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Saturday, March 17, 2018

Inequality: Is Violence the Great Leveler?

If you prefer to listen rather than read, this blog is available as a podcast here. Or if you want to listen to just this post:

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Much of what I talk about in this space touches on subjects and themes commonly found in science fiction, and while I’ve read a lot of it over the years (though always less than I wanted to read) I only recently noticed that much of it shares a common feature: science fiction novels frequently feature individuals who are unimaginably wealthy. This is particularly the case when you’re talking about novels in the cyberpunk genre. I would say all of the William Gibson I’ve read is that way, as well as much of Neal Stephenson’s stuff. Altered Carbon by Richard K. Morgan, which was recently made into a TV series on Netflix, also fits the bill. (Additionally I’m reliably informed that the Jean le Flambeur series by Hannu Rajaniemi also features incredible wealth. But don’t take my word for it, I’ve only read the first book, and Hannu Rajaniemi is nothing if not opaque.)

All of this is to say that when people imagine the future, particularly the near future, they imagine a world in which inequality has increased. Of course there are exceptions. Star Trek’s lack of money presumably puts it in a different category, though Star Trek is not the near future, and it also concerns itself with a very limited slice of the future it does imagine. (Consider, what your view of modern America would be like if it came entirely from stories about submarine crews?) I bring up this element of science fiction not as proof of some assertion, but rather more to support the general observation of where people think things are headed. Which is to say, inequality is likely to continue to increase.

As I said, pointing to a few (or even a hundred) science fiction novels doesn’t prove anything. But that’s where The Great Leveler by Walter Scheidel comes in. Rather than make a general observation about the proclivities of science fiction authors he went back through history. Bringing in statistics from as far back as Assyria and continuing all the way through to the present day. As you can imagine the farther back you go the worse the data is, though they’re able to make some significant inferences from the size of skeletons and the square footage of dwellings. Based on all these statistics he comes to the same conclusion as our example science fiction authors, inequality trends inexorably upward over time. That, absent massive societal disruption, (a subject we’ll be spending the majority of our time on) inequality will rise forever. Meaning that rising inequality isn’t just a literary tick of science fiction writers, but that it also matches the facts on the ground.

Of course inequality is not some unique concern of Scheidel, he bases much of what he says on Thomas Piketty’s well known work Capital in the Twenty-First Century. Though Piketty only covers the last 250 years or so, and recommends taxation as the solution for rising inequality. On the first point, Scheidel goes much further back and on the second point, he is far less optimistic that there’s any effective policy-based solution. If one were to consider merely Piketty’s numbers from the last 250 years the argument could be made that inequality is a function of the modern world, a child of the Enlightenment and the Industrial Revolution along with so many other things. Scheidel argues persuasively that it’s not, that recent levels of inequality are not an aberration, but rather just the way the world works. If this was the only point of The Great Leveler than it would be an interesting expansion to Piketty, but hardly be saying anything unexpected. It’s when we consider his second point, the difficulty of doing anything about inequality, absent, as I said, massive societal disruption, where the book really sets itself apart.

Before we get to the main discussion of what Scheidel considers massive societal disruption, and the identity of “The Great Leveler”, we need to deal with the book’s unstated assumption. The assumption that inequality is a “bad thing”. In my opinion not spending the time to lay out a foundation for why it’s bad is one of few weaknesses of the book. Though, I suspect that when you’re as deep into the subject as Scheidel is, the harm of inequality seems so obvious as to be not worth mentioning. And while I largely agree with this assertion, I think there are several arguments which could be made in opposition, and by not acknowledging them in the beginning, Some people will take it as an opportunity to dismiss the book out of hand. This might take the form of pointing out that, today, even the poorest people are so materially well off that it doesn’t matter that the top 1% of people have 40% of all the wealth. The modern poor still live lives that would beggar the imagination of even kings if you go back more than a few hundred years.

One of the reasons why Scheidel may have ignored this argument is that in the simplest sense it’s obviously not true. We don’t live in a society where everyone is getting more wealthy. Any explanation of inequality will not merely point out the disproportionate share of the wealth held by the top 1% (or 0.1%) but will also point out that real wages have been stagnant or declining for decades. Inequality is increasing in both directions so to speak. As I have pointed out in previous posts, it’s not merely that the rich are getting richer, the poor are getting poorer.

This is not merely something which is only happening in the present day. Inequality appears to always expand in both directions. Of course, this makes sense. In pre-modern times wealth was much more of a zero sum affair, nevertheless some of the examples Scheidel gave were striking. In particular I appreciated his examples from the middle ages. The fall of the Roman Empire led to an enormous leveling, which lasted for centuries. Thus in contrast to how most people view the “dark ages” we find that peasants were comparatively well off, and things actually got worse during the high middle ages:

English inequality rose throughout this period [1000-1300]. Whereas the Domesday Book survey of 1086 shows that most peasant households held enough land to achieve income above subsistence from their own plots alone, the Hundred Rolls survey of 1279 to 1280 suggest that most of their descendants could hope to break even only by supplementing their farm production with wage income from harvest work for others. A model simulation indicates that demographic growth by itself was insufficient to produce this outcome...Some peasants became entirely landless, which raised asset inequality even further. Moreover, English land rents for commoners rose greatly between 1000 and the early fourteenth century, even as the size of their holdings shrank. In France meanwhile, typical plot size fell from around ten hectares to often fewer than three hectares between the ninth and early fourteenth century.

In response to this, I can imagine people like Steven Pinker (a review of his book Enlightenment Now is coming) and perhaps some of the transhumanists saying, “Sure, that sort of thing happened back then, but now we have progress and technology!” In other words they don’t disagree that inequality may be widening, or even that the poor are not, by some measures, getting poorer, but that if we look at more subtle measures people aren’t actually worse off.

The argument goes something like this, we can imagine that technology is increasing at a rate such that even if an average person living below the poverty line has $0.90 of purchasing power for every $1 they had ten years ago, that this $0.90 buys more than the $1 did ten years ago. Certainly this is the case with computers and smartphones and TVs. It’s less clear that it’s the case with things like healthcare and education. Thus while there’s definite evidence for the simple argument being false, the argument that technological progress is moving faster than rising inequality has a lot going for it.

Unfortunately even if this more subtle version of the theory is true, I don’t think it will matter, because that’s not the way people see the world. You can tell someone they’re better off than they would have been 50 (or even 10) years ago till your blue in the face. You can provide charts and graphs and side by side comparisons, but they’re going to ignore all of that in favor of a good story. Stories like the one about the AIG employees who took home $1.2 billion in bonuses after needing a government bailout, or about how the average CEO is making 940% of what they were making in 1978, or the story about that guy they knew in high school making a million dollars a year on Wall Street. In light of these stories, the fact that the PlayStation 4 is ten times as powerful as the Playstation 3 while essentially being the same price, is going to have very little impact. Unfortunately, people don’t have some absolute standard of material well-being to measure themselves against. Rather they have a relative standard which is driven by the availability bias. Meaning even if people are objectively better off, it’s unlikely to make any difference in perceived inequality.

Accordingly the question of whether inequality is inherently bad may be beside the point, people experience it as a bad thing, and in the end this probably amounts to plenty of harm for our purposes. Having established that inequality is a bad thing, or at least if we agree to proceed from that assumption, the question then becomes what can be done about it? And the answer is nothing, or at least nothing anyone is going to be very excited about. As Scheidel puts it:

Thousands of years of history boil down to a simple truth: ever since the dawn of civilization, ongoing advances in economic capacity and state building favored growing inequality but did little if anything to bring it under control. Up to and including the Great Compression of 1914 to 1950, we are hard pressed to identify reasonably well attested and nontrivial reductions in material inequality that were not associated, one way or another with violent shocks. (emphasis mine)

And not only are all reductions of inequality associated with violence, but Scheidel further asserts that:

State collapse served as a more reliable means of leveling, destroying disparities as hierarchies of wealth and power were swept away. Just as with mass mobilization wars and transformative revolutions, equalization was accompanied by great human misery and devastation, and the same applies to the most catastrophic epidemics: although the biggest pandemics leveled mightily, it is hard to think of a remedy to inequality that was dramatically worse than the disease. To a great extent, the scale of leveling used to be a function of the scale of violence: the more force was expended, the more leveling occured.  Even though this is not an iron law—not all communist revolutions were particularly violent, for example, and not all mass warfare leveled—it may be as close as we can hope to get to a general premise. This is without any doubt an exceedingly bleak conclusion. (emphasis mine)

In other words, to end the suspense (not that there was ever very much of it.) Violence is The Great Leveler, the only thing, Scheidel claims, which has ever reduced inequality. GIving us two very unattractive options: either inequality increases more or less forever, and we get the dystopian science fiction worlds I started the post with, or we have to periodically have horribly violent shock to level things out. And of course this assumes that the two things are disconnected. It’s entirely possible that once inequality reaches certain extremes that something like a violent revolution becomes inevitable. That inequality will eventually create the violent shocks necessary to it’s reversal. That even if we decided we were fine with inequality because the violence necessary to undo it is worse, that we may not have a choice.

Most people, of course, are hoping that this is not the case, that there is some third way which doesn’t involve either extreme inequality, or extreme violence. Scheidel spends 400+ pages arguing that there’s not, but it’s worth reviewing those arguments.

First let’s start with explaining precisely what Scheidel means when he says violent shocks:

Through recorded history, the most powerful leveling invariably resulted from the most powerful shocks. Four different kinds of violent ruptures have flattened inequality: mass mobilization warfare, transformative revolution, state failure and lethal pandemics. I call these the Four Horsemen of Leveling. Just like their biblical counterparts, they went forth to “take peace from the earth” and “kill with sword, and with hunger, and with death, and with the beasts of the earth.” Sometimes acting individually and sometimes in concert with one another, they produced outcomes that to contemporaries often seemed nothing short of apocalyptic. Hundreds of millions perished in their wake. And by the time the dust had settled, the gap between the haves and the have-nots had shrunk, sometimes dramatically.

As you can see there’s not a lot of wiggle room, none of the horsemen are particularly attractive and even those that might seem okay, suffer from the flaw I already pointed out, that leveling is a function of violence, the more leveling the more violence. Meaning there’s no way to achieve leveling through “fake” mass mobilization, or peaceful revolution, or a smooth state failure or a pandemic that kills only a few thousand people. Still it’s worth going through each of the Horsemen in turn.

For the first Horseman, note that Scheidel specifies “mass mobilization warfare”, not merely just war. As it turns out previous to the era of mass mobilization war had no effect on inequality. This is, perhaps, one of the reasons why there was so much of it. The wealthy elites who were making the decisions didn’t suffer from the wars they started. The rich continued to get richer regardless of whether the country was at war or not. This is pure speculation, but this change is perhaps why, in addition to the deterrence provided by nuclear weapons, we haven’t had another large war. It was suddenly no longer something which the elites could engage in without consequence.

What this all means is that in order to achieve significant leveling through war, you need something like World War I and II, Iraq and Afghanistan and Syria are not going to cut it (though they probably work for the Iraqis, the Afghanis, and the Syrians.) And with the existence of the aforementioned nuclear weapons, it seems very unlikely that we’re ever again going to have large scale conventional war of the sort requiring mass mobilization. Some people like Paul Krugman have offered up the suggestion that it might be possible to fake mass mobilization (his idea was an alien invasion) but it seems unlikely that anything short of a perceived existential threat has the power necessary to produce the leveling. A real alien invasion would do it, it’s unclear that a fake one would…

The second Horseman, “transformative revolution” is where the connection between the amount of violence and the amount of leveling becomes most apparent. On the one hand we have the communist revolutions of the 20th century which accomplished significant leveling, but at a staggering cost, killing tens of millions of people in pursuit of that goal. On the other hand we have the French Revolution which:

...holds pride of place in the popular imagination and would seem a particularly promising candidate among potentially equalizing conflicts...That said, there is no indication that the French Revolution resulted in anything even remotely comparable to the leveling brought about by the major twentieth-century revolutions. Changes in landownership, wealth concentration, and income distribution occurred at the margins...But this process was far from transformative overall. This finding meshes well with the comparatively moderate degree of violence directed against the propertied classes: however much it may have scandalized conservative contemporary observers, a revolution that by later standards turned out to be quite restrained in its means and ambitions yielded correspondingly less leveling.

