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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.

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Daniel Hannan harks back to the days of empire - the Angevin Empire

Did the benign rule of some 12th century English kings make western France vote Macron over Le Pen?

I know a fair amount about British politics; I know a passable amount about American politics, too. But, as with so many of my fellow Britons, in the world beyond that, I’m lost.

So how are we, the monolingual Anglophone opinionators of the world, meant to interpret a presidential election in a country where everyone is rude enough to conduct all their politics in French?

Luckily, here’s Daniel Hannan to help us:

I suppose we always knew Dan still got a bit misty eyed at the notion of the empire. I just always thought it was the British Empire, not the Angevin one, that tugged his heartstrings so.

So what exactly are we to make of this po-faced, historically illiterate, geographically illiterate, quite fantastically stupid, most Hannan-y Hannan tweet of all time?

One possibility is that this was meant as a serious observation. Dan is genuinely saying that the parts of western France ruled by Henry II and sons in the 12th century – Brittany, Normandy, Anjou, Poitou, Aquitaine – remain more moderate than those to the east, which were never graced with the touch of English greatness. This, he is suggesting, is why they generally voted for Emmanuel Macron over Marine Le Pen.

There are a number of problems with this theory. The first is that it’s bollocks. Western France was never part of England – it remained, indeed, a part of a weakened kingdom of France. In some ways it would be more accurate to say that what really happened in 1154 was that some mid-ranking French nobles happened to inherit the English Crown.

Even if you buy the idea that England is the source of all ancient liberties (no), western France is unlikely to share its political culture, because it was never a part of the same polity: the two lands just happened to share a landlord for a while.

As it happens, they didn’t even share it for very long. By 1215, Henry’s youngest son John had done a pretty good job of losing all his territories in France, so that was the end of the Angevins. The English crown reconquered  various bits of France over the next couple of centuries, but, as you may have noticed, it hasn’t been much of a force there for some time now.

At any rate: while I know very little of French politics, I’m going to go out on a limb and guess the similarities between yesterday's electoral map and the Angevin Empire were a coincidence. I'm fairly confident that there have been other factors which have probably done more to shape the French political map than a personal empire that survived for the length of one not particularly long human life time 800 years ago. Some wars. Industrialisation. The odd revolution. You know the sort of thing.

If Daniel Hannan sucks at history, though, he also sucks at geography, since chunks of territory which owed fealty to the English crown actually voted Le Pen. These include western Normandy; they also include Calais, which remained English territory for much longer than any other part of France. This seems rather to knacker Hannan’s thesis.

So: that’s one possibility, that all this was an attempt to make serious point; but, Hannan being Hannan, it just happened to be a quite fantastically stupid one.

The other possibility is that he’s taking the piss. It’s genuinely difficult to know.

Either way, he instantly deleted the tweet. Because he realised we didn’t get the joke? Because he got two words the wrong way round? Because he realised he didn’t know where Calais was?

We’ll never know for sure. I’d ask him but, y’know, blocked.

UPDATE: Breaking news from the frontline of the internet: 

It. Was. A. Joke.

My god. He jokes. He makes light. He has a sense of fun.

This changes everything. I need to rethink my entire world view. What if... what if I've been wrong, all this time? What if Daniel Hannan is in fact one of the great, unappreciated comic voices of our time? What if I'm simply not in on the joke?

What if... what if Brexit is actually... good?

Daniel, if you're reading this – and let's be honest, you are definitely reading this – I am so sorry. I've been misunderstanding you all this time.

I owe you a pint (568.26 millilitres).

Serious offer, by the way.

 

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.

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