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Monday, January 17, 2022

Gender dysphoria and transition, part 5: What about identity?

When I first planned this series, I expected to write four posts, including the introduction. But since then I thought of one more topic that I should address.

Up till now, I have addressed all these topics from the outside, as a philosophical observer from Elysium or the Moon, without any indication that I know what it feels like to be on the inside of this question, to have it be about you. And so it is fair to ask, What about the very real suffering of people with gender dysphoria? When I sit here on the outside, placidly saying that surgery is dangerous and you can't force anyone to trust you, what do I have to say to the people who find that their fundamental identity is at odds with the physical body they find themselves in? Am I just totally insensitive to such a crisis of identity?

It's a fair question, and my answer may not be satisfying. In fact I have two answers. The first answer tries to speak to our ordinary, lived experience; the second is more abstract and metaphysical. In any event, I will give them both.

The first answer is that people build their identities around all kinds of things, and these identities can be deep and all-embracing. This person knows deep in his* heart, from an early age, that he's going to be a great sports star; that one is going to be a Top Gun fighter pilot; another one over here is going to grow up to cure cancer. It's easy to make fun of these identities if we stand outside them, but they can be intensely real and absolutely fundamental to the people who live them. They deserve to be taken seriously.

And yet, most of the people who grow up knowing that they are destined for athletic greatness won't make it. Most of those who grow up knowing that they are destined to be fighter pilots won't make it. And nobody has yet cured cancer. One by one, each of these people has to confront an identity that has been smashed by the world. Is it a trivial comparison? Am I making light of gender dysphoria by comparing it with disappointed ambitions? Maybe so, but I wonder. If there were any way to measure how much pain is suffered by the one or the other, where should we place our bets? If you look at this gender-dysphoric youth here and that disappointed basketball star there, which one will spend more nights crying himself to sleep? I don't think I can say for sure, and I would feel presumptuous if I tried.

Of course, in the case of a disappointed career there is often the chance for second-best. The disappointed athletic star might still get a career as a sports coach. The disappointed fighter pilot might become a commercial pilot. The one who wants to cure cancer might in any event become an oncologist and do some good in the world that way. And some people mght argue that there is no second-best in the case of a badly-fitting gender identity.

But I think I disagree. That was the whole point of my argument in Part Two, that for all we know there may be a dozen genders. The argument there is that the person who believes his* body to be the wrong sex has in fact mistaken sex for gender. Insofar as he* wishes his body were shaped differently, he will be disappointed; but if the question is how to relate to himself and other people, the answer is to forget about the shape of his body and express himself in the way that fits him best. In the process, he may highlight the existence of a hitherto-unexplored combination of characteristics and habits that come together to form a new gender. And in all this the actual shape of his body is more or less immaterial.

That's my first answer. 

The second answer backs away from the personal point of view, and tries to look at the whole question from the perspective of classical Buddhist teaching.

You see, in Buddhism, your identity doesn't exist at all. Or rather, more exactly, when you dive deep down inside yourself to find the core of what is really You, you come up empty-handed. This is the doctrine of anatta, or "no-self." And all it means is that when you try to strip away the habits you've acquired from your friends, and the prejudices you acquired from your family, and all the other superficial affectations you got from wherever-you-got-them, ... that's all she wrote. There's nothing left that is truly You. To those of us who grew up in the West, in the shadow of René Descartes's ringing proclamation, "I think therefore I am," this sounds crazy. If I don't exist, then who is doing all the thinking that I hear inside my head? But Buddhism teaches that the thoughts can exist without a thinker, as just one more part of the whirl of existence that blows through like a raging tornado and then dissipates.

All this sounds pretty abstract. But look at it in concrete terms. Think about when you were six years old. Who was that person? What were your big concerns back then? Now how about when you were sixteen? Probably your photos show enough resemblance to when you were six that you can say they are pictures of the "same person" with a fair degree of reliability, but what was important to you when you were sixteen? What were you proud of? What were you afraid of? Is there any meaningful sense in which you can say that those two people were "the same" except that they shared a name and a history? Now how about when you were twenty-six? Or forty-six? Again, what's really the same? If you ask me these questions out of the blue, of course at first I'll say that all those are the same person. But when I think about it, ... well gosh, let's see:

  • When I was six, my biggest enthusiasm was playing super-heroes.
  • When I was sixteen, my biggest concern was to do well in high school.
  • When I was twenty-six, I had just left graduate school and was trying to find my way in a new marriage. 
  • When I was forty-six, I was responsible for two children and my marriage was already unravelling.
What did those four people have in common? My name, and my hair color. Not even that, really, because by forty-six I had already started to go grey. But the point is that we didn't have any more than that in common. And the more general point, because this isn't really just about me, is that "identity" is mutable. We talk about identity as if it were a thing, something solid and concrete. But it's not. It can change. And that's why the Buddhists say that in the final analysis, it doesn't exist at all. 

Today it's this. Tomorrow it will be that. And the day after? Who can even see that far ahead?

So yes, many people find themselves strongly committed to an identity that is not borne out in the visible and tangible world. It causes deep pain. It sucks. Really.

But also, it isn't solid. That might sound patronizing and I don't mean it that way. But over time, one identity shifts into another. It's a mystery to me how this happens, but it happens.

For all that anybody knows, it might happen to you too.


* Once again, please remember what I said in a footnote to part 2 in this series, that when necessary "I still use he and his as the unmarked (generic) third-person singular personal pronouns.... [and that when I do] I am emphatically not trying to make a political point."


Friday, January 14, 2022

Gender dysphoria and transition, part 4: What about bathrooms?

Up till now, I've discussed the topics of gender dysphoria and gender transition from the perspective of the isolated individual: how to present yourself, whether to seek medical intervention in transitioning, and so forth. But we all live in society, and in a community governed by laws. So it is unavoidable to ask, How should other people treat or respond to the person who has chosen to transition from one gender to another?

The reason this is even a question at all is that, as a social and political community, we have chosen to make a number of discriminations routinely on the grounds of sex. The issue that always seems to serve as a flashpoint for collective outrage — on both sides of the topic — is the question of who is allowed to use which public bathrooms. For various reasons we have chosen, in nearly all cases, to say that bathroom usage should be segregated by sex; this legal provision causes difficulties for those whose sex does not align in an obvious way with their gender or their personal identification. But there are other kinds of examples. In certain contexts, professionals charged with intimate personal care are chosen so that they are of the same sex (and, implicitly, gender) as the patient. In athletic competitions, men generally do not compete against women because all the world knows that (on average, and ignoring individual exceptions!) men have innately larger and stronger muscles than women and therefore athletic competition between them would be in some ways unfair. There are surely other examples as well: some are cases of legislation (like the usage of public bathrooms) and some are cases of custom or perceived equity (like athletic competitions). But let me ask your permission to summarize all these questions, by synecdoche, under the general heading of "bathroom issues."

Why do we decide these questions on the grounds of sex? In the case of athletic competition, as noted, the fundamental issue is equity: there is a general presumption that it is not fair for men to compete against women. In most of the other cases, the fundamental issue is trust. When people are in very vulnerable circumstances, we as a society have chosen to presume that they are safer around members of their own sex — i.e., that members of their own sex can be trusted more than members of the other. This is an acknowledged pre-judgment, in advance of knowing the facts about any particular case. As a society we have decided that we don't need to know the facts in advance, because we are prepared to make this pre-judgment and encode it in law. "Pre-judgment in advance of knowing the facts" is the definition of the word prejudice, so this is a prejudice that we have chosen to encode as law. That's all.

So how should we think about this situation? If these laws are merely prejudices and nothing more, can they be justified at the bar of philosophical reason? Or should they be scrapped?

I answer that this is not a philosophical question at all. On the one hand, it is certainly true that to legislate the segregation of bathrooms by sex is simply to encode a kind of prejudice in law. On the other hand, coming at it from the other direction, it is nonsense to say that anyone has a moral right to require strangers to trust him under force of law. Remember that the context for most "bathroom issues" (leaving athletics aside for the moment) is that we as a society have chosen to say that in certain contexts people are safer with their own sex. We might have chosen differently, of course. We might have chosen to segregate bathrooms by race or by religion, while nonchalantly intermingling sexes. But we didn't. And when someone complains that he* is "forced" to use this bathroom when he identifies more with the people who use that bathroom, what he is really saying is, "Those people who use that bathroom should trust me to be around them when they are in a vulnerable state, and I want the law to force them to trust me by letting me use their bathroom!"

