This psychiatrist finally lays out a key point in this whole debate that I have wanted the medical and mental health fields to go on record discussing. First, this excerpt from the original Reddit post:
“...even when they were wrong they were appropriately trading a risk of long term morbidity for short term mortality.”
The issue: that if a teen is actively suicidal or self-harming, something must be done in the short term (transition) even if it causes harm in the long term (morbidity and/or regret) because - and here’s the sticking point I’ve wanted the profession to go on record about - apparently the mental health field has no other interventions for suicidality and self harm in their tool box??
Having no other treatment options for these suicidal and self-harming teens is the underlying premise we are all being told to accept by everyone shouting “life saving care” and “would you rather have a live son or dead daughter.” But this premise this treatment model is built on and that we’re being sold is not true and the mental health profession knows that, as evidenced by the original poster deep in the comments:
“I do not think we should do nothing for these patients, only counsel them with CBT the same way we do anyone else who is unhappy with their body, and the same way that trans affirming people themselves do when patients are at the end of the transition process, or unable to proceed for other reasons. What should a therapist tell a transwoman with gender dysphoria due to inability to become pregnant? Any answer to that question can be applied to other manifestations of gender dysphoria.”
They KNOW there are other treatment options - BETTER treatment options - as evidenced in this NYT article about DBT (a type of CBT) titled “The Best Tool We Have for Suicidal and Self-Harming Teens.”
What’s really keep about this point and DBT is that, unlike affirmation and “gender affirming healthcare,” we DO have a LOT of research on the efficacy of DBT. So why isn’t DBT or CBT the first line of treatment for these teens? (See this post for more!on that question https://pitt.substack.com/p/if-dbt-is-the-best-tool-for-teens)
We need to start asking this question and pushing on it insistently and loudly because already, this untested and unsupported ideology of affirmation only is infiltrating, taking over, and undoing the only treatments that actually have research support for their efficacy in treating depression, self-harming, and suicidality
There are many different interventions that can be used to keep a suicidal safe/prevent suicide. This Child Psychiatrist who has been transing children and now regrets it is being a little bit cute to pretend that the choice was to either put the child on hormones/book them in for surgery or allow them to kill themselves. That was never the case. There was never any reason not to treat suicidal ideation/threats/intention in the same way as we treat it in other patients.
Hospitalization until the crisis of suicidality passes, ECT to treat the underlying depression, medication to treat the underlying depression, therapy/counselling to explore and alleviate the causes of the distress using CBT, DBT, psychodynamic psychotherapy, or whatever other model you are familiar with (the research suggests that it doesn't matter which psychotherapy model you use nearly as much as your skill at using that model).
By the way, I'm a Registered nurse who worked for 20 plus years as a community mental health nurse, alcohol and drug counsellor, and psychotherapist so I do know what I'm talking about.
Thank you for the informative post. One clarification: If I understood right, the last citation you provide, "Transgender affirmative cognitive-behavioral therapy" is an example of the ideology taking over tried-and-tested methods. In other words, it is something NOT to be emulated, right?
"Basically: it’s terrible for your mental health to believe there is something fundamentally wrong with you."
This, this ,this, thank you for crystallizing it! I was anorexic in my late teens/early 20s because of this belief instilled in me, whether on purpose or not, by my parents, and it has taken my entire life to learn coping skills to counter it - it never completely goes away. I fear I would have been completely susceptible to gender ideology if I were a teen today.
We need to talk more about the use of social media to hammer this belief into vulnerable people, and examine the motives behind this behavior of coercion. Maybe it's not all nefarious but some of it has to be.
It's all nefarious, imo. One indicator is the dual hammer trying to separate children and young adults from those parents questioning and trying to help. I would like to see nothing less than a scorched earth policy to end this destructive cult.
But quite a dog's breakfast, a perfect storm of fantasy, delusion, political opportunism, religion, "conspiracies", and magic -- with precious little in the way of any science and facts for leavening. Though there is some -- arguably, a trail of breadcrumbs out of the swamp:
But it seems you're new to Substack so you might have some interest in UK philosopher Kathleen Stock's generally illuminating take on the phenomenon:
KS: "What I do find interesting, though, is how things went so badly wrong: the causes, not the reasons. I’ve had a lot of time to think about this. One big question for this newsletter will be: how did mainstream feminism come to embrace what I’m calling the stupid story [transgenderism?], so that many feminists ended up cancelling themselves out of politically effective existence? Effectively, the stupid story functions, for mainstream feminism, as a reductio ad absurdum: it reduces most of contemporary feminism to risible absurdity, necessitating urgent reflection on the tenability of prior commitments to explain how the absurdity ever got such a firm grip."
Sure can sympathize with that argument. However, the rot goes rather deep and which -- one might argue even if only as a Devil's Advocate ... 😉🙂 -- more or less makes us all culpable, to one degree or another, for our contributions to that state of affairs.
Not to belabour the point ..., but a big part of the problem is that "we" seem to find it impossible to agree on what we mean by the various terms we throw about with "gay abandon", so to speak. For examples, "sex", "gender", and, of course, the biggie, "woman". Apropos of the first two, I wonder -- as per previous discussions -- whether you think they're synonymous, and whether you'd accept "gender" as roughly equivalent to sexually dimorphic personalities and personality types:
Apropos of the third, I more or less fell off my chair when I heard Kathleen Stock's rather "brutally" but commendably honest take thereon in a YouTube interview with Peter Boghossian:
KS @51:10 : ".. there is you know, there's no kind of inevitability about the word 'woman' meaning 'adult human females' ...."
Peter Boghossian & Kathleen Stock: Lesbians Don’t Have Penises
She's definitely one of the saner feminists on the scene, although she too (still) has some very questionable and unexamined assumptions she's hobbled by.
But there are many other definitions for "woman" that "work" -- more or less -- and that may well be more useful, at least in some circumstances. Unfortunately that one has become something of an article of faith for too many which is, arguably, as much a part of the problem of transgenderism as of the solution.
I think that it's more complex than this. Sometimes it is extremely helpful to know that something is wrong with you, because it enables you to do what you need to do to look after yourself, and because it gives you an explanation for why you and your life and your struggles are the way they are. And sometimes it's just pathologizing and makes you feel bad about yourself, or makes you put unnecessary limits on yourself. So it's a very fine balancing act and is something that needs to be worked through in therapy (if you are going to give your client a diagnosis) so that it is a positive thing for them not a negative thing for them.
