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Notes -
The WPATH To Hell Is Paved With Good Intentions
Things are starting to move fast in Genderland, or at least faster than I can cover them with while giving any sort of justice to the topic. I haven't even gone through the entire WPATH Files, when the Daily Caller (...News Foundation - an important distinction if you're searching for the source materials) released the WPATH Tapes. By spamming FOIAs they were able to get a hold of over 30 hours of video from the 2022 WPATH summit in Montreal. A lot of it is the same old same old that I brought while covering the Files (you can see the short clip playlist here) - there's a public face of gender specialists where the science is settled, you can either have a happy daughter or a dead son, puberty blockers are reversible, etc., etc... and a private face, where they discuss amongst each other the very same concerns they dismissed, when they were brought up by skeptics of Gender Affirming Care. What's new is that the raw amount of footage allowed me to confidently reach a conclusion about a question that's been bugging for a while - what is these people's deal? Are doctors trying to do what's best for their patients, or are they a bunch of ideologically captured fanatics, blind to the harm they are doing? The answer seems to simply be: yes.
I already remarked how a lot of these clinicians come off as quite sympathetic back when I covered the Files. When you listen to their talks you hear them openly expressing uncertainty about many aspects of Gender Affirming care, discussing the limits of their patients' (and their parents') understanding of some of the interventions, and the importance of bringing them up to speed, or you hear them bringing up known and potential side effects, and ways of mitigating them. With things like this, they almost come off as urging caution... the problem is that if you keep listening you get the distinct impression you're on a train with no breaks.
The Introduction to Trans Health talk is a good example of the good and the bad of that WPATH conference. It opens with a pull-at-your-heart-strings story, of Dr. Ren Massey's FTM transition and the struggle to find acceptance in society and from his parents. I ended up being quite moved by the story myself, and yet, in the fastest "Oh god, oh no, baby, what is you doing?" I have experienced to date, he drops this slide, where he proclaims everything from non-binaries to eunuchs is hecking valid.
I try to be honest about these things - I am biased, I pretty much already reached my conclusion on the subject, and it's going to be a hell of process to change my mind again, but no matter how certain I am of something there's always the possibility of being wrong. The thing is, "being wrong" to me means it turning out that people like Jack Turban were right, that gender dysphoria is a valid diagnosis, that doctors can reliably tell people who have it from people who don't, and they have treatments that are proven to alleviate their suffering.
Well, fuck me then, I guess. It turns out that the "medicalized narrative" may have been used in the past, but it's outdated now. Not all trans people have dysphoria, and not everyone wants to transition from one side of the binary to the other. The doctor's empashis needs to be on removing barriers, and on patient autonomy. Between several name drops of "intersectionality", "power and privilege", or "minority stress", as best as I can gather these folks are certified Queer Theorists, tirelessly working to deconstruct the idea that (cis)heterosexuality is normal. Sure, they'll take into account the consequences of gender treatments, and they'll try to make sure that patient's "transition goals" are within the realm of physical possibility, but there should be no other limits placed otherwise. It feels like they flipped the table. What I thought was a conversation about the state of medical science turns out to be a fight over who's worldview should prevail.
This seems to be the only explanation that can make sense out of the whole thing, and tie up the loose ends of the WPATH clinicians genuine concern for their patients, with wild off-the-wall stuff like the Eunuch Archive, or why they pull the knives out for Lisa Littman and the ROGD hypothesis or Blanchard's categorization of trans people, while remaining unbothered by Dianne Ehrensaft's gender angels and gender Tootsie Roll Pops.
Back when I covered the Eunuch Archive it was declared that I am a bad, bad boy, because in a forum with explicit rules about not booing the outgroup, I limited myself to providing evidence that child castration fetishists have an influential role in setting standards for transgender care, and are using it to promote their fetish, but refused to speculate on their motivation, and wouldn't declare them evil or insane. Other than it not mattering, and me not knowing, there was something unsatisfying about the two explanations that were offered. They were a too lucid to plead insanity, and haven't expressed a callous disregard for the well being of others, or a singular obsession with their own self-gratification, that people straight-forwardly associate with evil. What they do appear to be is completely ideologically captured. They view everything through the lens of Queer Theory and intersectionality, and are simply doing what is considered good in the light of that ideology, that this might involve affirming eunuchs, or transitioning schizophrenics doesn't phase them in the slightest.
