Joyce activated, issue 45
In this issue I share my speaking notes for the keynote address at the first-ever Genspect conference, in Killarney, Ireland. I spoke about when ideology meets healthcare.
In this issue, I’m sharing my speaking notes for the keynote I gave yesterday at the first-ever Genspect conference, in Killarney, Ireland. Just a mile away, gender doctors and activists were meeting at EPATH, the European arm of the World Professional Association for Transgender Health (WPATH). The first part of my talk will be fairly familiar to regular readers, so if you want to skip through to the newer stuff, search on the page for ** and start there.
I’m going to put this in front of the paywall so non-attendees can read it. And indeed attendees, because as always when I speak, what I said didn’t precisely match what I prepared.
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I want to start by telling you how and why I got interested in this issue, and why I decided to take the risk of blowing up my life by writing my book. They’re two different reasons, although of course related.
And then I want to ramble for a bit about the specific ideology at play in talk of trans identities, which has implications in lots of areas, and some ideas I’ve come across recently that have really helped me to understand what is going on in healthcare in particular.
I got interested in this issue because I’m a journalist, and I used to be a mathematician, and I discovered some people really, really meant it when they said that men could be women. Of course I had known previously to that, that they kept saying “trans women are women”, but I didn’t think they meant it. I thought they were talking metaphorically, or with their fingers crossed behind their backs: saying something to be kind, with a tacit understanding that everyone knew it was just to be kind, and that nobody would be pushed to demonstrate in any concrete way to demonstrate that they actually believed it. That, like that old sign behind shop counters advising you not to ask for credit, men who identified as women wouldn’t put you in a position of having to reveal you were just being polite, because, as they say, “a refusal often offends”.
But it turned out no; some people really meant it. And therefore they really meant that straight men could be lesbians, and therefore lesbians who don’t do dick, who don’t do people who have or have ever had dicks, are bigots as bad as racists—so awful that they would cut an entire class of people out of their “natural” dating pool because of a factor supposedly as minor and irrelevant as skin colour, namely their actual sex.
It was so crazy I couldn’t look away, and the more I looked, the more crazy there was. I sometimes draw an analogy with introducing just one little falsehood into an internally coherent system, like a false equation into mathematics. You may remember from school that you can add or subtract the same thing from both sides of an equation, or you can multiply or divide both sides by the same thing. If you say that “1=0” then you can add or subtract or multiply or divide 1 on one side and 0 on the other, and eventually, from just screwing up one teeny tiny little equation, you have brought the whole edifice down, because now anything can equal anything. Any equation is true, and it is no longer possible to do mathematics at all. The tiny falsehood screws up everything, and the only things it doesn’t screw up are the things you haven’t noticed yet.
But that’s not why I decided to write a book. I had never intended to, because plenty of colleagues at The Economist had done so and I had seen how horrific it is as they all went bad-tempered and stressed, and it just didn’t seem worth it.
I decided I had to when I met detransitioners for the first time. It was at an event in Manchester in late 2019, and this particular group were all young lesbians.
They were a complicated bunch. One became evangelical and anti-gay sometime after that meeting, and has since reverted to a trans identity—I think she had originally said she was non-binary, and now says she’s a man—and last I heard she had had a mastectomy and started on testosterone.
Another was Keira Bell, who put herself through the nightmare of a court case in her judicial review of the Tavistock Clinic’s practice.
A third was a 23-year-old whom I called Lara in my book, who had suffered extreme bullying at school because of being lesbian. She had nearly died of bulimia, and had landed on transness as an explanation for her extreme misery with her natural curves. By 21 she had had her breasts, ovaries and uterus removed. Not much more than a year later she realised that the whole thing had been a total mistake—as she told me, when she searched online for information on why she still felt so dreadful months after the hysterectomy, and found support groups for women who had had hysterectomies for cancer or for endometriosis, it suddenly occurred to her to think: “Why is an operation that can only be done to women supposed to have turned me into a man?” And that was the sudden end of what Kathleen Stock calls the “immersive fiction”.
