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Former sex worker who slept with 'a million clients' thinks prostitution should be banned
Image:
Publishing date:
June 19th, 2018
Author:
Chelsea Ritschel
Website published:
the-independent.com
Allsides bias rating is Center-Left.
Article length:
677 words
~ 3 minute read time
She does not think the money is worth the risks
Escort Kat Lee sells sex lessons to students for a discounted price
A former sex worker who claims to have slept with “one million men” for £140-an-hour now thinks prostitution should be banned - because it's lonely, dangerous and damaged her health.
Kat Lee from Manchester began working legally as an escort alongside her twin sister when she was a teenager - after a photographer lured them into the industry. She described herself as an 'outcall' escort, meaning she visits clients, rather than inviting them to her home or hotel room.
But after a 15-year career, Lee, 32, has decided to leave the industry to become a bartender and charity volunteer, and has issued a warning about how the stigma of her previous profession has damaged her work chances.
“I worked as an escort from when I was 18 until I was in my 30s, I must have seen over a million clients,” Lee said. “I was a teenager when I got into it. It started because of a photo shoot where me and my twin sister were asked to take off our tops and knickers for an adult magazine.
“Later, the photographer said we would be good in adult movies, being twins, and that led to escorting.”
While working as an escort, during which time she said she felt like Julia Roberts in Pretty Woman, Lee received various gifts including an Audi convertible and trips to Milan and Paris.
Kat Lee says there are "better ways to live" than escorting
But although she always took precautions regarding her safety, but was once caught out by a man who spiked her drink.
She said: “I’ve only been in one dangerous situation on the job - when a client spiked my drink and took the money back after I was paid. I thought I was going to die. I couldn’t breathe or anything. I had a driver to get me to jobs and I wouldn’t have got home without him.
“I never caught diseases from clients, but I feel a lot safer in my bar job with CCTV. I used to see four to five clients a day. You do get idiot clients who come in drunk.”
One of the most dangerous aspects of the job was Lee’s own drinking in an effort to gain confidence before meeting clients - which led to her being hospitalised to have her stomach pumped.
“If I turned down a client, the agency would fine me £50, so I started to find my own clients. It meant I would be waiting in hotel bars for my next job and I would drink to gain confidence before seeing a client,” she said. “That led to public disorder offences and ending up in the hospital to have my stomach pumped.”
Looking back on her long career in the sex work industry, Lee also recalled how lonely it was - because “women doing it would dislike me because men booked me more than them.”
And despite continuing to work on webcam to “stay in touch with regulars,” Lee does not believe she will return to escorting.
“It was something that I got into and didn’t mean to. I carried on working and then it became a habit,” she said. “You can’t really get a different job because you’re on Google and you already have the attention.”
Because of the stigma associated with the work, as well as the dangerous situations escorts can find themselves in, Lee thinks a ban would be a “good thing.”
“Some people turn to prostitution for drugs or a place to live. There’s no jobs or houses so they turn to prostitution to find money to leave home."
She said it's weird earning £7-an-hour in the bar when she used to make £140 as an escort. "You think ‘Oh my God, I could have worked one hour for £140 instead of many hours work at £7,” she said.
But she's not tempted to return, saying: "There are better ways to live."
The moral case for non-medical interventions in adolescents with gender dysphoria
Publishing date:
March 9th, 2026
Author:
Jilles Smids
Website published:
tandfonline.com
Article length:
5386 words
~ 20 minute read time
ABSTRACT
In most European countries, medical interventions including puberty blockers and cross-sex hormones are still the first-line treatment for gender dysphoria (GD) in adolescents. This paper presents a cumulative case for instead adopting non-medical interventions as the first-line intervention. These include awaiting further identity development, psychosocial support, and psychotherapy aimed at relieving gender-related distress, while respecting the adolescent’s gender identity. The cumulative case is built from the following considerations. First, there is a significant lack of knowledge of the natural history of GD. Second, the causes of the changed profile of patients referring to gender clinics, now relatively many more natal females with adolescent onset GD and co-occurring mental health problems than before 2010, are poorly understood. Third, there are clear indications that puberty blockers may impede adolescent identity development, rather than providing relief and facilitating reflection, as intended. Fourth, despite insufficient and inconsistent evidence on both harms and benefits of medical treatment of GD, most likely the harms and risks outweigh any potential benefits. Fifth and finally, non-medical interventions are not inherently unethical, but rather the least invasive potentially effective intervention. Together, these five considerations constitute a strong case against early medical intervention and in favour of non-medical interventions.
1. Introduction
In the 1990s, the Dutch gender clinic in Amsterdam started to medically intervene in minors with gender dysphoria (GD). Adolescents with persisting GD became eligible for cross-sex hormones (CSHs) from age 16 onwards, and soon after, puberty blockers (PBs) became available for 12 year-olds. In the early 2000s and thereafter, this so-called ‘Dutch approach’ spread through many Western countries and the medical treatment model became the standard.
Over the past few years, however, several European countries have changed course to a more cautious approach, emphasizing psycho-social and other non-medical interventions as the first-line treatment. The growing acknowledgement of the weakness of scientific evidence on the benefits and harms of PBs and CSHs (Cass Review, Citation2024; Miroshnychenko, Ibrahim, et al., Citation2025) has been instrumental to this change. However, many European countries continue to routinely offer early medical intervention as the first line of treatment to adolescents with GD.
Building on the fundamental medical ethical principles of beneficence and non-maleficence and the norm that, in principle, less invasive interventions ought to be prioritized, this article argues against early medical intervention in gender dysphoric youth as the first line of treatment, and in favour of non-medical interventions. These include psycho-social support, treatment of co-occurring mental health problems, and psychotherapy treatments aimed at reducing gender-related distress (while respecting adolescent’s identity). In order to build the moral case for these non-medical interventions, the next section will first briefly explain what GD is, what we know and do not know about its natural history, and outline the medical gender affirmative care model. Then a developmentally informed approach will be taken to investigate how adolescent identity development and GD are intertwined, and how both may be impacted by early medical intervention. The next section will evaluate the harm-benefit profile of PBs and CSHs. Subsequently, two dominant charges against non-medical intervention will be evaluated: that they would be ineffective and unethical. Finally, two alternative justifications for early medical intervention, each acknowledging the weakness of the evidence base, are critically evaluated. In the concluding discussion, the findings of the separate sections are integrated into a cumulative case in favour of non-medical interventions as the first-line treatment for GD in adolescents, while simultaneously being studied within the context of a rigorous research programme to evaluate their effectiveness.
2. Gender dysphoria and medical treatment
Informally, gender incongruence (GI) refers to a strongly felt incongruence between one’s experienced gender and one’s natal sex. GI is also a formal ICD-11 diagnosis. Gender dysphoria (GD) can be understood as GI that is accompanied by distress. In its colloquial meaning, GD refers to significant distress regarding one’s sexed body and the gender one lives in, whereas GD may also refer to the formal DSM-V-TR diagnosis GD.
An important distinction is between childhood onset and adolescent onset GD. The natural history of childhood onset GD, which emerges well before puberty, is poorly understood. Population-based prevalence and incidence data are absent. Among various clinic-referred samples of pre-pubescent children with the DSM diagnosis ‘Gender Identity Disorder’, the precursor of GD, more than half (Ristori & Steensma, Citation2016), or, more precisely, on average 67% (Zucker, Citation2018) of them, no longer were gender dysphoric at the time of follow-up some years after the onset of puberty. Most of these children turned out homosexual as adults, which is consistent with the fact that gender non-conforming behaviour in childhood is common for homosexual people. Gender clinicians widely assume that GD that persists until after the onset of puberty is unlikely to resolve (e.g., de Vries & Cohen-Kettenis, Citation2012, p. 306). However, this assumption is not supported by research (Cf. Byrne, Citation2024). In addition, clinical experience is biased in many ways, especially observer bias. Clinicians never saw those adolescents with childhood onset GD whose gender dysphoria resolved several years after the onset of puberty, but whose parents never brought them to the gender clinic. In other words, it is unknown which share of children would (sufficiently) outgrow their GD without receiving specialist gender care.
Adolescent onset GD refers to GD that emerged with or after the onset of puberty. Historically, adolescent onset GD has mainly been studied in natal males (Leibowitz & de Vries, Citation2016), but from roughly 2010 onwards, many more adolescent natal females started to present to gender clinics (Cf. Kaltiala-Heino et al., Citation2018; Taylor et al., Citation2024). Among them, mental health issues, psychiatric comorbidity, and neurodiversity are common, with the causes of the change in sex-ratio towards a preponderance of natal females still being poorly understood (Taylor et al., Citation2024). While the natural history of the ‘classic’ childhood onset GD is itself poorly understood, this is even more the case with adolescent onset GD in natal females (Kaltiala-Heino et al., Citation2018). Relevant follow-up studies elucidating the natural history are lacking and clinical experience, prone to bias anyway, is much shorter than for childhood onset GD.
Medical treatment according to the currently still dominant ‘gender affirming care’ model consists of several phases (Coleman et al., Citation2022). The guiding idea of this model is that adolescents should be affirmed in their gender identity. For prepubertal children, often already socially transitioned, no medical interventions apply. If GD persists after the first stages of puberty, a diagnostic phase is initiated, which may result in starting with PBs. In the Netherlands, if GD still persists after, approximately, age 15, CSHs can be considered, followed by mastectomy at age 16 (Federatie Medisch Specialisten, Citation2018), but ages depend on country and healthcare provider and are sometimes still lower; the Standards of Care from the World Professional Association of Transgender Health from 2022 even has no age limits at all for these interventions, see Coleman et al. (Citation2022). Genital surgery is generally reserved for age 18 and beyond. Psychiatric co-morbidity generally is no contra-indication, because this is seen as likely to be secondary to gender incongruence. Mental health issues may, however, be addressed prior or simultaneously to medical treatment when they complicate diagnostic assessment or treatment adherence.
3. Adolescent identity development, gender dysphoria and medicalization
Adolescence is a crucial period of identity exploration and formation, both in a global sense and with respect to more specific identity-related aspects and domains such as worldview, religion, occupation, friendship, and also gender (Kroger, Citation2017). Most adolescence studies in developmental psychology are based on a model that was introduced by James Marcia (Citation1966), and that was on its turn based on ideas of Erik Erikson. In essence Marcia developed a model of four statuses, defined by the presence or absence of exploration (trying out different roles, beliefs, ideologies) and the presence or absence of commitment (making personal investments in these roles, beliefs and ideologies) (Kroger, Citation2017). The four statuses are: identity diffusion (no exploration, no commitments), identity foreclosure (commitment without significant exploration), identity moratorium (ongoing exploration without commitment) and identity achievement (resolving the adolescent identity crisis by making a firm commitment after a period of thoughtful exploration).
Adolescent identity development has a fundamentally social nature, involving various interpersonal processes and the formation of relationships. Gender dysphoria both affects, and is affected by, identity development. The onset of pubertal physical development profoundly affects psychosexual development. For some individuals, developing secondary sex characteristics initiates or exacerbates their gender dysphoric feelings, which may prevent them from engaging in romantic experiences. For others, the development of their body and, for example, falling in love, turns out to be instrumental in the resolution of their GD (Steensma et al., Citation2011). Gender dysphoria may be (partly) constituted by feelings of not fitting in with the gender role attached to one’s natal sex, by being treated as a member of one’s natal sex, or related to other social aspects of gender. This may lead to social withdrawal (Galupo et al., Citation2020), thereby impeding normal identity development.
Given these complex relations between adolescent identity development and GD, it is hard to predict the impact of early medical intervention, i.e., puberty blockers and cross-sex hormones, on adolescent identity development. Regarding puberty blockers, on the one hand, it appears plausible that halting puberty may indeed give adolescents rest and peace of mind, facilitating identity exploration and formation. On the other hand, from the very beginning, gender clinicians have also expressed concerns: ‘[a]dolescents may consider this step [i.e., starting puberty suppression] a guarantee of sex reassignment, and it could make them therefore less rather than more inclined to engage in introspection' (Cohen-Kettenis & van Goozen, Citation1998, p. 248, emphasis added). In terms of Marcia’s identity status model, this can be rephrased as the concern that puberty suppression leads to identity foreclosure: gender dysphoric youth may fixate on a future life as another gender, without first going through an adequate process of (gender) identity exploration.
Although there is no definite evidence, the available empirical evidence suggests that puberty blockers may be more likely to impede rather than facilitate gender identity exploration and development. First of all, the percentage of adolescents that continue treatment with cross-sex hormones after puberty suppression is very high, more than 95% (e.g., Carmichael et al., Citation2021). Remember that our knowledge of the natural history of GD is insufficient, and therefore, it cannot be claimed that such extremely high percentage was to be expected because GD would most likely not resolve after the onset of puberty. If puberty suppression would indeed facilitate identity exploration and development, one would expect that as a result, at the very least somewhat more adolescents would decide not to opt for medical treatment as a way to deal with their dysphoria, or would even (sufficiently) outgrow their gender distress.
Second, there are plausible mechanisms that explain how puberty suppression may impede reflection and identity exploration. As already noted, pubertal development of the body is essential for psychosexual development, and therefore puberty suppression may withhold adolescents’ essential bodily and romantic experiences that otherwise could have been instrumental in resolving their GD. Relatedly, puberty is a crucial period for brain development caused by increased levels of sex hormones. There are some indications that puberty blockers may indeed have a negative impact on cognition (Baxendale, Citation2024).
Third, a Dutch empirical study indicates that the (vast) majority of patients regard puberty blockers as the first step of their medical transition, rather than as interventions providing ‘time to think’ about whether to medically transition (Vrouenraets et al., Citation2022).
Finally, an early Dutch study gives at least some indication that when waiting longer, the strong wish for medical treatment is likely to disappear. Smith et al. (Citation2001) report on a group of 20 young adults who started cross-sex hormones at age 16 or later age, and on a group of 14 young adults who were not deemed eligible for medical treatment due to their psychiatric comorbidity, even though they experienced GD (be it somewhat less than the treated group). Of these 14, 11 did not express any regret, 3 slightly regretted, and 1 strongly regretted not having started medical treatment.Footnote1 Moreover, on average, their GD had significantly decreased, although not as much as the treated group. This is a significant finding and gives further urgency to the question what would happen if current adolescents were not to be given puberty blockers, but if instead watchful waiting were applied, with psychosocial support, until age 16 or perhaps even 18 or 21. A recent German study similarly shows that gender incongruence may change over time, also after the onset of puberty. After 5 years, 73% of natal females aged 15–19 no longer had a gender identity disorder diagnosis (Bachmann et al., Citation2024; see also Cass Review, Citation2024, p. 29).
In conclusion, while the lack of knowledge of natural history makes it hard to observe the precise impact of medically treating GD on adolescent identity exploration and formation, interference with normal adolescent identity development is inevitable. The total body of evidence gives substantial reason to worry that puberty suppression ‘locks’ adolescents into their GD and causes iatrogenic harm by putting them on the path to lifelong invasive medical treatment (Cf. Baron & Dierckxsens, Citation2022). Similarly, starting cross-sex hormones at age 15 seems likely to hinder the resolution of GD upon further identity development.
4. The harm-benefit profile of puberty blockers and cross-sex hormones
It is a foundational norm in medicine that treatments ought to have a favourable harm-benefit profile for physicians to be justified to prescribe them. This norm directly follows from the medical-ethical principles of beneficence, which requires physicians to administer treatments that improve their patients’ health, and non-maleficence, which requires them to minimize treatment risks and harms (Beauchamp & Childress, Citation2019).
Systematic reviews consistently show that the available evidence on the benefits and risks of PBs and CSHs is inconsistent and insufficient (e.g., Cass Review, Citation2024; Ludvigsson et al., Citation2023; Miroshnychenko, Roldan, et al., Citation2025). For PBs, possible benefits concern mental health benefits, such as reduced depression and improved psychosocial function, and reduced GD. One risk of PBs concerns impaired bone development, while it is unclear to which extent this is made up during cross-sex hormone treatment following puberty suppression. Also, there are the risks regarding brain development already mentioned above (Baxendale, Citation2024). Furthermore, there are fertility risks, especially for natal males when early puberty blockage (Tanner stage 2/3) is followed immediately by CSHs. Their testes will not develop to produce sperm, causing infertility and most likely even sterility.
For CSHs, the general picture of weak evidence is comparable to that of puberty blockers, with reduced GD and depression and improved global functioning as possible benefits (Miroshnychenko, Ibrahim, et al., Citation2025). The systematic review by Miroshnychenko also reports on death by suicide, bone mass density, and sexual dysfunction, but similarly concludes that the evidence is ‘very uncertain’ about the causal effect of treatment with CSHs on these outcomes. The conclusion of this review is telling: ‘There is considerable uncertainty about the effects of [CSHs] and we cannot exclude the possibility of benefit or harm’, and the systematic review on puberty blockers by Mirosnychenko and co-authors has a very similar conclusion.
While based on these systematic reviews it thus might seem that the benefits and risks of PBs and CSHs are on a par, i.e., both uncertain, there is reason to think that most likely, the overall harm-benefit profile is negative. Medical research in general tends to significantly underestimate the risks and harms of treatments (Stegenga, Citation2020, p. Ch. 9) and this seems particularly pronounced in the domain of paediatric gender care. One of the various causes for this underestimation discussed by Stegenga is a follow-up that is too short to register harms. For example, the systematic review by Miroshnychenko and co-authors cites a study showing no difference in sexual function in natal females after 1 year on CSHs. However, another very recent study with a much longer follow-up, in adult natal males who as minors received PBs, CSHs, and genital surgery, showed clear signs of sexual dysfunction (van der Meulen et al., Citation2024). As is generally the case with systematic reviews, Miroshnychenko et al. also underreport potential harms: ‘… we […] could not address others that may be important to readers, such as regret, anxiety, pelvic pain or cancers.’ However, on some of these outcomes, concerning studies exist, e.g., pelvic pain seems frequently observed in natal females on CSHs, leading many of them to request hysterectomies for pain relief (Zwickl et al., Citation2023).
Similarly, the fertility case shows why it is important to integrate findings from basic physiologic reasoning with the conclusions of systematic reviews. Given the paucity of research on harms, there is no evidence that clearly establishes infertility. Yet, from basic biology, it is evident that testes will not sufficiently develop when puberty is suppressed early and directly followed by CSH-treatment: male patients in Tanner 2 have not developed gametes yet. This is confirmed by clinical experience and underscored by the fact that gender clinics increasingly regard fertility preservation as an integral part of their care. Clearly, infertility is far more than a hypothetical risk of medical intervention. By way of final example, one of the 55 subjects in the Dutch study that is still the cornerstone of paediatric gender care (de Vries et al., Citation2014) died from a necrotizing fasciitis directly following vaginoplasty. What this foundational Dutch study does not report, however, is the fact that PBs stunt penile growth, which makes traditional vaginoplasty in which the penis is inverted to a neo-vagina impossible. This necessitates a more complex and higher-risk surgical technique in which the neo-vagina is constructed from a part of the patient’s intestines (van de Grift et al., Citation2020). However, this death has not been reported in various systematic reviews, which testifies to the fact that systematic reviews underreport risks and harms. Accordingly, lack of decisive evidence of harm in no way constitutes evidence for a lack of harm.
In sum, while sufficient evidence on both benefits and risks generally is lacking, additional considerations give reason to give more weight to risks and harms of PBs and CSH. Infertility, for example, is a serious harm that can only outweighed by benefits supported by sufficiently good evidence. Accordingly, all in all, a negative balance of harms and benefits following early medical intervention appears most likely.
5. Non-medical interventions
It is a basic clinical and medical ethical norm that doctors should always opt for the least invasive treatment that is sufficiently effective. Non-medical approaches to GD potentially qualify as such and can include psychosocial support, awaiting further (gender) identity development (i.e., watchful waiting), treatment of psychiatric co-morbidities, and psychotherapy for treating gender-related distress. Which approach is seen as most appropriate will depend on how the relation between GD and co-occurring mental health issues such as anxiety and depression is theorized: are they just co-occurring but independent, or caused by GD, or the result from minority stress, or related in still other ways? That is a difficult issue, but in any case, the discussion here will first focus on psychotherapy and other approaches directed at relieving gender-related distress.
Nearly 30 years ago, Dutch clinicians noted that: ‘Naturally, if a complete reversal of extreme and lifelong cross-gender identity were possible by treatment methods other than SRS [sex reassignment surgery, preceded by cross-sex hormones] clinicians should refrain from SRS in adolescents, and indeed in older patients’ (Cohen-Kettenis & Van Goozen, Citation1997, p. 264). However, they already claimed that psychotherapy as treatment of GD is ineffective, and over time psychotherapy has additionally gained the reputation of being unethical, and just a form of conversion therapy (for discussion, see Zucker et al., Citation2016). In order to investigate the viability of non-medical interventions, this section will address these two prominent charges, starting with the latter.
