Immiserate, Medicate, Replicate

In this GenderCraft essay I explore the psychiatric symptom as an emergent societal phenomenon made concrete by the structure of the psycho-medical industry and our collective credulity to it

My loneliness is killing me
Britney Spears, Baby One More Time

One of the tendencies of our current mode of production is the creation of alienation in its subjects. Our relationships with our labor, with one another, and even our relationship with our sense of self and our own bodies are all made threadbare or severed as a function of the continuous pursuit of profit. So what is to be done with this ever expanding and crushing loss of connection? As it happens, in a thoroughly neoliberalized society, the only solution that can be considered is the market. The market’s primary unit of intervention is the individual consumer and the only options it considered are the ones that optimize for profit.

The market product suited for this category of problems seems to rest on a conceptual inversion: a recasting of all negative feelings as a symptom and cause. You aren’t sad because of the forces you experience in your life, you’re depressed because you suffer from Depression. This little trick, the innovation of a noun that collapses a temporal social process into a static individual state, places the political-economy and its influence on our lives outside the scope of analysis. It isolates us from others who share our circumstances and their effects on us and finally naturalizes our suffering as a form of disease plaguing us. This framing is compatible with market logic - people labeled as suffering from this “symptom-as-disease” inversion can now be seen and see themselves as individual consumers seeking solutions in the medical marketplace.

An entire academic and professional nexus exists largely to capitalize on this business model, namely the manufacturing of novel “symptom-as-disease” inversions. With every passing year slightly different manifestations of capitalism’s crushing effects on our mental and emotional states can be discerned as patterns in society; the psycho-medical industry then springs into action to create a new entries in the DSM. The industry’s job is to decontextualize the misery from the complex societal forces that produced it and put them behind the veil of a new noun, a distinct disease descriptor compatible with new or existing market interventions.

To go even further and become more compelling, the market solutions eventually get implicated back into the diagnosis and we can go from “symptom-as-disease” to “absence-of-intervention-as-disease”. It’s not that you suffer from depression, it’s that you suffer from “low levels of serotonin”. Your understanding of your own state of malcontent is thus transformed in your own head in terms of the available market solution - SSRIs.

“Gender dysphoria” and its prescriptive corollary of “Transgender-ness” are examples of these medical conceptual inversions. An emerging or expanding pattern in society is observed (in this case people feeling alienated from their bodies or sexed social norms); it is then medicalized into a symptom: “gender dysphoria”; the next hop is to see these symptoms in terms of the absence of an available medical intervention - a cosmetic protocol of hormones and surgery originally developed for adult males with obsessive thoughts about appearing as women. In this way the complex distresses induced by capitalism’s intrusions are transformed into an innate and unquestioned need for a market intervention - one becomes a transgender person.

In the view of this profitable prescription, the infinite horizon of understanding the causes of individual distress is collapsed to a single point of interpretation. At the same time the aperture of this diagnostic/prescriptive lens widens, inviting greater potential customers in. This is the unavoidable logic of markets driving a product to seek more consumers. In this view, the ever-evolving nature of the conceptual abstraction of a transgender person will largely mirror the sales and marketing drives of the medical industry.

The Diagnostic Black Hole

The gap between sensory experience and subjective interpretation is one of the most interesting spaces for science and philosophy to explore. Most of us don’t realize that this gap even exists - both things (sensation and interpretation) appear to us, in our day to day experiences, as being one and the same. We don’t see an assemblage of features organized in a specific way which we then, by applying a learned social schema, interpret as a house; we just see, in a single moment, a whole concept of “the house”. Only when there are deviations from the use of common social schema do we suspect that we aren’t actually dealing with a single mental apparatus. A little personal times with psychedelics or a conversation with an individual experiencing a psychotic break is an immediate reminder of the existence of this gap and how large it can become. Case studies of non-psychotic people with Xenomelia, the Capgras Delusion, Somatoparaphrenia, etc… are fascinating illustrations of how this gap can manifest in narrow and bizarre ways. (I recommend the book “Phantoms in the Brain” or some of the earlier works of Oliver Sacks if you’re interested in such case studies).

That an individual might experience sensations that might make a specific limb feel distant or alien, as in Xenomelia, has been studied with research suggesting a neurological cause due to gray matter deficiency at the corresponding sensory location of the affected limb. If, and this is just a thought exercise, this same exact type of disassociation presented at the site of genitalia, it would be impossible in the our current social moment to think about it through a neurological frame. Our associations of genitalia with sex differentiation has created a cultural schema which has made people unable to think except in naive folk terms. A mysticism about misplaced gendered essences has created a diagnostic black hole that works agains basic scientific and medical inquiry. An unfalsifiable belief in people being “born in the wrong body” has killed the essential medical process of differential diagnosis.

That a girl might have witnessed a sexual assault at a young age that has unconsciously made the idea of entering adulthood a terrifying and emotionally distressing prospect is something that will immediately be sucked into the vortex of gender identity confusion. Patterns of behavior that suggest a parent might have Munchausen by Proxy and how that could result, in this highly frenzied social media environment around gender identity, in the manipulation of the child’s interpretation of their self image, are made unseeable. That an autistic boy with effeminate tendencies might need more time to develop the cognitive faculties needed to understand the nuances of social classification is afforded no such opportunity. The black hole of Gender-Body dualism absorbs all light - no inquiry beyond its popular acceptance can be seen.

At the British Tavistock Gender clinic that was recently shuttered: 25% spent time in the foster care system; the patients there were 10x more likely to have a parent that is a registered sex offender; 42% had lost a parent through death or separation. More noteworthy are the Tavistock numbers associated with what are referred to as psychological “co-morbidities”: 97% of those referred suffered from emotional troubles associated with at least one distinct non-gender related pattern of distress; 70% of those referred had 5 or more such classification; 35% were on Autism spectrum.

You might assume that all these realities are being taken into account by sober medical institutions committed to the Hippocratic oath. That the surrender to the strange diagnosis of being “born in the wrong body” is only happening after a robust process of differential diagnosis has been exhausted with the mantra of “First Do No Harm” blaring in their minds. You might assume that the term “transgender” represents a meaningful scientific understanding of a process within the human brain which rationalizes the associated interventions. Unfortunately, and quite catastrophically, these assumption would be naive. They stem from a misunderstanding of both the machinery of the modern medical system and the very nature of psychiatry as a discipline.

The Medical Assembly Line

Successful models of industrial production tend to spread. The innovation of the assembly line, that has been so effective in the production of cars and consumer electronics, has found a home in medical services delivery. The modern business of healthcare consists of a constellation of independent specialized practitioners that deliver narrow interventions in a series of stops on a healthcare conveyor belt. Each stop is largely decoupled from the ones preceding it and unconcerned with the ones that come after. The human is thus reconfigured, from the view of the modern healthcare system, into a collection of parts that match the specializations along this assembly line.

The General Practitioner is therefor reduced to a foreman at the entrance of the factory, pointing the person who comes through the door towards the right conveyor belt. For anybody with emotional distress coupled with obsessive thoughts about their body or their place in a sexed society, the script today demands they be redirected to “gender clinics” for evaluation. These highly specialized centers are not looking at or evaluating a complete person - they are interacting with a subsystem within the human. They specialize in a mystical organ that they believe inhabits human beings called Gender Identity. Their task is largely binary, determine whether the emotional distress can plausibly be explained by an incongruence between the sexed body and this ephemeral essence. These practitioners wield specialized dowsing tools in their analysis (such as asking “do you feel like a boy”) and there are no objective diagnostic tools for confirming the divination they arrive at - nor can there ever be for that matter. So in the end the only question facing these for-profit centers in their ‘diagnosis’, one which can never be falsified, is whether they want to gain another billable client or not.

The next stop on the conveyer belt is the endocrinologist, who has no interest or incentive to ask questions. They don’t see a person in front of them, they see a hormonal subsystem - one that an opaque clinical entity upstream on the conveyer belt has already determined needs modification. The fact that previous stop came to their determinations using what amounts to a tarot card reading is outside the scope of the endocrinologist’s concern and, more importantly, their available billing codes and their financial incentives. From there we go to the cosmetic surgeon. Then to post-surgical care. Then a lifetime of pharmaceuticals and various health emergency interventions or cosmetic tuneups. Medical-industrial money printer go brrr.

The key here is that at every stop on the conveyer belt, no medical professional is responsible for the physical or mental well-being of the individual as a whole. The medical professionals deal with body parts or systems (real and fictional). The patient is a consumer, making consumer choices that they are ultimately responsible for. The mantra repeated by some of the ghoulish pediatricians in this industry of “kids know what gender they are” is an embrace of the consumer ethos of “buyer beware”.

By being willfully blind to the structure and incentives of the industry, people can lean into the sentiment of “doctors surely know what they’re doing”. This deference to an amorphous cloud of expertise frees one from the responsibility of basic skepticism. In reality doctors don’t know what they’re doing since they are almost never concerned with an entire person as a whole, just whatever their narrow task is at their station on the assembly line - what they can bill for. That this specific medical meat grinder is being fed by gender clinics whose entire job is to search for, and are incentivized to find, a non-existent gender identity - should clarify the scale of insanity we are dealing with.

Invent a Noun and Study It

Blind credulity should never be granted to any institution, let alone one filled with the perverse profit incentives that are inherent in the American healthcare system. The field of psychology is an especially inadvisable area to surrender one’s skepticism. Psychology stands apart from most medicine. Its diagnoses, although couched in the same language as a cardiologist would diagnose an arterial blockage, are of a fundamentally different kind. Psychology is largely a narrative discipline with a threadbare relationship with the physiology of the brain, the organ within which the stories are meant to be taking place.

The scientific method can be applied to research in cardiology and prove or disprove a hypothesis. Applying the same methods to psychological hypotheses is largely an attempt at polishing a turd. It’s meant to provide a scientific veneer to a collection of fictions. Unsurprisingly, the replication crisis in science takes on astronomical proportions in the field of psychology. As captured in this piece by Adam Mastroianni, failure of replication and even outright fraud at the highest levels in the field seems to be rampant. More importantly these failures and frauds are basically irrelevant to the outcomes and practices of the discipline.

Psychology as a science is based, to a significant extent, on an approach that Mastroianni refers to as “pick a noun and study it”, something that he says is a “proto-paradigm [that] has never been scientifically productive, and won’t ever be.” More precisely in our analysis of “gender identity” and “trangenderness” we’re dealing with a case of “invent a noun and study it”. This practice, and the papers that work on researching these fictions and wrapping them in scientific lingo, seem to be sufficient in deluding people that they are dealing with a medical endeavor backed by reliable science.

The problem of the scientific unseriousness of psychological research is captured in this paragraph from a paper discussing the topic.

Closer examination reveals that the inferential statistics reported in psychology articles typically have only a tenuous correspondence to the verbal claims they are intended to support. The overarching conclusion is that many fields of psychology currently operate under a kind of collective self-deception, using a thin sheen of quantitative rigor to mask inferences that remain, at their core, almost entirely qualitative.

Tal Yarkoni, The Generalizability Crisis

In the case of gender identity and transgender research, there seems to be no bottom to this “collective self-deception”.

All of this being said, psychology shouldn’t be dismissed as a scam. There are certain severe cases of mental illness where professional intervention are necessary. Even outside of that, in its best form, it can help those who have lost robust social support and act as a modern day confessional; a place to be honest about their lives and receive advice about what models to use to help navigate it during the rough times. The trouble that too many people (and practitioners) fall into is the reification of those models - making the abstract real and the ideas into substances. In this, the psychological practice becomes the source of the very cognitive distortions that it should be driving people away from. While simply naive in most cases, the fallacy becomes dangerous when one of these reified abstractions (an especially absurd one in the case of gender identity) becomes the basis for pushing people unto the conveyor belt of serious pharmaceutical and surgical interventions.

The People vs Therapeutic Culture

We live in a world where all negative feelings and behaviors are medicalized. Everybody is increasingly taught to understand and express themselves through psychobabble. The paradigm of astrological signs of Pisces, Leo and Taurus has been displaced by DSM entries of ADHD, generalized anxiety, chronic Depression, Social Anxiety, varied traumas, and dozens of flavors of personality disorders. The human experience within the capitalist context is distilled, through the pachinko machine of the DSM, into distinct categories to be constantly surveilled and medicated with pharmaceuticals.

This culture is spreading and the power that the psycho-therapeutic paradigm holds in our imagination is increasing. We are taught to look inward, to obsess, to fall into a narcissism of negativity and to allow the results of that dark spiral to define us in totalizing ways. Transgender-ness is just an extreme example of this tendency and society’s credulous acceptance of it is an indication that so many have surrendered to this paradigm. I doubt this will be the last or most extreme.

The problems that we suffer, in most cases, are not within us but in the system that we find ourselves in. The solutions that we must seek are not in looking inward, but to steadfastly rebel against that tendency. What we face is a societal task that requires collective and persistent work against a shared system of exploitation. In this pursuit, the therapeutic culture we find ourselves is an unequivocal enemy.

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This essay is part of a series I’m referring to as GenderCraft.You can find the introduction and with links to the pieces as they materialize here