“Conversion Therapy”: The Trojan Horse Returns

The words ‘conversion therapy’ to most people, evince the spectre of homophobic practices whose purpose is to ‘relieve’ a person of their sexual orientation, and replace it with something more acceptable to others or, occasionally, themselves. It is an attempt to alter an objective fact (sexual orientation) in order to realise a subjective belief (most commonly that homosexuality is a sinful moral choice). Legal Feminist is implacably opposed to such practices. 

But current calls for the prohibition of conversion therapy are not confined to the protection of sexual orientation. The phrase has been repurposed. For the purposes of this campaign, the term ‘conversion therapy’ has been extended to include treatment for gender dysphoria, and in particular any treatment that fails to immediately affirm gender identity. This elision of gender identity and sexual orientation is a linguistic sleight of hand, designed to confuse the natures of the two. No discussion can flourish, no debate can find resolution, when the language used between the participants is not shared. 

Other than in the most self-conscious academic circles, it is uncontroversial that every person has a sexual orientation. Sexual orientation – whether homosexual, heterosexual, bisexual or asexual – is almost universally accepted as a fact of people’s lives; any moral, religious and political arguments about it relate to its internal diversity rather than any question of whether it exists. A broad consensus has been reached that an attempt to change a person’s sexual orientation is neither realistic nor humane.

It is, however, far from uncontroversial to state that every person has a ‘gender identity’. The concept of gender identity cannot be taken as a commonly agreed fact of human life, any more than the concepts of God, transubstantiation or reincarnation. Those who believe in such things are entitled to hold and express their beliefs without suffering unlawful discrimination, but that entitlement does not confer the status of fact on those beliefs. To approach the rights that attach to belief in any other way would lead to an intractable set of conflicts. 

Some people sincerely believe in gender identity. Others have given the matter little or no thought. Still others positively reject it, holding that the concept of gender identity is based on outmoded stereotypical expectations of how women and men should look and behave. The concept of being ‘transgender’ (as opposed to ‘transsexual’ or ‘transvestite’) is a relatively new one, and one whose meaning and scope are problematically vague. It is instructive that in the 2017 Memorandum of Understanding on Conversion Therapy in the UK (Version 2), signed by a number of therapeutic bodies, sexual orientation was defined with commendable clarity:

sexual orientation refers to the sexual or romantic attraction someone feels to people of the same sex, opposite sex, more than one sex, or to experience no attraction.’

By contrast, the best the authors could do by way of a definition of gender identity was painfully circular:

gender identity is interpreted broadly to include all varieties of binary (male and female), non-binary and gender fluid identities.

Sexual orientation is a fact, gender identity is an idea. People who identify as trans must be protected from any coercive attempts to change their beliefs. But those who call for a ban on ‘conversion therapy’ in respect of gender identity are seeking to ensure a state mandate for a solely affirmative model of treatment of those presenting with gender dysphoria. That model is predicated on an expectation of interference. It is, if not unique, a peculiar treatment model that accepts, with total incuriosity, a patient’s self-diagnosis. Its foundation is an acceptance that the person has indeed been ‘born in the wrong body’, and must be recognised as the sex they believe themselves to be, without exploration of why they feel that way, or whether social norms are the real problem. It anticipates, and drives the individual towards, medical intervention, in the form of puberty blockers and cross-sex hormones. It frequently leads to irreversible surgical intervention in the form of elective mastectomy of healthy breasts, phalloplasty, the creation of a neovagina, breast implants, facial feminisation and so on. 

Sexual orientation conversion therapy is a harmful form of interference, driven by the desire to subjugate reality to a subjective belief; a ban is a prohibition on that interference and the prevention of consequential harm. By stark contrast, a ban on anything other than the affirmative model of gender identity treatment would compel interference with objective fact in order to realise a subjective belief. It is precisely the irreconcilable nature of these two creatures which the misuse of language is designed to conceal. 

