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.

Msbeaujangles -

"a young male child" - a boy?
Use of language in this debate is like trying to follow a map. The words/ expressions predict the final destination and you set your feet on a path very firmly there

I am puzzled by the example of this child and would like to ask more questions. I won't as this is not the forum and this information should not be shared in public.

My perspective is as a child protection social worker. My concern is for those whose family circumstance could provide if not explanation at least insight into a child's "dysphoria". I wonder how information is shared with a clinic. It is not a child protection issue and so there would be no statutory obligation to either ask relevant questions or hand over possibly relevant information. That seems to me to be a failing. (I am talking about a variety of harm that may be relevant).

I always worry when a child is referred to as having mental health difficulties as can happen with gender identity issues. This locates a problem with the child rather than responsible adults. The child is subject to interventions that are sometimes nothing more than a means to enable them cope with inadequate parenting (or other circumstance beyond the child's control).

lets stop trying to "fix" children and have a look at ourselves instead.

Hi Terfmore

May I butt in? I am really interested in safeguarding.

Is there a red flag type system for safeguarding? Extrapolating slightly but you know that visits to A&E can result in a health visit to check that home life is ok...is there a similar flag for girls who want to transition to check they are not being abused? I think you are saying that is not the case.

Who is responsible for safeguarding here? Are we looking at a case where it is nobody’s responsibility? Isn’t that when you get systemic problems?

lets stop trying to "fix" children and have a look at ourselves instead.
Amen!

Terfmore

I don’t see any problem with discussing anonymised cases. There is nothing in my post that compromises confidentiality.

Psychologists should always approach their work with as broad a range of hypotheses as possible and to explore environmental and within child factors. Even where within child factors play a significant part in causation, environmental impacts can play a part, and importantly, a part in the solution.

When gender dysphoria is the presenting problem, a thorough exploration of all aspects of a child’s life should be explored, as with all other presenting problems. As I say, this exploration forms part of the ‘problem formation’ as well as designing the solution.

There are notable patterns in my work and whilst parenting issues can feature in any of it, these are far more prevalent in some other, more common, presenting problems than gender dysphoria.

bewilderness - about stopping trying to fix children. This is an underpinning philosophy of my work for those that are living fulfilling lives and harming no one.

In relation to this, much of my work involves working with adults to help them accept individual differences and stopping trying to change things where there is no compelling reason to do so.

I think notions of gender has a part to play here in relation to children being gender nonconforming and I believe the the term gender non conformity should be meaningless.

Even if gender as a construct didn’t exist, I expect sex dysphoria would, and perhaps this would be a better term for it.

There's a really in depth similar conversation going on on the transing children thread further down if you'd like to join us. Getting to the very heart of the issue which comes down to what gender identity actually is and how it is formed

@MsBeaujangles
Like Terfmore, I felt a bit uncomfortable about discussing real-life examples, even if anonymous, but I feel that your post about your patient raises more questions than it answers.

The child you talk about is male, but thinks of himself as a girl. This does not manifest itself in his appearance or preferred activities, but simply in his desire to be known by a female name and be referred to as a girl. Why is he seeing a psychologist? There is presumably some distress involved: depression? anxiety? anger? Does he feel disgusted by his body? Otherwise, surely you are medicalising a non-problem.

The real question here is what does he think being a girl is? Is he a quiet boy who sees girls reading or playing quietly indoors and boys running around playing football and fighting and prefers the girls' world? Does he have a sister who seems to be getting favourable treatment from some quarters and he thinks that this is because she is a girl, so if he is a girl he will also be treated better? Before puberty, there is no real understanding of what it means to be male or female other than genderised social roles, so he cannot have a meaningful understanding of what it means to be a boy/man or a girl/woman.

Obviously I don't expect you to answer any of this with regard to one particular patient, but your reply to me last night didn't really help me to understand what is going on.

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.

Why should anyone become gender conforming? A society which moved away from gender conformity would be a much more progressive one.

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

This sentence implies again that there is some sort of 'gender identity' which goes with a certain type of body. What is there to reconcile other than name or pronouns?

When it comes to sex and gender, there are competing ideologies and polarised views.

I think both 'sides' are guilty of using children to further their ideology, whilst fully believing that they are the ones truly trying to 'protect' the vulnerable.

Of course males cannot become females and suggesting otherwise is ridiculous and of course gender identity doesn't supersede sex. However, it is equally ridiculous to reduce the experience of gender dysphoria to being about stereotypes or being motivated by what is happening in the environment.

