If we want to
reduce the incidence of distress in people and families, we need approach all these issues with compassion and an open mind. The open mind means considering various possibilities, while still being rational.
Yes, one theory is that everything “just happens to be” innate from birth, and unchangeable, and we simply discover it later. This essentialist type of theory may in fact be the best one for extreme cases of any condition. But we have to be very careful applying essentialism across the board — is it true for even mild, increasinly widespread cases? Could we also not investigate the factors upstream of the issue? Not just before birth, but also in the environment, in the socialization, culture, economics, etc. And if we find factors that heavily seem to affect it, should we not consider trying to fix the problems upstream such that the “disorders” downstream become reduced in many cases?
In the case of gender dysphoria, and to a lesser extent of depression being caused by serotonin, is too politically charged to start with. Many extremely creative people we know were born biologically male - the Wachowskis, Justine who made redbean, etc. transitioned their identity. They are adults who make a decision to live in ways they feel are more authentic to themselves amid the current culture and technology and that is their choice, as it should be. But we have to be careful not to therefore say there are no major issues in society upstream of millions of people who are experiencing distressing conditions, and try to embrace and normalize those conditions as opposed to trying to reduce the incidence of them.
Let’s look rationally and scientifically at every other example with similar conditions but without the charged atmosphere, to get a feeling for what the Social Theory of Disability and similar approaches would say. The key is to think systemically, and to accept that an identity is socially constructed and reinforced, that people are nudged all the time by culture around them, while they and the people around them are coerced by economics into stable behaviors and arrangements that may lead to distress (eg both parents working for corporations and neglecting their children and parents, to afford the rent because they have been made to expect and enforce a certain level of decadent spending that their ancestors never afforded).
1. Obesity. Now, to be sure there have also been attempts, with varying degrees of success, to normalize being obese and even celebrating this condition and some encouraging others to embrace the lifestyle. Yet we know that there are real public health issues upstream of the condition, including but not limited to unprecedented processed sugar and starches in everything, high fructose corn syrup, overuse of antibiotics on factory farms etc. the reduction of minerals in our vegetables etc. in short massive changes on an industrial scale that affect millions of Americans.
Imagine we were to ignore this and simply be content with embracing obesity as a “identity” to be accepted and was always around, but finally people were willing to become their true selves, would be scientifically and socially derelict. It would also be defeatist and lazy from the point of view of public health and social reform, would it not? And yet there have been serious attempts to normalize the Big and Beautiful identity as something we should embrace have more of in USA. The thing is, both can be true: “fat shaming” can be bad, while simultaneously it also bad to not have a public health investigation for upstream causes of obesity — yes treating it as a disorder to be reduced.
2. Eating disorders like Anorexia Nervosa and Bulimia. On the surface, they share many characteristics with Gender Dysphoria, namely a distressing mismatch between the body you have and the identity of how you wish it to be and how you want to be perceived. In fact there have been entire industries promoting and enforcing body standards for their participants to enter and keep participating, such as fashion models and ballerinas etc. But in these cases when a person comes to the doctor and admits that they are indeed looking to be thinner, the doctor is told by their industry to so the opposite thing than in the case of gender dysphoria. The doctor does NOT tell them to embrace their anorexia as an identity, and modify their body, but instead tries to get them to how much of their identity is actually socially constructed by others around them, and this is true not just for young and impressionable kids but also adults. When it comes to eating disorders, or some issuss of body dysmorphia, the distressing body-rejecting condition is managed in a completely opposite different way, and it is considered correct to point out the social and economic factors.
In fact, human body modification has a rich history going back thousands of years, and using all kinds of technology available to tribes. Some tribes and cultures embrace it as an identity. (As one small example, lip disks in some African cultures.) The people who choose to practice these modifications may be embraced with a special status and identity. But we looking from the outside can clearly see the societal and cultural constructs behind nudging and reinforcing the identity. So what I am saying is, look systemically, when you analyze public health issues.
