Wednesday, March 29, 2017

Pseudonymous Federalist Contributor Likens Gender Affirmation to Lobotomies

Writing under the pseudonym Renee Gardner we are offered: “10 Ways The Transgender Push Mirrors The Lobotomy Craze.” That, of course, presupposes that there is a transgender push. Gardner, we are informed, has an ex-transgender daughter. We do not know if Gardner has so much as a high school diploma. We know nothing about her daughter. We know nothing about her medical care. All we know is that some woman in Ohio wrote a crazy piece being distributed by The Federalist.

Gardner appears to be active in (and seemingly the organizer of) 4thWaveNow which bills itself as “A community of parents & friends skeptical of the 'transgender child/teen' trend.” The domain name was registered in August, 2015. All of the contributors use pseudonyms. I have no idea why. Similar communities (or collections of cranks) are common throughout medicine. They are nonprofessionals who disagree with the AMA, APA or AAP for example. I could not find a link to join the community or submit a post. Obtaining “members” would seem to be a priority. For all we know the dozen or so contributors are all her. My failure to find a link doesn't necessarily mean that it's not there.


The simple fact is that every parent of a gender nonconforming child wishes that were not the case. They are prone to embrace unsupported and unprofessional theories about their children, particularly anything that opposes the general medical consensus.

The subtitle of this polemic reads:
We can learn a lot by looking back at history. Here I revisit the rise and fall of the lobotomy and compare it to today’s enthusiasm for altering children’s bodies to match their gender identities.
Are children's bodies being altered “to match their gender identities?” I do not think so. Was her supposed daughter's body altered? How and at what age? Practice guidelines generally require clinicians to provide only reversible therapies until a child is at least 16 years of age at which time they can be evaluated for possible hormone therapy.

For someone who claims to have a formerly gender nonconforming daughter, she seems oddly confused throughout. Being transgender is not a condition. Rather, it is a gender-affirming form of therapy that has a very wide range of application depending upon the needs of individual. Because being transgender is just a form of therapy, any serious, grownup conversation about transgender people must include a discussion about the underlying condition which is gender dysphoria. It is important to properly differentiate between the condition and a therapy. A failure to correctly address gender dysphoria demonstrates a predisposition to marginalize sexual minorities.

Gardner then fails to appreciate some basic differences. The first, and most important, is consent. People did not consent to lobotomies. They were deemed mentally incompetent and decisions about their care were made by legal guardians. Decisions about treatment for gender dysphoria are made primarily by the person being treated. If the individual is a minor those decisions are subject to parental consent but the child is the primary decision maker.

Secondly, a lobotomy is an irreversible one-step proposition. Treatment for gender dysphoria is progressive in most cases and is certainly progressive with children. Therapies are reversible unless and until there is virtual certainty about the extent of the underlying condition. Apparently Gardner's daughter had reversible therapy.
Back in 1987, Dr. Valenstein reminded attendees at a science conference to remember the history of the lobotomy. He warned that “all the major factors that shaped its development are still with us today.”
…desperate patients and their families still are willing to risk unproven therapies when nothing else helps. Ambitious doctors can persuade some of the media to report untested cures with anecdotal ‘research.’.…It could happen again.
I believe it is happening again—not with lobotomies, but pediatric medical transition. The treatment of “transgender” children is gaining significant momentum, despite the lack of research and regardless of the significant risks involved.
It is not the treatment of transgender children. It is the treatment of children with gender dysphoria. Let's get the nomenclature correct and I fail to see the comparison.

I am skipping over Gardner's history of lobotomy. At one point it was considered a miracle cure. It was not.
1. A High Level of Desperation

Both lobotomies and now the medical transitioning of young people have been more easily accepted because of their environment. A sense of hopelessness paired with yearning for a cure leads people to take chances they wouldn’t normally. …
Young people with gender dysphoria might have a high level of discomfort rather than desperation. There is no cure for gender dysphoria and, unlike lobotomists, no clinician is offering any therapy as a cure. The intention of therapy is to relieve the discomfort as safely as possible. I hate to repeat myself but the progressive, step-by-step, cautious approach provides a built-in safeguard.
2. Someone Besides the Patient Authorizes Treatment

During the lobotomy craze, many patients were not able to consent to the procedure themselves. Parents, spouses, and siblings were called upon. Many opted to have their loved ones lobotomized based upon a professional’s recommendation. Often they were given false hope and not informed of the serious side effects. Due to press’s lavishing praise, some people actually demanded their relative receive a lobotomy. …
Come on. No kid receives treatment for gender dysphoria in any form without their informed consent. Entirely different circumstances. Kid consents — parent approves. As for false hope, the child's discomfort is either relieved or it is not. The professionals work with these kids every day. They are continually and constantly evaluating their patient.
3. Highly Variable Results

