Andrea Long Chu and Transgender Happiness

Once in a great long while you read something in the New York Times or the New Yorker or the Atlantic which is really different, new and gives you pause.

"Surgery, Hormones, But Not Happiness," in the 11/25/18 NYT is one of those.

Speaking about her "transition" from male to female, Ms. Chu hits the main themes, that nobody ought to be made to feel badly, demeaned over something they cannot control, over a strong urge to change from what they have been to something different.

But she also touches on the very important reservations at least some doctors have about participating in the treatment of patients who say they feel they have been born in the wrong body, the wrong sex.

She addresses head on the medical aphorism: "First, do no harm," by asking what makes the doctor think he can always know whether or not he has done harm?

It is a fair question.

But Paul McHugh, when he left Cornell and went to Johns Hopkins, where he was asked to participate in the Hopkins transgender program as chief of psychiatry, some 40 years ago, discovered the suicide rate among patients undergoing transgender surgery and hormone medication was somewhere above 30%. He asked, "What other practice in medicine would be continued with a 30% death rate? Would coronary bypass surgery be allowed if 1/3 of the patients died?"

Nothing has changed in the suicide rates of transgenders since then, far as I can discern--in fact it is usually quoted as being close to 40%.

Discussing the reluctance of physicians to treat patients with "gender dysphoria" Ms. Chu remarks:
"In this view, it is not only fair to refuse trans people the care they seek,; It is also kind. A therapist with a suicidal client does not draw the bath and supply the razor. Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to a someone who believed she was a dog."

But what Ms. Chu argues is it is not for the doctor to make the judgment. The goal ought not to be to make a patient happy. Even after receiving treatment, she says, few transgender patients are happy. The goal is to serve the stated needs of the patient.

"As long as transgender medicine retains the alleviation of pain as its benchmark of success, it will reserve for itself with a dictator's benevolence, the right to withhold care from those who want it."

She then decries the condescension.

"I also believe that surgery's only prerequisite should be a simple demonstration of want. Beyond this, no amount of pain, anticipate or continuing, justifies it's withholding."

Up to this point, I was in Ms. Chu's thrall, but she lost me here.
The surgeon, it should be noted, also has a right to decide how much pain he is willing to inflict.
If you have a transgender surgeon who wants to do the surgery, fine.
But for my part, I do not see participating in what is a very unsettled realm which may be doing more harm than good, whoever gets to define that.

Ideals, I Miss Them So

A trip down memory lane this morning, watching President Obama, in a tuxedo, at the James Baker Institute at Rice University, speak in his halting, considered, wry way.
One of the things he said was that going into the Oval Office to meet with George W. Bush, after the election but before he was sworn in, was his first visit to the Oval Office. And he said, "You know, that place deserves a sort of reverence. Not for the place, but for what it represents and if you don't have it, well, you shouldn't be there."

Revered

Which, of course made me and everyone in the audience think of its current occupant.

But then, I thought: Isn't this what change and a disrupter and the rejection of previously accepted norms are all about? 

And maybe the new norm is no worse, just different.

Consider, as an example, the idea of a "scholar athlete." 
We all knew, for years, what a sham that was. Boys were admitted to Duke to play basketball, to Harvard to play football who had test scores and grades not remotely close to what was required of  other students.  And for most student/athletes, they weren't even interested in the student part. They attended classes only because it was part of their contract.

These players are more like the custodians Duke hires. They are employees of the university, but not students.

The Reality of Slavery

The most famous example was the Penn State running back, who, when the professor called on him, simply stared back at the professor, who persisted, "Uh, Mr. Moore, I asked you a question," the professor said.
"My name is Lenny Moore" he said, "I don't answer no questions. I just carry the ball."


That, at least, was an honest answer.


For years, Duke University, tried to pretend their basketball players were like the Ivy League players, young men admitted to play football or basketball, but who studied, and got their college degrees after four years on campus. Until about 10 years ago, that was occasionally true, with Duke players recruited, playing for 4 years before signing their NBA contracts. But now Duke recruits "one and done" players, who play their year, get their exposure, get drafted into the NBA and are gone. LeBron James changed the dynamic, showing a player with no college training could play in the pros.


Fantasy Hero of the Lost Cause

After LeBron, all that is gone. There is no attempt to even pretend the hired guns, these 17 and 18 year old players will even go to class, much less spend more than a year before cashing in and going off to the NBA.  Now the young studs skip college mostly, doing their year of audition then on to where they really intend to go. 

As a commentator from UNC recently observed:

First, let's be clear: the idea of a Duke “Scholar Athlete”, at least when involving their basketball program, is a fiction. Recruiting one and done players raises a lot of issues, including whether keeping someone academically eligible for one semester indicates any real commitment to balancing academics with the need to maintain a competitive basketball program. Duke University, by allowing Coach K to recruit academically deficient “One and Done” high school players, sends a very clear signal that education of athletes is not a priority. They are there for one reason – to win games for the basketball program, which for Duke is a cash cow, bringing in millions. It had better, because they've certainly got enough invested in it - in 2013 Duke head coach Mike Krzyzewski received a pay raise to to $7.2 million, making him the highest-paid coach in all of college sports.
--UNC sports columnist


Duke is, in a way, refreshingly honest, like that football player.
Sure, we used to talk about the value of a college education, about how these players represent something that is good about Duke, how they are part of the fabric of quality which is part of the university.
Now, it's, no, they are just hired help, entertaining the fans. We bid. Our competition bids and we buy the best we can get. Bread and circus. This is the circus.

In a way, this is all good. The whole lie that college was somehow materially valuable to students, whether they are elite athletes or, for that matter, for most of the students who will leave college for careers running HVAC businesses, landscaping companies, selling insurance or stocks is just that, a lie. College may expand minds, for those who do not spend it all on fraternity porches drinking themselves into oblivion, but expanded minds do not translate into dollars.  The fact is, for most people, all that is valuable to them is the certification process, which has devolved into a starkly commercial enterprise in the United States. Pay your money, take your exam, get your certificate, and you can move on.

The idea of "qualifications" whether it be for running a business or running for government office is a sham. You prove you are qualified by winning. 

Rules are made for breaking. Doing is the only important thing.

Think of Trump, who when it was suggested in a debate he had not paid income taxes replied, "Yeah.  If I had, they'd have just wasted the money."

The Reality: War is Hell

And his base lapped it up.

But there was some comfort in our illusions, sometimes. And even if we knew they were fantasies, they were warm dreams, or, as Hemingway said, "It's not true. But it was pretty to think it."

What Is Knowledge?

As an undergraduate in college, the Phantom sat in a classroom when a professor asked, "How do we know we, any of us, are even sitting in this classroom right now? How do we know we, you, are not somewhere else?"

Are Rhinemaidens real?

And the Phantom groaned silently. "I just want to go to medical school. Why am I sitting here in this classroom, listening to this?"

This had all started when the professor asked, "But what is a 'fact?'"

Real House or Just Hollywood mock up?

Students had offered up, "One and one equals two."
"That," the professor replied, "Is an agreed upon definition."
"I am sitting here," another student said.

Fake house by Obadiah Youngblood

And that's how we launched off into metaphysics.

But now, fifty years later, the Phantom is trying to remember the rest of that discussion, because now "facts" are much more fluid, in the age of the internet.

Fake House or Real House interpreted by Edward Hopper

The same class had spent time talking about the fine occasionally invisible line between fact and fiction, fantasy and reality, the notion of a non fiction novel. And now we have two excellent films ("Infamous" and "Capote") which are the reality of the Cutter family for millions.

Fake News?

All that liberal arts stuff which at the time seemed like so much mental masturbation--just playing with thoughts that had no real world application, and at age 20, the Phantom wanted to know more about the real world--he had lived long enough in his fantasy world. 

Real children or Just Actors?

But now, with Alex Jones telling us the children murdered at Newtown, Connecticut were just actors and the World Trade Center was an elaborate provocation executed by the American deep state, and with Trump insisting Obama was born in Kenya or Mars or wherever Trump is now saying, with his biggest ever in the history of the country crowd at his inauguration, and his "almost complete victory" in the midterms, all those classroom exercises seem suddenly relevant. 

If the Phantom could just recall what was said.

College is wasted on the young.

The lawyer for Alex Jones, defending his client asked the reporter, "But how do you know those children really were murdered at Newtown? Did you see the bodies? Were you at the autopsy?" And, about the moon landing which Alex Jones claims was staged at a Hollywood studio, "How do you know? Were you on the moon when Neil Armstrong stepped off that ladder?"

Indeed.

We are always living with doubt, with too little information.
But as my mother once observed, "You don't have to jump off a cliff to know that is not going to end well."

