Helen Webberley - hearing continues

The Working Group has recommended reconceptualizing the ICD-10 category F64.0 Transsexualism as Gender incongruence of adolescence and adulthood 72 and the ICD-10 category F64.2 Gender identity disorder of childhood as Gender incongruence of childhood73. The proposed diagnostic requirements for Gender incongruence of adolescence and adulthood include the continuous presence for at least several months of at least two of the following features: a) a strong dislike or discomfort with primary or secondary sex characteristics due to their incongruity with the experienced gender; b) a strong desire to be rid of some or all of one's primary or secondary sex characteristics (or, in adolescence, anticipated secondary sex characteristics); c) a strong desire to have the primary or secondary characteristics of the experienced gender; and d) a strong desire to be treated (to live and be accepted as) a person of the experienced gender. As in the ICD-10, the diagnosis of Gender incongruence of adolescence and adulthood cannot be assigned before the onset of puberty. The duration requirement is reduced from two years in ICD-10 to several months in ICD-11.

The ICD-11 abandons ICD-10 terms such as “opposite sex” and “anatomic sex” in defining the condition, using more contemporary and less binary terms such as “experienced gender” and “assigned sex”. Unlike ICD-10, the proposed ICD-11 diagnostic guidelines do not implicitly presume that all individuals seek or desire full transition services to the “opposite” gender. The proposed guidelines also explicitly pay attention to the anticipated development of secondary sex characteristics in young adolescents who have not yet reached the last physical stages of puberty, an issue that is not addressed in ICD-10.

The proposed ICD-11 diagnostic requirements for Gender incongruence of childhood are considerably stricter than those of ICD-10, in order to avoid as much as possible the diagnosis of children who are merely gender variant. All three of the following essential features must be present: a) a strong desire to be, or an insistence that the child is, of a different gender; b) a strong dislike of the child's own sexual anatomy or anticipated secondary sex characteristics, or a strong desire to have the sexual anatomy or anticipated secondary sex characteristics of the desired gender; and c) make believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The third essential feature is not meaningful without the other two being present; in their absence it is merely a description of gender variant behaviour. These characteristics must have been present for at least two years in a prepubertal child, effectively meaning that the diagnosis cannot be assigned prior to the age of approximately 5 years. The ICD-10 does not mention a specific duration requirement or a minimum age at which it is appropriate to assign the diagnosis.

The proposed diagnostic guidelines for both Gender incongruence of adolescence and adulthood and Gender incongruence of childhood indicate explicitly that gender variant behaviour and preferences alone are not sufficient for making a diagnosis; some form of experienced anatomic incongruence is also necessary. Importantly, the diagnostic guidelines for both categories indicate that gender incongruence may be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, particularly in disapproving social environments and where protective laws and policies are absent, but that neither distress nor functional impairment is a diagnostic requirement.

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Relevant Extract (my bolding):

PROPOSED CHANGES TO F64 GENDER IDENTITY DISORDERS

Over the past several years, a range of civil society organizations as well as the governments of several Member States and the European Union Parliament have urged the WHO to remove categories related to transgender identity from its classification of mental disorders in the ICD-1151-53.

One impetus for this advocacy has been an objection to the stigmatization that accompanies the designation of any condition as a mental disorder in many cultures and countries. The WHO Department of Mental Health and Substance Abuse is committed to a variety of efforts to reduce the stigmatization of mental disorders 54. However, the stigmatization of mental disorders per se would not be considered a sufficient reason to eliminate or move a mental disorder category. The conditions listed in the ICD Mental and Behavioural Disorders chapter are intended to assist in the identification of people who need mental health services and in the selection of appropriate treatments1, in fulfillment of WHO's public health objectives.

Nevertheless, there is substantial evidence that the current nexus of stigmatization of transgender people and of mental disorders has contributed to a doubly burdensome situation for this population, which raises legitimate questions about the extent to which the conceptualization of transgender identity as a mental disorder supports WHO's constitutional objective of “the attainment by all peoples of the highest possible level of health” 55. Stigma associated with the intersection of transgender status and mental disorders appears to have contributed to precarious legal status, human rights violations, and barriers to appropriate health care in this population 56-58.

