Paul Ambrose 🎭

This article brings me back to something I’ve spoken about many times. In the 1980s I saw people who had taken overdoses after discovering that sex reassignment hadn’t cured their existing problems. They had changed their bodies but the problems were still there. In those days, individuals were expected to spend two years living in their preferred gender role, with psychological assessment and psychotherapy before surgery. I think that time matters. We need to understand what the person thinks these interventions are going to do for them, and help them understand the limits of what transition can achieve. The numbers have gone up exponentially and the demographic changed. We are seeing many more neurodivergent young adults presenting when they go to university, fearful of the adult world and not feeling they fit in. Questions start getting asked about intimate relationships, how they are going to manage independently and what contribution they might make to adult life. The people I’m describing often feel detached from their body. They don’t really feel they own it, but they are also struggling to establish a mind of their own. It’s almost as if they believe they have to do something concrete and drastic to their body before they can claim it as their own. Many are riddled with self-hatred feeling they don’t measure up to an ideal of who they should be. That hatred is often directed towards the body, particularly the aspects they cannot control and find intolerable. They are desperately looking for a solution that doesn’t involve understanding any of this. Thinking about it is resisted because it threatens to bring back the doubt and confusion they have projected out. They create a sort of avatar in their mind and believe that becoming this person through medical transition will cure their problems. As I say in Identity and the Foundational Myth, over several years they can develop a belief system that explains their struggles through the idea that they were born in the wrong body. In the cases I’m talking about, I think this is a false explanation that provides cover for underlying anxieties and conflicts. We need to understand what is going on behind the belief. I’ve also seen the casualties: people who have had medical interventions and regret them. They hadn’t appreciated that surgeons can imitate aspects of natural biology but cannot reproduce its full workings. Afterwards, they have to live with the problems they had before and the additional problems caused by medication and surgery. Turning 18 doesn’t suddenly mean someone understands what this might mean for the rest of their life. And scandalously, the Levy review found that adult services didn’t have the outcome data needed to know how people were doing or properly assess the safety of their care. Why aren’t we following people up systematically and finding out? We need to know whether these expensive, irreversible interventions help people live productive lives, have relationships and make the contribution to society they want to make. How are they getting on in middle age? What has happened to the problems they hoped transition would resolve? The Finnish study found that psychiatric treatment needs did not subside after medical transition. It doesn’t answer the question about middle age, but it should make us want to find out more. We don’t seem very interested in what happens to people in the years afterwards. This is why I think a period of psychotherapy before irreversible interventions is so important. It should help the individual understand their own motives and beliefs, so they are in a better position to think about what they want, what they hope treatment will achieve and the risks involved. In the end, individuals have to decide how best to live their own lives. But a slow process, with time for reflection, can help them become more self-aware and make more informed decisions. @BayswaterSG @Telegraph @NHSEngland @YvetteCooperMP