I'm not promoting either. — Benkei

That's my poor wording at fault. I was attempting to engage with your argument at the level of public health policy. Policy will either promote or restrain certain approaches, it's extremely unlikely (not to mention very difficult) that a policy would do exactly neither and leave both options precisely equal.

As such, your argument, applied to public health policy, could be used equally to design policies which place barriers (or further barriers) in the way of pharmaceutical and surgical responses to gender dysphoria using exactly the same argument as is being used to design policies which remove or lessen those barriers.

As such, your argument, applied to public health policy, could be used equally to design policies which place barriers (or further barriers) in the way of pharmaceutical and surgical responses to gender dysphoria using exactly the same argument as is being used to design policies which remove or lessen those barriers. — Isaac

I don't think so because public health policy isn't in the business of resolving social issues. It has to work with the constraints it has and that's societies with gender stereotypes that are so stringently prescriptive @Andrew4Handel can't even imagine how a man can act feminine.

That said, even from a holistic point of view, doing away with gender stereotypes will not resolve all gender dysphoria (although I guess that won't be gender dysphoria anymore but something else, body dysphoria?) and I'd advocate the option because more choice is more freedom.

Edit: wait, I might be misunderstanding, are you saying currently policy promotes having gender affirming surgery?

because public health policy isn't in the business of resolving social issues. — Benkei

I find this hard to accept. I would take issue with it on its face - junk food, for example, is as much a social issue as a medical one and public health policy acknowledges that. But I would also take issue with it from the position of a citizen. If it is, as I believe, our duty as citizens to hold our authorities to account, then we needn't (nor ought to) limit our assessments to artificially narrow concerns.

If the social impact of a public health policy is negative, then the personal benefits to individuals need not outweigh that as far as we're concerned. The authority itself might have a narrow remit, but we don't.

doing away with gender stereotypes will not resolve all gender dysphoria — Benkei

I agree, but there are solutions to gender dysphoria which do not involve promoting the idea that it's the individual who needs 'fixing'. As @unenlightened has alluded to, there are mental health approaches which focus on acceptance (society's, not the client's), and strategies to deal with the lack of it. Therapies which focus the blame where it belongs and provide mechanisms for change on both sides of the individual's relationship with their community.

I find this hard to accept. I would take issue with it on its face - junk food, for example, is as much a social issue as a medical one and public health policy acknowledges that. But I would also take issue with it from the position of a citizen. If it is, as I believe, our duty as citizens to hold our authorities to account, then we needn't (nor ought to) limit our assessments to artificially narrow concerns.

If the social impact of a public health policy is negative, then the personal benefits to individuals need not outweigh that as far as we're concerned. The authority itself might have a narrow remit, but we don't. — Isaac

I think we should differentiate with the ideal world and the complex, large nation states we live in. In an ideal world, we have a holistic approach and public health policy is embedded in other socio-economic policy and they move and change in tandem and a cross-specialist interaction leads to (far more) optimal solutions. The reality is they are only tenuously related. It's public health policy to highlight the problem of junk food but individual choice trumps prohibitions in this area. And this is an issue; food safety doesn't deal with whether it's healthy. So we see small changes, where nutritional values and scores are given to food so people can make more informed choices. And we see people don't care. Well, actually, that's not fair. People with enough money to worry about their health do care, for too many people it's just a matter of what they can pay for and with the need for both persons in most relationships to work to even make ends meet, who has time to cook? So really, economic circumstances are making it much harder to have a healthy lifestyle. In the Netherlands that's mostly driven by stagnant wages and insane increases in house prices. Which in turn is driven by macro-economic policy choices, foreign direct investments and market liberalisation.

Yes, it's all connected but no we're not capable of untangling that web and I don't think anybody is. So we have to compartimentalise out of necessity.

