The obstacles presented by ideology in discussing trans issues

With kind permission from the author of the thoughtful blog ThirdWayTrans, I am reposting one of his entries here.

ThirdWayTrans describes his blog as “Alternate ways to think about gender dysphoria, gender identity, retransition, detransition and transgender issues from a former trans woman and psychology grad student.”


 

By ThirdWayTrans

One thing that makes discussion of trans issues very difficult is that it that it lies at the intersection of ideology and truth. Science strives to seek truth and to be ideology-free. It can never meet this goal because it is done by humans who are incapable of being ideology-free. Still, it is the best method we have for minimizing the effects of bias and trying to get at an accurate picture of the world.

Jonathan Hadit, who is one of my favorite psychological writers, studies moral reasoning. He wrote an excellent book about it called The Righteous Mind. One of the things he talks about is that people have certain values that they hold sacred. He talks about the ideological differences between liberals and conservatives as being largely due to the fact that they hold different values sacred. When the tribal values are threatened people are far more concerned with neutralizing the threat then what is true or not. These sacred beliefs essentially become religious beliefs and anything that challenges them feels like heresy.

This is just part of the natural condition of humanity, and the same people that can be very capable of reason and nuance about questions that do not concern their sacred values suddenly become incapable of it when they do. I remember having a co-worker who was a decent programmer. He was also a Scientologist, and would occasionally talk about how “L. Ron Hubbard was an incarnation of the Buddha, and a messiah” or other Scientology related topics. I found it perplexing that he could have the logical chops necessary to be a good programmer and simultaneously be a Scientologist, but once beliefs acquire a religious character they are immune to logic. It is much the same with political ideologies.

One of the other things Hadit talks about is the importance of diversity of ideologies in creating good science. Scientists, like all people have ideologies and sacred beliefs. Scientists are often quite passionate about their theories. They are far from neutral, disinterested observers. So, any one scientist runs the risk of having their bias interfere with their observations. Science has tools for neutralizing bias from double-blind studies to peer review. Peer review relies on other scientists looking over the science, but they too have biases. If you have an ideologically diverse set of scientists then the effect of their biases are minimized. However, to the degree that they are not ideological diverse, groupthink and other phenomena can prevail. This effect is increased if the scientific study in question contradicts the sacred tribal values of that particular group of scientists.

In the therapy world we are also concerned with the biases of therapist interfering with the therapy and making it hard to see the client clearly. This phenomenon is called countertransference, which is where the therapist projects their own stuff onto the client and does not see the client clearly. Being aware of this is a start, but therapists are people too and are often blind to their own biases and personal hooks. One way to counteract this is through consultation groups, to get the opinions of others who do not have the same biases that you do, and therefore can see things clearly that you can’t see. However, if the therapists in the group share the same ideological beliefs and biases, then this does not help, and can even make things worse as phenomena such as groupthink take over.

Having a strong conviction that the “other side” is absolutely wrong about everything is a sure sign of being engaged in tribal thinking. The truth is messy and cuts across ideologies. It can be very difficult to let go of tribal thinking as it gives a sense of belonging, which is a primal need. If one does commit to the truth wherever it leads you, you are likely to be denounced by all ideological tribes. That can be a very lonely path. Speaking out for truth that goes against your tribal values is very difficult. I recently read Alice Dreger’s excellent bookGalileo’s Middle Finger where she talks about the conflict between truth and activism. Indeed, Dreger, as someone committed to truth over ideology, is often denounced for both being a “crazy liberal” and “neo-reactionary conservative”. I once read two articles denouncing her in these opposite ways within 10 minutes of each other.

The community of psychologists and therapists is far from ideologically diverse. Hadit, who is a social psychologist, gave a talk to a group of around one thousand social psychologists and asked them how many identified themselves as conservative or moderate. As described in this article in the New Yorker,
only 20 or so identified as centrist and only 3 identified as conservative. There might have been more conservatives that feared the career ramifications of openly identifying themselves as conservative. Further research in the article confirms that 37.5% of those social psychologists surveyed would be less likely to hire a conservative colleague, so their feelings would be entirely justified. This article describes social psychologists specifically, but similar phenomena exist with clinical psychologists, social workers and other mental health professionals.

I have come to the reluctant conclusion that it is progressive ideology itself that is the one of the things that gets makes it difficult to work on these issues. As a life-long liberal, and former card-carrying member of the ACLU back when that was a thing, it has been tough to come to that realization. I have long considered liberals to be my tribe and to see this ideology as itself being a problem makes me feel like I am without a tribe. However, since tribalism itself is the issue, perhaps that is a good thing. I want to emphasize that all ideologies get in the way of seeing the world clearly, it is just that the particular ideology that dominates the psychological profession is on the left. In particular, the following aspects of progressive ideology, particularly the specific progressive ideology of the psychological profession come in to play:

Privilege / Power Dynamics

Progressive ideology views the world in terms of privilege and power dynamics. People are divided into privileged and marginalized people across various axes. Why this is relevant is that is trans people are seen as a marginalized class while cis people are seen as a privileged class. This brings in to play various aspects of progressive ideology which is concerned with equalizing power dynamics. Indeed, helping marginalized people have a voice is a noble goal, however sometimes this ideology can cause harm to the very people it is trying to support.

