This video critically examines the systemic failures within the UK's National Health Service (NHS) in providing timely and adequate healthcare for transgender individuals, highlighting issues of bureaucratic inertia, institutional prejudice, and a flawed diagnostic system that exacerbates suffering and inequality.
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hello my name is Abigail
over the last few years I have emailed
Britain's National healthcare provider
133 times trying to get a doctor's appointment
appointment
this video is about what that was like
why big institutions fall apart and why
they're so difficult to change
as research I've spoken to some of the
nhs's most senior administrators so over
the course of this rational analysis
I'll be revealing some exclusive Insider information
information
the video is sponsored by nebula but
after I've paid back the owner of this
laptop I'll be donating most of that
money to charity so you can sit back and
relax as I bring you a calm
dispassionate exploration of the big
questions at the heart of Britain's
National Health Service [Music]
[Music]
[Music]
here's how things are supposed to work
British citizens of all ages have a
right to free health care on the
National Health Service or NHS I was
born in the NHS and both my parents were
doctors my dad used to say when I was a
kid that he treated everyone from all
walks of life from literal Aristocrats
to prisoners from the local jail because
the point of the service is that it's
there for everyone since its Creation in
1948 the NHS has become the symbol of
the country that a lot of British people
are very proud of like the royal family
or William Shakespeare or beans on toast
the NHS is split into several Regional
bodies called trusts like there's a
Cambridge trust and an Oxford trust and
an East London trust and a West London
trust and so on the trusts get money
from the government which they spend on
Health Care Services like Staffing
equipment and supplies and they give
that to patients for free in this way
the NHS is funded mainly by the taxpayer
but even if you don't make enough money
to pay taxes you can still use it
because again the point of the service
is that it's there forever everyone
which it definitely definitely is as
well as the right to use the NHS we also
have the right to begin treatment within
18 weeks of referral and that right to
free medical treatment within 18 weeks
includes free medical transition for
transgender people of all ages if you
didn't already know
that includes me I'm a trans woman and
we'll be using the nhs's treatment of me
as our case study for today which will
reveal some more General things about
how the service is run and the
challenges that it's facing in the 21st century
century
if you want to medically transition in
England then you can start by going to
your local family doctor in Britain we
call this person a general practitioner
or GP your GPA will send you to a gender
identity Clinic where you'll be assessed
by Specialists to see if you fit the
criteria for gender dysphoria a
diagnosis that is definitely real and
which definitely makes a lot of sense if
you are diagnosed with dysphoria then
they'll let you use other bits of the
NHS for example if you want surgery
they'll send you to a surgeon if you
want hormones they'll tell your GP to
prescribe hormones for you which your GP
definitely will
once you're in the medical system you
can also change the legal sex that is
recorded on your birth certificate and
your passport in England you cannot
change either of those things without
first obtaining a doctor's permission
but it all starts with a friendly visit
to your local NHS doc who will be only
too happy to provide you with
world-class Medical Care from the finest system
system
several years ago I went to my GP told
her I'm trans and asked to be referred
to a gender identity Clinic the first
not exactly after a great start
I won't name her or any of the real
people I'll be referring to today
instead I'll call her
lieutenant scheisskoff [Music]
scheisskopf told me to come back in a
month and said that if I was still trans then
then
she would refer me
GPS in England aren't routinely trained
in trans medicine hence the separate
clinics so the idea that you're supposed
to wait a month before you can go
she made that up on the spot
she also tried to send me to Mental
Health Services which wasn't what I was
there for she only had one job send me
to the gender Clinic
but for some reason she wouldn't do it I
am not the only patient who fell at the
first hurdle
this is a 2013 NHS report titled
monitoring and promoting trans Health
across the Northwest the authors
investigated the needs of trans patients
across Northwest England and how GPS
were meeting those needs or rather they
tried to but they couldn't
because GPS overwhelmingly refused to
cooperate with the researchers only half
of the practices they investigated even replied
replied
and that was just the beginning it was
extremely difficult to get Beyond
reception staff to speak to practice managers
managers
for example the research was told many
times that the practice manager was not
in but would be later only to be told
later that they were on leave or did not
work in the afternoons
very few practice managers understood
what was meant by transgender people and
were unwilling to engage in this research
research
some practice managers receptionists and
GPS were spoken to express particularly
negative attitudes towards trans people
this study clearly demonstrates that
most GP practices are not sufficiently
prepared or knowledgeable to
appropriately address the needs of this
patient group 2013 was almost a decade
ago but more recent data and my own
experience confirms this is still a
problem this 2015 NHS report which
solicited feedback from patients and
staff also highlighted uncooperative GPS
as a major problem this 2016 article in
the British medical journal says the
same thing
in 2021 the non-profit Trans actual ran
a survey which included questions about
Healthcare 14 of trans respondents said
that their GPS like mine simply refused
to help them that's more than one in ten
as my friend Alice is fond of saying the
NHS is a wonderful Institution
unfortunately it is run by the British
but I didn't have any other choice so
I went away for a month as ordered and
30 days later surprise surprise I was
still transgender so I went back to
Lieutenant scheisskoff a second time and
this time she said she would refer me
six months went by
I remind you that we have the right to
be treated within 18 weeks so at this
point I've already waited double that
and I'm not even in the door
but after six months I still hadn't even
gotten so much as a letter from the
clinic saying I was in the system so I
went back to scheisskopf a third time
and this time she said oh
I must have forgotten to send it
I said dismiss Captain get the hell out
of my office the last time I took from
this was that my doctor was either so
incompetent she couldn't work a post box
or more likely she didn't want to give
me Medical Care
neither of which is great to be honest
honestly you think you're on good terms
with someone and then you come out as
trans and suddenly they don't want
anything to do with you anymore
in a lot of ways the NHS is just like my
dad I just like to clarify that that was
a joke I have a normal and happy
relationship with my father who is a
very supportive and loving man at this
point I moved to a different area of the
country and signed up with a new GP
and I went along and I asked to be sent
to the gender clinic but this time
I printed out the NHS rules on treating
trans patients and highlighted the
relevant sections so when he said I'm
sorry I can't send you to the clinic I
pulled them out and I said actually
doctor you not only can
you are required to
after a great deal of persuasion he did
in fact agree to follow the rules
and he referred me to the clinic I made
sure to get a signed and dated copy of
that referral
Under the Clock officially
started I waited 18 weeks
I waited 18 more weeks
and then I waited 18
18 more
there are currently seven gender clinics
for adults operating in England none of
them are seeing patients within the
required 18-week limit and waiting lists
are extremely long
how long you ask well at a time of
recording the largest clinic in London
has 11 407 patients on its waiting list
last month they offered first appointments
appointments 250.
250.
