Case Study For Discussion Of Psychosocial Determinants During The Pandemic

One of the starkest images of suffering due to the COVID-19 pandemic has been that of the
migrant worker heading back, even on foot, towards the idea of a safe, secure, familiar
village-home. However for many young people for whom home has been a site of violence at
worst and invalidation at best, being driven towards the familial home during the pandemic
has been nothing short of a nightmare.
Anita is a 24 year old transwoman, who was working in the entertainment industry in
Mumbai and studying fashion designing part time before the pandemic hit. She was living in
a rented apartment with two flatmates in a suburb of Mumbai. With the lockdown, dwindling
of work and shutting down of college, her flatmates left the city as soon as they managed to
get a train pass. Anita tried to hold on for a few more weeks but could not make enough
money to be able to afford the rent on her own. She has a few friends in the city but with
restrictions on mobility and with housing societies having the ‘no visitors’ rule, she was not
able to get much help from them either. Anita had to finally take a train and go back to her
family home in Telangana. At home, Anita has to live as Raju. She had to get a hair cut
before going home. She tries to wear unisex clothes such as kurta-pyjama but is taunted about
her attire, her mannerisms, her interests and ways of being. Her brother and his friends mock
her, call her names and tease her. All of this is humiliating for Anita and not being able to
live in her own gender is suffocating and increases her gender dysphoria. When the pain is
too much, Anita cuts herself on her arm and legs. This makes her numb and stops the pain for
the time being.
Anita’s family is aware of her gender identity. Since her childhood, her father, mother,
teachers in school and peers have tried many ways to correct Anita’s gender non-conformity
and get her to be the man that she never was. A year ago, Anita told her parents about her
plans to undergo medical transition and live as a woman in Mumbai and that she would start
her transition as soon as she had put aside enough money for it. Despite this, Anita’s parents
believe that the city has spoiled their son and that once ‘he’ gets married and has a child all
will be well. They would like to use this time that ‘Raju’ is at home to find him a match.

Questions for discussion:

1. What is wrong with Anita?

2. What are some of the causes of her distress?

Relevant terms for discussion:

a) Cis-gender: All of us, as infants are assigned a gender at birth after looking at the
external genitalia of the infant. Those of us who grow up to identify with the gender
we were assigned at birth are cis-gender persons or cis-man and cis-woman
b) Transgender: All those of us for whom there is incongruence between the gender
assigned to us at birth and the gender that we identify with are transgender persons.
c) Transman: A person who was assigned a female gender at birth but who self-
identifies as a man is a transman or just man. Transmen may or may not undergo
medical transition to match their bodies with their identified gender. Transmen would
usually use the gender pronoun ‘He’.
d) Transwoman: A person who was assigned a male gender at birth but who self-
identifies as a woman is a transwoman or just woman. Transwomen may or may not
undergo medical transition to match their bodies with their identified gender.
Transwomen would usually use the gender pronoun ‘She’.
e) Non-binary/ gender queer persons: There may be transgender persons who do not
identify with the gender assigned to them at birth but do not necessarily identify with
the opposite gender either. They may see themselves as outside the gender binary,
may describe their gender as fluid. Many non-binary persons may use the gender
pronoun ‘they/ them’. However it is always best to ask people what pronoun they use
for themselves.
f) Gender Dysphoria: Refers to the distress that may accompany the incongruence
between one's experienced or expressed gender and one's assigned gender.
DSM-V has a diagnosis of gender dysphoria. The ICD-11 has a diagnosis of gender
incongruence. One of these diagnosis by a mental health professional is currently
necessary for a trans person to undergo medical transition through what are known as
Gender Affirmative Therapies

Gender Dysphoria in Adolescents and Adults 302.85 (DSM V)

A. A marked incongruence between one’s experienced/ expressed gender and assigned

gender, of at least 6 months’ duration

B. The condition is associated with clinically significant distress or impairment in social,

occupational or other important areas of functioning

g) Medical transition: Many transgender persons may wish to undergo medical

transition to make their bodies congruent to the gender that they identify with.
Medical transition may include hormonal treatments and surgical interventions.
Historically psy professionals have attempted psychotherapy as a way to make the
mind of a transgender person congruent with their bodies (instead of the other way
round i.e. help the transgender person accept the gender they were assigned at birth).
Today these are termed as conversion treatments and are globally seen as unethical
and ineffective based on empirical evidence.
h) Dead name: Refers to the birth name of a trans person that they may want to
dissociate from in order to live in their gender of identification as opposed to gender
assigned at birth. Deadnaming can be a cause of distress and invalidation for a trans
person
i) Misgendering: Refusing to acknowledge the self-identified gender of a transgender
person and continuing to use the person’s deadname and referring to the person in
every possible way by their birth-assigned gender instead of their self-identified
gender
Note: The point of using a case of a transwoman during the pandemic is to highlight the not
so visible groups/ communities and ways in which their mental health and life has been
impacted by the pandemic. The reference to the migrant worker in the first paragraph is to
only juxtapose Anita’s reality vis-à-vis the most visible image of suffering and systemic
failure embodied by the migrant worker.