A Single Wrong Idea

 

Watching the Netflix Australian melodrama/saga "A Place to Call Home,"  Mad Dog has been swept along by the characters in a way he hasn't felt since "Downton Abbey" but the experience is the flip side of the Downton coin: In Downton the Earl of Grantham is constantly pulled back toward doing the kind and just thing rather than what the requirements and expectations of class and orthodoxy demand. 

In Call Home, we see no such concession to the humane, as the members of this particular upper crust family are slowly eaten alive by the strictures and misapprehensions imposed by class and virulent disdain for the underclass and the reviled minorities.

The central plot follows Bridget Sarah Adams, a woman born to a Catholic mother devout unto Hellfire and her gradual entanglement with the Bligh family at their estate suitably named Ash Park, and it is a place deep in the ashes of a world of the walking dead, cremated but unaware of it.

Of all the conflicts explored, the most raw and explosive is the homosexuality of the much beloved son, James, on whom the continuance of the dynasty depends. This is 1955, and the idea shared by virtually all the males of that era is that homosexuality is:

1. Disgusting

2. A perversion 

3. A disease in need of cure.

The women are, on the whole, much more open to the idea that male homosexuals should be accepted for their "nature," but various among them are appalled, scandalized, until at some point James' wife realizes there is more to the man than his sexual predilection and she embraces the soul of her husband rather than rejecting the problem his sexuality presents.

But this is not a blog post about "A Place  To Call Home." It's about the idea that  "single wrong idea" can drive the  prolonged, excruciating, wrong headed effort  to "cure" James of his homosexuality.

As has been said before by homosexuals: "Who would want to be born this way?" James emphatically wants to be attracted not to men but to women. He agrees, initially to undergo any treatment which can change him. 

The doctors who are very sure of the correctness of their approach, using first electroshock/convulsive (ECT) therapy and then proposing frontal lobotomy. The physician in charge makes Nurse Ratched of "One Flew Over the Cukoo's Nest" look like Mary Poppins. 

James' father reacts viscerally to the revelation his son is a homosexual. He has only recently learned James tried to commit suicide and now he knows why, and the father says, "Perhaps it would have bene better for everyone if you had succeeded." But father is brought to his senses by Sarah and James' wife, Livvy. 

Father has signed James into the clinic and only father can liberate James from it, but he does not know exactly what goes on in the efforts to exorcise James' demons, although Sarah is able to identify some clues: the bruises from the restraints on wrists and legs, the burn marks on the temples from the ECT.  

As viewers, we are spared no details as James is "treated' and suffers under the "care" of the doctor and the staff. This is some of the most excruciating TV ever screened.

Watching all this unfold in 2021, now that most people accept the notion homosexuality is not a "disease" which demands "therapy" we cringe, and we are outraged at the doctors who are so officious, so sure, so wrong.

But I saw something more, something I know others do not see. I saw this as a representation of what we are seeing in 2021 in another sort of clinic, where a single wrong idea drives suffering and despair: The Transgender Clinic.

The "single wrong idea" hypothesis about gender dysphoria is that this is a condition in which the basic nature of the problem is very much like that of the homosexual, an inexplicable root nature which causes some people to feel they were assigned the wrong gender by their parents, their doctors, their society. "I'm a girl trapped in the body of a boy." 

The argument is made that like homosexuality, "gender dysphoria" is simply a matter of "nature" and like homosexuality, this unalterable fact should be accepted, embraced and nurtured, and of course, something everyone would agree with: the person suffering should not be made to suffer more, but should be helped in whatever way we can. 

The "single wrong idea" concept was actually first explored not about gender dysphoria or homosexuality but about another type of person altogether:  It is the operative mode for the treatment of anorexia nervosa. Few would argue that the 18 year old woman, who is five feet six inches tall and weighs 85 pounds, and looks at herself standing naked before the mirror and says, "I am so fat!" perceives her situation correctly. She suffers from what the psychiatrist Paul McHugh calls, a "wrong idea" which dominates her life and frequently leads to death.

McHugh notes that few people would argue with the doctor who tells the anorexia nervosa patient she has a wrong idea about what is wrong with her. 

Paul McHugh, MD

McHugh arrived at Johns Hopkins Hospital years ago to chair the department of Psychiatry and was asked to coordinate the psychiatric services for the Hopkins Transgender Medicine Clinic and he discovered that roughly 40% of its patients committed suicide within three years of being enrolled in the clinic. He promptly put a hold on the Department of Psychiatry's participation until he could explore just what was happening in the Transgender Clinic. The more he investigated, the more disturbed he became.

Patients at Hopkins who believe themselves to be female but  born male underwent surgery to remove the penis, testicles and to construct a cavity which could function as a workable vagina by the Department of Urology. General surgery augmented breast size. Endocrinology provided estrogen and progesterone hormones. Psychiatry spoke with the patients and learned about their reactions to what had been done and to support their "transition."

McHugh became the focus of intense fury for questioning the program and ultimately opposing it. He was accused of homophobia, transgender-o-phobia, a hate monger and of being an agent of the Pope determined to undermine liberating therapy.

Medical students at Hopkins shunned him, refused to speak to him. The internet went wild making him a pariah, as if he wished to harm the patients who sought care at the Transgender Clinic. 

McHugh bore all this recrimination with a sigh, and responded that he was pretty sure, in the end, as time passed he was the one who would be sleeping well at night, not his critics and certainly not the doctors who ran these clinics.

In "A Place to Call Home" he would have been helping James limp out of the sexual deviance treatment clinic, a place ruled by a wrong idea.

Mad Dog sees that people who believe they have a transgender problem are different from homosexuals in one crucial way: Homosexuals do not need therapy to achieve a life of happiness--all they need is to be left alone, not tormented by others. But the transgender patient cannot achieve his/her goal alone; he/she needs hormones, sometimes surgery, in short he/she needs the cooperation of a physician and is, therefore, a patient.

And the "single wrong idea" concept is inverted in the case of the transgender clinic and the conversion therapy clinic for homosexuals: In the case of the conversion clinic the medical authorities were trying to destroy something in the patient; in the case of the transgender clinic, the medical authorities are trying to "affirm" the patient is correct. But each clinic got it wrong. And each clinic committed substantial harm to those who sought help there. 

Mad Dog knows he does not understand what drives the problem in transgender patients. He does not know if it is a single cause or a final common pathway coming from many directions. He does know there are certain well studied cases of patients who have certain biochemical abnormalities which makes them unable to make adequate levels of male hormone while in utero, during "the first puberty" and these folks wind up playing with toy guns and chasing boys around the playground as "tomboys" who never really felt like girls. And there are the 5 alpha reductase deficient people who "grow a penis" at puberty. So there are some known biochemical reasons for gender confusion.  But patients at Transgender Clinics can be screened for all that. And the vast majority have no identifiable biochemical abnormality.

At the most recent conference Mad Dog attended on Transgender Medicine the head of one of the largest clinics was asked about his clinic's suicide rate. "About 40%," he said, with a shrug, "Pretty much what every other clinic sees."

"My God!" thought Mad Dog. What other form of therapy would be allowed to go forward with a number like that?  If clinics for coronary artery bypass surgery or gastric bypass surgery had a 40% mortality rate, would they be allowed to continue?

Mad Dog has no answers. He only knows McHugh is not wrong. He sees this is a topic which even at an Endocrine Society meeting, that ultimate shrine of dispassionate analysis, academia all rational discussion is blown out of the water and emotions from the transgender clinic doctors, nurses, patient advocates stamp out all other questions and discussion. We have, pretty much, what you see in the clinic to treat the "depravity and perversion" in "A Place Called Home."

McHugh would say the person suffering from the feeling he/she has been assigned the wrong gender is suffering from a single wrong idea, just as a patient with anorexia nervosa is.  Thus, he would resist the request to cut off penises, to institute hormone therapy.  Is he correct? Mad Dog does not know. 

But one thing Mad Dog does know is that Clinics can be shops of horror. 

Transgender Politics and the End of the Republic

If ever Jim Jordan, the Freedom Caucus, Rush Limbaugh and the folks at Breitbart could conspire to dream up the perfect spider wasp to insinuate itself into the internal organs of the Democratic Party and left wingers everywhere, then transgender nation provides it.