that means that if you were referred today
today
and that's not 19 years for health care
either that's 19 years for a first
appointment of which you may have
several with months or even years
between them you might be wondering wow
only 50 maybe they had a really slow
month last month maybe that's throwing
the numbers off nope
50 is pretty typical
that's actually better than it used to
be when I was referred it was 26 years
the long waiting times contribute to
distress
among trans patients it also impacts our
access to civil rights like marriage
death and privacy because remember in
England if you want to change the sex
marker on your birth certificate or
passport you need a doctor's permission
if you haven't changed the marker on
your passport for instance because
you're on a year's Long waiting list to
get permission then every time you apply
to rent a flat or get a job you'll have
to show them your passport and they'll
instantly know your trans
employers and landlords are not allowed
ha ha ha ha ha ha long waiting times are
an especially acute problem when it
comes to trans children
if you know that you're trans at a young
age and you're forced to go through the
wrong puberty it can be very distressing
and it can cause dare I say it
irreversible damage or not really damage
but it has permanent effects for
instance I went through a testosterone
puberty as an adolescent and as a result
I'm taller than the average English woman
woman
also I can do this with my voice
whenever I want to [Music]
[Music]
I mean I think those things are
positives about me because I really like
being tall and also it's useful as an
actress to have two voices and a perfect
impersonation of Matt Berry on tap and
there are other effects that are
negative and also permanent so it's
especially important that trans children
get prompt treatment if you're 13 and
trans and there's a years-long wait to
get care
then by the time you're seen it could be
too late
and your life is not over if that
happens to you
but it will shape the rest of your time
on Earth
and that's what a lot of this comes down to
to
waiting for somebody else's permission
faced with these waiting lists a lot of
trans people do one of three things
option one is Private health care
obviously that's very expensive so it
tends to be the more privileged usually
white trans people who get to do that
and even if you can't afford it that's
money that you can't spend on a holiday
or a house or a wedding or it means you
go into a lot of debt option two is
self-medication that means buying
hormones off the internet or sharing
them with a friend I found a 2016
article in the Lancet which records that
40 of adult patients who get an
appointment at the London Clinic are
already self-medicating when they arrive
if that rate holds constant Across the
Nation that would mean there are tens of
thousands of people doing it although
because it's underground who knows anecdotally
anecdotally
every British trans person I know except
for two I think is either
self-medicating or has at some point if
you're a trans woman like me then
self-medicating in England is legal you
need a testosterone blocker and estrogen
and you can order both of those from a
foreign country without a prescription
on the internet and have them sent here
if you have them it's also legal to
share them with a friend who needs them
however if you're a trans man then
things are a little trickier because
you're going to need testosterone and
it's illegal to sell or share that the
government doesn't want trans guys
getting too yoked Richie sunax a short
King he doesn't want to be intimidated
by all these trans dudes walking around
getting buff but obviously taking pills
that you bought on the internet can be
very medically risky GPS are supposed to
help people who do though again some
simply refuse there is a large and
growing network of people in the trans
underground to help each other out
although mindful as I am of YouTube's
Community guidelines I can't tell you
how to self-medicate and please note I'm
also explicitly not saying that I
recommend it I'm just saying it is a
fact that a lot of people do
probably because they find that option
than option three
when people do die on the waiting lists
every year at trans Pride there are more
names read out of the people who aren't
here anymore there was a recent death in
the community of a woman who'd waited
more than a thousand days on the waiting list
list
I've had parents of trans children
email me about the kids that they've lost
I'm gonna be honest with you writing
this episode of philosophy tube has been
a struggle because the show is about
being compassionate and seeing all sides but
but
as a human being
I have a strong preference for my own Survival
Survival
and a strong emotional reaction when I
see other people needlessly suffering
what I'm saying is this episode might
get a little bit more personal than
usual because now
having waited much much longer than the
legal maximum waiting time I decided to
start sending some emails
I found out which trust runs the gender
Clinic I'd been referred to and I wrote
to someone on their board of directors a
man I'll be referring to
major Discovery is the trust's head of
compliance it's his job to make sure
that they're following all the rules
he's not a doctor and actually that's
worth bearing in mind the NHS is not
administered by doctors it's
administered by administrators
I wrote to Major Discovery every week
for several months and eventually
he wrote back
dear Abigail as you've noted in your
email we are unable to offer a first
appointment with the 18-week time frame
that operates for most NHS Services
although this 18 week recommendation
does in principle apply to our service
we and all the other gender Services
nationally are unable to meet this
target currently due to very high demand
here I can bring in one of our big
philosophers for today
Sarah Ahmed and her book complaint which
is all about how making complaints to
institutions reveals the way they really work
work
in his letter to me major decoverly was
using a very interesting technique from
management and business philosophy a
technique called lying
the 18-week time limit is not a
recommendation or a Target that applies
in principle
it's actually a right I pointed this out
politely of course and his next move
seemed a little better if you would like
to discuss any aspect of your complaint
further please do let me know and I will
arrange for you to speak to a senior
member of the gender identity Clinic
that sounded like progress talking to
the guy who runs the clinic yeah if
anyone can get me an appointment he
surely can so we arranged a meeting he
picked the time and place
and he never turned up I honestly cannot
stress enough to you how absolutely
[ __ ] [ __ ] all these people are at scheduling
scheduling
they miss emails they forget to press
send when they write their replies
multiple times we've arranged meetings
they chose the time and place and then
they just never turned up
trying to reach them is like attempting
The Impossible all these little mistakes
get made but they're always mistakes
that benefit the institution never the
person complaining and for this reason
Sarah Ahmed coins the term strategic inefficiency
inefficiency
the harder it is to complain the fewer
complaints they have to deal with the
more they can just carry on doing what
they're doing she also says that making
a complaint becomes a kind of unpaid job
because in order to complain about a
system you have to spend a lot of time
learning about how it's supposed to work
I don't think I can adequately explain
to you just how maddening it is to go
through all that organizational hell and
then when you finally get into the
meeting they don't know the rules that
they're supposed to be following
so often in this process I have wanted
to say to these people
why am I doing your job
just dozens and dozens and dozens of emails
emails
hundreds of hours spent doing this in my
free time just to get an appointment
with a doctor
and so that I can turn it into
educational content for all of you fine people
patreon Dot
com slash philosophytube
I am no longer asking sign the [ __ ] up
exhaustion can become a management
technique so much of the work of
complaint is work we would not have to
do with institutions were as committed
to creating open accessible and
inclusive environments as they claim to
be eventually I managed to reschedule
that meeting
and I came face to face with a man who
actually runs a gender identity Clinic
I'll call him
major major
he's not a doctor but he sat there and
he nodded and listened sympathetically
as I explained I'd been waiting for
longer than the legal maximum waiting
time and I'd like my appointment now
please he told me the exact same thing
major to coverly had
they aren't working within the 18-week
time limit
I I don't understand exactly what it is
that you think I can do you're a major
major major major
you can just sign things sign what the
form what form after several weeks of
back and forth it dawned on me that
major Discovery had arranged this
meeting not to actually solve the problem
problem
but to try and get rid of me Ahmed says
institutions handle complaints using
non-performative speech
in philosophy performative speech is
when you say something and by saying it
you also do it like when you say I
promise you're speaking but you're also
doing the act of promising or if you're
at a straight wedding and the officiant
says I Now Pronounce You man and wife
they're saying it and they're doing it
on the flip side non-performative speech
is when you say something and by saying
it you prevent it from being done like
we are listening to feedback we take
your concerns very seriously
non-performative speech is how an
institution can appear to be doing
something about a problem whilst
actually very deliberately doing nothing
major major supplied a top-tier example
when he said that whilst the waiting
times are bad
we are working hard
I said that's like telling me you're
going to keep kicking me in the face but
you're working hard to put on softer
shoes I pointed out that by failing to
treat patients within the required time
some of whom died
the clinic was doing a great deal of
harm to trans people and at this point
major major got upset
he said I'm a black gay man I'm a trans
Ally I have trans friends I'm on your
side here
which was very interesting because we'd
been talking about the failures of the clinic
clinic
but he substituted to the clinic for
himself as a person
he took my complaints about the failures
of the system as an attack on his character
character
and in so doing he made the conversation
about his feelings rather than the
failures that he's responsible for and
how he's going to fix them this is also
a management technique that Ahmed and
others have identified
The Scholar Manta akapadi talks about
her experiences trying to criticize
University departments for institutional
racism and she found that when she
raised this problem the white women in
charge of the University departments
often cried because they thought they
were being called racist
their hurt feelings then become the
problem and the real problem the
institutional racism
never got addressed open your eyes
Clevenger it doesn't make a damn bit of
difference who wins the war to someone
who's dead congratulations I can't think
of another attitude that could be
dependent upon to give greater Comfort
to the enemy the enemy is anybody who's
gonna get you killed no matter which
side he's on having established pretty
thoroughly the major major was a dead
end I went back to Major discovery and
this time he said that if I was still
unsatisfied with how my complaint had
been resolved
because it hadn't been resolved
I was free to make a complaint to the
Parliamentary and Health Service
Ombudsman which I guess in this example
would be like the military police
they're an independent body who was
supposed to investigate the NHS when
things go wrong so I made a formal
complaint to them and they told me that
they would assign an investigator within
eight weeks
16 weeks later they did
a man I'll be referring to as chaplain
Chapman Chapman Chapman was honestly the
only person I spoke to in this whole
journey who was the least bit sympathetic
sympathetic
he asked me how my experiences had made
me feel about major Discovery and major major
major
and I quoted Moby Dick to him which we
both found very funny Chaplin insanity
is contagious
everybody's crazy except for us you and
I have to be careful
we may be the only same people in the
entire world however after several more
months of waiting for him to investigate
he told me his superiors had ordered him
to drop
the case I apologize for this negative outcome
outcome
one thing I was surprised to hear from
chaplain Chapman though was that there
were other cases that he was also being
ordered to drop
it honestly hadn't occurred to me before
that anyone else might have taken it as
far as I had
Ahmed talks about how official
complaints procedures can be
individualizing which kind of just means
lonely the NHS has no way for a group of
people to complain together about the
same problem you have to do it alone and
bear the cost on your time and your
emotions alone too which is another way
of discouraging you from trying I guess
if somebody really wanted to they could
put together a kind of collective
complaint like they could get together
with some friends and go down to NHS
England's offices maybe with some signs
and placards and a microphone
so I did
together with a bunch of activists from
a group called transgender action block
I attended a protest outside NHS
England's offices
there were hundreds of us who'd all just
been denied Healthcare
some of whom had been left in pain
between surgeries some of
some of whom had lost friends and
relatives but it still didn't get me an appointment
appointment
NHS England never even publicly
acknowledged that protest took place
I cried on the phone to chaplain Chapman
I asked is there anyone else I can
possibly appeal to besides God
and he said I'm not aware of their being
but
he was wrong there is a higher authority
there is and after a few more months of
emailing I found him the man behind the man
man
the man who gives the orders
colonel caccott colonel Cathcart is the
head of NHS England's specialized
commissioning he tells the trusts how
they have to handle medical transition
he can't act on his own but everyone I
spoke to told me he's the guy and when I
emailed the CEO of the NHS herself
she also passed me back down to him I'm
Colonel Cathcart and as of now I'm in
charge of you sorry ass bunch of
homosexuals by the way a lot of these
people's emails aren't publicly listed
and it was kind of fun to go hunting for
them I managed to get in touch with the
CEO of the NHS by getting her old
workplace email off LinkedIn emailing
that and getting an automatic out of
office reply saying hey I'm leaving this
job now to go and run the NHS if you
need me here's my new email address and
I was like yes I'm in I told Colonel
Cathcart I had been waiting for much
much longer than the legal maximum
waiting time and I would like to have my
appointment now pretty please he told me
to take it up with major major in major
to coverly and I said Colonel you're not
going to believe it but uh
they've already sent me to you and then
he told me that the reason for the
delays was because GPS are uncooperative
the very problem I'd encountered at the
start he told me that everyone wants to
change the system and make it faster but
they can't because GPS won't let them
the GPS are scared he told me and one of
cathcart's flunkies sent me this this
document is from 2019 it was published
by the Royal College of GPS it's titled
the role of the GP in caring for gender
questioning and transgender patients
they really need a more exciting naming system
system
in it the Royal College acknowledges
that GPS get no training in trans
Healthcare and that trans patients
sometimes have bad experiences so they
recommend more resources in the system
and that's basically it there's nothing
in here to support cathcart's claim that
GPS are the ones standing in the way of
changing the system in fact it seems to
me that when you actually read this
document they acknowledge several
reasons why the system should change
it's even weirder too that he sent me
this given that it makes a bunch of
recommendations from 2019
and none of them have actually happened
so why send me this as if it explains or
solves anything but then I remembered
some more Philosophy from Sarah Ahmed
she talks about how documents become
tools of institutional performance they
don't really exist in order to be read
they exist to give the institution a
good image
an example might be anti-bullying
policies your workplace probably has one
and our match talks about how when she
encountered bullying in her workplace
she reported it to management and they
sent her a copy of the policy
even as they defended the bullies
documents create fantasy images of the
organizations they apparently describe
the document says we are diverse as if
saying it makes it so many practitioners
and academics have expressed concerns
that writing documents or having good
policies becomes a substitute for Action
as one of my interviewees puts it you
end up doing the document rather than
doing the doing furthermore the
orientation toward writing good
documents can block action insofar as
the document then gets taken up as
evidence that we have done it colonel
Kafka was just doing the same thing
major to coverly had trying to get rid
of me except instead of using a meeting
he was using a piece of paper but
since he tried to shift the blame to the
Royal College of GPS
you know I had to do it to him I emailed
her a college of GPS
and after doing that every week for
several months then let me speak to one
of our top guys a guy I'll call major Danby
Danby
I actually asked major Danby upright is
it true what Colonel Cathcart said Is it
true that GPS are the reason behind all
of this and he said oh no no
medical association's fault
so I emailed them too
I'm not giving up
this is my white whale
that's right [ __ ]
I was assigned hater at Birth they told
at this point I was feeling very calm
very normal
Joker makeup was bursting out of my Paws
I was turning into a giant insect
falling down an infinitely repeating
staircase things of this nature
I couldn't understand it we have the
right to be seen within 18 weeks
I'd waited at this point over a year
just what the heck is going wrong with
the NHS [Music]
[Music]
now I bet that some of you are sitting
there thinking
that sucks but what do you expect the
NHS is in crisis
and you are absolutely right to show you
just how right you are I'd like to take
a moment now to calmly
impartially explore exactly why the NHS
is in crisis it is true that the
situation is pretty dire for everyone
right now there are over 7 million
people in England on some kind of
waiting list for NHS care the majority
of maternity units in England no longer
meet safety standards there are parts of
England where you'll wait for several
hours just to get an ambulance and
public satisfaction with the NHS is at a
25 year low there are Regional
inequalities too the healthcare that you
get in Newcastle where I'm from might be
of a very different standard to the
healthcare you get in Sunderland just
one city over and that sucks because
as much as it pains me to say it
the people of Sunderland
do deserve to live
obviously on the condition that they
renounce their football team things are
certainly a mess but on the other hand
I'm sure the health secretary has a plan
to fix it
whoever that is this week depending on
who you ask there are different
explanations for all this Mass according
to the government things were pretty
okay but then covert came along and it's
true that covered did not help the
pandemic swallowed up a lot of the nhs's
capacity still is and a lot of Frontline
healthcare workers burned out or had to
be re-tasked or just died according to
people who don't like brexit brexit
caused a staff shortage and it's true
that that probably didn't help either
because a lot of NHS staff were from the
EU emphasis on were now that we've left
it is easier for them to go elsewhere
because European citizens have freedom
of movement if you're a doctor in France
and you want to work abroad
you could fill out a whole bunch of
forms and pay a bunch of money to go to
England or you could you could go to the
Netherlands for free where you've got
more rights and the pay is better and
also they have double decker trains in
the Netherlands which is really cool
we're having to recruit more medical
staff from outside the EU now to make up
for the brexit shortfall which is
happening but it does take a little bit
of time however we should also bear in
mind that this snowball has been rolling
for a while for the last decade and
change there's been a lot of cuts to
public services and when you slash
budgets not as much stuff can be done
things run understaffed overworked
underpaid people burn out new people are
hard to find anecdotally almost every
doctor I know is planning to move to New
Zealand there was already a staffing
crisis in the NHS before brexit or covid
and the capacity was already falling too
remember earlier I said there are seven
million people in England on some kind
of NHS waiting list well before the
pandemic that number was already four
and a half million so
I think the ship had a few holes in
before we even hit the iceberg Captain
the NHS has also been massively impacted
by cuts to local government because in
England local government handles Social
care for example let's say that you're
an older person and you have a knee
replacement in an NHS hospital after a
few days you're well enough to go home
but you need a social worker to go and
get groceries for you or to just pop in
and check on you every now and again
whilst you continue recovering well the
bad news is there aren't enough social
workers there aren't even enough people
to process your application for a social
worker because budget cuts
you're not sick enough to stay in
hospital but you're not really well
enough to go home on your own so you
just kind of sit there like a lemon
there are a lot of people sitting around
in hospital beds who don't need to be
there but who can't be discharged
because they've got nowhere they can go
and that means that new people can't
come in these cuts are also very
difficult to row back on one way that a
trust can make up a shortfall in its
budget is by selling its assets off to
private developers and once a piece of
the Health Service is owned by an
American private Equity Firm or a
Chinese Investment Group they ain't
going to want to give it back if a job
like nursing for instance just doesn't
pay enough for people to live on then
that creates massive recruitment
problems that are very difficult to get
around on the other hand
being impartial
I'm sure that after over a decade of all
these cuts the British economy is in
great shape
with all this ambient crisis going on
isn't it understandable that things are
bad for Trans patients I mean wouldn't
it be unfair to criticize the NHS even
ungrateful wouldn't it play right into
the hands of the people who want to
that's definitely an argument that some
people make and
I'm being calm and rational and
impartial so I'm not gonna say no
but I am
very strongly going to say yes
and my GP didn't refuse to help me
because they didn't have the money it
would have cost her nothing to actually
do her job
the 2013 and 2015 investigations into
trans Healthcare didn't find problems of
budget they found problems of bigotry
also in 2015 the women under quality
select committee issued a report on the
state of trans Healthcare which again
identified Prejudice as a major obstacle
and we aren't the only minority that
gets hit by it unfortunately remember
earlier I said that the majority of
maternity units in England don't meet
safety standards well black women are
four times as likely to die in
childbirth than white women
oh and if you're trans and a person of
color that's a double whammy pretty much
all of these reports also say that
getting trans Healthcare is even more
difficult if you aren't White
although they never say it in those
terms they're always like this report identifies
identifies
inconsistencies in the treatment of
transgender patients of colors needs are
not always consistently being met by the
Health Service and it's like guys if you
just call it racism think how much money
you'd save on printering I'm not saying
that everyone who works in the NHS is a
frothing bigot I'm just saying it is a
fact that the NHS admits not all the
problems are caused by a lack of funding
and with that in mind
I'd like to take a closer look now at
how the trans Healthcare System is
actually designed
let's say for the sake of argument that
you are a transgender woman and you want
to get an orchidectomy that's an
operation to remove your testicles in
the USA they say orchiectomy but here we
say orchidectomy because the whole point
is that you keep the d a trans woman in
England who wants that operation has to
first get an appointment at the gender Clinic
Clinic
then be diagnosed with gender dysphoria
then be on hormone replacement therapy
for a certain amount of time and then
she needs two separate psychiatric assessments
assessments
in contrast a cisgender man that is a
man who is not transgender who has
chronic scrotal pain and wants the same
operation can be sent straight to a
it's not like it's a difficult procedure either
either
it's just like getting a tonsils out
except they do it at the other end and
the same is true across the board
a cisgender woman with chronic uterine
bleeding who wants a hysterectomy that's
a removal of the womb can be referred to
a surgeon from her GP
transgender man who wants the same
operation from the same surgeon has to
go through all those extra steps a
cisgender woman who wants to take
estrogen for menopause can get it from
her GP in fact pretty soon she'll be
able to buy it from a pharmacy a trans
woman who wants the same medicine has to
go to the gender clinic and be diagnosed
with dysphoria first
this is the one that really gets me if a
cisgender man is worried about going
bald he can get testosterone blockers
from his GP
but we can't this isn't how other
countries do it the president of the
world's Professional Association of
transgender Health called the British
system outdated and inefficient in 2021
in Canada parts of the USA and Argentina
you can start medical transition a lot
easier by just going to a GP
that's a space GP not AGP this system is
very unpopular with patients too
speaking only for myself I find it a
little bit irritating that I have to go
to a separate clinic to get the same
medicine as everyone else I mean even if
I could go on the same day and there was
no waiting list why do I have to more on
that later speaking not just for myself
in 2018 the NHS ran a consultation in
which they asked patients what we wanted
to change about the system in 2015 the
women in equality select committee also
asked both reports clearly record
patients desires for an informed consent
system one in which we don't need to get
a doctor's permission to transition but
we can just get our health care the same
way everyone else does in 2013 that GP
report that I mentioned earlier also
recommended an informed consent system
surprise surprise systems like that are
associated with higher patient
satisfaction and it would save the NHS a
huge amount of money running these
separate clinics has massive costs for
Staffing and training and computers if
they just gave us Healthcare the same
way CIS people get the way other
countries do the way we've been asking
for years it would genuinely save the
NHS a lot of cash despite this Defenders
of the British system say that it makes
sure only Specialists control who
transitions this supposedly prevents
harm to patients in particular the harm
of someone transitioning and then
regretting it yes the system can be very
difficult but it has a benevolent goal
and if you're very clever you'll already
have spotted what's wrong with that argument
argument
cast your minds back to the very first
thing that happened to me in my quest to
get Healthcare my GP who had no training
in trans medicine refused to send me to
the gender clinic and there was nothing
I could do it's supposed to be that only
Specialists control who transitions but
in reality
everyone in this system from the
Specialists to the GPS to the
receptionist who answers the phone
everyone has the power to deny patients
Medical Care by simply refusing to do
their jobs
as sociologist Ruth Pierce points out in
her book understanding trans Health in
this system everyone controls who
transitions except the patient who's
doing it
the system also doesn't prevent harm as
we've seen it causes a great deal of harm
harm
denying patients Medical Care
some of whom die as a result
and many others are forced to take risks
like self-medication but regret is a
much more interesting consideration for
all sorts of reasons we don't have time
to get into today medical regret is
actually a fascinating field and one
that's very difficult to do studies on
because like what are the units of
regret wistfulness per kilogram perhaps
the data we have suggests that
transition regret is actually very rare
I found a meta-analysis of 27 studies
that looked at just under 8 000 trans
patients in several countries who'd had
some form of surgery and which found a
regret rate of about one percent
the other way of phrasing that would be
to say that gender confirming surgery
appears to have a satisfaction rate of
about 99 according to that meta-analysis
which is remarkably High especially when
we compare it to other surgeries and
that's the kicker because do you know
what kind of surgery actually has quite
High regret rates
knee replacements
but there's no need for a psych
evaluation before you get one of them
another example nose jobs
no psych evaluations there surgeon just
says okay tell me what you want Cyrano
de Bergerac or Lord Voldemort
if you're not gonna block CIS people
getting Medical Care on the grounds that
they might regret it
it's pretty paternalistic to only do it
for us
the argument from regret is supposed to
justify having this two-track system but
actually it assumes the very thing it's
supposed to be arguing for namely that
transmedicine and CIS medicine should be
separate that trans regret and CIS
regret should never be compared
designing the system to avoid
hypothetical regret also assumes that
there is a conflict of interest between
trans people and people who regret
transitioning but actually we could be
on the same side
there are a small number of people who
do de-transition I found one study from
Britain that looked at over 3 000 trans
patients and found that 13 of them about
0.4 percent de-transitioned and
interestingly most of those
de-transitioned temporarily and
re-transitioned later the study could
only find three people who stopped
permanently although there might be more
because if you just stop taking your
hormones and going to the clinic then
you're not going to turn up in the data
but regardless even if it is only three people
people
they still matter
they still need health care too
and having to go around the houses to
try and get it the same way we do is
presumably just as much of a pain in
their ass and this is the really
maddening thing the real jokification
juice if the NHS just gave us an
informed consent Healthcare System it
would save them a whole lot of money and
time and produce better Healthcare
outcomes for everyone who uses it
that's why I personally cannot accept
the argument that we should just suck it
up because the NHS is in crisis and if
you take nothing else from today's video
then please let it be this
the deadly waiting times for Trans
Healthcare in Britain are not caused by
underfunding excessive demand or a lack
of staff and when the NHS says that I'm
really sorry but they're just not
telling the truth
these problems are caused by bad system
design and once I understood that
I was ready for what came next
because Colonel Cathcart sat me down and
he said okay
you clearly understand the system and
all of its problems so
what do you propose
propose [Music]
this is not the first time that the NHS
has dropped the ball and looking at
previous mistakes might help us to learn something
something
so with that in mind I'd like to talk
for a moment about the natural births
Scandal Sometimes the best way to
deliver a baby is by doing what's called
a cesarean section so if the baby's the
wrong way around or if there's any
number of problems rather than push it
out through the vagina the doctor can
cut open the womb and lift it out and
when it's done properly the procedure is
very safe and normal I actually know
people who've been born by C-section and
it's completely fine
but starting in the 1980s the NHS the
Royal College of midwives and the Royal
College of Obstetricians and
gynecologists somehow got it in their
heads that C-sections are very bad and
you should only ever do natural birth
and there was never really any evidence
for this in fact this story is a great
example of the ways in which the top
levels of medical organizations can
sometimes latch on to things that aren't
really supported by the medical evidence
more on that later unfortunately
unfortunately
it had disastrous consequences the
Shrewsbury and Telford trust tried to
reduce their number of C-sections to
zero with the result that between 2000
and 2019 hundreds of babies were left
stillborn or with permanent brain damage
fractured skulls and other complications
from Forced delivery at least 12 mothers
died in childbirth and had they gotten
C-sections they'd still be alive
their families spent years campaigning
to try and get this investigated there
were inquiries and reviews which the
trust fought every step of the way but
eventually the truth came out the Royal
College of midwives has now officially
apologized and accepted that its
position on C-sections was not based on
the medical evidence the president of
the Royal College of Obstetricians has
also formally apologized and the
Shrewsbury and Telford trust has paid
out more than 58 million pounds in
Damages and Counting
the reason I tell this story is because
it shows that no matter how bad things
get it is possible to address it we
can't bring back the people who died or
undo the suffering
but the NHS can and does face up to its mistakes
mistakes
and if they can do it for the natural
birth scandal then they can do it for us
one thing that would be good then would
be if there was some kind of inquiry or
truth commission set up to look at the
issues we've raised today somewhere
where the people who were denied health
care and the families of the ones who
died had a chance to tell their story
something a bit more formal than lady
and silly costumes makes a video essay
it would be nice too if that inquiry
featured a majority of trans people on
its governing body there have been NHS
reports into this sort of thing before
but they tend to be oh CIS people have
investigated themselves and concluded
they did nothing wrong
the report from that inquiry would then
give us a nice place to start talking
about material changes like apologies
resignations changing the system
memorials damages public executions that
sort of thing it would be cool if gp's
got some training in transmedicine the
rcgp recommended that years ago so it'd
be great if they actually got around to
it there's lots of people who benefit
from that sort of thing actually people
who have endometriosis all who go
through menopause have a really hard
time getting GPS to listen to them so if
doctors actually knew a little bit more
about the communities are meant to be
helping as well as you know tackling
Prejudice in the workforce that sort of
thing would be really helpful too
decriminalizing testosterone might also
help a lot of people do have to resort
to self-medication when the NHS fails
them so a harm reduction approach would