But what ground does he have to stand on? By what abstract moral principle can anyone ask that the law force others to trust him? When the Supreme Court in this country struck down racial segregation of schools, it was on the grounds that one set of schools were manifestly inferior to the other set. Nobody claims that the public bathrooms for men are manifestly and consistently worse than those for women, or vice versa. So it comes down to trust. And sometimes people award their trust in prejudicial ways. That's normal.

Notice that I say it's "normal," not that it is right. My real point is that all of these distinctions are arbitrary. At my undergraduate college, many of the bathrooms were integrated by sex: this doesn't mean that they only had room for one person (like today's "unisex" bathrooms), but just that nobody enforced the rules about segregation. With a very few exceptions, you could walk into whatever bathroom was closest and not think about it. Maybe you'd find a man in there, maybe a woman, maybe one of each. Or whatever. And in a community where everyone expects that, it's not a problem. 

This is why I say that there is no philosophical issue here to resolve. The only issue has to do with what people expect, and what they accept. That makes it a political issue. We're a democracy, more or less. If you want to see the laws change, organize a campaign for that change and get out the vote. As a pure prognostication, based on my reading of the electorate, I'll wager $50 that you lose. But I wouldn't mind losing the bet.** 


* Remember what I said in a footnote to part 2 in this series, that when necessary "I still use he as the unmarked (generic) third-person singular personal pronoun.... [and that when I do] I am emphatically not trying to make a political point."

** If 100 people read this post, I'm not going to pay each of you $50. If anyone takes me up on this bet and then I subsequently lose, I'll pay off the first claimant and no others.


Thursday, January 13, 2022

Gender dysphoria and transition, part 3: Medical intervention?

In my last post, a couple of days ago, I argued that gender dysphoria is a real phenomenon, in the sense that there are people who are unhappy to have been assigned to a particular sex at birth and wish they were the other sex. To be completely clear, I am not speaking here only — or even primarily — of those who were born intersex, or whose sexual morphology is somehow ambiguous at a biological level. While those who are biologically intersex are naturally involved in this discussion, my focus is on those whose biological sex is unambiguous but who are made unhappy or miserable by it.

The second thing I argued in the earlier post is that gender (including how one presents oneself to others) is a social and cultural category; and is therefore different from sex, which is a biological category. And I added furthermore that while there are mostly two sexes in a biological sense (always excepting the intersex), there could in principle be almost any number of genders in a social or cultural sense. Therefore, if you were raised to present yourself one way, but you now feel profoundly called to present yourself in a different way, I see no logical reason to dissuade you. Regardless which sex you belong to biologically, you might belong to a hitherto-unknown gender culturally; and therefore you should be free to express yourself as such.

The next step, naturally, is that the sufferer says, "Look, I identify only with that sex. Of course it's great that I can dress like them and act like them, but I want my body to correspond with them as well. I want to belong to that sex when I take my clothes off. And modern medicine can do amazing things. So I want medical intervention to change me into a member of that sex."

How should we think about this request? What is the best way to respond to this desire?

I think the only reasonable place to start is with the very same premise on which I built my previous argument, namely, a general confession of human ignorance. There is a lot that we don't know. But in this case it is important to recognize that this ignorance applies even in areas we are proud of. In particular, yes, modern medical techniques represent a huge advance over the techniques common even one or two centuries ago. But for exactly that reason, I am convinced that by the standards of one or two centuries in the future, today's medicine will be seen as all-too-primitive. Doubtless the people then will give us credit for doing the best we could with such limited knowledge as we have today; but I expect us still to learn so much about the body — things that we don't know yet — that it will beggar description.

The medical techniques used to enable gender transition typically involve a combination of surgery and hormone therapy. Each of these is a significant intervention in the body system as a whole. And I think we do not understand all the side-effects of these interventions. Sex reassignment surgery is vastly more complex than, say, appendectomy. It affects systems that interact with every other part of the body. And it is therefore not credible that anyone can have calculated what the all consequences will be.

