Quotulatiousness

March 14, 2024

“The dark world of pediatric gender ‘medicine’ in Canada”

Filed under: Bureaucracy, Cancon, Health, Media, Politics — Tags: , , , , , — Nicholas @ 03:00

The release of internal documents from the World Professional Association for Transgender Health (WPATH) revealed just how little science went into many or most juvenile gender transitions and how much the process was being driven politically rather than scientifically. Shannon Douglas Boschy digs into how the WPATH’s methods are implemented in Canada:

An undercover investigation at a Quebec gender clinic recently documented that a fourteen-year-old girl was prescribed testosterone for the purpose of medical gender transition within ten minutes of seeing a doctor. She received no other medical or mental health assessment and no information on side-effects. This is status quo in the dark world of pediatric gender “medicine” in Canada.

On March 5th Michael Shellenberger, one of the journalists who broke the Twitter Files in 2022, along with local Ottawa journalist Mia Hughes, released shocking leaks from inside WPATH, the organization that proclaims itself the global scientific and medical authority on gender affirming care. The World Professional Association of Transgender Health is the same organization that the Quebec gender clinic, and Ottawa’s CHEO, cite as their authority for the provision of sex-change interventions for children.

These leaks expose WPATH as nothing more than a self-appointed activist body overseeing and encouraging experimental and hormonal and surgical sex-change interventions on children and vulnerable adults. Shellenberger and Hughes reveal that members fully understand that children cannot consent to loss of fertility and of sexual function, nor can they understand the lifetime risks that will result from gender-affirming medicalization, and they ignore these breaches of medical ethics.

The report reveals communication from an “Internal messaging forum, as well as a leaked internal panel discussion, demonstrat(ing) that the world-leading transgender healthcare group is neither scientific nor advocating for ethical medical care. These internal communications reveal that WPATH advocates for many arbitrary medical practices, including hormonal and surgical experimentation on minors and vulnerable adults. Its approach to medicine is consumer-driven and pseudoscientific, and its members appear to be engaged in political activism, not science.”

These findings have profound implications for medical and public education policies in Canada and raise serious concerns about the practices of secret affirmations and social transitions of children in local schools.

These leaks follow on the recent publication of a British Medical Journal study (BMJ Mental Health), covering 25-years of data, dispelling the myth that without gender-affirmation that children will kill themselves. The study, comparing over 2,000 patients to a control population, found that after factoring for other mental health issues, there was no convincing evidence that children and youth who are not gender-affirmed were at higher risk of suicide than the general population.

In the last week, a second study was released, this one from the American Urology Association, showing that post-surgical transgender-identified men, who underwent vaginoplasty, have twice the rate of suicide attempts as before affirmation surgery, and showing that trans-identified women who underwent phalloplasty, showed no change in pre-operative rates of suicide and post-operative.

These and other studies are now thoroughly debunking the emotional blackmail myths promoted by WPATH, that the absence of sex-change interventions, suggest that gender-distressed children are at high risk of taking their own lives.

March 11, 2024

“Is it possible that the new therapy culture and the emphasis on introspection is actually making things worse?”

Filed under: Health — Tags: , , , , , — Nicholas @ 05:00

In Quillette, Brandon McMurtrie asks us to consider why, with more people in therapy than ever before, the overall mental health of the population is declining:

Why has mental health got worse given the prevailing emphasis on self-care and accurately knowing and expressing oneself? And why do people and groups most inclined to focus on their identity appear to be the most distressed, confused, and mentally unwell? Is it possible that the new therapy culture and the emphasis on introspection is actually making things worse?

I am not the first to notice these developments — Abigail Shrier’s new book Bad Therapy has carefully delineated a similar argument. Her arguments are elsewhere supported by research on semantic satiation and ironic uncertainty, the effects of mirror gazing, the effects of meditation, and how all this relates to the constant introspection encouraged by therapy culture and concept creep.

Satiation and Its Effects

Semantic satiation is the uncanny sensation that occurs when a word or sentence is repeated again and again, until it appears to become foreign and nonsensical to the speaker. You may have done this as a child, repeating a word in quick succession until it no longer seems to be recognizable. It’s a highly reliable effect — you can try it now. Repeat a word to yourself quickly, out loud, for an extended period, and really focus on the word and its meaning. Under these circumstances, most people experience semantic satiation.

This well-studied phenomenon — sometimes called “inhibition”, “fatigue”, “lapse of meaning”, “adaptation”, or “stimulus satiation” — applies to objects as well as language. Studies have found that compulsive staring at something can result in dissociation and derealization. Likewise, repeatedly visually checking something can make us uncertain of our perception, which results, paradoxically, in uncertainty and poor memory of the object. This may also occur with facial recognition.

Interestingly, a similar phenomenon can occur in the realm of self-perception. Mirror gazing (staring into one’s own eyes in the mirror) may induce feelings of depersonalization and derealization, causing distortions of self-perception and bodily sensation. This persistent self-inspection can result in a person feeling that they don’t recognize their own face, that they no longer feel real, that their body no longer feels the same as it once did, or that it is not their body at all. Mirror-gazing so reliably produces depersonalization and realization (and a wide range of other anomalous effects), that it can be used in experimental manipulations to trigger these symptoms for research purposes.

