Trans Advocate Questions Mental Health Norms

Examining the Intersections of Identity, Healthcare, and Societal Power

A trans journalist and advocate is raising critical questions about mental healthcare’s role in gatekeeping access to gender-affirming treatments, and the broader implications for bodily autonomy and self-determination. The advocate shares personal experiences and incisive observations.

Challenging Psychiatric Norms

The author, Sandy Ernest Allen, realized their life and work increasingly clashed. To obtain gender-affirming healthcare, including testosterone prescriptions, top surgery, and a hysterectomy, they felt compelled to obtain a diagnosis they consider medically questionable.

As a journalist focused on mental health care, Allen’s work has explored the system’s complexities. One early piece investigated the case of a woman with psychiatric challenges shot by deputies. Further, their first book delved into the history and present of the mental health care system, specifically through the lens of the “schizophrenia” diagnosis.

The book became a project inherited from Allen’s late Uncle Bob, who lived alone in the California desert. Bob, diagnosed with “paranoid schizophrenia,” had written his life story in a chaotic, misspelled manuscript, which he mailed to Allen.

Unpacking Personal Biases

Initially, Allen admits to holding prejudiced views about Bob and others deemed “crazy,” shaped by family and cultural influences. Later, Allen came to recognize their similarities as outsiders, but in their youth, they resisted being labeled “weird” or “crazy.”

Allen argues that no one is truly objective when it comes to mental health or gender, suggesting cisgender people often falsely believe they are unbiased about trans people. Debates within psychiatry about assigning labels echo similar conversations about trans identity. This highlights the power dynamics involved in who gets to define pathology.

Historically, trans people were trapped within psychiatry’s diagnostic manual, the DSM. Today, many still require gender dysphoria diagnoses to access care. Mainstream psychiatry’s diagnostic manual defines which nonconformity is “pathological.” According to the American Psychiatric Association, a political consensus of members decides what goes in the DSM. Thomas Insel, former head of the NIMH, conceded that APA diagnoses lack sufficient medical validation for research.

Allen points out the shift that happened when (white, male) homosexual psychiatrists removed homosexuality from their book of supposed pathologies.

A Deeper Dive into Mental Health

Allen’s book about Uncle Bob was initially driven by a pursuit of “truth.” They sought to develop Bob’s manuscript, adding their own context and commentary about family, psychiatry, and society, and, at the time, Allen omitted details about their own mental health experiences.

The mental healthcare system is based on diagnostic categories that are subjects of great debate. Further, there are paternalistic paradigms in which professionals often disregard patients’ reports. This creates hurt feelings on all sides, and the public remains largely oblivious.

Allen notes that it is often former psychiatric patients, the “crazy” people, who fully understand the system, as exemplified by the publication Mad in America. Uncle Bob knew his stuff, a conclusion Allen reached after extensive fact-checking.

Today, Allen is more willing to address the issues within the psychiatric paradigm. Allen emphasizes that many Americans, including trans and queer individuals, take psych meds and may even adore them. Conversely, others are wary of traditional interventions due to negative experiences.

Trans people often must “prove” their “sanity” to access gender-affirming care. Even adults who have lived openly for years often need two letters of support from mental health professionals. In December, Allen’s coverage for a hysterectomy was initially rejected by United Health.

Trans people must interact with mental health professionals to obtain life-saving care. Yet this gatekeeping can harm those wary of psychiatry. Allen also expresses respect for individuals’ choices and understands the fear of losing access to life-saving medication. About 1 in 6 adults in the US take psychiatric medication, with antidepressants being the most common (CDC 2020).

Allen clarifies that they are not advocating for taking away anyone’s medication or treatments. Radical psychiatric patient activists are concerned with bodily autonomy. American psychiatry’s book remains powerful and authoritative, especially in schools, doctors’ offices, and courtrooms.

A Personal Crisis and Universal Considerations

Allen has been diagnosed with anxiety and CPTSD, which they attribute to childhood domestic abuse. In 2021, Allen experienced a severe psychiatric emergency, which will be discussed in their upcoming sequel.

This crisis reinforced Allen’s belief that mental healthcare matters, especially during severe emergencies. What options does society fund for these emergencies? Bullets and jails? ERs? Or more humane alternatives?

Allen identifies as a proud trans, queer, Mad reporter covering mental healthcare in a science-backed, humane way. They advocate for self-awareness of biases, especially among cisgender journalists focused on trans children.

Allen believes the delusion they are under is killing the trans community, especially vulnerable kids. Trans rights are human rights, and Mad Pride is another way of saying the same thing. These conversations address eugenics, bodily autonomy, and the diversity of humanity. The Supreme Court’s decision in Skrmetti hinged on the psychiatric diagnosis of “gender dysphoria,” again a prerequisite for trans folks to access care.

Ultimately, Allen argues that we are talking about power: Who gets to define you? Doctors? Governments? Or do you get to follow your own inner light?