An open letter to Ticehurst Priory.

Dear doctors, nurses, support workers, teachers, social workers, psychologists and anyone else caring for my daughter who has been told about my gender history,

In our society trans people who are visible are seen to be out waving the trans flag and it gives the impression that we are all out and happy for our gender histories to be shared and we’re all fine with this because we’re all out and proud. However, not all trans people want to be involved in activism, and many, like me, just want to live their lives with a certain degree of anonymity.  That’s no different to non trans people.  Furthermore, trans people who have been activists for a period of time may want to return to their normal lives and not want to be activists any more.  They may not want to be “seen as trans” but prefer to be seen as their birth gender i.e. their core identity, not their assigned sex at birth.  So I’ve found myself in a position where I have to put my activist hat on again, but this time it’s personal.  Normally you’ll not see me, like the other dedicated empathic women who have transitioned, I quietly support others who are going through physical and social transition in my spare time – that’s my kind of activism.

Trans people are scrutinised, analysed and publicised by the cis (non-trans) community, and the effect is a pervasive stress and pressure for anyone who does not identify as the gender they were assigned at birth. Trans people consider it insensitive to have this entitlement to their personal lives, as it dehumanises them and takes away their human rights – the right to privacy.  It lacks empathy and understanding to share that information without the knowledge and consent of the person themselves.

“Many gay people consider coming out a moment of liberation, because sharing their sexual orientation with the world causes them to be seen more authentically.  Often, the opposite is true for trans people. When we share our gender history, many see us less authentically — doubting, probing or denying our identities.”

– Zeke Smith

Zeke Smith, a trans man, was outed on television recently by another contestant during a “survivor” contestant game.  When binary trans people are outed, one minute they are seen by others as normal men and women, the next they are immediately transformed into the gender they were assigned at birth by many others.  It feels intensely distressing when this happens, and transports the trans person back into feeling the intense distress and dysphoria of their coercively assigned gender at birth.  Culturally it has been normalised to “out” a trans person, but it should be remembered that trans people can consider this like an act of violence against them.

Stigma and abuse from our society can cause a lot of stress and depression amongst trans people.  Sometimes the consequences of this can be catastrophic, as was the case for Dr. Vanderbilt, a woman who had transitioned and who lived her life in stealth (choosing not to publicly reveal her gender history).  After she was outed, following some excessive probing into her personal life, then by some publicity about her gender history, she committed suicide.  Many women and men who have had to transition have gone through a stage of having to be “out” while their body changes and they adapt to close the gap between their gender identity and gender expression.  This puts them under excessive scrutiny from the general public.  Sometimes excessive outing during this stressful and traumatic transition process can lead to tragic results, as was the case for schoolteacher Lucy Meadows, who tragically took her own life in 2013 following massive press publicity surrounding her transition.

In the United Kingdom there is a legal framework that is aimed at protecting trans people from harassment, abuse and discrimination.  The effect of disclosure of trans people’s gender history to trans people’s lives cannot be underestimated.  It is a criminal offence for anyone acquiring this protected information in an ‘official capacity’ to disclose it to a third party without the person’s consent.  Maintaining confidentiality and being absolutely sure to get the trans person’s written permission before discussing their case with anyone else is essential if this could identify them.  Telling others without the trans person’s permission could result in a criminal conviction and a £5000 personal fine.  Discrimination laws, such as the Gender Recognition Act 2004, the Sex Discrimination (Gender Reassignment) Regulations 1999 and the Equality Act 2010, provide the legal protection to transgender people.

In 2016, a local authority was taken to court after an employee exposed a trans boy’s status to the friends of his adoptive parents.

“Matters continued to deteriorate to the extent that [he] did not want his adoptive parents to be involved in his life nor to receive any information about him including any medical treatment he may undergo.” – the judgement said.

The relationship with his adoptive parents broke down, he entered foster care under a section 20 arrangement, and later moved to a local authority unit supporting semi-independent living.  The local authority paid £5000 for the breach in his right to a private life.

In addition to a legal framework for the provision of the right to a private life for a trans person there are also professional obligations for people caring for trans people and their family.  The GMC has published guidelines relating to good medical practice and confidentiality:

From Good medical practice:

  1. You must treat patients as individuals and respect their dignity and privacy.
  2. You must treat patients fairly and with respect whatever their life choices and beliefs.
  3. You must treat patient information as confidential.

