He’s cham­pi­oned trans­gen­der rights for years. But when this ex­pert asked ques­tions about whether young peo­ple chang­ing sex might later re­gret it, he was plunged into a Kafkaesque night­mare

Scottish Daily Mail - - News - by Re­becca Hardy

‘Dis­cus­sion is be­ing sup­pressed by a small but vo­cal mi­nor­ity’

‘Peo­ple are afraid to say what they think’

NO ONE could ac­cuse psy­chother­a­pist James Caspian of be­ing a bigot or prej­u­diced against trans­gen­der peo­ple. His LGBT — that’s les­bian, gay, bi­sex­ual and trans­gen­der — cre­den­tials are im­pec­ca­ble.

For this slight, mea­sured, gay man is not only a trustee of the trans­gen­der char­ity The Beau­mont Trust, but he has ded­i­cated more than a decade of his life to coun­selling hun­dreds of pa­tients who wish to change their gen­der.

He pub­lishes aca­demic pa­pers on the sub­ject, con­trib­utes to books and ad­dresses some of the finest minds in the health pro­fes­sions at con­fer­ences around the world — and has done ex­ten­sive work train­ing fel­low psy­chother­a­pists on trans­gen­der aware­ness.

If there was ever an ex­pert in this field, James, 58, is it. But lately James has had a gut­ful of the in­creas­ingly frus­trat­ing pol­i­tics sur­round­ing the trans lobby, af­ter a study he wanted to carry out into trans­gen­der peo­ple was blocked by Bath Spa Univer­sity for be­ing ‘po­lit­i­cally in­cor­rect’.

The na­ture of his re­search? To ask ques­tions about the in­creas­ing num­bers of peo­ple who were chang­ing gen­der and sub­se­quently re­gret­ting it. ‘I’m not anti­trans. I’ve helped hun­dreds of peo­ple while they were tran­si­tion­ing, but when I started to do pre­lim­i­nary re­search I was taken aback by what I dis­cov­ered,’ he says. ‘It wasn’t so much that there seemed to be in­creas­ing num­bers of younger peo­ple, par­tic­u­larly fe­males, tran­si­tion­ing, but that there were so many of them who seemed to be later re­vers­ing the tran­si­tion.

‘Some of those young women were say­ing they felt they’d made a mis­take, but had been in­flu­enced by a kind of so­cial move­ment ramped up by the in­ter­net.

‘When I talked to col­leagues about what I was find­ing, one said: “I didn’t think we were sup­posed to talk about that. ”Dis­cus­sion is be­ing sup­pressed by a small, but vo­cal, mi­nor­ity in the LGBT com­mu­nity who seem to have an agenda to push the bound­aries of trans rights what­ever the cost. It is why this re­search was im­por­tant.

‘I think we’ve ar­rived at a point as a so­ci­ety where peo­ple are afraid to say what they think, and that’s not a good thing in my field.’

James is not alone in his con­cerns. Since go­ing pub­lic with an in­ter­view on Ra­dio 4 last month about the dis­turb­ing cen­sor­ship of de­bate on gen­der iden­tity, he says he has been in­un­dated with mes­sages of sup­port.

One mes­sage from a trans wo­man reads: ‘I know many peo­ple, in­clud­ing my­self, who fully sup­port your re­search and it was so heart­en­ing to hear you speak on such an im­por­tant con­tem­po­rary sub­ject. Young peo­ple need to un­der­stand what a huge step this is to take. Let’s hope the univer­sity sees some sense. I send you very best wishes.’

Com­mon sense, how­ever, seems to have flown out of the win­dow in this par­tic­u­lar arena. James is keen to point out that he cares deeply about trans­gen­der peo­ple, but says he also wor­ries about im­pres­sion­able young­sters who could be rush­ing into de­ci­sions and re­gret­ting them later.

‘I want to be com­pletely clear. I don’t think there’s any­thing wrong with peo­ple ex­plor­ing gen­der iden­ti­ties,’ he says.

‘How­ever, some peo­ple are hav­ing med­i­cal treat­ment and surg­eries they are com­ing to re­gret. When peo­ple talk about young peo­ple tran­si­tion­ing, per­haps they don’t quite un­der­stand what a huge thing it is to do.

‘It in­volves treat­ments that can be im­pos­si­ble to re­verse, such as hys­terec­tomies, mas­tec­tomies and gen­i­tal surgery.

‘You need hor­mones for life. You change ev­ery­thing — the pi­tu­itary gland, the brain, ev­ery­thing — and there is al­ways a risk of side ef­fects.

‘For in­stance, the hor­mone testos­terone can in­crease red blood cells so there’s a higher risk of heart at­tack and strokes.’