For example, I have coeliac disease. Until I got this diagnosis (that something was fundamentally wrong with me) I had no energy and difficulty concentrating and was unwell all the time and felt viscerally as though I was rotten on the inside and couldn't exercise and had low key chronic pain. Other people understood this as me being lazy and not eating a healthy diet or doing enough exercise. I understood it as myself being lazy and a hypochondriac. The coeliac diagnosis told me not only that there was something wrong about me, but that it wasn't laziness, poor diet or hypochondria (moral weakness basically), but a badly damaged gut and an overactive immune system. It told me that I needed to give up gluten, which I did, and within day's my chronic pain, chronic depression and feeling of being rotten all vanished forever. So walking around knowing that there is something fundamentally wrong with me, and because of that I have to be very very very careful about what I eat is extremely helpful to me, because it enables me to have as close to a normal life as I can have (I can't eat at restaurants or other people's houses and there are a lot of foods that I can't eat period, but as long as I do that I can be well and live an otherwise normal life).
None of this is to say that pathologizing things that are normal or fairly common is a good idea. And yet again, on the other hand we are in the middle of an enormous epidemic of mental illness (and other chronic disease too of course) thanks to the incredibly unhealthy lives people now live in the west with chronic stress, and artificial light, and lack of exercise, and food that's of low nutritional value and full of poisons, and phytoestrogens in the air and water, etc etc etc. So a lot of people are genuinely unwell, a lot more than used to be.
I’m genuinely gluten intolerant but not coeliac fully. I recognise your description of removing gluten. The exclusion diet which diagnosed gluten as my problem made me feel better that quickly too.
I have struggled with ongoing viral meningitis symptoms for more than two years. Been tested for everything under the sun. Scans, lumbar puncture but no diagnosis.
I’m now cured, do not know whether the things I did or just time did it. Not having a diagnosis was frustrating but didn’t stop me getting cured.
I’m a runner, I love it to bits so am highly motivated to exercise. I think this desire prevented a slide into hypochondria. I tried running twice over the years but crashed with bad return of symptoms.
That Reddit post was such a pleasant surprise! What was interesting to me were the comments that said something along the lines of “I agree! It’s sad that we can’t bring any of this up in public though because of the evil bitch TERFs who will use it to demonize transwomen though.” Or “I agree with you! We can and should bring up these concerns you raise at work. I don’t see why we can’t, while still supporting gender affirming care.” I know schadenfreude isn’t a good look, but I can’t wait for some of these goobers to bring up their thoughtful concerns, get slurred as TERFs, and realize what we all have...
👁️👄👁️ if I’M a TERF...then are all those “evil TERFs” just people like me?
Thank you! So telling that a psychiatrist, supposedly an expert in the field, with advanced degrees, has to resort to the same common sense, observation and reason that the rest of us use when trying to figure out our problems and those of the people we care about and what to do about them.
Medical doctors started out as quacks, but were eventually redeemed by scientific advances in western medicine.
Psychiatrists and psychologists? Not so much. Our gut instincts, attention, empathy and common sense will serve us much better than their glorified medical billing classifications. Their expertise has utterly failed to protect our children from this travesty, and their own ranks have been among the most heavily susceptible to trans activist gaslighting.
I have a degree in psychology and mostly, not 100%, agree with your rejection of the field of psychology. Speaking of 'field' we should ban that word and problematize its use so that mental health professionals and lawyers can bill patients/clients to help them address the trauma, or seek redress for the trauma, of their lived experience with hearing the word 'field'-not. I'm pretty sure this already happens in Canada.
Gender Dysphoria is, by definition, a form of cognitive dissonance. Nothing I'd like to joke about, but that's another question.
I've always doubted the wisdom of affirming people in their cognitive dissonance, save, perhaps, in some very rare and extreme cases where there seems to be no other solution.
We don't generally do this. Not in everyday life, not in medicine. It's only with GD that we're told that it must be done, and only this must be done.
Granted, GD sits deeper than most cognitive dissonances, but no one has shown me any evidence whatsoever that GD is so qualitatively different from all other forms of cognitive dissonance that it must be treated in a fundamentally different way.
Now, I'm no medical professional, but having a medical professional (yet another) see this in a very similar way, and argueing his point by thoroughly and scientifically examining available research, tells me I am most likely not fundamentally wrong in my position.
And, foremost, let's not forget one thing: Yet another study that was intended to support the "gender affirming model" of treatment has demonstrated that "gender affirming care" does not work and is likely to cause a lot of harm. This happens invariably with all studies that keep up at least a semblance of scientific method. Positive outcomes are only yielded by research that does not even do that.
The entire Reddit post is absolutely worth reading. Unlike many "researchers" who allow themselves to be led by the dogma and then somehow twist the data to suit the preferred narrative (to the extent of blatantly misinterpreting the said data), the writer lets the evidence leads to the conclusions, wherever they might point to. It is also so refreshing to see a researcher who not only understands the research methods (statistics as applied to the biological sciences) but also their applicability to the specific discipline (psychology and psychiatry), with the discipline's own peculiarities and unknowns (see the very wise discussion on how a questionnaire in the "knowledge of Japanese" can lead to very misleading conclusions depending on the respondent's actual level and interest in Japanese).
Stated simply, the writer understands the subject deeply. And the depth of knowledge comes from not only writing a few papers fresh out of school by using "some data from somewhere" (more about it in the next paragraph) but also from the clinical experience that comes from treating a lot of patients in the specific subject area of GD. For example, see his later discussion refuting the "minority stress" hypothesis that he tackles in a separate post to answer a question from another poster (https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/jur62be/). His takedown is simple and elegant: first, he argues the methodological issue - the unfalsifiability of the thesis, in that it "creates a heads-I-win-tails-you-lose dynamic where even negative results can be spun as positive." And second, from a practical point of view, it really does not matter if the depression from GD is now replaced by depression from being a member of a minority. (And finally, the writer makes sure that especially in the context of Chen et al. (2023), the minority stress is a moot point: "the parents in Chen 2023 were all supportive enough to consent to GAH in their kids, and Boston, LA, SF and Chicago are some of the most trans-friendly places you can hope to find in America." This is a comment that should be read in its entirety.