[…]

The Satiation of Gender Identity

The number of people identifying as non-binary or trans has skyrocketed in recent years, and a growing number of schools are now teaching gender theory and discussing it with children — sometimes in kindergarten, more often in primary school, but especially in middle- and high-school (though in other schools it is entirely banned). While this may be beneficial for those already struggling with gender confusion, it may also present an avenue for other children to ruminate and become confused via “identity satiation”.

The kind of gender theory increasingly taught in schools encourages children to spend extended periods of time ruminating on self-concepts that most would not otherwise have struggled with. They are given exercises that encourage them to doubt their own unconscious intuitions about themselves, and to ruminate on questions like “Do I feel like a boy?” and “What does it mean to feel like a boy?” and “I thought I was a boy but what if I am not?”

Such questions are often confusing to answer and difficult to express, even for adults unaffected by gender dysphoria. But asking children to ruminate in this way may lead to confusion and depersonalization-derealization via the mechanisms described above. “Identity satiation” may then lead them to decide they are non-binary or trans, especially when identifying as such is rewarded with social recognition and social support. Many people who subsequently de-transitioned have described this process: “I never thought about my gender or had a problem with being a girl before”.

March 10, 2024

The rapid transition from the amazing smartphone to the “pocket moloch”

Filed under: Health, Media, Technology — Tags: , , , , , — Nicholas @ 03:01

Magdalene J. Taylor follows up her New York Times article from last year with more evidence that so many of the social problems identified today are caused by, or at least made worse, by the almost universal addiction to smartphones:

A year ago, I published an opinion essay for the New York Times that changed the trajectory of my career. It was about how fewer Americans are having sex, across nearly every demographic. For any of the usual caveats — wealth, age, orientation — the data almost always highlighted that previous generations in the same circumstances were having more sex than we are today. My purpose in writing the essay was mainly to try to emphasize the role that sex plays in our cultural wellbeing its connection to the loneliness epidemic. Many of us have developed a blasé attitude toward sex, and I wanted people to care. It wasn’t really about intercourse, and I said as much. It was about wanting to live in an lively, energetic society.

Since writing, I have been continuously asked what I think the cause of all this is. Obviously, there isn’t one universal answer. After publishing, I went on radio shows and podcasts and was asked to share what I thought some of them could be. Economic despair, political unrest, even climate fears were among the reasons I’d heard cited. But all of that, honestly, feels pointlessly abstract. It puts the problem entirely out of our hands, when in fact I believe it may quite literally be in them.

The problem is obviously our phones.

In February, The Atlantic published a feature about the decline of hanging out. Within it was a particularly damning graph sharing the percentage of teens who report hanging out with friends two or more times per week since 1976. Rates were steady around 80 percent up until the mid-90s, when a subtle decrease began to occur. Then, in 2008 — one year after the release of the first iPhone — the decrease became much more dramatic. It has continued falling sharply since, hovering now at just under 60 percent of teens who spend ample time with friends each week.

Some of us really don’t like our screen time habits criticized. Others may think they appear smarter by highlighting other issues, that they can see above the fray and observe the macro trends that are really shaping our lives, not that stupid anti-phone rhetoric we hear from the Boomers. And some of these other trends do indeed apply. Correlation does not equal causation. Lots of things happened in 2008. Namely, a financial crisis the effects of which many argue we are still experiencing. When I shared the graph on Twitter/X saying phones are the obvious cause, this was one of the most common rebuttals. Another was the decline in third spaces. There are indeed few places for teenagers to hang out outside of the home. Skate parks are being turned into pickleball courts with “no loitering” signs, malls are shuttering and you can no longer spend $1 on a McChicken to justify hanging out in the McDonald’s dining area for hours. But as the Atlantic piece explains, the dwindling of places to be and experience community has a problem we’ve been lamenting since the 90s. And it’s not just teens — everyone is spending less time together than they used to. “In short, there is no statistical record of any other period in U.S. history when people have spent more time on their own,” the article states.

March 6, 2024

Ted Gioia on escaping from the trap of Dopamine Culture

Filed under: Health, Media, Technology — Tags: , , , — Nicholas @ 03:00

Following up on this hot issue, Ted Gioia has some suggestions to get out of the habit:

My dopamine culture essay is still stirring up lots of discussion. And people have their own stories to share.

For example:

And also:

The same thing is happening everywhere — at concerts, at museums, at work, at church, while driving, or even at a funeral.

But it’s even worse when people don’t even try to multitask, instead abandoning essential life tasks—because of the compulsion to scroll.

I’ve now heard from

  • People who scroll instead of sleeping
  • People who scroll instead of engaging in physical activity
  • People who scroll instead of finding a life partner, or connecting with flesh-and-blood people
  • People who scroll instead of gaining skills, finding a job, and pursuing a vocation
  • Etc.

I originally focused on the impact on arts and creativity—because that’s the world I live in. I was worried that people had no patience for a movie or concert or book, because they can only digest stimuli in 15-second bursts.

But I now see that the problem is much, much bigger.

It’s almost quaint to worry about these screen zombies not reading books. The simple fact is that, increasingly, their entire life is suffering because of a technology shift imposed on them by Silicon Valley.

These addictive and compulsive behaviors are troubling. But even more disturbing is how the largest corporations in the world are investing billions in promoting and accelerating this compulsive use of their tech tools.

