Joey Wade can remember the first conversation, but not the exact time of day. He knows he was in Raleigh’s Dorothea Dix Hospital and in the Cherry Building. The 15-year-old knows he was in his room, sitting on his bed, and it was after the other residents had gone to sleep. That’s when a woman entered. She wore a white smock and spoke in a friendly tone of voice.

“Have you ever read the Bible?” she asked.

“I’ve read parts of it, sure,” he replied.

“Have you ever read where it says that homosexuality is a sin?”

“Yes, I’m aware of that part in the Bible.”

“You do realize you’re female, right?”

Joey stayed silent.

The nurse proceeded to explain that Joey’s life, as a transgender teenager, was against God’s word. She said he was wrong for living his life the way he was living it.

Joey let her speak because he didn’t want to talk to her. He had already endured humiliation at the hands of other Dorothea Dix staff: He was placed in the women’s ward, called “she,” searched regularly and forced to wear a bra.

At the end of the lecture, Joey started to cry. The woman attempted to calm him by making him drink Benedryl. When he refused, she threatened him. “She said if I didn’t drink it I would be put on level 1-A,” he recalls, “which is solitary confinement–in suicide-resistant clothing.”

So Joey drank.

There was little regularity to her visits. She would come in the evening, after dinner or at night. “The nurse knew what she was doing,” Joey explains. “She would come in my room and screw with my head.”

Every time, she would talk to him about being transgender. “She asked me about my not wearing a bra and how my chest was going to look when I was older. I would just cry and cry. I’d be like, ‘Please, would you please just go away and leave me alone?’ And she’d be like, ‘No, I think we should talk about it.’”

Few transgender policies

Although Dorothea Dix Hospital is one of the largest mental health facilities in the state, it does not have a protocol for treating transgender people, or individuals whose biological sex and gender expression or identity may not be the same. “In the case that we have special needs patients, we will work to make accommodations,” explains Dix spokesman Mark Van Sciver. “But that’s as specific as I can get.”

The same holds true for the Wake County Juvenile Detention Center, another institution in which Joey says he was mistreated. “There is not a specific policy that deals with transgender individuals,” explains Leigh Hines, communications director for the N.C. Department of Juvenile Justice and Delinquency Prevention.

It’s hard to say how many people are affected. The transgender population in the United States is about 1/2 to 1 percent of the total, explains Mara Keisling, executive director of the National Center for Transgender Equality. And it’s hard to make a perfect estimate, considering the dangers that many transgender folks face when they come out.

But the number of openly transgender people seems to be increasing. “I went to a youth meeting in Nebraska recently, and there were three or four transgender high school students who were out at their schools,” Keisling reports. “If that’s happening in Nebraska, it’s happening in Durham, in Charlotte and other places as well.”

The lack of protocols or protections points to a broad problem in North Carolina: There are nearly no transgender-specific policies anywhere in public record. “From my experience, there is virtually no information or awareness of transgender issues in the state’s mental health or social service sectors,” explains Samuel Allen, a Durham-based licensed clinical psychotherapist who specializes in working with transgender clients. “In fact, I haven’t seen any real awareness or sensitivity in the court system, group homes or juvenile detention facilities either.”

The only two trans-sensitive public policies exist in a Guilford County school system harassment policy and the Chapel Hill town employee non-discrimination policy, both of which protect gender identity and expression along with sexual orientation. The North Carolina Board of Education was set to include gender identity and expression in a list of many categories protected in a harassment policy but deleted the terms at the last minute. Hence, transgender people in North Carolina have almost no legal protections against being miscategorized and consequently mistreated.

North Carolina isn’t the only state with the problem. Most transgender individuals in the United States live without legal protections, explains Dean Spade, a lawyer in New York City and director of the Sylvia Rivera Law Project, an organization that works for the freedom of gender identity and expression. “This is really a major issue we have for transgender civil rights. It’s about people being put in the wrong jails, prisons, homeless shelters and foster care and facing extreme dangers in those places.”

Connie Spry, a transgender activist in Fayetteville, says she can cite at least two current cases in North Carolina in which transgender citizens have been placed in the wrong sex-segregated prisons and allegedly raped since incarceration.

The lack of legal protections or health care protocols for transgender people means they cannot be assured a nondiscriminatory environment when they enter state custody, request public services or seek health care. This leads many of them to forego help of any kind. They often resort to self-medication, endure poverty without assistance or fight depression without treatment. “That’s why the suicide rate among transgender people is so high,” explains Spry.

