Keira Bell v Tavistock Gender Identity Development Service

Update 18 September 2021: the Court of Appeal reversed the High Court decision, in part on their application of the law of evidence. It was looking bad for treatment for trans children, but is looking much better now.

1 December 2020: After the case of Quincy (or Keira) Bell, it will be exceptionally difficult for a trans child under 18 in the UK to get puberty blockers. The High Court has decided that the evidence the Gender Identity Development Service (GIDS) had to justify prescribing puberty blockers was insufficient, and children were not capable of consenting to the treatment.

The court did not consider all the benefit that the trans child will get from puberty blockers. It may be possible for individual trans children and their families to take court action to get that relief. It may be that a better understanding of the benefits from puberty blockers, or simply a better way of explaining those benefits, will enable trans children to get the treatment they need. However they will have to go through legal proceedings to demonstrate sufficient consent, as well as to convince psychiatrists that the treatment is appropriate, and the ethical and practical concerns for each will be different.

The court’s judgment discussed at length the GIDS practice, which bent over backwards to protect any cis child and avoid transition. Families may simply go abroad and go private, and have far less protection, as one family referred to in the case did.

This is how the court made its decision. Continue reading

The Afro comb

As any fule kno, different is always less. Me and my lot are simply the best way to be: if there were a better, we would be it! We look at those lesser types with sympathy.

Lemn Sissay was fostered by a white family until he was twelve, when they demanded that he be taken away and he was kept in a series of children’s homes. That white mother each morning would comb his hair, with “a strip of metal with barely visible slits”. “Mum dragged the comb through the roots until my skull felt like it had been dipped in acid and was pouring with blood.”

She just accepted this pain. “You have hair sore,” she would say. I don’t know why she didn’t use the kind of plastic comb I used to use, but possibly the tines broke.

Mum was a midwife, and one day she took Lemn, whom she called “Norman”, to see Errol Brown, the lead singer of Hot Chocolate. He had been visiting the hospital, they got chatting and she told of her Black foster-son, and Errol Brown promised her Lemn’s first Afro comb. “I stared at the strange and elegant genius of design and style: an Afro comb. ‘Your very first Afro comb,’ said Errol Brown.”

A comb that would not hurt him. Who would have thought it? If the comb hurt him, the problem was obviously him- his hair, so unlike that of normal people’s, the best kind of people’s, which would cause no kind of difficulty with a normal people’s comb.

It took a Black man to give Lemn Sissay the comb he, as a Black boy with Ethiopian hair, needed.

Francesca Happé studies autism. She notes that the Diagnostic and Statistical Manual of the American Psychiatric Association would not recognise PTSD, necessarily, in autistic people, because it requires the trauma to be life-threatening. She gives the example of a man who takes the bus to work every day. One day the bus goes on a detour, and he has no idea where he is, and no way of getting to work. After that he has PTSD: he may be triggered if he passes the bus stop he always used, or even by the colour of the bus.

This is a man who goes to work even though being late is a threat to him, and it actually happening traumatises him. I hope if I were in that situation I would tell my boss and they would tolerate it- it is apparently not my fault, don’t let it happen again. I would be irritated but not traumatised. We expect this man to live in a neurotypical society though it stresses him this badly.

One autistic friend suggests that autistic people don’t have jobs, often, because they try working and it does not work out for them, so they won’t do it again. If work can traumatise you, I am not surprised they won’t do it again.

It is hard work to see the value of difference, or the problems of difference. You comb hair with a comb. It is so obvious, no other solution is imaginable. When the child is hurt, the problem is with him.

Passing, or masking?

Trans people are often ambivalent about passing. Just because someone is courteous, does not mean that you pass- it could mean that they were not transphobic! If you pass, you may be worried that someone will read you, your secret will be out and you will never be seen the same again. So we pay out vast amounts for facial feminisation, for surgeons to grind away our foreheads and shape our noses, or perhaps masculinisation. The thought of a surgical scar across the top of the head, even if covered by hair (mine wouldn’t be, but by a wig) was enough to put me off.

The term used by autistic people, masking, gives a different view of the matter. Why should we (or they) pretend to be normal, just so normal people are not discomposed? This account of an autistic breakdown is a good example:

To be autistic is to live in a world where everything is too loud, too smelly and too bright, populated by people who say one thing and get angry when you fail to realise that they really meant something different. At the same time, your brain is struggling to keep track of and process the stimuli constantly bombarding it. Your brain and body then shut down and go into overdrive at the same time. Adrenaline courses through your veins. You are swallowed in a cloud of panic and cannot help but scream and sometimes lash out at others or even yourself.

That’s a clear example of the social model of disability. The autistic person does not melt down because of autism, but because of the need to mask her or his condition. Ideally, before meltdown, the autistic person would be able to reduce the sensory overload in some way, perhaps by withdrawing. Either other people nearby would notice and take care of them, or they would notice that it was getting too much. It seems the shame and exhaustion afterwards are socially enforced rather than natural. You have tried to mask too long, and that is exhausting. So, of course you have a meltdown. It should be nothing to be ashamed of.

Masking. You are different, and you hide that, because you know mockery or worse will ensue when your difference is discovered.

Autistic people devote energy to masking, to pretending to be normal so as not to disconcert the neurotypicals, when stimming or other ways of relieving the pressure would enable them to use their gifts far more productively. That we NTs demand the “normal” behaviour rather than being kind and accepting of their weaknesses, so their gifts may shine, is our loss as well as theirs.

If only we could just be people! There is no need to pass, and you would not be judged according to how well you conform. I could enjoy looking striking, without fearing the second glance that read me as Trans therefore Bad. I could be myself more, not wanting to conform so much (not that I want to conform, particularly).

Masking makes you safe. Masking avoids perturbing the neurotypicals, or the cis-het folk. We will all want to mask sometimes, even if only to go places where we would be less safe when read. But masking is a burden we take on, for no-one’s benefit really, from the stultifying social pressure to conform. If people could reveal their diversity more easily, everyone would be happier.

Everyone moderates their behaviour, in order to fit in, to a greater or lesser degree. If only we were freed from that burden!


I realised that the most important thing for me is suppressing my emotional reaction, at least my conscious feeling, rather than dealing with the issues making me frightened, frustrated and angry. Irresistably I am drawn to thinking of the low-status chimpanzee, who cannot show he is angry as it would attract the alpha-male’s attention. The feeling will continue until the situation causing it changes, and that could take weeks- when it could be much worse.

Counselling session. I am frightened of telling Tina this, the most sympathetic listener I can imagine, and I don’t want to say it. I want to make a joke and avoid saying it. Rather than acting, I reach for facebook and my blog stats pages, hoping to get a kick, though the returns are variable. I can feel unconsciously, but instinctively I see conscious feeling as the most important problem. Rationally I know there are things I must do, and I put them off. Holding feelings out of consciousness takes energy leaving me feeling lassitude.

There is the addictive rush of responses on facebook and the blog stats page, but the returns are variable. I reach for the computer in the morning hoping to get a hit big enough to get me out of bed, and often it is not there. At best it is borrowing a boost that has to be paid back later. But, suppressing genuine feeling, I can spend hours with half an eye on the TV and half on the computer, not writing or doing anything, and feeling rotten about my worthless inactivity.

On a facebook group, a man said he was leaving, because I had driven him out, and that I was “manipulative”- a high compliment, I have wanted to be able to manipulate people all my life. He calculated he would get enough “Oh Alex, please don’t go” comments to shame me into leaving and continue posting his drivel, or “inspiration of the Spirit” as he put it. Had I not gone on facebook that morning I would not have seen his post, as it was deleted. He had raised a serious matter in a solipsistic and frivolous way, and I had called him on it. Storm in teacup. This is not good for me, and it is most of the social interaction I get.

