“No religion can survive doubt” (Kanon, 2015: 270).
The gender ideologues have now clearly taken over the Academy as well as the Asylum. They also appear to have partly taken over the counselling profession, judging by the June 2023 issue of Therapy Today. This is the professional journal of the British Association for Counselling and Psychotherapy (BACP). Meanwhile, blackshirted gender ideologues (generally men) have progressed from trampling on the legal rights of women, to apparently seeking to trample on the actual bodies of women, in some of the major cities of the world. It is time to take stock and respond to this dire situation.
Therapy Today continues and intensifies a developing theme for this journal, by providing a bumper issue on the related themes of gender diversity, minority stress, relationship anarchy and gender identity. It is doubtful as to whether the journal’s readers are actually crying out for this rather large spoonful of corrective medicine, as distinct from it being decided that this is what we definitely need for our own good. My response will focus on the contribution on gender identity, coyly listed as ‘Opinion’, but which should perhaps be more accurately termed as ‘Ideology’ (Ellis and Reilly-Dixon, 2023). This response is unlikely to be published in the pages of Therapy Today, no doubt for fear of disturbing some readers’ fragile sensibilities. My response will focus on the need for informed dialogue, the unhelpful role of artificially polarised arguments, the limits of post-modernism as a useful guide to understanding the real world, the crucial importance of taking detransition seriously and the harms of medical interventions for gender distress.
A one-sided conversation?
The article points several times to the need to offer up ‘generative conversations’. This is a promising start, given the standard position often encountered in discussion on gender of: ‘No debate, this is not a free speech issue’. However, a conversation needs, at minimum, two participants, rather than constituting a discussion with an imagined opponent. This conversation feels more like a monologue. The presentation in the article seems testament to the hermetically sealed world of post-modern Queer Theory. This world seems impervious to the evidence of scientific research, contrary views, or inconvenient forms of lived experience, such as that of detransitioners, which lacks proper approval by the relevant queer authorities.
The return of the binary?
The article’s mode of argument is also puzzling. Given that the article appears to be in favour of diversity and multiple processes, the style of argumentation seems to be based around constructing a set of binaries and decanting all the positions it opposes into one camp. Hence gender identity and sexual orientation are split into LGBT and trans on the one hand, versus cis and heterosexual on the other. In terms of the supposed origins of different sexual and gender orientations, a division is suggested into the ‘naturally occurring’ gay category, and the ‘artificially mediated’ construction of the trans camp. This style of argumentation seems to require little in the way of evidence, other than appeals primarily to trans authorities and sources, buttressed by sometimes impenetrable post-modern jargon. This circular style of presentation presumably makes sense to those already converted, if departing from the quaint notion that argument equals opinion plus evidence, rather than just opinion alone.
Gender-critical positions reputedly include the Binary Mutual Exclusive Model (BME) of biological sex, and a pathologising approach towards issues of sex and gender, which is based on a deficit model of therapy. These apparently negative perspectives are contrasted with a range of models drawn from or influenced by post-modernist Queer Theory, such as the Multivariate Process Model (MVP) of sex and gender, and the key concept of intersectionality, which are linked in turn to a more humanist and affirmative model of therapy. On the one hand, this grand process of dividing ideas into the ‘good’ and the ‘bad’ seems to lack subtlety and nuance. On another, perhaps deeper level, this approach almost seems to be paying some kind of unintended homage to the unconscious power of the binary in making sense of the world, particularly when it comes down to biological sex.
Sticking with the binary model of sex
There are major problems, however, with the post-modernist dismissal of the Binary Mutual Exclusive Model (BME) of sex. Here, the article appears to be not just light on reality, but light on the causes of reality. The overriding weakness is that post-modernism radically overstates the power of words (‘linguistic signifiers’, if you must) to shape and determine the external world, as distinct from influencing our perception of it. Re-naming a thing (or a person) does not change actual reality. How we perceive a thing (or a person) does not necessarily change their actual, measurable qualities in any way at all. A person’s biological sex (e.g. DNA, chromosomes) is not changed by altering their external appearance, however superficially convincing this may appear at first or even second glance.