Progressive cities and states, such as Boston and New York, have led the way to create trans-sensitivity training programs and protocols for public service providers. It is illegal in Boston, for example, to make a transgender individual use a facility that does not comport with his or her self-identity.

Any other kind of treatment is considered abuse. “While someone is in state custody,” Spade argues, “he or she should come to no harm. And they will come to harm if their gender identity is not recognized and they are forced to wear inappropriate clothing. It’s a form of harassment and it’s certainly a form of abuse.”

A family exodus

When he was 3 years old, Joey told his mother he was a boy. At first, the process was metaphorical. “We had boy neighbors that Joey would play with, and every time he made a new friend, he would want to take on their name,” Cynthia explains. “One was Trevor. One was Michael. And one was Joey. Those were his friends, and one by one, he said, ‘I want to be Trevor, too.’ ‘I want to be Michael, too.’ ‘I want to be Joey, too.’ And finally I said, ‘I don’t want to be changing your name every day. Why don’t we just stay with Joey?”

Around this time, Joey also expressed concern that his older brother, Oliver, only had sisters. He told Cynthia that he wanted to be Oliver’s brother. “He said, ‘I’m going to be a boy, OK?’ I said, ‘OK’,” Cynthia recalls. “He’s 3 years old–be a dog, be a boy, be a tree, whatever you want to be.”

But Joey’s presence in the world altered. “I don’t think of 3-year-olds as having female or male posture, but his body language completely changed,” explains Cynthia. “Off he went. It was like waving a wand.”

Relatives and peers weren’t supportive of the change. When Joey stayed with his grandmother, she called him Peggy Elizabeth, his birth name, and spanked him when he refused to wear girl’s clothing. And Joey’s father continued to call him by his birth name. “It would just infuriate Joey,” Cynthia says. “He would just get ballistic if anybody called him Elizabeth. Not slightly annoyed–ballistic.”

Joey’s father was also acting hostile toward Cynthia, so she sought a safe place, outside of their home in Florence, Ala., to move with her children. Her daughter, Stephanie, was attending Warren Wilson College in Asheville, and praised the mountain city. Cynthia was uneasy. “I don’t want to get back into any other good ol’ boy Southern mentality,” she told her daughter. “I just can’t afford to go through that again.”

Stephanie reassured Cynthia that Asheville was a tolerant place. So she moved. She enrolled Joey in kindergarten and explained to the teacher just the facts: Joey was born as Elizabeth and will pitch a fit if he is called anything but Joey. The teacher was understanding; she would call her new student Joey.

The Wades’ life was going well until Joey entered fifth grade. He joined a class in which the teacher adamantly refused to call Joey “he.” When Joey was out sick one day, his classmates asked their teacher why she called Joey “she.” “While Joey was there, I guess she never responded,” Cynthia says. “But while he was gone she explained that Joey had female parts. It just blew the class’s mind.”

Joey’s classmates told their parents, who were shocked at the deceit. “The parents got outraged and freaked out. It was like a big witch-hunt. They started blaming Joey for all kinds of sexual perversions. All of sudden everything became Joey’s fault,” Cynthia remembers.

His classmates began fabricating stories about Joey. For example, they blamed him for toting pornography on a class camping trip. “It was as if all of the collective conscious of perversion was dumped on him,” Cynthia recalls.

Cynthia took Joey out of fifth grade and home-schooled him until he entered a charter school, which allowed him to register as a boy.

Joey’s school problems merged with three other unfortunate developments in the Wades’ lives–members of the Unitarian church acted coldly toward the family after the fifth grade teacher outed Joey; the family’s rental house was being sold; and their neighborhood was becoming increasingly crime ridden. Cynthia searched for a new place to live. Stephanie had since given birth to her second child in Raleigh. So the Wades packed up again and moved east.

Falling in love

When Joey got to Raleigh in 2002, no one knew he was transgender. He asked his mother not to tell anyone. So Cynthia enrolled the then-13-year-old in Sanderson High School as a boy. “Then they gave me a call about his birth certificate and my heart stopped,” Cynthia recalls. “I went down there and they were very cool about it. They just said, ‘He’s got to use a unisex bathroom.’”

That seemed like a good compromise to everyone except Joey, who identifies as a boy. So, one day, he got caught using the men’s bathroom. He was suspended for 10 days. “He was devastated,” explains Cynthia. “Any kid would be at that big of a penalty.”

As Joey continued into his ninth-grade year, he became increasingly disruptive. He smoked cigarettes in school and was late for class. “Just stupid stuff,” Cynthia says.