Therefore, I think it is only prudent to avoid any such surgery or treatment — at least until our knowledge is a lot fuller and our skill is a lot greater than it is today. I assume that in two hundred years, people will look back on our age and say in wonderment, "Can you believe the kind of surgeries they did back in the early twenty-first century? By comparison with what we know today, they might as well have been witch-doctors working with kitchen knives! It's a miracle any of their patients survived."

Less fancifully, every year patients die in surgery. Every year, doctors make mistakes that ruin the lives of their patients — that's why doctors all have to carry malpractice insurance. In the face of these indisputable facts, honestly, it is prudent to avoid any surgery unless there is no alternative. 

As I write this, I am aware that there are some people for whom such a transition brings about a significant improvement in their lives. I have written about one such story (one I heard second-hand) in another venue, describing the patient as "A young man very angry with the world." According to the story as I heard it, he was a lot less angry with the world after becoming a woman. So yes, for some people their lives afterwards are better.

But there is no way to know in advance whether this person in particular will be one of the ones whose lives get better, and there is no way to know in advance what other subsystems of the body might be disrupted by the treatment. Moreover, it's not a two-way street: if the surgery doesn't bring the desired results, one can't go back. This is the line between science fiction and medical reality. We do not live in Beta Colony, and we should not expect to benefit from the miraculous technology that the Betans take for granted.

I said in the beginning of this essay that I would not primarily discuss the intersex, but if I say nothing whatever about them I will be called to account for the omission. But here I would avoid making any general rule, suggesting instead that each case be addressed individually through deep consultation between doctor and patient. If there is no need for serious intervention, I think (as suggested above) that prudence cautions us not to intervene seriously. Naturally if there is a situation that has to be addressed — because the patient simply cannot live with the status quo, for whatever reason — then address it.


Tuesday, January 11, 2022

Gender dysphoria and transition, part 2: How to present?

The first question to address, when considering gender dysphoria, is also the easiest. Is this even a thing in the first place? Does gender dysphoria really exist?

The answer is obviously Yes. Dysphoria means pain or misery or unhappiness. If at least one person on Earth is unhappy about the gender he* was assigned at birth, gender dysphoria exists. That was easy.

But if someone suffers from gender dysphoria, what next? When people feel deeply alienated from the genders they** were assigned at birth, what advice should they be given about how to live their lives and present themselves to the world?

The answer to this second question is a little more involved, and relies on two premises.

The first premise is the modern (non-linguistic) distinction between gender and sex. This evening, Wikipedia defines gender as: 

either of the two sexes (male and female), especially when considered with reference to social and cultural differences rather than biological ones. The term is also used more broadly to denote a range of identities that do not correspond to established ideas of male and female.

In other words, if sex is taken to denote a biological structure — a structure involving genital organs shaped like this and hormonal chemicals balanced like that — then gender (by contrast) involves someone's social and cultural identity: how he acts, and how he is received and treated by others. This distinction will become important in a minute.

The second premise is a general confession of human ignorance. There is a lot that we don't know. And it behooves us to tread cautiously in areas we don't understand. Since we sometimes learn that we were confused even about topics we thought we understood,*** it behooves us to tread cautiously in most areas.

The implications of these two premises become clear when we ask the question, How many genders are there? The unthinking answer is, Two, of course! Umm ... aren't there? 

But let's slow down. We know that the vast majority of humans belong to one of two biological sexes. (A few people are intersex or fail to fit the standard male-or-female categorization in some other way at a biological level.) But gender has to do with cultural and social systems and categories. And we all know that cultural and social systems are far more creative, and show far more diversity, than biological systems. So how can we be sure that there are only two genders? How can we be sure that there aren't three, ... or four, ... or six, ... or twelve, ... or twenty-seven?

We can't.

And therefore there are no reasonable grounds on which to constrain the ways that people choose to present themselves. For all that we know, there are more genders than we are aware of: so perhaps this person belongs to one of those unknown genders, and perhaps members of that (unknown) gender normally dress like this and act like that. Maybe it is normal for people in the gender to which this person actually belongs to present themselves in this way, or in this complex of ways. We just don't know, because we just can't know how many genders there really are. And therefore we have no grounds for telling this person, You're doing it wrong

Therefore the advice to those who feel alienated from the gender to which they were assigned at birth has to be, Act, dress, and present yourself in whatever way seems right to you in your own eyes. We have no grounds to say anything else.     


