Transgender people are not getting appropriate psychological or medical treatment and, in breach of WHO guidelines, are being treated as if they have mental health problems
By Rachel Rathbone.
I always knew I was female, from an early age. Never more so than when I went to primary school, an all-boys school with me, a little Transgender Girl, in among the chaos of the boys in the 1970s and 1980s when even being gay was outlawed and ridiculed. I spent six long years being beaten and bullied by students and teachers alike, day-in, day-out without fail. I was left depleted and in the end destroyed. I dug down deep to try and hide myself, Rachel.
I found it hard to learn so I taught myself how to read and write at home. I was scared mentally and still am physically.
I thought a lot about suicide from around the age of 9. At the age of 14 I, Rachel, found out about a woman like me in an article I read, about her transition, her feelings and her struggles. I promised myself that I would one day make that change too
As I grew older life got harder for me within my own self, Rachel. I always felt scared, alone and somehow different. I thought a lot about suicide from around the age of 9. At the age of 14 I, Rachel, found out about a woman like me in an article I read, about her transition, her feelings and her struggles. I promised myself that I would one day make that change too. Until I read that wee article, I thought I was the only person in the world who felt the way I did. That was 1985.
I carried around a profound sense of sadness, hopelessness and hurt, all throughout my life, but I tried to make the best out of it and my darndest to conform. I became a single parent at the age of 28. By the age of 45 I simply could not take it, as that Rachel. It was either “Woman up” or take my own life. I asked the world to accept a new Rachel, my full identity.
Now I am openly living as Woman age 49, Rachel. You cannot understand what that means to me. I have been out, living my authentic self for almost four years. I have changed my name by deed poll and have my gender-recognition cert since March 2019 also. I would have obtained this on day one, but it took me a while to save up for it.
That was my social transition, to the world. But I need medical changes too.
So, after a long search as to what to do, in October 2017 I went onto the specialist gender clinic list at the National Gender Service (NGS) at St Colmcille’s Hospital in Dublin, which runs transgender healthcare for the HSE.
I was told that the waiting time was 17 months but in fact I waited 2 years on the gender clinic’s list, only to be told in November 2019, that I along with over 100 other Trans-folk, had mysteriously been lost from the list. We had been put on other lists e.g. obesity, kidney function. This seemed like a negligent approach to a vulnerable community. The Transgender Equality Network Ireland (Teni) said it was “shocked and disappointed at this disregard for patients. This will have a devastating impact on our community. It is a breach of trust”.
In the meantime, dejected, I started self-medicating with internet-acquired medication and informed both my GP at the time and the gender clinic as I was asking for at least some oversight of my blood-hormone levels but to no avail. I was completely ignored.
I was having trouble getting my medication on the internet so in May 2020 I contacted a UK/EU-based Transgender Clinic where I got a diagnosis and received a prescription. I am now paying privately for the meds they prescribed out of my dole, which is very hard and has left me in abject poverty. It is unfair. Trans people have to become experts in their own hormones. In many ways we are the best people to ask how we should be treated and what we need prescribed Reflecting this, our healthcare should be a GP-led, free service.
As it is, any time I go to my pharmacy there seems to be a problem with giving me my correct amount of hormones. This is predictably dangerous to my wellbeing. In particular I cannot get the necessary oestrogen patches. Hormone Replacement Therapy is prescribed as standard to women undergoing hormone changes. Failing to deal properly with my hormones is an abjuration of my human rights and is literally destroying me. I was quite frankly better off buying them illegally on the internet.
Along with all of this I have been getting both laser treatment and electrolysis on my face, both painful procedures that come with costs.
Procuring medication has become a full-time job, and an incredibly stressful one at that. I have not missed one day of the hormones since April 2018, even when I was gravely ill a couple of months back. The stress is now so bad that I have developed a tumour on my adrenal gland, the gland that controls stress hormones. I have also suffered at times from extreme anxiety so that I get violently ill; and sadly my teeth have been destroyed from the acid.