Then one winter afternoon, Joey and two other boys were hanging out at a playground. One of them started a fire in a concrete pipe and threw a tackle dummy into the flames. The boys got caught, suspended and called to court for destruction of school property. Even though he was found innocent, Joey completely lost interest in school. He failed ninth grade.

Then the summer started and Joey fell in love with a girl from his class–Tess Miller. Tess has bleached-blonde hair, a pale complexion and carries herself as if she were 30. Her maturity matches that of Joey’s, who, despite his skater-boy aesthetic, speaks with a conversational eloquence and insightfulness that suggest he is most open and comfortable around people twice his age.

As their relationship began, Joey says he discovered that Tess was having problems at home. She tried to run away multiple times, he says, to the degree that her mother poured Superglue down their house’s window locks. Joey saw it as his responsibility to save Tess from her home life. The young couple started running away together. “The reason Joey’s social workers wanted residential treatment for him was because he’s a high risk for running,” Cynthia explains. “Where does he run to? He runs to Tess. All he cares about is saving Tess, which is a problem.”

Cynthia’s greater concern, though, was that Tess’s parents hated Joey. Joey reported that they had threatened to kill him. So when Joey had to go to court on an unrelated charge, Cynthia asked the judge to rule that part of Joey’s corrective plan be that he not be allowed to associate with Tess or the Millers. This, she explained, was for his protection.

The couple, however, didn’t like the plan. On the day the judge issued his ruling, Tess waited outside the Wake County courthouse for Joey. When Joey exited the building, he saw Tess, tossed his mom the car keys and ran.

“Where are you going?” Cynthia yelled.

“Mexico,” he replied.

The court order and the young couple’s refusal to stop seeing each other prompted the Raleigh Police Department to get involved. During the investigation, Detective Russ Hepps discovered that Joey was born biologically female. He also discovered that Joey was waiting for testosterone treatment and considering sex reassignment surgery. He shared this information with Lynn Miller, Tess’s mother. Lynn told her daughter, who didn’t know Joey’s history.

Joey remembers the day his girlfriend found out. He had just returned home from therapy around 11 a.m. and got a call from Tess. She was at a nearby grocery store, she said, and needed to see him immediately. An hour later, Joey arrived at the store.

“She was like, ‘What’s PE mean to you?’,” Joey recalls.

“I was like, ‘Oh my God–Peggy Elizabeth.’”

Tess broke up with him that day. Suddenly, everyone in Joey’s world knew he was transgender. Lynn Miller, the Wades say, continued to tell Joey’s personal information to other people–the parents of Tess and Joey’s friends, Cynthia’s coworkers, and even the family’s neighbors.

After a short time, Joey and Tess resumed dating and meeting one another. On one occasion, they got caught by Tess’s father, Jeffrey Miller, and the result of the interchange is the subject of an assault-on-a-female charge against the father.

As Joey remembers it, the couple was sitting on a brick wall at Cameron Village last Dec. 10. Jeffrey Miller approached them, grabbed Joey by the ankles and yanked him off the wall. Joey fell to the ground. “I don’t want to fight you,” Joey said, getting up and backing off.

Tess slapped her father, who allegedly returned the blow.

Joey took off his vest, tightened his belt and emptied his pockets.

Tess’s father fumed at his daughter: “What are you going to do? Protect your girlfriend?”

Joey says he leaped onto Tess’s father, punched him in the ear, tackled him and brought him to the ground in a headlock. “I can’t breathe! Let me go,” the man yelled.

Tess ran to the nearest store, Monte Cristo’s, and banged on the window. Julie Proctor was working at the jewelry store’s back register. “I saw what I thought were three teenage boys embraced and rolling around,” she recalls. “Then the young girl banged on my window and asked me to call security.”

Security arrived. “You come up here with whoever you want and I’ll kick all of your asses!” Joey recalls Jeffrey saying. Tess’s father then left the scene.

An officer from the Raleigh Police Department came and took a report. “The officer indicated that the victim [Joey] had some relatively minor scratches to her neck and a sore back,” explains Jim Sughrue, a Raleigh police spokesman.

Tess was put in the backseat of the police car. And, in 10 minutes, Joey’s bus came and he left the scene.

Jeffrey Miller was charged with assault on a female, according to police records. Miller declined to discuss the case and referred questions to his attorney, Sam Currin. His case has been continued several times, and Currin says Miller plans to plead not guilty. He declined to discuss the case further.

Dorothea Dix

After the incident, Cynthia noticed that Joey had stopped sleeping again. He was acting increasingly manic and passing through dramatic emotional swings. He had demonstrated similar behavior during the previous fall and, as a result, had done short stints in three mental health facilities–Holly Hill outpatient (Sept. 15-23), Dorothea Dix emergency ward (Oct. 22-28) and Brynn Marr in Jacksonville, N.C. (Nov. 3-6). She thought he needed comprehensive, residential attention this time and sought help just before Christmas from the Dorothea Dix long-term care ward.

During the intake process, Cynthia wanted to ensure that the staff could accommodate her transgender son. She requested they not force him to wear women’s undergarments and that he be allowed to wear his bindings, a stretchy gauze wrap commonly worn over the breasts by female-to-male transgender folks. The intake staff said they understood. “What’s under the clothes is of no interest to us,” Cynthia recalls them saying. So she left her son in Dorothea Dix’s care.

The next day she spoke with Joey over the phone. He was crazed. Dix staff had forced him to wear a bra and panties. “They said it was in the rules so I couldn’t argue with them,” Joey recalls.

Cynthia was irate. She called Charles Johnson, a patient advocate at the hospital. She told him that the long-term care staff was making her transgender son wear women’s underclothing. He responded a few days later by letter: “Bras are to be worn by all female patients due to this being a co-ed building and activities involving exercising and being in the community,” he wrote.

Joey also reported that Dix staff searched his undergarments regularly, demoted him if he didn’t comply with the bra and panties rule, called him “she” and created an environment hostile to his gender. “People got in trouble for calling me ‘he,’” he explains. “The patients’ level was dropped for saying ‘he.’”

Joey’s Comprehensive Treatment Plan, at least, suggests that doctors wanted him to keep his gender issues quiet. They wrote that Joey should “handle her gender identity issues in therapy and not draw attention to these issues in a negative manner with her peers.” This negative manner, Joey adds, is the fact that he asked other patients to call him “he.”

Health professionals who worked on or heard the details of Joey’s case were shocked at the teen’s treatment. “Once you identify that your client is transgender, in order to provide ethical and competent treatment, you need to do everything you can to ensure that he is being treated as the appropriate gender,” explains Durham-based psychotherapist Samuel Allen. “That is part of the clinical treatment for this kind of case.”

If a medical professional does not have experience with a condition or type of person, the American Counseling Association’s Code of Ethics requires him or her to seek professional guidance.

What’s more, the proper procedures for dealing with Joey wouldn’t have been difficult or expensive to implement. “This client’s needs were fairly simple to meet,” a mental health professional close to the case explains. “They could have used the correct pronouns. They could have not made him wear a bra. They could have done all these things with little negative impact on anyone else in the facility.”

But Dorothea Dix staff, as well as the counselors at Wake County Juvenile Detention Center, seemed unconcerned with accommodating Joey. “I’ve been shocked at the absolute lack of fear of liability with anyone in any of these institutions,” the health-care professional says. “That has been my main surprise: I assumed he would be taken care of, not out of open-mindedness or goodwill, but out of their fear of liability. But that fear seems to be absent.”

Dorothea Dix officials say they can’t discuss a patient’s treatment, or even confirm that someone has been a patient at the hospital.

Wake Juvenile Detention Center

After about a month in Dix, Joey got out and continued to see Tess. Things seemed to be going well for a while, until Lynn Miller reported the couple’s renewed contact to juvenile services. They had Joey arrested and dropped off at the Wake Juvenile Detention Center. Joey discovered that the detention center, like Dorothea Dix, didn’t have a transgender protocol. He was placed in a women’s room, called “she” and forced to wear panties and a bra again. “They basically said, flat out, ‘This is what you have to wear and there are no questions asked’,” he recalls.

Joey resisted and the detention staff strip-searched him regularly. One day, when the staff came in to check his clothes, he just lifted his panty’s elastic band over his pants to show them what he had on. “They were like ‘No, take your clothes off’,” Joey remembers.

Joey then confided in Cynthia that he was feeling suicidal. She reported this to the detention staff, who continued to keep Joey in a monitored room. “Everything he does is viewable,” Cynthia explains. “Yet it’s ironic: The reason he’s on suicide watch is because he’s in detention, being strip-searched and made to wear a bra.”

Then, one afternoon, Allan Fuller, the detention center’s service coordinator, noticed that the teen was distressed. Joey remembers the man invited him to have a conversation.

“Why don’t you talk to me for a minute?” the man asked.

“OK,” Joey replied. He knew if he didn’t agree–being in a detention facility–he could get punished.

“So, you’re transgender,” Fuller said.

“I really don’t want to talk to you about this,” Joey stated. “You’re not going to understand.”

“Oh no. I’m a smart man. I’ll understand.”

“OK. Well, this is how it is: I feel male.”

