The Paradox of Gender in the DSM

Dr David Bell, a former staff governor at the Tavistock & Portman NHS Trust, discusses the fallout from the circumstances of his 2018 report, highly critical of the Tavistock Gender Development Service (GIDS), along with the criticisms by his colleagues from the Tavistock, that led to the growing public concern about GIDS, the Judicial Review, and the decision by NHS England, following the Cass Review, to close the service. Bell explores the complex terrain where the pro-medicalisation push within this demographic is at odds with the anti-pathology proponents, describing the paradox of a peculiar “double narrative” around gender dysphoria: those who claim they have a psychiatric disorder in order to covered by the NHS or by private insurance to be treated quickly and then the second group that claims they don’t have an illness, so they don’t need treatment. Bell also queries the politicisation of the treatments around gender dysphoria, stating, “Gender disorder…is a kind of ticket” where its adherents claim “that they know what the treatment is that they need.” Analysing the changes in the cultural context of gender dysphoria such as the co-morbidities associated with girls who identify as having “gender dysphoria” (eg. autism), Bell observes how current data on the decline of anorexia and bulemia cases suggests that girls who identify as transgender have much in common with the previous generations of anorexia and bulemia. Highlighting the complex and difficult relationship these girls have with their sexual body, Bell maps out the various ways these sorts of manifestations have changed according to cultural shifts: in Freud’s day it was “hysteria” to anorexia and bulemia in the twentieth century to this century’s manifestation of gender dysphoria. Noting how among young people in the UK presenting with gender dysphoria that 80% are girls, Bell ascribes this condition’s undercurrent as stemming from neoliberalism and misogyny.