If you look at the 10 largest companies in the world, half of them are trying to create this addictive relationship to technology. The days when the dealer in addiction had to hide in the shadows are over. They now operate freely in your home, and every other sphere of your life.

A few days ago, I promised to offer concrete suggestions for dealing with this. Some of these are listed below.

February 26, 2024

Time to pry the smartphones from the clutches of our dopamine-addicted youngsters?

Filed under: Britain, Education, Health, Media, Technology — Tags: , , , , — Nicholas @ 05:00

A couple of articles this weekend deal with the already acknowledged problem of dopamine addiction especially among the young whose brains and personalities are still in the formative stages. First, here’s Christopher Gage reporting with some delight that British schoolchildren are going to have to learn how to cope with a full school day without the electronic binkies they’ve grown so dependent on:

Detail of an article at bankmycell.com

I long for the day when gawking at one’s phone like a lobotomy patient invokes derision. Don’t you know your filthy addiction pollutes every atom of our society? You selfish bastard. You perverts should be ashamed of yourselves, etc. That day is on the horizon.

This week, British lawmakers banned smartphones in schools. Those pocket perils are lobotomising those whom sentimentalists call “the nation’s future”. Denied their devil devices, schoolchildren will endure hours of reading, thinking, and writing. Heaven forbid, they’ll talk to their friends and teachers in flesh and blood.

In these matters, I am militant. Children are not vessels of wisdom and wonder corrupted by a cruel world. They’re ignorant. By teaching them how to think and live, adults civilise children. That bleeping burping buzzing beehive in their pockets renders that civilising mission impossible.

Many disagree. But their knee-jerk reaction to this “knee-jerk reaction” crashes against concrete evidence. Smartphones erode concentration, dull critical thinking, blunt memory, and shred retention. The monstrous equation: Smartphones plus face-hugger apps equals ignorant, depressed, anxious youths.


Yes, technology invites moral panic. Plato worried that the written word would mulch minds into mush. But this is serious.

Last year, Dr Vivek Murthy, the United States surgeon general, issued a rare public health advisory. Across 19 pages, Dr Murthy warned that the effects of social media on adolescent mental health were “not fully understood”.

“There are ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents,” he said.

And what did we say? Not much. We had more important matters to attend. If I remember correctly, on that very day, Kim Kardashian revealed on Instagram her latest arse or her newest boyfriend.

However, serious people think this is a serious problem. Dr Benjamin Maxwell, a director of child and adolescent psychiatry at Rady Children’s Hospital in San Diego, said he is “immensely concerned” by a study linking social media and poor mental health. That “highly stimulating environment” may corrode “cognitive ability, attention span and memory during a time when their brains are still developing,” Maxwell said. “What are the long-term consequences? I don’t think we know.”

The UN’s education, science, and culture agency says the more young Jack scrolls through TikTok and the like, the lower his grades sink.

Countless studies show smartphones and their face-hugger apps — designed by behavioural psychologists to addict and milk the user — worsen anxiety, depression, and self-esteem. Not to mention lining up children for the predation of bullies 24/7.

Psychologists Jonathan Haidt and Jean Twenge are the canaries in the cultural coalmine. They say HMS Progress is crashing toward the icebergs — rising rates of suicide, depression, and anxiety. To them, the evidence is almost irrefutable. Turn back now, they say, or the ship sinks.

The second item is a follow-up by Ted Gioia to his post on dopamine culture last week:

My article on “dopamine culture” has stirred up interest and (even more) raised concerns among readers who recognize the symptoms I described.

One of the illustration went viral in a big way. And I’ve gotten requests from all over the world for permission to translate and share the material. (Yes, you can all quote generously from the article, and reprint my charts with attribution.)

This image was shared widely online

But many have asked for more specific guidance.

What can we do in a culture dominated by huge corporations that want us to spend hours every day swiping and scrolling?

I find it revealing and disturbing that readers who work on the front lines (in education, therapy, or tech itself) expressed the highest degree of alarm. They know better than anybody where we’re heading, and want to find an escape path.

Here’s a typical comment from teacher Adam Whybray:

    I see it massively as a teacher. Kids desperately pleading for toilet breaks, claiming their human rights are being infringed, so they can check TikTok, treating lessons as though they’re in a Youtube reaction video, needing to react with a meme or a take — saying that silence in lessons scares them or freaks them out.

    One notable difference from when I was at school was that I remember a lesson in which we got to watch a film was a relief or even pleasurable (depending on the film). My students today often say they are unable to watch films because they can’t focus. I had one boy getting quite emotional, begging to be allowed to look at his phone instead.

Another teacher asked if the proper response is to unplug regularly? Others have already embraced digital detox techniques of various sorts (see here and here).

I hope to write more about this in the future.

In particular, I want to focus on the many positive ways people create a healthy, integrated life that minimizes scrolling and swiping and mindless digital distractions. Many of you have found joy and solace — and an escape from app dependence — in artmaking or nature walks or other real world activities. There are countless ways of being-in-the-world with contentment and mindfulness.

Today I want to discuss just one bedrock of real world life that is often neglected — or frequently even mocked: Ritual.

I know how much I rely on my daily rituals as a way of creating wholeness and balance. I spend every morning in an elaborate ritual involving breakfast, reading books (physical copies, not on a screen), listening to music, and enjoying home life.

Even my morning coffee preparation is ritualistic. (However, I’m not as extreme as this person — who rivals the Japanese tea ceremony in attention to detail.)

I try to avoid plugging into the digital world until after noon.

I look forward to this daily time away from screens. But my personal rituals are just one tiny example. There are many larger ways that rituals provide an antidote to the more toxic aspects of tech-dominated society.

Below I share 13 observations on ritual.

February 16, 2024

“… the rise in emotional disturbance among young women correlates precisely with the introduction of the smart phone”

Filed under: Health, Liberty, Media, Technology — Tags: , , , , , — Nicholas @ 05:00

At Postcards from Barsoom, John Carter sets off all the alarms with a proposal to address the burgeoning issue of social media addiction and the closely correlated rise in mental health issues among young women:

The psychic breakdown of the young Western female has been the defining political phenomenon of the twenty-first century. Women are suffering from depression, anxiety, neurosis, and dysphoria as never before, they’re drugged to the gills to deal with it, and they’ve got the SSREyes to prove it.

This isn’t only a problem for young women. Their suffering is everyone’s suffering. The romantic paranoia engendered by MeToo, a mass hysteria that has grown directly out of this plague of neurosis, has destroyed courtship among the young. As a result a shocking fraction of young men are virgin incels, while their femcel counterparts are contemplating a future where 45% of them will be childless. Driven by their neglected ovaries to latch on to surrogate children in the form of migrants and minorities, and entering into lesbian civil unions with the Mammy State, childless women overwhelmingly vote left – as always, the party of the psychically distressed thrives to whatever degree it cultivates psychic distress. The political derangement is downstream of their emotional derangement, and the two feed on one another in a vicious spiral of crazed minds pushing crazed policies that craze minds yet further, a cycle that threatens to break civilization, either gradually through steady demographic deflation and spiritual demoralization, or perhaps – if the young men alienated by a society that has ruined their women cease stupefying themselves with porn, and cohere as an army – more catastrophically.

There’s no real mystery as to why this has happened.

Jonathan Haidt has demonstrated at length and in extraordinary empirical detail that the rise in emotional disturbance among young women correlates precisely with the introduction of the smart phone, and the mass migration of social lives onto social media that immediately followed. The slot machine engineers of Silicon Valley trapped the world’s young women in a Skinner box by hacking their instinctive sexual competition strategies. Suddenly every young girl in the world was measuring herself against every other young woman, all viewing one another through the distorting filters of flattering camera angles, ruthlessly curated digital photographs, makeup, plastic surgery, and AI filters that smoothed wrinkles, removed blemishes, and reduced unwelcome poundage. On the Internet no girl is ever the prettiest girl in the room, or even the second or third prettiest. Meanwhile they’re flooded with a relentless barrage of that most intoxicating of drugs: male attention.

Of course they went mad.

They’re all wandering around in a state of selfie-shock.

February 6, 2024

On gender issues, “Progressives may even find themselves — dare we say? — on the wrong side of history”

Filed under: Cancon, Government, Health, Media, Politics — Tags: , , , , , , — Nicholas @ 05:00

In the portion of The Line‘s weekly dispatch that’s visible to freeloaders, the editors discover to their horror that they have to weigh in on the gender fracas:

So to be clear, we really don’t have any problem with Alberta restricting elective gender-related surgeries on minors under the age of 17. While we are rather concerned about the use of puberty blockers and cross-sex hormones among minors, we also suspect that trying to ban these drugs for absolutely everyone under a certain age represents an overreach by the state.

Also, bluntly, we don’t think that in an ideal world, the state should be involving itself in most of this stuff at all. We want to exist in a country in which sports leagues, doctors, schools and teachers can be trusted to make sensible, evidence-based decisions on a case-by-case basis.

Take sports, for example: does a rec-league pickleball tournament need to have the same rules around trans participation as a competitive women’s rugby league? And do we really want any state regulation bulldozering over the people who are actually on the ground, and best understand the physical and cultural realities of that sport?

Or take puberty blockers.

Should we really be treating a 12-year-old who has displayed severe and crippling gender dysphoria since the age of three with the same treatment protocol as a depressed 14-year-old boy who comes into the gender clinic for the first time attached to a Munchausen-by-Proxy mom documenting every moment of her child’s transition for TikTok? Do we want politicians in Edmonton writing the precise rules that will be faithfully applied in both those situations?

Sigh.

We understand how we got here. Any discussion around trans issues is now highly insane; in a hyper-polarized, borderline hysterical moment, we actually can’t trust our institutions to possess the requisite reserve and dispassion needed to make credible and defensible decisions. These institutions are, or are perceived to be, too ideologically captured to be trustworthy.

For an example that just happened to cross our path today, take this quote from Dr. Simone Lebeuf, a pediatrician in Edmonton who specializes in gender-diverse youth. In it, she notes that restricting puberty blockers to children over the age of 15 effectively makes the treatment useless, as they would be administered at an age well past the onset of puberty.

“It’s done. The window has passed,” the doctor told City News. “And we really look at puberty blockers as an option for kids to have some space and time to make decisions about their future selves and who they might want to be as adults. Their puberty is not benign, it is not a nothing process to go through. The physical changes with puberty are permanent.”

