A Teen Therapist Writes About Gender Identity Issues — Sally’s Story

Sasha Ayad, M. Ed., LPC  is a therapist with extensive experience working with teens, and gender defiant teens in particular. When she started to notice her bright, creative gender defiant teen patients feel that they needed to define themselves by picking a label that then sometimes encouraged them to make permanent changes to their bodies, Sasha found herself thinking critically about this trend. She has researched gender identity issues in teens extensively, and has a private practice where she works to support gender questioning youth. In Sasha’s words

“I use non-judgmental, compassionate, dialogue that focuses on exploration rather than immediately seeking to affirm and transition your child. Together with your teen and family, we consider multiple complex factors that may contribute to their dysphoria, including social, cognitive, environmental, physical, and emotional factors. Treatments may include mindfulness, somatic, and integrative techniques as well as confidence-building, and age-appropriate sexual identity exploration. I also educate parents about the topic of gender identity, break down stereotypes, discuss risks, and encourage parents to become deeply invested in the process so they can best support their child outside of therapy sessions. While transition may be the best option for some kids, many others have had very painful and negative experiences with their transition, and I help families prevent this from happening. I believe I owe it to your child to be thorough and careful in my approach, placing safety, well-being, and happiness above all else.”

The following piece was posted originally on Sasha’s blog. While the current narrative around helping trans identified teens creates a false dichotomy between affirming a teen’s identity and being unsupportive or rejecting, Sasha’s work beautifully illustrates how one can offer unconditional support while helping a teen to navigate the confusing waters of identity.

Sasha can be reached at 888-945-8207 or  Sasha@Inspiredteentherapy.com. You can also find her on Facebook.

sally-blogI was busy working on a behavior plan for a very fidgety 6th grade boy when I heard an assertive knock on my office door. This was the third time this week Sally had left class without permission to come talk to me.

“Ms Ayad, how can I transfer schools? I really don’t think I can get a proper education here and none of the teachers know what they’re doing”, so began our 45 minute conversation. She often got fixated on one or two teachers, who despite their best efforts, could not find a good way to work with Sally. I had a very different relationship with her though, and I was able to help her work through some of her generalizations and logical leaps.

Her hair was always pulled back hastily in a low ponytail, the eczema around her mouth, though visible, wasn’t as noticeable as the smudges that covered her glasses – she pushed them up from the lenses every time. Often a curious little smirk would lift the corner of her mouth, even when she was clearly upset or discussing something serious.

She is one of those kids who teachers were often exacerbated by, but I got to see her in a different light, and I found her endearing, creative, and incredibly interesting.

Once we were able to conclude that switching schools was not the best option, and I taught her some self-regulation skill using a squeeze ball, it seemed she was much more at ease. She took a deep breath and said “Ms Ayad, can we talk about that other thing now?”

“You mean gender?” I replied. She nodded.

Sally and I had been talking for the last several months about her “gender identity”. When she first brought this up to another counselor, they referred her to me, knowing that I am experienced and confident in working with kids around this topic. However, Sally had certainly been exploring this issue online for months she brought it to the attention of her school counselors. Our first conversation on the topic made it clear that she had a broad vocabulary (straight from gender identity theory) which is not typical for most middle-school students.

My approach was patient, inquisitive, and I challenged her… just a bit. When she talked about her parents pressuring her to wear dresses and “act more like a girl”, I made a point of breaking this down, deconstructing what that means, and sharing ways that we all behave outside of gender stereotypes: and that’s a GOOD thing!

When she told me, weeks later, that she was looking for binders online and asked me to stop using the pronouns “her” and “she”, I felt deep pangs of worry, but took it slow. I asked her where some of these ideas were coming from: she was spending hours on tumblr, trans-advocacy sites for teens, and chat groups with other kids who she believed were “just like her”. I treaded very carefully, but told her about the medical dangers of binding and what the long term consequences may be. Our limitations in the school system made it hard to get too deep on these topics, but in every brief interaction with Sally, I found ways to empathize with her struggle, instilling pride in who she is, and still gently challenge her flawed ideas.

I deliberately pointed out all of the ways she doesn’t conform to gender stereotypes, without implying that she’s in the wrong body: her love of manga comics, her cargo pants, her disdain for dresses and “girly” clothes, in my eyes, made her a unique and awesome person. Hearing those compliments always brought that endearing little smile to her face.

Eventually, as her classroom behavior improved, her anxiety lessened, and she started making friends, she relied less and less on me for support that year. Several months passed and before I knew it, the school year was coming to a close. I wanted to follow up with Sally, so I pulled her from her PE class and we talked outside on a particularly nice, sunny afternoon.

I started with, “Sally, I’ve missed you, how are things going? It seems like we haven’t talked in forEVER!” A huge smile emerged on her face, and since her glasses were less smudgy than normal, I could actually see that her eyes were smiling too.

“Doing great! I’m getting along better with Ms Barnay and I haven’t been walking out of class when I feel frustrated”. We talked about the anime club, her plans for summer, and how her other classes were going. She paused, looking ready to tell me something that meant more to her than academics. “Ms Ayad, remember how we used to talk about gender a lot? Well, I’m kinda over it”.

“Ok, tell me what you mean by ‘over it’, Sally”.

“Well before, when I didn’t have any friends at school, I was meeting a lot of people online and I thought they were my friends. Then when I actually started hanging out with people in real life, things felt different. Before, I really wasn’t comfortable with myself so I felt like I needed to change. But now, I’m ok with myself”.

I nearly fell off the bench. This was one of the most profound realizations a therapy client can make – and she, even in her young 13 year-old body and mind, came to this conclusion by herself: “I really wasn’t comfortable with myself, so I felt like I needed to change. But now I’m ok with myself”.

I was grinning from ear to ear by this point. I told her how incredibly proud I was, that I was so happy she was feeling good about herself.

Over the summer I thought often about Sally’s story. While she turned things around largely on her own, I can’t help but wonder how things might have unfolded had I followed the prescribed gender identity model.

What if I had asked about using male pronouns?
What if I had been very supportive of her desire to bind her chest?
What if I had affirmed the idea that because she doesn’t like dresses and feels like she identifies with trans kids online, that she too may be a boy stuck in a girl’s body?

And what if I hadn’t directly (though gently) challenged some of her flawed beliefs – that stereotypes and clothing styles are a good foundation on which to question your biology, to modify your body parts, and to change your entire identity.

These are questions gender therapists HAVE to ask themselves, and it frightens me that most aren’t. Our kids are dynamic, different, and unique. But they also have insecurities, self-doubt, and are vulnerable to finding “solutions” in the wrong places. When a teenager feels isolated and misunderstood, trans-advocacy sites can convince them that hope lies in changing who they are. And isn’t this the opposite of what we’ve always tried to instill in kids: self-love, confidence, and embracing their uniqueness?

Regardless of the misinformation and wayward perspectives currently taking over the mental health field, I will continue to focus on self-acceptance for my clients. Sally’s story, and many others like it, will be our reminder that in counseling, self-loathing should never be promoted over self-love.

*The names in this story have been changed to protect the identities of the people involved.

Fifty years on: The Charing Cross Gender Identity Clinic and the funding of a category without parallel

Fifty years on: The Charing Cross Gender Identity Clinic and the funding of a category without parallel

by Susan Matthews, UK Academic

1966

The Charing Cross Gender Identity Clinic is the ‘oldest and largest adult clinic’ in the UK. It was founded in 1966, the year that the first sexual reassignment surgery was carried out at Johns Hopkins Gender Identity Clinic, the world’s first GIC  founded the previous year by psychiatrist and sexologist John Money (1921-2006). The founding clinician at Charing Cross, Richard Green (1936 -), came with an impressive academic pedigree, having worked with Money, collaborating on research on boys who demonstrated cross-gender behaviour. Money liked to claim (with some justification) that he had invented the modern sense of the word ‘gender’ – andit was Money who named the clinic (specialising in the treatment of intersex and transsexual patients) a ‘Gender Identity Clinic’.[1] (Up until the second half of the twentieth century, the word ‘gender’ referred to grammatical gender, a feature of language not human identity). Money was a psychiatrist by training but working with the new specialism of endocrinology his clinic was able to achieve unprecedentedly convincing results in gender transition.

1966 was the golden age of gender specialists, a period in which Money and Green felt an exhilarating confidence not only in their ability to improve the lives of intersex and transsexual patients through surgery, but also in their ability to understand the mystery of human gender (a concept that they themselves had defined). This was also the year that Money acquired what seemed a perfect test case and one that came with an inbuilt control when Bruce Reimer, one of a pair of identical twins, suffered a medical mistake that destroyed his penis in the course of a routine circumcision. Drawing on his expertise with intersex, Money recommended that the baby should undergo orchidectomy and be raised as a girl. Bruce became Brenda and was subject to yearly consultations with Dr Money. But when Brenda decided to revert to a male identity at 14, took the name David and refused to attend any more annual inspections, Money failed to correct the many publications that he had drawn from this case. In the end it was not so much the ‘failure’ of the gender reassignment, but the fact that Money lied about his findings, continuing to reissue earlier accounts and claiming that Brenda was ‘lost to follow up’ that threatened his reputation.[2] Some remained loyal, not least Richard Green who described Money in a 2010 BBC documentary as a ‘brilliant man, one of the most brilliant men I have ever met’. According to Green, Money did the best he could – given what was then known about gender.[3]

Back in 1966, surgical solutions for psychological problems seemed to offer a breakthrough in patient care and sex reassignment was not the unique procedure it now seems. At the time, there was no hesitation about naming transgender as a ‘disorder’, indeed the term ‘gender identity disorder’ was taken from Green’s work. This was the time when lobotomy was still widely practised: Antonio Egaz Moniz had won a Nobel prize for the procedure in 1949, and although the operation was banned in the US in 1967, lobotomy continued in the UK in reducing numbers until the 1980s. As a child I met a woman who had been my mother’s best friend, who had undergone a lobotomy after a breakdown following an affair by her husband – who as next of kin had authorized the operation on his wife. Seeing her capable of no more than flat small talk left me with a lasting horror of psycho-surgery. What I didn’t realise then was that demand for lobotomy came from patients, enthused by claims made for the procedure.

 

‘The Death Star’

Back in 1966, the science of gender identity was in its infancy and both Money and Green were highly respected. Money’s professional standing was based on his expertise in the treatment of intersex for which he devised a widely accepted protocol. But intersex was particularly important to Money because he believed that by studying intersex he could gain an unprecedented understanding of human gender identity. In a 1996 introduction to the reissue of his classic 1972 Man & Woman, Boy & Girl: Gender Identity from Conception to Maturity, Money explicitly thanks his intersex patients: ‘The majority of people who contributed to this new meaning of gender were hermaphrodites or intersexes. To them social science and social history overall owe a debt of gratitude.’[4] What Money did not acknowledge in this introduction was that by 1996 the consensus amongst clinicians about how to treat intersex had been challenged by the patients themselves – many of whom viewed Money’s protocol as invasive. Many felt that their bodies had been subject to unnecessary surgery and believed that they had been lied to: some called Money’s intersex clinic at Johns Hopkins the ‘Death Star’.[5]

The difficulty is to know which elements of the science of gender spawned by the Johns Hopkins Gender Identity Clinic need to be revised and which rejected.[6] For the Reimer case is open to many different readings. Zoe Playdon attributes the failings of UK gender identity clinics to this history, associating them with the ‘falsified research’ of the Reimer case and arguing that they ‘still generally coerce patients into extended psychiatric treatment, often lasting for years, in the absence of any identifiable mental health problems and without informed consent.’[7] But she is wrong to claim that Money and the Johns Hopkins clinic were ‘conversion therapists’.  In the field of transsexualism, they saw themselves as sexual radicals, at the forefront of supporting gender reassignment. If their model of gender roles was conservative that is unsurprising for a rigid model of gender underpins the whole field of gender reassignment with its insistence on matching bodies to socially defined roles. Certainly the psychiatric assessments described by the Reimer twins (both of whom subsequently committed suicide) appear to have been unprofessional and probably traumatic. But for intersex patients, so were the surgical therapies imposed on their bodies. Playdon cannot conceive that the medical and surgical procedures evolved in Money’s clinic might require challenge as much as the particular model of psychiatric assessment that Money used.

The Charing Cross GIC, then, was founded in a very different world from that we now inhabit, a world to which we would not want to return. The science of gender emerged from a tiny group centred on John Money and its findings were ethically compromised. It was a world in which the authority of the clinician was unchallenged, and in which transsexualism was believed to be rare but universal and unchanging. Although Money’s students and followers have gone on to found a series of treatment centres, the numbers of ‘gender’ specialists are relatively few. Echoes of the founding beliefs are still apparent in a 2011 paper by James Barrett, currently lead clinician at Charing Cross GIC. ‘Disorders of gender identity have probably always existed, inside and outside Europe’, Barrett writes, citing a 1975 study (Heiman).  Citing a 1996 study, he presents the condition as vanishingly uncommon: ‘It seems that the incidence of transsexualism is very roughly 1 in 60000 males and 1 in 100000 females, and it seems to have remained constant’[8] Given that ‘Treatment is drastic and irreversible’, Barrett insists that diagnosis must be entrusted to the experts of the gender identity clinic:

The least certain diagnosis is that made by the patient, made as it is without any training or objectivity. This uncertainty is not lessened by the patient’s frequently high degree of conviction. Neither does the support of others with gender dysphoria help, since conviction leads people to associate with the like­minded and to discount or fail to seek out disharmonious views.

 

For Barrett in 2011, the aim is to ‘pass’ and he reports that ‘At least one patient has been undetected by her general practitioner and by her boyfriend of 9 years. Another was undetected in the course of several lesbian relationships.’

2016

These assumptions do not fit the world that Barrett and his colleagues encounter now when rates of transsexualism are rising sharply – not remaining constant. The incidence of transsexualism in women exceeds that in men. The whole notion of diagnosis is seen as inappropriate: patients self-identify, drawing often on online guidance, and the role of the clinic is simply to accept a diagnosis formed by the patient. For many of those who claim a trans or non-binary identity, passing is no longer the aim. Above all, transsexualism, now redefined as transgenderism, is no longer a disorder. In this changed world, the function and the funding of the Gender Identity Clinic is thrown into doubt. Clinicians do not understand the world they now encounter, nor are their theoretical models adequate to understand their patients.

A mighty taxonomological struggle

It is not surprising, then, that Trans is now a thing like no other, a condition without a theoretical model. Barrett compares it, in a 2016 blog post for the BMJ, to ‘the Australasian Platypus’:

platypusThe first specimens were dismissed as a joke of some sort.

But then more came, and alive and kicking at that. There followed a mighty taxonomological struggle. They were reptiles or perhaps some sort of bird, surely, as they were warm blooded, laid eggs and were venomous. On the other hand, the fur argued for mammals, but they didn’t have proper breasts, the defining feature of the mammals, and that business of being venomous is more of a reptile-like thing, is it not? And they do lay eggs…but warm blooded…perhaps a bird of some sort…?

In the end, it was all solved by everyone admitting that the Platypus was real, important, couldn’t be dismissed and didn’t fit any existing category very well. It got its own, special category where it has paddled, very happily, ever since, albeit joined by echidnas and some long-extinct fossilised forebears.[9]

The difference from the Money/Green generation is striking. When Brenda Reimer insisted – despite an upbringing and a family that told her she was a girl – that inside she had never felt female, this high profile (and unique) case seemed to demand a new model of gender identity. For David Reimer as for many now, gender was a strongly felt internal sense of self. Richard Green’s 2010 comment that Money’s model of gender identity was the best that was known at the time was an attempt to overcome the threat to his professional identity as a gender specialist created by the fallout from the Reimer case. Yet there was no model to take its place. Trans clinicians are now unwilling to offer a theoretical model of gender. Doctors are asked to prescribe hormones on the basis that medication reduces distress and leads to an improved quality of life (claims that are hard to support from evidence).

