Is change possible?

Abstract

The social media response to the tragic death by suicide of 17-year-old transgender teenager Leelah Alcorn in Ohio, USA, has stirred up a storm of vitriolic blame and anger, beyond the confines of the lesbian, gay, bisexual, and transgender (LGBT) community. The outpouring of grief and rage is understandable, as is the resulting entrenchment of firmly held opinions. But this risks clouding or overriding the complexities of transphobia—experienced at home, school, work, and in the community—which is so ingrained in society that it permeates every facet of life. Calls for a ban on the controversial so-called conversion or reparative therapies that attempt to “cure” same-sex attraction or those who do not conform to gender-binary types have been re-awakened. In the USA, California and New Jersey are the only states that have enacted a bill banning the therapy. In the UK, major professional bodies are unified in discouraging this treatment as non-evidence-based and unethical. Even if prohibition was achieved, how might it prevent those exercising their rights under religious freedom not to practise it in less overt ways? The American Psychiatric Association (APA) issued a position statement on August 16, 2012, that supports access to care and civil rights for transgender individuals. The statement refers to the insufficient access to health care and medical intervention, widespread discrimination, fear of hate-crime, and unique social challenges faced by transgender individuals, points out alarmingly high rates of death by suicide, and calls on more laws to protect their civil liberties. Unquestionably, all these inequalities and disadvantages qualify for immediate and effective redress, but one significant question remains, how does this really help adolescents who are supposedly led to believe that to live as a transgendered individual is unattainable? Ohio rates poorly in LGBT equality, as presented in a state-by-state comparative analysis by the Transgender Law Centre. TransOhio, a support and advocacy group for transgender communities and individuals provides signposting for crisis intervention organisations, such as The Trevor Project and The Trans Lifeline. However, accessing such organisations might be a problem, especially for young people facing painful choices that risk alienating them from their communities and loved ones. Family and society undoubtedly have a responsibility to promote a culture of acceptance, but pointing the finger at individuals is shortsighted. Strong opinions about the damage of fundamentalist religious morality need to be addressed, particularly for those who might experience opposition, intolerance, and denial of a personal identity that they themselves could be struggling to understand. Is dialogue between the medical profession, transgender advocates, and the religious communities who advocate re-orientation possible? What role should the law have in protecting mental wellbeing, and how much does this collide with religious freedom? There are no easy answers, but the least health-care professionals and advocates can do is keep asking tough questions.