I'd be interested to hear your thinking on what problems the account I've given runs into (different from merely the plausibility of alternative models), such that it might fail to account for some aspect of the phenomena. That might also serve to focus the discussion - what aspects of the phenomena do we see which stand out as requiring certain types of explanation? — Isaac
TRANS HEALTH MANIFESTO
Trans health is bodily autonomy. We will express our needs, and they will be met. We will change our bodies however we want. We will have universally accessible and freely available hormones & blockers, surgical procedures, and any other relevant treatments and therapies. We will end the medical gatekeeping of our bodies. We will have full, historical accountability for the abuses perpetuated against us in the name of 'healthcare'. We will see reparations for these crimes, and the crimes committed against others in our names.
We are not too ill, too disabled, too anxious, too depressed, too psychotic, too Mad, too foreign, too young, too old, too fat, too thin, too poor, or too queer to make decisions about our bodies and our futures. We are all self-medicating. Our agency will be recognised. We each labour far harder for the health of ourselves and those around us than any doctor ever has, and we will continue build supportive communities on principles of mutual aid.
We deny the separation of bodies, minds, and selves - a violence against any part of us is a violence against all of us. We believe that the epidemic of chronic conditions in our communities is a consequence of the war of attrition waged against us over centuries. We do not exist in isolation, and it is essential to our healthcare that we are all healing together, healing each other, and healing our world.
Appendix B: Referral for surgical intervention
Referrals for a surgical intervention must be made by a Lead Clinician from a
specialist Gender Dysphoria Clinic that is commissioned by NHS England, with
necessary accompanying clinical opinions as described in this service specification.
A decision about an individual’s suitability for surgical interventions to alleviate
gender dysphoria requires careful assessment and support from a specialist multidisciplinary team, taking into account medical, psychological, emotional and social
issues in combination. As such, and given the potential range of complexities that
may be experienced by individuals on the NHS pathway of care and the potential
treatments, referrals to the specialist surgical team will not be accepted from other
providers or health professionals.
Before a referral for surgery is made, the Lead Clinician in the Gender Dysphoria
Clinic will have met with the individual to review current treatment interventions, and
to assess the individual’s needs and readiness for the surgical intervention, both as
described in the criteria below and as an assessment of the individual’s physical
health generally. The processes of shared decision making and of obtaining consent
(as described earlier in this document) will provide the patient with necessary
information, and will allow the individual sufficient time to ask questions, and to
reflect on the advice of the Lead Clinician to enable an informed decision on the
treatment options, risks and benefits. — Service specification: Gender Identity Services for Adults (Surgical Interventions)
So - to your question. Is it judgement neutral? I doubt it. I don't know anyone's capable of that, but here I'm small-c conservative. If we're to accept that clinicians are pressured into conformity (and assuming they can be persuaded out of it eventually) then I'd far rather they conform to existing societal pressures (which at the least are well known, if not all that healthy) than conform to what essentially can be indistinguishable from the latest fad. We have an obligation to do no harm, and I don't think that's met by rushing into treatments with low quality evidence when the evidence of the harm being mitigated is only of similarly low quality. — Isaac
What you call ‘compelling evidence’ is reductionist methodology: colour reduced to monotone, and shades of grey reduced to black or white. We make these judgements most accurately based on the perspective for each interaction, NOT based on some popular or politically-determined binary classification of characteristics. The way I see it, denial of colour or shade variation is harmful - as is asserting that black and white are not socially constructed and cannot be opted in and out of. — Possibility
There are reasons to expect, as with other living things, sexually dichotomous behaviour. — Andrew4Handel
Do you think a profoundly effeminate gay male or ‘butch duke’ fits neatly onto a dichotomous scale , or are you are arguing for a scale that expresses a masculine-feminine continuum? — Joshs
It's not a scale it is a dichotomy.
Everyone is a unique individual with a profound personal inner life.