Right off the bat, a statement like this ought to raise eyebrows, and not only because it’s a talking point we’ve already heard dozens of times on TikTok. This doctor — a physician who is actually treating children — is conflating the harms caused by artificially delaying a natural process with the apparent harms caused by the biological process itself. That logic is not sound. There is a clear difference between, say, permanent loss of sexual function and bone density caused by interfering in the natural course of puberty, and the harm of allowing a child’s body to grow an Adam’s apple despite that individual feeling like a woman.

Secondly, Dr. Lebeuf isn’t addressing the core concern with puberty blockers, above and beyond their physical side effects. The majority of children who present with gender dysphoria are not trans. Most of them turn out to be simply gay — a fact they discover via the process of growing up and sexually maturing. By delaying or denying a gender dysphoric child the opportunity to experience normal puberty, critics of these treatment protocols fear that a doctor may be preventing the very process by which gender dysphoria would resolve itself without medical intervention. Most — certainly not all, but most — gender dysphoric children would otherwise grow up to be at ease with their natal sex. But once kids start with the puberty blockers and then cross-sex hormones, this process of medical transitioning may be psychologically self reinforcing, pushing physically healthy minors into pursuing more and more unnecessary and invasive interventions with serious lifelong consequences.

In short, puberty blockers are not magic cures for gender dysphoria. They might be appropriate for some kids with lots of supports and monitoring. But they could be disastrous for others, and we have no foolproof way to know in advance which kids will fall into what camp.

This stuff is complicated, and it’s made more so because it’s difficult to study objectively in ideologically captured environments dominated by activists on all sides who muddy the waters with emotionally charged rhetoric, and confuse good science with bad. If you want to understand why people are turning to Danielle Smith instead of the Alberta Medical Association to address their fears, quotes like the one above are a prime example.

And, by the way, we include “The Media” writ large as having failed on this file. The lack of skepticism and neutrality that the media has demonstrated on even the most maximalist and unpopular positions on gender and sexuality has — to our mind — significantly contributed to the radical decline in its collective credibility.

January 26, 2024

Why isn’t Trump Derangement Syndrome or Biden Derangement Syndrome in the DSM?

Filed under: Health, Media, Politics — Tags: , , , , — Nicholas @ 04:00

At Astral Codex Ten, Scott Alexander wonders if the kind of political insanity that takes over the lives and personalities of so many Americans should qualify as a kind of mental dysfunction:

Everyone knows politics makes people crazy. But what kind of crazy? Which page of the DSM is it on?

I’m only half joking. Psychiatrists have spent decades developing a whole catalog of ways brains can go wrong. Politics makes people’s brains go wrong. Shouldn’t it be in the catalog? Wouldn’t it be weird if 21st century political extremists had discovered a totally new form of mental dysfunction, unrelated even by analogy to all the forms that had come before?

You’ll object: politics only metaphorically “makes people crazy”; we just use the word “crazy” here to mean “irrational” or “overly emotional”. I’m not sure that’s true. Here are some stray findings that I think deserve to be synthesized:

  • Very smart people lose basic reasoning abilities when the topic switches to politics. This isn’t just a truism, it’s been demonstrated in formal experiments. You can give people simple math/logic problems and confirm that they get the right answers. Then you can change the wording from “five apples and eight oranges”, to “five Democrats and eight assault weapons” and these same people will flounder and say idiotic things.
  • Paranoia and conspiracy theories, considered psychotic symptoms in individuals, are almost the norm in politics. Forget the people who believe that Biden/Trump/FEMA/whoever literally want to put them in camps. The coastal elites/the patriarchy/the rich/the liberal media may all be real groups with agendas different from yours, but the way some people think about them actively plotting to dismantle everything good in the world shades into paranoia (if you don’t believe this about your side, at least consider it on the other!) I’m not just making fun of other people, I find myself making this mistake constantly.
  • Politics can create such strong emotions that they impair normal social functioning. People mock college students who demand trigger warnings whenever they have to listen to a conservative speaker. But I’ve talked to some of these college students and they’re not making it up — they find listening [to] a politically discordant opinion is as unpleasant as (let’s say) a claustrophobic person sitting in an enclosed space. If you’re a right-winger who feels tempted to dismiss this response, imagine having to sit through a six-week diversity training workshop and give the answers the lecturer wants or else you’ll fail. Obviously you could just fake the right answers and fly through easily, but doesn’t something about this still sound profoundly enraging and invalidating on a deep level? Enraging even beyond the level of (for example) having to fake the right answers in a class on acupuncture because you’re doing an undercover investigation or something?
  • Politics can become something between an addiction and an obsession. People can spend hours every day watching cable TV or scrolling through their Twitter feeds, trying to stay abreast of the latest outrage the other side is perpetrating. To be clear, they hate this. Each time they hear another outrage they’re somewhere between dejected and enraged. But they keep doing it. For hours a day. They will justify this with claims like “I need to stay informed so I can make a difference”. Then they will forget to vote because they were tired on Election Day.

In any other situation, a condition with impaired cognition, psychotic symptoms, emotional instability that impaired normal functioning, and associated addictions/obsessions would qualify as a mental disorder. So again, which mental disorder is it?

This post is about the possibility that it might be trauma.

