Two things can be true at the same time, Mr Jones!

Being caught up in the gender wars is no fun and I have become increasingly tired of people tagging me into the many ridiculous debates about whether or not sex is binary, bimodal, a spectrum or possibly doesn’t even exist at all.  However, I didn’t wade into this debate to argue endlessly about the nature of sex and reproductive development – my aim was always to highlight the similarities between the current discussions of how best to support children with gender dysphoria, and the way that children born with variations of sex development were treated a generation ago.  How the ‘born in the wrong body’ narrative has been used to describe both groups of children – and how the ideological belief that emotional distress is best managed by medical and surgical interventions, has been prioritised over open discussion of the evidence. 

The longer I have been involved in this debate, the more it has come to remind me of one big mess of emotional dysregulation – and at the heart of this, seems to lie the belief that two things can’t be true at the same time.  This has most recently been highlighted by the response of Owen Jones to a mother’s concerns about her child’s gender dysphoria, being treated with medical & surgical interventions. 

There seems to be no willingness to listen or to try and understand where someone may be coming from.  Instead the most extreme stance is taken, which only leads to an increasingly polarised debate where you are “either with us, or against us”.  This helps no-one, especially children and young people experiencing gender dysphoria.  It made me think that maybe this whole debate needs a little bit of Dialectical Behavioural Therapy (DBT).

‘Dialectical’ means trying to understand how two ideas that initially seem to be opposing, can be true at the same time – and when considered together can create a new truth.  It should be possible to honour the truth on both sides of a conflict – and this does not mean you need to give up your values, but the world is not black and white and there is always more than one way to view a situation. 

Dialectics of the gender wars

Is this a rabbit or a duck?  Whilst the Owens of the world may be screaming Rabbit – many others will be screaming Duck.  But can this be both a rabbit and a duck?

In a similar way, is it possible for a caring and supportive parent, to want trans people to live without stigma or discrimination, whilst also having concerns that medical and surgical interventions are not the best way to support their child, who is experiencing distress about their gender?

Is it possible for people who genuinely want the best outcome for children and young people experiencing gender dysphoria, to also want open discussion of the evidence and ethical considerations? Does rebranding this as ‘anti-trans’, show a very concrete way of viewing the world and thinking about child development?

In all other areas of paediatrics and child mental health, debates are common. For example, the evidence and ethical considerations of using stimulants for ADHD or SSRIs for depression, are frequently and rigorously discussed. Being critical of their use, does not mean you are a bigot who is ‘phobic’ of children with ADHD or depression. Could it mean that you are not convinced by the evidence, which is often limited in many areas of paediatrics, due to the ethical issues associated with research involving children?  I am in favour of the use of both, but only following careful assessment and discussion of risks and benefits – and I encourage open debate and regular reflection on all treatments offered to young people.

The Owens of this world may believe that the only way to support a child with dysphoria, is for medical and surgical interventions to be easily accessible.  Whilst on the other side, many believe that no medical or surgical interventions should be available and that psychological interventions should be prioritised.  Is it possible that even with seemingly opposite views, both groups are wanting the best outcome for children and young people – and that the truth lies somewhere in the middle?

Maybe the most compassionate and thoughtful approach, would be to prioritise careful assessment, evidence based care and psychological curiosity, whilst acknowledging that for some young people, medical interventions may be in their best interests.  However, as with all other presentations to child mental health services, recognising that gender dysphoria is likely to be influenced by biological, psychological and social factors and that not everyone will benefit from a medicalised path, is also vital.  Both of these statements, although they initially appear to be opposing, can be true at the same time.

Is it also possible to see affirming or validating in a more nuanced way? This should not mean that we need to agree with everything a young person thinks or feels about themselves, but instead, it means that we should try to understand where they are coming from. 

If we really want the best outcome for children and young people – maybe we should all be trying just a little bit harder to understand where people are coming from. Including Mr Jones.

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