Journal Club: What Keeps Us Alive
A 2015 paper investigates what it is that motivates trans people to stay alive and keep going.
by Veronica Esposito
“The night that I had decided to kill myself, I thought of how much it would hurt my mom. So I decided to hang on for another day. That turned into weeks, then months, then years, and during that time my life improved dramatically and I have never contemplated suicide since.”
These are the words of one out of 133 trans individuals surveyed for the aptly named 2015 paper, “‘Without This, I Would for Sure Already Be Dead’: A Qualitative Inquiry Regarding Suicide Protective Factors Among Trans Adults.” In this paper, researcher Chérie Moody and colleagues set out to better identify the unique resilience factors that help trans people resist the urge to end their lives. It offers a rare intimate glimpse into the way that trans people survive on a daily basis in a world that is often hostile to their existence.
Suicide is a significant challenge within the trans community—Moody reported that the prevalence of suicide attempts ranges from 20 to 53% among trans people, compared to 1.9 to 8.7% of U.S. adults. This extremely elevated rate is largely the result of minority stress, which Moody and colleagues define as follows: “short- and long-term stress as a result of their trans identities in a generally transphobic society.” Suicidality is also the result of untreated gender dysphoria, as studies generally show a decrease in suicidal behavior following the administration of gender-affirming care.
In their paper, Moody and colleagues theorized that if there are factors unique to trans people that increase suicide risk, there should also be unique protective factors within the community. To find out what those were, they invited 133 trans individuals to participate in an online interview on overcoming suicidality, where they asked open-ended questions such as, “You have indicated that you have had a plan to end your life at least once but did not act on those thoughts. Please express why you think you’ve never acted on your thoughts of ending your life.” Individuals were recruited via LGBTQ+ and transgender listservs throughout Canada.
The answers provided a diverse and emotionally rich view into the realities of trans survival and resilience. One respondent shared what a huge difference it made to have just one loving, accepting person in their life: “I was very intent on ending my life as I entered my 20s. I tried very seriously twice. . . . Then I found someone I could talk to about my gender problem, and she accepted me, with all my defects. I married this person . . . and we have lived a loving relationship with each other for more than 40 years now, and I will likely continue to be blessed with her company for the remainder of our lives, even while now living life as her female partner.”
Another respondent shared the huge difference that came with understanding their trans identity and coming to terms with the need for transition: “I had been depressed most of my life but was only diagnosed 12 years ago. After much medication, which did not help, I came to realize that I was trans, but did not know where I was on the spectrum. After 3 years of struggling with my gender identity and after a suicide attempt, I realized I needed to transition in order to save my life.”
Altogether, Moody et al. grouped the interview responses into five categories that summarized trans resilience: transition-related factors, individual difference factors, gender-identity related factors, social support, and reasons for living. The below flow chart gives a sense of the various forms of resilience they categorized.
This research demonstrated that the high rates of suicidality in the trans community come from clearly identifiable sources and can be ameliorated with concrete, practical solutions. Steps such as building friendships, attending support groups, transitioning (or even having hope of transition), acting as a role model or advocate for others, developing an optimistic outlook, or developing coping and problem-solving skills can all reduce suicidal behavior among trans people.
It is important to note that, while Moody et al. showed that the ability to transition was an important form of resilience for many trans people, merely having the hope of transitioning one day was protective in and of itself. For instance, one respondent indicated that simply knowing that there were solutions to depression and suicidality made a world of difference. “As a young person with no clear sense of what was so wrong, depression/suicidality/despair/self-hatred could hit hard. Grasping that the issue was gender identity and that something could be done about that has been transformative.”
Another respondent spoke directly to the importance of hope in their life: “I only experienced brief suicidal ideation because despite my problems and stress, I continued to hope that one day I would be able to live in the world without the body parts that I wanted to get rid of.”
Such sentiments are of great importance currently, as policies that are being enacted to make transition more difficult to access are expressly designed to induce hopelessness among the trans community. This research indicates that hope itself can help sustain trans lives until such time that transition can be pursued.
Respondents also spoke to the importance of developing an optimistic outlook in spite of the inherent oppression that trans people must live with. One respondent connected that optimism to taking action to make the world a better place: “I’ve always been optimistic about the future, so I’ve always had something to look forward to. I’ve also always desired to leave the world a better place than I came into it.”
Another struck a similar note, acknowledging that if they are dead they will have no power to improve the lives of other trans people:
My GI [gender identity] is the reason that I experience such oppression and social marginalization. So it’s mostly the reason that I think about suicide. But knowing that dead trans folk cannot change the world keeps me from doing it. That and knowing that, with the amount of privilege I have, I would do my trans brethren a great disservice to end my life and not exercise my access to resources for social change.
Respondents also spoke to things like the importance of self-acceptance in trans resilience: “I was ashamed of myself and hated myself for most of my life until I understood I was not alone in the world and until I learned I was normal within the diversity of life.” One simply indicated that suicidality was a distraction from more compelling parts of life: “Suicidal ideation does happen, and there’s nothing I can do about that, but I need not dwell on it. It’s boring.”
Moody et al. made a number of recommendations that those outside the community can take to help address the outsized number of trans people attempting suicide. These include:
Help trans people to better understand their gender identities
Recognize that internalized transphobia is in part due to societal transphobia, and thus encourage helping reduce transphobia by being more understanding and accepting of trans identities
Increase access to means for making social and medical transitions
Such steps are increasingly important as governmental and other entities enact laws and policies meant to make the forms of resilience documented by Moody et al. harder to reach. Given current realities, it is incumbent upon mutual aid groups, friends and family of trans people, mental health providers, and others to advocate for and support trans individuals whenever possible.
Trans people currently experiencing suicidal ideation are encouraged to use the framework developed by Moody et al. to better understand their own resilience factors—it can be helpful to fill in the flow chart provided above with their own forms of resilience, or to ask other trans people about how they resist depression, demoralization, or suicidal behaviors. With the possibility that 2025 will be a historic year in state-sanctioned trans oppression in the United States, it is crucial to meet the moment with equally historic forms of trans resilience and support.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.