One for the related ideas is that a marginalized class has been silenced and it is important that their voices be heard, particularly about their own experience. The privileged class is deemed to not understand the experience of the marginalized class and should listen to them. This is indeed true, and there is a long history of medicine centering men and treating women as afterthoughts and other examples of only paying attention to the dominant class. So it is indeed good and important for trans voices to be heard about their own experience.

However, this ideology leads to trans narratives being taken at face value by clinicians, and digging underneath them to be seen as being against the tribal values of the clinicians working on these issues. This is a well-meaning attempt to bring social justice to the marginalized people.

However, digging underneath things can be very important. Psychology is full of ideas about how people have defenses, self-serving rationalizations and all kinds of ways in which they don’t necessarily understand their own motivations. This is just as true whether someone is privileged or marginalized, and to ignore this when working with marginalized people is to do them a disservice. Indeed it is giving them lesser care, than you give to privileged people.

Primacy of narrative / lived experience

Another part of this ideology is the primacy of narrative and lived experience. This means the subjective is more important than the objective, and that lived experience trumps scientific research. This goes triple when it intersects with the ideas of privilege/oppresion referenced above. This is another idea that has good roots but can be taken too far. Narratives and lived experience are indeed important. As a therapist it is important to bracket aside theory and make sure that you are not treating a client as an object, or a theoretical construct and seeing the person as an individual. People are messy and do not fit cleanly into boxes.

However, the theoretical constructs and scientific research matter also. There is a vast deal of difference in degree of scientific orientation among psychologists and therapists. One problem in psychology is that the academic community of research psychologists and the community of clinicians and therapists often don’t talk to each other. Some sections of the the clinical community are even actively anti-science. Some professors in my master’s program would use the term “evidence-based practice” almost as a swear word, like it meant un-evolved. The narrative is not the only thing that matters.

Nothing is pathological

Progressives are absolutely allergic to the idea of pathology and tend towards the idea that calling anything pathology is “stigmatizing”. So there are movements to talk about how everything from bipolar to schizophrenia is a healthy variation of human experience. Many even question the very idea of mental illness. They are quite correct that stigmazing causes harm. I think it is harmful to stigmatize people based on their conditions, however we should never lose track that some things are healthier than others. For me the question of whether something is healthy is not whether it is normal but rather whether it is functional. Even being functional in some environments is sufficient, that is just a matter of getting to the right environment.

I recently read the excellent book Buddha and the Borderline by Kiera Van Gelder. This book tells of a woman’s journey in healing from borderline personality disorder. She describes how much of her community as well as many of those therapists and psychologists that treated her did not want to give her the borderline label for the reason that it would be stigmatizing. She acknowledges that it can indeed be stigmatizing when she is labeled borderline by others, but it it is also helpful to acknowledge it as an illness and that helps her in working with it.

I think refusing to understand that there is a such thing as health and a such thing as pathology causes problems, especially if you are in a profession where you are supposed to be an agent of health. Pathology should not be mistaken for diversity.

The insider experience is the only one that matters

Progressive ideology centers the insider experience, and holds that the words of a member of a group are those that are valid about a group. For example, only trans people should speak about trans experience, only women should speak about women’s experience, only black people should speak about black experience etc. It is indeed quite true that people that don’t have a certain experience are likely to get things wrong about that experience. Women are likely to see things about their experience that men don’t see, etc. Problems arise when the people studying something are all of one group and they are studying a different group. This idea also intersects with the idea of priviledge/power, and so applies in a much larger way when it is a privileged class studying a marginalized class.

This is an important idea, and tremendous harm has been caused by the lack of representation of minority groups in health. It is a very good thing that their voices are being heard in respect to their own health. However, while it is true that the insider can see what the outsider cannot see, it is also true that the outsider can see what the insider cannot see. Fish can’t see water. How many times have you encountered someone who had some false idea about themselves that everyone but they could see? This is precisely why the outsider perspective is important also. It is best to see something from as many perspectives as possible. All groups whether marginalized or privileged are prone to cultural blind spots and groupthink. Particularly in the case of groupthink, an outsider perspective is precisely what is needed.