December 19, 2023

Behind enemy lines at the WPATH symposium

Filed under: Cancon, Health, Media, Politics — Tags: , , , , — Nicholas @ 05:00

Eliza Mondegreen reports her experiences at the World Professional Association for Transgender Health gathering in Montreal last year:

This was no ordinary medical conference. Over the course of three days, I learned a great many things. That eunuchs are one of the world’s oldest gender identities and that doctors should not judge their strange desires for castration but fulfil them. That, “ideally, patients wouldn’t be actively psychotic” when they initiated testosterone, but that psychotic patients consent to take medication like stool softeners and statins all the time and “people don’t pay that much attention”. That it would be “ableist” to question an autistic girl’s insistence on a double mastectomy. That patients who claim to have multiple personalities that disagree about which irreversible steps to take toward transition can find consensus — or at least obtain a quorum — using a smartphone app.

It is hard to shock me these days — but as I moved around the World Professional Association for Transgender Health’s symposium in Montreal in September 2022, I often felt as if I’d slipped sideways into some strange universe that operated in accordance with other laws: where up is down and girls are boys and medicine has left its modest brief — healing — far behind in its breathless pursuit of transcendence.

I wasn’t really supposed to be there. I hadn’t misrepresented myself — I am what I claimed to be: a graduate student researching gender identity — but this was a convocation for believers and I’m a sceptic. When WPATH, the world’s most prestigious and influential gathering in transgender healthcare, came to Montreal, I couldn’t resist the opportunity to see up close the people and ideas I had pursued through so many articles and books.

[…]

It’s difficult to imagine clinicians practising in other areas of medicine not asking such basic questions, especially when the basis for treatment is so murky. But a good gender clinician, looking at a patient, does not see what non-believers like you or I might see. A good clinician falls under the sway of the same fantasy as the patient and conspires with her to bring her transgender self into existence. Under this framework, there is no “really trans” or not. There is only what the patient says and the readiness of the clinician to put herself at the service of the patient’s vision.

A bad gender clinician, by contrast, feels an “entitlement to know” why a patient feels the way she does or why she seeks a particular intervention. She clings to a traditional conception of her role as a “gatekeeper” who evaluates and prescribes. She thinks she can “discern a ‘true’ gender identity beyond what is articulated by the patient”. She may believe she can “identify the ‘root cause’ of a transgender identity”, which is seen as pathologising. She may try to leave the door open to desistance — the most common outcome before gender clinicians started interfering with normal development by deploying puberty-blocking drugs — in which case she is guilty of “valuing cis lives over trans lives”.

A bad gender clinician is easily “intimidated” by complicated patients, while a good gender clinician knows how to secure consent even in the trickiest cases. Mental health difficulties become “mental health differences”. Severe autism or thinking you have multiple personalities living inside your head become empowering forms of “neurodiversity”. When it comes to assessment, “careful” and “comprehensive” have become dirty words: “The answer always seems to be more assessment and more time. That’s gatekeeping.”

During the Denver conference, presenters role-played how to secure informed consent for a hysterectomy and phalloplasty in the case of a schizophrenic, borderline autistic, intellectually disabled “demiboy” with a recent psychiatric hospitalisation. At no point do the role-players encounter any real barriers. Instead, they persevere. At first, the patient struggled to understand why a phalloplasty might require multiple surgeries, but then the clinicians “explained everything” and the patient understood. This is called “lean[ing] into the nuance of capacity”.

The moral of this story is clear: failure to achieve informed consent is a failure on the part of the clinician, a failure of imagination and flexibility, not a recognition that some patients — whether because of age or mental illness or intellectual disability — will simply not be able to consent.

November 8, 2023

Reality will continue to be real long after you can keep on denying it

Filed under: Media, Politics, USA — Tags: , , , — Nicholas @ 05:00

But, as Chris Bray illustrates, some people have truly heroic reality-denial complexes going on and they want you to deny reality along with them:

Hey, look, it’s the zeitgeist.

No one knows what to do. About this:

    Court records show the man who pushed Whitcomb currently faces charges ranging from harassment and menacing to assault and illegal possession of a knife. He has also been accused of groping and assaulting women on the north side of the neighborhood and is on the state’s sex offender registry for forcible touching and sexual abuse convictions in 2017 and 2021.

He hurts people a lot, and he’s a registered sex offender, and he sometimes carries a knife, and he walks up to strangers on the street and just hurts them for no reason, and he especially likes to hurt women quite a lot, especially in ways that seem pretty consistently sexual. It’s … complicated. Hard to know what to do!

Note that the story takes care to avoid identifying the person the story is about, because the reporter is concerned that identifying the serial aggressor will make it possible for someone to hurt him: “Gothamist has chosen to withhold the man’s name because of his mental illness and because he is at risk of additional attacks by people who want to take matters into their own hands”. And hurting people is wrong. To prevent attacks, see, you don’t tell people the name of a person who keeps … attacking.

The story warns that the constant aggression of [unnamed person] is a warning about “the systemic failures that allow people to fall through the cracks,” because what a man hurting people over and over again shows us is that the man who’s being forced to hurt all those people by society’s deep cruelty isn’t getting enough services. Greenpoint, an increasingly expensive neighborhood in Brooklyn, is represented by “some of the city’s most progressive lawmakers”, but they’re still struggling with these hard questions. America in 2023, ladies and gentlemen.

