Open Letter to Dr Hilary Cass

[Sexnotgendah]

Cass did great work but this puberty blocker trial is a huge mistake
https://genspect.org/an-open-letter-from-genspect-to-dr-hilary-cass/

There is plenty of published research to show it doesn’t get better.

But before that, how is it different? You say it’s about the sex of your body. What makes that part define it as a dysphoria, as opposed to someone have a different issue with their body that makes it a dysmorphia?

There is also plenty of published research that shows dysphoria does get better with transition.

Dysmorphia is an obsessive focus about a perceived flaw with the body, and gender dysphoria is not. People with dysphoria are able to accurately perceive their body and that’s what makes it different.

The research on outcomes is mixed at best. Plenty of studies show worsening mental health after transition.

How is gender dysphoria not an obsessive focus on a perceived flaw. Aren’t people who claim a trans identity who seek medical transition focused on the perceived flaw of the sex of their body, obsessively so? If it wasn’t obsessively so, why would there be a driving need to alter the body through medical or surgical means? Surely if it was a casual focus, medical transition would be neither here nor there.

And how are people with dysphoria accurately perceiving their bodies if they are falsely perceiving the sex of their bodies as somehow wrong?

Dysmorphia involves obsessive worries and compulsive checking behaviours. Someone with dysmorphia could believe a specific facial feature makes them ugly and then compulsive compare their appearance with other people and spend a lot of time looking in a mirror.

Gender dysphoria does not involve compulsive behaviours.

“And how are people with dysphoria accurately perceiving their bodies if they are falsely perceiving the sex of their bodies as somehow wrong?”
Because they are accurately perceiving that their body is male or female. They believe it should be different, but they are able to objectively view their body. If a man perceived a body feature to be female when it wasn’t and obsessed about it, that would be dysmorphia

Dysmorphia involves obsessive worries and compulsive checking behaviours. Someone with dysmorphia could believe a specific facial feature makes them ugly and then compulsive compare their appearance with other people and spend a lot of time looking in a mirror.

This sounds an awful lot like what people with gender dysphoria describe to me. Constantly wishing they were the opposite sex. So people with GD don’t do this, according to you?

Because they are accurately perceiving that their body is male or female. They believe it should be different

But why do they believe it should be different? Why do they think it’s wrong as it is?

If a man perceived a body feature to be female when it wasn’t and obsessed about it, that would be dysmorphia

Why is it only dysmorphia if you’re male and perceive it to be female? Why is it not dysmorphia if you’re male and perceive your genitals as wrong as you want them to be female? Who says dysmorphia only works one way like you say?

BDD: perceive a limb to be there but wishes it wasn’t. Seeks amputation.

GD: perceives the penis/breasts to be there, but wishes it wasn’t. Seeks removal.

So how are these different?

This sounds an awful lot like what people with gender dysphoria describe to me. Constantly wishing they were the opposite sex. So people with GD don’t do this, according to you?
A wish is not the same as compulsive behaviour to reduce anxiety and distress. People with gender dysphoria do not perform rituals in that way.

Why is it only dysmorphia if you’re male and perceive it to be female? Why is it not dysmorphia if you’re male and perceive your genitals as wrong as you want them to be female?
Male person who perceives a characteristic is female when it objectively is not and has obsessive worries and compulsions: distorted perception
Male person who believes they should have female genitals: no distortion because they know they accurate perceive their body to have male genitals.

Who says dysmorphia only works one way like you say?
Psychiatrists and psychologists. By definition it is an obsessive worry about a perceived flaw that involves compulsive behaviours.

In body dysmorphia, the body is perceived inaccurately.
In gender dysphoria, the body is perceived accurately but feels incongruent with identity.
One is a misperception; the other is a mismatch. That’s why clinicians don’t treat them as the same disorder

Psychiatrists and psychologists. By definition it is an obsessive worry about a perceived flaw that involves compulsive behaviours.

But I didn’t ask about the compulsive behaviour part. I asked why it’s only body dysmorphia when one sees a body part as female when it isn’t? Why is it not similar to BDD when you perceive something that shouldn’t be there? What’s the difference between wanting a limb gone or wanting your penis or breasts gone?

Ok, let’s say they’re not the same disorders, but there are similarities, aren’t there?

The perception of a flaw with one’s body that isn’t correct. There is nothing wrong with a child’s body is there?

but then you say:

In gender dysphoria, the body is perceived accurately but feels incongruent with identity.

So what part of a child’s identity is incongruent with the body?

And if the perception of the body is correct - a male child correctly perceives they have a male body - why does the body need to change? What can’t the identity become comfortable with what you say is the correct body?

And to bring it back to the thread:

The DSM 5 criteria for GD doesn’t focus on any of your points. It’s about stereotypes. And if you, as an adult, can’t logically explain what it is that’s wrong without raising more questions, how is this any sort of basis to enact irreversible lifelong sterilising treatments on children?

How can a study happen on something that can’t be defined?

