As I was walking out of the Trans Health Matters conference this afternoon, one doctor looked at me and asked “what are you doing to us, Helen?”
I’d just delivered a presentation about the TransDocFail phenomenon (which was quickly pushed out of the news by the furore over Julie Burchill’s article) and had given a very few statistics that had arisen out of the survey I had jointly set up with Sarah Brown and Zoe O’Connell.
The conference had heard story after story after story of abuse and discrimination. I use the word “abuse” based upon the definition that was given to me after my speech – an infringement of personal boundaries. Some of the stories were truly horrific. If you haven’t read the Trans Mental Health Survey yet, do so now – and be prepared for a stiff drink afterwards. It details explicitly how in many cases the trust between trans person and mental health professionals has broken down.
The seven tweets and four extracts I presented (all highly anonymised) were along the same vein. Why did I get such a strong reaction? Well, it might be partly down to presentation style – Christine Burns told me I had “shamelessly worked” the audience – but I doubt it. I think it was more because people could sense that something was happening.
Because, as well as collecting information, Sarah, Zoe and I had presented a dossier of 98 allegations to the General Medical Council (GMC). More significantly, perhaps, the GMC had come back to me and said they wanted to look in more details at 40% of the allegations I left with them. That’s a lot. Rather than being stuck outside explaining the abuse to nobody who was listening, we had got in through the door with allegations that simply couldn’t be ignored.
Dealing with abuse may take years. Individuals are frequently traumatised. It can take a long time before people can even begin to express what’s even been done to them. To get 130 cases documented is unusual. I’ve been scrupulous to maintain confidentiality and have anonymised everything that I’ve put out in the public domain, and have been really careful about that. Survivors of abuse need to know they can trust someone.
But I’m not sure the GMC totally get it. You see, trans people are dependent upon medics for ongoing treatment. Case after case showed very clearly that trans people were reluctant to complain with the explicit fear that their treatment would halt. And there were some allegations that treatment had, in fact, halted when people did complain.
This is not news. Sarah, Zoe and myself were part of a meeting with the GMC ethics people last year when the GMC heard exactly the same thing – a power imbalance, a position of potential abuse. But the support that the GMC is offering does not, yet, address this very real fear. I hope they come back soon with assurances and a proper support programme in place.
The fact that there were around 30 allegations that were to do with nurses, administrators or policy makers shows that the problems are not just with doctors. The system is broken. Over 10 pages, the Mental Health Study shows that around 1 in 3 trans people withhold information or actively lie to the medics in the GICs, and give a number of examples of systemic abuse – by which I mean abuse by the system.
I told the conference today that I had also written to Jeremy Hunt, the Secretary of State for Health. In that letter I quoted excerpts from the MacPherson Report into how the police had handled the investigation into the murder of Stephen Lawrence. It seems to me that the situation for trans people is similar to that MacPherson describes in his Chapter 6. There’s an unquestioning and implicit discrimination at the heart of the NHS provision. You have to prove that you are trans, but the ways of “proving” it are based on external norms and preconceptions. If you don’t fit – uh oh, there may be trouble ahead.
Of course those with this kind of privilege rarely have to question it. I have come to prefer the term “cis-genderism” over “transphobia” to describe it. A phobia is an irrational fear – but I think the institutionalised discrimination is more by people not thinking rather than intentional hate. We heard examples today of new NHS “body map” systems that assume a fixed gender binary – the fact that trans women may still have prostate glands forces medics to use a male body map, thereby forcing a male record to be (re-)created. It’s unthinking and unquestioning. And the end result is highly discriminatory and sometimes traumatic.
With the Richard Curtis case currently before the GMC, a stream of events have been initiated – TransDocFail being one of them. Trans people are finding their voice, they’re angry and the doctors must realise that they must start to listen and co-operate rather than dictate. I don’t think the trans communities are in any mood to compromise any more.
What am I doing to the doctors? Helping improve the service by highlighting the rot that’s set in. And I don’t think any medic should want me to do otherwise.