Thursday, February 29, 2024

On Drug Policy

Alberta in particular continues to ride the “War on Drugs” policy train from the 1980s.  In fact, in many ways the current UCP government has doubled down on it with an approach that basically says “recovery is the only option for addicts” - to the point of actually talking openly about using government coercive power to force people into treatment involuntarily.  

Their argument is largely based on a number of misguided notions about addiction, and how best to address it.  They largely view addiction as a personal moral failing - literally the addict is at fault for “putting the stuff in their body” in the first place, and should be grateful that we provide places for them to “get clean”.  

That is, to be charitable, a horribly naive way of looking at the issue.  I’m not going to spend a ton of time here reviewing the academic literature on addiction - if you want to get a taste of it, wander over to Google Scholar, and type in addiction and I think you’ll get a sense of the scope of the issues. 

However, since the 1980s, the illicit drugs world has changed a lot. Back then the most dangerous substances were things like heroin, or possibly freebasing cocaine.  Overdoses certainly happened, but compared to now they were rare. Today’s drug supply on the street is many orders of magnitude more dangerous, and compounds are being mixed together in ways that most of us can’t even begin to imagine. 

I do agree that addiction is a major problem for policy makers to address.  Where I disagree with policy makers across the board is in the simplistic, one (or maybe two) dimensional approaches to government policy being implemented.  We cannot treat this as a singular monolith issue any longer. 

We need to implement a package of policies to deal with the issues - and it will take significant resources on multiple fronts to do it right. 

A Proposal

Sunday, February 25, 2024

Affirming Care Is Not A “Conveyor Belt”

In reading the essay “Current Concerns About Gender Affirming Care In Adolescents”, it occurred to me that there is a fundamental misrepresentation about what Gender Affirming Care means, and the anti-trans movement has exploited it to their advantage. 

Before I delve into that too deeply, let me take you back to the days of “big hospital gender clinics” in the 70s and 80s.  There was one in Canada that stood out and that was the program at the Clarke Institute for Psychiatry (now known as the Centre for Addiction and Mental Health (CAMH)). The gender identity program there was notorious in the transgender community by the 1990s.  The reason for the notoriety was that it was very much a “conveyor belt” model, and the program was designed to be as obstructive as possible.  At one point, adult patients were not allowed access to Gender Affirming Hormone Therapy (GAHT) until they had lived full-time in their desired gender for two full years.  Patients were often told they had to change careers and take on jobs that were “more typically feminine”, and of course if you weren’t “passing pretty”, you were criticized for it.  The entire program was designed to make it as difficult as possible to transition - and this was not unusual for other similar programs that grew up in the 1970s.  They all had a very narrow understanding of what it meant to be transgender, and if you didn’t fall perfectly into the little box they had constructed, well I guess transition wasn’t for you.

That kind of program is very much a conveyor belt model - you either follow their steps, and do them to the satisfaction of the gatekeepers who are managing it, or you aren’t going to transition.  

Gender Affirming Care is portrayed by the anti-trans movement as though it’s a straight line of “social transition -> puberty blockers -> GAHT -> Gender Affirming Surgeries”.  This is not only inaccurate, but it is profoundly misleading.

The core principle of the model is the second word of the name: “Affirmation”.  This literally means you affirm the person as they are presenting themselves to you. If they tell you that they feel feminine (or masculine) you accept that statement at face value.  In other words, you meet the person where they are at that time.  That doesn’t mean that you blindly start making treatment decisions based on that - especially if the person before you is a child.  

There are all kinds of principles at play here, but one of them is careful observation.  You don’t tell the person that you “don’t believe them” - implicitly or explicitly.  Instead, you monitor over several visits while you gather background.  Each time you meet with them you meet them where they are. Your job is to monitor for consistency (or inconsistency), to check in with how they are feeling as they take steps on their path.  

BUT, there’s a big point here:  the person making the changes is who decides what steps they are willing to take.  Nobody else gets to dictate that.  That means if they start saying “hey, this isn’t feeling right”, or “I’m feeling really anxious now”, then it’s important to spend time processing with them what they are experiencing.  For some, that may be nothing more than “stumbling over a tree root on the path”, for others, it might be an indicator that it’s time to turn off the path they are on.  You process with the person, meeting them where they are at, and you help them make their best decision at that time.  