A final point I wished to make comes from another commenter (https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/juq4fzv/), who conducts a knowledgeable overview of the entire "research" in the area, starting with the WPATH SOC. But more importantly, this commenter does a thorough takedown of the 2015 US Transgender Survey, whose responses have driven the overwhelming junk of "research" in the area, most famously by Jack Turban, who has wrung the data one way and another to create a series of research papers that are not worth the bits that they occupy on the internet servers they pollute: "This has been cited about 3500 times in the literature and has informed every single US policy impacting transgender life. If you look at the original article, it's a complete joke. They used a grab sampling method. Basically an internet survey with no verification, asking people to invite others to fill out the survey. So a snowball sampling methods, a non-probability sampling method that you can not use to infer conclusions from a wider population...some of the questions seemed almost designed to create demand bias (when the participants are aware of the researcher's aims and thus more likely to answer in a way that supports the investigator's goals). Not to mention, some of the findings are nonsensical. 73% of respondents said they started puberty blockers after the age of 18. Obviously, that's simply not true." Another comment that should be read in its entirety.
This is a serious attack on the discipline coming from the inside rather than from "transphobe parents." There are a lot of dissident voices within the discipline and it seems that they are no longer keeping their voices down. A revolution becomes successful only when people inside decide to join the dissidents. Socially and politically, too, the mood seems to have changed - see for example NYT's uncritical coverage of the critics in the article that covered the decision by the AAP to do a systematic review of the literature, or the sports bodies coming to their senses and making various women's sports for women only (thank you, Lia Thomas). Or the fact that politically, the issue is becoming a baggage for the Democrats as people increasingly see the egregious examples of this ideology (https://www.liberalpatriot.com/p/the-democratic-party-left-vs-the). This is hopeful.
I am deeply relieved to see this post is still up after several days and there is actually conversation about this.
Over the years on Reddit I have had ALL my thoughts on this matter deleted (thousands of comments), been blocked from commenting, been thrown out of women’s only subs I contributed to for years and had multiple accounts suspended…been dogpiled downvoted, and received misogynistic threats to my inbox …all for trying to call attention to this medical malpractice and the harm it is doing.
I feel relieved to see that someone “got through” the silencing.
I feel this is a very important turning point for the mental health industry. The moment I heard about the trend of transitioning persons towards an endless series of body modifications I was reminded of the Diderot Effect. The body having become another platform for consumerism in the endless search for perfection. In a country served by a for-profit medical system this should not be surprising. https://en.wikipedia.org/wiki/Diderot_effect
Indeed something that is commonly overlooked when we discuss the trans trend, particularly the drive towards surgeries.
The trans trend has finally transformed the human body into a commodity.
Before, this was a fringe issue. Tatoos, alright, piercings, alright, but these were relatively cheap and superficial modifications, however we see them. Cosmetic surgeries were frowned upon by a lot of people, probably a majority. Maybe a bit of a facelift here and there, but if you overdid it, you were ridiculed or pitied. Surrogate motherhood, one of the worst forms of exploiting women, always was a controversial issue.
This has changed fundamentally. Now, your body parts are commodities to be altered or exchanged at a whim.
Needless to say that this will also facilitate more far reaching changes and abolish a lot of boundaries we have now.
There is no fundamental difference between "Don't like your genitals? Get new ones" and "Need cash? Sell your kidneys".
In the interest of giving the patient all the information they need to make an informed decision how is it that this information has not been made public? One of the comments on Reddit is from a surgeon who claims they will continue to do these surgeries on ‘consenting’ adults. How can anyone consent when they don’t have all the information? These surgeries offer something they can’t and don’t give. Often trading one problem for another.
Yes, this is a core issue - these people were not informed-I know that because their own doctors are not informed on these matters because NO ONE knows the long term /life long affects on health, sexual function, etc
In order To actually get true consent the practitioners would need to disclose to the patient that these treatments are ALL experimental with no long term data backing them and xyz are the known negative side effects of this treatment…
This info is hard to find online because of intense censorship, so it is impossible for patients to do the due diligence themselves as what they will find is all in support of these procedures…
If they can’t inform themselves, and their doctors don’t inform them…They are not able to consent
Surgeons, while most are amazingly trained and talented, don't maintain long term relationships with patients (I know there are a few who do). Generally, again GENERALLY, they perform the surgery that some other doctor has requested, like take out this appendix, cancer, etc. Of course they need to all speak in defense of their actions, otherwise how would they sleep at night? I believe that most do truly believe they are doing the 'right' thing. Their liability insurance is supported by the general practice du jour. Informed consent means I need to let the patient know EVERYTHING they need to know to consent to the procedure. Knowing, hearing and signing are often far afield from understanding.
Agreed. And as far as consent, many detrans folks have stated that at no point did anyone (physician, psychologist, surgeon-anyone) express that there may be other ways to move forward that would help their distress
True for sure. Also many of these 'kids' (mine is an 'adult') are being informed by very poor resources and encouraged to go forward by other 'kids', and sometimes even professionals ( see Marcie Bowers), who need validation for their own choices. People with high investment in the ideology ought not be allowed to encourage others to go on their path. There need to be checks and double checks. For example, it's well know that therapists who have been divorced are more likely to encourage clients in this direction, even though good therapy never includes advice.
Salient points! Yes, for such extreme interventions there should have been many checks and safeguards. Having been personally let down my physicians and specialists many times in my life…I inherently distrust medicine in this country and believe medical practitioners are given too much respect and power as to almost be beyond reproach, and that inevitably leads to harm that affects the patients…while the practitioners go on making hubristic mistakes with no one to humble them
“Consenting adults.” Like those just turned 18 adults who sneak into clinics when they’re away at college to start hormones. Ugh. They can’t rent a car but are somehow mature enough to sign off on surgery?
