What do I think?

My late father, who died when I was only 17, had a keen wit and a sceptical turn of mind. One of his favourite sayings was: 'There are two reasons for everything: the good reason and the real reason.'

I thought of this as I was reflecting on the education programme in the 1970s (I think it was) called Helping Youth Decide. It was based on the then-trendy ideas of values clarification, stemming from the work of Carl Rogers.  Its good reason was to encourage young people to make decisions based on their values - with regard to tobacco usage and drugs, for example.  

Its real reason - well, according to Dr William Coulson, long-time friend and colleague of Carl Rogers, it was funded by Philip Morris, the tobacco giants whose best-selling product is Marlboro. In Coulson's view, the tobacco industry had realised that nobody with a fully mature brain was going to take up smoking, so they needed to get to people whose brains were not fully mature - teenagers. 

Helping Youth Decide (later re-branded as Helping Youth Say No and promoted by the Tobacco Institute) was a way of teaching them, and the adults who should be looking out for them, that adults' views and values are irrelevant to their decisions. Meanwhile, of course, Philip Morris continued to spend millions of dollars inviting them to 'Come to Marlboro country.'  So their commitment to a non-directive approach was, how can we say this, a little selective.

All this came back to me (from a talk I heard William Coulson give many years ago) when I was thinking about the trans issue.

Assiduous readers of my posts may have noticed that I keep circling around this: it troubles me.  In part, it troubles me because I see the toxicity with which the issue tends to be discussed (particularly on social media) and the polarisation (particularly in Higher Education, where most of my work is done) that surrounds it.  But deeper than that, it troubles me because I fear that serious harm is being done.

At this point, of course, it would be easy to dismiss me as a transphobe.

But that is precisely the problem, in my eyes: tactics designed to shut down any discussion, and the reduction of this complex set of issues to a simple goodies versus baddies narrative that loses all nuance.

Yet I think it is complex; and I have no generalised fear of, or hatred of, people who identify as trans (or non-binary or anything else). I only wish them well; but I believe that we must seek truth, as well as offer care, if we are to achieve good ends for them and for society more broadly. That is why I see 'No debate' as a very bad approach.  As the Cass Review's interim report makes clear, 'There is lack of consensus and open discussion about the nature of gender dysphoria and therefore about the appropriate clinical response.' 

So in this post (and others that may follow) I thought I'd throw caution to the wind, and think out loud about that complexity; and if a nuanced approach offends anyone... well it is of course their right to be offended; but again, I think that the instinct to be offended at ideas that differ from ours is not a helpful one.

One of my concerns, then, is that I think well-meaning teachers who used the Letting Youth Decide programme with teenagers may have done great harm, by withdrawing from their adult responsibilities and teaching teenagers that whether to smoke or take drugs was a choice they should make as autonomous individuals. The result for many: addiction to tobacco (or worse) and the long term likelihood of severe health outcomes.  

Likewise, I think that well-meaning teachers who teach children counter-factual ideas (such as 'sex is a spectrum') may also be doing great harm.

In the first case, they ignored the huge pressures (from Philip Morris' and others' relentless advertising campaigns, and the need to look cool in front of peers) that meant that teenagers (whose brains, remember, are not yet fully developed) were unlikely always to make wise choices.

I fear that in the second case, we may have something similar; distressed teenagers who are under huge pressures (from social media influencers, and a need to find acceptance among their - often online - peer group) may reach conclusions that are neither accurate, nor in their best interests. And the results may be unnecessary double mastectomies and lifelong dependency on a drug regime that may result in sterility, loss of sexual function and other unwanted consequences. How many Keira Bells does it take?...

And for teachers to undermine truth by taking a naive, ideologically-driven approach (albeit with the best of intentions) risks many other serious unintended consequences. One, of course, is to undermine trust, both from parents and children. Another, is to de-stabilise children's sense of their own identity. 

We know that the young brain develops fast, particularly in early years, and again in puberty and adolescence. (The Oxford Brain Story is very good on making the research on this accessible). We should pay serious heed to this well-established knowledge, and banish the notion that children are 'born trans' - a proposition for which there is no evidence whatsoever. Instead, we should offer children clarity about the basic reality that they are born male or female, and that is stable (for the vast majority). Seeking to normalise the abnormal is irresponsible and dangerous. Of course there are exceptions, and they should be dealt with on an exceptional basis.

I return, finally, to my father's dictum, about the good reason and the real reason.  Why is the trans agenda being pushed so hard?  The good reason is that there are genuinely a small number of people who, for reasons we don't know, but most probably springing from damaged psychosexual development at an early age (and again we know the research about Adverse Childhood Experiences...) have a profound sense of dysphoria with regard to the sex they were born - and we should do nothing to make their lives harder. And I am sure that for many, that is also the real reason.

But for others, particularly some of the activists and activist groups (and their financial backers), I do wonder, what is the real reason?  Is it the huge profitability of this market, as some suggest?  Is it the need for those who have gone down this track (for themselves or their children) to validate their choices?  Is it the need for progressives to be progressive, to show that they are at the cutting edge; and for others to try to keep up, so that they are not perceived as lacking in 'inclusion'?  Is it the need for transgressives to be transgressive, come to that? Or some other reason I can't discern? Or some combination of the above?  I don't know - but I think the questions should be asked.

Of course, I could be wrong about any or all of this, and if you think that I am, I would be very interested to hear why you think so.  As I say, one of my major concerns is that we should be able to discuss these contested issues with clarity and charity.

A Visit to the Doctor

The other day, I had to go to the doctor's: I had a lump, where previously I had not, so thought it wise to get an expert view.

Needless to say, I consulted the internet, too, and decided it was probably a inguinal hernia, and therefore benign (so I liked that idea...). But I didn't look to see what cancers might cause similar symptoms, though that was, of course, my fear (not least as both my parents died of cancer, my father at a younger age than I am now.)

The doctor was very good: he asked if I had any ideas about what it might be, so I told hem. Then he examined me, and said my diagnosis was in fact correct. Which was a relief.

But it was only a relief because I believe that he is telling the truth - that based on his training and experience, he is sure that the lump is indeed an inguinal hernia.  

However, if he was practicing the new 'patient affirming care' that seems to be the fashion, at least in some aspects of medicine, that would be a problem. It might feel kind to tell me it's only a hernia, and that I am clever to have diagnosed it correctly; but if it is in fact a cancer, that is not a true act of kindness.

It would be equally bad the other way about, of course: if I had decided it was a cancer when it was in fact a hernia, and had demanded chemo and an operation - and he had affirmed my diagnosis and decisions and put me on the road to full cancer treatment. 

Absurd! you may say.

And yet, this is what seems to have happened at the Tavistock; and this is what many lobbyists and activists are continuing to demand now, for people who self-diagnose as trans. And just as I didn't want to look at what other explanations there might be for my lump, there is always a risk that others undertaking self-diagnosis may prefer to avoid explanations that they are less happy with...

The Tavistock's reputation, historically, was built on its exploratory approach: really working with patients to reach a deep understanding of the complexity of their lives and experiences. But at some time that was abandoned, and (according to one clinician, quoted in Hannah Barnes' Time To Think) the gender unit there took on the characteristics of its clients (in a bizarre example of parallel process) becoming strident advocates for puberty blockers etc on demand.

Given the large proportion of the Tavistock's patients who presented with complex conditions, (often including autism), this unquestioning affirmative approach seems appallingly negligent.

Yet it is understandable: there was a real desire to be kind and supportive to these troubled children. But love without truth is as dangerous, in its way, as truth without love. And I think that all those who enter this polarised conversation would do well to remember both halves of that proposition!

And I really, really hope that my doctor was being truthful!

Obedience

Stop! Before you read any further, I invite you to notice your immediate response to the topic of this post: Obedience.

If you are like me, and many others I know, your instinctive response may be somewhat critical, and you may have immediately started to think of the many reasons why blind obedience is a bad idea.

