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Sex and gender

‘It’s a real critical period around gender’

Sarah Davidson is Consultant Clinical Psychologist for the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust. Our editor Jon Sutton poses the questions.

25 July 2019

In your experience, is the next generation more 'up to speed' on gender identity issues than our own generation?
Inevitably, I think they are. Time is absolutely a context, and I think that is particularly the case for gender identity. I think that you can see evidence of that in legislative frameworks, through the Equalities Act for example; through how people are describing and labelling themselves. How they are experiencing themselves and being represented within different media, in schools, work, in communities and in the world. That's all evolving. I would say particularly rapidly. There are so many different factors and variables right now, that are creating a real critical period around gender.

It does feel like a watershed moment.
Yes. In recent years we've seen very large increases in the numbers of young people being referred to gender identity services, particularly in Europe and North America. Round the globe actually, including Australia and South East Asia. People are presenting with greater dissatisfaction with their identity, but we're also seeing a change in who those groups are. I've been working in the Gender Identity Development Service for more than 13 years now. Our referrals have increased from less than 50 a year to well over 2000 a year, and we're also seeing significant increases in people who are assigned female at birth, especially those referred in their adolescence,compared to those assigned male at birth. So there are shifts in the characteristics of people we are seeing, and also how they describe themselves and in what they want to achieve. A breakdown of the binaries. It's a complicated picture, some would describe it as a 'queering' of the picture.

As you say, it's complicated, and if I'm honest I sometimes feel like I don't have the knowledge or even the language to engage with the debates.
I end up feeling scared that I'm going to say (or publish) completely the wrong thing.I think that's an insightful concern… so do I!

I'm wondering if that's part of the generational aspect, and if the young people that you talk to are far more able to talk about it.
I think language changes over time for every generation, so we have to be careful in saying it's something about this generation in particular. But certainly I think there's something about social media which has potentiated and exponentially increased some of that evolution.

In terms of the people presenting, is that the main factor? Is it about awareness?
No. My go-to phrase is always 'multi-factorial'. Social media has operationalised the change in language and understanding, that's a very significant variable. But that's among many different variables. Language is associated with the people that have the power and the privilege, who are not unitary groups. There are different groups who are differently defining and re-defining this area, and even wishing it not to be defined. The language is contested, as well as the treatment pathways and the pathways of 'doing gender', performing gender, being gender. There are so many different groups constructing what is possible.

I'm interested in how peers relate to those presenting with gender identity issues.
Yes, more broadly we know that the Equalities Act recognises people with different protected characteristics. Gender is recognised as being more than just binary. That's fundamental, a seismic change, to be recognised as non-binary, or gender fluid, or pan gender. To be able to self-define rather than be defined by the powerful authorities. That has huge implications for authorities and particularly schools, who are socialising agents. They must respond to that shift in viewpoint.

So how are they responding to it, in your experience?
On the whole, really well. Of course schools face many challenges. People who identify differently to a majority are also at risk of having higher levels of bullying and stigma that needs to be addressed at the systemic and structural level, not at an individual level. I've seen some schools struggle with how to deal with it at that level rather than making it an individual or family issue. Some of the amazing schools manage to be aware in supporting staff tohave the most appropriate language or the most appropriate level of curiosity, flexibility, making appropriate adjustments to facilitate access to lessons, the curriculum and the social world.

There are also some young people who really struggle as a result of the very difficult experiences that they have with peers, with adults, within their communities. That's a real concern. Gendered Intelligence, and many other organisations such as the Intercom Trust, Allsorts in Brighton, lots of organisations are trying to work with school to challenge some of that. To enable people, regardless of how they identify, to have the education opportunities they should have.

How does psychology inform that work?
Psychology has a lot to say about making visible experiences of discrimination and maltreatment. Identifying stressors, the cyclic spiral that develops as a result of some of the difficult contexts and rules that get constructed. The impact of those on behaviours, emotions, beliefs. The impact on health and wellbeing for those individuals and those around them. Noticing where those spirals exist, punctuating them, providing psychoeducation, enabling more positive narratives… there's a whole host of literature drawing from different psychological models and approaches.

And that work can be done directly and indirectly?
Exactly. As a service, we feel it's important to work at different levels and with different agencies and organisations. For example, Gendered Intelligence works with the schools and the system. They work with government departments, professional organisations such as the Football Association, to try to challenge some of the ideas around sport, which can be very gendered and restrictive. They may work publicly with conferences, but also with individuals, group work, mentoring gender diverse young people to enable access back into education. So it's at all levels. Any successful intervention has to be at each level – multi-factorial.

That sounds expensive.
I would disagree. What could be expensive is if you worked at one level. The knee-jerk level is to work at the individual level, but then you are focusing all your resources on a very small unit, with the risk of maintaining the problem constructed in the individual. Meyer's minority stress model talks about the need to not locate issues within an individual. You could spend a lot of expensive therapy working with individuals, when you need to work with the socialising institutes - the schools, the colleges, the Departments of Health and Education – and then where necessary do the individual and group interventions.

I guess I was just thinking that in my experience of schools, when resource in terms of money or time are stretched, they may have a tendency to default to the binary... 'all boys do this, all girls do this, let's just crack on'. They're not necessarily set up for nuance, fluidity and non-binary. Or is that my imagination?
Right there, you've answered your first question – that's the difference! That's what was, not what is. The majority of schools are now much more clued in. Not all of them, but most are aware of the challenge, the unhelpfulness and the difficulty of having boys' and girls' anything – uniform, toilets, PE. As soon as you start to do that you create difficulties for people who do not identify in that way.

Is that evidence that what you are doing with organisations like Gendered Intelligence is working? Are we seeing more 'good citizens' of the future?
Yes, I think we're seeing more role models with different experiences to share, different identities and stories. By challenging the heteronormativity of the dominant world view, and providing alternative voices and experiences, it's complicating it but it's much more enabling for a wide group of people. That's progress.

What would your recommendations be to continue that progress? What would you like to see happen in the next five years or so?
My main one is a wish for this area to be less polarised. Notwithstanding all the work I have described, it feels we're as polarised as ever around very key discussions, such as the most appropriate approaches, and at what ages. My hope would be for us to be much more connected and less adversarial.

Is that because those discussions and debates are generally taking place between adults? Do we need to draw more on the young people themselves and their growing acceptance of various different aspects of gender?
It's complicated. Some of it is around the different positions that people become invested in, which are all about not being something, or being against something else. I was just reading a fabulous article by my colleague about how even in ethics, there's no such thing as an absolute truth. We forget that, in our search for what's best. We forget how contextually overlaid our experiences are, our beliefs are, our judgements are. Even when you talk about evidence-based practice, people talk about it being objective. But there is nothing that is purely objective, particularly in the world of psychology. The more we can recognise that and move forward together, rather than in opposition… criticising so personally and vehemently…

I guess it comes down to that natural affinity to express in terms of 'us' and 'them', but it's about defining 'us' in a more inclusive way.
Exactly. Human beings are connected in myriad ways, we are social beings who do best when we are connected in positive, affirming relationships. That doesn't mean that we can't disagree, and have challenge and conflict. But to be so polarised… it can't be helpful for people to feel inhibited to speak about something, that's a stimie for us to develop. 

Note: This interview is part of a special collection.