Mental Health and Transpersons in India

At least once in our lifetimes, all of us must have experienced what it feels like to be left out. It could have been not being chosen to play in a sports team or not being given a role in a school drama, being the last one to finish food during breaks, being the last in a running race, having to sit alone in a cafeteria, and so many other situations — irrespective of the cause of being subjected to it. Take a pause and try to recall. How did — being left out feel? Being ridiculed for not “fitting in”? Being labelled as an outcast only on a superficial basis with no solid reasons at all? It wasn’t a pleasant feeling, was it? We might have felt uncomfortable and hurt, and none of us must want to spend the rest of our lives feeling so.

When we were in school, some of us might have belonged to the middle category. The other sets of students being overachievers in academics and those students who were supremely good in athletics, and then there were those students who were somewhere in between — achieving decently in academics but not making it to the ranker’s list, or doing well in sports but not being brilliant enough to get selected for competitions. And that is where the perpetual mindset and socially influential label of being “not good enough”, or being the middle ones, or never being able to conform to the set standards of the “best” in the society came from. The weight of these labels is obviously not a happy place to be in and to spend a lifetime in that category can be quite stressful.

Transpersons in India sadly share a similar plight. They are constantly told that they don’t “fit” into the socially approved constructs of the male-female binary, they are regularly rattled with insensitive comments and are subjected to feelings of ignorant hate. They are those people who are struggling to be “good enough” on a daily basis, they fight each day to live as who they are; not because they suffer from any physical illness, but rather because they are victims of unruly social norms and rigid stereotypical attitudes. To be surviving in such a harmful social atmosphere is a task and such situations are a definite breeding ground for serious mental health problems.

Understanding related terminologies

Before we shed light upon their specific mental health and related conditions, it is important for us to understand a few terminologies with respect to the transpersons population. Sex refers to the classification of an individual on the basis of their biology. Gender refers to the state of being of a sexual identity with reference to social and cultural differences. Intersex refers to individuals born with physical characteristics that do not fit into typical binary notions of male or female bodies. Cisgender refers to individuals who identify with the gender that biologically corresponds to their sex at birth. Transperson usually refers to individuals who identify their gender as that of the sex that is not their birth sex. Transpersons are grouped in two major categories — Transmen and Transwomen. A Transman refers to an individual who was assigned the sex of a female, but identifies as a male. A Transwoman refers to an individual who was assigned the sex of a male, but identifies as a female. The term transperson is an umbrella term and includes a few other gender-related categories as well.

Sexual orientation refers to a person’s sexual identity with respect to the gender to which they are attracted. The sexual orientation of an individual bears no relevance to their gender identity. Over the years, the LGBTIQ+ (Lesbian, Gay, Bisexual, Trans, Intersex, Queer, Questioning, and others)has developed as a vibrant and strong community. They are a population of people who are united in having gender identities or sexual orientations that differ from the heterosexual and cisgender norms.

What does literature say of Mental Health issues amongst transpersons in India?

In India, the concept of transpersons is popularly understood in the form of the ‘Hijra’ community. An article published in 2017 in The American Journal of Psychiatry, titled “Understanding the Mental Health of the Hijra Women in India”, written by Dr. Vikas Jayadev, highlights the plight of hijras in India, with respect to their physical well-being and mental health concerns. It emphasises the lack of research conducted and literature available with regard to this population. The article comprises of the available literature and sheds light on the serious and troubled conditions of people belonging to the Hijra community — their physical health problems including high rates of HIV and, mental health problems like depression, anxiety, self-harm, suicidal tendencies and substance abuse. “Aside from poor sexual health, this patient cohort experiences perceived and internalised stigma, isolation, discrimination, and victimisation that predisposes them to mental health issues” writes Dr. Vikas.

A quote from the December 2016 report on the Psychology Today website titled ‘Why transgender people experience more mental health issues?’ reads as follows — “The American Psychological Association pointed out in its March 2016 report on the impact of discrimination, that adults who are LGBT and have experienced discrimination have average stress levels of 6.4, compared to 6.0 for LGBT adults overall. Among adults who are non-LGBT, stress levels are 5.5 for those who have experienced discrimination and 5.0 for non-LGBT adults overall.”

A study from Boston, published in 2015 in the Journal of Adolescent Health, reported that 180 transperson youth had a two-fold to three-fold increased risk of psychiatric disorders – including depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent – when compared to a control group of youth.

A review written in 2014 on research about suicide and the transpersons’ population found “an unparalleled level of suicidal behaviour among transperson adults”.

The transperson population is direly affected by mental health problems like depression, anxiety, suicidal ideation and self-harm. The statistics and information available are staggering and alarming. There is always some form of stigma attached to seeking help for mental health troubles, and to add to that, the severe stigma attached to belonging to the trans community makes it harder for people of the community to reach out for help. If they do so at all, there are chances of them being mistreated or not treated at all.

Transpeople were for the longest period of time considered to be pathologically ill. It is in the latest Diagnostic and Statistical Manual -V that the diagnosis of Gender Identity Disorder was replaced with Gender Dysphoria. The worldwide medical fraternity no longer refers to transperson individuals as having an illness, but rather that they have a choice and right to decide their way of living. This is all nice and fine on paper, but the harsh and haunting reality is the misguided and ignorant views of the general population on people belonging to the transpersons community.

One Future Collective is the outreach partner for the Trans Diamond Festival. This article series, across platforms, is a result of the ongoing effort of Make Room India and One Future Collective to discuss issues of the transgender community and build an ecosystem towards strengthening the trans rights movement in India.

Bansri Mehta is a Volunteer Researcher at One Future Collective.