The worry of conversion therapy is certainly understandable in the light of the history of psychiatry and transgender care. Attempts to change the gender identity of adolescents with GD in order to resolve their incongruence are likely to cause psychological harm, which may be severe. However, non-medical approaches do not need to aim to change adolescent’s gender identity towards alignment with their natal sex. Crucially, there is nothing inherently wrong with addressing the gender distress they experience, when there is no aim to change their gender identity. While it is an empirical question to what extent non-medical approaches can help adolescents to relieve their gender-related distress (while respecting their identity), prima facie this is a morally sound goal for clinicians to pursue – in fact it may be imperative, given the risks of medicalization.
And indeed, many trans persons, detransitioners, and clinicians and researchers from different perspectives are currently experimenting with ways to cope with and to reduce gender dysphoric feelings. A recent study by Lindley et al. (Citation2023) investigated, among other themes, various ways in which individuals with GD cope with their dysphoria. Their study participants reported various non-medical ways, including their choice of clothing and ‘through cognitively reframing their experiences and seeing the experience a different way’ (p. 606). The authors, working from an explicitly gender-affirmative perspective, note as a ‘practical implication’ of their findings that ‘Clinicians can assist clients to integrate mindfulness-based practices to cope with gender dysphoria’. They frankly describe ‘the ability of clinicians to intervene and reduce the distress caused by gender dysphoria’ as important for the well-being of trans persons, and they are currently working on developing such interventions (p. 592, italics added). Similarly, in a paper on managing gender-related distress by means of cognitive behavioural therapy, the authors explain that ‘we do not believe it is ethical for therapeutic work to focus on changing someone’s experienced/expressed gender but do believe that it is ethically necessary for anyone working in this field to be aiming to reduce distress’ (Canvin et al., Citation2022, pp. 3, italics added).
Further insights into ‘Alternative ways to deal with dysphoria’ can be found in the ‘Post Trans Booklet’ from the ‘Post Trans’ project.Footnote2 Many detransitioners report that treatment of co-occurring psychiatric conditions had a positive impact on their GD. Also, ‘[m]any find that meditation and mindfulness are helpful, as well as physical activities such as working out, practicing yoga and body awareness exercises’ (p. 41). As a final example, for some, active renaming of their experienced distress as just, e.g., ‘feeling uncomfortable with my breasts’, instead of ‘GD’ helped to reduce their distress (p. 46). Interestingly, there is clearly some overlap regarding the ways of coping with GD between trans persons and detransitioners, as reported by the above sources.
So far, the point has not been to claim that these interventions are proven effective, but only that stakeholders from very different backgrounds all clearly consider various non-medical therapeutic interventions to reduce gender dysphoria, including psychotherapy, as unproblematic and as (potentially) effective. This further undermines the idea that such interventions would be inherently unethical.
Moving to the second objection, how effective are various non-medical interventions? The Cass review has an insightful chapter on ’Psychological and psychosocial interventions’(Ch. 11), which also discusses the evidence on the effectiveness of psychosocial interventions specifically. That evidence is very limited since not many studies have been performed, and extant studies are of low quality (Heathcote et al., Citation2024). Noting the similar lack of good evidence for medical interventions, the review recommends ‘to explore other approaches for addressing the gender-related distress, which in itself is debilitating’ (p 155), and these approaches should be subject of well-designed studies to determine their effectiveness. Importantly, the Cass review notes that its underlying systematic review (i.e., Heathcote et al., Citation2024) revealed ‘no indication across the studies of adverse or negative effects’ (153). That does not mean that there are no such negative effects, but it is encouraging that they have not been observed so far. In addition, Cass notes that some interventions for co-occurring mental health problems are already evidence-based and should be offered to gender-distressed adolescents as well, just as they are to all other youth who need them. These interventions should be studied for their effectiveness specifically in adolescents with GD.
In conclusion non-medical interventions are potentially effective in reducing GD and in addressing co-occurring mental health problems, while not inherently unethical.
6. Alternative justifications for medical treatment of GD
In response to analyses outlining the harms and risks of PBs and CSHs and the lack of plausible evidence for (mental health) benefits, recently alternative justifications for medical treatment of GD have begun to emerge. Here, I will discuss two of them. First, a very common response is something along the lines of ‘but withholding treatment is not a neutral decision either, and likely harms adolescents with GD’. Here is a representative example:
It is important to realize that allowing puberty to progress in adolescents who experience gender incongruence is not a neutral act and may have lifelong harmful effects for a transgender young person such as stigmatization, personal physical discomfort, difficulty with sexual function, and difficulty with social integration.
(de Vries et al., Citation2021, pp. 221, italics added)
In addition, de Vries et al. point to the fact that halting pubertal development prevents the need for later invasive and expensive surgery, e.g., mastectomy and facial surgery.
Even though it is often being invoked, at its core, this argument is very weak. The harms from withholding treatment are just the mirror image of the benefits of providing treatments, and hence identical. And without plausible evidence for such benefits to follow from a treatment, there is simply no ground to offer the treatment, especially given its risks and harms. Accordingly, the appeal to potential harms from withholding treatments and framing this appeal as an additional argument is fundamentally mistaken. Consider an anticancer treatment that has no plausible evidence for overall survival gain and/or improved quality of life. It simply would not do to claim that ‘letting the cancer progress is not a neutral act, because this may shorten life and reduce its quality’.
Surprisingly, however, the ‘withholding treatment is harmful’ argument is frequently made in the literature as well as the public debate. Perhaps because PBs are very effective in suspending the dreaded puberty, some of the suggested benefits may seem so intuitive that it may appear harsh to withhold PBs to suffering adolescents. Yet professionals should not satisfy themselves with this argument but instead accept the burden of proof to provide evidence for any claimed benefits. Moreover, the argument trades on an invalid framing of the relevant clinical decision as either providing PBs (and CSHs) or withholding treatment. However, there are other options, including first offering non-medical interventions. Of course, in the meantime puberty progresses, but for all we know, this might just as well lead to the dissolution of GD in many or even the majority of adolescents.
This first alternative justification just discussed still centres on traditional outcomes, including mental health benefits, and appeals to the ethical importance of the harms and benefits of treatments. However, the second alternative justification that will now be discussed, the proposal by researchers and clinicians from the Dutch Amsterdam gender clinic, prioritizes the notion of autonomy (Oosthoek et al., Citation2024). The authors explicitly acknowledge the limited evidence base and the fact that some adolescents come to regret medical treatment. However, drawing from trans studies, they argue for ‘moving beyond the logic of improvement’: medical treatment ‘does not necessarily require demonstrating improvement to justify its provision’ (p. 16–7). Instead, they propose participatory action research to elucidate what adolescents themselves regard as important outcomes of ‘gender-affirming medical treatment’. One potential answer is reaching their embodiment goals.
There are decisive ethical problems with this proposed justification. First of all, the malleability of our bodies is rather limited. For example, if a natal girl’s embodiment goals change after CSH therapy and a double mastectomy, female embodiment goals are largely out of reach. Given the variability of gender identity over time in a substantial share of adolescents (see section III above), many will be unable to reach their altered embodiment goals. Similar considerations will apply to most of the goals adolescents might have with medical gender treatment. But more fundamentally, the proposal by Oosthoek et al. gives up on the professional role responsibility of doctors to ensure that any treatment they offer has a favourable harm-benefit profile. In other words, it gives up on their duties of beneficence and non-maleficence while absolutizing respect for patient autonomy. This reduces gender medicine to consumer medicine.
However, in medicine, respect for patient autonomy means that patients have the right to refuse medically indicated treatments, offered on the basis of their favourable harm-benefit profile. Or, in case of alternative treatment options, doctors should engage in shared decision-making, in which patients have the final say about which, if any, of the offered interventions they wish to pursue. However, autonomy is not an independent ground for offering treatment (Beauchamp & Childress, Citation2019).
To conclude, compared to a few years ago, it is certainly progress that currently virtually all participants of the debate acknowledge the significant limitations of the evidence. However, the two alternative justifications discussed are inconsistent with basic medical ethical considerations and therefore cannot serve as the basis for continuing current medicalization of GD.
7. Concluding discussion: the moral case for non-medical interventions
It is now time to draw the different pieces set out above together. First and foremost, it is striking how little weight is given by proponents of the medical gender affirming care model to the severe lack of knowledge of the natural history of GD. We have absolutely no idea about the share of adolescents with GD whose GD would (sufficiently) resolve when postponing medical intervention and awaiting further development of (gender) identity, possibly accompanied by psychosocial support and/or treatment of co-occurring psychiatric disorders. Accordingly, these children are now put on a life-long medical pathway with all its concomitant risks and harms without knowing whether this was medically necessary in the first place. Thus, to mention one important harm, many adolescents become infertile, some of them for life, without knowing whether their GD would have resolved naturally, without medicalization. The discussion in section (III) above shows that such resolution is a live possibility. Further contributing to this concern, PBs most likely are not an innocent reversible hormonal intervention to provide relief and buy time for reflection. Rather, they are an active intervention and there are plausible pathways along which they may consolidate GD.
One would expect that there were clear benefits of PBs and CSHs so as to justify harms such as infertility and many other risks, including risks to bone-mass development, brain development, etc. However, surprisingly, the evidence for a reduction of GD and for various mental health benefits is weak, too weak to outweigh the total of risks and harms flowing from medical treatment of GD in minors. While the poor state of the evidence recently has been acknowledged by most proponents of the gender affirmative care model, some of them have proposed alternative justifications for medical treatment. However, these justifications inappropriately treat respect for patient autonomy as a supreme medical ethical principle, or have other decisive shortcomings.
One very important further consideration is the changed case-mix of patients referring to gender clinics, discussed in section (II) above. While originally the medical model was developed for adolescents with childhood onset GD, from 2010 onwards natal females with adolescent onset GD became significantly overrepresented. This new type of patient also has more co-occurring mental health difficulties, and the steep rise in their number still lacks sufficient explanation. Naturally, this lack of knowledge should be further reason for caution.
Finally, doctors should always seek the least invasive treatment. Accordingly, various non-medical interventions should be the first-line treatment. While it is true that currently there is insufficient evidence of their effectiveness, they do not come with the risks and harms of medical intervention. Therefore, they should be offered first, while performing research into their effectiveness and risks is crucial.
A developmentally informed approach to the treatment of adolescents with GD should take seriously that their GD is inextricably bound up with their physical- and identity development, which continues for years after the first stages of puberty. Given the current state of knowledge, early medical intervention as the routine first-line treatment for GD is indefensible. There is a very strong cumulative case for prioritizing non-medical interventions in both clinical practice and in research.
A woman has told the BBC she felt “dehumanised and reduced into a sexual stereotype” after Grok was used to digitally remove her clothing.
The BBC has seen several examples on the social media platform X of people asking the chatbot to undress women to make them appear in bikinis without their consent, as well as putting them in sexual situations.
XAI, the company behind Grok, did not respond to a request for comment, other than with an automatically-generated reply stating “legacy media lies”.
Samantha Smith shared a post on X about her image being altered, which was met with comments from those who had experienced the same — before others asked Grok to generate more of her.
“While it wasn’t me that was in states of undress, it looked like me and it felt like me and it felt as violating as if someone had actually posted a nude or a bikini picture of me,” she said.
The regulator Ofcom said tech firms must “assess the risk” of people in the UK viewing illegal content on their platforms, but did not confirm whether it was currently investigating X or Grok in relation to AI images.
The proliferation of AI image-generating platforms since the launch of ChatGPT in 2022 has raised concerns over content manipulation and online safety across the board. It’s also contributed to an increasing number of platforms that have produced deepfake nudes of actual people.
In a related development, Grok on Friday blamed lapses in safeguards had resulted in “images depicting minors in minimal clothing” on social media platform X and that improvements were being made to prevent this.
Screenshots shared by users on X showed Grok’s public media tab filled with images that users said had been altered when they uploaded photos and prompted the bot to alter them. “There are isolated cases where users prompted for and received AI images depicting minors in minimal clothing,” Grok said in a post on X.
“xAI has safeguards, but improvements are ongoing to block such requests entirely.”
“As noted, we’ve identified lapses in safeguards and are urgently fixing them CSAM is illegal and prohibited,” Grok said, referring to Child Sexual Abuse Material.
Though backers of "sex worker" unions claim the groups promote rights, the women I interviewed seemed anything but empowered. (Pictured, Cambodian prostitutes.)
Prostitutes in Phnom Penh, Cambodia. (AP / David Longstreath)
During a trip to Cambodia in the summer of 2015 I came across a well-funded NGO that purported to run the largest union of “sex workers” in Southeast Asia. In Phnom Penh, I had arranged to meet a group of women who were, I was told, members of the “sex workers” union that had been founded by the Women’s Network for Unity (WNU). The WNU, which received funding by the Open Society Foundation, a multibillion-dollar fund set up by the investor George Soros, has a clear pro-prostitution agenda.
Our meeting was scheduled for 8 a.m. I brought with me a translator from another Cambodian women’s NGO. On arrival at the venue, I was surprised to find that a board member of the WNU had also decided to attend.
The women arrived, and, despite the fact that they had been out all night dealing with sex buyers and pimps, were warm, open and keen to talk about the violence and abuse they endure from sex buyers and police.
The board member interrupted them regularly, often speaking for them. I asked “What are the benefits of being in the union?” She answered on their behalf: “If the women are beaten up by the police, they are given legal training on their rights; if they are arrested, the WNU will provide food during the time they cannot work; and if one of the women dies, they will help to buy the coffin.” She concluded that “knowing their rights empowers them.”
The women seemed anything but empowered. One told me she could get out of prostitution only if she had $200 to buy formal identification papers, because this was the only way to secure legitimate employment in, say, the service industry or a factory. The other women joined in, saying this is also what they needed and wanted. They hated prostitution, they said.
WNU representatives claim they have 6,500 Cambodian “sex workers” on their books fighting for “sex workers’ rights.” The translator said that none of the women I met with used the term “sex work” to describe what they do, or “sex worker” to describe who they are. This language was used by the WNU. One of WNU’s aims is “to challenge the rhetoric around sex work, particularly that concerned with the anti-trafficking movement and the ‘rehabilitation’ of sex workers.” All the women asked me where they could get help to escape the hell they were in. Meanwhile, WNU board members and paid staff travel the region, speaking at “sex workers’ rights” conferences, distorting the voices of exploited women.
The prostituted women in Cambodia made it clear to me how much they hated prostitution. The board member said she had been at a regional conference with other “sex workers’ rights” activists and that “tens of thousands” of “sex workers” in Cambodia signed up to this so-called union. The women I spoke to had no idea that they were “sex workers’ rights” activists.
The experiences of these women were being used by WNU to promote the idea that unionization and decriminalization—a result of prostitution being formally recognized as labor—would solve all problems, despite the fact that the worst violence described by the women was by sex buyers. This NGO considered the concept of “sex workers’ rights” to be above and beyond the importance of the lives of the women themselves. I asked the board member if WNU was planning on raising money to help the women out of prostitution. She said “No.”
A documentary on prostitution in Cambodia titled “(Sex Workers Cry) Rights Not Rescue in Cambodia” is described as a collaboration between the 6,400-member WNU Cambodia and Paula Stromberg, the filmmaker.
The coordinator of WNU is interviewed for the film, and says: “WNU is an association of sex workers—adult women, men and transgender people. We choose to work. We are not victims. We are not trafficked. No one owns us. We don’t have pimps. No brothel owners enslave us. We do not want to be rescued.”
I found this statement quite difficult to process, having spent time in Cambodia speaking to prostituted women, pimps and bar owners.
In an email exchange with me, Stromberg wrote: “I would find it presumptuous for me as a Canadian to speak on behalf of the sex workers here in Cambodia. That is often the source of their problem—that everyone wants to speak about them, but few want to listen their voices.”
But as I had discovered in Cambodia, the WNU does speak for “sex workers,” literally putting words in the women’s mouths.
By the time I visited Cambodia I was very familiar with sex work lobbyists’ oft-adopted tactics of presenting pro-pimp organizations as “sex workers’ unions.” In 2002, the front page headline of a London newspaper read, “Sex workers to join trade union.” I had heard about the campaign, organized by pimps and their sympathizers in the U.K., to formally declare prostitution as “work,” but was nonetheless surprised that any credible trades union had bitten the bullet.
Britain’s third biggest union, the GMB, which was formed in 1889, had been persuaded by lobbyists for legalization of the sex trade that prostitution is a job, and that those selling sex deserve “worker’s rights.” In January 2002, to a fanfare of publicity, the Adult Entertainment branch was officially sanctioned by the GMB.
The Adult Entertainment branch began life as the International Union of Sex Workers (IUSW)—the brainchild of two academics who were not involved in prostitution. The IUSW—now operating mainly as a website—has never been a union, but a lobbying group for the decriminalization of pimping. Academics, sex buyers and pimps were welcomed as members of the IUSW, which eventually led one of its more leftist members to break ranks and spill its secrets to me.
In the early days, two gay men were the main spokespeople for the IUSW, making their rather unrepresentative voices dominant in the “sex worker’s rights” debate. One of them, Douglas Fox, a Conservative Party activist and co-owner of a large “escort agency” based in northeast England, was also an activist for Amnesty UK. In 2008, Fox proposed a motion for blanket decriminalization of the sex trade at the Amnesty International (AI) Annual General Meeting, a proposal that became international AI policy seven years later.
Thierry Schaffauser was prostituted on the streets of Paris as a teenager before moving to the U.K. Schaffauser became involved in “worker’s rights” campaigns, moved to London and joined the IUSW, soon rising to the role of president. But Schaffauser was unhappy with Fox being the public face of the organization, and, despite being warned not to speak to me about his views (other members were aware that I was researching the IUSW for for a news article), gave me an on-the-record interview. Partly as a result of this interview, Schaffauser was kicked out of the IUSW.
Lobbyists use the term “sex work” to include not just people directly selling sex, but also pimps, brothel owners, pornography producers and distributors, brothel security, sex trade propagandists, academics who research prostitution and even taxi drivers and advertisers.
The support of Amnesty International and other so-called human-rights-based organizations that advocate for decriminalization of the sex trade in the affluent West has a significant influence on sex trade policy and legislation in the Global South.
In the Netherlands, I have investigated the Red Thread, a now-defunct “sex workers’ rights” organization that masqueraded as a union until its collapse. Founded in 1984, it was funded by the Dutch government from 1987 with a mandate to combat HIV/AIDS. Red Thread closed in 2009, four years after losing its government funding.
At its height, however, the Red Thread had only 100 members out of an estimated 25,000 prostituted people across Holland. It never fought a case on behalf of a “worker” in court, and made no tangible difference to the “working” lives of prostituted individuals. It was a propaganda machine for legalization, and ensured that the Dutch were seen as “cutting edge” in their approach to complicated social problems. The Red Thread lost its governmental backing at the same time the international media began to report on evidence coming out of Holland that showed how legalization had been an unmitigated disaster.
But the damage had been done, and, in the true spirit of colonialism, the campaigners in the Global North that had run well-oiled propaganda machines, peddling the benefits of unionizing and legalizing the renting of women’s orifices, spread their influence to the Global South.
In India, the NGOs adopt the same tactic, and give red umbrellas—the symbol of the “sex workers’ rights” movement”—to the women standing outside the brothels waiting for trade. They want the women to march around Sonagachi, Kolkata—India’s biggest street prostitution zone—with their red umbrellas. “The pimps run these movements, and the prostituted women have no say in it at all,” says Ruchira Gupta, founder and president of Apne Aap Women Worldwide, an organization in India working to end sex trafficking.
“One day, in the late 1990s, there were female pimps seen around Sonagachi, speaking as ‘sex workers’ and claiming they were empowering the women in the brothels by forming unions to protect their rights in the workplace,” Gupta says. “But these women do not have any ‘rights’ in prostitution, and the ‘union’ was simply helping the pimps call for legalization.”Gregor Gall is an academic based in the U.K. whose specialty is the unionization of “sex work.” He has written two books on the topic, and it is clear that Gall has done his research. I asked Gall if he had come across any bogus, pimp-led “unions.” He admitted that he knew of one in India, and that it is likely they exist elsewhere in the Global South.
“There’s a union there [probably in Mumbai] for bar girls, meaning prostitutes,” Gall says. “It was set up by a non-sex worker … and there was evidence that the bar owners helped fund it because the bars were being closed down.”
Terms such as “collective” disguise the true nature of organizations that claim to be unions but in fact exist for the benefit of the johns, pimps and brothel owners.
SWEAT (Sex Workers Education and Advocacy Taskforce) is the leading pro-prostitution NGO in South Africa, founded in the early 1990s by two white “sex workers’ rights” activists, Shane Petzer, a gay male sex worker, and Ilse Pauw, a female clinical psychologist. Like other pro-prostitution NGOs, SWEAT uses the international language of human rights to argue for decriminalization.
“I looked at their leaflets, and saw cartoon drawings of happy looking women,” a woman who had recently exited the sex trade told me when I was in Cape Town in 2016, “and there were [speech] bubbles coming out of their mouths saying things like, ‘My union protects me,’ and ‘I can enjoy my job like anyone else,’ and it made me feel bad for [wanting] to leave prostitution. I thought it must be something wrong with me not to be enjoying it.”
SWEAT has been actively campaigning for decriminalization of the sex trade since 2000.
“To them it’s just [an] agency to sell sex, it is just work, ‘sex work,’ ” says Dudu Ndlovu, a gender studies student who was previously a volunteer at SWEAT. “To be a black woman and be prostituted in post-apartheid South Africa is to be reminded that you’re nothing, when we are now supposed to be liberated. SWEAT says that prostitution is your individual choice, and that there is no difference between my choices and yours,” Ndlova continues, “which is ridiculous, because you are a white woman living in the West and I am a black South African.”
Many of the so-called unions often appear to be set up as worker’s rights organizations in order to look attractive to funders.
George Soros’ Open Society, which funds the WNU in Cambodia, is one such group that looks kindly upon organizations claiming to help “sex workers” organize and achieve autonomy. The Open Society gives generously to SWEAT, and to other pro-prostitution NGOs in the Global South, such as those in Kenya, Cambodia and India.
Mickey Meji is a survivor of the sex trade and runs an exiting service in Cape Town for women who wish to leave prostitution. I ask Meji during my trip to Cape Town whether she believes it is possible to unionize the sex trade. “No,” Meji says, “because in South Africa the trade unions that we have, as far as I am concerned, represent people who are recognized as workers.” Meji is referring to domestic workers in South Africa, who are often ill-treated, underpaid and abused by employers, and, until the early 2000s, had no employment rights.
“People can unionize before they are legally recognized as workers,” Meji says. “We started having ‘house helps,’ and the employers decided what they wanted to pay and they [workers] decide if they want to accept it. Finally, through unionizing, they fought for the recognition of their rights. It was not a criminal offence to be ‘house help.’ That’s the difference; otherwise we’ll start having a union of smugglers and traffickers.”
I ask Meji: What if prostitution was legalized? She believes the stigma of being prostituted will never leave female prostitutes, even if there are no criminal penalties attached. “How do you unionize people in their absence?” she says. “When they march they wear masks; they want to be hidden and anonymous. How do you then unionize that? Because every industry that we know of, regardless of how gruesome it is or how dirty it is, people have taken ownership. But in the sex trade there is no real ‘pride’ from the women being prostituted.”
Janet M. Wojcicki, a white anthropologist based at the University of California, appears to consider black Africans such as Mickey Meji to be motivated by religious fundamentalism. In an article on the pro-prostitution movement in Gauteng Province, South Africa, in the early 1990s to 2000s, Wojcicke makes the extraordinary claim that, post-apartheid, “There is now a counter discourse opposing decriminalization, based on religion and on the argument that sex work is ‘un-African.’ ” The feminists opposed to the sex trade on the grounds that it is both a cause and a consequence of women’s inequality are neatly written out of the debate by Wojcicki. The sex trade can never be unionized because prostitution is not labor. Beatrix Campbell is a socialist, feminist and author of the classic text, “Wigan Pier Revisited” (1984).
“In all of the discourses about prostitution as work—is always—what the product is, who buys the product and what the relationship of this alleged purchaser is, in relation to power over and power to,” Campbell says. “That’s the other half of the discourse that needs to be explored. What do men think they’re doing when they are buying sex?”
The Russian Federation, which borders Europe and Asia, boasts a massive sex trade, and is known as a hub for pimps and traffickers.
Irena Maslova is the coordinator of Silver Rose, an NGO in Russia that campaigns for a legalized sex trade. Maslova told me, “I have 3 million sex workers behind me [across Russia].” Silver Rose was founded in 2003, and at the time was a small advocacy organization. By 2011 it was well funded, partly by George Soros’ Open Society, and expanded to 30 cities around Russia.
“Silver Rose is more a supporting role and promoting the idea of unionizing and getting together in order to stop the situation of violence and discrimination against sex workers,” Maslova tells me. I ask how many people in prostitution are in her union. “We have 3 million sex workers behind us,” she repeats.
Yet I have found no evidence of any employment tribunal finding, or any positive stories about the unionization of prostitution during my extensive research. Nor did any of the formerly prostituted women I interviewed from across the Russian Federation know of such a “union,” let alone say they’ve benefited from it.
The occupational hazards of regular workers are not remotely similar to those faced by women in the sex industry. Drug and alcohol misuse, violence in the “workplace,” unwanted pregnancy, sexually transmitted diseases and even death are daily concerns for many prostituted women, not the extraordinary issues they would be for regular workers. Prostituted women deserve human rights, not “workers’ rights.”
Janet Wojcicki claims that “… if one examines the language that is used in speaking and writing about sex work and sex workers in the post-apartheid period, it becomes clear that the movement to decriminalize sex work has incorporated the overall language of human rights that became enshrined in the African National Congress’ Constitution.”
But Nozizwe Madlala-Routledge, former ANC activist and founder of the feminist anti-prostitution (abolitionist) NGO Embrace Dignity, based in South Africa, has a very different take on this.
“We did not struggle to end apartheid to end oppression so that women can then be subjected to this kind of oppression and exploitation,” Nozizwe says. “Mandela would understand—I seriously believe that if we had gone to him to open his eyes, he would have been on our side, saying, ‘The Nation is not free while women remain in oppression.’ ”
Man Dressed as Woman Arrested for Spying Into Mall Bathroom Stall, Police Say
Image:
Publishing date:
November 18th, 2015
Author:
Not listed
Website published:
nbcwashington.com
Article length:
241 words
~ 1 minute read time
A man dressed as a woman was arrested in Virginia on Monday after police say he was caught peeping into restroom stalls three times in the past year.
Richard Rodriguez, 30, filmed a woman in a bathroom stall at the Potomac Mills Mall, Prince William County Police said on Tuesday. A 35-year-old woman was in the stall when she saw a bag moved toward her under the stall divider. Rodriguez apparently had been filming her, police said.
The victim rushed out of the stall to confront the man and saw him hurry to another stall, next to another woman. The victim alerted the woman and then contacted mall security of the shopping center on 2700 block of Potomac Mills Circle in Woodbridge, Virginia.
Photo of suspect in May 15 and Oct. 11 peeping incidents
Mall security detained Rodriguez until police arrived. Police then determined that he matches the description of a man who is accused of using a mirror to see into a women's restroom stall on May 15 at a nearby Walmart and also at the Potomac Mills Mall on Oct. 11.
The suspect in the May 15 incident allegedly spied on a 53-year-old woman, police said. The suspect in the Oct. 11 incident -- believed to be the same man -- looked in on a 35-year-old woman and her 5-year-old daughter.
Rodriguez, of Fredericksburg, was charged with three counts of unlawful filming of a non-consenting person and three counts of peeping.
me (saw it posted by @empress-hancock on this post)
Title:
Why do we still not know what causes PMS?
Image:
Publishing date:
August 12th, 2018
Author:
Not listed
Website published:
researchgate.net
Article length:
866 words
~ 3 minute read tmie
In 1931, a condition called “premenstrual tension” was described for the first time in a scientific study by gynecologist Robert Frank. His advice for women with severe cases of premenstrual tension? Radiate the ovaries, or completely remove them. Fast forward 80 years and the treatment of premenstrual syndrome (PMS) hasn’t progressed far from this drastic approach. Yes, as a last resort, women with extreme PMS still opt to have their ovaries taken out. If removing an entire organ sounds archaic, it is, but there’s a reason why this still happens in the 21st century.
For decades, PMS, its causes, and the question whether it is actually a medical condition have been shrouded in mystery. PMS is a complicated health problem as symptoms and severity differ in every woman and, even in individuals, often vary from month to month. This makes it difficult to study and has led to a vicious cycle developing in PMS research – scientists don’t understand what causes PMS, meaning there is little scientific research into it, and, in turn, less funding for new studies.
What’s known is that PMS has to do with hormone changes during the luteal phase of the menstrual cycle. Chemical changes in the brain – a reduction of serotonin triggered by these hormone change – may also play a role in PMS. So may lifestyle factors like stress and diet. Others may have a genetic predisposition to PMS, psychologist Carolyn Janda says.
To put how little research has been done into PMS into context, a search of titles and abstracts on ResearchGate found there are over five times more studies into erectile dysfunction than into premenstrual syndrome. That’s despite the fact that approximately 19 percent of men experience erectile dysfunction over the course of their lifetime, while over 90 percent of women report some symptoms of PMS.
Defining the symptoms is where the problem of researching PMS starts. Researchers still don’t agree on what the symptoms of PMS are – over 150 are commonly listed, from the predictable bloating and mood swings, to headaches, sleep disorders, and even clumsiness.
This lack of consensus means women are often unsure which symptoms they can actually attribute to their period, and which are unrelated. This also makes treatment – let alone finding a cure apart from hysterectomy – difficult. Treatment currently includes taking a class of antidepressants, selective serotonin reuptake inhibitors, to easy emotional imbalances. Hormonal contraception is commonly used too. There’s also evidence that certain alternative treatments help alleviate symptoms, including chasteberry. However, over 40% of women who have PMS do not respond to treatments currently available, and five percent have premenstrual dysphoric disorder (PMDD), a condition so severe that 15 percent of sufferers attempt suicide at some point in their lives.
Figure: Schmelzer et al. in Health Care For Women International 36
“When I experience intense bouts of PMS that include a combination of lethargy, irritability, difficulty concentrating, mood swings, anxiety or crying spells, seemingly simple things like getting out of bed or talking to more than one person at a time can feel like a feat,” said one woman. Symptoms like hers have tragically been confused with, and diagnosed as bipolar disorder.
“I suspect that this is a fancy way of saying it’s really just in a woman’s head”
According to PMS researchers, patient stories like these are unlikely to change until the science gets taken more seriously and receives more funding from institutions. Kathleen Lustyk, a psychologist from the University of Washington, has had grant reviews rejected on the grounds that PMS does not actually exist. Her reviewers suggested it was “merely a product of our society or culture that has painted a natural process in a negative light and that, given its monthly predictability, leads to suffering through anticipation.” “I suspect that this is a fancy way of saying it’s really just in a woman’s head,” Lustyk said. That’s despite the fact that PMS can affect women’s lives far longer than a couple of days per month – for example, symptoms of anger or anxiety can wreak havoc on relationships for years to come.
However, investment in research isn’t the only key to improving what we know about PMS. Researchers struggle to compare results across studies. The International Society for Premenstrual Disorders, a group of researchers and medical professionals working on women’s health, recently released a consensus to standardize the diagnosis and management of PMS. They recommend women keep a diary recording symptoms for at least two months. Period tracking apps like Clue could help to do this. Women use the app to record how their bodies change over the course of their menstrual cycle, including physical and mental symptoms. This information, the company says, is already attracting a lot of interest from medical professionals.
Together, eight decades after Robert Frank first described PMS, researchers, doctors and patients are getting behind this monthly medical mystery of the female body. They’re finding ways to study the syndrome, hoping to break through the vicious circle of ignorance and lacking funds. And who knows, maybe, written in the pages of a journal, or pulled from the data of an app, there’s a gentler cure to be found, too.
Pakistani 8-Year-Old Girl Gang-Raped for a Week, Then Strangled
Image:
Publishing date:
April 27th, 2016
Author:
Mary Chastain
Website published:
breitbart.com
Allsides bias rating is Right.
Article length:
434 words
~ 2 minute read time
Two men kidnapped an eight-year-old girl and gang raped her for seven days in Pakistan. They later strangled her.
Receiving an anonymous tip about the crime, police raided a bus and arrested the two men, one dressed as a woman. He told the police that “he and his accomplice had abducted five minor girls and killed them after subjecting them to rape.”
They confessed to kidnapping the girl, raping her for seven days, and strangling her. But one official said that “the victim might have died due to profuse bleeding that resulted from repeated rape.”
The news comes only days after the Society for the Protection of the Rights of the Child found that at least “10 cases of child sexual abuse took place every day in 2015, bringing the total to 3,768 cases in the last year.” The researchers found that 21 percent of girls married before they turned 18 years old. They also accused the government of failing “to formulate policies and legislation that would work towards eliminating child labour.”
The media reported the Council of Islamic Ideology (CII) considered a bill to outlaw pedophilia as “anti-Islamic” and “blasphemous” in February. The bill outlaws underage marriages and “recommended harsher punishments for those entering conjugal contracts with minors.” CII Chairman Muhammad Khan Sherani said Islamic laws say “marriage can be solemnised when a girl attains puberty.”
In January, four wealthy men kidnapped and gang-raped a seven-year-old boy. Officials said the men, while drunk, kidnapped the young boy and took him back to their settlement. They killed him with a rope after they raped him.
Two months later, the police rescued a nine-year-old girl from an arranged marriage to a 14-year-old boy in her village in Punjab province. They arrested four village elders responsible for the wedding.
“The girl’s brother’s wife died due to some health problems a few weeks ago, and (the wife’s) relatives suspected foul play and accused her family of murder,” declared deputy superintendent of police Mamoonur Rasheed. “On March 3, the village council decided to give the little girl in vani to settle the suspected murder.”
“Vani” means child marriage, which is common in Pakistan “to build and strengthen alliances, settle disputes or pay off debts.” Pakistani law does not allow children to marry under the age of 16, but most thwart the law and marry off their children. Police rarely intervene in these family matters.
Reuters reported the village elders “decided that the girl would be married to a 14-year-old cousin of her brother’s deceased wife, while the brother would pay 150,000 rupees ($1,430) to his dead wife’s family.”
On the Assassination of Feminist Leader Yanar Mohammed
Image:
Publishing date:
March 2nd, 2026
Author:
Not listed
Website published:
madre.org
Article length:
405 words
~ 2 minute read time
Today, Yanar Mohammed – one of the most formidable feminist leaders of her generation – was assassinated in her home in Baghdad in what appears to have been a targeted militia attack. We are devastated by her loss, and we mourn with all the people who loved her and whose lives she changed.
For years, Yanar lived under constant threat, as anti-rights and fundamentalist forces sought to suppress her activism for human rights and democracy. As the Founder of the Organization of Women’s Freedom in Iraq (OWFI), she built an enduring feminist infrastructure to support women and girls confronting violence, displacement, and systemic repression, and to lay the foundation for a better future. She provided food and shelter for survivors of violence and demanded an end to war and militarization.
She knew all too well how warmaking devastates communities and accelerates attacks on human rights defenders. In 2004, just after the US launched its war on Iraq, she founded OWFI to protect women, girls, and other marginalized people from these dangers. Almost immediately, she received death threats. She refused to be silent – instead, she called for the solidarity of the international women’s movement. MADRE responded to her, spotlighting her lifesaving work, demanding action from US policymakers, and launching decades of partnership.
Together, MADRE and OWFI provided humanitarian aid, human rights trainings, and community-led organizing for peace and justice throughout Iraq. We provided advocacy and legal support as OWFI fought back against restrictions on women’s shelters and against a years-long campaign of state harassment to impede their work. We will continue to stand by OWFI now, in these terrible days.
Yanar’s assassination is a stark reminder of the risks feminist leaders continue to face globally, and of the ongoing threats to human rights movements. Yet, we also remember that Yanar’s life was a testament to feminist courage rooted in action and fueled by love. She protected people where there was danger, created platforms where women could speak out, and insisted that all people deserve full rights.
As we grieve, we honor a beautiful life that propelled justice – with joy, purpose, love and courage.
Update:
The Yanar Mohammed Feminist Defense Fund was created to honor Yanar and support urgent needs of the organization she founded, Organization of Women’s Freedom In Iraq (OWFI). In addition, Yanar’s Fund will support women in Iraq and throughout the region who defend women’s human rights and carry forward Yanar’s legacy.
My daughter has had a difficult few months in school. By some administrative fluke, she ended up in a class where she was the only girl—it was just Layla, surrounded by a dozen or so 15-year-old boys. She could have found it tolerable, I think, if not for the rape jokes.
That’s right, in the year 2026—in a progressive Brooklyn high school—my daughter had to listen to her classmates ‘joking’ about rape. These are boys she thought were her peers and friends, some of whom she’s known since pre-school. And though the school ended up handling it well, I watched Layla’s light dim a little every time she came home from that class. For her, it was a regular reminder that the world sees her as less human, less worthy of dignity. Just less.
It’s a feeling I remember well, and one I couldn’t stop thinking about this weekend as I considered conservatives’ plan for the next generation of girls and young women. Because what they have in store for our daughters isn’t just about policy and politics, but dimming their collective lights.
A few weeks ago, the Heritage Foundation—the powerhouse organization behind Project 2025—released a 250-year roadmap to “save America.” Written by authors with close ties to the Trump administration, the document is a how-to guide for subjugating girls and young women: a detailed plan to push them out of college, funnel them into early marriage and motherhood, and then trap them there.
The document is part of a broad, well-funded campaign to reassert misogynist control by targeting women while they’re young and pliable—and chip away at one of Democrats’ most supportive demographics in the process.
According to Heritage, the future of the country relies on more straight married couples having more children. To make that happen, the group says, the government has to address multiple factors that “conspire” to drive down birth rates:
“These include the proliferation of birth control, more prospects for women to receive higher education and work outside the home…”
In other words, pretty much every major advancement for women’s rights and freedom is a problem. And whether it’s eradicating “cheap and ubiquitous” access to contraception or appointing family court judges hostile to divorce, Heritage has the answer.
Like the conservative movement more broadly, the organization wants young women to believe this is all being done for their benefit: that work is soulless and unfulfilling, that feminism has made women miserable, and that the real path to happiness is being a stay-at-home mom. The latest right-wing mantra for women? “Less burnout, more babies.”
This isn’t some fringe effort. From the tradwife explosion to MAHA disinformation about birth control, conservatives are pouring hundreds of millions of dollars into convincing the next generation that the rapid erosion of their rights isn’t a political and moral crisis—but a lifestyle upgrade.
Why bother with the horror of the professional and public world, young women are told, when you can just opt out? That message isn’t limited to Turning Point USA conferences, either: over the last year, outlets from CBS News to NPR have hosted earnest ‘debates’ on whether feminism “failed women.”
Even the Vice President of the United States is advising women to give up work for motherhood. At the March for Life last month, JD Vance said, “you’re never going to find great meaning in a cubicle or in front of a computer screen—but you will find great meaning if you dedicate yourself to the creation and sustenance of human life.” (He said something near-identical in a 2022 tweet.)
But there’s only so much choice conservatives plan to give young women in the matter—and other powerful misogynists are done bothering with pretense. This week, billionaire pro-natalist Elon Musk—who bemoans birth control and built an AI tool that lets men “undress” women’s images—co-signed this chilling X post:
When I say they’re coming for our daughters, I’m not exaggerating. The powerful people obsessed with the (white) birth rate and enforcing ‘traditional’ values and norms know they need young women to do it—whether those young women like it or not.
What do you think provocateur Jordan Peterson meant when he talked about “enforced monogamy” as a solution to men’s violence in 2018? Or why, nearly a decade later, one of the country’s most popular podcasts would seriously debate whether young men’s inability to find sexual partners and have children is a “mass extinction event” akin to “genocide”?
“Does society have a responsibility to intervene in some way, to course correct this?,” Diary of a CEO host Steven Bartlett asked.
If this were just about men’s overwhelming desire to advance their genetic lines, we’d hear podcasts and pundits talking about IVF or how to incentivize surrogacy. And if conservatives were simply concerned about the birth rate, they’d propose policy solutions that actually help families—like paid parental leave, affordable child care, and laws that don’t kill pregnant women.
Pretending this is some noble pursuit to save civilization is just a way to launder rape apologia and misogyny. The actual goal is good old-fashioned control and a world where women—young women, especially—have no choices.
And let’s be blunt: abortion bans and forced pregnancy were just the beginning.