Lobotomy outcomes were all over the map, which isn’t surprising if you consider the procedure was an imprecise “stab in the dark.” … …

There are a variety of outcomes from medical gender transitions as well. Some people say transitioning is life saving. Some react poorly to cross-sex hormones or have surgical complications. Some decide to de-transition or re-identify as their natal sex. …
I thought that this was about children. They are not surgical candidates. If a late-teen has an undesirable side effect from hormones their administration is stopped. Both sets of clinicians probably wore whites. That doesn't mean that a lobotomy is similar to gender-affirming therapy.
4.Treatment Based on Theories, Not Solid Evidence

As Freeman and Watts’ patient caseload grew, they gained confidence in their technique and wanted to share it with colleagues. They presented their findings at a Baltimore medical conference and declared they’d found a cure for mental illness. … …

There is a lack of research that backs up the medical transition of children. The current protocol being used in the United States is based on best guesses, not solid evidence. The gender affirmative approach, which advocates “supporting” children in their chosen gender identities, is a theory that has not undergone rigorous study. …
As of 2012 we were on version seven of the Standards of Care and they have been continuously evolving through the work of scores of qualified clinicians. There has also been considerable research which has produced guidelines for gender nonconforming children. Where there is an absence of evidence, the professionals rely upon expert opinion as the authors of the above guidelines explain:
Gender-affirming care for transgender youth is a young and rapidly evolving field. In the absence of solid evidence, providers often must rely on the expert opinions of innovators and thought leaders in the field; many of these expert opinions are expressed in this youth guideline. The four primary authors for this youth protocol represent many years of expertise in clinical care and research, in both academic and community practice settings, and within the disciplines of adolescent medicine, pediatric endocrinology, family medicine, and advanced practice nursing.
All that aside, the best determinant of the efficacy of treatment is the kid. Again, treatment is progressive. A lobotomy was an irreversible one-shot deal. There is no intellectually honest comparison.
5. The Power of the Press

Freeman used the media as a promotional tool. He often arranged for journalists and photographers to cover lobotomy demonstrations at mental asylums. “The Washington Star called lobotomy ‘One of the greatest surgical innovations of this generation.’ The New York Times called it ‘surgery of the soul,’ and declared it ‘history making,’” the PBS documentary says. …

Currently there are nearly daily examples of trans kid media stories. They tend to be pretty formulaic. From an early age, the child realizes he or she feels different from peers. A girl that throws a fit when mom puts her in a dress; a boy that wants to wear a dress. In general, preferences in clothes, toys, and haircuts are used to validate that they’re transgender.
Again she is confusing transgender with gender dysphoria. I would wager that no kid claims to be gender nonconforming because of the media. Moreover, the media has no effect on therapies. The media does improve acceptance by others and that is an appropriate role. According to research, gender nonconforming children are neither confused nor pretending. There really is no intellectually honest comparison in media effect.
6. An Embrace from Doctors

Initially many of Freeman’s fellow doctors were reluctant to embrace the lobotomy as an acceptable treatment, but that soon changed. Thanks to favorable newspaper articles, Freeman became somewhat of a celebrity. The public believed he had found a miracle cure. His services were sought.… … … (Damn this woman is painfully verbose!)

Currently, there appears to be widespread acceptance of medical interventions for gender dysphoric youth. Clinics all across the country provide gender care. It’s becoming more common to obtain insurance coverage for puberty blockers, cross-sex hormones, and surgeries. Some states have passed laws that forbid therapists from attempting to change children’s gender identities. Many mental health professionals seem to believe their duty is to simply affirm children’s beliefs, not to explore why they feel they’re the opposite sex.
What she is suggesting is the Christian party line. In point of fact (since she is so concerned about research) there is no research to substantiate the notion that talk therapy (or any other medical intervention for that matter) has any potential to reverse gender dysphoria. Again, both sets of doctors probably wore white so a lobotomy is just like gender-affirmation. Please.
7. Expanding the Patient Base

Freeman barnstormed mental asylums, operating on many patients in each location. He was frequently gloveless, mask-less and sometimes sleeveless. Once he performed 25 transorbital lobotomies in a single day. …

The first gender clinic in the United States opened in 2007 in Boston. An October 2016 article states there are now more than 60. Based on this information, in conjunction with the growing number of 4thWaveNow parents (many who note the number of trans-identifying students in their local schools are multiplying), it appears that the cases of young people with gender dysphoria are skyrocketing.
She has no way of knowing who those parents are or their number and she is loose with the facts. In February 2007 Boston Children's Hospital started its Gender Management Service (GeMS) clinic. It is America's first clinic to specialize in the treatment of gender nonconforming children. The percentage of gender nonconforming kids is probably the same as it was 20 years ago. The difference is the number of children being treated because there is less shame associated with the condition and because the research suggests better results with earlier transition.

