Critical Therapy Antidote

The American Psychological Association (APA) has passed another significant milestone in its accelerating demise as a credible professional association. Faced with an increasing number of US state bans on gender identity affirming healthcare, the APA governing Council of Representatives has passed a policy statement, by a majority of 153 to 9, with one abstention. In a wordy and repetitive resolution, the APA commits itself to redoubling its efforts to shore up the now crumbling politico-pharmaceutical enterprise of gender affirming healthcare.

Given the claimed problem of mistreatment and discrimination of persons seeking gender affirming healthcare, framed by minority stress, the APA is forging a wider political role for psychologists in reversing this process. Gender affirming care (GAC) is presented as having undoubtedly positive impacts for patients, whether adults, young people or children. However, state bans on the provision of gender affirming care obstruct wider access to such care, by limiting the legal rights of all patients and their carers to access it, and via imposing constraints on comprehensive healthcare insurance. The problem is made worse by credible scientific evidence on gender healthcare not being made fully available to the public, and by the promotion of unspecified, but unhelpful, ‘misleading narratives’ on the topic.

The solution? Psychologists need to take on a more assertive public role, promoting credible scientific evidence which will demonstrate the proven benefits of gender healthcare. Hence the APA supports the comprehensive provision of evidence-based gender affirming healthcare, of extended health insurance to fund this, and the rights of patients and parents to access this provision. Hence it opposes state bans on gender affirming care.

Figure 1: Diagrammatic representation of APA Policy Statement (2024) on Gender Affirming Care.

The claim that gender affirming care produces known benefits for child and adult patients raises some difficult issues for a professional association which is trying to promote evidence based clinical care in a highly contested field. The policy comes with the usual swathe of supporting references. However, this rather suggests that knotty scientific arguments are settled largely on the basis of the quantity of supporting evidence, namely by claiming more peer-reviewed papers than your gender-critical opponents can possibly muster. However, any ideological movement within the physical and social sciences can usually present any amount of superficially plausible supporting evidence. Such “sciences have institutes, conferences, journals (typically peer-reviewed), and sometimes even degree programs. In form, they display all the professionalizing markers of the establishment science they decry” (Gordin, 2021: 43).

Discrepant evidence and paradigm change

But this is not how science advances, in reality. Paradigm shift from one established way of understanding the social or material world to another perspective often comes about only through the emergence of a single, persistent piece of discrepant evidence, a hard seed in the otherwise bland pap of academia, a sharp, unreachable piece of grit in one’s shoe, a single paper-cut that gradually undermines an otherwise apparently robust body of thought. After all, no religion can long survive doubt (Galileo on trial for challenging Church orthodoxy regarding an Earth-centred universe: ‘And yet, it moves…’). Think of the 1950 medical paper establishing a link between smoking and lung cancer, and the 1961 medical reports identifying birth defects associated with medication for morning sickness (Doll & Hill, 1950; Lenz, 1962; McBride, 1961).

It may be that we have now reached an equivalent turning point in the form of a recent sober research paper (n: 2083) examining the relationship of transgender status to suicide (Ruuska et al, 2024). Rather than seeking to explain transgender suicide statistics in terms of the minority stress model, the authors found that “suicides appear to be explained by psychiatric morbidities” (Ruuska et al, 2024: 4). Thus, the fact of being transgender on its own does not account for greater risk of suicide. The policy and practice implications of this finding are profound, namely that “It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide” (Ruuska et al, 2024: 1). This is an important corrective to the dominant transgender suicide narrative, which centres on minority stress as the major factor driving suicide risk. Presumably, this paper would be considered an integral part of the self-same ‘misleading narratives’ which so concern the authors of the APA policy report?

Which brings us to some key questions for the APA, which they might like to consider answering.

Questions for the American Psychological Association:

1. What are the APA’s identified criteria for distinguishing between credible scientific evidence relating to gender affirming healthcare, and ‘misleading narratives’?

• Does the APA support the extension of equitable health insurance and access to healthcare to detransitioners, or only to those seeking social and medical transition?

• Does the APA affirm the legal rights of patients, parents and caregivers who are opposed to gender affirming care, or just of those who support it?

• Will the APA support and comply fully with current and future state bans on gender affirming care, or will it actively seek to subvert such bans, via encouraging internet patient access to puberty blockers and cross sex hormones, and/or referrals to states providing gender affirming care?

In the meantime, in case you were still wondering, the APA have definitely left the building.

References

American Psychological Association (APA) (2024) APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care

Doll, R. and Hill, A.B. (1950) “Smoking and carcinoma of the lung”, British Medical Journal, 2: 739. 30^th September. 4682 https://doi.org/10.1136/bmj.2.4682.739

Gordin, M. (2021) On the fringe: Where science meets pseudoscience. Oxford: Oxford University Press.

Lenz W, & Knapp K. 1962. Foetal malformations due to Thalidomide. German Med. Monthly. 7:253–258. https://pubmed.ncbi.nlm.nih.gov/14464041

https://pubmed.ncbi.nlm.nih.gov/38367979

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Commentary by Peter Jenkins, a member of Thoughtful Therapists, whose scoping survey for the UK government consultation on conversion therapy can be found here: https://thoughtfultherapists.org/scoping-survey-pdf/