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“We are part of humanity”: a conversation about the importance of trans depathologisation

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What do we talk about when we talk about trans depathologisation?

 

Pathologisation refers to the idea that someone – just by existing, so just by being trans – is somehow intrinsically disordered. Depathologisation, then, means shifting focus from treating trans and gender-diverse identities as mental disorders to prioritising the health and well-being needs of trans people in the same way that we do all other people.

For this new episode of Making Rainbow Waves, ILGA World has sat down with experts across the world on the occasion of this year’s International Day of Action for Trans Depathologisation, to learn more about how depathologisation can impact global health policies, what obstacles countries face in their commitments to the health of trans and gender-diverse individuals, and how important cross-movement solidarity really is.

“There have always been trans and gender-diverse people”, our guests told us. “We are part of humanity. I am very hopeful that, in the end, we will have a recognition across the world of our rights to equality and to human dignity.”

Our guests for this episode of Making Rainbow Waves are:

 

Making Rainbow Waves is a podcast by ILGA World, telling the stories and raising the voices of LGBTI human rights defenders worldwide.

Listen to the episode and subscribe to Making Rainbow Waves via Google Podcast – Apple Podcasts (coming soon) –  Spotify – Deezer – Stitcher – TuneIn – Ausha

his episode of Making Rainbow Waves was hosted by Darius Gervinskas, and edited by María Alejandra Gonzales Silva. Transcription and translation to Spanish by Daniele Paletta and María Alejandra Gonzales Silva.

Transcription of the episode: “We are part of humanity”: a conversation about the importance of trans depathologisation

00:07 (intro)

Making Rainbow Waves, a podcast by ILGA World.

00:14 Darius Gervinskas (host)

Welcome to Making Rainbow Waves, the podcast by ILGA World where we tell the stories of LGBTI human rights defenders worldwide. This episode is dedicated to the International Day of Action for Trans Depathologisation marked on 21st October. My name is Darius Gervinskas, and in today’s episode I will be speaking with not one, not two, but four wonderful guests: Dr. Anna Coates, who is the Lead Technical Adviser and Unit Head for Gender at World Health Organization; Anil Padavatan, who is the Health Program Officer at GATE – Global Action for Trans Equality; Andie Sophia Fontaine, from Trans Ísland; and Joey Joleen Mataele, from Tonga Leiti’s Association. Welcome, everyone.

01:00 Anil Padavatan

Hi. Welcome.

01:05 (host)

So I want us to begin by contextualising this conversation. Anil, could you share with us a little bit about what we actually mean when we say the words “trans depathologisation” and “trans psycho-pathologisation”?

1:20 Anil Padavatan

So, thanks, Darius. The idea of pathologisation: it’s a long word, but what it really means is the idea that someone – just by existing, so just by being trans – is somehow intrinsically disordered. That can refer to the idea that we might have some sort of physical illness or the idea that we have some sort of mental disorder.

01:42 (host)

Thank you very much. Could you describe the historical developments leading to medicalisation and perhaps describe the processes that led to Trans Depathologisation or trans de-psycho-pathologisation?

01:56 Anil Padavatan

Just very briefly, in most pre-colonial societies around the world, there was some recognition of trans and gender-diverse identities. But despite this, the pathologisation of trans identities was introduced into Western medical systems at a very early stage.

By the 1700s, being trans was considered some sort of physical disease in men in Western medical writings. By the 1800s, trans and gender-diverse people were also increasingly considered a danger to society. This view was then exported to the rest of the world during colonisation. Gender identity and sexual orientation were conflated by the colonial European powers, and laws were introduced that criminalised trans and gender-diverse persons in a number of ways. Either based on perceived sexual orientation or based on gender expression, which was often framed in terms of laws that criminalised cross-dressing or impersonation.

By the 1900s, there was an interesting development where there was a sexology approach to transgender studies, which developed in Germany. But this work was destroyed by the Nazis, and several of the transgender community members who were working as staff members of the Institute that was developing these studies actually died in Nazi death camps.

In post-war Europe and the USA, there was an increasing social awareness of trans and gender-diverse persons, and medical studies started, but these developed a psycho-pathologising approach where trans identities were actually framed as some sort of mental disorder.

As modern gender-affirming healthcare developed, so did the role of gatekeeping, with doctors seeking to identify what they were terming “true transsexuals,” who were given early forms of gender-affirming healthcare, while other trans and gender-diverse persons who didn’t meet their diagnostic criteria were refused treatment.

