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.
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