Welcome to this episode of the Thought Broadcast, the trainee podcast uh produced by Australasian Psychiatry. Today's a special episode. We are meeting today at Congress 2022 in Sydney. Congress has been special for many reasons, but one important feature of Congress has been the visibility and presence of many gender-diverse trainees within the college, trainees and fellows, I should say. Today we're here to talk about that increased visibility with two special guests in Zoe Christensen, an RNZCP trainee from Auckland, who is a trans trainee going by she, her pronouns, and Theo McTeague, who is a prospective trainee who works around the traps in New South Wales and goes by pronouns they, them. My name is Oliver Robertson. I'm the trainee editor of Australasian Psychiatry, and I go by uh he, him pronouns, and I'll introduce my co-host Michael Waiteman.

Hi, Ollie. Uh, yeah, pleased to be here, and I also use he, him as my pronouns.

And uh welcome, Zoe, uh, to the podcast today. How are you?

Yeah, hi guys, thanks for having us. I'm Sarry Christensen. Uh, I use the pronouns she, her, and I, which is a gender-neutral Tadeo pronoun as well. I think it's really great to see that we've got increased visibility at Congress. I think this is the first time that trans people have been visible at a psychiatric congress anywhere in the world. And I base this on I'm a member of the Transgender Professional Association of Transgender Health, who are 1,300 trans professionals working in this field. And their collective understanding is that this is the case. And I think it's really well-timed because yesterday happens to have been Idahoit International Day Against Homophobia, Biphobia, and Transphobia. And it shows that we're starting to shift as a college, which is really nice. Maybe I'll hand over to you, Fio.

Uh, good morning. Thanks for having me. It's great to be here and to be welcome to share my experience. Very glad to be a part of the Congress this year, and um particularly so to be witnessing the increasing visibility of um trans, non-binary, and gender-diverse people within the college.

Fantastic. Thank you so much for joining us. I think in the past number of episodes on the Thought Broadcast, we've talked a lot about scholarly projects and tried to understand the stories behind uh trainee research. Zoe, I know you've done quite a lot of research in your own right, but today what we're really interested in is providing that sort of peer-to-peer supervision on your experiences as a trans person in training. How did your training journey start and what was that like for you?

My training journey was a bit of an odd one in that I transitioned immediately prior to entering medical school. I'd previously done another degree and I'd gone traveling to kind of find my sense of self, I guess, would be the way people would phrase it. And I realized at that time, we're talking probably 15 years ago, now that a medical school probably wouldn't let me in if they realized I was trans. So I interviewed prior to transition, and prior to attending medical school, I transitioned. And then attended medical school straight off the back of that. So it was a bit of a challenging time and it's been turbulent along the way. And you know, you're well aware of whispers and rumors going on in the background, but I think there's a there's an analogy about if you let them see you bleed, then that's when the sharks start to circle. Which seems relevant in New South Wales.

I think Theo, just before we started recording, you were mentioning a similar experience because you're not yet on the training program, um, but looking to become a psychiatrist. And you had mentioned that you know coming on the show today and sort of uh I suppose coming out in a more public setting was uh something that was causing you some anxiety relating to whether or not that might affect your applications for training and things like that. Would you care to comment on that a bit further?

Yeah, absolutely. So maybe somewhat similarly to Zoe, my sort of awareness and um questioning around gender started in my early medical school years, in fact, um just prior to medical school. But through that process, I was quite aware of the way in which that gender nonconformity might affect my academic and then subsequently my sort of career prospects, um just being seen as other and um at times you know being essentially psychopathologized by the idea of transness as a mental illness, or for example, gender dysphoria still being classified as a mental illness in the DSM 5. So throughout that process of medical school, I you know tried to really adopt and portray myself through a more feminine lens as someone who was assigned female at birth. It didn't feel as though there was a space to safely explore my gender identity and expression within the professional context. So it's only really been since the end of my residency uh that I've been able to go forth with that exploration as a PGY3, or being in sort of stage PGY three of my medical journey. I've decided to take some time to locum, uh, which has allowed me time between jobs as well as sort of new opportunities of introducing myself in unfamiliar spaces. This is in fact the first time within a professional context that I have referred to myself as Theo. So this is a very new part of my journey, and the first time that I've been really out about my experience as a non-binary person. So it is a bit anxiety-provoking, not because I feel uncomfortable within my own gender experience or expression, but more so because of the way in which that, particularly in the context of psychiatry historically and still to this day, um, has been pathologized.

