It was brought to my attention that one of my recent posts left some of you scratching your heads, for which I apologise. The Centre for Addiction and Mental Health (CAMH) has a long and very thorny history with the trans community. That’s putting it mildly.
Between the oral history and what I’ve gathered from Viviane Namaste’s work, I’ll construct a portrait for you. I am sure that it is romanticized and sensationalized but the key points ring true to this day: the trans community had to be very resourceful, self-reliant against an apathetic on the best of days, typically demoralizing medical industry and displayed its incredible resilience through the ongoing adversity.
At the onset there were determined and clever trans people, most of them women. They approached what was then known as The Clark in hopes of getting medical assistance in Canada, rather than trekking across borders. They met clueless and largely unsympathetic doctors. Some of them, realizing that at the time the few books by the likes of Harry Benjamin, were hard to come by for laypeople, got involved with a few doctors to gain access to the precious (albeit not always as progressive as they would have liked) medical information. Armed with knowledge and access to medical jargon that impress the powers that be, they returned to The Clark and things began to change. Unfortunately, the changes came with new beasts for the community to tackle.
Insert here countless, heart wrenching accounts of trans people forced through inhuman “tests” that left many psychologically scarred for life. Some had to watch pornographic images, some of which involved children, while machines were hooked up to their penises to read blood flow. Some doctors believed there could be a correlation between pedophilia and crossdressing; try as I may, the logic behind this one continues to elude me. Some had electroshocks to “correct” “deviant gender behaviour”. Scores of kids underwent disturbing “therapies” to reacquaint them with their “proper” gender.
For a long time The Clark maintained that there was no such thing as trans men. They were lesbians, to be pitied because however butch they might be, they were definitively women. There was also no such thing as trans lesbians. Instead they were considered fetishists with sexual deviances.
In order to improve their chances of making it through, trans women from the Clarke’s support group would get together outside of group to trade stories and information about what the doctors wanted to hear in therapy so that they wouldn’t be dropped.
A trans woman wishing to legally and medically transition had to have her choice of name approved by The Clark who was “ensuring” it was “feminine enough”. Evan, Blair, Jordan many others raised eyebrows. This still happens to a lesser degree at CAMH today both for trans women and trans men.
Trans women were not allowed to get electrolysis or laser hair removal done until they were well into their real life experience. Electro and other types of permanent hair removal remain uncovered under the current coverage offered by OHIP. Cost depends on type and amount of hair. It frequently runs people up into the thousands.
A trans woman who wore pants even once, lost her job or was not busy developing “good” relationships with straight men and women while distancing herself from the LGBT community was not truly “committed” to the process and frequently dropped from the program.
Even after completing the real life experience and being recommended for surgery, funding for SRS could be pulled at any time for any reason, up until and including the night before surgery.
Fast forward to the first period during which OHIP covers SRS. I don’t know that a single factor could be singled out as the defining one but somewhere between:
- systemic transphobia and homophobia rooted in a ton of sexism
- fear of a burden on tax payers
- fear of legal repercussions
- a huge side of abilism
there came a need to limit the possible number of people who could get publicly funded surgery. Draconian requirements including the euphemistically named “real life experience” (most trans people refer to is by the more honest descriptor “test”) are drafted. A trans person is hired to “help” develop the guidelines, undergoes her own medical transition and THEN implements the guidelines for everyone else to endure.
I’m suppose to believe that a trans person cannot be transphobic, or at least, it’s harder to call someone from our own community out when we’re being screwed over in every unpleasant way possible. Adding insult to injury? There is a cap on the number of people that can be approved a year, in the neighbourhood of 7 to 8. That’s for trans men and trans women. Genderqueers need not apply. (Still true today!)
In 1998, the Conservatives delist SRS, forcing the tax payer to foot a bill larger for axing the whole affair than it costs to have it run for a few years. This is part of what many call the “common sense revolution.” I’m fiscally conservative but I can’t find the logic in this one. The same year Jurassic Clark, merging with a few other institutions became CAMH.