There are certain cases which, once swallowed by a defender of the faith, can cause an internal meltdown: One classic case of a poison pill is the Mad Cow paradigm for libertarians. 

  Ask a true libertarian, who sees no justifiable role for government, who wants to shrink the government down so small you can drown it in a bath tub, about the proper role of government in the case of a farmer who has a herd suffering from Mad Cow Disease and he dissolves before your eyes:

Leftie: So you say we do not need a Department of Agriculture, a Food and Drug Administration or a Center for Disease Control?

Libertarian: Absolutely!

Leftie: So when farmer Brown wants to sell his herd of cattle suffering from Mad Cow Disease to meat packing plants making hamburgers,  you would say the government has no business depriving him of his property and livelihood through the heavy hand of government?

Libertarian: Well, the market can regulate that.

Leftie: Mad Cow Disease is a prion disease, and if you cook the infected meat you do not destroy it. It enters your body and ensconces itself in your brain and spinal cord, silently, but 10-20 years later, you die as a writhing mass of drooling demented protoplasm.  No market force can remedy that because it all happens long after dollars have changed hands and statutes of limitations expired.

Receptor disorder: XY chromosomes

Now you are faced with one flayed open Libertarian.

Something like that happens when a right winger confronts the Leftie on transgender medicine, but this time it's the Leftie who melts down, because his own fundamental, absolutist principles tether him to positions which rapidly become absurd.

The Leftie is committed to certain principles, just as fervently as the Libertarian was committed to his principles:

1. Demeaning and disparaging people because of their sexual preferences of sense of self is cruel and wrong.

2. Tolerance of a wide variety of belief and self actualization is paramount to a free society.

3. History has shown how damaging and unfair the treatment of homosexuals was throughout the 20th century, with efforts made to "deprogram" homosexuals.

We accept these truths to be self evident.

But what do you do with the person who wants to say Susan is going to town and winds up saying, "Susan says they are going to town." ?

We have a crisis of the pronoun, you see, because Susan is gender fluid, does not consider herself either a she or a he, but something in between. 

And her best friend, Pat,  is a person who though born a boy, has discovered he is actually not a he, but a she in a male body and so is now taking high doses of estrogen and considering having his penis and testicles removed surgically. 

Pat's is living with Suzanne, who is a lesbian. They are lovers. They want to have a baby but there are problems.  The insurance company refuses to pay for in vitro fertilization at $10,000 a pop a cost which the insurance company will pass on to the American public.

So what to do? 

When this case was presented to the psychiatrist, Paul McHugh, he asked: Well, what kind of sex are Pat and Suzanne having? If Pat's penis goes into Suzanne's vagina, is she really a lesbian and is he really now a she? If this is not happening, what is? When they make love, does Pat get an erection? Does he ejaculate?  If so, why is in vitro necessary?

Paul McHugh, MD

Paul McHugh is a psychiatrist, who left Cornell to head the Johns Hopkins department, but when he arrived he was asked to help with the Hopkins Transgender Medicine Clinic, which included Urology, Endocrinology, Surgery and Psychiatry. McHugh did his homework and was shocked to see the suicide rate among patients in the clinic approached 40%. (This turns out to be not an anomaly, as even today most Transgender Clinics report similar numbers.)

This disturbing suicide rate among patients was then and continues to be written off by the directors of these clinics as being attributable not to any failure of the clinics but to the severe antipathy faced by these patients as they are berated and hated by American society at large.

But McHugh asked a different question: What if these patients are committing suicide because of a failure of the clinic to meet their needs, or worse, because of the therapies the clinic offered?

Until he had the answers to these questions, he withdrew Psychiatry from the Clinic, which caused an explosion of recrimination both within Hopkins--medical students and professors alike refused to talk to him--but when word got out, a host of attacks launched on social media. McHugh was imposing his 20th century Catholic beliefs on needy transgender patients, denying they had a disease, and he was as bad as those doctors who wanted to force homosexuals into "deprogramming" clinics in the 20th century. 