Identitarianism

I have written quite a bit about my views on identity here, and here The identity politics wing of progressivism strongly encourages a focus on identity, both the importance of personal identity and an identification with particular groups and classes. In addition to the critiques I made earlier, one problem with identiarianism is that it exacerbates the kind of tribal thinking that clouds truth. Once people feel their group is threatened they focus on defending their group rather than truth. This is just hard-wired into human psychology.

Conclusion

The nature of tribalism, identity and ideology increase the difficultly of find scientific truth on trans issues. The tense nature of these discussions drive away many people who might be interested in working on these issues, and also causes harm to trans people, as they are deprived of scientific advances and the best possible care. Understanding these effects and working towards minimizing them can help to reduce the tension in the ongoing discussion and help us work towards a future where all those who are dealign with these issues receive the best possible care.

Challenging trans truth

 In our work in UK universities and schools and in our own lives we see ‘transgender’ as an identity receiving widespread support and increasingly incorporated into mainstream liberal culture.  Television programmes, films, magazines, and newspaper articles promote the idea that girls and boys can be ‘born in the wrong body’. A life-time of injecting hormones is decreed to be a necessary part of transitioning, and children and young people are being assigned for surgical intervention. It is popularly thought that these medical interventions help match the sexed body with the individual’s true ‘born’ gender.   In addition, changes in the law, in combination with medical truths, are instrumental in defining transgender as an equality and human rights issue. On the whole society is steered toward being receptive to the moral claims of transgenderism; although there are dissenting views these are relatively seldom heard.

Even though there is no evidence that gender identity is innate, in the UK wherever we look, politicians, policy makes and practitioners are indoctrinating the public with this view.

Government recommendations include expansion of trans acceptance training programmes for teachers and for children in schools. We have Head Teachers imposing ‘Transgender Day’ for four year olds against the wishes of parents. Professionals and young people we speak to fear questioning the experience of children claiming trans identity is indicative of transphobia so that ordinarily occurring explorations of the ‘truth of trans’ are firmly squashed. No wonder youth are at the mercy of the internet and deeply confused. We are a Philosopher of the body and an Education Professor working out of the UK wanting to challenge the ‘truth’ of transgender. We want to examine transgender not through the lens of ‘truth’ but through the idea that transgender is a discursive ‘truth’ made up of a number of discourses and it goes along with this that the case for unhesitating, uncritical medical intervention is neither safe nor appropriate.  In our circles this critique is widely regarded as heretical and to date we are working anonymously to avoid facing personal tyranny and professional diminishment.

 Resisting trans orthodoxy

We are keen to extend our contact with other youth trans critical professionals and to use this blog as a space for those of us currently seeking to examine the norms, knowledges, politics and ethics that make up transgender identity.  We want to urgently examine counter-discourses which problematize the truth of transgender and which are currently unheard because we are hearing from young teens identifying as trans that they ‘know the truth’; they feel armed with a logic shored up by intensification of a culture of transorthodoxy and are unable, even if willing, to discover an alternative truth. We hope that this blog and wider activities planned for the coming year will help cohere the voices of youth trans critical professionals to bring counter-discourses to public consciousness for the purposes of productive dialogue that will liberate children and young people from a currently stifling climate of trans orthodoxy ~ ‘Children taught in schools to either adhere to strict gender stereotypes or view themselves as the opposite sex’ @cwknews  

 In our view, medical intervention with regard to the re-assignment of children and young people’s gender is a political scandal.  We empathise with parents who are reluctant to accept the phenomenon of their child being born into the wrong body and who do not regard medical and psycho-therapeutic intervention as valorising love, tolerance and acceptance. Gender confusion or gender fluidity is a component part of childhood, and medical intervention violates children’s human rights rather than upholding them.

‘Let’s think first about doing no harm’.

Emboldened by this website We hope to organise the first meeting of YouthTransCritical Professionals.org in the autumn of 2016.

Watch this space.

girl

What’s at Stake?

This month’s Psychotherapy Networker focuses on trans youth. I was disappointed to see how uncritically the trans narrative was embraced. In this piece in particular, trans kids are applauded and celebrated as if there isn’t another side to this issue, as if something very, very serious isn’t at stake. The article is also full of bad science. I don’t know that I will have the energy today to cover all of this, but let’s get started.

“As social acceptance continues to grow, will we see an increase in the number of people claiming a trans or otherwise gender-nonconforming identity? Will we see a corresponding increase in those requesting body modification? The answer to the first question is unquestionably yes: as understanding and support expand, more people will come out. But the answer to the second question remains to be seen. As trans people change the definition of identity, some are making idiosyncratic choices with surgery and hormones. Some will modify their gender presentation, but not their bodies. Others will modify their bodies to create nonbinary bodies that match nonbinary identities. Tanner, the 20-year-old son of a friend, takes a low dose of testosterone and presents as male, but doesn’t plan to have either top or bottom surgery.”

