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How to treat gender dysphoria Affirmation is not necessarily the right approach

Other mental health issues are being ignored (Beata Zawrzel/NurPhoto via Getty Images)

Other mental health issues are being ignored (Beata Zawrzel/NurPhoto via Getty Images)


August 30, 2022   8 mins

Annie’s parents had spent so much time tending to her autistic brother that they hadn’t realised their daughter developed similar traits: a high IQ, a tendency to obsess, discomfort with her body.

Annie was diagnosed with epilepsy aged five. After puberty, she started to have “autistic meltdowns“. When the pandemic hit, she became obsessed with her weight and was eventually diagnosed with an atypical eating disorder.

Amid her mental health episodes, she discovered YouTube videos of girls identifying as trans boys. Whenever Annie was in crisis, she would assume a trans identity and then drop it once the emergency had passed.

But her crises worsened. She was hospitalised again and again. Both Annie’s parents and her private therapist explicitly told staff at each hospital not to affirm her transgender identity, which was so inconsistent that Annie didn’t meet the diagnostic criteria for gender dysphoria. “No one who spent time working with her outside of the hospital thought the real issue was that she had gender dysphoria,” her mother, Linda, said. But each hospital ignored their pleas.

After she had paid for Annie’s medical records from her seventh hospitalisation in 10 months, Linda discovered that Annie had not only been secretly affirmed and socially transitioned but encouraged to deceive her parents, who had been marked in the hospital records as unsupportive. This despite the fact that Annie had written on a worksheet that what she valued the most was her parents and that calls from them made her cry “tears of joy”.

The transition didn’t help. At the hospital, Annie got markedly worse, slamming her head into walls, scratching her arms until they bled, and hearing voices that told her to kill herself. She had to be physically restrained and injected with antipsychotics and Ativan.

But the staff, according to Linda, seemed concerned with little other than gender. As they prepared to transfer Annie to a residential mental health program, they asked her — without consulting her parents — if she wanted to stay in the boys’ or girls’ dorm.

***

Stories like Annie’s — of kids who are not getting mental health treatment because clinicians interpret their issues as being caused by gender dysphoria — are increasingly common in the United States. The problem is called “diagnostic overshadowing”, and it was one of the main reasons that the UK’s Tavistock gender clinic was shut down last month. As Dr Hillary Cass noted in her Interim Report, “[M]any of the children and young people presenting have complex needs
 but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be subsumed by the label of gender dysphoria.”

Several parents I spoke to for this article told me their children were initially hospitalised for suicidal ideation, anorexia, and other mental health conditions. Once admitted, however, the children were diagnosed as suffering from gender dysphoria and encouraged to transition, often against their parents’ wishes. Their other mental health issues were then largely ignored.

Until recently, such mental health issues would have made therapists hesitant to facilitate transition for a young patient. The original Dutch protocol for treating adolescents with gender dysphoria, for instance, was based on research on patients with no serious comorbid psychiatric disorders. Although Dutch clinicians recommended the use of puberty blockers for certain patients, the children were not socially transitioned, which can increase the persistence of gender dysphoria.

But in recent years, concurrent with an exponential increase in gender dysphoria cases among teenage girls, the Dutch protocol has been overtaken by the gender-affirmative model. In this approach, “providers recognise, validate, and support the identity stated or expressed by the individuals served”, per the American Psychiatry Association. This means that clinicians are encouraged to facilitate social transition based on their patients’ self-diagnoses. In stark contrast to the kids from the original Dutch studies, however, the adolescents now presenting with “gender dysphoria” tend to have complicated mental health profiles.

In effect, the mental health profession has performed a U-turn. Whereas it was once understood that complex comorbidities such as depression, anxiety, or eating disorders might be the source of adolescent gender dysphoria, today, American doctors increasingly see it……. as the cause of all other comorbidities. Treat the dysphoria, the thinking goes, and the other conditions melt away.

***

A woman I’ll call Daria had entered her 17-year-old son into a psychiatric hospital treatment program for anorexia. Forty-eight hours later, while he was still on a feeding tube, a counsellor called to ask about her son’s gender issues. He’d never had any, Daria responded.

A week later, still barely eating, he was transferred to a residential programme. A counsellor there called Daria to say her son was actually her daughter and should start on oestrogen. Daria was sceptical, but the clinicians told her: “We have to address the gender or the anorexia just may never go away.”

