Helen Joyce on her NEW book: Trans — When Ideology Meets Reality

by Daniel A. Kaufman

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I talk with Helen Joyce, British editor of The Economist, about her new book: Trans: When Ideology Meets Reality (Simon & Schuster).

5:00 The overall aim of Helen’s new book. 11:20 The history and evolution of our conception of being transgender. 27:30 The current conception of being transgender, and how we got here. 35:30 “Non-binary” identification and the changing conception of civil rights activism. 43:40 The impact of “living online,” the idea of “self-madeness,” and the role of American culture. 52:15 Transhumanist elements / youth impact / de-transition. 59:00 Identitarianism and civil rights movements. 1:03 Predictions: In the UK things will get better. In the US things will get worse.

91 comments

  1. Terrific discussion.

    I noted David’s comment that if psychotherapy had been better in the 1950s, perhaps many could have avoided “invasive surgery on perfectly healthy organs and tissues because of psychic distress,” as a related idea occurred to me during a scene of “The Danish Girl,” the film about Lily Elbe, who was the first person to undergo sex reassignment surgery.

    In the film segment, Elbe is visiting numerous doctors and psychiatrists in an effort to resolve the psychological turmoil arising from the conviction that he is a woman. In the scene in question, one such doctor speaks with Elbe’s wife following his assessment of Elbe, and reports “Your husband is insane.” While I would substitute “mentally ill” for “insane,” that conclusion seems fundamentally accurate. But, in the 1930’s, psychiatric-medical authorities were so utterly incapable of addressing Elbe’s condition through psychiatry, so Elbe found one doctor who was willing to surgically aligning Elbe’s body to conform with his psychological perception.

    I don’t reject the idea that sexual dysphoria exists, and perhaps in some cases surgery is the only treatment for it. But, sexual dysphoria, autogynephilia, autism, etc. are all forms of mental illness. Additionally, many gay adolescents confuse their same-sex attractions with transgenderism. Yet, radical trans ideologues have in large part succeeded in shifting treatment options for mental illnesses to physical interventions such as surgery and hormone therapy, complete reversal of which are difficult or impossible. I suspect the motivation for that is the wish to evade any suggestion that transgender people suffer from a mental illness. (It reminds one of the Ghostbusters’ sales tag: “We believe you.”) Consequently, doctors who prescribe hormones or perform such surgery do so largely on the basis of the self-reports of patients and their parents, and the most perfunctory psychological evaluation or none at all, as their websites often confirm. I can’t think of a precedent for such momentous and dangerous treatments being conducted on the basis of the self-diagnosis of a potentially deluded patient.

    Widespread malpractice has, accordingly, been legitimized through a political campaign that few are willing to oppose for fear of serious retaliation by radical trans ideologues. I think the forecast in the US is more hopeful than Ms. Joyce’s, however, simply because the current approach is medically and psychologically unsound–its’ invalid and its invalidity will become increasingly clear. People are being hurt, and when people are hurt they go to the courts. Over the next decade, I expect to see increases in the rates of de-transitioning plus numerous high-profile lawsuits by former trans patients, such as the one by Keira Bell in the UK, including, possibly, class actions in the US. (Don’t get between a lawyer and a dollar!) That can choke off the supply side, as several surgery/hormone providers suffer huge judgments at the hands of American juries, and the rest can no longer obtain malpractice insurance. Following that upheaval, one would expect to see displacement of surgery and hormone treatment by psychological treatments. As psychological treatments become more widespread, they will achieve increasing rates of success, which can effectively end the horror and cost of the current approach..

    1. Let me add the following:

      It may be that the radical trans ideologues are defeated by trans people themselves. As increasing numbers of trans surgery and hormone patients suffer the terrible consequences they will encounter, including increasing rates of suicide, they are likely to receive more favorable attention from the media, having achieved the status of victims. At that point, public opinion may be informed regarding the underside of “trans rights.”

      Numbers overcome statutes of limitation, and the numbers in this instance are potentially in the tens of thousands, if not more. The precedent is the pedophile-priest litigation 25 to 30 years ago. As the numbers of victims increased across the US, state legislatures fell over themselves to create S of L exceptions.

      Any trial lawyer knows that, while figures such as priests and doctors enjoy a great deal of trust and prestige, once even a slight a crack in their probity is exposed, juries can be ruthless. The culpable doctors of trans patients, moreover, are unlikely to be able to successfully claim ignorance. Over the past few years, increasing numbers of credible studies have identified the risks and consequences of transition-on-demand. The National Health Service in the UK, which has supported virtually standardless availability of transitioning at all ages, and which formerly denied that puberty blockers had any ill effects, recently reversed itself, admitting, as reported by the London Times, that “‘little is known about the long-term side-effects’ on a teenager’s body or brain.” The Mayo clinic reports that puberty blockers can have long-term effects on bone density and future fertility. Keira Bell, in her testimony during her lawsuit against Tavistock, reported physical problems that have persisted during the years since she was given puberty blockers and hormones. The standard of care for mental-health screening recommended by one of the oldest trans research foundations—the World Professional Association for Transgender Health—provides that patients seeking transitioning be screened for schizotypal disorders, autism-spectrum disorders, personality disorders, dissociative disorders, post-traumatic stress disorders and more. And that’s for adults. As I mentioned, that is not happening even with adolescents.

      1. My grandson is non-binary, not trans, but he/she often wears women’s clothing, does “girlish” things and is very effeminate.

        I wouldn’t say that he/she is mentally ill. I’m not an expert on mental health, but unlike the person who imagines that he or she is Napoleon, he/she does not have any delusionary ideas about themself or about the world. He/she does not feel that their biological sex corresponds to who they are, understanding very well how others see
        him/her.

        1. That sounds perfectly harmless to me. Many people play and experiment with sex roles temporarily and longer term. My concern is with those who, because of youth or psychological issues make life-changing decisions before having reached a more secure stage of personality development.

    2. Other than for the absence of a need for intrusive medical intervention, how does what you classify as mental illness differ from assigning the same labeling of same sex attraction in the not distant past?

      I imagine your assessment of the mental health of these confused or tormented individuals may be valid in many cases but I don’t know how you or any “qualified “ mental health professional can claim to be so cocksure what is the source or essence of the poorly understood genesis of gender identity or sexual attraction. Too much or too little of a hormone in utero, a single misfired or array of genes, an epigenetic hiccup; who knows. Can anyone rightly explain what it feels like to be a man or woman, and why?

      I think your intentions are well placed and in many ways justified but you’re too cavalier for my taste in broad brushing an aberration like sexual dysphoria, as with other former conditions considered abnormal, to mean that you have the whole truth on what should be considered a mental illness (insane), We have much to learn and yes, a solemn duty to protect the young from too eager ideologues ready to inject and chop.

    3. I am sure I can guess the answer, but when I was young in the 70’s and 80’s I seem to recall the practice that someone considering sex reassignment surgery had to have had two years prior psychotherapy in order to transition. Am I correct about this and is that still a practice?

      It’s also interesting that you bring up gay teens. Katie Herzog and Debra Soh have both written about the influence homophobia plays in the decision to transition younger children, and how many children who would simply grow up to be gay adults are being encouraged to look at themselves through the transgender lens. Herzog has said she believes if she was a teenager today she would definitely be pushed to transition.

      1. The World Professional Association for Transgender Health (WPATH) recommends psych screenings before any modifications. The screening may lead to a recommendation for psychotherapy. Duration of the psychotherapy would vary depending on the nature of the issues, but precedes any body modification.

        I’ve heard Katie Herzog address the issue you mention. I believe Andrew Sullivan has done so as well. That issue is part of the reason serious psych screening is necessary, since nascent gay adolescents particularly may mistake their same-sex attractions as an indication that they are “in the wrong body.”

  2. As the diagnosis of the condition is difficult, why object to careful screening? What are you advocating? Immediate resort to surgery, hormones, and puberty blockers? Isn’t careful screening prudent before resort to unreversible treatments? The WPATH guidelines call for screening for the conditions I listed because those conditions are highly associated with transgender patients, and can lead patients to superficial and temporary beliefs that they are transgender.
    If anything is “broad brush,” it seems to me it is the radical trans ideologues insistence on transition on demand.

    1. I also wouldn’t call sexual dysphoria an “aberration.” It’s a mood disorder, of which there are many.

      I agree re the uncertainty of the etiology; but I think the more important issue is ensuring that the patient’s self-assessment is sound and durable. An experienced psychotherapist can provide the patient with opportunities to consider his or her feelings from different perspectives. That is also critical in regard to informed consent.

      Regards.

      1. Aberration, ideation, mood disorder. I don’t know if anyone is qualified to give a definitive answer to such a complex and unsettled phenomenon of the human condition, in every case.

        I’m sure we agree and are only mincing words, – – sugarpie, honeybunch:).

  3. There is nothing that you’ve said that I’m not in full agreement with other than what I thought I made clear; that in my opinion you were rather indiscriminate in bandying around the diagnosis of “mental illness”. I think that takes whatever nuance that may be had, off the table.

    As you can see from wallerstein’s comment, you’ve already, I’m sure innocently enough and with only the best of intentions, stepped on one toe so far.

  4. Terranbiped: Let me clarify. “Mental illness” is not a term of condemnation or derision, I used it as a neutral category designation subsuming a number of conditions psychotherapists regard as deleterious to well being. I thought I suggested as much in declining your designation of sexual dysphoria as an “aberration,” which I think is a much more loaded term. The APA handbook uses the term “mental disorders,” which seems to me to have about the same valence as mental illness.

    In any event, my apologies, but if I’ve stepped on only one toe, that would improve my average.

    1. This entire subject is rife with definitional land mines further complicated with biased advocacy and politics. I looked up pertinent definitions I.e., aberration (eminently apropos) , mental illness/disorder, GID in the GSM and it’s a no man’s land of pick your interpretation and strategy. As the saying goes, it’s a bitch being butch.

      I still find the analogy of homosexuality a telling cautionary warning in certain important and interesting ways. It certainly met all the qualifications you’ve brought forth in its own time of mental designation.

      You have my considered dispensation my son and, continue to wear soft soled shoes as you tip through the toes of others.

      Your humble servant.

      1. T: Once again: I’m not saying sexual dysphoria isn’t real, nor that there are not genuine candidates for transition, but rather that self-declaration, especially by minors, is unprecedented as a basis for the type of treatment routinely being provided, and that screening is essential to avoiding terrible consequences for those who are not genuine candidates. That has nothing to do with homosexuals, now or previously. But if that’s your take, it’s alright with me.

        Adios.

        1. I agree, I agree, I agree. Good god almighty I agree. I really do, amigo.

          Nothing to do with gays per se but, plenty to do with society.

          Via con Dios.

  5. One of the most ironic aspect of how the trans issue is discussed today is how it often undercuts its champions from examining the phenomena the from within their own viewpoints.

    1. One of the central tenets of the modern Leftist analysis of society is that it is best viewed as as a struggle for power between competing groups where invariably minorities will lose out. Yet transgenders, a numerically minuscule population, has achieved a tremendous cultural cache in the last decade. They are in fact one of the most talked about and protected groups in our society, How this came to be cannot be studied though due to a pre-commitment to the idea that they by definition can have no power.

    2. Intersectionality has become a modern buzzword and transgenderisms relationship to other groups not only should be controversial, but has also shifted radically. Originally it seemed that transgenderism was rooted in a biological essentialism. That transgender people were simply born biologically different. This would seem to make them a natural ally with gay groups who wanted to project a similar explanation, but at odds with second-wave feminism which was promoting a social constructivist view of gender/sexuality. Nowadays that biological essentialism seems to have been replaced with a post-modernist influenced idea that everyone has their own truth and no one can dispute that truth. Transgenders are that way simply because they say they are. But where does that leave the ideas of people who want to say homosexuality is a choice? And why is there such a furor to marginalize any feminist dissent from transgender ideology by putting it under the TERF epithet, when that is what feminists have been saying for decades, that being a women is not about having a vagina, it is about being the subject of a certain lived experience?