I agree, but there are solutions to gender dysphoria which do not involve promoting the idea that it's the individual who needs 'fixing'. As unenlightened has alluded to, there are mental health approaches which focus on acceptance (society's, not the client's), and strategies to deal with the lack of it. Therapies which focus the blame where it belongs and provide mechanisms for change on both sides of the individual's relationship with their community. — Isaac

I don't consider this realistic though and I don't find it helpful to build hypothetical solutions to actual problems. Maybe in relation to family members yes but the wider community is not in therapy - it doesn't resolve bigotry in every day life and on social media, it doesn't get you a job because people don't hire you because they think you're offputting or they don't want to create a scene with the high performing alpha male Jake they don't want to lose.

Basically, I don't disagree with anything you say, I just don't think it's in any way practical.

it's all connected but no we're not capable of untangling that web and I don't think anybody is. So we have to compartimentalise out of necessity. — Benkei

Do we? I agree it's too connected to unravel with great accuracy, but I'm less sure that reluctant compartmentalisation is the only answer. A 'rough sketch' of the likely 'web' seems another viable alternative, or 'as many plausible connections as you can manage' is another. I share your concern about pragmatic limits, but it doesn't seem too difficult to me for an institution like https://www.nice.org.uk/guidance in my country to consider social impacts. It already considers economic impacts. I accept it'll never cover everything, but I don't accept it's thereby under no obligation to even try.

I don't find it helpful to build hypothetical solutions to actual problems. — Benkei

They're not hypothetical, such therapies actually exist. Obviously they don't run therapy on 'society' but they do focus on an individual's methods of relating to a sometimes hostile environment as opposed to assuming there's some bodily, or in most cases chemical, 'imbalance' which needs a pharmaceutical 'fix'. There's long been a movement opposed to 'chemical psychiatry' it has a perfectly well-accepted pedigree.

I don't disagree with anything you say, I just don't think it's in any way practical. — Benkei

Yes, disagreements over the pragmatic feasibility of any solution are much harder to resolve. All I can give toward my case is that institutions like NICE already do take non-medical impacts into account, and non-pharmaceutical, non-blaming, therapeutic interventions do already exist and have been used with some success.

So some kind of comparison is in the essence of identity, right? — fdrake

I want to be picky, because it affects the direction I would like to turn us towards. It is ubiquitous, it is universally instilled from birth, but it is not essential. "Be good for Mummy." is the first commandment to alienate oneself. It is irresistible because the infant's dependency is total, and Mother's love is conditional. The rift between unacceptable essence and role-conforming performance is universal, and thus normal, and considered sane. To steal Smail's book title, This is the origins of unhappiness.

Some people think this is all a conspiracy theory apparently. :yikes:

people do have predispositions, perhaps some bodily, which constrain how patterns can be internalised into identity, which constraints work and which don't. That manifests as a constraint on someone's propensities for development, who they become depends on how they're set up to grow and set up to adapt, even though all the potential is not determined in advance. — fdrake

My daughter, aged 4, doesn't want to be taken to school by her mixed race mother, but by her white dad. She wants to be white but isn't. This is what she has learned in 2 weeks at kindergarten.

I don't want to call being mixed race brown and frizzy-haired a predisposition, nor being whatever sex one is; what is internalised as identity is other people's feelings about what they identify one as being. There is a functional body image of course, that develops and that is already complex, but it becomes overlaid with this cognitive internalised identification and that is where the pride and shame and desire to be different begin.

I don't think one can distinguish, at that level, (or at age 4) what aspects of the body can be reasonably developed, and what cannot. This results in all kinds of contradictions that play out in individuals, internalised from the contradictions in society.

A simple example is food. Food is portrayed as orgasmically pleasurable, and a huge industry of salty, spicy, sugary, fatty, carbohydrate heavy instant foods are pushed onto people. At the same time, the ideal of beauty is heroin chic, starvation diet thin and also pushed as the path to happiness. Anorexia and morbid obesity are the individual manifestations of this social contradiction. Neither, though, I would say, has its origin in an individual predisposition, it is all learned and internalised. "I am strong willed and starve myself to death, you are a weak-willed lard-arse." And the strong or weak will is also an identity internalised from the emotions of others. So the distinction between the anorexic and the morbidly obese is about as significant as which side of the rope the tightrope-walker falls.