With no theoretical model, analogy is often the next best thing. Those arguing for access to medical intervention frequently invoke – and discard – parallels with gay abandon. But in every case, the differences are as significant as the similarities.  A key claim is that the fight for transgender equality mirrors that for homosexual equality in decades gone by. It should not need pointing out that you don’t need to alter your body to be gay. Homosexuality does not depend on medical or surgical intervention – except in countries such as Iran where homosexuality is currently illegal.[10] Attempts to change the bodies of homosexuals are considered some of the most flagrant crimes of the last century. When Alan Turing, the early computer scientist and code breaker, was forced in 1952 to take androgen blockers to control homosexual urges or face imprisonment, we rightly blame doctors for complicity in denying his human rights.[11] But Turing’s treatment was later mimicked in Money’s clinic: in the key year 1966, John Money became the first US doctor to prescribe androgen blockers to a patient dealing with paedophilic urges. The parallels are at the least problematic. Responding to James Barrett’s 2016 piece, a GP writes: ‘I personally and professionally object to Dr Barrett linking the transgender status of a patient to that of being Gay or Black. My Gay and Black patients do not need me to prescribe medication to maintain their status.’[12]

Equally problematic is the comparison with intersex which formed the basis for Money’s theories on gender. Trans activists borrow terms like ‘assigned male (or female) at birth’ from the language of intersex: ‘When a person is born, a doctor assigns a gender by only looking for one thing: the presence or absence of what they consider to be a penis. […] As they grow up, the doctor’s guess can turn out to be wrong, either because the person had an undiagnosed intersex condition, or they are transgender and don’t identify with their assigned gender.’[13] Yet trans people by definition belong to the 99% of human beings for whom genital, gonadal and gene sex is congruent.[14] For this group sex is not assigned at birth but is a biological fact. To suggest otherwise is to co-opt intersex narratives. [15]

Trans treatment protocols were established within the academic fields of sexology and psychiatry. Yet trans (it is now claimed) has nothing to do with sexuality or with mental health: Barrett writes in 2016 that ‘My patient interviews are not ‘psychiatric’ just because I come from an originally psychiatric background. They relate specifically to gender dysphoria.’ [16] The body of professional knowledge that Barrett mobilises is the knowledge of gender, a discipline defined and originated in the clinic run by Money and a discipline whose methodology is unique.

 

Given the lack of any parallel, it is not surprising that the treatment protocol established over the last fifty years has been described as ‘a unique intervention not only in psychiatry but in all of medicine.’[17] It is also not surprising that it is increasingly difficult to know where gender specialists should be accommodated and who should fund them.

 

Over a period of fifty years, the Charing Cross Gender Identity Clinic has catered for a large number of patients. But it has also been somewhat accident prone. Perhaps clinicians become blasé as they become accustomed to prescribing irreversible treatments. James Barrett started his career as a sceptic and gatekeeper, joining in 2006 with colleagues Richard Green, Stuart Lorimer and Don Montgomery, to report the leading gender clinician at Charing Cross, Russell Reid to the GMC (General Medical Council) for professional misconduct, a charge of which Reid was found guilty. Colleagues, including Barrett, accused Reid of blurring ‘professional boundaries by calling patients his nephews and nieces’.[18] Past patients claimed that Reid ignored a series of traumatic events in supporting gender transition which they came to regret, and failed to acknowledge co-morbidities such as psychosis. In subsequent years, gender surgeon James Bellringer was eased out of the clinic for undisclosed reasons. And the clinic has found it hard to recruit sufficient psychiatric and surgical staff.

But only a decade since the Russell Reid inquiry, Barrett now presents a very different account of the clinic and of the role of the gender expert. A Freedom of Information request in 2016 by the Guardian newspaper revealed that the ‘number of referrals has almost quadrupled in 10 years, from 498 in 2006-07 to 1,892 in 2015-16.’[19] James Barrett told the Guardian:  “It obviously can’t continue like that forever because we’d be treating everyone in the country, but there isn’t any sign of that levelling off”.  (So much for Barrett’s 2011 claim that the incidence of transsexualism is constant and unchanging.) The clinic is currently funded by the West London Mental Health Trust. But funding this new demand places an intolerable strain on underfunded mental health services: the Kings Fund showed in 2015 that ‘Mental health problems account for 23 per cent of the burden of disease in the United Kingdom, but spending on mental health services consumes only 11 per cent of the NHS budget.’[20] For the mental health trust which funds the Charing Cross GIC, the only answer is to end their contract with NHS England, a solution that paradoxically matches the demands of trans activists who call for the depathologization of trans and the removal of medical gatekeepers. James Barrett is clear that clinicians have long felt that West London Mental Health Trust is not a good fit for the unique and specific service we provide (the vast majority of those we see are not mentally ill).”[21]

 

This claim is important, for if trans were a disorder (as in 1966), the work of the clinic would belong in a worrying tradition, one that harks back at the worst to lobotomy and calls up disturbing memories of the treatment of David Reimer. If trans has any links to body dysmorphia, to anorexia, or to self-harm, then it could not be appropriate to medicate or to offer surgery, however acceptable to the patient, however fiercely demanded. Colin Ross identifies the underlying ethical problem:

Gender identity disorder is unique among all DSM-IV-TR diagnoses. It is the only disorder in which treatment is designed to confirm, reinforce, and validate the belief that is the basis of the mental disorder. In all other diagnoses, the symptoms in the diagnostic criteria are viewed as pathological and the goal of treatment is to remove the symptoms. In gender identity disorder, however, the body is altered to match the belief that is said to be a symptom of mental disorder. This is self-contradictory. Either gender identity disorder should be dropped from DSM-V, just as homosexuality was dropped from the diagnostic system, or gender reassignment should be discontinued. The core contradiction in the current approach to gender identity is an ethical problem in the mental health field.[22]

For James Barrett and the Charing Cross GIC, the only way out of the quandary is to separate the GIC from the Mental Health trust. But to do so is to admit that this form of necessary body modification is without parallel. It is unique and specific. Gender is not like anything else.

 

‘Unique and specific’

In a recent discussion with Jay Stewart, founder of the Gendered Intelligence community support group for trans and non-binary young people, I was struck by the insistence that the young people he works with are not mentally ill. Any distress they might experience comes from people saying ‘unkind things’. Their problems are caused by a society which is slow to accommodate diverse gender identities. Yet Stewart’s claim did not match the picture I saw at a recent visit to the GI parents’ support group where a parent claimed that all the young people have co-morbidities.[23] Stewart dismissed the distress , the self-harm and depression that parents described as ‘an account I do not recognise’.  He does not use the term ‘gender dysphoria’ with its acknowledgement of unhappiness. Trans is a movement for health and happiness.

James Barrett by contrast admits that trans people can suffer from mental illness. But mental illness, where it exists, has nothing to do with a trans identity. Writing in 2016 to the London Review of Books, Barrett is proud that co-existing mental illnesses are no bar to accessing the unmitigated good of gender transition services:

Patients have already advanced perfectly satisfactorily through all stages of treatment with coincidental diagnoses of schizophrenia, chronic renal failure, paraplegia, emotionally unstable personality disorder, learning disability and autism. Patients currently being treated in the UK include those unwell enough to be detained under the Mental Health Act in a secure hospital.[24]

The contrast with Barrett’s position in his 2011 paper (or his 2006 action against Russell Reid) is striking and reveals what we already know: that scientific ‘objectivity’ reflects the demands and assumptions of the society it serves. The beliefs of the gender specialist have a history – a starting point and perhaps an end. Barrett’s position now means that gender dysphoria cannot be caused by mental illness (as Reid’s patient accusers believed). If trans is never a pathology, then existing mental illness is nothing to do with trans. Barrett does not offer a psychiatric assessment but a gender assessment to patients at the Charing Cross GIC.  A clean bill of mental health from Barrett can coexist with a disability diagnosis from a local mental health trust which has led to Personal Independence Payments (PIP). Yet to qualify for PIP you must have ‘a long-term health condition or disability and face difficulties with ‘daily living’ or getting around.’[25] It is curious that the onset of the diagnosed disability in the case known to me, coincided with the onset of gender dysphoria. But gender specialists work to a different model of mental health than Mental Health trusts. In the US, blogger, psychologist and detransitioner ‘Third Way’ says that ‘a lot of the treatment now for gender dysphoria just throws out the basic principles of psychology’. [26] He comments that ‘people who detransition often talk about issues of trauma’ and that ‘these are things that can be worked on psychologically’.

Voices that matter

A belief that trans is never a pathology makes it impossible to recognize evidence of psychological vulnerability and trauma in this population. A 2011 Swedish study into long terms outcomes of transgender patients concludes that this group is liable to suffer from a range of psychological difficulties: ‘Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.’ In this study, sex reassigned patients fared markedly less well than a comparable group matched ‘for premorbid differences regarding psychiatric morbidity’.

