Over the last few years the gender recognition act has been a subject of debate in the press and parliament.
Tomorrows Sunday Times appears be running an article that equates gender confirming therapy with homophobic conversion therapy.
This is a demonstrably false view, as the following two essays will show. Both originally written as part of my own MSc in social sciences, and drawing on my back ground in both scientific and medical fields The first covers the historical medicalisation of trans people and why to this day incidences of "trans ness" are still regarded as less real than other forms of biological diversity and variation. The second the affect that straight history has had, and is having on the trans population and wider queer communities.
Hope they go some way to redressing the balance of these arguments.
Categorical Medicalisation and Intersectional identities:
A critical examination of inequality resulting from current and historical medicalisations of atypical Sex and Gender.
In the following essay, we employ the concept of ‘Identity work’, for a case study based critical examination of historical and current medical and societal conceptions of people who experience atypical sex and gender Identities (Brown 2014, Serano 2016, Karkazis 2008). Identity work serves well as it can be applied to micro, meso and macro level identities and interactions (Brown 2014, Ballantine and Roberts 2012:21).
Our case studies are: psychologist Dr John Money’s 1965 John/Joan (JJ) case detailing his research into gender roles through the treatment of an injured patient, and a 2018 presentation entitled “science doesn’t back up gender as a social construct” by Dr Debra Soh, a neuroscientist specialising in the brain imaging study of paedophilia. The former became infamous as a mile stone in the history of medicalisation of intersex people, being one of the first studies to coin the terms ‘gender role’ and ‘gender identity’ that were later used by Robert Stoller in 1964. The latter was given by Dr Soh during the Canadian governments proposed legislative changes to pro-noun use and legal protections for trans and gender non-conforming people. Known as Bill C16, it was passed in the May of 2016 and given royal assent in June the following year. Synopsis of both case studies are included as Appendices A and B respectively, and it may be useful to read through those prior to the main discussion.
‘Identity Work’ could be considered a form of Hegelian “epistemic practice” built from conceptualised experience (Baur 2015:24). At the micro level it is described, though not named, by Goffman (1961) as a set of active processes which combine to form a sense of individual identity. These processes necessarily include social encounters whereby people “announce and enact who they are” and this of course includes interaction with medical professionals, who will not only represent their individual selves, but also meso level institutions. (Creed and Scully 2000:391, Freeman and Hughes 2010:9, Riska 2015:59)
Multi-level level cis-normative social environments add extra layers of complication to the identity work of people with atypical sex and/or gender identities, since they often face stigma, and exclusion from the legal and social landscapes (Ozturk and Tatil 2016, Bettcher 2018, Stryker, Whittle & Aizura 2013).
Particular aspects of that identity work process encounter health care provision and thus medicalisation & “diagnosis”, leading some to ask questions of the extent to which societal control of bodies has been, and is, ‘normalised’. In some cases, non-typical identities also collide with societal pathologization and related arguments of deviant and /or harmful sexual orientations (Conrad 2007:4, Blanchard 1985, 2001).
The themes this work will attempt to explore are social control, institutional “gatekeeping”, and their potential to cause the types of health inequalities described by Graham and Kawachi respectively as: “systematic differences in the health of people occupying unequal positions in society” and “differences, variations and disparities in the health achievements of individuals and groups” . Our case studies will aid in examining how these same inequalities are perpetuated though ‘testimonial’ and ‘hermeneutical’ injustices both causal or resultant and take us on a journey that spans from the year 1900, to 22nd April this year (Fricker 2007:1-8, Graham 2009:1-19, Kawachi et al 2002:647-652)
Three words to paint a big picture.
Firstly, we need to define macro meso and micro level concepts of individual and institutional “identity work” (Brown 2014). Specifically, what do we mean by the term’s ‘health’, ‘Medicalisation’, and ‘diagnosis?’ And also, what exactly is being referenced by the term “atypical sex or gender identity”
The world health organisation defines ‘health’ as:
“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
This definition has remined unchanged since it was first accepted on April 7th1948. Prior to 1948 ‘Health’ had been seen as merely the absence of disease, having a very much biomedical focus. The WHO included three domains of well-being, creating the foundation of George Engel and John Romano’s 1977 bio-psycho-social model (BPS) of health and well-being that we use today (Cohen et al 2010, Frasier 2020).
Fig1: The BPS model of health and wellbeing (taken from Physio-pedia.com)
However, medical and philosophical advances in the last 72 years have resulted in calls for an update to both definition and model. One that recognises difference, and the “ability adapt and self-manage” (Huber et al 2011). Ghaemi (2011) further suggests the biopsychosocial model “uses narrow concepts of biology, inconsistent mind/body relationships, unclear boundaries, and (offers) limited resistance to rebirth of biological dogmatism or determinism” (emphasis my own). Ghaemi’s criticisms will be revisited later, with specific relation to the inequalities herein examined.
“Medicalisation” has been understood in the latter half of the 20th century as a descriptor that categorises persons as “the patient” thereby creating “definitional arguments” of what a ‘medical’ need “is”. Conrad (1992:211) highlighted this in his work:
“Medicalisation consists of defining a problem in medical terms, using medical language to describe a problem, adopting a medical framework to understand the problem or using a medical intervention to treat it. This is a sociocultural process that may or may not involve the medical profession, lead to medical social control or medical treatment, or be the result of intentional expansion by the medical profession”
In an earlier work, Conrad also pointed out that medicalisation not only requires medical definition, but “Jurisdiction” as well (1975:12). Note that in the definition cited above, treatment is not required for ‘medicalisation’ to occur. Interestingly Conrad also presupposes a process of “problematisation” (indeed he uses the word ‘problem’ three times) but doesn’t define it, beyond a reference to ‘sociocultural process’, and suggests this may occur independently of what he calls the “medical profession”.
Combining both definitions suggests that holders of ‘medical’ jurisdiction are a series of changing agents, and that each of them will evidence a Durkheimian situational dependence upon their own time, place and space, whilst acting as “causal agents” in the medicalisation process. (Morrison 2006:252-258). As owners of the problematisation process, their conception of “the problem” will be similarly affected. This of course includes ‘the sociologist’ in interpreting the term ‘medicalisation’ which can lead to replication of extant assumptions about what counts as medical knowledge and practice (Correia 2017, Halfmann 2012:188-189).
Conrad’s conceptualisations ran concurrent with the timeline of Michel Foucault’s 1973 “birth of the clinic”. But prior to either, both Parsons (1951) and Zola (1972) had characterised ‘medicalisation’ as a means of social control, the latter suggesting it as “…an insidious and undramatic phenomenon accomplished by ‘medicalising’ much of daily living, by making medicine and the labels “healthy’ and “ill” relevant to an ever-increasing part of human existence.” (Riska 2015:60)
Intriguingly, this concept of societal medicalisation seems to simultaneously confirm and refute the well-known quote by Foucault: “The medical gaze regards the body without recourse to the person”, since to embody ‘the problem’ as entirely physical ignores the ‘voice’ of the “sick” person… yet in many cases, the reason they are deemed sick is because of a societal view of what they say or do, being constantly regarded through a socially situated lens of ‘normality’. “...if you are not like everybody else, then you are abnormal, if you are abnormal , then you are sick. These three categories,’ not being like everybody else’, ‘not being normal’ and ‘being sick’ are in fact very different but have been reduced to the same thing”
― Michel Foucault from discipline and punish: the birth of the prison. (1975)
Examples of the far-reaching influence of societal “medicalisation” include suffragettes, sex workers, lesbianism and racial segregation. The ‘diagnosis’ of ‘hysteria’ or ‘nymphomania’ in 18th and 19th century women, and even Drapetomania, a mental health diagnosis given to 19th slaves who continually tried to escape plantations! (Foucault 1973,1991, Wahab 2002, Bartholomew 2014). The owners of “power” use medicalization via ‘jurisdictional authority’ of ‘accepted norms’ as a device to ensure that their power is retained and perpetuated (Taylor 1982:21, Conrad and Schneider 1980:75-76). So, ‘medicalisation’ then is revealed not as a singular, discrete and objective action, but rather a socially situated multiplicity of process, that is itself dependent on many intersecting and co-dependent elements, one of which, as we shall see next, is ‘diagnosis’
We are brought to ‘diagnosis’ via the descriptions “normal”, “sick”, “healthy” and “ill”. The Meriam Webster definition of the term suggests that it is “the art … of identifying a disease from its signs and symptoms”. Furthermore, the term is used by doctors, nurses and even auto mechanics in the course of their work (Crombie 1963: 579-589, Gordon 1976: 1298-1300, Andreasen 2013).
For our purposes, if we factor all of the above aspects of health, power and medicalisation, into ‘diagnosis’ then we might consider an over-arching descriptor to be:
‘a process of identification, through observation, of both normal and abnormal function, with an inference to probable cause based on ones understanding of what one is examining, such that a mediated response may justifiably be applied.
But, as Foucault pointed out, there exists a definitional nuance here, if not exactly a contradiction. Philosophically, attempting a diagnosis presupposes existence of that for which one is searching, i.e. “the cause”. Furthermore, we often assume that the purpose of any identification thereof is in the interest of the examined, e.g. the doctor ‘curing’ a patient or a mechanic ‘fixing’ a fault on a car. From this it is apparent, even before any diagnosis is attempted/ratified, that a value judgment has taken place. Namely, of what is ‘normative and therefore worth observing and/or excluding’ and what ‘should’ be done about it. (Popper 2010:1-6)
It is this value judgement (problematisation) that evidences the point at which normal and abnormal must have alreadybeen deemed extant, otherwise diagnosis would be impossible. Accordingly, medical diagnoses rest upon the ‘epistemic interdependence’ of pre-existing study, aka the evidence bases of prior treatments (medicalisations) that created these definitions of ‘normal’ and ‘abnormal’ (Schmitt 1988, Halfmann 2012). Thus, macro level medical power can be slow to adapt to new forms of knowledge, since “medicalisation” is in principle and practice closely aligned with a somewhat positivistic objective realism, yet the micro level diagnostic process leans more into a critical realist perspective, the former based on what we know and the latter utilising an assumption of not knowing what we think we might, thus allowing for error. (Halfmann 2012, Conrad 1975 1992 2007, Conrad & Schieder 1980, Hammersley 2019, Tanlaka 2019, Eastwood 2019, Williams 2016:1-9)
It is unsurprising then, that the diagnostic process also acts, by virtue of its academic underpinnings, as its ownsocially situated power structure, and thus becomes a societal agent for meso and macro level ‘reification/rejection of concepts” which, in time, appears akin to “normalisation of the normal’ (Appendix A, Halfmann 2012) Furthermore, Individual physicians become bound by the time and place in which they operate and the prevailing evidence base extant at that time, plus, it has to be said, their own career aspirations (Griffiths 2018).
Whilst Conrad’s 1992 definition correctly suggests that ‘medical’ diagnosis is not an intrinsic part of medicalisation, one might argue that Foucault’s analysis of discourse suggests a conceptual reification/rejection (of disease and cure) as ‘societal’ diagnosis is inextricably linked to the process of medicalisation though mechanisms of power and authority. As a
result, both social and the medical power function as cyclical causes and effects. Simultaneously informing, reforming, rejecting or conforming to, a collective knowledge of pre-existing (accepted) diagnoses and practices within a medical/societal evidence base. In so doing they create the never-ending game of “chicken and egg” that is Medicalisation and De-medicalisation (Halfmann 2012:188-189).
In summary, (medical) diagnosis could be characterised as a continuous Hegelian “epistemic practice” of knowing, actively seeking its own contradiction, highlighting and thus avoiding “knowledge defeaters” in an effort to learn, and move closer to a (non-determinist) physicalist truth. A truth that is non the less situated within sociocultural factors that may help or hinder this process (Baur 2015:1-58). Or to put it another way. Medicine is continuously revisiting its own institutional ”identity work”. Only ever operating on a ‘current best guess’ of cause, effect and consequence, and at any given time is operating against a backdrop of extant socio-political power.
Atypical sex and Gender identity
What is meant by atypical sex or gender identity? ‘Atypical’ is a medical expression that describes ‘unusual’. An “atypical presentation” therefore describes a particular condition, e.g. Heart attack/Myocardial infarction which has a common subset of symptoms presenting to the physician differently (de Torbal et al 2006, Culic 2006). Whilst one could think of it as describing the ‘abnormal” It carries with it none of the preconceived societal notions of ‘wrongness’ that commonly accompany the phrase. (although as stated above it is non the less dependent on extant evidence bases) In this context it forms a short hand for any person who experiences development of a sexed or gender identity that falls within a minority remit, howsoever discovered. As such it is a term inclusive of both trans identified people and those whose gender identity has been affected by intersex conditions. The term recognises the epistemic practice necessary in order to realise atypical sex and/or gender identities, and that the social actors involved in doing so may include, but are not limited to, the person themselves. In this context it is not used to describe minority orientations, although as we will see, questions of desire and sexuality can hardly be avoided when considering sex and gender identity within medical frameworks.
Power, Positivism, Prescriptivism and Perspective.