People do not like to hear this very much; they have been sold the rational self-interested man in control identity, and having bought into the franchise, object to having it exposed as a fraud.

Yes, but that [a better, healthier direction] 's not the debate here. — Isaac

It wasn't, until you introduced it.

The argument, apparently, was that the state of womanhood is in danger from males transitioning to female. I do not believe that to be the case.
Another argument was that, if a small percent of the population changes gender at will, society might somehow be harmed. I do not believe that to be the case.
Another argument was that heterosexual men disguised as women have penetrated women's shelters and prisons for the purpose of committing rape and other crimes. I am not personally aware of such a case, but as crimes are sometimes committed by people in disguise, I see no reason to disbelieve it. I do not, however, believe that all trans people should be penalized for that fact.

Then there is this multipronged ?argument:

I'd prefer people not be encouraged to surgically alter their bodies [1] to 'fix' a mental health problem [2] caused by societal values [3] which are themselves wrong. [4] Fixing society's unhealthy attitudes by laying the fault at the individual is itself unhealthy, [5] but doing so by giving more power to an industrial complex [6] which is already responsible for some of the greatest tragedies we've recently been through is doubly bad.[7] — Isaac

1. I am unaware that "people" are being encouraged to alter their bodies, and if so, by whom they are being encouraged.
2. This assumes that you are qualified to assess whatever problems people you have never met experience in relation to their gender identity, or that these problems are necessarily and invariably psychological. I do not believe either to be the case.
3. Such psychological problems are assumed to have a single cause: societal values,
which are
4. presumed wrong in some unspecified way.
While both these assumptions may be correct, no proof is offered.
5.I do not believe that 'society's unhealthy attitudes' can be fixed, but I do know that laws are always drafted in such a way as to hold individuals responsible for transgressing social rules and mores. Whatever a society is right or wrong about, only individuals can be punished.
6. Industrial complexes already have a good deal of power through their economic influence. I don't follow which particular industrial complex is being empowered by gender transitions, or what that complex is expected to do with its new power.
7. Unclear also is what industrial complex has been responsible for what great recent tragedies.
This argument is interesting for its sheer impenetrable complexity.

To date, I have not "promoted" gender reassignment, though I have steered several young people to social service agencies that might be able to counsel them, and helped someone research medical procedures.
As to social policy, the fascists are coming, so I would strongly encourage anyone who values their individual freedom to exercise their options while they can.

You have an odd approach here...

no proof is offered. — Vera Mont

Yet in your counter...

I do not believe — Vera Mont

I do not believe — Vera Mont

I am unaware that — Vera Mont

I do not believe — Vera Mont

...all offered without a shred of proof nor even any argument.

Then there's...

This argument is interesting for its sheer impenetrable complexity. — Vera Mont

(Referring to arguments about corporate power), which is smartly followed by...

As to social policy, the fascists are coming, so I would strongly encourage anyone who values their individual freedom to exercise their options while they can. — Vera Mont

...which presumably is presented as an example of an argument as clear and penetrable as a mountain lake...?


Pushing on.

1. I am unaware that "people" are being encouraged to alter their bodies, and if so, by whom they are being encouraged. — Vera Mont

I'm seriously tempted to just call it quits there. You're either being deliberately disingenuous or are woefully uninformed. You've never heard of Tavistock Clinic, sued for medical negligence for doing exactly that, and then promptly shut down after a damning report by the Care Quality Commission?

2. This assumes that you are qualified to assess whatever problems people you have never met experience in relation to their gender identity, or that these problems are necessarily and invariably psychological. I do not believe either to be the case. — Vera Mont

No, it presumes someone is. Or rather, someone must.

3. Such psychological problems are assumed to have a single cause: societal values,
which are
4. presumed wrong in some unspecified way. — Vera Mont

Yes. Blaming people's bodies because society won't accept them as such is wrong. Categorically.

5.I do not believe that 'society's unhealthy attitudes' can be fixed, but I do know that laws are always drafted in such a way as to hold individuals responsible for transgressing social rules and mores. Whatever a society is right or wrong about, only individuals can be punished. — Vera Mont

Nonsense. Rules and laws can be drafted so as to bring about social change. Again, putting being disingenuous aside this is simply ill-informed.

6. Industrial complexes already have a good deal of power through their economic influence. I don't follow which particular industrial complex is being empowered by gender transitions — Vera Mont

Gender transitions require a lifetime of drugs. You work out which industrial complex benefits.

7. Unclear also is what industrial complex has been responsible for what great recent tragedies. — Vera Mont

Opioids crisis. Over 100,000 dead last year.

We could add to that insulin price hikes, the refusal to distribute life-saving vaccines at cost, any number of cases of proven criminal fraud over prescription drugs... This is the industry you're wanting to entrust with the lifelong 'solution' to gender dysphoria.

I read an article in the news recently in which there is some possibility that the male chromosome may become extinct. This has led to some speculation that men may die out. However, there are some species in which the male chromosome has faded away but what happened was not a disappearance of males but the evolution of a new species.

Gender in its various forms may be part of evolutionary pathways. The various differences, including intersex and gender dysphoria are aspects of nature, just as homosexuality is, so independent of how people choose to act, including transitioning or not, it may all just be seen as diversity in the spectrum of evolutionary possibilities.

... Christ almightly! Does everything one doesn't personally agree with have to be a 'conspiracy theory' these days? — Isaac

No. Only actual conspiracy theories.

What's lazy is dividing every position into one of the two ready-made media-friendly tribes on every issue instead of actually reading what people are saying.

Agreed. But also, lazy conspiracy theories are lazy.

Only actual conspiracy theories. — busycuttingcrap

OK. And you identify these how?

.all offered without a shred of proof nor even any argument. — Isaac

I don't think I should be required to prove my belief and disbelief to you, even if that were possible to do. And, no, I will not attempt to prove that I don't think so.

You've never heard of Tavistock Clinic, sued for medical negligence for doing exactly that, and then promptly shut down after a damning report by the Care Quality Commission? — Isaac

Correct. Woefully behind on UK news. But if it's been shut down, it's presumably stopped encouraging people.

Blaming people's bodies because society won't accept them as such is wrong. Categorically. — Isaac

Yes, I happen to agree, although not everyone agrees on categorical rights and wrongs. And I gather you assume that this blaming of bodies is the sole cause of gender dysphoria. Seems a tad simplistic.

No, it presumes someone is [qualified to assess whether a problem is psychological]. Or rather, someone must. — Isaac

As I understand the situation, that is standard procedure in all gender reassignment cases. It's a process, still being studied, researched and refined. https://www.ohrc.on.ca/en/discussion-paper-toward-commission-policy-gender-identity/current-issues

Rules and laws can be drafted so as to bring about social change. — Isaac

A law can be drafted 1. to prohibit something, 2. exact something, 3. lift a prohibition or 4. lift an obligation. It is enforced by punishing individuals who 1. do what is forbidden 2. fail to do what is required 3. prevent another from doing that which is permitted.
Eventually and incrementally, laws do contribute to social change and that changes attitudes over time. I suppose a government could pass a law saying: From Monday on, all citizens will be tolerant, but it would be difficult to enforce.

This is the industry you're wanting to entrust with the lifelong 'solution' to gender dysphoria. — Isaac

I'm not wanting anything of the kind. You sure piled a lot of grudges onto a simple argument for personal autonomy! I'm wanting to let people make their own decisions about their lives.
And also to regulate the pharmaceutical industry. And also to stop harmful criminal activity and medical malpractice where possible. But I suspect those three functions come under separate government departments.

I read an article in the news recently in which there is some possibility that the male chromosome may become extinct. — Jack Cummins

I've been hearing that rumour for about 60 years. If it had been serious, human males as we know them might have ceased to exists in the space of 100,000 to 5,000,000 years (different estimates by different authors). However, the situation is not so dire: https://www.bbc.com/news/science-environment-17127617

I've always been of the mind that its relatively safe to call things that quack and waddle "ducks".

