GESTIÓN EN SALUD PÚBLICA: BioEdge: Does ‘rapid-onset gender dysphoria’ exist?

domingo, 26 de agosto de 2018

BioEdge: Does ‘rapid-onset gender dysphoria’ exist?

BioEdge: Does ‘rapid-onset gender dysphoria’ exist?

Bioedge

Does ‘rapid-onset gender dysphoria’ exist?

by Michael Cook | 26 Aug 2018 | 1 comment

Another ethical fight is brewing on the transgender front. Lisa Littman, of the Brown University School of Public Health, has published the first serious study of “rapid-onset gender dysphoria” (ROGD) in PLOS One. This is a condition in which gender dysphoria suddenly appears in puberty or even after its completion. This runs contrary to the current model of gender dysphoria, which assumes that it is present from a very early age. Unsurprisingly, its opponents claim that ROGD does not exist and that Littman’s research is “biased junk science”.

Dr Littman attributes ROGD, in part, to social contagion, as it appears to occur in clusters and is associated with depressive symptoms, such as disordered eating, aggression, bullying, and drug use.

Ethical problems emerge in treatment for ROGD, as they do for early-onset gender dysphoria. But in the case of very young children, psychologists assume that the condition is present from birth and fundamentally immutable. In the case of ROGD, there is a strong possibility that it is a passing fancy.

More than 80% of parents said that their child’s announcement of being transgender came “out of the blue without significant prior evidence of gender dysphoria.” Shouldn’t their testimony be taken into account? Some psychologists discount input from parents and treat the adolescents as if they had standard gender dysphoria. This seems unwise, suggests Dr Littman, as many websites give advice to adolescents about how to fake their symptoms and how to construct a narrative consistent with life-long gender dysphoria.

“The findings that the majority of clinicians described in this study did not explore trauma or mental health disorders as possible causes of gender dysphoria or request medical records in patients with atypical presentations of gender dysphoria is alarming.,” she writes.

When an AYA presents with rapid-onset gender dysphoria it is incumbent upon all professionals to fully respect the young person’s insider perspective but also, in the interests of safe diagnosis and avoidance of clinical harm, to have the awareness and humility themselves to engage with parental perspectives and triangulate evidence in the interest of validity and reliability.

An earlier statement of Littman’s views was dismissed in The Conversation by two Canadian academics, who insisted that psychologists are eminently trustworthy:

Transgender children are in good hands. Therapists aren’t acting hastily in ignorance of scientific evidence. On the contrary, their approach is one that’s been built over decades of research and of following trans children. The unfounded idea of rapid-onset gender dysphoria is a poor attempt at manufacturing a new moral panic — based on the same old idea of “contagion” — over children who couldn’t be in safer hands.

Sunday, August 26, 2018

The Norwegian bioethicist Ole Martin Moen has published an unusual but intriguing article in the journal Bioethics. He analyses the arguments in the half-mad manifesto of the Unabomber, Ted Kaczynski. For those whose memories don’t stretch back that far, Kaczynski was a brilliant mathematician who became obsessed with the decay of American society. He retired to a backwoods cabin and worked as a serial postal bomber whose handiwork killed three people and maimed 23 between 1978 and 1995. The New York Times published his 35,000-word manifesto in 1995 which eventually led to his capture.

Moen says that Kaczynski’s concerns should be taken seriously and refuted philosophically, even if he is a terrorist. “Although philosophers can only play a modest role in fighting terrorism, it is striking that, today, the most obvious line of response to one’s adversaries—to listen carefully, to show that one has understood their position, and to explain why one believes they are mistaken—is hardly even attempted as a means to discourage terrorists.”

His words can usefully be applied to many other areas of public discourse today, not just dialogues with ideologically-motivated terrorists. It’s very seldom that opposing sides listen carefully to each other. In the Middle Ages, academic battles took the form of “disputation and debate”. Stating the other side’s argument in the strongest possible form was an essential part of the process – before demolishing it, of course. We need a bit more of this fairness, even for madmen like Kaczynski.