All this seems to show the limits of analyzing motivations, and has implications on what it means to "boo the outgroup". That the road to hell is paved with good intentions is not a new lesson, but it seems that it's rarely understood as something more than "sometimes people get carried away trying to do good, and go too far", when some cases are probably better understood as "sometimes ideologies can make you commit obviously grievous harm, with a smile on your face". Perhaps the evil/insane dichotomy was the real Boo Outgroup all along?
I think the steelman also includes a number of concerns about a patient's long-term interests and what they'll desire afterward, but yes, for the most part the Blue Tribe medical community position has been much closer to the tumblr/Ozy gender anarchy than to the medical necessity framework for about a decade now.
(and, correspondingly, they've not really struggled with the extent that the mental health component and especially suicide risk was no small part of what permitted under traditional analysis that they're, if unintentionally, rejecting)
That said, while I think you're directionally correct, I will push back on:
I think there's another plausible explanation: they think, with reason, that Blanchard's autogynophilia theories seems factually wrong, in their common form and any form but their weakest, and that Blanchard (advocates, such as Bailey) seem unwilling to engage seriously with counterexamples.
((Yes, I absolutely see and agree with the irony, here. There's reason you aren't very happy with WPATH sticking fingers in ears about detransitioners, right?))
As a metaphor that I do have deeper insight in, I'll point to other examples of what Bailey et all call Erotic Target Identity Inversion: treatment of fursuiting or feral-focused furries as 'autoanthrozoophilia' and 'autozoophilia', respectively. In this model, furries who fursuit do so solely because they're aroused by being seen as anthros/animals, and that this ties into the feelings of species dysphoria.
That's not just something I made up to strawman the Blanchard/Bailey perspective, but one that Bailey highlighted himself. While the terms are (almost certainly intentionally) a little weird and loaded, there actually are people who fit into the categories that they're trying to describe, and I can even give number of online psuedonyms for people who do things like transformation kink or where otherwise 'being their character' is a good part of the erotic purpose. And I'll admit that while the community isn't always adult-oriented, a lot of it is.
So these theories must be true?
Well, no, because there's more to the actual theory than just its name: each of these theories include some level of predictive analysis, such that the presence of an autogyne or autoanthrophile says something broader about most of all of the remaining community. In Bailey's take, the presence of some number of (bisexual or gynophilic) transwomen who hide arousal from dressing as a woman meant that almost all (bisexual or gynophilic) transwoman claiming a lack of such arousal were just not willing to disclose it. Many advocates for 'autozoophilia' as a theory take this even further, to mean every person, categorically, achieving certain therian practices must also have such a sexual interest first.
Which doesn't seem to be the case in the furry and therian world, and it's not particularly hard to find (common!) exceptions. There's a lot of overlap between therians and furries, but there's definitely non-furry therians, and not all furry therians are in it for the sex. Where there is a sexual component to the fandom interest, some people often just want to get railed by a Space!Roman chubby wolf, rather than imagine themselves as 'being' or becoming one. By contrast, a lot of the various fursuit and therian practices aren't arousing; "fursuit_bowling" unsurprisingly turns up zero examples on e621, therian meditation had a buuunch of weird results and 'get a boner' basically never shows up, and in the modern day mirror-dwellers don't get that sort of response.
((The first counterargument is that they're all lying, but all I can say there is that I'm not, and for a universal position a single counterexample is fatal. The second counterargument is that some rare outliers exist, but most people are lying, and I'm skeptical: there's none of the medical pragmatic arguments that, and when it comes to embarrassment... I'll avoid some of the more bizarre or detailed points, but for a relatively tame example, I don't think the fursuiter with a nickname of 'pool toy' would be worried about that.))