For Foucault, the controversial founder of post-modernism, language trumps reality: “Reality does not exist…language is all there is…” (Macey, 2019: 150). This could be termed the ultimate post-modern fallacy, namely that words determine reality. A child of six knows this not to be true. A letter to Father Xmas, however heartfelt, does not guarantee the arrival of a list of desired presents. Shakespeare unerringly nailed this post-modern fallacy fully half a millennium ago, when Hotspur slyly goaded the wordy and boastful Owen Glendower in the following exchange:
“Glendower: I can call spirits from the vasty deep.
Hotspur: Why, so can I, or so can any man; But will they come…?” (Shakespeare, 1597: PJ edit.)
In other words, if we really must engage in philosophy football here: Shakespeare 1; Foucault 0.
Recognising biological reality
Gametes rule. If post-modernists are so offended by the process of assigning biological sex at birth on the basis of observable external signs (phenotype), then perhaps it should be assigned instead on the basis of genotype (chromosomes)? In either case, observing and recording sex at birth is largely a simple recognition of a biological reality. Ellis and Reilly-Dixon’s opinion piece relies on the concept of Intersex conditions (an offensive term to many with Differences of Sexual Development, by the way) but this no more disproves the binary model of sex than reclassifying Pluto as a non-planet overturns the rules of astrophysics. The original source of all current BACP membership (and humanity as a whole) continues, all protests apart, to be accounted for by a crazy little thing called sex, unashamedly biological, binary in nature, and, yes, terribly old-fashioned and impractical by current post-modern standards.
Presenting the MOU as a threat?
The article refers several times to the Memorandum of Understanding on Conversion Therapy (MOU). This is an inter-professional policy agreement calling for a criminal legal ban on conversion therapy in the United Kingdom, not just on the grounds of sexual orientation, but also on the contested and somewhat elusive basis of gender identity. The MOU has been signed by most, but not all, professional associations in the field of medicine and therapy in the UK. Here, the MOU is brought in almost as if it were a threat to restless and non-compliant members of BACP. As a crucial policy document, the MOU has not been extensively debated within BACP, despite its evident flaws (Jenkins, 2022a). It does conform, however, to the key precepts of post-modernism, in failing to mark a fundamental boundary between therapy involving adults and therapy involving children. It also begrudgingly offers a notional space for exploratory therapy for clients who are unhappy with their gender identity, but not for those who have reached a premature fixity of purpose, after having been carefully groomed via Tik Tok and by peer pressure from online chat rooms. In fact, research on the crucial role of peer and media influence on young people declaring themselves as trans still remains redacted today on the BACP website. This obliteration of a key letter discussing Rapid Onset Gender Dysphoria is hardly a resounding testament of the BACP’s own commitment to free speech and open professional debate on this central issue (Davies-Arai, 2018). Hopefully, this apparent reluctance to open up proper discussion can be overcome in the not-too-distant future.
Crucially, in contradiction to the BACP Ethical Framework (2018: 21), the MOU makes no mention at all of safeguarding. Safeguarding could presumably conflict with the stance derided in this article as ‘gatekeeping’, i.e., setting clear criteria for access to powerful and ultimately irreversible treatment processes. In our own experience, members of gender critical groups such as Thoughtful Therapists who have dared to raise safeguarding issues within their practice have been summarily dismissed, or had their work contracts ended. Many therapists continue to live in fear of this happening to them, simply for complying with their safeguarding obligations, as required by the Ethical Framework.
How not to discuss detransition
The article seems to feel obliged to at least acknowledge the issue of detransition, but then appears to be a tad unwilling to deal with it on its own terms. Detransition is clearly the Achilles Heel of gender ideology. It threatens the unsustainable idea that gender identity is innate and immutable, rather than being socially generated within a particular form of late consumer capitalist society. The article seems to rely on the usual gender ideology tropes on this topic – namely that detransition is rare, is caused by minority stress, and lots of people regret any kind of surgery for all sorts of reasons anyway. These are trivialising arguments for what is, in truth, a very serious issue. The numbers of detransitioners may or may not be ‘low’ as claimed, but the gravity of physiological and emotional damage done to individuals remains substantial and severe. Keira Bell, amongst others, testified to this effect in the Tavistock judicial review (R v Tavistock [2020]). Even if numbers of detransitioners were low, this would not mean that the issue can easily be dismissed, any more than would be the case with low numbers of our clients expressing concerns over suicidal ideation, eating distress, or chronic fatigue.
