Alex Ker on being transgender and having anorexia.
Photo: Alex Ker
I spent the summer of 2015 playing the part of an anorexic girl’s stomach in a show about eating disorders. Her stomach was shriveled and starving. So was mine, although I didn’t know it at the time.
Back then, I thought there was no way I would ever develop an eating disorder. I wasn’t female. I loved food too much. I didn’t fit the role of a skinny white teenage girl who succumbed to the images in magazines.
As a person of trans experience, I now understand where my oblivion and deep-rooted denial came from: there is a significant lack of inclusive representation of identities in our discussions about eating disorders. An eating disorder is not about hating food or a sole desire to be thin. It is a mental illness with the highest mortality rate, an attempt to control the uncontrollable. Illness does not discriminate, and people of all genders develop eating disorders for different reasons.
I share my experiences of living with anorexia and gender dysphoria in the hope that people going through similar challenges realise that their experiences are just as valid as those of people who are visible.
Like eating disorders, everyone experiences gender dysphoria differently. For me, dysphoria and anorexia work in shifts; when one sleeps, the other keeps a watchful eye open. Some days it can feel like the only way to escape dysphoria is to fall into the eating disorder’s jaws.
There was a point at which anorexia had suppressed my body’s feminine features so much that for the first time since my childhood, I saw my body as a genderless vessel. I finally felt in control of a body that I previously had no ownership of. That’s what it felt like to me, at least.
In reality, I had lost control of my actions at the cost of my health. Yet the comfort of my shapeless body relieved my mind from dysphoria. I continued to run away from feeling anything for a long time, until I ended up in a hospital bed wondering why I was surrounded by a sea of frail bodies.
Here, I was forced to lend my trust to family members, friends and health professionals around me. They told me recovery would mean moving away from the fine line that lies between life and death, but I wanted to stay in the nest my eating disorder had created for me.
A small part of me, however, knew that through recovering from anorexia, I would gain back the freedom it had taken from me. It would also mean dealing with gender dysphoria again, and that was a daunting thought.
The world talks about eating disorders in an incredibly gendered way. The media are quick to blame privilege and feminine standards of beauty for the apparent eating disorder epidemic, and most recovery resources are targeted at cisgender women. In a way, this makes sense as most people affected by eating disorders do identify as female.
However, it would be wrong to assume that eating disorders are exclusively a women’s issue, let alone to assume that people whose bodies were assigned ‘female’ at birth identify as women.
Despite having a long way to go in tackling the stigma surrounding masculinity and mental illness, it is also promising to see that visibility is growing around cisgender males with eating disorders. The needs of cisgender females, and now increasingly more males, are largely being addressed by healthcare providers and support services. But for people whose identities transcend the gender binary, it can be hard to be taken seriously by those who we turn to for help.
Acknowledging our identity can be difficult when we do not see ourselves reflected in everyday life, which is the case for many marginalised groups. If the intersections of my gender identity and mental illness were represented in media or taught about in medical school, I believe it would have been easier for me to accept my situation more readily.
I know from the little research that has been done on trans identities and eating disorders, and from personally speaking with people in the LGBTQIA+ community, that gender-variant people make up a disproportionate amount of the population affected by eating disorders and many other mental illnesses.
I also know of many people in our community who regularly encounter health professionals who are unwilling to listen to or learn from our stories. If our conversations around eating disorders challenged the stigma around transgender identities, health professionals may also feel more confident in talking about these issues with their clients. Many medical experts are hesitant to help because they are afraid to talk about trans people with eating disorders.
At a recent hui, I spoke to a youth worker who was working with a young transgender person struggling with a restrictive eating disorder. Despite being critically malnourished, he was denied help from the local eating disorder service because health professionals did not understand his gender identity.
Because of cases like this, people fear seeking help because they know there is a high chance they will be misunderstood or discriminated against. Gender-diverse people need to be able to enter health and support services knowing that we will not have our experiences undermined.
Despite the anticipated return of some gender dysphoria that I cannot control, wonderful things have happened since starting recovery that my brain wouldn’t have allowed me to believe when I was at my lowest point. My relationships with other people have grown stronger. I am gaining autonomy over my body and can now imagine a future beyond thinking about the anxieties of my next meal. I am in awe of the miracles my body performs every day without me even being aware that they are happening.
The fact that gender-diverse people, including myself, inhabit so many types of bodies, should be embraced much more than it currently is. My body is a transgender body which informs my morals, academic interests and sense of self. Dysphoria still washes over my brain some days, but I now experience it with the wisdom that it will pass. After all, permanence is an illusion. Our minds and bodies are ever-changing landscapes that deserve to heal.
I wonder what would have been different if I had known that, acting as a grumpy stomach in the summer of 2015, I was worthy of help. If transgender people with eating disorders were visible in society, maybe I would have not denied my situation for so long, and others around me would have had the knowledge to make the connection between my dysphoria and mental illness before my situation became acute.
As individuals sharing our experiences and as health professionals working alongside gender-diverse people, we are collectively responsible for creating safe and inclusive environments for people who are relentlessly pushed to the boundaries. Instead of making gendered assumptions about mental illness, let’s become curious of difference.
This article originally appeared in the second issue of Atlas - a journal advocating for greater creativity and critical thought in medicine.