When is a support group not a support group? The troubling story of a UK trans support group.

Just as metaphors lose their metaphoricity as they congeal through time into concepts, so subversive performances always run the risk of becoming deadening clichés through their repetition and, most importantly, through their repetition within commodity culture where “subversion” carries market value.  (Judith Butler, Gender Trouble, 1999 Preface, xxii-xxiii)

My epigraph is from Judith Butler’s 1999 Preface to Gender Trouble, often taken as a foundational text of transactivism. Butler is alert to the way in which liberatory rhetoric can shift into its opposite, turning into a form of oppression. And her warning is appropriate to some of the ways in which transactivism has morphed into a regulatory discourse as it has become established as a business in recent years. The claim of transactivism, of course,  is that it is at the forefront of the fight for a new human freedom. Jay Stewart, energetic founder of the trans youth support group ‘Gendered Intelligence’ draws on Beauvoir, Nietzsche and Butler in his 2014 TED talk ‘We are living on the cusp of a Gender Revolution’ . His call for the freedom to create an authentic self, for a philosophically nuanced understanding of gender, for a rejection of essentialism, hits the buttons of current academic debate. Who would argue against ‘intelligence’? Who would not support GI’s vision ‘of a world where people are no longer constrained by narrow perceptions and expectations of gender, and where diverse gender expressions are visible and valued.’  ‘Gendered Intelligence’ has worked with the Wellcome Trust and the Science Museum. Specializing in art activities for young people from 11 to 25, it provides a supportive space for sometimes troubled youth. Young people who have retreated to the lonely space of the adolescent bedroom can freely interact with others experiencing the same struggles. At last they can find acceptance and belonging. For parents challenged by the changing identities of their young people, the organisation offers both an online forum and a monthly support group where they can share concerns free from worries about ‘political correctness’. What’s not to like?

Well, curiously, quite a lot.  My first visit to the London group was to a parents’ social event in December 2014 where we heard from the actress mother of a trans boy. Engaging and articulate, this mother told how she had wept when her then daughter revealed how viewing a Channel 4 programme ‘The Boy who was Born a Girl’ (Julia Moon, 2009) made her realise that she was a boy. This mother had already suspected that her fourteen year old daughter, attending a private girls’ school with strict uniform codes, was a lesbian (something that came as no surprise to her bisexual mother). But trans was a shock. Coming from a religious background, the mother’s response was to pray and when the next morning she came across a flyer from Gendered Intelligence, she took this a sign. As her teen entered the room to join the other gender questioning young people, she saw that she had come to the right place. Her ugly duckling had become a swan.  And now, two years later, despite the slowness of the NHS, her daughter was at last about to start hormones. At this point the room broke into spontaneous applause.

The applause worried me.  For the mother’s story raises a number of questions. Should a TV programme be the basis for irreversible medical intervention? (What would we feel if a troubled teen had instead watched an ISIS recruiting video and announced to her family that she was off to Syria to find a husband?)  Might not a teenager be made to feel uncomfortable about an emerging lesbian identity within the context of a private London single sex school?  Was the chance discovery of a leaflet for Gendered Intelligence really a sign from God? And how free was the child to pass through what might have been a transient phase once enrolled in a group where her newly formed identity would be reinforced by adults?

In the world of ‘Gendered Intelligence’, the thought ‘Am I the other sex?’ is a revelation of an essential truth. The role of the adult and of the parent is to support and affirm this identity. At the monthly parents’ group, we were encouraged to speak freely and not to feel that we had to be ‘politically correct’. But there was an underlying narrative: feelings were our own but the facts were in the possession of the convenor, and those facts were the ‘trans narrative’.  Our children could only be happy if we supported them through transition. We would find it difficult, we might grieve for the child we thought we had lost but this was merely part of a journey familiar to our experienced convenor, herself the parent of a trans man (who transitioned around age 21). The presence of this convenor necessarily makes it hard to question the trans narrative. ‘Where are you on the journey?’ asked the parent convenor, when I introduced myself.  My answer, ‘Which journey?’ did not go down well.

