The Problem with Being Trans and Mentally Ill


When I was nineteen, I was referred to a psychiatrist to be assessed for bipolar disorder.
The assessment lasted an hour, and at first, I thought it was going pretty well. Like many other people who have dealt with mental illness from childhood, I am very, very used to not being taken seriously, so it was refreshing to be treated like someone with actual medical issues rather than an attention-seeking teenager.
Of course, it didn’t last.
“So, is there anything else you think I need to know?” the psychiatrist asked, fifteen minutes from the end of our appointment.
“Well, I’m bisexual, but I don’t think that’s caused me any problems. I have some issues with my gender, too.”
“Ah, I see,” he replied, the shadow of a smug smile dawning on his face. “That’s definitely something you should look into.”
And from that moment on, it was as if I was twelve again. The doctor that had been all professionalism five minutes ago was suddenly the double of every patronising, dismissive child psychologist I’d ever seen. At the end of the appointment, he told me that I didn’t need the medication I was taking and that teenage issues often even themselves out with time.
“You should definitely look into those gender issues, though,” was his final comment.
There. Problem solved. Appointment over.

I am genderqueer. I am also mentally ill, in a very real way that affects my day-to-day life, and has done since early childhood. The way mentally ill young people are treated was something I was already well aware of. I was prepared to be dismissed because of my age; what I wasn’t prepared for was this reaction to my gender.
Don’t get me wrong – I’m well aware that many of my mental health issues are linked to the fact that I’m not cisgender. I think the same is true of many trans people. Feeling disconnected from or disgusted by your body can, I believe, have insidious and deeply damaging effects on a person’s psyche. Add this to the discrimination and hatred that many trans people face after they come out, and it comes as no surprise that such a high proportion of us suffer from depression, anxiety and other illnesses.
But what many mental health professionals seem to be totally unaware of is that trans folk are people, not two-dimensional cardboard cutouts, and can have mental health issues unrelated to their gender identities. Personally, yes, I imagine my long-running battles with disordered eating and self-harm probably do have something to do with the disconnect I feel between my mind and my body. Fair enough. But my issues with addiction and the few terrifying episodes of hallucinations and delusions that I’ve experienced – these things have their roots elsewhere.
Even mental health issues that stem from either discrimination or dysphoria won’t necessarily disappear post-transition. This, too, seems to be a major misconception among mental health professionals – the idea that, for a trans person with mental health issues, the only necessary treatment is transition.
To be honest, I feel like a bit of a fraud for writing an entire post about this topic, because I can tell you the problem with being trans and mentally ill in one sentence – people cannot separate the two.
Yes, being trans can bring with it a whole host of mental health issues. And personally, I do believe that transitioning can really help with a lot of those issues. I’m not denying that. But the assumption that trans people cannot have mental health issues unrelated to their gender identity – or that transition is a magic cure-all – is massively harmful, and leaves many trans folk struggling to find the mental health care that they need once they’ve started to transition.

I am genderqueer. For me, transition is an imperfect option anyway – I don’t know what kind of body I ultimately want. And considering all the loopholes that trans people are made to jump through before they access things like hormones and surgery, even if I figure out what that body looks like, I don’t know how long it’ll be before I get it.
I am mentally ill. I do not have bipolar disorder, even though I sometimes exhibit the symptoms of it. In fact, these days I’m increasingly aware of the fact that my symptoms do not fit any particular set of diagnostic criteria, and that trying to force my illness to fit one of the rigidly defined disorders provided to me by medical professionals is just as pointless as trying to force my gender identity to fit one of the checkboxes given to me by the binary.
I’ve learnt to be flexible when thinking about my mental health, and when figuring out what I want with regards to my gender. It’s that flexibility that has allowed me to work out a balance with myself, and to accept the fact that whilst I’m never going to find a solution which is 100% perfect, there are at least things I can do to take care of myself and be a happier and healthier human being.
I feel like the mental health professionals I’ve dealt with could use a little of that flexibility – because let’s face it, not every trans person fits the rigid narrative that so many doctors and therapists are taught to follow.

Feature image taken from

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  1. Thanks for writing this. I’ve seen mental health diagnoses and approaches change over the course of my own life, so I understand how complex it can be for practitioners, but still. My Offspring is gender non-conforming and there absolutely is this tendency to either attribute the issues of mental illness to gender and sexuality or vice versa, and this goes triple for the outside world. Mental health, gender and sexuality are so woefully (and often deliberately) misunderstood each in their own right, that making people think about more than one at a time seems to be an impossibility.

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