The Correct Treatment for Gender Dysphoria

On the issue of gender dysphoria, I have followed Jesse Singal closely. I admire his willingness to dig deeply into the numbers and to let the numbers speak louder than the many one-size-fits-all "experts" out there (on both sides of the political spectrum). An enormous problem facing therapists and health care professionals is that the data is not clear yet. There are a lot of studies that are highly suspect for methodological reasons. Yet families are demanding treatment now and they want certitude. What should a therapist do when the evidence is not clear? To put it another way, where should they set their default? I'm not a therapist or health care professional, but I would set the default here: Don't surgically and permanently cut off an adolescent girl's breasts and inject her with male hormones (which will almost certainly render her sterile) when there is a reasonable possibility that the gender dysphoria is a consequence of other psychological and health issues that can be treated (or a consequence of cultural pressures). Do no harm. Singal recently summed up his current position, which is well worth considering:

My understanding of social transition is that it is a psychological intervention that may itself have downsides, such as making it harder for the kid to grow out of his or her gender dysphoria (I don’t think this is established, but I do think you can make a circumstantial case that it’s sometimes true from the available evidence). So even that shouldn’t be approached lightly — you should be certain the kid’s gender dysphoria is durable, severe, and causing problems. Is it “many” kids who fit these criteria? I dunno. Same deal with medical treatments. They really, really shouldn’t be taken lightly. The evidence base sucks, regardless of what major liberal media figures keep saying. A kid should go on blockers or hormones only if they’ve been assessed very carefully.

I don’t think there’s any evidence that treating gender dysphoria qua gender dysphoria with “therapy and medication” will do much good in most cases. I do think that in some subset of instances in which a kid tells a therapist they have gender questions, or definitely feel they are some “other” gender than their biological sex, basic exploration of other factors will reveal some other issue. Sometimes it might be recent trauma, sometimes it could be anxiety or depression, and sometimes it could be other issues involving, say, the onset of puberty. I think those issues probably can be treated with therapy and drugs, at least in a lot of cases, and that doing so may cause the gender issues to abate, because they weren’t the root issues in the first place.

There’s a lot of disagreement among clinicians over whether the causal chain (1) is always gender dysphoria → other psychological issues, or (2) whether it can sometimes go in the other direction. This is a pretty high-stakes question, because it obviously will affect the direction of therapy. If a kid has gender questions, anxiety, and depression, then a therapist operating under (1) will assume that ameliorating the GD will in turn ameliorate the other issues (so no need to pay them much mind at first), while a therapist operating under (2) will have more of a winding road to traverse.. ..

Anyway, all of this is to say that no, I haven’t been swayed from the idea that on balance, these treatments are probably good for kids who would otherwise suffer from severe, unremitting gender dysphoria. But even in these instances, no one should act like they know exactly what they’re doing. Sometimes even severe, prolonged cases of GD go away!

I am concerned that much of what passes as dysphoria is cultural dissing of women, passed by contagion. The following Tweet thread was well articulated.

Much of this resonates with me. Society has, in many ways, belittled women. If you think this is overstatement, go turn on your TV. Our culture continues to do this in thousands of ways. If I were about to be born and you could choose your sex and you would be growing up in the United States, what is the likelihood that you would choose to be a girl in our current cultural stew?

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Jordan Peterson: The Danger of Obsessing About Yourself

Jordan Peterson had a long and intense discussion with writer Helen Joyce about transgender ideology. It is a well-worth listening to the entire episode, including the discussions of social contagion, the reasons girls reject their own bodies, the disrespect shown to older women (by younger women) and the pervasive role of narcisism. Peterson, who has worked as a clinical psychologist, offers this advice for people who suffer from social anxiety. From my personal anecdotal experience, I think this is spot on and important to note:

Helen Joyce: And alongside that, that you must choose your identity off a list of dozens, and sometimes hundreds, that require the most intense, constant rumination and self-examination. I mean, I was talking to somebody just yesterday--who was telling me that who has this check sheet for how do I feel? ... But you were meant to be thinking all the time, like, how am I feeling right now? And it was, you know, on a scale of one to 10, how happy am I? This is all a terribly bad idea.