Turning our attention to the case studies, on a prima facie view they would appear to agree. The John/Joan (JJ) case, although reported successful, was a catastrophic failure resulting in lifelong mental health problems and death for the subject: David Riemer. Dr John Money was attempting to prove his ‘radical social construction’ theory of gender via a positivistic scientific approach, using the brother of the test subject as a “control”. Money had spent the years between 1952 and 1965 at John Hopkins Hospital creating his ‘case management’ guidelines for medical & surgical interventions on infants who were anatomically intersex. Guidelines that went on to have a global impact (Griffiths 2018). His status as a social actor and the reported ‘success’ of the JJ case had finally “proven” gender identity as socially mailable. Thereby creating grounds for the medical profession to justify assigning a gender to a child that aligned with what was most easily surgically constructed, which of course was ‘female’ anatomy. Ethically this also meant that there was no possibility of “getting it wrong” and thus harming said child, a point that further strengthened medical jurisdiction at the time (Appendix A)
However, David Riemer’s later denouncement of his treatment by Money, and rejection of his imposed ‘female’ identity created doubt. The idea of a socially malleable and socially constructible gender identity appeared to have been disproven, and Money’s approach was called into question both methodologically and ethically (Appendix A). Dr Debra Soh’s presentation argues that gender is not socially constructed, and that science of which the JJ case is part, backs up this ascertain. It is the aim of this discussion to show that far from being aligned, these two case studies are in fact in total opposition to one another, though appear to be in accord due to terminological inconsistency and some considerable miss representation of the arguments therein.
The story of the treatment of intersex, and by association those who were then deemed ‘transsexuals’ by the medical establishment, does not start with the JJ case. Historical accounts date back to the 19th century, with many of the medical approaches transferring from UK to USA around 1910, and back again in the mid 20th century. During the period 1930 - 1955 an acceptance grew of the performance of surgery on those deemed intersex. Intervention became viewed as justified and routine even when these surgeries included removal of healthy gonadal and genital tissue (Griffiths 2018).
What is interesting are where the medical profession of the day chose to draw its distinctions for legitimate grounds for operations. While ‘Intersex’ operations were regarded as necessary and warranted, even when not specifically “functional”, ‘sex change’ ones were not. As Griffith (2018) puts it, those within the medical profession “attempted to purify these (two) fuzzy and overlapping categories, through the separation of children and adults, intersex and trans, biology and psychology, into distinct non-overlapping ontological categories” This delineation by the medical profession was partly as a reaction to a media who failed to draw such distinction around ‘intersex’ and ‘sex change’ at that time. (Griffith 2018:6)
The following extract from the 1944 book “Endocrine man” by the leading Charing Cross surgeon Lenox Ross Broster clearly illustrates this sharp divide:
“when their troubles are due to natural causes their plight is pitiable. Society in general is not a respecter of persons, is suspicious, and indeed often hostile to these abnormals. This attitude should be rightly reserved for the decadent imitators and propagandists of these perverted states, who form a festering sore in our midst.” (Broster 1944:95)
What Broster is referring to here as “natural causes” are the observable anatomical structures (Gentalia and Gonads) that gave rise the in the category of intersex. In stark contrast those who were deemed anatomically ‘normal’ but exhibited any wish to transition, were homosexual, or resisted offers of “normalisation” whether surgically or psychotherapeutically (what we today would call conversion therapy) were vilified as worthy of scorn and hostility (Griffith 2018:6-7, Haldeman1994:221-227).
Even more interesting is that for Broster ‘medical jurisdiction’ of ‘the normal’, which he based on a “dichotomous two sex model of sex and sexuality”, also worked in reverse. A point further made clear when a woman was discovered to have internal undescended testes (in a case that today would be recognised as ‘complete androgen insensitivity syndrome’) and wished to remain a woman, Broster seemed aghast at the prospect, especially when the patient adopted a child. Broster seemed unable or unwilling to consider the possibility that a patient of this sort, whom he viewed as “endocrinologically male” could ever wish to enter into motherhood. Further evidence of a prevailing inclination towards patriarchal social and academic hierarchy (Griffiths 2018:4-6). Indeed, this idea of a paternal dichotomy is borne out further his counterpart in the field of psychology at the time, Clifford Allen. Allen argued treatments should be strictly divided on the basis of observable anatomy. Surgery for those who were visibly abnormal, psychotherapeutic treatment for those who were not. Allen himself even going so far as to offer psychotherapy to a women who “wanted to be a man” in order to marry her girlfriend, to address what he saw as her unnatural homosexuality (Broster et al 1938:106-107).
It is important to note the socio-political context within which Broster and Allen’s medicalisation theories were operating. Specifically, the dual conditions of positivistic science, and the conservative Edwardian/Georgian social values of their day. Although to modern medical minds their words may seem absurdly judgemental, one has to consider that the years between 1910 and 1955 were a period full of immense and rapid discoveries, and socio-political change. Whilst lesbianism was largely ignored, male homosexuality was viewed as a disorder of desire and objectification. It was Illegal in the UK due to the introduction of the Labouchere Amendment of the criminal law (amendment) act 1885, itself an extension of the 1828 Offenses against the person act that prescribed death for the crime of “buggery”. The Wolfenden report was still decades in the future, not being published until 1957, and psychology was in the midst of its psychoanalytical heyday, with publication of Freuds essays on sexuality in 1905 and Psychoanalysis in 1917. The X and Y chromosomes, identified by Nettie Stephens and Edmund Beecher Wilson, were described in 1905, and at this point we are still some years before the discovery of the DNA double helix by Franklin, Watson and Crick (1953). August Comte, the father of social science and staunch positivist had died just 50 years prior in 1857, but not before heavily influencing both Emilie Durkheim and J.S Mill. The later of whom published his hugely significant “A system of logic and Ratiocinative and inductive” in 1882 which influenced, among others Bertrand Russell, (1872- 1970) Karl Pearson (1857 -1936) and the Vienna circle. The common thread amongst these Influential thinkers of the day, scientists, positivists and logical positivists, is a disregard of the discipline of “metaphysics”, preferring instead to place their faith solely in analysis and empiricism (Hammersley 2019).
Given all the above it is hardly surprising that we find Broster and Allen, two hugely important social actors of their day, taking a starkly obvious stance of “metaphysical scepticism”. After all, medicine and scientific philosophy have always enjoyed a close partnership, and regarding a psychologically manifested cross sexed identity as ‘real’, would have required the deployment of both inductive thought processes and a conceptual diagnosis from a ‘hypothesis of metaphysical cause’. A method and goal both thought unscientific at that time. The scientific and socio-political context of Conrad’s ‘medical jurisdiction’ therefore precedes Broster and Allen’s moral judgements upon those who refused to accept what they (the experts) evidently regarded as ‘real’. Namely observable, analytical, empirically testable manifestations (and the resultant definitions) of their ‘true’ sex (Griffiths 2018:6-7).
This then was the historical setting for the JJ case, against a back drop of a shift from Freudian psycho analysis into cognitive psychology and the very beginning of a post positivist shift in scientific thinking with the 1959 publication of Karl Poppers book ‘The logic of scientific discovery’ (Miller 2003). So, contextually we are left with the question, whydid Money’s study fail so spectacularly? We will return to this point later.
Turning our attention to Dr Soh’s 2018 lecture, the opening remarks of which state:
“Gender is binary & not a social construct we are drowning in miss information on this subject. Biological sex” is either male or female based on our reproductive functions. “gender” is how we feel, masculine or feminine in relations to our biological sex. When sperm fertilises an egg at conception the baby will either be male or female, biology will dictate hormonal exposure in utero and the child’s gender identity as well.” (emphasis my own)
Dr Soh is arguing for a biological component to ‘gender identity’, or is she? Her next remark which she repeats later on seems to contradict her own statement.
“for over 99% of us, our biological sex IS our gender identity [When Dr Soh ‘repeats’ this at 08:27, she drops the word identity]…
….. less than 1 percent of the adult population identifies as transgender, a number that has doubled in the last ten years. So, to rewrite children’s education as though its common place for a person to identify as the opposite sex is inaccurate, potentially confusing to them and irresponsible.”
In Dr Soh’s full talk there is never any attempt to explicitly state what in her view causes the gender identity of the 1% i.e. the trans gender population, nor define it. Nor does she explicitly state what she means by the term “social construct”. But nevertheless, her message is clear. Trans gender [identity] is not in her view “biologically determined” whereas a cis gender [identity] very much is. This leaves us with three unanswered questions:
1) What is Dr Soh suggesting a trans gender identity ‘is’?
2) What causes it?
3) Does she believe it actually exists?
A clue to the answers to these questions can be found further on in the talk:
“Another side effect is that clinicians who work with children aren’t able to do their job. We only have to look at the rapidly multiplying number of young children who are identifying as trans gender to see the social contagion aspect of this way of thinking. Many of these kids have some other medical condition that is leading them to feel the way that they do whether its autism, BPD, or trauma”
Dr Soh is the author of a number of articles on Dr Lisa Littman’s concept of ‘rapid onset gender dysphoria’ in children (Littman 2018, Soh 2018a). However, like Littman, whilst seemingly concerned for the welfare of children, she consistently fails to directly state why she views any spread of a trans gender identity amongst society as harmful, and a cis gender identity as benign. She attempts to do this by appealing to scientific underpinnings of what she deems ‘binary’ sex and therefore gender, based on the premise that “sex” and “gender” are inextricably linked, or more likely, (given her omission at 08:27 mins in) ontologically the same, thus she has “problematised” trans identities.
It would seem Dr Soh is suggesting that she believes trans gender identity to “be” a false differential diagnosis. One that can spread via the very same social structure that she suggests cannot and did not create extant underpinning notions of a binary gendered society. After all the difference between social construction and social contagion is merely a value based one, their under-laying mechanisms being very much the same in each case (Mallon 2019).
Philosophically Dr Soh is doing a number of things here. The first is creating a circular “slippery slope” argument: ‘A’ is bad, so if we let more people do ‘A’ that would be bad too. The second is that in deeming ‘A’ to be ‘bad’ one would be reliant on a value judgment of the evidence of what ‘A’ is, which she steadfastly refuses to state, leaving that to be inferred by the listener. The third is to use equivocation to blur the distinctions between the terms gender, gender Identity, gender dysphoria and transsexualism, all of which have distinct and separate meanings. This last echo’s Foucault’s point from earlier, as an amalgamation of the categories “not like everyone else, ‘not normal’ and ‘sick’.
Her ascertain that ‘A’ is bad is reliant on the presumption that ‘A’, in this case ‘a trans gender identity’ has no basis in biological causality, (an un-disprovable position and thus unscientific ascertain – unless one takes a positivistic view that ‘no proof is proof’) and that the said causality can only ever have two discrete outcomes (the very definition of a binary system – falsified by the existence of intersex people.). Thus, although philosophically valid in structure, her argument must to fail due to unprovable & false premises. It is hence revealed as nothing more than a value judgement. Furthermore, even if her argument for a non-biologically derived trans gender identity were true, that still would not answer the question as to why she believes trans gender identities to be comparatively ‘bad’ verses cis gender ones, thus she subtly subverts the ‘badness’ to ‘sickness’, in an attempt to hide the value judgment inherent in her position (Conrad 1992a).
But we might ask, why is this a problem? Well, because apart from the ethical duplicity inherent in the argument, it is also a non sequitur. Ontological arguments even if true, cannot settle ethical ones. David Hume famously pointed out, via what we today know as “Hume’s guillotine”, that one cannot directly define ‘an ought’ from an ‘is’ (Hume, 2007). In this way Dr Soh is replicating much of the value based “universalisable” arguments historically employed against homosexuals in the later 20th century, and once again dressing them up as something they are not. (Popper 2010:54-56, Corivino 2018, Corivino,2013:15:00-32:00)
Paradoxically though, Dr Soh does explicitly mention intersex:
“Bill c16* has contributed to this climate by writing false and unscientific ideas about gender into federal law. Nowadays self-determination is everything and some people will stop at nothing to push this agenda. they will torture logic and tokenise certain groups to gain political ground, like pointing to people with a difference of sex development which is a medical condition previously known as intersex as proof that gender is a spectrum.
Note the use of the word gender when referring to DSD, which is again suggestive of Dr Soh’s ontological position here. It is this passage that brings together the historical context preceding Dr Moneys work, the failure of the JJ case itself, Dr Sohs presentation, plus recent changes to the world health organisation’s classification of Trans people. Yes, Trans people have long pointed to the Intersex phenomenon in order to highlight that its very existence proves that the manifestation of an individual’s sex can be more than two discrete outcomes, ergo that sex is a non-binary particulate process. Dr Soh herself suggested at the very beginning that the ‘gender identity’ can be affected by those self-same factors in 99% of people. So, we must ask then: on what grounds do we collectively accept that a transgender person’s gender identity is not or could not, be genetically and hormonally caused?
Then and now: hermeneutical inequalities from testimonial injustices.
Dr’s Soh and Money both employ positivistic philosophical views of medicine and science. The former to suggest that a binary embodied sex disproves gender as socially constructed (by inference that gender doesn’t exist and is merely an expression of that same binary sex). The latter, by experimental process, hypothesising gender as entirelyseparate from biological sex, i.e. no causal relationship. Both arguments are dealing with children and medical “jurisdiction” and both represent radical viewpoints of the age-old nature/nurture debate, and in so doing commit opposing versions of what G.E Moore termed the fact/value ‘Naturistic fallacy’ (Pigden 2018:73-75)
Earlier we posed the question: ‘Why did Dr Money’s experiment with the JJ case fail so spectacularly?’ To answer this, we need to look at the approach Money took with surgical procedures and compare them to those of the “father of paediatric urology” and author of ‘The urology of childhood’, David Innes Williams, who was the resident to St Peters hospital in London, and urological registrar at Great Ormond street Hospital between 1948 -1953 (Griffiths 2018). Williams, like Money, was an advocate of early surgery on babies with indeterminate Genitalia, resulting from what he called “hermaphroditism”, or “disorders of sexual development” (Griffiths 2018:10-16). But unlike Money he advocated matching the surgery to the child’s psychological sex. Williams, like Money, was operating on children, and in contrast to Roster, Allen’s and arguably Money’s focus on the endocrine or ‘future adult’, and their sexuality, he considered the child’s psychology at that moment:
‘The guiding principle in the treatment of all this group of cases must be the adaptation of the external appearance to the psychology of the child, rather than histology of the gonad’
(Higgins et al, 1951:249)
Williams was less concerned with “social positioning” as per Roster and Allen’s heteronormative and binary stance, and more so with the well-being of the child. Although still employing a binary narrative of functional physiology (importance being placed on standing up or sitting down to urinate for example) the difference in approach is stark. William’s was using surgery to fit a child’s extant (natural) psychology, whereas Dr Money was using surgery as child psychology, hence his failure (Griffiths 2018:15).