The woman had not needed a wheelchair a year ago. It’s a lot to process as people crave independence. She can roll up to the Quaker meeting and be welcomed, but she wanted to get out of her chair into one of the ordinary seats so that she would not be obviously the woman in the wheelchair, the disabled person, just for a short time. Three times, Quakers meaning well took away the seat she was wanting to get into, thinking that she wanted to wheel her chair into that space. I saw the effort she put in to getting out of her chair. She WOULD NOT GIVE UP.

Ah. That story comes to mind, as an illustration of determination and frustration. It illustrates what I am feeling, unconsciously. It helps me understand how I am now.

The medical term for neuro-diverse folks passing as neurotypical is “masking”. Women, particularly, mask symptoms, at the cost of crippling anxiety. One came to the notice of the doctors because of her anxiety, her high intelligence predicting neurotypical behaviour when she could not read it “normally”.

Quakers are my main face-to-face social outlet. I have written a report for Quakers on my last weekend away. Still procrastinating, I did it probably the last moment I could, on Monday evening. Had I been politic, I would make it a serious report about the serious business of the weekend, and instead I made it entertaining, with jokes, and my own concerns: as H would say, I was “pissing about”. What I wrote has my passion, emotion, my Drive to achieve, my desire to do what is good (as I see it) for the World rather than for me.

There is a huge depth of motivation in me. When I want to do something and persuade myself that it’s possible, out comes my drive. My drive is powerful, and it is frustrating that I can fritter an afternoon with half an eye on the television and half on my blog stats page or facebook.

-This drive, strength, creativity, can it not hold and help the part of you that is distressed? Are they too separate?

I think it does, and I am bringing my separate parts together.
slowly, too slowly-
I think I am pulling myself together, reconciling myself within, writing and suppressing less, conscious of more-
I see how important it is to me not

not to feel a feeling and yet

I am more- feeling the feeling.
Seeing how hard the barriers are and taking the barriers down.

Don’t out me

He has held the core of the atomic bomb in his hands. “What? You touched plutonium?” Well, it was behind a screen, with insulated gauntlets bolted to the glass. And he had a radiation monitor. He wants to tell his stories. His Bentley has the gear shift on the right of the driver, which is unusual in a British car. Someone remarked on this to a friend of his, who had the perfect riposte-

“You mean, other cars have it on the left?”

He waited years to use that line, G tells me. He also tells me what he told the Archbishop he would say to St Peter if he was wrong to disbelieve in the afterlife: “I have lived my life as well as I can, and if that isn’t good enough for you, I don’t want in to your Heaven.” We agree. Of course. And he met John Paul Getty, who was a fascinating conversationalist.

I really like this gentleman.

As we are getting up to leave, P says to me “Say, ‘I want to be a vegetarian’, like you did last week. You sound just like Miss Fritton“. Which would be less objectionable if just after introducing me to his friend Sophie today he had not said the same thing. I am angry, and turn to G: was he aware that I am trans, I would ask. But G has turned about and walked quickly, about ten yards away, so as to be not part of this conversation.

I am particularly peeved at this because G is a humanist and P a Creationist, and Richard saw fit to bring that up. I disapprove of Creationism. It makes Christianity ridiculous. But we all know the arguments on both sides, and are not going to convince anyone to change their mind today. Bringing that up is shitstirring, so I rebuked Richard. I do not want a pile-on, I want a civilised conversation over tea and cake in the sunshine. I could have brought up P’s idiosyncrasy. That was a peculiarly autistic cackle he emitted, high pitched, loud, utterly unselfconscious. And this lack of awareness of others’ feelings is pretty autistic too- yet one can learn social rules. Don’t out people. It’s not difficult.

Probably G was aware that I am trans. I sound like Miss Fritton, after all, and he has been engaging me in conversation for half an hour. He is a highly intelligent man.

I want P to laugh his autistic laugh freely and without anyone objecting. I want people to know that his autism is part of the glorious diversity of humanity, and that it is nothing to be ashamed of. I am sad these things need to be said: when I say, “I am not ashamed of being trans”- needing to say that shows that I have been, and have worked to free himself of the burden of shame. Part of getting there is consciously not remarking on these things- P is autistic, I am trans, deliberately we think to ourselves, No-one should mind. Eventually, no-one will.

The church is beautiful. The misericords are 15th century: I taught Sophie what a misericord is. She looked at them and we chatted, friendly-like. She did not snub me because I am one of those people. Being trans is not a bad thing. The rood screen is 15th century too, and there is a Chantry chapel adjoining. I don’t think she had known what a rood screen is. Richard told me that one of the crests facing the nave is Thomas Becket’s, and that the stained glass showed the nine orders of angels from Pseudo-Dionysius. After they had gone, I waited in the churchyard for the sun to come round, to shine on the barefoot warrior. Perhaps coming back on an overcast day would show greater dedication to photography.

Understanding Neurotypicals

I feel qualified to explain Neurotypicals. After all, I am one.

As many neuro-diverse people will have realised, neurotypicals are not good at empathy. The neuro-diverse person will listen to words spoken, place themselves imaginatively in the speaker’s position, and know what they feel. A neurotypical will expect the speaker to “emote”. So it is not enough to hear the words “My dog died last week. He was only four years old” and realise that the speaker is sad: the neurotypical will expect the speaker’s voice to sound different, and certain facial muscles to move in a particular way, for that is how neurotypicals communicate that they are sad. If your face and voice do not do these things, neurotypicals may insult you. Please do not blame us for this. We do not know any better. For example we might call you “unfeeling”. And we expect a particular kind of reply, in wordless sounds like “aw” or “oh” and particular facial muscle movements. If you reply in words, to show you understand that way, we might become irritated or angry with you, and insult you with words like “unreasonable” or “weird”. This is because we are extremely sensitive, and many different stimuli will make us behave rudely to you. Please forgive us. We do not know any better.

A neuro-diverse friend asked, when speaking with neurotypicals why do they not take turns in speaking? Why do they ignore him when he listens courteously and then object when he takes his turn to speak? By now, many neuro-diverse people have learned that neurotypicals imperiously change the conversation from an enjoyable one to a weird neurotypical one. The neurotypical might say, “You’re infodumping. Stop.” Then they start talking to someone else. Infuriating as this is, it helps to realise that the easily-hurt neurotypical’s attention span is short, and many suffer from a lack of courtesy. Neuro-typicals are simply not as good at conversation as neuro-diverse people are.

Neuro-diverse people will take turns in conversation. Neurotypicals often won’t. Male neurotypicals especially often treat conversation as a kind of competition. They interrupt when you pause for breath, and want it to seem as if they know more about the subject than you do, even when they don’t. Some neurotypicals object to this behaviour, and call it “splaining”. However the neurotypicals who splain will never admit they are doing it, and some even deny splaining exists. Imagine a neuro-diverse person denying that info-dumping exists. As soon as anyone explained what info-dumping was, they would understand, and do it only with people who welcomed it. However, the more you explain splaining, the more the splainer splains.

Sometimes neurotypicals make rules for conversation, such as that one speaker has five minutes to speak and the other will listen, then they will change roles, so that the previous speaker listens, and the previous listener has five minutes to speak. That we need rules like this shows how competitive we are, and how poor at listening. Typically in such settings, there is a group leader who will explain the rules slowly and carefully, and even then the neurotypical will fail to keep to them: and such neurotypicals using these rules imagine that they are being particularly “spiritual”!

