Written by Genspect parent Derek Duval. (Para la version en espagnol, vaya aqui.)
On Saturday, November 20, 2021, Genspect conducted the first ever conference to explore Rapid Onset Gender Dysphoria, ROGD: What We Know and What We’re Learning.
The event united groundbreaking professionals at the heart of the debate around gender: Dr. Lisa Littman, author of the seminal 2018 study on ROGD; Dr. David Bell, ex-governor at the UK’s Tavistock & Portman NHS Trust; and Genspect’s founder, psychotherapist and bestselling author Stella O’Malley. The webinar also included a powerful contribution from a parent campaigner who is working to raise awareness about ROGD. The virtual audience of over 350 individuals from around the world included clinicians, researchers, journalists, filmmakers, and parents.
Acknowledging that the societal discussion around ROGD is often difficult, moderator Angus Fox opened the conference by saying: “This is brought to you in good faith…we are trying to help vulnerable people…no one has all the answers and we’re trying to ask the most thoughtful and relevant questions.” Because ROGD is a description of a phenomenon and not a diagnosis, Fox continued that the speakers’ intent is “to provide a deeper understanding of this new cohort and emphasize that one person’s experience does not negate the experience of another.”
Following are excerpts from each speaker, in an effort to summarize as well as to inspire others to watch the webinar in full here. The impact of viewing the presentations in their entirety cannot be overstated.
Stella O’Malley, a thought leader in the gender therapy field, spoke first about “How Clinicians Work with ROGD.” O’Malley stated that the most common question she is asked is “Where did all this come from?” and goes on to point out that especially for teens in psychological distress, there is almost nothing more alluring in life than for someone to say “You can be somebody different…you can be a completely new person.”
In a particularly salient segment, O’Malley highlighted that there is no peer-reviewed, long-term evidence base to support the affirmative therapeutic approach, and emphasizes that affirmation does not equal confirmation. “You affirm your client’s feelings but that doesn’t mean that you confirm every thought or idea they have,” said O’Malley, continuing that if clinicians slip directly from affirming into confirming young people who are exploring gender identity, “you can inadvertently remove autonomy, impede the therapeutic process, and also get in the way of opportunities for therapeutic progress.” Adolescence is all about the search for identity. You don’t stop it or freeze it at one moment.
O’Malley pulled no punches in addressing the baffling willingness of medical and mental health professionals to engage in child-led diagnosis and treatment. “When a child says they don’t care about their future sexuality or their future fertility…We have to listen…but we have to make sure we remain the adults in the room, and realize that a child can’t quite conceptualize the impact of the loss of fertility when they are twelve.” To do so is to abdicate everything we know about child and adolescent psychology.
While a strong cultural current celebrates anyone who claims a trans identity, it also boxes kids in. She noted, “When people are cheering them on, how do they allow themselves to move out of the identity?” Just as anorexia, cutting, and false memories of Satanic ritualistic abuse are current and historical maladaptive ways of dealing with inordinate distress during adolescence and young adulthood, a sudden, late onset of a trans identity is increasingly being discussed with similar etiology – a new way of dealing with an age-old symptom pool.
“Gender, dysphoria, ROGD, sexuality, trauma, and comorbidity are all complex topics which affect a diversity of people in a diversity of ways.… Each of these phenomena requires sensitive debate: one person’s experience does not negate another’s.” And yet there are many influential voices claiming a simplistic alternative: Quickly validating a young person’s self-diagnosis of gender dysphoria as evidence of an immutable trans identity, which requires immediate, irreversible medical intervention as the solution.
How did we come to a place where questioning each individual’s path to and presentation of distress in order better to understand, treat, and protect their future is wrong?
Jude, mother of a trans-identified daughter in Australia, spoke next and shared her story “From Theory to Reality: When ROGD Hits Your Family.”
As Jude bravely and eloquently shared her daughter’s mental health struggles, comments in the chat box seemed to leap off the screen offering her support, admiration, and all too often painful solidarity, as her story echoes those of so many other parents listening from all over the globe.
Jude described her family’s experience with her daughter’s sudden trans-identification at almost 18 after several years of severe emotional distress since puberty. Her story is a familiar account of iatrogenic gender dysphoria as a result of online and peer influence, as well as gender-affirming clinicians who cultivated the belief that “being in the wrong body” could “explain it all.”
One of Jude’s main themes all too powerfully resonates with many parents of ROGD children: How schools, medical doctors, and mental health professionals ignored and even derided Jude and her husband’s input, not just about their experience of their daughter throughout her entire life, but also about their daughter’s obvious mental health comorbidities. Instead of seeing her daughter’s sudden trans identity as part of a complex presentation of emotional turmoil, it was immediately affirmed, and her daughter was pushed down the path of medicalization. Jude recounted years of involved and loving parenting and closeness with her daughter, making being called bigoted, transphobic, and dangerous to her child by professionals who did not even know her extensive psychological history all the more devastating.
Jude described how claiming a transgender identity in the tumultuous teen years is “heavily promoted by mainstream media and social media as glamorous, brave, stunning, and cool.” Identifying as trans suddenly gives them status and cred, and they become the center of attention. For those who are neuro-atypical, depressed, anxious, or questioning their self-worth, sexual orientation, or just their very existence (as teens are developmentally inclined to do, per Erik Erikson), the idea of a sudden new identity that could end the angst is more than alluring. And there’s always a “glitter family” down the street or online to offer a mirage of support and a litany of disparagement for one’s “abusive” parents.