When matters like medical interventions such as puberty blockers, or GAHT come up, it’s really important to discuss the implications frankly with the individual and their parents (at least when we are dealing with youth).  I disagree that the youth is somehow “unable to form consent” here based on their age.  By the time puberty is beginning, the individual is capable of understanding a lot - claiming that they can’t possibly understand what they are doing not only infantilizes them, but it denies them agency at a time when that agency is critical.  Yes, parents have to consent as well for obvious reasons, but it’s also important to gather consent from the child.  If the child says “I’m not sure I’m ready for that”, or “I don’t understand”, something along those lines, then of course caution is needed.  Such is the complexity of consent.

Likewise with GAHT, open and frank discussions need to be had because the implications of GAHT are enormous.  Again, consent matters here.  Consent has to be formed appropriately with the individual.  Going from puberty blockers to GAHT isn’t “automatic”.  Some will decide to step away, others will not. Again, the decision here has to belong to the person making the changes, and nobody else.  

The principle I am describing is really the notion of a non-judgmental space where the person can be heard - more or less the core of Rogers’ Client Centred Therapy.  

Critics try to portray the process as some kind of forced progression, when the reality is that the progression is being put in the hands of the person transitioning, and the role of the caregiving team is to help the person along THEIR path, wherever it may lead.  Human development is rarely a straight line, and for transgender people - especially youth - it unquestionably is not a straight line.  As adults, our job is to ensure that they have a stable, loving environment that doesn’t question the steps that they choose to take. 

For the most part, the “doubters” like Dr Levine strike me as having lost sight of the big picture, and they are getting hung up on hypotheticals instead of enabling people to make their best possible lives. 

Thursday, February 22, 2024

I Get Comments

So, apparently people who have made careers out of attacking trans people (and trans women in particular) are "unfailingly polite", and it's trans people who are being unreasonable (apparently).

Let's put something in perspective here - people like Riley Gaines, Kelly-Jay Keen, and "Billboard Chris" make quite a living running around attacking trans women on a daily basis.  Most of them have built up huge social media platforms through notoriety, and they get heard as a result.  

It wouldn't be contentious if these people were working from a position of actual honesty and discourse.  They aren't.  For the most part, they engage in rage farming.  The language used is that of moral absolutes, the framing presupposes that trans women are basically what used to be called "peeping toms", or that they are rapists looking to get closer to their victims, anything that would naturally ramp up a fear response.  

Are they engaging in direct violence against trans women?  The answer here is "yes, they are".  Violence can be done through both words and deeds.  The harm of violence happens regardless of whether it is physical or mental abuse that happens - we know this from the psychological study of trauma and abuse.  

But, as has been demonstrated repeatedly in recent years, the words of these people can inspire others to act against the target group.  On Twitter, the account "Libs of TikTok" has been associated with anything from direct violence against individuals to bomb threats made against schools targeted by the account's owner.  There's a term for this - "Stochastic Terrorism".  Stochastic terrorism is quite literally provoking others to engage in violence. 

They love to characterize trans women as "hulkingly huge" (most aren't), of being "violent" (again, seriously?), of being sexual predators (also false in the large), of being "a danger to women" (a claim without merit), of "grooming children" (because they can't understand that trans adults were once trans children, even if they didn't have the language for it), and so on.  All of these claims lack objective merit, but they make wonderful slogans.  

So, when the trans community (and allies) comes out in numbers to challenge these people, I would argue that it is absolutely understandable that people are going to be angry - the violence has been ongoing for months and years, and these people are at the centre of it.  Demands that trans women be excluded from public life are not invitations to "sit down and have a cuppa and a chat" - they are quite the opposite. 

You asked, I provided. The violence is being done over and over, on a daily basis by these people and their followers.  If you think that's an example of "male violence", you're completely missing the picture. 

Tuesday, February 20, 2024

About That "Angry, Violent Trans Woman" Thing

Back in the comments here, one of this blogs semi-regular, anonymous TERF-y commenters claims that transgender women are "often violent" based on a single news story

The backstory here is apparently one Riley Gaines was scheduled to speak at San Francisco State University (SFSU), and was allegedly assaulted / held hostage or something by a group of transgender activists.  Our commenter seems to think that this is evidence that transgender women are generally violent and angry people.  

But just who is Riley Gaines?  Well, it turns out that Riley Gaines was one of the people who had a major grade temper tantrum after Lia Thomas tied with her for 5th place in a competition.  Since then, she has made quite a career for herself advocating against the inclusion of trans women in sport.  Arguably, she has become quite a darling of the political far right.  A quick peek at her posts on X (formerly Twitter) shows a predictable amount of anti-trans rhetoric that ranges from amplifying every possible story about trans athletes to the common, if annoying, accusations that transgender women are pedophiles (no, I'm not going to link to that trash).  

