First do no harm

Every social order creates those character forms which it needs for its own preservation … 

The character structure … is the crystallization of the sociological process of a given epoch. (Wilhelm Reich)

What I have to say will be divided into three sections. In the first, I will elaborate on what I have learnt about the healthcare of children suffering from gender dysphoria, focusing on the serious clinical and ethical concerns that I, like many others who have become involved in this field of work, have come to recognise. I will go on to discuss the socio-cultural factors that may be relevant to understanding the sudden huge increase in children and adolescents being referred to specialist centres. Finally, I will examine some of the characteristics of a peculiar form of thinking or, more precisely, non-thinking, that seems to have come to dominate the discourse in this area.

The understanding/knowledge that I have been developing comes from a number of sources, including my engagement with colleagues in the UK, other European countries (particularly Sweden), Australia and the USA.

First, I need to state an important rider – and the fact that I have to do so is symptomatic of the highly charged atmosphere in which discussions of this area take place, resulting in important and often highly motivated misunderstandings. Questions about the appropriateness of medical and surgical intervention, most particularly in children, need to be kept entirely distinct from questions of discrimination. I say this as there is pressure for these two matters to be elided, and I will return to this later. We are all appalled by the violent hatred that many trans people have to suffer and indeed we may have some psychoanalytic thoughts as to its sources. I also need to make it clear that I can see that for some individuals, medical transition is the only reasonable option.

Concerns regarding the understanding and treatment of trans children

It is vital to differentiate gender dysphoria from