I realise that one of my problems in following current debates about same sex spaces, participation in women’s sports and the like is that I don’t know what gender identity means. It is surprisingly hard to get an answer by consulting the sources one might expect to be helpful.
Here for example is the definition of a relevant protected characteristic in the Equality Act 2010 “A person has the protected characteristic of gender reassignment if the person is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.” So, if gender reassignment means reassigning the person’s sex then gender and sex mean the same thing, which isn’t how I’d understood it at all.
In an interesting technical paper prepared by statisticians involved with national censuses, the discussion centred on how to keep a long-standing question about sexual identity while allowing people who didn’t like it to opt out and identify instead their gender. At the time of writing ONS was considering a question for the next census, to add to the standard question about sex. In the paper they suggest:
What is your sex? Note: a question about gender will follow later if you are aged 16 or over. Male/Female
Is your gender the same as the sex you were registered at birth? Yes/No, please write in gender Prefer not to say/
Do you consider yourself to be trans? Here trans means your gender is different from the sex you were registered at birth. No/Yes, write in gender/Prefer not to say
This works at a basic level to allow data collection about those who are happy to be described according to their sex at birth and those who aren’t, but it doesn’t help with unpacking current debates about the minority who aren’t, mainly because it allows people to use “gender” to mean whatever they like. However it does signal that sex and gender needn’t mean the same thing.
So…on to two organisations you’d hope had something more substantial to say – The World Health Organisation because of its official status, and the campaigning group Stonewall because if its self-proclaimed status. WHO offers these definitions:
“Gender refers to the characteristics of women, men, girls and boys that are socially constructed. This includes norms, behaviours and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time.
Gender interacts with but is different from sex, which refers to the different biological and physiological characteristics of females, males and intersex persons, such as chromosomes, hormones and reproductive organs.
Gender and sex are related to but different from gender identity. Gender identity refers to a person’s deeply felt, internal and individual experience of gender, which may or may not correspond to the person’s physiology or designated sex at birth.”
And the glossary offered by the campaigning group Stonewall offers these definitions:
Often expressed in terms of masculinity and femininity, gender is largely culturally determined and is assumed from the sex assigned at birth.
A person’s innate sense of their own gender, whether male, female or something else (see non-binary below), which may or may not correspond to the sex assigned at birth.
Both definitions make it clear that sex and gender aren’t the same thing – drawing a fairly conventional distinction between the two. Gender identity is not however awareness of and subscription to one’s gender. The WHO definition implies a psychological characteristic (internal, individual) that is not based just upon reading off one’s social status. The Stonewall definition talks of something innate, implying a built-in feature of mental life and described by the words male/female rather than masculinity/femininity – a nod towards the idea that gender identity might replace sex assigned at birth.
The ”gender” in these definitions of gender identity therefore seems to have a third meaning that is neither a synonym for sex nor a name for a socially constructed role. Something like sex but not defined biologically or gender not defined socially or culturally. Pretty much everything I have looked at online brings me to this position, via circular definitions (your gender identity is how you identify your gender) that use under-specified terms.
I have recently read two books that come to more-or-less the same conclusion – Kathleen Stock’s Material Girls and Helen Joyce’s Trans. I can review them another time but for now I’d simply recommend both – the authors are not disinterested but they are lucid and thoughtful writers and cover a lot of ground in accessible ways. You don’t have to agree with them to be much clearer about what the arguments are.
I was brought up short by one observation in Stock’s book: “It seems clear that, if we want to understand what having a gender identity is like, we shouldn’t ask non-trans people, for many report no particular sense of one.” Frustratingly (and uncharacteristically for Stock) there isn’t a proper reference to support this assertion but it fits my own experience. I’ve got a sex (male) that defines me as a man; I’ve got a gender (conventionally conformist for a white Western European man) that I don’t regard as salient enough to call an identity (my social status is defined by all sorts – social class, education, whiteness, job…) and I can’t think of anything else I could call a gender identity. Stock is dismissive (again uncharacteristically) about this idea that most of the population doesn’t have a gender identity “Maybe, for all we know, there can only ever be misaligned gender identities, relative to sex, and no aligned ones. We shouldn’t let a desire for pleasing symmetry get in the way of actual evidence”.
This strikes me as unsatisfactory. It feels as if it says something about the status of gender identity as an idea if it can’t be defined in a non-circular and specific way. Of course it may be possible to define it better but I can’t find such a definition. And what does it mean about the nature of public debate about these things if it isn’t even acknowledged widely that lots of people have “no clear sense” of a gender identity?
It isn’t obvious that the disputes grounded in (or at least framed by) ideas about gender identity are going to peter out any time soon. Some of the practical decisions (for example about women’s sport) will be made without these ideas ever being adequately formulated. But I do wonder if in the long-run we need to sort them out better, ideally through non-adversarial debate and avoidance of posturing on social media.
A notable feature of the debate about conversion therapy is the degree to which it borrows from, implicitly or explicitly, the language of evidence-based practice. There are other criteria of course: the value-based judgement that all attempts to change sexual orientation or gender identity are wrong, or the pragmatic argument about unintended consequences that might come from poorly drafted legislation. Nonetheless it remains reasonable to ask how good the research evidence is, evaluated independently of these other arguments, in providing grounds for proposed legislation to make it illegal.
An immediate problem is posed by the broadness of the definition usually employed. For example recent government documents describe conversion therapy as…“techniques intended to change someone’s sexual orientation or gender identity. These techniques can take many forms and commonly range from pseudo-psychological treatments to spiritual counselling”. What this means is that the form, content or style of any intervention being evaluated is often unclear, or that widely differing interventions are conflated in a single intervention category.
Another barrier to interpreting research findings is the lack of attention given by many commentaries to the question of consent. For example the nature of consent is not reported in the UK survey of experience conversion therapy: the results show that more people were offered than received therapy, but not how many had consented to or even actively requested it. In a US study of the experiences of men who have sex with men, 40% of respondents who had experienced therapy said the decision to initiate therapy had been “mostly” or “completely” theirs. One might expect that unwanted or coerced intervention would be more likely to have negative outcomes, but the necessary analyses don’t seem to have been undertaken.
Apart from this (rather obvious) observation that coerced intervention may be the more harmful, there is another complication that arises. People who request therapy may be seeking help with a range of relationship problems that are conflated with their sexual orientation or gender identity, making it difficult to tease out the effect of the “conversion” element. The recent publication of Patricia Highsmith’s journals and diaries provides an example if a rather atypical one.
Reported outcomes typically describe one of two domains: change in sexual orientation or gender identity rarely occurs; negative effects for example on mood and sense of self-worth are commoner than in those who have not received therapy. The evidence is by no means clear that such negative effects are universal and by comparison, benefits have been rarely sought or reported.
One exception is a study of LGBQ individuals affiliated with the Church of Jesus Christ of Latter-day Saints, 720 of whom provided unstructured comments on their experiences in addition to completing structured assessments. The authors note, of these comments “Many found therapy to be a helpful, even life-saving experience. To be able to talk to a knowledgeable professional about a very private concern was salutary. Others reported improved relationships with family or other close associates. Of particular interest was the large number of individuals who reported decreased levels of depression and anxiety and improved feelings of self-worth…For some participants, psychotherapy was clearly unrewarding. As a general rule, however, experiences of harm or iatrogenic distress were much less frequent than reports of benefit.”
Qualitative studies suggest that benefit accrues from aspects of therapy such as discussions about the meaning of the immutable nature of sexual orientation or gender identity or about how to manage any resultant dissonance that arises in the family or religious groups. One interpretation of how attempts at conversion might contribute is that they can act as a sort of behavioural experiment the results of which will depend upon how they are handled. Sensitive discussion can help, while insensitive, coercive or rejecting responses will not. For example, one study of people who had experience of conversion therapy found that those who had subsequently left the religious community for whatever reason were more negative about the effects of therapy than those who had not. One consequence of the definitional problem (see above) is how difficult it is to find much in the research literature that notes whether conversion therapy came with a certain package of other responses or not.
One piece of evidence I have been unable to dig up is what happens next in countries where legislation has already been passed. Has it led to prosecutions? What is the effect on religious communities? In most of the relevant states evangelical Christian groups predominate and it is hard to find anything about other religions. What happens in the madrasa or orthodox Jewish groups? I think we simply don’t know.
In summary – nobody surely would disagree that imposed or coercive attempts to change somebody’s sexual orientation or gender identity are abusive and should not be allowed. However, the proposed UK legislation initially promised to impose a blanket ban on any form of conversion therapy. Even consented or requested therapy, competently delivered as part of a wider discussion of the issues, would be criminalised.
This takes us away from a popular caricature of conversion to a more complicated picture of a type of talking therapy that might be actively sought, with more mixed motivations and with attempts to use effects of the process as the basis for wider exploration. Should that really be criminalised? Such an approach might be argued about on the basis of values rather than evidence, but it is difficult to read the research literature and find unequivocal justification for it.
As things stand, the government has backed off (again) and now says it will not legislate on consented therapy involving adults. It is difficult to believe, of this government, that the decision is one of principle – more likely a response to legal advice about difficulties of drafting the law. Only time will tell what the eventual bill contains. Meanwhile some careful planning of prospective research would be a good idea.
Steven Meanley, PhD, MPH, Sabina A Haberlen, PhD, Chukwuemeka N Okafor, PhD, MPH, Andre Brown, PhD, MPH, Mark Brennan-Ing, PhD, Deanna Ware, MPH, James E Egan, PhD, MPH, Linda A Teplin, PhD, Robert K Bolan, MD, Mackey R Friedman, PhD, MPH, Michael W Plankey, PhD, Lifetime Exposure to Conversion Therapy and Psychosocial Health Among Midlife and Older Adult Men Who Have Sex With Men, The Gerontologist, Volume 60, Issue 7, October 2020, Pages 1291–1302, https://doi.org/10.1093/geront/gnaa069
American Psychological Association, Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Retrieved from http://www. apa.org/pi/lgbc/publications/therapeutic-resp.html 9 May 2022
Kate Bradshaw, John P. Dehlin, Katherine A. Crowell, Renee V. Galliher & William S. Bradshaw (2015) Sexual Orientation Change Efforts Through Psychotherapy for LGBQ Individuals Affiliated With the Church of Jesus Christ of Latter-day Saints, Journal of Sex & Marital Therapy, 41:4, 391-412, DOI: 10.1080/0092623X.2014.915907