So, let's take that in for a moment.  Someone who makes a career running around the country attacking transgender women encountered a protest by ... transgender people who are upset with her.  You're completely shocked, I'm sure.

Now, I wasn't there, so I can't say whether or not Ms. Gaines version of the story (which seems to be the only one I can find) is objectively accurate.  That's not really my issue here.  That's a protest by a group of people being directly affected by Ms. Gaines' advocacy.  It's in her interests to amplify and exaggerate what happened to her while ignoring the very direct role her advocacy plays in setting that stage.  

Having been on the receiving end of the kind violent threats that come out of the anti-transgender activism that people like Ms. Gaines has been engaging in, I don't exactly see her as blameless.  The transgender community as a whole sees what is going on, and is reacting to it.  

Does that make violent an accurate descriptor for the transgender community as a whole?  No. It clearly does not.  

The claim that trans women are "often violent" is part of the TERF/Gender Critical narrative that transgender women are actually men.  It exists in the same sense that the notion that transgender people as a whole are "pedophiles".  Objectively, such claims are false, and they really exist as part of a campaign of dehumanization.  In the world of people like Riley Gaines and her supporters, it's valuable to argue that transgender women (in particular) are somehow intrinsically dangerous to women.

Dehumanizing language like "you're not really a woman", or worse, is ultimately eliminationist rhetoric - it is the language used by those who want to eliminate others from public life.  It is always wrong, and it is always based on deliberately sown misinformation. 

Sunday, February 18, 2024

About Alberta's Proposed Ban On Trans Athletes

Among the heartless and cruel things that Danielle Smith announced in her "policy package" about parental rights (anti-transgender policy, really), was an absolute ban on transgender women competing in sports in Alberta. The rationale being that somehow "transgender women have massive advantages in athletics", and somehow that having transgender women playing in women's leagues creates a "danger" to women. 

But, more seriously, does this make any sense from a policy perspective?

Tuesday, February 13, 2024

The Collapse Of The American Empire

The United States is giving us a real-time view into the collapse of an empire.  The 2024 election cycle will determine whether the final failures happen quickly (and soon), or if there will be a slower series of failings that will eventually render the current American Republic neutered. 

Precisely when the collapse begins is a matter of opinion.  I think arguments can be made that point to either the election of Ronald Reagan in 1980, the election of George W. Bush in 2000, and the election of Donald Trump in 2016.  I don’t intend to spend this post making and evaluating those arguments.  Suffice it to say that each of those elections resulted in governments that played a significant role in setting the stage for where we are today.

Where are things today?  Well … we live in an era where evidence based decision making has been supplanted by conspiracy theories and often outright lies.  Conspiracy theories and their proponents are no longer the disheveled guy roaming the streets muttering to themselves. Instead, they are widely disseminated.  News media - the so called “fourth estate of democracy” - is dominated by commercial partisan interests.  

Then there is the political discourse.  What used to be a discussion from different perspectives which could eventually converge on some kind of middle ground has become a polarized “us versus them” war zone.  Trust has been destroyed on both sides of the partisan aisle.  People in the legislatures don’t see each other as colleagues, they see each other as rivals.  

Then we come to the leadership candidates. The United States has come to be governed primarily by old, white, men.  Look at the two candidates running in 2024.  We have an incumbent who is over 80 today, and his rival is well into his 70s. Seriously - when did the US presidency become a geritocracy?  Surely there are hundreds, if not thousands of potential candidates who are a good 20-30 years younger around, yet the parties are coalescing around two people who should be looking to retire and enjoy their last years? I’m not saying that older people don’t have things to contribute, but seriously, there comes a time to step aside and let younger people lead.  

Instead, we have a cult built around the utterly insane ravings of Donald Trump, and well - I’m not entirely sure about Biden - he’s basically “not Trump” in this race.  That’s how bad it is. 
From a “direction of the government” we literally have either “status quo”, or “burn it all to the ground” (the latter driven by conspiracy theories and wild rhetoric to whip up a mob).  There is no “middle ground” here.  Trump convinced his followers that the 2020 election was “stolen from him”, and that the entire apparatus of government is corrupted.  Biden has to find ways to fight that, and I have no idea what that’s going to look like. 

There’s basically 3 possible outcomes for the 2024 election:  

1). Biden wins a narrow victory again.