It’s frightening to imagine that even the French Revolution, as terrible as it was, had only a tiny effect on inequality. Which is to say that, if history is any guide, so-called revolutions like Occupy Wall Street are unlikely to have any effect on inequality.

I could spend a whole post on the third Horseman, state failure. Because, for all the advantages that come with the existence of a state, it is also the mechanism rich elites use to increase inequality. As an example of the inverse, to my surprise, I learned while reading the book, that the average Somali is doing quite well in the absence of a central government. We also saw this same thing earlier in the post with the average 11th Century European. And, indeed, historically, when the state collapses the mechanisms for creating inequality collapse with it. Though, as I’m sure you’ve already figured out, state collapse does not represent some non-violent shortcut for reducing inequality, it has always been exceptionally bloody.

The final Horseman, lethal pandemics, is also great at leveling, though again at enormous cost. The mechanism for this should be self-explanatory, so instead I’d like to focus on something else, the eventual adaptation by rich elites during the Black Death. From the book:

...this compression of inequality was not to last...remarkably the plague recurrence of 1630, which was the worst regional mortality since the Black Death itself and which is thought to have killed as much as a third of the population of northern Italy, failed to have any comparable effect on inequality...This suggest that after the initial shock of the Black Death and its immediate recurrences, which hit landowners who were ill-prepared to deal with the economic consequences, the propertied classes eventually developed strategies for protecting their estates in times of demographic shocks...It seems that even the most violent of epidemics could be tamed by cultural learning...

It is this adaptation, even in the face of staggering catastrophe, which makes inequality so hard to reduce, and which makes policy solutions largely ineffective. We’re about out of space so I’ll give just one example from the book:

The most detailed and precise equalization program that has been put forward to date, Anthony Atkinson’s recent blueprint for how to reduce inequality in the United Kingdom, illustrates the limitations of this policy oriented income tax rate should rise to 65 percent, income from capital should be taxed more aggressively than earnings from labor...every citizen should receive a capital endowment... guaranteed employment at the living wage...

And if the UK were to do all that?

...the Gini coefficient of equivalised disposable income would fall by 5.5 percentage points...To put this in perspective, by his own account the same British Gini has gone up by 7 percentage points between the late 1970s and 2013. Thus even a combination of several quite radical and historically unprecedented government interventions would reverse the effects of resurgent inequality only partially, and more moderate policies would yield even smaller benefits.

You can certainly see where the fantastically unequal future imagined by science fiction novelists appears less like a possible outcome and more like an unavoidable outcome. And unfortunately the advances envisioned by transhumanists would appear to only only exacerbate this problem (how much easier would it be for Bezos and Gates and Zuckerberg to hold on to their wealth if they never died?)

There was much in the book I didn’t cover, and some things I tossed out without necessarily going to the trouble of including the supporting passage, and I guess this leads to the question of whether I would recommend that you read the book in its entirety. Probably not. And this is not because it’s not a good book, if you were about to engage in a debate on inequality, I would definitely recommend it, if this is a subject you’re particularly interested in, I would also recommend it, but if you just want to understand his point, and you’ve read this far, then I’m sure you already do, and reading the entire book would not add much to that understanding.