“Well, that’s not really how it is.”

“I don’t want to talk to you about this.”

“You have to talk to me about it.”

“You don’t understand. Why do you want to talk about it?”

“Oh,” Fuller said, “my brother is transgender.”

Joey was suspicious.

“Doesn’t it make your life so much more difficult to make this choice?” Fuller asked.

“Why would I want to make my life that much more difficult?”

“Well, I don’t know, why would you?”

Joey went back to his room and reviewed the conversation: “He didn’t say that I’m a bad person. But it’s the ‘It’s-a-choice-why-did-you-make-it’ that really got to me.”

Joey complained about the conversation to Carmel Sweeny, a clinical services contractor at the facility. She said Fuller was simply trying to help. “She said, ‘He takes it upon himself to try to work people’s problems out,’” Joey recalls.

So Joey wrote a formal complaint to the center’s director, Sheila Davis, and cited the conversation, as well as other insensitivities he was facing. His concerns were never answered.

Cynthia brought Joey’s mistreatment to the attention of District Court Judge Robert Rader. Kimball Jane Sargent, a local transgender specialist, also contacted Rader. On May 6, the judge ordered the detention center to stop making Joey wear a bra, searching him and calling him “she.”

Joey remembers when the news hit the detention center. “They felt like I had won some sort of thing that I shouldn’t have,” Joey recalls. “They got pissed off and started searching my room a lot. They would come in, more than once a day, and totally strip my room. Just throw everything everywhere. Then they’d be like, ‘OK, go clean it up’.”

The detention staff, however, continued to call Joey “she.” Joey’s lawyer, case worker, therapist, trans advocate and mother all told Tim Montgomery, a juvenile court counselor in Wake County, that the staff needed to follow the judge’s orders. “The judge made it very clear that he wanted the pronouns to be honored,” Cynthia says. “But Tim completely dissed it.”

A transgender advocate confronted Wake County Assistant District Attorney Adam Moyers about the case. “Adam said he was going to go out there to tell them to stop using those pronouns,” Cynthia said. “And our advocate said, ‘Let me go with you. Let me do some sensitivity training.’ And he said, ‘No, no, no. I can take care of it.’ Well, he didn’t. They’re still doing it. And it’s torturing Joey.”

Joey was called “she” until he left detention. Emblematic of his stay, perhaps, he lived in a room marked female. “They had this thing over my window,” he recalls. “I had a problem with it. It had an F on it. A big pink piece of paper, with a big F on it.”

Search for treatment

Right now Joey lives with his mother during the day and his sister at night. A team of health workers meets weekly to discuss what to do with him. From their vantage point, they’re trying to do the impossible–find a transgender-friendly residential care facility in North Carolina.

Joey and Cynthia, however, don’t believe that residential placement is in Joey’s best interest, given his recent experience with institutions. They want Joey to stay at home, under Cynthia’s care. But the team questions whether this is a feasible option, considering Joey’s track record of running away. One factor bears important weight on their decision, however: Tess and her mother moved to San Diego as soon as the tenth-grader finished the school year, exactly one year after the young couple met.

Cynthia explains that her toughest task has been to make sense of the flood of social workers, therapists, lawyers, advocates and doctors who have entered her and her son’s life. “Everybody has their reason for wanting to be in Joey’s life,” she explains. “There’s something there they want to touch. Something they want to be close to. Something they’re curious about. Something they want to get involved in. Something they want to fix. Something they want to understand. He’s an enigma that everyone responds to–some negative, some positive, rarely neutral.”

For example, she’s been trying to read between the lines of the latest disturbing fact: Joey’s court case against Tess’s father has been postponed four times. Wake County Assistant District Attorney Matt Lively most recently explained that it was delayed because Tess’s father’s lawyer was in federal court. But Cynthia fears that Tess’s father is well-connected and, as a result, the postponement means that she is fighting the “good ol’ boy mentality” she feared when she moved to North Carolina.

Meanwhile, Joey’s experience with these institutions has been an intense lesson for him. “He didn’t know how much hostility and hate there is in the world,” Cynthia explains. “And it’s all hitting him now, at once.”

Getting help

Health care providers can find information about treating lesbian, gay, bisexual, transgender and intersex patients by visiting the Gay and Lesbian Medical Association’s Web site,, and accessing their publication, “Creating a Safe Clinical Environment for LGBTI Patients.”

Transgender youth can find information about turning their schools and other environments into safe spaces by visiting Lambda Legal’s Web site,, and accessing their publication, “Bending The Mold: An Action Kit for Transgender Youth.”