Perspective

Trump’s transgender military ban harmful for mental health

President Donald J. Trump
Donald J. Trump

President Donald J. Trump today indicated a reinstitution of a transgender ban from the military in a series of posts of Twitter.

In response, the APA expressed their support of the transgender community via an image on Twitter, which illustrated the harms associated with discrimination and lack of equal rights.

Further, the organization linked to their position statement on discrimination against transgender and gender variant individuals.

The statement indicated that the APA supports laws protecting civil rights of transgender and gender variant individuals, urges repeal of laws and policies that discriminate against transgender and gender variant individuals and opposes public and private discrimination against these individuals.

Elspeth Cameron Ritchie, MD, MPH
Elspeth Cameron Ritchie

In an interview with Healio/Psychiatry, Elspeth Cameron Ritchie, MD, MPH, a forensic psychiatrist who retired from the Army in 2010, explained harms associated with reinstating a ban on transgender individuals openly serving in the military.

“Drawing from experiences of gay service members, people may conceal their identity, which may be accompanied by anxiety and fear that someone may find out about you and ‘rat you out,’” Ritchie said.

This fear and anxiety could lead to substance abuse problems and suicidal ideation, attempts and completion, according to Ritchie.

According to the APA position statement, gender-based discrimination and victimization were independently associated with suicide attempts among transgender individuals, of which 32% reported a history of suicide attempts.

Further, in a study of 6,450 transgender and gender-variant individuals, 41% reported attempting suicide.

“Disruption” ?

Trump’s tweets suggested transgender participation in the military could cause disruption.

While little evidence exists proving this statement one way or the other, the impact of lifting the ban on gay military members may offer some perspective, according to Ritchie.

“We had a ban on gay military members for a long time. When the ban was lifted, it actually caused very little disruption,” Ritchie said. “It was amazing how little disruption it caused to lift the ban.”

Further, lifting the ban alleviated anxieties and fears among gay military members.

“It was also clear it made many people’s lives much easier because they no longer had to conceal their sexuality out of worry of being discharged for being gay,” Ritchie said. “We also know, based on gay military members, thousands and thousands of them have served their country honorably and well.”

Women’s participation in the military serves as another example of a successful integration of banned individuals with existing military members.

Unanswered questions

While the disruptive nature of transgender participation in the military remains unproven, some issues have yet to be addressed.

“This is a complicated issue,” Ritchie said. “I think it is inappropriate for someone to join the military in order for the military to pay for them to transition. I don’t think that’s a good idea. On the other hand, if someone has already transitioned and is comfortable with their new identity, I don’t see any problem with somebody being in the military.”

Currently, there are a number of medical conditions that prohibit service members from deploying, such as receiving a blood thinner or antipsychotic.

“The question of whether a person can be deployed when they’re transitioning remains, and I think that’s problematic,” Ritchie said. “I don’t think [deployment] is an issue after somebody has transitioned. But this is an area where emotions run high, so it’s important for people to think about the medical implications of transitioning when you are in the military and/or deployed to a war setting.” – by Amanda Oldt

Reference:

Drescher J, et al. American Psychiatric Association. Position statement on discrimination against transgender and gender variant individuals. 2012.

Ritchie EC, Naclerio A. Editors. Women at War. Oxford University Press, May 2015.

Disclosure: Ritchie reports employment with the VA and that her comments do not represent those of the VA.

 

President Donald J. Trump
Donald J. Trump

President Donald J. Trump today indicated a reinstitution of a transgender ban from the military in a series of posts of Twitter.

In response, the APA expressed their support of the transgender community via an image on Twitter, which illustrated the harms associated with discrimination and lack of equal rights.

Further, the organization linked to their position statement on discrimination against transgender and gender variant individuals.

The statement indicated that the APA supports laws protecting civil rights of transgender and gender variant individuals, urges repeal of laws and policies that discriminate against transgender and gender variant individuals and opposes public and private discrimination against these individuals.

Elspeth Cameron Ritchie, MD, MPH
Elspeth Cameron Ritchie

In an interview with Healio/Psychiatry, Elspeth Cameron Ritchie, MD, MPH, a forensic psychiatrist who retired from the Army in 2010, explained harms associated with reinstating a ban on transgender individuals openly serving in the military.

