suicide – UAB Institute for Human Rights Blog

No More No Less: Basic Human Rights are Transgender Rights

I am a person who is transgender.

Transgender is an umbrella term that includes those that identify on the gender spectrum. It is the term used to describe an individual whose gender identity and expression are different from expected societal norms. Gender identity is the personal sense of one’s own gender, and for the majority, it correlates to the sex assigned at birth. Gender expression is a person’s behavior, mannerisms, interests, and appearance that are associated with gender in a particular cultural context. The social normative gender spectrum in most western cultures has been for centuries, binary: male and female. The basis of this binary was the presence of sexual organs at birth. When I was born, the doctor, based upon the presence of a penis, assigned me male at birth, in accordance with the binary gender spectrum. However, internally I was female.

I identify as female. As a transwoman, I continually fight a battle against erasure of my life and existence. Since transitioning I have suffered erasure by losing a career of 23 years, health insurance that will not cover medically necessary treatments, been refused treatment by medical professionals, and the state will not acknowledge my identity.

To live my life, I had to do this without acceptance from others including family and friends. I did not live on the streets because I remained hidden. I understood from growing up with my deeply religious grandparents that if I were different—my true self, I would be disowned. I made many poor choices, started drinking at age 11 and dealt with anger issues up until I got ordered to anger management counseling by the United States Marine Corps (USMC). It must have been bad for the USMC to think I was too angry to deploy. I grew up before access to the internet (no old jokes), and I had no names for what I knew about myself, so like many I suffered in silence until I figured it out much later in life. I want to make it better for the young transgender and non-binary individuals that are coming out today.

Social-Ecological Factors

Every level of the social-ecological model, from individual or intrapersonal level, all the way up to the societal or structural level in the transgender community fights against identity erasure. Many, including myself, suffer from internal transphobia. Tran individuals encounter internal transphobia as a byproduct of absorbing negative messages about not following the societal norms. Internal transphobia can occur with something as simple as not using the preferred name or pronouns, and/or through the attempt by family members to “correct” the behavior through abusive methods. For example, if society continued to identity Caitlyn Jenner as Bruce Jenner, then society contributes to the manifestation of internal transphobia she might seek to overcome. Additionally, by not employing gender pronouns like he/him: female transitioning to male (FTM), or she/her: male transitioning to female (MTF), and encouraging abusive practices like conversion therapy or berating about dating/sleeping with members of the opposite sex, society infringes upon the rights of Trans individuals to dignity and personhood.

The feelings associated with internal transphobia are the result of many years of discrimination, rejection, and ignorance about the rejection of gender norms. Depression can result in dangerous behavior. At the interpersonal level, family and friends reject many trans folk when they come out as transgender or gender non-conforming, mainly due to the preconceived notion of a binary gender system. The rejection becomes isolating and often leads to homelessness. In addition, some receive abuse from programs designed to rid individuals of these kinds of thoughts. The non-conformance to traditional gender norms of male and female can lead many to demonize transgender people who are out and trying to live their life. As a marginalized community, members of the transgender population are subjected to violence, harassment, discrimination, and vilification by society as a whole. The National Center for Transgender Equality (2011) survey found that those individuals that are gender non-conforming in grades K-12 were 78% more likely to be harassed, while 35% report surviving assaults. The current situation in the U.S. in regards to which bathroom transgender individuals should use leads to increase harassment. Transgender people are viewed as perverts, and being attacked for wanting to pee in peace. These types of attacks create high levels of anxiety, depression, and isolation.

The constant threat of discovery lead many to remain in hiding, leading to increased suicidal ideology. For example, the Transgender population suffers from an abnormally high suicide rate of 41% compared to 1.6% of the general population in the US. The murder rate of transgender continues to climb each year here in the US. Since 2013, an average of 25 trans women have been murdered, and there have been 18 killed this year. According to Bauer et al., a high social support network showed a 48% decrease in suicide ideation and of those with ideation, 82% decrease in attempts of suicide. The population suffers from many forms of social exclusion, and one of the main determinates is that this population is rarely counted; thereby, resulting in the marginalization of the transgender population.

At the societal level, this population is highly marginalized, even within the LGB community and the “T” not well represented. Due to fear, many of those who identify as transgender, are unable or unwilling to make their voice heard. This discriminatory practice reinforces an individual’s ability to care for one’s self. Few policies provide protection for, and individuals gender identity or expression. The lack of protections at the local, and state level allows discriminatory practices to continue, contributing to the overall marginalization of the transgender community. The use of conversion therapy to cure this non-compliance with gender norms is only illegal a few states and the District of Columbia.

The current data suggests there are about 1.4 million adults within the US that identify as transgender. This estimate is double the widely used previous estimate, and many organizations believe this number remains far too low. The lack of research and information on transgender issues is a direct result of this form of social exclusion and leads to incorrect assumptions about the population. Individuals suffer from social exclusion by losing family and friends when they “come out,” or being bullied at school, work, or on social media sites because they are different and challenge the gender norms. Most Trans folk keep their identity private due to discrimination and harassment. Ninety percent of Trans adults report experiencing attacks or discrimination because of their identity. In the workplace, 47% of Trans folk are fired, denied a promotion, or not hired. I lost my career of 23 years when I transitioned.

I lost my job as a fire department captain/paramedic. When I began my transition I believe that my history of good performance and exceptional results over the years of service would provide a buffer for any negative concerns that were raised. However, this was not the case and upon my coming out to the fire chief and deputy fire chief it was clear they did not wish to continue my service to the community. Things were rocky, but the mayor and personnel director had taking my side in the arguments that developed. But, to my dismay the chief had work with the city council and gathered enough votes to begin my termination. I had 23 years in public safety and two more years till retirement. Due to the lack of protects for transgender workers, there were not many options available at the time. However, I had returned to school to build my education, fearing that this might happen I wanted to be prepared.

Despite the setbacks, I have accomplished what many transgender individuals are unable to do. I returned to school, completed my undergraduate and graduate coursework, and graduated with a Master’s in Public Health. Now, I work at UAB which has been accepting and minus a few speed bumps been inclusive of my gender expression/gender identity. I hope to make a difference in the local transgender community here in Alabama by starting the conversation and showing that Tran men and women positively contribute to society and only want to live their lives just like everyone else. So please come join the conversation with UAB’s Institute for Human Rights and Department of English as they present “A Human Rights Approach to Transgender Issues.”

I am just a woman trying to leave a better place than what I found and live my life authentically.

The History of Pride

Pride Flag flying — Rainbow Pride Flag. Source: Benson Kua, Creative Commons.

The month of June is known as Pride Month for the LGBTQ community. Pride means more than its dictionary definition to the LGBTQ community and has a long history.

The fight for marriage equality began in 2010 with United States v. Windsor. This case challenged the constitutionality of the Defense of Marriage Act (DOMA). This Act stated that only marriages between a man and a woman were recognized by the federal government, but allowed for state governments to recognize them. Edith Windsor was widowed after her spouse, Thea Clara Spyer, who passed away in 2009. She was the sole survivor of their estate. Windsor and Spyer were legally married in Canada in 2007, and their marriage was recognized by their home state of New York. Spyer left in her will that the estate would be left to Windsor, but because their marriage was not recognized by federal law, over $350,000 in estate taxes was issued to Windsor. If their marriage would have been recognized by the federal government, no taxes would have been issued.

Windsor filed a lawsuit against DOMA and its constitutionality in 2010. At that time, DOMA was upheld by the government; however, in 2011 President Obama and Attorney General Holder announced that they would no longer defend DOMA. The House of Representatives then created a provisionary group to defend DOMA but the district court found the group to be unconstitutional. Windsor was given a refund for the estate taxes she was forced to pay and DOMA was declared unconstitutional by the Supreme Court of the United States (SCOTUS). States were then allowed to issue marriage licenses to same-sex couples if their governments chose to allow such.

Efforts for marriage equality continued with James Obergefell and John Arthur James, who were residents of Ohio. They decided to go to Maryland to get legally married after years of being together when James was diagnosed as terminally ill. The couple wanted to designate Obergefell as the surviving spouse on the death certificate, but Ohio’s laws allowed for refusal of same-sex marriages and their recognition even if the couple was legally married in another state. Obergefell v. Hodges was brought to the South District Court of Ohio to challenge the state’s discrimination against same-sex couples. The Ohio Registrar agreed that the law was unconstitutional but the Ohio Attorney General decided to uphold the state’s same-sex marriage and recognition ban. The case continued through the fourth, sixth, seventh, ninth, and tenth circuit courts of Ohio. All but the sixth circuit court agreed that the state-level ban on same-sex marriage was unconstitutional. Because all of the courts did not rule the same, a Supreme Court intervention was inevitable. While the case was going through the circuit courts, James passed away.

During two years of appeals, Obergefell v. Hodges became larger. Plaintiffs of Bourke v. Beshear from Kentucky, DeBoer v. Snyder from Michigan, and Tanco v. Haslam from Tennessee were added. The plaintiffs in each of these cases had been denied marriage rights from their home state, even if their marriages happened in another, just as Obergefell had. It was in April of 2015 when Obergefell v. Hodges, which now consolidated the cases from all four states, presented oral arguments to the Supreme Court of the United States (SCOTUS) to challenge the states’ same-sex marriage bans constitutionality. Two months later on June 25th, SCOTUS ruled that marriage is a constitutional right and ruled in favor of marriage equality. This allowed for same-sex marriages to be legalized by the government.