Key to conservatives’ plan is getting girls and young women married and pregnant as early as possible. How early? Well, Heritage cites women in their early twenties as “more fertile” (yuck), but the authors also scold Democrats for “stigmatizing teen mothers.” One of those authors, Emma Waters, is working with the White House on a campaign to “persuade” women to have more babies—an effort that includes scrapping sex education in favor of “menstrual cycle classes” designed to teach the optimal time to conceive.
At the same time, the Trump administration has blocked funding for teen pregnancy prevention programs, blasting them as “radical indoctrination,” while Heritage has quietly dropped its hand-wringing about teen pregnancy in favor of a new term: the “non-marital teen birth rate.”
In other words, the problem is no longer that girls are getting pregnant before adulthood—it’s that they’re not married first. Pair that with the fact that most teen pregnancies are fathered by adult men, and with Republicans’ ongoing resistance to child marriage bans, and you start to see exactly what kind of future they’re fighting for.
Consider what all of this means for girls across the country, especially those in conservative-led states. Sex education is being eliminated or replaced with propaganda like ‘Baby Olivia’ videos, lessons telling girls that sex makes them ‘dirty’, and Trump’s menstrual classes. Planned Parenthood and other reproductive healthcare clinics are being shuttered in favor of crisis pregnancy centers, which doesn’t just make it harder for young people to access abortion—but contraception, too.
In fact, it’s only a matter of time before Republicans argue teens shouldn’t have birth control at all. They’ve already laid the groundwork by banning gender affirming care for minors, arguing that hormones harm young bodies.
Girls who would normally turn somewhere for help will also be out of luck. Conservatives aren’t just systematically stripping away support systems for teens, they’re eradicating basic information. Attorneys general in several states are fighting to ban ads for pro-choice groups that share information about abortion, while legislators across the country are introducing bills to make those sites illegal in the first place.
Lawmakers are also working to quash pro-choice speech in high schools and colleges—like banning campus health centers from even mentioning abortion, including in states where it’s legal. And under so-called ‘abortion trafficking’ laws, grandmothers and older sisters could face felony charges for helping a teen end their pregnancy. There are even attempts to criminalize lending a young person gas money to leave the state, or sending them a text message with a URL to an abortion clinic.
They want our daughters and granddaughters to have zero information about their bodies and sex, no ability to protect themselves from pregnancy, limited choices for an intellectual and professional life, and—once our girls have been corralled into early marriages—few opportunities to leave.
Push them into the home, force them to get pregnant, rinse and repeat.
And while it’s certainly easier for the Heritage Foundation and their allies if American girls fall in line, conservatives in power are just as happy to force them onto that narrow path. As with all coercive men, the fact that young women don’t want this is part of the appeal.
The truth is that the next generation is as ambitious as ever. The futures they want for themselves are broad and bright. Sometimes that includes husbands and children, sometimes it doesn’t. The most recent studies show that young men are actually far more likely to name children as their top marker of personal success. (Women cite financial independence and their careers.) It’s young men who are having a hard time finding partners, and it’s young men who are lonely.
In other words, despite years of cultural messages to the contrary—it’s men, actually, who are desperate for marriage and babies.
I suppose that’s what Heritage’s roadmap and the conservative agenda is really about: building the world that men want, and forcing women to live inside it.
I’m far more interested in the big, bright life my daughter wants, and ensuring it stays her own.
Crying wolf: on hollow "unity" and the left's affinity with humiliated men
Image:
Publishing date:
July 2017
Author:
reneejg
Website published:
reneejg.net
Article length:
3727 words
~ 14 minute read time
There is a story, told in Tim O’Brien’s The Things They Carried, of an American man who received his draft notice from the U.S. military at twenty, after he actively protested the Vietnam War. Before the notice came, “Stupidly,” he recollects, “with a kind of smug removal that I can’t begin to fathom, I assumed that the problems of killing and dying did not fall within my special province.” When confronted with the notice, he felt a “rage in my stomach” that later “burned down to a smoldering self-pity then to numbness.”
He describes having the opportunity to refuse conscription by heading for Canada, by diving from a fishing boat and swimming twenty metres to shore. He didn’t take it. “Intellect had come up against emotion,” he said. “What it came down to, stupidly, was a sense of shame. Hot, stupid shame. I did not want my people to think badly of me.”
In her recounting of this story in Unmaking War Remaking Men, Kathleen Barry writes about this man’s decision as “choosing the demands of masculinity over his humanity. It is a decision that would lead him to take others’ lives, and it would haunt him for years to come.”
Barry says that the smoldering in men who have learned their lives are expendable, becomes the source of rage the military will “tap” to prepare them for combat. The military also “counts on the cowardice”, she says, that is tangled up with this rage that masculinity seals away. The army employs humiliation to reshape trainees’ basic human needs to connect with others, to “produce in them the desire to belong to a team effort to kill.” Those who refuse to shoot know they are leaving the burden with their buddies, Barry says. The reward for the loss of soul that comes with destruction is masculinity: becoming one of the boys.
With these efforts the U.S. military, of course, creates enemies by emasculating men in every territory to which it sends its troops, rendering them incapable of carrying out the duty of protection that men everywhere – husbands, fathers, soldiers – are told is their duty as men. “Violated self determination of a people brings about resistance,” says Barry. Of course. She adds,
When men are made inferior, their condition is reduced to that of women. That is intolerable to most men. Those men in turn force women’s status to lower levels.
Barry is describing a pattern that affects all male socialisation, not just men in the military or under occupation. Militarism affects the socialisation of boys through toys, games and films – but the dynamic of brotherhood based on violation is not limited to the military. From religion to rugby to resistance movements to work, the household and television, this paternalistic masculinity reigns. That we ignore this and ignore the masculinity of violence – because it makes men uncomfortable – provides a big part of the reason for both the chaos and inertia of leftist politics.
There is a passage in Ovid’s Metamorphosis in which Jove reports a trip to visit King Lycáön (pictured in the feature image), that perhaps describes the dynamic we’re caught in. Jove says he descended from the “heights of Olympus” to visit King Lycáön, and “wandered over the earth, a god disguised as a mortal. It would take too long to recount the story of all the wickedness I discovered.” I honestly read this and think of Bill English paying a visit to the Radical Social Centre on Abel Smith street.
I entered the palace of King Lycáön and ventured beneath his inhospitable roof in the twilight hour of nightfall. I gave a sign that a god had come, and the common people turned to their prayers. Lycáön began by mocking their piety; then he said, “Is it a god or a mortal? I’ll settle the matter by using a simple test. There will be no doubt where the truth lies.” His plan was to make a sudden attack in the night… Not content with that, he applied his sword to the throat of a hostage sent from Epírus and under my own protection; and while the man’s flesh still had some warmth, he roasted part of it over the fire and poached the remainder in boiling water…
My lightning of vengeance struck, and the palace collapsed in ruins… Lycáön fled to the country where all was quiet… He was now transformed to a wolf. But he kept some signs of his former self: the grizzled hair and the wild expression, the blazing eyes and the bestial image remained unaltered.
Lycáön’s form became shaped by his rebellion and relationship to the King of the Gods. He became the wolf, the humiliated man, dangerous because every emasculated male hero seeks retribution. I see Lycáön as the kind of wounded male archetype to which leftist politics are most loyal.
Terrorism and gang violence tend to be viewed by leftists as “last resort” lashing out stemming from desperation and poverty. Jarrod Gilbert’s Patched: The History of Gangs in New Zealand and Robin Morgan‘s The Demon Lover: On the Sexuality of Terrorism both challenge the assumption that these forms of violence are linked per se to poverty. In any case, why is it not female gangs and terrorists making headlines? Women experience more sexual assault and poverty than men do. Yet the masculinity of violence is its most salient feature, and we don’t talk about that so much.
In the 1970s, Aroha Trust was established to help women gain autonomy from gangs. In her record of the trust, Aroha, Pip Desmond writes about how the women who lived in its Aro Valley residence suffered both gang and police intrusions, and considered the police to be another gang. They valued the “protection” their own gangs offered from the police, yet the women at Aroha lobbyed these gangs to insist that the men stop raping them and threatening them with rape.
The left does not tend to look at state, gang or terrorist violence from any kind of solid female vantage point. Labour’s Rob McCann runs White Ribbon, which recognises male violence through the lens of rugged male pride. We even refer to “child poverty” erasing the sexual politics of poverty and economic violence against women. The left’s views on gangs and terrorism too, are often built out of empathy with Lycáöns demoralised by the state. Many gangs are actually named after that state of establishment rejection: the Outcasts, the Mongrel Mob.
In her book Demon Lover, Robin Morgan views the relationship between terrorism and the state as fraternal:
What happens when we realise that far from being a threat to the state, terrorism is the means by which men under patriarchy judge one another fit to succeed?
Terrorism reinforces the state. If the terrorists fail, the current State is all the stronger for having put them down. If they succeed, then today’s terrorists become tomorrow’s statesmen (busily decrying terrorism).
Gilbert notes the respect that gangs and police often show one another, beyond the enmity and baiting. The masculinity of terrorism means that bonds of brotherhood can exist even between sworn enemies. Feminist writers like Morgan, Cynthia Enloe and Andrea Dworkin contend that the fact this goes unspoken is part of what alienates women from politics. “For many women,” wrote Gena Corea in 1979, “it does not matter who wins the various battles of domination going on over their heads… men will still beat women.”
No Pride in Prisons, originally named Petty and Vindictive, is an activist group that very much allies itself with Lycáöns. It advocates for prison abolition, and the removal of the sex offender register, yet it has no visible analysis or plan to address male violence. It promotes the shifting of the 19 male inmates in New Zealand prisons who identify as “trans” into already overflowing women’s prisons, much more than it ever draws attention to the plight of indigenous female prisoners, the fastest growing prison population. In their view, male inmates who identify as women are the most vulnerable… woman inmates.
Plenty of women in New Zealand are under pressure not to tell police when they are raped, since the police are the “army of the rich”, and to seek justice from them is to betray the leftist cause – or the Lycáön. The work of No Pride in Prisons is contributing to this pressure in activist circles.
Women have also been historically alienated from other forms of activism, including union activism. Unionists have typically insisted on drawing on a class analysis that allows for discussions of sex and race – within limits. Unions may fight capitalist exploitation, but they will not, for instance, challenge the commodification of women under patriarchy. Cybèle Locke’s history of unionism in New Zealand, Workers in the Margins, discusses how a pivotal 1985 report trashing the unemployed workers union
indicated that some trade unionists were stuck in a ‘1951 mindset’ – an understanding of trade unionists as white males organising on principles of working class solidarity without taking racism and sexism seriously. This mindset meant that they refused to treat leaders of the unemployed movement – especially women and Maori – as equals and wanted to control the unemployed movement.
When women brought feminism and Māori brought nationalism to unions, they were accused of “resorting to divisively separatist tactics”. This is ironic, considering that a “bottom up” politics should be informed by indigenous and feminist analyses, since these two groups are most alienated under capitalism. Yet, women have had to participate in unions largely on the understanding that working class solidarity was threatened by anything that was not white and was not male. The union struggle places working class men on the right side of history, and Māori and women threatened that ideal by questioning white society and masculinity. Wherever women and Māori found unionism a vehicle for politicisation, the handbrake was up.
The unions (like Bernie Sanders now) will discuss equal pay, which is perhaps why “feminists have refused to face the fact that equal pay for equal work is impossible as long as men rule women,” writes Andrea Dworkin. This is a tokenism when not couched in a broader feminist analysis, and a sentence to tread water. “Right wing women have refused to forget it,” Dworkin says. What needs to be recognised is that “The sex labour of women must be maintained; and systematic low wages for sex-neutral work effectively force women to sell sex to survive.”
As Barry suggests in Unmaking War Remaking Men, protecting men from humiliation by not raising the issue of sexual inequality actually does men no favours. Imagine being the one to suggest that our drafted Vietnam protester need not lose face by diving from his fishing boat to swim to Canada and escape fighting in war. Protecting the male ego in this way actually serves to lock men into a toxic masculinity. “You fear being belittled, ridiculed, humiliated if you do not hold up your part,” writes Barry, discussing how men learn to destroy rather than to lose face by conceding their humanity.
If social transformation really means “all hands on deck”, then facing masculinity and its enforcers is a task that men simply cannot be shielded from.
Sheila Jeffreys writes about the impact of emasculation on male homosexuals in Unpacking Queer Politics. She writes about how the normalisation of sadomasochism and self-harm in anti-establishment circles – which Audre Lorde also challenged – stems from gay male culture. Sadomasochism, Jeffreys says, “needs to be understood both as a practice that affirms masculinity for gay men who feel they have been shut out of masculine status and as a practice of self-mutilation which arises from abuse and oppression.”
Gay men are “feminized” in a culture that insists, as Catherine MacKinnon puts it, “man fucks woman; subject verb object”. To avoid this humiliation, a culture has developed within the gay movement in which sadomasochism, endurance, dominance and control shape sexuality. Jeffreys says the cutting and piercing industries of the 1990s have their origins here, in a culture that is changing mainstream understandings of sex.
Whatever, dude.
Queer politics is shaped by affinity with Lycáöns. So the LGBT movement champions marriage, even though the institution has always been challenged by lesbian feminists as both homophobic and sexist. It promotes transgenderism, ignoring critics who also call it sexist, and gay eugenics. It promotes breast binding, in spite of feminists recognising this as the sanctioned mutilation of women’s bodies. Most recently, the left seems to have relaxed its positions on militarism, in its confused responses to president Trump’s announcement that transgender individuals may no longer enlist in the U.S. military.
Through a feminist lens, the U.S. military is one of the most patriarchal, masculine institutions in the world, and any male who opts to enlist is simply not gender non-conforming. The techniques of medical and surgical sterilisation that transactivists lobby for, too, have been developed as part of eugenics programmes, for instance by Nazi doctors. In feeling compelled to respond to Trump’s announcement, many leftists would have been initially stumped, bumping right up against the hypocrisy of opposing militarism whilst supporting eugenics.
Not naming male violence – what Caitlin Roper calls “the worst problem in the world” – or seeking any kind of female lens or vantage point to look critically at social problems, leads to many such political inconsistencies. It seems that leftists will simply promote anything that a Lycáön says he wants or needs – regardless of whether the demands of all of these men are actually compatible or not.
The left will promote transgenderism, even though it reinforces the sex stereotypes that homosexual men suffer from. It will not bother to critique the church wherever homosexual men want to marry there, but will challenge it vehemently wherever anyone suggests restricting men’s access to women in prostitution. “Christian bigot!” is a common accusation leftists level at abolitionist women, to defend the rights of sex buyers who are not abusers, but just “sad and lonely” men in need of human connection.
The most frequent request johns make in brothels is for the “youngest girl”, and the New Zealand Prostitutes’ Collective distributes instructions to women on tolerating anal rape. Is raping a young girl anally really the antidote to loneliness that aids real human connection? And what about the fact that most johns are partnered? Our refusal to look at these questions from a feminist perspective in favour of the lonely Lycáön is leading to the promotion of practices like anal sex in prostitution, pornography, girls’ magazines and even government funded Safe Schools programmes.
When women resist this, we must be Christian bigots. Funny then, that if in solidarity with women living under Muslim laws we question the burqa, we are met with cries of “Islamophobia”. Arab men are discriminated because of racist “jihadist” stereotypes escalating in a context of ongoing state / terrorist violence. So now, Islam can no longer be challenged. Religious freedom is suddenly paramount – even though religious freedom could never be compatible with crushing critiques of religion. So Islam, prostitution, marriage and transgenderism are all defended ferociously as varieties of freedom, for contradictory reasons. This makes no sense. We need to be asking how men are using these institutions, and using them at women’s expense.
It used to be considered a woman’s “choice” to enter the sex trade, to service lonely Lycáöns. Enlisting in the military was another matter, because the military is imperialist and destructive. Now, since Trump’s announcement that transgender people are no longer allowed to enlist – suddenly, military enlistment is just a “choice”, too. The military is the welfare state of the poor, it is said. It’s the only way they can get access to healthcare and education.
Finally, we are seeing the same arguments applied to the patriarchal institution that is the sex trade, also applied to the patriarchal institution that is the U.S. army. And what did it take to make militarism a matter of “choice”? The left needing to save face for otherwise humiliated men. That loyalty is how all of these inconsistencies and blind spots are explained. It is also why I am being asked by liberals, more and more, to empathise with pedophiles. “Read up on child sexuality,” they say. They don’t mean, read I Know Why the Caged Bird Sings, and rage. They mean, read texts by white males who lobby to have pedophilia recognised as a misunderstood sexual orientation, and then wax philosophical about the benefits of child sex dolls.
Yuck.
Max Harris has recently noted the way leftists are “muddling through”. “Around the world, progressive-minded people are struggling to articulate an end-goal for politics,” writes Harris with Philip McKibbin in their essay on the Politics of Love. Well, yes. Harris and McKibbin’s essay title is inspired by a disillusionment with what Bernie Sanders calls “establishment politics” and a desire for a more values-based alternative. The left is in disarray, people are disengaging, how do we rile them up again?
Our politics are a hot mess. To resolve this, we carry on tinkering, and we hunger for more charismatic leaders, more vision and values, more eloquent idealism, more “hearts and minds” aspiration. Presumably, we have exhausted the language of community and sustainability, diversity and inclusion, change and hope, then. These have become “establishment politics”. These values have been neoliberalised and numb, so we are back on the prowl.
Surely people want to vote for health, welfare, housing, workers’ rights, child poverty and stopping climate change though? We are the good guys, that is a given. So the question we asks ourselves seems to be, how do we unite and inspire more people, more broadly, without actually radically altering the content of our politics?
Well, that’s one way to do it.
The other is with the injection of more zeal. “Community” was yesterday – now, let’s talk about “love”. Surely though, where more moral fervour is injected into an otherwise stagnant politics, that only adds new levels of righteous indignance to political discussions. Isn’t zeal already making politics so loaded that it is threatening freedom of speech? If it is a matter not just of “inclusion” or justice, but love to support the welcoming of males into women’s bathrooms, then it is a matter of hate not to. So girls who simply assert that girls are female, and girls’ bathrooms are for females, are suddenly bigots who need to learn how to “love”. The bullying of girls and women escalates through accusations of hate, bigotry, fascism, and all number of “phobias”.
It is no coincidence that all this serves to shore up the very practices of male dominance that leftists do not want to look at: prostitution, eugenics, pedophilia, criminal violence, patriarchal doctrine. It does this by making up in tone what our politics lack in content.
I have all the time in the world for a loving feminist politics – but who examines the positions leftist golden boys hold on women? Who cares that Jeremy Corbyn is pro-sex trade, or that Justin Trudeau has sold out women in Canada by instituting “trans rights”, ignoring feminist critiques? A friend of mine who works in a rape crisis centre in Vancouver is not allowed to record the statement “he raped me” without confirming with the perpetrator that he indeed prefers male pronouns. This is not a joke.
The Brave New World and Republic of Gilead in The Handmaid’s Tale were not wanting for value laden politics. The dystopian world of 1984 has a Ministry of Love (and a MiniPlenty, MiniPeace and MiniTruth). It is painful to read precisely because of the irony of patriarchal states employing rhetoric based on human values to attach people to methods of social organisation that commodify those very things. In the Handmaid’s Tale, women are designated as wives, prostitutes at Jezebel’s, infertile Aunts and Marthas, fertile handmaids used to spare wives from pregnancy and labour, and Econowives who perform all these roles for men of lower standing. There is no lack of idealism in this society – and it’s not idealism we lack in ours. What we lack is an analysis that understands that women – half the human population – are materially and politically real.
In fact, a values-based politics that accepts prostitution, surrogacy, and child sterilisation sounds to me all too much like the Brave New World.
In Right Wing Women, Andrea Dworkin writes about how conservative women respond to leftist politics: “a woman acquiesces to male authority in order to gain some protection from male violence”, she says, and the conservative Right “promises to put enforceable restraints on male aggression.” Fifty per cent of white women voted for Trump in 2016. “So the woman hangs on… to the very persons, institutions, and values that demean her, degrade her, glorify her powerlessness, insist upon constraining and paralyzing the most honest expressions of her will and being. She becomes a lackey.”
Are left wing women any different?
Metiria Turei has asked the left to “band together”. She’s not alone in making the request. Unity does not mean though, that we should embellish our patriarchal politics with more value-laden rhetoric; it means we need to develop an analysis that takes women and women’s oppression seriously. To speak of “love” means we cannot be institutionalising prostitution. Challenging capitalists means we can’t be accepting the commodification of human relationships. Sexism is not anti-establishment. Religious freedom is not compatible with pathologising women who question religion, marriage or prostitution. Pedophiles do not need support and empathy – victims do. Protesting militarism means protesting eugenics – and transgenderism is a eugenics movement.