Jude’s words resoundingly stand alone:
In his former role as a respected senior Tavistock clinician in the UK National Health Service, the third speaker, Dr. David Bell, heard the concerns of coworkers who were growing increasingly alarmed that children of diverse psychological backgrounds were being uniformly diagnosed as transgender and set on the path of medicalization without proper evaluation. This frontline experience as well as his professional devotion to understanding the depth of human experience and suffering make him exceptionally qualified to speak to the clinical and ethical concerns of the ROGD phenomenon.
Dr. Bell explained that the very word “transgender” is an unhelpful term because, as it is used today to an explosive degree, it covers a multitude of different individual stories, sufferings, and even symptoms. He implored all those who work with these youth and young adults to differentiate the experience of gender dysphoria from the identity of transgenderism.
“While it is clear that we are dealing with a complex problem with many causal pathways, and no single causative factor, gender services tend towards a very damaging, peculiar, superficial simplification.” Bell continued, saying “patient involvement in decision making is of course a good thing, but that needs to be distinguished from the non-questioning of the patient’s account…when it becomes non-questioning, here we see a perversion of clinical care…that is championed as patient engagement.”
Dr. Bell provided an insightful description of psychoanalysis and of the therapeutic process in general: “Having someone on your side but not someone siding with you…that is an entirely different matter…siding with someone is not an act of kindness…an act of kindness is to be able to hold a neutral, sympathetic position.” Dr. Bell lamented that in the currently popular affirmative paradigm, “Thoughtful engagement is treated as a kind of enemy…the wish to think over time and understand why this particular child has developed in this particular way comes to be seen as an expression of transphobia. This creates a paranoid universe and world where you are either with me or against me.”
Dr. Bell spoke to the similarities in patients presenting with late-onset gender dysphoria and those presenting with anorexia or body dysmorphia (with a compelling case example of a man whose insistence that he needed rhinoplasty, in disagreement with the referring plastic surgeon, resolved once he worked through his painful relationship with his father from whom he had inherited the shape of his nose).
Like many other clinicians who have watched the unfolding ROGD phenomenon, Dr. Bell is disturbed by how the importance of psychotherapy’s long history of understanding that people’s painful and often distorted beliefs about themselves can lead to various manifestations of self-harm is now forgotten or vilified when working with trans-identifying patients.
The headlining speaker of the conference, Dr. Lisa Littman, is the author of the seismic 2018 study, Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria. Her presentation described this landmark study (which coined the term ROGD) as well as her 2021 study, Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Dr. Littman also describes a third study (ongoing) in which she will further explore the experiences of desisters and detransitioners who no longer identify as transgender.
Perhaps because of the consistent attempts to “cancel” her as a result of societal backlash rooted in discomfort or politicization of her work, Dr. Littman authentically identified herself as “pro-LGBT, pro-prioritizing the health and well-being of all people who experience gender dysphoria, and pro-asking research questions to better understand a condition.”
With succinct, engaging slides, Dr. Littman clearly explained the two bodies of thought that are in conflict as clinicians around the world are working to understand and treat those presenting with gender dysphoria. She emphasized that what everyone has in common is the desire to help these individuals resolve their distress, but that the conceptualization of gender identity and the resulting treatments are vastly different.
One group believes in an innate, immutable gender identity that is as inherent as any other aspect of the self, and therefore, when one’s biological sex does not match one’s innate gender identity, transition is believed to be the answer, and delay is seen as harmful.” In this model, preexisting mental health conditions are irrelevant, and each person is seen as the gender they claim to be, and it is harmful not to affirm/confirm and provide medical interventions to make the body match the identity.
In contrast, an ever-expanding group believes in a developmental model to explain the statistically shocking increase in youth identifying as trans and is concerned that quick access to transition “fails to diagnose important conditions and provides the wrong treatment to some individuals.” Those who advocate for the developmental model of understanding and treating trans-identified youth believe that mental health comorbidities, in person and online social and political influence, internalized homophobia and misogyny, as well as the age-old difficulty of puberty all contribute to the appeal of the idea that one can change oneself and escape suffering.
Dr. Littman’s demeanor throughout her presentation was that of someone who is curious, caring, and humble while confident. For anyone aware of the controversy surrounding her work, she addressed the elephant in the room saying, “In a nutshell, why do I think my work is so controversial…I think it is because my research challenges the model and the approach to quick transition.” She went on to describe her methodology, placing it within established psychosocial research practices, and tactfully addressing the inconsistency and hypocrisy in critics’ arguments about the limitations in her research: “One panel called my study ‘methodologically atrocious,’ whereas another of my studies that used the exact same methods was described as ‘phenomenal.’ I do think that the pushback comes from a strong ideological place.”
Dr. Littman closed by reiterating that the striking changes in the population currently seeking care for gender dysphoria continue to fuel her own research. Because psychosocial factors including social influence, social contagion, maladaptive coping mechanisms, trauma, psychological issues, and internalized homophobia “may be one of several explanations” for ROGD phenomenon, much more research is needed, but it is clear that the state of evidence about the ROGD hypothesis is “increasing in strength.”
The conference ended with O’Malley noting the critical importance of retaining the parent-child bond. She encouraged affected parents to join Genspect where volunteer opportunities to help spread the word abound.
Genspect hopes this conference underscores that, while everyone involved with the ROGD population wants to help, without listening to the parents, without understanding the insight gained from Dr. Littman’s research, and without remembering and applying in-depth knowledge of adolescent psychological development, these young people will be harmed.
You can watch the entire conference here: ROGD: What We Know and What We’re Learning. This conference marks just the first of many that Genspect is planning. Please join us for a future conference.