As Butler suggests, a narrative designed to liberate can itself become oppressive when it turns into doctrine. Some parents revealed that they feared their kids were subject to peer pressure. A visibly unhappy couple were still in shock after their daughter’s announcement that she was trans. She was in her final year at university and they feared that the announcement reflected the undue influence of a new partner with strong links to trans activism. They were particularly worried that this partner had separated their daughter from her other friends. Another mother said that her ‘trans’ daughter was was voicing just the same kind of worries about her appearance that she herself had experienced at the same age. The difference was that her daughter was being encouraged to transition by her friends.

The stories were often troubling, suggesting in some cases that it was the parents who were taking the lead in pressing for their children to transition. Perhaps it is hard to understand why this should be so.  It may be that certainty (supported by the GI community) is easier than doubt. It may also be that gender dysphoria (unlike mental illness) is a diagnosis currently free from stigma which (understood as innate) allows parents to escape guilt. A couple were paying privately for female hormones for their son at Gender Care (a private gender clinic) because the NHS process was too slow. They were also paying for the injections to be provided by a private nurse because there was no agreement of care with the GP. He was now taking a year out of university so that he could begin again as a woman. But he had also developed agoraphobia and was terrified to go out in case anyone should detect that he was trans. At the same time he drew attention to himself by wearing bright red lipstick. These parents said that if their son was happy for a month it was worth it. Yet the changes they were paying for have irreversible life long consequences.

No mention was made to the parents’ group of the statistical likelihood that gender dysphoria in a child or adolescent would spontaneously disappear as they matured. According to a 2008 study: ‘As children with GID only rarely go on to have permanent transsexualism, irreversible physical interventions are clearly not indicated until after the individual’s psychosexual development is complete.’ None of the parents I met described their children as having displayed gender nonconformity as young children. Instead it had developed suddenly around a critical stage in their education when they were likely to be under stress, whether GCSEs, A levels or at university. When I pointed out that a majority of those who enrolled at the Charing Cross GIC dropped out and so did not proceed with medical transition my claim (derived from the information pack for new patients) was challenged by the convenor. She claimed instead that trans people might be put off by the questions they had to face at the GIC. For this reason, some might simply live as trans without medical help. But we were told that things were getting better all the time, and that there were people who had been trans all their lives and were able now to transition medically in old age.

Unchallenged both online and in the group was the belief that transition necessarily requires surgery – a belief that the NHS and responsible advice on gender dysphoria rejects. The convenor was proud that she had been able to accompany a young transwoman to the gender identity clinic and to support her through surgery.  Posters on the GI parents’ online forum are preoccupied with accessing medical intervention including surgery as quickly as possible. One thread discusses how to obtain a mastectomy (‘top surgery’) for a child under 18, something that is not available on the NHS.  Private Brighton surgeon Andrew Yelland is recommended as ‘the only surgeon I found who would do chest surgery for over 17’.  The problem, though, is that ‘Mr Yelland requires a referral from an ADULT psychiatrist to do the surgery on an under 18 year old’, something that is not offered on the NHS. Parents recommend contacting ‘Stuart Lorrimer (enqu…@gendercare.co.uk) and it cost £200. We sent a Tavistock referral letter to both Stuart Lorrimer and Mr Yelland so they both had the basic info.’  Let’s pause to make this clear: for a fee of £200, it is claimed, Stuart Lorrimer (a psychiatrist employed at the NHS Gender Identity Clinic at Charing Cross), will write a referral authorizing  a mastectomy for a seventeen year old patient at the Tavistock whom  he does not treat himself and whom his private clinic (Gender Care) is not licensed to treat.  But these are the tricks a supportive parent can pick up from the Gendered Intelligence online parents’ forum. Though, as Butler warns, ‘“subversion” carries market value’. In this case, ‘The surgery with Mr Yelland costs £6K and he operates on a Monday and Wednesday.’

Though revealing – and worrying – the GI online forum could be dismissed as peer support whose content in no way reflects the ethos of the organisation that enables it to function. Yet the parents’ group revealed equally worrying stories where a host of co-morbidities were ignored in order to privilege the issue of gender.

A central feature of of the trans narrative is the claim that trans is not a mental illness. There is a curious asymmetry in the ways in which gender dysphoria (the belief that your body does not match your gendered identity) and body dysmorphia (the belief that your body is aesthetically unpleasing) are understood.  According to NHS Choices, ‘up to one in every 100 people in the UK may have BDD [body dysmorphia disorder]’, a condition that ‘usually starts when a person is a teenager or a young adult’. Body dysmorphia disorder is treated with CBT and anti-depressants because surgery ‘can lead to a preoccupation with further surgery to try to get a better result, which in some cases will do more harm to a person’s appearance than good.’  Sensible. But then ‘BDD is a psychological or psychiatric problem and thus needs psychological or psychiatric treatment.’ By contrast, NHS guidance states that dissatisfaction with the body stemming from beliefs about gender identity ‘is not a mental illness’. In this case, a physical treatment is therefore appropriate: ‘Many trans people have treatment to change their body permanently, so that they are more consistent with their gender identity, and the vast majority are satisfied with the eventual results.’ Let’s not worry for a moment that there is a dearth of long term follow up evidence for a treatment protocol described as ‘a unique intervention not only in psychiatry but in all of medicine.’ For what there is, shows only that ‘Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.’

According to the parents, the children who attend Gendered Intelligence have serious co-existing problems.  Yet in the parents’ online group, transition is offered as a panacea for all problems. Here’s a mother, discussing her 17-year-old MTF child’s depression: ‘incommunicado, never leaving her room. She also has chronic pain syndrome in her leg which may excuse some of this behaviour as she is in extreme physical pain frequently, doesn’t sleep much/well, due to the pain and is taking strong painkillers. However she doesn’t do the recommended stuff to overcome the chronic pain so I suspect it’s all much more down to the gender dysphoria.’ Guidelines for GPs warn against ‘misattributing commonplace health problems to gender’. The mother intuitively gets this key point: ‘Sounds like she has severe depression actually’. But the belief (unchallenged within GI) that transition is curative prevents children from accessing appropriate mental health services. ‘With luck, she’ll attend the 1st GIC appointment and things may begin to look up’, says the mother.

A similar picture emerged at the monthly parents’ group. A mother accepted her sixteen-year-old daughter’s transition but was worried because she was self harming and would not attend school. That day her daughter was depressed and in bed because her period had started. Yet the child’s belief that her problems stemmed from gender dysphoria meant that she was refusing to engage with CAMHS (the child and adolescent mental health team). The daughter would only attend the Tavistock in order to get hormone blockers and later testosterone but hated the therapists.

It is known that a significant proportion of trans kids are autistic. Yet the role of autism in the understanding of social gender stereotypes is not discussed nor is a diagnosis of autism a contraindication in accessing medical transition on the NHS. One couple told how their tall son (on the autistic spectrum and doing A levels at an all boys’ school) had announced that he was trans. His interests were stereotypically masculine (trains etc). He had low self esteem and was physically unconfident. He would hold his hands in front of his chest as if to hide his body. His parents were always telling him to stand tall and open his chest and the mother seemed to feel disappointed with him. One day the mother was going through his clothes to see which still fitted him and which should be given away. She commented that he had put on weight and was beginning to develop breasts. (Humiliated?) he said that it didn’t matter because he was really a girl. The mother readily accepted the news and told him that he should go to the GP. The boy said that it was embarrassing and that he did not want to go. But the mother forced him to attend. She said that she was having to make him grow up and take responsibility for his medical treatment. He would have to deal with forms as soon as they arrived or he would not keep up with the process of transitioning. Although the father was struggling with the change both parents had enrolled themselves at the Tavistock and were trying to speed up their son’s transition even though he had not insisted on a female pronoun and had not begun to think about changing his name. At no point did it seem to occur to the meeting that this child was being rushed into transition by parents who had become stalwarts of the Gendered Intelligence parents group.

Far from offering ‘a world where people are no longer constrained by narrow perceptions and expectations of gender, and where diverse gender expressions are visible and valued’, ‘Gendered Intelligence’ resembles a cult in which medication and surgery are rites of passage and belonging. Despite a veneer of openness and despite idealistic motivations, it is a place where adults coerce the young towards a predetermined destination. In Philip Pullman’s 1995 trilogy for young adults, His Dark Materials, charismatic adults attempt to persuade children to undergo ‘intercision’, a ‘tiny cut’ that is variously compared to (but is not the same as) the creation of castrati by the Catholic church and female genital mutilation: ‘‘the doctors do it for the children’s own good, my love…[A] quick operation on children means they’re safe….All that happens is a little cut, and then everything’s peaceful. Forever!’’ (Northern Lights, 284) The promise by trans support groups that medication and surgery will provide peace from the difficult feelings that assail the young is equally dangerous.

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