The child I spoke about up thread does not think, or even care, about what 'being a girl' would afford him in societal terms. He doesn't really care what 'being a girl' is like for others. He is consumed by his sense of self being incoherent and believes this would not be the case if 'he was a girl'. The goal of intervention is to help him feel at one with himself. Nothing more, nothing less.

It is very easy for people who do not have an experience of a gender identity to deny that there is such a thing. It is very easy for people who are wedded to the idea of gender identity to insist everyone has one, whether they are aware of it or not. In the meantime, the young people I work with experience very real problems that challenge all notions of what gender identity is and isn't.

I am please that the staff at the Tavistock are thoughtful and reflecting on all of this.

Bernadette Wren has written a really good article about exactly this. it is called 'Thinking postmodern and practising in the enlightenment: Managing uncertainty in the treatment of children and adolescents' and it is published in Volume 24(2) of Feminism & Psychology

Thanks so much for your thoughtful comments.
In a former age when it was not accepted that boys can "become" girls, what do you think this child would have focussed his self-image difficulties on?

I expect the issue for this boy would be the same no matter what time or place he was in (this wouldn’t be my prediction for all of the young people who initially ‘present’ with gender dysphoria). If he lived in a time and place where he felt the need to mask or conceal his issues, I expect this would manifest in him experiencing a host of other stresses and strains on his mental health.

MsBeaujangles
Thanks for your reply which is interesting, but I'm still not sure that I understand any better. I am someone who does not have a gender identity, so really struggle to understand what it is. The explanations people give are always to do with stereotypes, so it is difficult to understand what else it might be.

I was not trying to reduce the experience of gender dysphoria or sex dysphoria to stereotypes, but I struggle to understand what it is if it is not about either someone's experience or a dislike of their body. In the case of the child you have been talking about, I suppose the question is, in what way does he think his life would be different if he was a girl? In other words, what does 'being a boy' and 'being a girl' mean to him?

I do not want to further any sort of ideology, but I am trying to understand a phenomenon which has the possibility of doing real harm to children.

I am pleased that the staff at the Tavistock are thoughtful and reflecting on all of this.

@MsBeaujangles It may be that there is a challenge to the Tavistock's way of working and that in some way the segment on R4 World at One contributes to this (deliberately or incidentally). Alternatively a pragmatic response to such long waits may be being proposed.

Dr Webberley's website seems to propose bridging prescriptions
gendergp.co.uk/why-are-trans-teenagers-resorting-to-diy-trans-pills-from-cowboy-chemists/

with support from some at Mermaids to enable quicker/easier access to treatment eg blockers/hormones
twitter.com/DrRachelHeath/status/988308666053836800

It is very easy for people who do not have an experience of a gender identity to deny that there is such a thing.

Gender means group. Or class. It means shared traits within a class containing many people.

It is 100% IMPOSSIBLE to have an identity that is 'gender'.

You can have an identity.
You can imagine that this is what other people also feel.
You may find a portion of people who agree SPECIFICALLY with you when you describe your specific feelings and identity, and you can certainly describe THAT group as a shared identity of sorts. But that group isn't ever going to be 'female'.

What you categorically can NOT do, is find a sub-sample of an existing group (people who all have XX chromosomes), IMAGINE that you share feelings in common with some or all of them, extrapolate that to the entire group, and then declare that you possess the 'gender identity' belonging to the entire group. Because the group themselves don't even share an identity.

It's possible to wish you had a different body.
It's possible to hate your own body.
It's possible to erroneously associate personality traits with one reproductive type.
It's possible to possess those traits and be the opposite reproductive type.
It's possible to reason falsely that you are an exception to the 'rule' rather than concluding that you are the evidence that the rule is wrong.

It isn't possible to 'possess' the 'identity' of an entire reproductive type.
Not even your own.
You can only know the experience of living with your own body.
Never anyone else's, let alone a group of billions.
At best, you can find the words to describe your life and experiences and some other people can agree that they too share them. And then, you have a common group experience of sorts, that you all agree you share. Finding your tribe, giving yourselves a name.

It frustrates me that people do not reason this out.

When anyone uses the word for A REPRODUCTIVE CLASS to name their feelings, they are co-opting me and every female person into their statement of who they are.

If a child or an adult claims they have a gender identity - the question needs to be asked 'what do you mean?' Until you uncover their true belief. And on the way you have to unpick every false idea that society has planted there.

I am female.
I share my reproductive class with billions of others.
But I don't share an identity with them.
I cannot and will not co-opt other people unwillingly into a class with me based on feelings which they may not share.

@MrsBeaujangles would you say that this child wishes he had different anatomy (given he has no real idea what having male/female physiology means, nor indeed secondary sexual characteristics)?
Because that is of course similar to a child with body dysmorphia. I know you said (and I wasn't surprised) that there isn't really a well evidenced treatment for that, either.

Or does he wish people would call him by a female-gender name/referents, as well as being "allowed" to wear/do "girl things"?

Or both?

I do understand where you are coming from. I also don't have an gender identity, I have serious concerns relating to the concept of gender and am 100% behind sex, as determined by sexed bodies, being a protected characteristic.

I think spending time with young people with dysphoria, helps me to understand it somewhat, but not completely.

In what way does he think his life would be different if he was a girl? In other words, what does 'being a boy' and 'being a girl' mean to him? For him it is as simple (or as complex) as wanting his sense of self to cohere, to feel all parts of himself align. At the moment, he is 'internally referenced' in all of this in that his focus is on how he feels about himself rather than how he presents/is received by others. He told me, in his own words, that if he was a girl he would be able to look up and look out, he wouldn't be consumed by parts of him not matching and could just get on with life. Basically, he just wants his dysphoria to go away so he can focus on life and thinks that this can only be achieved by ridding himself of the parts of him that challenge his sense of himself as a girl. He says, if given a choice, he would rather be a boy without dysphoria than a girl with dysphoria (this is what he sees himself as) because he wants to feel whole. Having said that, the question for him is not unlike asking you if you would rather be a dog or a cat - a philosophical choice. Definitions of gender and sex don't touch the sides for him, his lived reality is far more real that anything anyone tells him about the meaning of words.

My, VERY controversial view, is that we should just take away all options of physical intervention for children and young people (and I do feel somewhat conflicted in this view and sympathetic to those who disagree). I think by taking physical intervention off the table it would force us to offer on-going psychological intervention (of which there is very little). It would also force people like Dr Webberley and Mermaids to think about and support alternatives to physical interventions.

It's great that some professionals have not experienced or observed TRA pressure to practice unethically. Many are reporting they do, certainly in Ireland and UK.

@BarrackerBarmer

Your post seems to assume that someone's identity is a rational, thought out, consciously driven 'thing'.

I don't think that someone who 'feels like x' necessarily assumes that someone else who also 'feels like x' experiences the same feelings or that their lived experience of being x is the same as anyone elses.

This thread is about trying to understand dysphoria and for those whose dysphoria is persistent and difficult to tolerate, what are the best ways of providing support.

@Wanderabout - I have experienced and observed TRA pressure to practice unethically and I am seeing it more often!

As adults arguing for the potential existence of an identity shared by 3 billion people I think it behoves those of us who can see the impossibility to explain how this isn't possible.

As adults faced with a child who is erroneously labelling their individual, personal identity as if it were evidence of being synonymous with a group we need to explain how this isn't true.

The child's feelings may be valid: happiness/sadness/yearning and the child's personality traits may be valid: outgoing/expressive/submissive/emotional
All of which can be affirmed.
But the child's false conclusion that all of the above are in any way connected to the concept of 'girl' needs to be broken.
They need to unlearn their idea of girl.

I think part of that is removing the language that confuses, and replacing it with clearer language to give children the tools to articulate what they mean.

Every utterance of 'gender identity' in a clinical or social context imbues the idea with a credibility that isn't warranted. It adds to the problem.

I appreciate the caution from certain gender ID clinicians, but truthfully I think they add to the problem by insinuating that a compulsion, or yearning, or disconnect, or dysphoria, or belief or desire can be referred to as a 'gender identity'.
Where identity is a belief about one's self that may be true or false
Where gender is never explained in anything other than circular terms
And where the word chosen to label said identity references reproductive status.

Patients don't stand a hope in hell of working this our if the clinicians can't even examine their own concepts properly.

I'm in agreement with so much of what you say Mrs.

I just want the clinicians (and I'm thinking of the Tavistock here) responsible for giving this concept its validity to be rigorous in their LOGICAL examination of it, and to use unambiguous terms. I think they owe it to the children and adults who are being harmed by their understanding that medics are rubberstamping this concept.

You have to ask what the ultimate objective is.

TRAs tend to focus on transition and then say that trans people can not cope psychologically.

I tend to fall down on the side of thinking that isn't what it should be about. It should be about building the building blocks to cope psychologically whether they trans or not. Life long skills so they don't have to constantly be shielded or protected as fragile creatures.

Which does mean removing the goal of medical intervention as the focal point.

