Transgender child on R4 World at One

[Poppyred85]

Following on from a report about waiting lists to attend GID clinic, there was an interview of a 10 year old transgirl and her mother. I really don’t know what to make of it. Both the child and the mother sound to be genuinely struggling with this and I found it incredibly sad to listen to the story of her child self harming after identifying as a girl. Her mother commented that she wasn’t looking for her child to start on blockers or surgery but felt she needed psychological support and how lacking this was. Clearly the mother was doing her best but I couldn’t help but feel uneasy listening to why the child felt they were really a girl and the whole “born in the wrong body” narrative. From the sounds of things came across the term transgender because it was used as an insult by her classmates but had previously told her mother she has the heart of a girl. I thought the response from the specialist after the interview was quite measured.
It’s on now so not on Iplayer yet.

Telling a child who is dysphoric that they are being silly or ignoring their distress is not helpful.

Absolutely not. Just as telling a child with irrational anxiety or body dysmorphia that they are being silly or ignoring THEIR distress would also be very wrong.

But with those children we do not enter into their beliefs that they are going to choke on their food or that they are massively overweight when their BMI is 22.

In an ideal world we alleviate their distress, though I fully appreciate with CAMHS in the state it is, they are also often sent home with self help or parenting techniques.

When children experience distress and anxiety about their sexed bodies, and this persists, then this can be an indicator that intervention might be a good idea.

I'm sure there must be much more to it than just anxiety about their sexed bodies. Many women on here have said that they experienced great anxiety when puberty started, and really didn't want to become women, but are now glad that 'trans' was unheard of back then.

I can't see how anyone can defend giving powerful drugs such as hormone blockers to any child. If a child expressed distress at some other aspect of their body - too tall or too short for example - would medication be given to change their body, or for their mental distress?

This does seem to be the only condition where the mind thinks the body is wrong, and steps are taken to change the body rather than work on why the mind thinks the body is wrong.

Telling a child who is dysphoric that they are being silly or ignoring their distress is not helpful.

@MsBeaujangles I may have missed it, but I haven't seen anyone suggest that we tell distressed children that they are "silly". I think very many of us feel an intense empathy for a child who is dysphoric, not least because many of us on MN were gender nonconforming children ourselves.

What many of us disagree on, of course, is what we do about a distressed child. At the moment, any proper research or even discussion about it in the public sphere is dangerous for the professionals involved, which cannot possibly lead to a good outcome for the children involved.

MsBeaujangles - many thanks for your helpful posts, it is so much more complex than challenging stereotypes, take it from a parent dealing with this!
What is your view of how young adults (under 25), as opposed to children, are treated by gender specialists?

Is any consideration taken of their maturity or lack of, or is this not considered appropriate?

This does seem to be the only condition where the mind thinks the body is wrong, and steps are taken to change the body rather than work on why the mind thinks the body is wrong

I have yet to meet a professional working in this area who thinks that changing the body is 'the treatment' for dysphoria but rather it aims to help alleviate the symptoms. I haven't met any professionals who buy into the narrative of 'trapped in the wrong body' or 'brain doesn't match the body'.

But with those children we do not enter into their beliefs that they are going to choke on their food or that they are massively overweight when their BMI is 22

Linked to my point above, the professionals I know do not enter into the beliefs/ 'wrong body' beliefs.

As a psychologist (as opposed to a psychiatrist), it is unsurprising that I favour psychological over physical interventions. I am also gender critical and think that society has a lot to answer for in relation to expectations about gender conformity. I have significant reservations about the use of puberty blockers for children and other physical interventions that do not have a strong enough evidence base underpinning them. I also recognise that some children experience significant distress as a result of their gender dysphoria and the impact of this condition shouldn't be trivialised or under-estimated.

and the impact of this condition shouldn't be trivialised or under-estimated

I don't think anyone is doing this here, though.

I would be interested in your view of Mermaids' approach, MsBeaujangles, because that's where I see the main problem lies - deciding on a solution and shouting "transphobe!" at anyone who wants to discuss a range of different solutions, or even anyone who suggests that more research is needed.

@Archery Annie. You are right, nobody was talking about telling a child they were being silly, I was picking up on the comment so silly that he has to identify as transgender in order to wear sparkly clothes. It would have been better to have focussed on thinking of it as being 'silly'.

@StarkStaring. It is complex - in psychological terms many psychologists, me included, would see under 25 year olds as adolescents still. The developmental task of coming to a settled sense of self is often still on-going at this age and so, in my view, struggles with gender identity could still be part of this process. I am not convinced that someone who is struggling will not come to
a settled, consistent identity that is at one with their sexed body, given time.

Having said that, I think the age of onset it important. I think there are significant differences with persistent dysphoria that starts at a young age and sudden onset dysphoria (where social contagion aspects could be at play).

What some posters on this thread may be overlooking is that some children, from a very young age, present with passionately uncompromising narratives about their self-identity as male or female, despite the conflicting evidence of their sexed bodies. When talking to them, it is clear that their understanding of their own sexed bodies and of gender is complexly determined.

@ArcheryAnnie. I am not a fan of Mermaids for many reasons and I think their conduct has, at times, been is unprofessional.

I loath the 'Genderbread' models and 'Ken and Barbie' continuums that get circulated and think they are ill informed and pernicious.

@MsBeaujangles what is the standard psychological treatment for a child with body dysmorphia?

(Assuming, ha ha, that CAMHS actually has funding etc.)

MsBeaujangles I think what you’re saying reflects much of what other child psychologists I know say, and it’s reassuring that all professionals I know in this area are following a more conservative approach than we might hear about in the media.

Nevertheless, when I speak to them I’m struck by how our conversations reflect our separate professions. I can see that their concern is to treat the distress of the child and that requires action. Whereas for me, with my historian hat on, what’s most interesting about this phenomena of trans children is how historically specific it is to this place and time - which makes me wonder why these kids are manifesting this right now and doubt if we can really treat this as anything other than a delusion.

When my child was claiming, for many years and from a very young age, that their felt reality was different to their actual sexed body, I specifically never took them to any child psychologists for this exact reason. They’ve now grown out of it. I don’t believe this would have been the case had I taken to someone who believed this was a case that required treatment and therefore substantiated my child’s ideas. I may be wrong on this, of course!

I have yet to meet a professional working in this area who thinks that changing the body is 'the treatment' for dysphoria but rather it aims to help alleviate the symptom

Then what about the endocrine soc of America and their statement of belief on another mn post?

They are clearly of that view.ie they go along with the girl in boy body idea

some children, from a very young age, present with passionately uncompromising narratives about their self-identity as male or female, despite the conflicting evidence of their sexed bodies. When talking to them, it is clear that their understanding of their own sexed bodies and of gender is complexly determined.

What, exactly, is meant by 'gender' here? 'Gender' is usually used to mean (a) a synonym of sex or (b) the stereotypes which go with being either male or female. You clearly don't mean 'sex' here, so if 'gender' does not mean stereotypes in this context, what does it mean?

@MsBeaujangles Some great posts! You sound very well informed. I was wondering, did the medical profession encounter such cases in the past - and if so, were they diagnosed differently? In children, I mean.

Lots to reply to. I'll have a quick bask before feeding the hungry hoards!
@drspouse - I don't think there is a standard treatment. There is a lack of evidence to guide proper evidence based treatment.
@NowtSalamander. Your questions of why here why now etc. are very live for psychologists too. We are asking and trying to find answers to these questions.
@Wombman - I am speaking about the work of child and adolescent psychologists in the UK rather than endocrinologists
@OldCrone - gender here refers to the social and cultural expectation of how males and females should think, behave and how they should be treated by others. As I said before, I am gender critical and do not buy into sex determining femininity or masculinity. However, I do observe this being a reality for many.

@NotTerfNorCis. Gender dysphoria has been around for a long time. The rise in the number of children being referred for treatment has increased dramatically in recent years. Also, there are now far more girls being referred than boys

@MrsBeaujangles that doesn't surprise me - I'm an adoptive mum and nothing is evidenced for children with the kinds of difficulties adoptive children have either. Sigh.

Is there likely to be a push to refer to Gender GP's private practise if Tavistock clinic's waiting time is seen as too long?

I know with other types of GP referrals, this does happen. The call on R4 seemed to be for parity of MH services, is this the intended outcome?

Are there differences in approach between services?

Dr Polly Carmichael seems to take a more nuanced approach than the affirmation which seems more prevalent at Mermaids.

It worries me that there are organizations going into schools teaching children they were "born into the wrong body" and no organizations going into schools teaching children that their body is an integral part of themselves and "it gets better".

