that influence normative assumptions about gender, public perception of gender diversity, and consequently, the mental health of transgender individuals. Participants referred to aspects of trans-negativity and stigma in society based on cisgenderism that is enacted at the institutional and structural level (filtering down and perpetuated at interpersonal and intrapersonal levels, see sections 5.2 and 5.3). As well as cisgenderism within the broader context level, participants described aspects of socio- cultural reform that contributed to improving representation and public perception of transgender people. These broad themes will be discussed further in this section.
5.1.1.1. Cisgenderism and trans-negativity compromises
mental health. All participants made reference to dominant socio-cultural discourses that reinforced binary gender formations and cisgenderism, undermining and delegitimizing transgender people’s own experience and understanding of their body and identity, and contributing to instances and practices that erase, problematize, and stigmatize transgender people in comparison to cis-gender people. As predicated in Chapter Two,
cisgenderism provided the basis (and justification) for pervasive experiences of enacted and anticipated discrimination and micro- aggressions within interpersonal relationships (see section 5.2 for thick description). In this section, I include the following quotes to highlight the diverse mechanisms of cisgenderism that participants have experienced and/or observed among transgender people:
“I was constantly told [by doctors and family] that I was ‘just going through a phase, you’ll get over it’, or it was always boiled down to something else, [for example] my mum raising me the way she did, or the doctors would always bring in life factors as to why I was behaving this way. It was never ‘oh maybe you are transgender person’. Instead it was ‘ok well maybe you have borderline personality disorder, that explains why you are acting like another person’.” (Jay)
“In terms of unhelpful [for my mental health], one of the things I’ve noticed with a friend who is transitioning, he was quite girly as a girl and I’ve had numerous people comment on ‘he couldn’t be trans, he used to be a girly girl’. It’s that kind of perception that ‘ohhhh they used to wear dresses and makeup, how could they be trans?’” (Alex)
“I don’t like the term ‘passing’, it essentially means that something is faking being something else. So the idea that a trans man ‘passed’ for male is not a great term and it is meant in a nice way, but it’s not actually a good word to use. It’s a term that’s used so often, similarly to the term ‘stealth’, is another one that has the whole meaning that you’re deceiving people.” (Alex)
“The lack of media representation [of transgender people] and the stereotypical story really pissed me off, so if there was a story it’d be like “oh I felt it when I was a little kid and it’s so linear” instead of being like “actually I was afraid of being rejected and losing everything so I went back in the close and came out again later” (Andy)
“It was a huge eye opener for me to suddenly lose privilege, I lost male privilege, I lost hetero privilege, I lost cis privilege all at once. It was
enormously eye opening and enormously informative, I suddenly went ‘ohh this is the way the world works.’” (Indra)
These quotes highlight dominant discourses that invalidate and delegitimize trans individuals’ own understanding of their self and bodies, pathologizes gender non-conformity, reinforces binary gender formations, and results in social oppression and loss of normative privilege as a result of being, or disclosing one’s transgender identity. For trans participants, these experiences were associated with feelings of confusion, uncertainty, fear, and shame, that at various times in their life contributed to
depression, anxiety, and other compromising effects mental health. These findings are consistent with literature linking cisgenderism with poor
mental health for transgender individuals (Riggs et al., 2015a).As previously outlined, cisgenderism is reinforced through diverse mechanisms across and within broader context, interpersonal, and intrapersonal domains. Of continued relevance for the broader context section is the impact of cisgenderism on government policy (see section 5.1.2.1) and creating and maintaining barriers to accessing mental-health promoting resources (see section 5.1.2.3 and 5.1.2.5).
5.1.1.2. Aspects of socio-cultural reform may promote and protect mental health.
“I think that things (in society] are slowly changing. I’m very impressed with how younger people at university are embracing gender diversity, who are so interested and want to learn and will be the generation of
people, like my son, who will hear about someone and say ‘how can I help?’ I find that uplifting.”(Lauren)
Participants described ways in which the social and cultural climate is slowly changing providing more flexibility for gender diverse and
transgender individuals. As is consistent with previous research, descriptions of the broader context were dominated by references to discrimination and stigma (as will be discussed throughout Chapter Five). However, participants also described instances of social and cultural reform, reflecting on these changes in cautiously optimistic language. Firstly, both trans and practitioner participants reported observing changes across broader and LGBTIQ communities regarding views on gender fluidity and exploration. Secondly, most trans participants identified increased awareness and acceptance of gender diversity among the broader general population through increasingly positive media
representation. This section will provide examples of social and cultural reform as outlined by participants.