He chooses his words care­fully. He fears he has to be cau­tious about what he says for fear of be­ing ‘slaugh­tered’ by the vo­cal mi­nor­ity.

Fear seems to de­fine the de­bate sur­round­ing trans rights, he says. Chal­lenge the ex­trem­ists and you’ll be ac­cused of be­ing trans­pho­bic — prej­u­diced against trans­gen­der peo­ple.

It seems al­most ab­surd James should find him­self in this po­si­tion, as he’s one of Bri­tain’s fore­most trans­gen­der ex­perts.

Af­ter grad­u­at­ing from the Univer­sity of West­min­ster with a de­gree in Chi­nese, he de­cided he wanted to be a psy­chother­a­pist and did a post­grad­u­ate ad­vanced di­ploma at the Na­tional Col­lege of Hyp­no­sis and Psy­chother­apy.

He’d de­vel­oped an in­ter­est in trans­gen­der is­sues af­ter bas­ing his dis­ser­ta­tion on Chi­nese tran­sex­u­als, and was ap­proached in 2001 to be­come a trustee of the trans­gen­der char­ity, The Beau­mont Trust.

He’s also a mem­ber of the World Pro­fes­sional As­so­ci­a­tion for Trans­gen­der Health. Un­til the be­gin­ning of the year, he was a trustee of the of­fi­cial psy­chother­apy reg­u­la­tor, the UK Coun­cil for Psy­chother­apy.

He held the po­si­tion for two years, dur­ing which time he acted as a con­sul­tant to a work­ing group draw­ing up a ‘Mem­o­ran­dum of Un­der­stand­ing’ on trans­gen­der is­sues. This is an agree­ment between var­i­ous health pro­fes­sional, re­li­gious and LGBT groups on how to han­dle pa­tients.

The topic cov­ered was the highly emo­tive sub­ject of what’s called ‘con­ver­sion ther­apy’. This is the prac­tice of seek­ing to al­ter an in­di­vid­ual’s sex­ual ori­en­ta­tion or their wish to change gen­der through coun­selling.

The prac­tice dates back to the early 20th cen­tury, when ho­mo­sex­u­al­ity and trans­gen­derism were deemed dis­eases which could be treated.

Ev­ery­one in the work­ing group — in­clud­ing James — agreed con­ver­sion ther­apy should be banned.

James, how­ever, wanted the mem­o­ran­dum to specif­i­cally ac­cept that some peo­ple re­gret their tran­si­tion and that there are pa­tients who might have other un­der­ly­ing psy­cho­log­i­cal is­sues.

With­out spelling out th­ese ir­refutable facts, he feared health pro­fes­sion­als could be pre­vented from ex­plor­ing the po­ten­tially deeper rea­sons for a pa­tient say­ing they wanted to change sex.

The com­mit­tee, which in­cluded health pro­fes­sion­als and rep­re­sen­ta­tives from the out­spo­ken LGBTIQ (where ‘I’ stands for in­ter­sex and ‘Q’ for queer) group

‘There’s a fear you’ll be called trans­pho­bic’

‘Tran­si­tion­ing is seen as their panacea’

Pink Ther­apy and the As­so­ci­a­tion of Chris­tian Coun­sel­lors, even­tu­ally de­cided not to in­clude James’s rec­om­men­da­tions.

The Mem­o­ran­dum of Un­der­stand­ing will take ef­fect this month. Ef­fec­tively, it could pre­vent a ther­a­pist, when pre­sented with a per­son who wants to change sex, from ex­plor­ing any pos­si­ble ul­te­rior rea­son be­hind their de­ci­sion. This dis­turbs James greatly.

‘Any eth­i­cal ther­a­pist wouldn’t try to im­pose their view of how a client should be — but surely they should be able to ex­plore if gen­der iden­tity is truly the psy­cho­log­i­cal is­sue,’ he says.

‘We need a frame­work that al­lows ther­a­pists to freely ex­plore other un­der­ly­ing is­sues that may be present be­fore they start gen­der re­as­sign­ment treat­ment, with­out the fear of be­ing ac­cused of con­ver­sion ther­apy if they do so.

‘The Mem­o­ran­dum of Un­der­stand­ing is say­ing we must ac­cept what­ever gen­der iden­tity a client says they are with­out ques­tion.

‘I was one of the few peo­ple in­volved who un­der­stood tran­si­tion from a clin­i­cal per­spec­tive and was not a cam­paigner, so I had no axe to grind — just con­cern for the clients and the pro­fes­sion­als,’ he says. ‘When I looked at the ban on con­ver­sion ther­apy, I said, “If you’re not care­ful, you’re go­ing to make peo­ple think they can’t ever ques­tion what some­body com­ing to them is say­ing and that’s dan­ger­ous”.

‘Al­ready coun­sel­lors have con­tacted me to say they’re wor­ried that if a young client — say a 16year-old — comes to them with a num­ber of men­tal health is­sues or a his­tory of sex­ual abuse and says, “I want to tran­si­tion”, that it won’t be safe for them to say, “Well, let’s look at this sex­ual abuse you had. Could that have any­thing to do with the way you feel about your body?”, be­cause that could be con­strued as con­ver­sion ther­apy.

‘One psy­chother­a­pist who works with young peo­ple called me last night to say she is wor­ried this mem­o­ran­dum could sim­plify things to a scary de­gree.

‘She said: “If all I did was af­firm my pa­tients were trans with­out ex­plor­ing any men­tal health is­sues they might have, I don’t think I’d be able to help them prop­erly.”

‘Equally, peo­ple are afraid it might not be safe to work with some­one who wants to de­tran­si­tion, i.e. re­verse their sex change.

‘Let’s say a trans fe­male, who is no longer happy in their gen­der, goes to a coun­sel­lor to say they want to go back to liv­ing as a man. Could that coun­sel­lor be ac­cused of con­ver­sion ther­apy if they help them?

‘I kept ar­gu­ing for spe­cific word­ing to say, “We do ac­knowl­edge some peo­ple do re­gret their tran­si­tions and re­verse them, or change their minds.” But ev­ery time I tried to put that word­ing in it was re­jected.

‘There are lots of ac­tivists within the LGBT com­mu­nity and I sensed that ev­ery­one was scared of them.

‘One of them said to me on the phone, “Are you go­ing to block this mem­o­ran­dum?” Of course I didn’t want to block it, but I wanted to make it safe for ev­ery­body.

‘It was a long phone call and quite in­tim­i­dat­ing. I felt what­ever I said was be­ing in­ter­preted as a threat. I felt this per­son wasn’t pre­pared to lis­ten to any­thing I was say­ing. It lit­er­ally made the hairs stand up on the back of my neck. That’s re­ally pow­er­ful that sort of fear.

‘The prob­lem is that the ac­tivists feel only they have any right to say any­thing and any­one who dis­agrees with them walks on eggshells for fear of be­ing ac­cused of be­ing trans­pho­bic. I had sleep­less nights over the mem­o­ran­dum. I would wake up at 3am wor­ry­ing about it.

‘At that point, I hon­estly felt I was the only per­son in the world who was car­ry­ing the in­ter­ests of peo­ple who had tran­si­tioned and re­gret­ted it. No­body else in­volved knew what I knew about how th­ese peo­ple were suf­fer­ing, be­cause I was re­search­ing them.’

James orig­i­nally de­cided to em­bark upon his re­search af­ter talk­ing to the in­ter­na­tion­ally re­spected Dr Miroslav Djord­je­vic, a pro­fes­sor of urol­ogy and surgery at the Univer­sity of Bel­grade School of Medicine in Ser­bia, when he was in Lon­don for a con­fer­ence three years ago.

‘He does a lot of gen­der re­as­sign­ment surgery with pa­tients from all over the world. He said in the last year he’d done seven re­verse gen­der re­as­sign­ment op­er­a­tions on peo­ple who had tran­si­tioned from male to fe­male and then de­cided it was wrong and wanted to go back.

‘That means they couldn’t get back the male gen­i­talia so he was cre­at­ing phal­lo­plas­ties, cos­metic re­place­ments de­vel­oped in World War I for sol­diers who’d suf­fered ter­ri­ble in­juries.’

‘He said his work seemed to sug­gest the per­cent­age of peo­ple de­tran­si­tion­ing was in­creas­ing and there needed to be some re­search.

‘I de­cided to do it, so went to Bath Spa Univer­sity and signed up for an MA in Coun­selling and Psy­chother­apy, and started to do the pre­lim­i­nary re­search.

‘Tra­di­tion­ally, peo­ple had al­ways thought the re­gret rate among those who tran­si­tion is between 1 and 5 per cent, so the gen­eral at­ti­tude among peo­ple in­volved in the trans­gen­der world was it was so low that it wasn’t re­ally im­por­tant. But that was based upon old re­search from the Eight­ies and Nineties.

‘My pre­lim­i­nary re­search sug­gested those per­cent­ages were out of date. You just need to look at the in­creas­ing num­bers of those re­gret­ting and re­vers­ing their tran­si­tion on the in­ter­net on web­sites and in blogs.

‘Last year, a group of young women in the U.S. who de­tran­si­tioned had their first ever con­ven­tion.’

There are many posts on the in­ter­net from those who re­gret chang­ing gen­der. Each of them makes for des­per­ately sad read­ing.

Take, for ex­am­ple, the anony­mous 30-year-old who tran­si­tioned from a fe­male to a male and is now de­tran­si­tion­ing, who wrote on a blog re­cently: ‘I don’t blame any­one else for my id­iocy.

‘I just wish I would have learned to love my­self be­fore com­pletely turn­ing my life up­side down with all of this.

‘I’ve been in­ject­ing testos­terone for around three and a half years, have had top surgery [a dou­ble mas­tec­tomy] and a hys­terec­tomy.

‘I know I’ll be able to have re­con­struc­tive surgery on my breasts even­tu­ally. I mainly worry about how peo­ple will treat me un­til I can re-fem­i­nise my face, body and fix the thin­ning hair is­sue.’

James, a deeply feel­ing man who be­gan his work­ing life as an aux­il­iary psy­chi­atric nurse, shakes his head. Many of the younger peo­ple who present at gen­der clin­ics have a his­tory of men­tal health is­sues such as self-harm­ing, so­cial anx­i­ety, eat­ing dis­or­ders and so on. They see tran­si­tion­ing as their panacea.’

In ad­di­tion, James says that the pro­por­tion of peo­ple at­tend­ing gen­der clin­ics who are on the autis­tic spec­trum is ap­prox­i­mately six times higher than the gen­eral pop­u­la­tion.

‘The ac­tivist line is, “Oh that’s be­cause they’re trans so if they weren’t dis­crim­i­nated against and could just be them­selves and tran­si­tion they wouldn’t have men­tal health is­sues.” That’s far too sim­plis­tic. I wanted to try to find the truth.’

In Novem­ber 2015, James sub­mit­ted his first pro­posed Masters Re­search ti­tle, ‘An ex­am­i­na­tion of the ex­pe­ri­ences of peo­ple who have un­der­gone re­verse gen­der re­as­sign­ment surgery’, which was ac­cepted.

‘I had some peo­ple con­tact­ing me who said, “Yes we’ve re­versed our gen­der re­as­sign­ment, but we’re so trau­ma­tised we don’t want to talk about it.” It made me re­alise how very im­por­tant the re­search is.

‘Then a group of young women in the U.S. con­tacted me. They’d tran­si­tioned from fe­male to male, had dou­ble mas­tec­tomies, then re-tran­si­tioned back to fe­male.

‘They’d stopped the hor­mone treat­ment that had been sup­press­ing their men­strual cy­cles, but didn’t want re­con­struc­tive surgery to re­build their breasts.

‘I wanted to in­clude them in my re­search, par­tic­u­larly as some of the women said they thought their orig­i­nal de­ci­sion to tran­si­tion to male had come from so­cial and po­lit­i­cal pres­sure, not for psy­cho­log­i­cal rea­sons.’

He sub­mit­ted a re­vised ti­tle in Oc­to­ber 2016: ‘An ex­am­i­na­tion of the ex­pe­ri­ence of peo­ple who have un­der­gone Gen­der Re­as­sign­ment Pro­ce­dure and/or have re­versed a gen­der tran­si­tion.’

James ac­cepted the re­search might not be ‘po­lit­i­cally cor­rect’, but felt it was im­por­tant.

The next month the univer­sity re­jected his pro­posal on the ba­sis that ‘the post­ing of un­pleas­ant ma­te­rial on blogs or so­cial me­dia may be detri­men­tal to the rep­u­ta­tion of the Univer­sity’.

‘All I wanted to do with my re­search was lis­ten to what peo­ple were say­ing and re­port it,’ James says.

‘So­ci­ety is chang­ing so rapidly that a lot of peo­ple feel un­cer­tain of their place in it and they’re look­ing for some­thing. The fact is, the idea of trans iden­ti­ties is now be­ing brought into the class­room and is all over the in­ter­net.

‘I re­ally think it’s good peo­ple who have tran­si­tioned have rights and they’re legally recog­nised in their gen­der. Peo­ple fought for years for that and it’s very im­por­tant.

‘Some peo­ple need to tran­si­tion and ben­e­fit from it. It’s a com­plex field, which is why we need to be able to have a healthy dis­cus­sion about it and not feel afraid to do so.

This has all be­come a kind of Kafkaesque weird tan­gle. Some­body needs to call it out.’


Shocked: Bath Spa Univer­sity re­jected psy­chother­a­pist James Caspian’s re­search pro­posal

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