Thus began a two-year battle to help her son with his most pressing problem — restricted eating — while resisting attempts by clinicians to redefine his problems as dysphoria. Family therapy sessions centered around pushing Daria and her husband to facilitate their son’s social and medical transition. “It became a lot more trying to convince us that our kid was transgender rather than working with us on how to support him in eating,” she said. Counsellors helped him pick stereotypically feminine clothing and settle on a stereotypically feminine name, but the eating struggles remained.

Daria, a scientific researcher, asked for evidence that cross-sex hormones would alleviate anorexia, but was given none. She asked about side effects. A therapist told her: “You need to stop focusing on the evidence and start focusing on your daughter.” Once her son turned 18, his residential programme helped him access hormones at a nearby Planned Parenthood. They didn’t help either.

“He had suicide attempts before he started hormones. He had a suicide attempt after he started hormones. And, you know, he restricted before he had hormones. He kept restricting after he had hormones,” Daria said.

Daria learned on her own that many people with disordered eating have an internal voice that demands they restrict. Eventually her son told her that his was a female voice, one that bullied him and demanded he make himself look like her.

When you work with somebody with anorexia, said Stella O’Malley, a psychotherapist in Ireland who works with gender-distressed children, “you talk about softening this voice and integrating this voice into the personality and figuring out where it’s coming from”. Therapists don’t affirm anorexics’ inner voice or desire for a specific body because anorexia nervosa has the highest mortality rate of any mental disorder; they try to help them make peace with the body they have. But with gender-dysphoric patients, that same clinical approach is considered “conversion therapy”.

The backbone of treating anorexia is having the family deeply involved, setting strong boundaries, and focusing on the behaviour. Once that is under control, the remaining problems can be addressed. With anorexia, body dissatisfaction is often the last thing to resolve, so what may appear to be gender dysphoria could be a lingering symptom of anorexia.

The diagnostic criteria for gender dysphoria and body dysmorphia are similar, too, but the treatment for the former includes affirmation and medical interventions, while the treatment for the latter is therapy. “Pretty much everything that they did once gender was introduced
 was totally against the evidence that we know work for eating disorders,” Daria said. Lisa Marchiano, a Jungian psychotherapist, referred to this phenomenon as “gender exceptionalism” — the idea that  “gender dysphoria gets treated different than any other mental health issue”.

But many believe affirmation is most likely to resolve dysphoria. “If it is all interconnected, then treating the gender dysphoria will likely also improve some of the other things that are happening,” says Sabra Katz-Wise, assistant professor in the division of adolescent and young adult medicine at Boston Children’s Hospital and a proponent of the affirmative model.

What should she do if it turns out that gender dysphoria isn’t the source of the problem? “I think it’s pretty rare that gender dysphoria is a symptom of something else other than being transgender or gender diverse,” Katz-Wise said. Yet in a study of 237 detransitioners — those who medically transitioned and regretted it — 70% reported “having realised that their gender dysphoria was related to other issues”.

Eventually, Daria found a private psychiatrist, who urged the staff at her son’s residential mental health facility not to engage with anything gender related. Only then, Daria reported, did her son start to eat.

***

At 12, Sofia’s daughter Constance, who had always been typically feminine, began suffering from anxiety, depression, and perfectionism, which she relieved through cutting. After a breakup with a woman she’d met online, Constance was hospitalised for suicidal ideation. She identified as bisexual, and then as non-binary, and continued with self-harm. She began smoking pot daily.

As her mental health worsened, Constance went to a 35-day stay in a psychiatric hospital in the northeast. “We didn’t feel like it had anything to do with the gender identity because she wasn’t really talking about that stuff,” Sofia said. “Even her therapist at home didn’t think that that was the issue.” Yet once the gender issues came up, “it just felt like every session became about that”.

From there, Constance was sent to an intensive outpatient program, where, within a week, she was using male pronouns. Sofia only found out when the therapist accidentally sent an email using he/him. Constance posted online that she wanted money for hormones, complaining that her parents wouldn’t pay. The doctors, Sofia said, “didn’t ask us anything about, well, what was their childhood like or do you know if there was any trauma or anything like that? It was just: Accept it. This is who he is now.”

