More than 100 years ago at Craigievar Castle in Scotland, Ewan Forbes’ mother realized her 6-year-old was a boy, despite it saying “female” on his birth certificate. Instead of sending him to boarding school like his brother and sister, Gwendolen Forbes homeschooled a young Ewan and let him dress and play as he wished. To avoid the trauma of Ewan going through the wrong puberty, Gwendolen took her teenage son on a remarkable tour of European doctors.
Under the guise of a cultural excursion to maintain privacy, Ewan and Gwendolen traveled to Austria, Germany and France. New science was everywhere: in Vienna, Eugen Steinach’s work on “rejuvenation”—endocrinology—was flourishing; in Berlin, Magnus Hirschfeld was providing trans-affirmative medical care at his famous Institute for Sexology; and in Paris, researchers were developing synthetic hormone treatments. Ewan served as a guinea pig for early preparations of testosterone, and although unpleasant—including suffering “a terrible plague of boils and pimples” from one medication—he developed facial and chest hair and other male characteristics. His hormone therapy was accompanied by elective counseling for nine months, which helped launch Ewan into a life in which he trained to be a family doctor, and like other trans people of his day, corrected his birth certificate, married, and lived in complete equality.
Forbes’ case represents the earliest record of affirmative medical treatment for a trans child. A century later, it’s hard to imagine that self-identification could lead directly to affirmative medical care and equality for trans children. It is also deeply disturbing to trace the events that transformed that enlightened approach into the public attacks, reductions in medical care and social exclusion that trans children experience today.
From the 1880s, being trans was medically classified as a variation of sex development, a form of intersex. Clinically, it was believed there were many trans boys (people assigned female at birth) and that trans girls were a rarity, but as a matter of common sense and natural justice, doctors recognized that people knew their own minds and bodies, and aimed to support them in living their authentic, best lives. Consequently, the worldwide publicity given to trans woman Christine Jorgensen in the U.S. in 1952, and to her U.K. counterpart, Roberta Cowell two years later had initially stimulated trans affirmative medical care, led by U.S. endocrinologist Harry Benjamin.
At the same time, however, a group of U.S. doctors were developing a new set of ideas, built around the “problem” of intersex neonates. If newborn babies had ambiguous genitalia, surgeons routinely corrected them (usually to female) even though there was no life-threatening condition. What if they got the sex wrong? According to psychiatrists John Money and Joan and John Hampson, writing at Johns Hopkins Hospital in the mid-1950s, that wouldn’t matter: appropriate parenting would condition any child into the sex their doctor desired. They applied their idea of “gender identity” not only to the sex of a child, but also to its sexuality and its social behavior. Appropriate parenting would always produce children who were unequivocally male, masculine and heterosexual or female, feminine, and heterosexual, the psychiatrists argued. Read today, their work is a paean to social anxiety, and the measures they developed were draconian.
Influenced by Money’s work, psychiatrist Robert Stoller established a Gender Identity Research Clinic at the University of California, Los Angeles in 1962. Like its imitators, the clinic aimed to “cure” the “effeminacy” of trans girls and women, and the “masculinity” of trans boys and men with measures that included frontal lobotomy, electro-convulsive therapy, psychotherapy, aversion therapy (“faradic” electric shocks or chemically-induced vomiting) and induced comas. A new pseudo-medicine rejected decades of social acceptance and scientific evidence, and in a brief, violent “turf war” between endocrinology and psychiatry, a “stubborn will to non-knowledge,”as French philosopher Michel Foucault put it, won the day.
By 1969, Money and his coterie had redefined trans people as mentally ill. Transsexualism and Sex Reassignment, published by Money and his protégé Richard Green in 1969, positioned trans people as suffering from a “gender identity disorder,” traceable to inadequate or abusive parenting, which needed psychiatric rectification. If trans people’s delusion was so embedded as to be incurable then, regrettably, “sex reassignment” might be the only course, they argued. Uncomfortable cultural anxieties about masculinity informed their belief that the “disorder” mainly affected trans girls (people assigned male at birth) with trans boys a rarity. Green went on to spend 15 years elaborating these ideas, publishing them in his 1987 book, The “Sissy Boy Syndrome” and the Development of Homosexuality. Largely as a result of this pseudo-medicine, for 30 years trans people lost substantive civil liberties, were pilloried by the press and were subjected to a medical regime which included conversion practices and compulsory sterilization.
But in 1996, a landmark European case, P v S and Cornwall County Council, ushered in a period of restoring trans rights, including affirmative care for trans children. It was the first time anywhere in the world that case law prevented discrimination because someone was trans.
At the start of this century, U.K. and U.S. governments acknowledged that being trans is not a mental illness. Today, U.S. doctors such as Johanna Olson-Kennedy, Diane Ehrensaft and Norman Spack are world leaders in affirmative care for trans children. Like Ewan Forbes’ mother, Gwendolen, they recognize the need for early support, the importance of social transition, and the helpfulness of clinical interventions.
While much progress has been made, in both the U.K. and the U.S., things have gone backwards over the last year and a half. This year, a legal challenge to British trans children’s entitlement to puberty blockers was used as a “wedge” issue to attack girls’ and women’s reproductive rights. The attempt has failed but a further attack is threatened. Meanwhile, the U.K. National Health Service’s one and only service for trans children is oversubscribed, with long wait lists for time-critical treatment. The only alternative is private care from European services such as Gender GP or U.S. clinics.
In the U.S., establishing anti-trans policy has become a signature priority for state Republicans, with over a 100 anti-trans bills introduced in more than 30 states this year. Dozens focus on trans health, with Arkansas passing a ban on affirmative healthcare for trans children. The law, which was temporarily blocked by a judge this summer, criminalizes parents and doctors, and has caused families to flee their states to protect their children.
History tells us that trans children today need the support Gwendolen gave to Ewan: letting him tell her, by his actions and reactions, what his gender was and supporting him. Today, we know that helping trans children make their own decisions about what they wear, what name they use and how they play and interact socially is crucial. It is the only way that they and their parents can recognize the “insistent, persistent, consistent” pattern that distinguishes them from children going through a phase.
Affirmative medical care is as important as self-identification and blocks to appropriate access urgently need to be removed. But although science has progressed since Gwendolen’s day, the law has gone backwards. Parents are finding it harder to access appropriate care for their trans children today, than Gwendolen did for Ewan, a hundred years ago. Where Ewan had full legal equality, today’s trans children in many places are excluded from this fundamental, universal, inviolable human right. Restoring that legal status is urgent for our society as well as for trans children and their parents: none of us are equal until everyone is equal.
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