* Yes, I still use he as the unmarked (generic) third-person singular personal pronoun. I recognize that some readers will find this usage problematic, but I have not yet seen an alternative which is both euphonious and standardized. Often I will reword the sentence so that I can use they with a plural verb, but sometimes I find I have painted myself into a corner. In the cases when I use he, as I once advised in another context, I am emphatically not trying to make a political point.

** Ha! That time I got to use they! See? I do try. 😀

*** There were a lot of people who were certain they understood astronomy because they had studied Ptolemy, and who were certain they understood medicine because they had studied Galen. They were wrong.


Monday, January 10, 2022

Gender dysphoria and transition, part 1: Topics

A week and a half ago, I got a phone call from a guy I'd gone to college with forty years ago, and whom I hadn't really heard from since then. I'll call him Cassius. It was a long phone call, filled with a lot of news on both sides, and I've written about the rest of it elsewhere. But one of the things he told me was that he has come to the realization that he suffers from gender dysphoria, and that he wants to transition to living as a woman. (I don't remember if he said he was simply thinking about transition, or if he has already made plans. Some of his other news makes me suspect he is still at the "thinking about it" stage.)

I have to admit I wasn't expecting that, though when I discussed it with another common friend who knew us both back then she said she wasn't surprised. (That makes one of us.) What I told Cassius at the time, and in a follow-up email afterwards, was that I had not tought a lot about transgender topics, but that of course I supported my friends. This was only partly true, because I have actually spent a certain amount of time mulling the issue over the last few years, just because it seems to be somehow in the air. But until now I have not had any concrete reason to sit down and spell out my thoughts in any detail. Also, I didn't think that phone call was really the time to get into a philosophical exploration of the subject.

The stated purpose of this blog is to see the world through classical eyes, and the classical world certainly understood that gender is not an immutable category. Dionysus was in many ways a gender-bending character: nominally male, but without any of the martial or heroic attributes that the Greeks assigned to masculinity, and followed by women who were intoxicated and deadly. The seer Tiresias was transformed into a woman and spent seven years of his life as one before being transformed back into a man. And Greek mythology also recognized the character of Hermaphroditus, who can be thought of as an ancient Greek futanari.

What part of this requires philosophical thought? I think there are at least four questions to consider:

  1. Is gender dysphoria a real thing?
  2. When people are assigned to one gender but feel deeply that they belong to another, how should they act and present themselves?
  3. What should be the extent or role of medical intervention?
  4. How should these people be treated by our laws, and by society at large?
I plan to address these questions in my next three posts. I will address Questions 1 and 2 together, and then write one post each for Questions 3 and 4.

If there are other questions I have missed, or if you have any other feedback, I welcome comments.


Monday, December 28, 2020

Return to the One (sections 1-2)

I've started reading Brian Hines's Return to the One. Here are a few short notes on his first two sections, "God is the Goal," and "One is Overall."

He starts by making the point that Plotinus is an ascetic, but not because he wanted to be a joyless curmudgeon. He says that Plotinus is an ascetic because he wants to get at what is truly good, and not be distracted by lesser goods which are unsatisfying. That remark sounds a little like my thoughts about asceticism here. Then he says that we all desire the One, that we should therefore channel all our desires towards it, and that when we finally achieve the One (if we ever do) all our desires will cease. 

How does it make any sense to say that we all desire the One? Don't we desire a lot of different things? Food, shelter, love and companionship, money and nice things, admiration and respect, … and on and on? Well yes, of course. But Plotinus says that these are only distractions from the One, or at best they are reflections of it; whereas if we had the One Itself, we wouldn't need all the other things.

