Language and trans health

The use of appropriate language is a sensitive matter, because the meaning of words may be relative, situational, and language dependent. What is more, words inherently carry meaning that inevitably depends on underlying frames of reference. In this sense, language has a powerful performative power and impact. As a result, wordings, or word choices that are used without intent of harm (or even with the express desire to avoid it) may be experienced as harmful by listeners, who often bring their own experiential frame of reference to the table. Put plainly, words are often interpreted differently by individual readers, dependent on their situation and location (e.g., Hochdorn et al., 2016). Indeed, over time, contextually specific terms like transgender can change and shift in a complex fashion. It is, therefore, critical that we select language that is respectful, nonpathologizing and consistent with human rights standards, taking into account its shifting and complex contextual and cultural character. Ultimately this caution applies equally to trans health and all other formal and informal settings in which human interaction takes place. As both humans and researchers, language is our shared vehicle for expressing and presenting our ideas, thoughts, feelings, and opinions to the world and to one another. The word language itself is defined in the Oxford Textbook of English as (noun) “method of human communication, either spoken or written, consisting of the use of words in a structured and conventional way” (Stevenson, 2010). Put more explicitly, “the purpose of language is for communication” (Chomsky as cited in Osiatynski, 1984). Technological innovations have, of course, affected this, as has rapid globalization, which allows and encourages individuals from all over the globe to communicate and exchange ideas rapidly and continuously. Though technological advances have served as both medium and accelerator of communication, it remains language itself that ensures effective communication among cultures, countries, organizations, communities, and ultimately individuals, and it is critical that our linguistic choices are respectful of this. Clinical practice also has its own linguistic norms and conventions that further reflect the particular clinical model used. The use of language and clinical models that are respectful, nonpathologizing, and human rights based are critical principles of ethical contemporary trans health care, and clinical models must reflect this (e.g., approaches that can be classified as "reparative therapy" are to be avoided in all cases). At all times, it is important to account for and critically question existing power inequalities in one’s clinical practice, encounters, and writing, so as to join trans–health care users in dismantling pathologizing structures. Throughout history, language has been wielded to discriminate, abuse, marginalize, disrupt, and destabilize individuals and communities. With regard to trans people, language has been used (arguably, misused) by political, religious, legal, and medical cultural institutions for the purpose of normalizing their marginalization and discrimination against them. Examples are numerous (e.g., APA, 1987, 2000, 2013; Fenichel, 1930; Von Krafft-Ebbing, 1901; WHO, 1992), and cataloguing them is beyond the scope of this editorial. Suffice it to say that levels of linguistic discrimination range from simple cases of misapprehension and ignorance in the wider public to explicit acts of targeted violence by informed individuals. We are primarily interested here, having established a firm basis for the existence of such linguistic discrimination and violence, in articulating a strategy for moving past it in our clinical and academic practice, while holding accountable those who choose not to do so. One such strategy involves the development of trans cultural awareness seminars that promote respectful, nonpathologizing linguistic choices that are based on a human rights framework. Such trainings, which are useful in supporting clinical practice and promoting trans rights and health care broadly, are increasingly available to both the general public and health professionals. Indeed, these trainings are increasingly becoming mandatory for the latter group.