‘You wouldn’t tell an anorexic child to starve themselves’

Before the Cass Review laid bare the scale of medical negligence in England’s gender-identity services, a number of insiders had tried to sound the alarm. Clinicians, therapists and other professionals had long been warning that kids were being fast-tracked to medical transition. They revealed that puberty blockers and cross-sex hormones were being liberally prescribed, despite there being scant evidence of their safety or efficacy. These whistleblowers put their reputations and careers on the line. Anyone who questioned the automatic ‘affirmation’ of children in their chosen gender risked being branded a ‘transphobe’.

Dr Marcus Evans, a psychoanalyst and former governor at the Tavistock gender clinic, was one of these dissenting voices. What he witnessed inside the NHS gender-identity services disturbed him so much that he resigned from his position in 2019. Since then, he has continued to warn about the harms of ‘gender-affirming care’ and the insidious influence of the trans lobby in healthcare.

Evans joined Brendan O’Neill on the latest episode of The Brendan O’Neill Show to discuss the long road to the Cass Review. What follows is an edited extract from their conversation. Listen to the full thing here.

Brendan O’Neill: What’s your view on boys or girls claiming to be the opposite gender? Do you see it as a delusional belief?

Marcus Evans: The desire to transition comes from what I call an ‘overvalued’ belief. That’s when your entire way of thinking is orientated around one particular conviction. It doesn’t mean that you’re completely out of touch with reality. But it does mean that reality no longer really counts. What you often find is that it’s not entirely clear what this belief is based on. When a child says they’re suffering from gender dysphoria and wants to transition, you ask them: ‘What’s so awful about being a boy that you want to transition to being a girl?’ They often don’t have a good answer.

A lot of the time they just really don’t like themselves. I wouldn’t put it in as concrete and simplistic terms as that, but I am always thinking in this way. The problem is, you can’t get rid of elements of your psyche or surgically remove aspects of who you are. From a clinical perspective, you have to keep in mind that this child has created an avatar of themselves – someone who is going to be the solution to all of their difficulties, and help them purge the unwanted aspects of themselves. A lot of these kids struggle with an internal self-hatred of all their imperfections, often combined with chronic depression. They focus all that self-loathing into one aspect of themselves that they want to get rid of. In this case, it’s their sex.

An important part of development, of course, involves coming to terms with your various different flaws. Children will generally address some and learn to live with the others. It gets easier as you get older, when you begin to realise we’re all making the best of what we’ve got. But that’s very difficult for a kid to do. As a therapist, it’s my job to get these kids to think about why they can’t tolerate their imperfections.

O’Neill: What happens when healthcare professionals aren’t allowed to challenge those beliefs that kids have about themselves?

Evans: I see gender dysphoria as being a problem similar to anorexia and self-harm. You wouldn’t affirm a child’s belief that, by starving themselves, they can create a perfect version of themselves. That they can live a life where they have no appetites or desires.

The kids who are desperate to transition have a very similar psychological makeup to this. They have a desire to control everything, including other people. The major difference between self-harm or anorexia and gender dysphoria, however, is that political interference has stopped us doing our jobs as mental-health practitioners. It has absolutely undermined ordinary clinical thinking and normal medical practice.

Thanks to dodgy science, parents are afraid that not affirming their child’s identity will push them towards suicide. The reality is that children with gender dysphoria are no more likely to kill themselves compared with other mentally ill adolescents. There’s also the threat that kids will cut off contact with their families, encouraged by online groups and an overall culture that tells them their parents are bigots if they fail to unconditionally affirm their children. Parents are made to feel like they’re the problem if they have questions or concerns.

It also doesn’t help that children who identify as trans are very wary when you ask them questions about their identity and beliefs. They want to bring you into a narrow discussion about gender identity. They have this certainty that gender-affirming care is the solution. That it will get rid of all their confusions and doubts about themselves. They feel very easily assaulted when you challenge that certainty, even in an empathetic way. A good therapist will skillfully try to move through this discomfort and encourage the child to understand that their certainty is not necessarily a helpful, healthy thing. This is already a challenge on an individual, clinical level. But the politicised culture around the trans issue makes everything worse.

For the longest time, not embracing gender-affirming care had you instantly dismissed as a bigot. This just isn’t true. Those of us who don’t instantly affirm a child’s identity are the ones actually interested in opening up discussion. We’re interested in exploring the variety of rich and complex ways that a person becomes who they are. We are not interested in pushing children into narrow gender stereotypes, which state that boys are always logical and play football, or that girls inevitably want to dance and wear pink. These beliefs, on which gender-affirming care relies on, are deeply regressive. That’s why exposing them to external scrutiny, as the Cass Review did, has been so important.

Marcus Evans was talking to Brendan O’Neill on The Brendan O’Neill Show. Listen to the full conversation here: