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Culture War Roundup for the week of February 27, 2023

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Given the response to my post below about culturally bound illnesses I figured it would make sense to write out a top level post specifically discussing gender dysphoria, since I expressed a desire to avoid that topic initially. I was inspired by Scott Alexander's recent post on culturally bound illnesses.

The basic idea of my previous post is that some illnesses which seem quite common in our society, things like anorexia, depression, chronic pain, and gender dysphoria, seem likely to be highly culturally mediated - i.e. they would not exist if the cultural norms we are inoculated in didn't account for them. This goes against the standard narrative for LGBTQ+ people, who often put forth the idea that before a minority gets social approval, there are a ton of 'closeted' individuals who simply live in suffering. Under this model, the social approval actually creates the urge to, for instace, sleep with the same sex or transition gender. (I'm less confident about homosexuality being highly cultural.)

I'm sure someone here could give a better history of rough numbers of trans individuals/gender dysphoria cases over time, but the gist seems to be that numbers have exploded recently. A quick search shows laughable results such as:

The percentage and number of adults who identify as transgender in the U.S. has remained steady over time.

And then on the exact same website:

Our estimate of the number of youth who identify as transgender has doubled from our previous estimate.

This is some of the most clear double think I've ever seen, and I tend to be much less invested in the trans debate than many here. Other studies are more honest explaining that:

The population size of transgender individuals in the United States is not well-known, in part because official records, including the US Census, do not include data on gender identity. Population surveys today more often collect transgender-inclusive gender-identity data, and secular trends in culture and the media have created a somewhat more favorable environment for transgender people.


I think this whole topic presents a clear problem, but I'm less sure about the actual solution. I'm sure many would jump at the chance to say we should just tell people who have gender dysphoria to suck it up and keep it to themselves, but I doubt the feasibility of that given how easy it is to create subcultures on the internet. Also, if you try to apply that frame to other problems like say anorexia, or depression, the failure modes become extremely clear.

Then again we can't just let these culturally created illnesses run rampant through our culture, and I predict they will only become increasingly problematic as our communication infrastructure and leisure time scales up. Ideally we want to replace these unhealthy cultural memes with healthier ones, but we run into a chicken and egg problem.

So - what are your recommended solutions to the issue of transgender ideation and other culturally bound issues?

So - what are your recommended solutions to the issue of transgender ideation and other culturally bound issues?

In a word, gatekeeping. Assuming gender dysphoria is at least partially a culturally-independent phenomenon, attempt to separate such cases from the far more common culturally-dependent ones. And do not consider any "treatment" aimed at anything but relieving the ideation in the latter cases.

But how do you gatekeep when the only gauge is based on feelings? This is my biggest frustration talking to people about trans - it always boils down to "that's how I feel" and there's no real way to get around that since it's not a logical proposition.

Make it costly. It is very nearly costless to articulate a feeling. However, people feeling severe distress are far more likely to engage in costly activities to try and relieve it. Gatekeep transition therapies behind assessments that a patient is likely to (or has) attempt or engage in behaviors that are harmful to themself or others in order to relieve it. If someone is willing to self-mutilate out of extreme dysphoria and will do so regardless of what anyone else does, it's probably better that the same operation be performed by a trained surgeon less likely to make quite as much of a horrifying botch of it. Anything else, the focus should be on reintegration of self-perception and physical self.

it's probably better that the same operation be performed by a trained surgeon less likely to make quite as much of a horrifying botch of it.

Depends on the surgeons, seemingly there are some who do make horrible botches. Or the money-grubbers, who will push their services to young people like this wonderful specimen of my nation who is now infesting yours:

An Irish plastic surgeon based in Florida who has a huge social media following has been reported to the Federal Trade Commission (FTC) for alleged false promotion of services to under-18s.

Five organisations led by Genspect — an international alliance founded by Irish psychotherapist Stella O’Malley that has concerns about gender-affirmative treatment of young people — filed its complaint against Dr Sidhbh Gallagher in February.

...She has described herself as “Dr Teetus Deletus” online, in reference to her surgical removal of breast tissue for women transitioning to men. In her TikTok videos she regularly describes the procedure as “yeet the teets”. “Yeet” is slang for forcefully throwing something away.

Dr Gallagher has said she does up to 500 gender-affirmation surgeries a year. One a month involves a person under the age of 18.