Real wrestlers

But when it comes to Mr. Trump, the reason, the Phantom thinks, he upsets so many college educated people, is he challenges all they learned, or failed to learn along those 16 years of "education." He is proud of his anti-intellect. He is saying his way of thinking is superior and the fact he is in the White House proves it. Only winning matters in politics.

Fake wrestlers?

And in life, too. The victors write the history.

Reading the New York Times in New Hampshire

The Phantom moved to New Hampshire for reasons large and small, and has been a happy, grateful refugee ever since.

Of course, when he left Washington, DC, his friends wistfully told him, "Well, no matter how deep the snow gets up there, at least you won't be on ground zero."

The Phantom took considerable relief in that thought, until he discovered to his right, a two miles away, was the Seabrook Nuclear Plant, and 10 miles down the road, to his left, is the nuclear submarine facility at the Portsmouth Naval Yard. So, the likelihood of nuclear annihilation is, if anything, closer and more likely in New Hampshire. 

Nevertheless, there is a sense up here, that problems have been left behind in Washington, DC, a town which the Phantom regarded the way a person regards his  large, fractious family--it's part of you, but you are glad to have escaped, to the extent you can ever escape your own family.

Every Sunday, there is a letter from home, however.  It takes the form of the Sunday New York Times, which brings news from Washington, and from New York, a megalopolis, which has merged, intellectually at least, into a single place of the mind. 

This Sunday, two articles grabbed his attention: A piece by a woman leaving Germany, to move back to the States where she will place her children back in California schools, and an article by Tim Wu, about the problem of consolidation of economic and financial power in banking, the pharmaceutical industry, the internet companies, manufacturing, medical health care systems, and how this gives rise to oligarchs and destroys the basis for democracy and a middle class.

The article about schools the Phantom could read from the perspective of personal experience. The failings of public schools have been much on his mind. The idea of public schools has been perverted, undermined, by evangelicals, by identity politics and by bigness. The Phantom was told his public school was one of the best in the country, that his classmates were the creme` de la creme` and he believed it, until he got to college where he discovered everyone else, from Winnetka to Darien to Shaker Heights  to Orange County, California had been fed the same malarkey, and swallowed it whole.  Years later, returning to his home town, watching his kids go to the same schools, he realized, public schools had probably never been as good as he thought and had declined since then. They were instruments of public policy first and educational institutions second. The Phantom had personal experience with them and could judge confidently.

But for the Phantom, macroeconomics is not something with which he has personal experience. The idea of concentrated power, monopoly, lack of competition sounded nasty, but then again, Amazon is a monopoly of sorts and it serves the Phantom well. 

Then again, the Phantom has run up against the whip hand of anti competitiveness. In his part of New England, there are simply too few health care systems and this means whether you are a doctor working for one or a patient using one, you are at the mercy of the only game in town. 

Reading the Times in New Hampshire ties the Phantom to the rest of the world, to his country. That and the New Yorker and National Public Radio, and the Phantom has a new family, which reaches beyond the home town.  I know those folks--David Remnick, George Packer, Jill Lepore, Ky Rysdaal, Mara Liasson, Ninatotenberg. 

This is America now. The shire and the web which connects us. 

Subject to the jurisdiction thereof: The 14th Amendment

You know President Trump has been fed his ideas by people at the Heritage Foundation or some other White Power group when you hear him quote, "And under the jurisdiction thereof."

Like so much of the Constitution, phrases are thrown in which are underdeveloped to the point of opaque. Any English teacher worth her salt would circle that in a red crayon and give a D- to its author. Explain. Clarify.


Same for "two thirds of all other persons," but at least there, we have more than a wink and a nod--the authors already tell you they are not talking about Indians and the only folks left are slaves, the name they dared not speak.


But why did they throw in "and under the jurisdiction thereof" in 1865, rather than just saying, excluding diplomats, Indians and children born to members of invading armies?


We'll never know.
Well, actually, we will know, when the Alito-Thomas-Gorsuch-Kavanaugh-Roberts majority rule, the President does have the right revoke and exclude citizenship from children born in the United States if he wants to and whoever he wants to exclude.


Scalia disciples, Gorsuch and Kavanaugh being "originalists" and will find in the "original intent" of the authors the idea of what being under the jurisdiction means, as television disciples will know the mind of God, through his writings in the Bible.
The Constitution is not a living document but an immutable source which means only what it's 19th century authors meant it to say, which is to say, whatever Gorsuch and Kavanaugh want them to say.


So President Trump will be able to exclude whomever he wishes from citizenship.

And you know, wink, wink, who that is going to be.