In the 1960s and 1970s, at the same time that activists were successfully campaigning for homosexuality to be removed as a diagnostic category, the diagnostic categories related to trans and gender-diverse persons were being included in the DSM and the ICD under “sexual deviations and psychosexual disorders.”

And in the 1990s, when I was studying psychology, I can remember opening a textbook on psychiatric disorders and finding a page on something called “gender identity disorder.” This was the first time I’d encountered any information about being trans, and I can still remember the feeling of panic, asking myself “Do I have a mental disorder?”

04:30 Anil Padavatan

Fortunately, the trans community has a proud history of activism and actively opposed pathologisation throughout the 20th century. This activism gained increasing traction in the 2000s, with the International Day of Trans Pathologisation being commemorated from 2009 onwards.

In 2018, after extensive engagement by trans and gender-diverse state organisations, the World Health Organization removed “transsexualism” and “gender identity disorder of children” from the mental and behavioural disorders chapters of the ICD. In the ICD-11, we now have “gender incongruence” included in the chapter on sexual health, not as pathologisation, but in order to facilitate access to gender-affirming care.

This has been a great step forward. Unfortunately, around the world, pathologisation continues. Governments continue to put in place and enforce laws and policies that require a medical diagnosis before allowing trans and gender-diverse persons to access gender-affirming healthcare or legal gender recognition. Religious groups continue to use pathologisation as a rationale to push the use of so-called ‘conversion therapies’, despite the scientific evidence that these are harmful. And so, we are still continuing in our struggle against pathologisation.

05:48 (host)

Thank you so much, Anil, for providing the insight. I really appreciate how you provided insight on how – something that is sometimes kind of forgotten – pathologisation might actually impact trans and gender-diverse communities who live their day-to-day lives and experience their identities on a daily basis.

Like you sort of prompted, you know, it has been now around five years since the World Health Organization recognised that being transgender is no longer a mental illness and International Classification of Diseases 11th edition. Anna, could you explain the significance of this decision and its potential implications for trans and gender-diverse individuals worldwide?

06:35 Anna Coates

Yeah, thank you. I’d be happy to, Darius.

Perhaps not surprisingly, given the long history that we’ve just heard, I would like to begin by sharing that removing trans identities from the ICD chapter of mental health was a long process, it was an 18-year-long process. So, it really does mark a momentous step forward with profound implications for trans individuals worldwide. The most important thing is that this change, as we just said, marks a shift away from pathologising gender diversity as a mental disorder.

07:09 Anna Coates

And that’s really important for both practical as well as more social and political reasons of inclusion, of gender equality and of human rights. In terms of inclusion, of course, we hope that by no longer classifying transgender identities as a mental illness, it goes a long way to setting at least the basis for normalisation. It promotes the understanding that being transgender is a natural variation of human diversity.

So hopefully in the long run at least it will help reduce stigma. And we anticipate that that in turn can lead to a reduction in discrimination and violence against trans individuals by fostering greater acceptance and understanding, by reducing prejudice and discrimination and by promoting full inclusion in society on the basis of equality.

And of course, it upholds human rights principles by recognising the dignity and autonomy of all individuals to self-identify their gender, to live in a way that’s congruent with their gender identity and to have access to the care needed to make that a reality in whatever way an individual chooses for themselves. And I think that’s where the practical dimensions of depathologisation come in because it’s a really important move to promote better access to gender-affirming care, but also a more inclusive approach to gender diversity in general health care.

08:35 Anna Coates

On this very practical level, the reclassification reduces barriers to all aspects of gender-affirming care. So, hormone therapy, gender-affirming surgeries, and many others, which we know can be critical for the well-being of trans individuals.

And the removal from the ICD chapter on mental health could also have legal implications that we just heard. It can promote legal gender recognition on official documents like ID cards and passports, which is, of course, really important in many aspects of life, but it’s also instrumental to be able to access all aspects of health care in the way in which each trans person chooses and to address the discrimination barriers that many trans people face when accessing care when their identity documents don’t match their gender identity and the really many other health impacts of this as well.

09:28 Anna Coates

Legal recognition of gender identity can help remove stigma, which of course is associated with many negative mental health outcomes: depression, anxiety and, very sadly, suicide, as we know. So, in all, trans depathologisation is not the only answer, but it does open many doors to progress towards better health outcomes for trans people, as well as hopefully opportunities for a more dignified life overall.

10:00 (host)

Thank you so much Anna for sharing that. It’s quite striking, how you mentioned, how long that decision to remove trans identities from ICD took, I think you mentioned 18 years. And, of course, that decision also happened because of many, many years of advocacy efforts of trans and gender-diverse people to make that change happen. And I think on that note, I’d like to speak to Joleen and Andie a little bit about their experiences in their national contexts. So, Andie and Joleen, in your experiences, how has the de-psycho-pathologisation of trans identities influenced the situation of trans and gender-diverse communities in Iceland and Tonga?

10:48 Joleen Mataele

Well, thank you. I think that, when we started at the Tonga Leitis Association, some of these words – such as pathologisation and depathologising – were never in our language. It was never in our vocabulary when we started in 1992 until later on, as we were going towards the main goals and vision (of the organisation): that’s when we had to experience the actual wording that they were using in the scientific world to label us, the trans community. When we first started, that’s the first thing that came in from the Ministry of Health: they said that being trans or being a leiti was a mental health issue.

11:47 Joleen Mataele

I used to argue with them all the time, and I said, “What are you talking about? I’m speaking clearly to you. I don’t know what mental health you’re talking about because I ain’t walking on the road on my own and talking to myself. I’m actually talking to you. It is an issue that I need to know. You speak my language, so we can understand each other, and at the end of the day, we will know what we’re both talking about.” We started this association when AIDS hit Tonga in 1987, and we became more labelled with all sorts of words and scientifically marginalising words that they used, and we were the target: we were the sinful person, we were the cause of AIDS. Then our names became invisible. We were called AIDS. These were things that we started with thirty-one years ago. I don’t know how we survived today, but we’re still alive. The main thing that we did was trying to educate our own people, our own trans community – because our association was started by trans people. We wanted to educate our own community, especially not just the trans community, but the whole rainbow community, so they can understand and know where we stand. Nobody needs to come and tell you that your mental health is… that you’re crazy, you know.

We didn’t have the expertise in this line of work, and we’ve always joked about this. In the world of health in Tonga, there are doctors for animals, but there’s no doctor for trans issues, and they always joke about it over here. This is just our own community who joke about it, of course: some of the medical doctors didn’t like it, but that’s the reality. Nobody talks about it, nobody wants to talk about us, or our issues, let alone try to have proper counselling for someone who wants to take hormones.

These are some of the issues that we had to go through since we started to make sure that we educate our community. The first people that we actually educated were the church leaders, and I thank God that they didn’t condemn that. But things are a lot better now compared to 30 years ago, and they understand what we are talking about.

14:51 (host)

Thank you for sharing that. I think a lot of things that you say really resonate with me and what I also see in other countries and other contexts, especially around educating our own communities and trans communities and dealing with perhaps internalised ideas of self that are hurtful or sometimes damaging to trans communities or gender-diverse people who are dealing with internalised transphobia and things like that and actually learning to grow and understand that. Our identities are something that we can take pride in and that we can celebrate.

15:29 (host)

Andie, did you find that there was perhaps any overlaps or similarity or differences in Iceland from what you heard from Joleen?

15:38 Andie Sophia Fontaine

Well, um, yeah: especially when it comes to educating our own community. The pathologisation and depath process has been very educational in Iceland, I would say, because when we speak of trans and gender-diverse people, when the laws were changed, it was very educational to see who was immediately included and addressed and who was made to wait. When it comes to our own legislation, the Gender Recognition Act passed in 2019, and there were a number of changes that immediately went into effect for who we might call binary trans people. It’s because that is very easy to conceptualise, for a lot of cisgender people, that somebody transitions from one binary gender identity to another, and so the law addressing their concerns and their needs and their desires was implemented very quickly.

Left behind and made to wait in this where non-binary trans people and intersex people: they had to wait their turn because this was a little bit difficult for some cisgender lawmakers to be able to wrap their heads around why it was important, and what their needs were, what their desires were, and how they can best be addressed – even though we had made this very clear for years. When it comes to intersex issues: Intersex Iceland is a very active group in this country, and they have been lobbying for many, many years to stop performing non-consensual cosmetic surgeries on children – on infants, in most cases. You know: there’s a very clear demand.

But the bill was passed in July 2019, and even though that particular clause was in the original draft of the bill, it was removed by the government at the time because they wanted to form a committee to examine this and investigate this, and all kinds of legal jargon. Fortunately, that change was put into place in December 2020, and so there were also some changes made to the law that were more inclusive of non-binary and other gender-diverse people in terms of legal documentation such as passports and name changes and gender markers on legal documentation. But for myself, it was very interesting to see who was made to wait and who was readily addressed.

18:15 Andie Sophia Fontaine

Iceland prides itself on its stance on human rights and gender equality, and so when it came to this issue – especially in the wake of the changes that were made in the WHO in 2018 – it was very easy for a lot of lawmakers to wrap their head around like a binary trans person, but it was educational to see who was listening to other people and who felt that non-binary people could wait, intersex children could wait…

Fortunately, those changes have come to pass: it was just frustrating initially to see that some folks had to wait and who was prioritised and who was not. Another thing that was interesting, though, was that Iceland’s process was the process I went through myself: going through six successive interviews with psychiatrists and psychologists to basically give the same answers to the same questions before somebody who got educated about us – but very seldom talked to us – deemed you worthy of receiving hormone treatment or surgery, if you wanted it. When this law came to pass, and that process was largely done away with, there was still a slow response within the medical system: this bottleneck formed whereas the law said “yes” and went into effect, the medical system was not properly put up to speed, I could say. So, now there is a very long waiting list for types of gender-affirming surgeries and even just to begin hormones. The endocrinology department is swamped at the moment.

20:00 Andie Sophia Fontaine

And so there was a bit of incongruence between what was happening in parliament and what was happening in the healthcare system. That’s something that is still being addressed to the point where, when it comes to gender-affirming surgeries, Iceland just decided we’re going to just you know make a deal with a hospital in Sweden because they can’t handle it: we know we’re only talking about like two dozen people – I think something like 24 or 30 people. I don’t know the inner workings of the national health care system, but this is what we have been told anyway: that they cannot handle this tremendous capacity of two dozen people, and so they had to make a deal with a hospital in Sweden.

So, that’s where that’s where things are at right now in Iceland: it’s definitely better than it was for sure. It has just been very eye-opening and very educational to see what types of gender diversity gatekeepers within parliament and the medical system are capable of conceptualising, and therefore who is prioritised, and how the medical system was just basically left holding the bag – like, we pass this law, now you deal with it.

21:06 Joleen Mataele

I just wanted to add on to that, Darius: it’s exactly the same thing that we’re going through, even though we don’t have the proper doctors for hormone treatments and counselling and all that.

Within the legal side, with so many meetings and negotiating with the government, we were even able to change the “rape law”, the definition of rape, and at the beginning of this year in January it was passed in parliament. The law refers to anyone, and it’s more diverse, and the penalty goes to anybody to whom the issue will apply, and it has been passed. We were approached by the speaker in order for us to be able to educate our parliamentarians, our people, were for us to actually translate the SOGI guideline: you can just imagine the amount of words that we have for one English word. It was a most pathetic month of translation I don’t know where the heck we got all those translations from, because we don’t really have ah a proper scientific word in Tongan for sexual orientation gender identity & expression and sex characteristics. But we had to do it, in order for our people to understand who we are, the different genders and all that. So, after it was translated, we took it back to parliament, and the Lord speaker asked us to work with the Ministry of Internal Affairs and Women’s Affairs to actually insert the translated SOGI guideline into the Family Protection Act. Then, from there, we can start talking about all the law reform issues that we want to put in, so by then everybody knows what we’re talking about, that we’re speaking the same language. Even though it’s slow over here, we’re moving forward – starting from the legal side and with the government.

23:41 (host)

Thank you for sharing that. Especially what you mentioned about having to translate SOGI guidelines into a local, national context, and a cultural context that might not have the same sort of framework around understanding gender diversity or sexuality, I think this invites a broader conversation about how we can make these practices more inclusive internationally.

24:23 (host)

Anna, I want to ask you another question, thinking of this bigger picture. Um, could you tell us about how de-psycho-pathologisation can impact global health policies and perhaps countries’ commitments to the health of trans and gender-diverse individuals?

24:43 Anna Coates

I think perhaps the first thing to note here, as I think we’ve already heard as well, is that removing trans identities from the mental health chapter of ICD is a significant step forward, but we do also need the right policies as well as advocacy and education to really ensure that the shift is fully recognised, fully implemented at all levels to affect equitable and respectful treatment in all aspects of trans people’s lives – including with respect to their health. So. health policies at both global and national levels are really crucial, and at a global level, I think what pathologisation allows us to do is to shift our focus from treating trans and gender-diverse identities as mental disorders to prioritising the health and well-being needs of trans people in the same way that we do all other people.

Global health policies already emphasise inclusion and equity for all people irrespective of their sexual orientation, gender identity, gender expression or sex characteristics. And they specifically address equal access to quality healthcare without discrimination. In fact, several UN agencies have reiterated the application of these standards specifically to transgender people in recent years with a joint statement in 2015, calling on States to end discrimination and end stigma against LGBTQIA+ persons in all contexts including in healthcare. In 2017 that was reinforced with a joint UN commitment specifically to end discrimination in healthcare settings and that acknowledged that discrimination has a significant impact on both users of services and health workers. So: ending discrimination is crucial to achieving the Sustainable Development Goals, including universal health coverage. And we are, I would say, increasingly focused on accountability for those commitments in global policies. We don’t just want them to be nice words that are spoken, but really are something that actually motivates action and results. We have a long way to go, and I would say that the global picture is still quite mixed, to be frank.

Disaggregated data – meaning: data that shows how different groups of people experience health and access to care – are key to accountability: they can help identify healthcare disparities between different groups. They can inform more targeted interventions and track progress towards equity. For many years WHO has been calling for countries to collect, report, and analyse health data disaggregated by sex – and, honestly, even that is a challenge, but we are seeing some progress. The next step will also be to collect data on self-determined gender identity, not just sex assigned at birth. The availability of health data disaggregated by gender identity in most countries across the world is currently woefully inadequate. As we continue towards destigmatising transgender identity and transgender healthcare, hopefully, we can progressively move towards much better availability of that data.

Another reason depathologisation is important for global health policy is that it opens up the door to providing evidence-based, global-level guidance to countries to provide both gender-affirming and gender-inclusive care that’s aligned with principles of gender equality and human rights. So for example, I’m very happy to share that WHO is currently working on systematic reviews of evidence to inform the development of the very first WHO guideline on the health of trans and gender-diverse people, and I would say that in itself the development of that guidelines sends a really important message, because it’s the work of WHO which is the global standard-setting public health agency: any guidelines that WHO produced should hopefully influence national health guidelines. The priorities that we identified for this first guideline have been developed and established in close collaboration with the trans and gender-diverse community is going to cover the provision of gender-referring care services in healthcare settings, with a focus particularly on hormonal therapy – and we’ve heard already from Joleen and Andie how really important that is – but it’s also looking at some of the wider aspects of access to gender-inclusive care to meet all health needs for trans and gender diverse people, and that’s also fundamental.

We know that you know some trans and gender-diverse people are reluctant to even access emergency care for an accident because of the discrimination they face. So it’s going to be focusing on the significance of healthcare provider training to be able to provide knowledgeable and culturally competent care for trans and gender-diverse individuals including for survivors of violence – again, as we’ve heard, that’s really important – as well as how gender health policies and human rights align provisions of gender identity recognition law can enable the provision of both gender-affirming and gender-inclusive care and across all of the priority areas that we’re covering we do recognise the mental health challenges faced by trans individuals due to discrimination, to stigma, to violence, and as well as the impacts on a wide range of health outcomes.

Of course, at the global level, some countries like Vietnam and others like Iceland we’ve just heard about are already ahead of the curve in a sense in implementing changes motivated by depathologisation in the legal frameworks to recognise and protect gender identity and transgender individuals – including in healthcare settings. And that includes allowing legal gender marker changes on identification documents and eliminating unnecessary medical or psychological evaluations for access to gender-affirming care.

So I’d say depathologisation is slowly leading to more inclusive, equitable and affirming global national health policies, which perhaps give us some room for cautious optimism, but it is also really important to stress that it is a very unequal picture across countries. We do desperately need ongoing advocacy and policy development to harness the full potential of depathologisation and to address healthcare disparities and challenges faced by trans and gender-diverse communities across all countries and, as you know, unfortunately, we are definitely not quite there yet.

31:17 (host)

Thank you so much, Anna, for your very valuable insights. You have just spoken about the need for more advocacy efforts; so, on that note, I’d like to ask my final question and speak to Anil and Joleen and Andie. And I’d like to hear from you about whether there are any specific lessons or strategies from your country’s experiences with depathologisation that you think would be valuable for trans and gender-diverse activists in other countries to learn from or adopt.

31:51 Anil Padavatan

I think that Joleen and Andie have already spoken about some of the strategies that are kind of tried and tested and that activists have been involved in around the world. Building those linkages with the key stakeholders, ministries of health, officials, and regulatory bodies, and doing sensitisation and education, building public awareness, developing guidelines, doing language development… All of these are important activities, and we’ve also seen a lot of countries where trans and gender-diverse-led organisations have now been increasingly involved in conducting research, developing the data that we need to go and talk to our various governments and give them the evidence of what we’re talking about and why this is important.

But I think something new is emerging around the world and is of great concern is the fact that these are all business-as-usual strategies for advocacy, but we’re not in a business-as-usual environment around the world. We are seeing a very coordinated, well-funded anti-human rights movement, and it’s impacting us as the trans and gender-diverse community with the anti-gender disinformation and campaigning that happens in a lot of countries and is having a huge impact.

So, rather than seeing a kind of progressive realisation and increasing access to our human rights, we are actually seeing in some contexts a rollback where you were having additional laws criminalising people being introduced, criminalising trans and gender-diverse identities, criminalising same-sex relationships, and then also criminalising the gender-affirming healthcare itself: we’ve had some states in the US and some countries in various parts of the world introducing laws that are criminalising the provision of gender-affirming healthcare: this is very, very worrying, and I think that we really as a movement need to start building better linkages with the other movements, human rights movements that are experiencing similar issues because this is an anti-human rights backlash and they are targeting other communities as well.

They’re targeting the broader LGBTQI community, they are targeting sexual and reproductive rights, they are targeting women’s rights, they are opposed to gender equality, and they are opposed to the right to bodily autonomy. And if we are going to make the impact that is needed to counter this, we really need to have linkages with the organisations around the world and the movements around, if we’re going to really have the impact that we need to counter this anti-human rights movement. We need to build linkages with the other movements that are being impacted: the women’s rights movement, the broader LGBTQI movement, people who are fighting for access to sexual and reproductive health care services… and we need to have a coordinated response to addressing the anti-human rights backlash that we’re seeing at the moment.

34:58 Anna Coates

I just wanted to reiterate what Anil was just saying, because I think these kinds of opposition and fragmentation are playing out at national levels, but also at global levels. So, when we were just talking about what global health policy can do and what we can do with commitments across countries, we are seeing this polarisation.

And I would call it a polarisation because you have certain countries and groups which are increasingly progressive, but then you have the backlash and the opposition that Anil was just describing. In fact, the very existence of the two sides, or the two extremes, is in itself kind of creating some real problems for being able to progress on the global frameworks that I was talking about before. What we always do as UN agencies is trying to find a consensus between countries so that we can get these commitments signed off, and we’re finding it increasingly difficult at the moment because of these different groups that are involved in the organised nature – as Anil was saying – of the opposition.

But it’s also fragmentation, and I would say that, as the Gender lead for WHO, I think that we need to try and get over this fragmentation of what is women’s rights and what is transgender or gender-diverse rights. It’s part of the same strategy of gender equality in human rights, and we need to reiterate that message as much as we can, because we are only doing harm to ourselves if there’s a women’s rights movement which is focused increasingly on sex rather than gender – in some quarters at least – and then there’s a movement which is looking at a broader vision of gender equality. That’s not helpful to any of those, and I think we need to try to be as inclusive as possible and emphasise the commonality of discrimination, the commonality of inequalities of power that is really preventing us from progressing.

So I just wanted to reiterate what Anil was saying now and the importance of us developing different strategies, inclusive but different strategies. There’s a whole world out there: in a world of misinformation, in a world of digitalisation, we are still having the same advocacy strategies that we’ve often had, and that’s not necessarily quite working for us right now.

37:37 Joleen Mataele

I absolutely agree with both Anne and Anil, because our work here back in Tonga – and it’s the same that goes to all the other Pacific islands, but I will just concentrate in Tonga – in order for us to get things done, we have to work with everybody. We have to work with the women’s crisis centre. We have to work with the women and family crisis centre. We have to work with all our allies and the people that we know will back us up in the work that we do.

38:12 Andie Sophia Fontaine

Yeah. I think it’s a lot of fantastic points were addressed here, like the need for solidarity across intersections. Iceland is a particularly interesting case study, because we are in the midst of the beginning of a pretty intense backlash against queer rights at the moment, in particular with regards to trans people – of course, bigots are very fond of using trans people as the edge of the wedge that splits people apart: that’s as true in Iceland as it is in other countries in the world.

Because the backlash is just starting here, we have been fortunate, in a sense, to be able to learn from other countries and learn from the mistakes of other countries; one of the strongest weapons that bigots have is misinformation and the fact that it is very, very, very, very easy to spread misinformation very quickly and very broadly, but it takes about 10 times more energy to refute that and to correct it.

One of the strongest weapons that’s being used right now is just refuting misinformation. It’s really annoying to have to constantly repeat the same truths over and over and over again: it is incredibly exhausting. But that’s what the bigots are counting on: the bigots are counting on those of us who are on the front lines getting tired and giving up, and fortunately – as it seems right now – there is no sign of us giving up.

Repeating these truths has managed to cross a lot of affinity groups. Fortunately, mainstream feminism in Iceland is very trans-inclusive. At the moment, one of the more prominent voices against trans rights has spent the past ten-fifteen years also being an anti-feminist. So, the moment this person stepped forward to talk against trans rights, it was incredible to see some of the more prominent feminist voices in the country and women’s rights voices in the country just immediately take the side of trans people, because of this person. So: kudos to them for encouraging solidarity. But solidarity is definitely going to be key in this fight, and so is the fact that you cannot just refute misinformation one time; you can’t just do it twice, or three times; you are going to have to say it over and over and over again. It’s going to be annoying. It’s going to be exhausting, but it’s the only way forward, towards preserving our freedom.

40:47 (host)

Thank you very much for sharing that, Andie. I would like to leave us with a positive question, and that question is: what is one thing that you’re hopeful about?

40:57 Anna Coates

The thing that I am hopeful about is something that Andie was just mentioning: there can be solidarity as we move forward, and I think the fact that is actually we’re having this discussion, that there is an ability in different contexts. Whilst there are really difficult environments, we are able to have this conversation, and the fact that we’re able to have this conversation I think gives us real hope that we can move forward in a positive way and combat discrimination and just have a world where everybody can be whatever they want to be, and discrimination is not there. But we have to be able to have these conversations to be able to allow that.

41:42 Joleen Mataele

I believe that platforms like these and all other platforms open a lot of discussions about the importance of going from the old era to the new today, from the process of colonisation into depathologisation in Tonga and everywhere else in the Pacific.

In some regions, almost all of the colonised populations were forcibly turned away from their traditional belief system, and they were all forcibly turned away by the Christian faith, which colonisers used as a justification for the extermination of adherents of other faiths and enslavement of natives and their exploitation of lands and seas, especially in the majority of our Pacific islands. And these are things that we need to make sure that we don’t separate ourselves from: we don’t separate ourselves from our culture. We don’t separate ourselves from our own families and communities. We need to work, we need to be heard. We need to actually live and be proud of what we are.

43:10 Anil Padavatan

What I’m hopeful about is hearing what Joleen has just said and knowing we have always been here. There have always been trans and gender-diverse people. We are part of humanity, and we will overcome. We have overcome so much, and we have strong activists who are resilient and tenacious around the world and who will continue to say these truths over and over again. I am very hopeful that, in the end, we will have a recognition across the world of our rights to equality and to human dignity.

43:52 Andie Sophia Fontaine

What gives me hope for the future are lessons from the past: we have been through much, much worse than this and we have survived, and we’re going to survive this too because the only other option is despair and I’ve lived too long to despair now.

44:08 (host)

Andie, Anna, Joleen, and Anil: thank you so much for what I would call a fruitful conversation about trans depathologisation, and its impacts on trans and gender-diverse communities worldwide. It was such a pleasure to talk to you today and thank you so much for joining us.

44:26 Andie Sophia Fontaine

Thank you for having me.

44:27 Anna Coates

Thank you. Thank you so much.

44:28 Joleen Mataele

Thank you very much, Darius.

44:31 Anil Padavatan

Thanks.

44:44 (theme music plays in the background) host

Making Rainbow Waves is a podcast by ILGA World. This episode was hosted by Darius Gervinskas, and edited by María Alejandra Gonzales Silva. You can find every episode on all streaming platforms, or on ilga.org. Thanks for listening.