Part 4: Reversing the Damage of “Irreversible Damage: The Transgender Craze Seducing Our Daughters”. Therapy and Theory.
Chapter Six
Titled “The Shrinks”, chapter six focuses on the gender affirmative model of care. The chapter, like others before it, is interspersed with snide comments towards trans-identified adolescents which makes it seem like a bad faith attempt to explore the subject. Nevertheless, Shrier (2020) presents several tenets of this model (and gender affirmation more generally) incorrectly and it’s worthwhile to explain why in order to accurately represent said model.
Tenet 1: Adolescents know who they are.
The model doesn’t make this assumption. One goal is to help parents understand and cope with the notion that they can’t know how their child will identify as an adult. Therapists are encouraged to be open-minded and listen to a child carefully. They should attempt to determine whether an issue is most likely due to gender dysphoria or something else [1].
Shrier (2020) asserts multiple times that therapists actively encourage medical intervention in children who present with gender dysphoria without giving them a thorough evaluation or considering other possible conditions/factor contributing to their status. While no one can say for certain that all therapists are always ethical and always follow the most current guidelines, that isn’t the guidance provided by the model or the experts in the field of gender-related healthcare.
As a caveat: malpractice is a real thing and shouldn’t be ignored, but Shrier doesn’t present evidence of mass malpractice from therapists. The bigger issue in this case is ensuring therapists are adequately educated on gender identity to be able to provide quality care.
Tenet 2: Social transition and affirming equals a no-lose situation.
Shrier’s (2020) overall point is “that social transition is not nothing”. That’s absolutely true.
· Parent affirms and allows a social transition: That’s something.
· Parent doesn’t affirm and bans social transition: That’s something.
· Parent ignores child’s gender expression and disregards pronoun/name preferences but never explicitly addresses identity: That’s something.
It’s impossible to have a truly neutral, “nothing” response because even ignoring something is a response. However, it doesn’t follow that because social transition is actively doing “something” that it isn’t a no-lose scenario.
The reason behind the claim that there’s nothing to lose with affirmation and social transition is that it’s as temporary or permanent as the child wants it to be. On the contrary, choosing not to affirm or even outright prohibit social transition has been shown to lead to worse psychosocial outcomes for children [1]. So yes, affirming a child is definitely doing something, but doing something doesn’t automatically entail a losing scenario is possible.
Tenet 3: Not affirming can lead your child to commit suicide.
Shrier (2020) presents this as parents having a gun to their head: Either affirm the child or they’ll die, forcing them to concede and “give in” to the child’s demands. This isn’t a fear tactic professionals use in order to manipulate parents into giving children what they want. This isn’t about circumventing discipline and good parenting.
Imagine a medical professional chooses not to disclose possible complications, however likely or remote of a possibility they might be, and said complications occur. That provides excellent grounds for a lawsuit. Informed consent means that even uncomfortable events must be discussed. If a medical professional tells a parent about this possibility, it’s in the interest of providing full information with reference to what we currently know.
Tenet 4: One’s gender identity is immutable and conversion therapy doesn’t work.
The immutable part has already been partially discussed under tenet 1. Therapists are expected to understand the struggles that come with understanding your own identity.
Conversion therapy doesn’t work [1]. However, as noted above, therapists are encouraged to critically evaluate patients and try to figure out what might be due to factors outside of gender dysphoria. It’s possible to analyze the whole patient and identify issues that might exist outside of dysphoria without engaging in conversion therapy.
Shrier (2020) claims that therapists who consider that there might be issues more important than dysphoria risk losing their licenses, however. This makes it sound like the affirmative care model means affirm the patient, endorse the patient, and recommend medical intervention immediately. The model doesn’t suggest ignoring anything and everything outside of gender dysphoria. A therapist can respect a patient’s gender identity (referring to them as they prefer) and evaluate them as a whole. They aren’t mutually exclusive activities.
Chapter Seven
This chapter focuses on several professionals Shrier (2020) calls dissidents. Dissent isn’t a problem, but uncritical dissent is. A lot of the research referenced has either failed to be replicated or features conclusions not supported by the study’s results.
