In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) officialized Gender Identity Disorder, labeling transgender and gender nonconforming individuals as mentally disturbed. In 2013, the DSM-5 slashed Gender Identity Disorder, and reclassiffied it as Gender Dysphoria. This recent feat legitimized the transgender community and emboldened the current dialogue for acceptance and inclusion. However, despite my liberal sensibilities, it might be time to repathologize the condition.
Now hear me out — I am not saying I promote conversion therapy, or oppressive legislation, or the idea transgender people are mentally disturbed. What I am talking about are the National Transgender Discrimination Survey (NTDS, 2008) and the United States Transgender Survey (USTS, 2015). The NTDS was the largest survey of transgender and gender nonconforming individuals in history with over 6,000 participants; until it was surpassed by the USTS with nearly 28,000 participants. While their pool sizes are drastically different, unfortunately, the results vary only by a few percent points. It is important to note now that these reports documented suicide attempt rates, not to be confused with suicide death rates.
According to the 2008 survey, the average attempted suicide rate for transgender and gender nonconforming people was 41 percent. And in 2015, the USTS confirmed it to be 40 percent. This is a daunting figure on its own, but compare it to the general attempted suicide rate in the United States (4.6 percent) and these statistics are all the more confusing. Why is there such a huge disparity between transgender people attempting suicide and every other group of people in the U.S.?
Here is where it gets tricky. To some on the political right, this may be seen as proof of transgender people being mentally disturbed. Fifty-nine percent of the participants in the USTS that had a professional (medical, religious, or psychological) try to stop them from being transgender attempted suicide; so support of those “treatments” would be counter to my message.
The left, on the other hand, has pigeonholed the culprit. They view this as proof that America is horrendously anti-transgender, which in turn causes these statistics. Also, since transgender people are a minority group with intersecting minority identities, culture fails them in multiple respects — creating exacerbated “minority stress.” And of course, if we consider the other contingent background factors (abuse, family rejection, mental health, etc.) that increase the likelihood of suicide, the real numbers are probably much lower. Essentially, transgender attempted suicide rates are a cultural problem — nothing else.
The transgender community is not treated equally in many respects, and legislation today still demeans their presence in public spaces. Yet every day the U.S. is becoming a more tolerant, accepting country for the transgender community with representation and praise on media platforms, court cases affirming civil rights and nondiscrimination laws across states protecting transgender people in the private and public sectors. There is much more to do (beyond bathrooms) but the point is that the U.S. is not a terrifically deplorable nation for transgender people, at least not for suicide to be this prominent.
Concerning the idea compounding minority identities affects these rates, I agree to an extent. Minority stress is a factor in suicide rates with any minority group. However, the LGBQ community also is a minority group with persistent cultural and legislative oppression, and intersecting minority identities. Their attempted suicide rates range from 10-20 percent. While not completely analogous groups, if compounded minority stress truly causes stark statistical disparities, then the rates should be much higher for the LGBQ community.
Conversely, the last argument suggests the statistics may be inflated for not addressing underlying factors. Unfortunately, these factors were considered. For example, the USTS reports transgender people from unsupportive households have an attempted suicide rate of 54 percent compared to 37 percent that came from supportive homes. Moreover, transgender people that experienced family violence have an attempted suicide rate of 65 percent compared to 39 percent if otherwise. The baseline is still about 40 percent for those that come from healthy backgrounds. The numbers are not dropping, they are rising.
When we have agreed that culture is not the only factor at play, that leaves one other party — the transgender person. Similar to how the male and female brain differ slightly, transgender brains differ from cisgender brains, which in itself is not inherently wrong. Nonetheless, it does pose the question as to if the neurology of a transgender brain is somehow more susceptible to suicidal ideation than its cisgender counterpart. The DSM-5 states that comorbidity, having multiple mental illnesses or disorders, is common among transgender youth and adults, especially depressive and anxiety disorders.
When it comes to our solutions in helping the community live happier, healthier lives, we are not doing enough. Not only cultural reformation, I am also referring to counseling, hormone treatment, top surgery, genital surgery and other gender-confirming medical procedures. The NTDS reports that transgender people that want or had a gender-confirming treatment (of any kind) had significantly higher rates of attempted suicide than their counterparts that did not wish to have any treatment.
It may be time to pathologize transgenderism once more. The lifetime suicide attempt rate for trans men is 45 percent; for trans women 40 percent; and for nonbinary people 39 percent. The first step in solving a problem is admitting there is one. We need the scientific community to research this further, innovate alternative treatments that decrease suicide rates, and have the support they need to do their job. Transgender issues are not political issues, they are human issues.