Sir,
"Transgender" is a term used to describe people whose gender identity and/or gender expression is different from the sex assigned at birth. As per the census of 2011 total transgender population is 4.88 lakhs. Despite de-stigmatization laws involving protocols on addressing people, they are usually categorized through a gender binary as either male or female. Those not fitting into either of the groupings are deemed "deviant" by society.[1] The resultant discriminatory experiences can lead to increased physical and psychosocial problems.[2]
Mental health care needs and emotional well-being, particularly in younger peope can be compromised as majority are coming to terms with gender nonconformity. These are further complicated by issues regarding sexual orientation and social taboo that includes becoming estranged from the family, peer rejection. Thus they endure severe marginalization by the society.[3] Stigma-related prejudice and discrimination have a markedly negative impact on a person's well-being and lead to "minority stress."[4]
We came across a male, in his early forties, who visited us with marks of deliberate, self-harm on both forearms. After a detailed history, a diagnosis of gender dysphoria identifying self as a transgender, with current episode of major depressive disorder was made. Despite having temporary improvement initially with medications, he defaulted medications and reverted to us with a suicidal attempt by hanging. His history revealed a recent breakup with his male partner of 3 months. This coupled with ostracizing views from people known to him and constant stigma from parents and close friends, which began since he attained maturity and was ongoing, added to his stress. Despite many of them having proper education and awareness of his situation, it is the archaic views passed down over years and their patriarchal roots in the society that blind and encourage them to engage in such behavior against the patient.
This is one out of multiple such presentations encountered in our outpatient department.
Suicide rate and suicidal tendencies among transgender community are reported to be high compared to the general population.[5] The suicide rate among transgender individuals in India is about 31% and, about half of this population have attempted suicide at least once before their 20th birthday.[5]
Despite the plethora of awareness campaigns against such discriminations, as well as enforcement of laws, such incidences are occurrences of commonplace in lower-tier cities in India.[6] There is a trend for psychiatrists and psychiatry residents to endorse less negative attitudes toward transgender people as compared to professionals of other medical streams.[7]
Hence, as a psychiatrist, or being a mental health professional at any level of the society, we have a pivotal role to play to reduce such discriminatory behaviors.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Kon AA. Transgender children and adolescents Am J Bioeth. 2014;14:48–50
2. Dargie E, Blair KL, Pukall CF, Coyle SM. Somewhere under the rainbow: Exploring the identities and experiences of trans persons Can J Hum Sex. 2014;23:60–74
3. Kelleher C. Minority stress and health: Implications for lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people Couns Psychol Q. 2009;22:373–9
4. Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model Prof Psychol Res Pr. 2012;43:460
5. Virupaksha HG, Muralidhar D, Ramakrishna J. Suicide and suicidal behavior among transgender persons Indian J Psychol Med. 2016;38:505–9
6. Ming LC, Hadi MA, Khan TM. Transgender health in India and Pakistan Lancet. 2016;388:2601–2
7. Ali N, Fleisher W, Erickson J. Psychiatrists' and psychiatry residents' attitudes toward transgender people Acad Psychiatry. 2016;40:268–73
