This weekend, I wrote in to the Brown Daily Herald on the controversy over a recent study on “rapid onset gender dysphoria” by Brown assistant professor Lisa Littman:

I am writing in reference to a Herald article, “Gender dysphoria study criticism,” published Sept. 4. Much of the backlash following the removal of a press release on Assistant Professor of the Practice of Behavioral and Social Sciences Lisa Littman’s “rapid onset gender dysphoria” study has focused on questions of academic freedom and institutional support for faculty who conduct controversial research. In these discussions, the actual content and underlying soundness of this research have largely been considered an afterthought. For me, however, the content of the study could not be more relevant. Littman’s study directly quotes an article I wrote in 2013 on my experiences of gender dysphoria as a transgender woman. She labels such experiences “vague and nonspecific symptoms called signs of (gender dysphoria)” and implicates my work in her theory that online forums allow transgender identities to spread among the youth like “social contagion.” This could not be further from the truth. The symptoms I described are those of depersonalization disorder, a known condition of ‘feelings of unreality’ that is disproportionately common among trans people and often remits following transitioning. It strains belief that Littman would be unaware of the research on this disorder in trans people. As a result of this oversight, her study suggests that my own work and outreach to the trans community on this real condition is instead a causative factor in a supposedly new disease. This is more than a question of academic freedom. It is a matter of academic responsibility — and in her misrepresentation of my work, Littman has failed to exercise that responsibility.

As of yesterday, Littman appears to have addressed my specific criticisms for the first time, in a statement to the conservative Catholic outlet LifeSiteNews:

“There is an abundance of advice given to youth exploring gender on Tumblr and other social media sites, samples of which I excerpted in Table 1 of my study as background information. No specific source of advice was defined as a singular cause for all gender dysphoria nor was the sampling presented as a comprehensive list,” Littman responded in a statement to LifeSiteNews. “Regardless, teens who are experiencing concerning symptoms (including but not limited to symptoms of depersonalization) deserve to be evaluated by trained mental health professionals rather than relying on advice from Tumblr, online blogs or other social media sites,” she continued.

There is an admission implicit in this – is she acknowledging that my work on transgender depersonalization was indeed inaccurately portrayed as an example of “vague and nonspecific symptoms called signs of GD”? There may be an “abundance of advice given to youth exploring gender on Tumblr and other social media sites”, but even if there is, she still did not cite that abundance here. She cited one example of “vague and nonspecific symptoms called signs of GD” – my article – and that one example turned out not to be an example of this at all, but a description of a real condition commonly occurring in gender dysphoria.

To say that her sampling is not “comprehensive” would be an understatement: her sampling here is now absent, leaving the paper without any explanation or example of what is meant by “vague and nonspecific symptoms called signs of GD” that supposedly contribute to a contagious false belief of dysphoria.

While Littman quite correctly recognizes that gender-dysphoric and gender-questioning teens deserve a comprehensive evaluation that addresses any mental health needs, her paper inveighs against the very clinicians and specialists who would provide it. She relays that in instances where trans children had been evaluated for gender-related issues, 7 in 10 of these parent respondents felt that the clinician “did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria.” (Only 36.2% of parents in the study reported that their child had received an evaluation.)

Littman goes so far as to suggest that a likely-disapproving parent’s perception of their child’s gender identity – “child” meaning potentially any trans person, AFAB or AMAB, aged 11-27 – is more significant and important in the diagnostic process than both the trans person’s awareness of their own gender and dysphoric symptoms, and gender specialists’ own expert evaluation of that trans person’s clinical presentation:

