Mrs Benn

I have recoiled at the barrage of bile directed at gender dysphoric people in the wake of the Cass Review. It is as though anybody who ever opposed themselves to wokery now finds in Hillary Cass’s review the tablets of stone proclaiming their moral rectitude. People largely famed for their fulminations about toilets and changing rooms are now rejoicing in the fact that Cass has exploded the myth of gender dysphoria, condemning it once and for all to the dustbin of woke ideology. Well, perhaps not everybody. Kathleen Stock – a gender-critical feminist – is still very angry:

‘Instead, time and again in Cass’s report she is forced back into the conceit that the most pressing problem for contemporary gender medicine is the lack of good evidence for such interventions either way. It is as if a modern-day medic had been tasked with reviewing the efficacy of trepanning, and then ordered to defend her findings in front of fanatical fifth-century devotees. “It’s not that drilling a hole in a child’s skull to release demons is necessarily harmful, you understand — indeed, it may be the best outcome in some cases. The main issue is the lack of long-term follow up.”’

Two disparate groups of people, left-leaning gender-critical feminists and right-wing social conservatives, are united in their anger at being required to recognise the rights of trans people. For both groups, equality legislation has taken a step too far in extending protection from hate to trans people. Of course there are trans activists who hold extreme positions too; they have provided provocation and played their part in stokiong a vicious argument. The blame is certainly not just on one side. However, what is extraordinary about Stock’s article is its refusal even to consider the possibility that the challenges faced in a clinical setting are more complex than her simplistic rhetorical position allows. She writes powerfully, but her striking rhetoric springs from an ideological refusal to acknowledge the legitimacy of trans identities unless expressed within very narrowly prescribed boundaries.

The claim that the treatment of gender-questioning young people by the NHS is analogous to the practice of trepanning is extraordinary. Trepanning can of course be dismissed as a therapy because we do not believe that evil spirits inhabit people’s heads; there is no scientific evidence that evil spirits exist. However, there is an abundance of evidence – published in scientific journals – that people do exist who suffer from gender dysphoria. Even the transphobes’ favourite sexologist, Ray Blanchard, recognises that surgical transition is a necessary therapeutic pathway for many with gender dysphoria.

The clinical question, for a psychiatrist, concerns how best to help an individual to lead a life free from mental ill health. The Cass Review explores the challenges associated with providing healthcare to young people with complex mental health problems. This is founded in sound ethical principles and in Cass’s many years of clinical practice. While Cass points out that there is not currently an adequate evidence base for the use of puberty blockers, there is equally no evidence to the contrary; there is a lack of sufficient evidence, either way. Despite her career spent as a philosopher, Stock is either unable or unwilling to acknowledge that absence of corroboration is not the same as disproof. I have no idea what Cass’s personal intuitions are about puberty blockers. But the hypothesis that they may help gender questioning young people is testable, even if it has not yet been tested properly.

Kathleen Stock is a gender-critical feminist. She believes that there are two sexes, male and female, and that we must be either male or female. Because trans women are born male, they cannot become female, and vice versa. This position is based upon the belief that biological sex is an immutable biological reality and gender is a societal construct. However, it fails to recognise that societal constructs have real and immutable impacts upon human beings. And it fails to recognise that while most trans people are very well aware of the concrete nature of biology, there may be a way to allow them gender expression that differs from their natal biology. To examine such a position, to treat it with intellectual dignity, is in no sense analagous to belief in the existence of evil spirits; it is instead a recognition of the complexity of the human psyche and the challenges of the human condition.

It was unsurprising to find, as I scrolled down the long list of effusive responses to her piece from Dr Stock’s admirers, that the argument expanded to incorporate scepticism about climate change. “An A level in Physics has the information to scuttle the Climate Emergency drama.” says one admirer. I have quite a bit more physics than A-level, and I can assure anybody who has been unable to read the primary literature themselves that the evidence to support the hypothesis that we lie close to a climate catastrophe is overwhelming. Such climate scepticism has much in common with Stock’s stance on the treatment of gender-questioning young people: it pretends to take recourse to science, but ignores science in favour of an ideological position. In both cases the science is rather complex (a point that Hillary Cass makes very forcefully).

The NHS is not in the grip of a cult; this debate concerns real people with real problems, and a considerable associated scientific literature, for all that the evidence base for the use of puberty blockers might be inadequate. As Cass points out, the lack of an adequate evidence base for the use of puberty blockers is an international scientific problem. The person who is really advocating trepanning is Dr Stock. She wants to drill into brains, ignoring their delicacy and complexity, and expunge the evil spirit of transgenderism. It will not work, and such an approach carries the risk of causing colossal harm to vulnerable young people.