I know what not to do.

Margaret Anne Bulkley lived the last 56 years of her life disguised as a man. At about the age of 20 she took on the persona of James Barry in order to Matriculate at Edinburgh University and study medicine. Following this, in order to practice medicine, she maintained this pretence by living as adr_james_barry_28surgeon29 man until her death. When she died in 1865 (coincidentally the year Elizabeth Garrett became the first woman to qualify as a doctor) she had pursued a successful medical career and been promoted steadily becoming Medical Inspector General for South Africa. During this period of pretence it is believed that she managed also to give birth to a daughter while the world still respected her as a successful and powerful man.

We only have to look back a little time to see how much progress we have made. In the past so many of our personal and social roles were held to be closely tied to our sex at birth. Today we do not bat an eyelid when a woman wishes to be a surgeon, a man a nurse, a girl a footballer or a boy a dancer. We don’t think of very many roles being necessarily tied to biological sex. The days when women had to pretend to be men to pursue their desires have gone.

We should remember the travails of women who wanted to pursue aims at the time which were held to be only suitable for men – Joan of Arc as she tried to lead armies, Dorothy Lawrence who worked as a war reporter, Margaret Bulkley  wishing to be a doctor, and countless women who fell in love with other women. Remembering these women will stop us forgetting the ignominious aspect of our history which forced pretence on the few who were able to follow their dreams and stopped so many from even taking their first steps towards them.

We now tend to think there is a rather loose relationship between gender roles and biological sex. Something that is more important for groups and averages than something to be applied to individuals. The  biological differences we have are often subtle, and may help explain why one group is over-represented in one area or another, but are rarely felt to be important for the individual in their selection of, or for, activities.

If a child is born today with desires and aims that have been traditionally been seen as the domain of the other biological sex this is not an insurmountable problem. They may face some resistance, but as society improves this should lessen, but there will be no need for transvestitism, nor any pretence. They can aim for their dreams regardless of their biological sex. They don’t have to don the clothes, or names,  of the other sex and they don’t need to hide or alter their biology.

Thus there would seem no call for a boy who wants to follow gender roles traditionally seen as female to transition and alter their biology. Likewise any girl who wishes to pursue traditionally masculine roles or activities  need not alter their bodily appearance. The gender roles that we are often concerned about may have some of their historical development related to our biology (increased muscle mass may have lead us to see the army as a masculine role, for example) but most now are determined purely socially. Thus if someone feels the roles that they wish to pursue are discordant with their biology then the solution is social. The solution is to push for that role to be open to both biological sexes not to alter the person’s biological sex to fit the social role.

If people want to change their biological sex it must be for reasons other than wanting to pursue what are felt to be sex-inappropriate roles as the barriers facing them are considerably less than the barrier posed by the option of changing one’s biological sex. It would seem that the term gender dysphoria does sum up the primary reason for the desire to transition to the other biological sex. It is not a positive desire to be the other biological sex but rather a distaste or unhappiness (dysphoria) in being in the body you find yourself within.

This is not an unusual feature of psychological disorders arising in early adult life and especially around puberty. In addition to gender dysphoria, dysmorphophobia (a belief that one is disfigured or deformed) and the eating disorders (anorexia nervosa and related disorders) share the core belief by the patient that their body shape or configuration is wrong for them. These are serious, debilitating, and dangerous disorders with extremely high levels of distress and a significant mortality through suicide. Our understanding of these disorders is very poor and our treatments are of only limited efficacy. But we never mistake the faulty body image of the patient with anorexia, or dysmorphophobia, as the solution and make that the target of our treatment. We never offer pointless plastic surgery someone who believes their face deformed nor accept that the patient with anorexia should just continue to fade away and die as they see themselves as too fat. Instead we try and help them adjust to their body, and life, as it is and find ways to live with this.

Unfortunately with transgender patients we break with this tradition and offer to try medications and surgery to make their body fit with their internal thoughts. If such medication and surgery diminished distress and eased the patient it might be seen as a useful, if surprising, therapy. Unfortunately it does not appear to do so. The evidence is scanty but, as the American College of Paediatricans pointed out, work undertaken by Sweden’s Karolinska Institute does not find that surgery to transition people from one sex to another reduces the rate of suicide which remains, sadly, much higher than that in the population as a whole.