Are there differences in approach between services?
Dr Polly Carmichael seems to take a more nuanced approach than the affirmation which seems more prevalent at Mermaids.

The Tavi is the UK's only GID service for children and young people. The psychology team there are very reflective. They write interesting academic articles about things like gender identity and feminism and what it is like being gatekeepers to physical intervention/managing the pressure placed on them to offer hormones etc.

It worries me that there are organizations going into schools teaching children they were "born into the wrong body" and no organizations going into schools teaching children that their body is an integral part of themselves and "it gets better".
It worries me too. This and the apparent lack of understanding of (or decisions to ignore) the law that schools and local authorities exhibit when it comes to meeting competing/conflicts and interests.
There are quite polarised positions being presented and so much misinformation being bandied around.

MsBeaujangles - I'm really finding what you have to say interesting. Thank you

Thank you everyone for your thoughtful replies. Sadly I am well aware of the inadequacies of Camhs for all children with mental health problems, not just GID. I deal with it often in my professional life. I’m still processing my thoughts on all this and haven’t really got it into a particularly coherent form in my mind yet but I think my feeling of sadness related not just to the distress of the dysphoria or the helplessness of her mother to relieve it but the fact that there seems to be so little support for them both or indeed any real consensus on what is helpful and what’s not. I don’t think it’s as simple as letting a child express themselves however they wish but asserting their sex is immutable (and by that I am not saying that a person can change sex, clearly they can’t). That seems to me to be an inadequate response to such deeply held beliefs. To use the anorexia analogy, we recognise that people suffering with it hold those beliefs, however delusional, very deeply and we don’t just assert they’re not fat and expect them to be able to accept that. For me though, the answer doesn’t lie in using off label drugs with unknown long term effects in children either. I suppose my feelings on it are that greater psychological exploration and input is needed for these children, much as it is with all the mental health issues I can think of.
Sorry that’s a bit rambling...as I said I’m still organising my thoughts on it.

MsBeaujangles
gender here refers to the social and cultural expectation of how males and females should think, behave and how they should be treated by others.
This is what I find particularly troubling. I can understand people feeling they need to change their body in some way because they hate some aspect of their body. It seems wrong that people would wish to change their body because society has made them feel that their body is wrong and doesn't fit with their personality.

@OldCrone
It seems wrong that people would wish to change their body because society has made them feel that their body is wrong and doesn't fit with their personality

The construct 'personality' doesn't really fit with what dysphoric people are talking about when they talk about feeling male/female/neither. One of the things many dysphoric people struggle with is explaining this, in a meaningful way, to people who aren't dysphoric. We naturally try and map their experiences on to our own, but that doesn't work because we don't have any similar experiences to draw upon. We revert to thinking about personality and preferences, but these do not necessarily reflect the young people's experiences.

To try and make this less abstract - I am currently working with a young male child (aged 10) who thinks of himself as a girl. He doesn't really show any preference for typically feminine things. He doesn't own dresses or skirts and wears his hair relatively short. His parents want him to be happy and to thrive, they would love him to be happy in his sexed body and worry very much about the repercussions of physical intervention. They aren't worried about his preference for female pronouns, they are not concerned about his choice of a female name, they are happy for him to choose whatever clothes he wants to wear but they are absolutely desperate to avoid any physical intervention.

We are all hoping he will come to feel happy in his own body. His parents couldn't care less about his chosen pronouns, choice of clothes or career choices etc. when he is a grown man. They just want him to be at peace with his healthy body and to be able to access a full life.
He may become gender conforming but if he doesn't, my hope would be that he can come to tolerate the dissonance he experiences between his gender identity and his sexed body. If this is the case, I would like to think that people would call him by his preferred pronouns, and respect that his lived experience as a transwomen is hard to understand but is a valid one. I like to think that basic humanity and laws will protect him from hate and discrimination and that he can have a fulfilling life.
I also hope that he will reconcile the difference between his natal sex and his gender identity so he is comfortable in being male whilst being a transwomen; that he will respect that there some are places, services and sports that are for people with female sexed bodies and that this doesn't negate his experience as a transwomen.

@MsBeaujangles
Thanks for that detailed reply. There is clearly a lot more going on in many cases than just a liking for things associated with the opposite sex. I don't think we can easily understand what is going on in other people's heads if it's not something we have experienced ourselves.