Thanks for sharing this, Eliza. I'll read the whole thing. Does the fact that we might expect a big positive change merely due to placebo, and the minimal change measured, suggest there must be a compensatory negative impact? I've seen "trans allies" - when they admit regret exists - retreat to the position that we need more research to know which young people with gender dysphoria will be helped by transition and which harmed, and they insist, of course, that the majority are helped and live happy lives. Of course, they also rely on the prejudice argument as the main incentive for detransitioners. My hunch is that those who do live happily, or reasonably comfortably, with their transition, may be managing their cognitive dissonance despite some of those "fake" feelings or other damage. Perhaps some are lucky enough not to suffer many complications, and their incorporation (hmm, literally) of gender ideology keeps them steadfast and somewhat buoyant. There was that longitudinal Swedish study that indicated suicidality went up exponentially over time, too, and I imagine we'll see more regret and detransition as the long-term effects of hormones and surgery bite. It's very sad, and your work is so valuable. Edited to add: I said that about suicidality increasing with a dim memory where I saw it, and it should not be taken as fact. I'll ask more about this in another comment.
Yes, many take the tack of “we need more research” while not realizing that the “data” is coming from people who are literally the Guinea pigs-unbeknownst to them!
"What should a therapist tell a transwoman with gender dysphoria due to inability to become pregnant?"
I assume a therapist would encourage a post-menopausal woman who is sad due to inability to get pregnant to deal with her grief and develop coping skills. Most women wouldn't call such therapist an ageist, just for acknowledging the biological reality of age. Wouldn't helping patients deal with the limitation nature puts on their bodies be helpful in both cases?
Thank you, Eliza, for tracking down and sharing this important post. There are many good arguments in the post about all that's wrong with the ideas behind, the research into, and the practice of "gender affirming care" - and many important reflections in this community's comments. Thank you, all, for those - I learn a lot in this space. How, though, do these arguments move from Reddit and Substack to the wider world, and to the ears/eyes of the politicians, clinicians, insurers, educators, advocates keeping it going?
I'd expand on both the parenthetical quote Eliza shares ("only pain perceived as curable is intolerable") and the Redditor's comment quoted at the bottom, (summed nicely in the final lines: "What should a therapist tell a transwoman with gender dysphoria due to inability to become pregnant? Any answer to that question can be applied to other manifestations of gender dysphoria.)
It's largely outside the discussion of the paper, but not only does this "you're a broken version of your true self" sentiment damage self-esteem - it also stresses that you're an "other," and that'll you'll be forever outside society, or are not capable of being understood. And as the incongruence never abates, there's nothing the patient can do to feel "part" of humanity or society. They're forever a work-in-progress, estranged not only from some ideal version of self, but also that this work-in-progress is also a permanent outsider or adversary, even, of the public writ-large.
It seems that may have something to do with the increasingly violent and extreme messaging from the trans community (e.g., "trans genocide," the memes combining assault rifles and trans flags, etc.).
The whole cocktail of "affirmation" is a failure. The best way to support trans and potentially trans individuals is by *providing them care for the illnesses they have* and to *question their self-conceptions* as the Reddit author does when suggesting CBT be used in the place of affirmation.
Is the goal not to reduce suffering and help these folks feel comfortable in their own skin? Affirmation appears to be making this suffering worse. The road to hell is paved with good intentions, and all that.
"Only pain perceived as curable is intolerable." I'm sorry but that's just not true. One of the things that makes a difference to a person's ability to tolerate emotional pain is whether or not they feel hope for the alleviation of that pain in the future. When a patient gives up hope that they will ever feel different from how they do now, that is a major risk indicator of suicide, ie because losing hope that their pain will ever go away makes the pain feel intolerable. Which is why helping your patient to have realistic hope is a suicide prevention strategy in counselling work with suicidal patients. In the case of a menopausal woman or man who identifies as a woman and is grieving about not being able to get pregnant that realistic hope would look like "you won't ever be able to get pregnant, but you won't always feel this intense intolerable grief about this, because feelings change, and as you work through your grief your feelings about this will change, and you will learn to live with this and it will be okay."
But yes, the goal should be to help these folks feel comfortable in their own skin. And that would be the way to reduce their suffering. The goal is (or ought to be) to reduce their suffering by helping them to accept themselves as they are, and accept reality, and feel more comfortable in their skin. Just like working with a client with an eating disorder.
It’s good to hear from those entrenched in this battle. I see it as such because our pre teens and teens are being marketed to from the pro trans community. Social media being the devil that it is, if it weren’t for tik tok and the rest, would this mania be spreading at the rate that it is? Feelings we all experienced as teens, some better and some not, have been now translated into dysphoria. It was almost as if we as a country had crossed a point where homosexuality was no longer a line in the sand for most reasonable adults. Why all of the sudden homosexual feelings have become a pox and must be dealt with by gender swapping? I realize that not all that transition or want to may be same sex attracted. I truly feel for young people or any age struggling with identity but the current solution of transitioning is madness for some if not many? The article made me think of a person misdiagnosed with an illness and how they would react. Being treated for a cancer when one isn’t present and the patient’s clinical picture worsens for example.
This psychiatrist finally lays out a key point in this whole debate that I have wanted the medical and mental health fields to go on record discussing. First, this excerpt from the original Reddit post:
“...even when they were wrong they were appropriately trading a risk of long term morbidity for short term mortality.”
The issue: that if a teen is actively suicidal or self-harming, something must be done in the short term (transition) even if it causes harm in the long term (morbidity and/or regret) because - and here’s the sticking point I’ve wanted the profession to go on record about - apparently the mental health field has no other interventions for suicidality and self harm in their tool box??
Having no other treatment options for these suicidal and self-harming teens is the underlying premise we are all being told to accept by everyone shouting “life saving care” and “would you rather have a live son or dead daughter.” But this premise this treatment model is built on and that we’re being sold is not true and the mental health profession knows that, as evidenced by the original poster deep in the comments:
“I do not think we should do nothing for these patients, only counsel them with CBT the same way we do anyone else who is unhappy with their body, and the same way that trans affirming people themselves do when patients are at the end of the transition process, or unable to proceed for other reasons. What should a therapist tell a transwoman with gender dysphoria due to inability to become pregnant? Any answer to that question can be applied to other manifestations of gender dysphoria.”
They KNOW there are other treatment options - BETTER treatment options - as evidenced in this NYT article about DBT (a type of CBT) titled “The Best Tool We Have for Suicidal and Self-Harming Teens.”
https://www.nytimes.com/2022/08/27/health/dbt-teens-suicide.html
What’s really keep about this point and DBT is that, unlike affirmation and “gender affirming healthcare,” we DO have a LOT of research on the efficacy of DBT. So why isn’t DBT or CBT the first line of treatment for these teens? (See this post for more!on that question https://pitt.substack.com/p/if-dbt-is-the-best-tool-for-teens)
We need to start asking this question and pushing on it insistently and loudly because already, this untested and unsupported ideology of affirmation only is infiltrating, taking over, and undoing the only treatments that actually have research support for their efficacy in treating depression, self-harming, and suicidality
https://psycnet.apa.org/record/2019-21621-004
There are many different interventions that can be used to keep a suicidal safe/prevent suicide. This Child Psychiatrist who has been transing children and now regrets it is being a little bit cute to pretend that the choice was to either put the child on hormones/book them in for surgery or allow them to kill themselves. That was never the case. There was never any reason not to treat suicidal ideation/threats/intention in the same way as we treat it in other patients.
Hospitalization until the crisis of suicidality passes, ECT to treat the underlying depression, medication to treat the underlying depression, therapy/counselling to explore and alleviate the causes of the distress using CBT, DBT, psychodynamic psychotherapy, or whatever other model you are familiar with (the research suggests that it doesn't matter which psychotherapy model you use nearly as much as your skill at using that model).
By the way, I'm a Registered nurse who worked for 20 plus years as a community mental health nurse, alcohol and drug counsellor, and psychotherapist so I do know what I'm talking about.
Thank you for the informative post. One clarification: If I understood right, the last citation you provide, "Transgender affirmative cognitive-behavioral therapy" is an example of the ideology taking over tried-and-tested methods. In other words, it is something NOT to be emulated, right?
not to be emulated!
It's like: Let's do CBT but reinforce your biggest, most maladaptive cognitive distortion!
Correct! NOT to be emulated. I apologize for not making that clearer in my comment!
"Basically: it’s terrible for your mental health to believe there is something fundamentally wrong with you."
This, this ,this, thank you for crystallizing it! I was anorexic in my late teens/early 20s because of this belief instilled in me, whether on purpose or not, by my parents, and it has taken my entire life to learn coping skills to counter it - it never completely goes away. I fear I would have been completely susceptible to gender ideology if I were a teen today.
We need to talk more about the use of social media to hammer this belief into vulnerable people, and examine the motives behind this behavior of coercion. Maybe it's not all nefarious but some of it has to be.
It's all nefarious, imo. One indicator is the dual hammer trying to separate children and young adults from those parents questioning and trying to help. I would like to see nothing less than a scorched earth policy to end this destructive cult.
Agree. Everything is starting to feel like a conspiracy.
👍 Often rather difficult to tell the difference these days between data, wisdom, and outright conspiracy theory ... 😉🙂:
https://twitter.com/hdrochon/status/1294260219850129420
Aha! The Gender Unicorn. I knew it was a conspiracy.
🙂 Hadn't made that connection but a good one. Somewhat apropos of which:
https://www.thedistancemag.com/p/the-drug-smuggling-trans-activist
But quite a dog's breakfast, a perfect storm of fantasy, delusion, political opportunism, religion, "conspiracies", and magic -- with precious little in the way of any science and facts for leavening. Though there is some -- arguably, a trail of breadcrumbs out of the swamp:
https://humanuseofhumanbeings.substack.com/i/64264079/rationalized-gender
But it seems you're new to Substack so you might have some interest in UK philosopher Kathleen Stock's generally illuminating take on the phenomenon:
KS: "What I do find interesting, though, is how things went so badly wrong: the causes, not the reasons. I’ve had a lot of time to think about this. One big question for this newsletter will be: how did mainstream feminism come to embrace what I’m calling the stupid story [transgenderism?], so that many feminists ended up cancelling themselves out of politically effective existence? Effectively, the stupid story functions, for mainstream feminism, as a reductio ad absurdum: it reduces most of contemporary feminism to risible absurdity, necessitating urgent reflection on the tenability of prior commitments to explain how the absurdity ever got such a firm grip."
https://kathleenstock.substack.com/i/49437420/goodbye-to-the-stupid-story
Amen to that lady.
Nuke them from orbit -- just to be sure ... 😉🙂
Sure can sympathize with that argument. However, the rot goes rather deep and which -- one might argue even if only as a Devil's Advocate ... 😉🙂 -- more or less makes us all culpable, to one degree or another, for our contributions to that state of affairs.
Not to belabour the point ..., but a big part of the problem is that "we" seem to find it impossible to agree on what we mean by the various terms we throw about with "gay abandon", so to speak. For examples, "sex", "gender", and, of course, the biggie, "woman". Apropos of the first two, I wonder -- as per previous discussions -- whether you think they're synonymous, and whether you'd accept "gender" as roughly equivalent to sexually dimorphic personalities and personality types:
https://www.realityslaststand.com/p/feminism-or-conservatism-which-is/comment/21894653
Apropos of the third, I more or less fell off my chair when I heard Kathleen Stock's rather "brutally" but commendably honest take thereon in a YouTube interview with Peter Boghossian:
KS @51:10 : ".. there is you know, there's no kind of inevitability about the word 'woman' meaning 'adult human females' ...."
Peter Boghossian & Kathleen Stock: Lesbians Don’t Have Penises
https://www.youtube.com/watch?v=BhWyo9iYQNE
She's definitely one of the saner feminists on the scene, although she too (still) has some very questionable and unexamined assumptions she's hobbled by.
But there are many other definitions for "woman" that "work" -- more or less -- and that may well be more useful, at least in some circumstances. Unfortunately that one has become something of an article of faith for too many which is, arguably, as much a part of the problem of transgenderism as of the solution.
I think that it's more complex than this. Sometimes it is extremely helpful to know that something is wrong with you, because it enables you to do what you need to do to look after yourself, and because it gives you an explanation for why you and your life and your struggles are the way they are. And sometimes it's just pathologizing and makes you feel bad about yourself, or makes you put unnecessary limits on yourself. So it's a very fine balancing act and is something that needs to be worked through in therapy (if you are going to give your client a diagnosis) so that it is a positive thing for them not a negative thing for them.
For example, I have coeliac disease. Until I got this diagnosis (that something was fundamentally wrong with me) I had no energy and difficulty concentrating and was unwell all the time and felt viscerally as though I was rotten on the inside and couldn't exercise and had low key chronic pain. Other people understood this as me being lazy and not eating a healthy diet or doing enough exercise. I understood it as myself being lazy and a hypochondriac. The coeliac diagnosis told me not only that there was something wrong about me, but that it wasn't laziness, poor diet or hypochondria (moral weakness basically), but a badly damaged gut and an overactive immune system. It told me that I needed to give up gluten, which I did, and within day's my chronic pain, chronic depression and feeling of being rotten all vanished forever. So walking around knowing that there is something fundamentally wrong with me, and because of that I have to be very very very careful about what I eat is extremely helpful to me, because it enables me to have as close to a normal life as I can have (I can't eat at restaurants or other people's houses and there are a lot of foods that I can't eat period, but as long as I do that I can be well and live an otherwise normal life).
None of this is to say that pathologizing things that are normal or fairly common is a good idea. And yet again, on the other hand we are in the middle of an enormous epidemic of mental illness (and other chronic disease too of course) thanks to the incredibly unhealthy lives people now live in the west with chronic stress, and artificial light, and lack of exercise, and food that's of low nutritional value and full of poisons, and phytoestrogens in the air and water, etc etc etc. So a lot of people are genuinely unwell, a lot more than used to be.
I’m genuinely gluten intolerant but not coeliac fully. I recognise your description of removing gluten. The exclusion diet which diagnosed gluten as my problem made me feel better that quickly too.
I have struggled with ongoing viral meningitis symptoms for more than two years. Been tested for everything under the sun. Scans, lumbar puncture but no diagnosis.
I’m now cured, do not know whether the things I did or just time did it. Not having a diagnosis was frustrating but didn’t stop me getting cured.
I’m a runner, I love it to bits so am highly motivated to exercise. I think this desire prevented a slide into hypochondria. I tried running twice over the years but crashed with bad return of symptoms.
That Reddit post was such a pleasant surprise! What was interesting to me were the comments that said something along the lines of “I agree! It’s sad that we can’t bring any of this up in public though because of the evil bitch TERFs who will use it to demonize transwomen though.” Or “I agree with you! We can and should bring up these concerns you raise at work. I don’t see why we can’t, while still supporting gender affirming care.” I know schadenfreude isn’t a good look, but I can’t wait for some of these goobers to bring up their thoughtful concerns, get slurred as TERFs, and realize what we all have...
👁️👄👁️ if I’M a TERF...then are all those “evil TERFs” just people like me?
Yep. Salient point. When you realize that even something as simple as saying men are not women makes you a violent terf….ha.
You realize that the terfs were just regular sane people all along.
Thank you! So telling that a psychiatrist, supposedly an expert in the field, with advanced degrees, has to resort to the same common sense, observation and reason that the rest of us use when trying to figure out our problems and those of the people we care about and what to do about them.
Medical doctors started out as quacks, but were eventually redeemed by scientific advances in western medicine.
Psychiatrists and psychologists? Not so much. Our gut instincts, attention, empathy and common sense will serve us much better than their glorified medical billing classifications. Their expertise has utterly failed to protect our children from this travesty, and their own ranks have been among the most heavily susceptible to trans activist gaslighting.
I have a degree in psychology and mostly, not 100%, agree with your rejection of the field of psychology. Speaking of 'field' we should ban that word and problematize its use so that mental health professionals and lawyers can bill patients/clients to help them address the trauma, or seek redress for the trauma, of their lived experience with hearing the word 'field'-not. I'm pretty sure this already happens in Canada.
Gender Dysphoria is, by definition, a form of cognitive dissonance. Nothing I'd like to joke about, but that's another question.
I've always doubted the wisdom of affirming people in their cognitive dissonance, save, perhaps, in some very rare and extreme cases where there seems to be no other solution.
We don't generally do this. Not in everyday life, not in medicine. It's only with GD that we're told that it must be done, and only this must be done.
Granted, GD sits deeper than most cognitive dissonances, but no one has shown me any evidence whatsoever that GD is so qualitatively different from all other forms of cognitive dissonance that it must be treated in a fundamentally different way.
Now, I'm no medical professional, but having a medical professional (yet another) see this in a very similar way, and argueing his point by thoroughly and scientifically examining available research, tells me I am most likely not fundamentally wrong in my position.
And, foremost, let's not forget one thing: Yet another study that was intended to support the "gender affirming model" of treatment has demonstrated that "gender affirming care" does not work and is likely to cause a lot of harm. This happens invariably with all studies that keep up at least a semblance of scientific method. Positive outcomes are only yielded by research that does not even do that.
The entire Reddit post is absolutely worth reading. Unlike many "researchers" who allow themselves to be led by the dogma and then somehow twist the data to suit the preferred narrative (to the extent of blatantly misinterpreting the said data), the writer lets the evidence leads to the conclusions, wherever they might point to. It is also so refreshing to see a researcher who not only understands the research methods (statistics as applied to the biological sciences) but also their applicability to the specific discipline (psychology and psychiatry), with the discipline's own peculiarities and unknowns (see the very wise discussion on how a questionnaire in the "knowledge of Japanese" can lead to very misleading conclusions depending on the respondent's actual level and interest in Japanese).
Stated simply, the writer understands the subject deeply. And the depth of knowledge comes from not only writing a few papers fresh out of school by using "some data from somewhere" (more about it in the next paragraph) but also from the clinical experience that comes from treating a lot of patients in the specific subject area of GD. For example, see his later discussion refuting the "minority stress" hypothesis that he tackles in a separate post to answer a question from another poster (https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/jur62be/). His takedown is simple and elegant: first, he argues the methodological issue - the unfalsifiability of the thesis, in that it "creates a heads-I-win-tails-you-lose dynamic where even negative results can be spun as positive." And second, from a practical point of view, it really does not matter if the depression from GD is now replaced by depression from being a member of a minority. (And finally, the writer makes sure that especially in the context of Chen et al. (2023), the minority stress is a moot point: "the parents in Chen 2023 were all supportive enough to consent to GAH in their kids, and Boston, LA, SF and Chicago are some of the most trans-friendly places you can hope to find in America." This is a comment that should be read in its entirety.
A final point I wished to make comes from another commenter (https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/juq4fzv/), who conducts a knowledgeable overview of the entire "research" in the area, starting with the WPATH SOC. But more importantly, this commenter does a thorough takedown of the 2015 US Transgender Survey, whose responses have driven the overwhelming junk of "research" in the area, most famously by Jack Turban, who has wrung the data one way and another to create a series of research papers that are not worth the bits that they occupy on the internet servers they pollute: "This has been cited about 3500 times in the literature and has informed every single US policy impacting transgender life. If you look at the original article, it's a complete joke. They used a grab sampling method. Basically an internet survey with no verification, asking people to invite others to fill out the survey. So a snowball sampling methods, a non-probability sampling method that you can not use to infer conclusions from a wider population...some of the questions seemed almost designed to create demand bias (when the participants are aware of the researcher's aims and thus more likely to answer in a way that supports the investigator's goals). Not to mention, some of the findings are nonsensical. 73% of respondents said they started puberty blockers after the age of 18. Obviously, that's simply not true." Another comment that should be read in its entirety.
This is a serious attack on the discipline coming from the inside rather than from "transphobe parents." There are a lot of dissident voices within the discipline and it seems that they are no longer keeping their voices down. A revolution becomes successful only when people inside decide to join the dissidents. Socially and politically, too, the mood seems to have changed - see for example NYT's uncritical coverage of the critics in the article that covered the decision by the AAP to do a systematic review of the literature, or the sports bodies coming to their senses and making various women's sports for women only (thank you, Lia Thomas). Or the fact that politically, the issue is becoming a baggage for the Democrats as people increasingly see the egregious examples of this ideology (https://www.liberalpatriot.com/p/the-democratic-party-left-vs-the). This is hopeful.
I am deeply relieved to see this post is still up after several days and there is actually conversation about this.
Over the years on Reddit I have had ALL my thoughts on this matter deleted (thousands of comments), been blocked from commenting, been thrown out of women’s only subs I contributed to for years and had multiple accounts suspended…been dogpiled downvoted, and received misogynistic threats to my inbox …all for trying to call attention to this medical malpractice and the harm it is doing.
I feel relieved to see that someone “got through” the silencing.
I feel this is a very important turning point for the mental health industry. The moment I heard about the trend of transitioning persons towards an endless series of body modifications I was reminded of the Diderot Effect. The body having become another platform for consumerism in the endless search for perfection. In a country served by a for-profit medical system this should not be surprising. https://en.wikipedia.org/wiki/Diderot_effect
Indeed something that is commonly overlooked when we discuss the trans trend, particularly the drive towards surgeries.
The trans trend has finally transformed the human body into a commodity.
Before, this was a fringe issue. Tatoos, alright, piercings, alright, but these were relatively cheap and superficial modifications, however we see them. Cosmetic surgeries were frowned upon by a lot of people, probably a majority. Maybe a bit of a facelift here and there, but if you overdid it, you were ridiculed or pitied. Surrogate motherhood, one of the worst forms of exploiting women, always was a controversial issue.
This has changed fundamentally. Now, your body parts are commodities to be altered or exchanged at a whim.
Needless to say that this will also facilitate more far reaching changes and abolish a lot of boundaries we have now.
There is no fundamental difference between "Don't like your genitals? Get new ones" and "Need cash? Sell your kidneys".
In the interest of giving the patient all the information they need to make an informed decision how is it that this information has not been made public? One of the comments on Reddit is from a surgeon who claims they will continue to do these surgeries on ‘consenting’ adults. How can anyone consent when they don’t have all the information? These surgeries offer something they can’t and don’t give. Often trading one problem for another.
Yes, this is a core issue - these people were not informed-I know that because their own doctors are not informed on these matters because NO ONE knows the long term /life long affects on health, sexual function, etc
In order To actually get true consent the practitioners would need to disclose to the patient that these treatments are ALL experimental with no long term data backing them and xyz are the known negative side effects of this treatment…
This info is hard to find online because of intense censorship, so it is impossible for patients to do the due diligence themselves as what they will find is all in support of these procedures…
If they can’t inform themselves, and their doctors don’t inform them…They are not able to consent
Surgeons, while most are amazingly trained and talented, don't maintain long term relationships with patients (I know there are a few who do). Generally, again GENERALLY, they perform the surgery that some other doctor has requested, like take out this appendix, cancer, etc. Of course they need to all speak in defense of their actions, otherwise how would they sleep at night? I believe that most do truly believe they are doing the 'right' thing. Their liability insurance is supported by the general practice du jour. Informed consent means I need to let the patient know EVERYTHING they need to know to consent to the procedure. Knowing, hearing and signing are often far afield from understanding.
Agreed. And as far as consent, many detrans folks have stated that at no point did anyone (physician, psychologist, surgeon-anyone) express that there may be other ways to move forward that would help their distress
True for sure. Also many of these 'kids' (mine is an 'adult') are being informed by very poor resources and encouraged to go forward by other 'kids', and sometimes even professionals ( see Marcie Bowers), who need validation for their own choices. People with high investment in the ideology ought not be allowed to encourage others to go on their path. There need to be checks and double checks. For example, it's well know that therapists who have been divorced are more likely to encourage clients in this direction, even though good therapy never includes advice.
Salient points! Yes, for such extreme interventions there should have been many checks and safeguards. Having been personally let down my physicians and specialists many times in my life…I inherently distrust medicine in this country and believe medical practitioners are given too much respect and power as to almost be beyond reproach, and that inevitably leads to harm that affects the patients…while the practitioners go on making hubristic mistakes with no one to humble them
well said!
“Consenting adults.” Like those just turned 18 adults who sneak into clinics when they’re away at college to start hormones. Ugh. They can’t rent a car but are somehow mature enough to sign off on surgery?
The comments from surgeons and endos reek of "just following orders."
Indeed. Rather too many similarities between those cases. ICYMI, the classic, "Are we the baddies?"
https://www.youtube.com/watch?v=ToKcmnrE5oY
Hope there are a bunch of "doctors" who are starting to sweat bullets over that question.