Our mate Lycáön – the man whose form was shaped in the fires of state terrorism – has human rights. He also has responsibilities, and recognising that women are human is one of those. Let’s stop covering up how afraid we are to shame this man, whether out of sympathy or fear of retribution, in the name of his rights. That is called “men’s rights activism”, and it takes place at the expense of women and girls.
Let’s develop a politics that fully recognises women’s existence, that has a female vantage point – and that therefore actually makes sense, and gives us a shot at real transformation and an end to violence.
Synanon, the Brainwashing “Game” and Modern Transgender Activism: The Orwellian Implications of Transgender Politics.
Image:
Publishing date:
August 13th, 2017
Author:
Jenn Smith
Website published:
wordpress.com
Article length:
6230 words
~ 23 minute read time
Introduction.
What had happened was that Gloria walked in the front door of Synanon [for drug counselling] and they had gamed her right off. Someone, on purpose, had walked past her as she sat waiting to be interviewed and had remarked on how ugly she was. The next person to parade past had informed her that her hair looked like something a rat slept in.
Gloria had always been sensitive about her curly hair. She wished it was long … What the third Synanon member would have said was moot, because by then Gloria had gone upstairs to the tenth floor [to kill herself].
“Is that how Synanon works?” Fat asked.
Bob said, “It’s a technique to break down the personality. It’s a fascist therapy that makes the person totally outer-directed and dependent on the group. Then they can build up a new personality that isn’t drug oriented.”
from Philip K. Dick, VALIS.
The above quote is from Philip K. Dick’s pseudo-autobiographical novel VALIS and was based on his experience in the 1970s with what was once called the “most dangerous and violent cult America had ever seen,” Synanon. At first glance the quotation from VALIS would seem unrelated to the modern transgender (trans) movement, however, my experience with opposing trans-activism has led me to the conclusion that the activist element in the trans community has become and uses (knowingly or unknowingly) the techniques of cults such as Synanon.
Certainly those that constitute the more radical activists in the transgender movement behave just like cult members and are just as willing to ignore reality as any member of even the most bizarre religious cult.
There are a great deal of questions regarding just who is behind the international trans agenda and what their end game is, or why almost every organ of power is supporting the mass delusion that is the new transgender movement. Investigation has revealed several billionaires at work (notably Martine Rothblatt and Jennifer Pritzker), as well as funding and promotion from the pharmaceutical industry and even the highly lucrative cosmetic giants. Major governing bodies such as the Endocrine Society, who have conflicts of interest with big pharma, are making absurd statements such as claiming that three year-olds know their true gender identity while apparently ignoring Kohlberg’s findings regarding “sex constancy” which contradicts the very concept. But just who is promoting the transgender agenda and why is not the primary subject of this essay; the methodology of recruitment is. With that being clarified, there are of course both macro and micro levels of the trans agenda, and the macro level will be addressed in the conclusion.
It should be noted from the outset that the goal of this essay is not to draw exact equivalencies between Synanon and transgender activists, only to illustrate similarities in the basic psychological processes or agencies that facilitate transgender youths becoming part of radical transgender activism, which is typically centered on various online social media forums. It is difficult to address this issue without investigating and speculating on the reasons why governments all over the western world are pushing this so hard. It appears as if the creation and promotion of trans cult activism and ideology is part of a larger social engineering agenda, and one that requires everybody’s attention. Governments that engage in social engineering using deception and propaganda do not tell people why they are doing it. As was the case with the “incubator baby slaughter” fraud that was used to justify the invasion of Iraq by President George Bush Sr., we the people only find out after the fact, and in that case after hundreds of thousands of lives were lost. It thus becomes incumbent upon freedom loving citizens to speculate on the reasons why our leaders are supporting the mass delusion that is transgender activism, and this will be addressed in the final section of this essay.
Synanon and “The Game.”
Power is in tearing human minds to pieces and putting them together again in new shapes of your own choosing.
From George Orwell, 1984
In August of 1957, Charles E. Dederich was just one of many alcoholic test subjects at the University of California Los Angeles (UCLA) that were given the drug LSD in order to see if chemical mind alteration could modify extreme addictive behavior. Alcoholics Anonymous (AA) founder Bill Wilson was a subject of the same study, which was funded by the National Institute of Mental Health (NIMH). The project involved giving alcoholics large doses of LSD in an effort to break down and reform the personality of the subject. Dederich described the experience as critical in his own break from addiction and subsequent development. He was so powerfully affected by the experience that he “cried uncontrollably for days.” He reported experiencing a total self-surrender or destruction of his ego, and he emerged from the experiment with “feelings of omnipotence and omniscience.”
One of the most typical effects of LSD was the exact kind of self-surrender Dederich reported. The Central Intelligence Agency (CIA) focused many of its MK Ultra LSD experiments on the drug’s ability to clear the mind, and thus allow for the programming or brainwashing of a subject. Most of the MK Ultra documents were deliberately destroyed in 1973 under orders of CIA Director Richard Helms to avoid public scrutiny, but it appears from the documents that survived as if one of the goals was the creation of so-called “Robot Agents”, or sleeper agents brainwashed by the agency to serve its goals. Dederich realized, apparently on his own, that it was this destruction of the self or ego that allowed him to break from his bad habits and begin shaping a newer more powerful self. This loss of ego thus became a focus not only for Dederich’s later theories on drug rehabilitation, but Bill Wilson also came to the conclusion that the “ego has to be crushed” in order to reform or control an individual’s behavior.
After his experiences at UCLA, Dederich himself joined AA, and quickly became a fanatical member and a popular speaker. He also became obsessed with Ralph Waldo Emerson’s brilliant essay “Self Reliance,” and apparently took to heart literally Emerson’s suggestion that he should “be wholly his own man, and in turn the founder of a sect,” which is exactly what he did in 1958 when he founded Synanon.
Synanon (originally named the “Tender Loving Care Club”) was designed initially just for the treatment of drug addicts, using techniques developed in AA, but with a more intense focus on breaking down personalities/egos. While he recognized the power of LSD to induce the required state of total ego surrender, Dederich concluded that drugs could not be used to reform drug addicts and were ultimately too unpredictable in terms of outcomes (as the UCLA LSD experiments concluded as well), thus he turned to what he called the “ego-crushing [power of] peer pressure” as the best way to break down the individual’s former drug-oriented personality and force them to utterly reject their previous lives. Dederich coined the now popular expression, “today is the first day of the rest of your life,” as a kind of comment on the fact that the initiate’s former self and life had to be totally abandoned. His drug rehabilitation rates were very high – it was the first private institution to actually cure heroin addiction – largely as a result of one particularly effective tactic.
The center piece of Dederich’s drug rehabilitation program was a confrontational technique he called “The Game,” which involved hurling insults and profanity at an individual, and picking apart every aspect of their being until they felt totally worthless and unable to resist. Hence the insults directed at Gloria in the Philip K. Dick quote, but in an actual focused “game” session a “Synanist,” or experienced former addict, would lead an all-out group assault on the person. The technique, which could last for days or weeks, eventually led to an emotional breakdown and complete psychological exhaustion in which the person disavowed their former selves and ways completely. Once the former self has been rejected the group can work to “build up a new personality not drug oriented.” This kind of intense and prolonged assault had much in common with some of the “psychic driving” techniques employed by Doctor Ewen Cameron in his ghoulish MK Ultra experiments conducted in Canada.
“The Game” was recognized by Dederich and others as a form of highly effective brainwashing. Its ability to break down drug addicts and reshape them garnered Synanon the attention and financial support of Fortune 500 companies, Hollywood stars, and an endorsement from LSD guru Tim Leary. Eventually Synanon expanded its focus to include prostitutes and other troubled personalities, and courts began sending Synanon young offenders to reform. Prostitutes were subjected to intense shaming, some had their hair shaved, and were made to admit their “wretched lives,” which of course tended to throw them into complete emotional breakdowns, after which it was all love, group hugs and promises that today was indeed the first day of a brand new life. Synanon graduates became so dedicated that they eventually began giving up their outside lives and living with the group full time, and formed radical recruitment teams to seek out and bring in new members. The hair shaving technique became a common practise used on all troublesome members, thus society at large began associating followers with shaved heads and confusing them with religious cults such as the Hare Krishnas. Synanon’s success resulted in countless cult-like copycat rehab organizations that used the same “game” tactics, including another well-known group named Straight Inc.
Straight Inc. was founded by a good friend of the Bush family, former U.S. Ambassador to Italy Melvin (Mel) Sembler. After creating Straight, Sembler also created several spin-off groups, all modelled loosely on Synanon’s tactics (The Seed was one of those spin-offs). Sembler, interestingly enough, was friends with Robert Pritzker and sat with him on the board of the American Enterprise Institute for Public Policy Research – the Pritzker family has been heavily involved in funding transgender activism today, particularly via Jennifer (formerly James) Pritzker. More recently Sembler was appointed vice chairman of the Trump Victory Committee and remains one of the most influential men in Washington.
Straight became almost as popular as Synanon and was endorsed by former Drug Czar (for Richard Nixon) Robert L. DuPont and later by Nancy Reagan, who made regular high profile visits to Straight offices. Dupont oversaw a federal grant of almost two million dollars to start Sembler’s spin-off group The Seed. In conjunction with CIA subcontractor and mind control specialist Ruth Fox, Straight expanded and refined Synanon’s “Game” by creating something they called “Rap Groups,” which were comprised of nothing but peer group members, all graduates, who were all of the same age and would be locked in a room with new members all day. The “Rap Group” would also bombard the person with insults and questions designed to totally break them down. They called this tactic “tough love,” which has been in the popular lexicon ever since. The Straight operators discovered that age-specific peer pressure was more effective than just the general group pressure Synanon used. Fox stated that the goal was to change behavior in such a way that addictive personalities would become addicted to people (the group) instead of drugs.
The average age of Straight recruits was 17, with members as young as 12 and 13. The “therapy” thus was conducted initially almost exclusively by teens who were schooled in emotional bullying techniques, with the smartest and most effective leading. Both Straight and Synanon were eventually forced to close their doors due to allegations of abuse of members and violence against opponents, which led to crippling lawsuits; although Straight would be reborn in the guise of the Drug Free America Foundation (still operating, and which, coincidentally, gets much of its funding from the pharmaceutical industry that is also funding and supporting transgender research and activism).
The Transgender “Game” and those that support it.
Whether it is deliberate or not Synanon’s “Game” can be seen at work both directly and indirectly in the more extreme elements of the transgender community. For those familiar with the trans community, they will know that the vast majority of trans identified people fall under the category of “fragile, emotionally vulnerable, and confused.” I have certainly observed this in my many years in the community, and younger trans suffer from the same personality traits. Thus a young detransitioning woman I communicated with (@gnc_centric on Twitter) told me that among the young trans she has known, almost every one “had depression and/or anxiety. A significant number of them also seem to have PTSD or BPD too.” We are thus dealing with troubled minds and I have documented this extensively elsewhere.
Many, perhaps most, young trans are social outcasts, as I myself was when I was young. As social outcasts, many of these individuals have been subjected to non-stop insults and profanity from their peers in their daily lives (in some cases for years), thus that part of the transgender “Game” has already been completed by proxy. Transgender leaders and activists can thus just parachute into the lives of these troubled, wounded minds and start rebuilding them with their new “trans identity,” and they tend to become as dedicated to the trans cult as any Synanon member ever was. Although it should be noted that with all of the non-stop propaganda and pro-trans coverage in the media and Hollywood, “parachuting in” is not even required, because brainwashing and suggestion are constantly being broadcast on almost every TV channel. The rebuilding of the personality thus can be done by a form of electronic correspondence, without ever coming into physical contact with an actual recruiter. The use of incredibly slick multi-media presentations, the likes of which Dederich et al. could only dream of, makes this kind of programming even more effective.
It should be noted that some people have personalities that make it quite possible for them to “Game” themselves without any outside intervention needed. Some people are obsessively self-critical. When I was young nobody was harder on me than I was on myself. My experiences with female born transgenders (FBT) has suggested girls that do not fit the “Barbie Doll” image of femininity are highly prone to attacking themselves in this way. In these cases outside intervention is not necessary to break down the ego, the person has already attacked and broken down their own sense of worth. Synanon expert Paul Morantz spoke to this in his essay “The Devil and John Walker”: “Those who already had a negative self-image or identity confusion, plus inclinations toward all-or-nothing emotional alignments, were most susceptible [to the influence of cult brainwashing]. And the most vulnerable, often, were teens and young adults whose identities were still taking shape, who were still idealistic and emotionally polarized, and who were dissatisfied with” society at large. All of these characteristics of course are ubiquitous in trans identified individuals.
While much of the gaming has been performed either externally by society at large or internally by the individuals attacking themselves, there are also what appears to be more overt attempts at using Game-like tactics, specifically against opposition from less radical elements in the community. When I, as a transgender person opposed to child indoctrination and the destruction of women’s safe spaces and programs, began speaking out, I was immediately attacked quite viciously by numerous trans activists, who engaged either knowingly or unknowingly in a textbook example of “The Game”. They hurled non-stop insults at me, insulted every aspect of my appearance and identity. They said I was fake, pathetic, just a dirty old man, and pounded me relentlessly with one personal insult after another – classic gaming. When it became clear to them they had finally upset me emotionally and that I did not appear to be resisting anymore, they then suddenly changed tone and assured me that if I just came to a realization that I was wrong and they were right, that I too could be a real, beautiful, genuine trans and we could all triumph against trans oppression together. This latter stage of rebuilding is standard in Synanon-styled behavior modifying cults. It was when they began rebuilding me after tearing me down, that I realized that I was in fact being “gamed” by these people. When my tone changed, the insults came at me fast and furious again. This type of temporary break-through was common in Synanon when “gaming” somebody. A person might initially be broken down but then get a second wind of defiance and reassert themselves. Thus many days or weeks of gaming attacks and surrenders might be necessary to finally break a particular individual down.
Whereas Synanon would break down the recruit and then “build up a new personality not drug oriented,” trans activists break down potential recruits and then “build up a new personality not traditionally gender (or what they call “cis gender”) oriented.”
Miranda Yardley is a transsexual male who has been researching and critiquing radical trans activism for several years now, and is probably one of the foremost experts on the topic. In a private communication Miranda noted:
There are [clearly] aspects of cultish behaviour [in modern trans activism]. There are some core tenets which everyone is required to believe, for example, that gender identity is innate and takes precedence over biological sex, and that “trans women are [real] women”. It has its own language or redefines existing language to suit its purpose, generally emptying established words like “woman” and even “transgender” of meaning. Those who break the key rules are punished severely, excommunicated. There is no debate, no discussion of ideas. Heretics and critics are dehumanized, branded “TERF” and “transphobe” with little consideration to what these words actually mean.
Yardley’s observation on the brutalization of language is important here and worth an essay on its own. In his book Kingdom of the Cults, Walter Ralston Martin observed a similar attack on language by Christian cults; Martin noted it seemed as if there was a deliberate attempt to confuse language and rewrite the meaning of words, making communication either difficult or impossible. If you can distort language you can distort reality itself. As propaganda expert and journalist Stella Morabito has observed, the current trans propaganda “requires more than ever that the bystander reject physical reality in order to accommodate ever-shifting perceptions of others. This is huge. It … require[s] us to reject our own physical reality and question our own ‘gender identity.’”
Trans activism today is largely connected and organized via various online social media sites such as Twitter, Tumblr, and Facebook. Ken Zucker, head of the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto, regarded as one of the world’s foremost experts on gender identity issues in children and adolescents, has said “The No. 1 factor [driving the current transgender explosion] is the Internet.” “If you’re struggling to find out where you fit, the Internet is filled with things about gender dysphoria.” The internet has become the primary engine for non-clinical programming of confused young minds, not just via mind warping gender politics, but also via exposure to new and increasingly debauched “tranny pornography.” The “Gender Identity Clinics” are a new phenomenon that are busy indoctrinating and conditioning children as young as three, thus we can expect a totally new and totally different generation of trans to emerge in the near future, all chemically dependent for life, all likely to seek out surgery to alter their bodies, and all likely to be all-in members of the radical trans cult.
While Synanon utilized a brainwashing technique called the “Think Table” in which daily messages and support would be broadcast each morning to the breakfast table (People’s Temple founder Jim Jones used a similar system), social media sites now serve as a kind of “Think Table” for trans activism, broadcasting daily brainwashing messages from trans extremists such as Riley J. Dennis and Zinnia Jones, who spew non-sense about how sexual orientation and preference are really just thinly disguised transphobia. Trans dogma that suggests men are “real women,” that a man’s penis can actually be a female sex organ if he believes it to be, and similar nonsense is being apologized for and even parroted by politicians and academics (although I suspect many politicians and academics supporting this are well aware of its absurdity; they are not idiots). That so many people in the community at large are spontaneously piling on to the “a man can be a real woman” bandwagon, I think goes to affirm Emerson’s contention that “infancy conforms to nobody: all conform to it, so that one babe commonly makes four or five out of the adults who prattle and play to it.” It would be tempting to simply regard all of this as merely absurd and comical, were it not for the fact that it is currently putting grown men in swimming pool changerooms with women and young girls, and allowing men to take part in women’s sports and programs, all justified by this impossible suggestion that some men are in fact “real women.”
Dr. Robert Lifton, an expert on brainwashing and author of The Nazi Doctors, noted that all cult behavior modification and indoctrination systems involve an “excessive emotional experience demanding total self surrender.” Taking the “candidate” to the point of “total self surrender” was found to be a prerequisite of all effective brainwashing, and in this sense pre-trans youths are already blank slates awaiting a new identity, because there can be no greater a rejection of self than to reject one’s own body and biological self.
Destroying the Family Unit.
Total self surrender necessarily involves pulling away from anybody that would pull you back to former ways of thinking and behaving. Friends and family have always been the biggest threat to cult agendas. Synanon thus encouraged recruits to destroy their former selves and come join “the Synanon family.” Eventually they purchased a large ten story building to permanently house members and new recruits. One of America’s leading cult experts, Margaret Singer, observed that one of the most important steps in all brainwashing to is to keep recruits away from their real families. The group must now become the family of the recruit. She writes, “Many of the groups refer to themselves as ‘the family’ in one way or the other and emphasize ‘We are your new family now!’ /…/ Several of the groups tell members, eventually, that their parents are ‘satanic,’” or otherwise disparage them. Cult leader Jim Jones was so worried about the influence of family that he actually rounded up his followers and fled the country to avoid them. Charles Manson too kept his “Family” away from their real families; if real family members showed up he threatened them with violence so they would not come back. Interestingly, Manson did time in the Terminal Island prison when it had setup a Synanon program to treat prisoners; it is unclear if Manson himself was in the program, but he certainly used “gaming” tactics as well as LSD.
As the cult model would predict, we can see transgender activists encouraging youths to break away from their families if they are not supportive of their new transgender identity. A good example of this can be found in the guise of Charleston College philosophy professor Rachel McKinnon (4thWaveNow has chronicled McKinnon’s antics). McKinnon was born male, is still male (sex change is not possible; even genital surgery does not change sex), but dresses and expresses in a feminine way, much like the author of this essay. Nevertheless, McKinnon released a video on Mothers Day of all days, encouraging kids to walk away from unsupportive mothers. “I want you to know,” McKinnon said to kids watching, “that’s it’s ok to walk away from unsupportive or disrespectful or even abusive parents.” You will note here that the first reason to walk away is not “abusive” parents (which is last on the list of reasons), but parents that are merely “unsupportive” of their desire to transition. From a propaganda perspective the order of the words is very important. McKinnon went on to say, “it’s ok to walk away … and I want to give you hope that you can find what we call your glitter family. Your queer family” (video here). This is a classic cult tactic and it is highly unlikely a professor of philosophy would not know that, thus one must be extraordinarily suspicious of McKinnon’s motives.
How Charleston College could support such a blatant attempt to undermine parental authority is a real headscratcher. McKinnon essentially launched an assault on mothers on Mother’s Day, an incredible act of audacity and sign of contempt for the family unit. While the College of Charleston is apparently just fine with a professor encouraging the destruction of families, in Canada the University of Toronto Professor Jordan Peterson was officially censured or warned for refusing to use artificial pronouns like “Zir.”
Perhaps one of the most disturbing attempts to undermine families can be seen in a slick video produced by LGBT in the City, a multi-media organization that produces talk shows and videos related to LGBT issues and is sponsored by such monster corporations as Telus and TD Bank. To say LGBT in the City has a hedonistic focus would be a grotesque understatement and it might be argued that at least one of their videos encourages the sexualization of children, specifically in the form of an eight year old boy mockingly named “Lactacia.”
In a slick video released on Facebook with over one million views so far, a hyper-feminized/sexualized 8 year old boy (who some have compared to a drag version of JonBenét Ramsey) is featured partying in a hypersexual adult LGBT environment and telling kids watching that if their parents or friends do not support their desire to be drag (or trans), they need to get new parents and friends. Professional quality video and editing made this call to young children to the queer lifestyle all the more appealing. As “Lactatia” speaks to his peers, while an all too happy host leers, bold text leaps out at the viewer saying “YOU NEED NEW PARENTS! YOU NEED NEW FRIENDS!” You too can be a drag queen or transgender superstar and perhaps head out on the town to party with the wild LGBT boys and “Lactatia.” If your parents won’t get on board, they can simply be replaced with a new “glitter family.”
Parents concerned about their children should go online and research McKinnon’s statements and watch the Lactatia video (a link is provided in the sources below). Once you do you may understand why I say that all children are in danger from the insidious indoctrinating power of the new global trans cult that seems to have complete contempt for the family unit.
It should be noted that this “cult,” as I call it, does not represent the majority of trans-identified persons such as myself. Any criticism should be directed at activists and their funders specifically, because most trans identified adults just want to be left alone. Unfortunately most of those I have encountered in transgender rights, support, or activist groups, have shown all of the classic signs of cult psychology covered in this essay.
Implications of the Trans Cult Agenda.
Control of thought is more important for governments that are free and popular than for despotic and military states. The logic is straightforward: a despotic state can control its domestic enemies by force, but as the state loses this weapon, other devices are required to prevent the ignorant masses from interfering with public affairs, which are none of their business.
From Noam Chomsky, Deterring Democracy, 1992.
The reader needs to understand that the question raised in this essay is not so much whether the trans agenda activists are deliberately using cult techniques or whether the young people caught up in its spell are actual card-holding members of a trans-cult. The characteristics, tactics, and methodologies of cultism are present nonetheless. Although I do believe there is conscious “gaming” going on, it does not have to be conscious to be a factor. Similarly, I am not suggesting the much discussed and abused “dysphoria” is not involved, only that it is increasingly induced and almost always exaggerated.
More disturbingly, what we see in extreme transgender activism is what in previous generations would have been considered unthinkable: modern social outcasts, instead of being turned into the government and pop culture-abhorring Goths or punk rockers of the past, are instead now being repurposed to actually support official government lines and agendas regarding gender, the breakdown of families, and the erasure of sexual distinctions and associated protections. The aggression of the outcasts, which used to be turned against the state, is now being turned against enemies of the state and anybody that opposes its new reality warping transgender theories and laws. Trans-cultists are quickly beginning to resemble the brainwashed children in George Orwell’s 1984.
Even the right to sexual orientation is now under attack, from inside an organization that used to fight and argue for just that right. Many radical trans activists are suggesting sexual preference/orientation is in fact a form of bigotry and that people dating trans have no right to know whether they are really male or female and that to deny them intimacy if they have the wrong genitals is akin to racism. Thus we saw Caitlyn (formerly Bruce) Jenner on national television suggesting that asking about one’s sex status “was not an appropriate question to ask.” Anybody suggesting transgender persons born male are not in fact “real women” and even “female,” are called transphobic (including lesbians). That such an attack would come from within a community whose entire existence was based upon fighting for the right to sexual orientation is not only bizarre, it almost seems like a deliberate attempt to fracture the community from within.
As mentioned earlier, it would be easy to laugh this stuff off if it were not for the fact that government, Hollywood, mainstream media, and almost every institution of power is promoting this insanity. This fact should be a red flag for everybody. Why, when trans persons comprise such a tiny minority, is there such a sudden and urgent rush across most of the Western world to push the trans agenda?
As Stella Morabito has written, the trans agenda “seems far more organized, focused, faster-and-more-furious than any propaganda campaign in history. (Which means it can’t withstand much scrutiny.)” Why? What is this all about? The people at the top of our society, particularly the advisers behind the scenes, are not stupid. So why are they allowing the distortion of reality and the brainwashing of children? Why are they promoting the absurd notion that men can be real women? Why do we see Fallon Fox, who was born a male, in the UFC ring beating a real female to a pulp while everybody pretends like this is okay and normal? The people at the top know this is an outrage.
While those in the seats of power would tell you to just trust them and not speculate on the reasons why the trans agenda is so important, I would remind the reader of the words of Jacques Ellul:
The propagandist naturally cannot reveal the true intentions of the principal for whom he acts… That would be to submit the projects to public discussion, to the scrutiny of public opinion, and thus to prevent their success… Propaganda must serve instead as a veil for such projects, masking true intention.
It is my contention that young people today are being brainwashed and turned into Orwellian servants of the state for a much larger agenda. It has been suggested by others that the assault on sexual distinctions and on the perception of basic biological reality is part of a game to give absolute power to the state in the interpretation of reality itself. If the state can force people to admit that men are women, they can force them to believe anything. War is peace. Slavery is freedom. Men are women. All of these are equally contradictory. In this sense it almost appears as though we have a pre-fascist attempt to turn the whole of society itself into a brainwashed cult much as we saw in Nazi Germany. Such statements might seem fantastic, but again we just need to look to the history of the 20th century for lessons on why distrust of government and elite power is not only a good thing, but absolutely critical in protecting society against the rise of totalitarianism. Erich Fromm observed the rise of fascism first hand and noted:
When Fascism came into power, most people were unprepared, both theoretically and practically. They were unable to believe that man could exhibit such propensities for evil, such lust for power…or such a yearning for [the] submission [of the population].
At this point in human history there should be no question, it should not even be controversial, that political leaders and their supporters can become power mad and capable of the most insidious, carefully planned and executed, far-reaching evils imaginable. To ignore this capacity is irresponsible. One only needs, for instance, to watch the documentary Trudeau: Justin & Pierre to see that the seemingly saintly Canadian Prime Minister Justin Trudeau is actually a megalomaniac that spews a kind of “divine right of kings” philosophy in the sense that he believes he was born to lead the nation (one of his supporters had to implore him to be a little more humble). Justin’s father, Pierre, was the first prime minister in Canadian history to suspend civil rights and send troops into the streets. His son, Justin, has been at the forefront of pushing new reality-denying laws. When he was asked to allow inserting amendments into Bill C16 (the transgender rights bill) that would prevent males from entering women’s changerooms at pools and in schools, Trudeau specifically rejected the amendments. This shows he is in fact expecting males to enter women’s changerooms. Trudeau is thus the world’s leading champion of the trans agenda.
At a macro-level, if we assume the “masters of mankind” (as Noam Chomsky has called elite political figures), are trying to create a brainwashed totalitarian state, it would need to work to cause general chaos. “We need chaos before things can get better,” said Joseph Goebbels about the confusion reigning in Germany following World War I. “The dollar is climbing like an acrobat. I’m secretly delighted.” What Goebbels was hoping for, the betterment he expected, was the creation of a murderous control state the likes of which the world had never seen. Fascists have always sought to control the interpretation of reality, and the break down of social structures facilitates that. Thus anti-authoritarian scholar Hannah Arendt, commenting on the seizure of power by megalomaniacal leaders, wrote:
Before mass leaders seize the power to fit reality to their lies, their propaganda is marked by its extreme contempt for facts as such, for in their opinion fact depends entirely on the power of the man who can fabricate it.
The breakdown of society is necessary for the complete restructuring of society. Similarly, the breakdown of the individual ego is necessary for cults to restructure or redefine the individual. As Margaret Singer pointed out, happy people do not join cults unless they want to be part of the controlling hierarchy: “if the social structure has not broken down, very few people will follow.” This is true at both the macro and the micro level, hence the Nazi cult rose in Germany only after the breakdown of society, but with its leaders waiting and applauding the chaos behind the scenes. The chaos facilitated mass conversion of an otherwise indifferent population.
If we follow through the logical conclusions and outcomes of all these transgender laws being passed everywhere, it would appear to be about breaking down traditional morals and redefining humanity itself. As Morabito wrote, “The scope of the endgame is enormous: to legally and universally impose upon every human being a new definition — or rather, a non-definition — of what it means to be human.” Human casualties in the form of brainwashed, sterilized, mutilated children, and an assault on women’s right to privacy and their own sports and programs, are all incidentals or collateral damage in the mass social engineering and brainwashing “Game” that is the modern transgender agenda.
(I would like to end this essay by reminding everybody that this essay is not really about transgender people per se – I myself am transgender. The transgender youths that fall under the spell of the new transgender cult ideology, are really just tools being used in a much larger social engineering agenda. Do not focus on the tool being used, focus on the hands that are wielding it.)
Please note: My policy is not to screen republication requests. Thus I do not vouch for or necessarily agree or disagree with the views of anybody that may or may not publish my essays online. If people want to know what I believe they need to look at my words or ask me, do not assume that because somebody has published my essay somewhere that I agree with them. Thank you.
Impact of social support on PTSD : Chain mediating effects of insomnia and anxiety
Image:
Publishing date:
October 24th, 2024
Author:
Xiaofei Mao, Tianya Hou, and Yulin Zhang, Jianguo Zhang, Fan Zhang, Weizhi Liu
Website published:
cambridge.org
Article length:
4499 words
~ 17 minute read time
Abstract
Objective
To reveal the chain mediating roles of insomnia and anxiety between social support and PTSD in nursing staff under the stage of COVID-19 regular pandemic prevention and control in China.
Methods
A total of 784 nurses were recruited using the convenience sampling method in Jiangsu Province, China. Demographic questionnaire, Perceived Social Support Scale, Impact of Event Scale-Revised, Generalized Anxiety Disorder-7 and Insomnia Severity Index were applied to collect data.
Results
Social support, PTSD, insomnia and anxiety were significantly correlated with each other. Insomnia and anxiety acted as chain mediators between social support and PTSD.
Conclusion
Insufficient social support may trigger PTSD through the chain mediating effects of insomnia and anxiety in nursing staff under the stage of COVID-19 regular pandemic prevention and control. Measures focusing on social support, insomnia and anxiety should be taken to reduce or even prevent PTSD in nursing staff in Chinese hospitals in similar crises in the future.
Impact statement
Chinese nurses played a vital role in combating the virus under great pressure and during the COVID-19 regular pandemic prevention and control. It’s of great importance to investigate effects of insomnia and anxiety between social support and PTSD among Chinese nurses in the context of regular COVID-19 pandemic prevention and control. It could aid the hospital with interventions to ameliorate PTSD among Chinese nursing staff during COVID-19 regular pandemic prevention and control. However, studies focusing on the relationship among these variables are insufficient. The present study aimed to focus on how social support would influence PTSD in Chinese nursing staff during the period of COVID-19 regular pandemic prevention and control.
Introduction
The coronavirus disease 2019 (COVID-19) has brought about mental problems to the healthcare staff.
China stepped into the stage of the COVID-19 regular pandemic prevention and control on May 7, 2020 (The State Council, 2020). Therefore, the policy of national COVID-19 pandemic prevention and control was changed into regular pandemic prevention and control (Xinhua Press, 2020), resulting in an increased workload of nurses.
With the COVID-19 epidemic prevention work changing from emergency to normalization, hospitals were checkpoints for epidemic prevention and control, confronting potential risk factors and the nosocomial infection prevention and control measures will exist for a long period of time (Wu et al., Reference Wu, Li, Yan and Li2022). The contents of nurses’ jobs have changed. Excluding routine nursing work, they need to take on more responsibilities, including the strict procedure of admission of patients to hospitals and nursing services for patients from high- and medium-risk areas (Jiang et al., Reference Jiang, Wang, Shen, Zhao, Wang, Chen, Qiao, Wei, Dong, Ding and Yang2022). Moreover, constantly working under stressful environments has also resulted in pandemic fatigue among nurses (Zhang et al., Reference Zhang, Liu, Lu and Cheng2021). Thus, though the grim situation faced by Chinese nurses has changed, they still work under great pressure under the stage of COVID-19 regular pandemic prevention and control.
About 16.10% of Chinese nurses from low-risk areas still experienced moderate to severe psychological pressure during the stage of COVID-19 regular pandemic prevention and control (Chen et al., Reference Chen, Arber, Gao, Zhang, Ji, Wang, Wu and Du2021b). Moreover, Li and colleagues found that 50.54% of the frontline nurses in Wuhan, China, reported moderate (42.21%) to severe (8.33%) levels of stress in the context of COVID-19 regular pandemic prevention and control (Wen et al., Reference Wen, Shen, Zhang, Liu, Liu and XianYu2022). Nurses’ mental health was directly related to their performance quality in caring for patients and work efficiency (Mirzaei et al., Reference Mirzaei, Molaei and Habibi-Soola2022). PTSD was an important aspect of psychological health in Chinese nursing staff exposed to COVID-19 (Lai et al., Reference Lai, Ma, Wang, Cai, Hu, Wei, Wu, Du, Chen, Li, Tan, Kang, Yao, Huang, Wang, Wang, Liu and Hu2020). Therefore, it’s of great importance to investigate the influential factors of PTSD in Chinese nursing staff in the context of regular COVID-19 pandemic prevention and control.
Social support is defined as “the feeling that one is cared for and has assistance available from other people” and “that one is part of a supportive social network” (Somville et al., Reference Somville, De Gucht and Maes2016). The stress-buffering hypothesis supposes that social support plays a role in buffering stress by increasing the levels of self-efficacy and self-esteem (Cohen et al., Reference Cohen and Wills1985). Perceived social support was positively correlated with mental well-being and could help cultivate the ability to overcome stressful events (Xu et al., Reference Xu, Li and Yang2019; Huang et al., Reference Huang, Wu, Wu, Yang, Zheng and Wu2020). According to existing literature focusing on PTSD, social support was thought to be a strong predictive factor of PTSD among adults. A meta-analysis focusing on risk factors of PTSD has shown that low level of social support was the strongest predictor of PTSD (Brewin et al., Reference Brewin, Andrews and Valentine2000). Similarly, another meta-analysis conducted by Ozer and colleagues suggested a similar result (Ozer et al., Reference Ozer, Best, Lipsey and Weiss2003). Moreover, Guay et al. reviewed numerous studies and summarized that social support played a significant role in PTSD (Guay et al., Reference Guay, Billette and Marchand2006).
Recently, PTSD among medical staff has drawn plenty of attention from researchers. For example, it was supposed that lacking social support was a significant risk factor for PTSD among traumatized nurses from South Korea (Kim and Yeo, Reference Kim and Yeo2020). Besides, lacking social support was found to be a vital predictive factor of PTSD in healthcare staff fighting against the COVID-19 pandemic (d’Ettorre et al., Reference d’Ettorre, Ceccarelli, Santinelli, Vassalini, Innocenti, Alessandri, Koukopoulos, Russo, d’Ettorre and Tarsitani2021).
Therefore, we could infer that those lacking social support might be more prone to PTSD among nurses under the stage of COVID-19 regular pandemic prevention and control in China.
Insomnia has been proven to be associated with PTSD of healthcare staff during the outbreak of COVID-19. Blekas and colleagues found that 73.3% of Greek healthcare professionals with PTSD reported problems of insomnia. However, only 28% of the Greek healthcare professionals without PTSD suffered from bad sleep quality (Blekas et al., Reference Blekas, Voitsidis, Athanasiadou, Parlapani, Chatzigeorgiou, Skoupra, Syngelakis, Holeva and Diakogiannis2020). Yin et al. conducted a structural equation model and found that the sleep quality of Chinese medical staff could significantly predict PTSD symptoms (Yin et al., Reference Yin, Chen, Song, Deng and Dong2021). Li et al. discovered that insomnia played a significant partial mediating role between being a nurse and post-traumatic stress symptoms during the outbreak of COVID-19 (Li et al., Reference Li, Wang, Tan, Li and Yuan2022).
A study of Japanese daytime workers revealed that social support was an independent risk factor for insomnia (Nakata et al., Reference Nakata, Haratani, Takahashi, Kawakami, Arito, Kobayashi and Araki2004). Besides, social support was significantly related to the increased risk of sleeping difficulties during the COVID-19 pandemic. Specifically, people with good social support reported lower risk of sleeping difficulties (Grey et al., Reference Grey, Arora, Thomas, Saneh, Tohme and Abi-Habib2020). Moreover, it could be inferred from the existing literature that the protective effect of support from organizations on sleep quality among Chinese healthcare workers (Zou et al., Reference Zou, Liu, Li, Chen, Ye, Yang, Zhou and Ling2021) and nurses (Du et al., Reference Du, Liu, Zhang, Shao, Hua, Li, Lang and Ni2022) during the outbreak of COVID-19.
Based on the studies above, insomnia may play a mediating role between social support and PTSD in Chinese nursing staff during COVID-19 regular pandemic prevention and control.
Similarly, anxiety was also found to be a predictive factor of PTSD among medical professionals during the COVID-19 pandemic (Lu et al., Reference Lu, Ahorsu, Kukreti, Strong, Lin, Kuo, Chen, Lin, Chen, Ko and Ko2021; Yin et al., Reference Yin, Chen, Song, Deng and Dong2021; Yao et al., Reference Yao, Xie, Bai, Li, Zhang, Li, Ma, Hui and Chen2022). For example, Lu et al. found anxiety symptoms of COVID-19 frontline medical staff from Taiwan, China, significantly predicted PTSD using a method of hierarchical linear regression model (Lu et al., Reference Lu, Ahorsu, Kukreti, Strong, Lin, Kuo, Chen, Lin, Chen, Ko and Ko2021). Moreover, social support had a positive effect on anxiety among 4,658 adults (Roohafza et al., Reference Roohafza, Afshar, Keshteli, Mohammadi, Feizi, Taslimi and Adibi2014). Another research during the COVID-19 pandemic found that sufficient social support might reduce anxiety in medical staff (Zhu et al., Reference Zhu, Wei, Meng and Li2020).
Hence, it is reasonable to infer that anxiety may mediate the relationship between social support and PTSD in Chinese nursing staff during COVID-19 regular pandemic prevention and control.
Insomnia and anxiety always co-occurred and were significantly associated (Jansson-Fröjmark and Lindblom, Reference Jansson-Fröjmark and Lindblom2008; Marcks and Weisberg, Reference Marcks and Weisberg2009; Chinese Society of Neurology, 2020). Plenty of research investigated the relationship between insomnia and anxiety. Taylor et al. discovered that insomnia played a negative role in the elevated risk for anxiety in their review (Taylor et al., Reference Taylor, Lichstein and Durrence2003). Besides, subjects suffering from sleeping difficulties reported more symptoms of anxiety than those with good sleep quality (Taylor et al., Reference Taylor, Lichstein, Durrence, Reidel and Bush2005). Moreover, participants diagnosed with insomnia suffered from higher levels of anxiety, indicating the vital role of insomnia in anxiety (Mason and Harvey, Reference Mason and Harvey2014; Chen et al., Reference Chen, Huang, Weng, Wu, Ho, Wang, Tsai and Hsu2017). These studies above indicated that insomnia might lead to anxiety.
Consequently, it could be inferred that insufficient social support might lead to PTSD. Besides, insomnia and anxiety were significant mediators between social support and PTSD. Chain mediating model refers to a condition that there are two or more mediators in a mediating model, which is used to study how an independent variable influences dependent variable through a series of variables. In the chain mediation model, the mediators are not independent of each other (Liu and Ling, Reference Liu and Ling2009). Given existing evidence about the effect of insomnia on anxiety, we supposed that insomnia and anxiety might act as chain mediators in the association between social support and PTSD among nurses during COVID-19 regular pandemic prevention and control.
Therefore, the current study aimed to reveal the associations between social support, insomnia, anxiety, and PTSD among nurses. We hypothesized that insomnia and anxiety played chain mediating roles between social support and PTSD in nursing staff during the stage of COVID-19 regular pandemic prevention and control in China. Our research is of realistic significance and could aid the hospital with interventions to ameliorate PTSD among Chinese nursing staff during COVID-19 regular pandemic prevention and control. A chain mediation model was constructed to test our hypotheses (Figure 1). The variables in Figure 1 were listed as follows: X = Social support, Y = PTSD, M1 = Insomnia, M2 = Anxiety. Specifically, social support was the independent variable, and PTSD was the dependent variable. Insomnia and anxiety were calculated as chain mediators in the relationship between social support and PTSD among nursing staff.
