review of Shrier's "Irreversible Damage"

Irreversible Damage is a must-read for those interested in understanding transgenderism, especially its contemporary manifestations. Abigail Shrier focuses on claims about transgenderism in children and interviews experts, social influencers, parents, counselors, activists, people who are happy with their decision to transition, and those who regret it profoundly. (For a shorter version of ID, check out her Imprimis/Hillsdale essay/speech. For a review in Salvo by Nicole King, click here.) 

The catalyst for Shrier was free speech and defending others' rights to disagree with the establishment on this topic. Since publishing the book, her interest in free speech has become more personal—as her work has been attacked. (For this reason, I expected the book to be less measured, but was pleasantly surprised.) In this, she is in good company: an array of academics and advocates who have been criticized, crushed, and cancelled for holding reasonable, alternative views of the science involved. 

Much of the opposition comes from valuing ideology over science. Shrier discusses the hubbub over Lisa Littman and her famous PLoS One article in chapter 2. And she devotes chapter 7 to a litany of other scientific "dissidents": experts in their respective fields who ended up on the wrong side of the ideology that dominates for now—if not the wrong side of history (or certainly, science). The rabid response against those with dissenting views is more about bad religion and fundamentalism than liberal values or a respect for science. (And of course, this has led to all sorts of sad/funny semantics gymnastics.)  

Devaluing science is evident in other ways. The usual scientific and bureaucratic requirements to permit drug and surgical treatment are overlooked (164-165). The biology of male and female is quite clear but ignored. Shrier discusses the ease with which coroners can pick out adult males and females by skeletons: different size, sex-specific morphology, foreheads, mastoid regions, jaws, pelvis, and leg angles into the pelvis (162). 

The standards for medicine differ as well. Some advocates compare the relevant trans surgeries to breast reduction or enhancement (175). But even there, biological function is not compromised or destroyed (173). Its prevalent use among teens is unusual, when plastic surgery is usually reserved for adults. And the ethics of plastic surgery usually require many more questions to be asked than advocates of transition want for teens. 

All of this has obvious connections to a range of other ideological issues: the prevalence of asexuality (23) and the denigration of motherhood (208) in the culture—and its alignment with anti-human philosophies and policy positions such as anti-population, birth control, abortion, and eugenics. (In terms of Scripture, there are no direct references-- other than some hyperbole that happens to apply in Jeremiah 30:6-- but plenty of indirect references that would align it with any number of other misalignments between perception and reality, sin nature and the ideal.) 

All of this has an impact on lesbians: "Gender ideology puts transgender individuals into direct conflict with radical feminists who believe sex is the defining feature of one's identity." (150-151) More broadly, it's not at all clear how T fits into the gender/sexual alphabetical pile. More famously, it has an effect on all women and young girls, especially athletes who may be forced to compete with biological males (151-152). 

Ideology aside: the greatest value of the book is distinguishing between modern and "traditional" transexualism in five crucial ways. It is now: 

1.) much more prevalent (vs. exceedingly rare); 

2.) predominantly female (vs. male); 

3.) mostly emerging during puberty (vs. apparent from early childhood); 

4.) connected to peer groups (vs. random); and 

5.) often "treated" aggressively (vs. often resolving by adulthood). 

 

All of these provide at least weak evidence for peer effects as a primary factor. In any case, transexualism is clearly different today—whatever the reasons (xxi, 26, 32). 

 

On those who might be labeled "old-school" trans adults, Shrier reports: "Their dysphoria never made them popular; more often than not, it was a source of unease and embarrassment...they didn't want or need mentors; they knew how they felt...They do not need to be celebrated for the life they have chosen...That so much trans activism claims to speak in their name is neither their fault nor their intention. They have very little to do with the current trans epidemic plaguing teenage girls." (xix) "For many classic sufferers of gender dysphoria, celebration of their trans identity is anathema." (146) [She also offers some history as well, including an exception to this rule: Christine Jorgenson, the original "Caitlyn Jenner" (147-148). This article talks about DIY transitions for adults, outside even the fringe medical aspects of this.]

 

Another important connection: because gender dysphoria typically emerged in early childhood, parents were aware that their children were different from an early age. These days, parental influence and input are assumed away—in deference to the teenager's self-diagnosis (xxiii). This gets to the strangest and most disturbing aspect of this topic: psychologists and counselors frequently rely on their clients to analyze themselves (ch. 6). As Shrier notes, professionals are required to offer "respectful" and "supportive" care. But advocates want much more than this, including full acceptance of a teenager's self-diagnosis. Shrier asks the reader to imagine treating anorexia, race, or any psychological condition in the same way (99-101). 

 

The assumptions required for a heavy reliance on self-diagnosis are somewhere between dubious and laughable: 1.) adolescents know who they are; 2.) transition has little or no cost, harm, or risk; 3.) gender identity is immutable; and 4.) suicide becomes more likely without transitional treatments. This approach also ignores that teens often test boundaries with parents and society, take unfortunate risks without a mature ability to weigh benefits and costs well, and face a wide range of negative peer effects (107-120). All that said, Shrier still proceeds cautiously here: None of this is "a reason to proscribe all identity alterations or body modifications for teenagers," but it should be "cause for hesitation." (111)

 

In all of this, Shrier believes that there are real problems at hand for these teens, particularly for young women. She argues repeatedly, powerfully, and poignantly that it is really tough to be a girl going through puberty (1, 3, 144, 209), especially today with social media (4-5, 18). But she notes the oddity—if not the perversity—of letting struggling people self-diagnose. "Her distress is real. But her self-diagnosis, in each case, is flawed—more the result of encouragement and suggestion than psychological necessity." (xix)  

 

There are psychological factors (or temptations) at hand: "it satisfies the deepest need for acceptance, the thrill of transgression, the seductive lilt of belonging." (xxiv) Or more broadly, it may rarely be about gender, per se, at all (211). Proponents and practitioners also seem to be body-obsessed in a way that doesn't seem healthy (55b).

Sociology and peer effects are also involved in a way that at least mimics what we see in epidemiology (25). The "epidemic" could be caused by a benevolent form of acceptance that allows the condition to safely emerge. But other more-troubling hypotheses are at least as compelling in explaining "rapid-onset gender dysphoria" or ROGD (26-27).

"Psychologists who study peer influence ask what it is about teenage girls that makes them so susceptible to peer contagion and so good at spreading it. Many believe it has something to do with the ways girls tend to socialize...Girls are much more likely to reply with statements that are validating and supportive than questioning...[This] can be a productive and valuable social skill...But it also leads friends to take on each other's ailments...co-rumination, excessive reassurance seeking; and negative feedback-seeking"—all intensified by social media (35-36). 

Contemporary culture also has an impact. Intersectionality is one angle: "upper-middle-class white families, seeking cover in minority identity...they overwhelmingly come from progressive families..." (31) Notably, ROGD'ers are disproportionately white (90%). As one professor notes, "Of all of these badges of victim status, the only one that you can actually choose is trans." (154)  

There are many other contributing factors. Shrier provides a subset in her preface: "Our cultural frailty; parents are undermined; experts are over-relied upon; dissenters in science and medicine are intimidated; free speech truckles under renewed attack; government health care laws harbor hidden consequences; and an intersectional era...encourages individuals to take cover in victim groups." (xxiii)

But there are others too: In a pharmacological society, pills are an attractive option (19, 150a), including testosterone (discussed throughout the book). Shrier points to a "modern-day obsession with mental health, medicating everyone toward the optimal level of happiness..." (31) Another quick "fix" (that may never satisfy or end): surgery (176). (That said, breast augmentation for teens still dominates the rapidly-growing "top surgeries" for transitions.) Government-subsidized health insurance provides an additional subsidy for drugs and especially surgery (180). Add to this the capitalistic work of "influencers" (ch. 3)—those who attract an audience on social media, gaining popularity and money. Schools often oppose parents (chs. 4-5)—yet another occasion when the government schools' monopoly power is deeply troubling. (Check out this video.) Anti-bullying is the top stated concern—or a preferred cynical strategy—depending on whose wielding it. 

Parents, counselors, and doctors are in a rough spot here. In particular, what's the cause/effect with suicide? Suicide rates are high among trans youth, but that could be cause and/or effect (51). And Shrier documents how kids, sympathetic authorities, and influencers  often use suicide as a weapon—a brutal and cynical strategy against caregivers and especially parents (52, 55, 103). 

Unfortunately, suicide as a strategy undermines those who are actually struggling with suicide—one of many ways to know that this topic cannot be primarily about mental health (theirs or others). Another indication: the hypocrisy in heavily weighing subjective feelings that are consistent with trans ideology and utterly denigrating those whose subjective feelings change. If the top priority were mental or physical well-being, both would be celebrated. 

 

Detransitioners are the strongest manifestation of this phenomenon. Shrier documents some of the nascent blooms here, including groups like the Pique Resilience Project. (See also: a new movie.) In each case among those she interviewed, "they were definitely trans—until, suddenly, they weren't. Nearly all of them blame the adults in their lives, especially the medical professionals, for encouraging and facilitating their transitions." (201-202) 

Shrier ultimately compares the contemporary trend in transsexualism to other damaging fads that have plagued young women over the years: the Salem witch trials, nervous disorders in the 18th century; the "neurasthenia epidemic" in the 19th century—as well as anorexia nervosa, repressed memory, bulimia, and cutting in our times (xix). She also compares the trans movement to a cult (xxi)—with its highly subjective claims (many of them metaphysical or at least transphysical); non-falsifiable propositions (192); claims of salvation and the only path to happiness; "love-bombing" for potential adherents (185-186); shunning those who disagree; and ostracizing those who leave (191).

Irreversible Damage is a passionate but balanced critique of the latest social problem faced by young women. If you're interested in understanding the moment or ministering to the movement's members in the short-run—or in the long-run as the trend fades and the regrets increase dramatically—Shrier's book is a great resource.