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Transgenderism and the Social Construction of Diagnosis

Last week saw another attempt to silence debate and research whose findings diverge from an accepted orthodoxy. In the Advocate, transgender activist Brynn Tannehill decried a 2017 abstract that appeared in the Journal of Adolescent Health, stating that the research into rapid onset gender dysphoria or ROGD was “biased junk science.” The research that Tannehill so strongly objected to was undertaken by Lisa Littman, MD, MPH. Littman surveyed parents about their teen and young adult children who became gender dysphoric and transgender-identified in the context of belonging to a peer group where one, multiple, or even all the friends in a pre-existing peer group became transgender-identified in a similar time frame, an increase in social media use, or both. The findings of the research support the plausibility of social influences contributing to the development of gender dysphoria. The full research paper has not yet been published.

Tannehill subsequently posted the article to the Facebook page of the World Professional Association for Transgender Health (WPATH). A discussion ensued in which some commentators asked WPATH leadership to request that the journal retract the abstract. “So is something being done?” wrote one commentator. “As in are [sic] the Journal being asked to make a statement to retract or apologize for including it?” Psychiatrist and WPATH board member Dan Karasic, MD responded simply. “Yes.” (These comments were deleted from the original thread, but screen caps and a fuller description of what took place can be found here.)

As a therapist, I have spoken with hundreds of parents of teens who have announced a trans identity “out of the blue,” and I can corroborate Littman’s initial findings. The majority of these parents have a daughter aged 14 or 15 – an age at which teens are particularly susceptible to peer influence. These teens often have one or more of the following factors that contribute to their social struggles: they are academically gifted; they are on the autism spectrum; they are same-sex attracted; they have experienced trauma or major disruption; they have other mental health diagnoses such as anxiety or depression; they have a learning disability. Parents often report that their child made a sudden announcement about being transgender after spending increased time on social media sites focused on trans issues, and/or having one or more peers come out as trans. Some teens have even admitted to their parents that they have come out as trans “to fit in.”

In addition to the belief that they are trans, these teens also appear to have acquired rapidly the steadfast conviction that social and medical transition (now euphemistically labelled “gender confirmation”) must be undertaken immediately. Parents report to me that a teen’s coming out announcement is often accompanied by an immediate request for hormone treatments. Discussions of surgery usually soon follow. Some teens have even identified the local gender clinic nearest them where they can receive hormones, and share this information with parents at the time of their announcement. Parents are sometimes told that if they don’t accede to these requests for medical intervention, their child will become suicidal.

The belief that medical transition must be pursued urgently has almost certainly been suggested to them on the internet, by the mainstream media, and perhaps also by peers. This is despite the fact that most transgender adults transition later in life and survived adolescence without transition. Furthermore, the empirical claim that early transitions work is based on a small subset of studies whose results may not apply to adolescent onset cases, or cases where there are other psychiatric issues. In addition, the widely cited suicide rate that is often mentioned as a justification for urgent intervention is based on a study which does not prove that there is a causal link between gender transitioning and improvement in mental health. It is still unknown whether transition changes suicide rates for gender dysphoric individuals. No study to date has looked at whether parental support for teen gender nonconformity without medical transition results in a reduction of distress, though anecdotal evidence appears to indicate that it may. While there is evidence that medical intervention benefits adults with gender dysphoria, there currently remains a lack of evidence indicating that medical intervention is the best and only first-line treatment for children and teens suffering from the condition. Meanwhile, the push for immediate intervention is becoming entrenched as an orthodoxy in mainstream media accounts and within professional organizations – possibly steering us down a path that could potentially result in the unnecessary sterilization of of teenagers in the U.S. and around the world.

Activists and certain clinicians who are sympathetic to the activist movement appear to feel threatened by the idea of rapid onset gender dysphoria because the suggestion that dysphoria might be influenced by social or cultural factors undermines the notions of innateness. If dysphoria isn’t innate, justifying medical intervention becomes more complicated.

In fact, it must be true that there are cultural and social factors at work in gender dysphoria. If a social act such as donning a certain article of clothing or being called by a different name can alleviate a child’s distress, then how can the problem that caused that distress possibly be entirely biological? The diagnosis of gender dysphoria in children is based largely on culturally bound behaviors. For example, the official diagnostic description lists criteria such as a child having “a strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.” There is no lab test for it, no physical manifestation. Those who undergo medical intervention for gender dysphoria are usually physically healthy and phenotypically normal.

***

In 1851, a US physician published a paper in scholarly New Orleans Medical and Surgical Journal in which he described a new disorder. “In noticing a disease that, therefore, is hitherto classed among the long list of maladies that man is subject to, it was necessary to have a new term to express it,” wrote Cartwright, and named the new syndrome drapetomania. Drapetomania was a disease of slaves that caused them to run away. Early symptoms included slaves becoming “sulky and dissatisfied without cause.” Treatment to stop further development of the disease at this point called for “whipping the devil out of them” as a “preventative measure.” The eminent psychiatrist and psychoanalyst Thomas Szasz likened Cartwright’s analysis of the “disease” that would make a slave want to run away with our modern tendency to diagnose and medicate depression in those who work long days doing menial tasks in a windowless cubicle.