Research on rates of detransition
Given the claimed paucity of data, the article refers to a study which claimed to find only twos people from a sample of 3,398 undergoing permanent detransition (Davies et al, 2019: 118). Publicising this claim is useful, as it tends to undermine the article’s credibility in discussing rates of detransition. The claimed source is not a peer-reviewed academic paper, but simply a poster presentation at an EPATH conference. (EPATH is the offspring of WPATH; WPATH is comprehensively analysed elsewhere in: Jenkins, 2022b.) Poster presentation is the lowest possible form of research evidence, usually coming well before the testing rigours of peer review. The method described in the conference abstract suggests that this is not a research finding with real credibility. Medical records of an adult gender clinic were subjected to an electronic search for words related to regret and detransition, with correspondingly few hits. The poster authors then claimed for good measure that the low rates of detransition pointed towards the high quality of the clinic’s policies and standards, as a further gloss on the poster’s findings.
This example, rather than demonstrating low rates of detransition, instead might suggest that all research claims on this topic, from whatever quarter, should be very carefully examined rather than just being taken at face value. The poster’s research methods do not provide convincing evidence of a low rate of detransition. Rather than cite this reference, it might have been preferable to consider the alternative option of engaging with substantive research findings. Research in another UK adult gender clinic (n: 175) indicated a much higher detransition rate of between 7-10%, depending on the criteria used. This latter study concluded that “Detransitioning may be more frequent than previously reported” (Hall et al, 2021: 1). Accurate research into detransitioning rates must therefore become an urgent priority for post-Cass Report gender healthcare in the UK, in order to accurately gauge the significance of this developing medical and human tragedy.
Factors affecting research into detransition
The underlying reason why the frequency of detransition is so hard to estimate points towards a much wider scandal, namely that gender surgery clinics have generally failed to keep adequate follow-up records of medical treatment. Gender clinics appear to be primarily interested in meeting consumer demand and throughput. Clinics seem to hold little brief for closely monitoring patient follow-up, or rates of attrition and detransition. Research studies of detransition also tend to frame the issue in an overly narrow and restrictive manner, so that often patients must re-contact their original provider and specifically mention regret in order to be counted as having detransitioned. WPATH (World Professional Association for Transgender Health) sets the tone for this in insisting that detransition is rare (Coleman et al, 2022: S41), while apparently placing minimal expectations on gender clinics to keep records which might undermine this dubious claim. Thus, out of almost 200 current WPATH Standards of Care, only five refer in any respect to follow-up or after care. In this sense, WPATH Standards appear to represent more of a hard-nosed model of business than a reputable and compassionate model of care.
Research into detransition is underdeveloped, arguably because there are strong vested interests within gender medicine that fail to encourage it. Ellis and Reilly-Dixon’s opinion piece leaves us with the suggestion that gender critics’ concerns about detransition may well not be genuine at all, but may instead be “rooted in the idea that transition itself is harmful?” (2023: 34). Concern about detransition seems to be thus represented as a form of crocodile tears, i.e., a way for critics of gender ideology to discredit the process of transition itself. However, the issue of detransition needs to be carefully considered on its own merits. It involves key questions about social media grooming, and capacity to give informed consent to irreversible medical procedures. It deserves far better than being muddied with the claim that those overly concerned with this issue might be doing so from a position of allegedly bad faith.
Gender affirming healthcare and resultant foreseeable harm
And on the issue of the very real harm caused by transition, let alone the harms then compounded by detransition, the evidence is mounting up; this is neither acknowledged or recognised in this opinion piece. Instead Ellis and Reilly-Dixon make the startling claim that “the only evidence of harm is a few unhappy trans people” (2023: 34). Yet, there is serious consequential harm on a growing scale to children and adults in undergoing gender-affirming healthcare, starting with use of preferred pronouns and ending in mutilating surgery. These potential harms can include the following:
- destruction of healthy tissue and body parts for cosmetic purposes;
- long-term adverse health consequences (risk of reduced bone density, infertility);
- failure to resolve gender identity distress, despite irreversible medication and surgery;
- unnecessary and unethical medicalisation of same-sex attraction;
- failure to address or resolve concurrent long-standing conditions (anxiety, autism, eating distress, sexual trauma):
- medium-term risk of retraumatisation, via detransition or retransition;
- heightened longer-term risk of suicide.
(For supporting references, see: Jenkins, 2023).
