This is a more fully referenced copy of a letter I sent to the BACP Journal Therapy Today
I read with dismay the two letters published in December’s Therapy Today in response to Kaete Robinson’s excellent piece Look beyond the binary. I have been reflecting to myself whether such prejudice would have been published were it related to another minority group, although it is of course impossible to draw comparisons between the struggles of different marginalised minorities.
Obviously, Therapy Today does not publish all letters, and as such it must believe the ones it does publish have some merit. I wish to contradict this assumption.
Bev Gold’s letter first: In it she compares gender dysphoria with anorexia, and with negative self beliefs that lead someone to be “uncomfortable in their own skin”. But we have recently heard conclusive evidence from a Lancet study that gender dysphoria is indeed not a form of mental illness, but a legitimate phenomenon that needs not to be pathologised. She talks about the mental distress of trans people but ignores the sizeable body of evidence that suggests any mental health issues are created by stigma, negative attitudes, and barriers to transition, with studies demonstrating that support in transition and acceptance alleviate this distress, while efforts at reparative therapy, what she is clearly suggesting, only do harm.
I am left wondering if someone was as clearly arguing for reparative therapy of gay people, would their letter have been published? As someone who is a member of both trans and LGB communities, I experience a disparity between a growing intolerance of anti-LGB ideologies and an abiding tolerance and dissemination of anti-trans ideas.
In addition, Ms Gold makes the frustrating conflation that accepting someone as transgender will necessitate them having surgical transformations. Many trans people do not have medical treatment. For those that do, it has been proven to be inordinately successful in alleviating dysphoria, with very low evidence of regret. Ms Gold infers the opposite, that this is somehow a dangerous and tragic path.
Ultimately, trans identities need to be accepted and validated whether or not someone has made medical changes. The underpinning message of Ms Gold’s letter is that if a client enters the room and states their name and pronouns and how they experience themselves, we should cast doubt on this, pathologise it and force them to explore it, whether or not that is what they are asking for in their therapy. This is profoundly unacceptable and contrary to the principle of Autonomy in the BACP Ethical Framework.
The second letter is referenced, which lends it a veneer of respectability, however it transpires that one of the references, although appearing to be a reputable journal, is actually a renowned anti-trans blog, another reference is from Tumblr, a social media site, and that the author herself is a prolific anti-trans campaigner. The letter trots out some well-worn anti-trans myths. That detransition is common (it is rare); that the fact detransition occasionally happens means that transition is overall harmful (strong evidence refutes this); and that 80 per cent of trans children “desist” – this is evidenced in many places as a conflation of trans and gender non-conforming children.
In fact, studies have shown that genuinely gender dysphoric children have gender identities that are as consistent as those of cisgender children. In other words, if we talk about not allowing trans children to express their gender through pronouns, clothes, and gendered names, then we should equally be concerned about gendering cisgender children in the same manner.
Most concerning of all is her characterisation of “the autistic spectrum disorder teenage daughter [sic]who suddenly declares herself [sic] to be a boy”. First, let’s be clear that while there is a known correlation between autism and gender dysphoria (birth differences come in clusters, no surprise there), there is no evidence that autistic people lack the self-knowledge to understand their own gender. In fact, my local gender clinic in Nottingham has an autism specialist on staff whose main role is to help gender doctors to take autistic trans people as seriously as they would any other trans person, and not engage in blatant discrimination or infantilisation of the autistic community.
Secondly, she talks about “sudden onset” of symptoms, apparently having no knowledge or understanding of the lengths of time involved in obtaining a diagnosis of, and treatment for, gender dysphoria, or that clinicians will be looking for a consistent pattern and enduring and stable gender identity. Evidence demonstrates most trans people identify their dysphoria from a young age, and any “sudden onset” symptoms would not lead to treatment in anything less than years. Meanwhile, this child will be subject to the relentless doubt, questioning, bullying and attack that you trans people are subject to. It is far more plausible that trans children are dissuaded from transitioning by this stigmatising and hostile world than that we live in a culture where being trans is over-enabled. Anyone making this assumption is fundamentally unaware of the reality of trans lives and likely to do considerable harm.
There are many other inaccuracies and prejudices, too numerous to comment on. I experience the disrespectful tone of Ms Davies-Arai as unprofessional, and not appropriate for a journal, again out of chime with the Ethical Framework’s principles. She talks about “Transgender Indoctrination” as if it is possible for our tiny community to outbalance the from-birth indoctrination of cissexism – that is, the assumption that we should attach entire legal and social structures, names, pronouns, toilet arrangements and much more to the shape of people’s genitals. Not forgetting that intersex children often endure normalising surgery in infancy and later sometimes hormonal treatment, to artificially fit this binary – an issue that somehow incites considerably less outrage than the treatment of trans children in adolescence with entirely reversible puberty blockers.
The treatment of transgender children and adults is, contrary to these letters, slow-paced, conservative, well studied over nearly a century, and very well clinically evidenced. While there are intersections between the gay and trans communities, to suggest that trans people are simply confused gay people or that being trans is somehow more accepted and supported than being gay is not only ludicrous, it is a deeply regressive attitude that does not merit sharing in the pages of a professional journal.
My own article referenced below contains links to many of the studies referenced in this letter, and further information is available in the resources section of my website.