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"how many times did you receive electric shocks in the mental hospital?" ling'er blurted out: 7 times.

ling'er is 27 years old and a transgender woman. on july 22, 2022, she was sent to qinhuangdao jiulongshan hospital by her mother. this is a psychiatric hospital. she was diagnosed with "anxiety disorder and self-discordant sexual orientation" and spent 40,000 yuan to stay in the hospital for 97 days.

growing up in a traditional northern family, with a mother who is a teacher and a father who is a factory worker, ling'er is the second child and the only son in the family. ling'er often quarreled with her parents. her parents wanted her to marry and have children, and behave like a man, and threw away the estrogen drugs she saved money to buy - which could relieve ling'er's gender anxiety. in order to avoid further quarrels, she agreed to go to the hospital, but she didn't expect to be tied to the bed by the medical staff and electrocuted until she lost consciousness.

encouraged by community partners, ling'er sued qinhuangdao jiulongshan hospital nearly two years after she was discharged from the hospital. in her complaint, she wrote that as a person with full capacity for conduct, she clearly expressed her refusal to accept unreasonable or extraordinary medical measures taken by the hospital in a sober state, but she was forcibly hospitalized for treatment, and her rights were violated, and she demanded compensation of more than 80,000 yuan.

xiaomi, a transgender social worker, revealed that when discussing with her lawyer who to sue, ling'er refused to sue her mother who sent her to the hospital. before the trial, ling'er also met with her mother, but her mother still refused to acknowledge her as her daughter. "she wants us to live our own lives," ling'er was desperate. "what's the point of this lawsuit? i don't want compensation, i want my parents to change their minds and accept me completely."

"having a closet but no home" is a common dilemma faced by the transgender community. however, according to lu ping, former director of the transgender department at the beijing lgbt center, "whether parents can accept their transgender children depends more on the relationship between the parents and the children, or in other words, on their genuine and simple love. if there is such love, i think it is only a matter of time before they are accepted."

transgender and mental illness

in october 2022, after being discharged from the mental hospital, ling'er returned home and found that her cosmetics, women's clothing and estrogen drugs had been thrown away by her parents. another quarrel. the electroshock therapy did not drive away the ghost of gender anxiety. ling'er, whose life as a woman had returned to the starting point, changed back into men's clothing, but in her heart she was waiting for another opportunity to come out. it was also easier to make money as a man, and she had to raise funds to continue buying clothes and medicine.

ling'er saved money from working to buy hormone therapy drugs. in december 2022, the "list of prohibited online sales of drugs (first edition)" issued by the china national drug administration banned the online sales of commonly used drugs for transgender women, including cyproterone acetate (anti-androgen) and estradiol (estrogen). the channels for transgender women to obtain drugs have been further narrowed. (photo_provided by the interviewee)

the hospital admission file records ling'er's experience of being taken to seek medical treatment by her parents. ling'er liked to wear ancient costumes in her freshman year and got angry when she was restricted. in her sophomore year, her parents took her to a tertiary hospital and a psychiatric hospital for treatment. the doctors believed that there was no obvious abnormality and no need for treatment.

ling'er never told her parents that she wanted to become a woman, but her desire to become a woman grew stronger year by year. it was not until she returned home at the end of the year after graduation that her parents saw ling'er wearing makeup and long hair, and treating her "mental problems" became a knot in the family. in less than half a year, her parents took ling'er to two psychiatric hospitals. the first hospital diagnosed her with "anxiety disorder" and prescribed medicine, but ling'er did not take it. the second hospital was qinhuangdao jiulongshan hospital, which admitted ling'er for "bad mood".

qinhuangdao jiulongshan hospital is also the qinhuangdao fifth hospital and qinhuangdao mental health center. the hospital is the only professional mental health institution in qinhuangdao, responsible for many public health functions in the city and prevention, diagnosis, treatment and rehabilitation of mental illness. (photo_hospital official website)

jiulongshan hospital diagnosed ling'er as "self-disharmonious sexual orientation", and whether it is a disease became a focus of the court debate. on august 13, the changli county people's court of qinhuangdao held an online trial of the case. according to red star news, the hospital believes that ling'er dressed as a woman and participated in same-sex activities, which is inconsistent with daily concepts and there is a subjective and objective inconsistency. in response to ling'er's attorney guo bin's mention that according to the "international classification of diseases, 11th revision" (icd-11 for short), diagnostic codes related to sexual orientation have been deleted, and homosexuality and transgenderism are no longer diseases. the hospital argued that icd-11 has not been fully implemented in china, and the hospital is still implementing the relevant provisions of icd-10.

