Marshmallows, Accounting, and Catharsis

The Observer’s Dilemma

”I’m sorry sweetie, but you can’t have a marshmallow for breakfast.”

Kids are funny. No matter how much our society fights, argues, and protests, I’m convinced this simple truth is something we’ll (hopefully) always agree on. As a terminal cynic, it took me a while to realize this truth for myself. Most of my friends became parents before I did, and my previous feelings towards young children basically existed on a spectrum ranging from frustrated annoyance, all the way to neutral ambivalence. Fortunately, the birth of our daughter brought about some much-needed revisions to that mindset. It also helps that she recently began crawling, possesses an absurdly infectious laugh, and has indisputably made “da-da” her first word.

Not long ago, I had the opportunity to catch up with some friends from college, now married with a three-year-old daughter of their own. While us adults were eating normal breakfast foods like eggs or sausage, their toddler insisted on having a marshmallow, instead. She pleaded. She begged. She offered to share. Despite her best efforts, my friends remained steadfast. She would not be getting marshmallows for breakfast. Once their daughter realized her request would not be obliged, she hid behind the couch for a few minutes, whimpering just loud enough for us to hear. We talked to each other about how much we wished she would join us for breakfast, and eventually she reclaimed her seat at the table. It wasn’t long before she resumed smiling and pretending to be a dinosaur, as if the whole marshmallow incident had never happened.

My friends later told me that this was a regular occurrence during breakfast time. What I had witnessed was essentially par for the course: request, beg, tantrum, acceptance, dinosaur. As an aside, we all agreed that the part where she went back to her dinosaur routine was the best phase in this sequence. The situation also made me wonder what my daughter would be like at that age. I wondered how many similar moments my wife and I would have to navigate, and how we’d handle them. The kind of situation where “care” doesn’t feel like it at the time, and is instead met with frustration, hurt, and anger.

On my long drive home, I contemplated the marshmallow situation from a few different angles. The first was from the perspective of an observer who did not know what marshmallows are. This person would witness a child pleading for something, and the parents’ ardent refusal to oblige. What might they think? The observer could reasonably be forgiven for doubting my friends’ care for their child, or finding them to be harsh, unloving, or cruel. This person might even see my friends’ refusal to acquiesce as reason to question their actual competence as parents.

Consider a different scenario. An outside observer, fully aware of the problems with feeding a toddler marshmallows for breakfast, witnesses my friends’ obliging such a request. The observer is shocked to learn that not only are the parents aware of the health risks from such decisions, but that this is actually their normal breakfast routine: parents eat eggs, sausage, and toast, while their child consumed nothing but Jet-Puffed marshmallows. What conclusions would the observer draw in this scenario? How different would those conclusions be from the first situation?

There are two components to this hypothetical: The parent’s actions, and the observer’s knowledge. In the first situation, the parents have the information, and the observer does not. Once the observer knows what the parents know, the misunderstanding is over. “Ah, I see the issue now,” they might say. “Those marshmallow things are pure sugar, and would be harmful to your daughter’s health if that was what her breakfast consisted of. Now I understand.”

In the second situation, the observer also has the information. They are well aware of the harm caused by feeding a child marshmallows for breakfast, and are shocked to learn that this is something the parents have no problem obliging. In both cases, the observer experiences doubts about how the child is being treated. The prime difference is what the observer perceives to be the origin of harm, as it relates to the child. In the first scenario, the harm appears to be stemming from cruel and incompetent parents. In the second scenario, it comes from the child’s own desire for something they don’t seem to realize would be harmful to them.

In other words, those without the relevant information are forgiven for misunderstandings, and drawing faulty conclusions. Those who have the relevant information, and choose to ignore it, are not afforded such leniency.

“Where Are All The Trans-Friendly Gynecologists?”

Last December, the “Wellness” section of The Huffington Post ran an article by Mathew Foresta about the “general lack of competence” in the US healthcare system when it comes to dealing with transgender individuals. Generally, this is a topic I tend to avoid, for a myriad of reasons. However, this article contains enough important and illuminating information for our purposes here. The full spectrum of data presented has sadly been joined with a self-contradictory narrative, and thus warrants analysis. Our discussion and conclusions will be drawn exclusively from the information presented by Foresta, with an emphasis on the puzzling dissonance between the facts he presents, and the resulting conclusion he forwards for our consumption.

Beginning with an anecdote about a doctor visit gone awry (to say the least), Foresta walks us through stories, testimonies, and statistics to support the claim that the medical community has been grossly inadequate in dealing with transgender individuals. This combination of ignorance, bigotry, and incompetence has resulted in many members of the transgender community making the difficult decision to forego regular doctor visits altogether.

“It was a battle for Jaden Fields to even get the appointment. When he, a trans man, tried to make arrangements with a gynecologist’s office, he was met with disrespect and disbelief. So much so that his primary care provider had to make the appointment for him. When he arrived at the office, he was dismissed, misgendered by the staff and eventually had the police called on him.

“Engaging with the medical system as a trans person is always a scary proposition,” Katelyn Burns, a trans woman, freelance writer and Vox contributor, told HuffPost. “The health care system’s lack of general competence with trans people absolutely is a deterrent for all trans people to go to the doctor, but when we do find good medical providers, we tend to stick with them.”

“Burns encountered this general lack of competence after seeking treatment for minor post-surgery complications. The gynecologist she was referred to was inexperienced in dealing with her issues and offered few solutions. After this, she decided it was time to find a new doctor.”

Foresta then cites a 2018 study to support this claim, but we’ll get to that in a moment. Afterwards, he gives us another informative perspective.

“Ian Harvie, a trans comedian, actor, and writer, explained his issues with the medical system in a series of emails to HuffPost:

“Initially, for me, I think the problem was fear of going to a doctor at all. I think that’s one of the major obstacles for getting trans people health care, is getting us over our own fears of the unknown in the doctor’s office,” he said. “I told myself a lot of negative ‘what if’ stories. What if physician or office staff are not understanding, or don’t know what trans is? Will I be mistreated or misgendered, intentionally or unintentionally?”

“A more graphic fear was: ‘As a man, will getting in the stirrups for an exam make me feel like a girl?’”

“Tales of medical bigotry have spread through the community by word of mouth. In Harvie’s case, this had a big effect.”

“While there are excellent providers like Burns’ out there, the medical field in general still falls short of providing proper care to transgender patients. Deadnaming, improper pronouns and a general lack of knowledge about transgender issues lead many from the trans community to avoid the doctor altogether. General questioning of patients’ transgender identities is another common reason for doctor avoidance, said Kristie Overstreet, a licensed psychotherapist based in Orange County, California.”

Overstreet also pointed to “the broader problem of society’s failure to accept trans people. She said this can contribute to severe mental health problems such as depression and anxiety.”

Now that we understand the picture of medical bigotry and incompetence Foresta presents us with, let’s look at his supporting empirical claims:

“Research supports this. A 2018 study from Ontario, Canada, found that “54% of trans men surveyed avoided going to the gynecologist.” Approximately 59% of those who avoided it cited being misgendered as one of the main reasons; 70% cited having to educate their providers themselves was another deterrent; 86% said it was due to the gynecological exam itself, which many respondents found physically and emotionally distressing.”

Whoever knows the right thing to do and fails to do it, for him it is sin.

Regardless of what preconceptions one might bring into a topic such as this, what I find incredible is the degree to which Foresta’s argument is undermined by his own evidence. Let’s isolate the complaints:

“...health care system’s general lack of competence…”

“...this general lack of competence…”

“...general lack of knowledge about transgender issues lead many to avoid. ..the doctor…”

“...questioning patients’ transgender identities is another common reason for doctor avoidance...”

“Will I be mistreated or misgendered?”

“...medical providers need to check their conscious and unconscious biases…”

“They also need to be aware of the historical trauma the medical industrial complex has inflicted on people of color...”

