The Problem with the Transgender Affirmative Care Standard

This is an excerpt from a review  of Abigail Shier’s book Irreversible Damage by Dr. Harriet Hall, from a section called, “The customer is always right.”

A new “affirmative care” standard of mental health care has been adopted by nearly every medical accrediting organization. The American Psychological Association guidelines go much further than respecting and supporting trans identities; they mandate that therapists adopt gender ideology themselves. Therapists must accept and affirm the patient’s self-diagnosis. Shrier likens this to telling an anorexic teen “If you think you are fat, then you are. Let’s talk about liposuction and weight-loss programs”. She asks whether a standard guided less by biology than by political correctness is in the best interests of the patient.

We don’t provide affirmative care for anorexia. We don’t say “Yes, you are fat” and offer to help them reduce their weight even more. Part of a therapist’s role is to question a patient’s self-assessment.

Dr. Hall emphasizes that she is open to current treatments, but only where the patient needs them:

I support hormones and gender surgeries for adults who will benefit from them. I care about the welfare of these adolescent girls and it bothers me that some of them may be unduly influenced and take irreversible steps they will later regret.

Dr. Hall concludes:

[Abigail Shrier’s book] will undoubtedly be criticized just as Lisa Littman’s study was. Yes, it’s full of anecdotes and horror stories, and we know the plural of anecdote is not data, but Shrier looked diligently for good scientific studies and didn’t find much. And that’s the problem. We desperately need good science, and it’s not likely to happen in the current political climate. Anyone who addresses this subject can expect to be attacked by activists. Is ROGD a legitimate category? We don’t know, since the necessary controlled studies have not been done. I fully expect Shrier to be called a transphobe and to be vilified for harming transgender people, and I’m sure I will be labeled a transphobe just for reviewing her book.

She brings up some alarming facts that desperately need to be looked into. The incidence of teen gender dysphoria is rising and appears to be linked to internet influences and social peer groups. The number of people identifying as lesbians is dropping. Therapists are accepting patients’ self-diagnoses unquestioningly, and irreversible treatments are being offered without therapist involvement. We know at least some of these patients will desist and detransition, and we have no way to predict which ones. Children are being instructed in how to lie to parents and doctors to coerce them into providing the treatments they want. Families are being destroyed.

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Erich Vieth

Erich Vieth is an attorney focusing on civil rights (including First Amendment), consumer law litigation and appellate practice. At this website often writes about censorship, corporate news media corruption and cognitive science. He is also a working musician, artist and a writer, having founded Dangerous Intersection in 2006. Erich lives in St. Louis, Missouri with his two daughters.

This Post Has 3 Comments

  1. Avatar of Erich Vieth
    Erich Vieth

    Remember the olden days, when it would be enough to disagree with others? Too many of people in high places are now so fragile that they need to make disagreeable information completely disappear. I understand the use of this tactic when used by a 3 year old.

  2. Avatar of Erich Vieth
    Erich Vieth

    About detransitioners:

    The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both. Recruitment information with a link to an anonymous survey was shared on social media, professional listservs, and via snowball sampling. Sixty-nine percent of the 100 participants were natal female and 31.0% were natal male. Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned. There are many different reasons and experiences leading to detransition. More research is needed to understand this population, determine the prevalence of detransition as an outcome of transition, meet the medical and psychological needs of this population, and better inform the process of evaluation and counseling prior to transition.

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