5 - Bureaucracy, time, and space

Summary

Plumbing is not gender- neutral.

Crawford (2015: 65)

In this chapter I build upon the previous chapter by looking at three functions of social control as they are present in the lives of trans people in the UK: bureaucracy, time, and space. The data and theorization presented here supports existing work by Preciado, Vincent, Naugler, Pearce, Adam, Israeli- Nevo, Crawford, and Munt and extends that by Varela, Brown et al, and Maister to apply to gender, transness, and transition related healthcare. Specifically I focus on the varied elements of the medical bureaucracy which prevent trans people from accessing quality healthcare, waiting and wait times, waiting rooms, and bathrooms. In different ways a lack of control over each of these elements block trans people from good health and in combination they highlight the dire state of trans healthcare in the UK.

Bureaucracy

Framing trans healthcare as a bureaucracy illuminates many of the structural barriers trans people face. The bureaucracies I am describing here are all the National Health Service (NHS) and private healthcare pathways that trans people encounter and the relationship between those pathways, primarily General Practitioner (GP) surgeries, gender identity clinics (GICs), and mental health services. Just the prospect of having to engage with these bureaucracies can be enough to dissuade people from advocating for themselves. For example, George describes not pushing his GP surgery when they continued to have his title wrong in the system, an experience I have also had.

‘[W] hen you feel like you’re climbing up this massive hill, you let the little things go sometimes. Which you shouldn't because they do make you feel really bad and I dread my name coming up on that screen cause everybody's gonna be like “What?”. I just hope people think it's like an admin error, cause it's difficult when I go to pick my prescriptions up and it's actually Ms. you know it's just strange, very strange.’ (George).

In addition to this sort of general challenge, there are certain features of these bureaucracies; cancelled appointments, the exercise of ticking boxes, having to jump through hoops, and the shifting of responsibility, that have been flagged by the participants as points of frustration for trans people. Of course these bureaucratic features will be found throughout many healthcare services, but accessing transition related healthcare increases some trans people's exposure to these bureaucracies.