They were largely very gender non-conforming. Girls who had always felt that they were not in the slightest bit girly or feminine. Girls who had had a persistent sense that they didn’t fit in, and wondered why they were so unusual.
It’s my experience that if you talk to people older than about 35 they readily agree that extreme gender non-conformity is hardly uncommon in children and teenagers who will grow up to be same-sex attracted. Younger people have been misled by the societal narrative that all such things are socially constructed; that there are no innate differences between men and women other than the physical ones. It’s bizarre, when they also think that transness is innate, but there we are.
A lot of this gender non-conformity is about things that are hard to delineate and enumerate. They’re about affect—a style of moving and speaking. My little brothers certainly played with my dolls, but largely to pull their legs and heads off and hit things with them and use them as pretend guns. A researcher with a checklist would presumably have marked them down as “plays with dolls”, but they did so in very gender-conforming ways.
Meanwhile a gender non-conforming little boy who had no sisters might not have played with dolls at all. Kids can’t easily dress up as the opposite sex if the clothes aren’t around. If they don’t have siblings of the opposite sex to bring activities such as ballet or rugby to their notice, they may never know that they would have preferred the activities more usually preferred by the opposite sex. And the more traditionally masculine and feminine their father and mother, the more likely they are to actively reject their own sex’s stereotypes.
For what it’s worth, studies that have counted gender non-conforming behaviours do find that kids who grow up to be gay are on average strikingly gender non-conforming. But I think these studies understate these average differences.
I have a soft spot for gay kids, because I have one. Although my son has never suffered any type of gender dysphoria, listening to the young women at that meeting in Manchester did feel personal. And that evening I finally said to myself the sentence I’d been circling around for months, not letting myself stare directly at it: they’re sterilising gay kids. Not only gay kids, and not directly because those kids are gay. But that wouldn’t be an excuse if a policy was disproportionately and seriously harming, say, Jewish kids or black kids. We wouldn’t hesitate to call that policy racist or antisemitic, even if we accepted that it wasn’t intentionally so.
Many people keep quiet about their doubts concerning gender ideology until they realise what’s happening to children. They may not care about the other victims, or they may think that they can suck it up. They may think that female athletes should just accept men winning their medals, because for them the joy of sport can be in the taking part. They may be so lacking in imagination and compassion that they can’t see that same-sex oriented people are no more likely than anyone else to want to sleep with someone who isn’t of the right sex for them. But they really, really don’t like the idea of people lying to and hurting kids.
So there’s a sort of Scooby Doo problem for transactivists: they’d have got away with it, if it weren’t for those pesky kids.
It’s not easy for anyone growing up, and both gay and straight people have quite common and typical difficulties becoming happy, fulfilled adults in lots of ways, among them to do with their sexed and sexual identities.
For straight kids it’s the miserable business of having to deal with the opposite sex. I think this is underestimated as a source of grief in the teenage years. If you go to a single-sex school, as is still common in Ireland, you may not actually know many people your age of the opposite sex—that was certainly true for me as a teenager.
Even in mixed-sex schools the opposite sex can seem like an alien species, with strange and stupid preoccupations. And it’s hard to simultaneously fancy the opposite sex and find them incomprehensible. You feel judged by them in a way a younger child doesn’t feel judged by anyone, and you don’t understand the criteria.
And your own sex may be cruel judges, too. If you’re plain or fat or spotty, or think you are, or if you’re shy or awkward, you may be entirely typical for your sex but still be ostracised.
For gay people there’s the coming to terms with being different from the norm, wondering why that might be, and figuring out what that could mean for your adult life, including family formation. There are fewer of you, and the obvious reason why sexual desire even exists is to support reproductive sex, so you can find yourself a puzzle.
Negotiating platonic relationships with your own sex can be quite difficult, too, even if you don’t fancy them. Same-sex groups are, for most kids, places where they can talk without feeling that they’re being regarded as a sexual object, and when you factor in the impulsivity, lack of experience and randiness of teenagers, it can be very hard for everyone to feel comfortable.
