An international group of gender-change specialists urges caution for American doctors and therapists

July 16, 2023 • 10:00 am

A bunch (21) of doctors and Ph.D.s from nine countries (Finland, the UK, Sweden, Norway, Belgium, France, Switzerland, South Africa, and the U.S.) published the following op-ed in Friday’s Wall Street Journal. It might be paywalled, so I reproduced the entire short letter below.

First, be aware that this, as noted below, was in response to a letter from the President of the Endocrine Society published recently, a letter that staunchly defends the efficacy of “gender-affirming care.” That care involves a combination of therapy and, nearly always, medical intervention through hormones. That letter, from Dr. Stephen Hammes, said this:

Roy Eappen and Ian Kingsbury’s op-ed “The Endocrine Society’s Dangerous Transgender Politicization” (June 29) ignores scientific evidence and the conclusions reached by the American Medical Association, the American Academy of Pediatrics and other reputable medical organizations. More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

If you already know the evidence, you’ll know that this claim is wrong: there is not enough evidence to form a “clear picture” of either well-being or suicide. In response, the signers of the letter below (not shown) took issue with Hammes’s claims.

Click the headline to read, but here’s the whold thing. And I’ve put the important parts in bold:

As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.

Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

The politicization of transgender healthcare in the U.S. is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.

This letter is signed by 21 clinicians and researchers from nine countries.

There’s also a coda to this letter, which appears to be a kind of addendum (like a Supreme Court Justice’s partial dissent) coming from someone who may have been asked to sign the op-ed:

Transgenderism has been highly politicized—on both sides. There are those who will justify any hormonal-replacement intervention for any young person who may have been identified as possibly having gender dysphoria. This is dangerous, as probably only a minority of those so identified truly qualify for this diagnosis. On the other hand, there are those who wouldn’t accept any hormonal intervention, regardless of the specifics of the individual patients.

Endocrinologists aren’t psychiatrists. We aren’t the ones who can identify gender-dysphoric individuals. The point isn’t to open the floodgates and offer an often-irreversible treatment to all people who may have issues with their sexuality, but to determine who would truly benefit from it.

Jesus L. Penabad, M.D.

Tarpon Springs, Fla.

I agree with that letter, too. I would never ban transsexual medical treatment for those people old enough to make an informed decision (I’m thinking about 18 years old), but young people need objective therapy, not “rah rah—>hormones” therapy. If a therapist prescribes puberty blockers for a young person on the very first visit (or worse, sends them to doctors prescribing gender-change hormones), that is not a good therapist.

Of course the solution to this dilemma is research, which is why several European countries have put puberty blockers into the class of “clinical experiments” and are starting to practice less “rah-rah: transition” therapy in favor of actually listening to children without instantly affirming their desire to transition. That’s especially important because the large majority of young people experiencing gender dysphoria (about 80%, I think), eventually grow out of it, often by simply becoming gay. And being gay doesn’t run the risks of medical complications, sterility, and the inability to have orgasms: some of the side effects of hormone treatment.

And it would help if extreme gender activists would stop politicizing this issue. In all my years of writing on this site, I don’t think I’ve ever gotten such nasty and ignorant pushback as I have from gender activists who accuse me of transphobia simply because I think we need more research before we start injecting hormones into children and adolescents, lopping off bits of their bodies, and giving them objective rather than “affirmative” therapy. That view is not “fear of trans people”, for crying out loud. But the activists, who have ideology but not evidence on their side, resort to name-calling to intimidate their opponents. And it often works.

The pile-on also comes if one suggests, as did Abigail Shrier, that there can be social pressure that influences people to change their gender, a claim that by now I think is undeniable. (Adults, of course, are free to make their own decisions, but again, these should be informed decisions, and the long term effects, both medical and psychological, of transitioning are not often discussed. One reason is that gender activists rain down hatred on anyone who brings up these issues.)

In Friday’s Weekly Dish, Andrew Sullivan picked up on this letter and wrote about it, giving some statistics in response to the oft-heard claim made by some doctors and therapists advising parents of gender-dysphoric children, “Do you want a live boy or a dead girl?” That, of course, implies a very high risk of suicide by girls who aren’t allowed to transition to the male gender. Sullivan:

To give a sense of the bullshit, here’s Stephen Hammes, president of the Endocrine Society:

More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

Note the vagueness, and the absence of any mention of children — the only population we need to be concerned about. And here is the Endocrine Society’s own study on sex reassignments for kids:

We could not draw any conclusions about death by suicide.

Today, in the Wall Street Journal, 21 pediatric clinicians from nine countries call Hammes out. In those countries that have conducted systematic evidence-based reviews of all the studies involving children, all of them have concluded that “the evidence for mental-health benefits of hormonal interventions for minors [is] of low or very low certainty.” The risks — permanent sterility, inability to experience orgasm ever, irreversible changes to the body, voice and face — are very real. Yet the American Academy of Pediatrics refuses to conduct a similar systematic review, five years after its last guidance.

A survey of a decade of child transitions in the UK, from 2010 to 2020, found that the data “shed no light” on whether reassignment affects the suicide rate. But here’s the stunner: of the more than 15,000 children treated for gender dysphoria, the number of suicides was four. It is insane to believe that every child with dysphoria will kill themselves if not subjected to a sex change. If a doctor tells you this, find another doctor.

Why would they lie like this? I honestly don’t know. Here are some possibilities: misguided compassion for children in distress; believing you are part of a cultural revolution that starts with children; banking on the vast revenues of having patients for a lifetime of treatment; or just following ideological fiats, intimidated by woke peers, and fearing liability for past missteps.

I think that pretty much covers all the possibilities. I’m not sure why the U.S., compared to other countries, is particularly resistant to discussion of medical and psychological issues like this, especially given that this isn’t just an ideological discussion, but a discussion with medical consequences. As far as I can see, we should be doing what the Europeans are increasingly doing about this issue: collecting more data.