probably do a lot of good there that's
not something the NHS could do on their
own it would require political pressure
to bring about my dad suggested that I
write to my mp about all this so at time
of recording I have sent my mp 19 emails
12 phone calls and one handwritten
letter all of which she has completely ignored
I got a campaign leaflet through my
letterbox the other day being like hey
remember to vote for me at the next
election and I was like
babes you should book yourself an
orchidectomy because you've got some
[ __ ] balls external pressure could
also be brought through the courts
whenever I talk about this subject
Americans always tell me you should
launch a class action lawsuit which
sounds great but sadly it doesn't really
exist in England the NHS is currently
being sued by four trans people though
that's why Chaplin Chapman was ordered
to drop my case his superiors say he
can't do anything that might affect the
outcome at time of recording the case is
scheduled to be heard any day now and it
could have major ramifications at the
end of the day though the big solution
is the one that's been staring the NHS
in the face for years the one we've been
asking for for years the one that other
countries already do
an informed consent system
I actually said this to Colonel Cathcart
directly I said hey why not just close
the gender clinics get rid of the
waiting list entirely let us get our
health care the same way everyone else
does I mean we don't we don't need a
doctor's permission to change our bodies
right that's that's bodily autonomy 101 so
so
I mean everyone agrees the system is bad
aren't you
and Colonel Cathcart said yes I agree
things do need to change that's why I
have a plan
a plan to change
change
in 2020 NHS England commissioned a new
pilot scheme called transplus here in
London it's a sexual health clinic and a
gender identity Clinic rolled into one
and this is Colonel cathcart's baby he
told me so himself he wants this to be
the future of trans Healthcare in
England there are more clinics like it
on the way
patients and activists have been
campaigning for years to get something
done and
it's possible that this might represent
a slight Improvement at some point in
I wept because this plan doesn't change
the system at all
we still have to get permission from a
doctor to get the same Healthcare that
everyone else can GPS still have way too
much power it's still out of step with
what other countries are doing it's
still a massive unnecessary expensive
layer to the system patients still have
no control over what happens to us and
this is the bit that really gets me
he wants us to just forget about all the
horrible things that have happened Sarah
Ahmed talks about how institutions have
their own relationships to time what
philosophers call temporality
when you make a complaint you look back
at the harm that was done
but in all my conversations with NHS
senior officers they only want to look forwards
forwards
they don't want to look back
are the warnings they were given
are the promises they made
but the harm that was done especially
especially
they don't want to look back at the
people who died as a result of their decisions
decisions
or the people who were permanently
negatively impacted
it's nice
that they want to open more clinics at
some point
but what about the people who need
health care now what about the people
who are dead
even if we only look at the ones who
survived tens of thousands of people
were kept waiting and suffering
needlessly for years they knew about it
and did nothing
they're still suffering this is still
happening people's lives are being
destroyed by this system
there's nothing in cathcot's plan about
actually fixing any of it
not even an apology Ahmed says the
burden of forgiveness often falls on the
person making the complaint
we're expected to look forward like the
institution does and accept that we'll
never get Justice
I actually asked Colonel Cathcart Point
Blank who's looking into these cases
when are you awarding damages
when's the public apology coming
who is going to resign over these
failures colonel
time of recording and if we actually do
look back we'll find that this plan is
not what patients wanted remember we
said we wanted an informed consent
system several times they've been
publishing reports and investigations
and consultations into it for almost a
decade multiple times we told them what
we wanted and this is not that
however this plan shakes out it
represents NHS England and Colonel
Cathcart in particular I'm afraid
continuing to override the expressed
wishes of the people they are meant to
be helping when kafkart told me his plan
I went back to Major Danby a second time
and I said major
based on everything I've seen it seems
to me that decisions about the
Healthcare of patients are being made
not based on the medical evidence but
based on
interdepartmental politics and
institutional inertia and he said
so I mean at least someone finally
as I said this has been a very difficult
episode for me because
philosophytube is about compassion and reason
reason
but it's hard to maintain those things
in the face of a brutal and irrational system
in truth I I hate what this experience
has done to me it has
wasted my goodness and it has
made me angry and bitter
the angry easy explanation is that the
system is bad because the people in
charge are bad and that it won't change
because of them
and I don't want to think that way about
my fellow human beings
I I don't think my old philosophy
teacher Mr Baker would want me to think
that way either
and so there must be another explanation
why are institutions so inflexible why
are they so difficult to change is it
because ultimately people are nasty and selfish
selfish
or is there
a deeper reason and that's actually why
this topic is so fascinating to study
because this sort of thing's happening
all over
we've known that climate change is a
problem for ages we know what we have to
do to stop it but we keep doing things
that we know won't work
we know about the threats from rising
inequality and increasing extremism
we talk and we talk and we talk and we
don't do anything
well after a lot of research
Stafford beer was a management
cyberneticist which is a very cool job title
title
and probably explained by the fact that
he invented it basically he thought a
lot about computers and he tried to
apply what he knew to institutions the
job of any institution he says is to
take inputs and give consistent outputs so for example imagine you've got a very
so for example imagine you've got a very simple system with one employee and
simple system with one employee and their job is to push one button whenever
their job is to push one button whenever a customer asks them to in this case the
a customer asks them to in this case the input is the customer asking and the
input is the customer asking and the output is the button push the system has
output is the button push the system has two states that it can be in either he
two states that it can be in either he presses the button or he doesn't so we
presses the button or he doesn't so we say that it has a variety of two if you
say that it has a variety of two if you have 10 employees and they each have one
have 10 employees and they each have one button now the system has a variety of
button now the system has a variety of 1024 that's the number of possible
1024 that's the number of possible combinations of button pressed or not if
combinations of button pressed or not if you have a hundred employees now the
you have a hundred employees now the system has a variety of two to the 100
system has a variety of two to the 100 and if you have a system as big as the
and if you have a system as big as the NHS with employees who have jobs way
NHS with employees who have jobs way more complicated than pushing one button
more complicated than pushing one button and inputs a lot more varied than please
and inputs a lot more varied than please push the button
push the button you can see how things get pretty
you can see how things get pretty complicated pretty fast faced with all
complicated pretty fast faced with all this variety How can any institution
this variety How can any institution possibly deliver consistent outputs in
possibly deliver consistent outputs in an Ideal World an institution would have
an Ideal World an institution would have enough variety to cope with any possible
enough variety to cope with any possible input so for example in the ultimate
input so for example in the ultimate clothing store there is one shop
clothing store there is one shop assistant for every customer and there
assistant for every customer and there are infinite different sizes of every
are infinite different sizes of every single possible item of clothing you
single possible item of clothing you could ever want
could ever want and I still can't find a crop top I
and I still can't find a crop top I enjoy wearing
enjoy wearing obviously that's not practically
obviously that's not practically possible though especially when the
possible though especially when the institution is running on a limited
institution is running on a limited budget so beer says every institution
budget so beer says every institution has systems in place to keep variety
has systems in place to keep variety down we've already seen several during
down we've already seen several during my Voyage Through the NHS
my Voyage Through the NHS GPS with very narrow mindsets complaints
GPS with very narrow mindsets complaints procedures that are restrictive and
procedures that are restrictive and individualizing documents that exist to
individualizing documents that exist to be read but never followed
be read but never followed non-performative statements that are
non-performative statements that are used to brush people off these are all
used to brush people off these are all ways that the NHS tries to keep variety
ways that the NHS tries to keep variety down and keep on ticking to produce
down and keep on ticking to produce consistent outputs even when that means
consistent outputs even when that means consistently bad ones the drive to
consistently bad ones the drive to reduce variety beer says is like gravity
reduce variety beer says is like gravity or entropy he actually calls it a
or entropy he actually calls it a natural law and says that institutions
natural law and says that institutions do this even when the people working in
do this even when the people working in them don't want them to and even if it
them don't want them to and even if it makes things less efficient and more
makes things less efficient and more expensive
expensive this is why big institutions are so
this is why big institutions are so inflexible and why change happens so
inflexible and why change happens so slowly inch
slowly inch by Angry Inch beer was especially
by Angry Inch beer was especially interested in when this drive causes an
interested in when this drive causes an institution to collapse he says we
institution to collapse he says we shouldn't really think of them like this
shouldn't really think of them like this as a fixed hierarchy that's really only
as a fixed hierarchy that's really only useful if you're trying to find someone
useful if you're trying to find someone to blame
to blame instead he says try thinking of an
instead he says try thinking of an institution like a wave on a beach
institution like a wave on a beach a wave is a system
a wave is a system water molecules move in a circle and as
water molecules move in a circle and as they get closer to the shore the ones on
they get closer to the shore the ones on the bottom are slowed down by friction
the bottom are slowed down by friction with the seabed and so the circle
with the seabed and so the circle becomes
becomes elliptical
elliptical until
until it becomes so elliptical
it becomes so elliptical that the water molecules on the top
that the water molecules on the top collapse
collapse and the wave breaks
and the wave breaks this happens because the system of the