 

Perhaps the most important voices are those of transitioners and detransitioners who are now beginning to explore what they see as a relationship between trans and trauma, challenging the constricting logic which demands that the complexity of human experience must fit the constructs of the gender narrative. Carey Callahan describes how depersonalization both drove her to identify as trans and intensified while taking testosterone.[27] Not only is there a huge rise in teenage girls identifying as trans or gender non-binary but there seems to be a marked overlap with those suffering from eating disorders and self-harm. One blogger writes: ‘I am a female to male transgender with an eating disorder, and this kind of thing is very common among trans men. Gender dysphoria can cause us to have body dysmorphia because our minds and our bodies are not congruent and we hate the bodies that we were born with!’[28] Jack Monroe, the food writer who now identifies as transgender has described how ‘all through high school’ she ‘struggled with a severe eating disorder.’ [29] In studies, the overlap between trauma and gender dysphoria is striking.  How else could we explain the overrepresentation of trans people within US army veterans? A 2013 study shows that Gender Identity Disorder in the Veterans Health Administration is roughly five times higher than in the general US population (22.9 per 100 000 amongst veterans rather than 4.3 in 100 000 persons).  Suicide-related events among veterans with gender identity disorder occur 20 times more frequently than in the general US VHA population.  Gender identity disorder is increasing amongst US veterans, nearly doubling over ten years.[30]

 

According to Barrett, the interventions offered at the Charing Cross GIC make for ‘happier and healthier lives’. But if the rise in transsexualism is an expression of the multiple forms of trauma in modern life, then the attempt to de-pathologize trans and to separate trans provision from mental health services may have devastating consequences. It is an understandable response to the dark early history of gender identity study, yet gender clinicians remain fixed within a closed set of assumptions that blind them to the evidence.

 

 

 

 

 

 

 

 

 

 

 

[1] Terry Goldie, The Man who invented Gender: engaging the ideas of John Money (Vancouver: UBC Press, 2014); Lisa Downing, Iain Morland, and Nikki Sullivan, Fuckology: critical essays on John Money’s diagnostic concepts. (Chicago: University of Chicago Press, 2015); John Colapinto, As Nature Made Him: The Boy Who Was Raised as a Girl, p25.

[2] ‘Money continued to insist to his scientific, academic, and medical colleagues that the case was “lost to follow up”’, John Colapinto, As Nature Made Him, 202.

[3] BBC Horizon, 2010, ‘Dr Money and the Boy with No Penis’. Currently available at https://vimeo.com/55409956. The BBC team began following the Reimer case and recording interviews in 1979. (Colapinto, 168).

 

[4] John Money, Anke A. Ehrhardt, Man & Woman, Boy & Girl: Gender Identity from Conception to Maturity, Northvale N.J.: Jason Aronson Inc, 1973, 1996), xii.

[5] Alice Dreger, Galileo’s Middle Finger: Heretics, Activists, and one Scholar’s Search for Justice New York, Penguin, 2015, 40.

[6] A letter to the BMJ from Zoe Playdon claims

[7] Zoe Playdon, ‘Unequal treatment of transgender people’

BMJ 2016;353:i2329doi: http://dx.doi.org/10.1136/bmj.i2329 (Published 26 April 2016)

 

[8] James Barrett, Advances in psychiatric treatment (2011), vol. 17, 381–388 doi: 10.1192/apt.bp.109.007484

 

[9] James Barrett, http://www.bmj.com/content/352/bmj.i1694/rapid-responses

[10] http://www.bbc.co.uk/news/magazine-29832690

[11] http://www.pinknews.co.uk/2015/08/24/heartbreaking-alan-turing-letters-reveal-turmoil-over-gay-cure-treatment/

[12] Jeremy Luke, ‘Gender dysphoria: shared care is the answer’

BMJ 2016;353:i2326http://dx.doi.org/10.1136/bmj.i2326 (Published 26 April 2016)

 

[13] http://nonbinary.org/wiki/Assigned_gender_at_birth

[14] Daphna Joel, ‘Genetic-gonadal-genitals sex (3G-sex) and the misconception of brain and gender, or, why 3G-males and 3G-females have intersex brain and intersex gender’,

Biology of Sex Differences 2012, 3:27 http://www.bsd-journal.com/content/3/1/27Daphna Joel

[15] New Narratives 2014 rejects ‘COINing’, or co-opting intersex narratives: ‘we have a strict no-COINing policy (co-opting intersex narratives). That means, if you are a trans woman who “suspects” or wishes you were intersex, but have not been diagnosed, please either see a doctor or cut it with the appropriation.’

https://newnarratives2014.wordpress.com/author/newnarrativess2014/

[16] James Barrett, http://www.bmj.com/content/352/bmj.i1694/rapid-responses

[17] ‘Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden’

Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Långström, Mikael Landén

Published: February 22, 2011http://dx.doi.org/10.1371/journal.pone.0016885

[18] https://www.theguardian.com/uk/2007/may/25/health.society

[19] https://www.theguardian.com/society/2016/jul/10/transgender-clinic-waiting-times-patient-numbers-soar-gender-identity-services

[20] http://www.kingsfund.org.uk/projects/verdict/has-government-put-mental-health-equal-footing-physical-health

[21] http://www.wlmht.nhs.uk/news-events/future-charing-cross-gender-identity-clinic/

[22] Colin A. Ross, Ethics of Gender Identity Disorder, Ethical Human Psychology and Psychiatry, 11.3, 2009. https://www.questia.com/library/journal/1P3-1923231181/ethics-of-gender-identity-disorder

 

[23] https://youthtranscriticalprofessionals.org/2016/04/12/when-is-a-support-group-not-a-support-group-the-troubling-story-of-a-uk-trans-support-group/

[24] 19 May 2016. http://www.lrb.co.uk/v38/n10/letters#letter1

[25] https://www.gov.uk/pip/eligibility

[26] ‘TWT Another detransitioner speaks’. https://youtu.be/zZKDWpIggPQ.

[27] https://youtu.be/Zw4R7n9jMas

[28] http://www.mdjunction.com/forums/eating-disorders-discussions/general-support/2672664-trans-men-and-eating-disorders

[29] https://www.theguardian.com/commentisfree/2016/may/19/jack-monroe-little-bit-male-little-bit-female

[30] Blosnich, John R. et al. “Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care.” American Journal of Public Health 103.10 (2013): e27–e32. PMC. Web. 10 Aug. 2015.

Rapid Onset Gender Dysphoria Research Study: Recruiting Parents to Fill Out Survey

Below is a description and link to a research survey intended to collect information about rapid onset of gender confusion/dysphoria and social media use in teens and young adults. Sudden onset of gender dysphoric feelings in the teen years is an unusual presentation, and this researcher is looking to learn more about it. If your child or young person began experiencing gender dysphoria between the ages of 10 and 21, please consider filling out the survey. Also, please feel free to share the information below with the survey link with others you know or on social media. Thank you.

Please note: YTCP has collaborated with 4thwavenow.com and transgendertrend.com to disseminate this survey. This same material will be posted on all three sites.

Rapid onset gender dysphoria, social media, and peer groups

GCO# 16-1211-00001-01-PD
 
We have heard from many parents describing that their child had a rapid onset of gender dysphoria in the context of increasing social media use and/or being part of a peer group in which one or multiple friends has developed gender dysphoria and come out as transgender during a similar time frame. Several parents have described situations where entire friend groups became gender dysphoric. This type of presentation is atypical and has not been studied to date.  We feel that this phenomenon needs to be described and studied scientifically.
 
If your child has had sudden or rapid development of gender dysphoria beginning between the ages of 10 and 21, please consider completing the following online survey. If you have more than one child with gender dysphoria who fits the above description, please complete one survey per child.
 
This survey is completely anonymous and confidential and conducted through Survey monkey, an independent third- party. There is no way to connect your name with your responses. We do not track email or IP addresses. The survey should take 30-60 minutes. Participation in this research study is voluntary, and you may refuse or quit at any time before completing the survey.
If you know of any individuals with a similar experience who might be eligible for this survey, or any communities where there might be eligible parents, please copy and paste this recruitment notice and survey link to share.

“I Wanted an Identity So Badly:” A Desister’s Account of Trans Indoctrination

This is an important post. This brave and thoughtful young man has been generous enough to document his own process of becoming convinced that he was transgender. He identifies the cult-like thought traps that lead him to believe this, and discusses how difficult it was to work through these beliefs.

Fortunately, John did not take hormones or pursue surgery. Even without these medical interventions, his experience with trans ideology was confusing  and painful.