People with gender dysphoria do not perform rituals in that way.

Isn’t dressing as the opposite sex in ritualised ways, and other things like fixating on stereotypes, enforcing pronouns, discussion amongst similar individuals online and so on, all forms of ritual and compulsive behaviour?

Many trans people describe experiences like “gender euphoria” and rituals associated with dressing up and transforming into a different persona in exactly the same kinds of ways that others describe compulsive behaviours - some of the very first narratives of “trans” people and groups involve compulsive dressing up and ritualised behaviours behind closed doors, obsessive thoughts, and fixations on specific kinds of clothing, makeup or body parts.

Gender dysphoria isn’t BDD because the core issue isn’t misperception. People with BDD believe a body part is defective when it isn’t. People with gender dysphoria accurately perceive their bodies. The distress comes from a mismatch between their physical sex traits and their gender identity, not from thinking the body is “wrong” or “abnormal.”

When you talk about someone wanting to remove a limb you’re talking about Body Integrity Identity Disorder (BIID). Again something different to gender dysphoria. BIID is about a desire to have a limb amputated and become disabled. They both involve distress, but the causes and treatments are different.

And if the perception of the body is correct - a male child correctly perceives they have a male body - why does the body need to change? What can’t the identity become comfortable with what you say is the correct body?
I didn’t say the body is correct, only
that the person could correctly perceive their sex characteristics. People have tried to force trans people to change their identity and it doesn’t work.

Ok, so now define “gender identity” in a solid enough way to be part of a research trial protocol.

I guess I didn’t get the memo mumsnet is a single sex space 🙄

Actual definitions and traits of these disorders is psychobabble to you?

“Gender identity” is an extremely recent idea that wouldn’t have made sense before the mid-twentieth century, and only really acquired its contemporary meaning from the 1990s onwards. “Gender” was understood to mean the social performance of what used to be called “sex roles”, and not something that was an ineffable part of one’s internal selfhood. Like all these psychiatric diagnoses, including BID and so on, what they are made up of and what their “symptoms” are supposed to be shifts over time. They aren’t fixed categories, and they tend to be comorbid with other psychiatric conditions, too. Rigid definitions of them simply aren’t borne out in practice.

It’s a person’s internal and deeply held sense of their gender, and may or may not correspond to their birth sex.

And gender is defined as…?

Gender is the social category (man or woman) that people are recognised as. Gender identity is a person’s internal sense of which of those categories fits them

This entire idea simply didn’t exist before the last few decades, and it made no sense at all before surgical and hormonal treatments, as there was simply nothing that could alter even the outward presentation of one’s “birth sex” until very recently (apart from cross-dressing, which very much was understood as a compulsive behaviour, fetish or sexual neurosis).

Actual definitions and traits of these disorders is psychobabble to you?

Yes, because people who actually research or work in psychiatry or clinical psychology do not tend to treat psychiatric conditions in practice as having fixed definitions and traits. Most psychiatric conditions are messy things that overlap with others, and don’t always present in typical forms.

So to summarise, you think children can be trans, based on a diagnosis derived from their deeply held belief in which social category they believe they fit, and as such they should be allowed to be recruited into a trial that will permanently alter their bodies.

Ok.

And course there is psycho babble. Because the DSM5 states that the social category children determine suits them is based on stereotypes. They’re are right there, in the book.

But they do have official definitions and criteria in diagnostic manuals like the DSM-5. It may be more messy in practice, but that doesn’t mean gender dysphoria and body dysmorphia are the same thing even if they seem similar on a surface level

The diagnostic criteria also includes:

• A strong dislike of one’s sexual anatomy
• A strong desire for the physical sex characteristics that match one’s experienced gender

There are 8 criteria listed of which a child must have 6 of them and experience significant distress or impairment for at least six months

Why shouldn’t we regard them as on a spectrum or essentially very similar apart from the object of the condition?

Plenty of psychiatric conditions go in and out of the DSM all the time. Some end up breaking apart into different diagnoses; some come back together. Psychiatry is not like physical medicine: many of its diagnoses are heavily culturally inflected by the way we think about the self and culture at any one time (just look at the different ways autistic spectrum conditions have changed in formulation over the last thirty years). Unless you believe that somehow the current version of the DSM is the last word ever on psychiatry, it’s very likely to look different again in ten or twenty years’ time.

Yes and 4 of them are stereotype based. So a child can’t meet criteria if you don’t believe in stereotypes.

So how can a child have GD without stereotypes? Even your definition of gender is social, meaning stereotype based.

You didn't transition. No one can.

Four of them are, but one every child must have this one: A strong desire to be of the other gender or an insistence that one is the other gender.

Wouldn’t a trans child want to take part in the activities associated with their gender identify? I don’t think stereotypes are right and believe children should be free to express themselves however they want, but in reality activities and clothes are still gendered.

The diagnostic criteria does not say that any child that takes part in stereotypical dress or play of the opposite gender is automatically trans