Rethinking Mental Health Care for 2SLGBTQ People: Toward an Anti-Oppressive and Gender-Affirming Approach

A feminine-presenting person dances gracefully on the beach.

Introduction: The Limits of the Biomedical Model in 2SLGBTQ Mental Health

Mental health care for 2SLGBTQ individuals is often constrained by the biomedical model of mental illness, which, without applying an anti-oppressive framework, tends to pathologize distress and individualize mental health issues. This approach fails to account for the broader social, cultural, and systemic factors that contribute to the mental health challenges faced by queer and trans* individuals. The biomedical model, rooted in Western European ideologies, privileges a clinical, often reductionist, understanding of mental distress, which may not resonate with the lived experiences of 2SLGBTQ people, particularly those who experience intersectional forms of oppression such as racism, ableism, and classism (Pilling, 2022).

As the field of queer and trans* mental health continues to evolve, it is becoming increasingly critical to question and deconstruct the dominant frameworks that have long marginalized and medicalized queer and trans* experiences. In particular, it is important to recognize how the biomedical model reinforces cisnormative and heteronormative ideals, positioning queerness and transness as deviations from the norm rather than valid expressions of identity. By interrogating these Western-born structures, we can begin to embrace alternative models of care that honour the complexity of 2SLGBTQ mental health and offer more supportive, affirming, and non-coercive interventions (Pilling, 2022).

In this blog post, we will explore critiques of the biomedical model through the lens of queer and trans* madness, drawing on key insights from scholars and activists who advocate for a more expansive, anti-oppressive approach to mental health care. By examining how gender-affirming models can support the 2SLGBTQ community, we aim to offer a vision of care that centres autonomy, community, and the unique lived experiences of those most affected by systemic injustice.

Expanding Beyond the Biomedical Model: Queer and Trans Madness as a Path to Emancipatory Care

Merrick Daniel Pilling’s (2022) Queer and Trans Madness: Struggles for Social Justice offers a powerful and necessary critique of the biomedical model, illuminating how it perpetuates cisnormative and heteronormative ideologies that pathologize queer and trans* individuals. By framing queer and trans distress through a narrow medical lens, the biomedical model frequently erases the complex interplay of social, cultural, and systemic factors that shape the mental health experiences of 2SLGBTQ individuals. Pilling’s empirical research, which includes interviews with LGBTQ people who have experienced mental distress as well as analyses of psychiatric documentation, exposes the limitations of a framework that reduces nuanced queer and trans* lives to medical diagnoses.

The consequences of this reduction are profound. Pilling (2022) illustrates how the biomedical model often reinforces normative gender and sexual expectations, neglecting the critical ways in which systemic oppression—such as transphobia, racism, ableism, and sexism—contributes to queer and trans* distress. For instance, many queer and trans people report that encounters with medical professionals feel violent or coercive, not only due to the overt pathologization of their identities but also because the treatment paradigms they are subjected to often prioritize control and compliance over healing and empowerment. Instead of being viewed as individuals with valid experiences of oppression, they are frequently medicalized in ways that dismiss the broader context of their lives, leaving little room for care that centres autonomy and self-determination.

Pilling advocates for an urgent shift toward community-based, non-coercive mental health care that respects the lived experiences of queer and trans individuals and actively challenges the violent, oppressive structures embedded within traditional psychiatric care. This shift requires mental health professionals to move beyond diagnosing and treating individuals in isolation from their social and political realities. Pilling (2022) argues that a model of care rooted in queer and trans* interdependence offers a path toward healing that is affirming, non-coercive, and radically inclusive. This approach allows for the recognition of queer and trans* madness as a valid and even liberatory experience, rather than something that must be cured or corrected.

Moreover, Pilling’s analysis opens the door for practitioners to rethink their role in the mental health of 2SLGBTQ communities. By adopting an anti-oppressive, gender-affirming lens, mental health care can become a space where queer and trans* individuals are seen not as patients to be managed but as people whose distress is shaped by systemic injustices. This transformative approach emphasizes the need for care that not only acknowledges but actively combats the intersecting forms of oppression faced by queer and trans* people, creating possibilities for more meaningful and emancipatory mental health support.

Reclaiming Madness: A Radical Perspective from The Terrible We

In The Terrible We, Cameron Awkward-Rich (2022) offers a thought-provoking counterpoint to traditional mental health frameworks by embracing madness as a vital and productive force within trans life and trans studies. Awkward-Rich critiques the tendency within queer theory and trans studies to distance themselves from madness, illness, and disability—often in an effort to align more closely with normative standards of health, rationality, and wellness. He argues that this distancing not only perpetuates ableist assumptions but also limits the creative and survival potential of trans individuals by ignoring the complex relationship between madness and lived experience.

Awkward-Rich (2022) invites readers to consider what it might mean to think with madness, rather than attempting to reject or cure it. By embracing maladjustment and the “terrible” feelings that often accompany mental distress, trans people may be able to find new forms of resilience, self-expression, and community. According to Awkward-Rich, these emotions—while often pathologized—can provide valuable insights into the lived realities of trans existence, particularly in navigating hostile environments that continually marginalize trans bodies and identities. Madness, in this sense, becomes not a deficit but a source of radical potential.

This perspective challenges the conventional drive to pathologize and “fix” madness, suggesting instead that madness itself may offer trans individuals new ways of being and thinking outside the boundaries of societal norms. Awkward-Rich (2022) argues that by staying with madness and its associated feelings, trans people can cultivate creative, emotional, and intellectual strategies for survival and resistance. This perspective reclaims madness as an essential component of trans life, one that can empower individuals to navigate their worlds on their own terms.

However, this embrace of madness differs significantly from Pilling’s vision of mental health care reform. Where Pilling advocates for a more pragmatic, community-centered response to queer and trans* madness that emphasizes non-coercive care and structural change (Pilling, 2022), Awkward-Rich focuses on the personal and transformative potential of maladjustment itself, even when it lies beyond the reach of institutional reform. By engaging directly with madness, Awkward-Rich calls for a rethinking of what it means to live authentically as a trans person, without conforming to external pressures to normalize or “heal” from distress.

While both Pilling and Awkward-Rich recognize the inherent violence of the biomedical model and the need to challenge oppressive systems, their approaches offer distinct paths forward. Pilling emphasizes structural change and community-based solutions, while Awkward-Rich encourages a more internal, philosophical shift, urging us to reconsider madness as a valid and valuable aspect of trans existence. In this way, The Terrible We provides a radical framework for understanding trans life beyond the limits of normative mental health paradigms.

Toward Emancipatory Care: Anti-Oppressive and Gender-Affirming Mental Health Practices

Peter Kinderman’s (2019) A Manifesto for Mental Health presents a compelling argument for moving away from the disease-based model of mental illness, calling for a shift toward a holistic mental health care framework that emphasizes the lived experiences of individuals and the broader social contexts shaping their distress. Kinderman critiques the over-reliance on medical diagnoses, which often reduce complex emotional and psychological experiences to symptoms of an illness, ignoring the realities of people’s social environments. Instead, he advocates for mental health care that focuses on helping people navigate real-life challenges, centering human experiences rather than merely treating conditions. This is especially relevant when considering the mental health needs of 2SLGBTQ communities, who face unique stressors related to systemic oppression.

For 2SLGBTQ people, the traditional psychiatric model often imposes frameworks that pathologize their identities, reinforcing harmful norms that marginalize queer and trans experiences. Kinderman’s call for an anti-oppressive approach resonates deeply with this community, as it emphasizes dismantling the systems that contribute to their distress rather than simply diagnosing or treating the individual. By adopting a model of care that challenges oppressive structures like transphobia, racism, and sexism, mental health professionals can create spaces where queer and trans individuals are supported in their full humanity. This approach allows for a more compassionate and empowering form of care—one that recognizes the intersectional nature of oppression and the importance of addressing systemic issues alongside individual healing.

Merrick Daniel Pilling (2022) echoes these principles in Queer and Trans Madness, advocating for non-coercive care that honours the autonomy and self-determination of queer and trans* individuals. Pilling emphasizes the need for mental health interventions that focus on community support rather than institutionalization, medication, or coercion. For many queer and trans* people, mental distress is not a problem that can be solved through medicalized care alone. Instead, Pilling highlights how community-based interventions—such as peer support, mutual aid, and crisis response teams—are often more effective in promoting long-term healing and resilience. These non-coercive approaches offer safer, more affirming alternatives to the often isolating and disempowering experiences that queer and trans* people face in traditional psychiatric settings.

Kinderman’s (2019) manifesto also underscores the need for multidisciplinary care teams that integrate social, psychological, and medical expertise, allowing for a more comprehensive response to distress. In this model, medical professionals act as consultants rather than gatekeepers, ensuring that care is flexible, individualized, and inclusive of non-medical interventions. By focusing on the ecological validity of people’s experiences—addressing the real-world factors that shape mental health—Kinderman’s vision for mental health care is especially relevant for 2SLGBTQ people, whose distress often stems from societal marginalization rather than intrinsic pathology.

Ultimately, the adoption of anti-oppressive and gender-affirming practices can radically transform the mental health landscape for queer and trans* individuals. By shifting from a biomedical, diagnosis-driven model to one that prioritizes autonomy, community care, and systemic change, mental health professionals can foster more inclusive, supportive environments. These spaces allow 2SLGBTQ people not only to heal from individual distress but also to challenge and dismantle the systems that perpetuate their marginalization.

Conclusion: Imagining a New Future for 2SLGBTQ Mental Health

The time has come to radically rethink how we approach mental health care for 2SLGBTQ individuals. The continued reliance on the biomedical model has not only failed to address the full scope of queer and trans* distress but has actively marginalized these communities by pathologizing their experiences. By challenging the foundations of this model and embracing anti-oppressive, gender-affirming frameworks, we open the door to transformative possibilities for mental health care—possibilities that centre healing, autonomy, and justice.

As Merrick Pilling (2022) emphasizes, queer and trans* madness holds the potential for radical social change. However, realizing this potential requires that we dismantle the systems and structures that continue to reinforce cisnormativity and heteronormativity in mental health care. When we shift away from coercive, diagnosis-driven practices and towards models that respect the complexity of 2SLGBTQ lives, we foster an environment where true healing can occur. This means recognizing the impacts of systemic oppression, creating community-driven responses to crisis, and affirming the identities of queer and trans* individuals as central to their mental well-being.

Moving forward, we must strive for a mental health care model that is non-coercive, community-based, and grounded in principles of justice and intersectionality. Such a model not only supports the healing of individuals but also challenges the broader societal forces that perpetuate harm. In doing so, we can imagine a future where 2SLGBTQ people receive the care they deserve—care that affirms their identities, empowers their choices, and honors their lived experiences.

Let’s Continue the Conversation

If the ideas in this blog resonate with you, I warmly invite you to connect with me. Whether you’re a therapist seeking guidance on gender-affirming and anti-oppressive practices, or someone navigating mental distress and looking for compassionate support, I’m here to help. You may book individual therapy sessions or peer consultations online. Be sure to bookmark this blog for future insights, reflections, and updates.

References

Awkward-Rich, C. (2022). The terrible we: Thinking with trans maladjustment. Duke University Press.

Kinderman, P. (2019). A manifesto for mental health: Why we need a revolution in mental health care. Springer.

Pilling, M. D. (2022). Queer and trans madness: Struggles for social justice. Springer.

Disclaimer: This blog offers general educational information and does not constitute professional advice or establish a therapist-client relationship. Please consult a healthcare provider for personalized guidance. Any decisions based on the content are the reader’s responsibility, and Clayre Sessoms Psychotherapy assumes no liability. All case studies are hypothetical with fictional names and do not reflect actual people. We prioritize your privacy and the confidentiality of all of our clients. We are committed to maintaining a safe, supportive space for 2SLGBTQIA+ community care.

Clayre Sessoms is a trans, queer, and neurodivergent Registered Psychotherapist (RP), Certified Sensorimotor Psychotherapist, and Board Certified Art Therapist (ATR-BC), offering online therapy for trans*, nonbinary, queer, and 2SLGBTQIA+ allied adults and teens across Canada. With a deep commitment to trauma-attuned gender-affirming care, Clayre integrates talk therapy, experiential collaboration, and creative expression to support clients to grow, heal, or navigate change. When not working with clients or supervising newly-licensed therapists, Clayre finds solace in nature, where she recharges her creativity and compassion.

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