Right-Wing Attacks on Trans Health Care Rely on Ableist Logic

In 2021, Arkansas became the first state to institute a state-wide ban on best-practice medical care for trans young people. The bill made health care providers subject to professional discipline if they met their professional obligations to treat trans people under 18. A court order has kept that law from going into effect. Among other things, proponents of the ban have argued in court that most or all trans people assigned female at birth are autistic or have depression, ADHD, or PTSD, and so should not receive treatment for gender dysphoria.

Now Arkansas is considering a different law, which allows people to sue health care providers for providing gender-affirming care to those under 18. There is a narrow exception that could allow some treatment for trans young people, although it would still cause major delays and other harm. But there would be no treatment permitted at all for most trans young people with mental disabilities. Two medical professionals have to document that the young person has “no other mental health concerns, including without limitation depression, eating disorders, autism, attention deficit hyperactivity disorder, intellectual disability, or psychotic disorders,” or that gender transition “was the only way to treat the mental health concern.”

Hopefully this new bill will fail. But it’s far from the only one. According to the Equality Federation, 245 anti-transgender bills are pending in legislatures around the country; 96 of them involve health care criminalization and 21 involve criminalizing public appearance while wearing clothing not associated with one’s assigned sex at birth. Utah passed a trans health care ban earlier this year. It bars treatment for trans people under 18, with an exception for those diagnosed with gender dysphoria prior to the effective date of the law. To provide treatment even to those young people, providers have to comply with a variety of requirements, including one that involves documenting “other physical or mental health conditions” and considering whether to “treat” those before treating gender dysphoria. And even when not written into the laws themselves, ableist justifications for anti-trans legislation are everywhere. All trans people and all disabled people ought to be concerned about these attacks, and we have to understand how ableism operates to be able to combat this interwoven ableist and anti-trans targeting.

While our opponents often inflate the numbers — and certainly not all trans people have disabilities — it is in fact true that trans people are more likely than cis people to be autistic and to have anxiety and depression. The real dispute comes over what that means. One point of departure comes with the question: Why are so many disabled people trans?

The question itself can imply that there’s something wrong with being trans, being disabled, or both. But in the words of the Autistic Self Advocacy Network, “Autism Cannot and Should Not be Cured.” The overlap between autistic and trans communities could (and I think should) be seen as something to accept and celebrate, or as something interesting to explore for what it might tell us about gender normativity and neurotypicality. A number of trans and autistic writers have reflected beautifully on this intersection: Brandy Schillace explains that questioning their gender allowed them to accept that they were autistic; Lydia X. Z. Brown explains that being autistic can make it easier to question binary gender norms and figure out that one is trans; and Zel Amanzi points out that the experiences of being trans and being autistic have a lot in common, in that our internal experiences “turn social conformity into a sensory burden.”

We are people, not a problem to be solved.

When it comes to depression, the explanation for high rates in trans communities is fairly obvious. It has been confirmed in study after study. When we experience acceptance and support and get the health care we want and need, our rates of depression roughly track those for cis people. When we experience discrimination and violence and don’t get the health care we want and need, our rates of depression outstrip those for cis people. (Of course, it isn’t only trans people who have high rates of depression. Doctors and lawyers do too, yet we aren’t seeing bills criminalizing medical school or law school.)

It’s hard to argue that depression is something to celebrate — certainly, when my depression has been at its worst, I haven’t felt much like celebrating anything. Some of us probably would take a cure if it existed (it doesn’t). But I believe living with depression is also not something to mourn, because it’s still living. And for me even depression can have its silver linings. Once, when an episode of major depression lifted, I looked up at the sky and realized I could appreciate beauty again. Before that period of depression, I took the capacity to perceive beauty for granted. I still remember how the bare limbs of that tree looked against the pale blue sky that morning. I remember turning on my music for the first time in weeks and marveling at the way it moved me. Experiences of depression can also create moments of connection. Even at my worst, I deeply appreciated the friends and partners who spent time with me, as well as the strangers online who shared in ways that helped me feel less alone. Others have told me in turn that mentioning my mental disability helped them to feel like they didn’t have to hide their own. Depression — like being trans or, for that matter, being a lawyer or living in the U.S. — is a part of how I have experienced life and is one aspect of who I am.

Our opponents, of course, reach different conclusions. They claim that we think we’re trans because we’re autistic, depressed, or whatever else. Our opponents’ views suffer from a total lack of evidence, yet they have been gaining traction. It is hard to understand why without understanding ableism.

It is ableism when right-wing legislators undermine our credibility and argue that we should not get what we say we want and need; they are playing directly to perceptions of disabled people as either poor decisionmakers in need of nondisabled people to make our decisions for us or liars trying to get something we’re not entitled to. We can’t fight these assumptions without directly addressing the ableism at the core of them. Those of us with mental disabilities need to be trusted and supported to make our own decisions. We know best who we are and what we need.

Ableism also helps them frame transness as such a terrible fate that it is worth doing almost anything — no matter how extreme or unlikely to succeed — to keep us from becoming trans or “cure” us of being trans; they are playing directly to perceptions of disabled people as tragic objects of pity who need to be made into nondisabled versions of ourselves or prevented from existing in the first place. Scholar Eli Clare has written especially powerfully about the insidious and complex ideology of cure. On the one hand, many of us do want health care or relief from pain associated with our disabilities, and on the other, many of us reject the notion that there is anything about us, rather than society, that needs to be “fixed.” And I think nearly all of us fear the eliminationist logic that frames disabled people as a burden or a problem. Disabled people can and do live fulfilling, meaningful lives. We can and do help others, learn and grow, and experience connection and loneliness, pain and pleasure, loss and joy. And even if we couldn’t or didn’t do any of those things, our lives would still have value, because all lives do. We are people, not a problem to be solved.

Finally, our opponents use the ableist argument that to the extent trans people cannot be cured out of existence, we are a threat that must be contained; they are playing directly to perceptions of disabled people as dangerous and evil. In reality, nondisabled people are more likely to be a threat to us than we are to them. Our communities are not whole without us.

Of course, this is not the first time that gender nonconformity, public disability and reproductive autonomy have been targeted together — our unruly bodyminds perceived as a threat to the established order. In the late 1800s, cities around the U.S. passed public decency ordinances. As Susan Schweik explained in her book, The Ugly Laws, these laws criminalized such things as appearing in public while disabled and asking for money; appearing in public wearing clothing perceived to be for the “opposite sex”; making a “bold display” in public if a woman; and distributing pamphlets with information about contraception, uterine diseases, or other health concerns associated with women. These laws arose at the same time (though not always in the same place) as Jim Crow racial segregation laws, and also coincided with the emergence of eugenic philosophy. It’s hard not to see a parallel now. But if we have trod this path before, while it makes me angry, it also gives me a sort of hope. After all, we’re still here. No matter what they try, we will still be here. We will keep sullying their streets with our glorious, uncontainable, irreplaceable selves.