But I've I guess what you're potentially saying is something which doesn't actually get any different as you get further through transition, which is that everything is always a negotiation between your own sense of safety and your own sense of self. And that along the way you end up having to give up parts of yourself or hide parts of yourself. And a lot of trans people will go through periods where they become what we call stealth in the community, which is effectively they try and pass assist people. I've done that for phases. But it's this idea of working out whether I guess it's a risk benefit, much like any treatment. It's this case of working out does the benefit of me being visible to myself, to my own sense of self-identity, to my own sense of dysphoria, depression, minority stress, minority stigma is that more or less important to me in that moment than the risk that comes of losing my job, of experiencing discrimination, of experiencing violence. I've had rocks thrown at me, I've had verbal threats all sorts over the years. And I've had people try to manoeuvre me out of out of this job, out of this work. It's a very real risk and it's ongoing. And I think it's something that we actually have to be really honest about, that it is a problem. But because of that, it's not quite so straightforward as oh, you're trans, you can be honest about this experience, you can be open about it. Because with that comes risk. And that's something we need to change. It's something that as a group, it's it's why I I wanted to stand up, is because I know that we've got lots of newer trainees coming through, people like FIO, who I don't want that to be the case for them. And when I talk to people in the college, when I'm visible, when I'm open about that, my sense is that the vast majority of people it isn't existing because people are being malicious. It's because they're just unaware of it. And they're unaware of what we're perpetuating. And once they realise it, they're as angry and as upset about it as I am. And they also feel that it's our duty, it's our job to change this for you know people coming through next, people like Theo. You know, a bit like um I know you guys had Sky on a couple of weeks ago talking about trainee issues, it's very similar. It's instead of you know letting the problems perpetuate, it's taking the time to solve them for the next people.

Theo, like you're wanting to enter the training program, what would you like it to look like, feel like, be like for yourself and other people in your position?

I guess ideally, you know, sort of starting right from the very beginning of um something like putting forward, you know, my application and and my CV to the college, having a sense of freedom and acceptance in and sort of acknowledgement and validation of my identity as a non-binary person, that would be you know really a great place to start, to not feel as though that was something that needed to be hidden or to be silenced. Also, not necessarily sort of particularly accentuated, that it just is, and that perhaps there's something that in that identity and in that experience I have to offer in my practice um, you know, as a trainee and then as a psychiatrist, a degree of um potential empathy for our um trans, non-binary, gender diverse patients, and an understanding of what it means to be othered by society, which I think is something that many of um the people that we look after have experienced and and continue to experience as a result of their mental illness diagnoses. Sort of hospitals more broadly, as well as society generally, uh, could be better educated on using people's um preferred names, using people's appropriate pronouns, and perhaps also acknowledging the impact of what it means to live as a trans, non-binary, or gender-diverse person today, and how there might be healthcare needs um to be attended to, such as medical appointments or perhaps even periods of time that are uh required off, say in preparation for or following um surgery for people that wish to partake in a um surgical transition. And really facilitating that and allowing space for people to go through those processes uh would be wonderful.

I think it's good to note that there's some roots of change or little sprouts coming through. So one of the things that we noticed about this conference is that the venue, it's probably the first time at a college event that there's been non-gendered bathrooms available. And whether that was intentional or not, I I don't know. But regardless, it's a really good sign. And, you know, it really needs to be a precedent that we maintain going forwards in future events. I hope to see it in Puff.

I suppose things that were coming up in my head, and they might be way off, they might not have even been issues, but like I remember when I was in medical school, you know, we did like surface anatomy classes and all these things that we were doing, and there's lots of very gendered processes where women and men were split, and we did all these things, practicing intimate examinations and all this stuff that was kind of assumed that well, just because you're with the boys, it was fine, and because you're with the girls, it was fine, and you didn't have to worry. And then, you know, at the time I I didn't know a lot about gender diversity and I didn't think about it very much. And I'm just wondering what that's like from your experience. Is that sort of an obvious thing, or is that something that did actually cause distress? Like I'm kind of just curious.

So, yeah, you may be better as a non-binary person, you might actually be better placed to answer this than me, because I'm well, technically non-binary, but more binary.