Can therapists diagnose Trump as mentally ill, and warn people about his potential to promote violence, without examining him?

June 13, 2023 • 9:00 am

I’ve written twice about this subject: the controversies involving Yale clinical and forensic psychiatrist Bandy X. Lee (no longer at Yale). Lee has been accused of violating the Goldwater rule, which involves giving professional psychiatric opinions about public figures you haven’t examined—in this case Donald Trump. The article below from Mother Jones magazine describes her travails around “diagnosing” Trump and warning of his potential to incite violence. As I wrote in November of 2020:

I agree that Donald Trump is mentally ill, but I’m not a professional, and thus am not bound by the strictures of professional associations to avoid diagnosing someone you haven’t personally examined. And those strictures exist most prominently in the American Psychiatric Association’s (APA’s) “Goldwater rule“, created after a number of psychiatrists pronounced Barry Goldwater unfit for office in 1964. Here’s the rule from the APA’s “Principles of Medical Ethics,” and this rule is still in force:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

There doesn’t seem to be a penalty for psychiatrists who flout this rule, however, as psychiatrists who have diagnosed Trump as ill, or even lobbied Congress to proceed with the Trump Dump, have suffered no penalties.

In general I tend to agree with the Goldwater Rule, even if it’s nonbinding and the APA levies no penalties for flouting it (other people, as you’ll see, can punish violators). Yes, I think Trump is mentally ill, afflicted with narcissistic personality disorder, but I still think, as I did three years ago, that giving a professional diagnosis, whether you be a doctor or a psychiatrist (who are doctors), is pretty close to slander, and has far more potentially deleterious consequences than a statement by average Joes like me. “Professional” statements can be used for impeachment, removal from office, and so on. That said, I don’t see a problem with professionals warning the public about the dangers of someone based on their past behavior, without giving them a professional diagnosis. That’s what Lee claims to have done, and she was fired for it.

But in the past, Lee, who never examined Trump, appears to have come pretty close to diagnosing him. In a debate in Salon, Lee not only pronounced Trump to be mentally ill, but then went on to say the Goldwater Rule is itself harmful. Wikipedia notes this:

Lee then stated in an interview with Salon in May 2017 that Trump suffers from mental health issues that amount to a “state of emergency” and that “our survival as a species may be at stake.” She also discussed her political views, linking what she sees as increasing inequality in the United States to a deterioration in collective mental health.

And she discusses the 2020 debate with Biden.

[Salon]: Trump spent most of the debate heckling and interrupting, mixed with some blatant lying. How would you assess his debate performance?

[Lee]: The huge error was in allowing the debate to happen in the first place. “How was his debate performance?” is the wrong question to start. A debate presupposes mental health. We cannot pretend to have one when management of psychological impairment is what is warranted. The majority of the country may be horrified at what he is doing, but we continue to help the disorder in every way possible by treating his behavior as normal. It applies first to the politicians, then to the media and then to pundits who do not come out and honestly say: “This is beyond anything I have seen and beyond what I can understand — can we consult with experts?” And experts, for a psychological matter, would be mental health experts. Perhaps even specialists of personality disorders or sociopathy would be necessary, given the severity.

To me that comes close to giving a professional opinion, but it’s not 100% clear cut. She does say that he has a mental health disorder, and to me that’s a professional opinion. (After all, one psychiatrist said that “he may just be a jerk.”) There is, of course, a continuum between jerks and the mentally ill, and where to draw the line is unclear.

Bandy went on to organize a conference of mental-health professionals in April, 2017, that resulted in a collection of essays by various therapists, The Dangerous Case of Donald Trump, a book that became a bestseller. (Note: I haven’t read it.)

Mother Jones reports on the fallout, and on Bandy’s firing from Yale (click on screenshot):

Bandy certainly has the expertise to warn people about potential violence, and that’s what she continued to say about Trump after her book came out: the man has the behavior that tends to lead to violence among his followers, something instantiated in January of 2021. She has studied criminal gangs and their leaders, and sees their behavior mirrored in Trump’s. She also notes that these leaders lose their influence when they are put in jail. (Bandy also argues that since 1900, violence tends to spike whenever there’s a Republican President.)

At any rate, Bandy continued her warnings about Trump’s likelihood to inspire violence, which of course came true. And she continued to be criticized by the APA. She appears to have been skirting the Goldwater rule, saying that she didn’t violate it, yet also asserting that the rule doesn’t really apply when there’s another rule that overrides it. This is from her Wikipedia bio:

Lee says that when meeting with lawmakers, she was adhering to the American Psychiatric Association’s guideline, which precedes the Goldwater rule, and which urges psychiatrists “to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.” In an interview she also said, “whenever the Goldwater rule is mentioned, we should also refer to the Declaration of Geneva, established by the World Medical Association 25 years earlier, which mandates physicians to speak up if there are humanitarian reasons to do so. This Declaration was created in response to the experience of Nazism.”

And from the Mother Jones article:

According to Lee, Trump’s extreme dangerousness puts him in a completely different category from previous Republican presidents, who merely endorsed a set of harsh economic policies that are associated with increased violence. In contrast to past presidents with likely personality disorders, she believes, Trump has a psychological profile that is common among violent offenders. “There is typically a developmental arrest caused by early trauma or abandonment,” Lee says. “As adults, they still act like children in the playground; convinced that might makes right, they often can’t stop bullying others. “Trump’s mother, Lee points out, became chronically ill when he turned two, and his father was cruel and emotionally unavailable, repeatedly urging his son to be “a killer.”

. . . Despite the scolding directed her way by influential psychiatrists, Lee contends that she has never broken the Goldwater Rule, which, as she wrote in 2017, “is the norm of ordinary practice I happen to agree with.” In The Dangerous Case of Donald Trump, she and her co-authors challenged Trump’s fitness to serve based on his behavior rather than on a diagnosis per se. “The issue that we are raising is not whether Trump is mentally ill,” Gilligan writes in his chapter. “It is whether he is dangerous.” As proof of the psychological peril at hand, the authors point to Trump’s angry tirades and verbal abuse of subordinates, his admiration of authoritarian leaders, conspiratorial fantasies, aversion to facts, and attraction to violence.

