Look at the facts of the world. You see a continual and progressive triumph of the right. I do not pretend to understand the moral universe, the arc is a long one, my eye reaches but little ways. I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. But from what I see I am sure it bends towards justice.1
Transgender and gender nonconforming people defy society's preconceived notions and norms of gender identity. As a result, they embark on a journey of self-discovery and risk rejection by society in general and their loved ones in particular. Although some may make their journey without substantial obstacles, many struggle mentally and have the additional burden of stigma and discrimination. Most policies now seem to bend toward justice. But counter examples exist; just witness the fear and backlash from legislators about who can and who cannot use which bathroom. Such legislation can cause stress and anguish, adding to any suffering that transgender and gender nonconforming people already experience. Prohibitive legislation, born of ignorance, echoes past policies about who could and who could not use bathrooms based on race.
If, as healers, we accept that our role is to reduce suffering and increase wellness, it is imperative that we learn as much as we can about the trials, tribulations, and triumphs of transgender and gender nonconforming people. This issue of Psychiatric Annals, guest edited by Drs. Laura Erickson-Schroth and Tamar C. Carmel, is a great way to start.
In what ways are transgender and gender nonconforming people marginalized? In the first article, Dr. Hilary Maia Grubb counts the ways by starting with the many definitions and combinations of anatomical birth sex and gender, sexual orientation, and gender identity. The author then discusses issues of access to care, barriers to insurance, discrimination and stigma, and assumptions by health care providers. It's a moral issue of equity.
What are the roles of psychiatrists working with transgender people? In his article, Dr. Jack Pula discusses how psychiatrists can help transgender people with the specific transitions (social, medical, surgical) and how psychotherapy can be helpful while avoiding harm.
What mental health issues are faced by transgender people? In their article, the guest editors discuss trauma, discrimination, violence, mood disorders, self-harm, elevated suicide risk (especially in young people) as well as resilience.
What are the gender diagnoses in both the Diagnostic and Statistical Manual of Mental Disorders2 and the International Statistical Classification of Diseases and Related Health Problems?3 In his article, Dr. Jack Drescher discusses how to use criteria to understand standard diagnoses.
In the final article of this issue, Dr. Nathaniel Sharon discusses psychiatry's role in supporting healthy development in gender diverse youth with information about assessment, supportive interventions (environmental, social, and medical), and a clear caution against conversion therapy.
For transgender and gender nonconforming people who seek our help, we are responsible for addressing their suffering with knowledge, respect, and compassion.