Trans Activists, Don’t Throw Mad People Under The Bus!

Ed. note: This post was originally published on the Community site.

This article was written in collaboration with mad pride activist and SSHRC postdoctoral fellow Jijian Voronka.

Recently, the Canadian Centre for Addiction and Mental Health (CAMH) in Toronto shut down its Child Youth and Family Gender Identity Clinic (GIC), fired its head, the prestigious and highly controversial Dr. Kenneth Zucker, and removed him from his post as Psychologist-in-Chief of CAMH. Critics of the GIC have argued that its methods were tantamount to anti-trans reparative or conversion therapy, an approach which has long been discredited for gay people. CAMH denies this, but it does accept, in more muted language, that the GIC’s activities were not aligned with current and emerging best practice in the field.

We should be clear that the closure of the GIC is a major victory, not just within Canada, but worldwide, for campaigners against the dominion psychiatrists and psychologists assert over trans people’s lives, a dominion they enforce by gatekeeping access to hormones, surgery and often legal name and gender changes, as well as by leveraging the gullibility or prejudice of cisgender parents.

While the Toronto GIC only exerted direct control over trans children’s lives within Canada, Zucker’s opinions and methods have been enormously influential worldwide, and it matters that such practices are now being discredited. It sits alongside other recent victories, including the decision by Planned Parenthood to start providing trans hormones on an informed consent basis throughout the USA, and the recommendations in the UK of a parliamentary committee that applications to change birth certificates no longer be subject to permission from psychiatrists.

These victories form part of a process of depathologizing trans identities which parallels the depathologization of gay identities between the 1960s and the present day, and looks to it for inspiration. Fewer and fewer people think of homosexuality as a mental illness, and it is becoming rarer for gay people to be forced into the supervision of psychologists, or for doctors to attempt to cure them, electroshock them, or interrogate their desires and choices. Trans activists have been working for a similar transformation in treatment of trans people.

What trans activists need to be careful of, as we begin to win this fight, is this: that we don’t also imitate gay activists in throwing mad people under the bus in the interests of respectability.

We are using “Mad” in this context in a way derived from the Mad Pride movement, which rejects pathologizing psychiatric terminology for people who, for instance, hear voices or experience distress. Instead, much as LGB activists reclaimed “queer”, Mad Pride activists have worked to reclaim terms like “mad” and “crazy”. These terms have much longer, richer histories than psychiatric diagnoses, do not lend the same support to psychiatric establishments, and allow the difference of mad people to be recognized as part of their personhood, not as an external “illness” or “injury”. Mad Pride activists work to improve conditions for mad people within the psychiatric and psychological establishment, to challenge the coercive powers of psychologists and psychiatrists, and to shift conversation about mad people away from models of “illness”, “deviance” or “deficit” that must be corrected, towards models that emphasize providing diverse people access to the resources (for instance, housing) that they can use to flourish.

With very few exceptions, LGB activists campaigning against the pathologization of LGB people have not worked in solidarity with mad people. Despite their direct experience of the ways psychiatrists and psychologists acquisitively extend their dominion over areas of human experience with spurious “diagnoses” and mistreat and control people who they are able to so capture, gay activists mostly have been slow to ask questions about how psychiatrists and psychologists might be treating the other people within their diagnostic empire. Instead the LGB line has mostly been: “we’re not mentally ill, they are.”

A case in point: one famous LGB activist and writer, who we mostly admire greatly, recently came up in one of our Twitter feeds, writing about how wonderful it was that scientists were working to find a genetic basis for schizophrenia, and that this was the key to fighting stigma. This is not someone who would be caught dead praising similar attempts to find a gay gene, but the pathologization and investigation of the personhood of mad people is apparently fine with them.

It is vital that trans activists avoid being so blinkered. Most trans people in the West, as it stands, are de facto, if not self-identified, psychiatric survivors. We know what is like to have psychiatrists and psychologists insert themselves into your life, tell you that you have a problem, tell you on what model (their model) your problem needs to be understood, and then attempt to force you into solving it in ways they lay out, with the eventual goal of satisfying, not yourself, but them.

