This is a guest post from Michael Biggs who researched and wrote this analysis in September 2018 in response to the trailer for the new ITV drama Butterfly which promoted the line “I’d rather have a happy daughter than a dead son”.
Michael Biggs is Associate Professor of Sociology at the University of Oxford and Fellow of St Cross College. He researches social movements and collective protest. We are very grateful to him for allowing us to publish this piece.
‘I want a happy daughter, not a dead son’, proclaims Anna Friel in the new ITV drama Butterfly. This line required no creativity from the scriptwriter, as it is a constant refrain in interviews with parents. ‘I’d rather have a live daughter than a dead son.’ ‘We prefer to have a living son than a dead daughter’. ‘Our only choice was to have a dead son or a living daughter.’ ‘I’d rather have a living son than a dead daughter’. ‘Do you want a happy little girl or a dead little boy?’ ‘My wife and I decided that we would much rather have a happy, healthy daughter than a dead son.’
‘I have my daughter, whole and alive, but if I had refused to listen then it’s very likely that I would have a dead son.’
Like other transgendering advocates, she never shies from raising the spectre of suicide:
Her tweet implies that four trans-identified youths committed suicide last year, though the language is ambiguous and does not specify age. Another mother associated with Mermaids announced two trans teenage suicides in under a week:
When transgendering organizations cite evidence on suicide, it almost invariably comes from surveys that recruit respondents haphazardly—without random sampling from a defined population—and ask them whether they have ever attempted to commit suicide. These surveys have been scrutinized in two earlier posts, and also on 4thwavenow. One problem is that trans-identified respondents might be primed to respond affirmatively to such questions by the continual emphasis on suicide in transgenderist discourse. Toby Sinbad Walker, for example, suggests that trans-identified females will kill themselves if they have to wait for breast amputations:
What is the evidence on actual suicide amongst trans-identified young people in Britain? I submitted a Freedom of Information request to the NHS Gender Identity Development Service (GIDS), which serves patients aged under 18 in England and Wales. It provided information from 2016 to August 2018. One patient committed suicide (in 2017) and two attempted suicide. In addition, two patients on the waiting list committed suicide (in 2016 and 2017) and two attempted suicide. This makes a total of three suicides in two and a half years. Each case is a tragedy for the young person and for their family and friends. But the number is hard to square with the claims of Susie Green and @transmum.
Although GIDS told me that it could not provide information before 2016, its website in 2017 stated that ‘suicide is extremely rare, with one case in the service in the last decade, of a young person in an inpatient ward who was referred with severe psychiatric difficulties.’ Presumably this case occurred before 2016. This brings the total—for over a decade—to four.
Some trans-identified children might not be referred to GIDS, and therefore would not come within the scope of these figures. Fortunately we can check with a different source, the National Confidential Inquiry into Suicide and Safety in Mental Health. This covered suicides by children aged from 10 to 19 in England and Wales in 2014 and 2015. Out of a total of 316 suicides, 13 were ‘LGBT’ and 4 were ‘uncertain about their sexual orientation’.
The researchers kindly responded to my request for disaggregation. Of the 13 LGBT victims, 9 were homosexual and 4 were bisexual; to preserve confidentiality, they were unable to disaggregate by sex. None of the cases were identified as transgender. This increases our confidence in the comprehensiveness of the GIDS coverage.
In sum, we know that four trans-identified children committed suicide in England and Wales since about 2008: one in 2017, two in 2016, and one apparently before 2014. To put these tragedies in perspective, the number of patients seen each year by GIDS increased from 700 in 2013/14 (when reporting began) to 2,700 in 2017/18. Figures for patients on the waiting list are not routinely reported, but we know they numbered 1,652 at the end of 2017/18.
For a rough calculation of the total number of children at risk, we can sum all these patient numbers and add referrals as a proxy for patients seen from 2009/10 to 2012/13 (patients seen always exceeds referrals, of course). The grand total of 10,700 significantly undercounts the actual total population of GIDS patients, because it omits the numbers on the waiting list in years before 2017/18 and also the patients seen in the first part of 2018/19.
Before estimating the suicide rate, we need to disaggregate by age. Suicide amongst young children is vanishingly rare. In England and Wales, the suicide rate for teens aged 15–20 was 4.9 per 100,000 (averaged over the last decade), while for children aged 10–14 it was only 0.3. Therefore we should reduce the grand total by 40%, the proportion of patients referred to GIDS who are under 15 (from 2009/10 to 2017/18).
So the total annual number of older teenagers at risk since 2009 exceeds 6,400. With this denominator, four suicides (assuming that the earliest occurred since 2009) yields a suicide rate of 62 per 100,000. Because the denominator is underestimated, of course, this suicide rate is overestimated.
Although calculated from only four suicides, the suicide rate is much higher than for teenagers overall—in my rough (over)estimate, 13 times greater. This is a genuine cause for concern. By comparison, anorexia multiplies the risk of suicide by 18 or 31 times (depending on the method of estimation), while depression multiplies it by 20 (Smith, Zuromski, and Dodd 2018). One study finds that autism multiplies the risk of suicide by a factor of 8 (Hirvikoski et al. 2016). This latter figure is especially relevant, given the fact that 35% of children referred to GIDS recently have moderate to severe autism (Butler, De Graaf, Wren, and Carmichael 2018).
Whether the higher rate of suicide among trans-identified teens is due to gender dysphoria or to co-incident conditions such as autism deserves urgent research. At the same time, we must realize that suicides of trans-identified children are rare tragedies and not—as transgendering organizations like Mermaids imply—a common occurrence. Rational and compassionate policy-making cannot be driven by the threat of suicide.
My thanks to ‘Neverfallingforit’ and ‘SunMum’ for additional information and comments.
Animated GIF of Jazz’s mother from: