Not Quite Adults
By: Dominic Fox
Tags: Autism, Abigail Shrier, Transgender

A scene from the Star Trek episode “Miri”, in which the Enterprise encounters a planet of children

This is quite dreadful — he’s become obsessed.

There you go, there you go — narrow it down to obsession!

(Geoffrey Hill, The Triumph of Love, XLIII)

Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Daughters opens with an “author’s note” briskly affirming her determination to ignore the stated preferences with respect to gendered pronouns of the adolescents whose lives she will be discussing: “I take it for granted that teenagers are not quite adults. For the sake of clarity and honesty, I refer to biologically female teens caught up in this transgender craze as ‘she’ and ‘her.’” The subsequent paragraph, in which she allows that “Transgender adults are a different matter”, is presumably meant to be mollifying, but only solidifies the stance of unassailable condescension. What might be thought to be a minimal concession to the safety and privacy of her case studies is instead presented as a courtesy to their guardians: “I have changed the names and certain minor details of transgender-identifying adolescents…to ensure that none is able to recognize herself and accuse her battle-worn parents of treachery”. This is what you might call starting as you mean to go on.

The judgement given in Bell v. Tavistock on December 1st, 2020 similarly considers that certain aspects of the non-adult status of adolescents are to be taken for granted: “That adolescents find it difficult to contemplate or comprehend what their life will be like as adults and that they do not always consider the longer-term consequences of their actions is perhaps a statement of the obvious.” Perhaps it is, but the judicial smirk of collusion with the adults in the room is at the expense of the trans teenagers not in the room, whose ability to give informed consent to receiving puberty blocking medication was the crux of the hearing.

Instead, evidence was heard from “Professor Scott (Director of University College London’s Institute of Cognitive Neuroscience)”, who voiced “significant doubts about the ability of young people under the age of 18 years old to adequately weigh and appreciate the significant consequences that will result from the decision to accept hormonal treatment for gender dysphoria”. The scientific basis for these doubts was “the neurological development of adolescents’ brains that leads to teenagers making different, more risky decisions than adults…this is backed up by behavioural studies showing that when decision making is ‘hot’ (i.e. more emotional), under 18 year olds make less rational decisions than when the responses are made in a colder, less emotional context.” No doubt teenagers experiencing gender dysphoria are often quite emotional about it, but it is difficult to see how studies pertaining to “heat of the moment” decision-making can shed much light on the concerted, persistent avowal, across contexts both emotional and tranquil, of a gender identity at odds with that assigned at birth. A young person who has managed to arrive at the point of being offered hormonal treatment for gender dysphoria will already have shown a degree of perseverance normally associated with Duke of Edinburgh awards.

Indeed, when it comes to that perseverance, undaunted by two-year waiting lists and byzantine clinical gatekeeping, a different theory is required than one premised on the fickleness and short-term focus of teenage brains. For Shrier, it is evident that trans teenagers have fallen victim to a “craze”, a type of mass phenomenon which combines seduction with contagion. A rollerskating craze; a boy-band craze. But crazes have explosive popular appeal, and roll over fast from one summer to the next. The population Shrier is concerned with is orders of magnitude smaller, and considerably more tenacious. What can account for the composition of this group?

Shrier puts forward an explanation involving two mutually reinforcing factors. The first is the power of suggestion wielded by educators and medical authorities, and the second is the suggestibility of a particular subset of teenagers, those whose developmental path towards adulthood is already difficult and imperilled. She offers the following illuminating thought-experiment:

Imagine if anti-vaxxer groups — also representing a position miles outside the scientific mainstream — were brought in to speak to students, asked to provide materials for health class, allowed to present their own versions of science and offered a lectern from which to argue for the connection between autism and vaccination. It does not seem far-fetched to imagine that more students who had been vaccinated would begin to notice themselves fixating, struggling with empathy, misreading social cues, engaging in repetitive movement, tending to self-harm, and diagnose mild cases of autism in each other. It would not be at all surprising if such students began to adopt anti-vaxxer “science” and became more hostile to the perceived conspiracy by mainstream medicine to deny it.

The “anti-vaxxer” aspect here is somewhat of a red herring, introduced (one suspects) for the sake of cementing an association between trans advocacy and dangerous pseudoscience (“miles outside the scientific mainstream”). What is more significant here is the picture Shrier paints of a feedback loop forming between the promotion of a theory that suggested to young people that they might be autistic, that suggestion being taken up in the form of increasing self- and peer-diagnosis, and these diagnostic identifications then forming the basis for increased credibility being given to the underlying theory.

This strongly resembles the view taken by proponents of the Thatcher government’s notorious Section 28 legislation, which prohibited the promotion or normalisation of homosexuality in schools: their fear was that if it was presented as normal and acceptable to be gay, then more young people would come to see themselves as gay, and the resulting proliferation of gayness would in turn lend weight to the argument that it was normal and acceptable to be so, and increase hostility to the default homophobia of mainstream culture. The supposed susceptibility of the young, and the power of suggestion wielded by those presented as educators, were seen as a weak point in the edifice of heteronormativity, such that the same people who bleated about political correctness gone mad whenever homophobia was confronted and repudiated in public became enthusiastic advocates of regulating what was permissible to be said, and by whom, in an educational setting.

What is especially remarkable here is that Shrier’s example of a diagnosis amenable to being spread by “promotion” is, specifically, autism. (With lexicographical inevitability, “autism” appears next to “autogynephilia” in the book’s index). One of Shrier’s key terms in her discussion of the supposed state of mind of trans teenagers is “fixation”: they have become fixated on gender identity, to a degree that renders them impervious to rational entreaties. In her discussion of the case of “Maddie” and their (I have resorted to a neutral pronoun as the least worst option given the story as it is told) mother “Katherine”, Shrier paints a picture of a teenager who has come to a sudden and irrevocable decision about themself:

What Maddie had had was a school assembly. And like the transgender fifteen-year-old who had regaled the student body with her gender journey, Maddie informed her mother, she too had always “felt different”. She, too, didn’t quite fit in with the other girls. For all her verbal precocity and academic success, Maddie was socially awkward and had a tendency towards the fairly rigid — what her mother called being “black-and-white in her thinking”. Katherine suspected that her daughter might be on the autism spectrum. In fact, Maddie was later diagnosed with “high-functioning” autism.

The word “quite” is doing some interesting work in the phrase “didn’t quite fit in”, as it was in the phrase “not quite adults”: it implies simultaneous proximity to, and temporary distance from, an eventually-attainable norm. Teenagers will eventually become adults, and they will eventually learn to fit in. But autistic teenagers, like queer teenagers, do not converge on these goals so reliably; Maddie’s “precocity” is as much a sign of untimely, staggered developmental progress as their social awkwardness and “tendency towards the fairly rigid”. Rigidity and fixation are the enemies of progress, when the latter is pictured as a smooth process of normalisation: they are signs of goals being held onto which ought to be released, of caring too much about the wrong things. Maddie “was beginning to spend a lot of time on social media”; Katherine “did not think much of it at the time. She did notice that her daughter seemed to be fixating on this new identity and becoming increasingly enraged that her mother had not immediately embraced Maddie’s self-diagnosis”. (Unreasonable, untimely “rage” is another autistic trait, as seen from a neurotypical perspective: explosions of frustration that seem to come from nowhere, if you in fact have no clue whatsoever about where they do come from).

This “rigidity” is itself seemingly contagious, spreading from the autistic teenager to the professionals who affirm their gender identity: Katherine “could not shake a nagging sense that the therapist’s narrow and exclusive focus on her daughter’s gender as the source of Maddie’s problems was missing the broader picture of a troubled inner life. Her daughter’s autism — the social awkwardness and habits of rigid thinking — went completely unaddressed” (my italics). She sees Maddie in much the same way as having “been introduced to an explanation and latched on to it” (ditto). It is not entirely clear at this juncture who is meant to be seducing whom: is the story that trans teenagers are uncommonly persuasive in guiding physicians towards diagnoses (they may have to be), or that they are being mesmerised by those same physicians into adopting a view of themselves that would never otherwise have occurred to them?

In a footnote, Shrier makes explicit the connection she has been implicitly drawing between autistic “fixatedness” and the tenacious, indissoluble insistence of transgender identification:

Many of the parents I spoke to told me their daughters had some version of “high-functioning autism” — meaning their daughters were highly intelligent, characterised by fixation and rigid thought, had terrible trouble deciphering social cues, struggled to recognise interpersonal physical boundaries, or had difficulty empathising with others. In the course of researching this book, I learned two disturbing facts about autism and its treatment. Like gender dysphoria, the diagnosis of autism spectrum disorder has skyrocketed in the last decade. And many clinicians specializing in autism are actively encouraging gender exploration in their autism patients [citation needed]. The possibility that some clinicians working with adolescents who fixate might be supplying these kids with a fixation merits a book of its own.

Here, autism and autistic fixation are filling in a blank in the narrative of the transgender “craze”, accounting for its fixedness in the psychic lives of those it seduces or contaminates in lieu of any explanation grounded in the urgent and intractable desire to live differently, a desire Shrier can neither countenance as authentic nor imagine in any detail whatsoever. But Shrier also demonstrates a general ambivalence towards “diagnosis” as a practice which organises personality traits and potentialities into identities:

Nearly all of the mothers I spoke to offered me diagnoses of their daughters provided by therapists, the internet, or a book. They suspected their daughters might be a touch autistic, or have auditory processing issues, or agoraphobia. They may all be right, but I couldn’t help wondering whether the process of diagnosis wasn’t itself altering the outcome, helping to convince suggestible daughters that there really was something wrong with them. By the time they reached adolescence, self-focus and self-diagnosis had become an ingrained habit, a way to handle feelings that confused them. With the rest of the culture, they had been ready to participate in a therapy language game, in which everyone has some mental illness and the only question is what code to offer insurance.