You can see the conflict here. In the first paragraph, Lee implies that Trump has a personality disorder, and has a psychological profile—connected with childhood abandonment—that leads to bullying and promoting violence. That sounds very much like a claim derived from professional psychiatric experience. Yet in the second paragraph she says she’s never broken the Goldwater Rule: she was just warning people about Trump’s propensities given his behavior. But this is a distinction without a difference: that warning comes from professional experience. (Of course, people like us could also make such prognostications without penalty, but a prediction derived from professional experience comes awfully close to violating the Goldwater rule.)

Well, does it matter? Lee turned out to be right, of course, and Trump was impeached (unsuccessfully) as Democratic members of Congress, like Nancy Pelosi, called him “unhinged.” And then there was January 6, and other calls from Trump for his supporters to beat up people.

In the meantime, Lee was fired from teaching at Yale after 17 years following a Twitter kerfuffle with Alan Dershowitz (she said Dershowitz “had taken on ‘Trump’s symptoms by contagion'”, which again skirts the Goldwater rule). Dershowitz complained to Yale about this “violation,” and Yale dumped Lee. She’s now suing the University and, as she’s become un-hireable in universities, got a degree from Yale Divinity School. She’s now a visiting professor at Union Theological Seminary, where she’ll start a violence prevention institute.

So, if Lee turned out to be right, did she still violate the Goldwater rule? This is a close call, but on balance, and based on the fact that her opinions and warning were derived from her professional expertise, I’d say “yes”.

But two questions remain. First, is the Goldwater rule a good one? I’d say “yes,” given the dangers of chilling public discourse by giving quasi-professional medical opinions. It’s for the same reason that administrators of the University of Chicago don’t make pronouncements on public issues, even when speaking for themselves. It’s because even in private speech, their words carry an imprimatur of authority, and that could chill speech in the University. In some cases violations of the Goldwater rule are clear; if Bandy had diagnosed Trump from afar with narcissistic personality disorder, she would be in violation of the APA’s rule—even though she wasn’t a member of the APA.

But there are no professional sanctions that come with violating the rule.

This leads to the third question: should Bandy have been fired by Yale, even if her predictions about Trump were right? Here I say “no.” She was fired because Dershowitz complained to Yale about her violations of the Goldwater rule. But even if she violated it, Yale didn’t have an obligation to let Bandy go. And given that she claims, with some justification, that she warned about Trump based on his behavior, not a clinical diagnosis, I don’t think she should have been dumped. After all, Yale derailed the career of an accompanlished psychiatrist. Note how Wikipedia begins her bio:

Bandy Xenobia Lee is an American psychiatrist whose scholarly work includes the writing of a comprehensive textbook on violence. She is a specialist in public health approaches to violence prevention who consulted with the World Health Organization and initiated reforms at New York’s Rikers Island Correctional Facility. She helped draft the United Nations chapter on “Violence Against Children,” leads a project group for the World Health Organization’s Violence Prevention Alliance, and has contributed to prison reform in the United States and around the world. She taught at Yale School of Medicine and Yale Law School from 2003 through 2020.

That is positive accomplishment, which to me argues against her firing.

And had she been wrong about Trump’s incitement of violence, I still don’t think she should have been fired. And, as I said, there is some justification for what she did even if she did break the Goldwater rule. After all, she didn’t give a formal diagnosis just to criticize the man: she did it to warn people about what he was capable of doing. (Remember, psychiatrists are allowed to break rules about professional confidence if they think their patients are likely to commit crimes of violence.)

As I said, I haven’t read all of Lee’s writings. But based on what I have read, and on the description in Mother Jones, which of course does lean way Left, I think Lee was acting according to both her training and her conscience. Although her warnings didn’t have any effect in impeaching Trump or preventing the insurrection he promoted, she didn’t deserve to have her career forced off the rails by Yale.

h/t: Fred

Indigenous psychiatry: how valuable is it?

July 5, 2022 • 12:30 pm

I’ve written a lot about how New Zealand is valorizing indigenous knowledge, and the educational system is on the path to teaching Mātauranga Māori (“MM”)—a mixture of myth, legend, practical knowledge acquired by trial and error, and spirituality—as “science”, coequal to science in science classes. There is some science in MM, but as a whole it is certainly not the same thing as modern science, and many of its claims are either dubious or palpably false. To teach MM in science classes is to deprive the children of New Zealand of an understanding of science.

Many New Zealanders seems to regard everything about its indigenous people as not only valid, but admirable. A lot of it is, but many Kiwis are too cowed to stand up to some of the more questionable claims of the Māori, including the claim that their Polynesian ancestors discovered Antarctica centuries ago. I know about this fear because Kiwis who do stand up against nonsense get persecuted, and I get emails from lots of them who agree with me but say that they dare not speak up because they’ll lose their jobs.

The latest effort to “indigenize” knowledge is the bestowing of a huge pot of money on Māori organizations to use “ancestral knowledge” to help cure mental health issues among the indigenous people. This is described in the Newshub article below, which you can click to read:

The article notes that “The new Māori Health Authority has a budget of half a billion dollars and CEO Riana Manuel has allocated $100 million of that to support centuries-old treatments.”

And there is a need for treatment, for the article also notes this:

Māori have the highest suicide rates of all ethnic groups in New Zealand. Mental distress among Māori is almost 50 percent higher than non-Māori and 30 percent are more likely to be left undiagnosed.

Now of course we can’t attribute this to problems that are unique to Māori, as I doubt there was a control for levels of income and other stressors that differ among ethnic groups. But there is a push to use Māori-centered therapy to cure mental illness in that ethnicgroup, and 100 million dollars for using “centuries-old treatments” is a lot of money.