Whilst acknowledging diversity among groups and views within the LGBTIQ communities, a number of participants identified instances of increasing support for fluid conceptions and expressions of gender. Anecdotally, practitioners referred to previous generations of social
ideology within LGBTIQ communities that strictly reinforced gender binary conceptualizations of transsexualism as the norm. However, practitioners and trans participants similarly reported softening of these views that allowed space for exploration and fluidity of gender. For example, Jay
described the ways in which reinforcement of rules around gender expression within the trans community have begun to slowly ease:
“Yeah I do feel pressure [to conform to binary gender expressions and expectations], although I think it is starting to change. When I first came out there was a big pressure in the trans community itself, to be extremely masculine. Now I think it is ok if you want to paint your nails and have female friends, I feel that would have been frowned upon before.”
Having long observed social and cultural influences on, and perceptions of, gender diversity prior to affirming her gender in her 50’s, Lauren reflected on changes in the concept of identity exploration, transition and gender fluidity:
“I think that is an increasing trend [expressing gender fluidity], anecdotally. It certainly would have been poo-pooed a generation ago by the trans community, no matter which way they were going; it was sort of all or nothing then. The younger generation is far more laid back, more easy going about being a bit of both, being whatever, however the mood takes them.”
These quotes demonstrate the observation of subtle changes regarding views and reinforcement of expectations of gender expression among groups within the trans and broader LGBTQQ communities. This is an important development as attempting to meet the rules perceived within the trans community was described by participants as “stressful” and “anxiety-provoking”. Conversely, feeling that one has room and permission
to explore gender and present fluid conceptions of gender identity as they explore has been identified in the literature as protective for mental health (Bailey et al., 2014; Moody et al., 2015).
Participants identified increasingly positive representation of gender diversity within the media as another factor contributing to social and cultural reform. A number of trans participants referred to the negative perceptions and stereotypes of transgender individuals that they had perceived when growing up. Indeed, Indra referred to common depictions of trans individuals as “caricatures” or “the punch line of a joke”,making it difficult for young people to consider being transgender as a viable identity option. However, with trans people being discussed and celebrated in the media and accepted in to the world of celebrity, three trans participants felt this has had a subtle flow on effect for helping gender diverse individuals to gain understanding of self through seeing happy and successful others. According to participants, increasingly positive public representation has contributed to increased awareness and acceptance of gender diversity in the general population that in turn may influence identity development and self worth. The following quote highlights how subtle changes in media representation have positively impacted identity development and potentially mental health:
“The perception of trans people generally has not been positive, it wasn’t something that you could generally see yourself being, at least it certainly wasn’t 10-15 years ago. It’s changing slightly. But it never occurred to me that this was an option for me. I think if I was going through the same thing now I might have quite a different outcome because there are visible
trans people being represented in the media, still only intermittently, but they are there and it is not a universally negative representation. Finally trans people are not just the punch line to a joke. There’s something there that you can see as being an option for a viable identity. So that would probably be the biggest thing [for both combating stigma and promoting mental health], representation is important.” (Indra)
Whilst these potential social and cultural advances may not yet be enough to reduce experiences of stigma and discrimination, participants described feeling encouraged and hopeful of gaining further support and understanding from others in society. Many authors and public health advocates have identified socio-cultural reform as a vital ingredient in reducing and modifying stigma and creating a social climate where
transgender individuals have increased and equitable access to important life opportunities, including social inclusion, earning, employment, and health (Craig et al., 2014; Leonard & Metcalfe, 2014; Link & Phelan, 2001; Smith et al., 2014). This has important implications for mental health of this population as will be discussed further in Chapter six.
5.1.2. Institutional factors and mental health for Australian