Most men get over the strippers-and-sports-cars overreaction pretty quickly, generally to be replaced by a new outlook on life. The guys who have come through the midlife crisis are generally a lot better people — more focused, more outgoing, far less materialistic — because they’ve taken up, however briefly, the perspective of Eternity. If you’re religious, you wonder if you’ll merit heaven. If you’re not, you wonder how you’ll be remembered. Either way, you start thinking about the kind of world you want to leave behind you, and what you’re going to do to achieve it with whatever time is left to you.
Which is why I’ve found the COVID overreaction so bizarre. Realizing your own mortality changes things. You can always tell, for instance, when it has happened to a younger person — when they come home, combat vets often act like middle-aged men going through a midlife crisis. Readjustment to civilian life is hard. Read the great war narratives, and it’s clear that none of them ever really “got over it”. Robert Graves and Ernst Junger, for instance, both lived to ripe old ages (90 and 103, respectively), and were titans in fields far removed from battle … and yet, the war WAS their lives, in some way we who haven’t been through it will never understand, and it comes through in every line they wrote.
If the Covidians were really freaking out about COVID, then, I’d expect one of two broad types of reaction: Either party-hearty midlife crisis mode, or a new determination to get on with whatever’s left of life. Obviously neither of those are true, and I just can’t grasp it — these might be your last few weeks on Earth, and that’s how you’re going to spend them? Sitting in your apartment like a sheep, wearing a mask and eating takeout, glued to a computer screen?
If you want a measure of just how feminized our society has become, there you go. Call this misogyny if you must, but it’s an easily observed fact of human nature — indeed, it has been observed, in every time, place, and culture of which we have knowledge — that post-menopausal women go a bit batty. Though a man might know for certain that he dies tomorrow, he can still keep plugging away today, because he’s programmed to find real meaning in his “work” — we are, after all, running our snazzy new mental software over kludgy old caveman hardware.
Women aren’t like that. They have one “job”, just one, and when they can’t do it anymore, they get weird. In much the same way high-end sports cars would cease to exist if middle aged men ceased to exist, so there are entire aspects of culture that don’t make sense in any other way except: These are channels for the energies of post-menopausal, and therefore surplus-to-requirements, women. You could go so far as to say that pretty much everything we call culture — traditions, history, customs — exist for that reason. Women go from being the bearers, to being the custodians, of the tribe’s future.
Severian, “Life’s Back Nine”, Rotten Chestnuts, 2021-05-11.
April 17, 2024
QotD: The mid-life crisis, male and female versions
April 9, 2024
April 5, 2024
April 1, 2024
March 14, 2024
“The dark world of pediatric gender ‘medicine’ in Canada”
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?”
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
March 6, 2024
February 26, 2024
February 16, 2024
February 6, 2024
On gender issues, “Progressives may even find themselves — dare we say? — on the wrong side of history”
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?
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
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
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“.