’t have depression
and anxieties. I do not want to give the impression that all transgender people struggle with
this, but nevertheless, this is an issue to be concerned about and to address.
Next slide. We also found significant relationship and association between these experiences
of discrimination and the anticipation of rejection, the perceived stigma, and the psychological
symptoms. So we were able to show in the study that indeed this stress is associated with
the stigma that people experience.
The next slide. In other words, it is not inherent to being transgender, but as a result
of how they are treated in society.
Then we wanted to identify sectors of resilience and categorize the group into four different
smaller groups, categorize them based on the level of discrimination, or the next stigma
they encountered, and their mental health. And then we were interested in comparing the
resilience group who experienced a number of different experiences of discrimination
yet their mental health was good to the other groups. And the next slide gives those findings.
A lot of numbers here, but the main thing to focus on is that the resilient group had
greater levels of family support, greater level of peer support -- that is, support
from other transgender people -- and a pride in their identity, pride in being transgender.
So these three factors that emerged has factors that buffer against the impact of stigma on
mental health. Those who have family support, who are more connected to the trans community
and who have a sense of pride in their own identity are less affected, are more likely
to have good mental health despite the stigma that they might face.
The next slide. I’m going straight to the second bullet. It is interesting to note that
back to the Minnesota study, that the levels of these protected factors of peer and family
support were the lowest among transgender people compared to their brothers and sisters
in the LGBT community.
Next slide. Which then leads me to the recommendations; interventions need to confront stigma and
discrimination, for example, by taking a human rights approach to transgender health. Access
to transgender-sensitive and competent mental health services need to be improved. For example,
to provider training, what this training will hopefully contribute to. Third, treatment
should promote effective stigma management strategies, how to cope with stigma, strengthen
social support, foster pride and identity by affirming the added value of being a person
of transgender or *** experience. And that can be done by including family in
therapy in the mental health fields by encouraging community involvement by providing support
and therapy groups, and by challenging their internalization of stigma that many of our
clients deal with.