Has Helmer got a point?

Did you read this in the Daily Mail (yes, I know) today?

Roger HelmerHelmer says the NHS should be allowed to spend money on helping homosexuals become straight. He says it is no different to NHS sex-change operations and, bizarrely, compares it to homeopathy.

‘One person is unhappy with their physical sex and wants to change it and we say, “OK you can do it.”

‘You have a homosexual who says, “I’m homosexual, actually I’d rather be straight, is there a way of fixing it?” We say to the person who wants to change from a man to a woman or vice versa, “Please do that on the NHS.” We say to this guy, “That’s wicked, you’re not allowed to think about it.” ’

‘I don’t know if homeopathy works or not, but I will defend the right of anyone who believes it works to try it.’ He insists he is ‘taking a libertarian view’.

I’ve heard this argument made before and I think it’s quite interesting. Person A is male and wants to be female. For the moment let’s disregard why they want to be female. We seem to think that’s OK and we spend NHS money on helping them achieve their aim. Person B is homosexual and wants to be heterosexual. For the moment let’s disregard why they want to be heterosexual. Suddenly we are all up in arms and calling it an outrage.

You can see the surface appeal of the argument. And the vast majority of those who would say that what Person B wants to do is outrageous could not cite you one bit of scientific evidence to support their contention that Person A’s corrective desire is in any way superior to Person B’s.

But as you know, on this blog we like to be a bit more thorough.

Do we have any biological basis for supposing that Person A’s transgender desire is a valid choice? Well yes. There are a number of studies that have explored whether MTF (male to female) and FTM (female to male) brains are different from those who are “cisgender“. Some have been rightly criticised for assessing transgender patients once they have begun to take hormone replacements (for example this post-mortem study) but others have shown on pre-hormonal patients that interesting differences are present.

So on the medical ground we have a cause to contemplate transition, and on the mental health ground we also do as plenty of pre-transition transgender people report significant distress. Of course transiting might not be the only method of relieving this distress. Some of those with Gender Identity Disorder manage to dissipate this neurosis through therapyu and some of the leading researchers in the field held to a primarily psychological model of transgender formation though increasingly the evidence does point to a biological component.

Does transition work? Well we know that those post-transition do not have the same mental health profile as the average population. Transition does not provide a magic panacea to the issues around gender dysphoria and indeed for many more people than you might think it ends up being something they deeply regret.

One more thought. There is some very interesting twin study analysis that has been done on transgender people, which points us to the same kind of curious “nature / nurture” mix that we see in the twin studies on homosexuality.

Gomez-Gil et al. (2010) in their sample of 995 consecutive transsexual probands (677 male-to-female and 318 female-to-male) report 12 pairs of transsexual nontwin siblings (nine pairs of MtF siblings, two pairs of MtF and FtM siblings, and one pair of FtM siblings). These investigators claim that their data indicate that the probability that a sibling of a transsexual will also be transsexual was 4.48 times higher for siblings of MtFs than for siblings of FtM transsexual probands, and 3.88 times higher for the brothers than for the sisters of transsexual probands. Moreover, the prevalence of transsexualism in siblings of transsexuals (1/211 siblings) was much higher than the range expected according to the prevalence data of transsexualism in Spain (the country of their study). Their study strongly suggests that siblings of transsexuals have a higher chance of being transsexual than the general population and that the potential is higher for brothers than for sisters of transsexuals, and for siblings of MtF than for FtM transsexuals. An excellent review paper by Veale, Clarke, and Lomax (2009) offers a host of references of papers dealing with transsexual familiarity and, while concentrating on the role of genetics and prenatal hormones, also touches on the actual and possible aspects of the rearing environment. They conclude there appears to be a significant role for biology in transsexualism but conservatively caution that attention is given to rearing practices.

So let’s summarise all of the above – transgender issues seem to have some basis in biology but there is no evidence saying that is a key determinative factor and some experts want to suggest that nurture issues may also be involved. For those who do seek to transit we know that it isn’t really a “100%” success rate – genes in the transiting person remain the same and biologically hormone therapy may help to establish a new gender identity, but cut a little deeper and the person is just the same (i.e. the autopsy of a FTM transgender will reveal ovaries – unless they have been surgically removed and surprisingly a lot of FTM transgender people do not). Ultimately transgender transition is about providing a therapeutic and if necessary surgical framework within which the person who chooses to transit can live a life in coherence with his/her aspirations for personal fulfilment. There is never a medical necessity to transit, neither is there a clear biological indication that such a request for transit will be likely and there is no definitive gene or biological marker which predicts transgenderism. When the transition is made, for some people it will end up being a cause of distress and for others it will be a source of greater personal wellbeing.

Right, and now for sexual orientation change efforts (SOCE).

Many people who self-identify as homosexual / gay are dissatisfied with that and wish to transit to some form of heterosexual functioning. We know that there is a great degree of natural fluidity of sexuality to begin with (and as Lisa Diamond so clearly demonstrates in the link, the notion that these people are all “bisexual” is a scientific nonsense) and so the idea that some people might want to give that natural fluidity a helping hand is not an absurd one.  Of course, as Jones and Yarhouse point out from a longitudinal study, not all participants in SOCE actually see a significant shift in sexual orientation (and this can be seen as a comparison to the way that despite how a MTF transgender person has corrective surgery, their sex chromosomes remain XY). What we do find though (as Jones and Yarhouse did) is that through therapy and self-awareness and decisioning, many men and women establish a new sexual identity away from homosexuality which many of them manage to maintain (even into sexually and emotionally functioning heterosexuality) even with (for some) strong remaining homosexual attractions. Yes, some “ex-gays” do revert to a “gay identity” (my apologies – I couldn’t think of a better expression), but others do not. Others report harm from their SOCE (though as the RPA recognised this week there are no statistically robust measures of this harm and what Jones and Yarhouse looked at this as part of their controlled study using far better measures than Shidlo and Shroeder they found no evidence of harm) but this is exactly the same as post-op transgenders who also report anecdotal harm and distress from transiting.

Right then. Deep breath.

Where does this leave us? We have some people who exhibit distress at the incongruence of their desired gender and their sex (a condition that is still not fully understood but which seems to be a complicated mix of nature and nurture) who find that the way to resolve the distress is to engage in medicinal and surgical intervention, an intervention which doesn’t actually technically change their sex at all but simply provides them with the framework to live their lives in a much more emotionally healthy and belief congruent manner. A portion of these people then go on to label this transition as harmful. This transition is apparently a good thing.

We then have some other people who exhibit distress at the incongruence of their desired sexual behaviour and their sexual orientation and attractions  (a condition that is still not fully understood but which seems to be a complicated mix of nature and nurture) who find that the way to resolve the distress is to engage in therapeutic intervention, an intervention which might not substantially change their sexual orientation at all but provides them with a sexual identity framework within which to live their lives in a much more emotionally healthy and belief congruent manner. A portion of these people then go on to label this transition as harmful. This transition is apparently a bad thing.

Methinks Helmer may have a point.

Before I finish, may I remind readers that I have a cautiously open and positive position towards transgender issues so I am not “having a go” here at transgender motives. Rather, what I’m trying to do is apply the same kind of reasoning to the two issues.

What do we all think?

18 Comments on “Has Helmer got a point?

  1. I don’t know what we all think, but I know what I think: You just opened (or perhaps Helmer did) a big can of worms which does not sit well with political correctness orthodoxy … :-)

  2. To come back to Helmer: no big beef here with his views on immigration and homosexuality as stated in the interview — of course, he may actually believe more objectionable things, I can’t judge that. Regarding his views on the RCC, one would need to compare the proportion of racists in the Met with the proportion of pedophiles among RC priests, and I think at that point his comparison fails.

  3. A key issue here is the yardstick by which we measure therapeutic success.

    For the surgeon conducting transgender surgery, this might be measured by the effecting of an overt physical change in line with outcome of the patient’s recovery from the operation. That barometer of success will not be re-calibrated to recognise a significant proportion of patients who have post-operative misgivings.

    For SOCE, anything short of complete and irreversible change of orientation will be deemed a categorical failure. Needless to say, gender dysphoria is a recognised disorder. In contrast, it would be considered unethical for a counsellor to attempt a therapeutic intervention aimed at achieving desired change in response to a person’s distress over their sexual orientation.

  4. I’m an American, so forgive me if I say something stupid about British politics here, though I follow it more than the average Yank I suppose. Also, I’ll probably rehash something you’ve went over considering I’ve only recently happened upon this blog. I think Helmer has a point, and I don’t think this will damage him too much in the by-election considering UKIP doesn’t need a simple majority and it is in a relatively conservative constituency.

    It seems to me it is rather silly to have a dogmatic opposition to same-sex orientation change and then turn around and think sex change is perfectly acceptable. I thought liberals were for liberty and all that jazz? Shouldn’t someone who has same-sex attraction who wants to be attracted to the opposite sex be allowed to find a professional who would help them? It’s difficult to come up with an agreeable concept of “liberty” where that would be unacceptable.

    Personally, I’m afraid for the future of any world where those kind of choices are publicly attacked. It essentially reduces our personal moral agency and our very ability to make our own decisions about the very thing that the homosexual apologist will tell us they are fight for: Our freedom and ability to choose who we want to love. Anyone that tells me that they are fighting for freedom to love who they want to love but then turns around and tells me that the choice was programmed from the start and attempt to change is harmful seems disingenuous.

    Also, the harm that I’ve read about in testimonials from those who go through these SOCE usually seems to have to do with excessive guilt, but maybe I’m missing something. Perhaps some of these programs load on extra guilt that is unnecessary and harmful, not to mention counterproductive. That I could very easily believe. However, that isn’t intrinsic to the idea of attempting to change who you are attracted to itself, so if that’s the only type of harm they can come up with, that isn’t by itself an argument against any kind of counseling over changing SSA. Maybe a lot of these programs have backward methods, or maybe having a method is backward itself, but that isn’t a reason to discriminate against the entire enterprise.

    Attacks on conservative and Christian views of homosexuality seem to me to be attacks not just on those views, but attacks on moral agency itself. Do we have moral agency? If we do, then no matter how difficult, we can make a decision to try to become attracted to the opposite sex. Even if we fail, we can make a decision that celibacy or marrying the opposite sex anyway is the morally correct choice, and, therefore, the choice worth choosing even if extraordinarily difficult and even a revolt against what some biological part of me is telling me to do.

  5. Actually, Peter, pace Wolf Paul, you haven’t opened a big can of worms, or even a little one. There is nothing new about Helmer’s argument; it’s been used many times before. It’s even been brought up not too long ago on this very website, if my memory serves me, by a certain lady named Jill. Let’s just look at it calmly. We have here two situations:

    (1) The first situation is that of a person who believes that he/she has been born, physically speaking, in the wrong sex and wants surgery, hormonal treatment etc. to bring his/her body into line with the sex to which he/she believes himself/herself “really” to belong. Should this treatment be provided, and if so, should it be provided on the NHS?

    (2) The second situation is that of a person who, for whatever reason, does not like having a homosexual orientation and wants to change it to a heterosexual one. However there is no verified means of doing this. Should our health system, nonetheless, deceive the “patient” by pretending that there is, and offer useless treatment for this non-illness?

    As I’ve stated before, I am reluctant to say much about transgender issues, since I still know very little about them and understand less. But the two situations are quite different, and so are the questions. The answer to (1) has no bearing on the answer to (2), or vice versa. No matter what the answer to (1) is, the answer to (2) should clearly be “No”.

