• Nick

Transworld


Having amassed 41 years in the learning and practice of medicine, it is interesting to see how the

discipline not only follows research, but is at the mercy of vested interests. These are increasingly

pharmaceutical companies, as well as government departments (Medicare, AHPRA, Medical Boards,

the Colleges, and the AMA all have a stake in the direction and practice of medicine). Additionally,

medical practice now closely follows the zeitgeist in terms of ethics, morality and permissible

practices.


During my training, we were instructed that perceived victimhood was inherently unhealthy, and

that the role of the counsellor was to help the patient understand their pathology and then

empower them to overcome their victimhood status. In the present climate, the doctor or counsellor

seeks to glorify victimhood, and encourage the victim to revel in a state of perpetual self-pity. When

there are tangible rewards for remaining in a victim class, this is known as Secondary Gain, and was

once considered a state to avoid. Currently, whatever the minority group (race, sex, minority ethnic

or religious group, minority sexual orientation), the rewards for identifying as a member of that

group are potentially immense, and with society as a whole encouraging the victim, there is little

impetus for the individual to leave that status. Either it is a good thing to languish in an unending

victim mentality, or it is bad. I feel quite strongly that it is the latter.


As I wrote in my article on the divided brain and divided medical profession (https://www.nightwatchmen.org/post/divided-brain-divided-medical-practice-by-dr-g) , medicine on the whole encourages non-judgemental empathy. Up to a point this is a good thing. However, as with the art of parenting, strict boundaries are also required. Our job as parents is to encourage our children to explore the world and to develop into mature, independent adults. We also have to ensure our

children understand limits and dangers. As Jordan Peterson aptly states, we all make judgements in

everything we do- making judgements and acting on these by putting boundaries in place are

necessary for a functioning world.


In modern “non-judgemental” medicine, I believe we have taken the concept of empathy too far,

and to our patients’ detriment. I do not believe it is healthy to allow our patients to set the terms in

all moral and ethical considerations, and passively help reinforce their sometimes pathological

beliefs.


Take for example the group of mental disorders involving abnormal body image. These comprise

eating disorders, in particular Anorexia Nervosa, where the sufferer delusionally believes their

emaciated body is fat; Body Dysmorphic Disorder, which DSM-V defines (in part) as Preoccupation

with one or more perceived defects or flaws in physical appearance that are not observable or

appear slight to others”, and Gender Dysphoria (Changed in 2013 by DSM-V from “Gender Identity

Disorder”). Interestingly, DSM-V now states “gender non-conformity is not in itself a mental

disorder.” It would appear clear that the purpose of this is to avoid stigmatising if transgender

individuals. However, how the mistaken belief that one’s emaciated body is fat, or a person’s arm

does not belong on their body can be a “mental disorder”, but the belief that one’s body is the

wrong sex is not, is an area not explained.


A Swedish study published in 2011, following several hundred patients who had undergone gender

reassignment surgery for up to 30 years found “Persons with transsexualism, after sex reassignment,

have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the

general population. Our findings suggest that sex reassignment, although alleviating gender

dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric

and somatic care after sex reassignment for this patient group.” https://doi.org/10.1371/journal.pone.0016885


The study showed up to 20 times increase in suicides and attempts in the cohort. Many other studies

have shown similar findings.


This is not to suggest that people with gender dysphoria should not be treated with compassion and

empathy. It does not suggest that surgery is wrong in all cases. However, simply expecting that

strong, lifelong medications, and deforming surgery will cure the psychological anguish suffered by

those with Gender Dysphoria is a gross oversimplification. It also fits the “victim” narrative, rather

than to empower those with the condition. Additionally, the use of medical treatment for

adolescents with Gender Dysphoria, when a large proportion of these individuals are later shown to

have autism or are simply homosexual, represents a huge dereliction of duty of care by the

profession.


It is important for the medical profession to return to the dictum “primum non nocere” or “first do

no harm”. It risks undoing the good of hundreds of years of scientific progress simply by failing to

understand its own past.


By Dr G

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