The Problem With State Bans on Gender Care

Welcome to Up for Debate. Each week, Conor Friedersdorf rounds up timely conversations and solicits reader responses to one thought-provoking question. Later, he publishes some thoughtful replies. Sign up for the newsletter here.

Question of the Week

I’m a longtime opponent of drug prohibition––as I wrote in a 2014 article, “it is immoral to cage humans for smoking marijuana.” One of my favorite writers, Ross Douthat, is out this week with a column arguing that pot legalization is a mistake. Where do you stand on the issue? Have you, your family, or your community been affected by marijuana for better or worse?

Send your responses to conor@theatlantic.com

Conversations of Note

On Wednesday, the states of Florida and Texas moved forward with new laws that ban minors from receiving medical treatments intended to affirm transgender identity, including doses of the hormones testosterone and estrogen and drugs that block puberty in order to delay its onset.

Readers of this newsletter are divided in their assessments of the nature of gender, the benefits and costs of gender-affirming treatments, and what hurdles, if any, ought to be cleared by patients who want them. And assorted liberal democracies, like the United States, Britain, Spain, and Sweden, differ in the best practices or official guidance put forth by medical authorities.

How should legislators respond amid ongoing debate?

In my estimation, the best approach is to err on the side of individual liberty rather than state coercion. Adults should be free to assess the evidence for themselves and get the medical care they want. Parents, not politicians, should decide what’s best for children below a given age.

One more thing: I’m struck by how different the tenor of today’s debate is from an earlier instance when a state legislature acted to forbid a controversial medical treatment that some adults wanted. I wrote about that back in 2018:

That a tiny market for conversion therapy to “cure” homosexuality still exists today is deeply sad, even infuriating. But here’s the question: If a competent adult knows the most devastating critiques, and wants to pay for it anyway, should California law thwart him or her?

The Assembly thinks so. Assembly Bill 2943, which State Rep. Evan Low shepherded through passage last week, declares that “the potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient.”

The bill then goes on to prohibit advertising, offering or engaging in “sexual orientation change efforts with an individual,” treating such acts as a form of consumer fraud.

Supporters say the change is long overdue: Same-sex attraction is not an illness requiring treatment and, regardless, there is no scientific evidence that conversion therapy is effective. It is already banned for those under age 18.

But the bill’s critics, who hope it dies in the state Senate or is vetoed by the governor, say the wrongheadedness of such therapy is beside the point. In their view, a person’s freedom to choose and pursue goals in professional therapy is sacrosanct; the bill infringes on therapists’ 1st Amendment rights; and because of its language, such a law would have more sweeping consequences than supporters acknowledge.

California banned conversion therapy for minors in 2012. That law later withstood two legal challenges. I wonder if the precedents in those cases will affect legal challenges to the Texas and Florida bills as judges weigh whether legislators overreached in denying treatments many trans kids want.

America and the War

“Ukraine’s military said it had made new advances on Wednesday in heavy fighting near the eastern city of Bakhmut, and that Russia was continuing to send in new units including paratroopers,” Reuters reports, while Al Jazeera reports that “Russian missile attacks have again rocked Ukraine with one person reported killed in the southern city of Odesa and falling debris from destroyed missiles causing fires in two districts of the capital, Kyiv.” How should the United States approach the conflict going forward?

In The Atlantic, Tom Nichols argues that the Biden administration should increase aid to Ukraine:

The Ukrainians have been asking for jets, longer-range systems, and more artillery. The United States has sent Patriot air-defense systems, the United Kingdom has provided the Storm Shadow missile system, and Germany has shipped more Leopard tanks. But it’s not enough. The Ukrainians are burning through ammunition at a high rate, and they still need help stopping Russia’s missile attacks. The West can do more to ensure that the Ukrainian counteroffensive succeeds.

