Content note for strong anti-transgender rhetoric.
A high profile case holding that trans youth cannot obtain care in the United Kingdom will have rippling negative effects around the world. The Court’s opinion in December 2020 that trans children aren’t able to consent to puberty blockers goes against the overwhelming medical consensus that trans-affirming care, including puberty blockers, constitutes life-saving medicine. Anti-transgender activists across the globe are emboldened by the ruling against the country’s only referral service for trans youth.
In one sentence, the opinion in Bell v. Tavistock holds that youth under 16 are unable to meaningfully consent to puberty blockers as a diagnostic tool for gender dysphoria, citing evidence that a high percentage of youth who accessed puberty blockers then went on to receive further trans-affirming care. Yet, one would never argue that youth cannot consent to x-rays as a diagnostic tool for broken arms because a high percentage of patients who get x-rays for broken arms then go on to access further care for their injuries. Puberty blockers have been prescribed for trans and gender-nonconforming children for decades and have proven time and time again to be an essential component of comprehensive care.
The case is binding over trans-affirming health care in England and Wales, with non-binding influence over health care provision in Scotland and Northern Ireland.
Here in the United States, the Tavistock case has already been cited in testimony to support a Montana bill that would block all trans-affirming care for youth, negating the youth’s consent and a doctor’s diagnosis, recommendation, and referral. Montana is only one of 11 states to introduce bills banning trans-affirming care for minors in the first weeks of 2021.
On January 23rd, 2021, an international group of anti-trans advocates and activists gathered online, in a special convening, to discuss the Tavistock ruling and its implications in the UK and abroad. Among the speakers were psychoanalysts, sociologists, historians, and activists, united in their determination to end trans-affirming care for young people. The conference was hosted by Dr. David Bell (no relation to the complainant in the Tavistock case), a psychoanalyst who previously worked at the Tavistock clinic at the heart of the Tavistock case, although he did not work with trans people or with youth at all. Conference speakers included psychoanalyst Dr. Susan Evans, a former clinician at Tavistock, and her husband Marcus Evans who had served on the board of governors, both of whom testified against the clinic in the Tavistock case; philosopher Dr. Heather Brunskell-Evans, editor and author of several anti-transgender books; institutional anti-trans feminist Julie Bindel; and American anti-transgender psychotherapist Lisa Marchiano, who has written extensively about non-affirming care for trans youth.
The virtual conference was jovial and studious, with thoughtful questions from the audience. But the underlying content was foreboding. “Affirmative care rests on a false premise,” said Marchiano in her remarks. “Gender identity is not real. … Biological sex is binary and cannot be changed.” [emphasis added.] In the question and answer period after her own remarks, Dr. Susan Evans said that she “would prefer if no one under 25 could transition.” Marchiano agreed. “I’m with Sue, I wish these treatments weren’t available until 25.”
In a candid exchange, Dr. David Bell shared his personal assumptions about the Tavistock decision. “It’s my understanding,” Bell said, “that children couldn’t consent because they are young and because of psychological disturbance …” before being cut off by attorney Sophie Kemp, who injected the complainant’s argument from the case that the decision revolved around a child’s ability to consent to what the court deemed an experimental treatment. Bell was not alone in his belief that transgender identity is wrapped so tightly into mental illness as to be undistinguishable by diagnosis. “What do you say to a school affirming a child’s delusion?” asked British psychoanalyst Angela Joyce from the audience.
This foundational belief—that transness is undefinable and therefore untreatable—squirms at the center of the movement to ban trans-affirming care for youth. If transness isn’t a thing, and children are deluding themselves or being deluded by their parents and doctors, then trans-affirming care is inherently harmful.
In the last half hour of the conference, the rhetoric grew stronger. Anti-trans feminist activist Julie Bindel asked her fellow speakers if it might not be wise to “go back to look at every single diagnosis of gender dysphoria” in light of the Tavistock case. Dr. Heather Brunskell-Evans, co-editor of the anthology Inventing Transgender Children and Young People, responded. “[W]hat’s more difficult [than staying silent] is saying that this is a phenomenon that doesn’t exist. People can’t hear that. What they hear is that you have no care for children. It’s out of care for the children that we need to start saying that this is a fabrication, that the transgender child is a fiction.” That this ruling would drive momentum for silencing the needs of trans youth was already clear.
In his closing remarks, Dr. David Bell ironically summed up both the opinions of the speakers and my own opinion listening to the conference and thinking of the impact these activists will have on the health and well-being of trans youth around the world. “What an extraordinary aberration of common sense this is.”