Dr Polly Carmichael (Gender Identity Development Service Director)

[BloodyFreezing]

I haven't found a link to an actual video or audio of the talk but there are lots of interesting tweets about a talk she has given today on gender dysphoria - apparently including reference to rapid onset gender dysphoria in adolescents and recommending Transgender Trend as a resource to a parent:

twitter.com/hashtag/acamhMiller18

Transgender Trend are mentioned at 31 minutes here:

twitter.com/acamh/status/974676428972220417

Although this is a panel discussion, a lot of the comments and questions from the audience (of fellow professionals) relate to Dr Carmichael's talk and the subject of adolescents identifying as trans. It's good to hear that some professionals are actually thinking critically about and discussing this subject openly.

Dr Carmichael doesn't seem to have got any shit for recommending Transgender Trend. I can only assume it hasn't been noticed by TRAs.

They will be trying very very hard to ignore it.

The mention of transgender trend was a statement in response to a question about asd, and was that TT was founded by parents with concerns about autism and being trans. It was in no way a recommendation or endorsement, at best it was an acknowledgement of possible coincidence between trans and asd.

Debbie, as Polly stated, and as all experts in the area know, the link between asd & gender dysphoria is now very well established. There have been many studies, in several countries, demonstrating the same findings. That there is a link is no longer up for debate.

It is clear that Polly was citing TT as an acknowledgement of the fact that many parents are concerned about the dramatic rise of gender dysphoria in young people. Polly & her team share these concerns. She clearly stated that, in their opinion, social influences play a part in the rise of referrals.

There is no way an expert in the area, who is acutely aware of the controversy surrounding these issues, would mention TT within this context if she wasn’t endorsing it. It was obvious to me (& I suspect everyone in that room) they she was endorsing it.

Polly Carmichael said that they are concerned about children who might be 'caught up in something'.

She mentioned Reddit and Tumbler and the tendency to 'diss' experts along the lines of this is who I am, what anyone else says doesn't matter. And that it could be the expression of something, rather than something that has arisen from within.

Which is very much Transgendertrend's viewpoint too.

TT understands, full well, that autism/aspergers is over represented amongst trans kids.

Hence why she mentioned them.

It's here at about 30 minutes.

mobile.twitter.com/acamh/status/974676428972220417

Is she endorsing Reddit and Tumblr too then?, they were mentioned in the same context.

She at best acknowledged TT

As previously said, why else would she mention it uncritically?

Mentioning uncritically as briefly as she did is not endorsement, it's discussion. She didn't tell people to go check out their website or that gids were following TT guidelines or that gids supported TTs campaigns. She said as much about Reddit and Tumblr as TT. Stop making it out to be more than it is to suit your agenda. She simply said TT exist and why they were founded.

Really Debbie6666 - have you listened to it? It’s quite clear what Polly was saying.

Much better to acknowledge this & engage with the conversations this raises, than deny the reality.

The reality is that The Tavi have serious concerns about the dramatic rise in referrals; they are hypothesising that one factor in this rise are social media influences.

As Datun said, they are also concerned about the unquestioning ‘accept me for who I am ‘ narrative because they recognise, as experts seeing hundreds of these children, it’s not as simple as that. And the implications of getting it wrong are serious.

Everything Polly said was in line with the TT approach. Given the controversy, if she felt TT were a dangerous/bigoted group do you not think she would have mentioned this?

I thought that it was a brief but respectful reference to TT. She's not at the conference to endorse particular organisations, but watching the video I inferred from her mention of TT that she considered it to be a legitimate part of the wider conversation about why young people are presenting themselves to her clinic in such huge numbers. I got the impression that she recognised that social media could amplify young people's gender questioning and that being 'trans' was becoming or has become a social identity rather than the mental disorder she's perhaps more familiar with.

...and that for many being 'trans' was becoming or has become...

Stop making it out to be more than it is to suit your agenda.

Alternatively, stop making it out to be less than it is to suit your agenda.

She made specific reference to the reasons TT was set up, not the political campaigning they currently engage in. I agree that she showed similar concerns to TT's specific founding concern. Not that she endorsed TT's current activities or wider concerns as an organisation.

The op claim was Dr C was recommending TT and other have claimed endorsement. TT were mentioned the same way Reddit and tumblr were. Neither recommended nor endorsed, just as having relevance to the particular discussion point.

Reddit and tumblr were mentioned as part of the online problem of social contagion I think? Not really the same, is it?

She mentioned Reddit and Tumblr as platforms that spread social contagion. Not that they are concerned about it, but allow to flourish!

And mentioned TT as an organisation that has consistently held the view and the children on the spectrum can be influenced by that same social contagion.

Polly Carmichael understands this issue has become politicised, only too well.

And she mentioned TT in a positive light, not as synonymous with Reddit and tumblr.