(Note: Part of this post comes from a Reddit thread that John posted. I am using that with his permission here.)

Thank you, John.

I was 100% thoroughly convinced that I was a woman trapped in a man’s body. I went on believing this for the better part of 6 months, and it did a number on my psyche.

I think these trans communities are a cult. They target lonely, confused teenagers that have a fetish. Not all transgender people are like this but, the group I belong to is, and this group is heavily targeted by these online trans people.

I think that we are basically all masochists. I had several “odd” things growing up that got me going, bondage, humiliation, power dynamics where I was the powerless person — anything that could be considered “shameful.” When you are a horny 14-year-old with these particular sexual tastes, and you discover online porn, it won’t be long until you stumble upon the “feminization” genre (aka, sissification, sissy fetish,). It should be obvious why these genres are so prevalent. If you grow up in a conservative area, what could be more demeaning, humiliating, or thrilling, as having your manhood stripped away from you? (Not that I think there is anything shameful about being a woman, but as a young man you are constantly having to prove your masculinity and any sign of weakness is compared to being a “sissy” or a “faggot” or “like a girl.”)

So you have all these young men who don’t understand their sexuality, watching sissy porn. Eventually they are going try and find out what it all means.

This is where the trans ideology plays its part. The trans narrative sucks these confused young men like myself in with all the “answers.” You see many confused fetishists posting in places like r/asktransgender asking if they are trans. Whatever their questions are, the usual reply from these places is something like “if you could press a magic button that would give you a female body would you press it? If you thought about it, then you may be trans, because a “straight” guy wouldn’t hesitate for a moment.” They try to equate the masochistic thrill with a desire to be a woman. And once you fall for that they have you.

They create a very intricate web of bullshit that is very hard to see out of once inside. It is very cult like. Any non-kool-aid drinking source of information is deemed “transphobic.” Any therapist that doesn’t tow the line is a “gate keeper.”

One day when I was 18, I had decided to try and figure out what was the deal with my sexuality. I had been watching feminization/sissy/sissyhypno-type porn and crossdressing for a few years at that point, and I was very confused. I grew up in a conservative area in a pretty conservative family, and the only information I had ever gotten about sexuality was stuff I had picked up from kids at school and stuff on TV. I was pretty naive about it.

But at this point when I was 18, I had been on the internet for a few years and I had reformed my conservative belief system. Just 3 and 1/2 years before, I was very conservative and a Christian, but I’m the type of person that is constantly questioning everything and with internet access, it was just a matter of time before I became an atheist and began to slowly tear apart my conservative belief system. I went from thinking liberals were evil deluded fools that were going to destroy the country to coming around to their side and seeing conservatives the same way I had once seen the liberals!

So I had begun trusting the “reddit people” since they made so much more sense than anything I had been exposed to in my conservative town. During one of my late night jerk sessions I had come across the typical trans rhetoric somewhere on r/sissyhypno and it scared the ever living shit out of me. I had seen the link to r/asktransgender at this point too. I was terrified but i had to know more.

I stayed awake for over 24 hours pouring over threads in r/asktg trying to understand what for so long had made no sense to me. I think what really hooked me at first was the idea that my sexuality had been “repressed.” I think I fell for this because my sexuality had been VERY repressed. For lack of a better term, I had tried to “pray the gay away” for years. I had pretty much tucked everything I knew about my fetish in a deep dark corner of my mind, and I would try to think about it as little as possible.

So when the “reddit people” would say my fetish was a normal female sexuality that has been repressed for years due to male socialization and homo/transphobia, and that my crossdressing and fetish porn consumption was the only way for my “female self” to express itself, it kinda made sense. And then there were so many people talking about how they used to be just like me, but they eventually stopped lying to themselves and realized they were transgender.

I was completely fooled 100% after that. (And I think that perhaps this pattern does apply to “real transgender” people. But I think that in their efforts to validate their identities as women and coming up with all the trans ideology, they accidentally created a trap for people like me, who are really just people that are a kind of extreme degradation masochist that got into crossdressing as an expression of that.)

I didn’t make any steps in transitioning. I only believed I was transgender. I actually hated the idea that I was transgender at first. I was full of self-pity and I was very, very depressed. I kept trying to think of something to convince myself I wasn’t trans, to find a reason why I wasn’t trans but I could not do it.

Since I had accepted certain beliefs, I could not escape the conclusion that I was trans. It seemed the most logical explanation at the time. After a while of wallowing in self-pity and hating myself, it seemed the only way to be happy was just to accept the fact that I was trans and move on.

So I began to reconstruct myself psychologically around being trans. In the beginning, there was a brief honeymoon period. I felt like a huge weight had been taken off my chest, that I had finally accepted who I was, and I didn’t have to keep being so uncertain about everything. I even “came out” to my family and a few friends. It didn’t last long though about two months.

After that, some doubts started to eat away at my new “happiness,” but I put an immense amount of energy into squashing them. It was kind of ironic in a way, because not that long before, I was trying so hard to talk myself out of being trans but couldn’t. And then not very long after, I was putting the same amount of effort into talking myself into it. The doubt kept eating at me though, and I could no longer believe I was “fully” trans.

It happened in stages though. It was very hard for me to let go for many reasons, one big one being that I just could not accept that I had made a terrible, terrible, very embarrassing mistake. The first and longest stage was that I thought that I wasn’t “fully” trans, but that I was somewhere on the trans spectrum. So I was once again a misfit. I was believing all the trans ideology, but now I no longer had the benefit of finally having a concrete sexual identity — which I think was a huge part in me being seduced by the trans rhetoric, because I wanted an identity so badly.

I kept analyzing myself over and over and over. I just had to know what I was. I stressed so much over this that I eventually just kind broke psychologically. I just up and decided one day that I was tired of it all. I wanted to be free of the never ending questioning and anxiety, so I chose to believe something that didn’t make sense within my own mental framework. It was very strange, because even though I knew it didn’t make sense, I chose to believe it anyway.

I just started believing I was gay. It didn’t work for long, but for two days it was bliss. After that, I really started to lose touch with reality. I started believing things about myself that made no sense. Every week, or sometimes every day I would completely change all my beliefs about my sexuality. I would say and think contradictory things, saying and doing things I never would have said or done before — just all manner of craziness. After about three or four months of that, I regained my senses.

But I still hadn’t resolved the thing that started it all. I just ended up completely repressing and burying everything. I tried my damnedest to just forget about the whole ordeal entirely, and I did that pretty successfully. But I couldn’t block it all out completely because I was still watching all the same porn. Deep down, though, I still believed that I was trans at some level during this period.

This might be hard to believe but i think what broke the “spell” for me were psilocybin mushrooms. I really shouldn’t have been messing around with them at the time because of how unstable I was, but I was doing all kinds of stupid impulsive shit.

I was tripping and at some point all the trans stuff starting bubbling to surface, and it was what you could call a bad trip. All the things I had repressed came bubbling up to the surface. I had no control, and the mushrooms were doing the driving. They showed me that I had been fooled into fooling myself. Basically, they showed me how my own narcissism was blinding me.

Once I had seen this information, it was in my mind permanently. It took around 6 months or so, but I slowly came around to thinking that it was really all just a crossdressing kink that got elevated to extreme levels from watching too much porn. It shouldn’t have taken me that long to get it all figured out after the mushrooms, but it took me a long time to trust my own judgement enough to really BELIEVE in what I was thinking.

I had my mushroom trip nearly two years ago. Now I’m mostly back to my old self.

I forgot to mention a pretty important detail. I didn’t come up with the doubts on my own. I was 100% fooled, but I stumbled upon some dissenting voices and ideas that got the original doubts going. I don’t know how far I would have gone if it weren’t for these voices dissenting from the trans ideology.

Hey! Huffpo Transgender Child Comment Writers! Have You Really Thought This Through?

Two days ago, the Huffington Post ran an article entitled “To The Gay Man at the Vigil: I Didn’t Think I’d Have to Protect My Trans Son from You.” The back story is a familiar one. The author’s child was a gender nonconforming girl with a history of hating “pink dresses” and liking rough and tumble play. Heartbreakingly, the author reveals that her daughter was bullied for her gender nonconformity, being called “lesbo.” Being derisively identified as homosexual, the child “forced himself into being a girl.” (This is a very important point. The child attempted to fit into female sex role stereotypes after being derisively labeled a homosexual. This fits with what we are hearing again and again – that it is more socially acceptable for a lesbian to become a straight boy.)

After being labeled (in a bullying way) a lesbian and subsequently attempting to pass as a gender conforming female due to homophobia, the child became depressed and engaged in self-harming behavior. Sadly, we know that suicidality is very high among gender nonconforming youth. One study shows the 37.4% of gay, lesbian, and bisexual youth had had a suicide attempt. Then two months ago, this young person announced that they were transgender. The author mom supported her child’s transition, and saw the depression lift.

This piece fits the happy transgender narrative we so often see in the media. According to this narrative, kids who were being bullied for being gender nonconforming or appearing gay or lesbian immediately become warmly accepted and supported by peers when they embrace the rigid sex role stereotypes of the opposite gender. The comments on the article are overwhelmingly supportive and positive of the mom and her decision to embrace her child’s transition. According to the current narrative, this mom is doing exactly what she should do – supporting her child’s immediate transition without critical thought or exploration.

But here is what the supportive comment writers on the piece perhaps haven’t thought through.

This young person likely won’t be happy with changing their name, pronouns, and hair style for long. Many young people who come out as transgender feel an immense pressure to pass. (Clearly the young person discussed in the article is not passing at this point.) As a result, they often feel an immense pressure to start cross sex hormones.

A natal female who takes testosterone for some length of time will have a permanently deepened voice; facial hair; and possible male pattern baldness. The long-term effects of testosterone on female fertility are not well understood. Taking testosterone may cause permanent sterility. These changes will not go away even if she stops taking testosterone.

There are some further health risks. Testosterone may have a negative effect on one’s lipid profile by increasing bad cholesterol and lowering good cholesterol. It may raise blood pressure and lower the body’s sensitivity to insulin. These changes increase the risk of stroke, heart attack, and diabetes.

Taking testosterone as a natal female increases the risks of breast, ovarian, and uterine cancer. Not much is known about how these risks might be affected by long term use. Young people going on these cross sex hormones is a relatively recent phenomenon.

So the risks of long-term testosterone use are not insignificant.

But there is more.

Many young natal women who come out as trans decide early on that they would like “top” surgery, meaning a double mastectomy.

Mastectomies are a major surgical procedure that carry with them the usual potential for serious complications that all major surgeries have – infection, necrosis, blood clots, etc. It is a painful surgery, with a recovery time of at least a few weeks. And of course, having a mastectomy means one will never be able to nurse a child.

It is a principle of good medical care to choose the least invasive option possible when treating a condition. Identifying as transgender is NOT the least invasive way to address gender dysphoria because it often leads to serious, permanent medical intervention that can have life-long consequences.

The mom in the article insists it “isn’t a choice” to be transgender. The supportive comment writers (and presumably the HuffPo editorial staff) seem to agree with her. The gay man to whom she addresses the piece apparently does not. Empirical evidence is on the side of the gay man. It truly isn’t a choice to be gay. Sexual response can be — and has been — measured in the lab. Being gay means that as a man, you have an arousal response to men. This really isn’t subjective. Feelings of gender dysphoria certainly aren’t a choice. Intense feelings of discomfort with one’s body are not something most of us would choose. The decision to interpret these feelings as evidence that we are in the wrong body, however, is a choice. A choice with no empirical evidence to support it. No wonder the gay man in the article seems irritated.

Let’s support our gender nonconforming children. Let’s help them fight the homophobia that makes them go underground and feel terrible about themselves. Let’s allow them to defy narrow sex role stereotypes. Let’s look for ways to help alleviate their discomfort with their bodies without having to change those bodies.

Doomed to Repeat

Doomed to Repeat

A scant 25 ago, therapists with (mostly) the best of intentions managed to ruin many people’s lives. Through the use of recovered memory therapy, clinicians unwittingly participated in creating false memories of horrific abuse that in some cases permanently sundered relationships between parents and adult children, cast a life-long pall of suspicion on parents, and sent innocent people to jail for decades.

In the late 1990’s there were numerous lawsuits in which therapists or psychiatrists were successfully sued or settled on charges of having propagated false memories of childhood sexual abuse, incest, and satanic ritual abuse. Fran and Dan Keller served 21 years in prison after young children who attended their daycare began making wild allegations after having been coaxed by a therapist. According to one child witness, the Kellers “had everyone take off their clothes and had a parrot that pecked them in the pee-pee,” and “came to her house with a chainsaw and cut her dog Buffy in the vagina until it bled.” The therapist construed these childish imaginings as literally true, and concluded her small patient was a victim of ritual abuse. The Kellers were finally freed in November of 2014 after the only witness who provided any physical evidence of abuse – a doctor – recanted.

The false memory and ritual abuse scares of the ‘80s and ‘90s now seem bizarre almost beyond imagining. Therapists, psychiatrists, government agencies, congressional committees, and the media bought into the belief that worldwide satanic cults had infiltrated society and were ritually abusing children on a significant scale.

Tragically, history is in the process of repeating itself. Something strikingly similar is happening. The current trend to diagnose children as transgender bears an eerie similarity to this previous social panic. This matters because as with the previous panic of the ’80 and ‘90s, the current trend is harming people who will have to live with the consequences for the rest of their lives. Below, I outline the similarities – and differences.

1.) Victims of false memory syndrome and many transgender kids are orienting their identity and relationships to a false belief. Wikipedia defines false memory syndrome as “a condition in which a person’s identity and relationships are affected by memories that are factually incorrect but that they strongly believe.” Research has confirmed the suggestibility of the memory making process, making it clear that false memories can be created through cultural transmission, peer influence, and the techniques described as a recovered memory therapy.

The Wikipedia article goes on to state that false memories per se are not the problem. “Note that the syndrome is not characterized by false memories as such. We all have inaccurate memories. Rather, the syndrome is diagnosed when the memory is so deeply ingrained that it orients the individual’s entire personality and lifestyle—disrupting other adaptive behavior.” (Emphasis mine.) The false memory becomes a central point of the person’s identity and determines his or her interpersonal relationships.

The false memory may be bizarre and become obsessional. The McMartin pre-school trial was the longest and most expensive trial in American history. Those that testified claimed they saw witches flying in the air, traveled in hot air balloons, and were taken into an elaborate system of tunnels underneath the daycare.

In an account of the FMSF website, one patient recounts the bizarre things that she eventually came to believe:

“I recalled various fragments of movies, books, talk shows, and nightly news, and soon I had plenty of child abuse memories. But, it didn’t stop there. Eventually, I said I had taken part in Satanic Rituals, been buried alive, drank blood, and helped to kill a baby. With every new memory, my therapist was intrigued and building a case to prove he was right about me all along.”

And these bizarre beliefs can become one’s central point of reference, eclipsing critical thought, leading the person to surrender his or her rational faculties in service of the belief. This is described by a victim of false memory syndrome on the website of the False Memory Syndrome Foundation.

“Twice a week, I would go to therapy and be told the only way to feel better was to relive these memories. He would sit next to me on his couch covering me with a blanket while I, in a regressed, hypnotic state would start to have these “body memories.” This therapy continued and I had to be hospitalized six or seven weeks at a time. I’m now convinced that my depression and suicidality were mainly caused by the incredible conflict between wanting to be with my parents and pleasing my therapist.”

Through buying into the false belief, the person’s historical biography is re-written. Old events are re-imagined in light of the new “information,” radically altering the person’s sense of identity and sundering connections to family and friends.

As a victim of FMS describes on the FMSF website:

“I’ve lost six and a half years of my life, a chance to have an intimate relationship with my mother, time with my three young children, and my marriage of 21 years.”

Transgender children fall prey to the bizarre belief that they are born in the wrong body. There is no scientific validity to the idea that someone can be born a “man in a woman’s body” or the other way around. In fact, there is a great deal of research that indicates that there is no such thing as a male brain or a female brain. Taken away from the clamor and din of politics, the assertion that one is chromosomally and biologically one sex, but of a different “gender” in some mysterious way makes absolutely no sense and is every bit as strange as asserting that daycare workers sacrificed babies and fed them to children. Those who define their inner sense of being misaligned with their anatomy often cannot describe this experience without reference to sex role stereotypes, and an appeal to notions that seem much more metaphysical or subjective rather than empirical.

Please note that I am not denying the existence of gender dysphoria. Gender dysphoria is real and often causes significant distress. It ought not to be stigmatized, discounted, or minimized. Those who suffer from gender dysphoria deserve to have their pain taken seriously and to be offered appropriate help and support by both their families and society at large. In some cases, transitioning may be the treatment required to alleviate the gender dysphoria, though like all invasive medical procedures, it ought not to be the first line of treatment if a less drastic intervention can do the trick. It does not follow, however, that we must accept the groundless and bizarre explanation that someone is born in the wrong body. The feelings of gender dysphoria are undeniable. How we explain those feelings matters a great deal if one of those explanations leads to a young person undergoing serious medical intervention with lifelong consequences that may or may not adequately address the presenting problem. In some of the FMS cases, patients presented to a therapist with distress over a marriage, for example. The therapist wrongly attributed their pain to repressed incidences of horrific abuse, which made the patient worse, not better. Attributing a young person’s pain to being born in the wrong body is no less strange, and is just as likely to lead to an inappropriate intervention.

And as with the false beliefs present in many cases of FMS, the belief of gender noncomforming youth that they are actually the opposite gender disrupts other adaptive behavior, severs important relationships, and can become obsessional. Consider this story about a 16-year-old natal female who came out as transgender at age 14 or 15. The child, referred to only as PD, was adopted at age 6. The parents understandably had a hard time coming to terms with their child’s assertion of being a different gender, and they refused to call their child by the new name. This caused the child “very great annoyance and distress,” according to the courts. As a result of feeling misunderstood because the parents refused to use the new name, PD cut off all contact with them, refusing even to allow them to have any information going forward.

While the transgender teen story is usually portrayed in the media in celebratory terms, my contact with parents living through this indicates that at least some of the time, the tale is a darker one. Even supportive parents report that their teens become increasingly isolated and distressed after coming out. They withdraw from friends who aren’t trans. They cease their involvement in extracurricular activities. Their academics suffer. They stop talking to parents. They become obsessed with their appearance and with “passing.” They suffer outsized distress over the indignity of being “misgendered.” Their ambit of concern shrinks to encompass only the paranoid echo chamber of illusory oppression.

As is the case with FMS, the “discovery” on the part of a young person that they are trans brings about a reevaluation of their prior life that validates their diagnosis, altering their sense of identity and personal biography.

Following is a comment posted by a reader of this article. Note that the commentator reports on fairly common childhood experiences of gender nonconforming behavior that now take on momentous significance as evidence of being trans.

“I didn’t know since I was two. I knew I was different but I didn’t know how. Like I always envied the boys but never understood why. I wanted the boy toys, and never thought about why. I wanted to be in boy clothes cause I never felt comfortable in girly stuff, and never thought about why that was either. But I knew something was different.”

This commentator reaches the rather spurious conclusion that not being comfortable in “girly” stuff as child can now with hindsight be seen as early evidence and “proof” that she was trans. Of course girly stuff is rarely comfortable for little girls. And many little girls prefer “boy” toys, just as many boys prefer “girl” toys. Our refusal to accept narrow sex role stereotypes should not be evidence that we ought to reject our bodies. It ought to be evidence that we should reject sex role stereotypes.

2.) False memory syndrome and the transgender child trend involve highly sensational subjects that involve children and sexuality.

Children and sex are perennially two of the chief lightning rods around which mass hysterias often take form. The false memory and satanic ritual abuse panics of the ‘80’s and ‘90’s occurred in conjunction with a significant cultural shift, as women left home to go to work in huge numbers, leaving their children in daycare. The allegations of ritual abuse that swirled around daycares in the panic may have served as an expression of anxiety and ambivalence about this societal transformation.

Now, the popular imagination has been caught by transgender children. We celebrate the “courage” of these children and their families and rush to endorse hormonal treatment to forestall the “trauma” of puberty. What cultural current might this be in reaction to?

3.) In both FMS and the transgender child trend, the media played a key role.

Both of these trends have been presented in an uncritical way in the media. In the case of false memory syndrome, high profile media attention presented without critical dialogue fanned the flames of hysteria.

In 1983, Geraldo Rivera aired “Satanic Cults and Children.” In 1988, he did another episode mcmartinentitled “Devil Worship: Exploring Satan’s Underground.” In 1995, Rivera apologized for his role in spreading the hysteria with the following words:

“I want to announce publicly that as a firm believer of the ‘Believe The Children’ movement of the 1980’s, that started with the McMartin trials in CA, but NOW I am convinced that I was terribly wrong… and many innocent people were convicted and went to prison as a result….AND I am equally positive [that the] ‘Repressed Memory Therapy Movement’ is also a bunch of CRAP…”

In 1989, Oprah Winfrey hosted a show on “Child Sacrifice,” and Sally Jesse Raphael did a segment called “Baby Breeders.” In 1991, Raphael covered the story again with a show called “Devil Babies.”

20/20 and HBO both did special stories on the subject. HBO’s special was entitled “Search for Deadly Memories.” This documentary shows techniques for recovering “repressed” memories, and featured many doctors and other “experts,” lending credibility to the claims. Eventually, 20/20, 60 Minutes, and HBO would all produce shows that were skeptical of the panic.

I need hardly offer evidence for the media contribution to the current transgender child trend. It is difficult to go through a day without hearing reference to a transgender child on some mainstream media outlet. Nearly all of the coverage is uncritical if not celebratory.

4.) Both movements created high profile “stars.”

In 1980, the book Michelle Remembers by Lawrence Padzer and Michelle Smith was Michelle_Rememberspublished. It was the first book on ritual abuse, and is largely responsible for setting the SRA panic in motion. Though it has since been entirely discredited, it was reported on and taken as fact by journalists and talk show hosts including Oprah, who interviewed Smith on her television show. The book was a bestseller and a tremendous commercial success, and Padzer and Smith earned an estimated $350,000 from its publication.

Jazz Jennings is a 16 year old transgender girl noted for being one of the youngest publicly documented people to be identified as gender dysphoric. She received national attention at the age of six when Barbara Walters interviewed her on 20/20. Other high profile interviews followed. Jazz has her own company (Purple Rainbow Tails, founded when she was 13), her own YouTube channel, a children’s book, and her own reality TV show on TLC. In 2014, she was named one of “The Most Influential Teens” of the year by Time. She has modeled and appeared in television commercials for acne treatments.

5.) Both movements have been fueled by hysteria over immediate peril of children

In both cases, the narrative is driven by powerful fears over the welfare of children. In the case of SRA and FMS, anyone who expressed doubt over the veracity of the claims was subject to intense vitriol and claims that they were harming children by not believing them without question. An advocacy organization was formed by the parents of the children involved in the McMartin preschool trial called “Believe the Children.” It became a clearinghouse for information on SRA.

Regarding the transgender child trend, those who express doubt about a child’s claim that he or she is “born in the wrong body” are often accused of “killing” transgender children. The fact that there are very high rates of suicide attempts among those who are transgender is repeatedly cited as a reason why transgender children must be immediately affirmed and transitioned. (This is an uncritical use of the statistic. A study found that 41% of those who are transgender had attempted suicide. However, the study did not differentiate between whether the attempt came before or after transition. A study from Sweden indicates that suicidality among those who have medically transitioned is significantly higher than in the general population. It would appear that those who suffer from gender dysphoria do indeed have a high rate of suicidality. However, there is no robust evidence that transition reduces suicidality.)

 6.) Therapists played a significant role in the promulgation of both movements.

Protecting the innocent, advocating for those who are at risk and vulnerable – these are appealing roles for therapists to take on. Therapists in both movements have appeared to have the moral high ground. Many have been quick to jump on board to be sure to be on the right side of history.

Therapists used a variety of techniques that have come to be called “recovered memory therapy” to search for “forgotten” or “repressed” memories of trauma. Such practices spread quickly and were fueled by materials developed by those without clinical expertise such as the book The Courage to Heal, which was written by a poet and creative writing teacher and one of her students.

Of course, a darker side to the well-meaning impulse to help those who had been victimized is that the movement to recover repressed memories created lucrative earning opportunities for some therapists.

In recent years, there has been a growth in the number of therapists who identify as “gender therapists.” To my knowledge, this is not a protected title in any jurisdiction. Anyone can call themselves a gender therapist. At most, a gender therapist may have received training from a transgender advocacy organization. Most transgender advocacy organizations have few members with any clinical or mental health background. Online research indicates that a gender therapist is “someone who helps a transgender person with their transition.” This gender therapist, for example, has a video blog where she answers questions. To the question “how do I know if I am transgender?” she answers that “if you are asking that question, you probably are not cisgender.”

Gender therapy is a lucrative and in demand specialty at this point in time. The gender therapist noted above, for example, has recently released a book about discovering one’s gender identity.

7.) Governmental and professional organizations have bought into the movement’s narrative.

No less an organization than the US Congress held hearings on daycare abuse. Recent policies put forward by the International Olympic Committee, the National Education Association, and the Obama administration show that many of our most important institutions have bought into the gender identity narrative.

8.) The concept has penetrated deeply into popular culture, including children’s picture books

dont make me go backA 1990 children’s book entitled Don’t Make Me Go Back Mommy (Hurts of Childhood Series). The description of the book on Amazon reads as if it is a humor piece.

“Five-year-old Allison’s behavior indicates to her concerned parents that something is wrong at her day care center. In unseen action, they discover that the center practices sexual, physical, and psychological abuse in the guise of religious ritual. Through dialogue, Allison and her parents reveal their feelings and the beginnings of the healing process to counselors and legal personnel. Some details of abuse are familiar from the lengthy McMartin trial, such as the “movie star room” in which naked children are photographed. The appendix lists 10 guidelines for parents on how to handle their own feelings during this family crisis.”

There are a number of books for children about being transgender. I Am Jazz is just one i am jazzexample. It is recommended for children ages four to eight. Following is its Amazon description:

“From the time she was two years old, Jazz knew that she had a girl’s brain in a boy’s body. She loved pink and dressing up as a mermaid and didn’t feel like herself in boys’ clothing. This confused her family, until they took her to a doctor who said that Jazz was transgender and that she was born that way.”

9.) Because the false belief relies on self-diagnosis, it is impervious to contradictory evidence.

In the FMS and in the transgender child trend, someone’s subjective experience of him or herself trumps other claims, even without evidence. According to this paradigm, anyone who is not in the special class (abuse victim or transgender person) cannot speak about that phenomenon with any authority. The premise that the oppressed are infallible gets one way into the weeds fairly quickly. Something becomes true and unable to be questioned simply because a member of a certain special class says it is so.

10.) Both movements were spread by social contagion which relies on the very human trait of suggestibility.

The FMS episode gave rise to a great deal of research about how suggestible we all can be, how easy it is for well-meaning therapists to suggest things that didn’t really happen and in this way, create “memories.” A good overview of this research can be found here.

Many teens coming out suddenly as transgender without a history of prior gender dysphoria or even gender nonconforming behavior say they “knew” they were transgender after they read something online. The language that they use to describe their experience is quite consistent, likely an indication that they picked up the ideas from similar sources on the internet. For example, many parents report that their child said “Would you rather have a dead daughter or a live son?” or something similar. Many teens also talk about the “button” thought experiment – if you had a button that could make you into the opposite sex like that, would you push it?

In both cases, the indicators used to diagnose are vague. Neither SRA nor transgenderism are well-defined phenomenon. The definitions shift and alter as convenient. For example, some transgender advocates do not believe that someone should need a diagnosis of dysphoria in order to transition. Simply saying one is trans ought to be enough without any dysphoria.

In both cases, conclusions with far reaching implications are arrived at using suggestive techniques. Transcripts of therapy sessions in which highly suggestive techniques were used can be found here. The contagion was also spread in both cases by peer groups. Many teens coming out as transgender are doing so in the context of peer groups who are also coming out. I am aware of one school where nine natal girls all announced that they were trans within a short space of time. In regards to FMS, there were documented cases where some people “found” repressed memories after spending time in a peer group for survivors. (See “Therapist Not Needed to Recover Memories.”)

11.) Interestingly, in both cases feminists were the some of the first and most outspoken skeptics

The panic over SRA was problematic not just because it ripped families apart, but also because it diverted attention and resources from real child abuse issues. Some feminists voiced concerns about this. Today, feminists such as Elizabeth Hungerford, the blogger 4thWaveNow, Germaine Greer, and Rebecca Reilly Cooper are drawing attention to the inconsistencies in the transgender narrative and expressing concern about how this trend is distracting attention from issues of sexism and gay and lesbian issues. Of particular concern to feminists is the fact that many young lesbians are identifying as trans and going on to take hormones and have surgery. In this sense, transition acts like medical gay conversion therapy, changing lesbian girls into straight boys. Some suggest that many young lesbians are identifying as trans due to internalized misogyny and homophobia.

I have covered some of the ways in which I see the transgender child trend is similar to the phenomenon of false memory syndrome and satanic ritual abuse. How are they different?

The internet.

Information and ideas travel faster and further now, making it easier to spread social contagion.

In the case of FMS, most of the victims were adults. Now the victims are children.

If there is even a small chance that significant numbers of young people are permanently altering their bodies on the basis of beliefs about themselves that may change, shouldn’t we all be trying to slow this train down?

If we do not wish to repeat the mistakes of history, we are well advised to study and learn from them.

“I Was Not Given Options Other Than Transition:” Another Open Letter to Therapists from a Detransitioning Woman

This post is from Cari, who is 22. She began transitioning at 15 and began medically transitioning with testosterone at 17. She eventually had a mastectomy before deciding to begin detransitioning earlier this year. You can read more about her experience on her blog  guideonragingstars.tumblr.com as well as here. Thank you so much for your contribution!

 

When I try to think about the care I wish I had when I was transitioning, a few different things come to mind, but the single biggest one is the fact that I was simply not given options other than transition.

When it comes to picking apart the reasons for my dysphoria itself, it’s easy to point to something in hindsight, but the truth is I was a stubborn child and am now a stubborn adult, and it’s possible I wouldn’t have been receptive to treatment for these issues anyway, once I had set my mind on transition.

However, why did I think that transition was the solution in the first place? Largely, because I bought into the idea that it is the only cure for dysphoria. This idea seems to be ubiquitous in trans spaces. It’s meant to illustrate why transition care should be prioritized and covered by insurance, but it also has the effect of invalidating any kind of alternative treatments. Suicide is considered a direct outcome of dysphoria by many, as simply what happens when the proper treatment (transition) isn’t given, the same kind of causal relationship as death by diabetic coma might be for untreated hypoglycemia. The application of this idea to a diagnosis that has no objective test, that has many differential diagnoses that can be difficult to pinpoint or treat, that is infrequently questioned or scrutinized in any meaningful way by gender therapists, is very dangerous.

Very soon after coming out as trans, the “reality” that I would have to transition in order to be happy hit me, and I became deeply depressed. Transition became a huge focus of my life, because I believed it needed to be, that I needed to devote my energy to it in order to alleviate my dysphoria, in order to live my life, really. I’ve seen a lot of therapists, including three who specialized in gender therapy. Yet it wasn’t until I began reading the writings of detransitioned women that I had any clue there were other viable ways of dealing with dysphoria.

Another really important thing to me is the need for trauma-informed care. Therapists need to be looking at the histories of people who are seeking transition, to be working through their trauma with them in more ways than just talking about it briefly. When I was in therapy and soon to start hormones, I told my therapist about my trauma history, which seemed to do little more to affect my treatment than having a session or two devoted to talking about it, and then pressing forward with the idea of transition. The idea that trauma could have caused body image issues, dissociation, reality distortions, not wanting to be a woman because of the “target” status it conferred, was never brought up. Nor was there much of an attempt at treating my mental health symptoms other than through transition. This needs to be part of the conversation—even if there are so-called “true transsexuals” whose issues are caused by some kind of neurological difference, (controversial, completely unproven, and supported by highly flawed studies) there are also plenty of people who can recognize their dysphoria as being based in trauma or mental illness, at least once they know where to look.

The third thing I can identify as a cause is the lack of representation of adult women who were gender nonconforming or butch, and the narrowing of “acceptable” gender expression as girls grow up. It’s one thing to be a tomboy, but tomboys are expected to “grow up” (become feminine) eventually. For me, this realization came around the same time as puberty started to make itself known, and the associations I began to make between my female body and the constriction of gender roles I felt was powerful. It does no good to ask a child “could you be happy living as a butch woman?” if she has no idea what that could possibly mean for her as an adult. One of the ways you’re supposed to be able to tell if someone is “really trans” is for them to think about how they can see themselves living in 10, 20, 30 years—as a man, or as a woman? This is a flawed diagnostic for many reasons—how many people, trans or not, can picture their future in a positive light while dealing with depression or trauma? But when there are no models for the type of woman you want to grow up to be, it becomes even more skewed.