Figure 1.
Hypothesized model about social support, insomnia, anxiety, and PTSD.
Methods
Participants and procedures
The current research was conducted in January 2022. Inclusion criteria: I) normal ability of speech, comprehension, and expression; II) ≥18 years old; III) working as a nurse during COVID-19 regular pandemic prevention and control. Exclusive criteria: diagnosed with psychiatric illness before. A total of 784 nurses were recruited from five tertiary hospitals using a convenience sampling method in China.
The mean age of the participants was 26.37 years with a standard deviation of 6.59. 94.4% of the nurses were female. About two in three of the respondents were married. The average working seniority was 8.81 ± 6.87 years. A detailed flowchart is shown in Figure 2.
Figure 2.
Flowchart of subjects’ enrollment in January 2022.
Measures
Demographics
Demographic information (e.g., age, gender, marital status, and working seniority) of nurses was collected in this study.
Perceived social support scale (PSSS)
PSSS includes 12 items and is a classic evaluation tool for measuring the perceived social support (Zimet et al., Reference Zimet, Dahlem, Zimet and Farley1988). Each item is rated from 0 (strongly disagree) to 7 (strongly agree). The highest score of the scale is 84. The scale has shown good validity and reliability and has been widely used among the Chinese population (Mao et al., Reference Mao, Dong, Zhang, Zhang, Deng, Li and Hou2023a; Mao et al., Reference Mao, Hou, Wang, Tang, Ni, Zhang, Zhang, Deng, Chen, Wang, Li, Jia, Dong and Qian2024). In this study, the coefficient of Cronbach’s alpha was 0.968.
Insomnia severity index (ISI)
ISI is a 7-item questionnaire and a classic evaluation tool for perceived insomnia severity (Bastien et al., Reference Bastien, Vallieres and Morin2001). Each item was rated from 0 (not at all) to 4 (nearly every day). The highest score of the scale is 28. The scale has presented sufficient validity and reliability and has been widely used among the Chinese population (Mao et al., Reference Mao, Lin, Liu, Zhang, Deng, Li, Hou and Dong2023b; Mao et al., Reference Mao, Hou, Wang, Tang, Ni, Zhang, Zhang, Deng, Chen, Wang, Li, Jia, Dong and Qian2024). In this study, the coefficient of Cronbach’s alpha was 0.927.
Generalized anxiety disorder-7 (GAD-7)
GAD-7 is a 7-item questionnaire and a classic evaluation tool for anxiety and its severity (Spitzer et al., Reference Spitzer, Kroenke, Williams and Löwe2006). Participants were asked to report the frequency of each item during the last 2 weeks. “Not at all,” “several days,” “more than half the days” and “nearly every day” were scored as 0, 1, 2, and 3, respectively. The highest score of the scale is 21. The scale has been widely used with excellent validity and reliability among the Chinese population (Mao et al., Reference Mao, Zhang, Wei, Li, Huang, Sun, Zhang, Deng, Hou and Dong2023c; Mao et al., Reference Mao, Hou, Wang, Tang, Ni, Zhang, Zhang, Deng, Chen, Wang, Li, Jia, Dong and Qian2024). In this study, the coefficient of Cronbach’s alpha was 0.960.
Impact of event scale-revised (IES-R)
IES-R is a 22-item and a classic evaluation tool for assessing posttraumatic stress symptoms. There are three subscales (intrusiveness, avoidance, and hyperarousal) in this scale. The highest score of the scale is 88. The cut-off of IES-R is 33 (Asif et al., Reference Asif, Price, Ewing, Rao, Harmon and Drezner2016). The scale has shown good validity and reliability in the Chinese population (Mao et al., Reference Mao, Luo, Li, Zhang, Zhang, Deng, Li, Hou and Dong2023d; Mao et al., Reference Mao, Hou, Wang, Tang, Ni, Zhang, Zhang, Deng, Chen, Wang, Li, Jia, Dong and Qian2024). In this study, the coefficient of Cronbach’s alpha was 0.976.”
Statistical analysis
IBM SPSS (version 21.0) was adopted to analyze the data. The significance level is set as α = 0.05, and all tests are double-tailed tests (Mao et al., Reference Mao, Hou, Wang, Tang, Ni, Zhang, Zhang, Deng, Chen, Wang, Li, Jia, Dong and Qian2024). Common method bias was detected by the Harman single-factor test (Mao et al., Reference Mao, Lin, Liu, Zhang, Deng, Li, Hou and Dong2023b). Hence, the Harman single-factor test was chosen to detect the presence of common method bias in this study. Pearson correlation analyses is a common statistical method to detect the correlations between variables (Hou et al., Reference Hou, Yin, Xu, Gao, Bin, Li, Cai, Liu, Dong, Deng and Ni2021). Therefore, we calculated the correlations among anxiety, insomnia, social support, and PTSD with Pearson correlation analyses. The Hayes SPSS macro program process (version 3.4.1, Model 6) is a good tool to detect the chain mediating model (Hayes, Reference Hayes2013). We adopted the Hayes SPSS macro program process (version 3.4.1, Model 6) to conduct the bootstrapped method (5000 resamples) to estimate 95% confidence interval (CI) for significance testing for mediating model (Preacher and Hayes, Reference Preacher and Hayes2008). According to the method, the chain mediation model would be established if zero was included in 95% CI.
Results
Common method Bias test
Common method bias may appear in self-report inventory (Campbell and Fiske, Reference Campbell and Fiske1959). Harman single-factor test was selected to detect if common method bias existed in this study (Podsakoff et al., Reference Podsakoff, Mackenzie, Lee and Podsakoff2003; Zhou and You, Reference Zhou and You2004). Six values with an eigenvalue more than 1 were found. The first factor accounted for a variance of 36.81% (<40%). Therefore, common method bias did not exist in the current study.
Pearson’s correlation
Results of Pearson’s correlation among social support, insomnia, anxiety, and PTSD (Table 1) indicated that four variables were related to each other significantly (all P < 0.01).
Table 1.
Results of bivariate analysis among variables
Note: **P < 0.01.
Mediating roles of insomnia and anxiety
PROCESS 3.4.1 (Model 6) was applied to test the chain mediating model (Figure 3). Studies revealed age, gender, marital status (Zhou et al., Reference Zhou, Shang, Zhang, Wu, Sun, Jia, Yu and Liu2021) and working seniority (Goh et al., Reference Goh, Jou, Lu, Yeh, Kao, Liu and Kan2021) were closely related to PTSD. Therefore, demographic information (age, gender, marital status, and working seniority) was controlled as confounders.
Figure 3.
Chain mediating model about social support, insomnia, anxiety, and PTSD (**P < 0.01, ***P < 0.001).
As shown in Table 2, the direct effect was significant since the 95% CI (−0.245 ~ −0.102) did not contain 0. The total mediating effect was significant since 0 wasn’t included in the 95% CI (−0.382 ~ −0.260). The indirect effect of social support on PTSD via insomnia was significant as 0 wasn’t contained in the 95% CI (−0.064 ~ −0.012). Similar results were detected among the mediating effects of anxiety and the chain mediating effects of insomnia and anxiety.
Table 2.
Chain mediating roles of insomnia and anxiety
Figure 3 shows the chain mediating effects of insomnia and anxiety in the association between social support and PTSD. As showed in Figure 3, all paths in chain mediating model were significant (**P < 0.01, ***P < 0.001). The results revealed that the negative relationship between social support and PTSD was significant, with insomnia and anxiety partially mediating the relationship between social support and PTSD, respectively. Besides, a significant chain mediating effect of insomnia and anxiety was also detected in the current research. The total mediating effects was 64.77%.
To sum up, insomnia and anxiety played chain mediating roles between social support and PTSD among nurses during COVID-19 regular pandemic prevention and control.
Discussion
The present investigated how social support would influence PTSD among nurses during the period of COVID-19 regular pandemic prevention and control in China. The results revealed that insomnia and anxiety played chain mediating roles between social support and PTSD. As far as we know, our study is the first to focus on the effect of social support on PTSD among Chinese nursing staff via chain mediating effect of insomnia and anxiety.
We discovered social support could negatively and significantly predict PTSD, which was in line with previous research. Schnurr and colleagues investigated influencing factors of PTSD among Vietnam veterans. They found that social support played an important role in the development and maintenance of PTSD (Schnurr et al., Reference Schnurr, Lunney and Sengupta2004). Besides, leadership social support was supposed to be related to PTSD in pediatric oncology nursing staff (Schuster et al., Reference Schuster, Berbert, Meyer and Dwyer2022). Song et al. conducted a cross-sectional study on 14,825 Chinese medical staff during the outbreak of COVID-19. They found that those with insufficient social support were more likely to develop PTSD (Song et al., Reference Song, Fu, Liu, Luo, Wang, Zhou, Yan and Lv2020).
Social support is a protective factor against psychological difficulties. Kerasiotis et al. suggested that social support might act as a protective factor in helping nursing staff to deal with work pressure (Kerasiotis and Motta, Reference Kerasiotis and Motta2004). The coping theory supposed that social support was considered as a vital coping strategy when facing stress. Specifically, social support might have a significant effect in relieving negative influence from kinds of pressure events by solving problems and relieving negative emotions via assistance from social ties (Mo et al., Reference Mo, Chen, Lam, Li, Kahler and Lau2020). Besides, the stress-buffering hypothesis supposes that social support plays a role in buffering stress by increasing the levels of self-efficacy and self-esteem (Cohen et al., Reference Cohen and Wills1985). Insufficient social support played a predictive role in PTSD among medical staff during the COVID-19 pandemic (d’Ettorre et al., Reference d’Ettorre, Ceccarelli, Santinelli, Vassalini, Innocenti, Alessandri, Koukopoulos, Russo, d’Ettorre and Tarsitani2021). A Korean study indicated that nurses might experience more PTSD if they got lower levels of support from their managers during the COVID-19 pandemic (Bae et al., Reference Bae, Yoon, Kim and Kim2022). Moreover, social support was thought to be a protective factor of psychological resilience that maintained mental health and eliminated psychological barriers (Sripada et al., Reference Sripada, Lamp, Defever, Venners and Rauch2016). This may be the possible explanation for the positive effect of social support on PTSD.
As hypothesized, we demonstrated the chain mediating roles of insomnia and anxiety. Social support could influence PTSD through three paths (Figure 3). First, paths 1 and 2 indicated that insomnia and anxiety played significant mediating roles between social support and PTSD, respectively. The results indicated close relationships among insomnia, anxiety, and PTSD. Specifically, insomnia and anxiety were positively predictive factors of PTSD among nurses during COVID-19 regular pandemic prevention and control, which were in line with previous studies. For example, Yao et al. found sleep disorder and anxiety were significant mediators of PTSD in medical staff during the COVID-19 pandemic (Yao et al., Reference Yao, Xie, Bai, Li, Zhang, Li, Ma, Hui and Chen2022). Similarly, Yin et al. found sleep quality and anxiety were mediators of PTSD in medical staff combating against COVID-19 (Yin et al., Reference Yin, Chen, Song, Deng and Dong2021). Besides, Li and colleagues discovered that insomnia was a significant partial mediator, which explained 32.53% of the association between being a nurse and post-traumatic stress symptoms among frontline medical staff during the COVID-19 pandemic in China (Li et al., Reference Li, Wang, Tan, Li and Yuan2022). Meanwhile, anxiety symptoms of COVID-19 frontline healthcare workers from Taiwan, China were proved to be a significant predictor of PTSD (Lu et al., Reference Lu, Ahorsu, Kukreti, Strong, Lin, Kuo, Chen, Lin, Chen, Ko and Ko2021). Moreover, social support was proven to be a predictive factor of insomnia and anxiety among Turkish medical professionals (Yılmaz et al., Reference Yılmaz, Kıraç and Sahin2021). The same results were also observed in Chinese medical staff. Social support was negatively related to sleep quality and anxiety significantly (Xiao et al., Reference Xiao, Zhang, Kong, Li and Yang2020). Secondly, path 3 suggested that insomnia and anxiety acted as chain mediators in our model. Namely, insufficient social support would lead to sleep problems, which may increase the level of anxiety and then result in PTSD among nurses. However, previous studies did not classify the relationship among social support, insomnia, anxiety, and PTSD.
The current research is the first study to investigate possible mechanisms underlying the relationship between social support and PTSD of nurses during COVID-19 regular pandemic prevention and control.
Implications
The current study has several implications for the amelioration of PTSD in nursing staff after public health emergencies. Our study gave empirical evidence for the possible mechanism underlying the relationship between social support and PTSD among Chinese nursing staff. Social support could not only directly influence PTSD, but also indirectly impact PTSD through three pathways: (1) social support-insomnia-PTSD; (2) social support-anxiety-PTSD; (3) social support-insomnia-anxiety-PTSD. The results of our research suggested to the Chinese hospital authorities the possible methods to reduce or even prevent PTSD. The nursing staff should take action concentrating on promoting sleep problems and anxiety. Prior studies revealed that cognitive behavioral therapy (CBT) and internet cognitive behavioral therapy (I-CBT) were effective in treating psychiatric symptoms (Zhang and Ho, Reference Zhang and Ho2017) or psychological outcomes during the COVID-19 pandemic (Ho et al., Reference Ho, Chee and Ho2020; Soh et al., Reference Soh, Ho, Ho and Tam2020). Therefore, CBT and I-CBT focusing on promoting sleep quality and anxiety could be taken to reduce PTSD among nurses.
Limitations
There are some limitations in our study. Firstly, the cross-sectional design adopted in the current study could not determine causal associations among variables. Longitudinal or experimental approaches are needed in the future to infer the possible causal relationships among variables. Second, our subjects were recruited using the convenience sampling method. The small sample size might limit the sample representativeness, which may limit the generalizability of the findings. Further research had better-recruited subjects with random cluster sampling and expanded the sample size to enhance the external validity. Thirdly, burnout during the COVID-19 pandemic is an important public health issue and is worthy of further study (Mao et al., Reference Mao, Hou, Wang, Tang, Ni, Zhang, Zhang, Deng, Chen, Wang, Li, Jia, Dong and Qian2024; Lau et al., Reference Lau, Ho, Pang, Su, Kwok, Fung and Ho2022). However, burnout was not considered in the present study. Future research should consider this issue to explore the association of burnout with PTSD among nurses.
Conclusion
To conclude, the study demonstrated the chain mediating roles of insomnia and anxiety in the relationship between social support and PTSD among nursing staff during COVID-19 regular pandemic prevention and control. The Chinese hospital authorities need to pay extra attention to nursing staff with insufficient social support to prevent and reduce PTSD. Moreover, actions targeting the reduction of insomnia and anxiety also need to be taken to reduce or even prevent PTSD in nursing staff.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.91.
Data availability statement
The data that support the findings of this study are available on request from the corresponding authors. The data are not publicly available due to the de-identified data possibly containing information that could compromise the privacy and safety of the research participants.
Acknowledgements
The authors would like to acknowledge the volunteers who participated in the study.
Author contribution
Xiaofei Mao, Tianya Hou, and Weizhi Liu designed the study. Yulin Zhang, Jianguo Zhang, and Fan Zhang collected the data. Xiaofei Mao and Tianya Hou analyzed the data and drafted the manuscript. Weizhi Liu led the whole study. All the authors have read and approved the final manuscript.
Financial support
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Youth Initiation Fund of Naval Medical University (2023QN028); Social Science Cultivation Fund of Naval Medical University (2023SK015); Youth Talent Initiation Fund of Faulty of Psychology of Naval Medical University (2023RC003). Youth Social Science Cultivation Fund of Faulty of Psychology of Naval Medical University (2023SK001).
Competing interest
The authors declare no competing interests.
Ethics statement
All participants signed a written informed consent form in ethics approval and consent to participate. The study was approved by the ethics committee of Naval Medical University in accordance with the ethical standards established in the 1964 Declaration of Helsinki and its later amendments.
me (saw it posted by @gendiebrainrotreceipts on this post)
Title:
Unisex toilets put schoolgirls at risk of sexual harassment, claims women’s rights group
Image:
Publishing date:
February 19th, 2019
Author:
Olivia Petter
Website published:
the-independent.com
Allsides bias rating is Center-Left.
Article length:
420 words
~ 2 minute read time
‘No pupil should feel they are unable to use the toilet during the day’
(Sara D. Davis/Getty)
Unisex toilets in schools are putting girls at risk of sexual harassment and period shaming, claims one women’s rights group.
Women’s Voices Wales conducted a review into how pupils felt about gender-inclusive facilities after initial concerns were raised about safety and possible intimidation by parents and pupils.
“What we’ve heard so far ranges from girls not drinking water during the day so they can avoid using the toilets, to ‘period shaming’ from boys,” reads a statement posted to the organisation’s Facebook page on 14 February.
“Anxiety about coping with menstruation in schools has a serious effect on female pupils, including refusing to attend school. We are particularly concerned about any sexual harassment or intimidation taking place in mixed sex toilets.”
In Wales, the law requires schools with children over the age of eight to have single-sex facilities – unisex toilets can only be built in addition to, rather than replace single-sex facilities.
But Women’s Voices Wales claims that some establishments are not following such requirements and are substituting single-sex toilets for unisex ones.
The organisation has since written to the Welsh Government, reports Wales Online, calling for schools to do more to protect the “safety and dignity” of female pupils.
“No pupil should feel they are unable to use the toilet during the day,” adds spokesperson for Women’s Voices Wales, Helen Raynor.
“No child should avoid school because they are anxious about using the toilet, or stop drinking water so they don’t wee.
“Girls cannot ‘hold periods in’. Nor should toilets use risk “period shaming” from boys, or sexual harassment.”
Many parents concurred with the organisation’s fears, expressing similar concerns in comments on its Facebook page. Others contested that unisex toilets were in fact unsafe.
“Having seen [the unisex toilets] I don’t see an issue,” wrote one person.
“They are completely closed more so than other toilet cubicles. My daughter hasn’t got an issue.”
Another argued that rather than banning mixed-sex facilities, schools should focus on better-educating its pupils about issues such as period-shaming and sexual harassment.
“Let interpersonal respect be instilled in the children at said schools, so that mixed toilet facilities are no longer any issue,” they wrote.
“Let schools turn their efforts and full attention to safeguarding the kids in their care against such behaviour and correcting those who engage thusly. And let the rising number of nonbinary and trans kids use the bathroom in peace without constant daily misery.”
Potential Reporting Bias in Neuroimaging Studies of Sex Differences
Image:
Publishing date:
April 17th, 2018
Author:
Sean P. David, Florian Naudet, Jennifer Laude, Joaquim Radua, Paolo Fusar-Poli, Isabella Chu, Marcia L. Stefanick, John P. A. Ioannidis
Website published:
nature.com
Article length:
4839 words
~ 18 minute read time
Abstract
Numerous functional magnetic resonance imaging (fMRI) studies have reported sex differences. To empirically evaluate for evidence of excessive significance bias in this literature, we searched for published fMRI studies of human brain to evaluate sex differences, regardless of the topic investigated, in Medline and Scopus over 10 years. We analyzed the prevalence of conclusions in favor of sex differences and the correlation between study sample sizes and number of significant foci identified. In the absence of bias, larger studies (better powered) should identify a larger number of significant foci. Across 179 papers, median sample size was n = 32 (interquartile range 23-47.5). A median of 5 foci related to sex differences were reported (interquartile range, 2-9.5). Few articles (n = 2) had titles focused on no differences or on similarities (n = 3) between sexes. Overall, 158 papers (88%) reached “positive” conclusions in their abstract and presented some foci related to sex differences. There was no statistically significant relationship between sample size and the number of foci (−0.048% increase for every 10 participants, p = 0.63). The extremely high prevalence of “positive” results and the lack of the expected relationship between sample size and the number of discovered foci reflect probable reporting bias and excess significance bias in this literature.
Introduction
The nature of possible sex differences in behavior and brain structure and function has been a topic of debate in the scientific community for centuries1. Although the presence of Y sex chromosomes affects structural differentiation of some brain regions, such as the sexually dimorphic nucleus of the preoptic area, or “SDN”, in rodents2,3, neuroanatomical differences have not been consistently related to robust differences in human brain function4. In the field of human neuroimaging research, there are some who argue that sex differences in brain structure, chemistry and function are substantial and widespread5, while others claim that there is an overlapping continuum of brain structure and function rather than widespread stereotyped “gendered behavior”6. It is also speculated that there may be strong bias and major flaws, particularly in the corpus of neuroimaging literature7.
