How the WSJ handles the inconvenient facts of “rapid onset gender dysphoria”

Posted on September 12, 2018 by Zinnia Jones

Previously:

Zinnia JonesI was recently consulted on an op-ed in the Wall Street Journal about the dispute over Lisa Littman’s study of a supposed new “rapid onset gender dysphoria” condition said to be contagiously spreading among youth. Jillian Kay Melchior describes my involvement in this controversy:

Ideologues try to suppress a study on the increasing prevalence of ‘rapid onset gender dysphoria.’ …

Dr. Littman’s detractors also accuse her of bigotry. Her work “negates the experience of many transgender youth,” according to Diane Ehrensaft, of the Child and Adolescent Gender Center Clinic at the University of California San Francisco’s Benioff Children’s Hospital.

Transgender activist Brynn Tannehill calls Dr. Littman’s research “a naked attempt to legitimize anti-transgender animus with a veneer of academic responsibility.” And Zinnia Jones, founder of the website Gender Analysis, called rapid-onset gender dysphoria a “hoax diagnosis” perpetuated by those who would deny transgender children “acceptance and affirmation.” The motto of Ms. Jones’s website: “The personal is empirical.”

The effort at suppression had an effect. …

… As for Dr. Littman’s critics, they equate caution with bias, even hatred, and encourage teens to go through hormone therapy or surgery—drastic interventions whose effects are irreversible.

For background, I spoke with Jillian a week before her op-ed was published. She asked me to confirm that the two sentences about me were accurate, and I agreed they were. However, I informed her that the problems with the study are much more substantial:

Thanks so much for getting in touch with me on this. Those two sentences are indeed accurate, although my issues with the study in question run a bit deeper than that. This is a problem with the paper’s analyses and hypotheses that has not received as much attention as other issues with the study, but it is a serious flaw.

Namely, the study’s author directly quoted one of my articles on symptoms of gender dysphoria, and misleadingly labeled this “vague and nonspecific symptoms called signs of GD” while attributing it to a Tumblr blog. Her description of these symptoms as “vague and nonspecific” is simply incorrect, as I was describing symptoms associated with depersonalization disorder, a known condition that occurs vastly more frequently among trans people and is often successfully treated by transitioning. Numerous published studies confirm this. The author either was not aware of this or chose not to acknowledge it, and as a result, she implicated my own work in supposedly contributing to her proposed mechanism whereby cisgender youth are being led to believe falsely that they are trans via reading lists of “vague and nonspecific symptoms called signs of GD”. Because these are not in fact vague or nonspecific symptoms, and do often occur in untreated gender dysphoria, her hypothesis is badly compromised.

I’ve summarized the relevant evidence here (https://genderanalysis.net/2018/08/rapid-onset-gender-dysphoria-study-misunderstands-trans-depersonalization-ends-up-blaming-zinnia-jones/), as this is a major oversight of both her paper and the peer review process that allowed it to be published. Needless to say, it’s concerning to me that I would be personally implicated in causing the spread of a new “disease” based on her own misreading and misunderstanding of my work.

“The personal is empirical” is an acknowledgment that the life experiences of trans people, and the scientific evidence regarding transness and gender, are not at all in conflict as is often portrayed – rather, these are frequently complementary and consistent. What trans people often observe in their everyday lives, which would otherwise be relegated to mere community folklore, is in reality often supported by scientific findings. One example would be the phenomenon where a trans woman is seen as a woman by one person, but “clocked” as trans by another, even on the same day – this turns out to involve known cognitive and perceptual biases and individual factors influencing a person’s categorization of others’ genders (see more here: https://genderanalysis.net/2016/07/the-social-paradox-of-passing-gender-analysis-23/). Another example would be my own work on depersonalization symptoms in gender dysphoria. Many trans people have reported exactly these symptoms for years, even decades, as well as their amelioration with transitioning, but the community did not always have a framework for understanding the nature of these symptoms or what they meant. As it turns out, there is a name for this condition, and what they were perceiving was indeed real; multiple studies have confirmed the presence of these symptoms in gender dysphoria. “The personal is empirical” means that trans people can draw on the findings of science to help understand their own lives, and that trans people’s experiences can also provide useful hints about where scientific investigation can productively direct its attention and learn more about us.

Additionally, if you are interested, I’ve summarized some of the other issues with the study and its findings, including the significant sampling bias inherent in recruiting respondents from communities that demonstrate overt anti-transgender prejudice (https://genderanalysis.net/2018/08/meet-the-unbiased-reliable-not-at-all-transphobic-parents-from-the-rapid-onset-gender-dysphoria-study/), its inaccurate presentation of certain transgender community strategies for navigating healthcare as being a new development when in fact these have been known and observed for decades (https://genderanalysis.net/2018/08/rapid-onset-gender-dysphoria-study-omits-historical-context-of-transgender-narratives-and-medical-gatekeeping/), and its wide net of supposed “alternative causes” of gender dysphoria that seem designed to enable labeling any given trans youth as having “rapid onset gender dysphoria” (https://genderanalysis.net/2018/08/rapid-onset-gender-dysphoria-study-an-impossibly-wide-net-of-alternative-etiologies/).

Again, thank you so much for the much-needed attention to these issues. If there is any other help I can provide, please let me know :)

So, a WSJ writer covering the controversy was made aware of all of these serious issues with the study, a week in advance. I don’t see how I could have made it more clear that this is a matter of deeply flawed research and scientific criticism of that research – criticisms that would stand regardless of what any “ideologues” did or didn’t do at any point in time. Yet this engagement with the study’s substance – the very post-publication community review invited by PLOS One – is still reduced to an “effort at suppression” by “ideologues” against science.

Many people have rightly pointed out how the uselessly overbroad and practically meaningless theory of ROGD is based on egregiously biased sampling that selected for anti-trans respondents, as well as an ignorance of psychiatry and well-known transgender history. This theory is so bad, it implicates my articles on depersonalization – a condition already known to be real – as a causative factor in a (likely illusory) new “contagion”. I explained the many flaws of ROGD at length last month; my publication of that criticism can hardly be said to be an act of “suppression”.

Exactly how are we supposed to engage in critique of this study? We can do everything right, we can take the time to address the substance of the research, we can offer the relevant scientific review solicited by the journal, we can explain all of this quite succintly to those who invite our comment… and that still won’t keep the Wall Street Journal from reducing us to mere ideologues fighting to suppress science.

Since the study’s publication, several others have elected to cover this controversy using the same framing of suppressive ideologues versus scientific facts. Writing for Quillette, Jeffrey Flier, a former dean at Harvard Medical School, accuses the study’s critics of making spurious and ideologically motivated criticisms intended to suppress science:

Many papers face questions after they have been published, which is well and proper: the systematic assessment and scrutiny of published work is a core method by which the scientific community corrects errors, and builds upon imperfect preliminary observations. … But that is not what has happened in regard to Dr Littman, whose critics have not performed any systematic analysis of her findings, but seem principally motivated by ideological opposition to her conclusions. …

There is no evidence for claims of misconduct in Dr Littman’s case. Rather, unnamed individuals with strong personal interests in the area under study seem to have approached PLOS One with allegations that her methodology and conclusions were faulty. Facing these assertions, which predictably drew support from social media communities populated by lay activists, the journal responded rapidly and publicly with the announcement that it would undertake additional expert review.

In all my years in academia, I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published. One can only assume that the response was in large measure due to the intense lobbying the journal received, and the threat—whether stated or unstated—that more social-media backlash would rain down upon PLOS One if action were not taken.

To me, what’s most conspicuous in this article is what it leaves out. Flier offers this screenshot of a Twitter exchange between trans woman Hailey Heartless and PLOS One:

He just happened to leave out my adjacent tweet that did offer scientific criticism of the study’s misinterpretation of depersonalization in gender dysphoria, and was also acknowledged by PLOS One.

Is this not the very “assessment and scrutiny of published work” that serves as a “core method by which the scientific community correct errors”? Is it not an effort to build upon an imperfect preliminary observation? These contributions were neither spurious nor censorious. But if you choose to ignore the evidence that’s been placed right in front of you, then I’m sure it’s quite easy to say that critics of the theory “have not performed any systematic analysis of her findings” and must therefore be “motivated by ideological opposition to her conclusions”.

When I contacted Flier to let him know about the serious issues with the science of the study, he clarified that he was condemning the actions subsequently taken by PLOS One and Brown University, and was not taking a position on the quality of the study itself. He stated that while we may all have our opinions, this should never be used to influence a study’s publication.

