By Dr. David Laing Dawson
My field, broadly speaking to include doctors, psychologists and therapists of all stripes, has an unfortunate history of taking our patients’ anxieties and conflicts, usually stemming from that complex broth of nature, nurture, our intricate first 24 years of brain development, and our human awareness of self, and inventing a disease, or at least a defined and categorized “disorder”.
Part of this arises, I think, from our persistent failure to appreciate the extent to which our own presence, our words, our interpersonal exchanges and negotiations, affect the other’s perception of reality and memory.
Another part arises from our both professional and human need to categorize and label. Our patients share this need or wish. They often want a diagnosis. And then, of course, a role is played by insurance companies, our wish to have medical legitimacy, and big pharma.
In my professional lifetime we invented multiple personality disorder, and then satanic ritual child abuse. In the first instance we transformed a legitimate, entertaining literary conceit, into a medical reality. For the second, a naive psychiatrist followed his patient down a rabbit hole of fanciful experiences of cinematic child abuse and wrote a popular book about it. Both concepts flourished, and damaged thousands of lives before being debunked and diminished in size and scope.
Yet both linger on. The first in treatment programs for “dissociation disorders”, and the second in the search for, and assumption there is, an early “trauma” that would explain all of today’s anxieties and failures.
Beyond the damage these inventions have caused in and of themselves, they also undermine public understanding and empathy for actual neurological and mental illnesses. Beyond schizophrenia being persistently presented as a form of multiple personality by cinema and press, the very existence of invented fictitious diseases dilutes our concern for real diseases. Somehow schizophrenia has become a mental health issue while moments of adolescent perplexity have become disorders.
We can’t be human without being conflicted. Conflicted in our wants, desires, impressions, even our perceptions. Anxiety, stress, puzzlement, confusion are all necessary experiences in the evolution of our self awareness.
Our longest period of anxiety, confusion and puzzlement occurs in our adolescent years, and it is during those years that we are extremely and easily influenced by others, be they peers, teachers, dramatic fiction, cult leaders, popular culture, or that new phenomenon: social media influencers. The evidence is all around us in clothing, piercing, tattooing, and language fads. Every teen will say she is “expressing herself” in her clothing choices while obviously copying some trend or pop star.
In today’s popular culture there seems to be a strong belief in a journey to find oneself, one’s “true self”, as if this homunculus existed already, and awaits to be found hiding somewhere among the bushes of our seeking. Whereas, more realistically, the self we settle for (if we ever do) is an amalgam, sometimes a compromise, between our genetic directives and the stew of interpersonal and social imperatives surrounding and feeding us during our complicated brain development. To find that self, the adolescent brain really has only two basic modes of responding: reject/oppose or accept and imitate.
And today, of course, much of that interpersonal and social stew in which we simmer is virtual, distorted by social media algorithms, and often fictional. At a time when fact and scientifically established reality is readily available to all of us, we are bombarded with equal quantities of bull shit. And when we click on one piece of bull shit, Google and You Tube will start sending us endless streams of related bull shit.
Which leads me to a topic fraught with land mines: Gender dysphoria, binary, non-binary, and identity.
Now, before I go there, I have to say I have had a broad range of experiences with patients with “gender dysphoria”, from the extremes of a trans woman long post hormone treatment and surgery, now concluding it was all a mistake (“I should have been treated for obsession”), to a very smart, but socially very awkward young man, becoming a trans woman happier and more successful (socially and academically) than “she” was as a man (so far), and a young woman deciding she not only did not identify as female or male, she also did not “identify” as human. To say nothing of young men (always on the autistic spectrum) who are disgusted with their penises, to young women who have concluded, by experience, that it would be much safer to be a man.
This discourse could go in many directions but I would like to focus on the aspect implied by the opening paragraphs. We live in a time when we have cast out many rules and rituals and not found replacements, when the social stew in which our sense of self develops (in harmony or conflict with our natures) is, well, out-of-control, wild and uncontained. Dysphoria of all kinds is bound to increase. And, indeed, it has. Youth mental health is in the news every day, along with endless discussions of the effects of social media.
(How could it not increase when academic marks of A to D are replaced with terms like “emerging”, maternity nurses now talk of “chest feeding”, and almost any negative opinion is now considered “phobic”? )
So here is the question: Given all the above, might we health professionals be making matters worse by reifying this particular dysphoria, gender dysphoria, into a diagnosis (disorder, syndrome, disease)?
The numbers of children and youth diagnosed with this “disorder” are increasing at the same pace we once watched “multiple personality” and “satanic ritual child abuse” increase. The people who received these latter two “diagnoses” were of course troubled, dysphoric, seeking help, but the whole business of several named entities residing within one brain was an invention, complete nonsense, as was the whole notion that there were cadres of parents abusing and sacrificing children on Satan’s alter. As is the notion that a “person” can be born in the wrong body.
But all three situations tell us how much a confused and searching person (especially a child or teen) can be dramatically influenced by the social stew in which they live and breathe, and the damage naive counselors and health professionals can inflict when they ride the same waves of biological fictions.
To our shame we needed journalists and then law suits to stem our enthusiasm for multiple personality disorder. Perhaps we need the same with gender dysphoria disorder: