Blair is back to give Ed a headache

Not to put too fine a point on things, Tony is pissed off.

Tony Blair is back. The Middle East is aflame, the coalition floundering. Whatever your view of Labour's polarising former premier, he hasn't lost his sense of political timing.

"Blair the 'back-seat driver' tells Ed Miliband to up his game", reported the Sunday Telegraph. "The former prime minister has told Mr Miliband he has risked cheapening his role by intervening too often on too many relatively trivial issues."

Miliband was no doubt delighted with the advice. As Nick Clegg grapples the Monster Raving Loony Party for political survival – and David Cameron strides on to the international stage with all the gravitas and judgement of Dr Strangelove – Labour's current leader needs his predecessor popping up like he needs a hole in the head.

Attempts to brush off Sunday's briefing as part of a "regular" series of conversations between the two men have fooled no one. Blair is, not to put too fine a point on things, pissed off. He's angry at Miliband's apparent junking of New Labour. He's even angrier at attempts to tarnish his legacy with what he sees as misrepresentation of his efforts to bring Muammar al-Gaddafi into the international mainstream.

And he's most angry at what he regards as an effort to use the "Arab spring" as a further stick to beat him, his Iraq policy and his broader policy of progressive interventionism.

Ed Miliband's team believe this anger is now being channelled into a co-ordinated Blairite fightback. Jack Straw, Peter Mandelson, David Miliband and Jim Murphy have all made recent high-profile interventions defending Blair and his foreign affairs record and philosophy. "We know what's going on," said one Miliband supporter. "We're not stupid."

Claims in the Telegraph article that Blair was responsible for recent improvements in Milband's performance and standing have been met with bewilderment. "It would be ludicrous to pretend this is all down to Tony – the unpopularity of the government's spending cuts obviously plays a major role – but Ed is always happy to listen to his advice," said a leadership source.

Those close to the Blairite camp see things somewhat differently. According to supporters of the former leader, Ed Miliband is becoming increasingly nervous at his failure to build a proper support base within the party. "Last time Ed spoke to Tony he wanted his help and advice in shoring up his position," one said. "It's taking much longer to bring people round than Ed anticipated."

There are also frustrations among a number of Blairite supporters with what they see as Miliband's failure to build on his recent tactical success. "The coalition keeps screwing up, and we keep hitting them. But we're not building an alternative case for why people should back Labour. Our only argument is 'at least we're not the Tories or the Lib Dems'."

Yet differing emphases over the response to the tumultuous events in the Middle East are creating the most significant tensions. Miliband's team fervently believes there is no appetite among the voters for further international adventurism. "Even if we wanted to get involved in Libya, the public won't wear it," said one source.

This sits in stark contrast to the interventionist instincts of some members of his own shadow cabinet. At a speech to the Royal United Services Institute in London on Thursday, Jim Murphy issued a veritable call to arms. "Britain can and should play an important part in shaping world events and trends, with our armed forces its heart," he urged.

That Britain should have responsibilities beyond her borders, he said, was "not, as some would have it, ideological, but, as we have seen over the last few days, a necessary response to the world in which we live. This is a challenge for the Labour Party. Opposition is about proving your preparedness to engage with the issues you would have to in government if it is to be responsible and ultimately electorally credible."

Compare that to an article Miliband wrote for the Observer four days earlier and the difference in emphasis is striking. He wrote:

The neocons were wrong to think we could impose democracy at the point of a gun. In this new era, soft power will often be a better way to achieve hard results. That is why support for civil society, the promotion of national assets such as the British Council and the BBC World Service, is so important. Our template should be the EU's response to the democratic revolutions of 1989 which helped make change in eastern Europe irreversible, with economic aid, technical assistance and institution-building.

The crisis in the Middle East has forced Miliband to sit down at the chessboard of foreign policy rather earlier in his leadership than he would have liked. Because of that, he has yet to formulate a settled policy agenda.

But he does have one simple rule: avoid getting into the mess Blair got himself into.

It's not a foreign affairs credo the former leader and his supporters are likely to warm to.

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How society is failing transgender children

In the wake of the cancellation of a public debate on this subject, one of the speakers shares her view on where society's approach to gender nonconformity is going wrong.

In August this year, several UK councils issued guidance to schools on accommodating female pupils who wear binders. A binder is a constricting undergarment for the upper body: what it binds are the breasts, pressing them down to a flatness that the wearer feels is appropriate to their self-perception as masculine or gender-neutral. According to Cornwall Council, the binder is “very important to [the wearer’s] psychological wellbeing.” But binders have unwelcome physical side-effects too, including “breathing difficulties, skeletal problems and fainting.” Lancashire Council’s advice urges teachers to “monitor [wearers] carefully during physical activities and in hot weather. It may be necessary to subtly offer more breaks.”

When the NSPCC invited me to participate in a discussion on the subject “is society letting down transgender children?” (part of its Dare to Debate series), those guidelines were one of the first things I thought of. They’re written in accordance with the overriding principle of gender identity politics, which is that affirmation is all. Any bodily harms incurred count for little compared to the trauma believed to be inflicted by a “mismatch” between appearance and identity. It’s a doctrine that insists we’ve moved beyond the tyranny of physical sex and social pressure, and into a realm of pure selfhood where all must be able to live in accordance with their own inherent being.

And yet, look again at that list of side effects: breathing difficulties, skeletal problems, fainting, inability to participate fully in exercise. The female adolescents wearing binders have reproduced all the problems of tight-lacing corsets, this time in the service of restrictive anti-femininity rather than restrictive femininity. So is issuing guidance to reduce the harms of binder-wearing in schools an act of care for transgender children, or an abdication of it? Is the role of adults in authority – whether parental, educational or medical – to validate everything that comes under the rubric of transition, regardless of long-term consequences, or could another approach be better?

The number of children who identify as trans is small, but rapidly increasing: referrals to the Tavistock and Portman NHS Trust’s gender identity development service have doubled year-on-year. Putting gender-nonconforming youths on a medical track opens the possibility that they will be prescribed puberty blockers, delaying the physical changes of adolescence that individuals may find distressing. Later, treatment can include cross-sex hormones and surgery to create the desired sexual characteristics.

For many, this can alleviate profound anguish about the self, but not without costs. The long-term effects of hormone therapies aren’t known, and won’t be until the current generation of trans children have lived well into adulthood. There’s a risk that increased medicalisation could be imposing permanent physical changes on children who, left to their own devices, would discover they are quite happy living with their natal sex – about 80 per cent of children diagnosed with gender dysphoria desist before adulthood, but the normalisation of medical transition could commit many to irrevocable treatments they would otherwise avoid.

Remarkably, as I found out when I worked on a long feature on the subject, there isn’t any agreement on what gender identity is or how it relates to the physical body. Which means that transitioning children are receiving an untested treatment for an undefined condition. Medicine often involves a surprising degree of idiosyncrasy and guesswork, but this uncertainty both about what is being treated and the effects of the treatment should be a cause for caution. While many who transition find it wholly positive, not everyone does: doubt and detransition happen, and these stories tell us that the quickest path to reassignment is not always the best treatment for someone presenting with dysphoria.

Sometimes, a diagnosis of gender dysphoria might mask a different underlying cause to a child’s distress. Psychiatrist Susan Bradley reports that children with cross-sex identification are often (not always) either responding defensively to a violent background or engaging in the obsessive behaviours associated with autistic spectrum disorders. A policy of “watchful waiting” – listening to the child, supporting them and giving them freedom to experiment and develop – is vital if we are to give children the kind of help they really need. But in an environment where anything short of total and immediate reinforcement is deemed abusive, “watchful waiting” is not an option.

One more problem: if gender dysphoria is conceived as the problem, and gender reassignment as the solution, then transition represents the summation of a process which should in theory resolve everything. In practice, newly-transitioned young people (especially those crossing the threshold from child and adolescent mental health services to adult provision) can find themselves stranded, no longer in receipt of the support they had during transition. We simply aren’t getting the treatment of transgender children right if we’re only treating their gender.

The consequences extend well beyond children who identify as trans, of course. Schools are suffused with sexual harassment and sexual violence, yet girls are expected to accept a child they previously knew as a boy as female like them, or be called bigots. The naturalisation of sex-stereotypes in parental narratives of transition surely has a limiting influence on other children’s conception of sex-appropriate behaviour. For some gender-nonconforming children, the cultural celebration of transition leads to anxiety about whether they themselves should be trans, even if they’re happy in their bodies. Certainly, many gay and lesbian adults have looked back on their own childhoods and remarked nervously that their behaviour then would qualify them as trans now.

If we’re not able to address these issues, then we’re manifestly failing children. But addressing them is incredibly difficult: practitioners who privately mention their doubts about current approaches to gender noncomformity are afraid to ask questions publicly, anticipating personal attacks and the loss of their jobs.

They’re not wrong to do so. After announcing the Dare to Debate event, the NSPCC was put under sustained pressure, I was persistently abused, and following the withdrawal of the other panelist, the charity cancelled the event. Previous installments in the series have looked at child sexualisation, foetal alcohol syndrome, and asked whether the investigation of child sexual abuse has tipped into “hysteria”, but apparently it would be just too daring to talk about gender. Doctrine so bitterly defended that it must even be protected from good-faith debate is a kind of restrictive garment for the intellect. Wearing it can ease our mental pangs. But the damage it does besides is very real.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.