We still need to address the question of what to take from all of this? What should we do? Frankly, it’s not clear. Given the scale of violence necessary to reduce inequality, I suppose it’s probably better to accept inequality as a fact of life rather than risk the deaths necessary to do anything about it. But even if that is the best course of action, in the long run it may not be an option. Perhaps there are a few people who can calmly accept this conclusion and go on their way (almost certainly these people will be those who benefit from the inequality) but my sense is that the great mass of people will not. It may be that regardless of the potential consequences, people will inevitably and eventually resort to violence as a means reducing inequality. And that’s assuming that we can avoid the Four Horsemen of Leveling otherwise. In any event, when all is said and done this is one more potential reason why “We are not saved…”

Uplifting messages of hope and progress like the one I just shared are not cheap to produce, so if you enjoy my relentless optimism and perpetual cheer consider donating.

Saturday, March 3, 2018

The Trend of Transgender Identity (Part 2)

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One of the good things about doing a two part post is that you get the chance to receive feedback in the comments section on what you’ve said thus far. The last post was no exception, and an excellent discussion ensued in which some great points were made. But before I get to that, I’d like to have a bit of a meta-discussion, and set forth an editorial policy for this blog which will exist until otherwise rescinded. I like to show my commenters in the best possible light since they went to all the trouble of actually commenting, and thus I will take the liberty of making minor editorial corrections where it’s an obvious typo or mistake, if you really care about fidelity you can alway go back and read the original comment. With that out of the way let’s start with a comment from Mark:

From a sex perspective there is a difference, one of fundamental biology, in every cell of a person's body - male vs female. This comes down to the definitional difference of sex versus gender. If you can't agree that Jenner's sex is fundamentally male, there's nowhere to go from there. If we can agree on that, then it all boils down to the nebulous question, "what is gender?"

The general definition of gender is that it is socially, or potentially neurologically, constructed. If it's a social conduct, it's unclear what causes certain individuals to interpret their gender to be different from their biological sex based on cumulative social interactions. If it's neurologically determined, we really have no understanding of the fundamental mechanisms involved.

Since we really don't know what causes individuals to identify as a different gender, it's a little premature to claim victory for one side of the argument that claims it is a natural phenomenon to be respected and accepted, over the side the claims it's a condition to be treated. Both sides are arguing from the same degree of ignorance until we know what causes TG. Since we don't even know whether it's increasing our even increasingly identified, I try to be be a little less certain in my proclamations.

To begin with he makes a valuable distinction between socially constructed and neurologically constructed, a distinction which I mostly glossed over in the last post. Also he makes a very valid point about certainty. I know that listing a bunch of theories, with my own sense of likelihood, isn’t the best way to demonstrate a lack of certainty, but I really am not certain about what’s happening, which I hope is somewhat reflected by my kitchen sink approach to the whole thing. Also, while it’s not exactly a theory, we should include in our list the very real possibility that we have no idea, that it’s something we haven’t even thought of, or that it’s a combination of a lot of things, many of which I may have touched on, some of which I almost certainly haven’t. All of this was not emphasized enough in the last post.

Moving on, Boonton had this to say:

I suspect what is happening is probably akin to autism. On the one hand we know more about what to look for hence we see it more than we used too. On the other hand, the definition has been expanded so more are covered by it than they used to. However since we can't measure past populations with today's tests it's hard to rule out if autism has remained constant, decreased or increased. I think we might get to a point where we could rule some things out. For example, I think we could rule out 0% from your days in HS. Might, though, the rate have been 1.5% and now it's 2.5%?  

There might be something else afoot too...autism, like gender, is about how the individual relates to society and vice versa. Since society isn't constant, this isn't as simple as asking what the 'rate' is.

First, to clarify, I never claimed the rate at my high school was 0%. I claimed that there were zero individuals who were openly transgender, but that if I had to guess there were probably a couple who were closeted, which would be a rate of around a tenth of a percent. A number I’m sure Boonton and I disagree on, but I’m not trying to pull a there are no homosexuals in Iran stunt. Also as I indicated, I was more offering it up as a story/example of how the phenomenon played out for me than as actual hard data.

Second, I agree that autism is a pretty good analogy, particularly insofar as it speaks to a phenomenon where everybody agrees with Boonton’s point that part of the increase is due to being able to identify it better, while also expanding the definition of what it is. This all stems from the fact that there’s no blood test, brain scan, or other objective test for autism. It all depends on how closely the individual being screened for autism matches the criteria in the DSM. TGNC is similar and thus it is entirely conceivable that the increase is all just due to an increase in identification and a broadening of definition. The question, then, is once we account for those two factors do they explain the entire increase? Or is there something left over?

