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doc_k55 's review for:
Irreversible Damage: The Transgender Craze Seducing Our Daughters
by Abigail Shrier
Irreversible Damage: The book that has been the source of an extraordinary amount of controversy for dealing with a hot-button issue in a not-so-politically correct sort of way. And one of the best books I've read in a very long time.
The book is not, as some have postulated, transphobic. Nor is it homophobic, or hateful. What it is: an exploration of this topic - the rapid onset gender dysphoria that seemingly took down Lisa Littman, an ob-gyn and public health researcher - with a critical eye. The literature, medical/psychiatric/therapeutic professional associations, schools, media and online world are in lockstep: if a child announces that s/he is transgender or otherwise gender nonconforming, we should accept and support this announcement without questioning what led to it. Shrier asks a few simple questions:
- How does this differ from transgender identification in the preceding century?
- Why these girls, and why now?
- Are these girls getting better with this blanket support?
-What are the outcomes of the current medical/psychiatric approach to trans-identification?
As I noted in the last nonfiction book I read, even in nonfiction, authors always imbue the text with their own opinions, and Shrier is no different. She clearly has an opinion on this topic, but as noted above - she is neither transphobic nor homophobic (accusations that have been leveled at her). She is, however, skeptical and analytical - two features she points out are missing from most of the treatments (medical and therapeutic) provided to these girls. Like Littman, she notes a frequent co-occurrence of gender nonconformity among girls in a given school or among groups of friends, which is a statistical impossibility. How can this be? And how can society - especially those tasked with helping adolescents - ignore this?
I'm first a parent and second a physician, and my overwhelming sense after reading this book is that we have a whole generation of girls who are not getting what they really need from their parents, teachers, physicians and support system. They're getting lost on the internet (which I think is true regardless of the transgender issue - it's a huge problem, esp now with pandemic) and they are not receiving the mental health treatment they need. Depression, anxiety, social isolation, imperfection of body, stereotypical perspectives on what is masculine and feminine - kids are struggling with all of these issues. Some will navigate adolescence with bumps and bruises and emerge unscathed on the other side. Others will not, and the evidence provided by Shrier is that these kids are not getting support for the underlying issues. Instead of pursuing the things that may have led to their identification, they are receiving therapy and support for the identity they embrace. In fact, questioning why a teen suddenly identifies as transgender is anathema.
Shrier covers the history of this recent phenomenon and interviews physicians and therapists who have treated and studied innumerable transgender individuals. She interviewed multiple transgender adults, families of daughters who suddenly transitioned in adolescence, and some people who detransitioned. Of course, as in any social science book, her conclusions are informed by those who she interviewed, but this is a fairly unique and unstudied population. In the absence of other data, this is what she has to go on, and unless - and until - academic institutions create well-designed studies around this population, investigative reporting is the only source of information that counteracts the most popular views on this topic.
Shrier notes that in the end, some of these girls are transgender. Some of them are lesbians. Some of them are neither, but have other mental health issues that have not been adequately addressed or treated. She analogizes this rapid onset transgender identification to teenage clusters of anorexia, or multiple personality disorder, or recovered memories of abuse, and makes the point that providing life-altering treatment, or encouraging social transitioning, is not benign and should not be undertaken without full evaluation of the individual, as was done in the past (pretty much up to 2015). Finally, she makes some important points about womanhood: it is hard to get through adolescence, and the changes girls' bodies undergo are amazing and horrifying, but in the end they are wonderful beings with the ability to do just about anything they want to do without regard to their sexuality or degree of masculinity or femininity. And being a woman (and a girl) is an incredible thing.
As I said at the beginning, I think this book was fabulous. As a parent and a physician, I worry about ANY treatment that has the potential to cause harm, and I constantly weigh risks and benefits when dealing with my children, my patients and my community. I don't like to give antibiotics when they won't clearly provide benefit, even if patients want them, because they can cause harm. I don't support further hybrid/remote learning because I believe the risks of keeping our kids home outweighs the benefits. And I view this much the same way: risks and benefits must be evaluated for these girls. They should receive counseling for depression. Their parents should be asked for a social and psych0logical history, as I have been each time we have worked with a new mental health professional for my own children. A BASC should be completed by parents, children, teachers. And if after much therapy - focused on evaluating root causes of unhappiness and body dissatisfaction - a teen is found to have persistent gender dysphoria, transition should be discussed. In other words, treatment should be rooted in full assessment and an accurate risk/benefit analysis.
I strongly recommend reading this, especially if you disagree with the ideas postulated here. We've reached a bizarre point culturally where people believe they will be harmed by reading things they don't like. That makes no sense. If you read something you disagree with, you can then make a cogent argument refuting its points.
The book is not, as some have postulated, transphobic. Nor is it homophobic, or hateful. What it is: an exploration of this topic - the rapid onset gender dysphoria that seemingly took down Lisa Littman, an ob-gyn and public health researcher - with a critical eye. The literature, medical/psychiatric/therapeutic professional associations, schools, media and online world are in lockstep: if a child announces that s/he is transgender or otherwise gender nonconforming, we should accept and support this announcement without questioning what led to it. Shrier asks a few simple questions:
- How does this differ from transgender identification in the preceding century?
- Why these girls, and why now?
- Are these girls getting better with this blanket support?
-What are the outcomes of the current medical/psychiatric approach to trans-identification?
As I noted in the last nonfiction book I read, even in nonfiction, authors always imbue the text with their own opinions, and Shrier is no different. She clearly has an opinion on this topic, but as noted above - she is neither transphobic nor homophobic (accusations that have been leveled at her). She is, however, skeptical and analytical - two features she points out are missing from most of the treatments (medical and therapeutic) provided to these girls. Like Littman, she notes a frequent co-occurrence of gender nonconformity among girls in a given school or among groups of friends, which is a statistical impossibility. How can this be? And how can society - especially those tasked with helping adolescents - ignore this?
I'm first a parent and second a physician, and my overwhelming sense after reading this book is that we have a whole generation of girls who are not getting what they really need from their parents, teachers, physicians and support system. They're getting lost on the internet (which I think is true regardless of the transgender issue - it's a huge problem, esp now with pandemic) and they are not receiving the mental health treatment they need. Depression, anxiety, social isolation, imperfection of body, stereotypical perspectives on what is masculine and feminine - kids are struggling with all of these issues. Some will navigate adolescence with bumps and bruises and emerge unscathed on the other side. Others will not, and the evidence provided by Shrier is that these kids are not getting support for the underlying issues. Instead of pursuing the things that may have led to their identification, they are receiving therapy and support for the identity they embrace. In fact, questioning why a teen suddenly identifies as transgender is anathema.
Shrier covers the history of this recent phenomenon and interviews physicians and therapists who have treated and studied innumerable transgender individuals. She interviewed multiple transgender adults, families of daughters who suddenly transitioned in adolescence, and some people who detransitioned. Of course, as in any social science book, her conclusions are informed by those who she interviewed, but this is a fairly unique and unstudied population. In the absence of other data, this is what she has to go on, and unless - and until - academic institutions create well-designed studies around this population, investigative reporting is the only source of information that counteracts the most popular views on this topic.
Shrier notes that in the end, some of these girls are transgender. Some of them are lesbians. Some of them are neither, but have other mental health issues that have not been adequately addressed or treated. She analogizes this rapid onset transgender identification to teenage clusters of anorexia, or multiple personality disorder, or recovered memories of abuse, and makes the point that providing life-altering treatment, or encouraging social transitioning, is not benign and should not be undertaken without full evaluation of the individual, as was done in the past (pretty much up to 2015). Finally, she makes some important points about womanhood: it is hard to get through adolescence, and the changes girls' bodies undergo are amazing and horrifying, but in the end they are wonderful beings with the ability to do just about anything they want to do without regard to their sexuality or degree of masculinity or femininity. And being a woman (and a girl) is an incredible thing.
As I said at the beginning, I think this book was fabulous. As a parent and a physician, I worry about ANY treatment that has the potential to cause harm, and I constantly weigh risks and benefits when dealing with my children, my patients and my community. I don't like to give antibiotics when they won't clearly provide benefit, even if patients want them, because they can cause harm. I don't support further hybrid/remote learning because I believe the risks of keeping our kids home outweighs the benefits. And I view this much the same way: risks and benefits must be evaluated for these girls. They should receive counseling for depression. Their parents should be asked for a social and psych0logical history, as I have been each time we have worked with a new mental health professional for my own children. A BASC should be completed by parents, children, teachers. And if after much therapy - focused on evaluating root causes of unhappiness and body dissatisfaction - a teen is found to have persistent gender dysphoria, transition should be discussed. In other words, treatment should be rooted in full assessment and an accurate risk/benefit analysis.
I strongly recommend reading this, especially if you disagree with the ideas postulated here. We've reached a bizarre point culturally where people believe they will be harmed by reading things they don't like. That makes no sense. If you read something you disagree with, you can then make a cogent argument refuting its points.