Social acceptance of gender-nonconforming people is something we as professionals can generally support and feel good about.

But what about body modification?

In an upbeat, breezy tone, the author treats “body modification,” “surgery,” and “hormones” casually. Like, it’s no big deal to take a “low dose of testosterone” for decade upon decade. In fact, cross-sex hormones given to gender dysphoric young people are being used off label. Very little is known about the long-term effects of these drugs, and we are unlikely to know more for quite awhile.  Meanwhile, some of the potential effects of taking testosterone as a natal female, for example, are permanent or serious including: an increased risk for breast and uterine cancer; deepened voice; possible baldness; liver problems; and growth of facial hair. Surgery in this case refers to removal or modification of healthy tissue. There can be serious complications with such surgeries, and of course they are difficult or impossible to reverse, often resulting in sterility, depending on the procedure.

How is it ethical that we as professionals support and encourage young people in undergoing such treatments as a treatment for gender dysphoria? I would personally favor legislation making it very difficult for young people to access these treatments until they are in their late 20’s. I understand this would mean asking some people to live in a way that felt inauthentic or painful, but it would spare the pain that many might feel in the future when they wake up to realize they have permanently mutilated themselves.

We must be more critical of the assumption that medical intervention is the best option, that is it no big deal, that it is a choice to be celebrated for its “bravery.”

I know the next argument coming — what about suicide?

This question gets to one of the bad science moments in the article.”According to a 2011 survey in the United States, 41 percent of trans people had attempted suicide, as compared to 4.6 percent in the general population.”  This 41% statistic is frequently cited as a reason for ushering young people towards transition. In fact, the number comes from one study with fairly weak methodology. That figure is confounded by issues of co-existing mental illness and other issues. Perhaps most significantly, the study did not ask whether the attempts were made pre or post transition.

The following is a a quote from this blog post:

People who said they “did not want” these services had a lower self-harm rate. Does medical transition, or seeking transition services, decrease or increase suicide attempt rates? We don’t know, because the survey didn’t ask respondents if the self harm occurred before or after such services were soughtas the authors note:

The survey did not provide information about the timing of reported suicide attempts in relation to receiving transition-related health care, which precluded investigation of transition-related explanations for these patterns.

Upshot: The 41% is a questionable number to begin with. In any case, it isn’t clear whether transition helps or even worsens suicidality.

Let’s think first about doing no harm. Transition will remain an option in adulthood, after the prefrontal cortex has had time to develop. As clinicians and professionals, we do young people a disservice when we uncritically sing the praises of the “courageous” path of medical intervention.

Working with Parents

In my experience working with parents, the sudden announcement of a young teen that he or she is trans can bring confusion and isolation. Most parents that I have seen in this situation feel a strong urge to support their child, even while questioning whether such an announcement represents their child’s authentic expression, a transient exploration along that child’s developmental path, or the child’s effort to both fit in and stand out. Since unquestioningly affirming a teen’s sudden declaration of being trans can nudge him or her in the direction of serious, permanent medical intervention, caution should be the word of the day. Unfortunately, most parents are not supported in their desire to approach such a momentous shift slowly and carefully. Parents are chastised for being “transphobic,” and told to get on board or risk losing their child to suicide.

Given what is at stake, I feel that we as professionals need to educate ourselves about the very real effects of social contagion. In the ’60’s, young people embraced sexual and drug experimentation with abandon. Society would never be the same, and much was gained as a result of that social contagion. However, there is no question that lives were ruined or ended in the process. In the ’80’s, eating disorders were everywhere. College dorms were filled with young women supporting each other in counting calories or bingeing and purging. I do not know of any positive effects that the social contagion of eating disorders brought with it. I do know that, again, many lives were lost or ruined.

The current cultural shifts around gender may have the possible positive outcome of reducing prejudice for transgendered or gender non-conforming people. I imagine it could also have the positive effect of loosening cultural expectations around gender, making our society a friendlier place for “masculine” females or “feminine” males. These would be good changes. However, the most immediate effect of this social contagion — and that is certainly what it is in many cases — is that young people are seeking and in many cases receiving medical treatments that permanently alter their bodies and render them sterile.

We need to trust that parents that come to see us know their children and have their best interests at heart. When a parent has a child who is about to be swallowed by the trans cult, we need to help that parent trust him or herself. There is some anecdotal evidence that a parent standing firm in the face of a child’s declaration that she is trans can help that child remain intervention-free longer than if a parent equivocates or affirms. Given the seriousness and permanence of most medical transition treatments, remaining intervention-free for as long as possible ought to be the goal. Transition will always remain an option once the young person has become an adult. One can never regain one’s pre-surgical body or fertility once these have been sacrificed.