Are you referring to a scale of stereotypes? A scale of disorders of development? A genetic scale. — Andrew4Handel
Arent you arguing that there is such a thing as masculine and feminine behavior — Joshs
If you believe this, then dont you accept the possibility of intermediate forms of biologically-formed gender — Joshs
However social constructionism is a theory and a contested theory at that, you are simply claiming without evidence that certain traits are social constructed but if you apply that to everything consistently nothing is real (It is an anti realist stance). — Andrew4Handel
Intersex conditions I know tend to occur in either males or females. For example Klinefelter syndrome only occurs in males. Turner Syndrome only occurs in Females. Androgen insensitivity syndrome occurs in males. — Andrew4Handel
But we are here because a male impregnated a female and that is essential for the survival of our species and a fundamental. We need to know whether someone is the opposite sex to reproduce. — Andrew4Handel
I agree that the pathologising of the issue is the problem, but where I think I struggle is with what happens once that's been removed. If we no loner require the 'clinical distress', then the harm being resolved by the medical intervention is not clinical any more, it becomes, if not societal, then... ecological? We'd be claiming that there exists, naturally, a cohort of humans who identify as some other sexual phenotype than the one they were born as, but without this being a medical issue (not a defect), nor a societal one (we haven't fucked up and made a whole cohort of people unable to fit in). Just a naturally occurring feature of a population that some of them desperately (but not clinically desperate) need a different body (but not just any different body, they don't need a tail or broader shoulders, or a third arm, they need the body of the other sex). — Isaac
2. Where's the precedent? Tribes famously have long-accepted cross-gender roles. Some consider there to be a third gender, some simply accept that some women do men's things and vice versa. Suicide rates in tribes are famously low (with some not even having a word for the act). So where are the distraught Nádleehi, for example?
I have read of instances in the past where, when a Nadleehi was born into a family, a celebration involving other families would be held, as having a Nadleehi child was considered to be a great event. Then, in modern times, I see LGBTQ2S Diné and Nadleehi people today who were kicked out of their families, bullied viciously, or in the case of Fred C. Martinez, murdered.
I would not learn any of this until I went to college and started researching Nadleehi and other tribes that had Two Spirit people. When I first read about Fred C. Martinez and what happened to her, I wept. She was accepted by the matriarchs and women in her family as Nadleehi, yet would be bullied at school and sent home by officials for “wearing feminine clothing.”
Her life would come to a tragic end when she went to a party and left with Shaun Murphy. Her body would be found a week later and it was never charged as a hate crime. — The Struggle to be Nádleehi
"Cortez is a good community, but it has been my experience after living here 20 years that there are definite conflicts between Indians and whites," says Mark Larson, who represents Cortez in the state house of representatives. "We had [an incident in which] high school youth beat a Ute Indian to death in the park several years ago. And we had another incident where a couple of youths beat another Indian to near death."
But none of that history kept Martinez--a proud Navajo--in the closet. Friends always assumed that he might be gay, and his mother says she knew for three or four years that he was nadleehi. But it wasn't until summer 2000, right before his freshman year at Montezuma-Cortez High School, that the 6-foot-tall, 200-pound Martinez started to let his dark hair down and live in a manner that felt natural to him.
"He just started wearing makeup. He liked girl stuff," Mitchell says. "He felt good and he felt happy for being that way. And he said to his brothers and me, 'If you don't like the way I am, go ahead and tell me right now.' But nobody said anything."
Not at home, anyway. Friends, however, say Martinez was a frequent target of verbal harassment at school, and Mitchell says her son was sent home by school officials for painting his nails, plucking his eyebrows, and wearing makeup. "He would say to me, 'People don't like me for the way I am,'" she says. "And I would just tell him, 'Sonny, you just have to be yourself.'"
Dee Goodrich knows how difficult it must have been for Martinez to be himself. Goodrich, who is 26, is both Navajo and nadleehi. He grew up in Cortez and, until a couple of years ago, dressed almost exclusively as a woman.
"My sister was real traditional in her ways and was real active in the powwow circuit. I wanted to be just like her," says Goodrich, who performed as a female in powwow "jingle dances" and still designs stunning powwow costumes for his niece and others.
