The boy made to live as a girl — or the girl made to live as a boy?

I’ve been working on something about children and gender for some time, but I wanted to break off and discuss the case of a “boy raised as a girl by his mother”, because it raises some uncomfortable questions, and because I’m getting increasingly frustrated about the shallowness of reporting around this issue.

There’s a reason few in the mainstream media write about children and gender: it’s highly contentious, it’s difficult to talk to those involved, and no one can say with 100 per cent confidence they understand the science behind gender (cultural/personal), and its relationship with sex (biological). Who knows what a four-year-old truly wants? Everyone is trying to guess what a child “truly” feels about their identity, before they even know it themselves.

Anyway, this is an attempt to put a fuller version of the known facts in the public domain and raise some questions. If you’re familiar with the case and just want the discussion, skip to part 2.

Yesterday, the Guardian reported the following:

A seven-year-old boy who was “living life entirely as a girl” has been removed from his mother’s care after a ruling by a high court judge.
Mr Justice Hayden said the woman had caused her son “significant emotional harm”, and he criticised local authority social services staff responsible for the youngster’s welfare.

From the start, it’s obvious there are two ways to react to this judgement (read it in full here). The first — which is the line advanced by Mermaids, a charity for transgender youngsters, and some trans activists — is that a transphobic legal system and local authorities have taken a girl away from her mother and forced her to live as a boy.

A petition has been started, which states:

A recent court case has ruled a young trans girl to be removed from her mother and forced to live in her assigned gender. The mother has done nothing but provide support her child in being who she really is and has given her all the love and care in the world to allow her to live out as her true and authentic self.

The judgment gives a very different view: that the child has shown no interest in being a girl, but that the mother is controlling and manipulative, and has psychological issues — an “enmeshed relationship” — which prevent her from seeing the child as a separate being from herself.

— — —

The background: the parents, M (mother) and F (father) separate 12 months after the birth of the child (J). When J is four, contact arrangements break down. F wants to re-establish contact.

The mother claimed F was violent, which the court could not corroborate (there was one, apparently mutually heated, incident involving leaning through a car window).

A number of alarms are raised concerning J’s behaviour and appearance. One anonymous call (Mermaids say this was malicious) claimed the mother was using skunk in front of J, and that he had head-butted other children. There were then two referrals to the local authority, and one via the NSPCC.

In November 2013, J’s school also began to raise concerns about the mother’s “confrontational and inappropriate behaviour”. She claimed that J was being bullied because of his “gender variance”, although the school said there was no sign of bullying.

M wanted J referred to the Tavistock clinic, one of a handful of specialist children’s gender clinics in the country. She did not want him to see the child mental health service, CAMHS.

From the judgment:

In May 2014 information was communicated to social services from their own Housing Department which was entirely in conflict with the information they had previously received. In particular it contained the alarming assertion, which as it transpired was entirely untrue, that J had been ‘diagnosed as transgender’. It perhaps requires to be re-emphasised that J was at this stage 4 years of age.

The mother takes J out of school, citing the bullying. The police attend M’s home and she tells them J is the victim of a hate crime: other children have been pulling at his clothes to see if he has a penis.

In January 2015, an assessment concludes that J is not at significant risk of harm. Part of the rationale is that his mother is receiving support from Mermaids.

The judge is damning about this:

When all this is properly analysed it is clear that flares of concern were being sent from a whole raft of multi disciplinary agencies. Each was signalling real anxiety in respect of this child’s welfare. … This local authority has consistently failed to take appropriate intervention where there were strong grounds for believing that a child was at risk of serious emotional harm.

In other words, the social services had decided J was a girl based on his mother’s say-so, including her (false) assertion he had been diagnosed with gender identity disorder by the Tavistock. They did not question her assertions.

What about J’s views? Lots of the activist reaction to this case has been along the lines of “What about the child? Did no one ask her?” Here is the judge’s ruling:

There was no independent or supportive evidence that J identified as a girl at all, indeed there was a body of material that suggested the contrary.

