Sunday, December 13, 2015

Gender Identity and Mental Health

[This article is the second in a series on the topic of gender. As always, I encourage you to click the links to my source material to learn more about the stories I am discussing. Fair warning, this post concerns some pretty heavy stuff — suicide, mental health and identity crises. I believe this topic is an important one, but be prepared.]

In my last article, I explained that gender identity is a person’s internal sense of being male or female. Sometimes, that internal feeling doesn’t match a person’s biology — whether they were born with male or female anatomy. As Rikki Arundel explained in her Ted Talk, gender is a complex mix between society and biology that psychologists are only beginning to understand.

But one fact about gender is abundantly clear: when parents, friends and others disregard how someone, especially a child, feels about their own gender, he or she will become incredibly depressed.

David Reimer

David Reimer was born in Winnepeg, Canada in 1965. At the time, he was named Bruce by his parents. His twin brother was named Brian. Both were assigned male based on their biology.

However, when they were seven months old, both babies were diagnosed with phimosis, a defect in the foreskin of the penis that makes it difficult to pee. Doctors told their parents the problem could be fixed through circumcision, a medical procedure where the foreskin of the penis is removed. 

Unfortunately, the surgery went horribly for Bruce. In a terrible accident, his penis was mangled beyond repair. Doctors didn’t attempt the surgery on his brother Brian, and Brian’s phimosis later disappeared without treatment.

Bruce’s parents then saw Dr. John Money on TV. The physician was discussing surgeries on babies who weren’t physically male or female at birth.  Money advised the parents to raise Bruce as a girl and never tell him he had been born a boy.

And that is exactly what they did. While Money celebrated the case as a success, Bruce never felt right being Brenda.

At the age of 14, he confronted his father about his feelings. That was when his father told him what had happened. Brenda was incredibly relieved and changed his name to David.

"For the first time everything made sense," he said, "and I understood who and what I was."

He married a woman and adopted her three children. However, he struggled with his past experiences.

"You can never escape the past," he said. "I had parts of my body cut away and thrown in a wastepaper basket. I've had my mind ripped away."

David was distraught after the suicide of his brother Brian, who had schizophrenia. He lost his job, separated from his wife and was in serious debt after a bad investment.

David committed suicide in 2004. He was 38 years old.


I have been interested in the topic of gender for many years. This is far from surprising because I have also been interested in the topics of politics, law, literature, national security and most other academic disciplines as well. 

But when the topic of gender is raised in high school and college psychology, or in the resources I found myself during that time, the experiences of transgender people were never mentioned. The topic of nature vs. nurture is covered in depth. Often the story of David is used to support the belief that nature, also known as biology, has a larger impact than society on someone’s gender.

Without transgender voices and experiences, however, it’s often implied that boys are boys and girls are girls — and that someone’s genitals at birth always match how they think about themselves.

That just isn’t true. David’s story matches perfectly with those whose internal sense of gender conflicts with what others think their gender should be.

The discomfort with this disagreement is known as gender dysphoria. It leads to an incredibly high suicide rates among transgender individuals.

The National Transgender Discrimination Survey found that 41 percent of transgender people attempt to commit suicide, far higher than the national average of 4.6 percent.

The survey found rejection by family and friends, as well as discrimination in school, at work or when seeking healthcare, contribute to this higher rate of suicide attempts.

One story explains how these factors can end in tragedy.

Leelah Alcorn

Leelah was born physically male and named Josh in 1997.

She committed suicide in December 2014 by stepping in front of a tractor-trailer on the interstate in Ohio. She was 17 years old.

Leelah left behind a suicide note on Tumblr that was removed at the request of her parents. But her supporters kept copies of her words, which explain why she chose to take her life.

In her post, she wrote, “To put it simply, I feel like a girl trapped in a boy’s body, and I’ve felt that way ever since I was 4.”

Like David, Leelah was able to put her feelings into words when she was a teenager.

“When I was 14, I learned what transgender meant and cried of happiness,” she said. “After 10 years of confusion I finally understood who I was.” 

But she said her parents didn’t react well to the news. 

“I immediately told my mom, and she reacted extremely negatively, telling me that it was a phase, that I would never truly be a girl, that God doesn’t make mistakes, that I am wrong,” she wrote. 

Her mother, Carla Alcorn, told CNN that she remembers the conversation differently. While Carla said neither she nor her husband support Josh living as a girl, she made clear they loved him. 

"We don't support that, religiously," she said. "But we told him that we loved him unconditionally. We loved him no matter what. I loved my son. People need to know that I loved him. He was a good kid, a good boy."

Leelah encouraged other parents to embrace their children as they are, and not to try to change how they feel about their gender. 

“If you are reading this, parents, please don’t tell this to your kids,” she said. “Even if you are Christian or are against transgender people, don’t ever say that to someone, especially your kid. That won’t do anything but make them hate them self. That’s exactly what it did to me.”

Leelah said her mother took her to therapists who tried to change how she felt about her gender. Her parents wouldn’t let her transition and she had trouble building friendships. 

And she, like so many transgender people, decided to commit suicide. 

“Either I live the rest of my life as a lonely man who wishes he were a woman or I live my life as a lonelier woman who hates herself. There’s no winning,” she wrote.  

Leelah ended her suicide note with a plea for things to be different for transgender people in the future. 

“The only way I will rest in peace is if one day transgender people aren’t treated the way I was, they’re treated like humans, with valid feelings and human rights,” she said. “Gender needs to be taught about in schools, the earlier the better. My death needs to mean something.”

Even after her death, her parents thought of her as their son, not as their daughter. 

A Facebook post apparently from Carla Alcorn said her child "went home to heaven this morning. He was out for an early morning walk and was hit by a truck. Thank you for the messages and kindness and concern you have sent our way. Please continue to keep us in your thoughts."


Transgender children often don’t have supportive parents. The distress caused by the conflict between their own sense of self and how others view them creates great hardship. Like everyone else, transgender people are more than just their gender — they have jobs, relationships, hobbies and goals. 

But we wouldn’t see as many transgender people attempt suicide if there weren’t serious mental health consequences resulting from trying to stop people from being who they are. 

If we want to prevent the kind of suffering David and Leelah experienced during childhood, we have to take their feelings about their gender seriously. 

Until we accept transgender people for who they are, these kinds of tragedies will continue to happen. 

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