"Nadleehi is an old word for people who are blessed with the gift of being both a man and a woman at the same time. It's a sacred word," he says. "I always wanted to be like that. I always felt more feminine than I did masculine."
However, not all of Goodrich's classmates were privy to the same Native American teachings. And when Goodrich started to call himself Deanna, pluck his eyebrows, and powder his face, he was treated as anything but sacred. "No matter how many times I thought I was going to go to school and have a good day, I got harassed," he says; "faggot" was the slur most often tossed his way. "I felt secure the way that I was, so I didn't understand why people had to say what they said. For some reason some people just really wanted to knock me down." — Getting along in Cortez...
4. How do we frame such a state of affairs without invoking a 'female/male brain'? At best there's what appears to me to be a very thin line to tread here. We want to say that it's the sex of the body that matters (not just any bodily dissatisfaction will do). We want to fix that using endocrinological interventions (about as close to the brain as you can get without actual lobotomy). But we want to stop short of saying that the brain is sexualised in any way. Do you think that needle can be threaded? How are we to explain how GnRH therapy works to bring about the chosen identity, but at the same time not say that such an identity is created by natural gonadotrophin? I struggle to see how we can leave open to those who have naturally occurring gonadotrophins of one functional sort, any identity they choose, but at the same time say with confidence that artificial GnRH therapy brings about a certain identity with efficacy?
1. Why sex? Why not skin colour, hair type, height? If this phenomenon naturally occurs and isn't socially constructed, then is it just coincidence that it hinges on the most socially relevant phenotypical traits and not the socially irrelevant ones?
3. Why would this particular form of dissatisfaction deserve attention? We have famously limited resources (NHS on it's knees etc), if we remove the clinical need, then what differentiates this form of bodily dissatisfaction from any other? On what grounds do we deny steroids to the unhappily puny? On what grounds would we deny hair straighteners to those dissatisfied with their afros? I don't want this to be taken as a slippery slope argument, more a question of where (if) we'd draw a line.
The challenge to anyone who wants to reject my thesis is to come up with an answer to this question that is not based on relations with society. — unenlightened
When that character interacts with the education system, quiet passivity becomes laziness, unsteady hands become carelessness, forgetting names and faces is inattention and rude, and so on. I become moralised, and these things become 'wrong' with me rather than mere facts about me.
Otherwise than through they eyes of convention, how could there be anything wrong, uncomfortable, conflictual with being a man with a vagina, or a woman with a penis? One's physicality can only possibly be in conflict with an image of an ideal, which necessarily must come from others. — unenlightened
Am I right in thinking you see the genesis of identity as some kind social trauma, whereas character is something innate? — fdrake
The first is trans identity. I think broadly construed that applies to people who've transitioned surgically, people who live as the opposite gender otherwise, and I'd guess people like the Nádleehi. To me this is a binary concept - someone has trans identity or they don't. People are cis or trans. — fdrake
The proximal cause of the trauma seems to be having a tendency towards gender incongruous expression and people treating you like shit for not abiding to norms which forbid that expression. Compound event of what looks like an innate tendency with a social construction. — fdrake
having a trans identity is biologically predisposed, but that gender expression is socially constructed, administering hormones would change the biology but also the interaction effect. To put it another way. body properties are gendered, gendering works through societal expectation, if you change the body to better fit the societal expectation of the body, you'd be making a social and bodily intervention at the same time. — fdrake
gender dysphoria isn't determinative of trans identity. — fdrake
There's a sub issue here about distinguishing NHS time for treatment (a resource question) and whether it's permissible to treat some body issues with surgical/drug interventions in a moral sense. — fdrake
Unlike your definition of gender dysphoria, this definition still seems too vague to work with. It's seems no more than saying people who are trans, are trans. What is it to be trans? Is it wanting to act like another gender to the one assigned to you at birth, or is it wanting a different sexual phenotype to the one you have? Or is it both? — Isaac
What is it to be trans? Is it wanting to act like another gender to the one assigned to you at birth, or is it wanting a different sexual phenotype to the one you have? Or is it both? — Isaac
If the latter, then why sexual characteristics? Why not arm length, or head size, or hair colour? — Isaac
I think that works as far as avoiding the 'female brain' problem, but it lands us straight back into the idea that medication is only needed to better meet societal expectations. Again, would skin-whitening for black kids in racists communities be a good solution, something to promote? If not, then why sex changes for trans kids in gender-strict communities? — Isaac
If both of those make you feel a little icky, then what's the difference between them and gender re-assignment for people suffering the sort of trauma Fred Martinez experienced? — Isaac
Yes, I think we agree there, that's where I'd end up too. I can see a situation where there could be sufficient biological tendencies (through behaviours like imprinting) to explain universal gender preferences without resorting to notions like a 'female brain'. — Isaac
Yes, that's the direction I was going in. There's all sorts of clashes between one's body and society's acceptance of it, between one's body and one's own desires for it. Why privilege sexual characteristics? — Isaac
The best distinction I can come up with is that one - skin whitening - shames the body that it's applied to, and one is either an expression of that body's nature or is caused by a shamed incongruity between body and norm. I think the first is prejudicial violence "these people need to be white!" whereas the second is expressive change "We need to be otherwise!".
You could maybe rejoinder that someone could want to change their skin colour for precisely the same reasons. In that case, I think it's either a bullet bite scenario (which I don't like) or I should parry with a distinction. If we use unenlightened's social pressure/identity+shame dynamic as a proxy, the skin bleaching is explainable entirely by shaming social norms, my response to him was that trans identity is isn't explainable by shame, only trauma is.
The question about gender reassignment I think comes after the question about whether someone is trans, and the ethical norms are different. Oppression vs expression, shame being imposed from without vs undoing shame from within. I'd prefer not to think about it in terms of shame, because as you've highlighted people from more supportive social backgrounds (I imagine) have less chance of being traumatised about their gender incongruence. — fdrake
Putting it pretentiously, I'm under the impression that there's something affirmative in gender transition, but only something negating in the skin bleaching one. "Make me not this!" (skin bleaching) vs "Make me not this AND make me this" (transition).
Do you get the same impression? — fdrake
1) It kinda makes it sound like society is OK to push harsh bio-chemical interventions on it's minorities (rather than simply tolerate them) on the grounds that they "don't mind". I can't get to feeling good about that, even though I've no strict moral objection. I can get to a reluctant "Oh well, I suppose if they don't mind then I've no reason to stop them", but it's not something I'm going to waive flags over, I'm not going out on the street to cheer on the fact that society's found a way to get out of it's obligation to tolerate differences by using drugs. — Isaac
perhaps Mermaids aims of depathologizing trans identity and making treatment more accessible perhaps could be attained by making the current system better administered, the people who administer treatment more informed, and educating GP gatekeepers to treatments (this includes voice coaching and other non-invasive interventions etc). — fdrake
There was an NHS report to this effect (can cite if required) — fdrake
a lot can be gained by making the current treatment work better without a fundamental reimagining of how trans identity is seen by doctors. — fdrake
If we assume that the only reason for gender affirmation interventions is, essentially, peer pressure to shame their recipients, that would collapse the distinction between gender affirmation and "conversion therapy". The latter is universally traumatogenic, the former has a less than 1% rate of regret. — fdrake
I think we have made some progress though, — fdrake
Do we also agree the theory "social constructions alone determine gender incongruity" isn't established, and is likely to be too reductive — fdrake
To me this is a binary concept - someone has trans identity or they don't. People are cis or trans. — fdrake
based on their other activities (for example their attempt to de-legitimize LGB charities) — Isaac
I believe I've read it. This one? — Isaac
For me, both therapy approaches seem wrong because we shouldn't be tinkering with bodies or brains as if they were custom cars which can have parts swapped our with little effect on the whole. Not without very strong cause. We simply don't know enough to do that. — Isaac
For me, both therapy approaches seem wrong because we shouldn't be tinkering with bodies or brains as if they were custom cars which can have parts swapped our with little effect on the whole. Not without very strong cause. We simplydon't know enough to do that. — Isaac
2) I don't think the social peer effects can be ruled out. The placebo effect of having a cure for which everyone congratulates you ("how brave!") rather than berates you (the stigma of mental health treatment remains undented) is enormous when considering that the end points are all expressed in mental terms (how 'satisfied' you are, how many 'regrets'...as if such end points were not themselves social!) — Isaac
3) I know I've mentioned it before and you've diligently (and probably, sensibly) avoided it but I can't ignore the fact that the sex change option is supported by one of the largest industries in the world with the largest lobbying power by far. We can't pretend that isn't going to have an impact anywhere in this. Therapy is cheap and creates only employment. Drugs are expensive and generate huge profits for very powerful industries with a proven history of pushing profitable solutions over efficacious ones. — Isaac
Agreed. It's good to talk without the usual knee-jerk tribalism these topics so often descend into. As I've said, I've had colleagues affected by this. There are establishments, academic and otherwise, where this very conversation would at least be flagged, if not muffled entirely. — Isaac