The first report of the local authority, then, displayed “naivety and professional arrogance”, according to the judge. It was assumed that all the agencies raising concerns simply “did not have a full understanding of gender non-conforming children”.

A clinical psychologist is brought in, who also takes M’s assertion that J is a girl at face value. The psychologist does, however, find that M’s “narratives [are] illogical” and questions her decision not to engage with CAMHS. The judge concludes:

I consider that she has learnt that by creating ‘confusion’, to use Ms Sambrooks’ word, amongst the professionals, she generates a situation in which her own distorted beliefs gain greater traction and are able to prevail with less effective challenge.

In other words, M uses the prevailing orthodoxy — that gender identity is a measurable, objective phenomenon, and can be accurately gauged in a young child — to suggest that anyone challenging her is bigoted.

By October 2015, M has problems with everyone else involved in the case. She wants J’s Guardian re-appointed, the child’s solicitor replaced, and F’s counsel to recuse himself. As the case progresses, she makes complaints against some of the professionals involved. “Even more alarmingly J himself had entirely disappeared from view,” writes the judge. “He had not been permitted proper access to his Guardian, he was not attending school, his home address and living arrangements were unknown.”

The next month, it emerges that J has been living “in stealth” — as a girl. M says she has been advised to do this by the Tavistock Clinic. The clinic’s records do not support this: in fact its interaction with J has been limited.

February, 2016:

“The February hearing was very stressful for M. However what struck me forcibly, both then and indeed at this final hearing, was that M spoke of J only in the somewhat opaque and convoluted argot of social work and psychology. She offered an impressive, intense and highly articulate evaluation of the problems faced by children with gender dysphoria but she conveyed no sense of J’s personality, temperament or enthusiasms, notwithstanding frequently being encouraged to do so. Repeatedly she struck me as a professional witness giving evidence about somebody else’s child.”

This part of the judgement reminded me of BBC Radio 4’s interview with Leo, a “non-binary 10-year-old”. As the BBC’s write-up has it, “with research help from his parents, he’s decided he is non-binary”. Listening to the interview, it’s a bit more than that. The mother heavily coaches Leo, and at one point says that she asks him every morning what gender he is.

As the journalist Jesse Singal noted, that interview made no distinction between gender dysphoria — the intense feeling of alienation from your sexed body that is normally assumed to be the foundation of transsexuality — and more general gendered preferences about toys, clothes and so on. The word “transgender” collapses these differences, but in medical terms they are still important. “Every gender clinician I’ve ever spoken with believes that when a kid expresses uncertainty about their gender identity, it’s important to separate out two very different things: deep-seated gender dysphoria and discomfort with gender roles and activities,” writes Singal.

In the case of J, the evidence of dysphoria comes from his mother: “M’s case on this point has not always been either consistent or coherent, but my overwhelming impression is that she believes herself to be fighting for J’s right to express himself as a girl. She has told me how J ‘expressed disdain for his penis’.”

J is sent to live with his father. There is a slightly groan-worthy section where the judge suggests that liking SpongeBob suggests he is now happy to be living a boy. But, contrary to the impression given in news reports, it’s a small aside, and part of a larger discussion of what kind of clothes J wants to wear, and whether his father is pushing him towards stereotypically masculine activities against his will.

There are some more disturbing details of J’s behaviour (P is the father’s partner):

Initially every two minutes he would say he did not like his floppy bits flopping around. He has also said ‘my mother does not like her floppy bits flopping around’ and that ‘she has got a big fat sandwich’. This somewhat took [F] and [P] aback. [J] will talk about his mother but does not get upset.”

However I do feel that [J]’s inappropriate touching of others is of considerable concern. When considered alongside his comments and his behaviour towards his mother in contact (eg. April 22/4) then it would seem that [J] is very used to touching [M]’s breasts and that she has afforded him considerable knowledge or discussion of genital anatomy. Whilst this may reflect [M]’s view of [J]’s gender issues it is not in my view appropriate knowledge nor would a child of [J]’s age, transgendered or not, generally have such discussions.

Here are the social worker’s final conclusions, which are the nub of the judgement:

“[J] has been offered a choice since he has been with his father and would appear in the main to choose boyish things and very clearly identifies himself as a boy. He makes this clear whether or not his father is around and would not seem to be influenced by him. [J] chooses to present as a boy within school and in terms of his dress and would seem to be more comfortable with his male genitalia as time goes on.

Whatever her reasons then, the conclusion that [M] manipulated or influenced [J]’s gender orientation, for whatever reason, seems inescapable.”

This explains the latest ruling, which says the mother is forbidden to speak publicly about gender identity with regards to J, to try to prevent further distress to him. She remains convinced J wants to be a girl, and is being prevented from expressing his true identity by his father, and now the state. She suggests to the court that J is only playing along, as he has got the message he must act like a boy to return to her care.

When it is put to the father that J might still want to transition to a girl at some point, “F was prepared to engage in the hypothesis. I formed the impression that he had not reached an absolute conclusion that J will continue to identify as a boy, though he thought this the more likely outcome.”

Of the mother, the judge adds: “I find that she has overborne his will and deprived him of his fundamental right to exercise his autonomy in its most basic way. Whether J chooses to present as a girl or not, ought to be his choice. This is not a case about gender dysphoria, rather it is about a mother who has developed a belief structure which she has imposed upon her child.”

PART II

Reading all this, it is hard to support the interpretation by Mermaids and other transgender campaigners that this is a case of a girl being forced to live as a boy. Rather, it seems the other way round — here is a boy whose mother diagnosed him with gender dysphoria herself, and made him live as a girl. The child’s father seems open to letting J explore his gender, and perhaps even transition in time if that is what he decides for himself.

The one trying to force a gender identity on to J appears to be his mother.

Aha, you might think: but perhaps the judge has religious or conservative views which mean he would never accept that a young child would identify as the opposite gender. The whole thing is rigged! This does not seem to be the case, as he writes: “My experience in the Family Division leaves me with little doubt that some children, as young as 4, 5, 6 years of age may identify strongly with their opposite gender. Such children can experience rejection and abuse arising from ignorance both on a personal and institutional level”.

In other words, the judge believes that gender non-conforming children exist. But J doesn’t appear to be one of them.

Unfortunately, it has become something of a taboo to suggest that children do not develop a stable gender identity until later in their development, and that many very young children who appear to be gender non-conforming actually grow up not to be trans, but simply gay or lesbian. (This figure is estimated at 80 per cent.)

But as anyone who heard about the recent cancellation of an NSPCC debate about how best to support gender non-conforming children will know, any suggestion that early intervention is not always appropriate is easily recast as “denying trans people’s right to exist” or blamed for the high suicide rates among trans people. (Full disclosure: one of those asked to speak at the NSPCC debate has written for the publication I work for, and I’ve debated the other on radio.)

There is a fine balance to be struck here. How do we best support the children who will grow up to be happy trans adults, while not inappropriately influencing the others into a course that involves lifelong medical treatment, and (usually) sterilisation? Clothes, toys, names and even pronouns all signal to children and the wider world what gender they are. There is no neutral choice.

There is much reference made to “puberty blockers”, but what limited research there is suggests that few of those who start taking these to “give themselves time to think” revert back to the gender associated with their birth sex. They are largely a one-way ticket. There is also evidence that socially transitioning young children increases the likelihood they will stay in their new gender. Children’s identities are perhaps more fluid than a “born this way” approach to gender identity would suggest.

To me, this sounds like a legitimate subject for public debate. We know that trans people suffer discrimination and family rejection, and we also know that natal males “pass” better as adult women if they start hormone treatment before undergoing puberty. On the other hand, there has been a huge rise in the number of child gender identity referrals, up from 94 in 2009 to more than 900 last year. No one can say for sure if this reflects a previously hidden problem coming to light — whether previous under-diagnosis is being corrected — or whether children are influenced by the higher profile of transgender celebrities like Laverne Cox and Caitlyn Jenner, and perhaps by older trans children in their own schools.

