In honor of Mental Health Awareness Month, I want to honor and recognize
the transgender and genderqueer communities. Transgender individuals face unique mental health challenges related to their gender identity and experiences. Like any oppressed group of people, transgender individuals have so many life stressors that having their basic needs met can be very difficult. That lack can put enormous weight on one’s psychological well-being.
Maslow's Hierarchy of Needs
Psychologist Abraham Maslow developed at theory of human motivation that arrange five needs in a hierarchical order. Basic physiological and safety needs are at the bottom of the hierarchy, and needs for love and belonging, esteem, and self-actualization are at the the top. Let’s have a look:
Physiological needs: These are the most basic needs necessary for survival, such as food, water, shelter, and sleep.
Safety needs: Once physiological needs are met, people have a need for safety and security, such as freedom from harm, protection from danger, and a stable environment.
Love and belonging needs: After safety needs are met, people have a need for social connection and relationships, such as love, friendship, and a sense of belonging.
Esteem needs: Once people have a sense of belonging, they seek to feel respected and valued by others and to develop a sense of self-esteem and self-respect.
Self-actualization needs: The highest level of the hierarchy involves the need for self-fulfillment and personal growth, including the realization of one's full potential, creativity, and fulfillment of personal goals.
Here is the list as it is commonly depicted, in pyramid form.
The illustration of Maslow's hierarchy of needs helps bring to bear the suggestion that people must fulfill lower-level needs before being able to focus on higher-level needs. It makes sense that people are unlikely to be motivated to pursue self-actualization if their physiological or safety needs are not met. Further, if a person's physiological and safety needs are not met, they may be more susceptible to stress, anxiety, and depression. Similarly, if a person lacks social connection or feels that they are not respected, their mental health may suffer. Of course, Maslow’s hierarchy is rather reductionist, as it only suggests what might be possible when needs are met, all the way up to what may seem like a very lofty goal in a certain context: to realize one’s full potential. It doesn’t point out the flip side of the pyramid, which is increased risk of poor mental health outcomes.
That makes sense, right? And research backs it up: people who have their basic needs met are more likely to have good mental health. For example, people who have access to nutritious food, safe housing, and medical care are less likely to experience mental health problems than those who do not. Similarly, people who have strong social connections and feel valued and respected are more likely to have good mental health.
The Mental Health Challenges of the Transgender Community
This theory may be useful to consider when regarding challenges faced by the transgender community. Referring back to Maslow’s hierarchy then, let’s go back to it with that point being made and explore the challenges that are unique to the transgender community while keeping in mind that these challenges can vary depending on the individual and their circumstances including race and socio-economic status, both of can increase the risk of compromised mental health.
Physiological needs: These are the most basic needs necessary for survival, such as food, water, shelter, and sleep.
Safety needs: Once physiological needs are met, people have a need for safety and security, such as freedom from harm, protection from danger, and a stable environment.
I find it difficult to not lump these two needs together when juxtaposing Maslow’s theory with some of the terrible difficulties trans individuals face. When we are children, we obtain food, water, shelter and sleep from our families. But family rejection is a common problem among trans kids. Trans and gender diverse youth have the highest rate of homelessness in the United States. The most basic level of needs, physiological, of which many people including myself take for granted everyday, are not being met by these kids.
If your own family rejects you, well it comes as no surprise that transgender individuals are at higher risk for violence and harassment. There goes the second level of the hierarchy: safety and security. To add insult to injury, trans folx often face discrimination, prejudice, and stigma in society, So how are love and belonging, number three on the pyramid, and self-esteem, number four, even possible? (I'm aware that I've left out the tippy-top, self-actualization. I will get back to that). That of course is Maslow’s point. They aren’t possible. Even worse for the trans community the lack of having those first two needs met on top of reasons why that they aren’t met lead to a host of mental health problems. Feelings of isolation, low self-esteem, depression, anxiety can show up in any of these instances. Then there's the risk of PTSD if you've faced any violence or have been harassed (I'm going to assume that if you're trans, particularly if you are a trans woman, you've been harassed). Not surprisingly, given the enormous amount of stress any one of these issues can cause, substance abuse becomes common, leading to higher risk of addiction and related health problems.
Limited Access to Healthcare
I really want to highlight this one, because this is a grave matter today and it's getting worse. One of the main plights facing the transgender community right now is access to healthcare. Transgender individuals are at tremendous risk of facing barriers to accessing healthcare, including lack of insurance coverage for gender-affirming care, discrimination from healthcare providers, and limited availability of specialized services. In the past, one might argue that this was out of ignorance. I'm sure there's truth to that. Care and access have come a long way. However, you've been living under rock if you're not aware of this. We're facing a backlash. In much of this country, there is a deliberate march towards wiping out healthcare for transgender individuals, particularly children all the way up to age eighteen, regardless of the opinion or expertise of a qualified health care professional or if the child's parents are on board. This is going to have enormous health consequences, including mental health, of course.
A Community Under Attack
On the way home from work the other day, I scrolled through the New York Times headlines as I often do. My heart sank, although I wasn't surprised, when I read that the Texas legislature banned transgender medical care for children. There is so much that is heinous here, it's beyond the scope of this post to go into all of it. But I will point out that the article states that nearly 30,000 transgender children between 13 and 17 live in Texas, making up about 1 percent of Texans in that age group. I believe access to health care no matter what the reason is a human right, and it is the business between the provider and the person seeking treatment, not the business of the state. The decision is causing families of transgender children to actually flee, since opponents (enemies? opponents seems so squishy in this context) of care will go as far as to prosecute parents who seek out that care for their children. Doctors can be prosecuted too. And these kinds of laws are happening all over the country. To pass these laws, you have to spread fear and hate. In Florida, there's the Don't Say Gay law expansion and the possibility of providing transgender care to children a felony. Oh, and you no longer have the right to take your kid to a drag show. Performing in drag and being transgender are not the same thing, but parts of our country are declaring war on anything that is outside of the gender binary paradigm, although many drag performers are completely at home in their cis-gendered bodies. Doesn't matter. The implications are damaging and far reaching.
I digressed a bit by mentioning the drag shows, but it just goes to show how far-reaching and ridiculous this is. Ridiculous doesn't take away from the fact that it's terrifying on a lot of levels. But let's get back to care. I want to be sure to discuss an important aspect of need in the community.
Gender Dysphoria
Treating gender dysphoria is a big one. But does that even mean? Gender dysphoria is the distress or discomfort that some individuals feel due to a mismatch between their gender identity and the sex they were assigned at birth. This can lead to feelings of depression, anxiety, and social isolation.
Gender dysphoria is typically treated through a combination of medical, psychological, and social interventions. The goal of treatment is to alleviate the distress associated with the incongruence between an individual's assigned sex at birth and their gender identity. Not everybody with gender dysphoria chooses to pursue medical interventions, and treatment plans may vary depending on the individual's needs and preferences. Here are some common approaches to treating gender dysphoria:
Therapy: Mental health professionals experienced in gender issues can provide support and guidance individually or in groups. Exploring how the person (or persons) experiences their gender identity and supporting them in how they experience themselves and validating that experience is paramount to my personal therapeutic approach. Having the client learn and develop healthy coping strategies and ways to manage the stress that may come from gender dysphoria is also of upmost importance.
Hormone Therapy: For some individuals, hormone replacement therapy (HRT) may be an option. Transgender individuals may undergo hormone therapy to align their physical characteristics with their gender identity. This typically involves taking hormones, such as estrogen or testosterone, to induce the development of secondary sexual characteristics associated with the affirmed gender.
Surgery: Gender-affirming surgeries, also known as sex reassignment surgeries or gender confirmation surgeries is an option for individuals who desire them (although they are becoming more difficult to obtain by the day, it seems, as these new transphobic laws are affecting doctors who provide care). These surgical procedures can help modify primary and/or secondary sexual characteristics to align with the individual's gender identity. Examples include chest masculinization or breast augmentation surgeries, genital reconstruction surgeries (such as vaginoplasty or phalloplasty), and facial feminization or masculinization surgeries.
Social Transition: Social transition involves making changes in one's social presentation, such as name, pronouns, clothing, and personal appearance, to align with one's gender identity. This can help individuals feel more comfortable and accepted in their daily lives. Support from family, friends, and peers during this process is crucial.
Support Groups and Peer Support: Engaging with support groups and seeking peer support from others who have experienced or are experiencing similar challenges can be helpful. These groups provide a sense of community, understanding, and validation, allowing individuals to share their experiences and gain support from others who can relate to their journey.
It's essential for individuals with gender dysphoria to work with qualified healthcare professionals experienced in transgender healthcare, such as gender therapists, endocrinologists, and surgeons who specialize in gender-affirming procedures. Treatment options are highly individualized, and healthcare providers can guide individuals in making informed decisions based on their specific needs, preferences, and overall health. Unfortunately, in certain parts of the country, finding treatment is going to become increasingly difficult, if not outright impossible.
A Sinister Agenda
I realize that "sinister" is a strong word, but we need to be strong here and we need to speak out and rebuke the hate and repeal these horrible laws. Because there is an agenda here that is gaining traction in our country. I'm sure there is media out there that discusses this outright but I admit I am too upset to do that research (or at least revisit where I have heard it but if I do come across it I will post it in the comments). The goal of removing access to care, forbidding the use of appropriate pronouns in schools, putting teachers on notice, firing doctors and otherwise spreading suspicion and terror points to one goal. Make binary gender, male and female, the only option, at any cost. Make self-actualization impossible by destroying the pyramid.
The Courageous and the Cowardly
That tippy-top of Maslow's pyramid, I haven't forgotten it. I think there's a bit of a twist as far as anyone knowing that they don't fit into the gender binary. If you are either explicitly or implicitly rejecting heteronormative structures, and I believe that implies a level of self-actualization and that's a courageous move. Any effort to impede your journey is a threat to your soul, which is so horrible, especially if you have been born into the wrong body and/or are being forced to conform to gender norms that do not fit you. As a human being, you deserve to have all your needs met, and to self-actualize fully.
Those efforts to stop you are totally cowardly. And every single one of us who know these efforts are wrong must speak out. Health care, mental, medical, transgender, is a human right. Whatever you need to physically and mentally survive is your right, no matter who you are. Nothing should stand in your way of being self-actualized, and to strip a community of the right to care is utterly heinous, completely unacceptable and must be thoroughly rejected.
There's one more little twist here. I highly doubt Maslow gave any thought to trans folx at all when he developed this theory. One might argue that a pyramid structure doesn't really work here. It assumes that you are at home in the body you were born with, and that very structure has nothing to do with self-actualizing - that's all the other stuff, like pursuing a passion. For trans people, as an ally, I propose that self-actualization means becoming themselves in their own body, which may include other passions. But in order to do that, all the other needs must be met.
A list of helpful resources will be available on this site shortly.