In the first of our series on mental health, Jess Bradley talks about trans people, anxiety, and the need for democratic trans healthcare.

[Content note: general discussion of mental health. anxiety, violence, medical gatekeeping, and family stuff. No in-depth discussion of experiences]

Trans people are anxious. We are anxious at home, we are anxious at work, we are anxious at school. We are anxious on the bus, anxious at the Job Centre, anxious when praying. We are anxious in case our friends mispronoun us, anxious whether the presence or lack of stubble might affect how we are seen, anxious if strangers will shout at us in the street, or worse.

Anxiety dominates our lives and we are anxious about that. We are anxious about seeking help for our anxiety because it might impact on our ability to access healthcare. We are anxious about being not being “trans enough” when we don’t fit the neatly packaged medical narrative set out for us because it might impact on our ability to get healthcare. We are anxious about explaining our lives to medical gatekeepers who have the power to refuse us healthcare and we are anxious that our anxiety about that will give them reason to.

We are anxious because we live precarious lives. When we work we are one transphobic customer away from “causing a fuss” and losing our jobs. When we are on benefits we are one incident away from a sanction. When we live at home we are one angry reaction to a mispronouning from being out on the streets. When we are out on the streets we are one dickhead away from being beaten up. When we go to the psychiatrist we are one misplaced answer from being refused treatment. When we are in the closet, it feels like we are one decision away from either starting an an amazing authentic life, or ruining the one we have. When we are out of the closet, we are one bad reaction from a ruined day / week / year. When we are stealth we are one “curious” person away from potentially destroying the life we have built for ourselves. When we are disabled, queer, a woman, nonbinary, or a person of colour, we have to contend with our anxiety as a result of transphobia and the anxieties from others projected onto us through ableism, queerphobia, misogyny, nonbinary erasure, and racism.

We are anxious and we are taught that that is our fault. That we are too sensitive for being upset when a friend accidently misgenders us, too irrational when we are scared to leave our house for fear of strangers reactions, and too unreasonable for being angry about it. That it’s our fault for choosing this lifestyle, for messing with the natural order of things. If only we could pass better; if only we answered questions more politely; if only we had more money for treatment.

We need to recognise the reality of these problems: that they are systemic and not individual. We are anxious because we live under an economic system that treats everyone as disposable, and trans people as even more disposable. We are anxious because our healthcare system keeps our lives on hold for indefinite periods of time because the current project of dismantling the NHS and welfare system are overlaid on a wholesale disregard for our lives. We are anxious because transphobia is deeply entwined with patriarchy and capital and because corporations profit from our anxiety.

As trans people we need to create a machine which fights anxiety. One which allows us to connect our personal experiences to the way in which society is structured. One which allows us to tell our stories; produces theories and practices based on our experiences of survival. One which creates unalienated, empowering spaces from which we organise for a better world for trans people and for everyone else.

But what do we fight for? What demands do we have, and to whom are we making these demands?

It’s clear that for many trans healthcare is an issue that causes our anxiety, either directly through our precarious access to treatment, or indirectly due to the effects that hormones, surgeries, and mental health treatment can have on the way we are allowed to operate in the world. Do we ask nicely for more money, less waiting time, less intrusive questions, from the people who represent and benefit from those systems of oppression? Or do we take a principled stand, refuse to engage with those in power and organise new systems and structures amongst ourselves?

It is clear that only asking nicely from those in power gives them a legitimacy they do not deserve. It is also clear that organising wholly outside the established structures would leave many behind, because our resources are unlikely to match the resources of the state and we can’t put our liberation on hold til after the revolution.

We need a demand which speaks both to those in power and to those at the grassroots. “Democratise Trans Healthcare Now!” is that demand. It demands the state changes its structures, to provide more funding, to stop acting as gatekeepers. But it also acts as an incitement to action for trans people, an incitement to shape the future of what healthcare could be – for and by ourselves.

“Democratise Trans Healthcare Now!” is a broad and unifying call to action. It can mean different things to different people. For the trans person lobbying Parliament it can mean the call to secure more funding so that all trans people, regardless of how rich we are or how well we fit within certain narratives, can get access to treatment. For the trans person of colour, the disabled trans person, the non-binary trans person, and the queer trans person, it can be a call to ensure that the organisations and campaigns which speak for trans people are representative of all of us and not just the most privileged in our communities. For the trans community organiser, it’s a call to make sure that our community is robust enough to ensure that no trans person is left behind when the “official” structures fail them, a call to organise solidarity funds for trans healthcare, and for community responses to anxiety. For all of us, it’s a call to imagine what a world where trans people’s healthcare happens on our own terms would look like, and to take small steps towards creating that world.

“Democratise Trans Healthcare Now!” offers a paradigm shift in the way in which we do trans activism. By demanding what to some might seem impossible, we make possible what before was improbable.

[Props to the Institute of Precarious Consciousness and Plan C for the inspiration for this article.]

If you are interested in writing about the intersections of trans and mental health, please get in touch!