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Suicidality and Resilience in the Trans Community

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When first published in 2009 by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, the National Transgender Discrimination Survey shocked the LGBT community with the 41 percent suicidality number. That prevalence -- the number of survey respondents who reported at least one suicide attempt over the course of their lifetime -- is nine times greater than the general population, and roughly two to four times greater than the cisgender gay population. Clearly attention-grabbing, the number prompted the Williams Institute to drill down more deeply into the data, with the results published last week.

As reported, the most arresting finding of this latest analysis was again the 41 percent prevalence rate, with the rate for various subgroups ranging from 30 to 69 percent. The second highest rate, 65 percent, was associated with those with mental health comorbidities, which is to be expected, since those conditions bring their own greatly increased risk of suicide attempts. This data is scandalous and in and of itself is a condemnation of the climate of violence, discrimination and neglect visited upon the trans and gender-nonconforming population of this country. Many, including the Williams Institute, have estimated that 40 percent of all homeless youth are LGBT, and homelessness is correlated with the highest suicidality rate of 69 percent.

A few caveats are in order. The data was collected in 2008, and in a convenience sample that may not be representative of the population at large. The definition of "suicide attempt" was overly broad, and, most importantly, the data relates to attempts and not completed suicides. The relationship between attempt and completion is highly variable in the general population, with far more attempts and fewer completions amongst adolescents, and the opposite experience among the elderly. As in the general population, suicide attempts are often a last-ditch cry for help, an indication of the depth of despair felt by so many who participated in the study.

The question that circulated amongst the LGBT activists after this survey was published is what should be done next. This is a first step, a huge contribution to our scientific knowledge of the generally poorly studied trans community. More studies need to be done, with better methodology, and particularly the ability to ask questions about the specifics of those attempts. We need to know how far towards completion the attempt proceeded. We need to know at what age the attempts were made, the respondents' life status at the time, including medical and surgical transition status, family and social life at the time of the attempt. We know from other data that medical treatment and surgical reconstruction greatly reduce suicidality. We also need to collect data on death certificates that will not only respect the deceased in their reassigned gender but allow us to determine which of the deceased were trans (or gay).

In my mind, the most important missing element is the lack of data on resiliency, on the ability of persons driven to attempt suicide to climb out of the well of despair to the light of a healthy life. That healthy life is the ultimate goal, and just as medicine in general was so long focused on pathology, before it finally turned to wellness as a human value in itself, so must we examine resilience in the trans community so that we can offer solutions to those who need them most. It should be noted that the original discrimination study was produced and supported with the help of trans persons who have shown that very resilience in the face of adversity. Without their triumph over adversity, we would not have this needed data and analysis.

But what do we do about promoting this data? The data here is important for the trans community specifically, the LGBT community in general, and the medical and mental health community throughout the United States. We need to get the information into their hands, but I believe we must do so with sensitivity to a number of important political issues.

The major political issue for me is presenting ourselves as victims. Many of us are and have been victims, but the best way to gain allies, and to build support and empathy, seems to be by emphasizing our humanity, strength and resilience. Focusing on the victimization itself, instead of the resilience in the face of victimization, induces guilt and drives away support. It's one thing to say that the assault on any one of us is an assault on us all, but a focus solely on the pain can easily lead to emotional overload and distancing. Resiliency can be very contagious, in a positive psychological sense, as it makes those with whom we engage feel better about themselves. That positivity then helps elevate the entire engagement to greater growth.

Too often the media latches on to the most salacious or titillating news, perpetuating the myth that trans people are highly sexualized, engage routinely in sex work, suffer from sexually transmitted diseases and various substance addictions, and are emotionally broken. Eleven years ago members of the trans community mounted a very successful campaign against the pseudoscientific nonsense being promulgated by then-chairman of the Northwestern University Department of Psychology, Professor Michael Bailey, in his book The Man Who Would Be Queen. Bailey promoted the image of trans women as highly sexualized, psychologically damaged men. Watching and absorbing films such as Psycho, The Silence of the Lambs, The Crying Game, and now Dallas Buyers Club, it's no wonder parents come to PFLAG meetings with great concern about their children's future.

There's a real risk that by prominently promoting this data to the public, we not only fuel our opponents' campaigns against us, which is probably inevitable anyway, but alienate our future allies. Will we gain the support of a majority of the population who may believe we are all so fragile that we're not worthy of full integration?

There are examples of remarkable trans men and women out there, many of whom I've highlighted in this column. Fortunately, we seem to be slowly making some progress, most recently with Laverne Cox, a trans woman portraying a trans woman, speaking out powerfully for the dignity of the community, and Barney's New York promoting a new advertising campaign with trans models. Now if Laverne could just be cast in a role of, say, a computer engineer, judge, or the Secretary of State, we can really accelerate that progress.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.