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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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The UK press’s timid reaction to Brexit is in marked contrast to the satire unleashed on Trump

For the BBC, it seems, to question leaving the EU is to be unpatriotic.

Faced with arguably their biggest political-cum-constitutional ­crisis in half a century, the press on either side of the pond has reacted very differently. Confronting a president who, unlike many predecessors, does not merely covertly dislike the press but rages against its supposed mendacity as a purveyor of “fake news”, the fourth estate in the US has had a pretty successful first 150-odd days of the Trump era. The Washington Post has recovered its Watergate mojo – the bloodhound tenacity that brought down Richard Nixon. The Post’s investigations into links between the Kremlin and Donald Trump’s associates and appointees have yielded the scalp of the former security adviser Michael Flynn and led to Attorney General Jeff Sessions recusing himself from all inquiries into Trump-Russia contacts. Few imagine the story will end there.

Meanwhile, the New York Times has cast off its image as “the grey lady” and come out in sharper colours. Commenting on the James Comey memo in an editorial, the Times raised the possibility that Trump was trying to “obstruct justice”, and called on Washington lawmakers to “uphold the constitution”. Trump’s denunciations of the Times as “failing” have acted as commercial “rocket fuel” for the paper, according to its CEO, Mark Thompson: it gained an “astonishing” 308,000 net digital news subscriptions in the first quarter of 2017.

US-based broadcast organisations such as CNN and ABC, once considered slick or bland, have reacted to Trump’s bullying in forthright style. Political satire is thriving, led by Saturday Night Live, with its devastating impersonations of the president by Alec Baldwin and of his press secretary Sean Spicer by the brilliant Melissa McCarthy.

British press reaction to Brexit – an epic constitutional, political and economic mess-up that probably includes a mind-bogglingly destructive self-ejection from a single market and customs union that took decades to construct, a move pushed through by a far-right faction of the Tory party – has been much more muted. The situation is complicated by the cheerleading for Brexit by most of the British tabloids and the Daily Telegraph. There are stirrings of resistance, but even after an election in which Theresa May spectacularly failed to secure a mandate for her hard Brexit, there is a sense, though the criticism of her has been intense, of the media pussy-footing around a government in disarray – not properly interrogating those who still seem to promise that, in relation to Europe, we can have our cake and eat it.

This is especially the case with the BBC, a state broadcaster that proudly proclaims its independence from the government of the day, protected by the famous “arm’s-length” principle. In the case of Brexit, the BBC invoked its concept of “balance” to give equal airtime and weight to Leavers and Remainers. Fair enough, you might say, but according to the economist Simon Wren-Lewis, it ignored a “near-unanimous view among economists that Brexit would hurt the UK economy in the longer term”.

A similar view of “balance” in the past led the BBC to equate views of ­non-scientific climate contrarians, often linked to the fossil-fuel lobby, with those of leading climate scientists. Many BBC Remainer insiders still feel incensed by what they regard as BBC betrayal over Brexit. Although the referendum of 23 June 2016 said nothing about leaving the single market or the customs union, the Today presenter Justin Webb, in a recent interview with Stuart Rose, put it like this: “Staying in the single market, staying in the customs union – [Leave voters would say] you might as well not be leaving. That fundamental position is a matter of democracy.” For the BBC, it seems, to question Brexit is somehow to be unpatriotic.

You might think that an independent, pro-democratic press would question the attempted use of the arcane and archaic “royal prerogative” to enable the ­bypassing of parliament when it came to triggering Article 50, signalling the UK’s departure from the EU. But when the campaigner Gina Miller’s challenge to the government was upheld by the high court, the three ruling judges were attacked on the front page of the Daily Mail as “enemies of the people”. Thomas Jefferson wrote that he would rather have “newspapers without a government” than “a government without newspapers”. It’s a fair guess he wasn’t thinking of newspapers that would brand the judiciary as “enemies of the people”.

It does seem significant that the United States has a written constitution, encapsulating the separation and balance of powers, and explicitly designed by the Founding Fathers to protect the young republic against tyranny. When James Madison drafted the First Amendment he was clear that freedom of the press should be guaranteed to a much higher degree in the republic than it had been in the colonising power, where for centuries, after all, British monarchs and prime ministers have had no qualms about censoring an unruly media.

By contrast, the United Kingdom remains a hybrid of monarchy and democracy, with no explicit protection of press freedom other than the one provided by the common law. The national impulse to bend the knee before the sovereign, to obey and not question authority, remains strangely powerful in Britain, the land of Henry VIII as well as of George Orwell. That the United Kingdom has slipped 11 places in the World Press Freedom Index in the past four years, down to 40th, has rightly occasioned outrage. Yet, even more awkwardly, the United States is three places lower still, at 43rd. Freedom of the press may not be doing quite as well as we imagine in either country.

Harry Eyres is the author of Horace and Me: Life Lessons from an Ancient Poet (2013)

This article first appeared in the 20 July 2017 issue of the New Statesman, The new world disorder