    Helmer’s remark about homeopathy is here beside the point. Like him, I will defend the right of anyone who believes that it works to try it. I will also defend the right of anyone who wishes to try pyramid therapy, crystal healing, spirit healing, ex-gay therapy etc. That does not mean that these things should be provided by accredited health practitioners. They shouldn’t.

    • “However there is no verified means of doing this”

      Here you’re obviously talking about changing someone’s sex chromosomes from XX to XY (or vice-versa). Oh no, my mistake, you’re just being inconsistent in your argument. Why do we allow the NHS to “deceive” someone that they have changed sex when the biological fact is blatantly otherwise?

      • Peter, this is, I think, the second time just lately that you have used the pronoun “we” rather more freely than is justified. Who exactly are “we” in this context? Whatever the answer is, it doesn’t include me. I neither allow nor forbid the NHS to “deceive” someone that they have changed sex; I have no say in the matter. Nor have I defended gender reassignment surgery. I am well aware that the sex to which we belong is written indelibly into our chromosomes and that we carry it around to the day that we die, and therefore no-one can ever literally change their sex. Is there nonetheless a case for gender reassignment surgery for some people? That is not for me to say, although my personal instinct is to be wary of any mutilation of people’s bodies unless there is a pressing medical need.

        Gender reassignment surgery and sexual orientation change therapy are two completely different things. One’s view of the one does not logically have to dictate one’s view of the other. I TEND to disapprove of the former – although, as I have already made clear, I don’t feel that I know or understand enough about transgender matters to have a fixed opinion. On the other hand, I very definitely disapprove of sexual orientation change therapy. There is no inconsistency whatever in that. Notwithstanding, I support the right of “alternative” practitioners to provide it privately if there are consenting adults who wish to dabble in it.

        • What does gender reassignment surgery achieve if it doesn’t actually change sex, beyond making the individual happier with their life? Why do you think it is acceptable to let one person be happier but not another, just because it threatens a particular paradigm of sexual identity?

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          • Peter, you keep on talking as though I’m defending gender reassignment surgery. I’m not. I’ve already made it clear that I’m far from happy with the idea, although I’ve qualified my remarks by adding that I’m reluctant to be doctrinaire on a matter of which I know and understand so little. If you think that you can make a damn good case against it, please go right ahead. It won’t bother me in the slightest. But even if you can make a cast-iron case that gender reassignment surgery is unjustified, the logical corollary will be that our health service should stop doing it, not that it should start doing something else that is also unjustified. To the question “Has Helmer got a point?”, my answer is “No, at least not a rational and coherent one.”

            • Helmer’s point is that the NHS allows people one way of attempting to “pursue happiness” (i.e., Gender Reassignment Surgery) but not another (i.e., Sexual Orientation Change Efforts). The two are related in that both have to do with sexual identity. Why is one way of changing your sexual identity, or however we would put it, not paid for but another is? The answer is not that one has been proven to work and the other hasn’t, because neither has been proven to “work” at the level we are talking about.

              Going back to your original post: You are using two incongruous standards, and that is revealed in your biased language on the two issues. Look at the first sentences of your points:

              “The first situation is that of a person who believes that he/she has
              been born, physically speaking, in the wrong sex and wants surgery,
              hormonal treatment etc….”

              “The second situation is that of a person who, for whatever reason, does
              not like having a homosexual orientation and wants to change it to a
              heterosexual one.”

              You make the first sound like a sympathetic case of an internal identity conflict, which many of us will experience in our lives, albeit on different issues. However, the second is phrased as “for whatever reason” as if they are just being arbitrary. But how about a male who simply has always liked the idea of having a wife to procreate and raise children with, but for some reason finds himself constantly attracted to his fellow males? How is that not a case, under your view, of being born with the wrong sexual orientation, just like the transgendered individual was born with the wrong sex? Why shouldn’t professionals be allowed to explore the possibilities, however slim, of change or at least dealing with difficulties? Even if they don’t necessarily succeed in changing the subject of an individual’s attractions, they might be able to counsel them to both achieve their desires while living with the attractions.

              • No matter what you think I make the two situations sound like, they are different. But the obligation to tell the truth is exactly the same in both cases.

                A real change of sex is a physical impossibility. Nonetheless, should people, if they wish it, be given surgery hormone treatment etc. to make them look as though they belong to the other sex? No matter what the answer to that question is, people should not be told that surgical treatment will genuinely and objectively change their sex, because it won’t. The fact that people are “pursuing happiness” is no excuse for lying to them.

                It may be that a male, in your words, “finds himself constantly attracted to his fellow males” and has no sexual attraction to women, but nonetheless “simply has always liked the idea of having a wife to procreate and raise children with”. He may decide to adopt a heterosexual lifestyle in order to “achieve his desires while living with the attractions” – although he should NEVER do this without letting his prospective wife know well in advance exactly what the score is. But he should not be told that there is any known means of deliberately changing his sexual orientation, because there isn’t. The fact that he is “pursuing happiness” is no excuse for lying to him.

    • “No matter what the answer to (1) is, the answer to (2) should clearly be ‘No’.”

      I don’t think it’s so clear.

      “That does not mean that these things should be provided by accredited health practitioners. They shouldn’t.”
      Both of these quotes are assertions, not arguments. Assuming we are more than just products of physical chemical reactions, which most people, even in the relatively secular United Kingdom, believe, then our mental health will be decidedly non-methodical. Yes, there is no method that has been discovered, and I doubt there ever will be one discovered for changing someone’s sexual attractions. That doesn’t mean talking through the issues with a sympathetic mental health professional might not produce some kind of result that is desirable for the patient. Maybe the trouble is we are too focused on methods and formulas for something that is deeply resistant to that sort of thing.

  6. Transgender reassignment surgery can never succeed, since as you note, the underlying DNA is not changed by the surgeon’s knife. It only produces a cosmetic appearance of change. It may be enough to satisfy some of those who have undergone these gruelling procedures, but it is not a true change of gender. By contrast there is plenty of evidence to show that sexual orientation is a behaviour rather than a genetically determined disorder, and that a high proportion of those labelling themselves “gay” do not sustain that self-assigned identity without any medical assistance. However counselling has helped many to take that direction, to change learned patterns of behaviour, and to achieve a new identity of their own choice – counselling which is now proscribed not on medical but on political grounds, because homosexuality has become not a medical issue but a political issue which closes its mind to the unreality which is the homosexual condition. There is no gay gene: only a cultural and political demand that we should invent one.

  7. It would appear that Roger Helmer does have a point; but what is especially encouraging is that he has actually dared to make it – and hasn’t been fired as a candidate by nervous party bosses, running scared of the potential reaction.

    Some people will argue that he doesn’t have a legitimate point: that’s fair enough, and it’s called debate. Increasingly, though, it seems that the norm is for that kind of debate not even to be allowed in the public square. The only way to preserve free speech is by exercising it, and more strength to Helmer’s arm for that.

    • ‘Encouraging’ !!! Are you serious? Have you read the Daily Mail article Peter mentioned? Every comment this man makes about immigration is draped in insipid underlying racism and he makes ridiculous comments concerning the Catholic Church and the extent of paedophilia. But somehow he is an expert on transgender issues and SOCE. Talk about scraping the barrel. Sounds more aligned with Andrea ‘the world is 4000 years old and Islam is a false religion’ Minichelio Williams

      • I note that nothing in your reply actually addresses the substance of the point I was making. Ah, well…

  8. I wonder if the reaction would be any different if a heterosexual were to ask for therapy that would change their orientation to homosexual?

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