Part II: The Bigger Picture in Killarney, Ireland
By Eliza Mondegreen
I spent last week traveling up and down Muckross Road in Killarney, Ireland. I walked south to the European Professional Association for Transgender Health (EPATH) conference and north to Genspect’s The Bigger Picture. The two conferences could hardly be more different. This is part two, with updates from Genspect: The Bigger Picture to come. Read part one here.
The normal range of emotion at academic and medical conferences I’ve attended runs from undercaffeinated to overcaffeinated. WPATH and EPATH struck stranger notes, swinging from the merely bizarre to the downright alarming. The Bigger Picture—Genspect’s conference— plucked every chord. I’ve never seen so many people weep at a conference (I’m not sure I’ve ever seen anybody weep at a conference). I’ve never heard people laugh so hard either. Alasdair Gunn opened the conference by recognizing that many of those in attendance are “here for circumstances that they would rather not be here for.” Many people traveled to Killarney because gender has cost them something.
The reality is that many people have been harmed by gender: detransitioners who paid heavily for the impossible promises of transition, ‘disenchanted transsexuals,’ parents who lost contact with well-loved children, dissidents (“TERFs”) who sacrificed careers and shredded their social networks. And none of these people, with their very human needs and their very human pains, were reducible to some identification or diagnosis or slur: no label could encompass who they are or what they have gone through or what any of them will become.
That’s the bigger picture.
The bigger picture means putting gender back in context. Gender identity is not an endocrine condition or a birth defect or a revelation of some essential truth surpassing all understanding, but is rather a deeply human problem, a fresh expression of timeless needs for meaning and explanation and belonging. At Genspect, gender is not cut off from everything else that’s going on in a person’s life. A person is not just a patient in an exam room with a packet full of lab tests and a list of embodiment goals, but a person embedded in families, peer networks, and communities. What matters is not just this moment in time and no others, past or future: the history of the individual, the history of the field matter, and the future matters, too, with all its uncertainties.
A panel of detransitioned young people spoke about their lives, the context in which they came to identify as transgender, about the process of falling for what Stella O’Malley called “perhaps the most bewitching line in the world: that you can be a different person.” They talked about their interactions with a medical system that ultimately harmed them when they needed help instead, and how the stories they told themselves about transition fell apart. They talked about what real help might have looked like. “I realized that I didn’t have to live up to those expectations [of womanhood],” one young woman said, “and someone should have told me that when I was 14.”
Corinna Cohn said, “There’s a point where you realize you’ve been dreaming and that that dream isn’t something you can ever attain.”
We talked about shame and medical responsibility and the broken chain of trust and religion and the law and and the power of metaphor—and the dangers of it, too.
Helen Joyce spoke to the sense of fascination that has kept so many of us focused on this issue for years:
I got interested in this issue because I’m a journalist, and I used to be a mathematician, and I discovered some people really, really meant it when they said that men could be women. Of course I had known previously to that, that they kept saying “trans women are women”, but I didn’t think they meant it. I thought they were talking metaphorically, or with their fingers crossed behind their backs: saying something to be kind, with a tacit understanding that everyone knew it was just to be kind, and that nobody would be pushed to demonstrate in any concrete way to demonstrate that they actually believed it. That, like that old sign behind shop counters advising you not to ask for credit, men who identified as women wouldn’t put you in a position of having to reveal you were just being polite, because, as they say, “a refusal often offends.”
But it turned out no; some people really meant it. And therefore they really meant that straight men could be lesbians, and therefore lesbians who don’t do dick, who don’t do people who have or have ever had dicks, are bigots as bad as racists—so awful that they would cut an entire class of people out of their “natural” dating pool because of a factor supposedly as minor and irrelevant as skin colour, namely their actual sex.
It was so crazy I couldn’t look away, and the more I looked, the more crazy there was. I sometimes draw an analogy with introducing just one little falsehood into an internally coherent system, like a false equation into mathematics. You may remember from school that you can add or subtract the same thing from both sides of an equation, or you can multiply or divide both sides by the same thing. If you say that “1=0” then you can add or subtract or multiply or divide 1 on one side and 0 on the other, and eventually, from just screwing up one teeny tiny little equation, you have brought the whole edifice down, because now anything can equal anything. Any equation is true, and it is no longer possible to do mathematics at all. The tiny falsehood screws up everything, and the only things it doesn’t screw up are the things you haven’t noticed yet.
That same sense of fascination gripped me, too. I’ve written about that before, how something didn’t seem right to me. How I had that feeling astronomers must have when they’re scanning the skies for black holes, looking for the point around which everything behaves strangely. When I looked at trans activism, everything around it behaved strangely. I had to understand it.
At Genspect, there were too many questions and so everything ran over time. But down the road at EPATH, almost no one had asked any questions at all.
I realize this may not sound terribly modest, but after all this time, there are many things about gender that I have come to understand very well. I’d even venture that there may be a few things here and there that I understand better than anyone else. But what I don’t understand is how it is that gender does not fascinate its most avid proselytizers and practitioners. There is so much they seem incurious about, so many questions they don’t ask, so many answers they don’t want to hear. Perhaps those questions threaten the story they tell themselves about what they’re doing.
During every silence where questions were supposed to be, I found myself thinking of Hannah Arendt, who wrote about the desperate need “to prevent anyone’s disturbing, by the slightest reality, the gruesome quiet of an entirely imaginary world.” This imperative—don’t disturb the narrative!—imposes these odd silences. There is so much that cannot be said.
At EPATH, everything conspires against the clinician who wants to see the bigger picture. The outgoing president of EPATH, Joz Motmans, insists that no one believes the “science is settled,” that EPATH is a paragon of openness and debate. And yet the debate within EPATH is so tightly constrained that it can hardly be said to exist at all. Vaginoplasties at 17 or 18? This surgical technique or that one? Gender affirmation is a necessity, even if the outcome data disappoints. The answer to every question is always more: more affirmation, more gender, more procedures, more critical self-reflection on the part of clinicians who balk at what they’re being asked to do.
There’s something missing here. I first noticed it at the World Professional Association for Transgender Health conference back in September of 2022. But EPATH this April was no different. These conferences unfold on two levels: one abstract, high-flung, played out on the plane where affirmation and transphobia face off; the other purely technical: how to create a “super thin external pudendal artery flap” as part of a vaginoplasty, how to tighten the vocal cords to produce a more convincingly feminine pitch. What’s missing here, is, of course, the human dimension. Between the abstract and the technical, the human beings involved slip away. Between the cheerleading and the fearmongering, their absence goes almost unnoticed.
But the human dimension matters, nowhere more than when it comes to our most personal self-understandings and the way those self-understandings spill out into the rest of our lives, testing and tearing our families, and altering the course of medicine.
If Genspect’s The Bigger Picture can be boiled down to a single word it would be that it was humane or simply human. Among EPATH’s sins is a basic one—which no court will ever try and no state will ever ban—but it is a serious wrong nonetheless: “It simplifies the human condition and in that matter departs from the truth.”
So to move from one conference to the other is to move from a thrilling world of abstractions and technicalities to a world of limits. At EPATH, everything is possible—or will be shortly. Boys can be made into girls and women into men. Every ‘treatment wish’—no matter how unconventional—may someday be fulfilled. Genspect is where EPATH’s high-flying narratives come crashing down to earth.
It’s where we start to tell new stories and build new futures, too.