this happens because the system of the wave is internally unstable and there's
wave is internally unstable and there's nothing anyone can do about it it's just
nothing anyone can do about it it's just physics
physics so too Bia says institutions have the
so too Bia says institutions have the drive to reduce variety and if that
drive to reduce variety and if that drive contradicts what people actually
drive contradicts what people actually need from it then eventually
need from it then eventually it will fail bearing all that in mind
it will fail bearing all that in mind in my opinion this system is failing and
in my opinion this system is failing and will continue to fail despite cathcart's
will continue to fail despite cathcart's plan because the drive to reduce variety
plan because the drive to reduce variety contradicts what patients actually need
contradicts what patients actually need if we had an informed consent system
if we had an informed consent system which would be like allowing patients to
which would be like allowing patients to push the buttons ourselves that would be
push the buttons ourselves that would be better but it would massively increase
better but it would massively increase the system's variety it would require it
the system's variety it would require it to give a new kind of output
to give a new kind of output which it instinctively resists and
which it instinctively resists and there's one big example of this that I'd
there's one big example of this that I'd like to look at in the final section of
like to look at in the final section of today's video that I think explains a
today's video that I think explains a lot of the problems that we see here
lot of the problems that we see here this is the spicy bit this is the bit
this is the spicy bit this is the bit where probably a few people are going to
where probably a few people are going to get a little bit upset at me but
get a little bit upset at me but I would like to talk now about the
I would like to talk now about the concept
concept of gender
of gender dysphoria
dysphoria [Music]
[Music] here's the real [ __ ] we are firmly in
here's the real [ __ ] we are firmly in the territory of my opinion here not
the territory of my opinion here not everyone agrees with what I'm about to
everyone agrees with what I'm about to argue if I'd stayed in Academia this is
argue if I'd stayed in Academia this is probably what I'd have written my PhD on
probably what I'd have written my PhD on as we've seen by now medical transition
as we've seen by now medical transition in England and let's not forget a lot of
in England and let's not forget a lot of legal transition as well hinges on first
legal transition as well hinges on first being diagnosed with gender dysphoria
being diagnosed with gender dysphoria which is supposedly the feeling of
which is supposedly the feeling of discomfort that arises when there is a
discomfort that arises when there is a disconnect between the sex you were
disconnect between the sex you were assigned at Birth and the gender you are
assigned at Birth and the gender you are and I think that this concept
and I think that this concept as it is used in the NHS system
as it is used in the NHS system is a complete Croc of [ __ ] the
is a complete Croc of [ __ ] the philosopher Gilbert Ryle tells a story
philosopher Gilbert Ryle tells a story about a guy who goes to Oxford and asks
about a guy who goes to Oxford and asks to see the university and they show him
to see the university and they show him the colleges and the libraries and the
the colleges and the libraries and the quads and at the end of the day he says
quads and at the end of the day he says yes but where's the University you
yes but where's the University you haven't shown me that and he's made a
haven't shown me that and he's made a mistake what philosophers call a
mistake what philosophers call a category error he thinks the university
category error he thinks the university is its own building but it's not it's
is its own building but it's not it's just the sum of all those ordinary
just the sum of all those ordinary buildings A lot of people talk about
buildings A lot of people talk about dysphoria as if it was its own extra
dysphoria as if it was its own extra feeling and I think that that too is a
feeling and I think that that too is a category error
category error I don't think it is an extra feeling I
I don't think it is an extra feeling I think it's just the sum of
and CIS people also feel all those feelings maybe not about the same things
feelings maybe not about the same things or to the same intensity but they do
or to the same intensity but they do feel them if a cisgender woman goes
feel them if a cisgender woman goes through menopause and thinks oh my my
through menopause and thinks oh my my body feels bloated it doesn't feel like
body feels bloated it doesn't feel like my own I'm anxious and depressed
my own I'm anxious and depressed is that not gender dysphoria
is that not gender dysphoria if a CIS man is skinny and can't grow a
if a CIS man is skinny and can't grow a beard and looks at his peers and thinks
beard and looks at his peers and thinks oh I I should be manlier
oh I I should be manlier is that not gender dysphoria
is that not gender dysphoria if a sister and the woman has hair on
if a sister and the woman has hair on her face and thinks oh I've got a
her face and thinks oh I've got a mustache I look like a man I want to get
mustache I look like a man I want to get laser hair removal to get rid of it is
laser hair removal to get rid of it is that not dysphoria
that not dysphoria I think the only plausible answer here
I think the only plausible answer here is yes but when CIS people feel those
is yes but when CIS people feel those feelings it doesn't have its own
feelings it doesn't have its own clinical label and
clinical label and they don't have to be diagnosed with it
they don't have to be diagnosed with it to get treatment
to get treatment remember if a CIS woman goes through
remember if a CIS woman goes through menopause she can get estrogen from her
menopause she can get estrogen from her GP if a trans woman wants it we have to
GP if a trans woman wants it we have to go to the gender clinic and be diagnosed
go to the gender clinic and be diagnosed with gender dysphoria when we feel those
with gender dysphoria when we feel those feelings it's treated differently and
feelings it's treated differently and you might be saying well when CIS people
you might be saying well when CIS people feel those things that's body dysmorphia
feel those things that's body dysmorphia not gender dysphoria it is a different
not gender dysphoria it is a different thing but that's what I'm asking why is
thing but that's what I'm asking why is it different
it different to which the only answer is well
to which the only answer is well because you're trans
because you're trans and that's exactly my point
and that's exactly my point functionally in the English clinical
functionally in the English clinical system gender dysphoria just means the
system gender dysphoria just means the thing that trans people have
thing that trans people have and in that case you might as well just
and in that case you might as well just call it mad disease and it's not just
call it mad disease and it's not just the concept itself that raises my
the concept itself that raises my eyebrows the history of it is also
eyebrows the history of it is also questionable
questionable being trans used to be considered a
being trans used to be considered a mental illness transsexuality as it was
mental illness transsexuality as it was then called was added to the diagnostic
then called was added to the diagnostic statistical Manual of mental disorders
statistical Manual of mental disorders in 1980 and there was immediately a
in 1980 and there was immediately a campaign to remove it so in 2013 the
campaign to remove it so in 2013 the American Psychiatric association got
American Psychiatric association got together and said we gotta update this
together and said we gotta update this and they assembled a committee there
and they assembled a committee there were 12 doctors on that committee as far
were 12 doctors on that committee as far as I can find all of them were CIS side
as I can find all of them were CIS side note one of them was Ray Blanchard a
note one of them was Ray Blanchard a name that all the trans people in the
name that all the trans people in the audience will know because banchard has
audience will know because banchard has since been disgraced and his
since been disgraced and his um theories about us have been thrown
um theories about us have been thrown out by the medical community and
out by the medical community and thoroughly debunked including by other
thoroughly debunked including by other YouTubers more talented than me this was
YouTubers more talented than me this was the committee that pretty much invented
the committee that pretty much invented the modern concept of gender dysphoria
the modern concept of gender dysphoria as it is used today this team of 12
as it is used today this team of 12 looked at the history of diagnosing
looked at the history of diagnosing trans people looked for patterns in the
trans people looked for patterns in the medical literature and came up with
medical literature and came up with their new diagnosis dysphoria
their new diagnosis dysphoria unfortunately there was a major problem
unfortunately there was a major problem with the data that they relied on a
with the data that they relied on a problem which also makes the diagnosis
problem which also makes the diagnosis extremely difficult to actually use how
extremely difficult to actually use how do you diagnose someone with gender
do you diagnose someone with gender dysphoria
dysphoria or transsexuality or mad disease or
or transsexuality or mad disease or whatever we're calling it this decade
whatever we're calling it this decade when you get to the gender Clinic what
when you get to the gender Clinic what does the specialist actually do
does the specialist actually do well they ask you questions of course
well they ask you questions of course this person who has the power to decide
this person who has the power to decide what the rest of your life will look
what the rest of your life will look like asks you questions to make sure
like asks you questions to make sure that your answers fit the ones they have
that your answers fit the ones they have in their textbook
in their textbook and can you guess what the problem is we
and can you guess what the problem is we lie
lie or not even necessarily lie but just we
or not even necessarily lie but just we tell them what they want to hear
tell them what they want to hear there's a documented history of trans
there's a documented history of trans people doing this since at least the
people doing this since at least the 1950s and we're still doing it a 2015
1950s and we're still doing it a 2015 study found that about 30 percent of
study found that about 30 percent of trans-respondents admitted to lying or
trans-respondents admitted to lying or withholding information during their NHS
withholding information during their NHS gender assessments because of course we
gender assessments because of course we do
do if you wait several years for that
if you wait several years for that appointment and you finally get in the
appointment and you finally get in the room with a person who has your life in
room with a person who has your life in their hands a person who is almost
their hands a person who is almost certainly CIS and they ask you so when
certainly CIS and they ask you so when did you know
did you know of course you're going to say oh ever
of course you're going to say oh ever since I was a child yeah I wore my
since I was a child yeah I wore my mother's dress I called myself Wendy
mother's dress I called myself Wendy like all I want is to be a 1950s
like all I want is to be a 1950s housewife and marry a man of course
housewife and marry a man of course you're gonna say that