Against this background and after 3 years of waiting, I was seen in early September this year. I was questioned about many things unrelated to being transgender. For example, what the “occupation of my friend at school’s father was” (whatever the relevance of that!), “How did you feel about having wet dreams when a child”, something I had not mentioned nor feel has anything to do with me being Transgender. I was also interrogated about the cup size of my bra and what size my breasts are, which made me very un-nerved.
It is crucial to acknowledge that according to the UN, WHO and EU, trans-related and gender-diverse identities are not conditions of mental ill health and classifying them as such can cause enormous stigma. I think this was the underlying problem with the patronising diagnostic process I was subjected to.
I left the place feeling sexually degraded and, to be honest, it just all felt so wrong. This is just my opinion and how I felt. Maybe this questioning is acceptable to some but I am not comfortable with it. It was supposed to be a standard “three-hour” session, it took four hours, and I was informed by the male psychiatrist that next time we would talk about the sex stuff. However, sex and sexuality have nothing to do with gender and this is the type of questioning that the World Health Organisation (WHO) has deemed unnecessary and disproportionately counter-productive to mental health.
I was informed that I would have to go for another assessment. I told them that it was cruel to be doing this and that I would have to think about it. They said they would be in touch but never have been. I honestly felt suicidal leaving the place. That was an emotion I thought I had long left behind. Not for that day.
My life is not all doom and gloom, however. I have the love and support of my family, friends and the wider community, and Irish people are a truly kind and accepting bunch
My life is not all doom and gloom, however. I have the love and support of my family, friends and the wider community, and Irish people are a truly kind and accepting bunch.
And since I took control of my own life and transitioned and especially with my hormone therapy, my life has bloomed, I feel grounded, happy, at peace and Me, Rachel, not the fake stranger I once felt like I had to pretend to be for everyone else. I love my dresses and handbags and heels, and I will never wear jeans or trousers again.
I cannot go up the town without my eyeliner or nails done, I would feel naked and wrong without them. I have big dreams for a white wedding, I get broody around babies
I cannot go up the town without my eyeliner or nails done, I would feel naked and wrong without them. I have big dreams for a white wedding, I get broody around babies, I keep a keen eye out for a good drying day because I love to see a full line of clothes Ok the last is an exaggeration! What is certain is that I am a Woman through and through and I only wish I could have been treated with kindness, help and respect by our HSE.
I have only met barriers and gatekeeping.
Ireland has a long list of shameful acts pressed upon certain groups of people in our society: Women, Children, Travellers, Gay Folk, the Poor and the Trans Community.
Because of the treatment or lack of it I have become very ill. My tumour is proof of that
| And finally I am facing another major hurdle, this time from the UK authorities. They refused to change my English birth cert, I am one of those unfortunate Irish that was born abroad in decaying England, I hate it to be honest. They informed me that to get my birth cert changed I would have to move to the UK and go through their processes since they don’t accept the Irish gender recognition certificate. I have burnt my original duplicate birth cert anyway and I certainly have none with my actual name and gender on it. In any event of course I refuse to use my old one when it is not Me. My identity is important to me and I have fought so hard over the last three years, it has taken everything out of me and I just cannot and will not go through another year of this hell. I have an income of only €203 a week. It goes nowhere with my clear and ongoing need, due to the deficiencies of the Irish system, to get medicines on the internet. I have also developed a tumour on my adrenal gland, the stress hormone gland. Because of the treatment or lack of it I have become very ill. My tumour is proof of that. I have now been on hunger strike for eight days and I will stay on strike over Christmas and until 4 January – one day for every one of the 17 months lost to me by the ongoing broken promise to treat me. I am striking simply for my rights. THE RIGHT TO MY OWN BODY. I am absolutely sure anyone reading this would feel the same if told what they could do on such an intimate and personal level. I have had enough. I love my life, I love my children, and as anyone who knows me will verify I am a happy-go-lucky soul, but I am not able to go through 2021 like I have been this past three years. My head is wrecked. Please listen. |
The science:
The WHO says: Gender incongruence has thus broadly been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. This reflects evidence that trans-related and gender diverse identities are not conditions of mental ill health, and classifying them as such can cause enormous stigma.
If you are affected by any issue in this article, please contact Pieta House on 1800 247 247 or the Samaritans by telephoning 116 123 (free) or by emailing jo@samaritans.ie