At first hearing, this sounds bizarre. It comes from Plato defining the Good as that which we all seek, and that definition comes in turn from saying, "I want food because it is good; I want shelter because it is good; I want companionship because it is good," and so on. But to jump from saying all these things separately to saying that there is one single thing called "the Good" that we can somehow acquire and that will satisfy all our desires at once … that sounds like a joke. It sounds like Plato (or Plotinus) is playing with words to charm us or mystify us or confuse us, and in any event to get us to follow along. Of course Plato and Plotinus would deny that the Good (or the One) is a "thing" that we can "acquire." Also, they are both very smart; so if I can see that the jump from adjective to noun looks like a stretch, odds are that they see it too. Maybe there is more to it than meets the eye. Keep this question in mind as we go on.

Notice by the way that Robert Pirsig does something similar in Zen and the Art of Motorcycle Maintenance when he introduces the term Quality but refuses to define it beyond saying "Quality is what you like." [p. 232] There are some words in there about Quality as an immediate felt experience, but nothing very exact. If the comparison helps, I think it is fair to use it. 

When Plotinus says that all desires will cease he sounds for a minute like a Buddhist (I've remarked before that the Buddha dharma and the Πλατωνικός λόγος sound awfully similar) but his path doesn't sound especially Buddhist. Hines writes that, "Plotinus does not espouse the extinction of desire, but the channeling of desire. Within us is a spiritual engine, longing, that is always running strong.... [But] In truth, that hunger can only be satisfied by the One." [p. 40]

Is the difference real, or only apparent? I'm not sure yet. This is another question to keep in mind as we go, to see if it is answered later. I admit that when I hear that the way to the One involves using all our power of longing and desire but simply channeling it, the first thing I think of is William Blake's remark in The Marriage of Heaven and Hell that "at the end of six thousand years …. the whole creation will be consumed and appear infinite and holy, whereas it now appears finite & corrupt. This will come to pass by an improvement of sensual enjoyment." [plate 14] But I'm probably wrong: at any rate I make no claims here that Blake and Plotinus are saying anything like the same thing. 

So if we all want the One, where do we find it? Plotinus says that the One is everywhere, that it is the source (but not the creator) of all existence, and that the only way to see it is to look back on ourselves in contemplation, screening out all the other distractions that occupy our attention. Here again, the advice sounds quasi-Buddhist: meditate quietly in order to understand the true nature of reality. Right now my working hypothesis is that the methods and experience which Plotinus is teaching may turn out to be very similar to the methods and experience taught by the Buddha, but that the language and conceptual structure in which he describes them are rather different. Let's see if this hypothesis holds up.       

Sunday, December 27, 2020

What's wrong with following your passion?

There is a kind of fashionable advice on careers that says to find work you are passionate about. The argument behind it is that your passion will fuel your hard work, and the hard work will bring success. And usually there is an example given, of this or that person who never finished school or labored under some other handicap, and who nonetheless succeeded because of single-minded dedication fueled by passion. 

This argument is wrong in two ways, not just one. One well-understood flaw is that it is an example of survivorship bias. (See especially this section of the article, as well as this cartoon.) 

But the second error is that it assumes passions are immutable. On the one hand, if you find yourself becoming successful at something you are likely to start feeling passionate about it. But also, if you regularly fail at something you are likely to lose your passion. Think of a young boy who loves role-playing as a superhero. He hears the advice about following your passion, and so he makes it his life's goal to achieve fame and fortune in a career where he can role-play as a superhero. Of course such careers exist — there are actors who star in superhero movies, after all — but they are few and far between. So the numerical odds are stacked way against him, and the overwhelming probability is that he will fail.

What then? Will he be as passionate about playing superheroes at 45 as he was at 10? Probably not. His tastes will likely have changed over time, and his repeated failures to make even a bare living this way will likely have dampened his ardor. But if he then complains to the propagandist who sold him on the "Follow your passion" dogma years ago, how is that fellow going to reply? "Don't complain to me, Sonny. Just look at yourself: you're no longer passionate about superhero role-playing, and so of course your flabby commitment is dragging down your performance. Of course you failed. It's your own fault for losing that passion you had when you were younger, because if you had only kept the flame alive you would surely have succeeded one day."

In other words, "follow your passion to achieve success" really means "your failure is your own fault." 

But sometimes it ain't.

See also a similar point made by Scott Galloway on Twitter, here

This clip is excerpted from a much longer speech which you can find here: