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Author and academic Meg-John Barker joins Helen and Marianne to explore what it means to be non binary, the limitations of language when it comes to gender, the importance of education and the impact on our mental health of having to conform to gender stereotypes.

We hope you enjoyed this episode. If you have been affected by any of the topics discussed in our podcast and would like to get in touch, please drop us a line at info@GenderGP.com. You can also contact us on social media, where you will find us at @GenderGP on Twitter, Facebook, and Instagram.

We are always happy to accept ideas for future shows, so if there is something in particular you would like us to discuss, or a specific guest you would love to hear from, let us know.

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Gender, sexual and relationship diversity (GSRD): Good practice across the counselling professions – BACP

Find out more about MJ Barker here:
The Meg-John and Justin Podcast: https://megjohnandjustin.com
Follow MJ on Twitter: @megjohnbarker

Additional resources:
Sexuality and Gender for mental health professionals by Christina Richards and Meg John Barker
How to Understand Your Gender: A Practical Guide for Exploring Who You Are by Alex Iantaffi and Meg-John Barker
Gender queer and non binary genders by Christina Richards, Walter Pierre Bouman, Meg-John Barker
Understanding trans health: Discourse, power and possibility by Ruth Pearce
Transgender Health: A Practitioner’s Guide to Binary and Non-Binary Trans Patient Care by Ben Vincent

Thank you. We hope you enjoyed our program. Do go ahead and subscribe if you haven’t done so already. If you or anyone else is affected by any of the topics discussed on our podcast and would like to contact us, please drop us a line at doctor@gendergp.co.uk. We’re very happy to accept ideas for future episodes and guests, or if there is something specific you would like us to cover. You can also visit our website, www.gendergp.co.uk. You can follow us on social media @gendergp, and you can sign up to our monthly newsletter. Full details can be found in our show notes on the podcast page. Thanks for listening.

The GenderGP Podcast

Exploring the Binary with Meg-John Barker – The GenderGP Podcast S4 E2

Hello, this is Dr Helen Webberley. Welcome to our GenderGP Podcast, where we will be discussing some of the issues affecting the trans and non-binary community in the world today, together with my co-host Marianne Oakes, a trans woman herself, and our head of therapy.

Dr Helen Webberley:Today I am really excited to welcome MJ Barker. Thank you very much for joining Marianne and myself. And as always, I’m going to hand over to you to introduce yourself and tell us a bit about you and your work and your interest in this area.

MJ Barker: Absolutely. So yeah. MJ Barker, Meg-John Barker for my professional writing work, and my background is I’ve been an academic in psychology and sociology. I’ve also been a therapist for many years and an activist on LGBT matters for a long time. But I’ve given most of that up recently to become a full-time writer. So the main thing that I do is to write books, self-help books and gender relationships and sex, and also graphic guides comic books about introducing various ideas. So I’ve written a Queer: A Graphic History and the Follow Up on Gender which is out in November actually.And I’ve also written the book Life Isn’t Binary, so it’s taking non-binary thinking about gender and applying it to all kinds of other things, with Alex Iantaffi, my co-author for that. I also to have a podcast on sex and gender and relationships with Justin Hancock, the sex educator. It’s theMeg-John and Justin podcast. So we’ve got plenty of stuff on trans there. And I guess in this area I mean doing a lot of kind of non-binary activism is I can definitely speak to non-binary issues. And then Alex and I in our book How toUnderstand Your Gender, we talk a lot, and then Life Isn’t Binary, we talk a lot about breaking down binaries, including kind of a man-woman binary obviously, and gay-straight binary, but also maybe the trans-cis binary, and the non-binary-binary binary. So that might be something we can answer in terms of implications for what kind of gender affirmative factors might look like if we are questioning some of those binaries. I think that that does a decent job of introducing me.

Dr Helen Webberley: Okay, and that’s brilliant. Thank you. So those words obviously rolled off your tongue beautifully.The actual concepts are more difficult to understand. So you mentioned lots of binary: non-binary, cis binary, trans binary. Do you want just to help our listeners and me and I don’t know about you Marianne, and just unpick some of those words in the kind of easy to understand way.

MJ Barker:Yeah, absolutely. So it’s a non-binary gender is really anyone who doesn’t experience themselves as being man or woman,right?So and that’s sort of an increasing number of trans people who are coming to gender clinics and gender practitioners as they found in the government’s survey they recently did on LGBT, seven thousand number of non-binary people responded, which is actually more than the number of trans men and trans women put together. Not every single non-binary and a person identifies as trans, but if we think of trans as being in a gender different to the gender you’re assigned a birth, then that does kind of put non-binary people under that umbrella, because very few people have been assigned non-binary at birth or have it open as to what gender they going to be, certainly in Western culture. So non-binarypeople are those who don’t experience themselves as man or woman.In terms of the numbers you identify in that way, I think it was about one in 250 when given the option on a survey would say I am non-binary. So just sort of 4 or 5 per cent. I think there’s a study done by Dr Joel which found that if you ask people,“Do you experience yourself like as to some extent the other gender or near the gender or both genders?”And she foundand her colleagues found that over a third of people said that they did. So the number of non-binary people is somewhere between under 1 per cent and a third of people, depending on whether you are looking at identity or experience, which is really so much like bisexuality as well.(unclear 4:07) If you of whether being gay or straight for us coming to you identify two to four per cent depending on the study.But if you ask how many people experience attraction to more than one gender, it’s getting on for like 40 50 per cent depending on the study. So that’s non-binarygender. But we can also question the trans-cis binary. So transgender is people who have shifted in some way from the gender they were assigned at birth, and cisgender people are people who stay in the gender they were assigned at birth. And you could say often we talk about things as if they’re two very separate populations, but there are plenty of people who might fall somewhere in between those. In terms of like, that certainly, they’re not expressing themselves or experiencing themselves as it would have been expected for someone who was assigned a man or a boy or a girl, but maybe you haven’t embraced that label trans, so they would fall somewhere between trans and cis.And if we’re saying that there are really no binaries here, then we can even question the idea that there’s a binary between non-binary people and binary people. Because actually in terms of their lived experiences, maybe lots of people who fall between a kind of a simple I’m in the binary man or woman or I’m actually non-binary.

Dr Helen Webberley:Wow.Marianne over to you on that one,while I just digest some of that because it is one that is hard to understand.

Marianne Oakes:I think what I’m taking away from this is that language is very limiting when it comes to gender. And actually what we’re trying to do is make it, so people are cisnormative can kind of understand us in some way. And so we’re through. Like you say, it’s just an ongoing dialogue really which hopefully one day we won’t need to do that. People will just be seen for who they are.

MJ Barker:We’re going to do training about this. And also the book. I thinkpeople do say often it’s fairly complex and I think you can make it quite straightforward. It’s like why you start with the training or and some writing is like, come up with all of the ideas about what it means to be a man in our culture and what it means to be a woman. And like we got this big list on the board or whatever. And then I say well he fits perfectly on either side of us. And people will be like we’ll know and often that your kind of a spectrum between it’s like delicate, hard, rational, emotional.Blah blah blah. You know and get people to draw an X where they would be on those different spectrums and most of them you can chart like this and dominance submissive and unemotional so rational and it’s different and so different things or some of them they’re in the middle, or some of them they’re kind of a bit of both. And that’s what we are with gender. It’s just a lot messier than we’ve been given to believe. Well, we know from intersex people as well that even a biological level of fact is a lot messier than we are led to believe it’s not. That we have that binary of X X X Y chromosomes, but there’s quite a lot of different things in between.Similarly, in terms of circulating levels of testosterone and estrogens that can be all over the shop for different people. Genital configurations areclearly different for different people. So we could see even that as more of a spectrum other than either you have a clitoris, or you have a penis. So I just think it’s really all that stuff for people and to get away from the simple binary idea of gender and not just useful for non-binary people or for trans people, but useful for everyone. Because we know in terms of mental health that huge mental health problems in cisgender women and cisgender men are related to trying to hold very rigidly to gender stereotypes.So, guys who tried to be really hard and tough and not share their feelings are the reason we have such high suicide rates amongst men. And women who try really hard to be for there for others and care for other people often have high rates of depression sometimes the body image issues as well. So I think everyone could do with getting away from this very binary notion of gender.

Dr Helen Webberley:So there’s a real mix in there, isn’t there? Well in the past when I’ve tried to explain gender, and then people say why aren’t they just a tomboy, for example? You’re merely mixing up quite a lot and saying everything is in that pot, rather than you’recisgenderor you’re transgender or neither, you’re in the middle.Well, neither, you kind of took in all of that in the pot together.

MJ Barker: So yeah I think that that would be helpful in a way for gender services, maybe to get to that point of not recognizing, it’s not necessarily just about services to trans people. That everyone is going to need support somewhere on their gender journey. And there’s this whole diversity of ways of experiencing and expressing gender. So yeah, in terms of like mental health which is more where I’m coming from, it’s not just trans people who need to talk about their gender in therapy. Like when I worked in therapy, I was talking with cisgender people all the time about the kind of ideals of masculinity they were trying to live up to in terms of their relationships, in terms of sex, and in terms of addiction, things. And the same with nearly every woman I saw, was definitely talking about the struggles with those ideals of femininity and what it means to be a good woman.So yeah, I think. And the same with health services too. I think we get so fixated on trans people going through those particular hormones and surgeries. Actually, I know lots of cisgender people who have had some kinds of medical interventions in relation to their gender. Like I was talking to this person who had a breast reduction, and it was partly a physical thing to do with having less migraines, but partly also to do with having big breasts made her be sexualized all the time by the people or made her seem particularly maternal. And so she had a surgery on her body that made her feel much more comfortable in her gender.And certainly a lot of cis guys you have more (unclear 9:56). So there are quite a lot of guys who are having operations in relation to that, and there’s certainly cisgender men and women who take hormones at various points for various reasons and lots of people through menopause needing medical help with that. Lots of people through pregnancy needing medical help with that. So I just think it would be almost more useful if we just saw it as like people need help becoming comfortable with their gender at various points in life. Trans people quite often need that, but not all of them do.People often need that, but not all of them do. You know instead of having it as like the big thing about trans people that’s all about the medical kind of aspect.

Dr Helen Webberley:Yeah. I mean it’s certainly something that I understand and that we’ve talked about a lot in the past which is, does transgender health care need to be so specialist? Why can’t we just mix up all these people who need oestrogen replacement therapy for whatever reason or testosterone replacement therapy for whatever reason? Why is it the trans you need to go through this massive assessment and diagnosis procedure which, Marianne, I know you and I have talked about a lot in the past?

Marianne Oakes: One of the things that I kinda see a lot in the therapy room is people are coming in, they are trying to fit themselves into the binary. You’ll get trans women say I can not get access to help if I don’t fit this binary model, and I do feel that actually if we could just break down some of that and allow people just to be who they want to be without fear of invalidation of how they feel. And that’s one of the things that I see with non-binary, that they’re feeling forced to go further than they probably need to be.

MJ Barker:Absolutely. This is why I wrote this book with Christina Richardson and WalterBouman about this stuff.I’m looking at my bookshelf. It’sGenderqueer and Nonbinary Genders, but we got together as an edited book. We got together like surgeons and endocrinologists and psychologists and psychiatrists and everyone in the same book to be like, yes, non-binary genders exist. And this is what gender services should be offering in terms of non-binary people now.How much that’s been taken up by clinics, it’s so different for different places. I’m still hearing the horror stories of non-binary people who go to some clinics and are expected to be fitting the binary trans woman or trans man model when going through those particulars, assumed you’re going to want to be on this hormone and have these surgeries kind of gets questioned. It’s almost like your transness is questioned if you don’t want to fit that model.But certainly nothing (unclear 12:38). Well, those people are where I hope to be better on this stuff and other places too. So I think it’s slowly filtering through, but I think it’s better for everybody.You know, because again, it’s not all trans men and not all trans women wantto go through all of the things either. And it’s kind of like there’s just this old model where it’s just expected that you would tick all of these boxes and if you don’t want to, that would be questionable.We need to move away from that to more like, what fits this particular person? For all trans people and actually all cis people, it is like here are the options that are available to you. Like first, this woman has the opposite options available on menopause in terms of both physical treatments and hormonal treatments that might be available.

Dr Helen Webberley:Absolutely.And also what’s available and what might be right for you at that time, we could use it for reviewing it later if you want to change your path on that journey.And I think that’s why—

MJ Barker: There is such a panic that people might change their mind. But of course, we change our minds about things in our lives sometimes. And that’s okay to be supportive of and to be clear. These are the onesthat’s more temporary we could change again, these are ones that if you make that change, it’s more permanent but helping people to make their informed choices through that system.

Dr Helen Webberley: Yeah. You were saying, Marianne, you were saying last week, weren’t you, that there’s not so much of a change of mind as a reverse direction it’s a change of their mind as a forward direction.You were saying that about that, weren’t you?

Marianne Oakes: I was going to say that the more I’ve been thinking about it, it’s really something that the word transition seems really limiting, like we are either going forwards or backwards. And actually, if we could find—I think you mentioned it, Helen, actually in the last podcast. I wish we could find another word because actually, transition, I think, for non-binary more than anyone is really limiting.

MJ Barker: What are you going to call it?Like there were all these little changes we make over time. For me, it’s like a little a way to change my name, I changed my pronoun. There was a point when I did some surgery, a point when I did some hormones,but which of those points are you even going to pick? And arguably there are others that are more important than any of those, that may be more personal or whatever. But also like you say like it’s always a forward journey, isn’t it? This sort of idea of detransitioning is not helpful because even if somebody makes changes again, it’s a further change onwards, on a journey. It’s kind of like work, like we wouldn’t say okay, so that person is gone for this job which has this higher salary, but then they take on the job with a lower salary so that they can then do other things with their lives and then, later on, they’ve had this different goal, and they’ve done this.You know we see all of those is kind of an ongoing journey rather than oh, they’ve gone backwards because they nowearn less money or they’ve come backwards because they’ve retired. So it’s sort of like saying gender like that just like a life course thing, right?

Marianne Oakes: I think transition kind of fits the binary model, doesn’t it? We are either transitioning or detransitioning, and it actually seems far more complex than that. And maybe not complex,but more simple—

MJ Barker: Exactly, and (unclear 15:37) suggested as well, you know, part of the reason why it is AN incredibly small number of people who do what they call detransition anyway, isn’t it, that perhaps even less people would if the non-binary option was there. Like perhaps a lot of those people, it’s only because they were presented with a limited option of getting only in between a binary choice. So the more we can open up things like gender is diverse and you can make all of these changes or none of these changes. You know this is there’s no pressure to do that. It would just be really helpful.

Marianne Oakes: In any other walk of human existence, I think we’d just call it growth, wouldn’t we?

MJ Barker: Exactly.

Dr Helen Webberley: You were saying at the beginning that the percentage of people who are identifying as non-binaryis increasing. It’s much bigger than we would imagine.Some might argue that that is because being trans is not very cool or fashionable, and there’s a lot of hate crime associated with much discrimination.Is there an argument in that?

MJ Barker: Virtually non-binary people are not free from discrimination. So I don’t think it’s an easy path to choose, compared to like a trans man or a trans woman.So it’s not that. But I guess there’s something about how it’s much more culturally available. You can’t really be something that isn’t available in the wider culture.You know it’s incredibly hard to. I think the fact that there is now a discourse and understanding of a word for non-binary, multiple words. The different ways of being non-binary, that’s enabled, that’s opened up that possibility to identify in that way. So I think the main thing about the increasing numbers, especially of young people seeing themselves in that way is just that that’s now available. Certainly, we know across cultures and across time, that many cultures have had their genders or they’ve had five gender models, or they’ve had models that don’t have two genders.So it’s definitely a social construction that we see gender as a two. We could equally see it as a one or five or just as irrelevant like eye colour or something.But at this point in time, it’s very binary. You know you have this sort of idea of the Mars and Venus opposite genders is really quite a new one as well. It’s a lot rooted in the kind of points in capitalism where we needed women to work unpaid in the home, and a really good way to convince women they should work unpaid in the home is to tell them, well, you’re (unclear 17:55), and you’re natural nurturers, and you should be bringing up the children.You know a lot of those opposite ideas about gender; they weren’t seen in that way a few hundred years ago.So, I think it is an invention in a sense, the binary model of gender. And so now we have available again in history and in our culture that there might be non-binary ways to sustain gender thanmore and more people can begin to identify. Whether that people who were identified as trans man and trans women are now identifying as non-binary, in some ways probably. Because those were the only options available before. And now there is more flexibility, there are more options, so yes. But probably some people who would identify as cismen and women and identify as non-binary too, that’s just what happened when something becomes more available.But there is also a lot of pressure to not identify in that way because you’re going to be constantly misgendered. You know, the world hasn’t caught up yet. And for people’s mental health, it is so important to be mirrored accurately. When you’ve got your family and friends, and then people on the street and just everyday life misgenderingyou, you are going to be facing this constant kind of sense of I’m not being seen by people and that will take its toll.So, I don’t think it’s, yeah, it’s not useful to say that it’s an easy thing to do.

Dr Helen Webberley:You know, it reminds me that—I mean when I had my children, actually, I wanted to get back to work and I had three children very close after. I was out of work for five, six years.And there was big pressure on me to be a good mom, and I was a good mom. But I also wanted to be able to go back to work. The guilt that we feel for not fitting in with that stereotype where mums don’t go to work, mums stayhome. You know it’s not nice that guilt. It is not a subtle feeling. And when people look at you and presume that you’ve got three young children and presume that you’re going to be the nice homemaker. And actually, that’s not fitting. I understand with stress and depression, and anxiety can fit into that when you’re perceived wrong.

MJ Barker: What you’re saying is spot on.I think nearly everyone at some point in their life goes off the normative gender course for some reason. You know I’ve had people say what happens when I’m retired? Especially guys when they retire, and suddenly they’re not doing the thing that makes you a man, which is your work. I’ve had; certainly, people who go through prostate cancer or breast cancer and suddenly feel like that must go to be feminized or masculinized. People who are infertile so they kind of get so they decide not to have kids and suddenly it’s like everyone’s asking them about that and saying you’re not a real,you are not a real woman if you don’t have kids.All of these, you know, like getting a chronic health condition.A lot of these things just take you off that, like, here’s the expected life course that you should be having for someone of your gender. But we could be doing everyone a favour by getting rid of that in the first place so that everyone wouldn’t be having to go along and reach that point of failure. But I think it’s often that that makes people more sympathetic because this is not helpful for anybody. You know it’s just that trans people have really challenging facts. They’re really saying like we don’t have to be on this life course, we could actually change onto the other one, or we could question the whole thing.And I think that’s partly why I said you can come to a lot of people are so invested in that life course. But the sad thing is like nobody’s going to pass every point. At some point, everyone’s going to like do something about gender normative no matter what you say. Remaining single would be another example, you may be expected to want to settle down with a partner at any moment like that in your life. And then you feel what it’s like to have that constant question, and then everybody commenting on you all the time.


Dr Helen Webberley: Marianne, you have many non-binary clients in your workload. Is this something that you’re seeing more frequently or less frequently?

Marianne Oakes: I see more people identifying as non-binary who come for surgery referrals than I was talking to. I’m conditioned to think in a binary way. Much as I push the boundaries of that, there are two people who come to mind. One of them, in particular, was really conflicted over not wanting testosterone, wanting top surgery. I was working with them,and I asked, “What is it with that resistance to testosterone?” And they said it isn’t that I don’t want testosterone, I just want top surgery before I consider testosterone. I want to see how I feel about the top surgery, because the idea of having a deep voice and a beard and having a chest, I find really really troubling.And it might be that I don’t need testosterone after the surgery. The trouble is nobody would listen to that argument farther. Yeah, that’s what they were finding.It’s not just the medical profession but the family everybody was why would you not want testosterone?

MJ Barker: And those are good reasons to take it step by step and to do what feels right first and to go down that path. And also I seem to remember when I was going through this, my search, and saying that there was some good evidence that chest surgery went back to if you weren’t on testosterone. Don’t quote me on that because it’s not in the papers or anything. But certainly, there was a suggestion that I might be the case say like because they could make good arguments for doing one thing and then doing (unclear 23:13). You know it’s perfectly fine just to have chest surgery and not have testosterone. For testosterone, there are all these different options for having low dose or high dose.

Marianne Oakes: You know the second case that came to mind as well I was just saying that was somebody that came to us for a surgery referral. I just said why, what, why is it that you’ve not accessed testosterone yet? Is it not sorted on your side? And they said, “Well, I’m actually a professional singer.” And that is equally as important of a part of my identity as my gender.So I want top surgery, but I don’t want to use testosterone.

MJ Barker: That’s an example, and often like we’re not saying that people have multiple facets of them like certain health conditions mean that maybe surgery be possible not hormones, and in others, it’s hormones not surgery. And you’re right, certain careers mean you need a certain physique or a certain voice. So, therefore, again, that’s going to limit. And we should be just treating the whole person. You know we do. Again, we do this for pregnancy, right? For somebody who’s going through pregnancy, we’re going to take account hopefully of other aspects of life that might mean they need different kinds of treatment through the pregnancy and hope it’d be great if we could do this around a trans level, rather than having a one size fits all model.

Dr Helen Webberley: We talked about, of course, people ought to be able to inform and be informed and contribute to the way that their medical management plan should be at. But of course, both of those things, testosterone and surgery, are completely and utterly gatekept by the doctor in front of you or the surgeon in front of you. And there is such an enormous fear at the moment, of getting it wrong. And actually, I find that the fear isn’t of the patient coming back and saying you did it wrong. It’s on the other side. It’s those who regulate us, who are saying you should not have done that. Why ever have you done that? Nobody else would have done that. You’re stepping over boundaries here by doing that. That’s not what the protocol says. That’s not what we say. That’s not what we’ve done for the last 30 years.

MJ Barker: I just I have to say my stance before and this as well, I mean I can say this moral panic. People wouldn’t be, I’m sure in other areas of health they’re not quite that panicked all the time of getting anything wrong ever. But here it feels like somebody’s making the analogy today like a dermatologist, you treat in a skin condition. Right? I mean it’s like for ninety-five per cent or whatever, this cream is going to be helpful. Five per cent is going to have unhelpful side effects and not be good for this person. So of course, we’re going to give that a go, right? But with trans, it’s like it must be perfect. You must never—You must be able to predict exactly what impact these things are going to have on this person.

Dr Helen Webberley: It’s like any protocol or in a, actually, I’m imagining teachers and their board of directors in school, you’ve got to have leadership from above which tells the workers on the ground that we’ve got your back. We’re fine with this. Do the right thing for your patient, and we’ve got your back. And we’re missing that. And so, therefore, the media can have a field day with it because there’s no strong leadership coming from above saying this is right. We’ve looked at the evidence.

MJ Barker: And it loops around as well because there isn’t enough. And part of the reason that there isn’t enough is because I think that that level of fear is terrified because of the moral panics and how they never get picked up on (unclear 26:42). There’s really a sense of people being very worried about what response might happen if they get this wrong. And I think all of us so involved in anything around this area—So for that moment, I had a moment where my stuff was picked up in the media just last year. You know, and it’s really frightening when that happens, and then it was to do with the documents that I’d written to BACP, the counselling organization. And they were just really surprised to be suddenly caught up in this old trans moral panic, and they didn’t. They had to respond to that initially. So I think yeah like that tier of people we would want to like have our back and that they’re also just terrified at the moment of like what response is going to be like. And the whole culture needs to shift away from the massive panic about trans people, which is just there to keep our eye off the ball of this stuff that’s really going on in the world at the moment, right? It’s like clearly whips up to kind of say look at Brexit, look at climate crisis, look at the trans people.

Dr Helen Webberley: I mean you talked about gynecomastia earlier. Which for those who haven’t come across that word, gynecomastia, it’s like a little bit of puffy breast development that adolescent boys go through often when their hormones are just kicking in, and the body’s not quite sure what’s going on here. What, why should I develop? And very often early puberty in cisgender boys brings on a little bit of breast development which then goes away, and these boys hate it.They hate it. You know, you can always see them hiding it with a T-shirt or jumper.You go swimming with that t-shirt and so it’s absolutely they hate it. And then we’ve got other trans boys, sorry, trans girls, who are saying, please give me a medicine that’s going to make my breasts grow. Now, why ever would they do that? Why ever would they do that if they were not trans? You know what I mean? And yet, we still don’t believe them. We still believe this big, “Oh no, you know you’re gonna have to jump through a lot more hoopsto make me believe that.”

MJ Barker: It says a lot about how we treat kids in our culture. And I think this the stuff around trans, it’s about a lot bigger issues like how we think about gender. And like I said kind of about capitalism. What labour gets valued and what doesn’t. And it’s also about how do we treat children, and we don’t trust children. And therefore a lot of terrible harm gets done, but like why are people so scared about trans kids and not worrying about bullying in schools which is so problematic? Again, I think that means that example is a really nice one that says a lot of kids are struggling with their bodies and could do with some help around that. And it’s instead of just focusing only on trans kids it’s not a great way forward here. But again, people are very scared about teaching about gender in schools. Again for that reason, if like I’m not being supported by those higher-ups and the media is on the minute. And in a second—

Dr Helen Webberley: So, MJ, one day, if we had a magic wand, how would we make small steps and then take large steps in improving the health care for all genderqueer in the UK and across the world?

MJ Barker: I mean, I do think it is that cultural shift that’s needed to actually understand gender somewhat differently from how we do it at the moment. So yeah, I’d be wanting to get training and to help people understand how gender actually works, how sex and gender actually work. Training people on the diversity of ways in which people can experience themselves, the diversity of identities they might need on that, and ways in which they might need to express themselves, and then, the different kinds of support that people might need with that. And again, like I said I think the important thing for me would be to be able to break down some of those divisions between what men and women and non-binary people need and what trans people and cisgender people need, so we could start to see it as like everybody’s issue and step back from the sense that trans people are asking for some special that’s taking away from other people in some way. And that would kind of be my answer across the board I guess in terms of education, as well, or as far as healthcare and supporting trans kids in school.

Dr Helen Webberley: How about you, Marianne?

Marianne Oakes: Well, just to support what you’re saying there, MJ, the reality for me is that it’s got to start with education in schools moving forward. Because one of the things I’ve been relating to recently is I knew nothing. I was on my own in an environment when it was still illegal to be gay when I was at primary school. So it is better now. I mean we’ve got protests outside schools in Birmingham at the moment about teaching about diversity. This isn’t just about same-sex relationships. It’s diversityof gender.Now the next generation coming through don’t have to feel quite so bad.But then that’s got to filter through to the medical training, and it’s got to filter through counselling training.

MJ Barker: But it’s got to get to the structure of the BACP. There is no one on therapy training,gender is nowhere. But also race, class, disability, they’re nowhere. You know this is the kind of thing we definitely need to be teaching in schools and also teaching teachers and medics and counselling services. They can be working people with people in and from way aroundthis stuff.

Marianne Oakes: At the risk of upsetting the BACP. I’m a member of the BACP, but I am not allowed—I’ve not changed my name officially because I have an attachment to my old name. It doesn’t invalidate my gender identity. And I said, could I have my female name on the membership card? I’ve had to have both names on. So I’ve got Marianne and Andrew Oakes. They won’t let me just—they say computer says no.

MJ Barker:For assistant to therapist, would they be insisting for that person if they changed their name because they got married, had both names on?Well, I don’t think so.

Marianne Oakes: I go to the doctor, and to be fair, they’ve allowed me to have my preferred name on my records without question.The BACP, on the counselling directory—

MJ Barker: Like I said, they were really supportive, the BACP, while I was writing this resource, and it’s completely free online, which is great. So not even just the BACP members or maybe just counsellors anyone can download that document. Just search for the BACP GSRDandBarker. My name will come up. GSRD stands for gender sexual and relationship diversity.So we movetowards that language rather than LGBT againwith that sense of like encompassing everyone. So they work way ahead of the game with that.But unfortunately, I think I got some negative press after Mumsnet had some fun with it.