From Confidentiality:

  1. You must make sure that any personal information about patients that you hold or control is effectively protected at all times against improper disclosure.
  2. Seeking a patient’s consent to disclosure of information shows respect, and is part of good communication between doctors and patients.
  3. You must respect the wishes of any patient who objects to particular personal information being shared within the healthcare team or with others providing care, unless disclosure would be justified in the public interest. If a patient objects to a disclosure that you consider essential to the provision of safe care, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that information.
  4. You must make sure that anyone you disclose personal information to understands that you are giving it to them in confidence, which they must respect. All staff members receiving personal information in order to provide or support care are bound by a legal duty of confidence, whether or not they have contractual or professional obligations to protect confidentiality.

The RCN has also published specific guidance on the confidentiality of trans people:

“Disclosing someone’s trans status or history without permission or cause is, in some cases, a criminal offence. You should always gain consent before disclosing this information, with permitted exceptions only when it is not possible to gain consent and is essential for the delivery of services, for example the emergency care of an unconscious person, and only to the staff who need to know to effectively deliver relevant care.”

Disclosure and sharing of my gender history without my consent or knowledge during my daughter’s admission has been extremely traumatic for me.  As well as coping with the distress of having a daughter who has serious mental health problems and needing to be there for her as much as I am able to be, I’m also having to cope with being triggered (I suffer with “developmental trauma” or C-PTSD) by discovering how my gender history has been pervasively shared within the unit.  It leaves me with a sense of being trapped by my gender history and powerless to do anything about it.  I’m very frightened and very aware of the prejudice and stigma attached to my history and I’m not confident at all that all staff who know are trans literate, or aware of their legal obligations, or how I live in stealth without disclosing my history and how important my confidentiality is to me.  I find it very hard to trust people who know my gender history because historically so many people have been prejudiced and hurtful because of it, and, much though individuals might feel they are open and accepting, and some staff have been really very lovely, this is sadly no exception at Ticehurst.

It was disclosed to me recently that because of this disclosure some staff “didn’t know” whether to refer to me as a male or female in front of my daughter. Also I learned that I was referred to as a man to my daughter, and my gender was held up for scrutiny by that member of staff who referred to me with masculine pronouns. I learned that my daughter had to correct them and state that she had two mums and she was hearing no more about it.  I was told that another young person at the unit had a trans parent and he had difficulty in accepting her as a woman which is why they referred to this trans woman as a man, and why staff were somehow confused as to what pronouns they should use with me and whether to refer to me as a man or a woman in front of her.  I was shocked, not only to hear that the staff were enabling transphobia because a young person had unresolved transphobia relating to their parent, but was also shocked and humiliated by hearing that people called me a man in front of my daughter.  The RCN, NMC, and GMC are all very clear that people who transition should have their gender pronouns respected.  If a young person were to be openly racist or homophobic, I doubt that people would enable racism or homophobia to such an extent.  

This is because our society views trans people as abnormal, a view that is only just beginning to change.  It is discrimination, and this happened because my confidentiality had been breached.  I had no space to discuss my gender and family situation with staff at the unit because I didn’t know that my gender history had been shared, and no one thought to ask me about it or how I felt about the situation.  It is also prejudice not only because staff were treating my transition and my family in the same way as a young person with issues about their trans parent, but also because cisgender (non trans) parents genders are not held up to the same scrutiny in the same way that mine has been.  It shouldn’t be a surprise that not all trans people are the same, and neither are our families.  My daughter is incredibly proud of me for coming out and transitioning, and is open and supportive because she has been exposed to people who are open loving and supportive people, and trans people being loved and accepted for who they are (she has been to many “trans pride” events).  The thing is that she doesn’t really remember when I presented as male, she was too young, and neither does my son.  In their eyes they have two mums in a same sex relationship.  You are all aware that she has been subjected to transphobia and homophobia by association and yet this seems to have been re-enacted by staff at Ticehurst.