This is an odd assertion. Peer review, corrections, and retractions are all practices that have their places in academic publishing, and these are all instances where certain arguments and opinions do hold influence over the publication status of a given paper. It is the application of human judgment of whether or not the paper in question meets required standards. When I wrote in to PLOS One expressing my concerns with this study’s misuse of my work, I described this as exactly what it should be: a correction. Correcting a scientific article to address its inaccuracies is quite the opposite of censorship – it is a step in the direction of improving the quality of research.

It is puzzling to take a stance of supporting the study’s publication as well as its promotion by Littman’s university, while consciously withholding judgment of the study’s quality and overall soundness. When you decide to throw your support behind something, wouldn’t you want to be aware of just what it is you’re supporting, and whether that support is deserved? It is not at all outside the realm of possibility that a study can be so deeply flawed, it would in fact be appropriate for a journal to conduct additional review and a university to remove their press release promoting its findings. But when you choose to remain agnostic on the quality of the study, that possibility will not enter into your consideration – you wouldn’t be able to reach such a conclusion even in cases where a study is utterly abysmal and fully deserving of being withdrawn.

In “The Ethics of Belief”, W. K. Clifford highlighted the issue of those who readily adopt a given belief on a subject while wholly dismissing the task of learning about it:

“But,” says one, “I am a busy man; I have no time for the long course of study which would be necessary to make me in any degree a competent judge of certain questions, or even able to understand the nature of the arguments.”

Then he should have no time to believe.

Proponents of the ROGD study have certainly made time to believe it. It is less clear whether they intend to take the time to understand it. ■

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Posted in Depersonalization, Ethics, Gender dysphoria, Hoaxes, Media, Replies, Trans youth, Transphobia and prejudice | Tagged , , , , | Leave a comment

My letter to the Brown Daily Herald on “rapid onset gender dysphoria”, and Lisa Littman’s response

Posted on September 11, 2018 by Zinnia Jones
Previously:

Zinnia JonesThis weekend, I wrote in to the Brown Daily Herald on the controversy over a recent study on “rapid onset gender dysphoria” by Brown assistant professor Lisa Littman:

I am writing in reference to a Herald article, “Gender dysphoria study criticism,” published Sept. 4. Much of the backlash following the removal of a press release on Assistant Professor of the Practice of Behavioral and Social Sciences Lisa Littman’s “rapid onset gender dysphoria” study has focused on questions of academic freedom and institutional support for faculty who conduct controversial research. In these discussions, the actual content and underlying soundness of this research have largely been considered an afterthought. For me, however, the content of the study could not be more relevant.

Littman’s study directly quotes an article I wrote in 2013 on my experiences of gender dysphoria as a transgender woman. She labels such experiences “vague and nonspecific symptoms called signs of (gender dysphoria)” and implicates my work in her theory that online forums allow transgender identities to spread among the youth like “social contagion.” This could not be further from the truth. The symptoms I described are those of depersonalization disorder, a known condition of ‘feelings of unreality’ that is disproportionately common among trans people and often remits following transitioning. It strains belief that Littman would be unaware of the research on this disorder in trans people.

As a result of this oversight, her study suggests that my own work and outreach to the trans community on this real condition is instead a causative factor in a supposedly new disease. This is more than a question of academic freedom. It is a matter of academic responsibility — and in her misrepresentation of my work, Littman has failed to exercise that responsibility.

As of yesterday, Littman appears to have addressed my specific criticisms for the first time, in a statement to the conservative Catholic outlet LifeSiteNews:

“There is an abundance of advice given to youth exploring gender on Tumblr and other social media sites, samples of which I excerpted in Table 1 of my study as background information. No specific source of advice was defined as a singular cause for all gender dysphoria nor was the sampling presented as a comprehensive list,” Littman responded in a statement to LifeSiteNews.

“Regardless, teens who are experiencing concerning symptoms (including but not limited to symptoms of depersonalization) deserve to be evaluated by trained mental health professionals rather than relying on advice from Tumblr, online blogs or other social media sites,” she continued.

There is an admission implicit in this – is she acknowledging that my work on transgender depersonalization was indeed inaccurately portrayed as an example of “vague and nonspecific symptoms called signs of GD”? There may be an “abundance of advice given to youth exploring gender on Tumblr and other social media sites”, but even if there is, she still did not cite that abundance here. She cited one example of “vague and nonspecific symptoms called signs of GD” – my article – and that one example turned out not to be an example of this at all, but a description of a real condition commonly occurring in gender dysphoria.

To say that her sampling is not “comprehensive” would be an understatement: her sampling here is now absent, leaving the paper without any explanation or example of what is meant by “vague and nonspecific symptoms called signs of GD” that supposedly contribute to a contagious false belief of dysphoria.

While Littman quite correctly recognizes that gender-dysphoric and gender-questioning teens deserve a comprehensive evaluation that addresses any mental health needs, her paper inveighs against the very clinicians and specialists who would provide it. She relays that in instances where trans children had been evaluated for gender-related issues,  7 in 10 of these parent respondents felt that the clinician “did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria.” (Only 36.2% of parents in the study reported that their child had received an evaluation.)

Littman goes so far as to suggest that a likely-disapproving parent’s perception of their child’s gender identity – “child” meaning potentially any trans person, AFAB or AMAB, aged 11-27 – is more significant and important in the diagnostic process than both the trans person’s awareness of their own gender and dysphoric symptoms, and gender specialists’ own expert evaluation of that trans person’s clinical presentation:

Furthermore, although parents may be the most knowledgeable informants on matters of their own child’s developmental, medical, social, behavioral, and mental health history- and quite possibly because they are the most knowledgeable- they are often excluded from the clinical discussion by the AYAs, themselves. …

Adolescents and young adults are not trained medical professionals. When AYAs diagnose their own symptoms based on what they read on the internet and hear from their friends, it is quite possible for them to reach incorrect conclusions. … The patient’s history being significantly different than their parents’ account of the child’s history should serve as a red flag that a more thorough evaluation is needed and that as much as possible about the patient’s history should be verified by other sources. … The reported behavior of clinicians refusing to communicate with their patients’ parents, primary care physicians, and psychiatrists betrays a resistance to triangulation of evidence which puts AYAs at considerable risk. …

However, maintaining confidentiality of the patient does not prevent the clinician from listening to the medical and social history of the patient provided by the parent. … One would expect that if a patient refuses the inclusion of information from parents and physicians (prior and current), that the clinician would explore this with the patient and encourage them to reconsider. At the very least, if a patient asks that all information from parents and medical sources be disregarded, it should raise the suspicion that what the patient is presenting may be less than forthcoming and the clinician should proceed with caution.

Evaluation of gender issues by trained professionals is crucial – except the vast majority of such clinicians are allegedly remiss in their duty to provide all necessary care to their patients, patients’ likely-unsupportive parents may instead be “the most knowledgeable” about their child’s gender, a patient who is contradicted by their parents should be considered to be unreliable in their self-reports, and any patient who suggests their parent is untrustworthy should be considered untrustworthy themselves.

There’s also the small matter of Littman’s study choosing not to conduct any expert clinical evaluation of the trans youth and adults who were described by their parents, before promptly claiming to have recognized these as occurrences of an entirely new “rapid onset gender dysphoria” condition. A diagnosis of gender dysphoria requires thorough evaluation of the patient by specialists, but a diagnosis of ROGD requires only the perspective of the patient’s unsupportive parent.

But suppose these gender-dysphoric or gender-questioning youth and adults do receive an evaluation by gender specialists, just as they should. How might these clinicians explore their feelings and symptoms surrounding their gender? We can look to the 2016 book “You and Your Gender Identity: A Guide to Discovery” by gender therapist Dara Hoffman-Fox, LPC. In describing symptoms of mental discomfort potentially associated with gender dysphoria, Dara cites the very same article as Littman – “That Was Dysphoria?” – as an example of such symptoms and their possible resolution with transitioning:

“Mental discomfort” has to do with the way your brain is “wired,” gender-wise. Conflict can arise when you experience a difference between your physical body and your “wiring,” as well the experience of being perceived by others as your assigned-sex-at-birth when your “wiring” is telling you otherwise.

“Mental discomfort” can be difficult for someone to pinpoint and describe. That’s because:

– It’s possible it has been there for so long that, to a certain extent, you have gotten used to it.

– You figure it must be the way you are supposed to be feeling and just need to live with it.

– You don’t know what else to attribute that feeling to.

In her article, “That Was Dysphoria? 8 Signs and Symptoms of Indirect Gender Dysphoria,” Zinnia Jones states (emphasis added by me):

“Some of us suffer the distress that stems from dysphoria, but without many clues that this is about gender. (Its) relation to our genders may be obvious only in retrospect.”