Over the next decade, not to be outdone, the Grits get their fair shame of the blame as they continuously appealed Human Right rulings in favour of relisting the coverage. I’ve been explained many times that this was done out of support. That only if the courts forced the government hands in every way possible would coverage then be reinstated in a way that it could never again be removed.
And not cost a politician a riding.
Abraham Lincoln continues to be herald as a hero for ending slavery but in the 21st Century, politicians that care demand you go through the courts to face them and their publicly funded team of lawyers.
George Smitherman, who couldn’t get e-Health off the ground, ran out of ways of appealing. For this, I failed to consider applauding him when SRS was relisted in 2008. I’m unreasonable like that.
Meanwhile, I saw 6 mental health professionals as well as legally changed my name and sex on all of my ID. Every single local and international psychiatrist and psychologist I saw prior to CAMH considered me fit for bottom surgery and gave me carte blanche to get it, so long as I was willing to foot the entire bill. These professionals observe the World Professional Association for Transgender Health standards of care. I can’t say that I’ve enjoyed retelling the same stories as I answered redundant but vaguely relevant questions all those times. But at least there was a recognition that I did not need to be a cookie cutter guy without a co-existent mental dis/order to my dysphoria. It was tedious but there was some logic, coherence and an end point within reason.
CAMH still runs a program for children to impose narrow ender roles along with lifelong mental scars. One of its best known doctors succeeded in cementing the riff between my parents and me; a division that can never be bridged thanks to him.
It is to this institution I was told to return if I wanted OHIP coverage for phalloplasty. I would have to recount parts of my story for the Nth time. But this time, over the course of a year. Carefully cheery picking to fit the denied yet imposed mold trans people must fit to get a financial break. All the while being insulted and generally dehumanized. Suddenly it matters if, when and how I masturbate. It is regrettable if society’s transphobia or my family’s rejection took a toll on my mental health. Undesirable only begins to describe our sorry fate if one’s bi-polar, has AD(H)D or OCD. I don’t envy past/present cutters, those with documented suicide attempts or histories of in-patient psychiatric care. Forget it if there’s documentation of past psychotic episodes. For all the claims that there’s no “script” we must follow, most of us know that we must show ourselves to have enough dysphoria to warrant surgical intervention, but not too much so as to be considered “dysfunctional.” It’s a finer line than I can draw. I have yet to meet someone receiving dis/ability or their pension that was able to get through. Heck, they are able to discredit someone who works and studies full time. For now, my socioeconomic, lingual and singular gender privilege prevails. Like many, I have been granted conditional approval. But this has not come without near-constant taunts that I could lose it; even as I do all that I can to comply with all of their Machiavellian methods.
I know a handful of trans guys who have been approved but none of them know how to access the spare information to decide on a surgeon or in some cases, even on a technique. CAMH does not provide that though it claims that it could. That doesn’t fall within its responsibilities and from what I can tell, it isn’t within its best interest to do so, as it seems increasingly clear to me that it would result in a greater number of people seeking surgery.
So I forge on, weary of what I share for fear it will make it back to them and could somehow be used against me or at a minimum result in a lengthier process. It’s been recently announced that the Ministry Of Health and Long Term Care (MOHLTC) has intentions of extending trans access to health care by providing some resources to add three assessors operating outside of CAMH to recommend people for surgery. This sort of thing does not happen over night. Few psychiatrists have the necessary background, even fewer have the capacity to expand their services in the required ways and the qualified people become scarcer the further away from the GTA one gets. Trans people outside of Toronto rightfully need an assessor closer to their home, besides one that will follow more reasonable standards of care than CAMH. But it will be a good year if not more before that happens. So I am sticking it out with CAMH in hopes that I get definitely recommended for surgical coverage ahead of my surgery. Wish me luck!
