David Pilgrim posts…
A dozen private detectives, working 24/7, would struggle to fathom everything that is happening and not happening inside the BPS. A case in point is the remarkable persistence of the role of transgender activism inside the Society. In the book emerging from our amateur sleuthing, coming out in the New Year (Pilgrim, 2023a), we devote chapters to two symptoms of the underlying malaise of misgovernance, both of which implicate child protection. One deals with the distortions of risk appraisal in the extant official BPS advice on memory and the law and the other is the flawed, and in my view dangerous, Guidelines for Psychologists Working with Gender, Sexuality and Relationships (BPS, 2019)(GSRD).
We have campaigned, without success, to have this removed it its entirety, in the interests of child protection and to minimise the reputational damage to psychological practitioners. It is a scandal that the guidelines have not been withdrawn. Those purportedly revising the document seem to be more or less the same working group, but now minus several people who refused to be part of the review, some of whom – after complaining – have had their names removed from the 2019 document – Plus ça change, plus c’est la même chose.
While the UK health policy world is moving on apace in the wake of the Cass Review on paediatric transition and the closure of the Tavistock GIDS Clinic, with its ‘affirmative’ service ideology, it feels for now as though the BPS is simply carrying on regardless, with its old ‘trans-captured’ ways (cf. NHS England, 2022). The advice it has given recently to the Scottish government is a case in point.
Another indication of business as usual about a trans-captured organisation has related to the Society’s ‘Diversity and Inclusion’ manager (‘Equality’ has been disappeared as a prefix by ‘the BPS’, in its unending virtue signalling on steroids (cf. Ben Michaels, 2006).). That newly appointed manager operated in an ultra vires role in 2021, as the secretary for the ‘MOU Coalition Against Conversion Therapy’. So we have had a full time Society employee, paid from membership fees, at the centre of a transgender activist political campaign.
This raises a fundamental question about the probity and legitimacy of an organisation still registered, precariously, as a charity and claiming, more and more implausibly, to be a learned body. In the rush to curry favour with an imagined customer base, many organisations are happy to accept, unthinkingly, the challengeable rhetorical claims of transgender activism. The BPS is not alone in this regard; indeed it is probably typical today, as many universities and medical colleges go down the same self-righteous route. However, where there is power there is resistance, and a fight back by gender critical professionals is also underway. More on this now after a brief historical and sociological note for context.
‘The past is a foreign country: they do things differently there’ (Hartley, 1953: first line)
In the late 1960s and early 1970s, some British psychologists and psychiatrists worked together to deploy aversive conditioning techniques (‘anticipatory avoidance’) to try to alter the conduct of gay people. Electrical or less often, chemical, aversive stimuli were used within the broader orthodoxy of applied methodological behaviourism of the time. This was led by the clinical psychologist Hans Eysenck and the psychiatrist Isaac Marks from the Institute of Psychiatry in London, both doyens of the behaviour therapy movement. They encountered angry criticism at the time from an increasingly confident New Social Movement of gay activists (Pilgrim 2023b).
In parallel to the Eysenck-Marks defence of enforcing heteronormativity for the good of the patient, another and more researched and published project occurred between Birmingham and Manchester, led by a clinical psychologist Maurice Feldman and a psychiatrist Malcolm McCulloch. Their work is on the record in reputable journals and books for all to read (e.g. Feldman and McCulloch, 1968, 1971).
By the end of the 1970s aversion therapy for homosexuals petered out and its own early advocates recanted their position. Gay Liberation was in its heyday and homosexuality had been dropped from the Diagnostic and Statistical Manual of the American Psychiatric Association. In any case, aversion therapy simply created distressed homosexual patients, who remained same-sex attracted. Aversion therapy for homosexuality failed on empirical grounds. Moreover, it was now at odds with a successful de-medicalisation shift in societal norms in North America and Western Europe though, note, by no means globally. This controversy was emphatically about aversion therapy (not ‘conversion therapy’) and it was targeted on gay people. Transgender patients were missing from the picture.