Neurotypicals can have different speaking styles. One told me he always knew what he would say before he said it. Yes, I said, because you can think a sentence in an instant. Actually I didn’t, I said because you can think a sentence like that, and snapped my fingers: we find our ways of communicating without words useful sometimes. Another said he knew what he thought when he said it: trying to explain it to someone else helped him get it clear in his head. But it needs to be clear that we are having such a conversation, or someone else might just interrupt and change the subject when he paused to think. In that way, neurotypical conversation can meander from subject to subject without ever saying anything new or meaningful. This is because neurotypicals are poorly understood, and badly educated. With thought and practice, some neurotypicals can be brought to have conversations which are almost useful. However, often there is one dominant individual who just tells everyone else what to do. This explains the work environment neurotypicals prefer, with managers who have never done the job they are managing.

I wrote this post for Barry, who asked how neurotypicals negotiated conversations. He reported that most neurotypicals do not know, having never thought about it. This shows the need for more neurotypical education. With patience, study and understanding, some neurotypicals can be brought to live almost normal lives.

The intense world theory

“What is wrong with you?” is rarely a useful question. “How do you differ from me?” or “Who are you?” are different ways of approaching the other- as distinct from me, or as someone in their own right. How they differ is easier for me to understand, because I start from myself, and understand myself; but it might cause me to ignore important things, or see myself as the default. Anyway, I may miss parts of you which are too far from my own experience.

The intense world theory suggests how autistic people may be gifted, and how their gifts might be nurtured, rather than how they may be sick, and made as normal as possible.

Here is the Sally-Anne experiment.

Simon Baron-Cohen performed this experiment on autistic children, some of whom failed to answer correctly that Sally would look for her marble in the basket, not knowing that Anne had hidden it. He deduced that these children did not have a proper theory of mind, knowing that others felt and thought differently from themselves.

However, Henry Markram considered other possible explanations for the autistic children not answering the question correctly. They could actually be better at seeing into the minds of others. This is so disturbing that they develop strategies to avoid it. His theory predicts that all autistic children have exceptional talents that are locked up; an upbringing introducing them gently to a rich, diverse environment in a predictable way could allow those talents to develop.

The children are easily traumatised. Fear memories were so quickly acquired, lasted longer, were difficult to erase and over generalized… the neocortex could render the world intense, highly fragmented and overly specialized while the amygdala would dial up the emotional component of the intense world making it potentially extremely painful and aversive forcing the autistic child to take refuge in a secure bubble. Neural microcircuits in their brains process information more intensely, so that they see, feel and think more intensely. The infant brain should make and trim connections rapidly- that is why we sleep so much when we are babies- but the autistic brain develops these circuits too early, and does not trim the connections. Some microcircuits that should wait their turn to develop, develop too early and begin to dominate over the other microcircuits driving hyper-preferences, repetitiveness, idiosyncrasies and eventually making unlearning and rehabilitation very difficult.

Henry Markham claims this is a unifying theory, explaining all the observations. Other theories explain less, or are based on a view of autism as a form of mental retardation. We explain more if we can see something as good in itself.

This is from this article, which I found here. Simon Baron-Cohen, famous autism researcher, believes the problem is a lack of empathy, but I observe in my Aspie friends a great deal of empathy.

However, here I read that the child subjects were asked three questions-

Where will Sally look for her marble? (The “belief” question)
Where is the marble really? (The “reality” question)
Where was the marble at the beginning? (The “memory” question)

What were the autistics’ answers on the control questions?

Here, there are alternative explanations of why the autistic children might have been recorded as failing to answer the belief question. Autism would be a disorder of communication rather than of empathy.

I want to understand others as I want to be understood- not disordered, but different.

The “A” Word

In The α word, people are more than cyphers, and no-one gets murdered. There is hope for British TV drama yet.