Dr Helen Webberley: Marianne, I’m really interested in your language that you were just swiping there. I have written it down actually. You said they wouldn’t let me when you were talking about having your female name on the BACP. And then you talked about your doctor’s surgery, saying they’ve allowed me to use my name and it’s like, goodness gracious me. You know, talk about being at school, and they’re not letting me do this, or they are letting me do this. It just shows what a kind of power they have. Can you imagine a patient with cancer for example and saying oh I’ve been to the oncologist today and they’re letting me have chemotherapy? Do you know what I mean? it’s just like—they would say it’s suitable for chemotherapy or something like that, but it is this allowance, this permission from this cisgender person sitting that’s giving the permission. I think it’s really rude. And the other thing that you said is that the computer says no. So okay, okay, a human being says it’s not me, it’s the computer. And so often it’s the computer, or it’s the policy, or it’s the board. But no, actually I’m asking you if you will provide me with health care or if you will accommodate my name preference or my pronoun preference. I am asking you to accept my identity as I’m presenting it to you. And then they’re kind of blaming it on something else that we can’t touch, like a computer or protocol or a big panel that we have no access to. And I think that’s wrong. And when we’re talking about health care, for example, we blame the NHS. As if the NHS is a being that has a power that has a capability. It’s not, actually. It’s people within the NHS who are in charge of the prescription pad, the surgery timetable, their operating knife, the rules. Those people are people who have written those. And by blaming the NHS or the BACP, those people are kind of getting off the hook. And we’ve seen in history, there are lots of situations where I won’t go into here, in the war, where actually you blame that particular party or that particular right or whatever. But actually, the people did it. The people pressed those buttons or what have you. And we need to learn from that and bring that back in now. I think people should have their own responsibility for the actions that they are taking with their individual clients or patients or children in their school, for example.

MJ Barker: I know exactly. That’s a really scary practice, I think, going on around this area still. I mean I’ve been involved in a degree that sort of brought in the Memorandum of Understanding against conversion therapy. So at least we now have trans included in that so you shouldn’t technically be able to try and convert to a cis person. But again, there are still people who are doing pretty dodgy kinds of therapy with people around gender, who are just not well-trained in these areas. And it’s frightening how much people think, you know, I guess the foundations of therapy are kind of in its cisnormative ideas. I know that it’s always been we’ve kind of come up with these psychiatric lists of kind of what it means to be normal. You know,or disordered in some way, and then we’re trying to get people to conform more to being normal. And the whole therapy kind of institute in the middle from that model, so much more of an affirmative model of like how can people do that if they are, rather than trying to get them to kind of conform to certain norms. I think this sort of work around neurodiversity is really helpful, and this is one of the works on gender diversity.And as far as disability activism, all of these things are beginning to get the point across that people are just diverse. And it isn’t about finding the norm of what gender someone to be and what kind of relationship they should have and how much sex they should have and how they should manifest cognitively, you know, and try and get better at it. It is much more about like embracing the diversity of what it means to be human and helping people to be comfortable in the world with that full range of diversity in the sense of how their bodies and brains work, right?

Marianne Oakes: What I was going to say—I could feel your frustration there, Helen, by the way, in that situation. The reality is—I was just relating that to non-binary people— I think my case is fairly straightforward. When I explain it to be a BACP, and I didn’t just bow to that, well I argued and argued till he stopped replying to me and I just thought I was going to (unclear 37:57) counsellor here. There is only so much I can do.And the same with the counselling directory. I am registered as an organisation because they won’t recognise my female name. It’s a ridiculous state of affairs, and there are a thousand therapistsahead of me that will tick the box that they’re experienced with gender and the people that need to see me are not finding me. It’s just a reflection, it’s a snapshot into how society treats trans people and how ill-prepared these organizations are.

MJ Barker: We needto get everyone to get on board.Yeah like fornon-binarypeople it’s about making sure that they when they’re asking about gender, there’s a non-binary box as well as male and female. And also say that there are they pronouns for the title, Mx as well as Mr and Ms, and all the other ones you want to have.

Marianne Oakes: Yeah this, you know, when they put other.

MJ Barker: Yeah, when you have to tick the box “other”.