Regular readers know that this is something of a shift in my thinking. Early on in this conflict, I advocated for a firm but cautious policy. I wanted the U.S. and NATO to provide weapons, money, and support, but I did not want free-world nations, in those first months, to provide systems that the Russians could use to claim direct Western involvement in the conflict. (I was especially opposed—and remain so—to irresponsible calls for NATO to patrol Ukraine’s skies.) Both the military and the political situations, however, have changed significantly … First, at this point there is no way for Russia to lie about Western involvement, either to its own people or to anyone else in the world …

Second, any hope that the Russians could be encouraged to show restraint evaporated months ago … the Russians have descended into barbarism: War crimes and attempted genocide are now routine parts of Russian military operations. The Kremlin (wisely, for once) has avoided attacking NATO, and for the time being, Putin has chosen to stop making nuclear threats, but the Russian war plan in Ukraine has become little more than an operation to serve Putin’s rage and slaughter Ukrainians as retribution for their resistance. Finally, although I will always remain concerned about Russian escalation against the West, I think those risks are less severe than they were a year ago …

The longer this war drags on, the greater the chance of a black-swan event or another delusional miscalculation inside the Kremlin. Although the war cannot end until Putin decides to stop pouring men and metal into battle, the Ukrainians now have a chance to inflict so much damage, and retake so much territory, that Russian leaders will have to face failure, no matter what Putin or the ghouls who serve him on Russian television say. The sooner Putin and his coterie have no choice but to let go of the last shreds of their imperial fantasies, the better.

In Harper’s, Benjamin Schwarz and Christopher Layne reach a very different conclusion about American involvement:

Thanks to Washington’s efforts to arm and train the Ukrainian military and to integrate it into NATO systems, we are now witnessing the most intense and sustained military entanglement in the near-eighty-year history of global competition between the United States and Russia. Washington’s rocket launchers, missile systems, and drones are destroying Russia’s forces in the field; indirectly and otherwise, Washington and NATO are probably responsible for the preponderance of Russian casualties in Ukraine. The United States has reportedly provided real-time battlefield intelligence to Kyiv, enabling Ukraine to sink a Russian cruiser, fire on soldiers in their barracks, and kill as many as a dozen of Moscow’s generals. The United States may have already committed covert acts of war against Russia, but even if the report that blames the sabotage of the Nord Stream pipelines on a U.S. naval operation authorized by the Biden Administration is mistaken, Washington is edging close to direct conflict with Moscow. Assuredly, the nuclear forces of the United States and Russia, ever at the ready, are at a heightened state of vigilance. Save for the Cuban Missile Crisis, the risks of a swift and catastrophic escalation in the nuclear face-off between these superpowers is greater than at any point in history …

As the United States and its NATO allies pour ever more sophisticated weapons onto the battlefield, Moscow will likely be compelled (from military necessity, if not from popular domestic pressure) to interdict the lines of communication that convey these weapons shipments to Ukraine’s forces, which could lead to a direct clash with NATO forces … as Russian casualties inevitably mount, animosity toward the West will intensify. A strategy guided by “whatever it takes, for as long as it takes” vastly increases the risk of accidents and escalation.

AI and a Universal Basic Income

My colleague Annie Lowrey argues that artificial intelligence may transform the world in a way that revives an old idea:

The problem with AI is not the technology. The problem is not even the technology’s potential effect on the labor market. The problem is that we do not have any policies in place to support workers in the event that AI causes mass job loss. The good news is that we do not need to invent them. Say hello to the universal basic income, a 500-year-old policy idea whose time has perhaps finally come. It is simple and radical in its design. The government would raise revenue by raising taxes. It would then distribute the money to everyone, in small amounts, in perpetuity, with no strings attached.

To understand why this might be beneficial, imagine our economy as transfigured by AI—not 1,000 years from now, but 20 or 50 years … Let’s assume that AI will continue to improve at cognitive tasks … More and more businesses will use it for clerical, administrative, and creative work. This will reduce employment in the “middle tier of white-collar jobs,” David Autor, an economist at MIT and one of the country’s foremost experts on technological change and employment, told me recently. If that happens slowly, workers will have time to adapt, shifting into new jobs created by AI or into sectors impervious to automation … But if job obsolescence happens quickly, mass unemployment and wage stagnation are likely, with inequality yawning to previously unseen levels …

But none of that has to happen. The government could capture some of the enormous bounty generated by this new technology and redistribute it to the people who supplied the training data that created it in the first place … correcting the inequality that AI is likely to gin up. The program would act as a social dividend, ensuring that everybody gets to share in the country’s new growth. It would also act as societal insurance, making certain that technological change does not damage our families and our polity, as has happened before.

Therapy and Ideology

After speaking with more than two dozen therapists and clients, Lisa Selin Davis argues at The Free Press that the profession has suffered amid the rise of identity politics, painting a disturbing picture of what happens in the treatment room when therapists make ideology central to their work:

I spoke to new therapists, some still in training, who describe a profession that teaches the ascribing of oppressor or victim categories to patients, based on their innate characteristics, instead of seeing them as individuals. Several sources said their applications to graduate schools required them to make a written commitment to anti-racism. Some said they’d been penalized for asking the “wrong” questions in class, detailing how this ideological encroachment damages their own mental health.

I reviewed mission statements and other documents released by professional organizations in recent years, revealing how this revolution has transformed the central tenets of the therapeutic process. And I talked to psychologists and others fighting back.

They described their alarm at how the very people who are supposed to help ease trauma become the source of it, as therapy sessions transform into ideological struggle sessions. British psychotherapist Val Thomas told me “the reason this happened is that activists captured the institutions and professional bodies of counseling and psychotherapy.” At a time when as many as 90 percent of adults believe there’s a mental health crisis in this country, parts of the mental health profession are in crisis too.

In Tablet, William Deresiewicz argues that “Anglo-Calvinist moralism has turned the American arts into something strenuously polite and deadly dull.”

He writes:

The commissars are enemies of beauty. I’m channeling Dave Hickey here: Beauty incites desire, and desire is destabilizing. Desire is anarchic, and the commissars are control freaks. They tell us what we ought to want … Hickey was writing in 1993 (the essay is “After the Great Tsunami,” in The Invisible Dragon). He was attacking what he called “the therapeutic institution,” that glob of bureaucracies—“a loose confederation of museums, universities, bureaus, foundations, publications, and endowments”—that had placed itself in charge of culture, taming art by telling us that it was “good for us”: “enriching,” redemptive, conducing both to civic virtue and to spiritual health …

The institution-building of the “culture boom” did not begin in earnest until after World War II, when a rapidly expanding middle class began to feel the need, as it rose, for the trappings of taste—“classical” music, European art, the great books as peddled by Mortimer Adler—and a brigade of explainers, promoters, and organizational functionaries stepped forth to fill it. But it wasn’t until the 1960s that the business grew urgent. The culture was getting out of hand. The children of that same middle class were threatening to burn the whole thing down. It is no coincidence, from that perspective, that the decade witnessed the creation of the NEA, the NEH, PBS, and, in 1970, NPR: organs designed to furnish the college-going class with an officially sanctioned consciousness.

The same years saw the overhaul of admissions practices at elite colleges and universities, those bastions of the WASP aristocracy. Jewish quotas were removed, affirmative action was instituted, and the great unwashed—or, at least, their future leaders—were now to be initiated into the cultural folkways of high Protestantism. Meanwhile, the MFA, which had been invented in the 1920s, was proliferating. From 1940 to 1980, the number of institutions awarding graduate degrees in studio art increased from 11 to 147, with comparable numbers in creative writing. Artists became creatures of the university: produced there and more and more often employed there, which meant socialized and homogenized there.

Art, in short, was being normed. After a century or so, as Hickey explains, in which it had evaded institutional control … art was being standardized and, more importantly, moralized. The audience was being normed as well. Orthodox faith was declining, at least among the liberal elite. Art emerged as a substitute religion, but a religion in the old, persistent American mode. Into culture flowed the moral energies of Anglo-Calvinism, in all its joyless, witch-hunting glory.

That’s all for this week––see you next time.

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