What are these treatments? It’s not clear, but they’re based on lunar cycles and what can only be called psychoastrology. It’s confusing because the article is, as so often happens in Kiwi news, larded with Māori terms that even non-Māori can’t understand. See if you can suss it out:

Not so well known to non-Māori is their tradition of using the moon and stars to help treat mental health issues.

It’s called maramataka and will be incorporated into treatment by the new Māori Health Authority.

Rereata Makiha is on a mission to share ancestral knowledge with the next generation.

He’s an expert on maramataka Māori, or the Māori lunar calendar, and forecasting based on the moon cycles, star systems, tides, and the environment.

“The maramataka helps you, helps us to predict when things are going to happen, to tell us when the fish are going to run, when the eels are going to run – all those sorts of things,” he said.

“When you understand it a lot it’s a brilliant guide on when you should be doing certain things.”

Rikki Solomon teaches at-risk rangatahi and whānau how to use maramataka for improving mental health and knowing when to spend time doing certain activities in nature or around whanau.

“If we find that a whanau has had a low time or they may feel low, what we use is the maramataka to identify their cycles, their highs, and their lows,” Solomon said.

“What we observe in those low areas is what are some rituals at that time. And what I mean about rituals is what is the environment that they can connect to, because our environment is our biggest healer.”

That doesn’t really clear things up, but here’s more on the practice, with quotes from Riana Manuel, CEO of the Māori Health Authority:

“Connecting people back to those spaces and places that have been long forgotten is certainly something that will be investing in,” Manuel said.

Just like they do with Matariki, Māori use maramataka as a way of reading the cosmos to prepare for what’s coming.

“It’s a way of rebuilding the body, your wairua, and rebuilding your energy and getting prepared for the high energy days ahead,” Makiha said.

“So it goes in waves like that and if people understand it and go back to that rather than rush, rush, rush every day, I think that’s what drives a lot of the ill-health.”

If you can figure out what they’re doing from this, you’re a better person than I am.

Now there may indeed be a benefit to using Māori practitioners and ancient Māori practices to treat mental illness. After all, people often feel that therapists who have a background similar to their own are more desirable. Women, for example, often feel that a woman therapist will treat their problems better, and the same goes for ethnic minorities. So there may be something to shared experience and background that is therapeutic (there’s also, of course, a placebo effect).

My criticism here is simply that these practices are being adopted in the absence of clinical trials, and so there is only a “traditional” basis for the therapy. Might Māori be helped more with other practices, like cognitive behavioral therapy, practices that have been tested and shown to be efficacious? Or even medication, which has a significant effect on things like depression. (A combination of talk and drug therapy seems to be the most curative).

As a colleague wrote me, this absence of scientific testing of a method that will absorb $100 million is the same issue raised with MM: what is claimed (or assumed) to be “scientific” has not been vetted using the scientific method. To quote the colleague:

This is exactly the problem that led me to raise concerns about MM versus science in the first place. We now have two alternate sets of “facts.” One is based on scientific evidence, and the other may be supported by some evidence but has never been tested in a way that would be considered acceptable for medical science.

Mental health is a form of health, and this is like treating diseases using astrology and “traditional methods” that have never been subject to genuine scientific tests. Doesn’t it seem wise, before investing $100 million in mental-health treatment, that the government of New Zealand be sure that those treatments actually work?

Sadly, that’s not the way the New Zealand government rolls.

The woke termites burrow their way into therapists’ offices

August 14, 2021 • 10:30 am

You’d think that the last places one would start treating individuals as embodying characteristics of their “tribe” are the offices of therapists. After all, both psychologists and psychiatrists are expected to deal with their patientS as people with unique problems, and not impute to the patient “group” characteristics based on stereotypes or political ideology. Nor should they impose their own political views on their patients, which is a real no-no for therapists. (They do, of course have ideas on how to treat patients, and make suggestions, but not of the genre, “hey, maybe you’d feel better if you wore a MAGA hat.”)

Well, the idea that therapy is ideology-free is, of course, dead wrong, especially now when there is no tent in the Universe where the Woke Camel won’t stick its nose. And so the nose goes onto the couch, as recounted in this Persuasion article by Sally Satel. Click on the screenshot to read:

Now activist therapists aren’t new; for years we’ve had specimens who impose their own views on patients rather than sussing out a patient’s problems from their own words. These activists include “recovered memory therapists”, who, it seems, already know what memories are supposed to be recovered, and try to convince the patient about the truth of things that might never have happened.

You’ve heard of the McMartin preschool case, in which recovered memory therapists dug up instances of sexual and even Satanic abuse of children that never happened. The accused people spent several years in jail, but were eventually acquitted. Right now Jerry Sandusky is sitting in prison for sexual abuse of young boys, with a lot of the testimony that put him there “recovered” by therapists digging around in the minds of young people. (Some said they weren’t abused but, after some bouts with the therapists, suddenly remembered that Sandusky committed sexual acts on them).

These therapists are clearly activists, and one would, based on their activities and the political leanings of therapists, expect them to often be on the Left.

Sally Satel, a psychiatrist who wrote this piece, is against activism, though she is affiliated with the Right-Wing American Enterprise Institute. Wikipedia says she’s a “political conservative” and has also written several books about the incursion of Left-wing doctrine into medicine, like this one (click to go to Amazon site):

Satel’s also identified as working at a methadone clinic in Washington D.C. and as a visiting professor at Columbia University’s Vagelos College of Physicians and Surgeons. If you’re one of those, you can ignore her views simply because she’s a conservative, but you might be missing some truths. And her claimed truth in this piece, which can be at least partly checked by following the links she gives, is that therapy is increasingly turning into the instillation of woke attitudes into patients as the world because woker. I doubt that, in these times, you’ll find that thesis inherently unlikely! But here’s what she says:

Until roughly five years ago, people seeking mental health care could expect their therapists to keep politics out of the office. But as counselor education programs and professional organizations across the country embrace a radical social justice agenda, that bedrock principle of neutrality is crumbling. Mental health professionals—mainly counselors and therapists—are increasingly replacing evidence-driven therapeutics with ideologically motivated practice and activism.