And the suggestion that the declassification of homosexuality and/or gender dysophoria as mental illnesses was done on the basis of "social mores" or political agendas and not evidence or valid scientific/medical considerations (nevermind the extensive body of evidence/medical studies cited as the basis for those decisions) lands pretty comfortably in conspiracy theory territory, in my estimation... and especially when this is suggested on the basis of no evidence whatsoever, and in the absence of any relevant expertise.

This is the sort of nonsense you expect from vaccine "skeptics" or flat earthers, not people interested in philosophy, and not least because its simply lazy.

"Sexologist John Money is often regarded as the first to introduce a terminological distinction between biological sex and gender role (which, as originally defined, includes the concepts of both gender role and what would later become known as gender identity) in 1955"

https://en.wikipedia.org/wiki/Gender

"Before Money's work, it was uncommon to use the word gender to refer to anything but grammatical categories."

"A 1997 academic study criticised Money's work in many respects, particularly in regard to the involuntary sex-reassignment of the child David Reimer.[4] Reimer committed suicide at 38 and his brother died of an overdose at 36. Some of Money's therapy sessions involved sexual activity between the two brothers when they were children."

https://en.wikipedia.org/wiki/John_Money

"Money was a prominent proponent of the "theory of gender neutrality"—that gender identity developed primarily as a result of social learning from early childhood and that it could be changed with the appropriate behavioural interventions."

https://en.wikipedia.org/wiki/David_Reimer

"By the age of 13 years, Reimer was experiencing suicidal depression and he told his parents he would take his own life if they made him see Money again."

More on John Money and the invention of Gender:

"For several years, Money reported on Reimer's progress as the "John/Joan case", describing apparently successful female gender development and using this case to support the feasibility of sex reassignment and surgical reconstruction even in non-intersex cases. Notes by a former student at Money's laboratory state that, during the yearly follow-up visits, Reimer's parents routinely lied to staff about the success of the procedure.[failed verification] When Money learned about this, he continued to misrepresent the results as a success for decades. By the time this was discovered, the idea of a purely socially constructed gender identity and infant Intersex medical interventions had become the accepted medical and sociological standard"

I am familiar with the story of David Reimer and it is such an unusual one as I read his autobiography which he wrote some time before his suicide. Thinking about it now, the idea of raising a child who had lost his penis, in a circumcision accident, as a girl seems atrocious. But, for many years the case was important in sociology to show that gender can be learned socially. Money's work with Reiner was considered to be a great success.

It was only later that it was known that Reimer suffered so terribly. Even though he had been given surgery and hormones he still was extremely masculine and got made fun of for being so hairy. He did transition to male and I believe that he was going to have a phalloplasty and he struggled with depression. I knew that his brother had schizophrenia but I didn't know that he died of an overdose. It is not surprising that the twin suffered with all that had happened, especially the suicide of his brother.

The gay liberation[a] movement was a social and political movement of the late 1960s through the mid-1980s that urged lesbians and gay men to engage in radical direct action, and to counter societal shame with gay pride.

https://en.wikipedia.org/wiki/Gay_liberation

First the campaign.

The decriminalisation of homosexuality was one of multiple liberal social reforms to be passed under Wilson's 1966-70 government and the wider move towards a "permissive society".

https://en.wikipedia.org/wiki/Sexual_Offences_Act_1967

Then the law change.

In 1974, the DSM was updated and homosexuality was replaced with a new diagnostic code for individuals distressed by their homosexuality. Distress over one's sexual orientation remained in the manual, under different names, until the DSM-5 in 2013.

Then the science.

And the suggestion that the declassification of homosexuality and/or gender dysophoria as mental illnesses was done on the basis of "social mores" or political agendas and not evidence or valid scientific/medical considerations (nevermind the extensive body of evidence/medical studies cited as the basis for those decisions) lands pretty comfortably in conspiracy theory territory, in my estimation... and especially when this is suggested on the basis of no evidence whatsoever (as it has been here). This is the stuff of vaccine "skeptics" and flat earthers, not people interested in philosophy, and not least because its simply lazy. — busycuttingcrap

Don't let history get in the way of your ranting scientistic ideology.

