Affirmative Care or Child Abuse?

When a woman tries to turn herself into a man

There is in Britain a charitable organisation called Educational Action Challenging Homophobia (EACH). One of its aims is to ‘promote affirmative and accurate representations of LGBT lives’, whatever that means, and in pursuit of this goal has put out a video titled ‘What is gender?’

After excruciatingly irritating introductory music, the narration, full of pregnant pauses, is delivered in a male voice but it’s unclear who the speaker is. Is he a doctor or a birth attendant in some capacity? If so, I wonder how many births, if any, he has he attended when he says this:

When a baby is born (pause) the first question many people ask is (pause) ‘Is it a girl (pause) or (pause) a boy?’ Well (pause) actually (pause) it’s a baby! A box is ticked (pause) and a label is attached

Who are these many people? In any case, the first words uttered by the birth attendant are nearly always, ‘It’s a boy!’ or ‘It’s a girl!’ as the case may be. And the first question the mother invariably asks is, ‘Is he all right?’ or ‘Is she all right?’

The commentary in the video continues:

Sex is about biology. A person is given a label as male or female…Gender identity describes how you think of yourself. It’s how you feel inside, and how you want to be known by others. Only you (pause) can define your gender identity.

The narrator ought to be ashamed of himself to talk like this. ‘A person’ is not ‘given a label as male or female.’ Babies are recognised as male or female at birth (or often these days before birth from an ultrasound scan) and their sex is registered accordingly.

Now we come to the tricky bit: ‘gender identity’ and the related idea of ‘transgenderism’ as we might call it.

An attempt at defining these notions is made in a book called It Feels Good to be Yourself by Theresa Thorn and Noah Grigni. I’ll quote some of the text:

This is Ruthie. She’s a transgender girl. That means when she was born, everyone thought she was a boy. Until she grew a little older – old enough to tell everyone that she’s actually a girl. Girl is Ruthie’s gender identity.

This is Ruthie’s brother, Xavier. Xavier is a cisgender boy. That means when Xavier was born, everyone thought he was a boy, and as he grew older, it turned out that he was right – he is a boy.

Here we see the transgender ideology in full flight. It’s nonsense to say, as in the first example, ‘when she was born, everyone thought she was a boy.’ What everyone thought is irrelevant. The inescapable biological fact is that he was born as a boy and will remain a person of the male sex for the rest of his life. To say ‘she’s actually a girl’, to put it plainly, is a lie.

Similarly for Xavier. To call him a ‘cigender boy’ doesn’t add anything to the sense of just saying he’s a boy. When he was born, once again, it’s irrelevant what everyone thought. Likewise it’s nonsense to say ‘it turned out’ that he is a boy. He was recognised as a boy at birth, that is, a baby of the male sex, and will remain a male person for the rest of his life.

What is conversion therapy?
In discussions about gender identity the idea of ‘conversion therapy’ may be disapprovingly mentioned. A definition put out by Stonewall is as follows:

Conversion therapy (or ‘cure’ therapy or reparative therapy) refers to any form of treatment or psychotherapy which aims to change a person’s sexual orientation or to suppress a person’s gender identity. It is based on an assumption that being lesbian, gay, bi or trans is a mental illness that can be ‘cured’.

This approach was originally used in relation to homosexuality when it was wrongly believed that gay or lesbian people could be ‘converted’ to heterosexuality. The techniques used to attempt to change these people’s sexual orientation were aversion therapy (such as electric shocks) and prayer. They didn’t work, were physically and emotionally harmful, and are now rightly no longer used.

However, some vociferous proponents of what is called gender dysphoria have extended the discredited idea of conversion therapy to cover any form of talk therapy (psychotherapy, counselling) in children and adolescents who may be confused about their gender. As I have pointed out before, depression and low self-esteem due to difficult life circumstances may be projected onto the idea of being in the ‘wrong’ body, and if only it were possible to ‘transition’ to the opposite sex, all one’s problem would be solved!

The aim of therapy for people in this situation is not to convert them to a state of mind so that their gender identity conforms to their biological sex. There is, or should be, no such preconceived goal. If I were consulted by a young patient with this problem, my reaction would be to offer therapy to try to understand the source of their confusion so that they could work through their difficulties or at least come to terms with them. People consult doctors or therapists because they are in a dilemma or are unhappy about something in their lives. My role is always to help the patient, in so far as this is possible, find their own solutions to their problems; it is seldom to give advice and never to ‘tell the patient what to do’. And if a child or adolescent is content to think of himself of herself as belonging to the opposite sex and doesn’t want therapy, that should be respected.

What should and must be resisted, however, is a request for puberty blockers or cross-sex hormones in someone under the age of 18 with a belief, or rather, delusion, that they are of the opposite sex. It cannot be anything but harmful to disrupt normal endocrine functioning in a physically healthy child or young person. A fortiori, to perform mutilating surgery such as double mastectomy (removal of the breasts) would be unethical and amount to professional misconduct on the part of the surgeon, in my view.

Affirmative approach
The conflict exists because of insistence by pressure groups such as EACH that if someone suspects or believes that he or she is ‘trans’ this should be taken at face value. This simplistic and risky ‘affirmative approach’ means that any doubt is swept away or overlooked and the young person is regarded as already being on the road to transition.

The affirmative approach is based on the assertion that being transgender is an inherent and immutable part someone’s psychological makeup, but this is pure speculation. It should not be used as a reason to offer, or to agree to a request for, life changing hormonal manipulation in a person under 18.

It is the affirmative approach that should be banned. Conversion therapy is wrong, ineffective, and harmful, but this should not be confused with psychotherapy or counselling to explore the background of the person’s gender confusion if this is wanted by the patient.

Unethical research
As I mention in a previous blog, after a review by Dr Hilary Cass, the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Trust in London is to be closed down, and not before time. But how hard it is for doctors to let go of outdated and harmful concepts! Dr Cass tells us:

NHS England has accepted…that young people being considered for hormone treatment should be enrolled into a formal research protocol…with a more immediate focus on the questions regarding puberty blockers….more research is needed to understand the best treatment options for children and young people with gender dysphoria.

This appears to be based on an assumption that in some young people with gender dysphoria – an entirely subjective diagnosis – treatment options which include puberty blockers may be needed.

It has been shown that children and adolescents who have a strong identification with the opposite sex, if they do not grow out of it as many do, may end up as gay or lesbian. But I can think of no circumstances where research into the use of puberty blockers for people with gender confusion would be ethically justified. If they are taken for, say, two years, and then the person changes his or her mind and the drugs are stopped, one cannot put the clock back – two years in which the person would have been developing physically, mentally, and sexually will have been artificially disrupted; it is wishful thinking to regard the effects of these drugs as fully reversible.

What should also be banned is the use of hormonal manipulation in physically normal children and adolescents in any circumstances. 

Text © Gabriel Symonds

Photo credit: Aiden Craver on Unsplash.