We understand that this is not just a case of the ways in which psychiatrists and psychologists deny or ration access to services you need, and coerce you into taking up others you may not, but also of the ways their intervention drowns out and pre-empts your own self-understanding, and the ways the rest of the world recognizes you, so that you actually end up identifying with their description of you, and using it to describe yourself to others, even as you know how wrong it is.

We know that the various psychiatric diagnoses for trans people have not been based in sensitive listening or in any kind of scientific knowledge of etiology, that on the contrary they have been nothing but arbitrary and punitive vehicles for imposing normative expectations of how a person ought to be. We know that psychiatrists and psychologists don’t listen to us, or our communities, don’t know about us, or our communities, and don’t help us, or our communities. Why would we assume things are any different for all the other kinds of people psychiatrists assert dominion over?

It is vital that we recognize that this experience of psychiatrization is one we share with other psychiatric survivors, with a wide variety of mad and neurodiverse people, and that the way psychiatrists treat us is also the way psychiatrists treat them (this is not to say that there are not important differences). It is vital that we contextualize our struggle, not simply as one for “trans rights” but as part of the struggle of all the kinds of people whose bodies and psyches are deemed defective or deficient – not just mad people, but fat, disabled and racialized people too.

Trans people share both a common cause with these people, and a significant overlap – how many trans people have some kind of mental health diagnosis? How many trans people are sick or disabled? (And conversely, how many queer people work in and contribute to the psychiatric establishment?)

If trans activists follow the respectability-first model of gay rights then we also lose the potential to create powerful alliances with others who have experienced the coercive power of medical and psychiatric authority. This includes disability justice activism, anti-incarceration, and anti-colonial activism (psychiatric and psychological authority was and continues to be a tool of colonization and settler colonialism).

Whilst psychiatrists and psychologists certainly mistreat trans people, you do not have to look far to find practitioners engaging in a much wider range of coercive and abusive practices. Examples like CAMH’s recent scandalous isolation of Melville Ince without notifying anyone are only the tip of the iceberg. Whilst Ince’s case is remarkable because of the lack of notification, CAMH alone routinely isolates around six people every year for prolonged periods in solitary confinement (widely recognized as a from of torture).

We need to combat these egregious examples of psychiatric bad practice. But we also need to be careful not to view them as isolated instances (“bad apples”), or even as parts of a disturbing trend that can nevertheless be combatted by “good psychiatry” or “nice psychologists”. These practices are not only enabled by the authority granted to psychiatrists and psychologists as part of the psychiatric medico-legal complex – they are fundamental to their mission of governing the marginalized and excluded and patrolling the borders of normalcy in our societies. This structural violence is not incidental to CAMH and the worldwide psy establishment, it is foundational to it.

CAMH and other organizations like it work hard to ensure that the resources our society (reluctantly) allots to the care of people marginalized as different do not flow directly to those people, and to the satisfaction of their material needs (for instance by the provision of universal housing) but instead flow through the psychiatric establishment, giving psychiatrists and psychologists access to both comfortable jobs and significant personal power and prestige. In the case of CAMH, for instance, in addition to receiving government funding, they actively and successfully campaign to raise further private sector money, as for instance in their successful $200 million “breakthrough” campaign, begun in 2014

They justify this allotment of resources and power through their close collaboration with (and embodiment of) the carceral and punitive powers of the state. Psychiatrists and psychologists are an important part of the functioning of the justice system, in both criminal and family branches. More than this, psychiatric diagnoses, or even the implication of them, are routinely used to justify violent or hurtful actions by both police and social services (and, of course, with converse impetus, by white mass shooters). Studies suggest that as many as half of all victims of police are deemed “mentally ill” either before death or after. Even when the victim is provably without a psychiatric history, claims of “mental illness” will often be invoked to justify the police response. More information about the violence mad and neurodiverse people face can be found in this report.