There's also the small matter of other pressure groups being determined to ignore the social contagion part and link to autism.

It's quite evidently a phenomena.

Stephanie knows full well how social media use is influencing this.

Her approach is to empower parents to deal with a situation that is often out of the blue and extremely frightening. She recommends they restrict children's Internet use, for instance.

As opposed to GIRES who say trans-children should be rewarded with a cake and follow their advice
"before children’s views become influenced by the prejudices of the adults around them".

They have also, unbelievably, claimed, anecdotally, that coming out as trans actually cures autism.

Anecdotally, young people who have been successfully treated, are often described as having no residual ASD [Autism Spectrum Disorder]. The symptoms have disappeared once the dysphoria has been treated.

It seems a common thread with a number of trans pressure groups to disregard all the reasons children might be identifying as trans, and to worry the life out of parents if they are not completely on board with their ethos.

It's high time that parents everywhere are fully informed about the dangers of social contagion, and possibility of children with autism being drawn towards the ideology.

www.mumsnet.com/Talk/womens_rights/3188145-anyone-know-the-gender-identity-research-education-society-gires

As a psychologist one of the things that struck me listening to Dr Carmichael’s talk is just how little even the experts in the area understand about the development of gender identity issues.

In any other area of clinical work (& medicine) we work from an evidence base. If the evidence is not there we should proceed with caution/keeping all options open until the evidence is there.

The implications of delivering the wrong type of therapy isn’t necessarily disasterous. However, drugs that might lead to permanent changes are not offered on the NHS without evidence that the benefits outweigh the costs for most people. It’s hard enough to get funding for some drugs when the evidence is ‘good enough’.

I feel for Dr C & gids, as it must be such a difficult area to navigate, but it’s disconcerting to me that there is so much emphasis on hormone blockers rather than long term therapy for this group of children.

I though Dr C looked visibly uncomfortable towards the end when the psychotherapist in the audience stated it was a shame that the Tavistock, the home of psychotherapy, weren’t offering long term therapy for this group. I agree. The numbers just don’t stack up & I just can’t make sense of it from a clinical perspective.

I just can’t make sense of it from a clinical perspective.

We had a mum on here whose child was transitioning. The mother didn't want to go down the medical route. She felt there were more reasons behind it that would not be solved by hormones.

She was offered six appointments. That's it.

By the last appointment, the child was still adamant. So the mother virtually put herself in penury to pay for private therapy.

After several months, I can't quite remember how many, but maybe 10 or so, the child began to unpick the reasons, and was becoming receptive to the idea that maybe they were not trans.

But they had to pay privately, because there was no money in the NHS to pay for it.

I'm not sure how that tallies, with the alternative of lifelong medication and possible surgery? In terms of the money?

It seems as though they are robbing Peter to pay Paul.

6 sessions? I’m staggered . . .

The NICE guidance recommends at least double that number for people with even fairly straightforward anxiety disorders.

I’m also involved in clinical negligence work, and these children would have a very strong case against the NHS if they later detransition or decide they are not actually ‘trans’, after being prescribed hormones. I would be feeling very nervous if I was a clinician recommending medical intervention for children given the current research base. There really is little defense.

‘First do no harm . . ‘

My experience of therapy (albeit private paid for by insurance) is that it's often limited to six sessions since it's so open-ended that there's a risk that it goes on forever and becomes phenomenally expensive.

I can understand that, as that is the case with a lot of psychological issues / disorders, but 6 sessions is typically the very minimum that’s offered on the NHS, and for very recent / straightforward difficulties that we know we can treat effectively in a brief therapy e.g. recent onset panic disorder. Also, therapy doesn’t have to be weeks - it can be fortnightly, monthly. Just having ongoing, if infrequent , input can be helpful.

I hope your experience was good in the end Jaimes.

Other more complex psychological difficulties need more input. It’s a bit like only giving a quarter of an effective dose of analgesic medication to someone with chronic pain, or just a wee bit of insulin to a diabetic. Frankly, it’s unlikely to work.

The cost of hormone treatment and surgery is huge. Tens of thousands of pounds compare with 2-5 thousand for 6 months to a years worth of talking therapy. I wonder if the poor provision is also to do with the de-medicalising of gender dysphoria.

I wonder if the poor provision is also to do with the de-medicalising of gender dysphoria.

It hasn't yet been demedicalised yet has it? I thought had changed to a 'medical condition'?

The mother in question has now to go to court because she can't pay her rent. That's how bad it got.

Sorry, didn’t mean de-medicalised at all. I meant no longer considered a mental disorder, hence perhaps harder to argue for funding for long term psychological interventions?

Rapidonsetfrustration

I don't know. I'm still struggling to get past the financial implications.

Because, to my mind, it must all come down to money.

Talk therapy must be cheaper than lifelong hormones and surgery.