While the historic ruling by SCOTUS happened in 2015, June has been Pride Month for decades before marriage equality. We know Pride Month today as a month-long celebration full of parades, events, and parties. It did not begin that way. The first Pride Parade was a riot at the Stonewall Inn, which is known as “the place that Pride began.”

The Stonewall Inn. Photo by Tyler Goodwin

Stonewall Inn, New York City, 1969

It was illegal to engage in homosexual behavior, giving the police the “right” to attack anyone thought to be gay and arrest them. A majority of the gay bars and clubs had been raided and shut down by the New York City Police Department (NYPD). On the evening of June 28^th, a group of people gathered at one of the few gay bars that remained open, The Stonewall Inn. The police barged in shouting, “We’re taking the place!” The patrons then began to resist. As those who were at the Stonewall Inn were arrested, a large crowd formed outside of Stonewall. Marsha P. Johnson, a transgender woman of color and LGBTQ activist was outside. She threw the first brick in protest and ignited the Stonewall Riots. The riots were eventually doused that evening by police reinforcements but protesters returned the next night with over 1,000 people filling the streets. The people of Stonewall emerged victorious by fighting back. As a result of the riots, the police ceased to interfere with LGBTQ safe spaces and no longer attacked them on the streets; and by making headlines across the country, LGBTQ issues were brought to the forefront, organizations were started, and the community began to fight for their rights. The Stonewall Riots began the LGBTQ movement.

Marches, today known as Pride marches, sparked across the US when news spread of the riots. The Stonewall Riots were violent; however, they ignited a nonviolent movement across the nation and world. June has been deemed Pride Month in honor of the riots.

A Symbol of Unity, Hope, and Safety

The first Pride Flag was designed by Gilbert Baker in 1978, in San Francisco. It was in honor of Harvey Milk, who was elected to the San Francisco Board of Supervisors. Milk tasked Baker with drafting up a design for his campaign. His platform was hope for the young gay people, saying, “The only thing they have to look forward to is hope, and you have to give them hope.” Thus, the Pride Flag was born. Milk was the first openly gay person to hold public office in a major US city and was later assassinated for that same reason. After his death, the Pride Flag production increased. Businesses all over San Francisco were flying them proudly in remembrance of Milk. “T he flag is an action – it is more than just a cloth and the stripes. When a person puts the Rainbow Flag on his car or his house, they’re not just flying a flag. They’re taking action,” Baker said, “I am astounded that people just got it…that this was their flag. It belonged to all of us.”

The original Pride Flag had seven colors, with fuchsia, which represented sexuality, at the top. However, due to a shortage of fuchsia in the factory where it was reproduced, it was condensed to the six-color flag that flies today. The remaining six colors also represent something powerful and meaningful to the LGBTQ+ community. Red stands for life. To some people, coming out as LGBTQ can mean life or death. In a lot of scenarios, when one comes out their family shuns them, kicks them out, and/or verbally abuses them. This pushes a lot of youths to suicide. Suicide is the 2^nd leading cause of death among young people, and LGBT youth are four times likelier to attempt than straight youths, according to Innerbody Research. Red represents the importance of life, and how giving up on it is never the answer. Orange represents healing powers of love in the community. Yellow is for sunlight. It is a metaphor for being yourself rather than hiding in the shadows. Green stands for nature and everyone’s ties to it. Blue represents serenity, which is defined as a state of being calm, peaceful, and untroubled. Finally, violet stands for spirit, which is the most important of all the colors, as the spirit unique and inalienable.

Other symbols of Pride and safe-spaces have also emerged in the past few years. Organizations like the Human Rights Campaign have trademarked the yellow equal sign with a blue background. This symbol is known in the United States but the Pride Flag remains the prominent international symbol.

Human Rights Campaign. Source: Ron Cogswell, Creative Commons

Progress has been made for the LGBTQ community, but there have been large setbacks as well. During Pride Month last year, 49 lives were taken at Orlando’s Pulse Nightclub in the deadliest mass shooting in modern-US history that took place during Orlando’s Pride celebrations. Sean Kennedy was another hate-crime victim. In 2007, he was leaving a bar in South Carolina when he was attacked for his sexuality and died as a result of it. In 1998, Matthew Shepard made headlines across the nation when he was found beaten, tortured, and left to die while tied to a fence in Wyoming.

The United Nations Universal Declaration of Human Rights (UDHR) sets fundamental human rights to be universally protected. During Stonewall, the Pulse Shooting, and the individual murders, many rights declared by the UHDR were violated:

Article 3: Right to life, liberty, and security of person. The Stonewall Riots happened because queer folk had been attacked by the police without cause, violating their security of person. The Pulse Shooting and the Kennedy and Shepard murders were violations of the right to life.
Article 5: No one shall be subjected to torture or to cruel, inhuman punishment. Shepard was tortured and brutally beaten before he died.
Article 7: All are entitled without any discrimination and equal protection to of the law. In the case of Stonewall, NYPD had not only been attacking the LGBTQ community, they were being denied justice by not having their attackers persecuted.
Article 9: No one shall be subjected to arbitrary arrest. The LGBTQ folk were being arrested for being LGBTQ in New York.
Article 19: Everyone has the right to freedom of opinion and expression. Throughout history and in modern times, the LGBTQ community is targeted simply for existing.

There were many countries that gave same-sex couples the right to marry before the US. The Netherlands, in 2001, became the first country in the world to allow same-sex marriages. Many countries joined the Netherlands, including Canada, Belgium, France, and Ireland to name a few (You can see the timeline of when countries allowed same-sex marriage here). Today, June 30, German Parliament voted to legalize same-sex marriage. That makes 22 countries in the last 16 years allowing same-sex marriages, which is important as it shows that the world is growing to be more accepting of the LGBTQ community. Countries that allow same-sex marriage gives validity to its citizens that identify as LGBTQ and promotes a more accepting environment. According to Forbes, when same-sex marriage is legal, LGBTQ youths are less likely to commit suicide and hate-crimes decrease.

In contrast to the 22 countries that allow and support same-sex marriage, there are 76 countries that have anti-LGBTQ laws in effect today. Last week, Turkish police shot rubber bullets at Pride Parade attendees and proceeded to detain who they could. In Chechnya, reports of a concentration camp for those who identify as homosexual made headlines as more than 100 men were abducted, tortured, and few were killed in a systematic purge of the LGBTQ community.

The world can be a scary place for someone who identifies as LGBTQ. It is imperative that those of us who can remain resilient and visible by not being afraid to show who you are. Showing up at Pride celebrations are easy ways to let the world know that the LGBTQ community exists, and gives comfort to those who cannot “come out”. That is exactly what Pride Month stands for. It is a time for us to unite and show our pride. Pride means strength, unity, and acceptance.

A Peculiar Request: The Right to Life

the beginning of the March for Our Lives. A group of girls holding signs of some of the victims of gun violence — photo by Ajanet Rountree

Paducah, Kentucky.

This is the first school shooting I remember. All these years later, I still remember what I thought once I saw the photos: “How did this happen? Surely this is a random tragedy that will never happen again.” The writing of this blog comes just over five weeks on the memory side of the Marjory Stoneman Douglas High School shooting in Parkland, Florida and on the same day as the Great Mills High School shooting in southern Maryland. The shooting at Heath High School is a distance memory, eclipsed by Columbine High School in Littleton, Colorado, Sandy Hook Elementary in Newton, Connecticut, and Huffman High School in Birmingham, Alabama.

Many conversations and references, in recent weeks, center on the complicated nature of the gun control debate in the United States (US) due to the Parkland shooting and uncharacteristic demands of the teenage survivors. This blog does not directly address those conversations or references. There are many sides to the issue and other blog writers this week gave voice to some of those issues. Therefore, this blog explores the peculiar request of the teenage survivors, which is, seemingly lost among the defense of the Second Amendment.

The right to life.

It seems peculiar that children are demanding adults to protect their lives, to look out for their best interest, specifically when many in the US pride themselves on their pro-life stance. They champion every bill, legislative act, or protest which positions them as the protector of the “rights of the unborn”. As protectors of the unborn, they label women who choose to have abortions and the medical practitioners who perform the abortions as murderers. Some pro-life advocates stand outside Planned Parenthood centers, shouting vile, hurtful words and phrases at patrons and workers. They object to numerous women’s rights issues. All this occurs because of their belief in protecting the innocent, unborn baby who deserves the right to live.

Where are the pro-life advocates joining the protests initiated by the Parkland students who are demanding the protection of their right to life? These children lost their innocence when their classmate murdered their friends and teachers in hallways and classrooms on Valentine’s Day. Many pro-life advocates are standing on the sidelines, protecting their Second Amendment constitutional right to bear arms. Yet, at what point did adults abdicate their responsibility to protect the lives of children to protect their rights to own weapons? Does the “pro-life” label still apply when there is a willful and complicit allegiance to a hobby and lobbying group than to children?

Perhaps a reclassification needs to occur wherein we label pro-birth rather than pro-life.

The Convention on the Rights of the Child (CRC), in accordance with the Universal Declaration of Human Rights (UDHR) asserts, “A child means every human being below the age of eighteen years… [and] in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.” When the best interest of the child is the primary consideration, how has the brutal transformation of schools and universities continued? It seems implausible that for the last 20 years, parents across the US have sent their children to school with hopes and dreams for the future, only to have to bury their 5-18-year-old days later. The Children’s Defense Fund (CDF) reports “children are learning there is no safe place in America.”

a picture of a sign that reads "Human rights not guns: Right to Life" — photo by Ajanet Rountree

When No Place is Safe and Those Who Can/Should Help, Don’t

The US is the ONLY member of the United Nations to not ratified the CRC.

The cliché ‘no parent should have to bury their child’ seems redundant considering needless tragedies of gun violence. Its redundancy comes from the very real reality that pictures and videos from schools, universities, and playgrounds, as well as the rhetorical thoughts and prayers of government officials has yielded minimal results. Unlike natural disasters like tornados and earthquakes, controlling the impacts of gun violence is possible as evidenced in Australia, Great Britain, and Switzerland. Therefore, it is the normalization of violence in the US which continually isolates us from the rest of the world. Data reveals the hypocrisy of the ill-spoken narrative that children are the future of this country. CDF reveals

Children are forced to witness tragic mass shootings that occur with regularity in public spaces including schools, churches, concert venues, community centers, nightclubs and movie theaters.
Since 1963, the number of children and teens killed with guns on American soil was more than three times higher than the number of U.S. soldiers killed by hostiles in wars abroad. Nearly 180,000 children and teens died from guns in the U.S. between 1963 and 2015.

With less than 5% of the global population, American civilians own 310 million guns (35-50%) of the global civilian gun-ownership, whereas the US military and law enforcement possess nearly 4 million. The US spends considerably more on defense than on early childhood and education, than every other country with smaller federal budgets.

Children are not a priority in the US.

Who’s doing the shooting?

Brown et al. analyzed two cases, identified four characteristics, and concluded “school violence is a somewhat distinct form of aggression that should not be viewed through standard lens.” The typical mass shooter is a white male who exacts revenge on those he deems dishonored him in some way. Research identifies this cultural phenomenon as “culture of honor”. In a culture of honor, people favor the death penalty, more tolerant of expressions of aggression as a response to threats/insults, and conflate a high degree of connection with status or reputation. This culture fuels the overall feeling of slight through a lack of interpersonal conflict resolution skills. The culture of honor creates a cultural standard wherein brutality becomes the recommended response to a perceived affront to one’s dignity or reputation; thus, a misguided sense of justice.

This misguided sense of justice positions whites as unapologetic for the behavior of shooters. Mingus and Zopf studied four mass shootings: two with white shooters (Columbine High School and Northern Illinois) and two with non-white shooters (VA Tech and Fort Hood). Using “Racial Formations” by Omi and Winant as a key text on racial projections, Mingus and Zopf assert, “The historical significance of race is important in understanding the way in which race affects any interpretation of shooting rampages.” They find that white privilege allows for the addition of race as a factor when identifying the “abhorrent behavior of non-whites” and the subtraction of race when redirecting “focus away from whites as a distinct population by pathologizing their aberrant behavior”. They conclude that non-whites groups often advocate for themselves as a means of not facing retaliation, even offering an apology in the VA Tech tragedy, whereas being white means never having to say you are sorry.

a picture of a boy holding a sign which reads "books not bullets" during the March for Our Lives — photo taken with permission by Ajanet Rountree

“If they’re old enough to be shot, they’re old enough to have an opinion about being shot”

Reports occur daily of the ‘perceived threat of children’ when confronted by white people who feel a threat to their power or status. These reports extend beyond the scope of school shootings, and the requests to “stop killing us” commenced long before the Parkland shooting. The #NeverAgain movement includes the voices of the seemingly voiceless by including students from Chicago, Newtown, and 11-year-old Naomi Walder of Alexandria, VA. Walder, who highlights the deaths of Black girls forgotten by the media, organized her classmates during the National Walkout Day.

Political satirist and late-show comedy host Trevor Noah challenged the notion leveled by Fox News talking head Tucker Carlson after last week’s student walkout campaign. During a segment, Carlson questioned the validity of students making demands of lawmakers regarding guns by stating, “They’re not citizens; they’re children.” What’s interesting is that children are too young to make demands for gun control but not to find themselves in adult prison or forced into child marriage. Noah responded brilliantly stating, “…if kids are old enough to be shot, they’re old enough to have an opinion about being shot.” When processing the numbers provided by the CDF, it is time someone said something.

7,768 children and teens were killed in the US to gun violence during 2013-2015
113 children under five (5) died from guns in 2016, compared to 65 law enforcement officers killed by guns in the line of duty. Guns were used in criminal acts to kill 62 law enforcement officers while three (3) were killed in gun accidents.
In 2016, 43% of gun deaths were among Black children and teens, although they made up only 14% of all children and teens.
1,335 Black children and teens were killed by guns in 2016, one every 6 hours and 34 minutes.
The gun death rate for Black children and teens was nearly 4x that of White children and teens and more than 8x that of Asian and Pacific Islander children and teens.
Most gun deaths among Black children and teens were by homicide. Most deaths by White children and teens were by suicide.
Guns are more often used to cause harm than in self-protection. A gun in the home makes the likelihood of homicide 3x higher, suicide 3-5x higher, and accidental death 4x higher. For each time a gun in the home injures or kills in self-defense, there are 11 completed and attempted gun suicides, seven criminal assaults and homicides with a gun, and four unintentional shooting deaths or injuries.
More than half of youth who committed suicide with a gun obtained the gun from their home, usually a parent’s gun.

Given the fact adults consistently prove children are not a priority in this country, children have made an opportunity to make themselves a priority.

a picture of sign with names of some of the victims of gun violence — photo by Ajanet Rountree

Today, millions of children and adults domestically and internationally, participated in the #NeverAgain movement by joining the March for Our Lives protest. The campaign is not to initiate a disarmament; however, it is to reinstate the ban on assault rifles like AR-15 used in several mass shootings, including Las Vegas and Orlando. Additional demands include an expansion of background checks and a rise of the minimum age to purchase. At the core of the demands and the purpose of the protest lies a peculiar request for the most important human right: the right to live.

A right to a life without fear and terror.

A right to a life where adults apologize for hurting, neglecting, and not prioritizing children who are reliant upon them.

A right to a life without the trauma of relieving the horrors of running to save myself.

A right to a life that does not include witnessing my friends and teachers die before my eyes.

A right to a life by enjoying the full scope of childhood and adolescence which includes mistakes that should not end life because of a perceived threat

A right to a life because adults believe that I and my future are worth fighting for… just as they do for the unborn.

March for Our Lives is a pro-life movement.

We Beretta Do Something: Gun Violence, Public Health & Their Discontents

doctor-gun. Source: spacecoastdaily.com, Creative Commons

Continuing the Institute for Human Rights’ blog series on gun violence, this contribution illuminates a public health lens, offering an evidence-based analysis and pragmatic solutions to the U.S. gun violence epidemic.

Following the February mass shooting at Marjory Stoneman Douglas High School (Parkland, FL) that resulted in 17 fatalities, mainstream fervor on U.S. gun violence has, once again, returned. Parkland Students have utilized their recent tragedy as a platform to demand an end to gun violence and mass shootings, stressing why their lives matter. According to Amnesty International, the world’s largest grassroots human rights organization, U.S. gun violence is a human rights crisis. Human rights are protected and enforced by international and national policy, and with the U.S. government marshalling many of these treaties and laws, it is, too, culpable of upholding such rights.

The nation’s leading science-based voice for the public health profession, the American Public Health Association (APHA), claims gun violence is one of the leading causes of premature death in the U.S., killing over 38,000 people and injuring nearly 85,000 annually. Gun violence can not only affect people of all backgrounds but disproportionately impacts young adults, men and racial/ethnic minority groups. Recently, Parkland Students teamed with students in Chicago to address inner-city gun violence, a phenomenon commonly overlooked by the media while addressing its threat on young lives. Though most gun violence is not an agent to mass shootings, the APHA claims, in 2017, there were 346 mass shootings in the U.S., killing 437 as well as injuring 1,802.

Furthermore, the American Medical Association (AMA), who leads innovation for improving the U.S. health care system, labeled gun violence “A Public Health Crisis”. At their 2016 Annual Meeting of House Delegates, the AMA actively lobbied Congress to overturn legislation that averts the Centers for Disease Control and Prevention (CDC) from researching gun violence. The CDC is one of the leading institutions of the Department of Health Human Services (DHHS), working 24/7 to protect Americans from foreign and native health threats, whether they be chronic, acute, curable or preventable, accidental or intentional. Ultimately, the CDC protects U.S. national security and critical science is imperative to addressing health threats.

According to the Union of Concerned Scientists, a 1993 CDC-funded study published by the New England Journal of Medicine found that firearms in the home increased the risk of homicide in the household, as opposed to home protection. This galvanized the National Rifle Association (NRA), a major force in U.S. gun rights and education, to campaign against the CDC and its “anti-gun propaganda”.

In response to this 1993 publication and the NRA’s support, Congress in 1996 passed an appropriations bill known as the Dickey Amendment, named after former Arkansas congressman and NRA member Jay Dickey, which states, “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” Almost two decades and thousands of tragedies later, Dickey renounced these restrictions in 2015 by claiming, “Research could have been continued on gun violence without infringing on the rights of gun owners, in the same fashion that the highway industry continued research without eliminating the automobile.” Despite this humility, the Dickey Amendment persists, curtailing efforts to address gun violence in the U.S.

a picture of a Beretta handgun — Beretta 9000S. Source: James Case, Creative Commons

In the U.S., a common method to circumvent the argument that guns extrapolate acts of violence is to scapegoat people with mental illness. The American Psychiatric Association (APA), the leading voice and conscience of modern psychiatry in the U.S., recently published a book on gun violence and mental health. Specifically, they address the topic of mass shootings and mental illness.