3. Clinical depression. Many people here on HN have experienced clinical depression and I remember they have insisted for years that people should just “let it go” and it’s “just how things are”, and medications like SSRIs are the only real way to manage it. Over a decade ago people said Tom Cruise was a dangerous idiot, after his interview with Matt Lauer where he warned against overprescribing amphetamines, opiates etc. to treat these conditions. But once again, while the pharma industry and our US society at large has normalized this sort of overdiagnosis, “medicalization and treatment” of conditions, it was not always the case.
In 2022 studies and meta-studies came out in reputable scientific and medical journals questioning the efficacy of SSRIs at all vs placebo, and throwing into question the whole theory of serotonin being the main factor behind depression, and whether or not it is really preventable or manageable through changes in lifestyle, diet, mindfulness. But again, perhaps far and away the biggest questions were not systemically investigated: what is it upstream in culture and economics that systemically causes more Americans to be clinically depressed?.
More to the point, teenage depression and suicidal ideation is extremely high. Almost as high in the wider teen population as it is in the trans community! (I was shocked at the statistics.) So if something distressing rises so much, then it absolutely behooves us to look at what changed in society upstream of them. For example, the rise of tiktok and instgram and other social media as used by teens, for their body image and other things. Surveillance capitalism pushing certain things not just to teens but all of us (outrage, clickbait, echo chambers, even adults are more tribak and angry than ever, thanks to algorithms). Notifications that pop up at any time and distract us.!Instead of having the political will to address these issues and incentives, we accept them as a normal part of life. We are about to accept AI and robots that way, letting the industry “disrupt” anything and everything about culture, and leaving out-of-work men and women to figure it out (wringing our hands about usage of opiates and antidepressants while pharma industries gladly generate steady recurring revenues).
3. ADHD. I would call it the modern “hysteria” except for boys instead of women. We know hysteria was just a lazy catch-all to medicate women downstream of societal issues. In 50-100 years we may say the same about ADHD, as we have done with lobotomies etc. Do you see where I am going with this? I will leave the rest as an exercise for the reader for the sake of space here.
4. Autoimmune disorders on the rise as microplastics build ip in our bodies, while clothing companies put it in our clothes and bottling companies put out metric tons into bottles we drink from, but we throw up our hands and say there’s nothing we can do. While our ancestors reused glass bottles and washed forks, we discard plastic forks shipped from somewhere, into a landfill. Day after day without a thought to the next generation. Species are plummeting. One third of arable land is desertified. Our generation is living on an ecological credit card, that our children would have to pay. But we are told to shut up and work. Embrace and medicalize the conditions. We really have no time to organize against this stuff anymore. (Maybe we will once AI takes out jobs?)
Whether it’s obesity, diabetes, autoimmune disorders, eating disorders, depression, autism, and yes gender dysphoria etc. we can just stop at theories that essentialize new types of identities or we can actually take a public health approach where we look at them as “disorders” (word use by OP) that we want to minimize by gradually changing society. Not just for kids, but especially for them.
Lest you think I am just pontificating without actual solutions, here are some:
1. Gradually phase in a UBI for all US Americans. This will increase their disposable income and let them purchase goods made by startups (good for YC) as well as corporations. Let the money trickle up into the economy and tax the corporations. Our country is untold trillions in debt, it’ll have to print trillions to service that debt. May as well be like Alaska and give the first hop to each citizen equally. Then increasingly tax the corporations and their AI / robots / automation, and use that to pay down the debt over 30 years — after it has helped everyday Americans! PS: Alaska has had among the lowest Gini index of all states since it started this.
2. Reduce the 40 hour workeweek protections to 30 hours, as some countries did, or even 20 hours. Free up people from the hamster wheel so they can spend more quality time with their children and elderly parents, rather than school administrators and nursing home attendants (and their AIs). Stop normalizing this: https://www.youtube.com/watch?v=xNzXze5Yza8
3. Gradually phase out factory farm practices, be more like Europe. Go after corporations that pollute. Make the corporations switch to using biodegradeable materials rather than plastics and forever chemicals, rather than trying to forcing individuals dat the end of the production line to do that.
4. Consider implementing public health programs in schools like John F Kennedy did, modeled on the La Sierra high school. Same with math and STEM. Shorten the school day and let kids run around. Let children climb trees like in Finland.