The Graduate Counseling Program at the University of Vermont, for example, intends to “structurally align” itself with the Black Lives Matter movement and begin “the work of undoing systemic white supremacy.” After George Floyd’s death, the Johns Hopkins University Counseling Center advised would-be students to “consider us one of many resources in the difficult but necessary work of engaging with internalized bias, recognizing privilege, and aligning values of anti-racism and allyship with embodied and sustained practice.”

Such sentiments are not limited to mission statements—they are playing out in the real world of clinical training. Some counseling programs encourage students to engage in social justice activism. Most troubling of all, trainees are being taught to see patients not as individuals with unique needs, but as avatars of their gender, race, and ethnic groups. Accordingly, more and more counselors encourage their patients to understand their problems as a consequence of an oppressive society. White patients, for instance, are told that their distress stems from their subjugation of others, while black and minority patients are told that their problems stem from being oppressed.

The stakes for patients are high. When therapists use patients as receptacles for their worldview, patients are not led to introspection, nor are they emboldened to experiment with new attitudes, perspectives, and actions. Patients labeled by their therapists as oppressors can feel alienated and confused; those branded as oppressed learn to see themselves as feeble victims. It is difficult to imagine how a healthy therapeutic alliance between counselor and patient—a core bond nurtured through a clinician’s posture of caring neutrality and compassionate detachment—could thrive under these conditions.

Is it hard to imagine that therapists might engage in this form of indoctrination when secondary-school and college teacher do it all the time? Satel goes on:

The American Counseling Association, “the world’s largest association exclusively representing professional counselors,” has a Code of Ethics that explicitly cautions against such boundary violations: “Counselors are [to be] aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors.” Yet the association has said nothing about the overt ideological stance of some programs, or blatant instances of imposition.

It’s hard to argue with that paragraph’s advice. Nor is it hard to believe that any form of propagandizing patients will be aimed at moving them toward the left because, at least according to Five Thirty Eight, social and personality psychologists are about as liberal as college professors:

When New York University psychologist Jonathan Haidt asked about a thousand attendees at the annual meeting of the Society for Personality and Social Psychology in 2011 to identify their political views with a show of hands, only three hands went up for “conservative or on the right.” Separately, a survey of more than 500 social and personality psychologists published in 2012 found that only 6 percent identified as conservative overall, though there was more diversity on economic and foreign policy issues.¹ The survey also found that 37.5 percent of respondents expressed a willingness to discriminate against conservative colleagues when making hiring decisions. Psychologists, it appears, tend to fall on the liberal end of the political spectrum.

I expect therapists will line up pretty much the same way.

Now it’s okay if a patient’s problems involve politics. Perhaps he was driven to fury by Trump, and it’s upsetting his life. Or he can’t live in a world in which race seems to be the main driver of everything. Then the therapist can draw out the patients and suggest ways to improve their lives. But I don’t think it’s ever valid to impose your own politics on a patient, nor to treat them as a member of a political or ethnic group rather than an individual, like trying to urge them to be “more black or Hispanic” or “less white”. Satel has a couple of anecdotes about this, but remember, they are anecdotes.

Central to the ideology that’s creeping into the field of mental health care is a growing aversion to recognizing personal responsibility and agency. One colleague of mine who works in a prominent psychiatry department told me that during a group discussion of the growing problem of stress and suicide in black youth, her colleagues were unwilling to discuss explanations that pointed to factors coming from within beleaguered communities. Thus, participants who pointed to fear of police aggression and societal discrimination were greeted with nods, but when she suggested they also consider bullying by classmates, chaos in the home, or neighborhood violence, she was ignored.

I have had my own encounter with this growing illiberal strain. Following a lecture I gave earlier this year to a group of psychiatrists and trainees, I was castigated by several attendees for drawing attention to personal agency in overcoming drug addiction. My transgression, as they saw it, was to “blame the victim” and take focus away from factors such as racism, poor education, and poverty—which, as I had noted in my presentation, also predispose people to heavy drug use. But I was not “blaming the victim,” I explained in an icy Q-and-A; rather, I was drawing attention to the patients’ capacities to improve their lives and, therefore, to hope.

As a palliative, she touts an organization, The International Association of Psychology and Counseling, dedicated to promoting “critical thinking over indoctrination” and to an organization called FAIR in Medicine, a group designed to combat the incursion of ideology into medicine as a whole. As Satel says at the end (her emphasis):

Though I am worried for my profession, for colleagues who feel pressure to conform, and for the patients who depend on them, I take heart from these flares of resistance. I am confident that there is a silenced majority of clinicians who see the need to resist the ideological encroachment into the field of mental health care and the health sector more broadly. These new organizations are in their early stages but have the potential to attract the critical mass needed to rebuff politicized narratives and re-assert the primacy of individual patients in all their complexity.

Scientific American: religious or “spiritual” treatment of mental illness produces better outcomes

June 19, 2021 • 11:00 am

Scientific American continues to circle the drain, even after it retracted an anti-Semitic op-ed this week. Several readers have commented that they’ve canceled their subscriptions, and I’ve never had one. Perhaps the old-fashioned Sci Am that we knew and loved is no longer sustainable in a world where people want their science as short, click-baity pieces.

The latest dire piece is not an op-ed but an article, appearing in the “Mind” section under “mental health”. It’s a justification for including religious and spiritual therapy in mental health treatment, and could be taken as, in part, a defense of the value of religion. Indeed, it may be the case that for believers—though I haven’t checked the references; readers are invited to—some kind of god-infused therapy might ameliorate mental illness. The author gives references supposedly showing this. After all, if you’re already religious, you’ve drunk the Kool-Aid, and so buttressing the comforting bits of what you already believe might make you feel better. After all, that’s what a lot of church is about.

But there are a few problems with Rosmarin’s thesis. First, religious therapy enables religious belief, i.e., faith. Part of what is said to “cure” you involves reinforcing falsehoods rather than facing real or potential truths. I don’t object to that so much, though, as an antitheist, I don’t like it. Second, although “spiritual” therapy is mentioned many times, and is said to help even nonbelievers, the author never tells us what spiritual therapy really is. Given how broad the boundaries of the concept “spiritual” extend, almost any therapy that helps could be said to include a “spiritual” element. For example, one could tell a secular patient to learn to accept both good and bad as inevitable parts of life. That is the doctrine of many Buddhists, and could be said to be “spiritual”.

Importantly, there’s no mention of religion actually exacerbating or instigating mental illness, and I have no doubt that it does. Martin Luther is a famous example, but think as well of the many children who have been terrified by thoughts of heaven or hell, the people who do horrible stuff because they think God told them to, or the priests who, formally prevented from having sex, become pedophiles. I could go on, but will refrain. But there’s not a word about any of this.

Finally, why on earth is Scientific American publishing stuff like this? I suppose you could include it in the ambit of “popular science”, but barely. They might as well be writing about the value of acupuncture in helping physical ailments. Like acupuncture, religion is a regimen based on false assumptions, and its use encourages a naive reliance on faith: on stuff that is either untested or palpably false.

Rosmarin is a Ph.D. psychologist identified as “director of the Spirituality and Mental Health Program at McLean Hospital and an assistant professor of psychology in the Department of Psychiatry at Harvard Medical School.”

Here’s the evidence adduced by Rosmain:

His own SPIRIT program “suggests that spiritual psychotherapy is not only feasible but highly desired by patients”
During the last pandemic year, religious people were “the only group to see improvements in mental health”
Spirituality, says Rosmarin, is woefully lacking in most forms of therapy, as psychiatrists are the least religious among all medical specialties.
As Rosmarin says,

My own research has demonstrated that a belief in God is associated with significantly better treatment outcomes for acute psychiatric patients. And other laboratories have shown a connection between religious belief and the thickness of the brain’s cortex, which may help protect against depression. Of course, belief in God is not a prescription. But these compelling findings warrant further scientific exploration, and patients in distress should certainly have the option to include spirituality in their treatment.

You can check the references for yourself. They may show what he says they do. But I still would be wary of religious treatment, since it uses falsehoods and belief in falsities to help people get better. I don’t necessarily oppose that, but I would have liked to have seen a mention of how religion causes or exacerabates mental illness. It using religion any different from telling patients that acupuncture in their ears could help them, or that everybody really likes them?

Rosmarin winds up giving a few anecdotes as evidence for the efficacy of “spiritual” therapy (I suspect that a lot of the “spirituality” is old-fashioned religion), and asserts that the biggest group of patients who come to his SPIRIT counseling are individuals “with no religious affiliation at all.” These are, of course, the “nones,” but nones may be religious, and simply not affiliated with an established church or sect. Only a minority of “nones” would consider themselves atheists.

When I read this article, the words of Marx kept coming back to me—words from a famous passage usually (and unfairly) truncated to just the last sentence, implying pure religion-dissing. What’s left out is the first sentence in which Marx asserts that religion is often embraced because its the only form of help available to people in bad situations like poverty, illness, lack of social support, and so on.

“Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people.”

I doubt that Scientific American will ever get back to the format that attracted many of us to the magazine in the first place. Just have a look at its contents these days, which have become more overtly political with a good dose of fluff.

h/t: Will

A new paper by a psychoanalyst looks like a hoax, but isn’t

June 11, 2021 • 10:30 am

When I first saw the paper below, which is still on the pages of the Journal of the American Psychoanalytic Association—a journal I expected to be peer-reviewed journal and have a modicum of rigor even if it is about psychoanalysis—I thought it was a joke: a hoax “grievance” paper à la Pluckrose, Lindsay, and Boghossian. But I don’t think it is. Instead, it’s a horrid, racist gemisch of obscurantist chest-beating in the guise of antiracism. Click on the screenshot to read it, or download the pdf here. (The full reference is at the bottom of the page.)

Just three quotes, besides the abstract above, give the tenor of the paper:

Parasitic Whiteness infiltrates our drives early on. The infiltrated drive binds id-ego-superego into a singular entity, empowered to dismiss and override all forms of resistance. The drive apparatus of Whiteness divides the object world into two distinct zones. In one, the Whiteness-infiltrated drive works in familiar ways—inhibited, checked, distorted, transformed—susceptible, that is, to standard neurotic deformations. In the other, however, none of this holds true. There the liberated drive goes rogue, unchecked and unlimited, inhibited by neither the protests of its objects nor the counterforces of its internal structures.

. . .Parasitic Whiteness generates a state of constantly erotized excitement, a drift toward frenzy.¹ Fix, control, and arouse; want, hate, and terrorize. Whiteness resides at this always volatile edge, in a state of permanent skirmish, always taking on the never obliterated resistances of its nonwhite objects. Opaque to itself and hyperconscious of those objects, Whiteness pursues the impossible, a stable synthesis, an end point. It can therefore never rest. Blindly, then, it continues forward, unendingly bent on conquering. There seems no backward path, no mode of retreat. It faces an interminable forward march. If only it could totally and permanently transform these objects, turn the once feared and unknown into the now reduced and measured; turn the once unique and overwhelming into the now fungible and owned.

Whiteness originates not in innocence but in entitlement.

. . . Psychoanalytic work, then, need not properly target Whiteness itself here. Instead, it can effectively target the psychic receptor sites that provide Whiteness the interior vertical mapping on which it depends. The vertical map disrupts the identificatory bond that might once have bound subject to object. The bond persists, though, reshaped and hardened now into a vertical format. Identification morphs into disidentification, similarity into difference, affectionate care into sadistic cruelty. Diminish the spread and influence of these interior vertical receptor sites and, indirectly, the parasite of Whiteness is dislodged, loosed, itself becoming susceptible to exposure, as a differentiated and alien presence. Psychoanalytic work, in its most radical, fundamental, and, finally neutral forms, targets any and all of the effects of vertical mapping. Where verticality was, there horizontality will be.

Ah, the termites are dining well! Imagine if this paper used any ethnicity other than “whiteness”. It would not have been publishable, and the author would have been damned and demonized forever for racism. Indeed, I’m baffled why the editor of this journal even published the screed. It appears to say nothing beyond whiteness being a parasitic infection of the mind that needs to be cured by psychoanalysis (of course).

Is this a joke or a hoax? I don’t think so. The author has written quite a few articles for the journal and is identified at the article’s end this way:

Faculty, New York Psychoanalytic Institute [NYPI]; co-founder of the Green Gang, a four-person collective working with climate change denial and the relation between the human and the natural worlds; Chair, Program Committee, American Psychoanalytic Association.

Indeed, he’s listed as a faculty member on the New York Psychoanalytic Institute website. He’s a real person!

Here’s a photo of Moss from the NY Post:

Now there’s a different Donald Moss, another physician, who hastened to tweet that he wasn’t the guy who wrote this execrable paper. I don’t see the “correction and apology” on the website, though.

My name was misidentified as author of an article in Journal of the American Psychoanalytic Association about the “malignant, parasitic-like” condition of “Whiteness.” I did not author this article and am pleased to see that the publication has issued a correction and an apology.

— Dr. Donald Moss (@DonaldMoss) June 10, 2021

Lee Jussim, a psychologist at Rutgers, points out the similarities between Nazi racism and Moss racism:

"Judaism is Ruin, Destruction, Downfall&Murder!"
"The Jew is such a parasite!"
Quote from Nazi speech, 1944:https://t.co/UWUWDlq3uP

Now compare:
"Parasitic Whiteness renders its hosts appetites voracious, insatiable, perverse"
ht @AurelianofRome who 1st realized this parallel. pic.twitter.com/srcpMY5S5R

— The Dread Pirate Jussim (@PsychRabble) June 10, 2021

I don’t want to delve further into this steaming pile of psychoanalytic scat, as you can read the paper for yourself, and perhaps delve further into the writings of Dr. Moss. But you can conclude two things. First, this Donald Moss is off the rails, perhaps in need of treatment himself (but not psychoanalysis!). Second, the Journal of the American Psychoanalytic Association has no credibility and, apparently, no standards.

I wonder what his colleagues at the NYPI are thinking. . .

______________

Moss, D. 2021. On Having Whiteness. Journal of the American Psychoanalytic Association 69:355-371.

Should mental-health professionals diagnose Trump as mentally ill?

October 3, 2020 • 12:30 pm

It’s one thing for us to call Trump a narcissist or a sociopath, but it’s another thing entirely when a group of mental-health professionals argue that Trump should not be allowed to debate—or should be impeached—because he’s sick in the head.

Psychiatrists generally refrain from diagnosing people whom they haven’t examined, adhering to what’s called the “Goldwater Rule”. That rule, put into place by the American Psychiatric Association, came into being in 1973 when a group of over 1000 psychiatrists questioned Barry Goldwater’s fitness for office based on their long-distance diagnosis. Other Presidents, including Clinton, have also been diagnosed as mentally ill by the pros.

After the diagnosing of Trump started in 2016, the APA issued a statement in January, 2018 that reaffirmed the Goldwater Rule:

Today, the American Psychiatric Association (APA) reiterates its continued and unwavering commitment to the ethical principle known as “The Goldwater Rule.” We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable news appearances, books, or in social media. Armchair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.

The ethical principle, in place since 1973, guides physician members of the APA to refrain from publicly issuing professional medical opinions about individuals that they have not personally evaluated in a professional setting or context. Doing otherwise undermines the credibility and integrity of the profession and the physician-patient relationship. Although APA’s ethical guidelines can only be enforced against APA members, we urge all psychiatrists, regardless of membership, to abide by this guidance in respect of our patients and our profession.

A proper psychiatric evaluation requires more than a review of television appearances, tweets, and public comments. Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease. The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.

“The Goldwater Rule embodies these concepts and makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA stands behind this rule.”

I generally agree, for professionals should behave professionally. Doctors don’t diagnose patients without an exam, and psychiatrists are doctors. As an article in the Canadian Medical Association Journal (CMAJ) noted,

. . . One reason for The Goldwater Rule is the likelihood of error in a diagnosis made at a distance. A proper diagnosis requires much more than “a review of television appearances, tweets, and public comments,” the American Psychiatric Association noted in its statement. “The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.”

You can say we already know enough to agree that Trump is mentally ill, but remember, if you want to assert that in court, the perp has to be examined by mental-heath professionals. Courts won’t accept diagnoses without direct examinations.

Now some mental-health professionals say that there’s a “duty to warn” that overrides the Goldwater Rule, a “duty to warn” about the effect of Trump not just on the well being of America, but on the well being of Americans themselves, making them unstable, liable to suicide, and so on. And so a group of 27 mental-health professionals, including psychiatrists, issued a statement last October warning about Trump. An excerpt from that:

Efforts to bring Duty To Warn into the spotlight have been ongoing since Trump first stepped into the political ring. We are joined by mental health professionals from various field including, but not limited to, psychiatry, psychology, medicine, public health, public policy, and social work; in every field, professionals have been voicing their concern about the president’s instability.

We Are Mandated Reporters
Mental-health professionals are mandated reporters with a duty to warn our patients and the community around us if we feel there is a potential danger. In this case, we collectively feel there is a duty to warn the public of the threat Donald Trump poses both to our nation and the planet.

It is our duty to notice when an individual is a danger to themselves and/or others.

What about the Goldwater Rule?

“The Goldwater Rule is not absolute. We have a ‘Duty to Warn,’ about a leader who is dangerous to the health and security of our patients.” Mental-health professionals are “sufficiently alarmed that they feel the need to speak up about the mental-health status of the president.”

CMAJ counters:

Last October, when a group of 27 mental health professionals, including psychiatrists, published a book arguing that the current US president’s mental state was a danger to the nation, they said they were honouring another medical principle: the duty to warn. The idea behind “duty to warn” is that if you are in a position to know about a danger and have time to alert others, you should do so. Psychiatrists, for instance, are allowed to break doctor–patient confidentiality if they suspect a patient is about to harm a third party.

But part of that duty rests on having done a proper evaluation, according to Dr. David Goldbloom, a psychiatry professor and senior medical adviser for the Centre for Addiction and Mental Health. “You are intervening to abrogate fundamental civil freedoms,” he said. “You can’t do that from having read an article or watched television.”

Of course, we know that Trump is a danger to the country simply because of his statements and actions, and that seems to me independent of whether he has an official DMC diagnosis by professionals.

But Yale psychiatrist Bandy Xenobia Lee, in an interview with Salon (of course), says that it’s her duty to warn people about Trump’s instability.

Lee has a history of trying to publicize her views that Trump is mentally ill; see the section on this in Wikipedia, which also describes her lobbying Congress. That section says this:

in 2017 [Lee] was editor of The Dangerous Case of Donald Trump, a book of essays alleging that Trump suffers from psychological problems that make him dangerous.

. . . In an interview she also said, “whenever the Goldwater rule is mentioned, we should also refer to the Declaration of Geneva, established by the World Medical Association 25 years earlier, which mandates physicians to speak up if there are humanitarian reasons to do so. This Declaration was created in response to the experience of Nazism.”

And it’s possible that some of this has to do with, yes, inequalities in American society:

Lee then stated in an interview with Salon in May 2017 that Trump suffers from mental health issues that amount to a “state of emergency” and that “our survival as a species may be at stake.” She also discussed her political views, linking what she sees as increasing inequality in the United States to a deterioration in collective mental health.

She continues her efforts in the Salon interview (click to read):

First, she argues that Trump shouldn’t be allowed to debate:

Trump spent most of the debate heckling and interrupting, mixed with some blatant lying. How would you assess his debate performance?

The huge error was in allowing the debate to happen in the first place. “How was his debate performance?” is the wrong question to start. A debate presupposes mental health. We cannot pretend to have one when management of psychological impairment is what is warranted. The majority of the country may be horrified at what he is doing, but we continue to help the disorder in every way possible by treating his behavior as normal. It applies first to the politicians, then to the media and then to pundits who do not come out and honestly say: “This is beyond anything I have seen and beyond what I can understand — can we consult with experts?” And experts, for a psychological matter, would be mental health experts. Perhaps even specialists of personality disorders or sociopathy would be necessary, given the severity.

I’m not sure people treated his behavior as normal; the media was full of people saying that he seemed unhinged. Having someone like Lee weigh in that he’s mentally ill and shouldn’t have been allowed to debate adds little to that; in fact, I thought the debate was salutary in one sense: Americans got to see how unhinged Trump is. If they want to elect him after that, well, they’ll get what they deserve.

One gets the feeling, throughout this interview and in Lee’s other writings, that part of the reason for her crusade goes beyond her view that an unleashed Trump will harm America; it may well also involve her blatant dislike of his politics. In that respect she goes over the top in emphasizing the psychological toll of Trump on America, a toll that presumably should have mandated his impeachment:

The reinterpretation of the “Goldwater rule,” as happened at the onset of this presidency, has been exceedingly harmful, in my view, for silence in the face of grave dangers facilitates conditions for atrocities. Last month, we created a blow-by-blow account of how we exactly foretold the president’s mismanagement of the coronavirus pandemic, based on his psychological makeup. We could not effectively convey this in advance, because the public was led to believe that the “Goldwater rule,” which is a guild rule applying only to 6% of practicing mental health professionals, was universal, or worse yet, some kind of law. But in truth, to change a guideline whose purpose is to protect public health to protect a public figure at the expense of public health violates all core tenets of medical ethics.

Yet Lee has been broaching the Goldwater Rule for a long time (I don’t know how she gets away with this if she’s a member of the APA), and yet nothing has happened to Trump despite her books and her many interviews, all making the same point.

And she may well be right that Trump meets the ever-shifting psychiatric criteria for mental illness. I’m no professional, but Trump’s behavior seems way, way out of line—the tails of the human behavioral distribution. Still, I’m not comfortable with professionals giving a professional opinion by observing Trump the same way we do: scrutinizing his tweets, his press conferences, his debate performance. The man is out of control. But don’t psychiatrists need to talk to a patient before they tell the world he’s nuts? The effect of Trump on people is obvious, and you don’t need to be a mental health professional to see that his Presidency is risky to America. Having Dr. Lee tell us that, in our professional opinion, he’s nuts, adds nothing to our fear of the man.

In fact, if people tried to remove Trump from office, or prevent him from debating, based on Lee’s opinion that Trump is mentally ill, it wouldn’t work. People would just laugh at the attempt, and impeachment on the grounds of mental incapacitation wouldn’t do, either, at least not with a Republican Senate.

I can see where Lee is coming from: she’s a forensic psychiatrist and presumably sees nuances in Trump’s behavior that we don’t see. But we don’t need nuances—we know all we need to know, and if a liberal psychiatrist says Trump is certifiably a bull-goose loony, that will have no effect in swaying his supporters. We already have the means to stop Trump, and we can exercise it in the next four weeks by casting our ballots against him.

h/t: Randy

	Lorna Salzman on Amsterdam: Day 1
	Leslie MacMillan on University of Wisconsin-Milwau…
	Darryl R on University of Wisconsin-Milwau…
	Teresa Carson on Amsterdam: Day 1
	Darrell Ernst on Amsterdam: Day 1

Category: psychiatry