In the Wall Street Journal.
The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one’s maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.
With body dysmorphic disorder, an often socially crippling condition, the individual is consumed by the assumption “I’m ugly.” These disorders occur in subjects who have come to believe that some of their psycho-social conflicts or problems will be resolved if they can change the way that they appear to others. Such ideas work like ruling passions in their subjects’ minds and tend to be accompanied by a solipsistic argument.
For the transgendered, this argument holds that one’s feeling of “gender” is a conscious, subjective sense that, being in one’s mind, cannot be questioned by others. The individual often seeks not just society’s tolerance of this “personal truth” but affirmation of it. Here rests the support for “transgender equality,” the demands for government payment for medical and surgical treatments, and for access to all sex-based public roles and privileges.
With this argument, advocates for the transgendered have persuaded several states—including California, New Jersey and Massachusetts—to pass laws barring psychiatrists, even with parental permission, from striving to restore natural gender feelings to a transgender minor. That government can intrude into parents’ rights to seek help in guiding their children indicates how powerful these advocates have become.
How to respond? Psychiatrists obviously must challenge the solipsistic concept that what is in the mind cannot be questioned. Disorders of consciousness, after all, represent psychiatry’s domain; declaring them off-limits would eliminate the field. Many will recall how, in the 1990s, an accusation of parental sex abuse of children was deemed unquestionable by the solipsists of the “recovered memory” craze.
You won’t hear it from those championing transgender equality, but controlled and follow-up studies reveal fundamental problems with this movement. When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.
We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into “sex-reassignment surgery”—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as “satisfied” by the results, but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a “satisfied” but still troubled patient seemed an inadequate reason for surgically amputating normal organs.
It now appears that our long-ago decision was a wise one. A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.
We seem to have this popular idea in our culture now that the loving thing to do in every case is to just affirm whatever anyone feels like doing. Want to have sex-reassignment surgery? No problem. Want to be surgically altered to look like a cat? No problem. Want to have an amputation because you don’t like your arm? No problem. Want to have taxpayer-provided heroine injected by nurses? No problem. Want to adopt a lifestyle that involves having risky sex with hundreds of unprotected partners? We’ll wave a rainbow flag for you. Want to get drunk and have sex before you (and they) have even graduated high school? Here are free condoms and free abortions to fix anything that might go wrong.
The really, really bad thing that we must never, ever do, apparently, is to tell someone “it’s wrong”.
I am really struggling to understand why telling people NOT to do things that are bad for them is a bad thing. I set boundaries on myself to keep myself out of trouble. Why can’t I let other people know what they are? Why do I have to pay taxes so that other people can afford to do risky and/or immoral things that I would never do?