Origin stories are immensely important. When a dangerous and destructive force is let loose upon the earth people want to know where it came from and, most particularly, whether it was unleashed by nature or by man. During the Covid-19 pandemic it was therefore a matter of great interest and concern whether the virus that causes the Covid flu had sprung spontaneously from nature or had been leaked from a lab in Wuhan, China where scientists were doing gain-of-function research.
By now for all intents and purposes that question has been settled—given the unique features of the virus and the complete lack of evidence to the contrary, it was the latter. That being said, no one has ever denied that the Covid-19 pathogen is a biological entity and is therefore part of the organic world. Scientists have consequently been able to examine its physical characteristics in order to understand why it is so infectious, how it spreads, and how it acts on the body to make one sick.
The same cannot be said about another famous illness, the mental disorder now known as Gender Dysphoria. Unlike the scientists who fabricated the Covid-19 virus, those who introduced Gender Dysphoria to the world did not do so by altering an existing biological organism, nor did they discover anything that until that time had remained hidden in nature. On the contrary, this “professionally-certified illness” was dreamt up by a committee of psychiatrists sitting around a table without reference to any biological pathogen whatsoever.
Gender Dysphoria, which was originally called Gender Identity Disorder, first appeared in the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) along with 80 other new mental illnesses, all of which were conceived in much the same way, by a committee of psychiatrists sitting around a table and conjuring up new mental illnesses based on scant or nonexistent physical evidence. Nevertheless, though their methods of introducing these illnesses to the world were basically unscientific, psychiatrists are medical doctors and as such, rightly or wrongly, are also considered to be bona fide scientists.
It is impossible to exaggerate the importance of the fact that psychiatry, as a medical specialty, introduced Gender Dysphoria into the world. Though by now it is commonplace that radical elements in the feminist and gay rights movements have been strong proponents of the crusade to chemically and surgically alter the gender-identity of both adults and children, the ideology and advocacy of these political movements alone could never have given birth to the medical interventions involved in the treatment of Gender Dysphoria. Political movements, for all that they can accomplish using conventional methods of persuasion, simply do not have that power. For that authority and the power to do medical interventions one has to look to doctors, or, to be more precise, at least to those who have doctors’ credentials. They alone have the license to order all manner of medical interventions.
Though several other medical specialties eventually became deeply involved in the transgender movement, psychiatry alone has the distinction of being the linchpin that provided the impetus to medicalize it. Before psychiatry introduced Gender Dysphoria to the medical world, this illness was never even a glimmer in the imaginations of any other medical specialty. Without psychiatry the idea of fluid sex would have remained no more salient than any other crackpot psychological fad such as the Primal Scream and like them would have ended up on the trash heap of psychobabble. Only because it is a member of the medical fraternity was psychiatry able to bring to Gender Dysphoria the authority and vast resources of the medical-industrial-complex.
The year 1980 when DSM-III was published was a watershed moment for organized psychiatry. It was the year that a dying profession managed to turn itself around and instead begin to burgeon. In his consummate history of the explosive expansion of the psychiatric profession, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Robert Whittaker has chronicled how during the 1970s, prior to the publication of DSM-III in 1980, psychiatry was experiencing a crisis of shrinking relevance.
A number of factors simultaneously came into play to create this crisis. First, psychiatry was getting significant competition from rising non-medical professions such as clinical psychology and social work that were offering alternative, non-drug-based therapies for mental distress. Secondly, the drugs that psychiatrists had been prescribing were being rejected by patients for being neither safe nor effective and for causing very unpleasant side effects. Thirdly, fewer medical school graduates were choosing to go into the field. And finally, Thomas Szasz’s book The Myth of Mental Illnesshad made a big splash by arguing that mental illness was not real but merely a social construct. Consequently, many psychiatrists were publicly expressing the fear that their profession might die out.
This crisis was the context in which DSM-III was created.
In a way DSM-III validated Szasz’s thesis. Though 80 new illnesses were added to the psychiatrists’ manual, Homosexuality, a prominent one that had been around for a long time, was for the first time conspicuously absent. It was absent because it had been deleted. Why? It was well known and understood at the time that the reason that Homosexuality was scrubbed from the manual was due not to any new scientific discovery but to politics. For some time, gay activist lobbies had been pushing psychiatry to stop designating Homosexuality as a mental illness. Consequently, at a plenary session of the American Psychiatry Association (APA) convention in 1973 the attendees were asked to vote on the matter. Of the participants 5,854 voted to expunge Homosexuality as a mental illness while 3,810 voted to keep it whereupon it was duly scrapped. And yet, from the tally it is striking that even in making this monumental decision there remained serious disagreement among the profession about whether or not it was indeed a mental illness.
Now try to imagine if it was proposed at a meeting, say, of pulmonary specialists that they delete pneumonia as an illness. On the face of it the idea is patently ridiculous. Who would even think of doing such a thing? Then, if you try to imagine that despite the absurdity of the idea a vote was taken on the matter the results would be predictable: the proposal would be unanimously voted down. Why? Because the existence of the known virus that causes viral pneumonia and of the pneumococcus, the microbe that causes microbial pneumonia, simply would not allow anyone to vote for it. That is one of the major differences between psychiatry and the other medical specialties. It’s all about recognizable pathogens; that is, it’s all about biology.
Half a century ago in one of his critiques of psychiatry Sir Peter Medawar, a Nobel laureate in medicine, observed that in terms of its understanding of the organic nature of illness psychiatry was still stuck in the middle of the 19th century. Nothing of substance has changed since then. In contrast to physical illnesses, medical science has yet to discover any distinct biological markers for mental ones. And being unmoored from the biological origins of mental illnesses—assuming that they even exist—has meant that psychiatry is also unmoored from physical science. Though it is well understood that medical science is not exact and has serious shortcomings, all of the advances in modern medicine have been due to an ever-increasing understanding of human biology through scientific discovery using progressively sensitive tools to probe the complex systems of the human body. Based on this understanding, medical science has discovered and devised effective interventions to affect healing and cures.
All of these tools, including genetic analysis and brain scans, have been available to psychiatric researchers all along the way but none of them have been adequate to explain the etiology of mental illness. There is nothing in psychiatry equivalent to the knowledge that pneumococcus is the pathogen that causes bacterial pneumonia, nor of a targeted way to neutralize it with antibiotics. Despite intensive study of the human genome a palpable genetic basis for mental illnesses has not been discovered and therefore you will not find it listed among bona fide genetic diseases such as sickle-cell anemia and Tay-Sachs syndrome. Nor have brain scans revealed any physical pathogen that causes mental illness.
Under the circumstances one might be forgiven for thinking that, without the strictures of science, psychiatrists would be super-cautious about making diagnoses especially because modern psychiatric interventions use powerful drugs, dangerous shock therapy and, of course, in the case of Gender Dysphoria, hormonal and surgical interventions. Nothing could be further from the truth.
Being released from the discipline of science has meant that psychiatry has become the most politicised of all medical specialties. In an essay about the American Psychiatric Association convention in San Francisco in 2019 attended by 15,000 practitioners psychiatrist Scott Alexander has written, “you notice at the American Psychiatric Association meeting…that everyone is very, very woke…Were there really more than twice as many sessions on global warming as on obsessive compulsive disorder? Three times as many on immigration as on ADHD? As best I can count, yes. I don’t want to exaggerate this. There was still a lot of really meaty scientific discussion if you sought it out. But overall the balance was pretty striking…If you want to model the APA, you could do worse than a giant firehose that takes in pharmaceutical company money at one end, and shoots lectures about social justice out the other.”
He concludes, “Psychiatry has always been the slave of the latest political fad. It is just scientific enough to be worth capturing, but not scientific enough to resist capture. The menace du jour will always be a threat to our mental health; the salient alternative to “just forcing pills down people’s throat” will always be pursuing the social agenda of whoever is in power; you will always be able to find psychiatrists to back you up on this.”
Very few mental illnesses that were added to the DSM in 1980 became blockbusters. In fact, when it first appeared, Gender Identity Disorder was a sleeper because back then gender-transitioning was still a rather fringe idea. But including it in the DSM primed the pump for later explosive expansion. Before 1980 there was no state funding of the medical interventions used to treat Gender Dysphoria. The prohibitively expensive surgical and chemical interventions entailed in so-called gender affirmative care were not covered by any federal, state, or private insurance programs and therefore had to be paid for out-of-pocket by the patient who was always an adult. It was only after Gender Identity Disorder was designated as a medical illness that state funding for gender affirmative care was made available. This is how the system works—coverage and money from various government agencies and programs is triggered only for professionally designated illnesses. The flow of money for gender-affirming-care was again bolstered in 2010 with the passing of the Affordable Care Act.
Once the money was flowing the diagnosis of Gender Identity was given a further boost by giving it a different name. In 2013, shortly before the publication of the fifth edition of the DSM, the APA sent a note to practitioners announcing that in DSM-V the term Gender Identity Disorder would be changed to Gender Dysphoria. This was not the first time that an illness was renamed but, notably, there is no reference in the note to any scientific research or discovery that would justify such a change.
In the note, two main reasons were given for this seemingly innocuous bit of housekeeping. First, the APA wanted to remove the stigma from this condition because in mental health discourse the term mental disorder is universally viewed as being synonymous with mental illness. Indeed, the terms disorder and illness are used interchangeably in this very document. However, given the controversial nature of the gender transitioning movement, it is obvious from the note that in making this change organized psychiatry wanted to hide the fact that Gender Dysphoria is a designated mental illness. This was in conformity with the ideological narrative that insists that Gender Dysphoria is not a mental illness.
On the other hand, the APA explicitly states in the note that it did not want to completely delete this condition from its manual because they wanted to ensure that those diagnosed with it would continue to receive the care that the APA believed was appropriate. With all of these contortions one cannot help but notice that there is a striking contradiction built into the narrative; that is, that a non-illness nevertheless requires heroic and expensive medical interventions. Thus, by a stroke of the pen, the APA killed two birds with one stone; it legitimized the treatment and managed the image of this thing that was now called Gender Dysphoria.
To the best of my knowledge exactly what inspired the psychiatrists on the taskforce that created DSM-III to include Gender Identity Disorder is obscure. But for the decades preceding their discussions there was some prominent theory and research in the air that almost certainly influenced their thinking. Prof. John Money was a sexologist at John Hopkins University who was interested in the extremely rare anomaly, now known as intersex, wherein a baby is born with both male and female genitalia. Notwithstanding well-established knowledge of genetics as well as commonplace wisdom about the relationship between nature and nurture, he theorized that sex differences were learned rather than innate. And then he got lucky. A couple of subjects fell into his lap with which he could test his theory.
His subjects were a pair of twin boys, Bruce and Brian Reimer who were born in Winnipeg in 1965. Bruce’s penis had been seriously disfigured by a botched circumcision and his parents were naturally very concerned about how this might affect his future well-being. In 1967 they happened to watch a television show in which Money, who had worked with intersex children, claimed that sex was a matter of nurture rather than nature and naively contacted him to see if he could help them. Bruce was renamed Brenda, was castrated and given hormones, dressed in girls’ clothing, and encouraged to play with girls’ toys.
After the medical interventions Brenda and Brian endured over a decade of experimenting by Money to try to prove his theory. In point of fact, the experiment consisted almost exclusively in forcing the twins to role-play the sex act because Money’s perverse idea was that the sex act was the primary foundation of gender identity formation. To the boys’ parents he spoke of the experiment in calm and gentle terms but he was mean and angry when forcing the unwilling boys to perform sexual play-acting. The boys were tortured and miserable throughout this process but all the while Money published papers claiming that his theory was being vindicated and that his experiment was a resounding success.
This went on until at the age of 14 when Brenda finally informed his father about what was going on and told him that he had never felt like a girl. The boys were promptly withdrawn from the experiment. Brenda underwent surgeries to try to reverse those used to reconfigure his genitalia and took the name David in order to try to make a fresh start. But by then both boys had been so traumatized by Money’s experiment that despite their efforts to try to live normal lives—for a while David was even married to a woman who had children by a previous marriage—that they were too broken to be able to effectively put them back together. They were stressed and depressed and had trouble holding down jobs. The tragic upshot of all of this was that no matter how hard they tried to live normal lives both boys were too broken to succeed. They both committed suicide in their late thirties, first Brian by an overdose of psychiatric drugs and, after visiting his brother’s grave every day for about a year, David shot himself.
It is noteworthy and not just a little ironic that just around the time that David Reimer renounced the failed experiment that he and his brother were forced to undergo that the DSM included Gender Identity Disorder in its Manual. Moreover, it is very likely that Money’s decades-long published scientific fraud influenced their decision to include it but to be fair, at the time they probably didn’t know that Money’s work was rubbish. This fact only came out first in an academic critique in 1997 by the sex sociologist Milton Diamond and a couple of years later in a widely read expose by John Colapinto in Rolling Stone magazine which was later expanded into a New York Times best-selling book, As Nature Made Him: The Boy Who was Raised as a Girl. In Colapinto’s book the boys testified that though appearing mild-mannered in public, Money was angry, cruel, and pushy during their private sessions in which he forced them to undress and perform mock sex acts. When confronted with this evidence Money feigned ignorance. Meanwhile his ideas had developed a life of their own.
It was Money who coined the terms “gender role” and “gender identity.” The misplaced terminology “sex assignment” is also derived from Money’s work with intersex children. It may have been appropriate for children born with the intersex abnormality but of course never had meaning in the case of normal children whose sex was never “assigned” but rather simply observed. Despite the known failure of the experiment, Money’s framework has persisted in academic and medical institutions. It shaped the policies of organizations like the World Professional Association for Transgender Health (WPATH) and the American Association of Pediatrics (AAP), and gender clinics worldwide.
Today, debates surrounding “gender-affirming care” for minors simply omit the origins of this ideology. And they omit the fact that John Money’s theory — that gender is socially constructed and malleable — was founded on scientific fraud. The Reimer case, which was a known travesty, was soon buried or forgotten and became a template, was used for decades to justify what is called sex reassignment in children.
Much has been written about the social contagion that fueled the rise of the trans epidemic but the whole ecosystem that fueled it would have been harmless psychobabble if not for the actualizing and normalizing of gender transitioning in medical practice. Once something physical and organic is happening, once it is sanctioned not only by the medical fraternity and paid for by the state and insurance companies, then it at once rises to an astronomically high level of legitimacy and credibility and that in and of itself increases its contagiousness by orders of magnitude. If doctors weren’t there to legitimize doing these interventions and the money from the state and the insurance companies was not there to pay for them, they would be very rare among adults as was the case before 1980 and nonexistent among children.
In our time not only education but all of the so-called helping professions—psychology, social work, child protection—have been politicized but medicine is at the top of the hierarchy of these professions and without the authority that was lent to it by psychiatry the hype about gender confusion would have remained relatively harmless. All of the other medical specialties, such as the AAP, the endocrine and surgery professional organizations that have followed the APA’s lead in introducing powerful and heroic medical interventions, and acted as its enablers have done so not on the basis of science but on the basis of consensus—one might add manufactured consensus—and have openly stated so.
In 2022 the historical barbarities of psychiatric treatments were chronicled in a book titled Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness, by Prof. Andrew Scull, a veteran observer of psychiatric practice at the University of California, San Diego. In his Introduction Scull writes that it was not so long ago that psychiatry had “programs to induce fevers by deliberately infecting patients with malaria, by injecting horse serum into spinal canals to induce meningitis, or by placing patients in diathermy machines that broke down the body’s homoeostatic mechanisms; there was the surgical removal of teeth and tonsils, followed by the evisceration of stomachs, spleens, cervix and colons; the use of the newly discovered insulin to create artificial comas that often brought patients to the brink of death; the induction of artificial epileptic seizures, first with drugs, then with electricity passed through the brain; and most dramatically of all, the severing of brain tissue, either through surgical operations on the frontal lobes or by thrusting an ice pick through the eye socket into the brain—so-called transorbital lobotomies.
Virtually all of these were disproportionately visited on women, though the best data we have indicate that mental illness afflicts men and women almost equally.” The psychiatric illness known as gender dysphoria continues to disproportionately affect women both because more females than males are treated for it and because of its deleterious effect on women’s sports.
In reviewing Scull’s book in The Claremont Review of Books, the psychiatrist Anthony Daniels (who goes by the pen name Theodore Dalrymple) did not try in any way to sugarcoat the past barbarities of psychiatric treatment. In fact, he emphasized the blasé attitude of those administering the treatments and the perfunctory way that they were performed. As an aside he also mentioned that there are many physical ailments that resemble mental ones and observed that if he himself had been born a century and three quarters earlier that he probably would have spent his life in an asylum because he has a thyroid deficiency which was initially misdiagnosed as depression. Towards the end of his review Dalrymple remarks that future chronicles of psychiatric barbarities will also include sexual transitioning among them.
The world has been shrinking away from sexual transitioning of children and adults first in Europe and more recently in America. The Trump administration through executive orders has been trying to staunch the flow of government money for these interventions but the resistance is strong in the way of court challenges and state interventions. Dedicated clinics that specialize in these medical interventions such as Tavistock in England and CAMH in Canada have been closing, legislation has been passed in some jurisdictions banning them, and lawsuits have been launched for malpractice against medical practitioners who have been administering them and recently one famous case in New York brought by Fox Varian has resulted in an award of $2 million in damages.
But for the APA the march goes on—for all sorts of reasons one cannot imagine them ever deleting Gender Dysphoria from the Diagnostic and Statistical Manual of Mental Disorders which has often derisively been referred to as their Bible. If sanity prevails and the funding dries up and the sex-change interventions are finally stopped except in the case of a small number of adults who will be forced to pay for them with their own dime as elective procedures like cosmetic plastic surgery then society will look back on this movement as a scourge, or in Dalrymple’s terms, as one of many barbarities cooked up by organized psychiatry. All things considered, one cannot help thinking that it would have been better in the 1970s when psychiatry was in decline for it to have folded its tent and died a natural death.
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