But finally, as a test of the reporter’s good faith, we get a broader description that contextualizes the problem. There are a lot of people in New York City who are being forced to hurt other people because they aren’t being given enough services, and here comes a famous example: “Earlier this year, Daniel Penny fatally choked Jordan Neely, a beloved Michael Jackson impersonator who Penny said was ‘going crazy’ and acting aggressively toward fellow subway riders.”

That’s it — that’s the whole description. Who was Jordan Neely? He was a man who impersonated Michael Jackson, and he was loved a whole lot, but then for some unaccountable reason Daniel Penny claimed the beloved man was going crazy, so he just suddenly killed the poor man. It’s strange that this Penny person would say something like that, right?

Now, in a city of eight million people, Jordan Neely was on a list, kept by the city government, of the fifty homeless people whose behavior is most persistently troubling. His case was regularly monitored by the “Coordinated Behavioral Health Task Force”, which “consists of workers from across city government, including the departments of Health, Homeless Services and Hospitals, along with representatives of the nonprofits that the city contracts with to try to connect homeless people to shelter and services, a process known as outreach”. At the time when the mean Daniel Penny suddenly killed him for no reason, Neely had an active arrest warrant. And other passengers in the subway car said that — well, let’s turn to the headline in the New York Times: “Witnesses in Subway Chokehold Case Describe Fears of Death and Violence“.

September 25, 2023

Something, something “sins of the fathers”, something, something Elon Musk

Chris Bray provides an example of how “mainstream psychosis” has become the new normal, at least among academics and our so-called “elites”:

My argument is not “the news media lies”, or “there’s a lot of misleading discourse”. My argument is that whole overlapping layers of high-status America — in academia, in media, and in politics — are psychotic, fully detached from reality and living in their own bizarre mental construction of a fake world. I don’t mean this figuratively, or as colorful hyperbole. I mean that the top layers of our most important institutions are actually, literally populated by people who are insane, who have cultivated a complete mental descent through the looking glass.

So: Jill Lepore.

Lepore is as high-status as it’s possible to be. She holds an endowed chair at Harvard, she has a Bancroft, and she’s been on the masthead at the New Yorker for almost two decades. She has about as much institutional validation as an academic historian can get. And she just published an essay that wouldn’t be out of place in foot-high crayon letters on the wall of a mental institution.

“What happened to antisemitic rants before social media”, is the actual subhed. You see, before Twitter, people who said that Jews were bad were very marginal, and no one ever listened to them. At the risk of giving away too much personal information, I’m writing this in a bar, and the bartender is giving me some fairly aggressive side-eye over the burst of nervous laughter that I just dropped. Musk’s grandfather was named J.N. Haldeman, and he wrote a lot about how much he didn’t like Jews, and here’s what Lepore has to say about that:

    But Haldeman’s legacy casts light on what social media does: the reason that most people don’t know about Musk’s grandfather’s political writings is that in his lifetime social media did not exist, and the writings of people like him were not, therefore, amplified by it. Indeed, they were very unlikely to circulate widely, and are now quite rare.

Jill Lepore has a PhD in history, and she thinks that antisemitic speech was quite rare before social media. Here’s a link to a non-paywalled version of the essay, and I encourage you to go read it. Otherwise you’re going to struggle to believe me. See for yourself, and then come back and I’ll talk about it.

How, if you want to argue that negative statements about Jews had little reach before social media, do you explain … Jewish history? Why didn’t they have time for the bread to rise, Jill? Before Twitter, screeds against Jews “were very unlikely to circulate widely,” except for, I don’t know, Mein Kampf? We dip the parsley in the salt water to remember the bitter tears of our ancestors, who never faced any antisemitism because it was very marginal and never allowed to circulate widely.

It gets better, though, because Haldeman was born in Minnesota, then raised in Canada, and then moved to South Africa two years after the formal implementation of apartheid. He wrote white supremacist tracts in apartheid South Africa, and Lepore maintains that the reach of his racist literature was sharply limited by the absence of social media. See, it was very rare to be able to read racist views in apartheid South Africa.

September 18, 2023

QotD: Feelings

Filed under: Media, Politics, Quotations — Tags: , , , — Nicholas @ 01:00

The desire not to have one’s feelings hurt has been erected into a right, a right increasingly enforceable at law. Of course, not everyone’s feelings are treated with the solicitude that we show to a nice fluffy colorful species of animal that is, regrettably, on the verge of extinction. But there is no doubt that treating people’s feelings with this solicitude tends not only to preserve them but to cause them to flourish and multiply. The more you are preserved from hurt feelings, the more of them you have.

Theodore Dalrymple, “Once More With Feelings”, Taki’s Magazine, 2017-05-13.

September 11, 2023

QotD: The nature of human memory

Filed under: Health, Media, Quotations — Tags: , , — Nicholas @ 01:00

Perhaps the best newspaper columnist is the one whose columns are the least predictable? That may be going too far: too much novelty is exhausting, and we need an anchor for our expectations. But I well recall a friend saying that her favourite newspaper pandered to her preconceptions so much she didn’t really need to bother reading it; she could just think hard about everything she already held true. We scribblers should hope to do better.

One would not want a life of endless novelty, if only because that would mean a procession of superficial impressions and comparisons. Static, surprisingly, is impossible to compress without losing information, because its randomness makes prediction or interpolation impossible. Yet static is also meaningless. Too many random novelties, too fast, produces a lived experience not unlike static.