I have steadily lost the certainty of youth as I have grown older. I am now much happier to accept that I do not know the answer to many questions. Increased knowledge and experience has lead to reduced acceptance of simple or glib answers. However, although I may not know what to do I sometimes know what we should not do. In this case, whether people want to pursue a life in the gender roles that differ to those of the  body they were born within, either from a desire for the positive aspects of those roles, or from a disgust of their own bodily configuration, then attempts to alter their biological sex would appear unwise. At an individual level, obviously it is their choice and they may do with their bodies as they will, but any unbiased observer would counsel them against this as it is  unlikely to lead them to future happiness. At a societal level, I fear we may look back on this period sadly; we saw the problem of defining peoples’ roles by their genitals which forced the likes of Margaret Bulkley and others into dreadful situations but came up with the solution of making peoples’ genitals match the gender roles ! History may not be kind to us.

12 Rules for Life

12 Rules for Life

I watched an interview of Jordan Peterson by Cathy Newman recently and was rather surprised by what I saw. I was bewildered by Cathy Newman’s approach to her subject, she obviously found his views distasteful and was trying very hard to trip him up and reveal his dark and unpleasant, presumably misogynistic, side. She failed to do this and he remained placid, un-rattled, and replied fully and reasonably. Now I have seen her interview many people over the years and she is usually an excellent interviewer; able to debate with the best and able to handle herself in an argument She is, without doubt, one of the best news journalists we have on British television.  I was therefore surprised to see her have such difficulty with this subject, to the extent that at one point she was literally struck dumb and at a loss for words.

At this point I had not heard of her subject Jordan B. Peterson, a Professor of Psychology at Toronto University, nor did I know of his views. But, spurred by this interview, I read a little about him. It became clear that he has become very popular on account of his most recent book and also for his lectures on psychology which are available on YouTube. He is a clinical psychologist and academic who has made a bit of speciality of examining the role of religion in culture and personal psychology. But it became clear that this was not the reason for his widespread, and increasing, fame (or notoriety), this was because of his position on the issue of “compelled speech” (in regard to pronoun usage with transgendered people) and because he has recently published a book which has become a surprising best seller “12 Rules for Life : An antidote to chaos”.

The book, a self-help psychology text, has been very successful with young men and his position on free speech has caused him to be seen as a darling by the “alt-right“. The latter problem is a common difficulty experienced by those of us who try and safeguard free-speech. Those on the far-right often like to profess a support for free-speech as they think it protects them when they spew their bile, particularly their misogynistic or racist ideas. They do not realise that those who support free-speech do so specifically to be able to debate with such hateful ideologies and, through debate, destroy them. The best way to get rid of hateful erroneous ideas is to debate with those who hold them and make them, and their fellow-travellers, feel embarrassed and ashamed town such thoughts.

The fact that his book was popular with young men was interesting as this is a demographic not often drawn to reading. This in itself did not cause me concern, despite Cathy Newman’s obvious distaste for the book, but it did suggest to me that I should read his book. A quick trip to the kindle store and three days later  I was finished. It was a gripping read and one of the best books I have read in a long time.

To be fair this is a “pop psychology” book. It is written in easy chapters, each describing a basic rule. For example  “Chapter 6 : Set you house in perfect order before you criticize the world“, and so on. He writes well and is an erudite thinker with a wide knowledge base. He starts each chapter with a story to outline his thinking on the subject or rule. He then considers the cultural history and scientific knowledge about the issue before completing the chapter with practical advice on how to apply this knowledge to your own life.

Much of his thinking is based on current knowledge of scientific psychology but it is mixed with practical experience of working in clinical psychology, especially in working in the field of deep insight orientated psychology. He refers back to Jung, Neitzsche and Adler as well as to recent neuropsychologists. But perhaps more interesting is his use of knowledge of religious history. He looks at how the major religions have addressed psychological issues such as suffering, death, guilt and happiness and points out, whether you believe in a deity or not, that religion was mankind’s way of making sense of our life experience and many of the lessons learnt millennia ago are just as applicable today.

In essence, I discovered a very readable and wise book. I am glad it has been successful as it will prove much more valuable that many of the faddish self-help bibles which have come and gone. The chapter on parenting is a valuable counterpoint to many of the prevailing mistakes we are making today.  I found no evidence of misogyny or racism at all. Certainly there were some areas where he suggests that our evolutionary history has meant that some biological factors continue to influence our gender behaviours and he does not agree that this is entirely a social construct. Indeed, this might be his heresy. Today, we are meant to believe that all aspect of gender are socially constructed and that, barring organs of reproduction, there are no differences between men and women. This is clearly not true and the scientific literature attests to this. Unfortunately this is becoming a rather inconvenient truth and one that is not allowed to be said. I think this was the dynamic underpinning Cathy Newman’s interviewing style.

This is a problem. Womens’ rights have improved over the recent years but there is still a long way to go. If we are to obtain equality and fairness we will have to continue to fight for it. However, if there are uncomfortable facts, if there are biological factors influencing our behaviours, then we need to know about them and discuss them. It will not help our progress to pretend they do not exist and to cry “heresy” when people raise them. Biology is not necessarily our destiny but it has a bigger influence when it is ignored or denied; as a man I may be more prone to aggressive behaviours than a woman (on group averages) but knowing this only means I need to be more mindful. It is not an excuse and has no exculpatory power. For example, if I want to be a good man I need to know how to control and curb my aggressive instincts, to pretend that these  impulses are not there helps no one.

I think therefore, on this occasion, Cathy Newman was wrong. Rather then trying to explore or debate his ideas she tried to shut him down. Others, with a similar agenda, have  tried to minimise his works by smearing it, and him, as alt-right or similar. This means that his genuine insights are not considered but more importantly those young men who find meaning in his writings will be pushed and corralled into the area occupied by those who are indeed of the alt-right. This is a danger, as Peterson is aware, we need to help men to maturity and insight in our society, we need to make them more self aware, strong and confident because if you think tough men are dangerous, wait until you see what weak men are capable of”

 

 

 

 

 

Let’s stop genital manipulation.

Let’s stop genital manipulation.

Figure published this week (1) reveals that in the UK 2491 cases of female genital mutilation (FGM) occurred last year between April and September in the United Kingdom. This is far too many and a report which speaks to unnecessary pain, distress and possible future disability. I applaud all those who try and stop this barbarism to young girls.

This is a major moral problem as it lets us know that the rights of children are being ignored. They are being mutilated without their consent and any benefit (religious observance, cultural tradition) accrues to the person organizing it, not to the child. Indeed, for the child, it can only be anticipated to be a negative event in their life. Children are not the property of their parents, they have their inalienable rights, like all people. The only difference in the situation of a child is that, in addition to rights,  their  parents also have a duty  (which they contracted to when they decided to make the child) to take care of the child until it is emancipated.

The child’s rights are largely negative, as with all of us, and are predominately the right not to be subject to aggression or violence. It is the parent’s duty to safeguard this right. Genital mutilation, cutting the child for the benefits of the parent, breaches ths duty of care and infringes the child’s rights.

From a libertarian perspective this moral problem is easy to resolve. Genital mutilation should stop and any parent who perpetrates this on their children is not adequately fulfilling their duty of care and someone else should consider taking this role.

However, it is a moral problem, not a gender problem. This is not an issue of gender rights. To see this as a gender issue blinds us to the many young boys who suffer the same fate. In the UK about 12,200 male circumcisions are done annually. This is not a minor procedure as often portrayed. About 3% of babies have some complication following the procedure, lower rates of infection are reported in around 1 in 50 cases (2) and each year about 100 boys die in the USA following circumcision (3). The long term sequeleae are also important with significant rates of psycho-sexual dysfunction  being recorded.

People often believe that their are health benefits from circumcision in males. Research has not shown this to be the case (4)

People often think the reasons that FGM is done is particularly related to curbing female sexuality. This is wrong. Male mutilation developed from the same drives to curb sexual drive and masturbation. Dr Kellog (5), of the breakfast cereal fame, wrote

“A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment… In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement”

So lets see this as a moral question. Lets fight to push FGM into the history books where it should remain, but let us not forget our sons while we protect our daughters and let us stop male genital manipulation at the same time.

Boy or girl it is the same crime.

 

 

(1) Sky News – FGM case reported every 109 minutes in England

(2) Boyle GJ, Svoboda JS, Price CP, Turner JN. Circumcision of Healthy Boys: Criminal Assault? J Law Med. 2000;7:301–10.

(3) Bollinger, D. “Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths,” Thymos: Journal of Boyhood Studies Volume 4, Number 1 (2010).

(4) Intact America

(5) Narvaez D. Circumcision: Social, Sexual, Psychological Realities. Psychology Today. 2011 September 18.