Bernadette Wren:Tavistock 3

Part 3 on this talk by Wren.

You can see earlier parts of this series on this page:

Bernadette Wren

We rejoin Wren explaining about the rising referral rates to GIDs and the witch from predominantly male referrals to 75% female. Wren repeats the statement, made earlier, about the poor research base for the treatments for which she makes referrrals.

At this point Wren tells us that adults who have undergone these treatments do have a degree of continuing mental health issues, based on studies (which she does not name), but with small amounts of regret. For children and adolescents she references a Dutch study (again no specific reference provided) which followed a small group of “treated” referrals who were all doing well. She does, however, concede that this group tended to be very well functioning and arrive at the clinics at an older age. It is worth noting that the Tavistock were ideally placed to have conducted their own research. The childhood and adolescent branch of the tavistock was set up in 1989. They began administering puberty blockers in 2011. This talk was in 2019.

The next slide shows the diversity of the Tavistock’s clientele.

Evolutionary Biology

Finally we get to the question of evolutionary biology. Wren begins by pointing out that evolutionary biologists assume that humans are motivated by the aim of reproducing and leaving partial copies of ourselves on this earth; we are assumed to have an imperative to pass on our genes. She then breaks off and makes an interesting comment.

She continues by focussing on research re homosexuality which, she is careful to point out, she is not conflating with gender atypical presentations. She then says “Obviously, like Gender Dysphoria we assume like homosexuality has existed throughout history and in all known cultures” . I would say that is a highly contested statement, the latter yes, but “Gender Dysphoria” is a relatively new concept which has pathologised people who do not conform to expectations for their sex, many of them homosexual.

Wren continues by acknowledging that homosexuals are a statistically small section of society but then swiftly moves on to argue that sexuality can be fluid, particularly in females. (Is this how she is able to ignore the targeting of Lesbians who do not wish to entertain “male lesbians” as partners?).

Wren expresses caution about looking for a biological explanation, for both homosexuality and gender identity, because it risks being oppressive. If we seek explanations we could also seek the means to “cure” or “suppress” these experiences. This is where lumping homosexuality in with “gender minorities” is deeply unhelpful. The former does not need a lifetime’s dependence on cross sex hormones or risky surgeries.

Theories of adaptive advantage to homosexuality, she continues, are that they may confer advantages to relatives who do reproduce. Gay Uncles and Lesbian Aunts helping with child rearing, I assume she is referring to.

Next she turns to considering whether there is a biological basis for “gender identity”. Her hypothesis is that an explanation will not be located in a single gene but will be multi-factorial. She then switches to point out a third of their referrals have features of autism so, I assume she is making the link to autism as an inherited trait.

Heritability of “Gender Identity”.

Most of the evidence comes from twin studies. One such was by Holderman et al, in 2018. They looked at eleven studies. She breaks off to add a not of caution that these studies run the risk of conflating gender non-conforming behaviour with a transgender identity. [You don’t say! Exactly what we think has been happening at the Tavistock!]. Despite expressing reservations about the methodology, such as using sex stereotypes to determine whether a child displayed “opposite sex behaviours”, she repeats the conclusion that gender identity shows a pattern of heritability around 28% to 40% for identical twins, half that for non-identical twins.

Next she explores the work of Melissa Hines who looked at girls with disorders/differences of sexual development. They tended to show toy preferences aligned with “boy” choices but she concludes this was because they were less responsive to social cues directing them to “girl” toys.

Brain Structures

There is research looking at whether “transgender” individuals have brain structure more aligned to the opposite sex, with which they identify, or their natal sex. The criticism of these studies, that I have encountered ranges from small sample sizes ; failure to control for homosexuality; failure to consider the impact of opposite sex hormones and failure to account for neuro-plasticity. Wren concludes that the picture is uncertain.

Wren concludes that the explanations are likely to be multi-factorial, possibly a genetic predisposition, an interaction between social and biological factors and the role of culture; whether an individual lives in a society that encourages or suppresses atypical “gender identities”.