David Riemer, Dr Money’s test subject, was neither intersex, nor trans. His entire situation was imposed upon him, and thus his experiences artificially created what we today call ‘Gender Dysphoria’. His physicality did not match up with what he was being told as a child through external means. This was independent of any knowledge on his part until the truth was revealed by his father (Appendix A). Of course, to hold the JJ case up as absolute proof that an embodied sense of ‘gender identity’ exists would be to commit the same error of positivistic overreach as the initial experiment and an “epistemic fallacy”, i.e. epistemology as ontology (Roy Bhaskar 2012). Yet Dr Soh’s argument is suggesting exactly that, since a consequence of her position is that David Reimer belongs to the 99% of people with, as she calls it “a biologically determined gender identity”, since his matched with that assumed at birth.
A subtle but extremely important point is that Money, Broster and Allen, as social actors were all attempting to fit patients into their own predetermined concepts (and biases) of what they “should” or “could’” be, based on the jurisdiction of their expert knowledge (Serano 2016:138-139, Roger and Walsh 1982:275-276). In contrast William’s approach was merely helping the child to be what they, the child, already felt they were. This brings us back to Foucault’s point: medical authority regarding the body without recourse to the person. William’s approach was the exact opposite of this, since he regarded the child as an em-personed body, rather than an embodied person, and thus this account of his practice could be considered one of the early uses of a psychosocial model of “health” for a child (Griffiths 2018).
Roster and Allen’s metaphysical scepticism and the medical professions historical efforts to delineate intersex and trans treatments on ontological and ethical grounds has had far reaching consequences. Dr Soh’s lecture in 2018, nearly 8 decades later is still positing this same delineation. A moral hierarchy of ‘intersex’ over ‘trans’ people, which she re-affirms in the phrase: “trans people torture logic and tokenize certain groups in order to gain political ground”.As an academic, Dr Soh is inferring, though never outright stating, that ‘gender dysphoria’ is at most a mental health condition that has no physiological basis. She leans into demonstrably outdated views of a biomedical morbidity of DSD, citing endocrine (gonadal) and genital sex as being ones “true sex”, alongside Parsonian functionalist views of medical control creating what Adrienne Rich (1980) called ‘coercive heterosexuality’:
“….what I find most disturbing about this movement is that gay children are being encouraged to transition so that they appear heterosexual. If you take the example of the little boy who is feminine who tells his parents that he is a girl when he grows up he’s likely to be a gay man. If you take that same little boy and allow him to transition to female when he grows up he’s going to look like he is a straight woman”
This is a position that the medical, scientific and philosophical communities, whom she purports to represent, have all long since viewed as over simplistic and reductive. Furthermore, it highlights Dr Soh’s double standard. In citing ‘gay children’, whilst refuting the possibility of ‘trans children’ she begs the question and still does not explain why trans children would be ‘bad’. (Ainsworth 2015, Moser 2010, Rogers and Walsh 1982, Lundberg 2018 Karkazis 2008, Popper 2010, Baur 2015:18-58)
Dr Soh’s position stands in direct contradiction to what the JJ case suggests. It is also a further over simplification of the medical, anthropological and philosophical relationships between mind and body (Appendix A, Engle 1977,1980, Sapolsky 2017:328-386, Warburton 2013:137-156). Indeed, even the discipline of psychology itself would probably baulk at a complete cartesian dualist separation of mind and body, since in cases of specific and unambiguous ‘mental health’ such as schizophrenia or depression we often treat the mind through medicating the body (Miyamoto et al 2005, Mintz 1992).
Its hard not to be disparaging to Dr Soh, as she appears to disingenuously use academic privilege and medical language. Investigation of her other publications again suggests a view of gender dysphoria, if it exists at all, as simply an adult orientation (Soh 2018b). Yet even desire and sexuality have recognised physiological under pinning’s, so even on this point her ontological position regarding ‘trans’ people is obscured (Weeks 1998)
The current (2013) 5th edition of the Diagnostic and Statistical Manual of mental disorders (DSM-5) removed any reference to orientation as the ‘causal mechanism’ for an individual’s transition (Zucker 2015). The World health organisations (WHO) International classification of diseases 11th ed (ICD-11) published in May 2019 not only renamed the incidence of ‘Gender identity disorder’ as ‘gender incongruence’ but moved its classification, from ‘psychiatry’ to ‘disorders of sexual development’ or DSD, placing it on the same level as those with physical manifestations of difference (Lundberg et al 2018, Zucker 2015, Icd.WHO.int 2019, APA 2013). The medical profession has been discussing whether individuals born with a recognised intersex condition (now termed ‘DSD’ since 2006) should be eligible for a diagnosis of gender dysphoria since the third edition of the DSM in 1980. DSM 5 now includes ‘DSD’ (intersex) as a possible causal mechanism for Gender dysphoria, whether diagnosable or otherwise (Zucker 2015:35). Currently in the UK, the process of obtaining a gender recognition certificate is split on exactly this point. Intersex people, recognised by the ICD-11th ed under a heading of DSD, the same categorisation as gender incongruence, are deemed to not require a diagnosis of gender dysphoria in order to obtain a GRC. But trans people currently are.
Ironically, what Dr Soh misses is that she herself is part of the process that has and is socially constructing a trans gender identity discourse in relation to other, equally socially constructed, gender groupings. She conflates descriptive categorisation with ontological truth, and in the process fundamentally misrepresents both. (Baur 2015, Serano 2016, Butler, Popper, Fricker 2014, Denzin and Lincoln 2018:98, Sapolsky 2011)
If we revisit the criticism of Ghaemi 2011 who suggested the BPS model has inconsistent mind and body boundaries, we can now posit a rebuttal. People with Atypical sex and gender presentations are just one demonstration that the BPS model of health and health care adequately fits the human patient. Why so? because people and their health needs have those same inconsistent or “fuzzy” mind/body boundaries. If the medical establishment becomes too prescriptive, enforcing rigid categorical thinking, as it did in the early 20th century, we risk poorly defining both. In truth, patient histories, bodily causality and the identity work of people and institutions are very much intersectional, and the medical profession is no exception to this. (Collins 2016, Butler 2015 Foucault, 1965:159-198, 1973).
In collating all the above, what the two case-studies highlight is that the historical medicalisations of trans gender and intersex people are inextricably linked. As Sarah Teezle writes in her 2017 chapter on transgender eligibility policies in sport:
“Intersex and transgender people suffer from opposite problems for the same reason… Both problems arise from a heterosexist medical establishment determined to retain control over who gets to be what sex”
The early 20th century medical profession and its socially situated institutional standpoint wilfully separated ‘Intersex’ from ‘trans-ness”. The prevailing socio-political jurisdictional powers of the time, biomedical models of health that excluded sociological factors as causal, and a positivistic view of science, were all casual in this. Whilst historically we can perhaps place these occurrences in the proper context, to continue such a separation would in the authors view constitute a serious, and systemic testimonial injustice (Fricker 2007:1-29, 147-175) Not least because we now know enough about the genetic, hormonal, gonadal, and wider physiological components of sexual development to suggest that a binary mutually exclusive model of sexed and engendered bodies is a poor fit, and current postpositivist scientific models view ‘truth’ as that which is left when alternative propositions cannot hold up in the face of unpredictable possibilities (Popper 2010, Ainsworth 2015). Furthermore, it is this separation that sits at the very centre of the inequalities many trans people around the world continue to face today.
In a curious reversal of fate, In the United Kingdom, trans people now have more legal protections and status than intersex individuals, who currently receive little to no recognition outside medical fields (Equalities act 2010). However, treatment provision for trans people has always lagged behind that of intersex, and processes for accessing health care as a trans person are arduous, with protracted timelines of literal years. Well outside the 18-week NHS guidelines, and with the ever-present threat of testimonial or hermeneutical injustice preventing appropriate treatment.GP’s often fail to refer and/or treat trans patients, despite the wealth of advice and guidance on this issue from the WHO, General Medical Council and World Professional Association of Trans gender Health (ICD.who.int, 2019, GMC-uk.org, 2019 Coleman et al 2012). In 2019 the National survey of LGBT people reported that:
“Twenty one percent of trans respondents said their specific needs were ignored or not considered when they accessed, or tried to access, healthcare services in the 12 months preceding the survey. 18% said they were subject to inappropriate curiosity and 18% also said they avoided treatment for fear of discrimination or intolerant reactions” (Gov 2019)
Although the trans conversation is moving forward, it would appear that the medical and scientific communities still have some way to go in unravelling entrenched injustices of the last century and thus playing its part in resolving the resultant inequalities.
One step forward, two steps back
At the time of writing in the UK, socio-political power is attempting once again to draw distinct ethical boundaries around the issue of trans gender care for adults and children. Liz Truss Uk equalities minister echoing the arguments of Dr Soh et al and placing the long-term legal status of trans people in doubt in the United Kingdom. On 22 April 2020, she announced that she would recommend specific changes to the Gender Recognition Act 2004 (GRA) following the proceeding governments consultation process in 2018. Her remarks to Parliament's Women and Equalities Select Committee included:
"....First of all, the protection of single-sex spaces, which is extremely important. Secondly making sure that transgender adults are free to live their lives as they wish without fear of persecution, whilst maintaining the proper checks and balances in the system.
"Finally, which is not a direct issue concerning the Gender Recognition Act, but is relevant, making sure that the under 18s are protected from decisions that they could make, that are irreversible in the future,"
(Liz truss cited in an article by Andersen 2020)
It is interesting to note the language. Arguably, the population that is most invested in the GRA and its consultation period are trans people, yet they are listed as second in priority. So, it seems that the UK is set for yet more intertwining of trans gender medicalisations and the legal frameworks surrounding their existence. The wording of the minsters statements seriously concerned LGBTQIA+ and trans charities such as stonewall and mermaids, yet it was welcomed by the womensplaceuk.og, an organisation that has previously characterised trans women as predatory males, and highlights what it says are “concerns” over the number of younger women (under 18) presenting with gender dysphoria.
The current UK government, in looking to restrict healthcare provision for young transgender people is sending a message that people cannot and therefore will not be allowed to know themselves as trans gender until they are deemed an adult. More insidiously, this insinuates that being trans is a non-naturally occurring 'adult only' issue, unusual, abnormal, perhaps a choice, one existing the in mind, “less than” being “cis- gender” and therefore "wrong". As Talia Bettcher puts it, this is a “metaphysical scepticism” that resides at the heart of all trans phobia. The idea that trans people really are the sex and gender they were assigned at birth. They just think they aren’t. That this position should come from the UK government is extremely concerning and suggests Conrad’s socio-political jurisdictional power base of medicalisation is alive and well.
Donald Trump the 45th ‘president’ of the USA went on record saying that treatment of transgender patients during a world-wide pandemic was ‘optional’. That I and thousands like me, do not deserve the same right to life as cis gender people. Whilst the medical profession appears to have acknowledged its historical error of categorisation, it would seem the societal implications of 100+ years of moralising are set to rumble on for decades yet. As a trans person who lived through the era of section 28, I cannot help but feel that the fact we are still to this day moralising over the legitimacy of the em-personed body, and a person’s right to exist based on their being cis, trans, male, female, young or old, or any derivation thereof, is the saddest, and greatest injustice. After all, in the final, highly critical analysis, we could simply ask: who’s gender is it anyway?
Appendix A: David Reimer and the John Money Gender reassignment Controversy: The John/Joan case.
In the mid-1960s, psychologist John Money encouraged the gender reassignment of David Reimer. Born in 1965, David was one of twin boys, and a biological male who suffered irreparable damage to his penis as an infant during a failed circumcision. After encouragement from Money, Reimer’s parents decided to raise Reimer as a girl. Reimer underwent surgery as an infant to construct rudimentary female genitals and was given female hormones during puberty. Reimer was never told he was biologically male during his childhood, and both he and his brother regularly visited Money, who tracked the progress of his gender reassignment. The Reimer children unknowingly acted as an experimental subjects in Money’s controversial investigation, which he called the John/Joan case. The case results were reported as successful and were used to justify thousands of sex reassignment surgeries on children with reproductive abnormalities. Yet despite his upbringing, Reimer rejected the female identity as a young teenager, and began living as a male, after his father told him the truth of his childhood. A truth which had been concealed from him up to that point. He suffered severe depression throughout his life, which culminated in his suicide at thirty-eight years old. Reimer, and his public statements about the trauma of his transition, brought attention to gender identity and called into question the sex reassignment of infants and children.
At six months of age, both Bruce Reimer and his identical twin, Brian, were diagnosed with phimosis, a condition in which the foreskin of the penis cannot retract, inhibiting regular urination. On 27 April 1966, Reimer underwent circumcision, a common procedure in which a physician surgically removes the foreskin of the penis. Reimer’s circumcision failed damaging the penis. Reimer’s brother did not undergo circumcision and his phimosis healed naturally. While the true extent of Reimer’s penile damage was unclear, the overwhelming majority of biographers and journalists maintained that it was either totally severed or otherwise damaged beyond the possibility of function.