The WHO's 2015 report on Sexual health, human rights, and the law 58 indicates that, in spite of recent progress, there are still very few non-discriminatory, appropriate health services available and accessible to transgender people. Health professionals often do not have the necessary competence to provide services to this population, due to a lack of appropriate professional training and relevant health system standards 59-61. Limited access to accurate information and appropriate health services can contribute to a variety of negative behavioural and mental health outcomes among transgender people, including increased HIV-related risk behaviour, anxiety, depression, substance abuse, and suicide 62-65. Additionally, many transgender people self-administer hormones of dubious quality obtained through illicit markets or online without medical supervision 66, 67, with potentially serious health consequences 68-70. For example, in a recent study of 250 transgender people in Mexico City, nearly three-quarters of participants had used hormones, and nearly half of these had begun using them without medical supervision 71.

In spite of WHO's concerted advocacy for mental health parity 54, a primary mental disorder diagnosis can exacerbate problems for transgender people in accessing health services, particularly those that are not considered to be mental health services. Even in countries that recognize the need for transgender-related health services and where professionals with relevant expertise are relatively available, private and public insurers often specifically exclude coverage for these services 58. Classification as a mental disorder has also contributed to the perception that transgender people must be treated by psychiatric specialists, further restricting access to services that could reasonably be provided at other levels of care.

In most countries, the provision of health services requires the diagnosis of a health condition that is specifically related to those services. If no diagnosis were available to identify transgender people who were seeking related health services, these services would likely become even less available than they are now 72, 73. Thus, the Working Group on Sexual Disorders and Sexual Health has recommended retaining gender incongruence diagnoses in the ICD-11 to preserve access to health services, but moving these categories out of the ICD-11 chapter on Mental and Behavioural Disorders (see Table 2). After consideration of a variety of placement options 72, these categories have been provisionally included in the proposed new ICD-11 chapter on Conditions Related to Sexual Health.

Table 2. Classification of conditions related to gender identity in ICD-11 (proposed), ICD-10 and DSM-5

(see screenshot)

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To add to NitroNine's info about the World Health Organisation's revision of ICD-10 leading to the changed categorisation from Mental Health to Sexual Health in ICD-11.

This was done entirely:

• to "reduce stigma"
• as a result of political lobbying

Ray Blanchard had some interesting things to say about this when he appeared on "The Mess We're In" (Graham Linehan's YouTube Series):

The Mess We're In Ep. #90: Ray Blanchard
20 Oct 2021

"Without question the people involved in the WHO are politicos first and clinical researchers second.

Some of them, that whose names I've seen, as being involved in decisions regarding human sexual behaviour in the, on the ICD, the document you're talking about, really have no particular credentials that I know about.

So, you know, nothing would surprise me in WHO, because I know that they have politics in mind first and foremost when they're modifying clinical categories that pertain to human sexuality, you know"

Link to this point in the video:

(Credit: found on Twitter:
mobile.twitter.com/SuspendDisbeli2/status/1474657833274822657 )

==========

A fuller explanation can be found here:

"Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations"

Geoffrey M Reed, Jack Drescher, Richard B Krueger, Elham Atalla, Susan D Cochran, Michael B First, Peggy T Cohen-Kettenis, Iván Arango-de Montis, Sharon J Parish, Sara Cottler, Peer Briken, Shekhar Saxena

World Psychiatry, Volume 15, Issue 3, Oct 2016, pages 205-221

Abstract:

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.

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(ps. I cannot Preview posts so apologies for any errors or messed-up formatting)

Might as well get fundraising for the appeal because AB isn’t going to give up if the facts support her side but the judge is a TRA.

Oh ffs.

The judge (apparently) gave people the impression they might be stonewalled by talking about ‘people assigned female at birth’.

Infuriating if true, not least because the case is going to take weeks. If the judge is biased it would be helpful if they could say so upfront!

along with the "assigned at birth" judge in the Allison Bailey case

what happened? I didn’t get to watch on Monday.

We’re one election away from every front bench minister being captured. No time for over-confidence, I agree.

I'm appalled by this. Who sits on the tribunal panel? Are they medically qualified? They are parroting obvious nonsense. I think those of us who were following tribunal tweets on Twitter thought the evidence against Webberley to be damning.

This - along with the "assigned at birth" judge in the Allison Bailey case - makes me think we've been getting overconfident. We may have government on our side, but the judiciary, NHS, universities etc have all been captured. It's going to be a long, hard fight.

I don't know what the mechanism is which would allow that to be challenged, I'm presuming there's some sort of appeals process for either side. Would that be for the gmc to appeal? But they would have to be believe he made an error in the finding itself, aswell as the justification / arguments for it, I should imagine.

Yes.

It does have that feel, doesn't it. He couldn't just comment, he had to denigrate.

Mmm!

Agreed. It does feel like an overreach on behalf of the tribunal to be passing comment on such things. I don't know what the mechanism is which would allow that to be challenged, I'm presuming there's some sort of appeals process for either side.

He could have come to the same conclusion but expressed it more like this - the field is changing, there is some disagreement & a range of approaches taken by different ppl & bodies. Webberley took an approach at one end of the range of acceptable treatment methods, but her approach was supported by this evidence, and this professional body, so she was within her rights to do so.

Actually I see what you mean. It would be easy to say that one approach is acceptable without saying that another approach is wrong.

His comments remind me somewhat of the allegations in the original tribunal’s findings about maya F with respect to her views being unacceptable. Making value judgments.

rather than phrasing it in the kind of way the PP outlined.

I wonder if the findings go beyond what a tribunal is supposed to do? Are they supposed to decide which medical treatment path is correct when professional bodies and clinicians disagree?

It is their job to listen to the various evidence and experts and come to a decision based on the evidence they have heard and in relation to this specific case. Sometimes you have two experts saying completely different things so it is not a straight forward process. This panel must've preferred the evidence that HW's experts gave in relation to the appropriateness of treating such young patients with PBs and cross sex hormones.

The fact he uses the word "transgenderism" suggests he is not simply taking a framing given in training. Or if he is influenced by trainers he is not using the approved language very well.

I wonder if the findings go beyond what a tribunal is supposed to do? Are they supposed to decide which medical treatment path is correct when professional bodies and clinicians disagree? He could have come to the same conclusion but expressed it more like this - the field is changing, there is some disagreement & a range of approaches taken by different ppl & bodies. Webberley took an approach at one end of the range of acceptable treatment methods, but her approach was supported by this evidence, and this professional body, so she was within her rights to do so.

Instead he concluded webberley was right and the others were wrong and behind the times. But current developments actually show things are changing again and the more cautious approaches are the vanguard, webberley is behind the times.

It seems bizarre and inappropriate to me.

I've no involvement with the MPTS at all, but I am on a panel for another regulator. We've had no - zero - training on anything related to trans/gender identity or related issues. There was a brief flurry of some of the support staff using pronouns in their emails but that seems to have pretty much stopped.

We have had (very good and thorough) training on the relevance of domestic abuse to fitness to practice and trust in the profession, where it was suggested we should view it very seriously indeed.

As I say, can't speak for the MPTS, but it's not somethign that has arisen in the training for the regulator I sit with.

Hah! The chair of the tribunal outed himself with this comment:

The tribunal finds that the reluctance of the Endocrine Society and others to embrace enlightened views of transgenderism is symptomatic of the tendency in all professions to be slow to move with the times

Influenced by the lobby groups - no, not me.

How do you know this please? As the NHS has been wholesale captured along with the legal profession it seems a reasonable assumption. But I'd love to be wrong.

I believe that would be one of those nit-picky denials, in that Stonewall/GI wouldn't be offering direct training to individuals in those positions.

But rather, they would be offering training/guidance to HR/whoever in the relevant orgs who then go on to develop Stonewall/GI-compliant training for those individuals.

Someone needs to tell Angus MacPherson that scientific truth isn't decided by polls and following fashions.

Sharetoken for the Times article:

www.thetimes.co.uk/article/a836ccfc-c4ae-11ec-96a8-ce9dac41fe90?shareToken=cde53cf36acae7ec6ab49fe7bd1fde02

In the quotes. Angus Mcpherson, criticised endochrine/medical associations for not ‘moving with the times’ and suggested that ‘inertia’ was ‘similar to past attitudes on homosexuality’.

Times article today quoting the panel chair as saying that medical attitudes at the time were not ‘enlightened’, ‘trans’ children couldn’t get access to healthcare etc.

if the quotes are accurate, to me, suggests bias.

@Cuck00soup - I've now skimmed the determination. I can't see that any of the allegations of dishonesty have been found proved? May have missed it, mind.

(I HATE how the MPTS structures their determinations. You can't see the wood for the trees.)