Let This Be Your Wake-Up Call

Even in The Independent, Dr Az Hakeem writes:

For 25 years, I was a medical psychotherapist treating patients with gender dysphoria. Having trained at the Tavistock and Portman Clinics – once home to a gender identity clinic for children – I spent thousands of hours helping people explore their feelings about their sex, sometimes seeing the same patients every week for more than a decade. I've listened, questioned, challenged and, I hope, helped them better understand themselves. But I've now almost entirely stopped treating them. Not because the work isn't important, or because there aren't people who desperately need the help. Quite the opposite.

I now work in private psychiatry, having largely abandoned this specialism because treating patients with gender dysphoria has become a professional minefield. Ask the wrong question, challenge the wrong belief, and you risk being accused of practising conversion therapy and reported to your professional regulator. I know because it happened to me. A few years ago, a young patient who had decided she was a man came to see me for an assessment, despite having no previous history of gender dysphoria. I asked her: "So why do you think you're a man?" Because of that question, she accused me of practising conversion therapy. I was reported to the General Medical Council, which dismissed the complaint. But the damage was done. I had become the subject of a newspaper investigation, simply for asking a patient to explain what she meant.

I raise all this now because the government has introduced a Conversion Practices Bill, which the equalities minister Bridget Phillipson unveiled last month in the Independent. In my professional view, and as an LGB advocate, the legislation as it stands will only make matters worse for psychotherapists, as well as many other groups of people. The Bill seeks to criminalise anyone who attempts to change or suppress an individual's sexual orientation or transgender identity. And who could disagree with that?/ It is surely right that trying to "convert" gay people by threatening physical and psychological harm should be criminalised. Under several existing laws, it already is.

And how widespread are conversion practices? According to Stonewall's latest report, published last week, just 1 per cent of the LGBTQ+ people surveyed said they had been forced to undergo them, while a further 4 per cent said they had been offered them but declined. Of course, any genuine abuse is unacceptable. But these figures raise an important question: what, then, is this new law intended to criminalise that existing legislation does not already cover?

Which brings me to the measures in the Bill concerning gender dysphoria. The draft legislation lumps together same-sex-attracted people with those experiencing psychological distress arising from an incongruence between their biological sex and chosen gender identity. The government insists its legislation is intended to tackle serious abuse, not ordinary conversations or legitimate healthcare. But evidence heard by the parliamentary committee scrutinising the Bill last week only reinforced my fears that it will make any conversation, professional or pastoral, around someone's gender more difficult – and potentially criminal.

And not just for psychiatrists like me, but for parents, teachers and anyone else who believes that asking questions can sometimes be the most caring thing to do. Consider the mum who refuses to buy her teenage daughter a breast-binder, or who politely disagrees when her son says he thinks he was born in the wrong body; the dad who refuses to affirm a child’s request to use opposite-sex pronouns, or who withholds consent for them to undergo a medical transition. If passed, I fear this appalling piece of legislation will have a chilling effect. Families who seek, with the best of intentions, to dissuade children from transitioning will be left uncertain about what they can and cannot say. It will drive a wedge between children and their parents. Given that many gender-dysphoric young people will grow up to be same-sex-attracted, it could also do great harm to the lesbian and gay youths it claims to want to protect.

The Bill provides for sentences of up to five years in prison for abusive conversion practices that cause serious harm or distress. Where does legitimate questioning end and unlawful pressure begin? And who will decide? Asking "But are you sure?" should never be confused with a harmful, coercive attempt to force an individual out of their chosen gender identity. One of the questions I've heard repeatedly from detransitioners who came to see me after undergoing gender transition and regretting it is: "Why didn't anyone ask me what I was doing?" They'd told their families, friends and employers that they believed they were the opposite sex. And everyone did what they thought was the right thing – they supported them, affirmed them, encouraged them. But nobody had asked the most obvious question of all: Why are you doing this? Are you sure?

Questioning is at the very heart of psychotherapy. Yet I believe we are training a generation of doctors who believe that asking a patient to explain their feelings might somehow be forbidden. We don't simply affirm everything a patient tells us. If a severely depressed person believes they're better off dead, we don't agree with them. If someone with anorexia believes they need to lose more weight, we don't encourage them to starve themselves. We challenge those convictions. Why should gender dysphoria be the one area where we're afraid to ask questions? Such is the chilling effect of this legislation. It need not result in a single successful prosecution to do damage. If clinicians decide that treating patients with gender dysphoria is simply too risky, those patients will be denied access to the very psychological support they may desperately need. I've already submitted written evidence to the select committee, and will happily appear before it. Bad laws slip through when the silent majority aren't looking, because they don't know about them. And by the time the damage becomes apparent, it is often too late. To anyone who thinks themselves on the right side of history, let this be your wake-up call.

Dr Az Hakeem is a consultant psychiatrist and medical psychotherapist. He is medical director of Psyche Clinic in Harley Street, London.