The psyche speaks in metaphors
Kathleen Stock points out a drastic conflict at the Tavistock GIDS between storytelling and actual real world drugs and surgeries.
A crucial yet underappreciated part of the story is the clinic’s strong emphasis on psychoanalysis and psychodynamic approaches to mental health. The founder of the Tavistock, Hugh Crichton-Miller, was explicitly influenced by Freud and Jung. And when Domenico Di Ceglie founded the Gender Identity Service for children in 1989, later commissioned nationally as the only English NHS provider, he too was heavily influenced by psychoanalytic methods.
And the thing about those is, they’re much closer to the storytelling end of the spectrum than they are to the medical end.
In a 2018 article describing his process, Di Ceglie quotes a Jungian perspective approvingly: “the psyche speaks in metaphors, in analogies, in images, that’s its primary language, so why talk differently? We must write in a way that evokes the poetic basis of mind… it’s a sensitivity to language.”
Lalala, it’s all so profound, know what I mean?
This intellectual focus upon the fluidity and construction of meaning, and upon the power of narrative to create more stable personalities, is also heavily present in the published work of Bernadette Wren, Head of Psychology for 25 years at what insiders tweely call the “Tavi”. By her own description, she was “deeply involved” with the GIDS team for much of that time. Alongside psychoanalysis, she adds post-structuralist philosophy to her formative influences, citing figures such as Richard Rorty and Michel Foucault as important in her thinking.
All very well if you’re a lit crit, not so hot if you’re an actual doctor handing out meds.
True to the relativism of these philosophers, in Wren’s intellectual vision there are no objective truths but only a series of subjective narratives. She writes: “If the idea of living in the postmodern era means anything, it is that in all our activity together we are in the business of making meaning.” She continues: “In our time, it is hard to see any knowledge or understanding as ‘mirroring’ nature, or ‘mirroring’ reality.”
Awesome, man. Now about those blockers.
Against this intellectual background, the Tavistock’s flannel about being a thoughtful service sheltering from the storm of our present culture wars starts to make more sense. At least historically, senior clinicians at the Tavistock have never believed there is anything but certain context-bound forms of thought, floating about in a post-modern void. They have assumed meaning is constructed, not found. They have denied that there is any certain or timeless knowledge, but only specific cultural dynamics to navigate in the here and now. Under such an approach, what else could you do but be “thoughtful”?
And creative, and poetic, and fluid.
A recognition of ambiguity within the life of the psyche would be perfectly fine — indeed, I assume, therapeutically helpful — if all that had ever happened at GIDS was that people sat around talking to one other. But the general relativist stance of senior clinicians was made incredibly dangerous for patients by the presence of an additional factor in the therapeutic mix, nestling somewhat anomalously among Di Ceglie’s stated foundational aims for his service. Alongside commonplace psychodynamic goals such as “to ameliorate associated behavioural, emotional and relationship difficulties”, “to allow mourning processes to occur”, “to enable symbol formation and symbolic thinking” and “to sustain hope”, we also find: “to encourage exploration of the mind-body relationship by promoting close collaboration among professionals in different specialities, including paediatric endocrinology.”
Thud. Lalala, look at the pretty birdies, lalala here comes Fotherington-Tomas, lalala hello sun hello sky hello grass hello…paediatric endocrinology?
I don’t know about you, but when I read this, the birds — or rather the mermaids, perhaps — stop singing.
Same. There’s exploration, and then there’s medication and surgery.
For it’s at this point that it becomes clear to the percipient reader that these people think it a reasonable goal to alter a child’s healthy bodily tissue in order to accommodate a mind which is, by their own admission, constantly developing. It’s true they don’t think medicalisation is inevitable for every particular child, and it’s also true that they admit lots of uncertainty and liminality. But still, this option is on the table at GIDS, courtesy of friendly endocrinologist colleagues and their injections.
If they admit lots of uncertainty and liminality, why aren’t they more cautious? A lot more cautious?
Worse, with the availability of a medicalised option, there seems to have been little real recognition among managers that its presence put the remit of the service on an entirely new footing — one that absolutely required stringent standards of truth and falsity, and a thoroughly old-fashioned belief in the existence of prior standards of right and wrong. Talking to children about their identity issues and co-creating meaning with them may be an art, but giving them gonadotropin-releasing hormone analogues (GnRHa) is still very much a science — or at least it should be.
It’s so obvious when she spells it out, isn’t it. I’d love to know why it wasn’t obvious to the people at GIDS.
During GIDS’s experiment in administering these unlicensed drugs, doubts were already emerging about the poor quality of the evidence base, and about the potentially negative effects of GnRHa on brain maturation, bone density, kidneys, height, sexual function, and mature genitalia formation.
Trivial stuff like that.
Yet the Patient Information Sheet offered to patients and their parents by clinicians minimised the then-suspected risks. And though the process was widely advertised as a harmless “pause” on puberty, of the initial 44 children in their initial cohort for the treatment, almost all went on to cross-sex hormones, raising the question of what made this treatment a meaningful pause for reflection in any real sense.
Storytelling gone desperately wrong.
I have read where using post-structuralist “question everything” thinking allowed humanities and social studies scholars to achieve insights that they probably wouldn’t have had. But so often, it also seemed that they also confused themselves, and/or went on to believe even more strongly in what they’d always believed.
Then there’s the Sokal parody and other instances where the post-structuralists clearly didn’t understand what it was they were critiquing.
How can you believe that our “genders” (whatever they are, if they even exist) are merely contingent stories, while at the same time believing that a child’s notion of their “gender” is a fixed, real thing that supersedes the evident gender/sex of the body??? Why not just tell a story about how the gender can be realigned with the sex through talking about it?
I should dig for my old paperback copy of “The Teachings of Don Juan: A Yaqui Way of Knowledge” to recall how Carlos Castaneda used storytelling to create an alternative reality. Dude sold a lot of books. At least he didn’t start a clinic where patients did jimson weed.
And even now, very few have woken up to how appalling a medical scandal all of this is. I don’t know how much more ramming of facts down people’s throats it will take, it’s not as though we haven’t been doing that all along.
Expectedly, quite a lot of trans activist types are claiming that the closure of the Tavistock is what they wanted all along, that it was their idea and that we awful TERFs had nothing to do with it. There’s rarely much subtlety at play when one side claims a win from a loss (remember JoMo claiming victory over Matt Hancock?) and this is no different. But in this case, there’s an extra dimension; they’re flat out lying that the reason it’s being closed is that access for ‘trans children’ is poor and waiting times are long. They hand-wave away the fact that the main reason it’s closing is the danger it poses to children due to malpractice and shockingly poor administration.
I think they’re pretending they wanted and campaigned for the closure so they could try to control the narrative and conceal the harm being done to children. All to support an ideology which would be better served in the long term by righteous fury at the Tavi’s practices and pacifying lip-service to evidence-based medicine.
Be kind.
Me:
I’m very much in favour of techniques for provoking new insights, but eventually those insights have to be examined critically, don’t they? Otherwise it’s difficult to see what earthly use they could be to anyone.
Remind me never to enter any building or vehicle designed by postmodern engineers.
Indeed, that was the framing in that execrable NYT article.
A friend had shared an article about the warning recently issued by the FDA, so I pointed him at the very good article from Gender Clinic News on the Tavistock closure. This friend is a medical professional, but is among the distressingly large number of medical professionals who have bought into gender woo and think it’s the scientifically accurate side. In this person’s case, though, I think maybe there may be an opportunity to promote sense. We’ll see.
Richard Dawkins had it right:
Even the talking part can be problematic, if they are simply accepting that the child knows him/herself enough to state what what sex/gender they really are. Even talk therapy needs to be guided by reality, or things fall into disarray. When I was undergoing talk therapy, my doctor did not “affirm” everything I believed about myself, such as that I was pond scum, or that I was fat and needed to quit eating, or that I didn’t deserve to live on the earth. If he had, FSM knows what would have happened to me. I might have made some decisions even more awful than those I was already making, decisions that could not be reversed and restored.
Talk therapy is dangerous in the hands of people who accept the concept of “gender validation” as the important factor of what they do, even if it doesn’t lead to puberty blockers or the removal of healthy organs (I refuse to use ‘top surgery’ or ‘bottom surgery’; not only do those terms obfuscate, they sound like baby talk).
Baby talk, eh? I think you’re right.
How long until all right-thinking parents buy their kids gender affirmation dollies? Sally turns to Sam when you yeet her teets.
@7 I think it’s important to acknowledge the difference between science and engineering, two distinct and different human endeavours which historically didn’t start to converge until a) the discovery of aniline dyes or b) the exploitation of the electromagnetic spectrum, both of which happened around the same time so I’m happy to be agnostic about which ’caused’ the two fields to merge.
Science is a way for us to know things; engineering is a way for us to do things. Science is its own justification, while engineering is instrumental, directed toward objectives that people want to achieve (in our culture, what will make a profit for someone). It would be difficult, I think, for any sane person to argue that we should know less, whereas there are lots of things we could do but maybe it would be better if we didn’t. There are people who completely support both science and engineering, and people who completely oppose both science and engineering (primitivists etc.); there are also people who support science but not necessarily engineering, and people (I’ve heard them referred to as ‘creationists with guns’) who support engineering but not science.
For a while one of the hot topics in Skeptic Movement circles was debunking the highly-overrated Sigmund Freud, who, as Fredrick Crewes detailed in several articles and books was possibly the worst pseudoscientist of the modern era. Among other sins, his psychoanalytic theories were completely unfalsifiable. All observations fit. All conceivable observations would fit. His reputation as a serious intellect thinker was undeserved — and his legacy had a negative impact on real people. It was supposed to be mental health “medicine.” That the Tavistock was influenced by him isn’t surprising.
At various science-based freethinking blogs I used to ask what would falsify Gender Identity theory (that we’re all born with an internal gender which may or may not match our sex; that this defined man & women, etc.) I heard all sorts of reasons why that little problem didn’t apply to this bit of confirmed science — including inflated comparisons to the Theory of Evolution— and I encountered lots of deflections— particularly tu quoque well-what would-falsify-YOUR-view and why are you asking? But the lack of ability to answer the question itself didn’t seem to set off any red flags.
With the assumption that the mind takes priority.
So failing to challenge patient’s beliefs about themselves isn’t actually “kind” in the long run? Who knew!?
Looks like there’s a typo there. Lemme fix it.
“… he was too heavily influenced by psychoanalytic methods.”
There. Much better.
-_-
Is that an objective truth? No? Then go away.
So you don’t have any knowledge or understanding that mirrors the reality of what’s going on with your patients. So … um … How can you possibly help? In what sense are you an expert when you deny the very concept of expertise?
They view the chaos of the wilderness as liberation. Liminal space is the opportunity to shape narrative, and thus meaning, and thus reality, for in their view reality supervenes on mind rather than the other way ’round. They are hardcore Social Constructivists, and even more, as Jane Clare Jones has observed, they are Idealists. It is in the primordial deep that by clapping and believing in fairies, they make fairies real. Uncertainty is the raw material of creation.
Sastra @ 11 – truth. Fred Crews was an early fan of B&W and remains one. The trans mythology has a LOT in common with the Freudian one.
Me @ 1 – about those insights – I hear (or read) the word and my eyes go all beady.
In my militant atheist and skeptic days, the postmodernists always seemed to side with the true believers, and many of the true believers appealed frequently to postmodern philosophy. At first glance this might seem surprising, but on further reflection it makes perfect sense.
On the face of it, a philosophy that denies the very existence of objective reality, or, if there is such a thing, that we can know anything about it (even in the tentative scientific sense) doesn’t seem like a very promising starting point for supporting any belief system: If nothing is true, then neither is my favorite piece of woo; If nobody really knows anything, then neither do I.
On the other hand it’s pretty much the perfect philosophy for leveling the playing field: If it’s impossible to make a convincing case that my woo beliefs are objectively true, the second best option seems to be to deny that there are any objective truths, so at least I can tell myself that they are neither more nor less “true” or “justified” than anything else. 0=0.
And I’m hardly the first to point out the double standard: This alleged hyper-skepticism about truth claims tends to be very selective* and only go one way. Nor does it prevent them from making sweeping truth claims on their own (TWAW! TMAM! NBIAV! etc.). It’s basically just another immunizing strategy. The lack of infinite certainty mean you can never be proven right whereas I can never be proven wrong.
*Very much like conspiracy theories in this respect.
Many have commented on the link between postmodernism and the “post-truth” phenomenon. Putin’s Russia (where the post-truth era is often said to have arrived first) has been described as a “postmodern dictatorship” etc. I remember Alan Sokal once making the point that Putin, Trump, Duterte etc. almost certainly didn’t arrive at post-truthism by literally copying the postmodernists, but that the progressive Left’s infatuation with postmodernism deprived them of the tools, as well as the language, to effectively challenge or oppose the post-truth rhetoric of the far Right. As Timothy Snyder put it in “On Tyranny”:
And if the biggest wallet belongs to the far right…
Also, while the likes of Trump may not have developed their methods by copying the far Left, it doesn’t mean there isn’t plenty of copying going on in the other direction. As much as the woke crowd hate Trump, they seem to absolutely love what he has done to factual discourse because it gives them an excuse to forget all about facts and logic and evidence and go with whatever serves their particular ideological agenda.
In 2005 Stephen Colbert coined the word “Truthiness,” which won the coveted “Word of the Year” award. “Truthiness is what you want the facts to be as opposed to what the facts are. What feels like the right answer as opposed to what reality will support.”(Colbert) Or, as Wikipedia puts it “ Truthiness is the belief or assertion that a particular statement is true based on the intuition or perceptions of some individual or individuals, without regard to evidence, logic, intellectual examination, or facts.” It was specifically aimed as a slam against Republicans. Conservatives were, even then, playing fast and loose with the truth.
At the time I’d been having frequent conversations with a group of friends who were all both very politically liberal and very loosely-goosey New Age-y Spiritual. We’d been having a lot of debates during which I was repeatedly told I was a narrow Western thinker blinded to Other Ways of Knowing. So I decided to try an experiment. I carefully read out the Colbert description without the actual word and asked if this was what they were trying to convey. Big smiles. Oh YES.
They weren’t pleased when I gave context.
@Sastra: That’s the old bit of skeptic wisdom, yeah? If you want to know what’s wrong with Judaism, ask a Christian. If you want to know what’s wrong with Christianity, ask a Muslim. If you want to know what’s wrong with Islam, ask a Jew. And so on.
Everyone’s capable of seeing the problems in the outgroup’s beliefs and actions but blind to the faults of the ingroup. It’s a bias that requires constant vigilance, lest we fall into inbred groupthink. Beware those who demand the heretic monkey be exiled or executed.