The focus on medicalisation tends to create an undue pressure from the start. How do you remove 'undue pressure' from the entire equation. Undue pressure comes from friends, family, medics and society in general. If your entire support structure and identity is based around an affirmation only approach and the mere concept of gender identity it makes it very difficult to break out of and arguably very much represents undue pressure by definition. Robust challenging of this HAS to be part of the equation, not just to provide immediate help but also to establish long term coping strategies in life in general. Leading language and narratives is also part of this in certain cases (who suggests the pronouns?).

The entire political climate works against this being possible at present. Parents are almost forced to 'pick a side' early on which is desperately unhelpful and has contributed to a break down in trust about the whole system.

I'd also add that gatekeeping and care at GP level is often poor due to GPs lacking the skills and knowledge to help. The lack of funding and specialists available only serve to make problems worse when early intervention is so crucial. (but as mentioned before this is true of all children's mental health).

The focus on medicalisation is all part of this dynamic. Its a simple 'solution' to a very complex and difficult problem. It makes it attractive rather than tackling painful subjects. (For children and parents alike).

Two things that could be done to help would be to tackle this would be to throw some actual funding at the entire area in terms of the number of specialists nationally and working to remove the concept of 'affirmation only' as advocated by organisations which do not acknowledge the existence of desisting.

There NEEDS to be a sense that medicalisation is not a target and an inevitability. This would do a lot to regain the trust of parents which is absolutely crucial. I'd also argue for counselling of parents and sibling to be part of the package because the lack of space and time to deal with their own feelings in an affirmation only approach is lost and this can not help trans kids themselves. Being told their views and feelings are somehow 'wrong' is damaging in its own right and I'm sure this lack of consideration for families has contributed to the rise of the most militant of parents who are struggling to come to terms with it all in their own ways in the absence of this support from within the NHS.

My, VERY controversial view, is that we should just take away all options of physical intervention for children and young people (and I do feel somewhat conflicted in this view and sympathetic to those who disagree). I think by taking physical intervention off the table it would force us to offer on-going psychological intervention (of which there is very little). It would also force people like Dr Webberley and Mermaids to think about and support alternatives to physical interventions

I agree.

Perhaps the term 'gender' is muddying the water due to it becoming so politicised and embroiled in ideological nonsense. Similarly, the term 'identity' could also be problematic due to identity politics.

I just want the clinicians (and I'm thinking of the Tavistock here) responsible for giving this concept its validity to be rigorous in their LOGICAL examination of it, and to use unambiguous terms. I think they owe it to the children and adults who are being harmed by their understanding that medics are rubberstamping this concept
I had couldn't help but chuckle when reading this- the Tavistock is the home of the promotion of tolerance of ambiguity. It is through a tolerance of ambiguity that a dysphoric child moves forward in their 'stuckness'.

The Tavi practitioner may even draw parallels between the fixed views of a gender dysphoric child insisting they are 'a girl' despite their sexed body indicating that they are 'a boy' and the fixed view of somebody insisting there is no such thing as an inner sense of self in relation to ones sexed body despite this being the experience of some.

Where is the evidence that people are being harmed by the way medics are working? Do we know if they would do better if they didn't receive intervention?

I whole heartedly agree with your post @RedToothBrush

I particularly like your statement about the end goal being about people having the building the building blocks to cope psychologically whether they are trans or not.

Where is the evidence that people are being harmed by the way medics are working? Do we know if they would do better if they didn't receive intervention?

How will we find out when independent research into this is not commissioned due to the political and socia climate created by activists with an extreme ideology?

I agree RedToothBrush 's post is great. The point about trust is critical.

I don't think your opinion is controversial MsBeaujangles ftw.

The central pillars of removing 'undue pressure' and ensuring 'informed consent' have to be applied to all areas of medicine otherwise you are on dangerous ground.

Ideology and medicine are an unhealthy mix. It creates an environment in which harm is more likely.

Everything I hear on the subject of 'affirmation only' starts to raise red flags all over the place in terms of ethics.

Parents need to know that doctors are totally committed to those principles, whether or not TRAs agree with it or not.

In the current environment it is simply not sufficient for a child to be deemed Gillick Competent by a medic. Doctors also have to be sure that they are making decisions that do not exist within an echo chamber and are not simply reflective of the messages they are receiving.

The bar has to be set high, in order to maintain trust in the system as well as serving those who are in the system. This also protects professionals in an area full of contention.

There are very very areas of medicine (if any??) where there is a singular treatment which all patients should receive because we are all individuals. I get alarmed when this is presented as such. Care should be tailored to the individual rather than insisting on the integrity of care pathway by treating it as a monolith, which serves only to protect the ideology.