Transition

As I described in a previous post, after reading a fanfiction chapter in which someone seemed to draw comparison between depression and being transgender, I worried that this implied that depression is hardwired and unchangeable. 

After all, being transgender, like being gay – and like being autistic, as I am – is something that people are born with.  Children aren’t likely to show signs of autism until they’re a year old, and probably won’t realise that they are transgender until they are old enough to notice that there is a difference between boys and girls, or won’t realise they’re gay until they’re old enough to feel sexual attraction, but the neural wiring was there from before birth, and it isn’t going to go away.  Attempts to ‘correct’ any of these by training young children to behave in a socially acceptable way do nothing but hurt the child and teach them that they are unacceptable.

So, is depression something similar?  Some people consider being suicidally depressed to be their orientation.  I have seen angry comments aimed at therapists on suicide prevention websites from people who argue along the lines of, ‘Yes, if I die then it will distress my family and friends, just as homophobic parents are distressed if their child comes out as gay.  But that isn’t the gay person’s fault – a gay person needs to be free to express their sexuality, and I need to be free to kill myself without anyone trying to talk me out of it.’

Some of the people who argue in this way sometimes seem to assume that, if their experience of suicidal depression is as something lifelong and unchanging – that they had never wanted to live – then it must be the same for anyone who ever experiences suicidal thoughts.  Yet at the same time, the ‘suicidality is an orientation’ group will also insist that if the therapist writing the site has been suicidally depressed in the past and isn’t any more, then she can have no understanding of or empathy for what a suicidal person is going through. 

They will argue this way even on a messaging board full of comments from people explaining that they want to die because of the specific situation they are in – including being traumatised by a terrible experience, exhausted from looking after a disabled relative with no assistance, or simply old and ill and lonely.  From the range of comments from different people, it looks fairly clear that many people contemplate suicide not because of innate neurological wiring, but because modern society is too fractured to offer vulnerable people the love and support they need.

I don’t know whether in some cases, long-term depression is a hardwired neurological difference like gender dysphoria.  I don’t know whether it could be a kind of ‘mortality dysphoria’ in which, instead of being a person of one gender trapped in the body of the opposite gender, someone is born feeling that they should be dead but are trapped in the body of a living person.

But even if that could be the case, I don’t know how an individual could ever know for sure that they are in that situation, and that their depression might not be caused by external events (even if these are experiences going back to early childhood) and treatable.  There have been cases of people who mistakenly thought they were transgender, had gender reassignment treatment, and regretted it, and there is a limit to what medicine can do to reverse the surgery.  But, as PDB11 said when I suggested the idea of ‘mortality dysphoria’ to him, if you mistakenly think that you are innately suicidal and kill yourself, there is nothing you can do to reverse it.

But what if the parallel between gender dysphoria and mental illness such as depression works at a different level, if we shift the metaphor?  A transgender person is someone with a brain which knows they should be one gender, trapped in the body of a different gender.  What if a mentally ill person who wants to recover is someone with a soul that knows it wants to be sane, trapped in an insane brain?

In this case, I do need to transition, but certainly not to transition from a living person into a corpse.  Rather, I need to transition into a confident, assertive person who can accept myself and other people, and allow myself to be happy.  I need to transition away from the ideas I picked up in childhood and adolescence that I ‘should’ hate myself and make myself miserable, or that I am a worthless person.

For cisgender people, transitioning into the man or woman you were meant to be is something that happens of its own accord from the start of puberty.  It might be messy and uncomfortable at times, but at least we don’t usually need medical intervention (except in rare circumstances, such as the minority of girls who are born with a completely sealed hymen, and so are unable to expel blood when they menstruate).

For transgender people (and I realise that I don’t have personal experience of this, but I’m basing it on what trans friends have told me), it is much more complicated.  First, you have to realise that you are trans – which may have been obvious to some people since they were three years old, but for others, there was a moment in later childhood or even adulthood when they realised what the feeling of wrongness they had been carrying around actually meant.

Then, you have to work out what kind of transgender you are.  Might you be gender-fluid, or non-binary?  Do you simply want to change your name, your pronouns and the way you dress?  Or is the problem that you are in the wrong kind of body?  Do you need hormone therapy and surgery to transition to a body that feels right for you?

Then, if you are clear that you do need to change your body, you need to get a doctor to agree that you really are transgender and need appropriate treatment.  The process of transition is long and multifaceted.  It can involve changing how you think of yourself, changing how you present yourself to others, being legally recognised as the gender you identify as, and getting medicine (hormone treatment) and surgery to change your body – and it varies depending on what the individual wants.  It is likely to involve seeing a psychiatrist, not just initially to clarify that you genuinely are transgender and aren’t just imagining it, but to provide support throughout the process of transitioning.

I think there are some parallels here with overcoming depression, but things don’t come in the same order.  One big difference is that, because recovering from mental illness is about changing the mind rather than the body, changing the way I think of myself is the end goal, rather than the starting point.  However, to transition to being a non-depressed person, first I have had to realise that I don’t need to spend my life hating myself: that it is all right to want to change. 

Next, the process of recovery may involve seeing a therapist, and might also involve taking medication (antidepressants).  But, importantly, I don’t have to begin the process of getting treatment by demonstrating that I have already lived as a non-depressed person for at least a year.

I don’t think my problems are anywhere near extreme enough to need surgery to physically reshape my brain, or other physical interventions like electro-convulsive therapy.  But the brain is physically reshaped by exercise: by the thoughts we practise thinking, and by meditation.  So I need to get into the habit of meditating regularly.

To some extent, recovery involves changing the way I present to others.  This doesn’t mean I have to pretend that I don’t have problems, but, for example, when I go to work, I practice saying a cheery ‘Good morning!’ to customers.  When I phone friends, I can ask how they are, instead of launching into complaining about my own worries.  When I have a disagreement with other people, I can learn to listen and try to understand their point of view, instead of insisting on my own ultra-pessimistic viewpoint and shouting and ranting if they disagree.

Is the process ever complete?  Over the past few years, I’ve watched a friend of mine go through the process of gender transition, first socially transitioning to dressing as a woman, then practising speech therapy to talk in a more feminine way, getting rid of facial hair, and then starting hormone treatment, and getting excited about finally growing breasts in her thirties.  At one point, I remember her complaining that she worried that her face would never look properly feminine.  Another of our friends suggested that this could be something it was futile to worry about; that just as an anorexic person can never believe they are thin enough, so the person transitioning may never believe that she looks feminine enough, and cannot believe how she looks from the viewpoint of an observer.

I don’t know how long it will take me to change significantly, or noticeably – especially when the changes I need to make aren’t obviously visible.  I know I need to work on it.  But I also know that to do so, I need to be patient, and accept that I am a work in progress.