In 1987 the Medical Journal of Australia published a report that is now often quoted as evidence that young people experiencing gender dysphoria grow out of the condition.
Today a new report in that same journal questions those findings, and suggests the practice utilised by Western Australian researchers was a form of conversion therapy, and a woman who is transgender has come forward after realising she was likely one of the subjects of the study.
The paper was titled Gender-disordered children: does inpatient treatment help? and was written by Robert Kosky, who was the director of Child and Adolescent Psychiatry Services in Western Australia.
The report looked at eight children, all under 12, who were admitted for ‘inpatient therapy’ between 1975 and 1980, the subjects are described as gender disordered. Each child spent months in hospital being monitored on their behaviour. The paper argues that the patients gender dysphoria was a result of poor family dynamics, and it could be corrected during a long hospital stay.
The names of the subjects of the paper are unknown but Jayne MacFayden was admitted to the same hospital during a similar period as the eight children. Her childhood recollections align closely with the clinical details supplied for one of the children.
MacFayden is now the lead author on the new report that questions the historical study. Supported by her co-authors, McFayden disputes some of the reported details and conclusions that therapy aiming to change or suppress a gender diverse child was effective.
She reported that her experience delayed self-acceptance for two decades and caused long-term harm. Despite this, she wrote her sense of identity remained steadfast.
Speaking to the ABC McFayden recalled the months she spent in the Western Australian facility during her childhood in the 1970s.
While the 1975 report says staff did not encourage patients to act in a male or female manner, but McFayden says her experience does not align with that account.
“It was very much trying to get me to be a lot more masculine and to associate with men and other boys.” she said.
McFayden said after she was released from the facility she spent the rest of her adolescent years acting like a “blokey bloke” out of a fear that any sign of femininity would land her back in hospital. But underneath that facade, nothing had really changed.
McFayden went on to get married and have children, but in her thirties she found she needed to accept who she really was and transitioned gender.
“I felt a lot lighter in myself that I could finally see myself being who I always believed myself to be.” she told the ABC.
Dr Anja Ravine from the Murdoch Children’s Research Institute said the research team’s analysis of available details, including MacFayden’s hospital medical record and account of her experiences, both in hospital and subsequently, revealed that her therapy caused psychological harm and was ultimately in vain.
“Inpatient treatment intended to re-direct gender identity was reliant on denial and repression,” she said. “This therapy included coercive tactics that mirror conversion therapy, which is well-known to be incredibly damaging.
“Our research found the child’s agency and voice were overridden, they endured long periods of detention in hospital despite their and later their parents’ objections, discharge was conditional on displaying gender-stereotypical behaviours and a long-lasting legacy of fear of re-hospitalisation was instilled.”
La Trobe University Professor Timothy Jones, a co-author, said clear messaging from leaders in psychoanalysis, psychology and psychiatry was urgently required to counter misinformation.
“Suppressive therapy techniques rely on installing feelings of self-doubt, fear, shame, self-loathing and sometimes psychic trauma, most especially when they are administered in informal settings without safeguards such as behind closed doors in the family home or in some religious communities,” he said.
“Alarmingly, the 1987 article and publications of a similar age and theoretical background continue being referenced as if they were factual and reliable in current debates, cited to promote bans on gender-affirmative support for minors and quoted in clinical guides.
“These detrimental, yet likely peer-reviewed, papers are fueling the current escalation in anti-trans rhetoric, which is now actively harming gender diverse children and their families.” Professor Jones said.
Prof Virginia Barbour, Editor in Chief of the MJA said journals need to be open to questioning previously published reports.
“Journals need to be open to publication of analyses and critiques of papers they have previously published. This new paper also comes at a time when the importance of the voices of patients in the care they received is increasingly recognised.”
“Genuine evidence-based medicine requires epistemic pluralism, including understanding the value of patient voices. This is where the work of Jayne and her colleagues becomes particularly important,” Dr Zuccala wrote.
“What constitutes the best care for trans young people should of course be up for debate, as is the case for all areas of medicine. It is the role of medical journals to ensure that this debate is rooted in humane values and is driven by evidence — of which the views of patients are an essential part.”
Dr Kosky has declined to comment on the new paper.
Tonight the story will be explored on 7:30 on the ABC.
