Most of us are aware of the suicides among young LGB people, seeing them covered in both the national and local news in recent years. In our LGBTQ communities, though, there is a sub-population whose high rates of suicide and suicide attempts are not as well known: transgender people.
According to a study by National Center for Transgender Equality and the National Gay and Lesbian Task Force, 41 percent of total transgender respondents indicated suicide attempts, versus just 1.6 percent of the general population. Suicide-attempt rates were higher among transgender people of color than among white transgender people. The survey also showed that suicide attempts increase with unemployment (51 percent); job loss due to bias (55 percent); work in the underground economy, i.e., sex work or drug sales (60 percent); sexual assault (68 percent); and assault on youth by teachers or staff (76 percent).
This article explores external and internal factors affecting these high rates as well as what LGB people can do to support the Ts in our lives. I consulted with Nyle Biondi, MS LMFT, independent therapist in Madison; and michael munson, executive director of FORGE, a national organization focused on violence against transgender people and their significant others, friends, families, and allies, located in Milwaukee.
External factors such as acceptance, discrimination, victimization, and loss of friends, family, and jobs are some of the contributors to depression and anxiety. It’s common for a transgender person who has not yet come out to fear and assume rejection and to therefore become depressed and anxious. As a clinician, Nyle says he encourages people to first come out to the people they know will have their backs to get a base of support, no matter how small, and to continue on from there, as acceptance can lead to relief and decreased depression and anxiety.
It’s hard to separate the internal struggles from the external struggles. Many transgender people feel a deep sense of disconnection from their own bodies. Others feel fine about their bodies but are uncomfortable with the social roles assigned to those bodies and therefore struggle with being seen for who they are. Based on his experience, Nyle summarizes the influence of contributing factors this way: “Basically…anxiety, depression, and suicide rates are much higher correlated to external factors around acceptance than internal struggles. There’s no doubt it my mind that that’s true.”
In his responses, michael calls for more awareness of and compassion for mental-health issues in all people, challenging us all to commit to caring about each other even if we have differences. He says, “My overarching beliefs about suicidal thoughts and behaviors are much more about changing the culture in which we live—and that cultural shift is not specifically about trans people or any other demographic population.” By noticing that someone is experiencing depression or suicidal thoughts, it is easier to make direct connections, offer support, and help that person find supportive resources. Everyone, urges michael, should be more accountable and responsible, listen to and believe each other, start looking at mental health and suicidal thoughts/actions as public health issues, address inequalities of all kinds, and stop stigmatizing mental-health conditions.
Specific to transgender issues, LGB people can address their own feelings, attitudes, and behavior that may negatively affect transgender people. LGB and T people can also realize that not all suicidal thoughts or behaviors originate with trans identity; for example, they may be due to years of discrimination and microaggressions that have become integrated and customary.
I asked both how providers can support transgender people. Nyle addressed providers’ treatment of transgender people, citing respecting their identities as most important. Speaking to providers, he recommends addressing people by their preferred names and pronouns, asking questions only when they are relevant to your relationship with the person and not simply because you are curious, and avoiding comments on the person’s body or ability to pass. He also reminds providers to remember to listen to, validate, and respect clients and to take an open, non-judgmental stance. Finally, he says, “Educate yourself rather than expecting your client/patient to educate you; yet at the same time, listen to them and not assume they will be exactly like the people you read about.”
In his response, michael focuses more on the need for all providers to improve their approaches to mental health. He says providers need to be able to identify symptoms of depression or inferences of suicidal thoughts, take time to listen, and not rush in and out if someone is in distress. Providers need to be aware of the resources in their geographic communities, knowing which are trans-knowledgeable and which are not. All providers need to be unafraid to have discussions about mental health or talk with their clients about the health implications of living with chronic depression/suicidality.
In listening to michael and Nyle, I was reminded that their suggestions are what we would all want, regardless of our gender identity, gender expression, and sexual orientation. We want someone to listen with respect and to recognize our struggles. We want someone to believe us and approach without stigma. In other words, whether provider or community member, let’s offer others what we would want for ourselves.
Molly Herrmann is an activist, researcher, trainer, and consultant on LGBT intimate partner violence (IPV) with Humble Pie Consulting. She also currently works as a health educator in the state AIDS/HIV Program.