Transsexuality, Gender Dysphoria, and Sexual Alienation as an Identity
My Friend Alex
In October 1999, I began my degree in Theology at Durham University. Durham is a small, Medieval Cathedral city in the northeast of England. Like Oxford and Cambridge, Durham University (England’s third oldest university) is composed of a number of colleges in which you live. Mine was called the College of St Hild and St Bede. In the first week of term, there were many “getting-to-know-you” events, to make it easier to become friends with people beyond those who lived on your corridor. Somehow, I got talking to a very unusual young man. He was called Alex Waddell.
We had a few things in common. Alex was from Reading, in the southeast of England, not far from London, where I came from. Like me, he had been to a “state school” (in U.S. English, a “public school”), as opposed to a private school, which so many students at the college had attended. Most importantly, Alex was studying Philosophy. This interested me a great deal, and I had toyed with reading a Philosophy degree myself. He’d also had a “Gap Year” in the Czech Republic, teaching English and reviewing cocktails for magazines. This fascinated me because, at the time, I’d only been to France, Spain, and Holland. He also dabbled in writing poetry, as did I. So we had things about which to converse. Making conversation with Alex was rather hard work, however. He spoke in a very idiosyncratic way; a sort of staccato, with pauses in unexpected parts of the sentence. And he tended to deal with everyday statements as though they were philosophical propositions.
“So, are you trying to tell me that you’re going to go to the college bar?”
“Yes, Alex, I am.”
“And you’re asking me if I’d like to come with you to the college bar?”
“That is correct.”
“And when you propose going to the college bar, do you mean that we’re just going to go there and hang out or are you implying that we’re going to go there and have a drink.”
“I’m asking you if you’d like to come with me to the college bar and have a drink, Alex.”
“And do you literally mean a drink, or is that a term for a more indefinite number of drinks? If so, I might have to go to the cash point . . .”
Alex moved around a great deal, unable to sit still, a habit which was very distracting. He told me that this was due to suffering from curvature of the spine. This had been corrected a few years earlier in a lengthy operation in which metal rods had been inserted into his back. He also mentioned some kind of “syndrome” that caused muscle and abdominal pain. I later discovered that suffered from fibromyalgia, which causes not just muscle pain and abdominal problems but also sleeplessness and depression. And Alex was a vegetarian, for philosophical reasons, something that was considered extremely eccentric at the time.
The word “eccentric” really encapsulated Alex. The word “autistic” was not yet widely known, but it seems fairly clear now that this is what he was. He had trouble understanding how others might feel, which led him to be socially clumsy, thoughtless, and generally bizarre, but he was also highly analytical in his thinking, congruous with evidence that “systematizing” and “empathy” (in the sense of “theory of mind”) sit at opposite ends of a spectrum.
In line with this autism diagnosis, Alex was almost child-like in his guilelessness and lack of self-awareness. The small number of us that were his friends—there were two of us at his 21st birthday party in June 2001—euphemistically referred to him as “avant-garde.” This “party” was a plaintive affair. His parents had given him a substantial amount of money to take all of his friends out for a meal. But there were only two of us. Our pleas with him to just let us go to McDonalds and then blow all the dosh on gin were not well-received. His parents would be displeased, he told us, if they knew that the money had not been primarily spent on eating at a restaurant.
As the academic year continued, evidence of Alex’s autism became increasingly clear. He woke up the entire college out-building in which he lived—Hild Gym—at about 4 AM one morning by burning toast in the kitchen and thus setting off the fire alarm. Another time, a girl who lived on his corridor ran herself a bath and then left it, momentarily, to take a phone call. Upon her return, the bathroom door was locked. This was because, while she had been on the phone, Alex had gone to the same bathroom, with the same ablutionary intentions, found that a bath had been run already, and presumably thought to himself, “That’s lucky. Someone must have run the bath and then changed his mind.” He thus locked the door and got in. As the year passed, Alex became withdrawn, stopped washing, grew his hair long, and got shouted down at the Durham Union Society (a debating society) for a laughable and rambling intervention on the subject of prostitution. I remember someone hollering at him, “Sit down, sir!” Every time he tried to speak. The audience clapped, and this continued until he finally gave up and resumed his seat.
The following academic year, we didn’t live in college, as most second years “lived out,” in houses in the city, so I didn’t see Alex as much. Not having any close friends, he was living with a group of students whom he didn’t know. In that academic year (2000-2001), Alex was pursuing an American international student to whom he was attracted. He was also after a girl who studied at the university’s campus in Stockton, a sizable industrial town 34 miles away. The two were, effectively, separate universities, so I don’t know how Alex had made a connection to Stockton—possibly he had done so by using “the Internet,” something we normal students tended to eschew. But it transpired that Alex was going there on the bus, buying cannabis and selling it to students in Durham, where cannabis was more difficult to obtain and thus more expensive.
In the Spring term, Alex became president of the Philosophy Society. These student societies usually took your money at “Fresher’s Fair” and then did very little. But, with philosophy-obsessed Alex at the helm, things were different. He managed, in about October 2001, to persuade the Oxford philosopher of religion Richard Swinburne (b. 1934)—who has been described as “the premier rational defender of Christianity of our time”—to come and speak to the society. Everyone who had done A-Level Religious Studies had read about this giant. His appearance was so wildly popular that Alex hired the Durham Union Society Debating Chamber for it, and it was full to capacity, mostly with people who weren’t members of the Philosophy Society and so had to pay to be there. As Alex introduced Oxford University’s Nolloth Professor of the Christian Religion, so many people must have been asking themselves: Who was this eccentric—by then sporting a tennis-player’s headband—who had managed to achieve this coup? It was the same eccentric that told a group of teenage “locals,” from the window of my ground-floor flat, that all “Geordies” (people from Newcastle Upon Tyne and its environs, including Durham) were stupid, leading to Alex, myself, and two others having to cower in my flat while the offended Geordies threw stones at it. And it was the same eccentric who, the following academic year, did something very eccentric, indeed.
I met up with Alex in early October 2001. I didn’t see him again, other than at the Richard Swinburne meeting, for the rest of the term. It was December 2001, the night of the Christian Union’s Carol Service in Durham Cathedral. The Christian Union was a fundamentalist Christian student society, in which I had many friends. A third of my 15-person out-building in my first year—“Bede Gym,” a corridor over a gym—had been members, and I ended-up living with “God Squad-ers” for the rest of my time at university. Later, I even wrote my doctoral thesis, and first book, about them. At their encouragement, I always attended their Christmas Carol Service, held in the splendor of Durham Cathedral, which has been voted “the best building in Britain.” However, for some reason, the Christmas Party of the university’s LGB (Lesbian, Gay and Bisexual) Society always took place on the same evening as the Christian Union’s Cathedral Carol Service. As the two groups, in many ways, couldn’t be more different (the Christian Union opposed homosexuality, for a start), and because I was young and pretentious, I made a point, in order to be “avant-garde,” of always going to both events: the evangelical carol service, and then the LGB party in the Student Union building.
So this is what I did in December 2001. The tattooed-lesbian, Kerry, who was in charge (tattoos were very rare at the time) was an acquaintance of mine. In the darkened, disco-light-illuminated room, she introduced me to people and, eventually, she led me over to a rather pretty, young girl, whom I was immediately convinced I’d met before. She seemed out of place. She was very feminine. She had long hair, make-up, and an ankle-length skirt. She stood in stark contrast to the “butch” lesbians that constituted the bulk of the other females at the party.
“This is Dreya,” said Kerry. “This is her first time here.”
“Have we met before?” I asked, innocently.
“Um . . . no, I don’t think so,” came the high-pitched reply.
“I’m sure I recognize you.”
“Um . . . no, I don’t think we’ve met.”
There was a long pause and then, genuinely shocked, it came to me.
“Alex! What the fuck is going on?!”
My memories after this are vague. I recall Kerry telling me that I shouldn’t ask what was “going on” because “This is a safe space for Dreya.” I’d never heard of the concept of a “safe space”—meaning “place where your comforting delusions may not be questioned”—that was later to become so ubiquitous. I went upstairs to the bar and told my two friends—one of whom had been at Alex’s 21st and who also studied Philosophy—what was “going on.” I persuaded Alex to come upstairs and explain himself to them. What had happened?
What is Transsexuality?
We’ll return to what happened to Alex later. But, clearly, he was beginning the process of “transitioning” from being a “male” to being a “female.” Cross-dressing, of course, has been perennial throughout human history, usually confined to performative contexts: erotica, satire, theater, camp, or, in some cases, religious and folk rituals. But by the turn of the 21st century, something distinctly new has emerged in the Western world: transgenderism as an identity—one that is demographically significant, legally recognized, and, seemingly, on the rise.
It is difficult to be sure what percentage of Western populations are transgender, not least because the numbers are increasing. In 2016, UCLA’s Williams Institute estimated that 0.6 percent of the U.S. population (1.4 million people) were transgender. Rates were slightly higher in the states of California, New Mexico, and Georgia. Age also plays a factor: while 0.5 percent of adults over 65 are transgender, the rate is noticeably higher about 18- and 24-year-olds. A recent study of school children from Finland, aged 16 to 18, estimated that 3.6 percent of males, though only 2.3 percent of females, displayed some symptoms of Gender Dysphoria.
Moreover, there is also a certain aggressive and assertive character to the “trans” identity that is hard to miss (though, granted, this quality is not unique in today’s political climate). In 2019, a journalist for The Guardian, a biological woman, halted and reversed her “transition” to manhood in order to have a baby, then took up her transition once more afterwards. She demanded that a British registrar falsify history by designating her as the child’s “father” on its birth certificate. When the registrar refused, this “transman” took the authorities to court. Upon losing her case, she remarked on how “not fair” it all was. A similar determination or spitefulness was seen at the Democratic Socialists of America Conference that same year, when a transwoman made a “point of personal privilege” in order to angrily demand that speakers not to use the term “guys” (a typical American colloquialism meaning “everyone”) when referring to delegates, which he condemned as “gendered-language.”
And this spitefulness has, to a large degree, succeeded in changing the academic and legal arenas. Under English Law, despite the fact that no biological change has taken place, if you “transition” in this way, to the extent of having surgery so that you appear (often not very convincingly) to be of the “opposite sex,” then you are, legally, of that opposite sex and can obtain a “Gender Recognition Certificate” to prove it. A court case in December 2019 found that it was not legitimate to refute or undermine such a change. It became legal to fire somebody if they publicly expressed the opinion that a transsexual could not, in good conscience, assert that they were a member of the sex into which they had transitioned. Specifically, a 45-year-old woman, Maya Forstater, was removed from her job at the Centre for Global Development in London for tweeting “Men cannot become women.” She took her employers to a tribunal, claiming that the sacking breached her Human Rights, because she was fired due to her beliefs. She lost the case. The Canadian psychologist and author Jordan Peterson (b.1962) rose to fame largely due to his refusal to abide by state-mandated regime of using the chosen pronouns choice of transsexual students. This small act of defiance made him a conservative hero. Regardless, pronouns themselves have multiplied in recent years—many have adopted the non-binary “they” as first-person singular—and entered public consciousness in a way previously unimaginable. Newspapers’ style-guides have been altered to accommodate transsexuals, and even non-transsexuals have begun defining their pronouns of choice on their social-media pages. Everyone, it seems, is encouraged to rethink themselves and their sexual identity.
This is a major social trend, and I have discussed the ideological and religious perspectives that lie behind it elsewhere. But what I want to focus on here is the causes of transsexuality or, more properly put, Gender Dysphoria. Gender Dysphoria is a condition whereby a person feels profound distress due to what they regard as a mismatch between their biological gender and what they feel like on the inside, or what they feel that their gender should be. They believe that they can alleviate these feelings by, as much as possible, outwardly becoming their desired gender. Other recognized “dysphoria” include anorexia, when a person believes that they are fat, despite the fact that they are dangerously thin; and Mind-Body Integrity Disorder, when someone believes they are physically mutilated, yet they are not, and thus they mutilate their body.
What are we to make of this? What are the root causes of this, for many, baffling phenomenon?
A common conception (or you could say cliché) about transsexuals is that they are people “born in the wrong body.” This begs an important question: “How did they come to believe this?” How could they become convinced—to the point of drastically changing their appearance and lifestyle and even undergoing medical treatment and surgery—that they have, say, a female “soul” and a penis?
Transsexuals could suffer from this conception because they really do have the brain of X and the genitalia of Y. They were, in a way, “born into the wrong body.” However, if transsexuals also suffer from other delusions and personality disorders, then it is probable that there is some underlying factor that explains why they passionately feel this way. This is particularly true if these delusions and disorders manifest in advanced age.
This is what has been proposed by the psychologist Ray Blanchard in his so-called Transsexualism Typology. Blanchard argues that some “transwomen” (male-to-female transsexuals) are homosexual transsexuals. They are highly feminized, and they want to become, as far as possible, heterosexual women. And they show signs of opposite-sex behavior at a very young age. The rest are what he calls autogynephilic transsexuals. These are male fetishists who are sexually aroused, or otherwise profoundly satisfied, by the idea of having a female body, something which correlates with wanting to take action to obtain one, and which becomes an interest for such people during or after adolescence. In other words, autogynephilic transexuals transform their own body into an object of desire—a kind of erotic loop. More recently, Blanchard has averred that his model is also likely to apply to “transmen” (female-to-male transsexuals). Blanchard has estimated that at least 75 percent of transsexuals are autogynephilic and that percentage is growing, as more and more people “discover” that they are trans.
Not surprisingly, trans activists generally find Blanchard’s Typology difficult to deal with and often attempt to suppress discussion of it. As Alice Dreger has summarized in her book Galileo’s Middle Finger (2015):
There’s a critical difference between autogynephilia and most other sexual orientations: Most other orientations aren’t erotically disrupted simply by being labeled. When you call a typical gay man homosexual, you’re not disturbing his sexual hopes and desires. By contrast, autogynephilia is perhaps best understood as a love that would really rather we didn’t speak its name. The ultimate eroticism of autogynephilia lies in the idea of really becoming or being a woman, not in being a natal male who desires to be a woman.
Clearly, my friend Alex was in the autogynephilious category, and this category is the far more common of the two.
So let us make sense of the more unusual category first: those who display gender dysphoria from a very early age. The earlier a condition manifests itself, the more likely it is to be primarily an expression of genetics, or an epigenetic phenomenon, which has occurred early in development, especially in utero. In this regard, the heritability of Gender Dysphoria is relatively low. A review concluded that Gender Dysphoria is about 0.5 heritable in males and 0.4 heritable in females. Another review found that Gender Dysphoria was approximately 0.3 heritable among adults. The authors reviewed three studies of child samples, one of which contradicted the other two. Two of the studies found a heritability of about 0.3. Thus, the common belief that some people are “born into the wrong body” is, broadly-speaking, inaccurate. Gender Dysphoria is as much environmental as it is genetic, if not more so, in males; in females, it is certainly more so.
There is a convincing case for arguing that homosexual transsexuality is a direct result of “developmental instability.” “Developmental Instability” refers to development occurring in a suboptimal fashion. An example of this would be a person growing up to have an asymmetrical face. Developmental instability is caused by a combination of environmental pressures—if you are fighting off disease then you don’t have the bio-energetic resources left over to grow a fully symmetrical face—and also by mutant genes. If you have lots of mutant genes—a condition known as “high mutational load”—then you have a poor immune system and must use proportionately more of your resources in fighting off disease, leading to a less symmetrical face. You may also have inherited mutant genes relating to the face. Homosexual transsexuality—and, less directly, Gender Dysphoria in general—appears to be a manifestation of developmental instability.
One indication of developmental instability is left-handedness. Humans are generally right-handed, and, if their brain has developed symmetrically, then that is what they will tend to be. Accordingly, left-handedness betokens an asymmetrical brain and, thus, developmental instability, and correlates with many neurological and auto-immune problems, including asthma and allergies. Blanchard reports that there are elevated levels of non-right-handedness among both homosexual and autogynephilous transsexuals. He also shows that there is elevated left-handedness among homosexuals, pedophiles, and many others whose object of sexual arousal is atypical. Blanchard proposes that these may all be explicable, in part, by developmental instability. Specifically, in the case of a male homosexual, a pregnant female will react to male hormones, emitted by a male fetus, by releasing female hormones. If she releases too many of these, or if the fetus’ immune system cannot protect itself against them—which, in both cases, may be due to mutation—the result may be a highly feminized child, such as a homosexual. In this regard, it has been found that homosexual males, on average, are more physically and mentally feminized than are heterosexual males, yet they still regard themselves as male. An important piece of evidence in favor of this model is that there is a clear birth order effect on male homosexuality. Every older brother a male has increases his odds of being homosexual by 0.3. This is partly because the mother’s immune system will react more strongly with every male pregnancy, and there might be group-level evolutionary benefits, as well: if there are already a large number of boys, then a homosexual boy will not elevate inter-male conflict any further. Blanchard’s model of the causes of homosexuality has been applied to people suffering from Gender Dysphoria. There is a clear birth order effect: male homosexual transsexuals fall into a significantly later birth order than do autogynepilious transsexuals. Consistent with this, it has been shown that the brains of homosexual transsexuals (whether transmen or transwomen) differ significantly from those of the same gender who are not homosexual transsexuals:
Cortical thickness and diffusion tensor imaging studies suggest that the brain of [Males-to-Females] presents complex mixtures of masculine, feminine, and demasculinized regions, while [Females-to-Males] show feminine, masculine, and defeminized regions.
These data would indicate that the minority of transsexuals who are “homosexual transsexuals” are, to a certain degree, “born into the wrong body.” This is principally due to epigenetic processes that occur in utero. Homosexual transsexuals are likely to be marked out by the way in which they will have intense difficulty conforming to the expectations of their biological sex from an extremely young age.
Further evidence of both forms of transsexuality being manifestations of developmental instability can be seen in the health of transsexuals. Their physical and mental health is far worse than is that of so-called “cis-gender” people. Transwomen, compared to males, report markedly elevated levels of high cholesterol, high blood pressure, vision problems, hearing problems, chronic pain, arthritis, digestive problems, lung problems, kidney complaints, diabetes, Post-Traumatic Stress Disorder, depression, and anxiety. They are also more likely to abuse alcohol, and even hard drugs such as heroin and crack, and engage in commercial sex work. Transmen are elevated in terms of obesity, smoking, asthma, depression, schizophrenia, sexually transmitted diseases, pubic lice, inflammatory conditions, previous menstrual irregularities, and premature or delayed menarche. They are also elevated in hyperandrogenism and, therefore, in a series of complications associated with elevated testosterone in females, including adrenal hyperplasia, polycystic ovary syndrome, and hypogonadism. Transmen also have elevated rates of fibromyalgia (the condition Alex suffered from), though this is not significantly higher in transwomen than it is among the general population. Some of these conditions help to explain why the sufferers are transsexual (as we will see below) or reflect the stresses inherent in being transsexual. But others, such as hearing problems, are likely to simply reflect the underlying factor of high mutational load and developmental instability.
Transsexuality and Fetishism
For Blanchard, the kind of transsexual who most attracts public attention—and who are behind the prominence of transgenderism in contemporary public discourse—is the kind who suffers from autogynephilia. This is a fetish, or paraphilia, whereby a man, for example, is “sexually aroused by the thought of himself as a female.” Autogynephilia ranges in its severity from mere transvestitism, where a man is deeply satisfied by dressing as a female, to, in its most extreme cases, transsexualism, where a male wants to alter his body such that it is more female-like. Perhaps it could be argued that demanding that society accept them as “real women” with precisely the same rights as “biological females” is an even more extreme manifestation of this paraphilia. Remaining a “she-male” would merely be a partial manifestation of this paraphilia. It can be argued, however, that autogynephilia is more than simply a paraphilia, as there is a strong element of delusion involved in autogynephilia, which is not found in other paraphilia. In this sense, as discussed above, autogynephilia is as much an example of dysphoria as it is an example of a paraphilia.
