Last week, I was at The Third International Conference on Human Rights and Peace and Conflict in Southeast Asia organised by the Southeast Asian Human Rights Network (SEAHRN) in Kuala Lumpur, Malaysia. I was part of a panel of psychologists speaking on mental health and rights of LGBT persons in the region. My co-panellist was right to note that we were the only psychologists attending the conference.

I am happy to report that our panel was well-received and stimulated a lot of conversation; and the panelists received some very good feedback. In discussion during tea break with a lawyer who heard (half) the panel, I realised that there was little to no awareness of the links between mental health and human rights. I could not blame her because I myself am used to discussions of human rights focused on the law.

There are multiple intersections between human rights and mental health. Firstly, how is one supposed to enjoy their human rights when they do not enjoy good health and well-being? Mental health is not just about disorders and disabilities. It is not about the absence of mental illness. Instead, ‘it is the state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’. (WHO, 2004)

This definition then leads to the other intersection between human rights and mental health. How is one supposed to have good mental health if they do not enjoy their human rights? How can one realise one’s potential or work productively and contribute to society if one’s human rights are abused and violated? How can one cope with the ‘normal stresses’ of life when life itself is a stressful condition and the thought of death is the only prospect of there being less stress?

For many in the LGBT population in Malaysia, this is the reality of their existence. Repressive laws coupled with an intolerant culture leads to the community having their rights continually violated.

Human Rights Watch (HRW) recently released their report ‘I’m Scared to Be a Woman’: Human Rights Abuses against Transgender People in Malaysia. Representatives from HRW called Malaysia one of the worst places in the world for transgender people.[1] Their report documented not just gross abuse of human rights, but also subtle everyday discrimination that leads to violations to the right to work and access to health care.

The Syariah Criminal Enactment deems a crime ‘any man who dresses as a woman’.[2] This has led to arrests of transwomen by officials from the Islamic Religious Departments and the police. As the Syariah Criminal law differs from state to state[3], some laws criminalise a ‘male person posing as a woman for immoral purposes’, thus targeting transgender sex workers. Other laws penalise a man ‘posing as a woman’ in any circumstance.

Transwomen can, therefore, be arrested at any place and at any time. This makes it almost impossible for transwomen to be in public. How does one move? How does one carry out the daily errands necessary for life? How can they work?

A transwoman reported to me once that she had been arrested by officials from the Religious Department while she was at work. She ran her own bridal beauty business out of a lot in a small shopping complex. In full view of everyone at the mall, she was dragged into the officials’ vehicle and taken to the police station. After her release, she was embarrassed to return to work. When she was finally ready, she noticed a four-wheel drive with tinted windows parked outside her house. She watched it for a while from behind her curtained window and realised that they were from the Religious Department. She knew not why they were waiting for her, but she was afraid to come out of her house. Eventually, they left after a few days. What she was left with was anxiety whenever she left her home. Her anxiety was so bad that on many days she considered not leaving her house at all.

A transman reported to me that he becomes distressed every time he has to drive as he anticipates a police road block. He had once been stopped and the police officer asked for his driver’s licence. Noticing that the name on the licence was that of a woman, the officer then started a barrage of questions which caused him to become quite distressed. After passing a couple of lewd comments, the officer let him go. The whole incident lasted perhaps five minutes. But, the intense fear that this transman experienced was enough to make him nervous every time he had to drive.

Aside from these limitations on mobility, trans Malaysians may also face difficulties travelling abroad. The Malaysian registration departments do not allow the change of gender markers on identification documents. Hence, a transwoman will still have her given male name on her birth certificate, identity card and other legal documents. Atrans Malaysian then has to be ready and willing to pose according to the gender ascribed to them in these documents to get a passport. While it may seem an easy task, posing as something they do not identify with can cause serious anxiety and distress, leading to a condition known as Gender Dysphoria.

The psychological distress that trans Malaysians are subjected to is worsened by the limitations of national policies that lead to institutionalised discrimination. More importantly, it is caused by a lack of respect for their right to the freedom of movement which is enshrined not only in human rights documents, but also the Malaysian Federal Constitution – the law of the land. Transwomen who have been arrested have reported being mistreated while in custody: physical and sexual abuses have been documented. A recent arrest of 16 transgender women resulted in them having their heads shaved and being detained in the male wards of the prison.

Compounding the law is the attitude of people in Malaysia towards transwomen. It is difficult finding a job when the community at large associates them with the stigma of sex work and mental disorders. The HRW report documents many instances where transwomen were turned away from job opportunities when they disclosed their identities.  The discrimination here means that many have little choice but to turn to sex work to make ends meet. And that leads to the threat of being arrested.

It is a cycle of violence that perpetuates itself. This results in transwomen experiencing depression, anxiety disorders including Generalised Anxiety Disorder (GAD), Panic Disorder, Post Traumatic Stress Disorder (PTSD), and substance abuse. Further issues impairing their functioning may include low self-esteem, low confidence, and poor acceptance of self. As a result, it may lead to self-hate, self-harm (including acts of self-mutilation and substance abuse), and suicide (ideation and attempts). The worst effect of poor well-being is successful suicide – an ironic but technical term.

This forces many people to have to rethink their attitudes towards mental health. Poor mental health is not a sign of personal weakness. It is but one effect of human rights abuses and marginalisation. People with mental illnesses already suffer from stigma and discrimination. Add this to the mix of belonging to marginalised communities and they are plunged into further despair from the burden of double discrimination.

It is not all hopeless, though. A group of transwomen in Malaysia are challenging the constitutionality of the Syariah Criminal Enactment. The case is currently awaiting decision in the Appellate Courts. Aside from this, transgender rights activists have seen other progress here in Malaysia. One example is the ‘Be a Trans Ally’ campaign which features video testimonies that highlight the strength and struggles of trans Malaysians. The campaign also distributes educational materials covering subjects ranging from use of proper pronouns when referring to trans people to the importance of creating safe spaces within healthcare and education sectors.[4] Such progress is a symbol of not only resilience, but also of hope for the future.

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[1]Zachariah, E. (25 September 2014). Transgenders suffer sexual and other abuses, says human rights body. The Malaysian Insider, http://www.themalaysianinsider.com/malaysia/article/transgenders-suffer-sex-and-other-abuses-by-authorities-says-human-rights-b Accessed on 20 October 2014.

[2] Article 66 of the Syariah Criminal Enactment: “Any male person who, in any public place wears a woman’s attire or poses as a woman shall be guilty of an offence and shall be liable on conviction to a fine not exceeding one thousand ringgit or to imprisonment for a term not exceeding six months or to both.”

[3]Malaysia is a federation of 14 states under the Federal Constitution. The civil Penal Code applies to all Malaysians and comes under the jurisdiction of the federal courts. Syariah laws govern personal affairs of Muslims and come under the jurisdiction of each state.

[4]More information on the “Be a Trans Ally” campaign can be found at http://mytransally.weebly.com