Butterfly – a great TV drama
“Butterfly” has been a terrific drama. There were three episodes each shown on a Sunday evening at 9 pm on ITV. If you’ve missed it, do watch it on the ITV hub – it’s well worth it!
At the centre of the drama is an eleven-year-old child named Max, who was assigned male at birth on the basis of his anatomy. Max, though, feels that he is a girl, and has felt like this for years. He suffers from a condition known as gender dysphoria. The drama is about the efforts made to resolve this and their consequences.
Before I go any further, I feel I ought to say that although this article is about “Butterfly”, it isn’t a review. It’s my personal response, as a transgender woman, to a powerful drama about the transgender experience.
At the start of the drama we are shown how Max’s gender dysphoria has split the family, with the father, Stephen, living away from his wife and two children. He has access to the children, though, and Max attempts to please him by feigning enthusiasm for football.
But Max must be Maxine. The drama follows the journey made by the whole family as he/she seeks to achieve this. The drama shows us that a sufferer from gender dysphoria experiences acute distress as a result of a mismatch between the gender they feel themselves to be, and the gender suggested by their anatomy. It’s a serious condition. Sufferers, including children, have a high rate of self-harm and suicide.
Max, being eleven, is going to enter puberty soon, possibly within months. His voice will break and he will grow facial hair; his whole body will become, irreversibly, that of an adult male. This will bring two big problems; firstly, Max will suffer great distress at the physical changes; secondly, those changes will make it harder for him to live in his chosen gender role when he’s an adult. What’s to be done?
Well, certain drugs block the hormonal onset of puberty and delay the development of adult secondary sexual characteristics. So, Max’s voice won’t break, and his body won’t develop the characteristics of an adult man. This will allow time for him to mature before any irrevocable decisions about gender role are made.
This is the heart of “Butterfly”; the struggle by Max/Maxine, championed by her mother Vicky, to obtain puberty blockers. We see the family at an NHS clinic, and at a private clinic; we see Maxine start to live full-time as a girl, with the inevitable bullying at school; we see her feeling so unloved that she self-harms, with almost fatal consequences; we see the family pulled this way and that by their response to the situation. The biggest problem is that before anyone will prescribe puberty blockers both parents have to give consent – and Stephen simply will not do this.
Vicky resorts to desperate measures. The courts become involved. The Local Authority child protection team become involved. There is a real risk that Maxine will be taken into care, and then what would happen to her?
I won’t give any spoilers, except to say that the drama is tense, nail-biting, and has a believable finale.
Is it true to life? Yes, very much so. The common theme in all the responses to Max’s gender dysphoria is a personal agenda – I’d call it a moral agenda, except that prejudice is hardly a moral stance. Nobody was actually neutral, even the professionals who really ought to be even-handed. And that is completely true-to-life.
Even more poignantly, and powerfully, the drama captures little details like Max’s difficulties with the school toilets. He couldn’t bring himself to use the urinals, and clearly found the whole masculine environment overwhelmingly hostile. How well I remember that!
So “Butterfly” is both powerful and authentic. It’s worthwhile, therefore, to consider its implications in the real world.
In recent years there has been controversy about intervention where children feel themselves to be transgender, and “Butterfly” contributes to that debate. Watching it, and thinking about it, has crystallised my thinking on the matter (yes, the drama really is that good). In brief, the effective treatment of gender dysphoria requires irreversible changes. One viewpoint is that we should not give such treatment to children, “because they might be mistaken”; the other viewpoint is that where there is a clear and strong diagnosis of gender dysphoria we should intervene as early as possible, before puberty if possible.
Drugs to block puberty blur the lines of the debate a little by allowing time for the child to mature. They seem to be safe, but some people have questioned the reversibility of their effects if administered over a long period.
The current treatment of gender dysphoria is for the sufferer to live in the gender role that they feel is appropriate, supported by whatever surgical and hormonal treatment is necessary. Gender confirmation in this way has a good record of success.
If you don’t treat gender dysphoria, the afflicted individual goes on suffering. Because the suffering is intense, the individual is at a (much) higher risk of suicide. In fact, there’s only one thing worse than not treating the condition and that is treating gender dysphoria as a mental illness. This has a dismal record, especially where it is linked to condemnation of the transgender feelings, and has led to many suicides.
And yet, despite these facts, people persist in wanting to treat gender dysphoria as ‘special’, ‘different’ or just plain ‘morally wrong’. This inevitably finds its way into the treatment of transgender children. People say that they must be protected from these strange urges until they’re old enough to make a mature choice (of course, by that time puberty has well and truly done its worst…).
What would I like to be available for everybody who suffers from gender dysphoria?
Prompt referral to clinical specialists (the current waiting time is far too long).
Where gender dysphoria is diagnosed, prompt availability of treatment (currently once you have your diagnosis it’s at least an eighteen month wait before you can even discuss the options with a surgeon, and many months more before surgery takes place)
Treatment of everybody with a confirmed diagnosis of gender dysphoria. Age should not be a factor (subject to NHS guidelines for consent). Gender confirmation is a life-saving treatment, and this applies to young people as well as adults.
It’s worth looking at the NHS Guidelines for Treatment of Children and Young People
These set out the following criteria for consent.
“Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.
Otherwise, someone with parental responsibility can consent for them.
This could be:
- the child’s mother or father
- the child’s legally appointed guardian
- a person with a residence order concerning the child
- a local authority designated to care for the child
- a local authority or person with an emergency protection order for the child
The person with parental responsibility must have the capacity to give consent.
If a parent refuses to give consent to a particular treatment, this decision can be overruled by the courts if treatment is thought to be in the best interests of the child.
If one person with parental responsibility gives consent and another doesn’t, the healthcare professionals can choose to accept the consent and perform the treatment in most cases.
If the people with parental responsibility disagree about what’s in the child’s best interests, the courts can make a decision.
In an emergency, where treatment is vital and waiting to obtain parental consent would place the child at risk, treatment can proceed without consent.”
These guidelines seem to me to be all that is needed to safeguard young people. There is no need to treat intervention for gender dysphoria as something special; it’s just another medical procedure that will improve the lives of most of those who receive treatment.
“Butterfly” has done a great job of highlighting these issues, and I hope it helps to improve society’s treatment of young trans people. And, whatever your stance on the issues, do watch “Butterfly” – it’s a cracking good drama!