Introduction
The following piece provides a detailed critique of the human rights narrative which drives the new social paradigm for gender identity. The Lancet Psychiatry (2022) recently carried an editorial, reviewing the history of psychiatry as an oppressive form of medical practice with regard to sexuality and arguing for a more active stance against conversion therapy: Thus “Dr Amir Ahuja of the American Psychiatric Association argued that psychiatrists should educate themselves and offer LGBTQ-affirmative therapy, and that mental health practitioners should police themselves by lobbying organisations to ban conversion therapy and to threaten to remove licences.” The Editorial was followed up by a letter in The Lancet (Adelson et al, 2022), which provides the starting point for this critique. (The term ‘trans people’ is used throughout, rather than the more accurate term ‘people identifying as trans’ simply for brevity).
A letter to The Lancet
One of the most puzzling and concerning aspects of current controversy over gender wars has been the apparent ease with which esteemed professional medical journals and professional associations have moved to embrace belief-based gender ideology. If medical science is securely based on hypothesis and refutation, via carefully considered evidence, where does the new paradigm of gender identity fit? What future can there be for randomised controlled trials of medication for gender dysphoria, if the patient already knows that puberty blockers and cross-sex hormones are the answer and the prescribing medical team strongly agree?
Part of the difficulty facing therapists wishing to challenge the near-dominant status of gender ideology in medicine and therapy is the alarming degree of institutional capture of professional journals and professional institutions. As small and highly effective networks of activists have taken influential positions within clinical journals and professional associations, debate has been sidetracked by a plethora of official-sounding pronouncements, policy directives and memoranda, all seeking to advance the cause of gender ideology. This narrative, developed and articulated across different media, portrays a surprising degree of consistency and uniformity, for example, in its insistence that respect for gender ideology is simply a ‘human rights’ issue. In the post World War Two landscape, any reference to human rights now decisively trumps any other argument. Who but a bigot would want to question or restrict another person’s access to human rights?
Psychiatry and ending conversion therapy
This narrative about defending human rights is at the core of the recent letter to the prestigious medical journal, The Lancet, (Adelson et al, 2022). The letter is inoffensively titled “What psychiatry can do to end LGBT conversion therapy”, submitted by a group of authors from schools of psychiatry, law and public health at Yale University. The tone is measured and utterly reasonable, as if discussing the most effective way to reduce infant mortality caused by Covid, or some similar topic of medical concern. And yet, the measures suggested are rooted in another, arguably non-scientific, worldview, which is not open to challenge. Far from resting on an agreed medical consensus, each of the building blocks of the case for psychiatry to help overcome the harms caused by LGBT conversion therapy are the subject of ongoing systematic critique on a global scale. The main assumptions can be briefly stated, as in Figure 1 below.
Once stated in this schematic way, the underpinning axioms of this new social paradigm of gender ideology can be more easily identified and the evidence for each of them examined in turn. For example, the starting point would be “The concepts of trans and of gender identity are an integral and indissoluble part of the wider LGBT paradigm.” However, trans status is an overtly social construct, rather than a biological reality. The concept of gender identity is untestable, and therefore irrefutable, and so depends upon the adoption of a complex belief system, rather than resting on objective evidence, or validating criteria. In practice, groups such as the LGB Alliance in the UK, strongly contest the inclusion of trans issues within the overarching gay political spectrum.
Oppression and trans human rights
Other axioms are similarly open to challenge. The argument that “Trans people are an oppressed group, with minority stress leading to high levels of anxiety/depression, trauma & suicide risk “ is the absolutely key foundation for building a case for enhanced trans human rights. Yet the axiom clearly confuses correlation with causation. Trans people may experience stress and hardship via discrimination, but the claim that this minority stress is the single, paramount cause of mental health conditions, such as anxiety, depression, trauma and suicide risk is unproven. What is clear is that trans status carries with it a significant loading of co-morbidities, such as autism, eating disorders and sexual abuse, which are each independently associated with mental distress. This rush to an over-socialised model of mental illness by professional associations such as the American Academy of Pediatrics may be vastly reassuring to trans clients and their families (AAP, 2018). However, it jettisons the complex and nuanced models of diagnosis contained within the bio-psycho-social model of psychiatric care, carefully developed over recent decades. It opens the door to a self-service, supermarket model of care, providing easy access to powerful, life-changing medication, with little need for psychiatry as a gatekeeping profession with independent expertise.
It follows on logically from this premise that if trans people are so uniquely oppressed, then they should have access to higher levels of protection for their human rights. In the US, for example, trans rights are perceived in law as following on from civil rights fought for and achieved on the grounds of race, sex and sexual orientation, under Title IX of the Education Amendments of 1972. It is crucial here to maintain the assumption that trans rights flow seamlessly on and are entirely consistent with rights held by other socially oppressed groups, such as gay people (Axiom 1). As suggested above, this argument is not universally accepted. Also, rights exercised by one group can conflict with the previously existing rights held by other groups. Thus research suggests that the blanket application of trans rights in the UK criminal justice system has produced seriously adverse consequences for women in prison (O’Hara, 2022).
Banning conversion therapy
It is a short step from claiming that trans people need enhanced human rights to perceiving alleged conversion therapy as a serious threat to such rights (Axiom 4). However, the research into the very existence of conversion therapy in both the UK and US is weak (GEO, 2018; James et al, 2016) and overtly partisan (Jenkins and Esses, 2021). Indeed, it seems to be the case that the weaker the evidence available for the prevalence of conversion therapy, the greater the reliance on appealing to international human rights conventions, which are all part of the same self-supporting paradigm. As illustration, the draconian conversion therapy ban now effective in Victoria State, Australia, rests on a purposive sample of no more than 15 respondents (Jones et al, 2018). Equally, in a curious reversal of the standard legislative process, Ireland has legislated against conversion therapy, and is only now authorising research into whether conversion therapy actually exists on any significant scale.
Axiom 5 represents the outcome of the previous arguments, each open to empirical refutation: “Trans human rights therefore require: – a comprehensive ban on conversion therapy; – updated professional guidelines on practice.”
Legal bans on conversion therapy are now in place in Canada, New Zealand, Malta, Ireland and in two states in Australia. These bans have nominal and poorly defined protection for ‘exploratory therapy’, but crucially all now enshrine strong legal protection for gender identity affirmative therapy, perhaps the main legislative motive at work here. Significantly, Adelson et al are not calling here for strengthening of the law against conversion therapy, but merely for the updating of professional guidelines on best practice. As an exemplar, they reference the UK Memorandum of Understanding on Conversion Therapy (MOU), signed by most therapeutic professional associations and by the Royal College of Psychiatrists (RCPsych). (Though for dissenting voices within the RCPsych, see: CTA 2022). However, in the UK, the government has recently dropped gender identity from its conversion therapy proposals, citing complexity as the reason. In reality, the MOU is now probably further away from realising its goal of achieving a legal ban on conversion therapy for gender identity in England than at any point since its inception in 2017.
It is at this point that the underlying human rights narrative underpinning Adelson et al begins to unravel slightly. It is unclear whether no further evidence of conversion therapy is required, or even more evidence, of conversion therapy is required to convince the doubtful. As always, delay in legislating will cause heightened minority stress and greater risk of suicide. Questioning any of these axioms is in itself evidence of probable transphobia, rather than of a reluctance to accept the new social paradigm of gender identity. Yet, simply calling for updating of professional guidelines perhaps betrays a recognition that the tide is turning away from the trans movement and its insistent agenda. Hence, it may be much safer to rely on professional guidelines, policed by a self-reinforcing range of compliant and captured professional bodies, each with an impregnable air of respectability and authority.
Human rights reframed as medical consumer rights
The letter by Adelson et al may be a useful straw in the wind at this point, given that there appears to be much deeper social processes at play here. There is an increasing divergence at an international level with regard to medical intervention for gender identity transition, particularly for children under 18. Within polities such as the US, where the pharmaceutical industry wields enormous political and social clout, there is over-weening market pressure for assured medical validation of self-defined gender identity, (the ‘Lupron lobby’). This finds an echo in other major economies of the Pacific Rim, notably Canada, Australia and New Zealand. However, for polities with much stronger government traditions of regulating medical interventions, such as Finland, Sweden, France and now the United Kingdom, there has been a major policy shift away from validating early medical intervention for young people.
Assuming a critical perspective on this wider political process, it may now be time to question the human rights paradigm which drives the arguments presented by Adelson et al. Human rights are hardly absolute and non-negotiable under any circumstances. The Western liberal tradition, from John Stuart Mill onwards, explicitly recognises that one person’s human rights can be in conflict with their neighbours’, and this requires regulation and restriction, if necessary. Rather than resting on abstract appeals to human rights, it may be more useful to reframe the trans social movement at work here as a politicised medical consumer rights movement. This social movement is based on powerful cultural and demographic changes around the issue of sex and identity. This newly emerging medical consumer rights movement is in strategic alliance with a pharmaceutical industry, busily searching for new, lifelong markets for its off-label products, aided by a compliant and partially captured medical profession. The new social paradigm for psychiatry has just landed.
References
Adelson, S., Miller, M., Johnson, K. and Reid, G. (2022) “What psychiatry can do to end LGBT conversion therapy”, The Lancet. September. Vol 40. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00235-8/fulltext
American Academy of Pediatrics (AAP) (2018) Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. 142(4): https://pubmed.ncbi.nlm.nih.gov/30224363/
Critical Therapy Antidote (CTA) (2022) Psychiatrists pushing back against Stonewall’s influence. https://criticaltherapyantidote.org/2022/08/15/psychiatrists-pushing-back-against-stonewalls-influence/
Editorial (2022) “When therapy is not therapy”. The Lancet Psychiatry. Vol. 9: 261. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00076-1/fulltext
Government Equalities Office (GEO) (2018) National LGBT Survey: Research Report. Department for Education: Manchester. www.gov.uk/government/consultations/national-lgbt-survey
James, S.E. et al (2016) The Report of 2015 US Transgender Survey. National Center for Transgender Equality: Washington, D.C.. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
Jenkins, P. and Esses, J. (2021) Scoping Survey for Government Equalities Office Consultation on Conversion Therapy. https://thoughtfultherapists.org/scoping-survey-pdf/
Jones T. Brown A. Carnie L. Fletcher G. & Leonard W. (2018) Preventing harm, promoting justice: Responding to LGBT conversion therapy in Australia. GLHV@ARCSHS and the Human Rights Law Centre: Melbourne. https://static1.squarespace.com › static › t › LGBT…
O’Hara, M. (2022) Transgenderism and policy capture in the criminal justice system. Policy Exchange: London.
Legal reference (US):
Title IX of the Education Amendments of 1972 20 U.S.C. 1681-1688
By Peter Jenkins, counsellor, supervisor, trainer and researcher. He has been a member of both the BACP Professional Conduct Committee and the UKCP Ethics Committee. He has published a number of books on legal aspects of therapy, including Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017).
https://us.sagepub.com/en-us/nam/author/peter-jenkins
Peter Jenkins is also a member of Thoughtful Therapists, whose scoping survey for the government consultation on conversion therapy can be found here: