THE FRED STUDY: STORIES OF LIFE SATISFACTION AND WELLNESS FROM POST-TRANSITION TRANSGENDER MEN by Marcus Skidley Greatheart B.A (Hon.), The University of Victoria, 2007 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) January, 2010 © Marcus Skidley Greatheart 2010 ABSTRACT The Fred Study is a Vancouver-based narrative study exploring life satisfaction, mental health and wellness as described by eight transgender men. Focus groups and follow-up individual interviews were conducted and guided in part using a strengths-based model commonly used in social work practice. Participants in this study discussed how peers and service providers alike perpetuate a dominant “negative transition story” which suggests all transgender men struggle with long- term substance abuse issues, depression, suicide, and life-long gender dysphoria, and will endure endless healthcare waitlists for hormones or surgical interventions ensuring they conform to normative gender standards and behave as heterosexual after transition. Despite these perceived challenges participants described having a positive transition experience while demonstrating resilience and self-efficacy in negotiating the healthcare system to access the care they desired. Coping strategies and impacts on mental health and substance abuse are discussed here, as well as implications for social work practice and ongoing research with this population. An assessment tool is described that mental health providers can use to assist trans clients uncover potential transgender-related stress or trauma. ii TABLE OF CONTENTS Abstract...................................................................................................................... ii Table of Contents...................................................................................................... iii List of Tables..............................................................................................................v Acknowledgements ................................................................................................... vi Dedication ................................................................................................................ vii Chapter 1 Introduction...............................................................................................1 Recent Issues in Transgender Health.....................................................................4 Personal Connection to Transgender Health and Wellness ...................................7 Assumptions .........................................................................................................11 Context .................................................................................................................11 Delimitations .........................................................................................................14 Conclusion............................................................................................................15 Chapter 2 Conceptual Context ...............................................................................16 Theoretical Underpinnings....................................................................................16 Theoretical Frameworks .......................................................................................21 Social Work Practice in relation to Trans Issues...................................................33 Conclusion............................................................................................................39 Chapter 3 Research Design...................................................................................41 Qualitative Research and the Use of Narrative.....................................................41 Data Generation ...................................................................................................43 Sampling and Recruitment ...................................................................................48 Data Collection .....................................................................................................49 Sample .................................................................................................................51 Data Analysis........................................................................................................51 Ethical Issues........................................................................................................52 iii Validity Issues.......................................................................................................53 Limitations ............................................................................................................55 Conclusion............................................................................................................56 Chapter 4 Findings.................................................................................................57 Part One: Thematic Analysis ................................................................................57 Part Two: In-depth Studies ...................................................................................71 Chapter Summary.................................................................................................90 Chapter 5 Discussion .............................................................................................92 What was Learned about the Lives of Trans Men ................................................92 Findings in Relation to the Literature ....................................................................97 Implications for Developmental and Identity Theory ...........................................101 Implications for Social Work Practice..................................................................103 Implications for Research ...................................................................................112 Conclusion..........................................................................................................117 References.............................................................................................................119 Appendices ............................................................................................................131 Appendix A – Promotional Flyer .........................................................................131 Appendix B – Consent Form...............................................................................132 Appendix C – Focus Group Questions ...............................................................135 Appendix D – BREB Certificate of Approval .......................................................136 iv LIST OF TABLES 5.1 An Assessment Tool for therapeutic exploration of narratives with transgender men..........................................................................................113 v ACKNOWLEDGEMENTS I am deeply grateful to many people who helped me through the research process: The study participants for their generosity in sharing their beautiful and fascinating stories; My advisor, Dr. Brian O’Neill, for his guidance and belief in the importance of this work; Dr. Pilar Riaño-Alcalá for offering resources and support throughout this process; Dr. Aaron Devor for providing invaluable knowledge and insight; Drs. Amy Salmon and Beth Snow and the mentors and trainees at IMPART for their opening minds and mutual passion for research; Michael Anhorn for his assistance with the focus groups, encouragement and comfortable sofa; Geoff Watland for amazing administrative support; Evie Erdmann for his love and friendship throughout this project; Chas Nol for helping keep my heart open; Marion Dewar, whose love and unwavering support makes her the best Mom ever; My sister Garth Greatheart MSW, who paved this route ten years before me; Tom Lampinen for believing in the researcher within me; Evin Taylor, Devon MacFarlane and the late Catherine White Holman for their unwavering support of this project; my friends, the many colleagues in trans work, and fellow MSW students who have inspired me along the way. This research was funded in part by a fellowship from IMPART, the Integrated Mentorship Program for Addictions Research Training, and by a Masters Graduate Scholarship from the Canadian Institutes for Health Research. vi DEDICATION For my dad, Fred Dewar, who encouraged me to follow my academic dreams and to whom I am eternally grateful. vii 1 INTRODUCTION While recent years have seen increased interest in research on transgender communities, much of this has been deficits-based, focusing on the problems these individuals experience, particularly in regard to mental health and substance abuse. My intent with this research study is to provide an alternative view of transgender men in research, one that highlights their supports, resources and competencies rather than the ongoing pathologizing that underscores present literature. In doing so I hope to present a more complex, nuanced and participant-driven exploration of gender transitions and transgender communities. Transgender People Transgender people have existed throughout history and across numerous cultures, with many indigenous cultures recognizing some form of third gender individuals who are afforded great respect within tribal culture (Cole, Denny, Eyler & Samon, 2000). Susan Stryker (2008), among others,