A year later, Reimer’s parents sought the help of John Money, a psychologist and sexologist who worked at the Johns Hopkins Hospital in Baltimore, Maryland. In the mid twentieth century, Money helped establish the views on the psychology of gender identities and roles. In his academic work, Money argued in favour of the increasingly mainstream idea that gender was a societal construct, malleable from an early age. He stated that being raised as a female was in Reimer’s interest, and recommended sexual reassignment surgery. At the time, infants born with abnormal or intersex genitalia commonly received such interventions.
Reimer’s parents decided to raise Reimer as a girl. Physicians at the Johns Hopkins Hospital removed Reimer’s testes and damaged penis and constructed a vestigial vulvae and a vaginal canal in their place. The physicians also opened a small hole in Reimer’s lower abdomen for urination. Following his gender reassignment surgery, Reimer was given the first name Brenda, and his parents raised him as a girl. He received oestrogen during adolescence to promote the development of breasts.
Throughout his childhood, Reimer received annual check-ups from Money. His twin brother was also part of Money’s research on sexual development and gender in children. As identical twins growing up in the same family, the Reimer brothers were what Money considered ideal case subjects for a psychology study on gender. Reimer was the first documented case of sex reassignment of a child born developmentally normal, while Reimer’s brother was a control subject who shared Reimer’s genetic makeup, intrauterine space, and household.
During the twin’s psychiatric visits with Money, and as part of his research, Reimer and his twin brother were directed to inspect one another’s genitals and engage in behaviour resembling sexual intercourse. Reimer claimed that much of Money’s treatment involved the forced re-enactment of sexual positions and motions with his brother. In some exercises, the brothers rehearsed missionary positions with thrusting motions, which Money justified as the rehearsal of healthy childhood sexual exploration. In his later Rolling Stone interview, Reimer recalled that at least once, Money photographed those exercises. Money also made the brothers inspect one another’s pubic areas. Reimer stated that Money observed those exercises both alone and with as many as six colleagues. Reimer recounted anger and verbal abuse from Money if he or his brother resisted orders, in contrast to the calm and scientific demeanour Money presented to their parents. Reimer and his brother underwent Money’s treatments at preschool and grade school age. Money described Reimer’s transition as successful and claimed that Reimer’s girlish behaviour stood in stark contrast to his brother’s boyishness.
Reimer and his brother had unknowingly provided data that was then reported on by Money as the John/Joan case. A case which, according to biographers and the Intersex Society of North America, was used to reinforce Money’s theories on gender fluidity and provided justification for thousands of sex reassignment surgeries for children with abnormal genitals.
Contrary to Money’s notes, Reimer reports that as a child he experienced severe gender dysphoria*, a condition in which someone experiences distress as a result of their assigned gender. Reimer reported that he did not identify as a girl and resented Money’s visits for treatment. At the age of thirteen, Reimer threatened to commit suicide if his parents took him to Money on the next annual visit.
In adulthood, Reimer reported that he suffered psychological trauma due to Money’s experiments. In the mid-1990s, Reimer met Milton Diamond, a psychologist at the University of Hawaii, in Honolulu, Hawaii, and academic rival of Money. Reimer participated in a follow-up study conducted by Diamond, in which Diamond catalogued the failures of Reimer’s transition.
In 1997, Reimer began speaking publicly about his experiences, beginning with his participation in Diamond’s study. Reimer’s first interview appeared in the December 1997 issue of Rolling Stone magazine. In interviews, and a later book about his experience, Reimer described his interactions with Money as torturous and abusive. Accordingly, Reimer claimed he developed a lifelong distrust of hospitals and medical professionals.
With those reports, Reimer caused a multifaceted controversy over Money’s methods, honesty in data reporting, and the general ethics of sex reassignment surgeries on infants and children. Reimer’s description of his childhood conflicted with the scientific consensus about sex reassignment at the time. According to NOVA, Money led scientists to believe that the John/Joan case demonstrated an unreservedly successful sex transition. Reimer’s parents later blamed Money’s methods and alleged surreptitiousness for the psychological illnesses of their sons, although the notes of a former graduate student in Money’s lab indicated that Reimer’s parents dishonestly represented the transition’s success to Money and his co-workers. Reimer was further alleged by supporters of Money to have incorrectly recalled the details of his treatment. On Reimer’s case, Money publicly dismissed his criticism as antifeminist* and anti-trans* bias, but, according to his colleagues, was personally ashamed of the failure.
In his early twenties, Reimer attempted to commit suicide twice. According to Reimer, his adult family life was strained by marital problems and employment difficulty. Reimer’s brother, who suffered from depression and schizophrenia, died from an antidepressant drug overdose in July of 2002. On 2 May 2004, Reimer’s wife told him that she wanted a divorce. Two days later, at the age of thirty-eight, Reimer committed suicide by firearm.
*Emphasis my own.
Gaetano P (2020) "David Reimer and John Money Gender Reassignment Controversy: The John/Joan Case". Embryo Project Encyclopaedia [Available online] https://embryo.asu.edu/pages/david-reimer-and-john-money-gender-reassignment-controversy-johnjoan-case
Appendix B: Video transcript of Dr Debra Soh’s 2018 Presentation : Science doesn’t back up ‘gender is a social construct’
The following transcript is from a presentation given by Dr Debra Soh, the author of “the. Trans gender battle line: childhood, and proponent of the “rapid onset gender dysphoria’ critique regarding the validity of a trans identity in younger people. The transcript first appeared in blog form on the authors own website. Dr Soh was addressing an audience regarding the introduction of trans gender legislative protections via bills C16 and 77 in Canadian law.
“Gender is binary & not a social construct we are drowning in miss information on this subject.”
“Biological sex” is either male or female based on our reproductive functions. “gender” is how we feel, masculine or feminine in relations to our biological sex
“When sperm fertilises an egg at conception the baby will either be male or female, biology will dictate hormonal exposure in utero and the child’s gender identity as well.”
“for over 99% of us, our biological sex IS our gender identity”
“So, if we want to talk about things from a scientific perspective there are only two sexes and there are only two genders to suggest otherwise is not scientifically accurate. I first started writing about the issue of gender because mainstream media’s coverage of it frankly terrifies me from my time in academia I can tell you there’s a long list of areas of research that are forbidden, and this is affecting what the public is and isn’t allowed to know.”
“Bill c16* has contributed to this climate by writing false and unscientific ideas about gender into federal law. Nowadays self-determination is everything and some people will stop at nothing to push this agenda. they will torture logic and tokenise certain groups to gain political ground, like pointing to people with a difference of sex development which is a medical condition previously known as intersex as proof that gender is a spectrum. But this isn’t accurate because people with a difference of sex development who make up roughly 1 percent of the population possess anatomy characteristic of both sexes. For example, a child may be born with a vulva as well as testicular tissue this is due to difference in genetics and hormonal exposure in the womb so even in these cases biology is still dictating someone’s sense of gender.”