ling'er's admission record at jiulongshan hospital. she was diagnosed by the hospital as having "self-inharmonious sexual orientation" (photo provided by the interviewee)

lu ping confirmed the hospital’s statement.at present, icd-11 has not been implemented on a large scale in my country.although in 2018, a notice was issued that 'icd-11 chinese version of disease coding and classification will be fully used from march 1, 2019', it was not widely implemented afterwards due to some unknown reasons.

"but neither icd-10 nor icd-11 will send a trans person to a psychiatric hospital for electroconvulsive therapy. what is electroconvulsive therapy? it's used to treat serious mental illnesses, like schizophrenia, bipolar disorder, and it's not a treatment for transgender or queer people."

some public and private hospitals are still providing so-called "conversion therapy", which attempts to convert sexual minorities' gender identity or sexual orientation to cisgender heterosexuality acceptable to mainstream society based on the erroneous assumption that "sexual minorities are patients with mental disorders who need treatment". (photo_internet)

"from the hospital's diagnosis, they didn't figure out what transgender and homosexuality are," lu ping explained. ling'er is a transgender person, and her self-gender identity is different from cisgender (referring to people whose birth sex, physical sex and psychological sex are consistent). ling'er's self-gender identity is female, and she likes boys, so her sexual orientation should be understood as "heterosexual" according to popular concepts, not "homosexual." the hospital's approach made lu ping feel absurd: "how can the hospital treat patients if they confuse even these most basic concepts?"

the 2021 national transgender health survey report released by the beijing lgbt center also shows thatamong the mental health professionals sought help by transgender people interviewed, less than 20% had "relatively good or very good knowledge of transgender issues."

in 2019, artist wu laobai and gay policeman lin he jointly launched the "lovers" art project. inspired by the movie "three billboards outside ebbing, missouri", they posted slogans opposing sexual orientation conversion therapy on three trucks and toured in shanghai, nanjing, jinan and other cities. (photo_internet)

there is a cabinet but no home

after returning home and spending the spring festival, ling'er severed ties with her family in the autumn of 2023. relatives visited each other in a prosperous and lively atmosphere, and even her sister did not know that ling'er, who was dressed in men's clothes, wanted to become a girl.

ling'er had a period of switching between men and women. later, she saved money from working and bought estrogen drugs, which she took for a year and a half. she could no longer tolerate the inconsistent life of a man with a body and mind, and wearing women's clothes made her feel relaxed. when she was struggling with her gender transition, ling'er rarely went home, but every time she went home, she was dressed as a man, either because she had not yet fully adapted to women's clothes, or because her parents asked her to change back to men's clothes. her family was also very secretive about this matter, "they felt that this was a shameful and embarrassing thing," ling'er said.

ling'er's selfie (photo provided by the interviewee)

lu ping is the former director of the transgender department at the beijing lgbt center and a volunteer who accompanies ling'er. she has come into contact with many transgender parents during her work and witnessed the sad reality of kinship. "many transgender children become very anxious during puberty when their sexual characteristics begin to develop. they may use various methods, such as binding their genitals and secretly buying hormones, to reduce their gender anxiety. when parents discover these behaviors, because they have not received positive education about transgender and do not know how to treat their children correctly, their first reaction is to nip this in the bud. in this process, transgender children may suffer domestic violence, then run away from home, and then may be deceived or even raped. these are real cases that have happened in the community."

after lu ping's popular science, some parents gradually began to understand their children, and they also burst into tears, worrying or feeling unfortunate about their children's difficult lives. however, there are also parents with strong traditional concepts who would rather believe that their children are schizophrenic than accept the fact that they do not have any mental problems, but are just transgender.

because they don't know much about transgender, and the homepage of online searches is often filled with advertisements for transgender reversal agencies, many parents have become the targets of these quacks. transgender social worker xiaomi has come into contact with a poor transgender family. both parents work in factories in jiangsu and zhejiang. the tens of thousands of dollars that the family used to build a house were thrown into the internet addiction school. the family's savings were emptied but the child was not successfully "reversed". some parents turned to praying to gods and buddhas in despair. there is a photo of a buddha statue in the "there is a cabinet but no home" online exhibition in which xiaomi participated. this was provided by a survivor. his parents thought that the child was possessed by evil spirits and wanted to get rid of the body of his parents, so they took him to a temple and asked him to kneel in front of the buddha and confess to him.

