Religion is a Mental Illness

By: Bernard Lane

Published: Mar 25, 2024

Not good medicine

The dominant “gender-affirming” treatment approach—which promotes puberty blockers, cross-sex hormones and mastectomy for minors—is “fundamentally incompatible with competent, ethical medical practice.”

That is the conclusion of a new paper by academic psychiatrist Andrew Amos in the journal Australasian Psychiatry.

Dr Amos says treatment guidelines from the World Professional Association for Transgender Health (WPATH) and the Royal Children’s Hospital Melbourne (RCH) “assert without evidence that pathology plays no part in the development of gender diversity,” which is said to be part of nature.

“If it is admitted there are some pathological causes of gender diversity, then it becomes necessary to assess the health or illness of all presentations [of gender identity],” Dr Amos says.

But the gender-affirming model insists that self-declared gender identity be affirmed, not interrogated for underlying mental illness.

“The emergence of non-binary and fluid genders means there are no boundaries to self-reported gender identity, which may include a gender consistent with one of the two biological sexes; a combination of features consistent with both sexes; the absence of features of gender; an identity as a voluntarily/involuntarily castrated eunuch; or arbitrary and rapidly changing variations,” Dr Amos says.

“From a psychiatric perspective, the proposition that psychopathology plays no role in gender diversity is absurd.

“The most detailed personal description of the experiences of psychosis is that of Daniel Paul Schreber, a German judge who minutely described his belief that God had turned him into a woman and was sending ribbons from the sun through his body to impregnate him and repopulate the earth.

“It is difficult to imagine a more pathological aetiology [or cause] for gender diversity, yet the [gender-affirming model] provides no framework for assessing such a patient, and does not view Schreber’s case as an absolute contraindication to social, medical or surgical transition.

“As Schreber illustrates, it is certain that pathology causes some cases of gender diversity. Differentiating between healthy and pathological gender diversity, or, more likely, gauging the relative contribution of healthy and pathological processes originating within or in the environment of each patient, can only be achieved by the comparison of an individual’s patterns of behaviour with patterns of normal and pathological development.

“While [gender-affirming] advocates have argued transition is safe in patients with psychosis because it is easy to differentiate psychotic from non-psychotic aetiologies of gender diversity, they have provided no guidance on how to do so, and no empirical evidence that it is safe to try.

“To the extent they discuss the role of psychosis or severe personality pathology in the development of gender diversity at all, it is only to deny that either might prevent transition.”

RCH Melbourne’s treatment guideline—promoted as “Australian standards of care”1 and used by children’s hospital gender clinics across the country—states that psychosis in a minor “should not necessarily prevent medical transition.” It does not explain how to discern those cases when psychosis should indeed rule out transition.

In the leaked WPATH Files, clinicians were revealed debating how to manage “trans clients” with dissociative identity disorder (multiple personalities or alters) in which “not all the alters have the same gender identity.”

Dr Amos argues that gender-affirming treatment guidelines “abandon the clinical discipline of diagnosis and make treatment contingent upon the unconstrained subjective experiences of children and potentially disturbed adults.”

“This is unethical, because modern medicine relies upon accurate diagnosis and evidence-based clinical reasoning to ensure that treatment is likely to help and not harm patients.”

Dr Amos notes tension in the 2023 gender dysphoria policy of the Royal Australian and New Zealand College of Psychiatrists between a traditional mental health approach and the unevidenced assertion that, “Being trans or gender diverse does not represent a mental health condition.” This policy area has occasioned sharp divisions within the college since 2019.

“Although it is clear that this [2023 policy] compromise balances the concerns of different stakeholders, the medico-legal implications for psychiatrists and their patients may be too important to long defer a conclusive position on the aetiological role of mental illness in gender diversity,” Dr Amos says.

He points out that the lack of evidence for the gender-affirming model has led an Australian medical defence fund, MDA National, to restrict coverage for private practitioners facing claims because of their involvement in the medical transition of under-18 patients.

[ Video: England’s NHS has radically restricted puberty blocker drugs, but it’s business as usual for Australia’s gender medicine lobby ]

Taking cover

On May 9 last year, GCN reported that MDA National planned to restrict cover for private doctors assessing minors as eligible for medicalised gender change or initiating cross-sex hormones for them.

The insurer cited “the high risk of claims arising from irreversible treatments provided to those who medically and surgically transition as children and adolescents.”

The news appears to have alarmed the lobby group LGBTIQ Health Australia (LHA)2, whose access to federal Health Minister Mark Butler produced an “URGENT one day turnaround” brief from his department on the issue, according to documents obtained under Freedom of Information law.

These documents suggest Australia’s federal government is focused not on the international debate about safety concerns and the lack of evidence for youth gender medicine, but on expanding access to gender-affirming treatment as requested by well-connected LGBTQ lobbies.

On May 23, LHA chief executive Nicky Bath—who sits on the government’s LGBTIQA+ Health and Wellbeing 10 Year National Action Plan Expert Advisory Group—alerted Mr Butler’s office to MDA’s proposed restriction of insurance cover. (By market share, MDA is the second largest medical defence fund.)

That same day, the Department of Health and Aged Care3 secured a detailed account from MDA chief executive Ian Anderson of the insurer’s rationale for the change to take effect from 1 July 2023.

In its urgent brief sent to Minister Butler on May 30, the department relayed Mr Anderson’s explanation that—

In its brief, the minister’s department makes no reference to systematic reviews overseas showing the evidence base for paediatric transition to be very weak and uncertain.

However, the note suggests that if the regulatory Medical Board of Australia had to intervene in a case involving gender treatment of a minor, it would use the treatment guideline issued in 2018 by the gender-affirming clinic at the Royal Children’s Hospital Melbourne (RCH) and badged as “Australian standards of care.”

“In determining what is safe clinical care and what is the best available evidence, doctors should have regard to relevant Australian standards of care,” the briefing note says.

There is no hint of the controversial status of the RCH treatment guideline.

The department’s note says the RCH guideline “clearly outlines the role of GPs in the assessment and care of adolescents with gender dysphoria”, which the note says includes prescription of puberty blockers or cross-sex hormones “in collaboration with a paediatrician, adolescent physician or paediatric endocrinologist.”

However, towards the end of 2023, the RCH gender clinic changed precisely this section of the guideline consistent with a campaign by the gender-affirming lobby to ramp up GP provision of cross-sex hormone treatment for minors—the very issue that MDA was concerned about.

Gender-affirming clinicians see the mainstreaming of hormones through local medical practices as one answer to long waiting lists at children’s hospital specialist gender clinics, where older adolescents may age out before treatment.

The current, version 1.4 of the RCH guideline still says a multidisciplinary approach is “the optimal model of care” but adds new advice that, “GPs with sufficient expertise and skill in initiating and monitoring [cross-sex] hormone therapy can consider initiating and optimising hormone therapy for [minors].”

“This would typically be within a primary care-led multidisciplinary team tailored to the patient’s needs and availability of services…” (Emphasis added.)

It is not explained how GPs will know when they can go ahead without a multi-disciplinary team. Version 1.3—still available on the RCH website—did not recommend that GPs initiate cross-sex hormones without the precaution of specialist back up.

In November 2023, gender-affirming GPs keen to mainstream hormones for 16- and 17-year-olds without specialist back up complained of mixed messages as to whether or not they would be covered for this4 by the country’s largest medical defence fund, Avant.

Avant, which is understood to be defending psychiatrist Dr Patrick Toohey against a 2022 claim by detransitioner Jay Langadinos, told GCN it had not changed its cover. The fund did not answer the question whether it would cover claims arising from GP members initiating opposite-sex hormones for 16- or 17-year-old patients without the backing of a multi-disciplinary team.

Version 1.4 of the RCH guideline did not cite any new evidence supporting the practice of GP-led hormones, nor was the opportunity taken to cite fresh data reported since the guideline was first issued in 2018.

The RCH document makes no reference to systematic evidence reviews in Finland, Sweden and England since 2019. These reviews, undertaken independently, found the evidence base for hormonal treatment of minors to be very weak and uncertain.

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"Gender affirming care" is pseudoscientific faith-healing quackery.

By: Bernard Lane

Published: Jul 21, 2023

A rising star of Australia’s centre-right Liberal Party, Claire Chandler, has called for an independent expert inquiry into medicalised gender change for minors.

Senator Chandler suggests a national inquiry into the evidence for treatment of young patients diagnosed with gender dysphoria could be modelled on England’s independent review led by paediatrician Dr. Hilary Cass following controversy over the London-based Tavistock gender clinic.

In an interview with GCN, Senator Chandler said: “We know that in Australia there has been a huge explosion in the number of young children accessing care at gender clinics.

