sodiummuffin
No bio...
User ID: 420
sodiummuffin
15d ago
Right, but "Gender Dysphoria" is the name used for the overall condition in the DSM-5. "A strong desire to be rid of one’s primary and/or secondary sex characteristics" and "A strong desire for the primary and/or secondary sex characteristics of the other gender" are potential symptoms but not required ones. In fact diagnosing it in "Adolescents and Adults" only need 2 off this list, so for instance "A strong desire to be of the other gender" and "A strong desire to be treated as the other gender" are sufficient. (Diagnosing it in children requires 6 off a different list.) Of course in practice psychiatrists don't just do what the DSM-5 recommends and there is considerable variation.
So for those (including many psychiatrists) who believe self-identification is paramount to transgenderism, this means that a girl who comes in and says "I'm transgender" after the rest of her friend group did the same should be diagnosed with Gender Dysphoria even if she doesn't seem particularly upset with her body. (Not that discomfort with your body, particularly during puberty, is uncommon. Or believing yourself to be discomforted with it after learning that's how you should feel, or saying it after learning those are the magic words you should say to get past medical gatekeepers.) That people can genuinely feel that way and then have it go away after they ignore is obviously also important, but I was referring to the issues with the concept of transgenderism that claims self-identification is all-important.
sodiummuffin
15d ago
There are countless anecdotal reports online of people who are happier after transitioning.
This is fundamentally just a really bad way to judge whether a treatment works, one that we rightly dismiss for other treatments. There are also countless anecdotal reports of people who recover from cancer after faith-healing. And unlike spontaneous remission of cancer, which is rare, regression to the mean in mental health is the norm. "My mental health got so bad that I sought out X treatment, after which I got better" is the default result.
Go read Scott's Alcoholic Anonymous post (another treatment that a lot of supposed beneficiaries swear by that some critics accuse of being cult-like). Notice both how the evidence base is a complete mess (because it's really hard to test these things) and how the ultimate conclusion seems to be that AA (and pretty much all other treatments tested) is similarly effective to your doctor spending a few minutes telling you that alcoholism is bad and you should stop. Well, the evidence regarding gender transition is even worse. If it turns out outcomes for gender transition are equal or worse than your doctor spending a few minutes telling you "puberty can be scary but you'll be fine" or "accept yourself", that's something we really want to know rather than continuing with a standard treatment with so many downsides. Really it's something we should have known before establishing it as a standard treatment, but instead it went from "so rare you can't do decent studies" to "so common and standard that it would be unethical and difficult to have a real control group" without the step where we actually find out if it works.
A lot of arguments regarding gender transition research seem similar to other arguments that you pick up reading about medical research from people like Scott or Derek Lowe, just with the additional politicized element.
-
A lot of treatments are based on popular theories on how things work that make the effectiveness of the treatment seem like an inevitability, then crash and burn in randomized control trials. Suggesting a biochemical pathway is bullshit is less likely to get you fired than suggesting "inborn gender identity" is bullshit, which makes it even worse.
-
"The trial doesn't look good but maybe it works in a subgroup" is the sort of dubious cope you see all the time. At least the p-hackers saying "efficacy was shown in middle-aged hispanic women" have some sort of evidence, saying "okay but assuming the treatment works we just need to do a better job of diagnosing the people it'll work on" is even worse. The only saving grace is that the negative studies on gender transition aren't high-quality randomized control trials because none of the studies on the subject are.
-
Most fundamentally, everyone knows that the vast majority of prospective treatments fail and the burden of proof is with the people who think they'll succeed. You can have a clear mechanism, anecdotes, observational trials pointing the right direction...and people know not to get too excited. Yes there are standard treatments that are grandfathered in without going through the FDA or equivalent, but the reason why that works isn't really "standard of care", it's "so incredibly obviously effective that the result was clear with much lower standards of evidence". The argument would be that gender transition is such a case, but the various negative studies (and "positive" studies that are pretty negative on closer examination) seem to show it's not really that obvious.
If you believe all trans people are delusional, why do you care about the specific etiology of the transness of a specific subgroup of trans people?
Because it calls into doubt both the advisability of the current standard of care and the theoretical framework the treatment is based on. If "diagnose people with gender dysphoria if they say they're trans" is an effective diagnosis method, why is it getting so many apparent false-positives? If "gender identity" is an inborn trait that people have an internal sense of, how are all these people getting it wrong? Why don't they just feel "gender dysphoria" the first time someone calls them "he" and immediately stop? For those who think they're not false-positives, why does it seem to so obviously spread socially? If the answer is something like "because the born-trans members felt more comfortable coming out", how does it get such absurdly high rates among not-very-selected subgroups? If 40% of a classroom in a private girl's high-school comes out as trans, does that mean we should believe 40% of all women throughout the world and all of history are closeted transgender people? I don't think you have be certain about whether you think "inborn transgenderism isn't real" or "inborn transgenderism is real but 99% of post-surge ones are false-positives" or "more than 1% are real but there's a large fraction of false-positives" to point out the ways the dominant theoretical framework and treatment methodology doesn't really make sense. Nor is there going to be a lot of a agreement on those among critics. Also "Are there a group of people with an inborn 'wrong gender identity' disorder that is best treated through gender transition?", "Are those people 'really' the other gender?", and "Would it be best if society did X to encourage or enforce classifying them as the other gender?" are three different questions.
sodiummuffin
21d ago
Democracy is a sham. It doesn't matter who gets elected, the bureaucrats remain the same, the teachers remain the same, the university professors accrediting the teachers remain the same, and the people making movies remain the same. So, of course, nothing changes; it's the same government!