Of course for many the difficulties of being gay and coming out will include outright homophobia and self-hatred. But I think it’s facile to imagine that if all prejudice were to end it would be as easy to be gay as it is to be straight.
I hesitate to say this because it might sound like I think it’s “bad” or “unnatural” to be gay—that I’m committing the naturalistic fallacy. But I feel I have to say it, because I think that for gay youth the path to adulthood is already more complicated, and so it’s even more important that the world is set up in such a way as not to add unnecessary obstacles.
Yet for both sexes, but especially for the proto-gay kids, it’s as if we’ve set out to do it almost as badly as we can. Part of that is that we are catastrophically messing up when it comes to mental health and young people. I saw it put really well recently by Jonathan Haidt, co-author of the 2018 book The Coddling of the American Mind. In a forthcoming book, Kids in Space: Why Teen Mental Health is Collapsing, he says that American schools and universities have started to promote three pernicious falsehoods: 1, what doesn’t kill you makes you weaker; 2, feelings are a good guide to reality and action; 3, people are all either good or evil, and life is a battle between the two.
He calls these beliefs “anti-cognitive behavioural therapy”, and they’re highly dysfunctional. They encourage mental fragility and a culture of “crybullying”: using claims of victimhood to harass others.
And then on top of that there’s another highly dysfunctional belief that’s being taught to children: that male and female, or man and woman, are self-declaratory opt-in categories. The criteria by which you should judge your own gender identity are ineffable—everything you think you are must be right, but there are no external or observable tests. It’s possible to be a masculine woman or a feminine man, and so it’s not masculinity or femininity. A boy who’s feminine may be a feminine boy or a girl. A masculine girl may be a masculine boy or a masculine girl.
It’s hard to imagine anything more confusing to tell children. All kids, but especially the gay ones. Or to think of anything so likely to destabilise their mental wellbeing and self-understanding. Because it’s about something fundamental to being human. It seems as unwise as telling them that breathing air or water is on a spectrum and that the only test is what they think and feel about how their respiratory system works. And that nobody else can tell them, there is no test, there are no criteria for where they are on the “breathe air to breathe water” spectrum: they will just know.
** To those of us not indoctrinated into this bizarre belief system it’s endlessly hard to comprehend why anyone would give it the time of day. I’ve said a lot both in my book and in various interviews about why this, and why now. But I want to add something today that I only recently understood from talking to a bunch of philosophers at a symposium I recently attended, who situated gender-identity ideology as a part of what they called “hyper-liberalism” or “hyper-individualism”.
What they explained to me, and I’m probably not doing this justice as a non-philosopher, was that you can think of what it means to be a person in either a communal or an individual way.
From a communal point of view, we’re people because we’re humans, a particular type of animal that has language and self-consciousness. We have a lot in common with each other, and those shared feelings, understandings, interests, desires and so on are why we are even able to have a concept of the common good, and why we can even think of writing a “universal declaration of human rights”.
That it’s good to be free from torture. That it’s self-evident that we should want life, liberty and the pursuit of happiness. That the point of society is to try to give life to these commonly held ideals, and there will be societal impositions and restraints on individuals whenever they butt up against structures intended to uphold these shared and communal notions of the Good.
But we’re also individuals, and that too is very meaningful for what it is be human, to be good, to be happy and to flourish. In particular, there’s a long and important tradition of seeing individuals as the main authority about themselves. And a lot of what we think it is to be happy is to be self-actualised, to be free to make decisions and to choose what for ourselves what it means to live the “good life”. From this point of view, self-knowledge, or being “in tune with yourself”, matters more than living according to shared values.
One way of understanding the difference between people with conservative and liberal leanings is which of these two concepts they regard as closer to correct. Do people need to be constrained by society, to seek to live up to an external idea of what is good? Or do people need to be as free as possible to pursue their own idea of happiness, and to be as aware as possible of what they personally find appealing?
A so-called “liberal democracy” is an attempt to combine and balance these: our universal human rights must be based on some shared understanding of what it is to be human, and to flourish, but many of those human rights are rights to make our own choices and express ourselves as we wish, albeit constrained by other people’s rights. Rights sometimes “collide”. “Freedom of conscience”, in particular, explicitly places our own will and judgment ahead of communal values.
One way to understand what is happening right now is that the liberal side of this balance has been pushed to an extreme. The philosophers at that symposium saw what is happening on the campuses where they work as Rousseau-ian, in this sense. Rousseau emphasised the individualist line of thinking, claiming that people in a state of nature co-exist peacefully and happily because they can follow their own will at all times. In this state, they are naturally equal because inequality is something created and imposed by society. He saw human nature as inherently good, and society as what corrupts us and makes us vicious.
From this point of view, people left to their own devices will naturally find their way to a right understanding of their true selves. Those true selves are good and beautiful, unless society has twisted and deformed them. And for each individual, they embody what it means to be morally good. Inclusion, meaning the lack of external constraints based on objective definitions, is an automatic good. And discrimination, in its original neutral meaning of noticing and when necessary acting on differences, is automatically bad. By definition, it can’t be bad to “be yourself”, or to “bring your whole self to work”.
From this point of view, communal ideas of “shared human nature” look coercive. And states in particular, coerce by labelling and categorising. Any time a person says they are something, and “the authorities” don’t agree, it’s the authorities that are not only wrong but evil, in that they are harming individuals and forcing them to live inauthentically.
I think you can probably see where this is heading. An idea that had an awful lot to offer when “be yourself” and “follow your natural inclinations” meant “don’t feel you have to marry whoever your parents want you to marry” and “there’s nothing wrong with you if you’re same-sex attracted” and “you don’t have to be a carpenter or cook just because that’s what your mum or dad were” has been pushed to the point where it means “you are whatever you say you are, even if you say you’re the opposite sex or no sex at all, and disagreement is downright evil”.
By the by, this idea that state classification is coercive because it may not match your own self-conception explains why the expressions “assigned at birth” and even, as I sometimes see, “coercively assigned at birth” have been appropriated from an abusive, obsolete treatment protocol for children with ambiguous or injured genitalia. And it’s why “self-ID” seems like such a no-brainer: linguistically, it taps into the highest ideal of this hyper-individualist way of thinking, namely self-definition.
There’s no test for the sorts of things you can identify as and the things you can’t, and there’s no consideration of what it means to other people if identifying as something means you gain access to resources you would not, on any objective measure, be entitled to. If you think that another person’s self-declaration harms you, you must be mistaken, because by definition people understanding themselves are doing a virtuous and praiseworthy thing—the only thing you are an authority on is yourself, and you’re being coercive and bigoted telling other people anything about them.
As someone brought up in the older, classical liberal, tradition, I see this as, among other things, hopelessly romantic in the Rousseau-ian sense. It just isn’t the case that we can all act on the same stage putting on different plays. Perhaps if we all put in earplugs and do one-man or one-woman performances without worrying about whether or not we have an audience—which is sort of where we’ve arrived at regarding religious beliefs...
But when it comes to gender identity, we’re not allowed to put earplugs in. Because we aren’t all just putting on our own one-person plays in solitary splendour: we’re required to play supporting roles in everyone else’s play. And we’re required to be everyone else’s audience, too, and forced to clap endlessly, and not allowed to leave. We have to affirm, in other words.
And that’s before we even get to acknowledging that people are on occasion bad actors who seek to hurt each other, including by lying, including by telling lies about themselves.
There are many strange things about this ideology. One is that it’s internally inconsistent, picking up bits and bobs from here and there without any attempt at coherence. It’s a scavenger ideology. Internal contradictions, such as gender being fluid, and innate, and socially constructed—all at the same time—make no difference to the faith of believers. Because people aren’t necessarily consistent, and their feelings aren’t either. And on what grounds could you possibly disagree with them, when there are no yardsticks or external sources of verification?
An example of this inconsistency that’s often cited is the way you can identify out of being male and into being female, but not out of white into being black. At one level, this is because they’re theorised in different fields. Skin colour is covered by critical race theory, which holds that whiteness is something like original sin: to be atoned for by “doing the work”—a type of work that is never done. You definitely can’t identify out of it. Gender identity, by contrast, is covered by queer theory, which sees the blurring and upending of categories as virtuous.
But that difference is happenstance: a product of America’s specific racial history. More generally, the inconsistency is because there are no requirements to be coherent if self-knowing is your only measure of what is good. I’ve even heard people say that it’s a very wrong thing to allow white people to identify as black because they don’t have the shared history of oppression that black people have—well, female people do have a very real shared history of oppression. This is obviously a post-hoc justification, but if there’s anything humans are good at, it’s finding justifications for what they already believe or want to do, and then concealing the weakness of those justifications from themselves.
Another is that it is so subjective that, if taken to its limits, it makes the practice of science, the collection of statistics and the imposition of legal codes impossible. All these things are about objective criteria and standards, and require categorisation. But what we’re calling hyper-individualism or hyper-liberalism is atomised. It allows you to collate and group people’s experiences only under headings like this: “people who think of themselves as belonging to a certain category, for which I can give no objective definition, say they experienced things they understood as instances of a certain sort of experience, for which I can also give no objective definition.”
You can’t say: male people commit most violent crimes, or most rape victims are female, or that nearly everyone who works as a firefighter is male, or that every human being who has ever got pregnant is female. You have no test of the “reasonable person”. No yardstick by which you can even hypothetically judge whether a crime should attract for the hate-crime aggravator.
A third is that it has arisen within, and co-opts the language of, the liberal human-rights framework, even though that framework is based on a “declaration of universal human rights”. It’s a liberal framework, sure, in that it’s largely about freedoms—to not have other people constrain your speech, belief, etc. But the way it’s all laid out, there are objective tests for what sorts of beliefs are covered, and when other considerations take precedence.
And yet this hyper-individualism makes those tests, with their need for balancing and yardsticks, essentially impossible. Take privacy and free speech, two human rights that particularly often collide. Both are regarded as qualified within the human-rights framework—we may override one person’s privacy if that unreasonably restrains free speech, and vice versa.
But when a person’s privacy is to do with what they conceive of as their identity, the only proper position to take is that they are right. To “affirm”. To include. And if that means draconian limitations on other people’s free speech, that’s too bad. As for it imposing on their privacy—well, that is understood to be an impossibility, because “people are who they say they are”. The transwoman stripping off in the women’s changing-room is a woman, and is no more an imposition on other occupants’ privacy than any other women stripping off would be. And if that’s not how it looks to those other women, well, they are siding with the state that coercively assigned that poor transwoman male at birth, and are therefore evil and don’t deserve any rights.
Even when rights are supposedly based on something objective—there’s a ruling in the European Court of Human Rights that being forced to undress in front of a member of the opposite sex is an Article 3 violation, that’s the one that refers to torture and inhuman or degrading treatment, particularly important because it’s an absolute not qualified right and so states cannot balance it away—well, that objective fact of sex dissolves in the face of self-declaration.
So we supposedly have a framework of universal human rights that operates on liberal principles, and in which there are objective criteria for when one right trumps another, and for what it means for an action or situation to be, for example, inhuman or degrading—one in which, in the words of the American jurist Oliver Wendell Holmes: Your right to swing your fist ends where my nose begins. And the place where that collision happens can at least in principle be judged objectively.
But within that framework, and co-opting its language despite being entirely inimical to it, is this emerging hyper-liberal position. Which holds that someone male expressing themselves to be female or non-binary and thereby entering, say, a marathon race, isn’t swinging their fist, and female people who say that he’s bashing their nose are wrong, because he is indeed female or non-binary. And there was no such thing as male for him to be in the first place. He was merely assigned—coercively assigned—male at birth.
There’s nothing to object to (except authoritarian and coercive norms), no harm done (because people are who they say they are), and no grounds for objecting (because everyone is the authority on themselves, and nobody can override anyone else on matters of identity).
For me, thinking through this was immensely helpful when trying to understand how this ideology is making such inroads within healthcare.
The professionals who work within this system were, at least until the last few years, trained within the objective scientific tradition. To carry out differential diagnosis using validated self-report measures and objective symptoms; to study what it means for each organ or biological system to function in a healthy or unhealthy way; to seek to understand for any sort of ill-health what caused it and how it progresses; to develop treatments by generating and testing hypotheses; to understand that all treatments are likely to have both costs and benefits, which can be measured and weighed against each other; to seek treatment pathways that minimise risks and harms; and overall to promote patient autonomy but within a framework in which it’s understood that clinicians know much more about the workings of the human mind and body than patients do.
Gender clinics are working within this system—holding consultations, taking blood tests, offering diagnoses, writing prescriptions, referring to other specialists, making claims about outcomes and efficacy—but none of it is really medicine. It fools people into thinking it is, because it sort of looks like it is. And the people it fools include not just patients, but specialists in other fields of medicine, such as endocrinology and surgery, as well as funding bodies, insurers and governments.
What’s called gender medicine today is better understood as a performative expression of the hyper-liberal, or hyper-individualist, notion that each person has a true self, and knows that true self, and by definition cannot be wrong. That any attempt to classify people is an imposition, is coercive, is authoritarian. That societal norms or strictures, notions of the common good or human nature or objective standards of wellbeing are meaningful only in something like the way Judith Butler thought gender was.
Butler famously said it was an “imitation for which there is no original”—that it’s meaningful only because we do it over and over again. In this worldview the entire superstructure of medicine becomes something like this—a repetitive practice that is meaningful only because we keep doing it. And the purpose of gender medicine is simply to help people be their true selves. To affirm identities. The gender clinic becomes a scenario, a backdrop, against which people can perform their identities. And gender clinicians tell their patients—in reality not patients, but purchasers of identity validation—that once they leave the clinic everyone else will play along.
Here’s what it would look like if it actually was medicine—I’m not saying good medicine, by the way, just something that could fit within the medical paradigm, and which would eventually stand or fall depending on outcomes and evidence. Clinicians would say that transition is not right for some people, but is for others, so right that it’s worth other people being forced to go along with something they don’t necessarily like. They would then seek to find ways to predict who is in both groups.
This would be a sort of ‘balancing rights’ claim, as in the case of Goodwin at the European Court of Human Rights, which was the reason for the UK’s Gender Recognition Act of 2004, the first national law in the world that granted people the legal fiction that they were members of the opposite sex, at least in some circumstances.
I would argue that those judges got it wrong, and for the usual reason—that they didn’t think their thoughts all the way through to the end, and thereby set women’s rights at zero. But anyway, it was a balancing argument within the human-rights framework. It requires you think that:
Anyone who doesn’t accept people as the sex/gender they say they are is a bigot
Toilets and changing-rooms don’t really matter, they just want to pee and change.
Sport for women is about taking part, teamwork, fitness etc, not winning.
To be clear these are not propositions I agree with.
But you could say all of this and also accept that kids are still in the process of forming their identities, are too young to weigh up irreversible consequences of a sort they cannot possibly understand with their limited life experience, and should wait until they’re grownup.
And you could also say: even adults may temporarily identify as members of the opposite sex for all sorts of reasons. They might change their minds. You could still weigh up the costs of medical treatment against the benefits. You could accept that there might not be any treatment that could make people who wanted to be members of the opposite sex feel any better. You could still think that there are trans-identified people for whom transition is the best policy, and people for whom it isn’t (to be clear I no longer agree that anyone should gain any status as members of the opposite sex, because the consequences for other people are too serious. However, you may decide that you don’t care about other people).
But that’s not what’s happening in gender medicine, because it’s not medicine. And that’s why the Scooby Doo problem: they can’t back away from the kids.
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