I don't disagree with much of what you say here, but you've switched from opposing frames to alternate frames, which is why I don't find much to disagree with.

It's true that one way of looking at this is dualist. Or is in some ways more constructivist than perhaps I would prefer. Or that there are some useful and valid paradigms which provide a neat frame for many of the discussions around consciousness. But none of them are necessary, and that's the position I originally argued against. The notion that neuroscience and its approaches fail in some way to answer a question. I'm not arguing that alternative answers are not out there, nor am I arguing that they are less useful, or less accurate. I'm arguing that the answers given in the reductionist framework (which I don't even subscribe to by the way) are no less valid within their paradigm than phenomenological answers are within theirs.

Of course consciousness is a state. At any time you may be either conscious or unconscious. The point of general anesthesia is to change your state of consciousness to off. An anesthetic works if it changes your conscious state, and doesn't work if it does not. If consciousness is somehow merely a description, how does an anesthetic have causal efficacy? — hypericin

Anaesthetics work on neurological signals. They work entirely because we directly identify consciousness with certain neurological activity. If consciousness were something in addition to that activity then anaesthetics would not work since they only act on chemical activity, not 'the realm of consciousness'. 'conscious' is, in this frame, our name for certain neurological activity. We don't need to further explain why we named it thus.

As I said earlier, the component parts of a car are the same as 'the car'. There's not an additional thing on top of the components. The sort of consciousness dealt with by anaesthetics just is a particular set of neurons acting in a particular way. the answer to the question "why do they do that" is that they are stimulated to do so by preceding neurological activity. The answer to "why do they do that" in teleological terms is "because there's some evolutionary advantage to doing so and we're evolved creates". there's no sense to any other 'why?' question.

They have been shown and discussed even on this thread. A true Putinista is obviously someone or a movement/group who supports and works for Putin's objectives and agenda.

Like... — ssu

The comment was...

in Europe and America both the far-right and the far-left are Putin's closest allies. — SophistiCat

"Europe and America". Not "Russia".

Try reading first and commenting second. It works best that way.

Ideally default positions have arguments for them IMO. But I doubt we need to get into it here. — fdrake

Fair enough. I suppose I'd argue for it in terms of not creating new models where old ones are adequate. we already have a model of societal intolerance creating pressure to conform, we do not already have a model of how brains might create identities out of what are seemingly social categories which are nonetheless clash somehow with the body. If I can explain the phenomena using existing models, I'm not sure I need to go looking for a new one.

I'm wary here of p-hacking on a massive scale. We wouldn't want to start with the notion that trans identity has to be such as to be resolved by sex-change and then go searching for data sets that might show that.

like "passing" there's a question about whether this is even an atypical response to particularly salient and fundamental norms about society. You can find similarly strong norms about race, disability and sexuality. There is a third possibility, which I think unenlightened is close to (though please correct me if I'm wrong), in which all identity works like passing, and passing is nevertheless expressive. — fdrake

Yes, the models of identity I typically work with take this as a stating point - I mean, at one time I was working on the social construction of perception, so I'm pretty heavily invested in the notion of social construction in general (perhaps too heavily to get a sufficiently detached picture, I'll grant). As we've discussed before with perception though, the space within which social construction works is itself constrained by an external world which imposes limits on what can be believably constructed. Likewise I'm sympathetic to your raising the idea (reading your exchange with @unenlightened) that identity construction might be similarly constrained by biological factors (both somatic and psychological).

It's just that, as above, there doesn't appear to be a need for such constraints en masse insofar as the phenomena is already explained by well-trodden models of social acceptance. I needn't theorise that some, as yet hidden, genetic constraint limits the selection of identities from the 'supermarket shelf' of society's offerings in such an alarming way that one's own body must be rejected and replaced with another in order to make a satisfactory choice. It's plausible, but seems unnecessary.

If we think of passing as a moral imperative, that "if you are X then you ought to behave as expected of X", it raises the question of where those expectations are coming from. I don't think it's reasonable to explain the imperative to conform to cisgender+heteronormative gender norms as arising from trans activist pressure to pass, transition etc - that expectation arises from a social consensus. — fdrake

Absolutely. If I had a complaint about the mainstream trans movement it would be of being overly conservative, of undermining the hard-won progressive achievements of feminism over the last decades which finally allowed a slightly wider range of societal roles for natal women.

Society as a whole imposes the notion that some of it's smorgasbord of identities are available only to those with breasts, or only to those with penises (as well as other such restrictions). Thus anyone whose internal biological constraints might limit their choice of socially constructed identity to only those society makes available to the female form will be stuffed if they happen to have a male body. The solution is for more people to choose those options anyway. It is not for people to change their body to comply with society's arbitrary criteria as to who can have what identity.

As I said to @Benkei above, one option here is that people, quite understandably, not able to cope with the conflict this creates, choose the easier route. But then the appropriate response is one of sympathy for the individual and anger at society. That's not the message we're getting from groups like Mermaids who are pushing medical transition as the end goal, not as an unfortunate necessity for many because of the weight of social pressure (which needs to stop), but as an 'affirmation' of who they 'really' are. It's this narrative that I think is dangerous insofar as it reinforces these arbitrary restrictions on choice. It attempts to replace the notion that these restrictions are societal with a medicalisation of them. It makes the problem one of an individual's biology, not of a society's arbitrary sex-based role assignments.

It is majorly affirming to have something which you identify as a core aspect of your being affirmed socially. Not just for "fleeing shame", but by skilfully controlling an aspect of your presentation to better perform your identity. — fdrake

Yes. I can see an argument for this. No different to getting a tattoo. Essentially a 'modelling' of one's body to match an idea one has of it as an aesthetic construction - an art project. I don't see any issue with that. I don't doubt that some small quantity of plastic surgery falls into that camp too. but that wouldn't pathologise the problem. No child is traumatised by their inability to get a tattoo despite feeling strongly that they want to present that way. Individual ideas about presentation may drive some gender expressions (and include bodily re-forming), but it's society which renders the inability to achieve that traumatic, as opposed to merely frustrating.

Again we're in danger of searching out data to match the theory here. It's possible that people's need to express their body image is so great that the trauma is internally generated (or partially so), but it's not necessary. There's already explanations with existing models which don't in any way fail to capture the nature of the phenomena.

if we're talking about whether it's permissible to surgically transition or delay puberty, we've got informed consent for that right? — fdrake

Well, yes, but that's not how we handle other similar issues. We don't use such an approach with other medical interventions on offer, for example. We have strong systems in place to control recommendations based on efficacy, cost, and other factors. We don't simply give patients the Pfizer catalogue and say 'take your pick'. Consent to drugs and/or surgery is not like consent to some act (like sex, or skydiving). One hands over a good deal more trust to the medical professional given that details of the potential consequences are not generally part of public knowledge. As we've seen at Tavistock, that trust can be interfered with by social pressure and campaigns. That's not a good thing.

Furthermore, the whole issue is about societal pressures, which, if real, precede consent. One consents to that which one feels one ought to consent to. If society is creating unhealthy pressures then it will act on consent as much as any other choice made. Women were not, centauries ago, dragged kicking and screaming into loveless marriages of servitude. They consented to them. They consented because society imposed, from birth, the idea that they ought to consent.

I'd side with yes if we're comparing it to unestablished future risks vs established reports that individuals tend to be satisfied and have low levels of regret for surgery , but I don't think I've got a fortress of an argument for that claim. — fdrake

That's understandable. As I said, I think there's arguments for both sides and the evidence is far from clear either way (one of the main criticisms of the Care Quality Commission was the lack of data gathering meaning we could not reach properly informed decisions here). If, as has been established in the Tavistock case, medical professionals are in fear of their livelihoods if they do not conform to certain narratives, then we're in even more of a position of wariness than usual when it comes to results from a handful of small trials with (usually) methodological holes you could drive tank through.

The issue, though, is one of framing. Framed as a concerned political debate about the efficacy of medical treatments, the direction society ought to take to be as inclusive and just as possible... in that context I think the jury is out on how we ought proceed. But that's not the framing. One only need read a few comments here (but more pervasive in wider society) to see that it is framed as progressives vs bigots, as The Science™ vs 'conspiracy theory'. In essence that's a bigger problem because if that toxic approach to disagreement can't be surmounted then the idea of any future direction being hashed out between concerned parties for the best might as well go out of the window.

I don't think it's bad, just misplaced, as long as doctors stick to agreed ethical standards. — Benkei

Really? You must be unaware of the campaigns here.

Mermaids (a trans charity in the UK) are pushing for faster turnaround times and greater availability of puberty blockers and gender-affirming endocrine treatments for children. Treatments which our country's leading paediatrician has had to close the country's main gender clinic for over prescribing.

They were implicated by the commission with helping to create an environment which put children at risk because drugs with little clinical evidence of success and marginal data on long term effects were promoted out of fear of being labelled transphobic by charities like Mermaids. According to the testimony of some of the 35 clinicians who resigned from Tavistock before it was shut down "We are extremely concerned about the consequences for young people... For those of us who previously worked in the service, we fear that we have had front row seats to a medical scandal".

The report goes on to say...

Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters

I think promoting an environment where clinicians are unable to prescribe in the best interests of their patients for fear of consequences is a little more than 'misplaced'. It's been bad here. thing are improving since Tavistock, but there's a lot of pushback even on the decision to close it.

It baffles me that you think any of these questions are unaskable, that they "just are". — hypericin

You're asking for the cause of a description, not an event or state. 'Experience' is the description we give to the neuronal activity, it's not another thing on top of the neuronal activity which needs further causal explanation. Neuronal activity doesn't cause experience, it is experience. 'Experience' is a word we use to describe it. Only there's a disconnect because of the anomalous monism inherent in our linguistic practices relating to the world that language brings into being.

It's like asking how all the individual horses cause the category {horse} to exist. They don't. horses are things, the category {horse} is a human linguistic convention.

Likewise neuronal activity is within neuroscience, 'experience' is within human linguistic conventions. the one doesn't cause the other in any way other than the way in which we choose to relate the two (or conceptual models). 'Experience' simply isn't in the same conceptual model as 'neurons' so we can't derive one from the other without some act of translation and that act will just be made up, it's not a fact we discover.

"By what mechanism does an engine, carburetor, wheels, etc, assembled as a car, drive?" — hypericin

A car driving is a physical act, it's within the same conceptual framework as the levers and gears that work the car. 'Experience' is a description, not a thing. It's not in the same conceptual framework.

What circumstances do you think require a reason via those that do not? — Joshs

Reasons are human-related (when distinguished from mechanics). If ask "why did you smash that vase?" I'm not expecting "because my arm raised, my hand released it and that caused it to smash". I'm asking about your motives.

In Physics, chemistry, neurosciences...etc, the distinction doesn't make any sense. There are no motives, to 'why?' and 'how?' are the same question. As I alluded to earlier, about the closest we could get to a distinction is in evolutionary sciences where 'why?' refers to the evolutionary advantage, and 'how?' refers to the genetics, but even there it's just convention. we could ask 'how?' of evolution too and get a good set of theoretical answers.

Equally, if I asked a physicist 'why did the vase smash?', he might say 'because gravity pulls objects toward the earth and brittle things like vases smash on impact'. That's considered an answer. I could ask why both those laws are the case, but all I'd get is further, more fundamental, rules. At the end of my questioning there'd always be 'it just is'.

What the proponents of the 'hard' problem' seem to want is to forever maintain a type of answer which, by definition, will not be satisfied by mechanics or 'it just is', but since we have no such answer in any other field of human inquiry I cannot think of a reason why it's odd that we don't have one in neuroscience. I can't think what such an answer would even look like and neither, it seems, can any proponent of the problem.

Put differently, what kind of reality is it that cannot be potentially construed in an alternate way, so that we come to see it’s role within an order that did not exist to us previously? — Joshs

Roles within previously hidden orders are just more mechanics though (unless you're implying teleology). Say we found an entirely new function of the brain, something we didn't even know it did (let's say it taps into morphological fields) and we discover that consciousness plays an essential role in that. Does that answer the 'hard problem'? Apparently not, because if I theorise it plays an important role in survival (evolutionary advantage) that's not an answer apparently. So why would another role in another system be any more of an answer?

This is analogous to the origin of species before and after Darwin. Pre-Darwin, the answer to the question ‘Why are there different species’ was , because God made them arbitrarily unique in themselves. Beyond this, no deeper inquiry was attempted. After Darwin, the deeper ‘why’ question could be answered ‘ because each is the product of an overarching process that allows us to relate one to the other via temporal genesis. — Joshs

Exactly. Darwin found a mechanism for producing multiple species. The answer to the question 'why are there so many species?' was 'species evolve by natural selection and this process produces many species as a consequence of its mechanisms'. The answer to the question 'why doe we have consciousness?' is 'our experiences are produced by the brain activity and the mechanisms of the brain are such that experience is a consequence'... only apparently that isn't an answer either.

Don’t we choose one paradigm over other because changing the way we look at things ‘solves more puzzles’, as Kuhn put it? It seems to be that choosing the way that works by solving more puzzles, albeit differently, amounts to finding a why where there was none before. — Joshs

Yes, I agree, but you can't have your cake an eat it. Kuhn shows us how paradigms are discontinuous, they are not answers to the questions left by the previous one (that would merely be a continuation of the investigation within the previous paradigm) they a new ways of framing the problem such that those question become meaningless. So the mere possibility of a new paradigm doesn't mean the questions in the prior paradigm are unanswered, just that they might, in future become obsolete, or meaningless.

We don't go around saying that physics hasn't answered the question of acceleration due to gravity simply because a new paradigm might one day make that question obsolete. It has answered it (9.8 m/s/s) and a new paradigm might one day make that answer obsolete.

Observation: Putinistas tend to be radicals ✓ — jorndoe

On what evidence? What actions determine one is a 'Putinista'? Not official alliances. Not declarations of support. Not direct acts of support (arms sales, financial aid).

What identifies the 'Putinista' in this laughable theory is simply that they don't support current US policy. Anyone not voicing full-throated support for a military solution is a 'Putinista', So by definition, 'Putinistas' are radicals. It's not a discovery, it's a definition.

It's nothing but a transparent effort to smear the left (typically seen as well-meaning, if too ideological) by associating the with the far-right (more typically seen as 'evil', or at least very selfish). It's such an obvious ploy that I didn't think anyone would actually give it any serious consideration, but I suppose I didn't account for everyone...

Perhaps I have missed this, but don't you need to establish that a trans person's stated need for transition is caused by intolerance? — fdrake

'Establish'? That would imply the default position is that it isn't (or that it's not being so has already been established such that I need present evidence to the contrary).

As ever in these kinds of debates I'm more interested in the manner by which the debate is conducted than by the positions within the debate themselves. Here, what peaked my interest was the accusations of bigotry, 'conspiracy theory' etc. So it's not so much about whether one position has been 'established' or not. It's about whether one position is even in the debate. The question I'm asking is - why is it seen a illegitimate to even hold the belief that a trans person's need for transition is caused by intolerance? I don't need to prove it as established fact to investigate that, only that it is as plausible an explanation as any other.

There only seem to me to be two broad positions here (from which many more nuanced ones arise). Either;

1. there exists such a thing as a male/female brain and as such it is possible to be born with the wrong brain for your body.

or

2. behaviour typically associated with male/female bodies is frowned upon to such an extent that it you have a male/female body but behave in ways usually associated with female/male bodies, respectively, you will not be treated fairly.

Of course both can exists and merely manifest in different people.

In the case of (1) surgery (or drugs) to make the body match the brain seems a viable option. But so would medical intervention to make the brain match the body - yet so called 'conversion therapy' is very much a shut off route (it doesn't work at the moment, of course, but then transitional techniques didn't work at first either - further progress is shut off on ideological grounds, not practical grounds, no one is even researching the possibility).

A further complication of (1) is that females born in the 'right' body must, if we're to accept the premise of (1), have 'female-type' brains. ie there's a different brain type for females, it's fixed, and nothing short of medical intervention can change that. Anyone who can't see the very serious implications of accepting such a model for women, people of colour, the disabled... that different phenotypes have predictable and fixed ways of thinking...

It's essentially the issue that feminists have with this framing - that there's a 'female brain' which causes people to want to wear dresses, feel sexually attracted to men, and enjoy Bridget Jones.

So I don't buy (1), not without overwhelming evidence, which we don't have.

That leaves (2). Under (2), treating the person wanting to behave in ways more typically associated with the opposite sex by medically changing their sex so they more closely match society's expectation is unjust at best, abhorrent when pushed on young people by media representations.

I don't see a third option.

I'm also interested in what's made you so worried about the availability of puberty blockers? — fdrake

Hopefully explained above, but if not see... literally any pharmaceutical company's track record on ensuring their products are safe and efficacious first, profitable second.

This is from Hilary Cass, a senior paediatrician who has been reviewing NHS gender services for children.

As already highlighted in my interim report, the most significant knowledge gaps are in relation to treatment with puberty blockers, and the lack of clarity about whether the rationale for prescription is as an initial part of a transition pathway or as a ‘pause’ to allow more time for decision making…

We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation. We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process.

and on 'gender-affirming' hormones...

Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria

These are obviously just snippets within the wider debate. as I said, I'm less interested in the technical details here than in the manner in which the discussion is conducted.

They can campaign but it's not going to change the ethical rules doctors have to abide by. — Benkei

So you'd disagree with any such campaign? If so, we have no subject of disagreement. There are such campaigns in England.

Unsurprisingly, in Europe and America both the far-right and the far-left are Putin's closest allies. — SophistiCat

You don't seriously think anyone is stupid enough to fall for that?

Step 1. Define anyone opposing the centrist policy as a 'Putin ally'.

Step 2. Voilà. Non-centrists are automatically Putin allies by definition.

Unless you're about to furnish us with a definition of 'ally' which hasn't just been hand crafted to fit your propaganda.

I think the mainstream position is concerned with that if a person has gender affirming surgery then people should accept it. — Benkei

On what grounds?

About the question whether persons with gender dysphoria should have gender affirming surgery, I think opinions are much more qualified. But maybe things are simply different here than in the UK. — Benkei

I think gender surgery is still not easy to get in the UK, but I'm including any medicalisation of the problem, so puberty blockers and hormone therapy. Puberty blockers were, until very recently, alarmingly easy to get here in the UK, and the campaign groups are not saying "phew, that was a narrow escape, thanks for shutting Tavistock", they're saying they want more drugs, more easily available.

One of the ethical pillars is the subsidiarity principle that requires practitioners to employ the means that have the least impact to reach a specific goal. So a gender affirming operation is only on the table if other less impactful measures have failed. — Benkei

Yes, we have a similar code. The issue is not it's existence, the issue is the very strong campaign to ignore it in favour of more readily available treatments. The trans movement slogan is not "things are about right as they are, thanks"

Whenever our sciences leave us with an arbitrary starting point , this should be an impetus to start asking ‘why’ questions. — Joshs

But to say it's arbitrary is to already frame it as requiring a reason (but lacking one). 'Arbitrary' doesn't make any sense in the context of things not even requiring a reason.

Asking why a physical constant happens to be what it is is part of what led to the hypothesis that our universe with its constants may not be the only one , that perhaps an evolutionary development of universes produced a series of constants linked to each other via a genesis. Thus, ‘dont ask why’ was transformed into ‘this may be why’. — Joshs

I don't see how. In a multi-verse theory (which I make no claims to understand I should point out), we would have one speed and other universes would have another speed. That doesn't in the slightest answer the question why we have the speed we have, it only says that others don't.

the recent ambitions to explain consciousness were only possible as a result of innovations in thinking about biological processes which removed the basis of those processes from traditional accounts of physical causality. One cannot derive consciousness from a conceptually impoverished physicalist account. — Joshs

I don't see why not. I mean, I don't personally favour the reductionist accounts, but I don't see anything in them that somehow fails to account for consciousness. There's no fixed reason why consciousness can't be a direct physical result of chemical interactions. We only need allow such a narrative. Personally, it's not the narrative I find most appealing, but it's not ruled out in any way.

‘Just because’ ignores the fact that facts are what they are because of their role within paradigms( the ‘how’) , and paradigms are upended ( the why) on a regular basis. — Joshs

Again, I think you're really forcing the question 'why?' into a paradigm-shifting role which is it only very tangentially involved in. alternative mechanisms don't require even a question of 'why?' let alone an answer. One can simply say 'it needn't be that way'. All it takes to shift paradigm is an understanding that things need not be looked at the way they are, that grounding assumptions can be questioned. none of those questions need be 'why?' they could be 'is it?'

If you think "the proletariat" in these countries are so high on the opium of media agendas, I would beg to differ. — ssu

Go on then. Differ. For what reason do you think they're not?

First and foremost, on a thread about the war in Ukraine to ignore the Ukrainians is something I would think being an mistake as they themselves surprised the West ...and of course Putin too.

Then for example the change in Sweden and Finland, where any discussion of joining NATO wasn't going anywhere before, suddenly a huge reversal from a small minority to a huge majority happened basically overnight left the politicians to desperately to change their stances and react. (For example after 24th February our social democrat prime minister first proposed that NATO membership should be discussed in the social democrat party meeting in the summer, then had to backtrack and had to start immediate negotiations with her party's members of Parliament and with other parties.)

Or then we could go and discuss just how unprepared the "military-industrial complex" was with the events. Prime example would be Germany, with it's huge problems in rearming even if it wanted to do it. — ssu

You're just reverting to your preferred narrative again. this is pointless. Experts disagree. If experts disagree, you are not qualified to determine which experts are right and which are wrong, you can only choose which you believe. Therefore the only matter for discussion is why you made the choice you made. That matter cannot be the technical grounds since you're not qualified to determine the technical grounds.

So do you want to discuss the reasons why you choose to believe that narrative, as opposed to the alternatives? Or do you want to pointlessly keep pretending that a couple of laymen can actually judge which of these experts are right and which are wrong - as if we knew?

if you ignore all above and other issues just because "their role isn't radically different to the US", then that just doesn't give an accurate answers to what is happening.

But I guess that doesn't interest you, because it seems to be the typical tankist view. And all other talk is just pro-US propaganda. — ssu

...and we're back to square one.

When was the last post you voluntarily posted that was critical of US policy toward Ukraine? When was the last post in which you registered anything but unwavering support for the US? I can't think of a single post. So you are ignoring US-issues (relating to Ukraine). I'm ignoring non-US issues. I've given an explanation for why I'm ignoring non-US issues. What's your explanation for why you're ignoring US-issues?

Again, you're trying to make this one-sided. As if focussing on the US were the only ideological move. Painstakingly avoiding focus on the US is no less an ideological move.

Sorry, but we aren't as post-nationalist / post-nation state as you think (or hope) we are. — ssu

Go on. In what way does the power of the nation state over-rule that of the corporation? What examples do you have of the populace restraining the will of the multi-national? In what part of the world are multi-national corporations struggling to get by because the will of the people is so dominant?

We can be in favour of both social change and gender affirming surgery. The latter is therefore not antithetical to the former. — Benkei

You showed you can. Not we can. Hence my example of gun ownership. The fact that you can hold those two concepts concurrently foes not prove society can any more than the fact that I can safely own a rifle proves that society can.

It's quite normal, and indeed advisable, to design policies around the likely responses of society as a whole. Society as a whole does not have such a good track record as I've no doubt you have.

It's better to teach people to cope with the underlying causes of potential criminal behaviour than to lock criminals up but I'm still in favour of locking up criminals. — Benkei

Yes, but locking up criminals does not contradict anything about their crime having underlying causes. If we locked them up with no attempt at rehabilitation, it would. And indeed I would be vehemently opposed to that approach.

As I said, a very reluctant and guarded use of surgery because we have no better option is not what's being proposed. People in favor see it as an objective in its own right, and people opposed are labelled bigots. The disagreement is ideological, not practical.

Then I'm having trouble placing your comments when you call it "antithetical". That sounds to me like you disapprove. — Benkei

Of surgery, yes. Of therapy, no. There's a massive difference. I disapprove of medicalising the effects of intolerance. That includes surgery, pharmaceuticals and blame-based therapies, but it does not exhaust all forms of treatment.

is there a difference between offering the option (which I'm advocating) and your idea of "promoting" gender affirming surgery, which you claim is currently happening? — Benkei

There is a difference, yes. But even within the 'offer' camp (into which I also fall) there are degrees of enthusiasm behind that offer which matter, I think, considering that, as I said, the mainstream position is not merely a reluctant offer.

In many ways I see the current thread as having some diverse opinions, — Jack Cummins

It does, but 'pro-trans' (for want of a better term) positions are not the ones being labelled 'conspiracy theory'. Not all opinions are equal, and the reasons for that inequality interest me.

if anything what I question more than anything is why on a forum such as this, so many threads are created focused on trans issues. — Jack Cummins

Few issues deny the validity of other people's opinions on such ideological grounds. I think that scares people (quite justifiably). You and I might disagree vehemently on, say, economics, we might call each other all the names under the sun, but at the end of the day, Marxism is a valid economic theory, as is Free-Market Capitalism (though I have to rinse my mouth out for admitting it). Same with, say, clashing theories of evolution, quantum physics, psychology... even religion.

But there's this (I believe, new) category of issue, of which transgender is an example, where certain points of view are considered invalid on ideological grounds alone. We don't simply debate whether transitioned women are 'real' women, or whether they ought have all the rights and benefits of natal women. It's considered an invalid opinion to disagree (as opposed to a valid opinion which I merely disagree with). But there's no fact of the matter about such a question. It's something society simply comes to some shaky agreement on. We can't run a test on it. So if people feel excluded from the decision, then they're going to become frustrated about that.

In my experience (the circles I move in are hardly representative, I'll admit) people are nervous. A state of affairs has come to exist where certain views can be (on a whim, it seems) declared verboten with moderately serious consequences. It's a real issue, especially in academia. I've mentioned Kathleen Stock before. Her experience sent quite a few shock-waves through certain academic circles. She's neither a bigot, nor a cruel person. She's actually very friendly and intelligent. But she was physically attacked because she held views which were unpopular and her University (my University too) did not even properly support her.

Whether that's what motivates the influx of threads, I don't know. Maybe unlikely. But that's where my interest is.

there is a need to step back and look at evidence as critically as possible — Jack Cummins

I should add, that if you're keen, there's no reason why doing so might not be interesting nonetheless. Do you have a particular clinical study in mind?

I am not sure what many, including yourself, are suggesting for gender dysphoria. — Jack Cummins

I don't necessarily think this is the place to discuss specific therapies. I assume everyone is broadly aware that alternative therapies exist. If your position is that there literally are no alternatives to surgery, then I'm happy to go through what those alternatives are, but presuming you're aware of them, I'm not sure what you're asking.

So much seems to be based on opinion rather than any clinical basis. For example, you say that 'antidepressants do more harm than good' which is merely your viewpoint. Surely, there is a need to step back and look at evidence as critically as possible, not picking and choosing what to select. — Jack Cummins

Do you feel capable of doing that? Do you trust the government to do that? Looking back over the history of medicine (particularly psychology, particularly sex and gender...) what would you say our track record has been on 'stepping back' and looking at the evidence critically?

In order to offer approaches which are intended to aid those who are struggling with gender identity issues, there is a need to look at the issue from various angles. — Jack Cummins

I agree. Do you think the current debate is one that's welcoming of "various angles"? How have the angles other than a full-throated agreement with all claims been received? Would you say alternative viewpoints to the mainstream trans agenda are welcomed in intellectual debate?

What evolutionary advantage is there to having the experience of hunger when all that's needed is some adrenaline here, some dopamine there, and voila. — frank

"Some adrenaline here, some dopamine there" is the experience of hunger. there's not the mechanisms and then something else. The car isn't an additional thing on top of the engine, the wheels, the chassis, etc..

I think the problem is that you make a juxtaposition between pro-American and anti-American. And there's not anything else.

You simply don't see that Nordic or Eastern European people would (or could) have ideas of their own in this case. And to simply forget the role of the Ukrainians in this war is, well, condescending. Because this war is a matter especially between Ukrainians and Russians, not the West Europeans and the Americans. — ssu

You're framing it as an error, or an oversight without arguing the case. Yes. I'm ignoring (largely) the role of the Nordic countries, the Eastern European nations and the Ukrainians. Not because they don't have a role, but because it's not radically different to the US's. Big industry lobbyists push political agendas which serve their interests. they do so in the US, Europe, Sweden and Ukraine. Influence over media agendas manipulates a proletariat, the support of which is then used to justify the original objective. There's little point in discussing which flag they operate under, especially considering most are multi-national companies.

The notion of independent nation states with their own culture and unique objectives belongs to a colonial era of World Wars and imperialism. But it's hellish convenient when the arms industry needs another war.

So if you think it's an error, argue the case. Why do you still believe in nation states? What leaves you unconvinced about the massive influence corporate lobbying has over foreign policy? Why should we believe polls and vox pops are anything but cynical attempts to manipulate data to appear favourable to powerful interests.

Here's what we have...

1. American (and other) arms industries and energy companies are making a fortune from this war. Plus a swathe of American industries will benefit from the crippling of Russia. American senators and representatives are open about the fact that it's in America's interests to fight Russia in Ukraine.

2. American government and corporation have several channels, both legitimate, and clandestine, through which they can manipulate global affairs, and they're one of the most powerful forces in that game

Nether (1) nor (2) are even contested, they're taken as established facts.

You're asking us to believe that despite (2) being true, (1) just happened anyway, by chance. That despite having the power to bring X about and X being in their best interests, they didn't actually bring X about, but it just happened anyway.

Imagine if I could compel you all to write "Isaac is great" for your next posts, we all know I have the power. Then you write "Isaac is great" for your next posts, and I say "I didn't do it, it just happened anyway". Would you find that default position remotely plausible?

Everything that's happening in Ukraine is happening almost exactly in a way that benefits powerful interests who we know for a fact have sufficient influence to steer events such as these. And benefit them, not just in an ordinary way, but to a level virtually unprecedented in history. Profit margins the likes of which have barely been seen before. And you want me to believe they just got lucky. They nobly restrained themselves from exercising the power no-one disputes they have and were rewarded by God for that restraint by getting the thing they wanted anyway?

It's just absurd on it's face. If very powerful interests benefit massively from something they had the power to bring about, they brought it about.

That's a false dichotomy though. — Benkei

I don't see how.

It doesn't actively make it worse at all. I seem to be quite capable of holding both views simultaneously because I theorise some reasons for gender dysphoria have to do with one's surroundings. — Benkei

I'm not sure what you 'seem' to be capable of is a very good measure for appropriate public policy. I seem to be capable of owning a gun and not shooting anyone with it. Does that lead to the conclusion that we ought allow everyone to own a gun without restriction?

A lot of depression and anxiety in younger people is due to worry about climate change, shall we not treat that depression (hopefully through cognitive therapy only) because it's not their fault? — Benkei

No one is talking about not treating those with gender dysphoria. As I've said, lots of good therapies are available. If you were asking a like-for-like question - say "should we not give depressives SSRI drugs assuming the problem is their faulty neurotransmitters", then yes I agree with that sentiment. I think anti-depressants do more harm than good in the long run and ought to be severely restricted. Should we not treat depression at all? No. But that's not what I'm suggesting here for gender dysphoria.

As the experience with Tavistock clinic and campaign groups like Mermaids is testament to, these medical interventions are promoted as end goals, not as reluctant stop gaps awaiting societal change. As I said, no-one in the mainstream trans movement is treating opposition like Kathleen Stock as being well-meaning but over idealistic, they're treating them as bigots. This isn't a question of ideology vs pragmatism. It's a question of ideology vs ideology.

Can you link a paper or article? — hypericin

Well, Tulving's paper is here https://psycnet.apa.org/doiLanding?doi=10.1037%2F0003-066X.40.4.385 but it won't give you much of an insight into how it's used in theories of consciousness without seeing also https://journals.sagepub.com/doi/abs/10.1111/1467-9280.00102 and https://www.pnas.org/doi/abs/10.1073/pnas.94.11.5973

Are you really suggesting that "why not? What's stopping them?" is an adequate answer to any of these? — hypericin

I don't think the question makes any sense at all. We don't ask why the speed of light is 299,792,458 metres per second, we don't ask why protein channels block certain molecules, we don't ask why water boils at 100C. Why would we expect an answer to the question of why these neurological functions result in consciousness. They just do.

We could give an evolutionary account, some natural advantage to consciousness. Random changes in neurological activity one time resulted in proto-consciousness which gave an evolutionary advantage to the creature and so it passed on that genetic mutation. There...is that satisfactory, and if not, why not?

Well, we are still replying to each other. So that should tell something. — ssu

Ha! I wouldn't say we're replying to each other. Technically, maybe, but in spirit, no.

There's two types of post from the pro-US contingent, either spam-posting pro-US news stories, or dismissing anti-US posts as being pro-Russian (or worse).

We could pretend to be experts, analysing the data as if we knew better than those who've already done that work...but short of a ego-stroking LARPing game I don't much see the point. Which leaves the only real matter for discussion our ideological bases. The reasons why we choose one expert over another (presuming we've rightly eliminated from serious discussion those who can provide no expert support for their positions).

In my view, a discussion between laymen on this subject can only really consist of idle speculation (sometimes fun), or ideological conflicts and their exposition. What we have here is neither. Facebook nation has twisted every discussion into nothing more than a crude exercise in tribal taxonomy.

You were the one arguing that perceptions were effable. So you would eff whatever their perceptions are like to them. — hypericin

What does it mean for a perception to be 'like' something?

Cite one you think is satisfactory. — hypericin

I really don't think this is the format for discussion of neuroscience in detail (I've been there, without positive outcome). If you're interested, my preferred approach starts from Tulving's concepts on autonoesis, which were first identified in neurological terms by Emrah Duzel back at the turn of century (love saying that, it sounds ages ago), and Fergus Craik in an unrelated PET study.

You can look them all up, but without a basic understanding of the principles they're working from it's unlikely it'll make much sense.

"Why wouldn't they?" possesses exactly zero explanatory power. The question is rather "why would they?". — hypericin

Why?

Is there a question as to why glutamate exists, why bones have the structure they do, why atoms are small, why stars are far away, why the sea is wet...

Where was that? — Vera Mont

I took the questions in...

If a man who feels acutely uncomfortable in the role of a man, because he knows he is meant to be a woman, and decides to have his external appearance altered to match his internal self-image, and he is happy with the result, that's a benefit for her. What is the harm, to whom?
If one such altered person in a hundred later regret their choice, that is his decisions doing harm to herself. Who else being harmed?
If then the 99 others who would benefit from the same alteration are prevented from doing so, just in case they might regret it later, that 99 unhappy people who for the rest of their lives bring little joy to anyone around them. Where is the benefit? (And that's even without asking why that one regretted his choice. Was it perhaps because bigots made her new life difficult?) — Vera Mont

...to be rhetorical. Tone is not an easy thing to communicate in short written comments.

If not, then...who else is being harmed?

All other transexuals, depressed people, autistics, schizophrenics, anorexics, bulimics...and so on. Basically anyone who really ought to benefit from society adapting to their neurodiversity but instead now suffers from an increase in the trend to see the fault as being located in their biology, not society's attitude toward them.

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.

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.

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.

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.

Can you know what it will feel like to be a bat without being a bat yourself? — Philosophim

The question simply makes no sense. What could an answer possibly be? "It feels like...?" What words could possibly fill the blank?

we don't even know what a theory which explains it would look like — hypericin

Again, the fact that you don't personally understand the neuroscience of consciousness is not an indication that there's nothing there to be understood. Dozens of researchers in consciousness think they know exactly what a good theory would look like and they've constructed their experiments closely around those models. The fact that you don't grasp them is not a flaw in the model.

we cannot conceive how a cascade of biological processes can lead to the observed symptoms of consciousness, because we cannot conceive how any physical process can lead to consciousness. — hypericin

I can. It's simple. Some collection of biological processes leads to the observed symptoms of consciousness. Why wouldn't they? What's in the way? What compelling physical law prevents biological processes from causing whatever symptoms they so happen to cause?

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?

Only actual conspiracy theories. — busycuttingcrap

OK. And you identify these how?

Somehow I doubt one could do a poll in Donetsk right now. — Olivier5

No. I don't suppose they could. Nothing in which difficulty renders a poll about ceding territory which doesn't even consult the people living in the fucking territory concerned anything less than a sham.

That such polls are done is entirely understandable.

That they're cited by people not even involved in this war to prop up the blatant war profiteering of the most powerful nation on earth is not.

What is it like to be an apple? — Philosophim

What does green sound like? How much does love weigh?

Just being able to string words together in question format doesn't imply an answer is wanting.

The sample did not include residents of territories that were not temporarily controlled by the authorities of Ukraine until February 24, 2022 (AR of Crimea, the city of Sevastopol, certain districts of the Donetsk and Luhansk oblasts)

In other words all the people who are likely to think otherwise.

Imagine if Northern Ireland policy were decided entirely by consulting only the population of England. Or more accurately for Ukraine...ignoring the population of Northern Ireland, but consulting the population of Switzerland.

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.

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.

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'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.

who would've thought that pushing lazy anti-intellectual conspiracy theories — busycuttingcrap

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

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.

society still won't remain unchanged, so you who resist a specific change must still decide on:
a proposal for the healthier, more beneficial, more ethical direction in which you want some unnamed factions or agents to steer the issue. — Vera Mont

Yes, but that's not the debate here. For clarity (although it's been spelled out already) I'd prefer people not be encouraged to surgically alter their bodies to 'fix' a mental health problem caused by societal values which are themselves wrong. Fixing society's unhealthy attitudes by laying the fault at the individual is itself unhealthy, but doing so by giving more power to an industrial complex which is already responsible for some of the greatest tragedies we've recently been through is doubly bad.

Not having the option would lead to other mental health issues, in particular depression with significant increased risk in suicide. I don't think that's a problem though. We deal with suboptimal solutions all the time. We incarcerate people instead of resolving the underlying causes for instance. — Benkei

If we have two options (simplistically - promote gender altering surgery or don't), and each has it's potential flaws, but we accept suboptimal solutions all the time... does that lead us to either option? It reads to me as an argument for either.

If I've genuine concerns for the social impact of such policies then is it not just as legitimate to say that, yes, there'll be downsides to not promoting such surgery (mental health impacts on those who might otherwise be helped), but no policy is perfect and we accept suboptimal solutions all the time?