Wren also points out that if a biological maker were identified that may limit treatment for those who do not have that marker. That’s quite the statement. What it means is that Wren is happy for people to be medicalised even if it is discovered that they do not have the condition! She justifies this by reference to bodily autonomy and Human Rights.

Reproduction

There are a lot of “ifs” in this next statement. I guess when you have presided over the sterilisation of children you believe what you need to so you can sleep at night.

In the next bit Wren postulates that gender non-conformity in “cis-gendered” people may be an attractive feature signalling genetic superiority and this somehow leads to the idea that we may replicate gender diversity for some sort of evolutionary advantage. This, to me, feels like clutching at straws.

Cultural Evolution

Leaving evolutionary biology, Wren moves on to cultural evolution. This is the idea that these things can be “culturally transmitted” which, to me, seems dangerously close to the idea it is a social contagious.

She further reflects on how this might impact, in particular, adolescents for whom “there may be complex social forces shaping the formation of an atypical gender identity”.these social forces, she continues may be: 👇

In other words all the features of a typical adolescence that few people escape.

By jove she’s close to getting it!

But, not quite. She speculates on the interconnected ness of this generation and the speed of the transmission of ideas and how our youth are “a generation who are , almost routinely, asking themselves if they might be “trans” or differently gendered to explain their feelings their bodily alienation and discomfort and they are resistant to cultural norms for male and female behaviour and heteronormative sexuality”

Because of the above some people, she concludes, will feel they are “a better fit for another gender or indeed to attempt to be a different sex” . So, not to challenge societal norms at all, just take drugs and surgeries to better fit with the sexist stereotypes associated with the societally enforced, norms of behaviour you are putatively rebelling against!

Her conclusion.

Is it me or does she look haunted as she finishes with this statement?

Questions

There are questions about autism and how an inability to read social cues might lead to feeling of gender dysphoria. Wren answers this with reference to how their autism and their emerging gender identity may play a role. I don’t know the intention of the questioner but, to me, the concern is that autistic girls, and boys, may latch onto “Gender Dysphoria” as a more palatable explanation for not fitting in.

Another man asks a question which relates to cultural issues giving rise to “Gender Dysphoria” . This question very nearly hits the mark.

Wren thinks it is a very good question about “whether there are aspects of our culture that are amplifying gender dysphoria” and furthermore, in respect of the dramatic increase in numbers “as a service we are really on the backfoot in relation to these numbers” . She admits there are issues around the question of the high number of females referred to the Tavistock. She conceded that the pathways to the clinic may be very different for “people born into female bodies” ! Of course there are!

The next question centres on future directions for research. Wren can’t resist a side swipe at the Daily Mail who, she says, would have you believe the “trans lobby is very powerful” . Research, she answers, is very much focussed on the brain as preferred by “trans” people who see it as a route to validation. She talks about a focus on the suffering of those with “gender dysphoria” and whether the problem is an individual problem or societies for a lack of acceptance. (It does not seem to occur to her that if we tolerated behaviours that don’t match sexist expectation, for your sex, we could work to transform society instead of putting children/adolescents on a path requiring drugs and surgeries). She herself does not have a preferred area of research but does state that the Tavistock have just obtained a very large grant to track the people that have been through their service, for long term follow up for ten, twenty or thirty years. (Which is interesting because the Tavistock have previously claimed that is too difficult because people have changed their NHS numbers). Here was her answer.

The final question asked if a biological, or other cause is found and a treatment to resolve Gender Dysphoria (absent drugs and surgeries, I assume he means) would it be ethical to take this route? Wren answers with stories of people who reconciled to their sex after having been, initially, certain about their gender identity. She is careful to say they would not practice “Conversion Therapy” but if the young person was willing they would work, therapeutically with that person. This sounds as if a young person was so certain and would not co-operate then they would not get the chance to reconcile their sex /sexuality.

My conclusion.

Looks like we have our answer about which way the service is heading.

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