An autoethnographic critique of a past report of inpatient psychiatric treatment for gender diverse children

Objective

To review reporting on a case series of “inpatient therapy” administered to pre-pubertal children presenting with gender expansive behaviours previously published in the MJA and to compare this reporting to the adulthood recollections and past contemporaneous medical records of a person who had received such treatment.

Design

Retrospective analysis of autoethnography, archived mental health records, and patient details published in a 1987 MJA case series of eight children.

Setting

Stubbs Terrace Hospital, a Western Australian state-funded child and adolescent psychiatric hospital, no longer in operation.

Participant

Jayne McFadyen (J), a transgender woman whose recollections align with the clinical details supplied for Case 5 in the case series, and an author of this article.

Main outcome measures

Concordance and discordance among details documented in the published case series, J's autoethnography of her hospital treatment, and archived childhood psychiatric records obtained through freedom of information.

Results

J's recollections align closely with details in the archived records. Both align with many, but not all, published details, most notably the following published statement: “No conscious attempt was made by the staff members to encourage masculine or feminine role behaviours.” Some of the verified recollections are of psychologically coercive and aversive practices typical of sexual orientation and gender identity and expression change or suppression efforts (SOGICE). Despite inpatient treatment aimed at suppressing or changing her transgender identity and expression, J's sense of whom she understood herself to be remained steadfast.

Conclusion

A retrospective review of “inpatient treatment” intended to re-direct gender expansive identity formation revealed pseudo-psychological strategies reliant on denial and repression. These were directed towards extinguishing childhood behaviours deemed to be socially undesirable. These practices are indistinguishable from the defining characteristics of suppression or change practices, or so-called “conversion therapy”, seeking to achieve cisgender and heterosexual outcomes, efforts which are now known to be futile and harmful.