Don't let history get in the way of your ranting scientistic ideology. — unenlightened

He says, while ignoring the relevant history. Pot, meet kettle. :roll:

(and as always, bogus accusations of "scientism" are a reliable indicator that someone's argument has fallen apart and that they're now grasping at straws... so thanks for that)

Meanwhile in reality, the APA's decision was based on (and explicitly cited) scientific studies on the subject, particularly the extensive "Kinsey Reports", i.e. "Sexual Behavior in the Human Male" (1948), and "Sexual Behavior in the Human Female" (1953), as well as Hooker 1957 ("The Adjustment of the Male Overt Homosexual"), Ford and Beach 1951 ("Patterns of Sexual Behavior"), and others (the list of citations for the APA task force report on the subject is seriously like 30 pages long).

So homosexuality was declassified as a mental illness due to a compelling body of evidence showing homosexuality to be a normal, natural, and healthy variation of human sexuality... not because of some conspiracy among liberal psychiatrists or pressure from a woke mob of LGBTQ activists or whatever other fanciful nonsense you've talked yourself into.

(The irony is that homosexuality's original classification as a mental illness was due primarily to social and cultural biases and presuppositions in the absence of really any relevant empirical support, and was only changed in the face of an overwhelming and growing body of empirical counter-evidence).

Life can be mundane and it feels like our choices and actions make small difference. This is the appeal of superhero movies. These are people of robust action. That is what highlights the men. Nurturing traits are less short term oriented and might be seen as less interesting but are important in their own way.

in my estimation — busycuttingcrap

Exactly. And your qualification to unilaterally make such an estimation is...?

Anyone who isn't frankly terrified of the blind obsequience to authority inherent in this modern attitude has not been paying sufficient attention to the last 100 years of human history.

The medial establishment said so, so it simply must be right.

The same establishment that has been found guilty of mass and systemic corruption resulting in the deaths of hundreds of thousands only a few years ago in the opioid crisis. The same establishment with the demonstrable 'revolving door' between drug companies, government approval agencies and institutional bodies. The same establishment funded almost exclusively by the companies profiting from its decisions.

One serious question - if a report on global warming was produced by a group of scientists funded by fossil fuel companies, whose members often go on to sit on the boards of fossil fuel companies, who had, in the past, been proven to have colluded with fossil fuel companies... How big would their list of citations have to be for you to just blindly accept everything they say?

This is the sort of nonsense you expect from vaccine "skeptics" — busycuttingcrap

Funny how it's always vaccines... Would you claim that all drugs on the market are safe and efficacious? That all the (literally) hundreds of court cases where drug companies have been proven in criminal or civil court to have lied about either the safety or efficacy of their drugs are all 'conspiracy theories'?

If not, then what magic protects vaccines as a class of drug from this exact same pitfall?

the APA's decision was based on... — busycuttingcrap

This will be the same APA who, from 2005-2014, colluded with the US government to alter it's ethical guidelines to allow psychologists to be involved in extraordinary rendition practices (aka 'torture')? That APA, the completely independent, unimpeachable, totally devoid of bias or ideology, APA?

I don't think I should be required to prove my belief and disbelief to you — Vera Mont

Then why should I be required to prove mine to you?

if it's been shut down, it's presumably stopped encouraging people. — Vera Mont

Seriously? You're suggesting that the most plausible explanation for the near criminal misconduct of the nation's leading gender clinic is that it was just one single bad apple? Thank God they didn't put you in charge of the the Stephen Lawrence Inquiry.

(The irony is that homosexuality's original classification as a mental illness was due primarily to social and cultural biases and presuppositions in the absence of really any relevant empirical support, — busycuttingcrap

That's not irony, that's normal procedure. The irony is that you think it supports the probity and social independence of psychology.