The foreseeable legal and practical difficulties with the introduction of any legislation made on the basis of this conflation should give long pause for thought. For most individuals (ie: those who are not bisexual or asexual), the process of transition between a male and a female ‘identity’ will amount to a conversion of that person’s sexual orientation. This is not meaningless, or trivial; it can be seen in action in Iran, where gender transition is used as a ‘cure’ for homosexuality. The fact that the tenets of gender identity ideology are both embraced and legally enforced by a country with as poor a record on freedoms and human rights logically calls into question the endlessly repeated claim that the notion of gender identity is inherently progressive or liberal. It is not. 

The law governs our obligations and restrictions, and must be expressed with absolute clarity. It must be readily intelligible to those not burdened with legal expertise and, in its prohibitive aspects, should never seek to rely on a presumed consensus in order to operate properly. A statutory prohibition which elides the fact of sexual orientation with the belief of gender identity is freighted with confusion, internal contradiction and the wholly predictable possibility of long, costly, distressing litigation whose only beneficiaries will be lawyers.  

The battle lines have been drawn across the bodies of children. Proponents of the affirmative model advocate a pathway which enjoys the support of little reliable or objective evidence. They brook no contradiction that a child’s preference for toys, clothing and behaviour traditionally attributed to the opposite sex is a proper diagnostic basis for serious, life changing and sometimes irreversible treatment.  

With a grey, depressing ineluctability, those juvenile bodies are overwhelmingly female. The recent spike in young people identifying as transgender most markedly affects teenaged girls, already a particularly vulnerable cohort. On the basis of information from the Tavistock NHS Clinic, referrals of young people have increased from 72 in 2009 to 2,590 in 2018, although this cannot represent the overall numbers because so little data is available from private clinics. The paucity of reliable data in this area (including the numbers of people identifying as trans, engagement in any process of transition, medical intervention – whether prescribed or not, surgical intervention, desisting and de-transition) should be treated as a cause for the greatest concern and caution, rather than a basis for legally enforcing an ‘affirmative’ approach.

The proposed restrictions on clinical and therapeutic practitioners will be draconian: treatment to address gender dysphoria will be confined to those who believe in gender identity and are prepared to relinquish any critical enquiry into their patient’s reported difficulties. The enforcement of an exclusively affirmative approach ignores a number of factors which are, or may be, highly relevant in assessing a patient’s suitability for medical/surgical treatment. Girls with neuro-diverse conditions such as autism, ADHD and ADD frequently suffer from profound discomfort with the social behaviour and expectations traditionally regarded as ‘feminine’;  compounding this, they are frequently diagnosed late, or missed entirely because the prevalent diagnostic model is still based on male symptoms.

The high incidence of eating disorders and self-harm amongst teenaged girls cannot be ignored when an assessment is being made of a patient’s sense of alienation from their own body. Peer pressure (particularly in the context of a heavy reliance on social media), and social contagion are also highly relevant factors which need a great deal more scrutiny before the purely affirmative approach can be regarded as safe. The decision-making process for people under 25 should also be firmly placed in the context of their neurodevelopment; the frontal cortex of the brain is not fully developed until the early-mid 20s, leaving young people vulnerable to a limited capacity for consequential thought. Decisions which are both life-changing and potentially irreversible need to be taken with the greatest of care and the most reliable and balanced information possible. The affirmative-only approach not only falls far short of fulfilling this need, it advocates away from doing so.   

The same voices to call for the affirmative-only approach are swift to dismiss the experiences of those who desist or de-transition as statistically insignificant. It is an easy claim to make, but difficult to back up with anything other than rhetoric. Those who detransition often don’t return to the therapists and doctors who originally treated their dysphoria. Because the experience of transition is treated by proponents of the affirmative model exclusively as a cause for celebration, and is heavily defended from any more enquiring approach, it is likely that vulnerable children and teenagers will feel a powerful reluctance to ‘come out’ about their change of heart, and an even greater reluctance to bring that decision to someone in authority who so clearly advocates for transition as being overwhelmingly beneficial in its nature. Consequently, the gaps in gathering crucial data about those who de-transition or desist are too significant to make any reliable assessment. Enforcing a model when the rates of success and failure are entirely unknown, and the metric of success and failure remains both nebulous and ideologically driven, is reckless in the extreme. 

10 thoughts on ““Conversion Therapy”: The Trojan Horse Returns”

  1. We have to ensure we only outlaw harmful and coercive “therapy” without outlawing exploration (& age appropriate, fully informed consent) of correct diagnosis & less invasive alternatives, prior to major (& currently still untested) life-altering drug & surgical treatments

  2. In light of the finding of the Keira Bell case, there will be a much greater expectation in future that every effort has been made to ensure that any kind of medical interventions (puberty blockers for under 18s) is the right course of action. Judges will be looking much more closely at how thorough the psychological assessment has been, which pretty much negates the affirmative approach and throws the MoU under a bus! (hopefully)

  3. “Northern Ireland’s only gender identity clinic (GIC) has been unable to take on any new patients since 2018.

    Brackenburn Clinic has 403 people on its waiting list but has temporarily stopped its drop-in service due to limited resources and soaring demand.

    A spokesperson for the Belfast Trust said: “The GIC, in line with services across the UK, has seen a significant rise in demand from individuals seeking assessment and treatment. This is upwards of 75% from 2014.”

    https://m.belfasttelegraph.co.uk/news/northern-ireland/northern-ireland-transgender-clinic-unable-to-cope-with-demand-38904770.html

    I don’t think you realise just how starved of resources the NHS has become in this area over the last 5 years.

    As for the nonexistence of Gender Identity – how to explain the infamous David Reimer case? If castrating a boy and rearing him as female doesn’t work, with all the social pressures and attempts at “brainwashing ” to make him believe he was female, what is the explanation?

    Then there’s the multitude of cases on Intersex children surgically assigned a sex with disastrous consequences.

    Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth by Reiner and Gearhart, N Engl J Med. 2004 January 22; 350(4): 333–341.

    RESULTS Eight of the 14 subjects assigned to female sex declared themselves male during the course of this study, whereas the 2 raised as males remained male. Subjects could be grouped according to their stated sexual identity. Five subjects were living as females; three were living with unclear sexual identity, although two of the three had declared themselves male; and eight were living as males, six of whom had reassigned themselves to male sex. All 16 subjects had moderate-to-marked interests and attitudes that were considered typical of males. Follow-up ranged from 34 to 98 months.
    CONCLUSIONS Routine neonatal assignment of genetic males to female sex because of severe phallic inadequacy can result in unpredictable sexual identification. Clinical interventions in such children should be reexamined in the light of these findings.

    In order to invalidate the existence of Trans people, it is necessary to deny the existence of Gender Identity regardless of the evidence. This appears to be the reason for this belief.

    The mutilation of Intersex boys and girls is an inevitable consequence, labelling any who do not conform to the arbitrarily assigned sex as “mentally ill”. As happened 50 years ago.

    Collateral damage in the fight against Trans people’s existence.

    1. How does the forceful and unconsenting medical and surgical intervention to destroy evidence of a child’s biological sex, and falsely create the impression of the opposite sex demonstrate the existence of “gender identity”?

      Could it not simply be evidence that surgically and medically creating a false impression creates serious discomfort for patients?

      Which is to hypothesise that a natural body feels natural, and a medically and surgically altered one may not?

      1. @Arcadia
        “Which is to hypothesise that a natural body feels natural, and a medically and surgically altered one may not?”

        Excellent point. That does leave open the question of what is a “natural body”, anf what causes the “feelings”?

        “Experts at the University of California in San Diego, USA, found that 60 per cent of interviewed heterosexual men who had their genitals surgically removed following cancer claimed to continue to experience the sensation of having a penis.

        Intriguingly, the same study showed that only 30 per cent of originally male transsexuals, whose genitals had been removed as part of gender reassignment, reported the same phenomenon.

        “We explain the absence or presence of phantoms in these subjects by postulating a hardwired gender-specific body image in the brain that does not match the external [birth] gender” said lead author and phantom limb expert Vilayanur Ramachandran. He argues that before birth the brain may develop an image of the body that may not necessarily match the physiological outcome.”

        See
        Occurrence of phantom genitalia after gender reassignment surgery V.S. Ramachandran, Paul D. McGeoch – Medical Hypotheses (2007) 69, 1001–1003

        While that would explain a lot, from “phantom limb syndrome” and the varied responses to radical mastectomies, as well as the existence of “no op” trans people who have no desire for surgery… and why the correlation with expressed gender identity is extremely strong…

        It’s a hypothesis. How the heck would one go about testing it?

        The data in the Ramchandran paper does not support the “natural vs medically altered” hypothesis. That would dictate that both figures, the one for gay males and trans women, would be broadly similar instead of radically different,

        Your question was an extremely good one though. I had assumed only a gender identity based difference, so you got me thinking and examining my own suppositions. I had to look up the papers that had originally caused me to come to that conclusion.

        And that in turn led me to some later research that provided more detail.

        Altered White Matter and Sensory Response to Bodily Sensation in Female-to-Male Transgender Individuals , Case et al, Arch Sex Behav 2017.

        ” We measured the sensory evoked response in right hemisphere somatosensory and body-related brain areas and found significantly reduced activation in the supramarginal gyrus and secondary somatosensory cortex but increased activation at the temporal pole for chest sensation in the FtM group (N = 8) relative to non-transgender females (N = 8). In addition, we found increased white matter coherence in the supramarginal gyrus and temporal pole and decreased white matter diffusivity in the anterior insula and temporal pole in the FtM group. These findings suggest that dysphoria related to gender-incongruent body parts in FtM individuals may be tied to differences in neural representation of the body and altered white matter connectivity.”

        May be.. suggests.. that’s Science. You want Certainty, try Religion. It might be Right, is far more often Wrong, but is always Certain.

  4. More Collateral Damage

    https://www.pinknews.co.uk/2021/03/09/heather-fisher-rugby-alopecia-gender-england-worcester-olympics-bathroom/

    “International rugby star Heather Fisher has spoken out about how she has been forced to “lift her top” to prove her gender in public bathrooms.

    Fisher, who has played for Team GB at the 2016 Olympics and England at the 2010 Women’s Rugby World Cup, has alopecia, an autoimmune condition which causes her hair to fall out.

    The Worcester player, 36, told BBC Sport that she is regularly questioned on her gender, and “why she has muscles and no hair”, especially in public bathrooms.

    When using the correct toilet for her gender, Fisher has been locked inside before finding police waiting outside, been shoved out of a cubicle, and has even been prodded with a broomstick.”

  5. More on NHS starvation
    ” NHS gender identity clinic (GIC) The Laurels, one of only seven in the entire country, has assessed just two patients in a year, with one person left on the waiting list for almost six years.

    The shocking figures were revealed when a service user submitted a Freedom of Information (FoI) request to the Devon Partnership NHS Trust, which runs the West of England Specialist Gender Identity Clinic in Exeter, commonly known as The Laurels.

    The service user submitted the request after finding “the lack of public information extremely distressing, and a constant drain on [their] mental health”.

    The FoI response by the NHS trust showed that between 1 December, 2019, and 30 November, 2020, 495 referrals for new patients were accepted by The Laurels, yet just two patients were assessed by the clinic.

    However, there are currently 2,592 people on the waiting list for the clinic, with one patient having been on it 2,092 days, almost six years. This is 17 times the NHS legal guideline for waiting times of 18 weeks.

    At its current assessment rate, it would take The Laurels 1,296 years to assess every patient on its waiting list.

    Marianne Oakes, lead therapist at the private trans health and wellbeing service GenderGP, said in a statement: “We hear the suffering of these trans people on a daily basis.

    “Suicidal thoughts and self harm are a very real consequence of being denied this essential care.

    “We have to listen to trans people. We have to help them.

    “Right now, this section of society has been cut adrift from the NHS and abandoned. Anyone who tries to do something about it is shamed, silenced or worse.”

    Nationally, more than 13,500 trans and non-binary people in the UK are currently on a waiting list for a GIC. Waiting times vary by location but nowhere is it possible for a trans patient to see a gender specialist within the NHS legal guideline of 18 weeks.”

  6. Thank you for drawing attention to the fraudulent commandeering of the term conversion therapy by “gender identity” activists.

    1. @Guglielmo Marinaro

      “Fraudulent”? I think not, given the number of academic papers describing conversion therapy applied to trans kids. Many claim success, if the result is not a trans adult – say, if they kill themselves instead.

      Here are two successes, documented in
      https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences

      ” It does seem to be the case that, at least in the short term, Carol’s son Bradley is struggling in some ways with Zucker’s therapy. Carol says it was particularly hard at the beginning.

      “He was much more emotional. … He could be very clingy. He didn’t want to go to school anymore,” she says. “Just the smallest thing could, you know, send him into a major crying fit. And … he seemed to feel really heavy and really emotional.”

      Bradley has been in therapy now for eight months, and Carol says still, on the rare occasions when she cannot avoid having him exposed to girl toys, like when they visit family, it doesn’t go well.

      “It’s really hard for him. He’ll disappear and close a door, and we’ll find him playing with dolls and Polly Pockets and … the stuff that he’s drawn to,” she says.

      In particular, there is one typically girl thing — now banned — that her son absolutely cannot resist.

      “He really struggles with the color pink. He really struggles with the color pink. He can’t even really look at pink,” Carol says. “He’s like an addict. He’s like, ‘Mommy, don’t take me there! Close my eyes! Cover my eyes! I can’t see that stuff; it’s all pink!’ ”

      Still, Carol says, Bradley has made some progress. Today, he is able to play with boys. He has a few male friends, and has said that he now enjoys boy things. And there are other signs of change.

      “I mean, he tells us now that he doesn’t dream anymore that he’s a girl. So, we’re happy with that. He’s still a bit defensive if we ask him, ‘Do you want to be a girl?’ He’s like ‘No, NO! I’m happy being a boy. …’ He gives us that sort of stock answer. … I still think we’re at the stage where he feels he’s leading a double life,” she says. “… I’m still quite certain that he is with the girls all the time at school, and so he knows to behave one way at school, and then when he comes home, there’s a different set of expectations.”

      And another:
      ” When I visited the family, John was lazing around with his older brother, idly watching TV and playing video games, dressed in a polo shirt and Abercrombie & Fitch shorts. He said he was glad he’d been through the therapy, “because it made me feel happy,” but that’s about all he would say; for the most part, his mother spoke for him. Recently, John was in the basement watching the Grammys. When Caroline walked downstairs to say good night, she found him draped in a blanket, vamping. He looked up at her, mortified. She held his face and said, “You never have to be embarrassed of the things you say or do around me.” Her position now is that the treatment is “not a cure; this will always be with him”—but also that he has nothing to be ashamed of. ”

      And another
      “Yet Zucker’s approach has its own disturbing elements. It’s easy to imagine that his methods—steering parents toward removing pink crayons from the box, extolling a patriarchy no one believes in—could instill in some children a sense of shame and a double life. A 2008 study of 25 girls who had been seen in Zucker’s clinic showed positive results; 22 were no longer gender-dysphoric, meaning they were comfortable living as girls. But that doesn’t mean they were happy. I spoke to the mother of one Zucker patient in her late 20s, who said her daughter was repulsed by the thought of a sex change but was still suffering—she’d become an alcoholic, and was cutting herself. “I’d be surprised if she outlived me,” her mother said ”

      A close examination of Zucker’s paper reveals “At the assessment in childhood, 60% of the girls met the Diagnostic and Statistical Manual of Mental Disorders criteria for GID, and 40% were subthreshold for the diagnosis ”

      So nearly half were not Trans to start with.

      Anyone familiar with the havoc wreaked by “Conversion Therapy” will recognise both the methods and typical results.

      “As his pile of toys dwindled, Carol realized Bradley was hoarding. She would find female action figures stashed between couch pillows. Rainbow unicorns were hidden in the back of Bradley’s closet”

      Reckers’ earlier conversion therapy efforts at UCLA as part of the “sissy boy” experiments, involving CSST – contingent skin shock therapy, the use of cattle prods, are even more notorious.

      Fraudulent? No, just.. unfashionable now. Not openly publicised, as they were ten to twenty years ago.

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