“We don’t necessarily know exactly how all of these children are being treated, whether or not the way they are being treated is beneficial for their circumstances, whether or not it’s having good clinical outcomes.”

The number of minors enrolled in state children’s hospital gender clinics rose from less than 500 in 2016 to more than 2,000 in 2021, with the biggest caseloads in the states of Victoria and Queensland.

In Australia’s federation, the states deliver health while also drawing on federal funding; states pay for puberty blockers and cross-sex hormones enjoy federal subsidy.

Chart: Demand surges at Australia’s gender dysphoria clinics in children’s hospitals

[ The green line shows patient enrolments; orange tracks the number of children on puberty blockers; purple indicates the number on cross-sex hormones. Data was obtained under freedom of information law. It is not clear if these figures for hormonal treatment include prescriptions filled outside the hospital. Credit: Dr. Dianna Kenny ]

Europe’s turn to caution

Senator Chandler cited official findings in Finland, Sweden and England that the puberty blockers and cross-sex hormones given by gender clinics internationally are based on very weak evidence and carry risks of harm and troubling uncertainties.

In each country, the recent policy advice is to restrict access to these hormonal treatments for minors, especially puberty blockers, which England’s National Health Service will confine to clinical trials as an experimental intervention.

Senator Chandler has been raising concerns for more than two years about the risks to vulnerable children from invasive medical treatments and the lack of good public data on the operation of gender clinics.

In the last few months, an Australian child and adolescent psychiatrist Dr. Jillian Spencer has become a rallying point for growing clinical disquiet over the dogmatic “gender-affirming” treatment model and its poorly evidenced hormonal and surgical interventions.

She went public with her criticism of the American-influenced gender-affirming treatment model after she was stood down from her job as a senior staff specialist at a public children’s hospital in Queensland; she was reportedly accused of “transphobia” after an interaction with a young patient from the gender clinic.

Dr. Spencer has argued that the gender-affirming model forces clinicians to go along with the social and medical transition of children despite the evidence base not showing that the benefits outweigh the risks and harms.

“It is incredibly distressing to be forced into harming other people’s children, or otherwise face potential loss of one’s career, livelihood or to be cast out of the workplace, as has happened to me,” she said at a Sydney women’s forum last month.

Earlier this month Dr. Spencer began circulating a petition for health practitioners who want an independent inquiry “to guide Australian doctors in what treatments for children are safe to be delivered, at what age and under what conditions.”

By last night, she had signatures from 36 child psychiatrists, 33 adult psychiatrists, 22 general practitioners and 10 paediatricians straddling all six states, albeit mostly concentrated in the three eastern states of Queensland, New South Wales and Victoria.

“Sadly, lots of people have contacted me to say they’re too scared to give their details,” Dr. Spencer said.

Exposure

This week, the medical indemnity fund MDA National, which on July 1 cut back its coverage of private doctors involved in risky medicalised gender change for minors, has noted the renewed push for an inquiry in Australia.

“We understand that there is a growing number of professionals and politicians requesting an urgent review of the research to ensure that children and adolescents presenting with gender dysphoria and incongruence have the very best medical care,” MDA National’s spokeswoman told GCN.

She was responding to a decision by the Australian Medical Students’ Association (AMSA) to disaffiliate from MDA National on the grounds that its July 1 policy change would reduce the supply of youth gender medicine. AMSA’s statement claimed that gender-affirming treatment was based on “high-quality evidence” but did not reply when asked for references.

MDA National said it was disappointed at AMSA’s decision—the insurer had spon.sored association events—but stressed that its main duty was to protect its doctor-members from “the risk of potentially high-value claims.”

The spokeswoman said the fund would “continue to monitor the legal landscape of this area of emerging risk and will update our policy coverage to reflect any changes in medico-legal risk as required in the future.”

Litigation by regretful detransitioners has begun in Australia, Canada, the United Kingdom and the United States.

“[The health professional defendants] lied when they told Prisha she was actually a boy; they lied when they told her that injecting testosterone into her body would solve her numerous, profound mental and psychological health problems; and they lied when they told her about the nature and effects of ‘breast reduction’ surgery, which in actuality was a surgery to remove her healthy breasts and render her incapable of nursing a child (should she even be able to conceive one, which, due to her taking testosterone for years, may not be possible)”—court complaint of 25-year-old detransitioner Prisha Mosley, North Carolina, U.S.,17 July 2023

Evidence rules

This week Australia’s National Association of Practising Psychiatrists (NAPP)—which in 2020 issued a cautious, less medicalised policy on managing youth gender dysphoria—restated its view that a proper inquiry into gender clinics is needed.

“We support an objective national inquiry headed by a panel of experts that allows all sides of the debate to be expressed,” NAPP president Dr. Philip Morris told GCN.

“But the bottom line is that the inquiry must be based on the evidence base, not opinion.”

The Royal Australian and New Zealand College of Psychiatrists, a larger group than the NAPP, is expected to publish its updated position statement on gender dysphoria “later this year”, the president Dr. Elizabeth Moore has told members.

In 2021, the college adopted a more cautious policy, noting the “paucity of quality evidence” on treatment outcomes and acknowledging that “evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate.”

The policy was denounced as “inappropriate and harmful” by a group of Australian and New Zealand advocates of the gender-affirming way.

From March-September 2019 the college’s LGBT mental health policy had explicitly endorsed the gender-affirming treatment guidelines promoted as “Australian standards of care” by the Royal Children’s Hospital Melbourne, which is home to the country’s most influential gender clinic. Those guidelines have come under intense scrutiny.

Video: Senator Chandler denounces inquiries that went nowhere

In the hunt

After critical coverage of gender clinics began in mid-2019 in The Australian, the then health minister Greg Hunt asked the Royal Australasian College of Physicians (RACP) to conduct a review.

In March 2020 the RACP sent Mr. Hunt a four-page letter of advice. It did not describe gender clinic medical treatments, nor discuss their risks; there was no mention of less invasive treatment options.

Instead, the RACP asserted that the national inquiry being sought by some health professionals “would further harm vulnerable patients and their families through increased media and public attention.” No evidence was offered for this claim.

It emerged that the RACP, which trains paediatricians, had previously lobbied for cheaper, quicker access to the medical treatments it was called upon to evaluate for Mr. Hunt. The RACP did not reply when asked at the time if it had a conflict of interest.

Mr. Hunt then gave public assurances that a federal-state body of health officials—the Health Chief Executives Forum—would deliver a new, uniform model of clinical governance across Australia’s gender clinics and a common system for proper data collection. Nothing appears to have come of this.

GCN understands that in response to recent questions from members, the RACP has—

Against this background, Senator Chandler said an expert inquiry independent of government was “clearly required to lay the facts on the table and stop the buck-passing and the culture of silencing that everybody from parents to medical professionals to journalists have experienced and have been targeted with in this debate.”

She said the inquiry would also have to be independent of “the youth gender industry.”

“We can’t be in a situation where the [gender clinic] industry, which has in effect created its own rules, is then put into a position of reviewing those rules,” she said.

“And [the inquiry] must be run in a very transparent and evidence-based way that takes into account some of those international findings that we’ve seen in other jurisdictions [such as Finland, Sweden and England.]”

In the Australian Senate’s next sittings, starting on July 31, there is expected to be a vote on a motion for a committee inquiry into youth gender medicine.

Moved last month by Senator Pauline Hanson of the populist-right One Nation Party, the motion urges inquiry into questions including—

Asked about this proposal, Senator Chandler said a parliamentary committee inquiry would be better than no inquiry at all, but the numbers in the Senate would not favour an independent inquiry, and in any case, it would be better for an inquiry to be “removed from politics, if possible.”

The ruling centre-left Labor Party (with 26 of the total 76 senators) is seen as uncritically committed to the gender-affirming model, while the Australian Greens, with 11 senators, have lobbied for a taxpayer-funded expansion of these medical treatments.

The Liberal-National opposition, with 31 senators, will have a conscience vote on Ms Hanson’s motion. One Nation has two senators.

Note: GCN sought comment from federal Health Minister Mark Butler and Assistant Minister for Mental Health and Suicide Prevention Emma McBride

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Australia makes awkward moves in the same direction as the UK and other European countries.

Interesting that the medical side of is being - at least partly - driven by the medical insurance industry; that doctors who subject patients to risky medical experiments will not be professionally protected when the patient comes back and sues. Doctors themselves might be able to deny the results of evidence reviews, but their insurers damn well won't. It's surprising the US, a much more litigious country, hasn't done more of this.

Also notable that you can tell at a glance which institutions have been ideologically compromised. The claim that there is "high-quality evidence" to support self-diagnosis and self-prescription of treatment is an ideological one. But they're never in favor of systematic reviews, for some reason. If what they're doing is so scientifically grounded, you'd think they'd be pushing to resolve this once and for all. They never do.