My gut says that there is, for a couple of reasons. First, to use the example of autism, the rate continues to increase despite an awareness of the problems of overdiagnosis. Second there are studies which have tied autism rates to paternal age, premature birth, and toxins in the environment. All things which have been increasing recently. Still it would be nice if there was some clear objective standard for whether someone is definitely autistic or definitely transgender. And in a roundabout way this takes us to our final theory for the increase.

Gender dysphoria is a body dysmorphic disorder similar to anorexia and bulimia

If you do a search for this theory on the internet you’ll find that it’s a popular but very controversial explanation for gender dysphoria. Up until recently, the sense I got was that this was one of the main explanations for what was happening. And people were confident enough in it as an explanation that it led people like Paul McHugh, the Chief of Psychiatry at John Hopkins from 1975 to 2001, to shut down their gender-identity clinic, which was only re-opened last year. An act which I think mirrors the arc of this theory. What was once one of the main explanations for TGNC, gradually came to be one of those things that people don’t bring up in polite society. It’s not hard to see why, the association is definitely negative, but more than that, it doesn’t offer any immediate solution even if you grant the connection. Anorexia and bulimia are notoriously difficult to treat, meaning there’s not some simple solution which then can easily be transferred over and tested on people with gender dysphoria to see if it works. Moreover to the extent anorexia and bulimia can be treated, we haven’t identified the underlying cause, meaning that what works has been more a matter of trial and error, than anything that gets to the root of the problem.

This inability to discover an underlying mechanism makes any connection between the two conditions speculative at best. But they both share the qualities of being something entirely unexpected from the standpoint of evolution, at least partially driven by culture, and apparently increasing. For many people it’s the evolutionary angle that’s the most interesting. Though there is a group of phenomena I mentioned in a previous post which might help explain things. The phenomenon of supernormal stimuli, edge cases where trends which previously had an upper limit set by nature, are allowed to exceed those limits by technology, creating unexpected behavior with no survival value.

Along those lines, if you’ll permit me to digress into some fairly wild speculation. Historically the vast majority of people would have no examples of extreme masculinity or femininity, being limited to the narrow sphere of people they came in contact with in the local village. None of these people would have much in the way of access to fancy clothing, to say nothing of makeup or a hair stylist. The modern world has changed all that, and now we are confronted with extreme examples of both masculinity and femininity all the time. And by extreme we’re talking about the one in a million supermodel or athlete.  The kind of person our ancestors wouldn’t encounter in a hundred lifetimes. People have already drawn a connection between anorexia and bulimia and the constant exposure of young women to incredibly skinny models. Could a similar exposure to gender extremes have created gender dysphoria? Also, consider, going back to our historical example, the lack of fancy clothing and similar didn’t apply to nobles and interestingly enough, that is precisely where we see most of the examples of androgyny, and similar “gender-bending” behavior. As I said, it’s some fairly wild speculation, but not completely baseless either.

Here we arrive at the roundabout connection I mentioned earlier. Whatever you feel to be the similarities between anorexia and gender dysphoria (and you may think there are none). The former is at least easy to diagnosis objectively unlike autism. Which is to say, we have an example of an objectively diagnosable condition which modernity has definitely made worse, and if there’s a connection maybe the same applies to gender dysphoria, despite the difficulties of evaluating it in a similarly objective fashion. That said when considering the likelihood there is at least one way in which they are dissimilar. The growth rate in anorexia and bulimia peaked quite a while ago, and more recently it’s basically plateaued, while, as I pointed out, the TGNC rate appears to have spiked only in the last few years.

