The Quillette piece by the Evanses leaves me so conflicted. I'm in awe of their contribution and courage. I'm grateful that they are providing a different narrative. I feel reluctant to offer any criticism at all, because of what they are trying to achieve. And yet.
There's so much brilliance and honesty in what they say. Examples include:
If a child wants to change their name from Joanne to John, the therapist should keep in mind who Joanne is and why she is so unwanted or unacceptable.
Mental health is based on an ability to integrate various aspects of the self, not pretend them away, while differentiating between psychotic and non-psychotic forms of thought. This means being able to recognize the difference between reality-based thought and wishful thinking, and helping patients learn to do likewise.
In many ways, the therapist must find a means of relating that avoids pointless confrontations, but without colluding in self-destructive ideas. We take the view that people might change their name and other identifying details, but they cannot get rid of the person they were. You can perform surgery on the body, but it is a mistake to try to surgically remove a part of one’s personality.
The fantasy that the body can be changed and sculpted as a way of being rid of profound psychological problems needs to come under closer scrutiny. There is a reluctance even to consider that a person’s difficulties can be understood, at least sometimes, through the lens of body dysmorphia, whereby an individual becomes obsessed with a perceived physical flaw. Plastic surgeons are quite familiar with patients who seek surgeries in order to erase or manage a psychological difficulty, and the more ethical among them refer these patients to psychiatrists.
Throughout our careers in mental health care, we have been familiar with similarly challenging clinical presentations. Depressed patients feel worthless and suicidal; anorexics feel too fat, and starve themselves; and obsessional patients perform rituals repetitively before other interactions. Professionals need to show both empathy and understanding of the mental defences, while also making objective assessments of patients’ difficulties. In our opinion, this general principle must apply equally to patients seeking gender transition, not in order to pathologize them, but to help heal their internal worlds.
All superb points. Brilliant.
But.
Amongst the brilliance of their writing in the article are small nuggets of nonsense that threaten to undermine their ability to get to the actual unadulterated truth.
But although medical interventions may interfere with the body and block its sexual development or functioning, such interventions cannot completely eradicate a patient’s natal gender
They mean sex. The use of the phrase "natal gender" here is jarring and sends up an immediate red flag that the perspective here is flawed in its understanding of sex and gender. It's such a critical distinction. But even had they used the appropriate term of 'sex' here, the statement is still flawed and misleading. Because the truth is that interventions cannot even partially eradicate a patient's sex. They are entirely ineffective in altering a patient's sex at all. Why even imply that a 'natal gender' can be partially eradicated? It can't, and for the good of the patient the therapist cannot collude with the false idea that it might.
Perhaps because there remains this final misconception:
But as yet, there is no proven method to determine who is “truly” trans
There is of course a fail-safe and proven method to determine who is "truly trans". Reason and logic, infallible every time it is applied properly.
No human being that is male, is ever "truly female", nor can they become female, nor can they be said to have been female ever. No person can transition between male and female. No psychological perception of oneself, or deeply held misconception about the true nature of the opposite sex changes one's sex. Ergo, there is no transition. No-one is truly trans. It's all an illusion.
I am perhaps really churlish to point any of this out. But I think of these breadcrumbs of false hope as offering a nonexistent Holy Grail prize to patients. "Only the special few, the chosen few are truly trans. Might it be you? Perhaps. It is real. Most are not. But you might be the one true person that is."
It perpetuates the idea that you never know, it might be you. It is real. It does work for some.
EVERYONE thinks they are the exception to the rule...but the truth is there are NO exceptions.
I don't think it is ethical to offer 'transition' to a child or an adult. And I don't think it will ever work without the collusion of an entire society, all forced to go along with the lie. And until you either successfully force an entire society to collude without exception, that 'transition success' is ephemeral.
False hope.
How many people play the Euromillions lottery each week? And what are the odds of winning? How many people lose, week after week after week? Almost all.
People believe that an almost certain outcome of losing something of value is still worth it for the hope of some remote prize. Almost everyone who takes that gamble will spend a lifetime trying and be worse off for it. Why? Because the payoff might be worth the almost inevitable loss. People believe that it might be them. Because they know it happens to a miniscule number of people.
But for most, in a money lottery, what is to be lost is not of great value, and what might be gained is immense enough to outweigh it.
In a falsely promised medical 'transition' the reverse is true. What is lost is immense. What is gained is an illusion, one that society simply can't maintain for the patient.
Would people still play if there was GUARANTEED no payoff? No. What would be the point? Guaranteed fake lottery with no prize?
There is no payoff ultimately in the True Trans lottery. And there's a lifetime to realise the winning cheque was ultimately fake, and other people don't and won't ever accept it as currency.