By: Marcus Evans
Subjects: Adolescent Studies, Developmental Psychology, Gender & Sexuality, Psychology
It is commonly acknowledged that while biological sex is
genetically determined, gender is a social construct. A human being
cannot—and should not—be reduced to their biology, or indeed their
genitals, because psychologically we are as much a product of the
way that other people treat us as we are of our genetic
inheritance. Homo sapiens are social creatures: our
ability to cooperate is what gave us the evolutionary upper hand
over our stronger Neanderthal cousins. Without parents, siblings,
peers, colleagues, friends and lovers our idea of ourselves would
remain ill-defined—we wouldn’t know who we were.
Imagine you were raised by wolves in a cave—let’s call you
Mowgli—but then later met another human of the opposite sex. You
would notice the physiological differences. But as to interpreting
those differences, where would you start? Without being exposed to
the concept of “man” or “woman”—let alone “laddish” or
“girly”—you’d lack any mental map to provide the pointers to the
typically “male” and “female” behaviour instilled in us by human
society.
Precisely because gender is a social construct, the evolution of
its boundaries and meanings will tell us something fundamental
about our society. And gender-wise something really big is going on
in the UK—but it’s not the big something you might think.
Transsexuality is a talking point like never before, and a
glance at the figures sheds some light on why. The number of
children, in particular, being referred to the Tavistock and
Portman Foundation Trust’s gender identity development service
(Gids)—the NHS service through which all UK candidates for a sex
change under 18 are funnelled—is up from 77 in 2009 to 2,590 in
2018-9. But what’s almost as dramatic as the headline numbers are
developments in who is transitioning. In November 2017,
the Guardian reported that 70 per cent of referrals were
female. This was a surprising statistic because only 10 years
previously the overall ratio had been more like 75 per cent males
seeking to be female, and indeed it is still the gender traffic in
that direction that dominates the increasingly noisy, divisive and
panic-inflected debate.
Recently, though, alarm bells have begun to ring among a handful
of psychiatric professionals about the number of teenage girls
arriving at the Tavistock’s door and the nature of their treatment.
Right now a legal case is being brought by Susan Evans, a former
psychiatric nurse at the Tavistock and Portman NHS Foundation
Trust, alongside a parent of an autistic female child wishing to
transition to be male, arguing that children are not legally
capable of consenting to a gender transition. November last year
saw the launch of the Detransition Advocacy Network, a UK group
numbering several hundred members. And in January, the NHS
announced an independent review into puberty suppressants and
cross-sex hormone treatments, to be chaired by Hilary Cass,
formerly president of the Royal College of Paediatrics and Child
Health.
But until the end of 2019, you could be forgiven for thinking
that a panic about trans women using the “wrong” toilet cubicles
was the biggest gender issue of the day (instead of something that
could be easily solved by affording everyone the same privacy).
Whenever the issue flares up politically—as when the Labour
leadership candidates were asked to sign a pledge that labelled
trans rights sceptics as “hate groups,” or the Scottish government
proposed reforms to allow a change of legal gender without a
medical diagnosis of gender dysphoria—it always seems to come back
to loos and changing rooms. These vitriolic debates keep bubbling
up—especially online.
But there is a much bigger scandal brewing than any
Twitterstorm. While there have been a great many thoughtful doctors
at the Tavistock, the picture is sometimes disturbing. Marcus
Evans, a psychotherapist and former governor of the Tavistock and
Portman NHS Foundation Trust, resigned in February 2019, citing an
institutional rush to prescribe puberty-blocking hormone treatment
to children questioning their gender and who may wish to
transition. “The Tavistock is behaving recklessly with these kids
who are in a distressed state,” he claims. What’s especially odd
about the alleged rush to prescribe rather than consider
alternatives, he argues, is that this clinic’s international
reputation was built on the quality of its talking therapy.
“Over the last five to 10 years there has been a complete change
in the profile of the people presenting,” says Evans. “These
children believe that they are in the wrong body and they are very
persistent and forceful in saying that they want a solution—and
that that is physical intervention. But I’ve been in psychiatry for
40 years and when people are in a distressed state they often
narrow things down and fix on one thing as a solution, putting
pressure on clinicians for a magic bullet.”
In psychiatry “generally,” he says, the aim is to “open things
out,” and take the time to ask questions about “what is going on.”
After all, “adolescence is a moving picture. We move through
experimenting with different identities as our bodies change and
our role in society changes. An individual has to tolerate a
-certain amount of confusion and anxiety and we should be able to
help with that through therapy.” But when it comes to “the
Tavistock’s gender identity service,” he says, “this work has not
been done… the entire area has become unnecessarily
politicised.”