But some clinicians interpret this research as licence to punish parents if they don’t affirm. At both the hospital and the outpatient programme, Sofia said, clinicians told her and her husband that if they didn’t affirm Constance, she would kill herself. “You bring your child there and then you become totally powerless,” Sofia said. “It always felt as though I was the last to know. And she had this group of adults supporting her and affirming her. So of course, we look like the bad guys because we never did [affirm her]. Our relationship was absolutely destroyed.”

Research does show that familial support is key to the mental health of LGBT kids. But that shouldn’t give clinicians licence to undermine parents if they want to assess rather than affirm. “I don’t think that driving a wedge between parents and children is going to help them,” said Caitlin Ryan, director of the Family Acceptance Project, which helps “ethnically, racially and religiously diverse families to support their LGBTQ children”. “I think working with parents and caregivers to increase support is one of the most important things we can do.”

The oppositional stance taken by Constance’s doctors, O’Malley says, is bad clinical practice. “It’s well-established in therapy circles that you try not to triangulate between parent therapist and child. It’s so destructive for the family unit, for the parent-child relationship, and for the actual the betterment of the child. And yet this triangulation is happening inevitably as soon as a clinic decides to not work with the family.”

Eventually, Sofia pulled Constance out of the programme and sent her back to her original therapist. There, she admitted that she had been sexually harassed and threatened in a chat room by a man who sent her nude photos. He told her if she didn’t send nude photos of herself, he would kill her family. “That’s when we really started to dive into why she was rejecting her femininity, why she was trying to take her power back,” Sofia said. Now in a residential facility, doing equine therapy and not focusing on gender, Sofia is finally doing well, her familial ties beginning to repair.

***

There are no easy answers for how to treat gender-distressed children. O’Malley advocates the “biospsychosocial model”, which is in essence a form of holistic care. It involves “looking at the body and the mind, looking at all the diagnoses, looking at how everything impacts — the cultural context, the family context, the internal biological context,” she says.

But she also knows that this cohort of kids with multiple and extensive multiple health issues needs a delicate yet exhaustive approach. “They are a very, very vulnerable cohort that need gentle and very cautious interventions,” she said. Clinicians shouldn’t leap to the conclusion that dysphoric kids are trans and need immediate social or medical transition to keep them alive.

Jack Drescher, clinical professor of psychiatry at Columbia University and section editor of the DSM-5-TR chapter on gender dysphoria, has no problem with the idea of affirming a child’s stated gender identity. He said it’s not necessarily the therapist’s job to contradict a patient’s subjectivity, to tell them they’re wrong, but rather to explore their perspective. But even he strongly believes in comprehensive evaluation.

“There are kids who will benefit from treatment and there are kids who will not benefit from treatment. And until we come up with a better way to decide how to distinguish between those two groups, then we’re going to be having these kinds of arguments,” Drescher says. “This is the biggest problem, to talk about the complexity of the subject. There is so much we don’t know.”

For some families, at least, it seems clear that affirmation is not the right approach. Linda told me that she and her husband called 16 facilities, searching for one that would treat Annie’s multiple mental health problems rather than fixating on her gender. “Almost every programme we called said that their official policy was to affirm,” she told me. “One programme told us that they affirm everyone so they don’t get sued.”

Eventually, however, they were able to transfer their daughter to a residential mental health facility in a Western state that was willing to look at her dysphoria as a symptom of her other issues, not the other way around. Annie is stable now, and her condition is slowly improving. Her family connection is restored. She lives in the girls’ dorm, and no longer identifies as transgender.


Lisa Selin Davis is the author of Tomboy. She writes at Broadview on Substack.

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JP Martin
JP Martin
1 year ago

“Gender affirming treatments” like cross-sex hormones and reassignment surgeries are the lobotomies of our times.

Alan Tonkyn
Alan Tonkyn
1 year ago
Reply to  JP Martin

Very well put, and future generations will marvel at the arrogant insouciance with which so-called ‘experts’ were willing to compound a form of mental illness by treating with hormones, and even by encouraging damaging surgery. That celebrated transwoman, Jan Morris, has said in her autobiographical account ‘Conundrum’, that no-one in the history of humankind has actually change sex. Robert Winston has pointed out (and been excoriated by some for doing so) that every cell in our bodies is marked XX or XY, and there is no way of changing that. Those encouraging vulnerable teenagers to think that ‘transitioning’ is the way to solve all their typical teenage angsts need to remember these things and think again about the advice they are giving.