This ambivalence leaves Shrier unable to decide between a story about autism in which it is part of a universal tendency towards overdiagnosis of what were previously considered “outré” disorders (“the therapy language game”), and a story in which it is a material cause in the overdiagnosis of gender dysphoria, as “high-functioning” (read: middle-class) girls with autistic traits persuade their therapists to persuade them that the key to their “troubled inner life” lies in their gender identity. Her rhetoric of suggestibility, fixation, unreasonable perseveration and so on draws simultaneously on stereotypes about the reasoning abilities and emotional style of teenagers, and stereotypes about autistic people specifically. The combined (and intended) effect is one of delegitimisation, the withholding of attribution of competence.

This ambivalence enables Shrier to have her cake and eat it, instrumentalising autism where necessary as a collection of cognitive and social deficits which render autistic young people helpless in the face of seductive explanations for their sense of being generally out of sorts, while brushing off self-diagnosis of neurodivergence or queer identity as expressions of a cultural “habit” which itself causes people to take their passing moods and tempers more seriously than they deserve: “were it not for this compulsion to categorize and diagnose, minor bouts of anxiety, depression, obsession, romantic impulse, sexual inclination, and all manner of good and bad feelings might be left to grow, develop, change course, or die off”. (Even here, while derogating the “therapy language game”, Shrier cannot resist employing its terms of art, speaking of a “compulsion” to categorize, etc). Shrier is also skeptical about the professed sexual orientations of teenagers (her phrase “sexual inclination” is tactically minimising): don’t be silly dear, you’re not “bisexual”, you just have an adolescent crush on your best friend — it’s a phase, take it from me.

Shrier may have a point about the embedding of the language of trauma, therapy and diagnosis in the self-understanding of both adults and adolescents, but her own pathologisation of a “contagious” self-diagnosis rests entirely on a highly motivated decision to attribute trans teenagers’ self-reports to cognitive and developmental deficits which she herself assumes an unquestioned authority to diagnose in absentia (no trans teenagers are interviewed at length in the book, which deals predominantly with the perspectives of anguished parents) and call upon in explanation. Indeed, the assertion and performative reinstatement of this authority, concentrated in the figure of the embattled, browbeaten parent, is the entire point of her book, from its opening sentences onwards.

The judges’ ruling in Bell v. Tavistock expresses surprise at the “lack of data analysis — and the apparent lack of investigation” around the percentage of GIDS patients who also have autistic spectrum condition diagnoses, but does not explain why this should be thought meaningful or worthy of attention. The second complainant in the case, “Mrs A”, is described as “the mother of a 15 year old girl who has ASD”, but again it is not said why this is relevant. Is the background assumption that autism and transgender identification are materially connected (which they conceivably might be: autistic people often find ourselves to be dissonantly embodied one way or another, and the available statistics do suggest a correlation, if not a causal link), or that autism is a form of cognitive impairment which may lead teenagers into mistaken transgender identification? By not spelling it out, they leave the matter open to expedient interpretation. The ruling stands at a nexus of issues around young people’s liberation and bodily autonomy, disability politics, and trans healthcare and human rights; the passing mention of autism is not accidental, but serves as a way of importing assumptions about autistic selfhood and accountability which are harmful and unwarranted, and which continue to be instrumentalised in the effort to delegitimise trans identity.

People of all ages sometimes become attached to ideas about themselves that are harmful and distorted, or find that their long-standing investment in such ideas, unquestioned since childhood, becomes suddenly problematic as circumstances change. Those whose self-image is in crisis will naturally call for validation and reassurance, but may equally need help in bringing to light and revising the untenable premises behind the selfhoods they want to project and inhabit. The work of therapy involves helping people to hold themselves together through times of necessary change. This applies as much to the parents of trans and autistic teenagers as it does to those teenagers themselves. Shrier offers certainty, a position of embattled moral correctness, armed with a stigmatising and pathologising vocabulary that can be used to reassert, unchallengeably, the authority of the (cisgender, neurotypical, etc) parental worldview. In doing so, she meets a demand but not the underlying need. Her vividly paranoiac portrayal of a world of medical professionals heedlessly confirming their patients in their assertions of self-identity describes precisely the function performed by associations of “autism warrior parents” and “Mumsnet TERFs”, who make a battleground of their children’s complex lives in order to preserve a fearful, simplistic and inadequate vision of their own identity as parents and adults. Her book is almost as dangerous to the parents who will read it as it is to their children.