Furthermore, although parents may be the most knowledgeable informants on matters of their own child’s developmental, medical, social, behavioral, and mental health history- and quite possibly because they are the most knowledgeable- they are often excluded from the clinical discussion by the AYAs, themselves. … Adolescents and young adults are not trained medical professionals. When AYAs diagnose their own symptoms based on what they read on the internet and hear from their friends, it is quite possible for them to reach incorrect conclusions. … The patient’s history being significantly different than their parents’ account of the child’s history should serve as a red flag that a more thorough evaluation is needed and that as much as possible about the patient’s history should be verified by other sources. … The reported behavior of clinicians refusing to communicate with their patients’ parents, primary care physicians, and psychiatrists betrays a resistance to triangulation of evidence which puts AYAs at considerable risk. … However, maintaining confidentiality of the patient does not prevent the clinician from listening to the medical and social history of the patient provided by the parent. … One would expect that if a patient refuses the inclusion of information from parents and physicians (prior and current), that the clinician would explore this with the patient and encourage them to reconsider. At the very least, if a patient asks that all information from parents and medical sources be disregarded, it should raise the suspicion that what the patient is presenting may be less than forthcoming and the clinician should proceed with caution.

Evaluation of gender issues by trained professionals is crucial – except the vast majority of such clinicians are allegedly remiss in their duty to provide all necessary care to their patients, patients’ likely-unsupportive parents may instead be “the most knowledgeable” about their child’s gender, a patient who is contradicted by their parents should be considered to be unreliable in their self-reports, and any patient who suggests their parent is untrustworthy should be considered untrustworthy themselves.

There’s also the small matter of Littman’s study choosing not to conduct any expert clinical evaluation of the trans youth and adults who were described by their parents, before promptly claiming to have recognized these as occurrences of an entirely new “rapid onset gender dysphoria” condition. A diagnosis of gender dysphoria requires thorough evaluation of the patient by specialists, but a diagnosis of ROGD requires only the perspective of the patient’s unsupportive parent.

But suppose these gender-dysphoric or gender-questioning youth and adults do receive an evaluation by gender specialists, just as they should. How might these clinicians explore their feelings and symptoms surrounding their gender? We can look to the 2016 book “You and Your Gender Identity: A Guide to Discovery” by gender therapist Dara Hoffman-Fox, LPC. In describing symptoms of mental discomfort potentially associated with gender dysphoria, Dara cites the very same article as Littman – “That Was Dysphoria?” – as an example of such symptoms and their possible resolution with transitioning:

“Mental discomfort” has to do with the way your brain is “wired,” gender-wise. Conflict can arise when you experience a difference between your physical body and your “wiring,” as well the experience of being perceived by others as your assigned-sex-at-birth when your “wiring” is telling you otherwise. “Mental discomfort” can be difficult for someone to pinpoint and describe. That’s because: – It’s possible it has been there for so long that, to a certain extent, you have gotten used to it. – You figure it must be the way you are supposed to be feeling and just need to live with it. – You don’t know what else to attribute that feeling to. In her article, “That Was Dysphoria? 8 Signs and Symptoms of Indirect Gender Dysphoria,” Zinnia Jones states (emphasis added by me): “Some of us suffer the distress that stems from dysphoria, but without many clues that this is about gender. (Its) relation to our genders may be obvious only in retrospect.” In other words, the actual frequency and intensity of your “mental discomfort” will more than likely be revealed after you begin to make changes that help to align your mind and body with your actual gender identity. Here are ways some of my clients have described the experience of no longer experiencing “mental discomfort” after taking steps to be in harmony with their gender identity physically and socially: – “I had no idea how much irritability/dissatisfaction/stress I was feeling on a regular basis until I…” – “I didn’t know how depressed/anxious I actually was until I…” – “‘I never knew how much I wasn’t ‘me’ until I…” – “I never knew what ‘peace’ could feel like until I…” – “I had no clue how cluttered my mind has been all of my life until I…” – “Having to wear ‘guy clothes’ to work didn’t bother before (or at least I didn’t think it did) until I…” – “Being addressed by my birth name used to be fine, but it definitely isn’t anymore now that I…” – “I didn’t realize how disconnected I was from my body, myself, my life until I…”

Clinicians, already aware of these symptoms years before Littman proposed her new condition, may very well see what Littman calls “vague and nonspecific symptoms called signs of GD” and recognize this as actually being a specific presentation commonly associated with untreated gender dysphoria. While dismissing specialist knowledge as deficient and inadequate, Littman demonstrates her own unfamiliarity with that same clinical knowledge – and ends up calling a real disease a fake one, and a fake disease a real one. ■