This seems like you redefining influential members of the culture as the real government in order to argue that the government controls the culture. Of course you aren't going to think the government is weak if you redefine anyone with power as part of the unofficial government. But someone who agrees with you but is using normal definitions is going to say that the the control of the U.S. government over culture is weak, and when they coincide it's generally because an influential cultural faction controls the government rather than the other way around.
Definition issues aside, I think you're also very mistaken about it being top-down. I saw the rise of SJW ideology, and it didn't originate from film-makers or bureaucrats or teachers. It was developed, refined, and spread by posters on websites like Tumblr and Something Awful. The influence over institutions like media outlets came later. Some of the words and ideas originated from academia decades earlier, but plenty was altered or brand new. "Demisexual" originated from a young teen girl on a play-by-post roleplaying forum (used to explain why her slutty RPG character had sex with some characters but not others) and spread when another poster from the same forum made a Tumblr post about it as a joke. Now plenty of big official institutions and university professors and so on take it seriously. (The original girl now identifies as demisexual herself, having "discovered" that she was projecting it onto her character, while the Tumblr poster regrets having accidentally unleashed it on the world.)
The rapid rise of SJW ideology had less to do with the power of the people creating or spreading it and more to do with a sort of selective memetic immunodeficiency among institutions and much of the public, with the internet serving as a breeding ground for ideas that maximally exploited those openings. To the extent that specific people were influential at all it was by being the sorts of weirdos who posted on the internet a lot and/or became skilled at internet posting. Not every change in culture is going to follow that pattern, but in the internet era I think such changes tend to be grassroots.
Look at any communist revolution
The government can influence culture a lot more if it's killing anyone who publicly disagrees and engaging in very extensive and relatively successful censorship. That doesn't mean every country (or the world as a whole) works the same way, or that establishing a totalitarian government is easier than influencing culture in other ways. There are multiple communist groups in the west who think engaging in normal politics is a waste of time because communism can only be achieved through violent revolution. Needless to say they're a lot less influential than the Something Awful posters who spent a decade refining their shitposting skills to amuse a few hundred other forum posters, then discovered those skills were transferable to influencing millions of people on social media. Which isn't to say that direct mass-appeal on social media is the only way, Scott Alexander demonstrates another approach.
Is this true? Typically lower mortality and higher quality of life are associated with lower birth rates. There are also various programs to lower birth rates more directly, like providing access to contraception and educating women, which could plausibly outweigh any increase in births due to saving lives.
A quick search finds a study saying "USAID was one of the largest providers of family planning services worldwide with almost $600 million for contraceptive services in poor countries." and a New York Times article claiming that $8.1 million in contraception was ruined after being stranded in Belgium due to the cuts. I do not know how much of these programs ultimately ended up being cut vs. being moved around.
This Givewell analysis estimates that each year of contraception prevents 0.3 unwanted pregnancies, of which 45% result in birth. This comment from someone at MSI Reproductive Choices says their average global cost per year of protection is $4.88, though increased marginal access could in some cases be $20 or more. So preventing a birth apparently costs around $36 for a private charity. Obviously USAID contraception could be less efficient than EA-adjacent charities, or more efficient due to increased economies of scale, but just multiplying it out implies USAID directly prevented the birth of around 16 million third-worlders per year, and that the one stranded Belgium shipment meant for Africa resulted in an additional 200,000 africans being born (or more because $8.1 million was the cost of the physical contraception, while $4.88 includes last-mile delivery). Realistically some of those averted pregnancies will probably be delayed rather than prevented entirely, since people might get access to contraception and use it based on how many children they already have, but it gives a rough idea. The Lancet study claims cuts would result in additional 14 million deaths but that's over 5 years, over the same period USAID contraception programs are (by these rough estimates) preventing 80 million from being born. Of course the Lancet's death estimates are based on assuming cuts to programs like PEPFAR that were actually moved to a different department, and I can't easily find whether the same happened with the contraception programs, so I don't know how it actually balances out.
I think this demonstrates the nature of low-hanging fruit/"neglectedness" in international aid and the importance of even very rough numbers over going by vibes. Because places like Africa are very poor, there is a lot of low-hanging fruit. Because more people are interested in saving lives than preventing births, there is even more low-hanging fruit in the latter. It's $3,000 to $8,000 to buy enough anti-malarial bednets to save a single african life, but only ~$36 to improve the average well-being of humanity by preventing someone from being born in Africa to begin with. Even though contraception was only 1.3% of USAID's $47 billion pre-cut budget, it seemingly had more of an impact on third-world population numbers than the rest combined. Spending fairly trivial amounts of money on increased contraception funding for the third-world could have a much bigger impact, save money long-term, and be much less controversial than the USAID cuts. Of course left-wingers are not immune to this sort of innumeracy either - consider how estimates of net lifetime costs to the taxpayer for Somalian migrants is over a million dollars per migrant, because doing things in the first world is expensive. Instead of improving the life of a single poor african by importing him to the first world you could save the lives of hundreds of africans by spending the money on insecticidal nets. And then because birth-control is even more neglected, for the cost of saving a single life from malaria you could potentially prevent over a hundred from being born.
More options
Context Copy link