However, after 1980, the postmodern turn (everything was now to be about narratives and discourses, not material reality), Queer Theory and third wave feminism began to coalesce to afford a celebration of diverse identities (Butler, 1999; cf. Oakley, 1972; Watkins, 2018). How people saw themselves (subjectively) and wanted others to recognise them (inter-subjectively) now was to become as important as their transgressive actions, as was homosexual activity in past times. By the turn of this century, the grounds for particular forms of special pleading, within expansive identity politics, were becoming slippery to the grasp for many. What about paedosexuality or incels or those ‘into’ BDSM or kink? Should they be embraced in a spirit of unending inclusiveness? That question is pertinent for any reader of the current BPS Guidelines.
Mirroring those changes, ‘sex’ was displaced by ‘gender’ in social, though not biological, research (Haig, 2004). Neologisms like ‘cis’ and ‘misgendering’ created much head-scratching in ordinary people, who were losing confidence in being able to express their common sense perception of others. This culture shock and perplexity about transgender politics is explored at some length in the ten episode series from ‘Nolan Investigates’ (BBC Northern Ireland, October 2021, available on BBC Sounds). This series challenges the legitimacy of public bodies, including the BBC itself, of being coached and appraised by Stonewall about their take on transgender politics.
In the past few years, ‘gay’ and ‘transgender’ became, for many organisations such as Stonewall and those it coached and appraised, the same amalgam target of oppressive norms in society. Hetero-activism, homophobia and transphobia were alloyed as one. The personal bigotry of ‘cis’ and heterosexual people, not the reversal of structural inequalities, became the salient priority to attack. This was reflected in the campaigning of the ever-elastic LGBTQ+ ideological formation, which hid a major contradiction. If we bracket the connecting glue of gender non-conformity, then we find that sexuality and gender identity are orthogonal; they are not the same either conceptually or in practice. Unfortunately, they have been lumped together in the BPS GSRD Guidelines.
Gay people are sexually attracted to those of their own biological sex; this is about sexual desire and preferred forms of intimacy and sometimes sub-cultural habits. By contrast, transgender people may see themselves as straight, gay, bisexual or even a-sexual. Moreover, even the connecting glue of gender non-conformity is open to question. For example, many transgender people do not challenge gender conformity at all; they actually affirm and reinforce conservative gender stereotypes as they alter their bodies and clothing in line with the latter. Also, some gay men and lesbians are not manifestly gender non-conforming in their dress and demeanour. The glue eventually became weak and hence the split from Stonewall of the LGB Alliance; the transgender contention was the catalyst but the lack of clear grounds for ally-ship had been around since the 1970s.
And then there has been the tricky problem for that ally-ship of the ontological, not epistemological or normative, aspect of sex itself (Hull, 2008). Within the transgender activism world, boys and girls with respective immutable XY and XX chromosomes are no longer described validly at birth but, instead, their identity is only provisionally ‘assigned’. Our gender identity has now been reified as a purely subjective matter of choice and a newly sacralised human right, as part of the norms of recent identity politics. The ontology of sex has been ignored or scorned as a political irrelevance.
The objective over-determination of being a man or a woman by materiality (i.e. our chromosomes and being raised in a supra-personal socio-economic regime of patriarchy) have been backgrounded, or simply denied with contempt, and replaced by a kaleidoscope of self-identifications (Pilgrim, 2022). Many gay men and lesbians today know that as children, they could have been shepherded, under the pressure of recent transgender activist demands, into a different and problematic bodily state. Some of them knowing this are concerned for the fate of gay children today. The LGB Alliance now make this point very clearly.
The red herring of intersex is invoked sometimes by transgender activists to demonstrate that ‘sex is a spectrum’. Apart from the fact the 99.99% of us, like all mammals, are sexually dimorphic, even those people who are born intersex still have fixed genetic material. Our genes are immutable. We are not born in the ‘wrong body’, just one that we may or may not come to like. ‘Wrong’ is a human judgement not a biological fact.
The University of Birmingham Report on ‘Conversion Therapy’
What has all the above to do with the BPS? The answer lies in the opening to the recent report (June 2022, available online) conducted by staff members of the University of Birmingham, on behalf of their employers. The title of it is pertinent as a headline message: Conversion Therapy’ and the University of Birmingham, c.1966-1983. This is what it says, in the first paragraph of the executive summary quoted in full:
“The University of Birmingham agrees wholeheartedly with the British Psychological Society and the Royal College of Psychiatry (sic) and numerous other organisations and professional bodies, which state that there is no moral or ethical support for activities aimed at changing sexual orientation or gender identity (often called ‘conversion therapy’). The Memorandum of Understanding on Conversion Therapy in the United Kingdom is endorsed by 26 prominent health and therapy organisations, including NHS England and NHS Scotland. Crucially, there is no robust scientific evidence to support the use of ‘conversion therapy’. This report places that term in inverted commas, precisely because these interventions have no form of therapeutic value. Efforts to suppress same-sex desire or enforce conformity to social expectations of gender do not ‘work’ as intended; in fact there is substantial evidence that shows how harmful it is.”
As with so much going on in the diversionary world of identity politics, this statement has more than a kernel of validity. However, at no point is there any self-reflection from Birmingham on the historical context of current controversies, which leads to a partial (in both senses of the word) account.
This accusation here may seem odd about a report, which is explicitly about history and for the most part is a very good summary of what happened in the 1970s. However, turning what could have been a relatively simple look back at the work of an ex-staff member (Feldman) from fifty years ago, into a political platform for current rhetoric about transgender politics, suggests a virtue signalling exercise with instrumental value for the university ‘brand’. The facts of the central role of a single staff member were known forty years ago. A critical review of his work could have been carried out there and then. So why now and why in this form?
It is not a journal submission or commissioned piece of work by outside historians of British psychology. Instead, it has emerged from within the identity politics zeitgeist now shaping the academy and its public statements (such as UCL’s recent decisions about Galton and Pearson, or Sheffield’s about Darwin). The report is driven by current political decision-making and posturing from university managers in response to consumer pressure from below. The sequencing of sections of the document confirms this point.
First, there is a dramatic health warning about people who might be currently affected by the content of the report (see point 3 below). Second, there is a mea culpa statement from the university’s Vice Chancellor. Third, the report itself is offered, which ipso facto is not about current anxieties but the fifty year-old research of Feldman and McCulloch. In light of this character of the report’s own historical context, the following points are relevant to compensate for that lack of self-reflection, from those producing it and endorsing it uncritically:
1 Past scandals and current risks. The current term of ‘conversion therapy’ is projected backwards onto history. The behaviour therapists used the term aversion therapy and they were focused explicitly on homosexual orientation, not transgender people and their existential confusion. All mental health interventions, inter alia, are about rule enforcement according to the contemporary ’emotion rules’ of a situated culture in time and space, whether that is done with voluntary or coerced patients (Thoits, 1985; Bean, 1986). The behaviour therapists were enforcing rules of heteronormativity in the genuine belief that this was in the patient’s interests in order to ease their social acceptance and personal angst or guilt about being gay. At that time, with male homosexuality only recently legalised (and even then with a lack of equality about age of consent), being gay was still seen as problematic by many people, including some gay people themselves. Cultural norms typically lag behind legal changes; look today at the presence of casual racism, despite the existence of the Race Relations Act.
2 Professional therapy and religious fundamentalism. Conversion practices (not therapy in any reasonable sense) in relation to gay people have remained associated with some conservative Christian groups, not with professional psychological therapy. The paragraph cited from the executive summary quite correctly identifies that professional therapy and counselling organisations today have no truck with aversion therapy. It has been dead in the water since 1980. Given this fact, where is the evidence today in the UK that, outside of a few fundamentalist religious organisations, there is any such thing as ‘conversion therapy’? The truth is that there is none. However, there is evidence that many mental health workers defend exploratory psychological therapy with clients and the need for revisable co-constructed formulations that develop over time.
Those insisting on ‘affirmative’ clinical practice, conveniently reframe this orthodox stance, of supportive cautious waiting and personal exploration, darkly as ‘conversion therapy’. We now find that purported prevalent risk of ‘conversion therapy’ as being weaponised against a cautious wait-and-see approach to existential confusion in unhappy young people. For the transgender activist, the exploratory therapist of today, with their ‘first do no harm’ caution, becomes the very same demon as the aversion therapist, circa 1970.
3 Instrumental vagueness. What exactly was this report trying to achieve? A reader of it is not at first clear or, if they have a critical imagination, they realise that it is open to different interpretations. Despite the fact that aversion therapy from the past no longer exists, which is confirmed by the substance of the report itself, suddenly the ominous term ‘conversion therapy’ crops up, as if it is a grave and immediate danger to many people right now. No evidence provided of this implication or assumption. It is implied strongly in the report because of the yoking of sexual orientation and gender identity (see point 4 below). Indeed, it is considered to be so important that the report’s first page has this dramatic warning sticker, from the outset intimating the grave conclusion of a report which remember has, as its alleged focus, the past not the present. Note the blurring of the past and present, from point 1 above, and the unwarranted privileging of gender identity below, given the time period supposedly under focus:
“ Note: this report deals with activities aimed at changing gender identity and sexual orientation. It discusses psychological ‘treatments’ used in the past in sometimes graphic detail. Readers affected by this material may wish to make use of this dedicated resource: National Conversion Therapy Helpline If you are currently experiencing abuse aimed at changing, altering, or ‘curing’ your LGBT+ identity, or think this will happen to you if you come out, Galop’s Conversion Therapy Helpline is here for you. So-called conversion therapy can have a long-term impact on LGBT+ people. If this has happened to you in the past and you are still struggling with it, you can reach out to Galop’s support services. The helpline can provide a safe, confidential listening and information service to any LGBT+ person aged 13+. There are different ways to contact us. All of them are free: Phone 0800 1303335 Email CThelp@galop.org.uk The helpline is open: Monday to Friday 10am – 4pm Calls will last 40 minutes.”
Instrumental vagueness characterises the report in a range of ways cuing the next point about terminology.
4 The semantic trickery of eliding sexual orientation and gender identity. The compound phrase of ‘gender identity and/or sexual orientation’ is now de rigueur in public documents, when and if sex, gender and sexuality are being considered. In this report, we have the example in the warning sticker of: “changing gender identity or sexual orientation (often called ‘conversion therapy’)”. What used to be about sexual orientation, specifically, has now become an amalgam that routinely includes gender identity. This change came with the revision of the Memorandum of Understanding (MoU) about ‘conversion therapy’ after 2015 by transgender activists from the BPS, Pink Therapy and other therapy organisations. In 2015, the MoU only alluded to sexual orientation but three years later the document was modified, with the repeated and insistent addition of ‘gender identity’ at every opportunity. Dissenters supporting the older focused defence on gay rights, left the working group, when their cautions were rejected out of hand. Accordingly, groups like Thoughtful Therapists and Gender Critical Clinicians have emerged in response to transgender activist capture in their field of interest. In large part, these gender critical campaigning groups are responding to that capture, cueing the next point.
5 Transgender activist entryism. Transgender activists have been assiduous and very effective in entering policy making groups to ensure that sexual orientation is no longer the sole focus of sinister therapeutic intent, even though it is a ghost from the past. The linking of past empirically discredited practices about sexual minorities, who are now tolerated or celebrated (depending on one’s value system), with transgender phenomena, mixes apples and oranges. Homosexual orientation is about same sex desire, whereas transgender phenomena are very wide ranging. They include a minority who, like gay people after 1970, now want to completely de-medicalise their existential state and others, who want free and ready access to biomedical transition (drugs and surgery) with many steps in between. They include children and adults. They include a-sexual individuals, ‘trans-lesbians’, ‘a woman with a penis’ and autogynephiles, in various states of medically-induced body modification. Even the defining notion of ‘gender dysphoria’ moves in and out of relevance, for this mix of people with their varying demands. The ‘trans community’ is not of one voice, even if transgender activists tend to pursue a narrow policy of bio-medicalisation on demand. They decry anyone questioning that, quite reasonably, as being automatically a ‘transphobe’, or a ‘TERF’, or more modestly ‘anti-trans’ in academic discourse. The distinction between legitimate ethical debate or evidence consideration about transgender healthcare and hostility or bigotry against transgender individuals is collapsed. Moreover, the remaining and unresolved tension between second and third wave feminism is simply ignored, when it remains an important point of historical reference.
