Becoming Laura, installment two: 'Finding My Way in the Dark'

"First revealing yourself to be trans – coming out - unleashes a kaleidoscope of emotions over several days. It can be profoundly unsettling. At the time, I didn’t know this and couldn’t anticipate it. Through the week, though, I felt the upheaval without being able to name it. Everything was swirling for me – partnership, parenthood, work, as as-yet-unrealized transition. I drank and smoked heavily for a few days, forgetting to eat, and found myself dehydrated, booze-sick and strung out."

By Laura Shepherd

My point of entry into the health care system as a trans person came through addiction services.

I met a counselor assigned to my case and she asked me why I thought I used. “I’m trans,” I said. I don’t think I’d ever said that before. “Why don’t we start there?” she said. My life has not been the same since.

Shauna wasn’t the first counselor I saw. She was the first one I was honest with. I told her I’m trans and I told her my substance use had grown into dependence. Any time I had previously sought treatment for what I thought was depression, I hedged full disclosure of those matters. I was ashamed to disclose. I was aware this compromised the effectiveness of the therapy I received, but I got some relief from the treatment so I kept my mouth shut. I knew, in the back of my mind, that transition would require a more penetrating commitment to honesty, and that frightened me. I had grown comfortable in my bad habits.

I initially came to Shauna in emotional crisis. My marijuana use was impairing my ability to be productive. It was impairing my relations with others and my view of myself. It would be unfair to those who have grappled with genuinely debilitating physical addictions, however, to depict my experience as similar. I’m physically addicted to tobacco – I know what my body does in withdrawal. Pot, on the other hand, fosters a disabling dependence, but the breaking of the cycle is not the endurance test that physical withdrawal entails. While psychologically challenging, it delivers no horror show of delirium or hallucination, no bone-grinding pain and organ revolt. Still, the mental health care system encourages self-referral (it did not always) and responds when you show up and say you have a problem. I completed the intake questions to enter treatment.

My partner was travelling internationally with a friend at the time and we were in conflict, an early stage in determining that we were moving in different directions in our respective lives. I could sense the life-changing implications, and was dismayed. This exacerbated the urgency I felt to get on with the nuts and bolts of transition.

One of my children – the one who already knew I am trans - was also travelling independently, while the other was home with me, watching in wonder and concern as I melted down. I felt I needed to come out to them, as much as an explanation for my behaviour as a revelation, so we took a drive and had a talk. My kid said, “You’ll be the same person, only more so. It doesn’t matter to me what you wear,” which is as good as it ever gets when you come out.

First revealing yourself to be trans – coming out - unleashes a kaleidoscope of emotions over several days. It can be profoundly unsettling. At the time, I didn’t know this and couldn’t anticipate it. Through the week, though, I felt the upheaval without being able to name it. Everything was swirling for me – partnership, parenthood, work, an as-yet-unrealized transition. I drank and smoked heavily for a few days, forgetting to eat, and found myself dehydrated, booze-sick and strung out on a holiday morning, thinking, I’ve ruined my life. I called the only place that was open where I could get help: addiction services. I used my parental duties as an excuse to keep from being immediately admitted to a 48-hour treatment program; I truly didn’t think my case demanded it.

There was something about that first meeting with Shauna that made me realize coming out as both trans and substance-dependent were necessary steps to move forward. I couldn’t go forward with one without going forward with the other. That’s what I knew would be different about therapy this time.

The public mental health care unit on Nova Scotia’s south shore then consisted of a psychiatrist and a handful of psychologists, each of whom offered treatment to a range of individuals who arrive in the system through various streams – addiction, anxiety, depression, etc. While each practitioner may have an area of special expertise, they do not practice as specialists. I was the first trans patient Shauna had, but she knew what trans people were. I’d had to explain it to previous practitioners. Shauna didn’t care that I’d come through the addiction stream, she was prepared to address my whole case. I hadn’t met a practitioner that enthusiastic before, and it engaged my collaboration.

The question Shauna wanted to probe was, why had I stayed in the closet for half a century if I’ve more or less always known I’m trans? I had layers of shame (from the misunderstanding of myself and others) and fear (of the reaction and consequences of declaring anarchy on so foundational an orthodoxy as the polar nature and exclusivity of gender). I could only offer the comments outside of the parentheses, then, but I could name my shame and fear.

I had reason to feel vulnerable, personally and professionally, in a cultural climate where people migrate toward similarity and sameness to navigate the world, a culture in which the perceived difference of the ‘different’ is, itself, construed to be cause for suspicion. In a performance evaluation as a school board communicator, for example, I was bluntly told, “You’re different.” I was then directed, not advised, to minimize the nature of my differences to fit in better at work. There was no onus on anyone else to accept me as I was. It’s that kind of culture.

I never held a professional job in this province that didn’t have a public profile – advocate for the disabled, journalist, legislative researcher, executive assistant to a cabinet minister (in the Savage government), communications officer for a school board, news broadcaster on a local radio station. Until this decade, I was acutely aware that any movement I made toward transition, toward coming out as trans, would not only be met with profound wonder by those I knew personally and professionally, but stood a very good chance of being a news story. I couldn’t imagine it being the kind of story that would assert and affirm my identity. I just assumed it would destroy me.

Shauna gave me a workbook about shame, to which I devoted myself with ferocity. It resonated deeply with me. I put my shoulder to the wheel, unpacking my shame.

It took me roughly fifty years of my life to admit to myself that, not only am I trans, but I must be able to live that way to experience myself in my life as it really is, and as it could be. I didn’t want to die without getting to be ‘me’. I could see I was ruining myself and my relationships.

For much of my life, I had no words to describe myself. I knew it wasn’t a performance, a character. I had no ambition to be, nor felt any affinity with what were billed as “female impersonators”.

I understood the word, transvestite¸ to connote something of a fetishistic nature. When I gathered cast off women’s clothing and wore them privately alone at home, it wasn’t about sexual gratification or fetish, although the compulsion to cross-dress caused stress and confusion. There was something else I couldn’t name that I experienced.

I had no other words I could use, even as an objective statement of the reality of my experience. We didn’t have words and phrases like ‘gender dysphoria’ or ‘transgender’ until I was approaching middle age.

I assembled a small wardrobe. I learned the basics of, essentially, cross-dressing: less is more, lavender tights and auburn hair hurt the eyes, heels are foolish when you’re five feet, ten. I went through my “blue eye shadow” and “gi-normous breasts” periods by myself, in my room. I am eternally grateful for these small mercies. I tutored myself well, in privacy and shame.

I was in my mid-thirties, married with two kids and a mortgage, when Nova Scotia got the Internet. That’s when I found out there are other people like me. Not a few, either. Thousands. We were all around each other our whole lives and nobody knew, nobody said a thing. Then we all spoke at once. No one then had any idea how unfathomably noisy it would become in cyberspace.

I lived as Laura online and when no one else was home for fifteen years. Actually, I was Sarah then Maura then Julie then Laura. It’s harder than you may think to choose your own name.

My partner always knew. Alone among those I knew online in my thirties, I had a supportive and encouraging spouse. That doesn’t mean either one of us knew what to do about it. I used drugs. I enlisted my partner as a reluctant enabler. The wagon of love doesn’t always break under the load of life. Sometimes it just gets lost in the fog. That we have recovered ourselves and our friendship – moved beyond the intimacy of a relationship to the endurance, with our children, of a family physically separate but emotionally present and close - is a special kind of love story to be living.

Shauna put her shoulder to the wheel, too. Each meeting, she would share further resources she had gathered. Referred by her own bureaucracy, she tried desperately to make contact with a social worker in Halifax who treated trans people. Informally through my online contacts, I learned the fellow had retired a year and a half earlier. Shauna reported her health authority could identify no one else with experience, so we worked together, feeling our way in the dark, without benefit of a community of peers or of practice.

At the time, a major medical reference document was changing. The Diagnostics and Statistics Manual¸ commonly called the “DSM”, is a compendium of formal diagnoses in the mental health field. At the time of my intake into the province’s health care system, the potential diagnoses included Gender Identity Disorder, Early Onset Transsexual, Late Onset Transsexual, and others. In other jurisdictions, enforcement of expectations of heterosexual orientation and stealth identity were dominant in some professional communities, and fostered the widespread belief in trans circles that practice means jumping through hoops, satisfying gatekeepers, and sticking to a straight and narrow narrative to qualify for treatment and services, something that is still a reality in many places.

I arrived, not passing and not being sure it mattered, identifying fundamentally as lesbian, and using the word “transgender” to identify myself. About a year after I first saw Shauna, the DSM changed its definitions. A more inclusive, less judgement-laden diagnostic category – Gender Dysphoria - has replaced the smorgasbord of earlier diagnoses, and separated them from sexual orientation. Importantly, the word, disorder, has disappeared. It becomes possible to self-identify in this paradigm – a formal diagnosis of disorder is no longer, from a professional perspective, part and parcel of being trans. It opens the door to a model of treatment based on informed consent.

In tandem with this process, the Standards of Care (“SOCs”) for transgender and gender non-conforming people was under revision by the World Professional Association of Transgender Health (WPATH), the premier worldwide professional association of health practitioners active in the field of transgender health.

In previous protocols, other issues were identified– anxiety, depression, addiction among them – and demanded treatment in advance of any trans health provision, per se. Transition protocols included a monitored period called Real Life Trial, or RLT. Further in the past, trans patients had been counselled to deny their pasts completely, inventing fictitious back stories in order to preserve the secret of their trans-ness.

Research on actual trans populations forced a change in practice.

Most trans people experience anxiety and depression before we come out, before transition. Substance abuse is not uncommon, as in the population at large. Our rates of self-harm, suicidal ideation and suicide attempt are extraordinary in comparison with other groups in our society, and highest in the months before we start Hormone Replacement Therapy, or HRT. Accessing appropriate services used to be a chess game between trans patients and a reluctant medical system. Now, their delivery is a priority of practice.

Increasingly, trans people have, through successful authentic living, dismantled a gender paradigm that is binary and oppositional in nature, articulating a nuanced spectrum of gender identities, performances, presentations and roles. As more trans people become involved in the construction of formal care treatment protocols and paradigms, and collaborate with cisgender professionals, the field better shapes itself to our needs. The current Standards of Care are the first to remove, in effect, the power to declare someone trans from the professional domain. This, too, is an important step toward a care model based on informed consent.

My ex-partner is an amateur musician, and a group she once played in included a medical doctor. Two months after I began seeing Shauna, the group was asked to perform and gathered to rehearse. My ex- came back from the first rehearsal and said, “You’ll never believe what Chris (the doctor) is doing, now. She’s counselling trans people.” I emailed Chris that night, and had an appointment within a couple of weeks.

Shauna continued to work with us all as a family, guiding my kids through the issues my transition and their parents’ separation provoked for them, helping us all get used to the idea of Laura. I began seeing Chris for transition-related counselling. I still do.

I did not know I was assembling my own team of practitioners. I did not know I was one of the first to be treated under a model approaching informed consent – I still do not, to my knowledge, have a formal diagnosis. I just tried to jump on every possibility I found, I was so desperate to make progress in my transition. Coming out to Shauna opened the flood gates, there was no going back.

In the intervening five years, Nova Scotia has trained more practitioners per capita in the latest standards of care than any province in Canada. prideHealth, a small division of Capital Health, has led the way in spreading information and conducting formal training with social workers, psychologists, nurses, family doctors and other health care providers throughout the province. They have provided important medical research to support advocacy efforts toward increased rights protection, expanded health care services, recently introduced gender and name change legislation, and other accommodations that make space in our communities for people who are not cisgender. Were I first arriving at Shauna’s office today, I’d be engaging a more informed and prepared health care system.

Shauna went on maternity leave just as I was moving to the city. I have regrettably lost touch with her. I still see Chris as my counsellor. I see an endocrinologist three or four times a year, who manages my HRT medication and the endocrine response of my altered body chemistry. I have acquired an informed family doctor – something I lacked in rural Nova Scotia. Together, they are the professional team with whom I collaborate to accomplish my transition. I enjoy an unusually productive relationship with my medical partners.

Seeking addiction treatment was the best decision I ever made in my life. It is no stretch of the imagination to say it saved me. It enabled me to become me. None of this would ever have happened if I didn’t take that first step.

This is the second installment of Becoming Laura. Please do read installment one, which can be found here.

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