Why would over-diagnosis be an issue? Because it would mean subjecting children to serious, unnecessary medical interventions. Here’s medical ethicist Alice Dreger:

“Why not transition everybody who says she or he is the other sex? All other things being equal, it’s a lot easier on your body if you don’t try to change your sex hormones, genitals, etc. The interventions involved in sex reassignment are non-trivial.
Make no mistake: If you start hormonal sex change before your inborn-sex-directed puberty is well on its way, then you’ll end up much better off in terms of your adult sexed appearance and in terms of avoiding other interventions, and so you’ll also benefit psychologically, if it was the right choice. So, for example, if a birth female starts sex change early in puberty, that person will avoid growing breasts that he would later want surgically removed. A birth male who starts sex change early in puberty will avoid having the voice and body hair patterns become male-like, features that are very difficult to undo once set in the body.
That’s why starting transition earlier is good for young people who will benefit from changing their sexed bodies. But as I said, these interventions are not trivial, and many are not easily reversible. This is particularly true for females who undergo male hormonal puberties by taking testosterone. So you want to make sure you get right your calculation of who will benefit.”

There is a small, but increasingly vocal, community of detransitioned women who make exactly these charges. But once your voice has dropped, it’s dropped. Equally, it’s very hard to reverse the procedure that inverts a penis into a vagina. Detransitioning brings its own mental health complications and risks. The rates are very low, but that might be due to the medical gatekeeping currently in place.

Yet these questions are rarely discussed. I sympathise with the trans activists who feel, firstly, that much has been written “about them, without them”. But as the case of J shows, it’s not that easy to say who belongs to what group. Added to that, gender affects all of us: it’s a foundational point of feminism that women are not “naturally” suited to darning, or wearing frilly bows, or care work, or earning less. We’ve heaped a huge amount of cultural baggage on to differences in biological sex.

In this case, the judge suggests that fear of being labelled transphobic prevented several child protection agencies from pursuing their concerns about J:

“I believe that in this case the profile and sensitivity of the matters raised by the mother blinded a number of professionals from applying their training, skills and, it has to be said, common sense. They failed properly to investigate M’s assertions, in part I suspect, because they did not wish to appear to be challenging an emerging orthodoxy in such a high profile issue.”

One particularly overwrought headline about the NSPCC debate accused it of being “anti-trans child abuse”. Let’s unpick that. Not only is questioning the idea of a child having a defined gender identity at the age four now cast as “child abuse” by itself, so is even the act of debating it.

In this climate, it’s not surprising that professional agencies were reluctant to contradict, or even question, M’s claims about her child.

There is also something uneasy about the inevitable (and usually positive) identity of “campaigner” that parents of unusual children often acquire. The parents of deaf children often campaign for better treatment, and so do the parents of transgender children. But that identity itself, and the attention it brings, will be attractive to some people regardless of the actual situation of their child. That’s why I said on Twitter that this case reminded me of Munchausen’s by proxy, where a carer receives attention, sympathy and validation by seeking repeated treatment for someone else, who in reality has nothing wrong with them.

I’m regularly contacted by people who are worried that there is currently a “trend” for children and teenagers to use gender to define themselves, to emphasise their individuality and to break from their parents’ generation. Others are worried that we are funnelling thousands of children into a system which often results in lifelong medicalisation, with treatments which are as yet largely untested. (The drugs used are often prescribed off-label, eg HRT drugs).

All this is happening in an evidence vacuum, because the acceptance of childhood transition (socially and medically) is such a recent phenomenon. Nature magazine recently reported on a large-scale study looking at the best treatment options for gender non-conforming teenagers. It notes:

The debate is so heated — and evidence so sparse — that the authors of the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were unable to reach a consensus. “People are making declarations of knowledge that are their belief systems, that aren’t also backed up by empirical research,” says Jack Drescher, a psychiatrist at the William Alanson White Institute in New York City.

I think we can all agree with that. And the case of J shows why more research is needed. Both competing interpretations suggest real harm has been done to a child: either being forced to live as a girl then, or being forced to live as a boy now. We need more evidence, and we need a public debate.