And of course you are right.  But the title isn't blind obedience; it is obedience.  And I suspect many of us have been educated and culturally conditioned to conflate the two.

Allegory of Obedience, Giotto

Our educationalists and our culture place such a high premium on being an individual, true to yourself and so forth, that the idea of obedience as a Good seems somewhat alien.

Yet clearly it is, and I think we do ourselves and others a disservice by not recognising that fact and interrogating it with a little more rigour.

And if you think I am making a bold, or even rash, claim with 'clearly it is,' I invite you to consider a few practical examples.

In this country, we drive on the left. It is really, really good if people obey that convention. It has terrible consequences if people neglect to do so, even inadvertently.

The lifeguards on one of my favourite beaches in Cornwall tell you not to swim outside the flags, as there are riptides. Again, it is good if people obey that instruction.

But I want to make a more profound point, beyond drawing your attention to our cultural dislike of the notion of obedience (and its practical importance). And that is, I think we all obey, all of the time. The question is what, or whom, do we obey.

The word obey comes, originally, from the Latin: ob + audire; literally to listen to. So whom do you listen to? When you are considering whether to have one more drink, for example, do you listen to the part of you that counsels you to do so, or the other part that suggests that you have had enough already?

If you place all your obedience at the service of your own autonomy, how do you differ from a narcissist?

And as we are social beings, we need rules of some sort at least to coordinate potentially conflicting behaviours (such as which side of the road to drive on).

So the issue, as I see it, is deciding how to use our obedience: what rules, authorities, sources, people or institutions are worthy of obedience?

I think this is an important question for our times, not least as children and young adults in particular need boundaries, to keep them from harming themselves and others. And I fear we have created a culture in which any idea of obedience is so abhorrent to some that they are unable to follow evidence-based health advice, for example, and that the simple sharing of information about healthy life styles is seen as an oppressive practice.

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As so often, this post is my thinking-out-loud rather than my final view; so I'll be interested in others' perspectives, particularly if I've got this wrong...

A challenging tension

I have been reflecting on an interesting tension, which I can see no obvious way to resolve. So, as I often do in such situations, I thought I'd write about it, both to clarify my own thoughts and in the hope that others might be interested and might have insights to share. 

So here's the thing. One of the issues that the current enthusiasm for Diversity and Inclusion as values is addressing, is the phenomenon known as 'othering.' (I know, my linguistic sensitivities don't like it either, but it seems to be the vogue term). This is the process of identifying someone or some group as outsiders, often accompanied by negative stereotyping,  For a full (and fairly typical) account, see here. Clearly, this can be problematic, whether in an organisational context, when it will impede working relationships and therefore organisational effectiveness, and also at a societal level, when it can lay the foundations for prejudicial discrimination, and in extremis, de-humanisation and persecution. 

One of the responses to this is to lay great stress on our common humanity, and to expand the bandwidth of what we perceive as normal, so that we do not see people who are different from us as abnormal, or 'other.' A fairly common example is when people say, with regard to Autism Spectrum Disorders, ' Of course, we're all on the spectrum somewhere.' Yet this well-intentioned attempt to normalise ASD can meet a very angry response. Some people with ASD, and those who advocate for them, point out that this approach has several unhelpful, unintended consequences.

One is that it risks minimising the very real difficulties some people face. For example, I am not particularly socially skilled, particularly in unstructured situations. But to attribute that to my being 'a bit on the spectrum' seems to belittle the very significant difficulties some of the people I know with autism encounter in such contexts. They (and I) would argue it is a difference in kind, not just of degree.

A second and related risk is that it may obscure the need for reasonable adjustments at work and in broader society to enable the full and fair participation.

So that's the tension: how do we sufficiently normalise difference that we reduce the risk of othering, whilst maintaining sufficient and useful distinctions, so as to ensure that differing needs are fully understood and met?

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Images: Tug-of-war generated by 123RF; Autism Spectrum seen repeatedly on Linked In, but I haven't found an attribution or originator: happy to credit if anyone tells me!