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Hate speech has consequences

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  • Oh boy, this isn't going to be a popular opinion. I'm a former therapist and I still work in healthcare. Part of why I left therapy is because I disagree with the prevalence of gender affirming care.

    You're allowed to disagree with me. I know it's a contentious issue. But my experience is that our culture and institutions are using one label and one treatment as a panacea for a variety of issues where they are not appropriate. People with a variety of underlying mental health problems are being convinced into believing they have gender dysphoria, and they are funneled into that diagnosis and a type of treatment that is not as reversible as we pretend. Hormone therapy can be extremely detrimental to a developing body and mind, there are lots of studies out there to show this.

    I think the core concepts behind the Trans acceptance movement are positive. I think people who can only find relief for their dysphoria through transitioning should be allowed to, and should be accepted and respected just as any other individual should be. As much as people hate Jordan Peterson, he has said these exact same things. I don't see hatred in this stance. I see caution.

    The anger you mistake for hatred is due to the concern of over-use of gender affirming care, not the existence of it. It absolutely should exist for those who don't respond to other treatment methods. But I've seen a lot of patients come in assuming they are trans, desiring gender affirming care, when the reality is that you don't have to be trans to hate yourself, hate your body, or feel an affinity for archetypes of the opposite gender. A lot of these people come in believing that transitioning will cure them of their disordered thoughts, but it is not a cure-all for all identity disorders or associated depression. Even if you do specifically have gender dysphoria, jumping to gender affirming care is radical. It's not how we treat any other kind of disordered thinking, and largely stems from political interference into medicine rather than from science, in my opinion. There is no medical reason not to try more traditional forms of therapy and medications before pursuing the less understood and riskier treatments. We fast track this type of treatment now for ideological reasons regarding the sanctity of trans identity, not because it makes sense from the benefit/harm analysis used in every other aspect of medicine.

    I very much wish the LGBT community could try to understand where moderates like myself are coming from. I have never treated a trans person with less respect than I would treat anyone else. I believe some people absolutely do not have any other viable options, and that transitioning can provide much needed relief for some. But I believe politics has overstepped into the realm of medicine in this case. At the very least, my hope is to protect children and teenagers from undergoing gender affirming care until it is absolutely clear and necessary that it is the only path of treatment. Not because trans people are evil, but because these treatments can do more harm than good if they aren't absolutely necessary.

    • To clarify, you're suggesting that you're okay or at least sympathetic to people who suggest jailing your former colleagues because you think your colleagues should employ more diagnostic caution? You're understanding of or even supportive of laws that outright ban gender affirming care because some professionals make professional errors? I'm not in the field, I'm not suggesting your experiences are invalid, but I would suggest you consider the downstream consequences of your sympathies. Gender affirming care may or may not be appropriate for any given case, but I absolutely believe that for some youth it can be life saving. Obstructions or bans can therefore cost lives.

      I also find it interesting how vehemently Musk, Peterson, and others will come out against gender affirming care while remaining silent on issues like the overuse of prescription drugs as a means to treat youth struggles. We give kids mind altering drugs to treat their behavior, often without considering other treatment pathways, and usually without consent. This seems to be the same sort of issue, no? And yet Musk and Peterson are focused on the gender issue instead. Does that not suggest that those you are expressing sympathy for here are not also politically motivated rather than motivated by genuine concern for a child's well-being?

    • Gender affirming therapy is a proven intervention to save lives. What people tell me about their experience of gender doesn't match my own, and I think there is room for other paradigms of gender. But that doesn't fucking matter in the face of saving people from suicide. Whatever alternative you want to suggest has to save lives. It doesn't matter if it matches your personal gender theories or not. That's irrelevant. Gender therapy exists to save lives.

    • Even if you do specifically have gender dysphoria, jumping to gender affirming care is radical. It's not how we treat any other kind of disordered thinking

      Gender Dysphoria is not disordered thinking. That’s exactly why the name was changed in DSM-5 (formerly Gender Identity Disorder in DSM-IV). Or if you prefer, it’s exactly why ICD-11 renamed it to Gender Incongruence and moved it out of the “Mental, Behavioural, and Neurodevelopmental Disorders” section. Shouldn’t a former therapist commenting on the issue know that?

      Does Gender Dysphoria present alongside disordered thinking? Quite often! But that doesn’t invalidate one’s gender identity. Transition didn’t make my F33.2 Major Depressive Disorder, Recurrent Severe magically go away, but it sure is easier to cope with and treat these days. (Well, I guess it’s 6A71.3 now that ICD-11 is out.)

      I think people who can only find relief for their dysphoria by transitioning should be allowed to

      And there we have it: the core of the argument you’re making is that people should only be allowed to transition if a gatekeeper is satisfied it’s the only way they can get relief. And the only way to “show” that is to suffer more and more — unnecessarily! — until someone like you finally believes them, which might never happen. Do you believe trans people genuinely have the gender we say we do? If so, withholding treatment is simply cruel. Or do you not believe us and just think it’s okay for us to “pretend” if nothing else works? That’s not real acceptance.

      There is no medical reason not to try more traditional forms of therapy and medications before pursuing the less understood and riskier treatments.

      Scientists still don’t fully understand how antidepressant medications work. They come with a black-boxed warning (the strongest kind) in the US, and similarly strong warnings in the Canadian product monographs. Benzodiazepines commonly used for anxiety disorders can be extremely risky. Puberty blockers and hormone treatments are better understood and carry less risk in many cases.

      I very much wish the LGBT community could try to understand where moderates like myself are coming from.

      Oh, believe me, we understand exactly where you’re coming from… quite possibly better than you do. You’re only fooling yourself with that “moderate” label.

      And that’s why I wrote this reply out for the bystanders — it’s not actually for you.

    • I understand what you're saying but I don't agree.

      The tweets from Peterson and Musk aren't nuanced arguments that gender affirming care should be one of many options.

      It's hate speech that says lock up the doctors. It motivates haters like this lunatic.

48 comments