To summarize Foresta and his sources: The medical community is incompetent, ignorant, bigoted, prejudiced, biased, and cruel towards transgender individuals. As a result of this massive systemic failure, transgender people are choosing not to go to the doctor, even if it means suffering harm from lack of medical care as a result.

Despite this conclusion being the narrative Foresta confidently puts forth, we’ll use his own data to consider a different perspective. If we were to isolate the largest causal factor in the 2018 study, coupled with the strongest anecdote given by the transgender comedian, this is what we see:

-86% of trans men surveyed said they avoid going to the doctor due to the gynecological exam itself, which many respondents found physically and emotionally distressing.

-”A more graphic fear was: ‘As a man, will getting in the stirrups for an exam make me feel like a girl?’”

The question is this: If the medical field is rife with incompetence and bigotry, why do the biggest issues of deterrence have nothing to do with incompetence or bigotry?

I’m not saying the external component of frustrating encounters at the doctor’s office aren’t a factor here. Clearly they are. But the data set put forward attributes the primary discomfort and distress as coming from the internal psychological experience of transgender individuals. Ian Harvie’s comment about “feeling like a girl” in the stirrups supports the distress that comes from “the gynecological exam itself,” rather than being rooted in medical incompetence and lack of understanding. Harvie admits that all the “what ifs” about the exam rooted in the bigotry of others are just that: hypotheticals. The fear of “feeling like a girl” when sitting in stirrups is also a hypothetical, but one rooted in internal anxiety over the exam, not bigotry or cruelty.

Like so much of the English language, the term ‘dysphoria’ is rooted in ancient Greek. The prefix ‘dys’ simply means ill, or badly. Dyslexia, for example, combines this prefix with ‘lexic,’ which refers to something “relating to words.” Hence, those with dyslexia have issues related to words, impacting their ability to read. ‘Dysphoria’ is the same principle, applied to the Greek word ‘phor,’ which means “to bear. ” Just as Euphoria is “to bear pleasure,” Dysphoria literally means “to bear illness, to bear discomfort.”

Dysphoria is associated with a myriad of physical and mental health conditions, ranging from bipolar disorder to chronic pain. It can accompany everything from how a person feels after sex, to their general outlook on life. Dysphoria can be fleeting, or last a lifetime. Those who experience gender dysphoria feel distressed or uneasy about their gender. As of approximately ten minutes ago, the contemporary definition of gender has moved into a bizarre, self-contradicting milieu that simultaneously has nothing to do with biological sex, and everything to do with biological sex. Therefore, for the sake of time we’ll avoid the now amorphous concept altogether, and assume that it means whatever Mathew Foresta wants it to mean.

Consider again our observer’s perspective. Let’s assume that every issue of bigotry, incompetence, and prejudice has been dealt with. The 59% of transgender individuals who avoided the doctor for fear of being misgendered are no longer afraid of this. The 70% who worried about having to “educate their providers” are equally at ease with these interactions. Individuals such as Ian Harvie no longer fear being “mistreated or misgendered. ” Drawing on the issues Foresta presents us with, would these sweeping reforms turn the doctor’s office into an anxiety-free utopia for those who are transgender?

As is common with the activist left, Foresta selectively focuses on the details that might accrue him the most virtue points, but does little to practically alleviate the suffering of those he claims to be advocating for. If the instances of “deadnaming” were dropped to zero overnight, Ian Harvie would still have every reason to fear “feeling like a girl” when undergoing a cervical inspection. Consider also this staggering perspective shift: differently stated, Foresta’s statistics reveal that transgender individuals are 27% more likely to avoid going to the doctor for issues definitionally related to dysphoria than issues related to bigotry. If those numbers were reversed, do you think Foresta would find it statistically relevant?

The article concludes by circling back to trans comedian Ian Harvie, who offers advice for health care providers going forward:

“Harvie said he hopes more physicians seek education on trans issues in order to alleviate some of the fears he discussed.”

“Be kind, believe us when we tell you who we are, educate yourselves on trans people’s medical needs, make sure your staff is educated as well, every member of a medical office has to be on board of the kindness train, make great effort with pronouns, and if you mess up, apologize and try again,” he said.”

“Be kind” is an axiom most of us can agree on. Well, it used to be. Ellen DeGeneres recently came under fire for having the audacity to suggest that kindness be extended to those we disagree with. Outliers aside, most people agree on the value of kindness. What kindness looks like on an instance-by-instance basis, however, is more complex. Even granting Foresta and others like him the benefit of the doubt, we once again encounter our observer’s dilemma with breakfast marshmallows. With no information other than “bigotry is keeping transgender individuals from going to the doctor,” these outside observers would be forgiven for assuming bigotry, incompetence, and lack of “kindness” is the source of harm keeping Trans people from visiting the doctor. They don’t know what marshmallows are, so they assume the parents are simply mean.

Unfortunately, lack of information is not the issue here. It’s ‘Scenario Two. ’ Activists like Foresta know exactly what the primary issue is, and are instead focusing on anything and everything they can to avoid addressing it. Worse yet, this intentional avoidance is done under the guise of “kindness,” when it’s anything but. How can it be kind to ignore suffering?

Our observations here are admittedly descriptive, rather than prescriptive. If a friend were to tell me they’re experiencing acute, extreme pain in their hand, I would not attempt to create a treatment plan for them. Nor would I blame every doorknob turn, keystroke, or other task that exacerbated their injured hand. I would, however, recommend that they minimize use of that hand, and have it looked at by a doctor. In other words, I’d suggest they address the true source of their discomfort.

One could easily misconstrue what I just said as support for some elective gender transition surgery. Far from it. Ian Harvie’s discomfort and fear of “feeling like a girl” was rooted in the simple act of sitting in the stirrups at the gynecologist’s office. This internal strife is dysphoric in nature. Individuals like Harvie are bearing psychological discomfort and suffering, and well deserving of our compassion and kindness as a result. But to ignore the most difficult component of this- the internal discomfort and pain- is the exact opposite of “kindness.”

In sum, the issue is not with well-intentioned folks who just want to help, but lack all of the relevant information. Rather, the issue is with those who have the information, and ignore any parts of it that contradict their preferred narrative. Worse yet, choosing narrative above all else often comes at the expense of those the narrative is supposed to help. As the book of James says: “Whoever knows the right thing to do and fails to do it, for him it sin.” Regardless of your opinion about the Bible, there is little controversy in saying “Those who know what is right, and ignore it, are doing wrong.” This is obviously true. In light of what we’ve seen here, I’d add that those who ignore the pain of others by choosing narrative over truth, have also forfeited the credibility to lecture anyone on compassion or kindness.

Author’s Note: The piece above was one of the more difficult I have written. When the seeds of inspiration were first taking root, a discouraging encounter with a family member sufficiently demoralized me to the point of wanting to quit writing altogether, let alone finish this particular analysis. A few weeks later, I wrote a reflection on the encounter, which eventually became the “Accounting and Catharsis” component of the title. Only one paragraph of this essay was written at the time, but I couldn’t proceed without first reminding myself of why I write about difficult things in the first place. What follows is that reflection.

How I ruined Christmas, and “counting the cost.”

”Little shocks are good, but they can really freakin’ hurt.”

For as long as I can remember, I’ve been writing. Despite my continuous claims of not particularly enjoying the process of writing (I really don’t), I gravitate to it nonetheless. When I was in high school, I wrote a decent amount of fiction, including the better part of a fantasy-fiction book. I had intended it to be the first of a trilogy, but abandoned the project when I arrived at college. I also had a notebook containing various jokes and stories, for it I ever decided to go into standup. After it was accidentally thrown away, I ceased writing such things down.

Once I was in college, I wrote a fair amount of poetry when I realized the various girls I dated appreciated that sort of thing, provided it was administered in small, spontaneous doses. I also dabbled with movie reviews, as well as short anecdotes. One such piece was a reflection on the time a recent widow stopped me at the grocery store to tell me that I bore a strong resemblance to her late husband when they had first met. I remember finding it impossible to ignore her battle to hold back the tears, as she awkwardly prolonged conversing with a complete stranger in order to feel close to her husband again, if only for a brief, counterfeit moment.