Jordan Peterson: Well, it's clearly bad. One of the things I learned when I was treating people who were socially anxious, I had a lot of anxious people in my, in my clinical practice, which is hardly surprising because that that's the kind of suffering that requires people to seek clinical intervention. Socially anxious people, when they go into a new social situation, think obsessively about how others are thinking about them. Yes. And so then they become self conscious often about bodily issues. But not only that, they might become self conscious about their lack of conversational ability, and the fact that they're not very interesting, and the fact that they're being evaluated by other people, it's a litany of obsessive thoughts. And you can, you might say, well, you can train people to stop thinking about themselves. But you can't stop people from thinking about something by telling them to stop thinking about something. But what you can train people to do is to think more about other people. And so one of the techniques that I used in my practice was okay, now, when you go into a social situation next time, like we'd go through the niceties of introducing yourself and making sure they knew your name, and get that ritualized, so that it was practiced and expert and therefore not a source of anxiety. But the next thing is, your job is to make the other person that you're talking to as comfortable as possible, to pay as much attention to them. And so we know that the more you think about yourself--this is literally true--there is no difference between thinking about yourself, and being miserable. They load on the same statistical axis. And so these kids that are constantly being tormented by 150 identities, that's a front not of freedom, but of utter chaos. And then asked to constantly reflect on their own state of emotional well being and happiness is the surest route to the kind of misery that's going to open them up to psychogenic epidemics. The clinical data on that are clear.

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America’s Make-Believe Racial Categories

I just finished reading "The Lunacy of U.S. Racial Categories," by Rich Lowry of the National Review.

I completely agree with Lowry, having just heard David Bernstein discuss his new book on Coleman Hughes' podcast: Classified: The Untold Story of Racial Classification in America. I'm currently reading Bernstein's book and I've already read Bernstein's amicus brief filed in the Harvard affirmative action case, in which he makes a mockery of America's "racial" categories. Here's an excerpt from NR article:

It’s not just that colleges and universities discriminate on the basis of race, ethnicity, and national origin. They do it badly. This is one of the themes that emerged in the oral arguments at the Supreme Court in the Harvard and University of North Carolina affirmative-action cases last week.

The racial categories that the schools use are completely bonkers, an arbitrary mess mostly left over from the work of federal bureaucrats in the 1970s that can’t withstand the slightest scrutiny.

The administrators who rely on these categories are beholden to senseless and unscientific distinctions — they aren’t even competent or rational racialists. . ..

As the Bernstein brief notes, the Hispanic category “includes people whose ancestors’ first language was not Spanish and who may have never spoken Spanish. This includes immigrants from Spain and their descendants whose ancestral language is Basque or Catalan. It also includes indigenous immigrants from Latin America whose first language is not Spanish, whose surnames are not Spanish, and whose ethnic and cultural backgrounds are not Spanish.

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George Carlin’s Frustration with Walking Billboards

I'm reading a big book of George Carlin's writings. Here's an excerpt:

I’m tired of being unable to buy clothing that doesn’t have writing and printing all over it. Insipid sayings, pseudo-wisdom, cute slogans, team logos, designer names, brand trademarks, small-business ego trips; the marketing pigs and advertising swine have turned us all into walking billboards. You see some asshole walkin’ by, and he’s got on a fruity Dodger hat and a Hard Rock Cafe T-shirt Of course you can’t see the shirt if he’s wearing his hot-shit Chicago Bulls jacket. The one that only 50 million other loserjock-sniffers own. And since this cretinous sports fan/consumer zombie is completely for sale to anyone, he rounds out his ensemble with FedEx sneakers, ValuJet socks, Wall Street Journal sweatpants, a Starbucks jock strap, and a Microsoft condom with Bill Gates’s head on the end of it No one in this country owns his personal appearance anymore. America has become a nation of obedient consumers, actively participating in their own degradation.
From 3 x Carlin.

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