Whatever the panic, girls are always victims

All these incredibly successful films involved the sexuality and physical development of young girls. Two were suggestive but one was also consequential. Sybil — which won four Emmys and was estimated to have been seen by one in five of all Americans — was based on a book telling the “true” story of how a questing psychotherapist unlocked the multiple personalities (or “alters”) of her patient, uncovering the terrible, repressed secrets of her hidden abuse.

I saw Sibyl in my early twenties and, with its perfect narrative arc, it made a big impression on me. But not just on me. Sibyl the book and the series prompted a sudden increase in the diagnosis of multiple personality disorder (MPD) in the US from under a hundred to the several thousands.

As one increasingly sceptical American psychotherapist later wrote, “At the height of the fad, it seemed that every third or fourth patient was presenting with a long list of newly developed multiple personalities”. One woman patient, he recounted, “managed to embody 162 distinct alters — including representatives of both genders, all ages, a wide variety of personality types, and some leftovers from previous lives”.

I was reminded of this surge when Janice wrote about how the figures for referrals to GIDS had soared from 72 in 2009-10 to more than 1,800 in 2016-17, and how 70 per cent of the referrals were for girls. The rise in itself might merely have reflected increased awareness of the issue of gender dysphoria, but the hugely unbalanced sex ratio suggested something else entirely. And given that the clinic was now often prescribing puberty blockers, if this was essentially a diagnostic fashion, it was one with consequences.

Janice reminded us of one past psychiatric cure-all, the mid 20th-century use of the lobotomy. But by the enlightened 1970s we were moving beyond all that surgery. New trends awaited. Sibyl created a fashion for a diagnosis of MPD (now known as dissociative identity disorder). Some benefited. In one famous 1970s case, now the subject of a Netflix documentary, a serial rapist at a US university escaped punishment by convincing the court that it wasn't him but an “alter” who had committed the crimes.

It is a disastrous theory, which led to the construction of false narratives of forgotten abuse, innocent people being sent to prison and close loving families destroyed. It also gave birth to the great satanic ritual abuse panic which, for nearly ten years, was rampant among social workers, child protection charities and psychotherapists around the world.

According to some estimates, by the mid 1990s up to 50,000 US therapists accepted the notion of repressed memory and many of them believed that there was widespread satanic abuse, involving child murder, cannibalism and bizarre rites — despite these practices never leaving any traces. Practitioner conferences were held in which “satanic indicators” were circulated. A 1994 survey of 7,000 professionals in the US reported 12,000 cases of possible ritual satanic abuse. It was the hot topic on talk shows and featured in documentaries by respected journalists such as Roger Cook.

There is something that all these phenomena have in common. As the historian of psychiatry Andrew Scull wrote recently, there were 12,296 lobotomies conducted in the United States in the 18 months up to July 1951, but although a majority of the patients in the wards were male, “nearly 60 per cent of the psychosurgery had been performed on women”.

The same was broadly true of electroshock therapy. During the period of the great multiple personality fad, up to nine times as many women as men were diagnosed with the condition. And now this striking and sudden imbalance in diagnoses of gender dysphoria.

Puberty for girls is not like puberty for boys, which is why (I believe) Carrie and Regan were not male characters. As a sceptical Tavistock therapist reminded Janice, “most anorexics are natal females who reject their femininity and are repulsed by their secondary sex characteristics”. It's not entirely surprising. I've seen one estimate that nearly 140,000 girls in the UK miss school each year because of a lack of access to sanitary products. Parents of girls I talk to have, in recent times, seen this temporary physical self-loathing sometimes turn into a desire not to become a woman at all.

Worse, any therapeutic intervention which seeks to look at the many possible reasons for a young person's distress can now be labelled “conversion therapy” unless it immediately accepts a self-diagnosis of gender dysphoria.

In each of the historical instances I've talked about here a fashionable and narratively satisfying diagnosis captured a profession and an institution. It wasn't because people were wicked or liars or that there wasn't a genuine problem. But a dogma was established which it was initially very hard for other professionals to question without being condemned.

The US psychiatrist Richard Noll, writing a few years after the satanic panic, was dismayed at the time by the “resounding silence” of senior figures in his profession. It left younger therapists like him, he said, wondering whether “these satanic cults were real; the experts did not know if they were real and were afraid of insulting the patients; or there was an abject failure of ethical leadership”.

He concluded it was the latter and he said so at the time. And he was right.