“There are thousands of studies showing the effects of pre-natal testosterone on the developing brain. Even before birth exposure to testosterone changes the way in which male and female brains grow. There’s no way that social differences that we see between men and women are purely due to socialisation unless someone want to argue that the unborn child is capable of learning gendered stereo types while they are still in the womb”
"The bottom line is the environment plays a role in shaping us, but it can’t override biology”
“People supporting the idea that gender is a social construct will often say that science back up their views and the next time you encounter someone like this I suggest you ask them what science you are referring to?”
“If they’re able to come up with anything, they’ll probably point to a study that came out a few years ago claiming that male and female brains exist along a mosaic and aren’t actually any different from one another. But a group of my colleagues reanalysed the exact same data from that study and found that you could in fact tell a male brain from a female brain at a rate much higher than chance. What’s disappointing is that the media promote the first study to no end, because its finding were flashy and politically correct, but they refused to cover the second study because apparently being scientifically accurate isn’t as lucrative. It isn’t sexist to talk about sex differences, what’s sexist is assuming that women need to be identical to men in order to be worthy of equal treatment. Defending biology nowadays gets you called not only alt right and misogynistic but trans phobic bigot too”
“And so, this brings me to the hate speech part of my talk people can identify however they like, but none of these identity labels are based in any science at all.
That goes for being gender non-binary, gender neutral, a gender, bi gender pan gender, gender fluid, gender free or moon gender just to name a few all of these labels mean that you identify to some extent as either both genders or neither. Moon gender I’ve learned, means that. Your gender only comes out at night. I’m not making it up I swear
The reality is no one is 100% male or female typical, think of the average guy, he’s probably into a bunch of things that guys like, but he probably has some female typical traits too and there’s nothing wrong with that. Maybe he likes watching sports, but he also like talking on the phone.
“I see that you guys are laughing but if anyone gets upset when this is on the internet these are gendered traits that are commonly used in the field of social psychology, so you can’t call me a sexist for using them as examples.”
“In my case I’m a woman who loves watching mixed martial arts which is sport that has mostly male fans, so I spend a lot of time asking myself am I really both genders, or gender neutral or neither or does it just mean that I’m a woman that likes watching a male dominated sport?”
“No one espousing this gender nonsense seems to have really thought it though, because from a practical stand point, to say that you are both genders, or neither still depends by definition on the concept of gender being binary”
“Some people might say that ok, so it’s just kids on Tumblr having fun why Debra do you have to go and rain on their parade? well I say it has implications for the rest of us when we look at the education system the elementary teacher’s federation of Ontario teaches children that gender is not binary. As I wrote in the globe and mail on Monday Ontario’s most recent sex ed curriculum taught children that gender is a social construct, the result of traditional gender norms and that some people are both genders or don’t have one. The other day someone sent me guidance from a school board a few hours from here, their sex ed curriculum teaches kids about puberty as it should but it refers to children as people with e penis and people with a vagina instead of simply calling them boys and girls”
“As I mentioned earlier for 99% of us our biological sex is our gender, less than 1 percent of the adult population identifies as transgender, a number that has doubled in the last ten years. So, to rewrite children’s education as though its common place for a person to identify as the opposite sex is inaccurate, potentially confusing to them and irresponsible.”
“Planned parenthood in Iowa recently tweeted that anatomy isn’t male or female it just is, and that it is trans phobic to believe otherwise. They also warned that the adults in the room may not get it and it’s a child’s job to re-educate them”
“Paediatricians will also have an interesting perspective going forward. the Canadian paediatric society released a guideline a few months ago that was meant to help doctors and parents understand the concept of gender, among its recommendation’s Drs were told that gender is a spectrum, that gender identity and gender expression are unrelated, and a child sex is assigned at birth. And finally while attending a research talk at a university a few months ago one of the presenters actually showed slides of both the gender bread person and the gender unicorn, for those of you who may have been fortunate enough to not be exposed to either of these atrocities, they were cartoons that were made for the purpose of teaching children that there are more genders than male and female, that gender identity has nothing to do with gender expression, anatomy or sexual orientation”
“So where does that leave us >?”
“More and more people don’t know what the truth is. More and more of these gender fantasies are being taught as part of the education curriculum means that young children are growing up with a distorted world view. I find it really unsettling that many parents who know better seem to be ok with this because they would rather be seen a progressive than dare to rock the boat”
“Another side effect is that clinicians who work with children aren’t able to do their job. We only have to look at the rapidly multiplying number of young children who are identifying as trans gender to see the social contagion aspect of this way of thinking. Many of these kids have some other medical condition that is leading them to feel the way that they do .whether its autism, BPD, or trauma “
“But because of the current political climate along with laws like Bill77** that incorrectly conflate any kind of questioning of gender identity with conversion therapy therapists and doctors are too afraid to push back because they could lose they livelihood for doing so. I’ve written previously about my experience growing up as a straight woman in the gay community and what I find most disturbing about this movement is that gay children are being encouraged to transition so that they appear heterosexual. If you take the example of the little boy who is feminine who tells his parents that he is a girl when he grows up he’s likely to be a gay man. If you take that same little boy and allow him to transition to female when he grows up he’s going to look like he is a straight woman.
“Let me be clear, I believe that transgender adults, people with a difference of sex development and those who are gender non-conforming deserve dignity respect and equal rights. I believe that gender dysphoria is a real phenomenon and those who are suffering should be free to live their lives as they choose including pursuing a social and medical transition in adult hood if they decide to. My issue is that the way we talk about biology and gender should not be maligned in order to facilitate these rights. Children should not be used as pawns to further this a gender.”
“Scientists should be able to do their work without interference they shouldn’t have to waste their time debating facts as obvious as how many genders there are. What I find most frustrating about bill c 16 is that is doesn’t even achieve what it presumable set out to do which is increase societal acceptance for people who don’t fit our expectation around gender norms.”
“The ideology promoted by bill c 16 only fosters resentment shuts down meaningful discussion and impairs our ability to understand what it means to be human”
*c16 was the amendment to the Canadian human’s rights act to include transgender as a protected characteristic
**Bill 77 was the affirming sexual orientation and gender affirming act 2015
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 “Individuals with Atypical sex ‘anomalies’ or intersex variations. Including chromosomal, gonadal, genital and hormonal markers of sex” (Griffiths 2018) Now called “Disorders of sexual development” (DSD) since 2006 (Lundberg et al 2018)  Cis-normative is a term that describes that being ‘cis’ gender, i.e. ‘not trans’, is viewed as a normative cultural expectation. That most people grow up in line with the ‘gendered assumptions’ assigned upon them at birth. It is a term distinct from connotations of sexuality and/or orientation.  Emphasis my own. Ontology as descriptors of being: existence, in this case positing a metaphysical difference between categories.  Gonads: ovaries of testes, part of the hormonal or ‘endocrine’ system in humans.  DSM 5: The Diagnostic term used to describe the difficulties a person may experience by virtue of a gender incongruence. (Zucker 2015) Formerly known as Gender identity disorder in DSM-4