Abused and misunderstood even by mental health experts, transgender people walk the edge

'I have transgender friends, whose family members poured hot water on their genitals when they came out'

news LGBTQ

By Mrinalika Roy

It’s a sultry April afternoon in Bengaluru, and the phone rings in the office of Swabhava, a Bengaluru-based NGO, started by Vinay Chandran almost 14 years ago to provide counselling to LGBT individuals.

I hear a soft muffled voice at the other end. After a moment, Vinay replies in a somewhat terse voice – “No, we do not provide such information. This is a counselling helpline.”

He puts the receiver down. “It was some guy asking for information on WhatsApp groups for gay men. One of the fallouts of having a helpline number, you keep getting calls from people with strange requests. We started the helpline to reach out to genuinely distressed people of the LGBT community, who have no support system,” he explains.

Distress calls – like the case of a young gay man from Mumbai who wanted to commit suicide, and the 70-year-old man from Bengaluru, abandoned by his family because he wanted to undergo sex reassignment surgery, or the young techie who came up with an elaborate plan to fake his own death instead of coming clean to his family about his sexual orientation – these are some of the people Vinay has been helping on a daily basis.

His NGO Swabhava provides counselling or emotional support to members of the LGBT community. People can visit the NGO office or call on the 24x7 helpline. It is a space to air grievances, seek counsel and express oneself.

Imagine being considered an anomaly by society, shunned by your family, humiliated and abused by many. It is bound to take a toll on your mental health. But this is what transgender community battles every day.

“Most transgender persons live in poverty and beg on streets. Many turn to sex work where they are abused by customers and police. They are usually runaways and have no close familial ties. All these result in low esteem, anxiety and depression,” Vinay says.

But, the emotional volatility begins much early. “I remember feeling out of place since I was a child. I did not want to play with dolls, when I was a teenager I developed a crush on my close friend who was a girl. It was very confusing and there was no one I could confide in,” says Arnav, 37, a female-to-male transgender.

Most transgender people experience this gender dysphoria early in life, but have nobody to turn to. Even science is often not on their side. Sample this: The World Health Organisation still classifies transexualism (A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex) as a mental or behavioral disorder.

Most transgender individuals who take the step to come out to their family often face emotional and physical abuse. “I know of transgender friends, who had hot water poured on their genital areas by family member when they came out. It was used as punishment for deviating from the normal and also for curing them,” says Arnav.

The gender dysphoria felt by transgender people is often seen as a mental problem or moral corruption. There are numerous examples of transgenders being admitted to mental hospitals by family members, in a bid to cure them.

“This is the reason most transgenders run away from home and join Hijra communities. They find acceptance there and shelter,” says Arnav. But, years of torture often translates to low self-confidence and depression.

Another trigger for depression is rampant hormone abuse. Most transgender people do not go through proper legal-medical channels for transitioning. “Most male to female transgender people opt for quacks to undergo cheap emasculation surgery (removal of penis) and then take over-the-counter hormone pills like Mala-D for breast augmentation. Such unregulated hormone ingestion often leads to imbalance and mood swings. This could also be a trigger,” Vinay adds. Depression often gives rise to alcoholism, substance abuse and suicide at worst.

In India, mental health is a taboo. Depression and other mental illnesses are often brushed under the carpet. In some cases, with no way out, people kill themselves. According to the NCRB figures, between 2004 and 2014, the number of suicides have recorded an increase of 15.8%. In 2014, 1,31,666 people committed suicide, of which 7,104 cases were attributed to mental illness.

So, it is no surprise that there are no government-backed projects to provide counselling to transgender persons except during transitioning surgeries.

“If you go for breast removal or emasculation surgery in a government hospital, it is mandatory to undergo counselling. You can continue the sessions after your surgery. But, most transgender persons are so poor, they can’t afford the surgery. These sessions are only to gauge your mental preparedness for the surgery. They don’t offer any other advice your help,” says Sonu, a female-to-male transgender, who recently underwent a breast removal surgery at Old Ramaiah Medical College in Bengaluru.

Most medical professionals are also ill-equipped to deal with transgender patients. “Initially, I was going to a certain doctor for counselling. But, he was clearly transphobic. He made me uncomfortable. I told my endocrinologist in-charge of my surgery and she replaced my counsellor. I am sure, this was not an isolated incident,” adds Sonu.

Most transgender persons avoid going to medical practitioners for fear of being judged, misunderstood and ridiculed. “We have also been giving training to lawyers, doctors and counsellors on how to address transgender clients. Most doctors passing out of medical colleges are given no training in this regard. This is a big lacuna,” says Vinay.

In the absence of anyone to turn to, transgender individuals often turn to the bottle. “Alcoholism is a big menace among transgender community. Especially, among those who earn their living as sex workers. Most respondents in our survey admitted to drinking and taking drugs as a form of escaping from reality. Many sex workers drink with customers as a coping mechanism,” Vinay says. This often turns to dependence and addiction.

“People have this perception that LGBT community is alcoholic or drug dependent, but what they don’t see is the pain they are trying to cope with. I have lost many friends to addiction,” says Uma, who identifies as a woman, and runs a counselling center for the transgender community.

According to the NCRB, 16 people from the transgender community committed suicide in 2014. Of them, 13 took the extreme step because of illness, drug abuse and/or mental illness.

In 2009-2010, after 39 unnatural deaths were reported among the transgender community in Karnataka, NGOs Swabhava and Sangama undertook a survey among transgender women (born with male genitalia but identify as women) and kothi community to map their mental health.

The exercise revealed grave statistics. Almost 50% of the respondents admitted to have either contemplated or having attempted suicide. Body image issues, abandonment by family, abusive relationships and substance abuse are major triggers. “Transgender people face physical and emotional abuse regularly. The survey showed us how vulnerable they felt. Emotional well-being is just as important,” says Vinay. It is to be noted that a total of 60 transgender persons were killed in unnatural accidents in 2014.

Most transgender individuals suffer physical and emotional abuse which affects their mental health. Their mental well-being and how it is conditioned through psycho-social interactions is often neglected. The National Institute of Epidemiology has not undertaken a single nationwide study to gauge mental health of the transgender community.

The answer lies in more suicide prevention research, campaigns and more effective targeted interventions with the transgender and sexual minority populations in India. Along with these, inclusive policies and need based service delivery relevant for national mental health are also the need of the hour. The recently passed Rajya Sabha Bill decriminalising attempt to suicide, and giving individuals with mental illnesses new rights that include access to health care and insurance is the step in the right direction.