Semenya: Androgen receptor dysfunction

Of course, McHugh was saying nothing of the kind.  Homosexuals did not seek therapy from clinics or doctors. They did not need hormonal therapy to achieve their goals of leading a happy, normal life. They did not have 40% suicide rates, even though they faced horrific discrimination, had been excluded from church, jobs, social clubs.

"Gender dysphoria"  is a different thing altogether, McHugh postulated. If gender dysphoria can be defined as a sense by an individual that the role he or she had been assigned, and in fact the anatomy he or she possesses is different from what they feel inside and in fact is simply wrong.

McHugh wondered whether the real model for transgenders who want to go from male to female or from female to male is in fact not homosexuality at all, but anorexia nervosa.

The patient with anorexia nervosa, typically a young female, who is five feet seven inches tall and weighs 90 pounds, looks in a mirror at her body and says, "I am SO fat!"

That, McHugh calls "a wrong idea." And that wrong idea takes control of the patient's life and ultimately ruins or ends it. Few people would argue the patient should be accommodated, should be helped to lose weight and to maintain such a low weight or be assisted in continuing to driving it downward. 

But when a 13 year old girl tells her parents or the doctors at the transgender clinic she feels like a boy trapped in a girl's body, that cannot be a wrong idea and anyone suggesting otherwise is like those old doctors who tried to convince homosexuals they had to be deprogrammed and changed to conform to society's demands.

5 A reductase: Girls at birth, boys at 12

Complicating all this is the well studied arena of disorders of sexual differentiation, which by the mid 1970's had been explored biochemically and genetically and which continues to be studied today.

What has happened, of course, is doctors who never understood the disorders of sexual differentiation science have conflated these disorders with "gender dysphoria" as if the gender dysphoric patient is simply another variety of patients afflicted with a disorder of sexual differentiation.

But there is a substantial difference: In the case of biochemical disorders of sexual differentiation, the hormonal and neurological mechanisms have been discovered and defined and can sometimes be treated, but none of that has been possible (yet) for gender dysphoria. What makes it even more complicated is that way back in the 1970's some patients with some types of biochemically induced disorders of sexual differentiation did complain of the same phenomenon: Some said they never felt like a girl, even though they had been identified as a girl at birth, and raised as a girl. They were, in fact, in many important ways, boys in girls' bodies, just as the gender dysphoric patients say today. And when science finally caught up with these individuals, it was discovered that girl was XY (as opposed to the normal XX female chromosomal complement). There were even some villages in the Dominican Republic, where there was lots of consanguinity (intermarriage) where the children were given gender neutral names--the Spanish equivalent of Pat, Chris or Robin)--because at age 12 some of the village "girls" grew penises and developed into strapping boys. (The five alpha reductase deficiency.) These were boys who really were trapped in girls' bodies and in fact, transformed themselves (transitioned) at puberty.

Penis at 12 patient

But these folks are a far cry from today's Transgender Clinic populations, where the vast majority of patients feeling trapped in a body of the wrong sex, have no identifiable biochemical abnormality, no genetic abnormality; from the point of view of male and female hormone levels, of chromosomes, of genes (the SHY gene) these girls saying they want to be boys or boys saying they want to be girls, by all tests known to man, have no identifiable "reason" to feel this way.

Of course, it is possible we simply are not smart enough yet, do not have the biochemical tests yet to understand why they feel that way. But until we do, these people are said to have a "psychiatric" disorder. Or, no, we cannot say "disorder." These people should not be called "abnormal," be "accused" of having a disease. We should be more open minded (a liberal absolute), more accepting of differences, and by all means, Heaven forbid, we should not be judgmental!

In some of those 1970's patients who were raised as girls but feeling like boys, until their underlying biochemical problem was identified, the question was raised: How did this boy know? He never wanted to play with dolls or do girlie things. He always chased around playing war with the boys, although his testosterone levels were normal female. What happened? The tentative explanation was that during the "first puberty" which happens during fetal life, a time when male hormone in the male fetus surges, just enough male hormone was made in these boys who were identified as girls, to condition parts of the brain where male and female behavior are programmed. This is different, apparently, from parts of the brain where sexual preference is programmed. But all of this remains an unproven hypothesis.

At Mad Dog's last trek through the international Endocrine Society meetings he went to two sessions which alarmed him greatly, as a sequence.

#1 Abuse of Anabolic Hormones:  This was a session given by a professor from the University of Michigan, who we will call Dr. Apologist. He present the case of a patient who is very familiar to any practicing endocrinologist. 

This patient is a twenty something man referred for "hypo T." That is, low blood testosterone levels. He arrives at the office, often in form covering clothes but in the exam room, with his shirt off, you see two things: Massive musculature with trapezius, pectoralis, bicep and deltoids which would put Arnold Schwartzeneger to shame. There is also a hint of excess breast tissue ("man boobs".) Looking at his biochemical testing: the tell tale biochemical profile of someone who have been injecting industrial doses of testosterone for months to years but then stopped about 6 weeks before having his bloods drawn.  The patient is clearly getting testosterone from some source, likely among his gym rat friends but now he wants a more reliable, less expensive source from the doctor. 

Endocrinologists from the Netherlands in the audience noted that this is such a common group of patients they have actually established "Androgen Abuse Clinics" there, where patients are treated as if they have any other sort of drug addiction problem, sign contracts to gradually taper off in a classic "detox" mode. These patients look in the mirror at their Incredible Hulk bodies and see a 98 pound weakling.

#2 Transgender Medicine: From that session, Mad Dog walked into the session with a panel of the heads of Transgender Medicine Clinics at university hospitals from Boston to New York to San Francisco.

A case of a female to male transgender was presented. This patient had been given doses of testosterone to help grow lip hair and also to suppress menstruation, which continued despite the male hormones and served as a reminder to the patient of her own persistent internal organs. The doses are what knocked the socks off Mad Dog.

A normal dose of testosterone is 200 mg every two weeks. This patient was getting 300 mg three times a week, thats 3600 mg a month compared to 400 mg--nine times the recommended, "safe" dose. None of those "androgen abuse" patients had anything on that transgender clinic patient. 

Mad Dog texted Dr. Apologist from the prior session to ask how this could be sanctioned by the Endocrine Society and Dr. Apologist texted back that this was not androgen abuse because it was "gender affirming" therapy.

Notice, when the man uses 1/9 of that dose to maintain his bulk, he is treated as a substance abuser, a man very like the patient with anorexia nervosa, who has the wrong idea about his body, but if the Transgender Clinic doctor prescribes that dose, he is "gender affirming."

Which brings us back to why Transgender Clinics will spell the end of the Republic.

Once Jim Jordan gets ahold of this craziness, those who want to embrace Gay, Queer, Transgender rights will cling to their desire to be warm and accommodating, to not make people who suffer gender dysphoria suffer any more than they already do, and they will cling to that main mast as the ship of state sinks beneath the waves.

The very conflation of LGBT/Q is a harbinger of demise for liberal politicians.

Saying that Lesbian & gay & bisexual folks deserve to be treated as anyone else should be emphatically embraced by liberal politicians. This is about "sexual preference." These folks need no clinics and request no change in the English language surrounding pronouns.

Not sure, exactly the difference between "queer" and L and G is, but not a major thing.

It's grouping "T" --transgenders--with that group which spells doom. It's like adding an "A" for anorexia nervosa folks into that. Yes, of course, patients, people with a "problem" should be treated with respect and sympathy and empathy, but let's not confuse folks with distinctions the average American has no patience for. Educate the public, fine. But let's not sink the Democratic battleship with that torpedo.

The more middle America who know nothing about the biology of sexual differentiation, the difference between genetic sex and gender identity, the difference between being homosexual and wanting to change your sex, the more middle America is confronted with locker rooms, bathrooms, being told they are obtuse because they cannot wrap their heads around calling a person who looks like a girl "they" and stumbling over pronouns, the sooner those politicians who look weak and incapable of standing up to all this craziness will be shown the door. And those politicians are AOC, who is otherwise laudable, but fatally flawed on this issue and then more moderate Democrats and we'll have another four years of Donald Trump or someone like him.