Yeah, um definitely have noticed very gendered language um over the course of my medical training. Sort of very uh anatomically based language in various areas of medicine. If we look at, for example, in um obstetrics, often the patients are uh referred to simply as mum, which fails to acknowledge the way that um trans people um who don't identify as women can still experience pregnancy and may really wish to be acknowledged in in their own sense of self, whether that's you know simply as a parent or as a father, um and moving away from using language such as breastfeeding to you know to other alternatives and each individual person will have their preference as to um what that is. Yeah, then you know, looking at things even as simple as uh sort of the questionnaires that people might fill out, patients might fill out, for example, on arrival in a medical setting where they're asked to describe their gender identity, making sure that we allow for space for people's pronouns to also be expressed because that encourages us to be thinking about that on a broader level. What we can be doing for our patients is very much mirrors what we can do for the trainees and you know, people coming through medical school and beyond in terms of validating their gender identities and experience. I think also throughout my medical school, we had one lecture that was delivered on trans healthcare, and it really was insufficient. I mean, as someone who's been living sort of socially within those those contexts for a long time, I felt that it was all very familiar content, but witnessing the way that my peers responded to the material, um, you know, they were still struggling to get a grasp around how to use different pronouns and considerations around terminology that was non-gendered. So sort of a a one-hour lecture in the course of four years of medical school, you know, really, really isn't sufficient.

Have you have you either have you received support from fellows of the college, like as in in a mentorship role or kind of uh you know in a more positive relationship way?

Like uh no, I I haven't yet had that opportunity, but I I would definitely be open to to receiving that. Yeah, would would love it if there if there were a um particularly uh non-binary fellow in the college who felt able to provide that kind of mentorship. I think that would be really wonderful.

My answer to that would be from who? Because ultimately, if you know, we're talking part of one of their themes which has come from this Congress is people talking about role models and people who came before them. Like, show me where the trans role model is, love to meet them. But I don't think in a college we've ever allowed people to be visible. I think people would consider it the lunatics running the asylum, these upper D trans people coming up and being beyond their scope. You know, if you've um one of the things that I talked about in this talk yesterday was about, you know, um trans history. Christine Burns's book, Trans Britain, highly recommend to anyone. But one of the things that they talk about is a group of them went to the Royal College of Psychiatry conference, I think it was in the 70s, and they heckled. And to me, that's that's probably the last time trans people have probably spoken at a psychiatric conference is as hecklers, as nuisances, and they're people that are dragged out by security. And I'm still half expecting security to show up and kick me out. And honestly, like I wouldn't be stood up here and doing this and talking to you guys openly if I wasn't very aware of the fact that I've passed all my exams. So centrally, there's not very much the college can do. And I'm quite lucky because the New Zealand branch had gently dipped my toe over the years, and I'm pretty confident in those guys to do the right thing and back me up, and particularly our directors of training as well. And I'm I'm really lucky in that respect because it means it gives me the freedom to do this and educate people, which effectively is what I'm asking the rest of the college to do, is give your trans colleagues the freedom and the safety to provide that source of education because it's not just for them, it's for all of these trans kids coming through now that are suffering and really struggling. It'll be to their betterment as well. One of the other things that's been really good about this Congress is it's helped me be able to network and talk to some other people. So the gender equity group have really kindly agreed to look into how they can help trans and non-binary people as well. And one of the things that they're going to look into is whether they can help us set up some networking for people going through like FIO in the future. So hopefully that'll change.

Yeah, I mean, you mentioned earlier, Zoe, like you'd been dipping your toe in, I think was the word you used regarding the New Zealand uh section of the college, and you feel like you've got their support. So, like, you know, you've obviously talked about the danger of assumptions, but it sounds as if there have been some kind of positive relationships there and things support in some sense that you know what you're doing is is okay and it's safe and that you're able to be yourself essentially. Can you kind of comment a bit more on that?

Like, so one of the really challenging things I find as a trainee is every six months you move around. So every six months I have to spend probably a month re-establishing how safe I am and how visible it's safe for me to be, and how much support I'm gonna get in a particular environment. And I've had runs where I've basically kept my mouth shut and kept my head down because I didn't feel safe. But I think that was actually to the detriment of the people in the run. Because there's some really, really experienced psychiatrists who I've been really lucky to work with, people that that really stand out in my mind. Yvonne Fullerton, in case she's listening, who's happens to be one of the dams for Auckland. I had some fantastic conversations with Yvonne, Josephine Stanton, who runs the uh Child and Adolescent Unit in Auckland as well, who traditionally, as people that are a bit older, older women, you know, are people, and and both of them I think have quite strongly held religious views, are people who historically I wouldn't have thought I'd have been safe around. And they did a really good job in shattering my expectations around that as well, and showing a degree of openness around it. And, you know, as a result, it was it was to the benefit of both of us. I trust these people to support me in sharing this knowledge. They've helped me kind of feel safe in doing so. And I like to think that they've learned something from me along the way as well, which I think from someone who's, you know, people that are towards the end of their careers and retiring, I think they'll say it's it was probably quite a refreshing experience.

Theo, you've never been in supervision. You've never had a supervisor, I'm assuming, because you've not yet entered the training program. And um Zoe spoke about the experience of being with different supervisors over time. Is that is there anything that supervisors, if they were listening to this, could get out of it that might make it a safer space, uh better space for you?

So I never had a sort of a supervisor per se, but I did a number of psych terms over the course of my internship and residency. So I did have a number of bosses who you know intermittently tried to provide some form of supervision, even though the terms were quite short. And uh in the last psych term that I did in in my residency, that was the first time that I had someone in the workplace ask me about my pronouns. Yeah, thank you very much to um Dr. Dom Sadik, who really created that safe, that safe space for me to um to speak openly. So, yeah, some something as simple as that, as well as an understanding of the way in which experiences as um trans and gender diverse people might play out in the um therapeutic dyad with our patients, acknowledging that perhaps if we're seeing a patient who um is experiencing suicidal ideation and in the context of being trans and sort of struggling at times with their social environment, that that might bring some things up for us. Yeah, and holding space for that in the way that we might hold space for for other experiences that that people have had in that sort of supervision dynamic.

Michael, have you got any last questions?

No, it's been really great just listening and trying to learn from you, but I thank you for well, that's that's why we're sharing the experience, you know. It's it's one of these things of if you're open about it and give people the opportunity to answer questions, then all of a sudden this really controversial and polarized geopolitical discourse, I think that's the phrasing in our position statement, all of a sudden people realize it's rubbish. It's not, it's normal. I was just thinking about what Theo was saying about supervision. And actually, it's it's pronouns are something which offering them makes difference. And and the way that I've come to advise people to go about this is instead of asking people for their pronouns, because from the perspective of someone that's that's trans, it can seem like people are are reading you as trans, and that can be feel dangerous in itself. But actually, the other way of doing it is simply you know what we asked you guys to do at the start, which is when you introduce yourself, just include your pronouns. Hi, I'm Zoe, I use she, her pronouns. Taiko White's uh Reservation Dogs recently, great show, opens with the kid introducing himself with his pronouns or or themselves. I can't remember whether they're non-binary. But it shows you that actually that's the way that we're shifting. And you don't have to do it every time. But if there's a suspicion, it's a really gentle way of kind of flagging actually this is something that I'm thinking about. It's something that I know enough about that I can try and generate a little bit of a culture of safety. And what you'll find is that the people that are resistant to doing that are the same people that it's probably unsafe for me to talk to directly anyway.

Round the room, has anyone kind of got anything else they would like to cover or say at this point we feel like we've missed?

Just gonna say thank you for having us. And, you know, if at any point you want to have us back and talk about something else or talk about something, well, controversial in commas that I'm gonna tell you isn't, then let me know and I can come and demystify it. You know, I think part of what we need to do and part of what visibility is, is it's having open discussions about these things, taking them out from behind closed doors. But importantly, with these including trans voices, people that have lived experience of this, people who, you know, intrinsically know what it is to be trans and having them contribute and lead those discussions, because ultimately, I suspect that the way I see this is probably different. It might be to the betterment of people like me and like Theo. I don't know if you feel similarly.

Yeah, absolutely. It's you know, it's really great to have essentially a seat at the at the table and to have our voices elevated in in this way. Wonderful to be a part of um, you know, reimagining a future in which we can transcend into a new awareness of um of trans people in in their identities and how we can best support them through the process of of training. We're not always on on the other side of the therapeutic diad. Sometimes, you know, we are the people who are also offering that care. So yeah, just really, really great to be here and um very grateful to to have the opportunity to to share my voice and my story.

No, thank you both so much for coming on the podcast and thanks, Michael, for your support today. I think as we've touched on, hopefully this Congress and today's discussion can be a bit of a pivotal point for moving forward on and gaining some momentum in this space. I'd like to thank our production team, David Beal and Joe Rose. Thank you so much from the RANZCP. Thank you to Shady Dave for our music and also to Sidoni Prentice for our artwork. Look out for more interesting and enjoyable conversations from the Thought Broadcast in future.