“Drawing from experiences of gay service members, people may conceal their identity, which may be accompanied by anxiety and fear that someone may find out about you and ‘rat you out,’” Ritchie said.

This fear and anxiety could lead to substance abuse problems and suicidal ideation, attempts and completion, according to Ritchie.

According to the APA position statement, gender-based discrimination and victimization were independently associated with suicide attempts among transgender individuals, of which 32% reported a history of suicide attempts.

Further, in a study of 6,450 transgender and gender-variant individuals, 41% reported attempting suicide.

“Disruption” ?

Trump’s tweets suggested transgender participation in the military could cause disruption.

While little evidence exists proving this statement one way or the other, the impact of lifting the ban on gay military members may offer some perspective, according to Ritchie.

“We had a ban on gay military members for a long time. When the ban was lifted, it actually caused very little disruption,” Ritchie said. “It was amazing how little disruption it caused to lift the ban.”

Further, lifting the ban alleviated anxieties and fears among gay military members.

“It was also clear it made many people’s lives much easier because they no longer had to conceal their sexuality out of worry of being discharged for being gay,” Ritchie said. “We also know, based on gay military members, thousands and thousands of them have served their country honorably and well.”

Women’s participation in the military serves as another example of a successful integration of banned individuals with existing military members.

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Unanswered questions

While the disruptive nature of transgender participation in the military remains unproven, some issues have yet to be addressed.

“This is a complicated issue,” Ritchie said. “I think it is inappropriate for someone to join the military in order for the military to pay for them to transition. I don’t think that’s a good idea. On the other hand, if someone has already transitioned and is comfortable with their new identity, I don’t see any problem with somebody being in the military.”

Currently, there are a number of medical conditions that prohibit service members from deploying, such as receiving a blood thinner or antipsychotic.

“The question of whether a person can be deployed when they’re transitioning remains, and I think that’s problematic,” Ritchie said. “I don’t think [deployment] is an issue after somebody has transitioned. But this is an area where emotions run high, so it’s important for people to think about the medical implications of transitioning when you are in the military and/or deployed to a war setting.” – by Amanda Oldt

Reference:

Drescher J, et al. American Psychiatric Association. Position statement on discrimination against transgender and gender variant individuals. 2012.

Ritchie EC, Naclerio A. Editors. Women at War. Oxford University Press, May 2015.

Disclosure: Ritchie reports employment with the VA and that her comments do not represent those of the VA.

 

    Perspective
    Charles Hoy-Ellis, MSW, PhD

    Charles Hoy-Ellis

    For some transgender Americans, having served in the military may be associated with lower levels of depression and higher mental health related quality of life in later life. While hiding one’s transgender identity might be helpful in the short term, over the long-term this becomes a chronic stressor that has significant negative physical, mental, and social health outcomes. The detrimental impact of prohibiting transgender Americans from serving in the military is not limited to the individual.

    Estimates suggest that there are approximately 15,000 currently serving transgender military service members. There is abundant evidence that transgender (and LGB) Americans have served honorably in the U.S. military for decades upon decades.

    Far from destroying morale, LGBT service members have contributed every bit as much as their heterosexual counterparts have. One of the cornerstones of unit cohesiveness is trust; trust relies on openness and honesty.

    Allowing transgender Americans to serve openly would significantly reduce the impact of minority stress. Stating categorically that our transgender citizens cannot honorably serve in any capacity will severely and negatively influence the mental and physical health of transgender military service members and ultimately diminish the effectiveness of our military.

    References:

    Canaday M. The straight state: Sexuality and citizenship in twentieth-century America. Princeton, NJ: Princeton University Press. 2009.

    Gates G, et al. Transgender military service in the United States. Los Angeles: The Williams Institute: UCLA School of Law. 2014.

    Hoy-Ellis, CP, et al. The Gerontologist. 2017;doi:10.1093/geront/gnw173.

    • Charles Hoy-Ellis, MSW, PhD
    • College of Social Work, University of Utah

    Disclosures: Hoy-Ellis reports no relevant financial disclosures.