Is this the LGB Alliance you're talking about? Any other examples? — fdrake
I figured it was time I started asking you hard questions as well. — fdrake
For me, both therapy approaches seem wrong because we shouldn't be tinkering with bodies or brains as if they were custom cars which can have parts swapped our with little effect on the whole. Not without very strong cause. We simply don't know enough to do that.[hopefully replaced the bolding correctly, it doesn't transfer in quotes] — Isaac
it's of weak relationship to any norms of administrative treatment in this context. It would need to be more concrete and evinced. — fdrake
I've taken a similar approach with the highlighting of qualifiers. What measures the strength of such a relationship and in saying it needs to be 'more' concrete, you're implying some target level of concreteness that's not yet been reached? What is this target level? The pharmaceutical companies have been legally (in some cases criminally) convicted of fraud. I'm struggling to see what greater level of evidence would be required that they engage in fraud. I can see a point about not assuming every drug is promoted fraudulently, simply because some are, but I can't see how one would support a proposition that multiple convictions for fraudulent activity do not weigh at all into an argument about whether some current activity might not be entirely on the level. — Isaac
hat measures the strength of such a relationship and in saying it needs to be 'more' concrete, you're implying some target level of concreteness that's not yet been reached?
but I can't see how one would support a proposition that multiple convictions for fraudulent activity do not weigh at all into an argument about whether some current activity might not be entirely on the level. — Isaac
But also the giving of medical advice to children contrary to NHS guidelines. It's not a good look. — Isaac
Examples of court cases? No, I think that's the one all this has pretty much coalesced into. but I'm talking about the wider debate, the attempt to demonise people like Kathleen Stock, the harassment of feminist journalists like Julie Bindell, Suzanne Moore, Hadley Freeman... But also the giving of medical advice to children contrary to NHS guidelines. It's not a good look. — Isaac
To tackle (1). I've not yet heard any update to Dr Cass's meta study for the NHS. It may be that I'm out of the loop, but at this stage, the best data I have on evidence is that it is "weak". That goes for 'puberty blockers', gender re-assignment surgery, and gonadotropin therapies. So I consider (1) to be a given, but I may be persuaded otherwise in the light of new evidence. — Isaac
So to (2), a much harder case to make. Is leaving things alone the best policy if you've only weak evidence an intervention will help? I have to admit that this comes from a gut feeling. I'm going to justify it, but I'm going to be open about the fact that the justification is post hoc. I wouldn't have to give it a moment's thought to feel it's wrong to give medication to someone because it might help them. I suppose an obvious life-or-death situation would change my mind, but it would have to be clear, not just more guesswork on weak evidence. — Isaac
Of course, I wouldn't advocate a position that no medication can now be trusted, that would be absurd, but I do think it has to constantly weigh in the balance now. We're just unfortunately in an economic system where that's a constant factor. If one is weighing risks, one has to include in that calculation the risk of fraud. — Isaac
So, to actually attempt a post hoc justification. I think the first argument is one of a sensible baseline for therapy (of any sort). If we don't accept a 'state of nature' as a baseline, then we have no grounds to distinguish pathology from merely bad design. Is my appendix a pathology? Should women's cervical openings be a little wider for easier childbirth? Do I have the optimum number of fingers? It's essential in medicine to be able to identify a pathology. That's done by assuming that whatever flaws it may have, there exists an archetype which acts as a default model of physiological function, and that archetype is based, not on a sci-fi 'blue-sky-thinking' ideal. It's based on a 'state of nature'.[/quote
I think this is a decent start. Though I don't think it plays well with the simultaneous intuition that gender is socially constructed. A "state of nature" in context, seems to me, would consist of the current state of play of gender norms and an individual's place within them. The archetypes there would be the gender roles of men and women, which are the default mode. The default mode of functioning would be expected conduct and appearance of men and women.
I don't find what I just wrote particularly persuasive, what I want it to do is draw out how badly those two concepts play with each other.
— Isaac
The second argument is one of responsibility (not going to invoke the bloody trolley scenario but...). We are generally held to be more responsible for that which we actively do than for that which we reasonably fail to prevent. I'm responsible if I detonate the bomb, but I'm not responsible for not interfering with its detonation (unless doing so would be really easy - hence 'reasonable'). As such, doctors and other clinicians ought pay closer attention to the potential side effects of the drugs they administer than to the potential outcomes of a failure to administer. Side effects are weighted more heavily. In the case of weak evidence for both, weak evidence of side effects trumps weak evidence for negative outcomes from a failure to intervene. — Isaac
As far as I know, even non-surgical interventions are relatively difficult to obtain - if they were handed out like candy there would be much fewer complaints about the process being obstructive. I believe that's also evinced by the NHS report. — fdrake
Though there's no guarantee that every healthcare system has similarly strict/harsh/draconian/badly administered barriers. I think that's a mark against the factual claim that there's been an effective pressure by drug companies to popularise transition treatment and hormone therapies - they're still seen as insufficiently available or badly administered by trans rights groups. — fdrake
I suppose there is an angle there where pharmaceutical companies are making policy decisions for trans rights groups, or some entryist angle, but I wouldn't believe that without hard evidence in context.
Hard evidence in context is what I meant by concreteness. Give me documentation about exactly how one pharmaceutical company has influenced one major service provider and I'll be more convinced this line is relevant. — fdrake
I'm left with a sense that you believe these misadministration are a direct result of how trans rights organisations comport themselves? If so, why do you think that's the case? — fdrake
I would also need to know why you believe this state of affairs isn't a good look to engage properly with your opinions. — fdrake
Is this being evaluated in terms of long term alleviation of mental health symptoms associated with gender incongruence? Would appreciate the paper link. — fdrake
I believe a consistent case could be made for cancelling/deprioritising resource allocation to these treatments, but to me it seems suspicious why a broad point like insufficient evidence of improving long term health outcomes is being leveraged in the context of trans healthcare rather than for the broad swathe of treatment it would apply to. Why appeal in this context and not others? — fdrake
I think we'd need an argument that also takes into account the very low regret rate of transition surgery - which is much less than other highly promoted, even deemed necessary, surgeries which manifestly alleviate some source of harm (lined earlier, can relink if required). — fdrake
it seems this is another place where the means of your criticism applies generically to healthcare services, rather than to gender affirmation specifically. — fdrake
What do you think distinguishes the seemingly benign example of administering anti-fungals for a non-fungal rash with no test from the less benign example of administering gender affirmative interventions after other mental health screening has been done? — fdrake
Also, this is just a literature request: I am interested in "potential side effects of failing to administer" too, do you have any literature on this? — fdrake
Yes. I'm saying that Any combination of male/female/no-sex brain and body, along with any combination of hormone regime that naturally occurs is bound, short of physical pain resulting, to be accepted as 'just the way I am' unless there is an induced conflict between that and 'the way I ought to be'.
In short the only possible source of conflicted identity is social. I mean who d'you even think you are, fdrake? That's just a duck! :razz: — unenlightened
But it may be a clash of incompatible world-views. Happy to drop it if so, I've been there before to no gain. — Isaac
That's true, to a point. But as I said. The Mermaids campaign slogan is not "things are fine just as they are, but let's not let them get worse". If there are currently sufficient barriers to treatment (and if treatment is something which oughtn't be 'handed out like candy') then things are fine as they are, the campaign objective of Mermaids are wrong. — Isaac
The argument (for me) is the one I gave above. If we have a material solution vs a mental solution, the material solution will be favoured (regardless of long term outcomes). It's easier and we have a psychological bias in favour of believing external causes more than we believe internal ones. Also, the end points are insufficiently robust at measuring personal gains, they still ask about 'satisfaction' or 'regret' which are both socially mediated. Clinical interventions ought not be measured on the basis of the degree to which society finds the end goals attractive. — Isaac
That crisis was brought about by northing else but the over-prescription of anti-biotics. Medical interventions are not isolated. Our biochemistry is not like the custom car whose parts can be swapped out. We ourselves are a very finely tuned ecosystem of chemicals and biota, and socially we form an even greater such system. — Isaac
If we can't make a society in which a few incompatible narratives can be allowed to exist alongside one another without resorting to court or institutional bullying then we've lost hope. — Isaac
That makes it important for there to be a community with enough freely available narratives for people to be able to find ones which make sense of their particular experiences. — Isaac
the reasons for focussing on trans issues are, as Dr Cass highlights, that the numbers are increasing exponentially. There's no precedent for that. — Isaac
A1 ) Surgical transition is permissible in some contexts, y/n?
A2 ) Hormone treatment is permissible in some contexts, y/n?
A3 ) Gender affirmation schooling (voice therapy) is permissible in some contexts, y/n?
A4 ) Therapy for gender dysphoria is permissible in some contexts, y/n?
A5 ) Counselling for trauma which has caused all this shame is permissible in some contexts, y/n? — fdrake
B1 ) If identities are socially constructed, what stops shame from being an essential part of one?
B2 ) What general consequences does this "artificiality" of shame have for people who have it?
B3 ) Why can't people's characters be inherently shameful? We can be quiet or good at mathematics, but not shameful, why?
B4 ) Why is it appropriate to treat "character" as a state of nature, prior to social identity, whenever we observe someone their character's expression becomes identified? As much as socialisation builds character, it builds identity - that these two develop in tandem undermines treating one as a state of nature and the other as social artifice. — fdrake
To be honest, I don't have the expertise to answer — unenlightened
This all feels to me rather like the question of abortion. Given social pressures, economic and normative, on women who become pregnant, that we are not going to treat or try to change, should, abortion be legal? A reluctant yes, but removing the stigma and properly funding childcare and motherhood would be a better solution in almost every case.
To be honest, I don't have the expertise to answer, but it is clear to me that there is a need or desire to transition only to the extent that what one is, is, or is felt to be, "wrong". And that means it is a social artefact. And what is permissible is an artefact of the same society. So I suppose that what society says is wrong with an individual, it needs to facilitate them changing. But I don't have to like it. — unenlightened
B1. Shame is ubiquitous, but what stops it from being essential is that it can only arise from comparison. — unenlightened
So the division between state of nature and social artifice is indeed part of the same division in psyche, and of course the individual cannot actually be divided, so some aspect must dominate and some aspect must be suppressed. Or some aspect acted out, and some aspect hidden away. and because we feel this division, we look for and cherish the imagined unity of 'authenticity', the great prize of therapy. — unenlightened
B2. This is a huge question, that I could make a whole thread on. From shame one hides oneself and tries to be what one is not, leading to anxiety of being exposed as a fraud, and from being hidden comes the sense of isolation and loneliness. Think of anorexia for an example of how social pressure creates lethal misery through body-shaming. — unenlightened
That makes sense to me. I can sympathise with reluctant support somewhat. Do you think it's in no one's "character" to transition? Further, is gender part of someone's character (vs sex)? Like... is it in my character to have male gender identity? — fdrake
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