One of the virtues of experience is that it can attune us to subtle details and deep connections: “a world in a grain of sand, and a heaven in a wild flower”. (It may also allow us to draw out meaning from a brief allusion to a larger body of work.) But if repeated experience becomes humdrum, and we do not look for the depths, our days will be thin and forgettable.

So if you want a full life, rich with memories, keep searching for new experiences. That is far easier for the young than the old, but it should be possible for anyone. Surprising conversations are always there for the having and, while a holiday on the other side of the world is a costly (if reliable) source of vivid experiences, novelty is affordable for almost anyone in the form of new music, books, even walking an unfamiliar path through your own home town. It is always worth seeking out whatever is excellent — but for vivid memories, the same old excellence is not quite enough. Freshness matters, too.

Tim Harford, “Why going on holiday gives us more memories”, Financial Times, 2019-04-26.

September 6, 2023

QotD: Functional delusions

Filed under: Health, Humour, Quotations — Tags: , , — Nicholas @ 01:00

Many of us go to our graves thinking that if only we had had enough time we should have triumphed in some way or another. A few of my patients claimed that, had it not been for some trifling injury to them that was somebody else’s fault, their career would have taken off, as in fact it was just about to do before the injury was done them. This was absurd, for — objectively considered — there was no indication that they would ever have amounted to very much. On the whole, overweight 38-year-olds do not become world-famous athletes, nor do people become concert pianists who take up the piano at the age of 50. But my patients would claim compensation as if their new careers were established fact rather than mere fantasy.

Did they really believe what they were claiming? The human mind, as I am sure many people will by now have observed, is a complex instrument, and works at several levels at the same time. Hence one can be sincere and fraudulent at the same time. It isn’t necessary to be a psychoanalyst to believe in the reality and prevalence of self-deception; indeed, it is necessary to be a kind of Candide not to believe in them, and to be utterly impervious to self-examination into the bargain.

Theodore Dalrymple, “The Grand Illusion”, Taki’s Magazine, 2017-08-19.

September 3, 2023

Online dating apps

Filed under: Health, Media, Technology, USA — Tags: , , , , , , — Nicholas @ 05:00

The modern dating scene is evidently catastrophic for the majority of men:

After all, dating apps digitally castrate 85 percent of men.

On Bumble, sixty percent of women say they’re looking for a six-foot-tall or taller man. Just 30 percent will drop their requirements one inch lower. Just 15 percent of women would consider a man just one inch shorter than the average 5’9 man. Shorter than that? Your chances fall with each descending inch. Understandably, 80 percent of men lie about their height. Why? Dating apps are merciless, Latin American economies. Most women on dating apps like Tinder and Bumble seek the top 20 percent of men, leaving the rest to compete for a small portion of the dating pool. Reader, I’m not bearing a tall grudge from a short height, I’m six-foot-two.

When I was younger, we used to meet people in person. This antiquated exercise was meritocracy in action.

For the genetically ungifted, that is, the ordinary 80 percent of men, this was the great leveller.

No matter how short or aesthetically unblessed, meeting in person gave all a fair hearing. As the great Christopher Hitchens once wrote, there’s a good reason why men employ humour and why women tend to value a man’s mastery of humour.

Dating apps are anti-merit. Essentially, they provoke a biological feudalism that determines your prospects before you escape the womb.

The 5’9 guy with good humour, high intelligence, seasoned wit, and good manners? Nope.

Social media mutates the ideal into the ordinary. Every man is six-foot-plus. Every woman resembles a Reality TV star: big lips, ballooning bum, bouncing boobs.

In this strange, digital landscape, some porn-addled men use dick pics as a greeting. Three-quarters of women have endured such “greetings”.

Dating apps are a primitive world in which some men say “hello” by showing you their rather ugly organs.

Offline, leery weirdoes masturbating vigorously (Is there any other way?) on the night Tube often end up in jail or in the newspaper. Endearingly, the Daily Telegraph still calls this “performing a sexual act” as if on a stage before a ticket-waving audience and a shrivel of critics.

Reader, I’m no reactionary prude — I’m spiritually French — the only people on earth a majority of whom think adultery is an invigorating hobby rather than a grave sin.

The business of life works better without a screen and an algorithm.

Unsurprisingly, presenting oneself as a product on the “dating marketplace” degrades self-esteem, afflicts mental health, and corrodes our sense of reality. I’m no philosopher, but maybe our burgeoning mental health crisis has something to do with our living as if products on a shelf to be thumbed over by complete strangers.

As Rob Henderson reported last year, the world of dating apps is a hellscape for everyone but the tiny minority of men who get a “swipe right” from vast numbers of women:

Some findings on dating apps:

  • 18 to 25 percent of Tinder users are in a committed relationship.
  • Women aged 23 to 27 are twice as likely to swipe right (“liked”) on a man with a master’s degree compared with a bachelor’s degree.
  • Men swipe right (“liked”) on 62 percent of the women’s profiles they see; women swipe right (“liked”) on only 4.5 percent of the men’s profiles they see.
  • Half of men who use dating apps while in a committed relationship reported having sex with another person they met on a dating app. All women who used dating apps while in a committed relationship reported having sex with another person they met on a dating app.
  • 30 percent of men who use Tinder are married.
  • In terms of attractiveness, the bottom 80% of men are competing for the bottom 22% of women and the top 78% of women are competing for the top 20% of men.
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