In this scenario,  I think you will see Trump ramp up the “electoral fraud” rhetoric to his followers.  We’ll see another round of unrest coming up to Biden being inaugurated into his second term.  It will be messy, but ultimately sets the US on a slower path to the collapse of the Republic.  It is possible that during that time, the Democrats will be able to groom a decent successor to Biden who isn’t in their 70s or 80s.  If they do not, then whatever is leading the GOP after 2024 is going to win in 2028.  

2). One of the two contenders dies or is incapacitated during the campaign

Age is a nasty thing this way.  Both candidates are of an age where any number of things could render them unable to finish the campaign, effectively handing a free win to their challenger.  It’s a rare occurrence, but given the ages of the contenders this time, one we have to be prepared to consider.  

3).  Trump Wins

This is the scenario that is far more likely to collapse the Republic very quickly, and in fact is the scenario I will spend most of this post writing about. 

Monday, February 12, 2024

About That "Car Theft Problem"

So, in the last few days, much virtual ink has been spilled by the press and conservative politicians about Canada's "car theft problem".  I'm not going to spend a ton of time analyzing it, but I do want to point out a few things on the matter. 

Conservatives always jump to "tougher penalties", and sadly, our justice minister seems to be following suit (presumably to shut Poilievre up by taking a card out of his hand).  Tougher penalties is easy politics, but frankly has nothing to do with any kind of deterrent effect.  At most, you're basically going to round up a handful of street level operatives who are stealing cars - but they aren't the real problem. 

The real problem here is organized crime.  This isn't a "steal a car for a joyride" thing, this is a big business, with a sophisticated supply chain for acquiring cars, shipping them overseas, and reselling them as luxury goods.  Same thing with illicit drugs on our streets - the problem isn't the drugs on the streets, it's the criminal organizations who make, distribute, and ultimately sell this shit. 

You want to bring this to its knees?  Go after the high level criminals.  Those old enough to remember the cops going after "Mafia" in the 1970s and later will recall that those investigations took a long time to bear fruit.  It involved getting people into the organization, or recruiting informants, and then spending years gathering the evidence needed to take down the people in control.

That's what we need to do again.  Only this time it isn't the "Italian Crime Family" that needs to be dismantled, it's a criminal enterprise that is far more sophisticated.  International cooperation will be essential to chasing these people down, because I guarantee you that most of what is in Canada are low to mid-level players.  The captains of these underground businesses are elsewhere. 

Saturday, February 10, 2024

Let's Talk About Protecting Children

The ostensible reason for the UCP government's recently announced bundle of policies around transgender youth (actually, all trans people - but we'll come back to that) is to "protect children".  I'm going to speak to this from a professional and therapeutic perspective, because I have relevant training and experience in that regard. 

First, let's consider what it means to "protect" someone else's interests - to safeguard them.  The approach being taken by the UCP seems to be more about preventing the individual from making decisions for themselves, apparently on the basis that you "can't possibly understand the consequences unless you're an adult".  This clearly misrepresents the idea of safeguarding, and ultimately robs the individual of autonomy.  

The UCP's approach basically is based on the old nuclear family concept that the parents, siblings, and relatives magically "know what's best" for the child.  This is reflected in Smith's statements, as well as in the bizarre "mandatory notification" model being imposed on schools.  However, again, this model ignores the person most affected by these decisions - the child.  It's no longer given to them the opportunity to say "no, I'm not comfortable with notifying my parents right now".

And this is where the entire policy construct shows us its wrong-headedness.

Monday, February 05, 2024

About That Consultation Thing

I'm sure that we all heard Premier Smith claim that she has consulted widely on the draconian anti-transgender policies that she announced last week.  

Now it starts to come out exactly whom she consulted with - and surprise, surprise, it's not exactly a group of people well-qualified to help guide the development of government policy on a topic like transgender youth.  

Let's take a closer look, shall we? 

Sunday, February 04, 2024

Alberta's Proposed Trans Policy

It's been 3 days since Premier Danielle Smith dropped a bomb on Alberta's transgender community, and I'm still reeling.  I'm alternating between being angry with the government, and grieving for the youth that will be most deeply affected by these policies

Before I dive into a deeper analysis of what Premier Smith announced, and my thoughts about it, I just want to say to my readers who are not themselves transgender, and may be looking at this as "well, this seems reasonable":  Ask yourself how you would feel if your access to treatment, social validity, and activities were arbitrarily legislated away?  Because that's exactly what's being done to transgender people (not just youth) here. 

Now, onwards into the policy bundle that Premier Smith announced on Wednesday.

The Cass Review and the WPATH SOC

The Cass Review draws some astonishing conclusions about the WPATH Standards of Care (SOC) . More or less, the basic upshot of the Cass Rev...