In case you missed it, my first post for Genspect went up this week, exploring the tragic case of David Reimer and its dark resonances with gender medicine today:
… critics within the field were gaining ground. One of the more responsible physicians featured in Colapinto’s account is Dr. William Reiner, who opposed Money’s approach “in which a sexual identity is imposed on a child through unshakable fiat of physicians, and any doubts or confusions the child may express about the assignment are denied by the caregivers.” In contrast, Reiner argues that medical providers “have to learn to listen to the children themselves… They’re the ones who are going to tell us what is the right thing to do”—a sentiment he echoed in a 2005 interview with the New York Times: “When you hear someone declare with such clarity that they know themselves far better than the experts, it is life changing.”
But today these impassioned arguments against medically unnecessary interventions have been turned upside-down, deployed to argue for experimental medical interventions instead and applied to a wider population of children and young people than ever before. Medical providers then and now talk about following their young patients’ lead. This is one thing in the context of attempting to avoid unnecessary medical interventions and quite another today, when “listening” to young patients is more likely to accelerate interventions than forestall them.
Sue Evans writes an insider’s account of how the Tavistock came tumbling down:
The external influence of the advocacy groups increased. Instead of being a clinical, research-focused service where we were learning and developing ideas, it felt like it was a fait accompli that we had to go along with what Mermaids and patients wanted—even if we, the mental-health-care professionals, had legitimate questions about the appropriateness of the treatments that patients and patient advocates were demanding.
For example, a weird paradox arose at a conference on transgender health care hosted by Tavistock around 2005: the opening speaker declared that we were no longer supposed to think of gender dysphoria as a mental illness. But we were a mental-health team working at a mental-health facility. What were we supposed to be doing if not treating patients with psychological conditions?
Remember, this was all before the internet took hold of an entire generation of teenagers. There were no online groups dedicated to gender affirmation and coaching kids on what to say to their providers to secure cross-sex hormones. We mostly saw younger boys who believed themselves to be girls from an early age and a few teenagers who felt like they were trapped in the wrong bodies. So, although I felt aware of the gathering force of thinking around the area of gender dysphoria and transgender identity, it was hard to foresee the slow-motion avalanche that would hit over the next two decades.
Yet even what I saw in those years worried me deeply and working on the Gender Identity Development Service started to affect my personal well-being. I would come home with a headache on the days that I worked in the unit, and my heart would beat quickly when I went in the next morning. It felt like every time I raised a concern about us rushing prematurely to prescribe drugs that would have permanent effects on our patients, I’d be met with an eye roll and the unstated “Oh, here she goes again,” or “Can’t she just fit in?”
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