you're gonna say that I'm not saying you should lie to your
I'm not saying you should lie to your doctor I'm saying it's a fact that it
doctor I'm saying it's a fact that it happens
happens it's always been a problem and it's
it's always been a problem and it's always going to be a problem as long as
always going to be a problem as long as we have to pass a behavioral assessment
we have to pass a behavioral assessment to get health care
to get health care to put it in cybernetic terms we
to put it in cybernetic terms we ourselves reduce the variety of inputs
ourselves reduce the variety of inputs to the system because unless we give the
to the system because unless we give the right inputs
right inputs we don't get to live it's a running joke
we don't get to live it's a running joke in the British trans community that the
in the British trans community that the assessments for gender dysphoria are
assessments for gender dysphoria are ridiculous but to be honest the
ridiculous but to be honest the questions they ask can also be very
questions they ask can also be very humiliating
humiliating how do you masturbate
how do you masturbate how often
how often what do you think about when you
what do you think about when you masturbate what do you wear when you
masturbate what do you wear when you masturbate
masturbate who do you have sex with how often what
who do you have sex with how often what positions
positions tell me about your childhood were you
tell me about your childhood were you abused as a child what toys did you play
abused as a child what toys did you play with were you abused as a child which
with were you abused as a child which other children did you choose to play
other children did you choose to play with were you abused as a child
with were you abused as a child what was your first sexual experience
what was your first sexual experience when did you start having sex
when did you start having sex tell me again specifically in detail how
tell me again specifically in detail how do you masturbate
do you masturbate on and on
on and on and on
and on it's humiliating enough as an adult to
it's humiliating enough as an adult to be interrogated like that by a stranger
be interrogated like that by a stranger I can't imagine what it's like if you're
I can't imagine what it's like if you're a trans child
a trans child and it's not like you can say hang on a
and it's not like you can say hang on a minute where's your evidence that any of
minute where's your evidence that any of this is medically relevant because they
this is medically relevant because they have the power to deny you health care
have the power to deny you health care and if you're the committee in 2013
and if you're the committee in 2013 going through the reports from those
going through the reports from those assessments trying to find the patterns
assessments trying to find the patterns you've got no way of knowing how
you've got no way of knowing how accurate that data is which raises
accurate that data is which raises serious questions about the reliability
serious questions about the reliability of their conclusions
of their conclusions there's no way of knowing whether gender
there's no way of knowing whether gender dysphoria is a real diagnostic pattern
dysphoria is a real diagnostic pattern or just
or just a collective invention I remind you that
a collective invention I remind you that getting trans Healthcare in England and
getting trans Healthcare in England and a lot of legal transition to requires
a lot of legal transition to requires you to go through that interrogation
you to go through that interrogation first that's the real reason the waiting
first that's the real reason the waiting list is so long there are very few
list is so long there are very few Specialists who conduct these
Specialists who conduct these assessments apparently it's hard to
assessments apparently it's hard to recruit people to do the job of asking
recruit people to do the job of asking strangers how they jack off but even if
strangers how they jack off but even if there were a million of them even if the
there were a million of them even if the asking strangers have a jack off sector
asking strangers have a jack off sector became the biggest employer in the
became the biggest employer in the country I just don't think it's a
country I just don't think it's a valuable clinical diagnosis I don't
valuable clinical diagnosis I don't think it even makes sense and it's also
think it even makes sense and it's also a little bit insulting that I have to do
a little bit insulting that I have to do that but a CIS person doesn't
that but a CIS person doesn't I'm like The Emperor's New Clothes with
I'm like The Emperor's New Clothes with this man gender dysphoria
this man gender dysphoria there's nothing there now we're bullied
there's nothing there now we're bullied and insulted and harassed and shoved
and insulted and harassed and shoved around all day long by insane people and
around all day long by insane people and we do our duty mission after mission 35
we do our duty mission after mission 35 40 then we're told it's not good enough
40 then we're told it's not good enough with all that said why not just ditch
with all that said why not just ditch the concept of dysphoria if it's
the concept of dysphoria if it's grounded in philosophical error based on
grounded in philosophical error based on unreliable data incentivizes patients to
unreliable data incentivizes patients to lie creates a deadly bottleneck in the
lie creates a deadly bottleneck in the system and adds this whole extra
system and adds this whole extra expensive layer we don't need why not
expensive layer we don't need why not just get rid of it
just get rid of it we could still use the word if somebody
we could still use the word if somebody says how are you Abby and what I want to
says how are you Abby and what I want to say is
say is I feel bad about my body and the way
I feel bad about my body and the way that it is perceived by myself and
that it is perceived by myself and others in a way that relates to my
others in a way that relates to my gender because there is a gap between
gender because there is a gap between what I want and what I have then it's
what I want and what I have then it's probably just faster to say dysphoria or
probably just faster to say dysphoria or honestly most of the time it's faceted
honestly most of the time it's faceted just making noise like
that there have been calls for years
there have been calls for years internationally to ditch the clinical
internationally to ditch the clinical use of dysphoria and just give trans
use of dysphoria and just give trans people Healthcare without that extra
people Healthcare without that extra step of a diagnosis there are some
step of a diagnosis there are some practical hurdles to be sure
practical hurdles to be sure the diagnostic requirement is very baked
the diagnostic requirement is very baked into the NHS and British law in 1999
into the NHS and British law in 1999 there was a landmark legal case a trust
there was a landmark legal case a trust in Lancashire announced they weren't
in Lancashire announced they weren't going to fund transition anymore on the
going to fund transition anymore on the grounds that it was merely cosmetic and
grounds that it was merely cosmetic and they were sued by three trans patients
they were sued by three trans patients who said actually it was necessary to
who said actually it was necessary to alleviate their gender identity disorder
alleviate their gender identity disorder as it was called at the time the
as it was called at the time the patients one which
patients one which meant that we have a right to free
meant that we have a right to free transition but it also codified the idea
transition but it also codified the idea that we need to be diagnosed with
that we need to be diagnosed with something first the NHS tries to cure
something first the NHS tries to cure illness rather than maximize Health
illness rather than maximize Health those are not necessarily the same thing
those are not necessarily the same thing so gender dysphoria provides an illness
so gender dysphoria provides an illness that they can respond to practical
that they can respond to practical hurdles can be overcome though
hurdles can be overcome though it would take some work to change the
it would take some work to change the system sure but it's not impossible we
system sure but it's not impossible we could have a system that gives us free
could have a system that gives us free healthcare and doesn't rely on
healthcare and doesn't rely on diagnosing us with mad disease
diagnosing us with mad disease other countries already do
other countries already do again and this is the question I kept
again and this is the question I kept coming back to with Colonel Cathcart why
coming back to with Colonel Cathcart why not change the system I have a theory
not change the system I have a theory about what's really going on here and to
about what's really going on here and to explain it I want to draw on some
explain it I want to draw on some philosophy of disability
philosophy of disability in her book the capacity contract
in her book the capacity contract philosopher Stacy Clifford simplicon
philosopher Stacy Clifford simplicon Compares two different ways of thinking
Compares two different ways of thinking about what it means to have a disability
about what it means to have a disability one is the so-called medical model you
one is the so-called medical model you have a disability if you have a medical
have a disability if you have a medical problem and the other is the social
problem and the other is the social model
model you have a disability if for example you
you have a disability if for example you use a wheelchair and your building
use a wheelchair and your building doesn't have a ramp
doesn't have a ramp the problem isn't your body the problem
the problem isn't your body the problem is that the building wasn't designed by
is that the building wasn't designed by you simplicon says that the medical
you simplicon says that the medical model can be very appealing to
model can be very appealing to able-bodied people because it soothes
able-bodied people because it soothes our anxiety
our anxiety I don't want to think about the fact
I don't want to think about the fact that Society is unfair or that the
that Society is unfair or that the systems I'm part of exclude people I
systems I'm part of exclude people I definitely don't want to think about the
definitely don't want to think about the fact that I could acquire a disability
fact that I could acquire a disability and then I'd be the one who was excluded
and then I'd be the one who was excluded so the medical model allows me to
so the medical model allows me to imagine that there is a very distinct
imagine that there is a very distinct line between them and me
line between them and me a line that is located in their bodies
a line that is located in their bodies where the problem is
where the problem is and that also presents an obvious
and that also presents an obvious solution get them out of here I think
solution get them out of here I think that gender dysphoria does a similar
that gender dysphoria does a similar thing
thing because here's the real secret of the
because here's the real secret of the universe if you want to change sex it's
universe if you want to change sex it's possible
possible for all of human history we've had this
for all of human history we've had this divide between men and women
divide between men and women but if you want to cross that divide if
but if you want to cross that divide if you want to transcend it entirely and be
you want to transcend it entirely and be neither
neither it's possible
it's possible in particular hold in one hand all of
in particular hold in one hand all of masculinity 4. Leonidas Beowulf James
masculinity 4. Leonidas Beowulf James Bond Andrew Tate Jordan Peterson all of
