No such thing as ‘normal’

Personally, I’m not a fan of the word ‘normal’. Looking around the offices of NHS Leeds West CCG, I can’t see anyone who you could describe as “normal” in a more traditional sense; no two people are the same. As a total sum of their being – physically, mentally, hobbies, interests, I could go on. I feel there is so much stigma around things that aren’t considered “normal”.

I have spent the last seven years working in private mental health hospitals in West Yorkshire. Working with people, who as a group report feeling stigmatised against because they have a mental health condition, something that is not considered “normal.” You wouldn’t behave differently towards someone with cancer or diabetes, so why do nine out of ten people belonging to the mental health community report experiencing stigma at some point? The problem? There are probably a lot of reasons why the mental health community are stigmatised against, for me one of the big reasons is knowledge and understanding.

It’s been my experience that people fear what they can’t see or understand and often become much more defensive in an unknown situation. It can certainly be argued that this is the case for a lot of things, but not everyone is like that of course. For me, I want to learn; to understand so that I can help someone, maybe that’s because of my background, based on where I’ve worked previously, but it’s not a hard quality to develop.

I have been working with the CCG for three weeks now and already it has taken me all across the locality; meeting lots of new people (and learning lots of new acronyms). All this time I’ve also been trying to learn and understand lots of original and very interesting things about healthcare; physical, mental and wellbeing. Recently, I was fortunate enough to be asked to attend a gender identity educational session held at Leeds Student Medical Practice. The session was run by Ben Vincent, a fascinating authority on gender identity and the transgender community.

I will openly admit that I didn’t know a lot about the transgender populace, I was aware of the community of course, but my knowledge more or less stopped there. I had only considered that they were men or women who did not feel comfortable in the gender they were from birth and wanted to be the opposing gender (i.e. man wanting to be a woman or vice versa). There is so much more to it that I hadn’t realised and I was really grateful for the session. It really made me understand the difficulties that people in the transgender community face.

The session lasted for just over an hour and a half, discussing a wide variety of subjects around the transgender community and their difficulties within healthcare. I am going to do my best to highlight some of the key points below. One of the major ones being language:

Language is super important – as with most things, language use is pivotal in showing a level of respect and also acknowledging a person correctly. Here are some things to consider:

  • Cisgender and transgender – if you are comfortable with the gender you have and the body you were born in, then you are classed as being “cisgender”, “cis” meaning “the same”. Anyone who does not feel comfortable with their gender in their current assigned body are classed as “transgender”.
  • It doesn’t stop with male and female – people who fit into a singular male or female identity (both cisgender and transgender) are defined as “binary”. Anyone who doesn’t identify as one or any of the genders defines themselves as “non-binary”. Non-binary can be for people who feel they might have no gender (agender), both genders at the same time (bi-gender) or multiple genders, even some that haven’t been identified as yet (pangender/omnigender).
  • Referring to someone who is transgender – titles, names and pronouns all need to be taken into consideration. I had not considered that people may want to be addressed as “Mixter” (Mx) as opposed to Mr or Mrs. People may often get flustered when trying to refer to someone, “he-she” for example. Quite often the preferred choice is a singular form of “they”. It’s also important to acknowledge the preferences of the person, they will choose their name and how they would like to be referred to. They will usually be grateful for being asked “what do you want to be called?”

There were also discussions about gender dysphoria, which refers to the psychological distress that can be caused as a response to dealing with difficulties in a gender identity crisis. This can present itself in various forms such as anxiety, depression and stress (as we know causes all sorts of additional physical and mental health problems). Treating someone with respect and with humanity, like we would all expect, can make a real difference to people, especially if they have felt maligned in the past.

We also learned that there are concerns in healthcare for people of the transgender community. Long wait times for a first appointment  as well as battling presumptions of illness and the “trans-cold”. It has been reported by transgender patients that some clinicians have decided that a particular physical health ailment (in the example given a sore throat) was somehow related to the person being transgender. This rang true with me, as many mental health patients have reported a similar experience. For example, someone who may experience depression and is currently feeling fatigued doesn’t mean that the fatigue has anything to do with the depression. Patients in these situations can feel like less care is taken, or that they are being “given the brush off.”

These discussions were related to experiences provided from people around the country and it is apparent that we could all do with a bit more awareness and information. This will help us better understand a diverse group of human beings, who equally deserve the same care and treatment from others and the health service as anyone would expect.

In this instance, to be treated normally. Normal is a setting on a washing machine; it refers to the status quo. I think you could ‘return to normality’, for example, after being unwell,  where you return to a point where you feel like yourself again.

I have a full report that I wrote up of the session which I am happy to share, click the link to send me an email.

Adam Stewart

Engagement Officer, NHS Leeds West Clinical Commissioning Group (CCG)