Empathy gaps: A reply to Rebecca Buxton

Empathy gaps: A reply to Rebecca Buxton

A series of tweets from Rebecca Buxton a couple of days ago left me feeling pretty depressed. Here was yet another feminist philosopher that, from my perspective, was displaying a carefactor of zero for the pain and suffering of a group of (mostly queer) women that have been the victims of deep injustices at the hands of psychiatry and surgeons. One of the most shocking aspects of how the philosophy community has handled discussions about gender-related topics over the past few of years, has been the extent to which people I thought would display a healthy scepticism about sex[gender], drugs, and biopolitics in the pharmacopornographic era (Preciado), have completely averted their eyes from these thorny issues and acted as if there is absolutely nothing to worry about.

The purpose of this post is to provide a brief analysis of where I think Buxton erred both ethically and epistemically. (Especially) if Buxton is going to invoke the status of her institution and title, she should be much more careful. I also hope that this post helps inspire more sympathy for the humanity and lives of neglected vulnerable minorities. One of the biggest issues, I'll suggest below, is that many of the academics jumping in to support transgender people lack first-personal experience of 'gender troubles', unlike many queer people, who know all too well that the transgender-cisgender binary is... yet another false binary. I'll also point to one way that middle-class academics are overlooking issues of socio-economic class.

Buxton tweeted:

“I shared eight peer-reviewed studies on detransition/regret rates with someone in the comments on Rowling's post. They said it was all based on data faked by the scientists. I have no words.”

“He kept saying that I was coming up with “research” to support my own view. PEER-REVIEWED LONGITUDINAL STUDIES.”

The studies Buxton links to feature regret rates of between <1% and a little over 2%.

I traced back Buxton's engagement with this person to try to understand what point she was trying to make. What was her aim in arguing that detransition and/or regret rates are in fact ~1-2% or less?

Whilst Buxton's motivations are still not entirely clear to me, a plausible explanation is that she thinks that The Times should not have published its photo essay on detransitioners, and JK Rowling should not have bolstered its exposure, because detransitioners are such a small minority of people, and narrating and highlighting their stories at this point in time does damage to trans people. It seems this might be it, since Buxton says in one tweet:

“This is a total distraction from the fight for trans rights and is being used as a reason to question the identities of trans people”

If that's the thought, then I think Hadley Freeman's reply is a good response:

”...acknowledging the pain of these women in no way negates the legitimacy of trans people’s lives. Anyone who says otherwise should ask themselves why some vulnerable minorities are more worthy of protection than others.”

Let's say the rate of detransition is in fact 1% (I'm not sure we have good evidence to accept that claim, but I'll get to that in another post later this week). By emphasising this figure, Buxton et al. implicitly communicate the following sentiment: I endorse sacrificing the health and wellbeing of one person, if 99 other people's health and wellbeing is improved. Buxton's and other's “only 1%” tweets are essentially telling detransitioners that they don't matter, that they're collateral damage for a greater good.

This sort of crude utilitarism is the real distraction. Both the health and wellbeing of people who benefit from various types of transition and those who don't (or we might even say, are harmed by it), warrant our moral concern. In place of the 'only 1%' variety of tweets, we could instead convey our concern for these detransitioners' lives and ask the question “how can we lower the rate of false positives?”.

How you handle inductive risks, and thus how many false positives you tolerate and how you balance those with false negatives (or in this case: implementing policies and procedures that may result in other people having to way longer periods of time to commence down certain transition paths), is moral question. The famous contemporary paper from philosophy of science on this issue is a paper by Heather Douglas (2000). It's an inescapable problem in this debate, and one that has largely been neglected.

Buxton might respond that it's not about that – she really does have a carefactor of > zero for detrainsitions (even if she's not vocal about it); what she's upset about is the balance of social and media attention on detransitioners compared with trans people who've had positive transition experiences. I think it'd be hard to argue for that, as at the moment the media coverage of trans people's stories almost certainly out-numbers the media coverage of detransitioners' stories at rates greater than 99:1. If anything, detransition warrants more coverage not less.

Someone might then claim that the problem is that we can only reduce the rate of false positives at the expense of raising the rate of false negatives. 'False negatives' here might best translate as a delay to certain aspects of other people's transitions, rather than a false negative per se, as someone who really will benefit from transition is very likely to eventually transition. I think the assumption that we can only reduce false positives by raising the rate of false negatives is a false assumption in this case though, even if it's true for other problems in science. When we obtain more accurate diagnostic tools in general, we reduce the rate of false positives and false negatives simultaneously. So what we need is better 'diagnostic tools' – more accurate ways to distinguish between people who are more or less likely to benefit from certain types of transition.

How do we obtain better 'diagnostic tools'? Gender dysphoria isn't like coronavirus – you can't see it under a microscope or in a brain scan [1]. The only thing we have, at least at this point in time, is observational studies that may give us some clues, and the testimonies of gender diverse people. But this is where, for me, the muffling of voices in discussions of 'gender' is foolish and dangerous – because maybe the people who can provide us with the biggest clues are actually detransitioners. I think we'd do well to pay detransitioners more attention if what we care about is providing the best care for all gender diverse people.

To my knowledge, gay philosopher Edward Stein is the only philosopher who has paid the issue of inductive risk in gender dysphoria much attention. His article Commentary on the Treatment of Gender Variant and Gender Dysphoric Children and Adolescents: Common Themes and Ethical Reflections, whilst not perfect, is worth reading in full. In the section 'Appropriately Distinguishing Gender Dysphoria and Gender Variance' he criticizes some of the psychiatrists/physicians for not paying this issue enough attention and suggests that they should be reporting higher rates of false-positives and that it's problematic they're not. Many of us watching over this debate are concerned that, almost a decade later, these two groups are still being conflicate and confused by medical professionals and by society more broadly (with our concern motivated by the fact that we were gender diverse children, and often remain gender diverse adults, ourselves). But Stein doesn't go far enough: he seems to imply that distinguishing between these two types of children is easy when it's far from it, especially when gender dysphoria (gender-related distress) also exists on a spectrum.

The other group of people that probably hold clues, and who detransitioners could have benefitted from hearing more from before making transition decisions, are another group of people Stein points to – desisters. Desisters are those whose gender dysphoria (distress) fades at some stage of their development. As Stein underscores, although there is some disagreement about the precise percentages, the clinical literature agrees that:

A majority of children with GID [gender dysphoria] turn out to be desisters. As adults, a majority will turn out to identify as gay men, lesbians, or bisexuals, with a signiﬁcant portion of the rest becoming heterosexuals without gender dysphoria.

Many gay men, lesbians and bisexual people within academia have been trying to communicate this fact, and communicate their own gender-related challenges and experiences, many of which were also traumatic. But they're often cast aside as 'hateful', 'transphobic' or 'bigoted' when they try to talk. Again, this is regressive, as their testimonies could help to improve care of gender diverse children and young adults. Of course, the baseless accusations also wrong and harm these people too.

Another issue scholars entering this debate, either formally or informally, should seriously consider, is that it may turn out that there are class-based patternings associated with which people end up being detransitioners, with people from lower socio-economic classes over-represented in this group. This is only a suggestion, but it's one that should be subject to emprical research. Here's something from Stein's article that is the sort of thing that has lead me to thinking this could plausibly be the case:

*More importantly, from my perspective, pairing the clinical articles with ethical reﬂections allows parents, clinicians, and others to not only compare the treatment options but to consider their possible risks, their social costs, and some of their problematic assumptions*

Of course, highly educated middle and upper class parents will have the ability to do this, and lower-middle, working class and welfare class parents are less likely to possess these capacities. Hence, they're also less likely to be able to properly scrutinize the medical and other authorities wielding much power over their loved one's life. Similarly, the kids with these socio-economic background are more likely to lack these sorts of critical capacities too.

I'll end this post here, but in my next post i'll ask whether the current evidence base actually supports the 1% claim. In answering that question, we'll first need to clarify what the actual claim is that people are trying to make when they invoke the 1% statistic.

[1] Although some recent studies have claimed that transgender persons brains are more like the brains of persons of the opposite natal sex, we should be very careful about these claims. As far as i can see, none of the studies control for sexuality, either, which is worrying because about ten years ago the neuroscience claims of the day were that gay men had brains more like female persons, and lesbians had brains more like male persons. Compare these 2008 articles in New Scientist and National Geographic on the brains of gay men and lesbians with this 2018 article on The Scientist the brains of trans persons. Same shit, different decade! Here's another from 2006 on CBS claiming that lesbians' brains react differently to sex hormones than straight women (sound familiar?). Even more reason to be concerned about inductive risks and confounds, i think.