Tony Sandy
Tony Sandy
1 year ago
Reply to  JP Martin

Totally agree

Alan Thorpe
Alan Thorpe
1 year ago
Reply to  JP Martin

Or simply sterilisation.

William Shaw
William Shaw
1 year ago
Reply to  JP Martin

There are plenty of young people posting on YouTube who claim these treatments were a lifeline. Watching a few would help all of us gain a more nuanced and balanced understanding.

Julian Farrows
Julian Farrows
1 year ago
Reply to  William Shaw

‘Young people’ – in a few years many of these will be asking why no adults stepped in to prevent their brain-sickly imaginings. It’s normal for children to have bizarre ideas about themselves, but adults should be protecting children from self-harm, not condoning it. Years from now we’ll be reading accounts by trans people who deeply regret the consequences of stunting their growth and sexuality.

Andy Griffiths
Andy Griffiths
1 year ago
Reply to  Julian Farrows

Agreed – but we don’t have to wait till years from now, there are plenty of accounts out there already from detransitioners, and they make for heartbreaking reading. Wrecked young bodies with no sexual function and all kinds of other physical issues such osteoporosis and premature menopause.

Jane Awdry
Jane Awdry
1 year ago
Reply to  William Shaw

“..young people posting on YouTube”. There’s your problem right away. A lifeline to what? Body mutilation, permanent sexual non-function, reproductive sterilisation & a physical state forever at odds with their biological & chromosomal reality.
It is grotesque to suggest that impressionable & suggestible adolescents are in any emotional or intellectual position to make decisions with such serious & longterm consequences.

Kenda Grant
Kenda Grant
1 year ago
Reply to  William Shaw

I’m sure if we investigated these videos we’d find most children have mental health issues which are the presenting problem – depression, anxiety, autism – not the resultant thoughts/behaviours – cutting, anorexia, bulimia and now transgender. It reminds me of the series Botched. Every episode has someone coming in to get cosmetic “correction” where they want bigger implants, lips, butt, etc. Each time the doctors refuse because of medical (and psychological) reasons, pointing out the dangers of more surgeries/treatments. The “patients” ignore reality (skin so stretched its translucent, lips so big their face is distorted, dubious chemicals injected into their body), and say they are happy with their appearance – while seeking to increase the already bloated body part. They are deluded, and so ignore the advice and vow to find another doctor to “help” them. Perhaps “altering” their body is a quick fix, alleviating (temporarily) the pain they feel.

Dominic S
Dominic S
1 year ago
Reply to  JP Martin

One of the key ways to interact with poeple with mental health issues has always been to challenge them with the truth, not affirm the fantasy.

Persephone
Persephone
1 year ago
Reply to  Dominic S

No. It is generally seen as unhelpful to DIRECTLY challenge a delusional belief, because the patient pushes back against it in a way that reinforces the belief in the patients mind. To affirm and go along with a delusional belief is known to be harmful and is seen as unethical (in every case except gender dysphoria). So what we are left with is either essentially ignoring the belief and working around it, saying “I’m not here to talk to you about that, how are you sleeping? lets do some gardening,” (the usual tack taken with people with chronic schizophrenia, the “case management” approach) or to explore the meaning that the belief has for the persons life and how it serves and doesn’t serve them (the therapy approach, used more for people functioning in the borderline range, trauma, eating disorders etc). The case management/ignoring approach aims to not make it worse, and the therapy/exploration approach hopes to soften the belief over time (which may or may not happen).

Arkadian X
Arkadian X
1 year ago

Dear me…
Anyway, some of the stories presented seem to point towards dysphoria as social contagion – both for the kids and the institutions – but unfortunately it is not mentioned explicitly here.

John Findlay
John Findlay
1 year ago
Reply to  Arkadian X

Not explicitly, but it’s implied by the references to internet usage by the victims. No-one wants to point the finger at the internet and its pernicious influence, as it would raise all sorts of questions about access limitations for minors etc.. Difficult territory.

Brian Villanueva
Brian Villanueva
1 year ago
Reply to  Arkadian X

Go read PITT or Abigail Shrier on substack. She’s written a book about it, and PITT is a series of stories about the nightmare of transitioning teens.

https://abigailshrier.substack.com/
https://pitt.substack.com/

j morgan
j morgan
1 year ago

So much easier to trans kids than treat their actual problems. And then if the worst happens, well, trans kids are known for suicidal ideation and having “unsupportive” parents wouldn’t help! Dreadful.