In other words, the actual frequency and intensity of your “mental discomfort” will more than likely be revealed after you begin to make changes that help to align your mind and body with your actual gender identity.

Here are ways some of my clients have described the experience of no longer experiencing “mental discomfort” after taking steps to be in harmony with their gender identity physically and socially:

– “I had no idea how much irritability/dissatisfaction/stress I was feeling on a regular basis until I…”

– “I didn’t know how depressed/anxious I actually was until I…”

– “‘I never knew how much I wasn’t ‘me’ until I…”

– “I never knew what ‘peace’ could feel like until I…”

– “I had no clue how cluttered my mind has been all of my life until I…”

– “Having to wear ‘guy clothes’ to work didn’t bother before (or at least I didn’t think it did) until I…”

– “Being addressed by my birth name used to be fine, but it definitely isn’t anymore now that I…”

– “I didn’t realize how disconnected I was from my body, myself, my life until I…”

Clinicians, already aware of these symptoms years before Littman proposed her new condition, may very well see what Littman calls “vague and nonspecific symptoms called signs of GD” and recognize this as actually being a specific presentation commonly associated with untreated gender dysphoria. While dismissing specialist knowledge as deficient and inadequate, Littman demonstrates her own unfamiliarity with that same clinical knowledge – and ends up calling a real disease a fake one, and a fake disease a real one. ■

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Posted in Depersonalization, Gender dysphoria, Hoaxes, Psychology and psychiatry, Replies, Trans youth, Transphobia and prejudice | Tagged , , , , | Leave a comment

SHOWDOWN: Chuck Tingle vs. Laci Green

Posted on September 1, 2018 by Zinnia Jones

By Heather McNamara

Did you SEE what happened on Twitter?

If not then honestly I envy you. It’s a terrible place. We gather there to stress out about what the orange tyrant says, criticize hollywood for being sexist and racist, and to laugh at dril. But occasionally, magic happens on Twitter. Maybe this is why so many of us are willing to suffer through all the rest of it. Or maybe we’re all just hoping Chrissy Teigen will notice us. Continue reading →

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Y’all know comorbidity is a thing, right?

Posted on September 1, 2018 by Zinnia Jones

By Penny Robo

One of the most frustrating arguments to encounter when witnessing discussions involving gender-crits on whether or not a person is “really trans” is the invocation of other conditions the person has as a catch-all explanation. “You’re not trans, you’re just depressed!” “You’re autistic, not transgender!”

This shallow gotcha tactic not only ignores the numerous public discussions trans people have on comorbidity, but also fails to account for the great number of people with those conditions that aren’t trans. Myself and another sibling both suffer from depression, another is autistic, all deal with anxiety to varying degrees, a whole slew of various other conditions and negative experiences plague the entire family, and yet I’m the only one that’s trans. Why haven’t any of the others laid claim to this wondrous, magical explanation for all that ails them???

Because the very concept is ludicrous. Any trans person will tell you that while depression is not a catalyst for gender dysphoria, gender dysphoria can very much be a catalyst for depression. In my case, it acted as a multiplier, amplifying my other issues in much the same manner as losing a job can amplify a person’s existing anxiety. Ignoring such basic ideas and rejecting such universal experiences in favor of this concept of GD as a phantom illness fabricated whole cloth by other factors is as ridiculous as claiming that someone can’t have a broken toe because they already have a broken ankle.

Not only is this a baffling argument to be made, it also belittles the experiences, emotions, and hard-won self understanding of the individual they’re supposedly attempting to “educate”. Because as anyone who’s ever faced multiple illnesses simultaneously can tell you: not only can you have a broken toe and a broken ankle at the same time, but they also tend to make the other feel that much worse. ■

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A Lesser Worn Path

Posted on September 1, 2018 by Zinnia Jones

By Penny Robo

Realizing that you’re trans comes with the additional realization that the path your life is to take is not as well-worn as what most find themselves on. Fewer feet have tamped down the earth and tamed the grass, less resources have been expended to smooth and pave, and many forks are devoid of signage to help you navigate forward. Many of the maps were burned away long ago and the current offerings are as likely to offer you correct directions as they are to admonish you for even considering this path in the first place.

And heaven forbid that you should openly share the route that worked for you. Continue reading →

Posted in Personal, Transphobia and prejudice | Tagged , | 1 Comment