    3. Numbers for self-identification as trans/queer/non-binary are skyrocketing, but attributing that to the idea of social conformity seems to be forbidden as well. The idea that people are just following a fad is seen as demeaning. Yet doesn’t this mirror exactly the idea that social forces are almost entirely responsible for our anorexia problem. If desire for social conformity can lead young girls to adopt a potentially fatal mental illness why can’t it lead other young people to get radically altering elective surgery?

    1. You’ve presented a great overview and asked all the pertinent questions. The difficulty is, there is no comparison to the most fundamental differentiator between humans; the biologically sexual distinction between make and female. Only one is capable of being impregnated and only one has the ability and desire to forcibly see that it happens. The presence of a penis is not always welcome.

      So any solution to this thorny problem of competing “rights” rests on the word accommodation in both senses of the word, noun and verb. Public spaces and the ability to compromise through accommodation. Realizing as a rational adult that certain natural realities: psychology, empathy and societal necessities must be taken into account while still maximizing the equal rights of all.

      A Pygmy can claim to be a 6’ tall Norwegian named Sven and we can know the truth of that unsupportable claim but if someone says they are in the wrong gendered body or are sexually attracted to the same sex, what choice do we have but to initially take them at their word. It’s only the social consequences of such proclamations that further consideration and evidence be mandated. Will teen girls claiming male identities willingly register for the draft? Will young men claim the opposite to avoid selective service? We certainly live in interesting times.

  6. If I am not mistaken Helen Joyce didn’t actually say the name “David Reimer” when discussing John Money, but it needs to be brought up more around this discussion. I am not sure how this case is generally seen within the modern transgender debate, but ironically Reimer may lend strong support to the idea of gender dysmorphia as it seems to be evidence for a biological essentialism, that sex differences are an absolute biological based reality, which ironically a lot of today’s ideologies seem to want to deny.

    1. Yeah, I wondered about this too. Many people say, on the one hand, there’s nothing that it feels like to be a man or woman; and David Reimer knew he was a boy.

      How did Reimer know? I’m not saying that these two claims are irreconcilable, but I wonder what Joyce says about this.

      1. How did Reimer know? Sounds like the $64,000.00 question. A possible Rosetta Stone to get at the ultimate answer about sexual identity essentialism. But, if I remember correctly, Joyce said there were many such procedures performed and so what of their results?

        One case study only raises more questions than it answers. Was Reimer’s experience the rule or the exception? His experience proves nothing. This “experiment” would have to be flawlessly performed on a large enough data set to even approach a tentative answer and allay all the possible confounding variables of genetics, development, hormones, intrauterine and extrauterine environments etc..

          1. I know and we’ve discussed it. I even agree with you. I wouldn’t know how to adequately put my subjective “maleness” into words, though many if not all of us going through life having sense of where we fit in gender wise in society, even if atypical.

            Can you honestly say your perception of yourself as being the male in your marriage does not differ from how you perceive your wife? Is it all socialization, I haven’t the foggiest but I tend to think not.

            Like pornography, maybe we only know it when we see it. I mean we can’t even explain sexual attraction. We think visual cues are important but blind at birth men know whether they are attracted to the male or female and appreciate the same qualities in the object of their affection as do their sighted peers.

            By the way, this is Azin. I got caught up in a Tarkeena (whatever your other screen handle was) to appease the gods of World Press.

          2. First, I agree with you 100% in your response to wallerstein about adult responsibility and stewardship over the life changing “desires” of children.

            As to my second paragraph, I really don’t know how to make it any clearer. Do you feel the only difference between your wife and yourself can be summarized as different plumbing and individual personalities? You don’t feel there is not even the slightest perception of difference between you that somehow transcends the generic neutrality of your wife just being another human that differs not one bit above the neck from being a male.

            That seems like a hard position to maintain from a heterosexual point of view. I do admit that on rethinking this question as I type, the answer one may arrive at may depend greatly on a subjectivity that transcends a more logical consideration.

            I can understand if you still don’t understand my point from your perspective which I imagine is that people are just people in different meat robots. I’m not totally immune to such a notion that we project certain qualities and magnify certain signals from the opposite sex.
            But, I just thought of something that might be of interest to this perplexing problem. You wholeheartedly agreed with Joyce that an effeminate (homosexual) male is decidedly different in affectation /type than the feminine version manifested by females. Now, why would this be so if there is no discernible mental difference between the XX and XY?

          3. Do you feel the only difference between your wife and yourself can be summarized as different plumbing and individual personalities?

            = = = = = = =

            Yes. And all the other myriad physical differences.

            Do I think that there are psychological differences between males and females. Certainly. Do our gender norms and stereotypes reflect this? Only to a very imperfect and indirect extent.

          4. I think we have found common ground here. Psychological differences can cover a lot of ground and account for many subtitles in behavior – attitudes and preferences.

          5. Nonsense. You’re running a 3 ring circus here without a program.
            Knowing me, it wouldn’t have been extensive or memorable;)

          6. Right but how did Reimer know? I’m not saying he knew he was a boy because he “felt” like a boy, despite being told he was a girl. I’m just wondering: given that you *can’t* feel like a boy or girl, how did Reimer know he was a boy? I’m not saying that Reimer disproves your thesis! I’m only saying I don’t know how someone who accepts your thesis explains how Reimer knew he was a boy.

          7. Not to simplify your question but, he knew he was a boy because of social observations and comparisons. Obviously if he grew up in a society absent any male figures we can imagine he might feel different somehow (and who hasn’t) but he would have no conception of something other than the female. I think this holds for all the permutations of sexual and gender identification. You see what seems to be what you feel or imagine yourself to be or not be You cannot disregard environmental input.

          8. “He didn’t.”

            I confess, I didn’t expect that answer! But now when I think about it, I guess if there’s nothing it is to feel like a woman or man, then he couldn’t have *known*. He may have strongly felt that something was “off” about his body (i.e., experienced gender dysphoria), supposed that he was actually biologically male, and then discovered that he was right. But in his case, there is at least something that would make it make sense to say that he’s right. But if you feel gender dysphoria, and know exactly what your biological sex is, I suppose it’s harder to determine how you could be right about what your gender “really” is.

            I wonder if there’s a private language argument in the vicinity here? If so, has anyone brought that up? I imagine someone must have.

          9. I don’t know how familiar you are with the Reimer case Professor Kaufman, but do you have an opinion on what the source of Reiner’s life-long troubles might have been, if it wasn’t gender dysphoria issues, that led to his eventual death?

        1. A lot of people won’t like this answer, but I don’t think we can rule out the idea that a lot of what is called gender identity and roles today are actually based in biological reality. In other words the reason boys like trucks and girls like dolls is because those are societal manifestations of inherent sex differences, and Reimer was ironically pushed toward a female gender role he didn’t accept. It’s an interesting inversion of the idea that gender roles are entirely a social construct as assuming that is what undermined its truth in the Reimer case.

  7. On liberal or libertarian grounds it’s wise to be careful about extending the categories of mental illness. I have no idea what is considered mental illness in 2021, but in 75 years I’ve seen those categories shift and change.

    If someone believes that they are Superman and that they can fly out of the 10th floor window, that’s a delusion and they should be treated as mentally ill. Even more so if someone believes that they are James Bond and that the pizza delivery guy is a terrorist from ISIS and must be hunted down.

    What about the 14 year old kid with male sex organs who believes that he/she is really a girl? That may seem wacky to me and to you, but there are a lot of people with wacky ideas walking around and are they all mentally ill? The people who believe in astrology? In Qanon? In creation science? That Moses parted the Red Sea with a wave of his stick? That Trump really won the 2020 election?

    I don’t think that they should be considered mentally ill. In the Soviet Union dissidents were considered to be mentally ill and maybe that was just cynical abuse of the concept or maybe some true believers in Communism really did consider them to be crazy. I can see a future woke society labeling Kathleen Stock as transphobic and hence, mentally ill.

    So we should be careful about who we call “mentally ill”. People make mistakes in life and probably it’s a mistake for a 14 year old to get sex change surgery or treatment, but we can’t go around correcting everybody’s mistakes. A lot of us learn from our mistakes, some don’t.

    1. Illness implies dysfunction. Most mental illnesses have the word “disorder” as part of their name for a reason. For example, substance use is not a problem, but substance use disorder is because the use of substance for some individuals is dysfunctional.

      In a medical setting, generally (adult) function is defined as the capacity to perform activities of daily living to maintain health (e.g. bathing, dressing, eating), provide oneself with food and shelter (e.g. through a job, a partnership (i.e. family), accessing charity), carry on healthy relationships (e.g. with partner, children, friends, society at large), and the ability to have an internal sense of wellbeing.

      By this definition, issues of sex, gender, gender expression, and sexual orientation do not in and of themselves constitute illness because they are not inherently dysfunctional. Bigotry in society may make some people feel bad, but this is a societal illness not a personal one. The somewhat controversial idea of gender dysphoria would be an illness, and this is where “treatment” for this disorder in the form of gender surgery comes in. But there are profound questions raised by such a conceptualization.

      In any event, as Helen Joyce points out, such a circumstance as gender dysphoria is likely rare, and much of what passes for gender dysphoria these days is arguably the ageless pains of early adulthood that has been relabeled/mislabeled and that in the past labeled as “teenage angst” and the like.

    2. S.W.: I agree regarding the propriety of being careful with language. In this case an “illness” simply was implied by the prescription of a medical treatment or procedure, such as surgical or hormonal treatment. An illness can be a state of mental distress, such as with sexual dysphoria. Use of the term “mental illness” was not to emphasize “illness” but rather “mental.” If that is inapt or uncomfortable, then let’s say mental or psychological “condition.” A “belief” about oneself can be described neutrally as a “condition,” no? So, if one, believing oneself to be of the opposite sex, nonetheless lives without distress in such belief, and thus without the need for medical or psychiatric intervention, there would appear to be no “dysphoria.”

      But my point, and my concern, is that surgical treatment–“top surgery,” “bottom surgery”–is being prescribed for “sexual dysphoria,” a mental/psychological condition. The last instance I can recall of the use of surgery to treat a mental condition was the treatment of depression with pre-frontal lobotomy, and that didn’t end well. The use of hormones and puberty blockers to erase or prevent other bodily characteristics or conditions, is hardly less concerning, especially as some results or side effects of such treatments are apparently permanent.

      1. Agreed. The idea that there is no problem — or violation of the Hippocratic Oath — in destroying perfectly healthy organs and tissue, in order to address psychological distress strikes me as borderline deranged. There are times, when I cannot even believe we are talking about double mastectomies for young women with no breast cancer and the like. This will be looked back on as a dark period, akin to eugenics and other bogus and terribly ill-conceived medicine of the early 20th century.

        1. All the more so when the psychological distress may very well be temporary or the misplaced result of something other than the apparent belief that one is “really” the opposite sex. All the more so when the psychological distress is that of adolescent girls, for whom psychological distress is virtually the norm. All the more so when the ancient Hippocratic Oath is being overridden by a political movement that hardly even existed 20 years ago, and that rejects free discourse, but rather imposes its views through personal destruction and character assassination.

          1. People get cosmetic surgery all the time. They get their nose reshaped, they get their fat suctioned off, they get their behind remodeled, etc., and from time to time one reads in the news that someone dies on the operating table during a supposedly routine treatment of cosmetic surgery. It’s a huge business. I don’t know what the rules are about it in the U.S. (I live in Chile), but we live in a global world and by the way, if certain surgical procedures are prohbited in the U.S., people will fly to Thailand or Brazil or Cuba, wherever they are done for a fee.

            All surgery is dangerous, I know, but people dream of having their lives changed through surgery, whether sex change surgery or having their behind remodeled and that’s the world we live in. I live with my wrinkles and my flab, but some people can’t.

          2. Where do we draw the line? I don’t feel that I have the right to decide for others which surgical proceedings are legitimate and which are not.

            And in any case, as I point out above, if one country bans them, other countries will market them.

          3. For sure.

            I personally believe that healthcare is a human right and that a just society should give priority to basic healthcare needs. From what I see, in the U.S. (and in Chile for sure) there are people who don’t even get basic dental care or
            a yearly check-up with a doctor, things that should come before sex change surgery, whatever one’s opinion on it is.

            However, we live in a capitalist global market where healthcare is a commodity and within that reality buyers of health care will seek those who sell whatever they perceive or imagine are their needs.