There's pragmatic reasons these theories are concerning -- non-autogynophile and non-autoanthrophile fursuiters or non-autozoophile therians want neither sexual practices permitted in public nor their non-sexual practices from being restricted -- but even before you get that far there's a certain Someone Is Wrong On The Internet about things. It'd be like some sexologist making weird Pepe Silvia diagrams from people who find motorcyles empowering to talking about how people who change their own oil get off on it: I'm sure it happens somewhere, but no. Just no.
Crap like Keo-Meier/Ehrensaft (in addition to just being creepy) speak badly about the intellectual honesty or commitment to actual outreach to the unconverted: even as someone who's thrown together a list I recognize couldn't be all-inclusive, they're got a muddled mess of ingroup terms without any real inclusive or exclusive meaning.
That's all there is, though. It's not even predictive enough to be wrong.
I have no issue with people rejecting Blanchard. To the extent I think there's something to it, it's probably fair to describe it as it's weakest form. It's the "knives out" attitude that bothers me, in my experience most opponents don't reallly respond to it.
Consider the ROGD example, there was valid criticism of Littman's study when it came out, but most responses seemed to encourage dismissing the hypothesis outright, rather than verifying it with a higher quality study.
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Yes, despite deep skepticism of the trans worldview I've always modeled it as more confused than evil or anything. The people behind it clearly think they're making the world a better place and that there are tons of kids that are suffering immensely worse lives for not being found and allowed to be "who they really are". They don't seem to adequately grapple with the possibility that someone could be deluded into believing strange and untrue things about themselves especially when those things are packaged into appealing memes that contain soothing explanation for why they don't fit in or are confused at puberty. They genuinely believe that if someone say they're trans there is a special sense that definitely have in their head that is providing them total proof and that it can't possibly be imagined.
Believe it or not, that's already a toned-down version of that worldview. The more hardcore version of Queer Theory would assert that there's nothing to prove. It's like asking for proof of you liking chocolate ice cream. Like I mentioned - not all trans people have dysphoria, not everyone wants to be binary, not everyone even wants to medically transition. The idea is it to enable self-expression, even if that involves hacking off body parts.
Oddly enough, what you call the "hardcore version" seems a much more sane and reasonable perspective than the "toned-down version"
To each their own, I suppose.
I figured stubbornness is a common enough trait, but treating the human body like it's Mr. Potato Head, with full knowledge of what that entails, freaks me out quite as bit.
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Evil vs incompetent is, at this level, a false dichotomy. These doctors are lying to cover up their ideologically-driven confusion. That’s both those things.
Communism is bad at managing agricultural production. That’s not because it intends to cause famine, that’s because its prescriptions are retarded. But that doesn’t make it blameless. Likewise doctors confidently mouthing off ideologically-driven answers to questions that the available evidence indicates a different answer two.
Yeah, that's been a bit of a sticking point for me too. I think they're aware of not being perfectly honest, but if you see your opponents as even worse, what's a little white lie to ensure the ultimate victory of the cause? I think they can plausibly call themselves well-intentioned, but I also agree with your "both" answer. Is a mass-suiciding cult not-evil just because they really honestly believe that this is the road to paradise?
What does "evil" mean to you here, even? It's hard to see it as anything other than an "opposed to my values", paired with a certain claim to license to transgress normal boundaries in order to bring the evil person or action in line with what your values are. The former is okay, but the latter surely is out of place in this forum, being somewhere in the space between "shaming" and recruiting for a cause (even if that cause is just to stand by and do nothing to interfere as you proceed to smite evil). At least I don't think you can argue that calling something evil is merely the former - I expect that if I started calling your preferred views on sexuality evil, it would rain downvotes and possibly reports if I am obstinate enough about it, which surely would make no sense if I were just communicating my values.
Telling a knowable lie when you have a professional responsibility to speak truthfully is evil.
The problem with the way you've phrased it is, well, who defines responsibilities? Police states always say everyone has a responsibility to report dissent; is lying to cover dissidents or the persecuted evil? But if the responsibilities set in law and by dominant organisations can be void, then who decides? You? But then your statement reduces to "[I think] telling a knowable lie when I think you were morally obliged to tell the truth is evil". Well, no shit doing the opposite of what's morally obligatory is evil. That's practically vacuous.
In this particular case there are enough hypocrisies and contradictions that the issues with the full version of this statement don't really engage, but come on, man, that was a soundbite extraordinaire.
That sounds like a more convoluted way of saying "have a professional responsibility to speak truthfully", otherwise where are you getting the idea anyone should avoid being hypocritical and contradictory?
My point here is that these are basically the same people promulgating and violating the responsibility, so they're in a sense estopped from raising the defence of "that responsibility is fake and void"; they could have chosen not to define that responsibility in that way.
To more directly answer your question, though, I think there's at least an imperfect Kantian duty to do so and plausibly a perfect one (if everyone's a hypocrite about the same thing, the denunciations can be said to cease to have meaning).
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I'm totally okay with use of the word "evil". Evil is inherently subjective. Tyrants quite often think they are doing the right thing. So did Chinese parents who bound their girls feet, or people in south-Saharan Africa who perform genital mutilation. Even criminals who seem obviously motivated by selfishness often have a victim narrative that excuses their actions.
Which is to say this. In a sense no one is truly "evil". We are all flawed. To understand all is to forgive all.
But let me defend the user of the word "evil". I think the evil done by some doctors is more than just an ideological difference. It is the unwillingness to engage with the actual harm that is being done to some patients. In the same sense, it would be "evil" for a general to bomb a city without considering the lives that would lost. Perhaps they would do it anyway out of necessity. But if they deluded themselves, saying "nobody died, the media is lying" then it would be evil.
Many doctors who perform gender transition surgery seem to have the same attitude as that general. They don't want to consider the awful truth that some of their patients are harmed in horrible ways.
To me, this is evil.
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I wish I could give you a cogent answer to that. Moral philosophy has always been a tough nut for me to crack, and whenever someone brings it up I usually head for the nearest exit. Still, I don't think it's as simple as "being opposed to my values". Many, many people are opposed to my values, and it's no skin off my nose. Like I indicated by saying "that's been a sticking point for me too", I think it's the deception that does it for me, combined with the raw amount of effort and coordination required to sustain their project.
It's not quite that. I was hinting at a broader point that I should have probably made explicitly. I've been trying to come up with a way to bring this up without running into Godwin's Law, but so far it's the only analogy I have. Give or take a few posters here, we tend to have no issues with calling Nazis evil. The sheer scale of the horror they created is a bit much for most people (which is why even their sympathizers tend to deny or minimize it), no matter their reasons for going through with it, we tend to think they should have stopped and reassessed what they're doing before things got this far. By contrast we don't do that with progressive ideologies, even when they rack up a similar, or greater, body count. "Ho hum, things got out of hand, but their heart was in the right place", and I'm saying their heart being in the right place only makes the ordeal more horrifying.
WPATH is no Lenin or Stalin, they aren't even French revolutionaries, but they did fall into a failure mode common to progressive ideologies, and I'd like that failure mode acknowledged, and remembered next to examples of conservative failure modes, like various forms of chauvinism.
Now, it could be you're just a very consistent moral relativist, and you'd say the same thing, if someone hinted at, say, the people running the Tuskagee experiments being evil. If so, I guess I'd have to approach the argument from a completely different angle, but I'll need to see receipts to believe you are actually this consistent.
I think the thing is that these people do mostly share some distorted version of my values in the way that the Nazis don't. The Nazis tried to exterminate a people that they thought were vermin while invading their neighbors in a war of aggression. While the WPATH people are doing what they're doing out of a mistaken application of empathy and harm reduction. The modal true believing Nazi is a hateful bigot, the modal true believing WPATH person is someone who cares a lot about trying to alleviate suffering even if circumstances tragically end up such that they are causing more suffering. The camps weren't the Nazis trying to turn the jews and undesirables into Germans, they were built for the horrible purpose that they were used for. Trans healthcare is built to help people.
I think we should exterminate vermin, and you probably do too. So Nazis do share a distorted version of our values. Of course, we don't think humans qualify as vermin, and Nazis do think that, but that's what makes it distorted--it's still a version.
This feels like quite a stretch. Maybe it's just the time I've spent among the progressives in my life but I know the type of people who, through blinding empathy, advocate for things like the WPATH guidelines.
There are certainly leftists who resent, hate and advocate for violence against people that I can see as analogous to nazis, as there are rightest for whom the comparison would be taken as high praise. So I don't think I'm just incapable of comparing modern people to nazis.
Rather than thinking of the consequences would you rather live with empathetic but misguided people or slightly more correct, with their own wrongness, people who advocate for and are willing to partake in violence against their out group?
Consequentialism in a moralish society has this quirk where straightforwardly evil people can't get public support and thus can't do much harm and thus rank low on consequential harm measures. While moral empathetic people can get lots of support and thus can cause lots of, inadvertent, harm and thus can score high on harm measures. This is a dynamic to look out for and we should always be critical and careful with those we entrust with great power. But it seems a horrible mistake to conclude that the moral empathetic people are as bad as the straightforwardly evil people on these grounds. It really matters that if we entrusted other groups with the power that the progressives are entrusted with that things would be much worse and they should get some reasonable credit for that. Not absolution, not a free pass, but they're not nazis.
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Yeah, I've been hearing that argument for years, with Nazis vs. Commies. I never quite bought it, but nowadays I'm buying it even less.
Take another example: should Christians take the excesses of the Crusades, the Inquisition, and witch trials as cautionary tales about what can happen with too much religious zeal, or just go "haha, I guess things got out of hand, but at least their heart was in the right place"?.
WPATH people didn't "tragically end up" causing harm, it was an inevetible consequence of their progressive zeal. They were literally warned about it, and they rejected those warnings over and over.
I suppose my entire point is that trying to alleviate suffering too much can be just as bad as being a hateful bigot, and progressives have a really hard time reckoning with that.
Well thats because most people are not hard consequentialists. So doing a bad thing for good reasons and doing a bad thing for bad reasons are seen as different.
If instead of trying to murder Jews, the Nazis were trying to save them from a disease and ended up killing them by mistake, then most people would see those Nazis as morally better than our actual historical Nazis. Even if they were warned it was a risk.
So most people would not see it as being just as bad. They just fundamentally disagree with you there. Someone honestly trying to alleviate suffering is simply better than someone trying to cause suffering, even if in the end they both end up causing it. Motivations are an important part of judging moral behaviour.
And if you think about that makes sense. If i just want to honestly help Jews then there is some set of information that can persuade me I am not helping. If i mean to kill the Jews then that avenue is closed. You would have to persuade me first not to want to harm them, and then persuade me to want to help them and then try and come up with a solution that works. You are many further steps away from a positive outcome for Jewish people (assuming for the moment that is your aim).
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I think, for many people, once you reach a certain threshold of harm to others, it doesn't really matter that much. Especially if you're supposed to be held to a higher standard.
I don't believe that people's beliefs are not within their control. Looking at the response to the Cass Report, it seems there are a lot of people who have chosen to inure themselves against the opposing viewpoint almost before it even dropped (in some cases literally immediately, to the point where they linked to the wrong document).
Professionals and activists are responsible for the ideological castles they build in their head. A person who was willfully ignorant about say...prescribing opiates is not treated kindly by most. Others have recognized and pulled themselves out of these echo chambers.
I can give a random confused mother a pass for picking any particular intervention that the alleged truth-seeking organizations drive towards. Those same organizations must surely be treated differently, or why do they have any authority or prestige?
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