My parents were always quite supportive of my on-again, off-again hobby. When I was unable to answer the question “What will you do when you graduate?” they always suggested I try my hand at writing. Despite their encouragement, I spent many years without completing anything of substance, aside from the eight pages I wrote on “Official Statement” forms to kill time while awaiting bail after a mix-up resulted in my arrest (seriously).

My hiatus from writing ended when Dave Rubin launched his website, rubinreport.com. Even with my break from writing complete works, I had pages upon pages of notes, bullet-points, and fragmented theories I had accumulated over the past couple of years. I had also been making YouTube videos for a while, and had dozens of Google docs for my outlines, sources, and future topics I wanted to discuss. The format of Dave’s website, along with the prospect of actually being able to converse with fellow free-thinkers, drew me back into writing my thoughts once more.

I’ve mentioned in the past that my family leans heavily to the left. Even though I also came from the ideological left, have never voted Republican, and continually try to choose principles over bias, I never really expected my family to engage with my content. The decades worth of encouragement and insistence to express myself was nowhere to be found once I entered the cultural and political arena. Again, this was no surprise. The real surprise came recently, when I was actually asked about my content.

Over this past Christmas break, my family (mom, dad, brother) was kind enough to make the ten-hour trek out west to visit my wife and I. The plan was to ski for a few days, and then have our family Christmas together here in the mountains. I suspect the potential to have their granddaughter all to themselves was also a motivating factor, but that’s fine. Free babysitting and time to go skiing? What’s not to love?

Having only tried skiing once before, my intrepid mom decided to use the opportunity to sign up for a private lesson. The morning of, she and I drove to the slopes together, to be joined by the rest of the family later that day. I decided to bring my laptop to work on some things during her two-hour lesson, and early in the car ride, she surprised me with an inquiry about what I intended to write about.

Initially caught off-guard, I told her I was working on an analysis addressing the poor quality of our nation’s social discourse. The piece (not yet finished) was partly intended to re-establish the “rules of the game” for disagreement. I expressed my frustration that people seem to constantly talk past each other, and rely more on character attacks than actually conversations. She agreed, remarking that she’d observed this as well. I brought up the fact that people will never be able to have productive conversations if they assume disagreements are rooted in moral failings, rather than honest differences of perspective. She concurred once more, and expressed excitement to read it once it was finished. Hearing that little bit of support, and experiencing the freedom to talk about what matters to me, was just… nice. Really, really nice.

After we arrived at the ski resort, I helped mom get oriented, wished her luck, and got to work. While taking a break from the original piece I was working on, I stumbled upon a Huffington Post story about the need for “Trans-Friendly Gynecologists.” The story was riddled with cherry-picked information from its own data set, and struck me as fundamentally immoral and cruel in the narrative it presented. I immediately remembered an anecdote involving marshmallows which seemed thematically related, and followed the inspiration into a new essay. I was about a paragraph in, when my mom returned from her lesson. This, as they say, is when the defecation hit the oscillation. In other words, the crap hit the fan.

After she told me about the lesson (it went well), she asked how my writing was going. I told her I decided to write a different piece, and told her about the Huffington Post article. She seemed confused, and eventually asked me why I wanted to write about such a topic. I responded that it was the same reason I wanted to improve public discourse, or promote civility: I just want to help. As I saw it, the tragedy of the Huffington Post article was in ignoring the primary cause of suffering being experienced by those they claimed to be advocating for.

“Wait, so you think transgenderism is some sort of mental disorder?” she finally asked, not fully revealing her mounting incredulity.

“I mean yeah, but I don’t think that’s the point, nor is that a matter of my opinion. That’s how dysphoria has been classified forever, but that’s irrelevant for what I’m talking about. The point is that it’s not compassionate to ignore suffering, even if it’s emotionally convenient to cherry pick which data to focus on…”.

splat! The fan will require cleaning before further use.

I’m not going to transcribe the conversation from this point, though it remains crystal clear in my memory. The gist is what’s important. I had obviously hit a nerve. She went from 0 to 100 in a matter of seconds. The change in demeanor and tone was so swift, it took me several moments to even comprehend what was happening. I was informed in no uncertain terms that I was judgmental, had no empathy, and didn’t actually care about compassion. When I asked for more information, my request was denied. This was not a conversation. I was to be told, quite specifically, of my gross moral deficiencies, how I had ruined Christmas, and that was where we would end it.

In a last-ditch effort to move the interaction in a positive direction, I asked if she would be willing to explain her position, with the promise that I wouldn’t respond, and that the conversation would end there. No such luck. I briefly expressed my feelings of confusion and hurt from her reaction, particularly in light of our conversation that morning. “This is what I was talking about in the car…” I started to say, but was quickly cut off. Accepting the situation, I apologized for upsetting her, got up from my chair, and walked away.

I found an empty table in another part of the dining area, and sat down. The first thing I noticed was that my hands were shaking, though I didn’t particularly feel angry. My stomach was in knots. I felt cold and hot at the same time. “What… what just happened?” I kept to myself until the rest of the family arrived, and hit the slopes as soon as I was able.

As I sat in solitude on the ski lift, the gentle rocking of the lift chair calmed my body. My mind, on the other hand, continued to race with an endless stream of questions and doubts. “Maybe it’d be easier to stop. Is it worth it, this culture war? Do I really need to participate? I have, like, 50 YouTube subscribers. It would not matter if I just stopped. Could I have said something different? I should have asked what her definition of ‘mental disorder’ was. Would that have even mattered? If this ideology is so insulated from outside perspectives that my own mom won’t listen, what hope do I have of reaching complete strangers?”

This internal strife continued for some time, until I was able to process the events later with my wife. She talked me out of deleting my accounts on YouTube, Rubin Report, Twitter, and the like. As a side note, this is why it’s important to marry the right person. Having my wife listen, and then remind me why I’m doing what I’m doing, is more meaningful than I’m capable of expressing with any degree of accuracy. As we processed the situation together, I was reminded of the book “Antifragile,” where Nassim Taleb discusses the importance of little shocks to the system, which serve to better prepare us for shocks in the future. I realized that the interaction with my mom could be categorized as such a shock. I was caught off-guard. It took my body hours for the anxious pit in my stomach to subside. I didn’t notice the signs of her frustrated response to the topic. I wasn’t prepared. Shocks are what help us to be more prepared for next time. But man oh man, they can hurt like hell.

When I was part of a campus ministry leadership team, a common theme we would impress on our students was that of “counting the cost.” When describing the reality of following Jesus, we would always remind them that such a decision wasn’t without cost. Jesus Himself said in Luke 14:

“For which of you desiring to build a tower, does not first sit down and count the cost, whether he has enough to complete it?”

When we take positions that are unpopular or polarizing, there will be consequences, even if we believe we’re doing so on based on the most virtuous principles imaginable. In fact, consistently being met with extreme responses should cause us to be in a constant state of self-assessment, always verifying that the path we’re on is the correct one. In Jesus’s case, He was warning the disciples to take careful stock of their situation, and make certain of their decision to follow Him. Otherwise, they would be like builders who did not first ensure they could complete a project.

For those of us engaged in this culture war, interactions like the one I had are both difficult, and necessary. They serve as shocks to the system, a form of callus-building to help prepare us for the next shock, and the next. Additionally, they provide us the opportunity for self-reflection, to take stock, and to count the cost. Some will come away from this internal accounting, and decide it isn’t worth it. Perhaps the relational strife, threat to their employment, or some other stressor simply won’t be worth speaking out about things. For others like myself, it feels like a betrayal not to speak up. That is for each of us as individuals to decide. The conflict with my mom was never resolved. It wasn’t brought up again, and recounting it for you still left a pit in my stomach. But the frustration, the hurt, the anxiety, all passed a little quicker than the last time I thought about it, or the time before that. We adjust to the shocks, and thank God for that.

Assess the task. Count the cost. Get to work.