Some popular misperceptions are:

Mass shootings by people with serious mental illness represent the most significant relationship between gun violence and mental illness.
People with serious mental illness should be considered dangerous.
Mass shooting will be effectively prevented with gun laws focusing on people with mental illness.
Gun laws focusing on people with mental illness, or a psychiatric diagnosis, are reasonable, even if they perpetuate current mental illness stigma.

On the other hand, it is evidence-based that:

Mass shootings by people with serious mental illness represent less than 1% of all annual gun-related homicides.
People with serious mental illness contribute to an overall 3% of violent crimes. An even smaller percentage of them are found to involve firearms.
Laws for reducing gun violence that focus on the previously mentioned 3% will be extremely low yield, ineffective, and wasteful of resources.
The myth that mental illness leads to violence is perpetuated by gun restriction laws focusing on people with mental illness, as well as the misunderstanding that gun violence and mental illness are strongly linked.

However, a significant caveat related to mental illness and gun violence is suicide. The American Foundation for Suicide Prevention (AFSP), who funds research and offers education on suicide, claims depression is one of the most treatable psychiatric illnesses yet is seen in over 50% of people who die by suicide. Suicide lays in the shadow of repetitive, media-frenzied mass shootings, while representing nearly two-thirds of gun-related deaths in the U.S. Harvard University T.H. Chan School of Public Health indicate a number of factors that define lethality of suicide methods, including inherent deadliness, ease of use, accessibility, ability to abort mid-attempt and acceptability — all attributable to gun ownership and usage, specifically in the U.S. To strengthen civil discourse on gun-related deaths and injuries, we must uphold a national platform for suicide prevention, too. If you or a loved one is experiencing a suicidal crisis or emotional distress, the National Suicide Prevention Lifeline is 1-800-273-8255 (available 24/7).

Last year, researchers at Johns Hopkins University School of Medicine analyzed data from the Nationwide Emergency Department (ER) sample between 2006-2014 and concluded the U.S. accumulates an annual $2.8 billion in hospitals bills from gunshot wounds, with an average ER cost of $5,254 and approximately $96,000 in follow up care per patient. This study was limited because data was only used for gunshot victims who arrived at the hospital alive; people who did not seek medical treatment or were dead on arrival were not counted. Furthermore, after accounting for lost earnings, rehabilitative treatment, security costs, investigations, funerals, etc., a 2015 Mother Jones report estimated gun violence cost Americans $229 billion annually.

The APHA insists gun violence is not inevitable but preventable, and suggests core public health activities are capable of interrupting the transmission of gun violence. Notable ways to curb gun violence are:

Better Surveillance
- Increased congressional funding of The National Violent Death Reporting System which is currently employed in 40 U.S. states, D.C. and Puerto Rico.
More Research
- Lifting restrictions on federal funding for research on gun violence. There is barely any credible evidence on the effect of right-to-carry laws.
Common-Sense Gun Policies
- Criminal background check on all firearms purchases. This includes gun show and internet purchases.
Expanded Access to Mental Health Services
- Funding for mental health services has declined, so increased financial support for the Substance Abuse and Mental Health Services Administration (SAMHSA) is advised.
Resources for School and Community-Based Prevention
- Intervention and preparedness programming to prevent gun violence and other emergencies in communities, namely schools.
Gun Safety Technology
- Innovation that prevents illegitimate gun access and misuse such as unintentional injuries.

If the above prescriptions are not followed, the tragedies will likely continue. So, it is imperative we support leaders who will encourage gun policy that protects public health and our right to life. Tomorrow, March 24, 2018, people across the world will March For Our Lives, demanding the lives of kids and families, amidst the controversy circling around gun violence, become prioritized.

A march for our lives, your life and mine is exactly what the doctor ordered.

The Transgender Military Ban, Part 2: Costs to the American Transgender Community

A bathroom sign titled "All Gender" — Asheville’s response to NC Bathroom Bill. Source: Bradley Griffin, Creative Commons.

On July 26^th, 2017 President Donald J. Trump tweeted the following:

“After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow… Transgender individuals to serve in any capacity in the U. S. Military. Our military must be focused on decisive and overwhelming… victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you”

The Real Cost to Transgender Americans

Transgender individuals, many of whom already face daily harassment and discrimination for their gender identity, have been shown to actively avoid situations where hostile confrontations may arise. In 2016, after a political storm erupted out of North Carolina and the then-governor Pat McCrory’s “Bathroom Bill”, a landmark study on the lives of 27,715 transgender persons documented several startling changes that occurred in the lives of transgender persons. These include:

59% of transgender persons avoiding bathrooms for feared confrontations
12% report being harassed, attacked, or sexually assaulted
31% avoiding eating or drinking to avoid needing to use public restrooms
8% contracting a kidney or urinary tract infection as a potential consequence for avoiding the use of public restrooms

Similar studies also document the prolonged and repeated stress endured by transgender individuals, when using public restrooms, after the “Bathroom Bill” was proposed. Situations in which their minority status is negatively highlighted or emphasized, such as the use of public restrooms, are loaded events for transgender individuals. Until recently, the link between a culture of antagonism towards issues related to transgender individuals and the subjective experiences of these individuals themselves has been suspected but unsupported. A study published earlier this year in the Journal of Abnormal Psychology examined the gravest mental health crisis experienced by transgender persons: suicide.