On top of what has happened on the ward, I’d like you to know that I’ve also been subject to distressing treatment from the family therapist in the community, (who reacted, unsurprisingly, in exactly the same way as the family therapist in Chalkhill who found out my gender history without my consent) and I have had to write to her to explain how her insensitive handling of my gender history lead her to jump to the conclusion (like the family therapist in Chalkhill did) that transitioning has somehow traumatised my children. My affect was read as people were “walking on glass” around me, maybe that I had controlled them in some way?  The reality of the matter was that I was terrified of transphobia, I felt scrutinised and misunderstood, I was triggered and trying to internally manage painful dysphoria.  I have had to cope with all kinds of reactions to being trans from many people, many therapists and professionals and I suspected that she knew; she simply re-affirmed this to me.  I do not view professionals as safe because I haven’t had reason to trust them.  I have had a psychologist say to me that “I didn’t have to put on a front with her” and it was only later when I realised that she knew my gender history that she was actually just treating me as less authentic because she learned that I had transitioned. She was meant to be helping me.  I was initially just genuinely confused as to why she was saying I was putting something on.  Let’s also be very clear when we talk about trauma, is that it was external abuse from society which has affected my family – the bullying at school, the lack of support from schoolteachers when my children were bullied that my daughter really needs to talk about.  Maybe, dear family therapists, when you’re dealing with minorities, maybe you could start with discussing minority stress?

As I have discussed, trans people have been known to commit suicide after disclosure and I am no exception as to the levels of emotional and psychological distress being outed has caused.  Like other trans people, I consider it an act of violence, and in this case on an institutional level. I’m currently having to use all of my therapeutic tools, including taking PRN medication, as well as having to rely on the support of an understanding partner and support network to get through this. I have trouble sleeping because of it, which has affected my performance at work, have been less able to keep to a normal daily routine which is important to my mental health, and feel less able to be there and be supportive to my daughter or manage the changes in my family life.  I have discussed it with my psychiatrist and my psychologist who have been equally supportive and deeply concerned about how this has affected my mental health.  My psychiatrist has offered to write to the unit to express his concern about its affects on my mental health, and my psychologist came out himself in support and empathy with the situation I have found myself in.  I’m hoping that writing this helps to resolve some of the distress and anxiety it has caused.  I’m really troubled and anxious about being outed, I find it difficult now to make eye contact with people at Ticehurst, I cannot trust that decisions made about my daughter’s care have not been born out of prejudice – for example, I’m very concerned about the decision made by someone who has never met me that I’m not allowed to visit Kira because it might upset her isn’t born out of bias and discrimination because of the experiences of working with a transphobic young person.  I feel like I’m seen as “less than”, less of a mother, less of a person.  I feel dehumanised, vulnerable, ashamed, scrutinised, powerless, humiliated, violated and trapped.  My family and I have been exposed to prejudice and transphobia because my gender history has been shared without my consent and I haven’t been consulted about it.  This is exactly why I live, on a day to day level, in “stealth” and I explicitly do not consent to having my gender history shared – even among professionals.

I am given the impression at Ticehurst, and with other professionals, that you have an entitlement to know about my gender history.  As far as I am concerned, people do not automatically have this right because they are looking after my daughter.  She doesn’t remember when I transitioned, she doesn’t remember me presenting male.  What she does know is that she has a trans mum who she is proud of but has suffered mental health problems because of societal stigma and discrimination, and she has suffered because of this too – such is the nature of oppression and intergenerational trauma.  This need only be shared verbally between key staff that she and I trust.  I very strongly object to it being written down and shown to every staff member at the unit and other agencies like it has been, and it leaves her really vulnerable and open to transphobia by association.  Please if you aren’t transphobic, if you’re empathic and caring, please try and protect her from this.

The endocrinology department in Brighton has many trans people under their care and they have a specialist consultant who deals with them.  They know, through feedback from trans people, that it is insensitive (and illegal) to share the trans status of their patients, even to other “professionals”, so for example on the blood forms, they do not say that a person is trans.  Working with families where you discover a parent is trans needs to be done with great care and sensitivity. There are guidelines and organisations available to help you make informed decisions as to when you need to out them by sharing their gender history, I just wish that people pay them more attention to them, and I hope that by advocating for myself and writing this I can help you to understand what a tremendous impact it has had on me, my family and loved ones, and implications for the children and families I care for in my professional life.

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