Shrier (2020) claims all dissenting voices in her chapter believe that a social contagion may be at work and followed the Littman study with great interest. As noted in part 2, this study was fundamentally flawed. Many points made in previous chapters are made again, and because those were discussed with their respective chapters, will be ignored in this article.
Presentation of Typology
Blanchard’s transsexual typology is presented next. In this typology, male-to-female transgender individuals are divided into two types: Those attracted to and aroused by men and those attracted to the idea of themselves as women. The latter was coined “autogynephilia”. Blanchard hypothesized that “homosexual” transsexuals (male-to-female) were attracted to men, while the autogynephiles had misdirected their “normal” sexual attraction to women toward themselves as a woman instead [2]. However, there wasn’t a clear empirical basis as to why he separated the groups into homosexual and autogynephile. The studies were survey based and correlational and don’t provide a basis with which to create a typology.
Furthermore, cisgendered women have answered questionnaires similarly to how those classified in Blanchard’s studies as “autogynephiles” did [3]. In other words, had there been a control group in his original studies, he might have found that many women reported being aroused by the thought of themselves as women. Blanchard also claimed that the opposite of autogynephilia, autoandrophilia (being aroused by the idea of one as a man), didn’t exist. More recent evidence suggests otherwise, however [3].
Shrier (2020) presents this typology without reference to the empirical criticisms, focusing only on “activist outrage”. She then proceeds to point out that this is a problem in the case of women’s only spaces, explaining how it could be harmful if trans-women are allowed in those spaces when some are “autogynephiles” (Shrier, 2020). Given that the autogynephilic subtype of trans-identified women isn’t supported by the literature, this comes across as fear mongering. It’s also seemingly beside the point as the book’s focus is supposed to be on adolescent girls.
She seems to weave it back together as evidence that the social contagion is truly a social one and not representative of actual gender dysphoria. Her point appears to be that there is less evidence that being a female-to-male trans person is a real thing when compared to male-to-female trans people. Going back to sexuality, she claims researchers haven’t ever reported women aroused by imagining themselves as men (Shrier, 2020). As noted above, this isn’t true; research has been done with women reporting arousal imagining themselves as men [3].
Moreover, gender identity and sexual orientation are separate constructs. It’s beyond the scope here to outline all the reasoning behind this, but an overly simplistic example of sexuality can be used to illustrate.
Let’s pretend you can either be attracted to women or men only as a binary, ignoring any exceptions and the general notion that sexuality exists on a spectrum. All of the following are possible (have existed and continue to exist in real life, ya know!):
· A feminine woman attracted to women
· A masculine woman attracted to women
· A feminine woman attracted to men
· A masculine woman attracted to men
· A masculine man attracted to women
· A feminine man attracted to women
· A masculine man attracted to men
· A feminine man attracted to women
Misrepresenting It All
She concludes the chapter with a discussion from a psychiatrist who claimed that surgical procedures related to gender affirmation are experimental yet exempt from the oversight other experimental procedures have (Shrier, 2020). Without diving into the historical data and evidence to the contrary, it suffices to say that such surgeries don’t count as experimental procedures [4]. They aren’t new and although some innovations might occur along the way (a better method for phalloplasty that reduces complications as an example), this doesn’t relegate these surgeries to an experimental status. If it did, many more procedures would count as experimental.
This is not a general statement that if a surgery isn’t experimental it is automatically safe, in the best interests of a particular patient, or without complications. It’s also important to acknowledge that a surgery isn’t completely ignored in research simply because it’s no longer considered experimental. Studies are often performed to assess the technique and outcome for those surgeries; it’s just that the surgery itself is not experimental. Plus, not all research endeavors are experiments. Many are observational and/or retrospective in nature, meaning information is gathered from patients at a point in time or even collected from electronic medical records.
The next article will be the second to last, covering chapters 8 and 9.
Non-Hyperlinked References
Shrier, A. (2020). Irreversible damage: The transgender craze seducing our daughters. Regnery Publishing, a division of Salem Media Group.