Research evidence and the need for open debate
To return to Ellis and Reilly-Dixon’s opening remarks, we look forward to a proper conversation, generative or otherwise, on the research evidence underpinning the above list of very real harms caused by gender affirming healthcare. Affirmative therapy can become an all-too complicit partner in this harmful process. The lack of real-world evidence on the efficacy of medical treatments for gender dysphoria such as puberty-blockers has emerged in a raft of damning systematic reviews across Europe and parts of the US, including Finland, Sweden, Norway, France, England and the state of Florida. This staggering absence of evidence for efficacy has led to medical authorities in these countries to press the ‘pause’ button on radical interventions for young people. In England, the Interim Cass Report (2022) has expressed the need for caution before rushing to provide life changing diagnoses and irreversible medical interventions for gender distress. BACP and Therapy Today have done relatively little so far to properly educate their readers about these seismic changes regarding policy on gender issues, culminating in the closure of the Tavistock Gender Identity Development Service. Nor have they so far followed the promising lead of other professional journals, such as the British Medical Journal (Block, 2023), in recognising the need for informed debate on these issues, rather than the imposition and policing of an orthodoxy reflecting the various myths and tropes of gender identity ideology.
This is not what we should expect from a reputable professional journal, as a pale reflection of a tragedy being played out in gender clinics across the world. It needs to end now.
References:
Jennifer Block (2023) “Gender dysphoria in young people is rising – and so is professional disagreement”, British Medical Journal. 11/3/23, 348-352. Gender dysphoria in young people is rising—and so is professional disagreement | The BMJ
British Association for Counselling and Psychotherapy (BACP) (2018) Ethical Framework for the Counselling Professions. Lutterworth: BACP. https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf
Cass, H. (2022). The Cass Review: Independent Review of gender identity services for children and young people: Interim report Interim report – Cass Review
Coleman, E. et al. (2022) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 23: sup1, S1-S259. DOI: 10.1080/26895269.2022.2100644 Standards of Care – WPATH World Professional Association for Transgender Health
Davies, S., McIntyre, S. and Rypma, C. (2019) “Detransition rates in a national UK gender identity clinic.” 3rd Biennal EPATH conference: Inside Matters – on law, ethics and religion: Conference Abstracts: 118. European Professional Association for Transgender Health (EPATH) Conference 11-13 April. Boof-of-abstracts-EPATH2019.pdf
Davies-Arai, S. (2018) “Letter: Ideology over reality.” Therapy Today. March. 29(2): 17-18. Letter to the BACP concerning Transgender Trend (google.com)
Ellis, S. and Reilly-Dixon, J. (2023) “Opinion.” Therapy Today. June.34(5): 33-35. https://www.bacp.co.uk/bacp-journals/therapy-today/2023/june-2023/articles/opinion/ (BACP member login may be required)
Hall, R., Mitchell, L. and Sachdeva, J. (2021) “Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: Retrospective casenote review”, BJPsych Open, 7(6), e184, 1-8 doi: 10.1192/bjo.2021.1022. https://pubmed.ncbi.nlm.nih.gov/34593070/
Jenkins, P. (2022a) “Through the looking glass: Making sense of the MOU: Part 1.” Critical Therapy Antidote: https://criticaltherapyantidote.org/2022/03/31/through-the-looking-glass-making-sense-of-the-mou-part-1/
Jenkins, P. (2022b) “WPATH 8 Standards of Care: Greasing the slipway towards medical transition.” Critical Therapy Antidote: WPATH 8 Standards of Care: Greasing the Slipway Towards Medical Transition – Critical Therapy Antidote
Jenkins, P (2023) “Trans affirmative therapy: Engendering harm beneath a veil of protection?” Critical Therapy Antidote: Trans Affirmative Therapy: Engendering Harm Beneath a Veil of Protection? – Critical Therapy Antidote
Kanon, J. (2015) Leaving Berlin. Simon and Schuster: London.
Macey, D. (2019) The lives of Michel Foucault. Verso: London.
Memorandum of Understanding on Conversion Therapy (MOU) (2022) Memorandum of understanding on conversion therapy in the UK (bacp.co.uk)
Shakespeare, W. (1597) Henry IV Part 1: Act 3, Scene 1. SCENE I. Bangor. The Archdeacon’s house. (mit.edu)
Legal references
By Peter Jenkins, a counsellor, supervisor, trainer and researcher in the UK. 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: https://thoughtfultherapists.org/scoping-survey-pdf/
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