6 LGBTQ+ or LGB? Gay people in the 1970s recognised that they were objectively men and women, simply described, whereas Queer Theory since then has made it all about language and subjectivity. Gay people in the 1970s, as today, just wanted to be left alone to be full citizens, whereas the demands from such a variegated transgender community now are difficult at times to pin down. Some of it is about being left alone. Some of it is socially performative. Some of it is about intruding into women-only spaces, like prisons and shelters, as well as female sports, with impunity. Within this contestation about transgender politics, which should be opened up to full democratic debate, we find that orthodox exploratory psychological therapy has now been given precisely the same ethically-unworthy status, by activists, as aversion therapy was in the 1970s. This is a deliberate strategic mystification, which has shaped the position of many managers and academics alike in recent times (who may or may not have insight into transgender activist strategizing and tactics). The half-baked report from the University of Birmingham is an example of this point.
What’s in a word?
What then exactly is ‘conversion therapy’ as currently used? The definitional approach of mixing aversion therapy from the past and religious conversion practices since the 1970s, along with the discursive elision of sexuality and gender identity, is reflected in the Wikipedia entry on the topic, which is described as ‘pseudoscientific’. To confuse matters, searching ‘medical views’, linked to this entry, leads to a very strong focus on homosexuality, not gender identity. An outlier was the emergence of the National Association for Research & Therapy for Homosexuality in the USA, which contained socially conservative therapists with religious affiliations, promoting what has also been called ‘reparative therapy’.
Whereas the behaviour therapists were rule enforcers of heteronormativity, some psychoanalysts continued to contend that homosexuality represented a perversion of psychosexual development, even if their therapeutic stance was not prescriptive. It is true then that psychological models do indeed reflect social norms and norms are open to legitimate challenge, as Gay Liberation demonstrated successfully. The question now is whether the vaguer expectations of such a diverse ‘trans community’ can be considered in the same way, logically or politically.
Gay people being left alone to get on with their lives is not the same as the campaigns to have hormones and surgeries on demand, including for children, with wise clinical caution being confused with oppression and bigotry. One indicates a preference for de-medicalisation (the rejection of aversion therapy and a diagnosis of morbidity) and the other the very opposite (demands for a diagnosis of gender dysphoria as an immediate gateway into life-long bio-medicalisation). The expressed need for the first group focuses on citizenship, whereas for the second it is about patient-hood on demand, in the absence of physical pathology. These scenarios are like chalk and cheese.
The warning sticker on the Birmingham report above exemplifies the semantic problem of not dealing with actual or perceived threats from psychological therapists, as in the use of this type of phrase: ‘…..often called “conversion therapy”’. But who is doing the calling and on what grounds? This important question is not explored; ‘conversion therapy’ is simply taken for granted as a ‘bad thing’. However, neither its conceptual validity nor its empirical validity are considered properly. Like the words ‘transphobe’ or ‘TERF’, ‘conversion therapy’ is now a slur requiring no justification. This matters ethically and politically, if aversion therapy and exploratory psychological therapy, promoted by most formulation-based models within professional orthodoxy today, are being casually conflated.
That casual conflation is then a tactical position adopted by transgender captured groups, such as those producing the BPS GSRD Guidelines ; it is all about challenging and defeating those who problematize the bio-medicalisation of unhappy children. The BPS affiliated and staffed MOU Coalition Against Conversion Therapy is a practical expression of the document’s campaigning intent. Moreover, the celebration in the document of BDSM and calling women ‘sluts’ just adds to the heart-sink of reading this prescriptive libertine manifesto, dressed up as professional guidance. For anyone new to this document, they will find no proper literature review and no rehearsal of contention or debate in the field, but instead a long ‘thou shalt’ approach to ‘affirmation’ throughout. The ‘no debate’ position of campaigning is replicated dutifully in the document. This then is not professional guidance from a position of equipoise and careful deliberation, but a manifesto from a group of political activists.
The focus on children by those activists (not on adult transsexuals pursuing biomedical transition) is the very reason that we have identified a serious child protection concern inside the BPS, and we will continue to do so. Yoking aversion therapy from the past, with legitimate and ethically defensible practices in exploratory psychological therapy today, is wrong-headed if it is an honest mistake, and unconscionable, if it being done deliberately by some people in authority. To explore is not to convert. Some who have tried to defend this ethically defensible wait-and-see position in practice, such as the Canadian clinical psychologist Ken Zucker, have been punished. His service was closed down by his employers as a result of transgender activist lobbying and he is now held up as their bête noire, despite his mainstream opinions in the therapy world about best practice (Zucker et al. 2012). He was eventually completely vindicated, via the courts, and his ex-employers had to settle financially in reparation for his wrongful dismissal. However, he remains a target of transgender activist hostility for what he symbolised.
Moreover, arguably the real conversion therapy is to take healthy young bodies and sterilise them with hormones and surgeries (Butler and Hutchinson 2020; Brunskell-Evans and Moore, 2018). This accruing iatrogenic harm means that patients will be angry and feel betrayed by service providers from their past. This reminds us of the serious ethical questions surrounding paediatric transitioning, encouraged by the affirmative approach – note still endorsed by the BPS (Steensma et al., 2017). Here, for example, is an account from a FtM de-transitioner, now in chronic distress in 2019 in a conference in Manchester on the topic:
“It doesn’t make any sense to me why this is called ‘transition’ or a ‘sex change’ because it’s not, it’s castration. And now that I am trying to care for my health as much as possible I spend a lot of time on hysterectomy support sites and message boards for women. For women, because only women get hysterectomies and only women deal with the consequences of a hysterectomy. So, excuse me but what the hell are surgeons doing calling this ‘gender reassignment’ or ‘gender affirming health care’? ( ‘Livia’. Detransition: The Elephant in the Room. Make More Noise (Available from: https://08e98b5f-7b7a-40c9-a93b-8195d9b9a854.filesusr.com/ugd/305c8f_34b673d3097c4df88bf9b9e8f6ed1006.pdf?index=true)”
These sorts of accounts from distressed patients, in the wake of an ‘affirmative’ service ideology which is proposed by the BPS still as a progressive alternative to ‘conversion therapy’, graphically expose why we need to reflect on what we mean, exactly, by the term. These angry victims of bio-medicalisation are queuing up at the doors of medical negligence lawyers today. An irony, which will be recorded historically, is that such a medical scandal has been led not by medical practitioners but by psychologists.
If counselling or clinical psychologists are caught up in this legal reckoning, because of their compliance with an affirmative service ideology, what advice was given to them in the recent past by the BPS and what will it give now? After complaints about the gender guidelines were made, the BPS did not withdraw them (the wise option, for a period of deliberation). Instead the BPS indicated that they were not intended to apply to those under the age of 18. However, the document (which remains on the BPS website) on page 12 still says this, contradicting that claim (and note its heavy biomedical emphasis):
“Psychologists working with GSRD youth should be aware that reproductive options and considerations may be more complex than with their heterosexual or cisgender peers. Assistive reproductive options may be needed and should be discussed openly and frankly, perhaps especially in the case of trans youth who are seeking treatments which will remove reproductive options at an age below that which people commonly consider becoming a parent”
This is a clear indication that the transgender activists driving the production of the BPS Guidelines had a view about an age cohort which cannot consent to sex or a piercing or buy alcohol. Those children are still being encouraged to enter a bio-medicalised lifelong process in the name of social justice and presumed mental health gain. Their wellbeing is being jeopardised and in some cases egregiously sacrificed at an altar of ideology.
Our political action to expose the secretive world of the BPS has quite properly focused on poor governance in general. It did not start with single issue politics in civil society, such as the many now linked to identity politics. However, child protection has come up for us in the two ways I noted at the outset.
In this piece, I have drawn out the contradictions inherent to the politics of gender identity. The Cass Review confirmed that we were correct to open up for scrutiny those mental health professionals, who defend exploratory psychological therapy for the good reason to protect children, on the one hand, and, on the other, the libertine transgender activists, who have captured the policy process for now, in the BPS and elsewhere..
The gaps of understanding between the Cass Review and the one cited from the University of Birmingham are worth exploring. Both reports should be read by anyone new to the topic who wants to demystify some of what has been going on inside the BPS. To finish on a repetition: the contention about the GSRD guidelines is a symptom of a deeper problem of poor governance in the Society. As a consequence the welfare of children continues to be put at risk from what is purported to be professional guidance.
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