A Reflective Position Piece on the Intersection of Protected Belief, Law, and Professional Ethics
This article is a clinical exploration of the psychological and linguistic tensions currently facing the profession. It is intended to foster dialogue and reflection on the maintenance of clinical boundaries and the integrity of professional language in the light of recent legal rulings. It represents the author’s protected philosophical beliefs and clinical reflections.
On social media, I have noticed gender realists becoming rude about trans people. I have cautioned against this, but it led me to thinking what may be causing a sense of aggression toward a bunch of gender questioning people, instead of the neutral feelings they nurtured in the past.
I used to think that gender confusion was a mental health condition of diverse origin that needed to be understood, and my feelings were neutral too. I confess that I experienced an aversive reaction to those people in whom trans presentation looked perverse, with a gross exaggeration in their performance of what is considered womanly – such as extreme makeup (“woman-face”), exaggerated fingernails and sexualised clothing. It was like a caricature of what it is to be a female. And I would recoil from it. I asked myself why?
Then it brought to my mind Little Red Riding Hood’s wolf dressed up in grandmother’s clothing; a story that acts as a powerful metaphor of archetypal protection. In this story, grandmother is the ultimate figure of safety, nurture, and the female lineage. By dressing in her clothes, the wolf isn’t just “identifying” as a grandmother; he is hijacking a symbol of safety to gain access to a vulnerable space and destroy the girl who will birth the next generation. Not to be trusted, a predator likely to attack and destroy. Clearly the man in woman’s clothing brings about an atavistic and emotional reaction that requires understanding.
In recent years there has been a big societal change. The speed of this change can be defined as “culture-shock” – something that always generates resistance. Resistance to rapid cultural shifts isn’t necessarily “bigotry” or “phobia”; it is a deeply embedded psychological and biological survival mechanism where rapid change, especially if proposed by people who are not one’s peers, gives rise to cognitive dissonance.
My own neutral and compassionate feelings were intruded upon by an increasingly vocal ideology from ‘out there’. Like the frog sitting in water who becomes increasingly warm, without recognising his discomfort, I had no idea of my shifting mindset. Integrating bizarre new expressions such as ‘people with cervixes’ into my linguistic map, was hard for my epistemological reality. I was born into a society where women had to strive for their rights and opportunities. My mother was among the first to be allowed a vote.
It was not “trans” people per se I found troubling; it was the people claiming to “ally” with them, with the full paraphernalia of tabards and lanyards, champions, certificates, displays of kink (why?), ad-hominem attacks on those who had a different worldview, and the infiltration of ideology into the workplace by a partial DEI. I and others developed trauma-by-proxy on behalf of the people I saw persecuted for their opinions.
All this went on under the radar, such that it surprised me to have reacted with pleasure when the Supreme Court pronounced their ruling on sex and sex-based rights. My clinical self was able to accept “labels” such as gender-fluid, binary, etc. while believing that inner experience and beliefs did not transcend biological sex. I retained a sense of concern for, and compassion to gender-questioning people, even while feeling fully congruent with the change in our law.
However – the kickback and the explosion of vicious ad-hominem attacks by the trans movement – mostly the allies infesting our public spaces and institutions, unwittingly transformed my feelings (and that of so many colleagues) regarding trans people into something more unpleasant. I found myself wondering – these ideologues with their acronyms and their “champions” like “Big Brother” telling us how we MUST feel and act – do they realise to what extent they are really helping trans people? Through conflation with their own variety of bigotry, they are fostering the very antipathy and stigma that they are complaining about.
Perhaps this is why, when I find someone labelling me as “cis” – I find my hackles rising before I set it aside, reminding myself that there is only one class of women, with many variations, all excluding males. I strive, constantly, not to conflate this ontological exasperation regarding the attempted dismantling of the “category” I belong to.
I see this exasperation reflected in the tendency of some of my colleagues to be disparaging toward “trans” people in their language. Some propose to redefine trans people as “pretenders” (in the military sense, trying to reclaim something that is not theirs). I have seen other therapists invite us to redefine men who use adaptations to look like women as “transvestites” rather than trans-women. I am uncomfortable with this too, since the motivations for dressing as a woman have always existed. I’m reminded that people like Danny La Rue, RuPaul and Dame Edna Everege made cross-dressing their theatre and did not offend, since they did not lay claim to “be” female. We could accept the performance while drawing a line regarding clinical belief. There is no dissonance when there is honest artifice rather than enforced belief.
In the light of the new Law on sex, there are attempts to muddy the water by defining gender identity (feelings and beliefs) – using the term “identifies as…” as an expression of one form of reality, which it is not, in biological terms. We are asked to cement this story for respect, and to avoid minority stress by using pronouns that our common language has evolved to define a biological separation between men and women, or to express plurals such as “they”.
The term “identity” is a psychological construct which is always real to the individual, but is not to be mandated on the beliefs and experiences of others. We are not, for example forced to accept that a person declaring themselves to be a “hat” is one. Hence, coercion to accept identity as “real” does not signify a truth with which I must agree. The therapist can respect (without concurring) the distinction between objective reality and a client’s sincere impressions, such as the anorexic who insists that he or she is fat.
Dealing with an client in the counselling space is a nuance I am trying to maintain here as I navigate a very fine line between my clinical background, which views the trans issue through the lens of possible mental health and distress – and my personal boundaries as a woman who has strongly experienced that her reality is being erased.
As a clinician, I caution against the private in-group insults and jibes, that I see among colleagues in spaces online. I view these reactions as a projection of the hostility which has been levelled against them, not only by activists, but also by their own Professional Associations. So, is there a better word to use as a descriptor for people who HAVE made alterations in body and appearance to live “as if” they are a sex that they are not? You might ask why the word “trans” won’t do? For some, this term is wrong because of the inference that someone has “become” what we congruently believe to be a fiction – as if someone has waved a magic wand to effect a real “transformation” from a “pumpkin” to “Cinderella’s carriage.”
Could we call them ‘as-iffers?‘ Maybe not. One possible term I have investigated is ‘Ersatz’. It is a term suggesting that the appearance might be there, but the biological substance is missing. That symbolically (in the context of semiotics) captures the feelings that this adjustment is merely an imitation (see disclaimer below). Other possible linguistic terms include ‘purported’, ‘simulated’ or ‘asserted‘ males and females.
As a clinician, while believing that sex is binary and immutable, I will take care not to invoke “minority stress” – a syndrome that our professional associations are using to explain the mental distress caused by stigma. It is the same as the effort we take with obese individuals not to invoke weight stigma. Here is why I continue to caution people against using disparaging language, even while I understand why they do, given the ad-hominem attacks they experience for their beliefs. Clinicians with protected beliefs about sex are humans too; we react to external attacks and institutional coercion with human emotions, especially if forced to act incongruently with our professional judgement.
The point I am trying to make is the classic irony of activism: the more aggressive the “kickback,” the more it alienates the very people who began with a stance of clinical curiosity or neutral concern. By resorting to foul language, professional coercion and ad-hominem attacks, activists essentially “prove” the point that the movement is driven by an ideology of enforcement rather than a pursuit of evidential healthcare or equality for all.
I see among too many members of the BACP in their social media accounts, this tendency to unprofessional reductive language and the mantras of activism with its logos, symbols and flags. This was particularly apparent in a recent post by one of their Trustees. The BPS purports to a higher level of academia, which is more subtle. Psychologists do not call each other names; they simply rewrite the “received truth” through editorials, silencing of alternate views, platformed articles and the quiet removal of scientific neutrality nicely dressed up as social justice.
I will continue to call out language that belittles the people we care for as well as the therapists who care for them, whatever their beliefs about sex. However our first priority is in the performance of our statutory duties. This is the only way to protect our professional integrity among others who do not. It is through appropriate language, debate, freedom from practice coercion and mutual respect that we will restore balance and integrity to our work.
PS this is an academic explanation of psycho-linguistics, not personal beliefs, to map the difference between the signifier and the signified.