a story of a survivor and a buddha statue in the online exhibition “a closet without a home”

(photo_exhibition website)

sometimes, parents accept their children’s gender identity out of the simple idea of ​​“choosing the lesser of two evils.” a single mother with a disability who receives a minimum living allowance told lu ping, “my child is transgender. if i don’t let him do what he wants, he will become depressed and commit suicide. between a living child and a dead child, i would rather have a living child. i must support his ideas so that my child can survive.”

"many parents may never understand transgenderism in their lifetime because they themselves are not transgender, but because these are their own children and they love their children, they can accept them. many parents cannot reach the stage of active support, but at least they will not interfere too much with their children, and will not use their status and resources to contain and correct them. if the children suffer outside or encounter danger, they will go to help, and that's good." lu ping said.

ling'er said that since she severed ties with her family, her parents have not called her once. she is in poor health and has fainted many times due to chest pain and had to go to the hospital for treatment, but her parents have never asked about it. outside, there is a "best friend sister" who is also a transgender woman who takes care of her life from time to time, but the mother of the "best friend sister" does not welcome ling'er. "auntie thinks i am destroying their family relationship. what does this have to do with me? if i don't go, your son will not be a woman?" although the mother doesn't like her, she still envies the "best friend sister" for having a mother who often visits her.

wandering: in public space and in the workplace

after leaving her hometown, ling'er worked in jinan, chengdu and other places, and now she is in tianjin. she has no place to live, and she sleeps on the floor outside every day. she puts a blue yoga mat on the ground, covers it with a small plaid quilt, and sleeps at the subway entrance or in the square. fortunately, the summer in tianjin is not that unbearable.

ling'er's belongings while sleeping on the streets of tianjin (photo provided by the interviewee)

in the hot weather with a temperature of over 30 degrees, taking a bath became the top problem. ling'er usually went to her "best friend's sister" house to take a bath, but her mother made ling'er really unable to cope, so she would go to the public bathhouse when it was not convenient.

once, ling'er went to a public bathhouse wearing a red suspender skirt and a pair of white flat sandals. she could experience the bathing service, and the online group purchase price was only 30 or 40 yuan, which was very suitable for ling'er who was short of money. the auntie who was doing the bathing was very curious about her dress and asked tentatively: "sister, are you a man or a woman?" ling'er felt uncomfortable: "people in tianjin call any woman "sister". you already call me "sister", and you still ask me if i am a man or a woman?!"

the bathroom was divided into men's and women's bathrooms, and she was pushed to the men's bathroom. ling'er felt that she had no clothes that were suitable for men, and she couldn't accept taking off her underwear in front of a group of men. after putting on her clothes, ling'er returned the money and left.

lu ping is also a transgender woman. she can’t find a place to stay in private collective spaces such as changing rooms and public toilets. lu ping has long hair, wears earrings, and dresses in a feminine way. she is worried that going to the men’s bathroom may make the men uncomfortable, and going to the women’s bathroom may easily attract criticism from some women. she is also afraid that if she is discovered, she may be regarded as a pervert and hooligan, and face the risk of committing a crime. so now when she goes out, she tries not to drink water, and when she wants to go to the toilet, she holds her urine, which also makes her bladder problems worse.

lu ping used to like swimming, but after becoming a transgender woman, she never swam in a public swimming pool again. due to the use of hormones, her breasts have developed, which makes it impossible for her to change clothes in the men's locker room, and the women's locker room is not a good option. she noticed that outside of the binary, there are still many third toilets in china, but they may be marked as disabled toilets, without emphasizing the gender-free attribute. even if she goes to a toilet clearly marked "unisex", lu ping will be stopped by the cleaner and asked to go to the men's bathroom according to her assigned gender (referring to the gender assigned or designated at birth).

third toilets are becoming more common in china, but most are still considered "parent-child toilets" or "disabled toilets," ignoring the needs of transgender groups. (photo from the internet)

the expulsion of them from public spaces has also extended to job hunting. ling'er studied music performance in college, and after graduation she interviewed many live entertainment companies, hoping to find a job as an online anchor. according to her, someone in one company directly called her a freak and told her to get out, and then blocked her on wechat. live companies also arrange packaging styles according to gender, and it is difficult to find companies that specialize in training transgender people.

in her first year as a live streamer, the live streaming company asked ling'er to go for a masculine style. ling'er said that she was petite and about 1.6 meters tall wearing high heels, so it was not good to pretend to be a man, so she later changed to a female style. the company she is currently working for asked her to go for a cross-dressing style, creating a "transvestite" persona who secretly wears women's clothes. ling'er also started a personal live broadcast on douyin. the audience was a mixed bag, and it was common for her to receive offensive words such as "modified car", and other anchors were unwilling to connect with these "abnormal people" online for pk.

while working in jinan and chengdu, ling'er found that there was still room for her to enter the catering service industry. she often got along well with her boss, who saw that she was quick and capable, so he tacitly agreed to hire her, but then the employees had objections. on the one hand, it was difficult to arrange work. usually men were arranged to be cooks in the kitchen, and women were arranged to be waiters. ling'er was "neither male nor female", so it was difficult to arrange for either. on the other hand, there was accommodation. older female employees did not recognize transgenderism, and younger female employees still regarded her as a man and were afraid of being violated.

now she hopes to find an electric bike to deliver food in tianjin one day. there is no gender restriction for deliverymen. if customers are concerned about her inconsistent appearance and voice, she can solve the problem by wearing a mask. compared with sleeping on the roadside, spending only a dozen yuan a day on food, and looking for food in trash cans when she is in trouble, the 150 yuan she earns a day delivering food is enough for her to spend.

ling'er shares her daily meals: a bowl of white porridge with pickled mustard tuber (photo provided by the interviewee)

lu ping also observed that in the face of employment discrimination in enterprises, many transgender people prefer to do odd jobs on their own, which leads to unstable incomes, and very few of them enter traditional enterprises or even public institutions. "for example, a male transgender partner in the community,she works in a public institution and has already had the surgery, but she still goes to work dressed as a traditional man. she has not come out as gay in the company, so she is actually living a double life.”

the reason for not coming out is due to practical considerations. after all, a brilliant academic degree will become worthless after transitioning. xiaomi has met bai yufei, a transgender woman who graduated from fudan university school of medicine. she used to work for a multinational pharmaceutical company. after resigning, she maxed out her credit card and had a gender reassignment surgery. the gender on her id card was also changed, but she couldn't find a job for the next year because the gender on her academic degree didn't match the gender on her id card.

yu fei told xiaomi that she couldn't even afford a five-yuan cup of milk tea on the street, so she was forced to interview for a cleaning job at a nightclub. she found out that she was required to accompany drinking, and she escaped after a thrilling experience. because it was difficult to get a job in a big company with a fake degree, lawyers from the guangzhou gender education center and social workers such as xiaomi assisted her in negotiating with the education department, and officially changed the gender on her degree. later, she returned to work at a multinational pharmaceutical company.

in 2012, youth daily reported on bai yufei's difficulty in finding a job. in 2018, with the help of many parties, she sent her application to the higher education department of the ministry of education and finally received a call back. she successfully modified her academic information, becoming the first case in the transgender community to successfully modify her academic qualifications. (photo_internet)

in 2014, the ministry of education issued a regulation that "after the academic qualifications are registered and made available for online inquiry, the school shall not change the certificate content and registration information; in principle, the degree awarding information is not allowed to be changed after it is submitted for review." in short, academic qualifications information cannot be changed after graduation. many transgender people have to work for a period of time to save enough money for gender reassignment surgery. completion of the surgery is the basic condition for changing the gender on the id card and academic qualifications, but at this time, it is obviously past the best time to change academic qualifications. lu ping said thatbecause the ministry of education has vigorously cracked down on fake academic qualifications in recent years and tightened the policy on changing academic qualifications, the previous method of changing academic qualifications by requesting colleges and universities to write letters to the ministry of education's higher education department has also been affected, and it has become increasingly difficult to change academic qualifications.

"if you are born a woman, you must be a woman all your life. if you are born a man, you must be a man all your life. then what is the meaning of living? you must always live for your so-called biological gender." ling'er's anger dissipated in the air and was beaten back by the invisible wall.

refusing to be “mentally ill”: support and autonomy

in its reply, jiulongshan hospital, based on articles 28 and 36 of the mental health law, argued that ling'er's self-awareness was incomplete and that "she was unable to go through the hospitalization procedures," and stated that the family's signing of the informed consent form and the admission of ling'er to the hospital were in compliance with laws, regulations and treatment standards.

according to red star news, ling'er's other attorney guo ruiting stated in the court that ling'er had no violent tendencies, no suicidal behavior, no possibility of endangering society, and had full civil liability capacity. she had clearly stated that she did not need hospitalization and did not meet the standards for compulsory treatment, but the hospital still admitted her, which was a fault.

in the opinion of attorney huang xuetao, founder of shenzhen equitable agency, this is an easy lawsuit to win, as the legal flaws in the hospital's treatment are quite obvious.

huang xuetao began to pay attention to the issue of compulsory treatment of people with mental disorders in 2006. at that time, her client, zou yijun, a girl from shenzhen, was sent to a mental hospital twice for more than three months of compulsory treatment because of disagreements and conflicts of interest with her family. she carefully studied the "mental health regulations" of various places and found that there was no legal procedure for forced treatment, and the hospital deprived patients of their personal freedom as if they were in a no-man's land. this prompted her to establish the equitable organization in 2010 and serve as the head of the mental health project to promote legislation.

in 2006, huang xuetao, who was a legal consultant for a temple, accidentally intervened in the "zou yijun was forcibly sent to a mental hospital by his family" case that shocked the whole country. the incident triggered strong public opinion, and the hospital was forced to stop treating the person involved. (photo_internet)

the legal provisions that ling'er's attorney guo rui relied on benefited from the changes promoted by the equity institutions.during the deliberation period of the mental health law, which was being discussed by the national people's congress, the equity agency submitted five legislative proposals and successfully replaced the original "self-awareness standard" with the "danger principle of involuntary hospitalization."the current law is that patients also have the right to refuse hospitalization. as for the danger to oneself and others, it can be discussed again, rather than being roughly defined by medical terms.

article 28 of the mental health law stipulates that "close relatives of patients suspected of mental disorders may send them to medical institutions for mental disorder diagnosis." the hospital argued that because ling'er's mother signed a series of documents such as the involuntary hospitalization medical notice, involuntary hospitalization informed consent, and involuntary hospitalization condition assessment, the hospital's admission has a legal basis. however, huang xuetao believes that family members do have the right to force diagnosis, but there is no legal basis for involuntary hospitalization and involuntary treatment. the law does not say that family members can sign informed consent on behalf of incapable people.

"why do you say that a 27-year-old person is incapable? does being sick mean she is incapable?" huang xuetao said. the word "capacity" - civil capacity - is a legal concept, and jiulongshan hospital mistakenly understood it as a "medical standard."

the hospital's argument that ling'er's "self-awareness is incomplete" has no legal basis. "in the discourse system of psychiatrists, lack of self-awareness equals lack of ability, and lack of self-awareness equals lack of informed consent. this was the case more than a decade ago, but this is actually a substitution of concepts, using medical terms to replace legal terms. the 'self-awareness standard' has long been abolished from legal texts, but in reality, this kind of inheritance may still exist."

huang xuetao called it a "hospital that undermines the autonomy of the parties involved and that medical decisions are taken over by guardians".“substitute decision making”she believes thatthe legal capacity of the parties cannot be denied, and those who lack capacity also have the right to make independent decisions, but external support is required"we can even treat vegetative patients in a way that supports autonomous decision-making. when a person has completely lost the ability to express himself, we should still try to find out what his wishes are, and recall whether he has left any words, what he likes and dislikes, instead of making decisions for him by saying 'i am doing this for your own good'. if we find some traces and evidence that our decision conflicts with his decision, then we should still give up what we think is 'good'."

huang xuetao is also a mother. she can imagine that transgender family members must also face many obstacles that need to be overcome. as parents, we should not become the biggest obstacle in the middle and aggravate the pain of our children. what parents should provide is support to help their children face the challenges and difficulties of the outside world.

the attorney revealed that two days after the trial, the hospital immediately asked ling'er through the court whether she would accept mediation. currently, the two sides are still in a stalemate and have not reached an agreement. the lawyer is also more inclined to mediation, which can get the money faster. however, for ling'er, no one can compensate her for the loss of family happiness.

(to protect the privacy of the interviewee, ling'er is a pseudonym)