In the same vein, David Brooks recent post in the NY Times, "What if We’re the Bad Guys Here?"
https://www.nytimes.com/2023/08/02/opinion/trump-meritocracy-educated.html?unlocked_article_code=2XqiO5kUU3RcAdFbLhYdhkA7a4mUdyCs5kA7lb_kcGExAGUB69_lfIXk0vKfHDZV_C-qlJzzhLhty2cVKPkmRV2FjlKPkvbQpW949ZP1euD-kfMYNG-kfSw7XpJGSDKeHLWMVUG_XJOVNHDZ71s0O6pxmqSKJn0q1-olp--MDQm3D1ZolADY53-IYkYZFYviW0d-kkJUm2Bb4To-OQ7dIGxCA7YA02z4FXUw9VlIyCYV6E_pihPoeXHkBfvfQeSLFFeZ4U4-a7G13iVPKvkA069YImDqcp0yIiQcP4vuwg54h8hqvEG10XPCrO_E7HGvmT_J6xQNk-_6WZAxXfN2G_BPEak&smid=url-share
Seems that that wasn't a terribly popular opinion there at the NYT which probably underlines the problem with the Democrats in general.
Thanks for sharing this, Eliza. I'll read the whole thing. Does the fact that we might expect a big positive change merely due to placebo, and the minimal change measured, suggest there must be a compensatory negative impact? I've seen "trans allies" - when they admit regret exists - retreat to the position that we need more research to know which young people with gender dysphoria will be helped by transition and which harmed, and they insist, of course, that the majority are helped and live happy lives. Of course, they also rely on the prejudice argument as the main incentive for detransitioners. My hunch is that those who do live happily, or reasonably comfortably, with their transition, may be managing their cognitive dissonance despite some of those "fake" feelings or other damage. Perhaps some are lucky enough not to suffer many complications, and their incorporation (hmm, literally) of gender ideology keeps them steadfast and somewhat buoyant. There was that longitudinal Swedish study that indicated suicidality went up exponentially over time, too, and I imagine we'll see more regret and detransition as the long-term effects of hormones and surgery bite. It's very sad, and your work is so valuable. Edited to add: I said that about suicidality increasing with a dim memory where I saw it, and it should not be taken as fact. I'll ask more about this in another comment.
Yes, many take the tack of “we need more research” while not realizing that the “data” is coming from people who are literally the Guinea pigs-unbeknownst to them!
Excellent find!! Such a wonderful crack of light - thank you for keeping up the good fight, and sharing!
"What should a therapist tell a transwoman with gender dysphoria due to inability to become pregnant?"
I assume a therapist would encourage a post-menopausal woman who is sad due to inability to get pregnant to deal with her grief and develop coping skills. Most women wouldn't call such therapist an ageist, just for acknowledging the biological reality of age. Wouldn't helping patients deal with the limitation nature puts on their bodies be helpful in both cases?
Thank you, Eliza, for tracking down and sharing this important post. There are many good arguments in the post about all that's wrong with the ideas behind, the research into, and the practice of "gender affirming care" - and many important reflections in this community's comments. Thank you, all, for those - I learn a lot in this space. How, though, do these arguments move from Reddit and Substack to the wider world, and to the ears/eyes of the politicians, clinicians, insurers, educators, advocates keeping it going?
I'd expand on both the parenthetical quote Eliza shares ("only pain perceived as curable is intolerable") and the Redditor's comment quoted at the bottom, (summed nicely in the final lines: "What should a therapist tell a transwoman with gender dysphoria due to inability to become pregnant? Any answer to that question can be applied to other manifestations of gender dysphoria.)
It's largely outside the discussion of the paper, but not only does this "you're a broken version of your true self" sentiment damage self-esteem - it also stresses that you're an "other," and that'll you'll be forever outside society, or are not capable of being understood. And as the incongruence never abates, there's nothing the patient can do to feel "part" of humanity or society. They're forever a work-in-progress, estranged not only from some ideal version of self, but also that this work-in-progress is also a permanent outsider or adversary, even, of the public writ-large.
It seems that may have something to do with the increasingly violent and extreme messaging from the trans community (e.g., "trans genocide," the memes combining assault rifles and trans flags, etc.).
The whole cocktail of "affirmation" is a failure. The best way to support trans and potentially trans individuals is by *providing them care for the illnesses they have* and to *question their self-conceptions* as the Reddit author does when suggesting CBT be used in the place of affirmation.
Is the goal not to reduce suffering and help these folks feel comfortable in their own skin? Affirmation appears to be making this suffering worse. The road to hell is paved with good intentions, and all that.
"Only pain perceived as curable is intolerable." I'm sorry but that's just not true. One of the things that makes a difference to a person's ability to tolerate emotional pain is whether or not they feel hope for the alleviation of that pain in the future. When a patient gives up hope that they will ever feel different from how they do now, that is a major risk indicator of suicide, ie because losing hope that their pain will ever go away makes the pain feel intolerable. Which is why helping your patient to have realistic hope is a suicide prevention strategy in counselling work with suicidal patients. In the case of a menopausal woman or man who identifies as a woman and is grieving about not being able to get pregnant that realistic hope would look like "you won't ever be able to get pregnant, but you won't always feel this intense intolerable grief about this, because feelings change, and as you work through your grief your feelings about this will change, and you will learn to live with this and it will be okay."
But yes, the goal should be to help these folks feel comfortable in their own skin. And that would be the way to reduce their suffering. The goal is (or ought to be) to reduce their suffering by helping them to accept themselves as they are, and accept reality, and feel more comfortable in their skin. Just like working with a client with an eating disorder.
It’s good to hear from those entrenched in this battle. I see it as such because our pre teens and teens are being marketed to from the pro trans community. Social media being the devil that it is, if it weren’t for tik tok and the rest, would this mania be spreading at the rate that it is? Feelings we all experienced as teens, some better and some not, have been now translated into dysphoria. It was almost as if we as a country had crossed a point where homosexuality was no longer a line in the sand for most reasonable adults. Why all of the sudden homosexual feelings have become a pox and must be dealt with by gender swapping? I realize that not all that transition or want to may be same sex attracted. I truly feel for young people or any age struggling with identity but the current solution of transitioning is madness for some if not many? The article made me think of a person misdiagnosed with an illness and how they would react. Being treated for a cancer when one isn’t present and the patient’s clinical picture worsens for example.