See here, for another conspiracy theory:

Showalter described how the prevailing attitudes toward the mentally ill, and toward women in particular, were influenced by the social changes of each historical phase and how these attitudes affected the thinking and treatment used by the psychiatrists.

https://pubmed.ncbi.nlm.nih.gov/1938342/

It's amusing really, you use the label 'conspiracy theory' and other derogatory labels just the same way psychology always has and continues to use medicalised slander to delegitimise critical views of its practice. Disagreeing with psychology shows 'lack of insight' or 'paranoid delusions'; the label is the argument, diagnosis, and evidence all in one.

https://www.nice.org.uk/guidance in my country to consider social impacts. It already considers economic impacts. I accept it'll never cover everything, but I don't accept it's thereby under no obligation to even try. — Isaac

Can you share a guidance where you think they're doing this because I just tried to randomly and after spending 30 minutes reading, I couldn't find what you're referring to.

Not that it much matters for the point your making and the one I'm trying to make. I don't know about the UK but in our healthcare landscape we're currently spending over 1,5 billion EUR on healthcare policy with a multitude of advisory organs at various levels, continuously pouring out advice and reinforcing each other's opinions (but they never advise getting rid of the overhead they're a part of, how surprising!). That's definitely compartementalisation taken too far and with ridiculous (and expensive) consequences.

As a result, I'm not so optimistic given this is often the state of "modern" government. I do think we could have afforable healthcare not through policy but healthcare worker autonomy - they decide what care their patient should get. I'd suspect a significant 1 billion EUR saving in not dictating policy and an uptick in people actually helped because their care becomes central instead of following policy and procedures. But then, this leads to maximum compartimentalisation because every patient becomes unique and the socio-economic issues cannot be taken onboard (because healthcare workers are working one-on-one with their patients). And to change social issues, we need to aggregate, so we need policy and procedures again. And we're back at square one. :-)

Meanwhile, what to do with people with gender dysphoria? "Yeah, it really sucks you're depressed but it only took us over 50 years to get gay people accepted and then maybe in 50 years you'll feel comfortable with your gender expression and the dysphoria will change, so have a bit of patience, ok?" Except of course, identity is already formed by then and the social change won't resolve the problem for them. So yes, allow gender affirming operations, it will save lives while society tries to catch up with not being dicks about other people's gender expressions.

A 'rough sketch' of the likely 'web' seems another viable alternative, or 'as many plausible connections as you can manage' is another. I share your concern about pragmatic limits, but it doesn't seem too difficult to me for an institution like https://www.nice.org.uk/guidance in my country to consider social impacts. It already considers economic impacts. I accept it'll never cover everything, but I don't accept it's thereby under no obligation to even try. — Isaac

You probably already know this, but GPs, therapists and the whole healthcare system violates the nice guidelines everywhere. They're guidelines and do almost nothing to change the behaviour of healthcare professionals as far as I'm aware. It has a moral obligation to try, it usually just pretends to.

I think we can all agree that there are three levels at which the problem can be looked at...

A) Realistically, people are dicks and are unlikely to give a man in a dress the time of day let alone a job or any respect. Realistically public health policy is driven primarily by politics and money - lobbying - and we're unlikely to get much of a say.

B) Ideally, people could be whoever they want, we wouldn't 'medicalise' different ways of being and society would do it's best to accommodate different neurotypes.

C) Pragmatically, we can make some progress toward the latter despite the former (otherwise we might just as well give up now).

With regards to the trans debate as a whole (and medical interventions specifically) a number of issues arise in relation to these divisions.

1. The majority of the debate is about (a) not (c). You have good points to make regarding (c), but they're peripheral to the main debate. Kathleen Stock, for example, was not pelted with eggs for being too idealistic. Mermaids are not attempting to strip feminist campaign groups of their charitable status because they think they're trying too hard. Medically induced sex changes are, without doubt, an ideological goal of at least a large vocal proportion of the trans movement. My critique is mainly against this target.

2. The above makes me slightly suspicious of attempt to get the same result as above, but via a (c)-like argument. It's all just a little too convenient. When the ideological argument looks shaky, a pragmatic one is hastily pulled from the sleeve. Not saying that's your approach, just explaining my ickyness toward such arguments.

3. Pragmatic arguments are nearly impossible to make any headway on. The quality (and specificity) of empirical data required to make a compelling pragmatic argument is very high. For this reason it's rarely forwarded as such. I think it's dangerous to treat an assumed pragmatic limit as an objective position in the absence of very strong evidence of the necessity, which we simply don't have here.

We ought not be saying 'we probably can't push society away from medicalising it's intolerance so we'd better support the exact process we're trying to avoid, just in the case it might still save some lives'. I just don't see that as a very compelling argument.

Can you share a guidance where you think they're doing this because I just tried to randomly and after spending 30 minutes reading, I couldn't find what you're referring to. — Benkei

This should explain https://pubmed.ncbi.nlm.nih.gov/18767894/

I do think we could have afforable healthcare not through policy but healthcare worker autonomy - they decide what care their patient should get. — Benkei

I agree this is a good way forward, but with a public healthcare system we do need some means of limiting the options available to those which are safe, effective, and cost-effective. I cannot see a compelling reason why 'socially progressive' shouldn't be added to that list of requirements.

what to do with people with gender dysphoria? "Yeah, it really sucks you're depressed but... — Benkei

Well, yes. Unfortunately. You said yourself, solutions are usually suboptimal and if we don't have an optimal solution available then someone's going to suffer. That said, as I mentioned above, there are perfectly good, non-medical therapies available with reasonable indicators of success. The typical 'treatment vs non-treatment' studies cited as support for medical intervention do not (in any I've read) account for the type of non-medical option being compared.

allow gender affirming operations, it will save lives while society tries to catch up with not being dicks about other people's gender expressions. — Benkei

The point is that it's currently actively antithetical to that progress ever being made. Promoting an intervention which continues to treat intolerance as a fault of some individual's biology just further embeds the intolerance, it doesn't just fail to tackle it, it actively makes it worse.

Edit - I realised you might be meaning something more specific with NICE guidelines. An example would be any one of several changes to increase patient choice (for example in treatment of depression). There's no clear evidence of the clinical effectiveness of patient choice (although it seems likely to have a beneficial psycho-somatic effect). Increasing patient choice is an entirely ethical principle. A decision that patients simply ought to have more choice, not that better clinical outcomes result from more choice, just that this is how things ought to be.

GPs, therapists and the whole healthcare system violates the nice guidelines everywhere. They're guidelines and do almost nothing to change the behaviour of healthcare professionals as far as I'm aware. It has a moral obligation to try, it usually just pretends to. — fdrake

Absolutely. I'm not saying changes there will be a panacea, I'm more suggesting it in the context of the distinction I've made in my reply above. We should not, on principle, exchange assumed pragmatic limitations with actual objectives. Especially in cases where the former is actively antagonistic to the latter.

Then why should I be required to prove mine to you? — Isaac

You're not. Far from it!

You're suggesting that the most plausible explanation for the near criminal misconduct of the nation's leading gender clinic is that it was just one single bad apple? — Isaac

How should I know all the fuck-ups of your health care system? There may be lots of bad apples misconducting themselves all over the place. Shut down all of the criminal ones.

This is in conflict with women's rights and dignity such as not undressing in front of a male bodied person in a changing room and not being physically intimately examined by a male bodied person etc. — Andrew4Handel

I actually would prefer individual dressing rooms for everyone. I go to the gym and some people just walk around naked, like they'll get around to putting on their clothes after they check their phone or do whatever. I mean good God man, can we have a little decency?

Some things you just can't unsee.

How should I know all the fuck-ups of your health care system? There may be lots of bad apples misconducting themselves all over the place. Shut down all of the criminal ones. — Vera Mont

I was merely countering your responses. You seem pretty adamant about the lack of harms for someone who is knowingly unaware of the publicised harms.

You seem pretty adamant about the lack of harms — Isaac

Where was that? I recall wanting to weigh the harms against the benefits; not denying that people are harmed by other people, but asking in each case: Who benefits? Who is harmed?