A rear view of a person in motion disappearing as he walks towards the sea at sunset wearing warm winter clothes
Artillery Row

The spectre of suicide

Against the weaponisation of youthful suffering

When a child identifies as trans, the spectre of suicide is frequently raised by campaigners — sometimes in a highly manipulative and unethical form. A talk by philosopher Kathleen Stock at the Oxford Union in May was interrupted by an activist glueing her hands to the floor. She wore a T-shirt stating, “No more dead trans kids”. Parents are told that unless they immediately “socially transition” their child — i.e., refer to them as members of the opposite sex, and present them as such to everyone else — their child is highly likely to self-harm.

Perhaps the most egregious form this claim takes is that unless a child is swiftly medicalised, first with puberty-blockers and then cross-sex hormones to cause their body to develop towards the “right” sex, the risk of suicide is hugely elevated. This emotional blackmail is expressed in the activist catchphrase, “Better a live daughter than a dead son”. Susie Green, former chief executive of the trans lobby group Mermaids, has described medicalisation of gender-distressed young people as “literally lifesaving”.

The idea that suicide is practically inevitable in this group instills such fear that people around them often take immediate action to try to mitigate this risk. Caution about the unintended impacts on the gender-distressed person themselves — and on those around them — are frequently overlooked.

In schools this may mean socially transitioning a gender-distressed child without clinical assessment, or perhaps even without informing parents, let alone gaining their consent. Perhaps most seriously, a health professional may prescribe a distressed adolescent hormonal interventions with potentially lifelong effects, without assessing or treating co-occurring mental health conditions.

These may include puberty blockers — an under-researched intervention that can affect brain and bone development. These powerful drugs are often presented as a reversible “pause button”, but in truth they are a fast-track to further medicalisation. Research shows that 98 per cent of children who take them to treat gender dysphoria will go onto cross-sex hormones and often chest or genital surgery.

As for cross-sex hormones, many of the changes they cause are permanent. For girls, the deeper voice and male-pattern facial and body hair that follow testosterone can never be reversed. Breasts, genitals and internal sex organs that are removed are gone for good.

This hurried, medicalised approach is entirely at odds with what mental-health practitioners know about assessing and managing suicide risk. The majority of patients who are suicidal are depressed, anxious, psychotic or experiencing ongoing trauma such as bullying, domestic violence or abuse. They feel hopeless and ashamed. Patients try to “carry on as normal” and hide their despair from those around them. Frequently they avoid acknowledging, even to themselves, that they are having serious mental health problems.

A clinician’s first step will be to build a therapeutic relationship with the patient: to understand what is going on (what clinicians call the “biopsychosocial formation”) and then to offer the right sort of help. They will consider underlying factors such as neurodevelopmental conditions and attachment experiences growing up, as well as experiences that may trigger suicidality or cause it to continue. These can be biological, such as chronic pain; psychological, such as personality style or propensity to catastrophise; or social, such as immigration status, overcrowded housing or a homophobic family.

At the same time the clinician will seek to understand the positives in the person’s environment that could be bolstered to protect them. These might include peer and family support, or engagement in activities such as education.

Failing to investigate the underlying distress and instead simply giving the patient what they want might even increase the risk of suicide, since the patient would continue to feel misunderstood. The hope is that the therapeutic relationship, along with interventions (psychological, social or medical) allow the patient to emerge from despair and once more wish to live.

This is sensitive and highly personalised work that involves constant risk assessment and many fine judgement calls. Is a patient safe to go home? Do they need a Mental Health Act assessment? Will they seek help if they feel suicidal again? No one would expect non-clinicians, such as teachers or parents, to assess and manage these sorts of risks on their own.

When activists raise the highly charged topic of suicide, parents and professionals such as teachers may respond with fear, guilt and even anger. These emotions are so unpleasant that they create a compulsion to act, even if the course of action may be harmful in the long term. The anger can get directed towards the imagined “enemy” — for example, a doctor who doesn’t think puberty blockers are the right treatment, a teacher who’s worried about the impact of socially transitioning a child on classmates, or a women’s-rights campaigner who opposes allowing male people into women-only spaces.

There is, thankfully, no evidence to support the idea that having a trans identification in itself leads to a higher risk of suicide. Being gender non-conforming can cause so-called “minority stress”, and people who identify as trans often suffer from mental-health conditions that are related to self-harm and suicidality. The website of the main NHS child gender clinic, GIDS, says that “suicidality in young people attending the GIDS is similar to that of young people referred to child and adolescent mental health services”.

However, a young person who hears repeatedly that they are at risk, if they are denied social transition, puberty blockers or cross-sex hormones, may come to believe this claim. Thus the rhetorical use of suicide in itself risks harming the mental health of already vulnerable people. GIDS says that “it is not helpful to suggest that suicidality is an inevitable part” of gender distress in children. The Samaritans warns against attributing suicide to a single cause, which it says “could increase the suicide risk of someone else experiencing similar issues”. It also warns that young people are more susceptible to suicide contagion.

These concerns are amplified by the strong association between gender distress and a wide range of mental health and neurodevelopmental conditions, which involve poor social skills, obsessive rumination, depression and anxiety. All of these can contribute to suicidal thoughts.

Every child who experiences gender distress deserves high-quality, evidence-based care. They do not deserve to be treated as rhetorical devices by campaigners and politicians who wish to forward a political agenda. They seem to have lost sight of the harm they are doing to this very vulnerable group.

Enjoying The Critic online? It's even better in print

Try five issues of Britain’s newest magazine for £10

Critic magazine cover