With the final theory out of the way (and remember it may be a combination of these theories, and it also may be none of them). It’s time to tackle the question of why it matters. If it were simply a matter of fashion, say the return of bell bottoms, or even if it was a full on epidemic of cross dressing, but lacked any additional desires for surgical changes, it might merit a paragraph in my blog, but I certainly wouldn’t spend two whole posts talking about it. Clearly, however, this phenomenon goes beyond just a change in labels. There is definitely something more going on, the question is what? For some people it’s enough to label the whole thing as unnatural, and depending on how broad you want to make the definition of that word, it almost certainly is, but I’m enough of a libertarian to not care if something’s unnatural if it’s mostly harmless. Thus the question is not whether it’s unnatural (which is difficult or impossible to answer) the question is whether it’s harmless? And here the answer appears to be “no”, and on this point I find myself deeply indebted to an anonymous individual who took the time to comment on the last post:

I can say from experience that dealing with gender dysphoria is very stressful. I've frequently felt suicidal, and I haven't even had to deal with bullying or any of the other stuff that people who are living an 'out' TG lifestyle have to put up with. There's definitely more to the high suicide rate than just bullying.

Here he mentions the issue that eventually gets brought up in any discussion of people who identify as TGNC, particularly if you’re speaking about harm, the issue of suicide. A couple of the other commenters get deep into the weeds trying to determine exactly what the rate is, and if you’re interested in that I would urge you to read their discussion. But I think even those who are most strident in arguing for a lower rate than what you can find in the literature (also their might be some confusion between suicide attempts and suicides) would agree that TGNC individuals are at a significantly greater risk of suicide than the general population, and of course the question is why.

One of the most common explanations, is that the increased risk of suicide is due to bullying. In which case there’s no harm inherent to the TGNC identification itself, all of the harm comes from the ignorant people who surround the individual. Here is where you see why I’m so indebted to the anonymous commenter, because he provides a first person account that his gender dysphoria made him feel suicidal and it had nothing to do with the bullying. This is a point I’ve made in the past, though when I made it then I was looking at some statistics rather than a first person account. Specifically I was pointing out the fact that the suicide rate was going up, particularly among TGNC individuals, but that it was going up at the same time that society was becoming increasingly tolerant. Two trends that should have been inversely correlated were positively correlated.

Which brings me to one of the things I was hoping to accomplish with these two posts. If we can agree that the suicide rate among TGNC individuals is higher than the general population, and if we can agree it’s not solely because of bullying or because society is becoming less tolerant. Then I assume that we can all further agree that if we could reduce that rate without any other unintended consequences that we would want to do that. Right? From this it more or less follows that if TGNC is increasing and we can figure out why it’s increasing and stop that increase we should do it. Correct?

In response to anonymous’ original comment I said:

I hope you won't mind if ask whether you would take the opportunity to eliminate your dysphoria if that were an option? Say there was a drug you could take with minimal side effects. Or is it so much part of your identity, that despite it being "very stressful" you wouldn't want to eliminate it?

To which he responded:

I would have it removed in an instant. I would give up anything else too, as long as I was assured that I would be happier afterward.

Which means we have at least one person who is actually experiencing gender dysphoria who would answer “yes” to that question, i.e. that if we can figure out why it’s increasing and stop it from increasing (or even reverse it) then we should.

Obviously a lot hinges on whether it’s actually increasing. If the rate is static, as many people assume, than regardless of suicide risk there may not be much we can do. (Absent something radical like gene editing, and this assumes it’s actually genetic.) It may be, as they say, part of the landscape. However, as I’ve repeatedly said, I don’t think that it is static, meaning, there might be things we can do or not do. And speaking of things not to do, when considering transgendered individuals and suicide, much has been made of the suicide rate after gender reassignment surgery. And in fact, in the previous post on this subject I brought it up as evidence that merely doing everything possible to match the outward expression of gender to what the person felt like on the inside was not a surefire solution to depression and suicide.

In the course of revisiting the subject while writing this post I did look for any rebuttals for this increase. And I came across an article on The article brings up some excellent points, but they are all related to the way things were interpreted, they don’t question any of the actual results. You are welcome to read it for yourself, but as far as I can tell the chief complaint they have with the interpretation is that there was no control, that these are people who suffered so strongly from gender dysphoria that they went through with surgery even in a time when it was still relatively new and taboo (1973-2003) and that as part of that the amount of societal backlash was severe. Thus first, an accurate interpretation would have to account for the greater “bullying” experienced by post transition individuals, and second you need a control group of people who felt equally strong dysphoria but who didn’t have the surgery, your control can’t merely be anyone who identifies as transgender regardless of the intensity of that feeling. (See here for something similar.)

Both of these points make sense. The study was done when gender reassignment surgery was still very new. And one would expect the backlash to be greater. (Indeed if you look at people closer to the end of the study the increase appears to vanish.) Similarly given how new the surgical option was, it would make sense that only those with the most extreme cases of gender dysphoria would have taken that option, and at that level it may map to an increased suicide risk regardless of whether they underwent surgery.

All that said, I think the main point remains. We have this idea of what will help TGNC individuals, more tolerance, surgery, greater acceptance, etc. And all of them essentially flow out of my first theory (and maybe the second). That basically there’s just this hump where tolerance lags behind reality, and if we can just get over it, TGNC individuals will be no more suicidal than anyone else. And while I agree that tolerance is important, in fact the most important thing with respect to our day to day interactions, society just keeps getting more tolerate without any corresponding decrease in the number of suicides. Also this skips over understanding whether the increase is just an increase in the number of people identifying as TGNC or if it’s an increase in the actual underlying rate.  Instead we skip over that understanding and move straight to the tolerance step, and often times then rush straight on to the surgery step. But as far as I can tell there’s no evidence this reduces suicidal ideation. The article may be right that it doesn’t increase it, but I haven’t seen any numbers claiming that it decreases it, which means our best case scenario is that it holds things constant, with the possibility still open that it makes things worse.

This takes me to the other potential harm I worry about, how all of this plays out with respect to children. An increasing number of children identify as TGNC, and the question of how to handle them is becoming acrimonious to say the least. From The Economist:

What is unforgivable is that children are caught in the crossfire. Soaring numbers are seeking help for gender dysphoria...If they are unlucky, what happens next will have more to do with an adult battle over identity than with what is right for them.

Gender reassignment is a momentous choice, since it causes irreversible physical changes and, if surgery is done to reshape the genitalia, perhaps also sterility. For gender-dysphoric children the clock is ticking, since puberty moulds bodies in ways no drugs or scalpel can undo. Waiting until adulthood to start the transition therefore means worse results.

Some clinics buy time with puberty-blockers, which suppress the action of sex hormones. But these may have harmful side-effects. Furthermore, most gender-dysphoric children will probably not become transgender adults. Studies are scarce and small, but suggest that, without treatment, a majority will end up comfortable in their birth sex, so treatment would be harmful. Unfortunately, no one knows how to tell which group is which. Yet some trans activists have thrown caution to the wind. Specialists who start by trying to help gender-dysphoric children settle in their birth identities, rather than making a speedy switch, risk being labelled transphobes and forced out of their jobs. Few are willing to say that some such children may actually be suffering from a different underlying problem, such as anorexia or depression.

That’s a long quote, but it covers a lot of ground. And since I’m basically out of time, the key point I want to draw your attention to is that most transgender kids do not grow up to be transgender adults. (In another article The Economist gives the number as 12-39%). Meaning that understanding what’s going on, determining whether it’s increasing and why, are becoming more and more important.

I don’t know what to do, or what’s going on. Or which if any of these theories is the correct one, or what to tell a parent who has a TGNC child, or what to tell my anonymous commenter. Though I definitely think he was on to something when he said this:

I'm glad you're finding this interesting. I'm finding it nice to be able to talk about.

I also think it’s nice to be able to talk about it. And I think being able to discuss all possible theories without fear of being labeled a horrible person might be a good first step

There will be no post next week, I’m going to be travelling. I probably still could have done something, but I didn’t want it to be rushed. In light of that I will lay off the guilt for the week as well. No request for donations. But if a lack of guilt is what you were waiting for then go right ahead.