Saturday, March 26, 2011

The naïve pursuit of balance

Following the prestigious launch of the Trans Media Watch Memorandum of Understanding a fortnight ago, Channel 4 has delivered the first tangible fruits of what says it wants to do, in the form of a nightly series of short films. The seven 90 second films in the evening prime time slot are designed to provoke public debate. That is the remit of the long-running show in which they feature. But, as the full series has unfolded night by night, I've been inclined to wonder whether some aspects have been as balanced as the makers doubtless intended.

Can poorly thought out 'balance' result in distortion, the antithesis of what was being sought? And do broadcasters and journalists need to learn about a subject in depth before they can lay claim to being able to judge what's proportionate and relevant?

The background

During the week commencing Monday 21st March, Channel 4 has been screening a series of transgender-themed short films in the mid evening slot

This tiny slot appears 365 days a year and is billed as "a space for sharing your thoughts on beliefs and ethics".

The show is no stranger to controversy. Last year some gay and lesbian commentators were angered when an early programme in the series featured Stephen Green, national director of Christian Voice, quoting from the Book of Revelations to support his view on that week's question, "Is Homosexuality a Sin?"

"There's something inherently destructive about the homosexual lifestyle", said Green, "because it's based on a lie – that homosexuality is equivalent to heterosexual love and marriage and it can't ever be."

This week's series of shows were framed in the same way, around the question "Is it wrong to change gender?".

This is the way the program pitches its' subjects. It's a style that invites potential comparison with the issues hotly debated when the BBC recently invited readers of their web site to debate "Should homosexuals face execution?".

I do suggest you pause for a moment to read the commentaries about Stephen Green's appearance and the BBC debate question as they raise concepts that you might wish to consider when reviewing this week's transgender-themed programmes. I particularly like this line from Patrick Strudwick on the former:

Balance is achieved when the proximity of two arguments to the centre ground are roughly equal but opposing. Having Green on Channel 4 is like putting a pound of flour on one side of the scales, and dropping a house on the other.

On the balance front, this week's series appeared on the face of it to do quite well...

The show's protagonists

The series began on Monday with the Rev. Christina Beardsley, one of several religious ministers I've come across who has themselves transitioned from man to woman. Christina cited the Bible in a novel way to argue that God is pretty relaxed about people making that journey to be themselves. Her argument was directed at the Archbishop of Canterbury, calling on him to make the Church a more welcoming place.

Tuesday saw the appearance of young journalist Paris Lees (another trans woman) who believes that prejudice against trans people is one of the last taboos to be addressed in our society. Paris is a leading light in Trans Media Watch, so could be said to have a bit of a stake in this series.

Wednesday was the turn of Keith Tiller, a Christian who claims to have struggled with his gender identity for 40 years, and who asserts that he has been able to resist that through the power of his faith.

What viewers wouldn't know, is how Mr Tiller campaigned hard alongside the Evangelical Alliance to oppose the passage of the Gender Recognition Act in the years leading up to its' passage in 2004; how he is associated with the publication of the EA's widely condemned booklet, "Transsexuality" in 2000, and how his Parakaleo Ministry has been criticised for being economical with the truth about the effectiveness of faith in countering gender identity issues.

Indeed, having met with Tiller's poster protegé Marissa Dainton in 2004, as she picked up the pieces of her life after a disastrous reversion of a her gender reassignment (which had been encouraged by her local church group), I can personally bear witness that this kind of "ex-trans" philosophy can have tragic consequences, which the advocates are perhaps understandably reluctant to discuss.

For all that, I couldn't find myself objecting all that strongly to the inclusion of Keith Tiller. Looking at him against the happy and positive trans people the rest of the week (who bear no resemblance) the audience might draw their own conclusions.

Thursday featured an engaging young trans man, Benson Bell, accompanied on screen by his girlfriend and looking forward to their life ahead.

Then Friday saw a really interesting contribution from Pav Akhtar, who works with the Muslim trans community. Pav argues that Western culture could learn something from the East, where countries like India and Pakistan have long acknowledged and had a place for a 'third gender'. Judged by commentary on Twitter, the audience found this show to be one of the most thought provoking.

I'm writing this on the Saturday, before Sunday's show featuring trans woman Delia Johnston, talking about lack of support and depression as she tried to suppress her transgender feelings for decades. However, it's the Saturday show that I particularly want to highlight.

Saturday's slot featured Charles Kane -- a familiar face in the media for his story of having transitioned once from male to female in 1997; decided he didn't like it; and then having sought surgery to revert back to the man he now presents as today. His position is that many trans people are unhappy about their transition but are afraid to speak out. He advocates that gender reassignment surgery should be a lot harder to obtain.

Keeping score

Before I discuss this last case, however, let's tot up the scores

Three trans women / One trans man

Two young trans people / Two mature ones

One cis-gender (non trans) advocate / Two ex-trans / Four trans people

On the face of it, if 'balance' were only about keeping score, that would appear to be pretty creditable. Even the ratio between trans women and men is in keeping with generally known demographic data.

However, as Patrick Strudwick suggested above, balance is a much more slippery beast than that. You don't achieve balance if you mislead an audience to believe that one argument has more significance than it really has. As a viewer you'd have to know something about Christian Voice, for instance, to be able to evaluate how representative Stephen Green's views about homosexuality are in the scheme of things.

So let's discuss the inclusion of a figure like Charles Kane in's sequence of shows.

The myth about widespread transsexual regret

The idea that lots of transsexual people regret their transition and are unhappy is one that has enjoyed an enormously long lease of life -- especially when you consider the evidence for how rare genuine cases of regret turn out to be.

I have a theory that the assumption that regret is common enjoys so much popularity because it seems intuitive to cis-gender (non trans) people.

Indeed, a transition for a cis-gender journalist would be a disastrous mistake. The difficulty those commentators seem to have is with understanding that a profound discomfort in the birth-assigned gender and happy embrace of transition defines what it is to be trans. That difference is what makes a genuine trans person's response to transition the reverse of anyone else's.

To be sure, post-transition life may be no bed of roses. At the recent Channel 4 event Equality Minister Lynne Featherstone MP herself acknowledged the degree of discrimination that many trans people face every day, and the morale-sapping effects that can have. Some may well be unhappy about the life they face. Some may be unhappy with the quality of surgery they received. However, that's not the same as saying that those people regret changing or would have been better off without.

The solution to unhappiness created by discrimination is to stop the discrimination. The solution to poor surgical outcomes is to train better surgeons.

What do we know about outcomes?

Although there are criticisms that can be levelled at follow-up research on post operative transsexual people in the past, all of the studies point in the same direction -- towards very low levels of regret for the change itself.

These studies are commonly cited in the evidence-based commissioning policies which NHS Primary Care Trusts have produced to justify funding such care. I've helped put them in there in a couple of cases. The NHS doesn't usually fund treatments without evidence of effectiveness.

One of the most interesting recent studies was undertaken in 2008 by the specialised commissioning group representing the whole of the Greater London region. Although this was ostensibly a study into patient satisfaction with treatment services themselves, the commissioners included some questions to find out how people felt about their transition, warts and all. The researchers said,

"In total 98% of those who had surgery felt it was a positive or mainly positive experience and were happy with their outcomes."

So, the reason why we probably see so much about Charles Kane is because journalists who've wanted to regurgitate the myth of widespread regret have had to recycle the same small number of cases which any of us know about. The good news is that it's genuinely hard to find more. You can see why Kane is the "go-to" man for anyone lazily seeking a case to feature.

A highly conservative process

Charles Kane's argument appears to be that gender reassignment treatment should be made harder for everyone because it didn't work out for him.

To decide whether that argument has any merit you need to know that gender reassignment treatment in the UK is already subject to extremely careful evaluation, designed to ensure that only appropriate candidates are recommended for surgery.

In the NHS the patient pathway typically takes at least 2 years to reach a possible referral for reconstructive surgery, during which time candidates all undertake what is called a 'real life experience'. This phase is there to ensure that the patient has full time experience of what they are committing to, and what that will mean for the whole spectrum of their life.

Although some trans people criticise the delay such a lengthy process involves for them, the result is the extremely low levels of regrets we've seen. Part of the reason these protocols are maintained is because of fear of cases like Mr Kane.

And the point is that in reality Charles Kane didn't go through this process. He used the fact that he had money to bypass it. He demanded rapid treatment, glossed over things that might have rung alarm bells for the psychiatrist evaluating him, and went abroad for many of the additional procedures he sought out, like facial feminisation surgery.

Charles Kane took full control of his situation. He spent his way around any of the checks that would have encouraged more lengthy investigation and consideration of his options. He can be argued to be the architect of his own demise. Yet he insists that the vast majority of people who aren't like him should be constrained disproportionately.

Numbers, numbers

But surely we still need to talk about this for 'balance' I hear you say...

Well, let's consider the numbers.

1500 patients a year enter the treatment pathway for gender identity issues in the UK and roughly 300 a year progress to the extent of qualifying for legal recognition of their acquired gender. That disparity alone points to the extent of filtering that occurs. Nevertheless, overall, there are at least 5-10,000 people who have completed such a permanent transition over the course of the last 50-60 years.

By contrast, we can find only a handful of people who have gone on record to express regrets, and even fewer who have sought reversal of surgeries. In six years since the gender recognition process came into effect, over 3,000 people have applied for legal recognition and none has ever applied for reversal of that.

To be fair, a caption in Charles Kane's short film did say that reversal surgery is "extremely rare". But, if so, how does the repetition of a rare case example that's been aired many times already contribute to balancing the week? Especially when trans people generally face so much ignorance already?

The documented regret cases (about a dozen) represent a fraction of one percent of all trans people who have undergone gender transition. Furthermore, the number appears to have been static for over a decade .. suggesting that even cases like Charles Kane wouldn't get through the system today (unless, like him, they bought their way past the checks and balances).

I've laboured the point, but for an obvious reason: Regret cases are rare. And, if we were to discuss them on television then Charles Kane would not be the person to present the case. You'd need more than a 90 second TV slot. And you'd need to objectively examine all the kinds of evidence and reasoning I've advanced above.

Distortion in the pursuit of cosmetic balance

Giving Charles Kane air time to present his position as though it were on a par with the other experiences shown is therefore not achieving balance in my view. On the contrary, it achieves precisely the opposite effect. It feeds the prevailing falsehood that regrets are a significant issue and that we should put even more obstacles in the way of patients than they already face.

There's a difference, as I've tried to show, between a naïve numerical concept of balance in broadcasting, and the genuine and intellectually sound variety. The latter requires more knowledge on the part of programme makers before making decisions about what to include and what to omit -- what's proportionate, and what's misleadingly disproportionate.

I have no objection to Channel 4 looking into regrets; however the responsible way to do that would be via a thorough documentary investigation considering the available evidence. Such a complex topic can't be explored in 90 seconds, and it is irresponsible to even try.

The long road ahead

At the end of the day, however, this maybe just emphasises the enormity of the hill that broadcasters have to climb.

One day we could hope that an independent producer of a show like would know enough about trans people's lives to be able to recognise what's valid to include for balance and what isn't. After all, we don't see the BNP routinely included into programmes about racial discrimination. Directors and commissioners both understand that that would be disproportionate and damaging.

On balance, therefore, it's seems clear to me that Channel 4's heart was in the right place and the makers of probably thought they were doing their very best.

However, on this occasion I think I'll have to withhold a point and have them settle for 9 out of 10.




Anonymous said... have to understand that come from a religious leaning and they try and shoe-horn "God" into their shows regardless of the reallities and complexities of the subject.

Anonymous said...

Then of course there is the less-intellectual, and more direct summary of Charles Kane; that he is a flake.

He's a duplicitous liar in every respect, expecially in regard to his own life experience.

I regard his input into trans issues on a par with Lauren Harries.

Toxic in every respect.

Christine Burns MBE said...

When balance fails in the way I've described and people understandably call for that to be corrected by a change in editorial emphasis, the word 'censorship' is often thrown back in their faces.

For instance, is it 'censorship' or the application of genuine editorial integrity to decide we've perhaps heard a disproportionate amount about the regret myth? Is it censorship that larger and more significant issues are displaced and never talked about because of that misguided focus?

For that reason I intend to follow up this piece with an examination of the warped thinking around that subject too.

In preparation for that, however, what (for you) are the most egregious examples of inappropriate calling of the 'C' word?

OllieFace said...

Although I agree with the basic premise of your piece; that the idea that trans-people's right to existence should be debated is in and of itself a privilege of the cisgendered and pharmful for the trans* I take extreme exception to the use of the phrase 'The myth of transsexual regret'.

Yes the stories of people who have de/re transitioned are used -indeed, often hijacked- politically to deny agency to trans people.

That does not mean that we are 'myths'.

We are real people. We happen. We do not deserve our expriences to be brushed under the carpet by the transcommunity because it is more convenient to deny our existence.

It is not just discrimination, or poor surgical choices which lead to people detransitioning. Some people discover that the gender identity they have taken on is ultimately not for them. We are not the majority, but for you to pretend that we do not exist is disengenuous and offensive.

Christine Burns MBE said...

Dear Olivia

I'm genuinely sorry if you felt that I was trying to airbrush you away. I acknowledged in this piece that regrets do occur and, indeed, I tried very hard a few years ago to track down more cases to talk to so that we could understand them better. This is also why I support the need for better care, rather than cries to banish care professionals from the system.

Just to be extra sure, however, I've been back and edited this piece to insert the word 'widespread' into the two occurrences of the 'myth' phrase.

I don't for a moment want to erase the pain and difficulties of people who genuinely find that transition hasn't worked for them. However, the point of this piece was about how the scale of that is represented.

Regards, Christine

OllieFace said...

Thanks, for your response, I really appreciate it, and your editing.

I understand that its hurtful for transpeople to have de/retransition stories used to (amongst other things) deny them treatment.... but its also important to note that it is hurtful for re/detransitioners to have those stories coopted and hijacked from us to do so, as well, particularly those of us who continue to campaign for trans rights, and/or continue to identify as trans.

I genuinely believe that if people were allowed to speak honestly in therapy at GIC clinics (rather than having it connected to approval for treatment) then it would cut down on transition regrets... and be more useful for all transpeople.

I personally would prefer that my experience was used to illustrate the fact connecting approval for treatment to people's gender counselling fundamentally discourages them from speaking honestly, and taking the time to work through their issues and doubts, and encourages them to either present uncomplicated, uncontroversial narratives that will garauntee access to treatment or go privately and forego the counselling process entirely.

David Zennaro said...

I think Olivia makes two very good points: 1. that we need separation between the gatekeepers and councelling. In Denmark we are now working to try to separate them because if a person has decided to change their gender then there is the risk that this person will tell the gatekeepers what he/she thinks they want to hear.

2. that some people DO regret and we as a community should not put down those who regret. On the contrary, we should stop and listen and learn what we can. However, what angers me about Charles Kane's performance is not the fact that he has regretted - that fact I commiserate with him, but rather that just because it was a mistake for him then it has to be for everybody else as well. That is a very arrogant viewpoint, and because we already undertreated then it is potentially very dangerous.

Virtually yours,
David Zennaro

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