Pseudo-science: Delusional, dangerous, psychotic…and that’s just the therapists

I am going to treat this article as a sort of run-up. A flexing of critical muscles briefly, before taking yet another tilt at the ramshackle, pretentious, ultimately very dangerous edifice that is the pseudo-science of therapy – espesh when it is used to contain a very vulnerable other set of people: trans men and trans women.

In part, I was set back on this track by a post from a friend. In part because some of the less fastidious papers, when it comes to matters of fact-checking and accuracy – have been in a lather lately defending so-called “scientists” from the depredations of us marauding trannies. This is going to be more than one article.

Warning: Therapy can damage your health. A lot.

I am going to start with a fact – which is the sort of thing remarkably absent from many therapeutic discourses – that emerged from a conference by British Psychologists a few years back. The outcomes from therapy across a range of disorders were no better than the outcomes from no therapy at all.

That’s bad. It implies a lot of wasted money. Worse, though the researchers had identified that for some conditions, therapy was MORE likely to result in suicide or attempted suicide than non-therapy.

The response from therapists? Why: therapy is very individual and it can help in some cases. Yep. Much like cannabis. Or a placebo. Or garlic.

Autotheophilia: an all-too-common disorder

What they absolutely failed to acknowledge – and this is what chilled me to the bone – was the finding about suicide. Because for me, as a human being, if someone had demonstrated that statistically, someone was more likely to die if I continued doing what I was doing, I would be mortified. I would stop. Instantly. And not go back to what I was doing without having understood a little better what was going on.

But no. Either because they didn’t care, or were so arrogant that they felt they knew better than available scientific evidence, these therapists blithely stumbled on. Autotheophilia was my diagnosis – a condition in which an individual, often a professional white male, likes to think of himself as God.

The reparative urge

That has enormous resonance when placed beside the mail from my correspondent, who reminds me that despite a setback last year, when the Royal College of Psychiatry abandoned a session ABOUT trans issues without any real involvement by trans experts or the trans community, Dr Az Hakeem, who was set to be one of their main speakers, is still out there proposing stuff that looks suspiciously like “reparative therapy”.

Here’s the abstract from an article in a recent “Advances in psychiatric treatment” published by the Royal College of Psychiatry, by the good Doctor himself:

“This article describes a special adaptation of group psychotherapy as a psychological treatment for people with a variety of gender identity disorders. It can be used as an alternative to or concurrently with hormonal and/or surgical interventions for transgender people.

“It is also suitable for individuals whose gender identity disorder remains after physical interventions. The article draws from a UK specialist pilot for such a treatment service and describes the explicit aims of the psychotherapy, the specialist adaptation of therapeutic technique required and observed thematic features relevant to working in this specific field”.

Hmmm. It is impossible to tell more from just this. However, according to my contributor, Estella Welldon both started this group and can be found writing in a book, “Tranvestism, transsexualism in the psychoanalytic dimension”.

In one chapter, she states that they started with the assumption that the “gender dysphoria” was a condition, a problem to be understood and solved, before going on to assert that transitioners in their late forties are at times motivated by a midlife crisis in which a more youthful and attractive image is pursued.

At other times unconscious psychotic mechanisms are at stake…”all requests for body “mutilations” may be the tip of the iceberg for very disturbing conditions at which a severe self destructive aim is at the core”.

The psychotic reality

Good stuff. Of course, we now know that current thinking (pace WPATH 7) is to regard all this reparative twaddle as…well, not just twaddle, but unethical twaddle to boot. But there is a dark side – and that is the extremely negative outcomes that we know can be associated with failure to take GID seriously.

Anti-social behaviour. Self-harm. Suicide.

No matter. What we are dealing with here is a delusional framework, on the part of a particular group of therapists. It’s a framework which begins with a view of how the world works – with little more to support it than highly selected confirmatory evidence.

If it were merely a delusion to the effect that the moon is made of green cheese, it would probably not matter. Unfortunately, as I will argue later, these delusional creatures have immense power over other peoples’ lives – often with disastrous consequences.

Their lack of empathy – their refusal to acknowledge any reality outside of their own narrow unproven world view – has about it all the hallmarks of psychotic behaviour, with consequences every bit as serious for their victims, as had they fallen foul of some knife-wielding thug in the street.

jane xx

21 Responses so far »

  1. 1

    Hi Jane
    Your article uses the word therapy to include Psychiatry and psychology. You imply but it isn’t clear if you are applying it to all Psychotherapy across the board.

    Any effective Psychotherapy would never be reparative and your statement that all therapy is ineffective is a very broad sweeping statement. I’d be interested to hear your comments for clarification

    • 2

      janefae said,

      i need to get past this in two ways. In the sense, that is, that i know i have somewhat gone for the jugular and i am being unfair to the likes of yourself and Stuart Lorimer who, i feel, do do good.

      Two responses – or maybe three.

      First, i’d be happy to post up a thoughtful piece from someone defending the therapy approach..or maybe, as i do acknowledge, drawing a distinction between bad and good therapy.

      Second, i have mapped out in my own head a series of pieces which should put some perspective around this first one.

      And third? We-ell, i am not sure i am damning therapy as ineffective, so much as having a tilt at the framework within which therapy operates, which is frequently – though by no means always – normative…in the sense that it seeks to “repair” or put someone (back) to a state they ought to be in, as opposed to helping the individual with where they are.

      Last…i am very pro psychology – at least the investigative end of it – which i consider capable of being meaningful in a scientific sense. The broad sweep of what i am writing about here is what it means to be scientific…and how important it is to be scientific, against a media backdrop that is suddenly having a go at treatment of gid on the grounds that it lacks scientific basis.

      Again, i think a framework error.

      jane xx

  2. 3

    sedeer said,

    I wonder if you’re not conflating two issues which might better be kept separate:

    (1) Therapists wanting to continue to practice despite studies showing that therapy can be ineffective or even harmful.

    (2) A prevailing (?) normative approach in therapy which views GID as a condition to be corrected rather than, as you say, “helping an individual with where [who?] they are”

    I agree that (2) is problematic at best and would love to see it change. A similar thought process is also why I dislike hearing people talk about a “gene for homosexuality”. I’m more bothered by the terminology, which implies that homosexuality is a condition (with phrasing to, for example, “gene for cystic fibrosis” or “gene for autism”), than by the question of how much of a genetic element there is. I would be much happier with the phrase “gene for sexuality”, which is more similar to “gene for eye colour” and therefore less normative.

    On the other hand, I feel like (1) might be less damning an issue than you make it out to be. Couldn’t a similar case be made about medical practice? For example, doesn’t surgery sometimes fail to help or even cause complications (which might be fatal)? I think it’s important to be aware of these problems and to discuss them, but I’m not sure I would jump straight to tarring the entire practice or calling therapy a placebo.

    By the way, I’d love to see the actual studies you mentioned (from a “conference by British Psychologists”). You wouldn’t happen to have the references so I could dig them up?

    • 4

      janefae said,

      I am going to develop these points separately…or at least: the normative issue is one that i think is very important.

      Alas and sadly…the BPS study is somewhere back in the mists of time. I am well aware that were i writing an academic paper, this simply would not do – and besides, the point of highlighting that here is not to dig into the details of that finding, which i suspect was actually quite specific, so much as to pick up on the Therapic reaction at the time.

      That’s the one that has me pretty flabbergasted. Because whatever i was doing, if someone presented some evidence that i was actually causing serious harm in the process, i’d want to stop and evaluate, as opposed to just carry on regardless.

      Its the latter that seems to me most telling.

      jane xx

      • 5

        k said,

        Good post, Jane. There was also a study in which people were given counselling by English professors as well as professional psycho/the/rapists – they found that the English professors were just as effective as the “trained” counsellors.

        I am afraid that I am not surprised about the theraputic reaction to the suicide findings.

        Estella Welldon’s chapter in “Tranvestism, Transsexualism in the Psychoanalytic dimension” may be found by googling “Az Hakeem transsexual”.

        In this chapter, she mentions that all of the group had “breakdowns of one sort or another” in a throwaway line.

        Whilst a breakdown might, under carefully controlled circumstances, be benefical for someone, it can also lead to suicide.

        As Welldon repeatly asserts that her “patients” are suffering from “severe psychopathogy”, suicide as a reaction to the “psycho/the/rapy” would simply be attributed to the so- called mental illness of the victim.

        As for Stuart Lorimer – she approvingly quotes Argentieri (2006) who argues that the surgical medical teams who carry out gender reassignment would benefit from therapy groups where psychodynamic insight would be applied as psychoanalysts have a more sophisticated understanding of these patients.

        I find the idea of the Charing Cross team being analysed by the Portman quite amusing.

      • 6

        sedeer said,

        It seems “most telling” in what sense? I agree that it’s problematic if there is evidence that therapy is having little effect (or even being harmful) and that shouldn’t be ignored, but I think I’m less willing than you are to jump from that to therapy being no better than garlic. I can think of at least two different reasons why therapy might be generally ineffective and I think they require radically different responses:

        (1) Therapy is ineffective because it’s sheer quackery. At best, it’s simply a placebo; at worst, the normative pressures exerted in therapy can cause serious harm.

        (2) Therapy is ineffective because it’s immature. It’s a relatively young field trying to address an incredibly complicated subject, so it’s not surprising that it’s inadequate to the task. Hopefully, we’ll do better as we learn more.

        In the first case (which seems to be your position?), therapy is no better than homeopathy and deserves similar derision; people should be warned to avoid it so as not to risk harming themselves. In the second case, however, what’s actually need is more attention and research in the field in order to help it advance sufficiently to deal with the complexities it faces.

        Obviously, this is something of a simplification, but I wanted to present it for your consideration. I have no personal experience with therapy, so I’m not going to venture an opinion. In fact, I think I may just be trying to give you “a thoughtful piece from someone defending the therapy approach”.😉

      • 7

        janefae said,

        ye-es…cept i’m not jumping from the attitude thing to therapy being no better than garlic. i’m highlighting a particular experience of how therapists responded to an assertion (which at the time seemed to have some factual basis to it) not with any intention of dissing therapy, but with a view to showing up an irresponsible tendency within the community.

        a little of this is back to front. i’m pulling together a series of posts dealing with the “scientific nature” (not!) of how treatment within the trans area is developed. Along the way, i am dumping different topics into posts as makes sense to me, logically, if i am to build the case.

        i am not really saying therapy is ineffective, so much as asking first off where its meant to be taking us. You cannot, should not be asking whether something is “effective” in a vacuum. i am pretty sure there are some things therapy is effective for…a big problem for me is it feels a lot like therapy has been over-puffed AND its populated by people who haven’t really understood their own limitations.

        Let’s allow ourselves to begin from there.

        jane xx

      • 8

        sedeer said,

        Sorry, I hope it didn’t seem like I was trying to give you a hard time. Thinking about “where therapy is meant to be taking us” sounds like an excellent place to begin. I look forward to reading the rest of your series of posts.🙂

  3. 9

    annierose55 said,

    I think you are purposely ignoring a glaing reality and that is that…”transitioners in their late forties are at times motivated by a midlife crisis in which a more youthful and attractive image is pursued.”

    In addition I do not think that you can deny that in MANY cases…”unconscious psychotic mechanisms are at stake…”all requests for body “mutilations” may be the tip of the iceberg for very disturbing conditions at which a severe self destructive aim is at the core”.

    I nthink it is highly presumptuous and irresponsibe to dismiss this as…’not just twaddle, but unethical twaddle to boot’.

    • 10

      janefae said,

      Oh good. Argument by assertion? Which is exactly the issue with the original claim.

      Which is little more than a view given by an individual with a particular set of experiences and neuroses, albeit sanctioned by the fact that they wear a white coat (probably figuratively…i’ve never met the woman).

      Its certainly not the sort of thing i’d expect from anyone claiming to do science…and that, as much as my dig at the dishonesty of some therapists, is my principal target here: the way that a bunch of people who in another age would be high priests to a cult have managed to wheedle their way into popular discourse as somehow having access to knowledge of a higher status than everyone else has.

      And that is bollocks.

      jane x

  4. 11

    sophia said,

    Tend to think the main problem is to get that initial general accord that treatments for transsexuality are limited by the fact that the basic neurological dimension isn’t affected by them.
    Helping the individual understand and come to terms with their condition and providing appropriate treatment should be the main focus, but there is still a heavy investment in the ‘psychological’ genesis of the condition(s). Frankly, though, much of trans self descriptive narratives are themselves framed, especially in terms of ‘real selves’, in a similarly dubious manner.
    As someone who has gone through a very sharp gender shift, my training as a psychologist and therapist, in the dim and distant, has helped enormously in coping with the transition and understanding the cognitive nature of neuro-hormonal congruences. I do see the role of cognitive psychology in investigating and providing useful pointers for
    support during transition, as potentially hugely important.
    As Anne says, there are some possible scenarios in which individuals may seek transition for wholly wrong reasons( in the sense of probably unsuccessful outcomes or it being a sub-optimum solution). The possibility of a late transitioner being drawn by primarily fetishistic reasons is one that may exist for a very small number. The possibility of the individual being deep closeted gay, which Anne herself has been used as an example of, is another. There may be a valid gatekeeper role in spotting such rare occurrences, but that shouldn’t by any means be the main focus.

  5. 12

    k said,

    “In part, I was set back on this track by a post from a friend. In part because some of the less fastidious papers, when it comes to matters of fact-checking and accuracy – have been in a lather lately defending so-called “scientists” from the depredations of us marauding trannies.”

    It’s interesting that the Michael Bailey book row should have resurfaced with the absurd allegation that the “transgender taboo” is a threat to “academic freedom”.

    One wonders whether the said commentator would similarly defend the F**saw demonstration at the end of one of Bailey’s lectures on kinky sex:

    http://www.northbynorthwestern.com/story/bailey-issues-statement-on-fucksaw-demonstration/

    Many of the criticisms of the “science” involved in Baileys book seem directly applicable to what seems to be going on on the NHS at the Portman:

    http://ai.eecs.umich.edu/people/conway/TS/LynnsReviewOfBaileysBook.html#anchor991133

  6. 13

    annierose55 said,

    I am finding myself at a bit of a disadvantage here in that I know very little about the NHS other than it is publically funded and thus necessarily hampered by a bureaucratic maze that is essentially self-serving and answerable to what ever political winds might be in season.

    If the criticism is directed at those “gate-keepers” who at best have not even a shadow of a clue, and at worst are are using “science” to justify and/ legitimitize their own personal proclivities, then I must agree with the criticism.

    I must admit to being a bit intrigued by “Sophia’s assertion that I have been offered as an example of a “deeply closeted gay”. Besides giving me a good laugh, I would like to know WHERE or BY WHOM such a laughable assertion has been made.

  7. 15

    Anon said,

    This worries me. I’m being seen at the Portman at the moment. I often feel a lot worse when I leave, but my therapist seems to think that this is necessary on the road to… well, I’m not sure.

    Sometimes it’s almost unbearable, though. I come out of therapy and self-harm just to deal with it. I really wonder whether it’s the right thing or not, but don’t feel I have a huge amount of other options.

    I’ve googled for that study by the BPS but can’t find it. Wish I could – really don’t know whether I should continue or not at the moment.

    Hmmm…

    • 16

      janefae said,

      without a lot more in the way of detail, i really cannot, should not give out anything other than the broadest of advice. Still, your comment worries me. One of the things i understand therapy is meant to do is CONTAIN issues within the session (maybe someone can let me know if i’ve got that wrong).

      I guess it depends what you mean by “feeling worse”. A bit down…OK. Suicidal? Then there is an issue.

      Please feel free to drop me a line direct. I wouldn’t publish any further remark you make: I would possibly, try to put you in touch with someone who has an alternative approach on the therapy front.

      As for the survey…we are talking dim and distant stuff here. I’ll ring the British Psych Soc on Monday, since various bods have asked about this. However, i don’t think chapter and verse is germane here. They were noting a statistical effect, which means that in general terms, outcomes were less good for some conditions with some therapy.

      That doesn’t mean all non-therapeutic outcomes worked splendidly. Nor does it mean that ALL therapy didn’t work.

      Therefore, if you have issues, it could be all manner of things…and a survey published a decade or two back won’t really give you much insight.

      Please, please, though…if you are self-harming “as a result of” therapy, talk sto someone. Me if you’d like. But someone.

      jane xx

      • 17

        Anon said,

        Thanks for this response. Don’t worry, I’m not suicidal, and any self-harm is done in a controlled, risk aware way. Thanks for the offer to get in touch with you. Realistically, I probably won’t, as I’m not exactly proud of the fact that I am resorting to cutting to cope and would prefer to maintain my anonymity, but I really do appreciate the kindness of your offer.

        As for people who have an alternative approach on the therapy front, maybe it would be useful, if you had the time, if you did publish something publicly? After eventually getting referred from my GP’s counselling service to the Portman, I was hardly enthusiastic about going there. But it seemed preferable to a three month wait for another six weeks of counselling. My GP appeared to have no idea where else to refer people struggling with issues around gender and sexuality (i.e. bdsm), and neither do I. If I was able to suggest somewhere else, it’s possible they’d be receptive.

      • 18

        k said,

        @anon

        “This worries me. I’m being seen at the Portman at the moment. I often feel a lot worse when I leave, but my therapist seems to think that this is necessary on the road to… well, I’m not sure…….”

        I think you have good reason to be worried. On the one hand, if someone, for example, is dealing with some form of, say childhood sexual abuse in therapy then it is entirely understandable that he or she will feel worse after the sessions as it will bring up all the negative emotions and hopefully lead eventually to them being less strong or the person finding more adaptive ways of dealing with them.

        On the other hand it sounds as if there is no clear objective to the therapy to which you are being subjected which seems entirely typical of psychoanalytically orientated therapy which is potentially very dangerous and counterproductive.

        If I were going for therapy I would want to know the objective of the treatment and as much as possible and as much as possible about the qualifications, theoretical background and attitudes of the the/rapist.

        The Observer did an article on the Portman a few years ago which may be read here:

        http://www.guardian.co.uk/lifeandstyle/2008/nov/23/health-wellbeing-therapy-society

        It’s interesting that they apparently regard “transsexualism” as a “compulsive sexual behaviour” ….and the article continues to make it rather obvious that they treated gay people as perverts and strongly suggests that they were practicing reparative therapy on them and are now using the same practices on other socially marginalised groups:

        “Richard Davies has been at the Portman for 26 years, four of these as clinical director before Stan Ruszczynski. ‘It’s good that some things have become more normalised,’ he said. ‘There are still a lot of young people who feel it is abnormal to masturbate, so it’s helpful that that’s become more open. The clinic used to treat homosexuals for years. They were grateful to come somewhere, because many homosexuals found they didn’t have an easy life and they had a lot of conflicts. But the social situation changed in the Eighties with gay pride and more equality, and so those homosexuals who wanted to come here may have felt, “I’ll be letting down my friends.” We got a lot of criticism from gay pressure groups who used to hate us – we were treated as a clinic that treated homosexuality as a perversion, but we didn’t: we just treated homosexuals who came to this clinic.’

        These days, the clinic is often visited by transvestites and transsexuals, and people who practise bondage and other sexual fetishes. ‘They come here because the desired effect of those things, what they were intended to do, has started to break down, usually when they’re in their thirties,’ Davies says. ‘The papering over the cracks that those practices fulfilled is no longer working. Some patients who are just post-operative can be despairing.’ “

  8. 19

    Katrina2 said,

    Two peneth from the other side of the vail. I’m 60, a late transitioner at 52. A midlife crisses, yes and no, yes to crisses, no to mid, for I have had crisses/mental turmoil thruout my life, starting age 6 when I first saw a psychologist, curtesy of school referal. That saw 2years in a classroom on my own! The rest of schooling, sitting at a desk, behind the teacher, why?
    Late teens, seeking help as to who I am or what. Psy’ say, ‘no worry, your gay! O! Into 20s, guilt, shame, confusion, again a psy’ say’s ‘no worry you are bi, a lot of people are’. O really.
    Into 30s, by this time, I’m married, but for all the wrong reasons. As too life, I tried to be a man, I threw myself into hard task, but at night, in the quiet, I cried, I sought refuge in my shame, and, the guilt of same, I buried deep inside.
    After a divource, I again asked to see a psy’, only to be told, ‘ you have a personality disorder of some severity! Pills and counselling, only led to suicide bids, nearly suceeded. After a short stay in a psy’ hosp’, I resolved to be alone, haunted and ashamed, of having this p’d’.
    I worked hard, but at night or early dawn, I found peace. For me xd’ing soothed my troubles, and prepaired me for the day. Yes, She took over, she was me inside, but I could not let others see her, yet she wanted freedom, and so thus, she became who I am today.
    I have heard similar life stories. If someone said to me, ‘but that does not make you a transsexual woman’, I’d reply, ‘fair comment, do you know?’
    All I know, from the time I renounced maledom, and followed my inner self, to my re-birth, and to now, I have found peace, happiness, contentment, but, most of all, I found me.

  9. 20

    Gávi said,

    Dear anon,

    I would strongly encourage you to find a therapist who can respect your gender and your wishes. Please know that you are not alone. Your negative experience at Portman tracks with numerous other stories I have heard from many other people who felt degraded and even suicidal as a result of the ‘treatment’ they received there. Some of the clinicians associated with Portman have published academic journal articles that refer to people who designate their own gender and do not agree with the gender they were assigned as ‘delusional’ (exact quotations and citations to substantiate this comment are available through simple searches on PsycINFO or GoogleScholar; look up published articles by Az Hakeem, in particular). Several others have been associated with practices that are now considered backward or ethically problematic according to the latest professional standards. While not all of the clinicians may share problematic views, there are many other people in a similar situation to yours who have shared confidential experiences with me of self-harm or damaging side effects as a result of going to Portman.

    This dangerous system will not change until people complain and take action. Some possible options for you to consider… You may want to file an anonymous complaint through the NHS about this clinic and also notify GIRES (again, anonymously). GIRES have collected experiences like yours and used them in efforts to improve the system. You can visit http://www.pinktherapy.com/ to find a professional who will treat you with the respect you deserve. Some well-known UK therapists with a respectful and ethical approach to gender affirmation are Meg Barker, Dominic Davies, Alex Drummond, Tina Livingston, Lyndsey Moon, Jemma Tosh… There are many others, I just mention a few of them here, so that you know there really are many other places where you could find helpful and not hurtful therapy that will enhance and not damage your wellbeing. Additionally, you may wish to discuss your experience with folks at GIRES and/or Mermaids to see whether they could advocate for you with your GP. In the past, I have provided training on these issues for GPs, and found most GPs to be well-intentioned, even though many were unfamiliar with beneficial resources and helpful response options.

    While self-harm is a concern that should not be treated lightly or ignored, unfamiliar professionals can sometimes be inappropriately alarmist. Research documents that many people who self-harm are not trying to commit suicide and that the two aims do not always overlap. Self-harm varies widely in magnitude, risk, and intent. In addition, one person’s ‘self-harm’ could be another person’s ’empowering body modification’; I once heard an adult clinician with mutliple body piercings and several tattoos describe a young person’s self-tattooing as self-harm, ignoring that the young person considered it an empowering body mod with no intention to self-harm and that the clinician’s tattoos were far more extensive. It helps to listen to each person’s motivations and views about their own actions and to avoid imposing our own worldview where it does not fit.

    Professionals with experience in self-harm issues often respond very differently depending on the circumstances. Anon has been clear about not being suicidal, and sounds like a person who is trying to cope with life as best as possible with limited resources. I am somewhat relieved to hear that the self-harm is being done in what anon described as “a controlled, risk-aware way”; this comment suggests at least some degree of self-care, as does the stated intention of the post. ***Without specific details, it is impossible to estimate the risks involved in this situation or determine an appropriate response.*** From a Harm Reduction perspective, one of the best ways for anon and others in this situation to minimise self-harm is to have regular access to supportive resources that would reduce the desire for self-harm. Until then, I hope anon will be as compassionate and self-respecting as possible within these extremely challenging circumstances, and will seek out help from respectful, affirming loved ones and professionals if the situation deteriorates.

    Wishing you healing and comfort,

    Gávi

  10. 21

    Gluhwein said,

    I was in email contact with Az Hakeem, asking him for access to his academic papers. He was perfectly happy to reply several times – until I outed myself as trans, with him then immediately cutting off contact. I think that tells us a lot about what he is really like!


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