Tony Sandy
Tony Sandy
1 year ago
Reply to  j morgan

Mess up the body, rather than connect with the mind. So much easier to chop bits off and add bits on isn’t it? Engage with these minds and maybe you’d understand these people as individuals but that requires the courage of involvement as per somebody like RD Laing, psychiatrist extraordinaire or others of that ilk.

Caroline Watson
Caroline Watson
1 year ago

‘Gender’ dysphoria will not exist if ‘gender’ stereotypes do not exist. Stop telling boys and girls that they are ‘supposed’ to dress in a certain way, or play with certain toys, and the conflict between their physical body and their personality will no longer exist. It doesn’t matter whether Constance was ‘feminine’ or not; if her body is female, she is a girl and can be nothing else but a woman. She can, however, be a totally ‘unfeminine’ woman who has relationships with other women if that is what she prefers. She will still be female.
Autistic children do not pick up social cues about how they are ‘supposed’ to behave. They are honest and authentic. In teenage years, if they are in an environment where eccentricity and individuality is not valued, they become distressed and probably bullied by conforming teenagers. The way to deal with this is not to ‘help’ them conform, but to encourage them to value their individuality and treat conformity with the contempt it deserves.
America, probably because of its obsession with religion, has always been a much more conformist society than Britain. Despite laws against male homosexuality, particularly in the 1950s, we have always valued flamboyant, arty, homosexual men and high achieving, eccentric, lesbian women. It is sad that, instead of continuing to do so, we have adopted the American culture of conformity but the religion, rather than various oppressive, non-conformist Christian cults, has become ‘gender’ ideology itself. It needs to be stamped out, with no concessions, and we need to return to our British tolerance of people who don’t fit norms.

Tony Sandy
Tony Sandy
1 year ago

True. The problem is not to be found in bodies but minds and personally I am getting sick of the American infantile invasion of the UK (Simple Simon says… and everyone dances to this stupid tune). Why didn’t we stay in the European Union, with other adult nations, instead of opting for Plan B and a second childhood of irresponsiblity?).

Caroline Watson
Caroline Watson
1 year ago
Reply to  Tony Sandy

I also suspect that much of the ‘gender’ conformity now expected of children has been driven by American culture and companies such as Disney. If little girls are told that they are supposed to be princesses in pink, they will pressurise their parents to buy plastic Disney rubbish and princess dresses. When children played outside wearing their older siblings cast offs there was none of that nonsense.

Linda Hutchinson
Linda Hutchinson
1 year ago

The first thing that I noticed about this trans phenomenon was that it affirmed all the gender stereotypes that were being questioned and abandoned. Another regressive step for the “progressives”.

Persephone
Persephone
1 year ago

I think it’s worse then just gender stereotypes causing the problem, though that is part of it (and contagion obviously). I think that the patriarchy has a lot to do with the distress at the heart of a lot of young girls gender/body dysphoria. A lot of this is a response, socially conditioned, to the letcherous/desiring male gaze that fixes upon girls at puberty. If you are autistic, or immature ie just not ready for it, have been sexually abused, or come from a family where the men behave like pigs, then this can feel overwhelming and impossible to cope with. It’s patriarchy and misogyny that allows and subjects girls to this situation, that priorities male desire over their needs and wellbeing.
Also, thanks to misogyny and patriarchy growing up to be a woman sucks and is genuinely second rate. You realize as a girl that you are going to grow up to be seen and treated as second rate. Your going to be paid less. Your going to be expected to do a whole lot of unpaid, unvalued “woman’s work” both in your work place, in your flat, in your marriage, when your socializing, for the rest of your life and if you don’t you’ll be judged and criticized. Your brothers get out of all of that. There is a heavy cost to growing up to be a woman in the patriarchy; it’s no wonder a lot of young girls aren’t thrilled about it.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  Persephone

That’s not the patriarchy. That’s huge numbers boys who have never been taught how to behave and a culture where advertisers sell products using sex. And instantly accessible pornography, from which young people gain a totally unrealistic and commodified view of sex. And the extraordinary dissonance between dramatised lives on the screen and real actual lives.

A proper patriarchy would contain noble, decent grown ups who set an example; there would be a cultural expectation that children should treat others and themselves with respect.

Instead we have grown men behaving like immature, spoilt children.

And unsurprisingly, utterly confused children, some of whom try to rationalise the malign dissonance in which they live by concluding that they are confused because they happen to have been parachuted into a body of the wrong sex.

The trans epidemic isn’t a disease: it’s a symptom of a deeper disease. That disease is 2 generations of Western adults using 50 years of peace and prosperity as an excuse to behave like Peter Pan.

B Davis
B Davis
1 year ago

So called ‘gender stereotypes’ are founded — as all stereotypes are founded — on real, commonly experienced human behaviors & preferences. That is not to say that ALL men or ALL women will ALWAYS do or say XYZ…rather it is to recognize that, in general, most individuals in a category will probably possess / display those commonly shared attributes for that category..
Men tend this direction….women tend that direction….with significant and regular overlap in many common qualities. The fact that men tend to be more assertive/aggressive does not mean that women are not assertive or aggressive…nor does it mean ALL men are. But yes, on average, in general, a population of men will display those qualities significantly more often…or more freely…or more significantly than women.
The truth is…Men & women are different. Our different anatomies, biologies, neurologies, biochemical soups, and genetics combined will tend to create differences in attitudes, aptitudes, and behaviors.
Children grow-up in households in which they most typically see a Father and Mother who behave differently, dress differently, speak differently, and like different things. Boys tend to imitate fathers and girls tend to imitate mothers. Again, this is normal, and well within the fat bell-curve of human history and behavior.
Autism does not make one more ‘authentic’…but it does tend to disallow the development of normal socialization/interaction capabilities. Conversely, as we develop those capabilities (by watching and learning from parents, family, and friends in a variety of evolving social situations) we do not become less ‘authentic’ (whatever that means). We simply become more adept at social interaction….which is a good thing.
As for what is and is not ‘conformity’ vs. ‘maturity’ vs. ‘expediency’ vs. ‘effectiveness’ vs. ‘silliness’ vs. ‘freedom’ vs. ‘eccentricity’ vs. whatever…how little those stereotypical categories actually matter. As adults we are perfectly free to do what we wanna, wanna do and go where we wanna, wanna go….and swimming with or against the current (recognizing that the current changes regularly) is entirely our business, and ours alone.

Wim de Vriend
Wim de Vriend
1 year ago

That this affliction is increasingly found among adolescent girls is historically unsurprising. Our past has seen many social manias among youngish women, of which the witch crazes and “possessed” French nuns were only two; the “recovered memories” craze of the 1980s and anorexia are more recent ones, although some “saints” of the distant past starved themselves to death as well. What is most disturbing about all this is the eagerness of the psycho-profession — which includes psychologists, psychiatrists and ‘therapists’ of various stripes — to make a living off this garbage — for which, hopefully soon, they will be presented with bills for having inflicted irremediable damages.

B Davis
B Davis
1 year ago

As a man, I cannot be ‘gender affirmed’ as a woman. To indicate, in any way at all, that I am a woman is to lie. I am not a woman; I can never be a woman. So-called ‘transition’ from male to female is not possible.
Affirmation Therapy, used to validate an understanding which is unreal, is wrong. The validation of something which does not and cannot exist is fundamentally cruel & deceptive. Affirmation leads those suffering from this gender-confusion to believe that it can be resolved if the whole world plays-pretend to ‘affirm’ what is impossible.
If I think myself the King of Siam (my preferred pronoun is ‘your Majesty’) and insist that everyone bow or curtsy when entering my presence….to affirm my delusional understanding is to build an equally unreal expectation that the world itself is now obligated to indulge my royal fantasy. It’s not.
If we begin with that fundamental truth — that people cannot change from male to female or female to male — then the door to ‘gender affirmation’ therapy is nailed shut. If I then show-up at the hospital, desperately confused about my royal lineage…if Harry walks in desperately thinking he might be a Hillary…the doctor (who takes his Hippocratic Oath seriously) will work first and foremost to disabuse us of that delusional thinking.
Conversely, if the hospital ignores reality and adopts, instead, the insane perspective that whatever an individual ‘feels’ to be true is indeed true, then the fool of a physician who treats us will always, mistakenly & tragically, be working to affirm what cannot, in the real world, exist.
Think you’re a zebra….you’re a zebra…and here’s your stall, your hay, and a whole team of zebra specialists to help you with the transition.
That so many of the Medical Profession have come to believe in this Unreality is both pathetic and frightening. 

Robert Cocks
Robert Cocks
1 year ago
Reply to  B Davis

Gave a thunbs up to this excellent comment. But want to ask B Davis how it’s firm realism anchored in an objective truth external to the self squares with his earlier comment to Caroline Watson. I also gave that one a thumbs up. However, with distance, feel that the culture that obcesses with affirmation (and not only on issues of gender identity) may be rooted in the kind of self absorbed
libertarian/narcissistic impulse that ends the comment to Miss Watson.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  B Davis

Not ‘so many’. Actually very few. Most doctors I know will admit (if gently challenged out of earshot of others) that the world has gone mad; and that wearing a wig doesn’t magically change every Y chromosome in your body into an X; and 2 blobs of silicone and some artistic FGM doesn’t make half your X chromosomes turn Y.

But a lot of timid people fear for their jobs if they don’t follow the orthodoxy. And there is a genuine and completely laudable desire to be kind. The transgender lobby have succeeded in persuading people that ‘kindness’ means ‘pretending something terrible is OK’: a seismic victory for Trans, who are anything but kind themselves.

I’m 58. If I get sacked as an NHS consultant for refusing to endorse this group hysteria, it’s a price worth paying. Ideally of course after 5 or 6 years being suspended on full pay during investigations


Perhaps I’d be a little more expedient if I were 25 with a mortgage and a young family.

Douglas H
Douglas H
1 year ago

“ they affirm everyone so they don’t get sued” – a throwaway line, but possibly the key to what’s going on.

Andy Griffiths
Andy Griffiths
1 year ago
Reply to  Douglas H

Yes. The irony being that in years to come, sued to high heaven is exactly what these people are going to get. Apparently one of the main reasons GIDS at Tavistock is closing is not just the Cass Report, it’s because they have hundreds of lawsuits coming their way.

Tony Sandy
Tony Sandy
1 year ago

Could it simply be that depression is about loss of identity? It is definitely lack of interest in the outside world and that includes looking after your own welfare. Dysphoria seems to be another fashion label to hang things on and to follow avidly, even into self destruction (if I am not my body, who am I? Do I really exist? Should I continue to exist? Will this get me attention and is it the kind of attention I need as opposed to want?).

Margaret TC
Margaret TC
1 year ago

I warmly recommend: Heather Brunskell-Evans, Transgender. Body Politics (2020), the best book on this socio-medical disaster.

Andy Griffiths
Andy Griffiths
1 year ago
Reply to  Margaret TC

I’ll check it out. “Trans: When Ideology Meets Reality” by Helen Joyce is a very good read also.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  Andy Griffiths

For some light relief ‘What is a woman’, Matt Walsh’s documentary: in equal parts hilarious and shocking.

Jon Walmsley
Jon Walmsley
1 year ago

The knee-jerk prevalance of gender dysphoria diagnoses among mental health clinicians reminds me a bit of GP’s proscribing anti-depressants to anyone coming in feeling a bit mopey – give them the most extreme and lazy solution we have and let them sort out the rest. What a brilliant system.

Nick Marsh
Nick Marsh
1 year ago

It’s funny how everything these days gets compared to the Nazis. Questioning the trans movement is one such thing, but any point of view that contradicts contemporary opinion is prone to the accusation. Certainly, a right-wing stance may fit the comparison, but what we fail to understand is that the study of history is to inform ourselves on human nature rather than human dogma.
The main feature of the Nazis (and many other, less-glamorous, movements) was that normal, respectable, even highly-educated, people acquiesced to increasingly dubious social norms. They did so, not because they came from an unusually violent society, but simply because they experienced the familiar social pressures we all experience in everyday life. After all, in the early to mid thirties, the Nazis offered much potential and even gained prominent foreign admirers.
Today’s parallels, therefore, come not from the precise mapping of political viewpoints, but from observing those groups and individuals who jump easily onto fashionable bandwagons, and are intolerant of anyone questioning their viewpoint.

Sarah J
Sarah J
1 year ago

Excellent article. I may just add, the treatment of anorexia has its own dark history, though not at same level of barbarism as “gender affirming care.” Children and adolescents with anorexia were often drugged with powerful psychiatric medications, despite objections from parents, and keep in psychiatric wards for months on end. Desperate parents turned to unqualified quacks, who were sometimes celebrated by the mainstream press. The Montreux clinic is a notorious example – celebrated by Oprah, 20/20 and Princess Diana – finally shut down in the early 2000s for unethical and negligent care.

Daniel Lee
Daniel Lee
1 year ago

The future is going to be astonished at the lethal metastatic toxicity we’ve allowed into our culture by letting the Left weaponize every form of non-conformity, pathology, dysphoria, anomie, ordinary teen angst, and simple selfishness into their battle to drag down society and rebuild it to their specifications – which of course start with them being in charge. Will this naked assault on vulnerable children finally be what convinces us to put these people behind us?

William Shaw
William Shaw
1 year ago

I suspect that this is one subject where if you are not personally affected it’s impossible to fully understand the topic.

B Davis
B Davis
1 year ago
Reply to  William Shaw

Yes & No.
Certainly to FULLY understand anything, one must be fully immersed in that thing….be it gender dysphoria….acne….Formula 1 racing….linear algebra….tomato gardening….or heart surgery.
But equally we can say that understanding at some reasonable level (far less than full immersion) is what all of us do with most of the things which fill our lives. That kind of ‘limited’ understanding is, indeed, what makes the world go round.
I don’t need to understand physics, fluid dynamics, or the design & function of an internal combustion engine in order to drive a car….to go to the store to buy tomatoes (nor do I need to know the biology of tomatoes).
So yes, to FULLY understand gender dysphoria, one must probably suffer from same. But suffering drives bias and discourages, in general, any kind of fully objective analysis….so even then, immersed in dysphoria, we might doubt the real depth or quality of our understanding.
We must also say, that we don’t need to fully understand mental illness to recognize the difference between what is and is not real. We don’t need to truly feel the ‘sense’ that one is mis-gendered to recognize that transitioning to that other gender…to become the opposite sex is impossible. And knowing it’s impossible we can — even from the outside — say: the gender dysphoric individual is disconnected from reality. In such a case, affirming what is not and cannot be true is not good medicine.

William Shaw
William Shaw
1 year ago
Reply to  B Davis

The difference in this case is that people are seeking to interfere in the lives of others and restrict their freedom of choice.
To follow your analogy, it’s not your car or tomatoes that are being discussed here it’s people’s lives.
Everyone is entitled to their opinion, but how do you justify forcing it upon someone else without fully understanding how it affects them?
You’re so confident that you are in the right that you have no problem taking away their right is self determination.
If there is any doubt whatsoever about what is the correct course of action perhaps it would be advisable to defer judgement.

Last edited 1 year ago by William Shaw
Julian Farrows
Julian Farrows
1 year ago
Reply to  William Shaw

Many adults can transition. That’s up to them, but surely you agree that sex-reassignment surgery shouldn’t be performed on children who have no real of concept sex and sexuality? I think that that is the general issue here.

Paul Pennell
Paul Pennell
1 year ago
Reply to  Julian Farrows

Whilst I agree with your comment I feel I must comment that Most adults are someone’s child, Julian.
It is no less painful for a parent to see their 18year old go through this as to see their 16 year old go through it.
The fact that “it’s up to them” makes the parents even more powerless.. and heartbroken

Julian Farrows
Julian Farrows
1 year ago
Reply to  Paul Pennell

Totally agree. I have a family member who is trans. The pain and devastation this has left on our entire family has been felt across three generations.

Andy Griffiths
Andy Griffiths
1 year ago
Reply to  William Shaw

But William, some of us would argue that the trans ideologues are already doing just that – forcing their opinions on society and telling us how to behave and talk, like the whole pronouns issue, getting people (mainly women) banned from social media, threatened, harassed, losing their jobs (like Kathleen Stock) etc simply for stating biological facts… I have no children of my own, but three of best friends have ‘trans’ kids, I have a nephew who’s now my niece and a niece who’s now non-binary. It is becoming increasingly difficult NOT to be personally involved

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  William Shaw

Maybe. But if one’s personally affected it’s hard to retain the objectivity that this issue needs.

The onlooker often sees more of the game.