          4. I had to google her to see who she is.

            We live in a society of spectacle, as some French thinkers back in the 60’s called it. Transgender surgery is a symptom, not a cause.

            How to change that society? I have no idea.

          5. This is evasive. We are in the middle of this debate in this country and others right now.

            Jaz Jennings was put on Puberty blockers. As a result, Jaz’s penis never developed. Thus, when it came time for the vaginoplasty, there was not enough tissue to fashion a vagina. The pseudo-vagina, as a result, is un-viable. Jaz will never have a normal sex life.

            This is child abuse. It is medical malpractice. It is ghoulish and appalling. And it should be subject to criminal sanction for all the adults involved.

          6. Some people aren’t interested in having a normal sex life. We’d have to ask her if she prefers a normal sex life or to be the person that surgery created. That’s her option, not mine to define.

          7. Oh for god’s sake. If this is your position, we are so far apart on fundamental, basic values and norms regarding children that we won’t have a productive conversation. I find your stance here completely unacceptable. Outrageous, really.

          8. I don’t find your position to be “outrageous”, but if you believe that we cannot have a “productive conversation”, I’ll
            bow out. Actually, I confess I found the conversation interesting.

          9. I was being intemperate. Forgive me. Having raised a daughter, I am sensitive on this issue.

            We don’t extend children the responsibility to make these kinds of life-altering, permanent decisions for a damned good reason. They are not up to it. What you are describing — and what is being done now — represents a level of negligence, disregard, and abdication of adult responsibility that should be abhorrent to every decent person.

          10. I don’t follow the U.S. media much (besides the Electric Agora and Leiter) and where I live, the issues of trans rights are not in the news at all. Thus, more or less all I know about the subject comes from reading the Electric Agora and watching your videos. That being the case, trans rights are also not a subject I think about much: we’re in a presidential election campaign here and I have a candidate, I donate money, I participate in debates every day, etc.

            So when I talk to you or others in the Electric Agora, I’m not stating firm thought-out positions about trans rights, but learning what I think through dialogue with you and others. I had never heard of Jazz before an hour ago, and I’d have to study her case with more detail before I venture a thoughtful opinion.

            However, in previous conversations with you I recall that in general I am much more libertarian than you about teenagers’ right to decide on their lives, to choose their own path in life and to make mistakes. For example, I’m in favor of lowering the voting age to 16 or even 15 (it’s now 18 in Chile). I’m also generally in favor of lowering the legal age of consent.

            Thus, in discussing this subject with you I’m exploring my own views on the subject of both trans rights and the the right of teenagers to decide, even to make stupid decisions.

          11. Apology accepted of course.

            It’s interesting for me to talk about new subjects such the trans issues because I learn not only about the issues, but also about myself. If I talk about the current election, I already know all the arguments and simply repeat them.

      2. Further to Terranbiped, S. Wallerstien, and jofrclark:

        The idea of being “in the wrong body” seems inherently bizarre. Who believes that a person is some free-floating consciousness that occupies a body like a suit of clothes? One doesn’t have a body, one is a body. Additionally, to assert that one is a “female brain in a male body,” one implicitly asserts that there exists such a thing as a “female brain.” Is it less bizarre to install female genitals to match a “female brain” than it would be to install a “female brain” to match female genitals?

        Although I wish such unfortunate people well, these anomalies seems to confirm that trans people are delusional, and hence suffering a disorder of some type. Why then should we “take them at their word”?

        Clinicians have identified a condition known as “bodily integrity dysphoria” (BID), also known as “amputee identity disorder” and “xenomelia,” symptoms of which are psychological distress with being able-bodied, or a desire to be disabled. (It was not included in the DSM V (for which inclusions and exclusions are highly politicized), but it was included in ICD-11.) BID people are already self-organized–people with BID actually refer to themselves as “trans-abled.” The treatment often sought is removal of an unwanted, but otherwise health, limb. The medical ethics of such amputations are, unimaginably, under current debate.

        Should BID patients be taken at their word, and thus granted their amputations? If one claims there is no right to decide for others which surgical proceedings are legitimate and which are not, should doctors be permitted to hack off healthy limbs as they hack away genitals, with no concern that the patient’s desire “to have his or her body conform to his or her self image” is actually symptomatic of a psychological disorder?

        1. And, BTW, I am not arguing for or against the existence of male and female brains—i.e., that male and female mammals have certain sex-related traits as a result of genetic evolution. That conclusion seems to be in the ascendant among those qualified to have an informed judgment. It is just one node, however, in the web of interactions between the social movements of the past fifty or sixty years and related scientific findings, including flash points around questions such as “what is a woman.”

          Of course, the existence of sex-related behavioral traits would in no way undermine the principle that men and women must be free to choose and pursue their own paths in life. It would, however, invalidate many presumptions regarding the reasons for statistical disparities between men and women in employment, social roles, status, etc.

        2. This is a most remarkable post. You obviously feel quite strongly on this subject to the point of making faulty equivalences, comparisons, strange assumptions and logical inconsistencies. I appreciate that you did rehabilitate it somewhat in your subsequent addendum.

          You said it’s not uncommon for you to step on toes. I try my best not to do so and submit this with some trepidation that you might interpret my words as being dismissive or confrontational but, I could not in good conscience not point out the obvious. You are of course entitled to your opinion but you presented little in support other than the obvious fact that what you don’t understand or approve of in the human psyche must be delusional at best and somehow a kissing cousin of BID and similar unhinged pathologies.

          I can only apologize for my terseness, being in transit and without access to a real keyboard.

        3. There’s a difference between wanting the surgical removal of a healthy limb and sex change surgery.

          I think that we or at least I can follow the logic or rationale of the person who wants sex change surgery while I don’t see the logic or rationale behind wanting a healthy limb amputated. It seems to be based on a simple delusion.

          If we accept the concept of gender (I don’t know if you do, but I do), we can see the lots of people don’t fit into the gender stereotypes associated with the sex that they were born with. Maybe none of us actually fit into all the gender stereotypes, but in some people the lack of fit is clearer.