Bond Andrew Tate Jordan Peterson all of them
them and in the other
and in the other hold just two milligrams of estrogen a
hold just two milligrams of estrogen a day
day and tell me which one is more powerful
and tell me which one is more powerful we live in a culture that valorizes men
we live in a culture that valorizes men treats them as the default
treats them as the default but when you're a trans woman you can
but when you're a trans woman you can take all of that and just
and you can be happier for it in a male-dominated gender hierarchy where it
male-dominated gender hierarchy where it is assumed that men are better than
is assumed that men are better than women and that masculinity is superior
women and that masculinity is superior to femininity there is no greater threat
to femininity there is no greater threat than the existence of trans women who
than the existence of trans women who despite being born male and inheriting
despite being born male and inheriting male privilege choose to be female
male privilege choose to be female instead by embracing our own femaleness
instead by embracing our own femaleness and femininity we in a sense cast a
and femininity we in a sense cast a Shadow of Doubt over the supposed
Shadow of Doubt over the supposed supremacy of maleness and masculinity I
supremacy of maleness and masculinity I think that some CIS people are made a
think that some CIS people are made a little bit anxious by that
little bit anxious by that I think they like to imagine that male
I think they like to imagine that male and female are naturally occurring
and female are naturally occurring stable categories and that we are just
stable categories and that we are just the exceptions that prove the rule I
the exceptions that prove the rule I think they like to imagine that there is
think they like to imagine that there is a clear Line Between Us and Them
a clear Line Between Us and Them and the concept of gender dysphoria
and the concept of gender dysphoria draws that line
draws that line it locates the problem within our bodies
it locates the problem within our bodies and also creates a class of Specialists
and also creates a class of Specialists who can Patrol that line and decide who
who can Patrol that line and decide who gets across hell there are some trans
gets across hell there are some trans people who like that line being there
people who like that line being there there are some not naming names who say
there are some not naming names who say I'm a real transsexual I've been
I'm a real transsexual I've been diagnosed with the mental illness that
diagnosed with the mental illness that is gender dysphoria not like all these
is gender dysphoria not like all these tenderqueer non-binary teenagers with
tenderqueer non-binary teenagers with their green hair and their Lucy and Yak
their green hair and their Lucy and Yak dungarees and I'm like babes you've been
dungarees and I'm like babes you've been diagnosed with bologna suffered beer
diagnosed with bologna suffered beer famously said that the purpose of a
famously said that the purpose of a system is what it does and what he meant
system is what it does and what he meant was there's no point claiming A System's
was there's no point claiming A System's job is to do something it consistently
job is to do something it consistently fails to do it functions how it
fails to do it functions how it functions it gives the outputs it gives
functions it gives the outputs it gives with that Outlook
with that Outlook I don't think anyone can really claim
I don't think anyone can really claim that the nhs's current system exists to
that the nhs's current system exists to help trans patients it might
help trans patients it might occasionally do that as a side effect
occasionally do that as a side effect but in my opinion it's real function its
but in my opinion it's real function its main output is control
main output is control NHS gender clinics exist as part of a
NHS gender clinics exist as part of a larger system that is gender itself
larger system that is gender itself and they reduce variety within that
and they reduce variety within that system parades aren't designed to teach
system parades aren't designed to teach us anything they're designed to
us anything they're designed to humiliate us they're designed to make us
humiliate us they're designed to make us suffer the indignity of doing something
suffer the indignity of doing something entirely pointless so that sadistic
entirely pointless so that sadistic Scheid scarf can demonstrate he has
Scheid scarf can demonstrate he has power over us the more pointless the
power over us the more pointless the activity the greater our humiliation and
activity the greater our humiliation and the more power he feels and we can sit
the more power he feels and we can sit here and pretend all we want that there
here and pretend all we want that there must be some more noble war effort type
must be some more noble war effort type purpose that was walking around in
purpose that was walking around in [ __ ] rectangles but there isn't one
[ __ ] rectangles but there isn't one we do parades so scheitzgov can feel
we do parades so scheitzgov can feel like a tough guy that's what parades are
like a tough guy that's what parades are for in my opinion the concept of gender
for in my opinion the concept of gender dysphoria pathologizes transness so
dysphoria pathologizes transness so people can avoid the endearing truth
people can avoid the endearing truth that there is no line and that really we
that there is no line and that really we aren't so different
aren't so different and so that some of them can avoid
and so that some of them can avoid asking themselves the big question
asking themselves the big question given that human beings can change sex
do you want to [Music]
I should have known that the ending of my story would be as
that the ending of my story would be as absurd as all the rest of it
absurd as all the rest of it one day I got a phone call
one day I got a phone call and they said
and they said come in on Tuesday
I don't know whether Colonel cathcock did something
did something or whether someone ahead of me on the
or whether someone ahead of me on the waiting list died
waiting list died they just said it's on Tuesday
and I thought I would be happy or excited
excited but to tell the truth I was
but to tell the truth I was angry
angry with them and with myself
with them and with myself I was angry because why did I
I was angry because why did I why did I get that phone call and then
why did I get that phone call and then someone else didn't
someone else didn't It Is by luck and a hell of a lot of
It Is by luck and a hell of a lot of privilege that I am here to tell this
privilege that I am here to tell this story and the arbitrariness of that
story and the arbitrariness of that system compounds the survivor's guilt
for a hell of a lot of people by the time they finally get an appointment
time they finally get an appointment they've either already self-medicated
they've either already self-medicated or
or they've gone private so
they've gone private so there's hardly any point in even getting
there's hardly any point in even getting one
one it seems that the only way to get trans
it seems that the only way to get trans Healthcare in Britain is not to need
Healthcare in Britain is not to need trans Healthcare and there is actually a
trans Healthcare and there is actually a specific name for that kind of logical
specific name for that kind of logical trap
trap it's called
there's some catch that catch 22. it's the best there is
I hope that sharing my story does some good
good I'm going to tell you the real
I'm going to tell you the real on YouTube Everything has to be
on YouTube Everything has to be clickable and shareable and homogeneous
clickable and shareable and homogeneous it's very difficult to get a message out
it's very difficult to get a message out when you make something like this which
when you make something like this which is a little bit different but when we
is a little bit different but when we try
try it can be wonderful
it can be wonderful I recently wrote a stage play called the
I recently wrote a stage play called the prince which was on here in London with
prince which was on here in London with me in it
and we won an off West End award the highest award we were eligible for
the highest award we were eligible for we won it I've gone from making YouTube
we won it I've gone from making YouTube videos in my bedroom to
videos in my bedroom to award-winning playwright
award-winning playwright because it turns out when we're actually
because it turns out when we're actually allowed to tell our own stories for a
allowed to tell our own stories for a change
change they're pretty good
they're pretty good the play was filmed and the filmed
the play was filmed and the filmed version is going on a streaming service
version is going on a streaming service called nebula if you'd like to see it
called nebula if you'd like to see it there's a link in the description
there's a link in the description curiositystream.com philosophytube the
curiositystream.com philosophytube the way it works is you click on that link
way it works is you click on that link you sign up to curiositystream and you
you sign up to curiositystream and you get nebula included as well the whole
get nebula included as well the whole bundle costs like 15 a year which is
bundle costs like 15 a year which is ridiculously cheap for what it is and
ridiculously cheap for what it is and you also get everything on
you also get everything on curiositystream included and there's
curiositystream included and there's loads of good stuff on there like David
loads of good stuff on there like David Attenborough has a documentary about
Attenborough has a documentary about bioluminescence that I came across
bioluminescence that I came across randomly on curiosity stream it's really
randomly on curiosity stream it's really good it's about animals that give out
good it's about animals that give out light
light that's what I'm trying to be I'm going
that's what I'm trying to be I'm going to donate most of the money that nebula
to donate most of the money that nebula gave me to the charity gendered
gave me to the charity gendered intelligence they're run by trans people
intelligence they're run by trans people and they help educate the public about
and they help educate the public about what we need
thank you for watching and best of luck
best of luck fly
glory glory to God
is everybody happy by the sergeant looking up I'll give a deeply answered
looking up I'll give a deeply answered yes and then they stood him up he jumped
yes and then they stood him up he jumped into the icy plastic static line of hook
into the icy plastic static line of hook and he ain't gonna jump no more
[Music] glory glory
glory glory to God he ain't gonna jump no more
to God he ain't gonna jump no more zones
he counted long he counted loud he waited for the shock he felt the wind he
waited for the shock he felt the wind he felt the cold he felt the awful drum the
felt the cold he felt the awful drum the silk from his reserve Spilled Out and
silk from his reserve Spilled Out and wrapped around his legs
wrapped around his legs [Music]
he ain't gonna jump no more so so
your eyes are swung around his neck the nectar's practice long suspension lines
nectar's practice long suspension lines were tied and not so wrong to skinny
were tied and not so wrong to skinny bones
bones [Music]
one day she lived and loved and love kept running through his mind it's all
kept running through his mind it's all about the girl back home the one he left
about the girl back home the one he left behind
behind it's all about America
[Music] to die
to die [Music]
seems to me that you spend a lot of energy railing against things that you
energy railing against things that you can't control and who says I can't
can't control and who says I can't control them
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