Transgender individuals, as compared to the general public, are 14 times more likely to think about committing suicide and 22 times more likely to attempt suicide. This horrifying trend holds in countries outside of the United States, and these rates may even be higher in transgender adolescents. With this new data and analysis, the role of culture, across 2 different theoretical models, was shown to significantly impact the rate of suicide ideation in transgender individuals. Suicide ideation was significantly predicted by factors such as victimization (specific attacks on an individual for their status as transgender), rejection (social reluctance to engage with transgender individuals), and non-affirmation (the active reminding of a transgender individual their gender identity is not accepted or validated). To restate the findings, transgender individuals were more likely to seriously contemplate suicide, or wantonly envision a future in which they are not alive, if surrounded by a culture characterized by isolation, discrimination, and outright antagonism. An important caveat remains: researchers will never be able to interview transgender individuals who have completed the act of suicide. The ‘edge point’, or the final motive impelling a transgender individual to successfully end their own life, can be hinted at but will never be known with absolute certainty. However, combining previous research on the statistical likelihood of suicide and suicidal ideation in transgender individuals, coupled with the recently supported theory that culture is a major implicator in the suicide risk of transgender individuals, presents the concerned public with startling information. For these victimized individuals, a culture of transphobia can exacerbate a predisposition for suicide, potentially resulting in a public health crisis with deadly results.

a spray painted sign of Trans Lives Matter — Source: Dimitra Linardou, Creative Commons

Culture, according to Riane Eisler, is in constant flux. People choose both their internal response to the forces of culture around them and their externally exertion of control over culture in future interactions with others. According to Eisler’s Cultural Transformation Theory, a culture of transphobia (the ignorance, fear, or outright hatred of transgender individuals) can change to a culture of empathy, partnership, and mutual understanding. Likewise, a culture of tentative acceptance can be quickly reversed to one of arbitrary discrimination and empowered domination. One way a pro-social Eislierian cultural transformation for transgender persons can occur is through the creation, maintenance, and protection of human rights for transgender individuals (Eisler, 1988). In the United States, transgender rights have a high degree on variance, mostly along state or jurisdiction lines (a graph displaying specific issues related to transgender rights in the US can be found here). The scant federal rulings on the rights of transgender persons have involved only a few aspects of life for transgender persons, including discrimination in the workplace, marriage equality, and conversion therapy. The rights of trans persons are still in flux, and the Trump Administration may indeed roll back these protections as their time in governance continues. Rollbacks of trans rights might, as is supported by Testa et al.’s and the National Center for Transgender Equality’s research, create a public health crisis for transgender persons. Creating a culture accepting of and empathic to the needs of transgender persons must include comprehensive human rights legislation protecting this vulnerable group without fear of retraction from a hostile administration, such as the Trump administration.

President Trump, under the guise of “medical costs” and unit “disruption”, attempted to used his public platform to instill a culture of blatant disregard for the patriotism, self-sacrifice, and protection of freedom offered by transgender persons who volunteered, volunteer, and may yet volunteer to serve in the United States Armed Forces. The costs he associated with transgender persons serving in the military are non-issues, and a sober analysis of his proposed logic illuminates a stunning disconnect from the actual militaristic consequences of allowing transgender persons to serve in the US Armed Forces. The literature, including both personal and academic accounts, reveals a population within America severely prone to self-harm, suicidal thoughts, and suicide attempts in the aftermath of public controversies regarding a fundamental part of their very identity. The oppression of the transgender community has been shown to have far-reaching and oftentimes permanent consequences for trans persons- such as suicide. The cost to the trans community from attacks such as these far outweigh the illusory costs to the Trump Administration in allowing trans persons to live a life unencumbered by blatant discrimination.

If you or someone you know is contemplating suicide or self-harm, here are resources to contact:

National Suicide Prevention Lifeline (press 1 if you are a US military veteran in crisis): 1-800-273-8255

Trans Lifeline: 877-565-8860

The Trevor Project (youth service): 1-866-488-7386

GLBT National Help Hotline: 1-888-843-4564

Call 911 if you believe there is an immediate threat to your and / or someone else’s physical safety and wellbeing.

References

Eisler, R. (1988). The Chalice and the Blade. San Fransico: Harper.