Recent systematic reviews and empirical evaluations of the human neuroimaging and animal studies literature suggest that publication and other reporting biases are prevalent and most studies are underpowered8, such that small sample sizes particularly for functional magnetic resonance imaging (fMRI) studies of the brain undermine the reliability and precision of results across the field9,10,11. Specifically, we previously reported evidence of too many statistically significant studies evaluating differences in morphometric measures of regions of interest studies for multiple neurological disease states12, and inflated numbers of statistically significant foci in small voxel-based morphometric studies (VBM)13 and fMRI studies of the brain14.
The goals of the present investigation are to (a) characterize the literature of fMRI studies of the brain that evaluated sex differences and (b) empirically evaluate for evidence of excessive significance bias, which may reflect selective reporting of “positive” (statistically significant) results in this complex and controversial field of neuroscience. The theoretical framework for the present investigation is based on the notion that studies with large samples have more power to detect abnormalities, therefore the number of reported foci should show a positive relationship with the sample size. Small studies should detect only a small proportion of the true signals, whilst larger studies should detect a larger proportion of the true signals. As shown in previous empirical evaluations of neuroimaging studies, a weak or null relationship could indicate potential reporting biases affecting the smaller studies more than the larger studies11,14. Moreover, we assessed whether there were any published studies in this field that concluded that there were no statistically significant sex-differences. Given that many studies in the field are very small, a substantial number of studies should find no sex-differences, even if genuine such differences exist. A very low proportion of such “negative” studies would also be cause for concern for similar selective reporting bias.
Methods
Inclusion criteria
Articles were included in our analysis if they reported the results of functional magnetic resonance imaging (MRI) studies of human brain to evaluate gender/sex differences. Individual studies were eligible regardless of the topic investigated (task, neurological or psychiatric condition or disease, or other). Exclusion criteria were the following: (i) non-human studies, (ii) studies reporting no direct sex comparison with respect to imaging findings, and (iii) studies that did not report a number of foci. Only English-language publications were included.
Search strategy
We conducted a four-step literature search. First, we searched on PubMed using the Boolean terms limited to Title and Abstract (“neuroimaging, functional” or “functional brain imaging” or “brain imaging, functional” or “imaging, functional brain” or “fmri” or “mri, functional” or “functional mri”) and (“sex differences” or “sex difference”). Second, we searched on Scopus using the Boolean terms limited to Title and Abstract (“neuroimaging, functional” OR “functional brain imaging” OR “brain imaging, functional” OR “imaging, functional brain” OR “fmri” OR “mri, functional” OR “functional mri” OR “functional magnetic resonance imaging”). All publications listed in PubMed and Scopus over 10 years (between January 1, 2004 and December 31, 2013) were considered. A team of research assistants (EE, EP, EW, IC, KL, RV, SA, SJ) reviewed the abstracts and text of potentially eligible publications for exclusion criteria in double independently. Duplicate publications were eliminated using PMID or DOI. Full texts were retrieved for further scrutiny for all potentially eligible publications. Then the retrieved publications underwent an initial culling of ineligible studies. These publications were then hand searched for inclusion criteria and selected by two analysts independently, with any discrepancies adjudicated until 100% rater agreement was achieved. To achieve a high standard of reporting we have adopted “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines15.
Data extraction
The research assistants extracted the total sample size, the year of publication, the type of task (cognitive, motor/somatosensory, resting state fMRI (e.g., task-independent connectivity analyses), the imaging parameters (magnet intensity, slice thickness, degree of smoothing and software packages used), the use of correction (FWE corrected, FDR corrected, unclear correction or no correction), and the possible use of regions of interest (ROI). Data extraction was also performed in double independently by two extractors with any discrepancies adjudicated until 100% rater agreement was achieved.
For the main outcome, two reviewers (JL & FN) identified in each paper the analysis of sex differences that reported the maximum number of foci and extracted this number. Any disagreement was resolved in consultation with a third reviewer (SPD). We also extracted information on whether the authors concluded in the title of the paper or in the abstract that there are no sex differences, i.e. interpreting their results as “negative”.
Statistical analysis
We followed here the same approach that we used in two previous analyses assessing the relationship between sample size and number of claimed discovered foci13,14. Given that studies with large samples have more power to detect differences, the number of reported foci should show a positive relationship with the sample size. A weak or null relationship could thus indirectly indicate potential reporting biases affecting the smaller studies more than the larger studies.
Specifically, the relationship between the number of reported foci in each study and the sample size of the study was assessed with a negative-binomial regression16. We used this model instead of a Poisson regression because the distribution of the number of foci showed over-dispersion (mean = 7.2, standard deviation = 7.7). For the sake of completeness, we also conducted simple linear Pearson and non-linear Spearman correlations.
In order to explore experimental variables influencing the relationship between sample size and number of reported foci, sensitivity analyses were conducted on the following subsets of studies: studies published up to and after 2009, studies with up to or more than 32 individuals, studies with up to 80 individuals, studies employing cognitive tasks, studies employing mixed tasks, studies employing motor or somatosensory tasks, resting state fMRI studies, studies conducted in MRI devices with magnets up to or stronger than 1.5 Tesla (T), studies with MRI acquisition slices thickness up to or thicker than 3 mm, studies employing Statistical Parametric Mapping (SPM) or other software packages to pre-process and compare the images, studies applying a smoothing inferior than or of at least 8 mm of full-width at half maximum (FWHM), studies using regions of interest vs. whole-brain analyses, and studies using correction (FWE corrected, FDR corrected, unclear correction or no correction). The sample size of 32 patients was chosen because it has been advocated that the minimum sample size for a neuroimaging study should be 16 patients per group17. P-values from subgroup analyses were corrected according to a Bonferroni correction for the number of subgroups assessed (n = 23). All calculations were performed in R.
Data availability statement
The dataset is available as supplementary information.
Results
Database
Our literature search identified 1082 references, which were assessed for inclusion criteria. After a first selection based on abstract and title and a check for duplicate or overlapping studies, a final set of 325 individual neuroimaging studies were selected for review of full text articles, resulting in 179 unique studies - constituting the study population. The literature search and the characteristics of the included studies are detailed in Fig. 1 (PRISMA diagram). As shown in Table 1, the number of participants ranged from 8 to 470 across studies (median = 32, 1st quartile = 23, 3rd quartile = 47.5). The number of reported foci per study ranged from 0 to 45 (median = 5, 1st quartile = 2, 3rd quartile = 9.5). 134 studies (75%) reported 10 foci or less in the analysis reporting the greatest number of foci. Other descriptive details of all included studies and by strata of publication year, study size, type of task, and types of imaging and analytic parameters, are depicted in Table 1.
Figure 1
PRISMA Flow chart (Liberati et al.15) of literature search.
Studies with “negative” results and conclusions
Of the 179 papers, only two had a “negative” title (“No gender differences in brain activation during the N-back task: an fMRI study in healthy individuals” and “Culture but not gender modulates amygdala activation during explicit emotion recognition”) and found 0 foci. Another three suggest similarities between sexes in their titles (“Females and males are highly similar in language performance and cortical activation patterns during verb generation” and “Comparable cortical activation with inferior performance in women during a novel cognitive inhibition task” and “Sex influences on material-sensitive functional lateralization in working and episodic memory: men and women are not all that different”).
17 (9.5%) papers did not highlight sex differences in their abstracts. Among these, 11 found 0 foci and 6 found some sex differences in analyses that were not highlighted in the abstract. An additional 4 papers found 0 foci, but claimed in the abstract that sex differences were present (based on effects observed in males or in females but without differences observed when genders are compared). The remaining 158 papers (88%) conversely reached “positive” conclusions in their abstract in congruence with reporting some foci related to sex differences in the paper.
Association between sample size and number of foci in individual fMRI studies
The median number of foci in small studies (≤32 subjects) (median = 5, range: 0–45) was approximately the same for larger studies (>32 subjects) (median = 4, range: 0–36). There was no statistically significant relationship between sample size and the number of foci in individual studies for all 179 studies using negative binomial regression, Pearson or Spearman correlations (Table 2 and Fig. 2). Nine of the ten studies that had reported the largest number of foci (> = 25) had a sample size <50.
Relationship between sample size and identified number of foci per study.
Subgroup analyses did not show any robust relationships between sample size and number of foci when adjusting for multiple corrections (Bonferroni α = 0.05/23 = 0.002). Although not robust to multiple corrections, resting state studies (11 studies) approached significance for negative binomial regression (0.56% foci increase per 10 subjects, p = 0.006) and Pearson correlation (r = 0.67, p = 0.012). For this subgroup, the various association measures were always pointing to a positive correlation.
Furthermore, although subgroup analyses by publication year did not demonstrate the expected relationship, to further explore whether the postulated bias might have improved over more recent years, we conducted a negative binomial regression including sample size and the interaction between sample size and year of publication. This is a post hoc analysis stimulated by external reviewer comments. The interaction had a weak but statistically significant effect (p = 0.009). Specifically, the estimate of the negative binomial regression was found to increase 0.12% each year, with the fitted estimates being −0.968% in 2004 and 0.116% in 2013.
Analyses performed for all other subgroups, were not able to identify any relationship between sample size and number of foci in individual fMRI studies. Of the 132 studies using a correction, cluster-level corrections were made in 30 and voxel-level corrections were made in 32, while this aspect was not specified in 70 studies. Results were similar when we examined the subsets of cluster-level correction studies and of voxel-level correction studies (data not shown in Table 1 because of the unreliability of this variable in our analyses). However, posteriori analyses by cluster-level vs voxel-level did not demonstrate any statistically significant correlation between sample sizes and number of reported foci.
Discussion
This study explored the potential confounding role of reporting bias in fMRI studies of sex differences by assessing the prevalence of “positive” results and conclusions and whether or not the number of reported foci was positively related to the sample size of the studies. Across 179 identified fMRI studies of the brain published over a decade, few had a title that focused on the lack of sex differences or similarities between sexes and only 17 did not highlight sex differences in their abstract. Given the typically very small sample size of the studies in this literature, this “success rate” is implausibly high. Moreover, there was no statistical correlation between sample size and the number of identified foci. We analyzed relationships across different types of spatial smoothing, slice thickness, date of publication, use of corrected or uncorrected p-values, use of SPM or other statistical approaches, whole brain or ROI studies, and a range of different behavioral and somatosensory tasks. Nonetheless, there was no clear and consistent relationship between sample size and the number of significant foci. These results are surprising because owing to higher statistical power, studies with larger sample sizes should have been able to detect more differences when true sex differences are present9,10,11.
The lack of relationship observed in these analyses may reflect systematic reporting bias in small fMRI studies that produces a published literature with more sex difference signals than truly exist. We have previously reported a small but significantly positive correlation between sample size and number of brain abnormalities in VBM studies with variance by publication date, statistical thresholds and other imaging parameters13, and a lack of a consistently positive relationship between sample size and foci across the larger field of published fMRI studies14. The median number of foci in small studies (≤32 subjects) was approximately the same for larger studies (>32 subjects). As has been shown for morphometric12 and fMRI studies at large9,10,11,14, it appears that there is reporting bias driving an excess of significance. Studies with smaller sample sizes and reduced statistical power have been shown to produce imprecise and frequently spurious false positive results and it is possible that studies and analyses with more significant results are selected for publication. While, this problem is not specific to the study of sex differences but inherent to small-sample fMRI research, this problem might be exacerbated by the very simple fact that subgroup analyses based on sex are always tempting to do and easy to perform (in most datasets, information on sex are generally present). It is probable that the high proportion of “positive findings” result from a combination of factors including publication bias due to journal editorial practices favoring positive results, and significance biases including selective outcome and analysis reporting bias (reporting additional analyses that were not pre-specified), under-reporting of null results (“file-drawer problem”, particularly in underpowered studies), p-value “hacking” (manipulation of the analysis parameters until significant results are obtained), and other factors identified across the psychological literature18,19 and in the fMRI literature8. We have published suggestions for reducing these practices8 and there is some evidence that efforts to promote open science are bearing fruit as more light is shed on these problems20. We do not know if these recommendations are now widely followed by researchers, but if investigators are following the recommendation to use more stringent primary thresholds only for higher power studies, this might explain why higher-powered studies are not reporting more foci; if this is rampant and systematic across the field, it would represent a type of reporting or significance bias.
Our results could also reflect a dearth of biologically plausible sexual dimorphism in brain function across a range of many tasks published in the literature. A previous systematic review of fMRI studies concluded that there was widespread publishing of underpowered studies with “false-positive claims of sex differences in the brain, to enable the proliferation of untested, stereotype-consistent functional interpretations”21 and suggested that widespread scientific assumptions that female and male brains are functionally distinct, dichotomous, fixed, and invariant due to a sexually differentiated genetic blueprint are not scientifically justified and may be sexist22. Other investigators have posited that sex differences in cognitive test performance are explained by hormonal differences throughout development in combination with cultural influences, gender stereotypes, and biopsychosocial interactions23; and that females and males belong to a single heterogeneous population rather than two distinct populations with regard to brain structure and function24.
Some limitations should be acknowledged. First, in order to prevent any difficulty due to multiple measurements, we extracted foci for the analysis with the largest number of foci. But in many studies there was more than one analysis. As a result, some studies may have claimed to have identified far more significant foci than the number we have extracted. Thus, our analysis probably underestimates the potential problem of having too many statistically significant claims for sex differences in fMRI studies. Second, there were differences in the types of study designs across studies. We attempted to address this methodological heterogeneity with sensitivity analyses across different subgroups defined by methodological features. However, these subgroup analyses might be underpowered to demonstrate the relationship explored. Conversely, the one positive subgroup result encountered may be a spurious association found by chance since it did not survive correction for multiplicity. Third, the statistical significance of the results of fMRI studies may depend on the analytical method used and some parametric methods have been shown to yield inappropriate type I errors25. Here, we considered the correction used but did not re-analyze the raw data or to confirm the results using the same assumptions and statistical methods employed by the original authors. In addition, we sought to control for the level of correction (cluster-level vs. voxel-level) in each study. We attempted to extract this information but use of clusterwise vs voxelwise statistical correction was often not clearly documented in the different papers. Another open question that we were not able to control is how to appraise the statistical stringency. That is, is for instance 0.005 cluster-level FWE more or less stringent than 0.01 voxel-level FWE or 0.01 cluster-level FDR and so forth.
Fourth, our literature search was limited to studies published in the decade 2004–2013. Curating the database required extensive time and effort and it was not felt that enough additional information would be gained to justify updating the searchto capture more recent studies at this time. It is unlikely that earlier or more recent studies would present a different pattern, but empirical evaluations of very recent fMRI studies may be worth performing in the future, especially if large, multicenter investigations start appearing more frequently in this literature. Interestingly, we observed a small but statistically significant interaction between sample size and publication year, suggesting that the most recent studies may have operated in an environment where the strength of biases may have decreased.
Fifth, our searches were extensive, but we might have missed some studies of sex differences. In particular, we may have missed some studies that found no significant sex differences and this “negative” result was alluded to only in some fine print in the paper and thus could not be retrieved with our literature searches. If so, this would also be a form of reporting bias, if “positive” results are not only more likely to be published, but are also more prominently presented when published, as compared with “negative” results.
Sixth, we acknowledge that an increase of the sample size and power may enable non-significant voxels between two close clusters to achieve statistical significance, thus sometimes converting the two close clusters into a single larger one. The number of foci should not be affected by this conversion, but some authors choose to report only three foci per cluster. We did not assess reporting of <= 3 foci/cluster in our sensitivity analyses. In such a case, the relationship between the sample size and the number of foci could be downwards biased. However, in a previous publication, we found no evidence of an effect of this practice on the correlation between sample size and number of foci reported13. Although this modeling was from a database of VBM studies, it should be noted that in our earlier mega-analysis of fMRI studies14, we found the expected relationship between sample size and number of foci in meta-analyses – which also have the same effect of converting close clusters into a single, robust activation focus using activation-likelihood estimation. We may also not have extracted some other important confounders such as study quality defined in other ways. We cannot exclude that some large studies may be of poor quality and thus are less prone to find foci than smaller studies. Nevertheless, it seems unlikely since one would expect higher quality criteria in larger investigations that are typically performed by more experienced teams.
Importantly, our evaluation cannot conclude that there are no biologically plausible functional sex differences in human brain function, cognition or behavior that would be reflected in fMRI studies of the brain. However, the present data suggest that there is likely excess significance bias in the reported results of fMRI studies of sex differences of the brain.
This excess significance and reporting bias may stem from a constellation of factors that are likely to affect more prominently the literature of small studies. These factors include, but are not limited to, lack of pre-registration8, large flexibility in the modes of analyses26, inappropriate statistical methods26 and selection pressure from the current reward and incentives system to report the most significant results8. Conversely, solutions to this problem may involve pre-registered protocols and registration databases8, openness and transparency with wider data sharing practices such as Neurovault27 and OpenfMRI28, as well as pre-registered reports29 and other efforts that try to minimize selective reporting20,30.
Acknowledgements
We would like to thank Edmund Posadas, Elena Wadden, Ellen Encisco, Kenny Leung, Rocio Vides, Samuel Alimi and Samuel Jacobo for the initial data extraction for this paper. Personal funding for Sean P. David from National Institute on Minority Health and Health Disparities grant U54-MD010724 and Stanford NeuroChoice. The research was also supported by a National Institute on Drug Abuse grant T32-DA035165 post-doctoral fellowship. Florian Naudet is funded by Laura and John Arnold Foundation, La Fondation Pierre Deniker and Rennes University Hospital, France (CORECT: COmité de la Recherche Clinique et Translationelle). METRICS is funded by a grant from the Laura and John Arnold Foundation. The work of Joaquim Radua is supported by Instituto de Salud Carlos III (Co-funded by European Regional Development Fund/European Social Fund) “Investing in your future”) Miguel Servet Research Contract CP14/00041. The work of John Ioannidis is supported by an unrestricted gift from Sue and Bob O’Donnell. The sponsors had no role concerning preparation, review, or approval of the manuscript.
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Stem Cells From Menstrual Blood Offer New Hope in Organ Transplantation and in the Treatment of Numerous Diseases
Publishing date:
Not listed (no later than May 22nd, 2026)
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cellmedicine.com
Article length:
470 words
~ 2 minute read time
Stromal cells are found in the endometrial lining of the uterus and are shed every month during menstruation. Stromal cells are also found in connective tissues throughout the body, and are known to differentiate into new cartilage, bone, fat, heart, skin and brain cells. Such cells are now the focus of intense research throughout the world, as the discovery of their presence in menstrual blood offers a new opportunity for easily and noninvasively collecting such prized cells. Known as MenSCs (menstrual blood stromal cells), these cells may be harvested from a potentially unlimited, inexpensive, and continuous source by methods that are free of ethical controversies.
According to Dr. Amit Patel, director of Cardiac Cell Therapy at the University of Pittsburgh’s McGowan Institute of Regenerative Medicine, “Uterine stromal cells have similar multipotent markers found in bone marrow stem cells and originate in part from bone marrow.” When the MenSCs were grown in the laboratory, the cells were found to divide very rapidly, even more rapidly than stromal cells that are harvested directly from bone marrow. Although MenSCs do not divide as fast as embryonic stem cells do, MenSCs also do not carry any of the risks that are associated with embryonic stem cells, such as the formation of a particular type of cancerous tumor known as a teratoma.
Cryo-Cell International was a partner in conducting the research. According to Julie Allickson, vice president of laboratory operations, research and development at Cryo-Cell, “The preliminary results are extremely encouraging and support the importance of further study of these cells in several different areas including heart disease, diabetes and neurodegenerative disease.” According to Dr. Dwaine Emerich, a section editor for Cell Transplantation, “These studies are a significant step forward in the development of transplantable stem cells for human diseases because they address major issues including routine and safe cell harvesting of renewable cells that maintain their differentiation capacity and can be scaled for widespread clinical use.”
It is believed that these rapidly dividing MenSCs may be of particular usefulness in those diseases that require organ transplantation. Instead of transplanting an organ that has been donated by someone, scientists will instead be able to grow a new organ, and the other new tissue that is needed, from MenSCs such as these.
These findings with MenSCs offer further substantiating evidence for the potency of endometrial regenerative cells (ERCs), the properties of which were first described by scientists of Medistem Laboratories, who published the first full elucidation of ERCs in the Journal of Translational Medicine in November of 2007 in an article entitled, “Endometrial Regnerative Cells: A Novel Stem Cell Population”. The Medistem scientists were then honored with an award by Biomed Central for the best research article of 2007 in medicine, which was presented at the Royal Society of Medicine in London in March of 2008.
