Saving You, From Yourself is more important than ever as thousands of trans people lose access to healthcare
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I’m writing this on a humid Saturday evening from the safety of my home. I am undeservedly lucky. It’s May 16, 2020, and over 30 million people in the US have filed for unemployment, often losing not only their job but their health insurance. It is among the cruelest ironies that as the Covid-19 pandemic continues to spiral out of control so many can no longer access health services and medication. As always, this hits those along the margins the hardest.
Writing for Insider, Canela López describes how trans people are being forced to share hormone treatments and turn to grey market dealers as they lose their jobs, health insurance, and sometimes even their housing. Without these treatments, trans people are denied their transition and face side effects of stopping treatment midcourse. Transitioning is already personally challenging, financially taxing, and socially dangerous in the best of times - Marie Claire estimate than an average transition costs $15,500, and that close to half of all transgender people have attempted suicide.
In a country that possesses a comically inadequate healthcare infrastructure, trans folx are among the most marginalized, and the pandemic is adding yet more challenges for those seeking access to life-saving treatment. These are the worst of times, but squint and they look uncomfortably like what trans people have been dealing with for decades.
Released in 2018, Saving You From Yourself (Taylor McCue) is a hand-drawn visual novel following one trans woman’s attempts to medically transition. The game begins from the perspective of a therapist whose job it is to “judge” if their patients should be allowed access to hormone treatments. They call in Arle, assigned male at birth, and proceed to ask them questions that range from tepid to invasive. Then the player decides if they will write Arle a prescription.
Saving You From Yourself can end after the very first of these sessions, or the player can draw them out over repeat visits. It’s a visual novel with multiple routes meant to be replayed, but even with that mechanical knowledge, each subsequent run feels increasingly perverse as you draw out Arle’s therapy for reasons only the player can answer.
With each denial of a prescription, we see a vignette of Arle’s daily life as they struggle to pay for the appointments. First, it’s their collection of video games. Then they lose their pet. Finally, they reach a point where they would be unable to pay rent and decide to find another path towards treatment.
Through all of this, the therapist is impassive. This is just another patient, one whose life can change exponentially with the scribble of a pen, but another patient all the same. It is exhilarating to finally write Arle the prescription she’s been giving up everything for, but even doing so at the first chance it’s clear this scenario is broken. Why is Arle being interrogated before she can transition? Why do we get to decide what their life looks like, how much they have to sacrifice?
Saving You From Yourself is not meant to be subtle. It is raw and messy, screaming for you to get it and do better. Backgrounds and character models form collages across the screen as scenes shift and the situation becomes direr as if each image barely has time to come together. There is no room for bad faith interpretations, the experience is too provocative, too direct.
It takes less than half an hour to run through every conversation option. We’re not witnessing Arle’s life, after all, we’re just their therapist. By condensing the game so tightly, Taylor McCue amplifies the power imbalance at play. A therapist sees hundreds of patients for varying degrees of time. Ultimately, they are just another appointment. But what is a brief encounter for them will determine the other person’s lifetime.
If the player keeps denying Arle medication, they eventually turn to grey market solutions. These are dangerous drugs with unknown side effects, but at a certain point, it’s worth the risk. Even as just a game, it feels wrong to push Arle this far just to see what they do.
2017 was the year the American Psychiatric Association finally declassified gender dysphoria as a mental disorder. Three years ago. Despite numerous studies showing that very few people regret transitioning, it remains incredibly hard for trans people to actually access hormone treatments and other medical procedures. It is impossible to overstate the challenges unique to trans people, but even as they are granted more access to health services the gap remains wide.
So we return to 2020, and many trans people are facing realities much like those from pre-2017 when most medical personnel were entirely unable or unwilling to provide them with hormone treatments. It is a testament to the trans community that in these dark times they are still finding ways to support each other when the system does not, but it is an embarrassment to our country they have to take these steps.
Saving You From Yourself is just one story. In this one, it is possible to have a happy ending, for the experience of transitioning to be as frictionless as possible. But at every point it emphasizes how discrimination corrupts that process, making a moment of self-actualization a sequence of bureaucratic roadblocks. It was timely in 2018 and has only grown more significant in the time since release, taking on new meaning as the challenges facing trans people are prolonged and warped. The ease of Arle’s transition should not feel like a fictional happy ending. We have to do better.