Lobotomies were being marketed. The increasing number of clinics treating gender nonconforming children represents “pull” rather than “push” I suspect. Gardener cannot substantiate any of this “information” regarding the child population.
8. ‘Correcting’ Sexual Orientation

Up until 1973 homosexuality was considered a mental disorder. Lobotomies were sometimes performed to “correct” sexual orientation. The current practice is to treat prepubescent trans-identifying kids with gender affirmation and puberty blockers. But according to decades of research, 60 to 90 percent of gender dysphoric children, if left alone, grow out of their distress. Most mature into lesbian and gay adults.
I do not know what correlation she is suggesting. As “proof” of her contention that most children grow out of gender dysphoria she points to a 2016 article on a website that references research without, at least, links to the abstracts. Some of it dates back to 1972. It is selective observation without regard to the credentials and reputations of the investigators or the reputation of the outlet. The author of the piece, James M. Cantor, is a Canadian psychologist who practices coercive reparative therapy and was employed by the now closed CAMH Gender Identity Clinic in Toronto. He is best known, perhaps, for his Wikipedia editing war.

In any event the fact that lobotomies were sometimes used to “cure” homosexuality has no correlation to treatment for gender dysphoria which has no intention to cure the condition. It simply supports the needs of the patient as cautiously as possible.
9. Earlier Interventions to Prevent ‘Problems’

Initially Freeman claimed the lobotomy would be an operation of last resort. He once said, ”I won’t touch them unless they are faced with disability or suicide.” But as time went on he started advocating for lobotomy earlier, as a way to prevent mental deterioration. In a 1952 Time article (“Mass Lobotomies”), he is quoted as saying, “it is safer to operate than to wait.” …

It is assumed that treating children earlier will help them appear more convincingly as the opposite sex. This, along with consistent affirmation of their gender identity, is assumed to help these children avoid suicidality, depression, unemployment, sexually transmitted diseases, drug abuse, and homelessness commonly found in the current adult transgender population.
Again, the correlation is manufactured. The fact that there were efforts to treat youth does not mean that lobotomies are anything like the therapies for gender nonconforming children. One is irreversible, the other progressive, reversible and supported by research. It is not just that they will be more successful in transition but earlier treatment addresses collateral issues such as depression.
10. Ambitious Doctors

Freeman came from a prominent medical family. His grandfather, William Keen, was a famous surgeon, the first to extract a brain tumor from a living patient. Freeman looked up to his grandfather and wanted to be as successful. Early in his career Freeman became determined to alleviate patients’ emotional torment. He spent countless hours examining the brains of dead mental patients, trying to find a defect which could be corrected. But he was never able to find any. …

In 2007, endocrinologist Dr. Norman Spack co-founded the first U.S. pediatric gender clinic in Boston. Spack frequently talks about suicide rates in media interviews, saying “almost one in three trans individuals will attempt suicide if they do not receive treatment until after puberty.” He is a big proponent of using GnRH-agonists to pause the puberty of gender-distressed children. Gender specialists often describe puberty blockers as “safe,” “reversible” and “life saving,” but many have reported severe side effects, especially when administered to children.
I cannot believe that I finally got to the end of this fucking screed (or near the end). I do not know if Spack is ambitious or not. The most notoriously ambitious doctor treating gender nonconforming children is the thoroughly disgraced reparative therapist, Canadian Dr. Kenneth Zucker. At one time he was a leading researcher of gender dysphoria but he refused to change with advances in the literature.
The uncritical championing of child transition will eventually fizzle. Lessons will be learned. Science will evolve. Eventually books and documentaries may try to explain how things got so out of hand. How long that will take is anyone’s guess.
Uncritical? Nothing could be further from the truth. Gardener is making a prediction based solely on personal bias. I think that we are just at the beginning of understanding and treating gender nonconforming children. My prediction is that the crackpots will go away and a future pope will not make gender dysphoria his favorite ignorant hobby. My vision for the future is also based on personal bias but seems more consistent with the direction of medical science.

Frankly, I should not have invested this much time in a crank's comparison. Apparently The Federalist is willing to be an outlet for preposterous bullshit.

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