All this is in addition to the direct work psychiatrists and psychologists do as agents of social order as part of their everyday jobs, restraining, incarcerating and forcibly medicating those deemed deviant or defective. As we contest the injurious role psychiatrists have played in the lives of trans people, we are, whether we know it or not, part of this wider struggle. And the backlash we are about to be facing is therefore not just about trans justice.

Zucker is, as a powerful and wealthy man, deploying legal means to contest his disgrace, suing both his former employer and the trans activists who campaigned against him. But the backlash is also happening in the media, most notably, in New York magazine, which has published an article and a series of blog posts on the controversy by Jesse Singal. New York magazine has a history of transphobic coverage, most notably in their 2014 article on Martine Rothblatt, the “trans-everything CEO”, although smaller examples abound. And in some senses, Singal’s article is merely the continuation of these. Certainly, he understands trans identity as a unfortunate outcome, and trans people’s identities as something that ought to be questioned.

More striking, to me, however, is how his discomfort is grounded. While Singal certainly seems to be somewhat uncomfortable with trans people existing at all, what makes him most uncomfortable is the idea that trans people might know more about their lives than psychiatrists. And while Singal certainly supports psychiatrists in their particular reluctance to give up dominion over trans people (and with it over that fertile field of human emotions we capture with the term gender) what he is really arguing against in these articles is the idea that a “handful of activists” of any kind can legitimately challenge the psychiatric establishment. [Ed. note: Singal objects to this characterization.] 

In one of his preparatory blog posts, Singal had this to say:

Because the GIC was so reviled in a segment of the LGBT community, its closure was met with widespread celebration. That has been the dominant story line so far in public coverage of the event, but some current employees at CAMH see things very, very differently. They’re not happy with their employer and are wondering aloud whether their own departments, should they come under political pressure from outside forces, might be next. According to the handful of current staffers I’ve spoken with, there’s a widespread sense that CAMH bowed to political pressure.

Singal thinks of psychiatry as scientific, and of science as utterly separate from politics, and he is therefore shocked at the idea that political pressure by activists should be brought to bear on a man of science like Zucker.

Trans people, of course, know that Singal’s vision of powerful activists threatening beleaguered doctors is far from the truth. We have experienced the psy disciplines as a blunt and repressive tool in the service of social order. We know how far they are from the sort of dispassionate scientific investigation we associate with theoretical physics (not that physics is an innocent science either!); how systematically they are engaged, not in finding out about us, but in controlling us.

It has been 30 years since Sandy Stone so clearly pointed out to psychiatrists and psychologists that trans people would say anything they wanted in order to get access to hormones and surgery, and so that that their maintenance of power was diametrically opposed to, and rendered impossible, any sort of meaningful interest in the reality of trans people’s experiences. And yet it seems psychiatrists and psychologists still cannot grasp this simple point. Or maybe they were just always more interested in power than knowledge.

We know how much mistreatment we have endured from this system and the powerful men and women who embody it, and how hard it has been to get any traction against their institutional might and social prestige. We know it has taken us 40 years just to get Zucker’s GIC shut down, and that the fight is far from over. We know it is a political fight.

But maybe Singal’s vision should give us some hope. We have won an important victory, and the psychiatric establishment is feeling afraid of us. And what they are afraid of, most of all, is not just that they will lose dominion over trans people, or over children’s gender, but that this will be a precedent, that the fight will be taken to them in other areas.

When LGB people disentangled themselves from the psy disciplines, the psychiatric and psychological establishment pursued a successful strategy of divide and conquer. LGB people accepted the belief that “we’re not mentally ill – those other people are mentally ill” and so abandoned other pathologized groups, including trans people, to the psychiatrists and psychologists’ diagnostic remit. We must not make the same mistake. If we stand in solidarity with mad people, and work together to continue and develop this challenge to psychiatric and psychological power, maybe we could really become as powerful as Singal is afraid we are.