This is not to say that there is no such thing as major depressive disorder, or to insinuate that medication is an ineffective or inappropriate response to feelings of discontent or lack or meaning. It is to point out that our distress occurs in a social and cultural context, and is in part interpreted and even constructed by this. In what philosopher Ian Hacking described as the “looping effect,” what our doctors expect us to manifest is offered to us as the symptom language through which our distress finds expression. And when we express it thus, the psychiatric establishment becomes further convinced that they are dealing with a discrete entity, that the illness is, indeed, a natural kind, occurring outside of human-made categories. In fact, mental health symptoms always have some kind of social or cultural input, as is illustrated by a cross-cultural look at psychiatry.

The various hobgoblins of the psyche that we call disorders each have roots in the body and its biology. Genetic factors have been found to play a role in virtually all of the diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Yet they are not merely products of our biology. Their particular manifestation is dependent upon our individual biography, the zeitgeist of our current cultural milieu, and the particular time and place in which we find ourselves. The culture provides the symptom language, the metaphorical wrappings in which our distress is clothed.

One mental disorder demonstrably caused largely by biological factors is schizophrenia. Something like schizophrenia exists around the world, it appears to be quite heritable, and there is evidence that exposure to certain viruses in the womb may predispose someone to developing the disease later in life. However, schizophrenia manifests in markedly different ways in different cultures. Strikingly, the social context in which the disease occurs appears to have a significant effect on prognosis. While a diagnosis of schizophrenia in Western cultures usually comes with an expectation that the person will be burdened with a debilitating illness for life, schizophrenics in other cultures are more likely to experience a full remission. Even a disease, then, that is significantly biological in origin has an important component that is socially constructed, and the social component can have a substantial effect on whether those suffering from the disease do well or do poorly.

To point out that a diagnosis has a socially constructed component is not to assert that it isn’t real, that its sufferers are “crazy,” or that they don’t deserve compassion and treatment. Acknowledging the reality of the social construction of psychiatric diagnosis does, however, allow us a wider range of options to choose from when deciding how to address the attendant suffering.

In therapy, we pay attention to cognitions because our thoughts influence how we respond to things. Cognitive therapists often point out that there is the thing that happens, and then the story we tell ourselves about that thing. A psychiatric diagnosis can be a story we tell ourselves about the feelings we have. The diagnostic criteria for childhood gender dysphoria in the current DSM includes such items such as the following:

In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.

According to the DSM, then, not liking girly things as a child could mean that I have gender dysphoria. But for any individual, alternative explanations should be ruled out before life-altering interventions are prescribed. For example, researchers have noted that cross-gender play and clothing preferences in childhood are associated with adult same sex sexual orientation. Symptoms that some see as evidence of being transgender can also be an early expression of being lesbian or gay. Given that research indicates that the majority of cross-sex identified kids will desist if left alone, and that most of these will grow up to be gay, lesbian, or bisexual, it seems prudent in many cases to wait and see.

Consider another explanation that has been less widely discussed or even acknowledged: since the majority of teens presenting at gender clinics are natal females, we might also consider that many girls feel uncomfortable with gender roles, and that discomfort with one’s body is an experience shared by 90% of adolescent females. Teen girls are often very preoccupied with fitting in socially, and are generally more likely than teen boys to manifest emotional problems. Could teen girls be latching on to the narrative supplied online and in the media to construct a story about themselves that serves to explain their feelings of difference while offering a path to transformation?

Australian psychiatrist and psychoanalyst Roberto D’Angelo works with gender dysphoric young people in his practice. He has noted the tendency of young people to adopt the symptom language of gender dysphoria as a way to explain distress that may not have other words—

Dysphoria is often presented as a “condition” by patients I see, which they are unable to describe very clearly. They frequently have no sense that this feeling might have developed in response to social or interpersonal contextual factors, including family dysfunction and trauma. I think that with some ROGD, the individual is already struggling and unhappy (dysphoric) due to other issues and trans is appropriated as a solution to their difficulties. People I have seen often have a fantasy that transitioning would make them into a “new person,” free of all the old difficulties. I think the social contagion aspect may relate to the availability of the trans narrative as a compelling solution to pain and distress.

It matters which story or explanation we choose – how we decide to construct our distress – because this will in large part determine the kinds of responses open to us. Some clinicians are constructing feelings of gender discomfort in teens as indicative of the need for medical intervention that includes sterilizing hormones and amputation of breasts. Given the drastic and permanent nature of these interventions and the relative paucity of data on long-term outcomes for those who transition as children and young people, does it not make sense to explore other possible stories that might suggest different treatment pathways?

A commitment to dialogue, inquiry, and rigorous research has helped us to debunk politicized diagnoses such as drapetomania. It has helped broaden our understanding of schizophrenia so that we understand its cultural components, including the ways that the diagnosis has been misused as social control. And it has helped us to discover less invasive and more humane ways of treating this condition. Littman’s initial research does indeed seem to confirm that there are significant social and cultural elements involved in the current tendency among teens and young people to declare themselves as trans. Research likes hers can help us learn more about who might best benefit from which treatments. And isn’t that what we all want?

 

Lisa Marchiano is a clinical social worker and Jungian analyst in private practice in Philadelphia, PA. Her writing on parenting issues can be found at motherhoodtransformation.com. Follow her on Twitter @lisamarchiano

52 Comments

  1. Awakened says

    Another great article! Thank you Lisa. I very much appreciate your insight and thought provoking writings. My young adult child is now on hormones along with their best friend. To every therapist we have seen I have brought up female body hatred and they all say this is “different”. No one ever tells me how they know it’s different. My child is a legal adult and there’s not a thing I can do to stop them from medical interventions. It’s heartbreaking.

    • Andrew Roddy says

      What is hearken-breaking? Can you explain what is hurting you?

      • Mark says

        The fact that her daughter has been encouraged to reject her womanhood and make permanent changes to her body at an impressionable young age?

  2. ga gamba says

    Transtrenderism is a real thing, and no surprise given the fawning admiration of for any act of bender gender expressed by those who control the cultural capital. In a few years I predict we’ll see many reports of regretful young adults who undertook transitioning not because they’re genuinely trans but because it was the in thing to do and gained them recognition from their peers. What consequences to their physical and mental health remain to be seen.

    • L. Davis says

      Lots of law suits I expect – particularly as many of them will have been sterilised by the process. Not being able to have children may not seem like such a big thing in your teens but its a whole different ball game 10-20 years later.

  3. Shattered Mom says

    Thank you, Lisa, for writing this excellent article. As the mother of a daughter who developed ROGD at age 14, I can attest to the fact that it is a nightmare. It is beyond appalling that doctors performed a mastectomy and hysterectomy on her before her 18th birthday, without my consent, and that it was fully funded by the United States government. The doctors who mutilated my daughter should have criminal charges brought against them, but are instead protected by law. Parents of ROGD children are fighting back and we are not going to stop! Thank you for your dedication.

    • Sarah10 says

      I cannot believe my eyes and ears on this issue. They performed this on your daughter before she reached adulthood without your consent? This is just madness. I don’t understand the transgender push being advocated by the media, healthcare sector, the education sector, etc.. This is just a small fragment of people from the already small 0.6% of people who identify as transgender that seem to be calling all the shots on this issue, and one has to wonder what or who is backing it and why.
      My heart feels for you and wish you the best in your fight.

  4. LukeReeshus says

    Excellent article—a well-informed explanation and exploration of this controversial topic. My one minor quibble is that it’s almost tooprofessional. Take the bulk of the first concluding paragraph as an example:

    Some clinicians are constructing feelings of gender discomfort in teens as indicative of the need for medical intervention that includes sterilizing hormones and amputation of breasts. Given the drastic and permanent nature of these interventions and the relative paucity of data on long-term outcomes for those who transition as children and young people, does it not make sense to explore other possible stories that might suggest different treatment pathways?

    This is well-crafted technical prose (despite the awkward “constructing” in the first sentence—would “interpreting” not be a better word?). And the demurring question at the end presents a subtle yet incisive challenge to this new, disturbing social trend. We need level-headed, professional people like Lisa in the public forum, because without them polemicists like me would be the only voices. Why, I could never write a paragraph like the one above. I would have to write something like:

    Certain doctors are granting total legitimacy to the puberty-addled subjective feelings of adolescents and are enabling radical and permanent changes to the most fundamental aspects of their beings on the basis of those feelings. In the absence of strong evidence that doing so results in reliable, long-term benefits, these doctors are obviously reckless, and the broader social forces which are influencing them are obviously deranged.

    It’s a good thing Lisa is a writer, while I am a mere commentator.

  5. Non sequitur:”If a social act such as donning a certain article of clothing or being called by a different name can alleviate a child’s distress, then how can the problem that caused that distress possibly be entirely biological?”

    In fact, later you describe schizophrenia as biologically caused, but point out how social influences affect its prognosis.

    • She is saying it’s both in both cases. Biology plays a role. Social influences play a role. It’s not all one or the other. Many activists of the current transgenderism ideology claim transgender is completely innate, predetermined and permanent state. To merely question social influences playing a part in a teen’s attraction to a transgender identity is ignored, instills anger, and that person should be silenced.

      If people supporting an ideology have to silence views that don’t align with their worldview, you have to wonder how strong their claim is if it can’t stand up to scrutiny or allow nuance of judgement.

    • Robert Paulson says

      I did a double-take when I read that to. While I’m sympathetic to the sentiment, I think it needs elaboration.

      Perhaps she could have noted that a problem with biological origins can also have social solutions because of the complex interaction between our brains and the social environment.

    • RalphB says

      It follows as night follows day that if what alleviates an apparently social problem is biological, that the problem may not be entirely social but may be at least partially biological and if so, the problem cannot be entirely social.

      It follows as day follows night that if what alleviates an apparently biological problem is social, that the problem may not be entirely biological but may be at least partially social, and if so, the problem cannot be entirely biological.

      You haven’t uncovered a non sequitur, but a reasonable hypothesis. Now all you have to do is wait for the controlled studies to tease out the relative influences of the causal factors — i.e., for those who prefer science to mere preconceptions and strong feelings.

  6. Something to think about says

    A little perspective here.

    I am a transgender woman, and this is general issue is one of the reasons I don’t engage in any sort of community-based activism. At this point, the majority of youth who receive the diagnosis turn out not to be transgender.

    This is, of course, because gender identity is more fluid in children, whereas it is essentially fixed in adults

    I can more or less attest to this in my own life. Once puberty hit, the dysphoria I felt went from manageable to unmanageable.

    However, I can understand the attitudes of Brynn Tannehill and others, even if I don’t come to the same conclusions.

    Imagine living with a disconnect between brain and body, finding a highly qualified therapist to help you deal with the issue — and then having your own mother try to argue, against all evidence to the contrary, that you are not transgender and that no such thing exists. Then multiply your mother’s reaction by large portions of the world’s population. It’s not hard to understand why some transgender people question the motivations of even those who make legitimate claims against some aspects of some transgender activism.

    While the evidence here does indeed highlight the problems of early diagnoses, it’s also worth noting that this is a talking point used by the anti-transgender (and the larger anti-LGBT) crowd to deny, a la a mother in denial, that transgender people exist.

    And while I don’t attribute bad motives here, Quillette hasn’t exactly provided a nuanced platform on these issues.

    A few weeks ago, the site published a largely positive review of a book by a Catholic critic of all things transgender. Clearly, any site is free to review any book by any author of any religious background.

    But my credulity is strained when the Quillette writer uncritically accepts the Catholic critic’s utter lack of understanding of the most basic issues here. The Catholic actually believes that transgender people are making the same claims about gender as gender feminists are, when indeed the claims are completely opposite each other.

    http://www.latimes.com/opinion/op-ed/la-oe-soh-trans-feminism-anti-science-20170210-story.html

    Also, lost in the championing of Jordan Peterson is the fact that, no matter how wrongfully Wilfrid Laurier acted in the Lindsay Shepherd “controversy,” Peterson either has not read Bill C-16 or does not understand Canadian law particularly well. Despite the scientific evidence for non-binary genders, his refusal to use pronouns will not result in any legal action — unless that pronoun use is accompanied by something dark enough to rise to the level of hate crime.

    All of which makes it that much easier for me to see why some transgender people wind up accepting some of the more logically specious frameworks out there. I’m thinking of intersectional feminism in particular. If the everyday world wants nothing to do with you, the religionists want to throw you off rooftops — and even the self-described free thinkers want to overlook the content of the law in order to attribute to you the creep toward the Gulag — then going along with Linda Sarsour’s sharia feminism could be a legitimate lesser of evils.

    • Thank you for sharing your perspective. As the author of the piece, I appreciate your willingness to engage. You bring up the way that rejecting or judgmental attitudes toward your experience cause many to become more extreme in their views. Of course I see how this happens. One of the earlier commentators here chided me for being too careful in my wording, but this issue you raise is precisely why I am so. It is important for us to have a respectful, nuanced exchange of ideas on this topic. Let’s keep talking. Thanks again.

      • Something to think about says

        Thank you for responding.

        Again, I’m not attributing a bad motive to the article. I’m simply pointing out that Quillette seems to present a fairly one-sided (i.e. negative) set of opinions on transgender issues. Even worse, the other articles I’ve read have accepted egregious fallacies and presented them as fact.

        It’s just not a good look for the site.

        • I agree that Quillette has appeared to be a little one-sided about this issue, but I think it’s also fair to assume that Lisa Marchiano is not Ryan T. Anderson, the Catholic author of When Harry Became Sally. For starters, Anderson believes that homosexuality is a sin, and while his book did point out the desistance rate of transgender adolescents, he conveniently ignored the fact that many of these desisting teens grow up to be lesbians, bisexuals, or gay men. After all, the idea that sexual orientation might be fixed and present from childhood undermines the Christian notion that it is a freely chosen behavior that can be repented of and healed. I mentioned this in the comment section of that review, but some other commenters thought that criticizing Anderson’s Catholicism was an ad hominem attack.

          While Anderson’s faith makes him opposed to homosexuality and transgenderism in all cases, I think Marchiano is careful to point out that her concern is primarily about adolescents making life-changing decisions too early. That’s also my concern, and I’m grateful that Quillette posted this article.

          • Something to think about says

            I don’t disagree. In fact, my first comment even provides a link to an article that also deals with the problems of early transition.

            It just seems to me that Quillette is doing its readership a disservice by presenting all things transgender in a negative light — and, in the case of the article on Anderson and the ones on Peterson, misrepresenting the relevant information and ideas.

            The LA Times article I provided is instructive here. It does discuss the problems with early transition — but with the caveat that gender feminists, who essentially deny the existence of transgender people, are wrong on the relevant science and research more generally.

            In other words, even though there are still issues with early transition, that hardly means that transgender people are lying about their dysphoria.

            I understand that that’s not the point of Marchiano’s article.

            However, if my social media feeds are any indication, more and more otherwise clear thinking and decent people are starting to parrot the anti-transgender talking points. And many of those points, whether they’re made by Feminist Current, Anderson, Jordan Peterson, or whomever else, turn out to be explicitly feels-over-facts.

            On the other hand, even intersectional feminists are out to lunch on transgender issues. Without getting into too much detail, I can tell you from firsthand experience that they their acceptance of transgender people (and women specifically) isn’t based on the biological basis of transgender identities; the explicit intersectionalists I’ve met see transgender people as some sort of challenge to Western hegemony or however they might phrase it. They wind up echoing separate-but-equal rhetoric in ways whose irony must escape them.

            All of which explains why I relate so much to The Invisible Man, even though those identity questions are not mine.

        • Alex says

          May be the reason is that hormone treatment before puberty is complete is equivalent to chemical castration. Why not bringing this up in your comment?

          I understand it must be horrifying to feel you’re in the wrong body, but Quillette courageously brought up an entirely different issue: Transgenderism in infant.

          Don’t you think it is at least worth waiting that the child is old enough to understand she/he will never be able to have a child?

    • Molly says

      But in fairness, most of these parents are not arguing that there is no such thing as being transgender. They are querying whether the distress their daughters feel is really down to their daughters having a fixed and permanent male gender identity. They are not saying that transgender people don’t exist, they are querying whether there own daughters are in fact transgender. Not the same thing.

      • Something to think about says

        But that’s not the point I made. I simply pointed out that every transgender-related article I’ve read on Quillette has had a negative focus, and that this particular article is the only one that hasn’t presented misinformation as truth.

        That alludes to my larger gripe with Quillette’s articles on transgender topics, taken as a whole.

        Some people wind up conflating the points made by research-based articles (such as this one) with those made by Anderson, Peterson, and so on. It doesn’t take a slippery slope, then, to accept the nonexistence of transgender people.

        Certainly, not everyone goes down that slope. But I’m seeing more and more evidence that more and more people do.

        • Robert says

          Peterson’s concerns with the law are not unfounded. It’s now largely accepted that gender and gender expression are subjectively determined. Mis-gendering a trans person has already amounted to a human rights violation in British Columbia (http://www.bchrt.bc.ca/shareddocs/decisions/2015/mar/54_CORRECTED_Dawson_v_Vancouver_Police_Board_No_2_2015_BCHRT_54.pdf). The trans activists, especially those on campus, are militant and confrontational. A successful human rights action over a professor’s refusal to use a made up pronoun is a reasonable foreseeability.

        • Softclocks says

          How can you claim that Peterson’s concerns are unfounded when the repercussions he spoke of already came to pass?

          Further you keep chiding the Quillette for not presenting the trans issue in a positive enough light, why? The Quillette serves as a platform for free speech and seems to mainly give attention to viewpoints and research that isn’t given the light of day in other, more politically oriented outlets (almost all of them). Its purpose, to my understanding, is not to equally distribute arguments for and against every issue under the sun.

          Instead of tallying up articles for and against trangenderism I suggest you take a stroll to and through the myriad of other sites that are happy to put your feelings first and the truth second.

          • Something to think about says

            With due respect, you’re more or less making my point for me.

            I have my doubts that Peterson has read Bill C-16. It clearly won’t criminalize the actions he claims it will. Ask a Canadian law professor:

            http://sds.utoronto.ca/blog/bill-c-16-no-its-not-about-criminalizing-pronoun-misuse/

            Also, please reread my posts. I do not chide Quillette for not presenting transgender issues in a positive light. I simply pointed out that the coverage is one-sided, and always factual or accurate. Certainly, a platform for free thought isn’t the same thing as a platform for flights of fancy.

        • Molly says

          To: Something to think about

          But is Quillette refusing any articles written by anyone on this topic?

          I mean, on the children issue, has any transgender activist come up with a coherent argument for the transitioning of children, given that the evidence seems to be that gender identity is not fixed in childhood? If any person has a coherent argument for this, and is prepared to defend it, in a hopefully civil way, without abuse, in the comments section, I’m sure Quillette would be very prepared to publish it.

          • Something to think about says

            Please reread my post. I not only agree with the problems presented by early transition, I even provide a link that documents some of those.

            My issue is not with this article, but with Quillette’s apparent editorial stance on transgender issues.

        • Lisa Marchiano says

          I agree that there could be a backlash due to more people becoming disenchanted with the more extreme transgender activists activities. This would be very unfortunate for trans people, and possibly for gays and lesbians, whom it might also affect. I would not want that to happen. I can’t speak for Quillette, obviously, but I can say that nowhere else would have the courage to publish this article being discussed here.

          • Jake says

            The possibility of extremists chasing away their own potential allies has always been with us, I think. I’m reminded of a classic Onion headline from the last decade: Gay Pride Parade Sets Mainstream Acceptance Of Gays Back Fifty Years.

            The worst extremists are the ones whose entire identity is subsumed into their cause — in this case, people who act as though they have decided that their sexual and gender identity is the ONLY interesting or important thing about them. There’s something sad about a person whose entire persona is nothing but: “Boy, am I ever (x)! Look how f___ing (x) I am! I can work (x) into any conversation and talk about it for hours!” That’s not a good look on ANYONE who does it.

    • Ian says

      Just for clarification, the letters that Jordan Peterson received from his Dean at the University of Toronto ordering him to use non binary gender pronouns invoked the regulations of the Ontario Human Rights Commission. This was the legal opinion of the lawyers working for the University of Toronto who presumably crafted the two letters, not simply Jordan Peterson’s personal opinion. Jordan Peterson had issues with bill C-16 as well, but that was a separate issue, since had not been passed at that point.

    • LukeReeshus says

      Also, lost in the championing of Jordan Peterson is the fact that, no matter how wrongfully Wilfrid Laurier acted in the Lindsay Shepherd “controversy,” Peterson either has not read Bill C-16 or does not understand Canadian law particularly well. Despite the scientific evidence for non-binary genders, his refusal to use pronouns will not result in any legal action — unless that pronoun use is accompanied by something dark enough to rise to the level of hate crime.

      See, this is exactly the problem Peterson was pointing out in in his criticism of the Bill: its ambiguity of terms. Your final sentence demonstrates this perfectly: when exactly does language become “dark enough to rise to the level of a hate crime,” and thus call for “legal action”? I know of no person on Earth whom I would trust in deciding that question. And neither does Peterson, which is why he objected to it. He’s stated multiple times that he has no problem addressing people by their preferred pronouns. But he regards any imposition by law upon that personal interaction as an impingement on freedom of speech. Like him, I find such impingement intolerable and totally at odds with (classically) liberal principles.

      As for your next paragraph:

      All of which makes it that much easier for me to see why some transgender people wind up accepting some of the more logically specious frameworks out there. I’m thinking of intersectional feminism in particular. If the everyday world wants nothing to do with you, the religionists want to throw you off rooftops — and even the self-described free thinkers want to overlook the content of the law in order to attribute to you the creep toward the Gulag — then going along with Linda Sarsour’s sharia feminism could be a legitimate lesser of evils.

      This is all shamelessly hyperbolic. What “religionists” in the US (or anywhere in the Western world) want to “throw you off rooftops”? None, so far as I can see. And “sharia feminism” is an oxymoron—why anyone would trust traditional Islam to treat those suffering from gender dysphoria more compassionately than the modern West is utterly beyond me. It makes no sense.

      We in the West have managed, in the 21st century, to fashion a society where personal, subjective feelings are paramount in political considerations. And yet the personally and politically aggrieved still feel like they have something owed to them, far beyond any rational considerations. What exactly those considerations are, and to what extent we ought to offer them, I don’t quite know (and at this point I’m starting to doubt they really know either). Yet we keep offering.

      Now, let me return to where I sympathize with you:

      Imagine living with a disconnect between brain and body, finding a highly qualified therapist to help you deal with the issue — and then having your own mother try to argue, against all evidence to the contrary, that you are not transgender and that no such thing exists. Then multiply your mother’s reaction by large portions of the world’s population. It’s not hard to understand why some transgender people question the motivations of even those who make legitimate claims against some aspects of some transgender activism.

      This paragraph is on-point. I sympathize with it, I try to feel for it. That “disconnect between brain and body” must disorient people horribly. And those who, by accident, have their genotypes and phenotypes line up “naturally,” and function “properly,” cannot even remotely appreciate how lucky they are for their good physiological fortune. They take all of it for granted.

      But still, they deserve their say in society—their proportional say, at least.

    • Suzanna says

      You described what gender dysphoria felt like from your own perspective: While manageable in childhood, it became unbearable when you reached puberty, and so, you can understand where the more militant transgender advocates are coming from.

      I have no issue with this. I can’t pretend to understand how difficult that would be.

      However, it is transgenders with your perspective who are dictating how my daughter should be treated.

      This, I have a major problem with. The two are not the same, and should not be treated that way.

      And have you considered the issue from the perspective of the mothers?

      We do not want to refer to our daughters using male pronouns, because they are most likely suffering from rapid-onset gender dysphoria. To use male pronouns would be to reinforce a false belief and perpetuate their troubles.

      While Bill C-16 does not apply to what happens in the home, in Ontario we now risk being found guilty of child abuse and have our children removed from our home if we do not comply.

  7. Ian Cognito says

    Thanks, Lisa. It was an interesting piece that will make me do some more research on cultural differences in the expression of certain disorders. One of the things on this topic that concerns me is the notion that the next DSM will roll out and we will see gender dysphoria redefined, not for research or medical reasons, but because of social/cultural/political pressure. Keep up the good fight for long term research, especially as it pertains to transitioning children.

    As a side note, I wanted to respond to the commenters mentioning Quillettes onesidedness on this topic. My understanding is that if it seems one sided, it’s simply a matter of either no one submitting an article from another point of view, or perhaps no one submitting one that was up to snuff research-wise. If you feel there is another point of view worth putting out there write it up. I’d love to read it.

  8. Alex says

    The cost of a transition is on the order of $20k, not counting permanent medication, and long term side effects. None of the medical procedures involves ground-breaking surgeries, or R&D in pharmaceutical products. In fact, those hormones are so well known that in Northern America, there’s only one manufacturer (Endo Pharma) in its generic form.

    Does the author know why transitions got so easily covered by insurances, which are traditionally very picky – to say the least – when it comes to coverage?

    I see a most disturbing alliance between local province officials, the trans lobby, and a de-facto monopoly situation with a fairly big pharmaceutical company.

    How did we come to this?

  9. Had our current crop of mental health professionals been around in the middle ages they would have been quick to suggest a diagnosis of rapid onset sadomasochism to explain the flagellants.

    Back in the day, c.a. DSM I or II, all this nonsense would have been collected under the diagnosis “personality disorder.”

  10. My female child learned the concept of transgender at age 17. At 18.5 years old she ….who now goes by “he” in “his” circle….was on testosterone.

    Does anyone really think this is a good idea? How did the Trans Train get to be a Super-fast Train? I know for a fact that she was unsure,…and then she talked with 2 university-affiliated psychologists who downplay the seriousness of a transgender identity with medical treatments, just cheerleading students to keep them happy in their years on campus. Absolutely no long-term view, no attempt to ask about mental health issues and life-events that may be playing a part…indeed, their lips have been professionally zipped. Unbelieveable.

    Whether or not this will work out as the best decision for my child is besides the point. There are many parents with young adult kids with known and diagnosed mental health conditions who are still put on the Super-fast Trans Train, like it will solve their underlying issues.

    History tells us it won’t. Thank you Lisa and thank you Quillette for shining a light on this issue. The current model of self-identification, affirmation-only, and informed consent clinics is not helping young people come to terms with their bodies and underlying/motivating issues.

    The slow train is safer for all.

    • Alex says

      When a person of power claims privilege, we ought to ask her:
      Who appointed you?
      Who pays you?
      How do I get rid of you?

      80% of said kids outgrow their gender dysphoria, but no, the trans lobby want to put 100% of them under the knife.

      This is a bloody shame.

      • nicky says

        “80% of said kids outgrow their gender dysphoria”: do you have any reference for that? Not that I don’t believe the number, just that I would like to know for possible future use.

  11. Shannon says

    I’m trans. This article raises some good, often overlooked, points. That’s why I read Quillette – for that. The presuppositions of the author belie transphobia; rather, the nerve to offer nuance to an emotionally polarized debate – which is needed.

    My thoughts: We need to establish widespread distinction between trans kids and Rapid-Onset-Gender-Dysphoric kids.

    Trans kids deserve to have the right to transition.

    ROGD kids deserve not be pressured into transition.

    We all deserve to have an open landscape for debate without accusations of ‘bigot’ and ‘pathological indoctrinator’ levied from opposing echo-chambers.

    My solution: Only talk to people that you agree with and shelter yourself from opposing opinions. Quick!

    • Ian Cognito says

      I think you can’t eve. Diagnose someone with a personality disorder until they are over the age of 18? How can you properly identify and then also implement such life altering changes before then too. 18 might honestly still be too young to determine it based on what we know about stages of development.

  12. ccscientist says

    Anyone looking back on their life who is honest will admit that they were idiots when they were teens. We do not let 13 year olds drive, vote, buy alcohol, sign contracts, have sex, or get a full-time job, and yet we should honor their requests for hormones and surgery that will prevent their normal development and preclude ever having children? Really? And until someone has had sexual and romantic relationships, how can they know where they come down on the gender identity thing? They cannot.

  13. Andrew Roddy says

    I have no idea how Quillette (its editors and readers) imagines itself. I am one of its readers. I see a space for people who are culturally conservative and even reactionary (whatever that might mean) who like to imagine themselves as fair-minded, compassionate and evidence-oriented. I suspect that is the broad myth. I don’t think I buy it at all but I feel there are ideas expressed here that are worth reckoning with.

    • Alex says

      “For people who are culturally conservative and even reactionary” Sitting on his left pole, where all way out points to conservatism, the clergyman has spoken.

      The entanglement between leftists and people in power has really become insufferable.

  14. augustine says

    A “dysphoric” condition should elicit sympathy in the witness. It may stretch our ability to think and feel about others. This dynamic is something very different from activism that presents alternate sexualities as ideas to be accepted as normative under penalty of being ostracized by liberal society or even penalized under law. The champions of these radical ideas would do well to operate more fully in the former realm of empathetic personal connections and avoid demanding political innovations that invite misunderstanding and hostility.

  15. Pingback: Link: Transgenderism and the Social Construction of Diagnosis – Quillette – David's random ramblings

  16. Lorne Carmichael says

    OK, I’m going to raise an issue that I know will make some people here angry, but it is an issue that has been raised elsewhere and has not been answered anywhere, to my knowledge.

    Many years ago (the 1980’s) I met a psychologist at a party who told me that there were fashions (his word) in the way that mental illness presents itself to the world. His example was catatonic schizophrenia. In those days old black and white movies on TV were part of everyone’s cultural capital, and every old movie with a scene in an asylum would have people standing rigidly and unresponsively up against the walls. This was a real condition, but died out in the 1930’s. It’s not that a cure was found — basically, no-one gets it any more.

    This was before the time of anorexia, but later, during those troubling years, I often thought back to this conversation. I can’t help but think of it again with respect to Rapid Onset Gender Dysphoria.

    The elephant in the room is that a young girl with anorexia who is starving herself to death will look into a mirror and believe, totally, that she is seeing a fat person. But that overpowering belief, a conviction that is stronger than her will to live, is objectively wrong.

    What if a similar thing is happening in young women with ROGD? What if the strength of their convictions sheds no light at all on their underlying condition?

    Maybe the answer is “Who cares?” People with anorexia die because you can’t force a tube down their throat forever. Maybe ROGD really is an illness but the permanent cure is transition.

    On the other hand, I have a niece who showed signs of anorexia as a teenager but recovered and has gone on to a very productive life. What if transition is a permanent cure for a temporary condition?

    It seems obvious to me that we are conducting an experiment of human subjects that would never pass an ethics board. Ever.

    • Alex says

      Sounds pretty reasonable. Have you heard about the RaeRae in Tahiti?

      There’s no trans lobby down there, because there is no need to. Trans are accepted, there’s a miss trans every year, and nobody has a problem with it.

      Where I live trans are part of the decor, I’m not saying parents are happy about it (family + kids is important), but they have a life.

      The trans lobby is making kids sick, the social stigma that prevailed 40 ago was replaced by an urge to medicalize everything and anything. This is so wrong.

    • I suggest that if ROGD really is a mental disorder and if surgery and drugs are the only possible relief for some small number of people who have this disorder then treating this problem with irreversible surgery and drug regimes is a decision that only the individual can make and that decision must be postponed until the individual is emancipated.

      There are simply too many examples of mass hysteria going back over a thousand years that show such phenomena are closely related to social and environmental selection pressures to presume that this is anything more than the sexual confusion all adolescents have always had to cope with.

      • Brigitte Lechner says

        Why is nobody looking at the problem from the angle of the cognitive processes involved in identity formation? I am thinking here of Antonio Damasio or Ulrich Neisser. We all have to do it, do it unconsciously and use a variety of internal and external perceptions and observations to do it with. It’s a very complex and enduring process and in a culture where anything goes, particularly if it can be paid for,young people in particular may get profoundly confused. There is no reason to pathologies this confusion but there is a need to help the confused. But nobody is talking about this elephant in the room.

  17. KDM says

    The super fast trans-train is real and working in real-time in the American Education system. Read below.
    The American right has always been accused of conspiracy theorism when saying that the far-left wantvto take away parental rights and work in the educational institutions to make that happen…. This is why that “conspiracy myth” has lasted so long.

    Proposed Delaware Education Regulation 225 Will Allow Students to “Self-Identify” Gender and Race

    If you’re a parent – this new regulation will permit your child to change their gender or race – without your knowledge or consent.

    Specifically, section 7.4.1 of the proposed regulation states that your school may “consult” (privately) with your child to determine “the degree to which” you are perceived to be supportive of your child’s decision to change their identity. Who exactly makes that determination?

    There’s more, sections 6.3.1.2 – 6.4 will allow for boys to play female sports, and male students may access female restrooms, locker rooms, and overnight accommodations. They simply need to “identify” as female to gain access.

    https://www.votervoice.net/mobile/DEFPC/Campaigns/54829/Respond

  18. “People I have seen often have a fantasy that transitioning would make them into a “new person,” free of all the old difficulties.” This is the broader vision that motivates socialists, to escape the difficulties and problems of the current world and society via a “revolution” whereby society is totally destroyed, and from which wreckage a new perfect society arises.

    The analogy here is stunning. Attempting to create a “new man” from the “revolution” of irreversible surgery and the use of powerful drugs. From the human wreckage, a better person is expected to emerge. But the stunningly high suicide rate tells us that the majority of people who go through this process are worse off rather than better off.

  19. Pingback: Sex change is physically impossible | Designs on the Truth

  20. Julius says

    Jordan Peterson has cited research done by Simon Baron Cohen who studied the long-term effects of stress hormones on fetuses. He found that that the children of women who were considered stressed (defined as suffering through at least one major, stressful event) were much more likely to display behavior that’s generally attributed to the opposite sex. The video where Jordan discusses this is his 2016 lecture on trait agreeableness of the Big Five theory. He starts reading excerpts from the study at the 32:50 mark if you’re interested. https://www.youtube.com/watch?v=UgRaLmCOwYU

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