It is truly bizarre to see how willing the medical establishment has been to double- and triple-down on the idea that no one needs to worry about any of this because gender-affirming care is literally NEVER administered based on a misdiagnosis. Sure, the Rachel Levines and Jack Turbans of the world will admit (if pushed), giving teen gir…
It is truly bizarre to see how willing the medical establishment has been to double- and triple-down on the idea that no one needs to worry about any of this because gender-affirming care is literally NEVER administered based on a misdiagnosis. Sure, the Rachel Levines and Jack Turbans of the world will admit (if pushed), giving teen girls double mastectomies as a treatment for anxiety and depression might not make sense if their anxiety and depression are coming from causes other than gender dysphoria. But don't worry! Clinicians are able, with 100% accuracy, to ALWAYS accurately detect when anxiety and depression are caused by true, persistent, gender dysphoria. And no clinic in these United States has ever, or will ever, perform a double mastectomy on this population without one of those perfectly accurate diagnoses (but don't you dare suggest mastectomies should be limited to those who've received significant counseling and diagnosis, you filthy gatekeeper).
It's just nuts. I'd wager that every person on this board has, personally, been the recipient of at least one medical diagnosis that, in retrospect, proved obviously incorrect. Medical diagnoses are really hard! The idea that we don't need to worry about mistakes in gender-affirming care because NO MISTAKES WILL EVER BE MADE is insane.
Oh, don't worry. Dr. Olson-Kennedy famously pointed out that if a patient changes their mind, they can always get reconstructive surgery. So what's the big deal?
And just like that, the clinic can get paid twice. Once to lop off the patients' natural breasts and then again to sew on new fake ones a few years later.
That comment by Olson-Kennedy is really unbelievable, isn't it? I don't know whether it's more stupid, more ignorant, or more condescendingly arrogant.
Anybody who has ever been involved in mental health care, or is close to someone who has, should absolutely understand that the idea of getting a diagnosis and a treatment right on the first try with any consistency is laughably naive (my now-wife was diagnosed with like 3 different things before they settled on bipolar disorder and has been on at least half a dozen different treatments, not counting dosage changes, before they settled on something that consistently worked).
The thing is they're also dealing with motivated patients. It's like screening adults for ADD you're gonna get a fair amount of ppl who specifically want to be Dx w/ Adult ADHD so that they can be prescribed Adderall . The smart ones will go online and quickly get a good overview of what they should say and how they should respond to questions in the ADD assessment they're asked to fill out. With these childhood GD cases you've got basically the same thing. A group of highly motivated patients seeking a specific thing who have been told or read online exactly how they should respond to these assessments. So even just checking all the boxes and doing all the assessments isn't really enough.
The psychiatrist really needs to interview the patient in detail to get a more honest view of the patient. Ideally they'd have a neutral non activist therapist talk to them for several sessions. It's much easier to con a quick assessment form than it is to keep up an act for hours of therapy.
If they want any hope of getting something approaching the honest truth they need to evaluate these kids over many sessions and using many different assessments that the patient likely hasn't taken the equivalent of a study prep course for.
It's also critical for doing differential diagnosis. Even without some highly motivated patients who've been coached on how to answer questions there's still a chance someone could score high on GD but the underlying cause be another mental health issue. When it comes to young kids they should be screening for basically everything else and trying out treatments for those discovered conditions before pulling the trigger on permanently life altering medical interventions.
I think this is a very good point. I generally agree with the point that much of psychiatry is less well justified than the rest of medicine. That's one reason I am so skeptical of surgical treatments for mental/emotional complaints such as gender dysphoria.
However, if you're trying to win over the psychiatric establishment and turn them away from particularly bad behavior, it makes sense to be strategic, and make a distinction between better and worse methods of diagnosis and treatment, and better and worse research. I think that's what Jesse is trying to do.
It is truly bizarre to see how willing the medical establishment has been to double- and triple-down on the idea that no one needs to worry about any of this because gender-affirming care is literally NEVER administered based on a misdiagnosis. Sure, the Rachel Levines and Jack Turbans of the world will admit (if pushed), giving teen girls double mastectomies as a treatment for anxiety and depression might not make sense if their anxiety and depression are coming from causes other than gender dysphoria. But don't worry! Clinicians are able, with 100% accuracy, to ALWAYS accurately detect when anxiety and depression are caused by true, persistent, gender dysphoria. And no clinic in these United States has ever, or will ever, perform a double mastectomy on this population without one of those perfectly accurate diagnoses (but don't you dare suggest mastectomies should be limited to those who've received significant counseling and diagnosis, you filthy gatekeeper).
It's just nuts. I'd wager that every person on this board has, personally, been the recipient of at least one medical diagnosis that, in retrospect, proved obviously incorrect. Medical diagnoses are really hard! The idea that we don't need to worry about mistakes in gender-affirming care because NO MISTAKES WILL EVER BE MADE is insane.
Add to all of that the fact that the "diagnosis" is officially up to the child, and that suggesting alternative explanations is supposedly unethical.
Oh, don't worry. Dr. Olson-Kennedy famously pointed out that if a patient changes their mind, they can always get reconstructive surgery. So what's the big deal?
And just like that, the clinic can get paid twice. Once to lop off the patients' natural breasts and then again to sew on new fake ones a few years later.
Which will also need to replaced every ten years. KA CHING
That comment by Olson-Kennedy is really unbelievable, isn't it? I don't know whether it's more stupid, more ignorant, or more condescendingly arrogant.
Dr. Olson-Kennedy must have read 'Sneetches' and thought Sylvester McMonkey McBean was really on to something.
Anybody who has ever been involved in mental health care, or is close to someone who has, should absolutely understand that the idea of getting a diagnosis and a treatment right on the first try with any consistency is laughably naive (my now-wife was diagnosed with like 3 different things before they settled on bipolar disorder and has been on at least half a dozen different treatments, not counting dosage changes, before they settled on something that consistently worked).
As a Biological Psychologist, I agree with you completely.
The thing is they're also dealing with motivated patients. It's like screening adults for ADD you're gonna get a fair amount of ppl who specifically want to be Dx w/ Adult ADHD so that they can be prescribed Adderall . The smart ones will go online and quickly get a good overview of what they should say and how they should respond to questions in the ADD assessment they're asked to fill out. With these childhood GD cases you've got basically the same thing. A group of highly motivated patients seeking a specific thing who have been told or read online exactly how they should respond to these assessments. So even just checking all the boxes and doing all the assessments isn't really enough.
The psychiatrist really needs to interview the patient in detail to get a more honest view of the patient. Ideally they'd have a neutral non activist therapist talk to them for several sessions. It's much easier to con a quick assessment form than it is to keep up an act for hours of therapy.
If they want any hope of getting something approaching the honest truth they need to evaluate these kids over many sessions and using many different assessments that the patient likely hasn't taken the equivalent of a study prep course for.
It's also critical for doing differential diagnosis. Even without some highly motivated patients who've been coached on how to answer questions there's still a chance someone could score high on GD but the underlying cause be another mental health issue. When it comes to young kids they should be screening for basically everything else and trying out treatments for those discovered conditions before pulling the trigger on permanently life altering medical interventions.
I think this is a very good point. I generally agree with the point that much of psychiatry is less well justified than the rest of medicine. That's one reason I am so skeptical of surgical treatments for mental/emotional complaints such as gender dysphoria.
However, if you're trying to win over the psychiatric establishment and turn them away from particularly bad behavior, it makes sense to be strategic, and make a distinction between better and worse methods of diagnosis and treatment, and better and worse research. I think that's what Jesse is trying to do.