          That hurts psychologically and the male kid who is bad at sports, not able to defend himself in a fight, lacking in “normal” male aggressivity may well feel more comfortable around girls, playing with them or identifying with them. That for me can be interpreted in terms of gender non-conformity, but it’s not difficult to see why someone might interpet that in terms of being a girl or a woman inside, of their real identity not conforming to that one associated with their sex organs.

          Is that a pathological delusion? I don’t think so. It seems like a mistake, but all of us, especially as teenagers, desperately seek a solid identity to hang on to and I don’t see why the male kid who concludes they are really a female is any more deluded than the kid who concludes they are really Jewish or really African-American or really a leftist or really a conservative. I agree that the results of sex change surgery are more definitive than that of deciding that one is really Jewish and that is a reason to argue in favor of the non binary or gender non-conforming concepts.

          One is never really anything, but it takes years to fumbling through life to realize that and no teenager has the wisdom to realize that or to understand the wisdom of their parents, grandparents or teachers when they tell that teenager that we are chaos in search of a defintion which never arrives.

          1. The idea of comparing sexual reassignment surgery for sexual dysphoria with believing one is an amputee who desired the removal of a limb to fulfill the delusion, or thinks one is Napoleon, is a gross oversimplification and a category error. We know little to nothing of the physiological and psychological complexities underpinning sexual identification or attraction. Sexuality/gender and personal identity are primordial forces unto themselves that I would imagine follow different ontogenetic pathways than BID and other singularly bizarre and non life affirming pathologies.

            I’m assuming this is the case for “authentic” cases of those feeling trapped in the wrong sexed body and not those with more comprehensible mental health issues or the victims of group hysteria and fads.

            I had a thought experiment pop into my head today that has me somewhat puzzled. What if either of us one day woke up to find we were now occupying a female body. The last thing I would contemplate would be to start amputating my breasts and trying to get my clitoris to reside on a lump of high jacked flesh over a sewn up vagina and dangling prosthetic orbs. I would make the best of the reality, proclaim myself a lesbian and live my life in a healthy and intact body.

            The question is, am I unusual in my outlook and why do those trapped in the “wrong” body feel it necessary to look the way they feel? I suppose this is more integral to the psychology of a young person with limited experience still creating and trying to conform to their image of themselves. But I really can’t understand the more mature person putting themselves through this imperfect ordeal that carries with it the promise of almost certain health consequences.

            From my perspective, and I’m sure it’s limited by my experience, there may be something more going on in this trans phenomenon that is not fully accessible to the average person. No doubt it’s real but why it manifests itself as it does is only superficially understood in my opinion.

          2. Is questioning “gender dysphoria” unthinkable, even when the confusion around the subject is obvious? For example, you have compared gender reassignment surgery to a nose job. You are also on record as saying ” I don’t feel that I have the right to decide for others which surgical proceedings are legitimate and which are not.” Presumably, that would apply to BID patients, who assert that the nonconformity of their bodies with their internal sense of themselves “hurts psychologically,” as you put it. Your response is to claim that BID is “a simple delusion,” yet would you nonetheless allow the desired amputations? And doesn’t BID share with gender dysphoria at least the nonconformity between an internal sense of one’s self and one’s physical body? I think the BID model is a much closer analogy to transgenderism than a nose job,

            You also seem comfortable with transgenderism’s reification of gender stereotypes, stating “we can see the lots of people don’t fit into the gender stereotypes associated with the sex that they were born with.” Gender non-conformity is the principal criteria by which trans candidates are identified, yet, most gender-nonconforming people never identify as trans. Doesn’t that suggest a potential incongruity?

            At the outset, the “wrong body” model does not appear to differentiate or account for the potential effects or cross-effects of other psychological and neurological disorders, the rates of which are known to be elevated among trans patients. The lack of differentiation is not surprising, as there is so little psychological testing or screening of trans candidates. It means, however, that the self-diagnoses as trans may be due to other undiagnosed conditions such as histrionic disorder, autism, or neuro-developmental problems.

            Most adolescent trans candidates suffer from related mental illnesses—63% have pre-existing psychological disorders or neuro-developmental disabilities; 35% are on the spectrum for autism, a disorder characterized by fixated behavior. Elevated rates of psychiatric disorders or neuro-developmental disabilities are found in trans people generally. https://www.nature.com/articles/s41467-020-17794-1.pdf .

            The potential confusion is aggravated now that trans status has become a mark of distinction and prestige among adolescent girls on social media. Adolescents and, increasingly, young adults, are highly suggestible and susceptible to social contagion, especially girls. Female juvenile suicide has increased four-fold since the spread of the use of social media. Girls are also almost exclusively the patient population for anorexia nervosa, the delusion that one is fat, which results in refusal to eat, and which, notably, results in a higher rate of actual suicide than does gender dysphoria.

            Isn’t social contagion a form of delusion? Yet, the radical trans ideologues and the doctors who have developed prosperous transition-on-demand practices, have adopted a self-exonerating market-based principle—everyone can know what they want and are entitled to get it—that allows to avoid addressing a critical medical responsibility.

            That the “wrong body” self-diagnosis is very often delusional also is indicated by the increasing thousands of trans patients who have de-transitioned or are seeking to do so, a trend the radical trans ideologues attempt to deny. That denial is telling, as the growing number of de-transitioners represent the extent to which the “wrong body” model was a misdiagnosis, if not delusional.

            Moreover, while the existence of a putative condition may be established by the effectiveness of the use of a known cure, the inverse is also true: the ineffectiveness of the cure is a strong indication of the absence of the condition. Yet the “wrong body” model persists even though the effectiveness of transitioning as a response to depression and suicidal impulses attributed to putative gender dysphoria has increasingly been called into question by long-term studies of transitioners.

            One such study in the Netherlands in 2011 found that, although general functioning improved during puberty suppression—and de-transitioners attest to a “honeymoon period” on puberty blockers or hormones that can last for an extended duration of years—there was no change in levels of anxiety and anger, and females showed similarly elevated problem behaviors before starting blockers and at follow-up. Moreover, levels of gender dysphoria and body satisfaction did not change.

            The most statistically significant long-term follow-up study was conducted in Sweden, and found that after transition, transgender people still had a suicide rate 19 times higher than matched controls. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885.

            When the surgical or hormonal treatment of the “wrong body” condition so often fails to alleviate the conditions symptoms—i.e., after the “wrong body” no longer exists—the validity of the diagnosis itself is questionable.

            When a psychological disorder creates depression or anxiety, the standard response is to treat the depression and anxiety. In the cases of trans patients, however, screening and treatment of depression and other underlying issues is neglected in favor of the trans patient’s self-diagnosis. That’s a shame, as depression has never been more treatable. Addressing psychological distress through physical alteration, on the other hand, has a bad history, as reflected in the former practice of frontal lobotomy, the effects of which were permanent, and which eventually was regarded as too barbaric to be continued.

            I do note that you acknowledge that the “wrong body” perception “seems like a mistake,” and I appreciate the honesty of that concession. It seems like a mistake to me as well.

            Regards.

          3. First of all, we should differentiate between woke trans activists and young kids who don’t feel comfortable with their biological sex and especially with the gender roles normally associated with that biological sex.

            People, including the woke trans activists and the trans health industry, take advantage of those kids and of their insecurity about who they are. By the way, taking advantage of the insecurity of young people about their gender or sex identity is not confined to the woke trans activists and the trans health industry: when I was young (and maybe still today, I have no idea), the Marines recruited with the slogan: the Marine Corps builds men. Young men, insecure about their masculinity, joined the Marines and died in Viet Nam as a result. A lot more people died as a result of the Marines’ cynical manipulation of young males’ gender insecurities than have as a result of the manipulation of other gender insecurities by the trans crowd.

            Still, let’s condemn the manipulation of teenage insecurity in general. And let’s support insecure teenagers, without adding insult to injury by labeling them as “mentally ill” because they feel that they are really of another sex. Let’s show a bit of compassion for the victims of our whole stupid adult worldview, which we are all responsible for.

            I’ve been slowly trying to find my way through this unknown territory of trans issues and from what I’ve learned, it’s important to try to talk to and reason with kids and to show them that they are gender non conforming, as we all are in some ways, that the gender stereotypes are stupid and repressive and that there is a possibility to live a decent life as a non binary or gender non conforming person, without unnecessary surgery. However, if they insist on surgery, I’d let them have it (after a certain age, which I cannot be precise about with the little information I have), because
            it’s their life and they make the decisions about it, not me.

            Regards…

          4. Now that’s the old KHM. You present empirical data that seriously questions the efficacy of sexual reassignment as the expected panacea for a possible host of underlying neuroses and disorders that masquerade or present themselves for whatever unknown, as sexual dysphoria.
            And exactly; if the transition at least helped to bring happiness or contentment to these tortured souls, it could be considered a boon.

            As was mentioned elsewhere, some parents are more favorably disposed to having a chic trans child than a gay or lesbian scion.
            You also brought up the initial “high” experienced by neophyte trans. This has been especially documented in the case of biological females getting shots of testosterone. But as you say, a high only lasts until the crash.

            Don’t quite understand your analogy of a lobotomy, other than it was permanent and didn’t help. One little quibble as regarding wallersteins comment about a “mistake. He was not making a summary judgment on the whole enterprise but only specified specific instances where children and young people were confused and/or unduly influenced.

            I fear this land rush will be annotated in journals and history books as a cautionary tail of not taking this subject seriously enough in screening and alternative curative approaches. Political, mercenary and cultural forces superseded the Hippocratic Oath To help some, while the carnage of others were left in the wake.

          5. Perhaps you should let Wallerstein profer any clarification. And “tail”? Surely “tale.” Never mind, though.You can have the last word, if you wish.

          6. wallerstein has been exquisitely clear and consistent in his numerous posts on the subject of trans-forming and trans-itioning. He acknowledges the risk of mistakes but appears to be a strong advocate for medical intervention in general and on principle. More libertine in his approach than I and certainly you. It’s a messy business all around.

            Tail? Oh really? Funny that. People were curious if you were the exiled big frog from Bloggingheads; screen name Oreaally (sp). A prodigious compliment by the way and we’ll deserved.

            I’m rocking along on I75 pecking on my micro keyboard and you point out a stinking typo. LOL! I guess you are aptly named or was it your good conscience that compelled you. I’m no stranger to that.

            I appreciate your even temper and wry wit. It’s been a pleasure. Y’all come back now, ya hear…

          7. Terranbiped,

            We can only know if sex change surgery is a mistake by the results: does it better the life of the person involved?

            With teenagers, having sex change surgery seems like a risky bet. A risky bet isn’t necessarily a mistake: it may turn out to be a winning bet, but a confused desperate young person who is seeking an identity isn’t in the best position to make decisions which will determine the rest of their life.

            What is missing from this conversation is a sense of how cruel the teenage years are to someone who does not fit the normal gender stereotypes. I’m male and I have three male children, no female children, so my experience is limited to males growing up and any young male who is bad at sports, incapable of defending himself in a fight and lacking in so-called normal male aggressiveness will be mocked and bullied. Since as a teenager, one’s sense of identity comes from the world around one: a teenage male who does not fit the usual male stereotypes will feel that he is nothing, nothing I repeat. In that situation it seems almost logical for him to decide that he is really a female, especially if he feels more comfortable with so-called normal female pasttimes and pursuits. How can we blame him for that? How can we label him as mentally ill for that?

            As I’ve said previously, a less risky bet would be for him to see himself as non binary or gender non conforming, but desperate people clutch at whatever refuge is closest at hand and seems more secure.

            For adults whether or not they decide rationally or wisely is none of our business.

          8. That’s me, on the banks of the Zuiderzee,
            tiptoeing through the tulips while thinking of thee.

          9. I know we’ve discussed this already, but I just want to be clear that I think what you describe represents a catastrophic dereliction of adult responsibility and duty that should carry serious legal penalties and sanctions. It is 100% the job of adults to do with regard to minors what you are saying is none of our business. To try to institutionalize and normalize systemic abrogation or responsibility not just in our institutions (which is rampant today) but within families is beyond wicked. It is deranged.

            All sorts of people have to face all sorts of difficulties during adolescence. Fortunately, as they are not growing up in Darfur or Sierra Leone, their experiences are almost always within the realm of normal hardship and navigable through the normal means by which people have coped forever. That has exactly zero to do with what we are talking about here, which is sterilizing and performing irreversible surgeries on children and adolescents and whether children as young as *middle school* should be allowed to decide to do that.

            Fortunately, as this dumpster-fire of a conversation has moved out of activist circles and into the broader, general public, it is meeting stiff and significant resistance. Among those who have raised children and especially girls, overwhelming majorities categorically reject this, and will continue to do so.

            My worry is that because what activists are pushing for is so beyond the bounds of anything even remotely acceptable in a civilized society, the backlash that is coming will extend far beyond activists and set back the rights and prerogatives of trans people for decades.

          10. Understandably you are trying to formulate a compromise to obtain the most good for the most people with as little collateral damage as possible. I’m sure that is the desire of all well meaning and empathetic people.

            But, as Kant.h.m has pointed out the results of basically irreversible surgery has at best, not had stellar results physiologically or mentally.

            Though I’ve agreed with much of what you have opined, I disagree that even adults should be allowed unfettered access to such surgeries and hormone replacement without rigorous psychological evaluation and advice. I also think you are wide of the mark in your example of a young male of perhaps a bookish, sensitive and passive nature having any reason whatsoever to begin to consider that he would be better off as a female. I think you cast your net to far. This is not my understanding of sexual body dysphoria. Only the normal tribulations of growing up. But in the current zeitgeist this seems to be lost for an easy out. Be careful not to get sucked up into the topsyturvey world of wokeness.

            Respectfully,

  8. Interesting and timely subject and interview.

    Will have to check out the book, but would have liked to have heard more about the terminology problem that underlies much of the current discourse and the confusion therein. How has the use/meaning of words regarding these issues evolved over time – male, female, man woman, feminine, masculine, trans, bianary, gay, straight, etc.?

    If we are to uncouple physical sex at birth from gender and then further from gender expression as well as sexual orientation (not unreasonable given observed human behavior and reported human experience), then a way forward would be to collectively clearly define the use of words in our language in order to indicate specific (conceptual) meaning – i.e. physical sex at birth = male/female/ambiguous, psychological gender identity = man/woman/trans, gender expression = masculine/feminine/butch/effeminate, sexual orientation = heterosexual/homosexual/bisexual.

    Then moving forward being collectively conscious of the use of such terminology in public discourse (newspapers, articles, podcasts, social media (?!)) about such issues and how they relate to things such as transhumanism, identity politics, toxic individualism, freedom, justice and such would help the discourse along.

    I don’t see much attention to this in the current discourse and indeed attempts to resist such definitions from both sides of the debate.

    For example, if you feel like a man (gender), that doesn’t necessarily mean you’re male (sex), nor does a surgery to cosmetically alter your appearance make you male, even though it may (or may not) relive your symptoms of gender dysphoria. All this would be independent of wether or not your masculine and further wether or not your gay.

  9. Dan Kaufman,

    I believe that you misread my last comment. I said that the decisions of adults about whether they want sex change surgery are none of our business. My previous paragraphs indicate my position regarding the decisions of teenagers, which are much more nuanced.

    1. My mistake, thank you for correcting me.

      I am confused though, because in an earlier part of the conversation, you said we should ask whether Jaz Jennings wants to have a normal sex life. Her botched and irreparable vaginoplasty was due to her having been put on puberty blockers, which meant that her penis did not develop normally and thus, have sufficient mass from which to draw tissue to fashion the pseudo-vagina.

      As one goes on puberty blockers when one is middle-school age, it makes it all rather confusing what your position is. If you are against puberty blockers and surgical interventions on minors than we have far less of a disagreement.

      1. As I said a few days ago, I had never heard of Jazz and had to google her. Since then I’ve followed this discussion and listened to several more conversations on the subject in Youtube and I no longer think what I did a few days. You should be proud that you’ve convinced me of something. However, I’m not against puberty blockers and surgical interventions on minors: I merely believe that they should be used more prudently, after some reflexion and analysis of each personal situation.

        I still haven’t read up on the case of Jazz, so I’ll pass on that issue.

        These two psychotherapists on what it means to be non-binary were very helpful to me.

        1. Puberty blockers cause sterility and are the reason why later efforts at surgeries fail.

          I’m not really trying to convince you. Just pushing back against what I think are really dangerous positions that will have devastating consequences and which we will regret.

          I also want to resist in the strongest terms the kinds of catastrophizing of adolescent experiences in developed nations that you engage in. It not only is at odds with reality, but it is part of a larger exercise in catastrophizing within the First World that strikes me not just as historically and globally ignorant, but as clearing the way for crazy and destructive interventions of the sort we are talking about here.

        2. God, even in the first two minutes: “I don’t like the label ‘man’, I don’t like the label ‘woman’, so I’m neither.”

          Sweet lord. You actually think this is compelling? Or the way professional clinicians talk?

          God help us all.

        3. Don’t know if you’ve seen this interview with Ayad. Not a huge fan of the podcaster, Boyce, but an interesting convo nonetheless. She is very concerned about the medical interventions we are doing.

          1. Will try later. I listened to Boyce with Helen Joyce a few days ago and found the interview illuminating. Joyce is very very smart, although I don’t always find her convincing.

          2. Another of the unfortunate consequences surrounding this cultural zeitgeist is there are parents out there who seem to view having a transgender child as a badge of honor. It allows them to tick off a lot of boxes: progressive, tolerant, avant-garde, open-minded. This seems to be increasingly prominent in celebrity culture. The moment your five year old son says he feels like a girl today that is a signal to put him in a dress and give him hormone blockers.

            Another throwback to John Money is the apparent faking of data. There is so much pressure from the trans lobby to silence any talk of things de-transitioning that we may be ending up with a very skewed perspective of things.

  10. I’m actually working on an essay on the expression, “I identify as…” I think I am going to argue that the expression is ungrammatical — in the Wittgensteinian sense, not in the sense of syntactically ill-formed — and is really intended to avoid saying “I am…” which would be overwhelmingly rejected. It is an effort to muddy and obscure what is really a quite outrageous and preposterous claim.

      1. That sounds like a great idea. You might take a look at Sartre’s description in Being and Nothingness of the waiter who believes he IS a waiter, that is, who identifies totally as a waiter and why that’s in bad faith according to Sartre.

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