Dr Helen Webberley: It goes back to what I was saying earlier, you know, if I gave you the magic wand and you talked about how it’s necessary to training, isn’t it? And education, you talked about education in schools. And ironically doctors are taught in medical schools. You mentioned that there was no training for you, and you’re still training, in medical school curricula. There was no training in the postgraduate curricula.There is no specialist register for this kind of thing. So there’s no specialist register for you to be a gender specialist.Yetif you’re a GP, which isn’t a generalist, but a little bit of everything, you’re not allowed to. You’re not allowed to? (unclear 39:40)

MJ Barker: And it’s so important for trans people to be able to find out where there are people, where there are GPs who are safe enough to go to. It’s goals for me, and I’ve been, I can go to a GP surgery that doesn’t know what non-binary gender is, and there is no non-binary option on the form. And I know that my GP is going to be at least to some extent clued up on this stuff. But we have to go on kind of like the grapevine, really, of like who’s good on this stuff.And that shouldn’t be that way. But yeah at the moment, you really do need a trans-knowledgeable GP if you’re trans.

Dr Helen Webberley: You just said you’re lucky enough to live in a place where it’s safe to go to the GP. Can you imagine, us living in the UK and there being an acceptable concept that it’s that some GPs are not safeto go to? And it’s true.

MJ Barker: (unclear 40:36) found a lot of trans people having horrific experiences in health care and what toll is that taking on their physical health? They’re probably just not going, right? And just trying to deal with stuff. Certainly, when it’s more invasive things like cervical smears and that kind of, you know, prostate exams and things like that, people are going to be really wary about that. So they’re definitely going to be more at risk of getting the kinds of things that those kinds of tests could be testing for.

Dr Helen Webberley: Yeah. So education, we’ve got a long way.I’m sorry, Marianne.

MJ Barker: It should totally be there on the curriculum.

Marianne Oakes: I was going to say, though, I don’t think this just has to be about teaching GPs about the medical care of trans people. I think if we could teach GPs or the medical profession about the diversity of people, because that’s what this comes down to. When you go into your GP, they’re in a really privileged position that you’re going to impart information that you may never have shared with anybody ever in the world. It is untrodden territory. They are the first person to have heard you articulate it. And the stories over here of doctors going into panic or into meltdown over it.And that just makes the patient fearful.Who can I trust in the world?

MJ Barker: Well,that should be like a really safe environment cause you’re going in, and you’re frightened. You don’t know what kind of results are going to come. It’s like you shouldn’t have to be worrying.You know, and it’s not just the case for trans people, as well. I mean a lot of disabled people, a lot of fat people, a lot of people from the non-white race and racial groups have miserable experiences as well as because the GPsdon’t know what’s going on. Basically, anybody who’s outside the cisnormative norm.But once you add all those groups together, it ends up being a lot of people.Basic diversity training of all of these intersections, really.

Dr Helen Webberley: So, you mentioned the resource on the BACP, the GSRD resource.We’ll put a link to that at the bottom because that sounds brilliant. Are there any other resources out there that you think would be useful in your opinion or any others?

MJ Barker: Yeah well, I guess I can say Ruth Pearce’s book and (unclear 42:52)’s book on trans health care, like, both of those people are more clued up about the health profession than I am. Mine’s more like mental health. Most of my work rather than physical health, although that would be rather another problematic binary, I guess. So people themselves are looking into gender stuff for themselves or their families or their friends. Then there’s quite a lot of resources on my website,Rewriting Rules. And I’ll say the podcast with Justin, which is Meg-John and Justin.And Alex and my book How To Understand Your Genderis hopefully a really nice starting point. We basically wrote it for the younger versions of ourselves, going back to what you were saying, Marianne, about not knowing anything while we were in school. And there was nothing on this stuff. But also for families who are struggling to get their heads around it, like you just said. All of these words can be quite confusing.That’s a real 101 on that.

Dr Helen Webberley: That’s brilliant, thank you.

Marianne Oakes: Well, what I would say is as well, and I have done the postgraduatediploma withPinkTherapy.

MJ Barker: Oh yeah. Pink Therapy. Brilliant.

Marianne Oakes: Yeah, well, they recommended your book, and I can highly recommend it as well. Sexuality And Gender.

MJ Barker: For mental health professionals.

Marianne Oakes: Yes.

MJ Barker: Yes. So that’s another book with Christina Richards. Like I said, the one with Christina and Walter on Genderqueer and NonbinaryGenders, if people are specifically like they’re health care professionals and they want to know about non-binary or genderqueer health care, then that is definitely the go-to book because we got all of the experts across the field for that one.So yeah, thanks for that.

Dr Helen Webberley: Well, I think we’ll draw it to a close. I’ve certainly learned a lot. I’m always learning, and I have to say that the best way to learn is to talk about people who it comes from the heart. It comes from their experience, comes from the heart, and a lifetime of living in your body and your brain.And thank you so much for sharing that with us. I am hoping we are another step closer to trying to understand it. It feels so complicated but actually, break it down, and it just should be so easy. So, you know, thank you ever so much for joining us today. I’ve really learned, and I’ve really enjoyed it. The work you do is amazing.

MJ Barker: Thank you.