Joe’s life revolves around his self-soothing activities. Autistic and five, he blocks his family out with his father’s loud music, repeating what people say to him word for word, and walking off down the Pennine lane. Who can blame him? His mother approaches with a ghastly grin on her face, pretending that some activity she wants him to engage in will be delightful for both of them, rather than perplexity and misery. So he learns to block her: if she asks him anything he will say “Well, let’s see-” but nothing follows.

She wants him to express emotion, and because he does not in ways she can recognise she imagines that he does not feel. Certainly he feels, but as everyone else in the family is more concerned with appearance than reality- what should we be feeling? Let us pretend to feel that, even to ourselves- he would have learned that it is not safe to feel authentically or express feeling anyway.

She wants him to be normal, and enjoy normal things. She spots him briefly in the school playground with two other low-status boys, and invites them over for a sleepover, without any preamble or getting to know the parents. This is a normal activity and it must be undertaken, whatever the discomfort for everyone involved.

She is enraged and terrified, and when something appears to help Joe she is desperate for it to continue. She hangs around outside offices until people agree to see her, then shouts at them.

-You really got through to him!
-It was just a technique, the speech therapist tells her.

At one point, other boys are having a football party, to which Joe has not been invited, and the family choose to have a picnic in the same park. They knew the party was going on, and in the Pennine town there will not be more than one park, so this is ill-judged. The father has a football, which he attempts to kick to Joe, but Joe evinces no interest in kicking it back.

(How wonderful! You don’t want to do it, you don’t see the point, so you just don’t! Yet if we can communicate enthusiasm within a family or group, then we can share it.)

For some reason they wander over to the other boys, rather than fleeing. Joe gets in the middle of the field but does his random thing rather than conforming or following instructions. I find this unbearable. I am weeping in embarrassment.

Andrea Vaccaro, penitent Magdalene

The Imitation Game

Turing memorialThis film makes the commanding officer of Bletchley Park a blimpish buffoon, and Alan Turing a traitor. Is that forgiveable?

It is difficult to make drama out of Ultra, which cracked the Enigma code. A few very clever people get together and two years later have solved a difficult mathematical problem with a precursor of the digital computer. Hooray, but not dramatic, even with scenes of enemy planes dropping bombs and U-boats firing torpedoes. A documentary could tell of some of the problems they faced, and the film tells of one: having decoded enemy signals, how do they conceal that they have done so? By statistical analysis to find what number of enemy attacks foiled will enable the allies to win the advantage without demonstrating to the enemy that their signals have been decoded. The film makes this drama by showing one of the first signals decoded showing that there will be an attack on a passenger convoy: they cannot save the convoy. “But my brother’s on that ship!” Thinking about it later, the film fails on both counts: we have a dry explanation of the statistical problem- not drama- and a man begging the others to save his brother- not believable.

Charles Dance prowls about beautifully as Commander Denniston, the CO of Bletchley. He cannot understand Turing, and so short-sightedly opposes him. This creates drama, and possibly there were problems, but six redcaps marching in and shutting down Turing’s computer is not history. It is too silly. Though it did not break my suspension of disbelief at the time.

Then there is the Queer scene. Turing discovers John Cairncross, who was never at Bletchley, is a Soviet spy, because of a silly mistake. Cairncross says he will reveal that Turing is a homosexual. Turing backs down. I just don’t know. On the plus side, it shows the pressure gay men were under when “gross indecency” was criminal. On the minus, it shows Turing not shopping Cairncross. I come down for. Most of us watching this film will get it- gay men had an awful time, but showing Turing blackmailed into a Betrayal shows the level of the pressure. And- I don’t like him being seen in misprision of treason.

The mistake: from a bit of dry expository dialogue, we know a spy is using a code based on Matthew 7:7- Ask, seek, knock- so when we see a Bible open at that verse, the visual image tells the story. Simplify, to tell the story visually.

They are all very beautiful, BC and Keira Knightley and Matthew Goode. Was Turing autistic? Autism campaigners might want him as one of theirs- “Man who won the War Autistic!” I don’t have a horse in that race.