If it is reasonable to conceptualize transsexuality as a paraphilia, then the correlates of transsexuality and other paraphilia should be very similar. The same should be the case with the correlates of other dysphoria. So, what is associated with more widely experienced fetishes—such as masochism, sexual sadism, or paedophilia? Reviews have consistently found that paraphilia is comorbid with hypersexuality, Autism Spectrum Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, and Psychopathic Personality Disorder.
Paraphilia experience is placed on a spectrum ranging from no arousal to extreme and exclusive arousal by the paraphilia in question. It has been found that paraphilics have low cerebral serotonin levels, something which leads to high testosterone levels and thus a high sex drive. They report higher levels of sexual arousal, meaning that they might associate non-sexual targets, such as objects, with arousal because they are so easily sexually aroused. They report more diverse sexual interests, greater sexual orientation fluidity, more sexual activity, and a higher number of lifetime sexual partners than do non-paraphilics. These findings are very interesting in evolutionary terms, because they would potentially help to explain how paraphilia remains in populations. In line with the predictions made by Blanchard’s model, it has been found that transsexuality is comorbid with hypersexuality. Hypersexuality, and other sexual dysfunctions, also correlate with anorexia.
Autism Spectrum Disorder
Autism Spectrum Disorder (ASD), as already discussed, is associated with deficiencies in empathy and a concomitant propensity towards extreme analytical thinking. It has been conceptualized as the “Extreme Male Brain,” and autistic people tend to be physically masculinized, displaying various markers associated with high levels of male hormones. Congruous with this, autistics tend to attach meaning to concrete visual representations: they are interested in “things,” rather than people, disliking the unpredictable and unscripted nature of human interaction. You probably know someone who seems highly detached socially, overly logical, and is obsessed with his job, hobby, or some arcane, whether it be video games, online gambling, or evolutionary psychology.
Paraphilia crosses over with autism in the sense that paraphilia involves strong attachment to an object (usually a visual stimulus) and is highly scripted, in the sense that specific situations involving this stimulus can be particularly sexually arousing. It has been found that High Functioning (intellectually normal) autistics, particularly those who are male, are more likely to have paraphilic interests than are the general population. Consistent with Blanchard’s model, it is quite clear that transsexuality is associated with autism. Gunter Heylens and his colleagues found that transgender persons were six times more likely than the general population to suffer from Autism Spectrum Disorder, with transwomen being more likely to have an Autism Spectrum Disorder than transmen. Anna Van der Miesen and colleagues, who conducted a systematic literature review, found that children with Gender Dysphoria score higher on all subdomains of Autism Spectrum Disorder than do controls. It is therefore a reasonable conclusion that transsexuality is associated with Autism Spectrum Disorder. Anorexia, a prominent example of a dysphoria, is also robustly associated with ASD, according to a systematic review of eight studies.
Borderline Personality Disorder
Autism is associated with Borderline Personality Disorder and is characterized by a weak sense of self. Autistics lack the feeling that they are the same person across time and lack the feeling that they are in control of their thoughts and actions, possibly because, lacking empathy, they find that they cannot predict the consequences of their actions and, hypersensitive to stimuli, they easily become overwhelmed by the world. The result is a chaotic and frightening void, which can result in a coping mechanism whereby you create an extreme and certain identity. However, eventually, chronic self-doubt results in the collapse of this identity and the adoption of another, sometimes very different one. This, in turn, is the essence of Borderline Personality Disorder, which is elevated in both paraphilics and autistics. BPD is characterized by difficulties regulating emotion, feeling intense emotions, and having problems returning to a stable baseline, frequent mood swings, a fear of abandonment, and a disturbed sense of self. Specifically: “The self is impoverished, poorly developed, or there is an unstable self-image, which is often associated with excessive self-criticism; chronic feelings of emptiness; and dissociative states under stress.” Such a person has difficulty developing a sense of self that is stable in terms of beliefs, and life goals over time. He can have extreme and polarized self-conceptions, sometimes to the extent of developing multiple personalities; he can lack a coherent image of who he is; he can undergo “explosive shifts into states where the perception of self is distorted and shows weak correspondence with external reality”; and he may lack a capacity to flexibly adapt to change. Sufferers experience discontinuity in their development of self, rapidly alter their roles and relationships, and “identify only with their present affective states and have no sense of their continuity over time.”
It has been found that sexual masochism is 10 times higher in women with Borderline Personality Disorder than it is among controls. Many other studies, also of men, have found a robust association between paraphilic sexuality and Borderline Personality Disorder. It is also associated with Gender Dysphoria. At least two separate studies have found that 80 percent of transgender people display symptoms of Borderline Personality or related disorders. Anorexia, as another example of a dysphoria, is also associated with Borderline Personality Disorder.
Narcissistic Personality Disorder
In terms of a strongly distorted sense of self, Borderline Personality Disorder crosses over with the related condition of Narcissistic Personality Disorder. Indeed, in some respects, Narcissism can be understood as an example of Borderline Personality Disorder, though it is more common among males than females. Narcissistic Personality Disorder is characterized by:
- Grandiosity, with expectations of superior treatment from other people;
- Fixation on fantasies of power, success, intelligence, or attractiveness;
- Self-perception of being unique, superior, and associated with high-status people and institutions;
- Needing continual admiration from others;
- A sense of entitlement to special treatment and to obedience from others;
- Being exploitative of others to achieve personal gain;
- Unwilling to empathize with the feelings, wishes, and needs of other people;
- Being intensely envious of others, and believing that others are equally envious of them;
- A pompous and arrogant demeanour.
Narcissistic Personality Disorder has also been found to be a key predictor of paraphilic sexuality. It is also associated with Gender Dysphoria. One study found that, of a male and female sample of people suffering from Gender Dysphoria, 57 percent fit the criteria for Narcissistic Personality Disorder and 81 percent fit the criteria for some kind of personality disorder, mainly Borderline Personality Disorder. A review has found other studies that have highlighted this relationship between Transsexuality and Narcissistic Personality Disorder. It has been found that Anorexia is associated with Narcissistic Personality Disorder, specifically with the “vulnerable Narcissism” sub-type. Such people display all of the symptoms of standard Narcissistic Personality Disorder except “grandiosity.” This is replaced by “vulnerability,” characterized by a constant need for reassurance that one is exceptional, by introversion and by being self-absorbed, high in Neuroticism (feeling negative feelings strongly) and hyper-sensitive to criticism. In all of these senses, the Vulnerable Narcissist is the opposite of the Grandiose Narcissist, for the latter will be confident that he is exceptional, will be extraverted, and will appear relatively impervious to criticism.
Thus, we can see why Narcissism would be associated with transsexuality. The autistic is prone to sexual arousal by objects (fetishes), to a weak sense of self (fundamentally questioning who and what he is), and to Narcissism (as a means of coping with his fundamental sense of fear and chaos). These would come together in his being sexually aroused by the ideal of himself as the perfect female. Those who questioned his femaleness would, therefore, risk destroying his necessary coping-mechanism, resulting in “Narcissistic Rage.” It has been suggested that this makes sense of the often aggressive and furious way in which trans activists seem to respond to those who dare to disagree with them.
Psychopathic Personality Disorder
Psychopathic Personality Disorder, now officially known as “Anti-Social Behavioral Disorder,” is characterized by,
- Inability to sustain consistent work behavior;
- Non-conformity, irritability and aggression;
- Failure to honor financial obligations;
- Frequent lying, failure to plan ahead and impulsivity;
- Reckless behavior;
- Inability to function as a responsible parent;
- Failure to maintain long-term monogamous relationships;
- Lack of remorse;
- Conduct disorder in childhood.
Psychopathic traits are associated with paraphilia, possibly because of the way in which psychopaths are highly interested in power and control, causing them to be aroused by voyeurism and sadism, in the case of males. However, it may simply be that psychopathic personality and paraphilia are both expressions of developmental instability. As we would predict, there are elevated levels of psychopathology among transsexuals.
In summary, it can be seen that people who suffer from Gender Dysphoria display all of the key psychological traits that are associated with paraphilics. And like paraphilics, they are more likely than controls to be hyper-sexual, to suffer from Autism Spectrum Disorder, to be diagnosed with Borderline Personality Disorder or Narcissistic Personality Disorder, and to display evidence of Psychopathic Personality Disorder. In addition, we have noted that all of these characteristics are found, to an elevated degree, among those who display another well-researched dysphoria—namely anorexia nervosa.
Gender Dysphoria and Masculinization
We are confronted with additional question. Are late-onset transsexuals suffering from a delusion about themselves? Or are they correct in their assertion that they were “born into the wrong body” but have, for some reason, only recognized this as adolescents or adults? If it is the former (that is, they are delusional), then sufferers from Gender Dysphoria should display the same, or similar, correlates to those who suffer from other mind-body dysphoria, such as anorexics. Specifically, they should display evidence of masculinization, and it is masculine traits that are associated with other dysphoria, including anorexia, which is generally a dysphoria from which females suffer.
A study led by Riittakerttu Kaltiala-Heino has tested this possibility. The authors conducted a series of systematic reviews on original studies in order to test the relationship between Gender Dysphoria and at least one correlate of androgens (male hormones) out of Autism Spectrum Disorder, Left-handedness, 2D:4D Ratio (the shape of the hands, being male, and male heterosexuality. They found that people with Gender Dysphoria did, indeed, tend to display these signs of masculinization. They were more likely to be left-handed, suffer from Autism Spectrum Disorder, have a low (masculinized) 2D:4D ratio, be male, and want to have sex with females, even if they were male-to-female transsexuals. The authors found studies indicating that 65 percent of gender transitions in the U.S between 2002 and 2013 were male-to-female. They also found research from Finland, from 2019, which found that 3.6 percent of male children—but only 2.3 percent of female children—displayed some symptoms of Gender Dysphoria. They also pointed out that a 2015 survey of 3,000 transwomen reported that at least 60 percent claimed to be gynephilious (sexually attracted to women) in their new gender; 27 percent were exclusively gynephilious; and 19 percent exclusively androphilious (sexually attracted to men). For what it’s worth, the most famous transwoman of them all, Caitlyn Jenner (formerly Bruce Jenner), is reportedly in a relationship with another transwoman. Among transmen, in contrast, only 12 percent were exclusively gynephilious, while 23 percent were exclusively androphilious, but the proportions of those who were non-exclusively attracted to either sex were not reported. They observed that 2 percent of the British population claim to be lesbian, gay or bisexual; so, clearly, transwomen, as the authors would predict, overwhelmingly retain male sexual interests. And even among transmen, what is effectively lesbianism, which is associated with masculinization, is strongly over-represented.
The authors also found that other dysphoria display similar correlates. Female anorexics, compared to controls, are not only higher in autism but also have a lower 2D:4D ratio: their hands are more masculinized than is generally the case with females. The authors hypothesized that autism may be key to understanding the development of dysphoria. Dysphoria are also comorbid. Thus, transsexuals have elevated levels of anorexia. The authors argue that autistics tend to have a weak sense of self, making them more prone to the disturbed sense of identity, and of reality, that is inherent in all dysphoria; in other words, you believe that you are something that you are not. Autistics would also be more likely to develop fetishes, and it is in its paraphilic nature where gender dysphoria diverges from other dysphoria. This is consistent with Gender Dysphoria being characterized as a paraphilia of “erotic target identity inversion,” whereby people attempt to become the object by which they are sexually aroused. Accordingly, it appears that transsexuality should be characterized both as a paraphilia and as a dysphoria and, moreover, that there is considerable crossover between these two concepts in terms of their correlates. Autism itself, for example, has been found to be a manifestation of developmental instability. Not only is it associated with numerous markers of developmental instability, such as sinistrality, but it is robustly correlated with paternal age. This is because, as men age, their semen includes more de novo mutations, including those which lead to the development of autism.
What are the Environmental Causes of Transgenderism?
So, having established that there is a sound theoretical case for understanding transsexuality both as a paraphilia and as a dysphoria, we now need to make sense of its environmental causes. This is crucial because, as we have seen, it is significantly a function, in the case of autogynephilious transsexuals, of environmental factors, although many of these may be confounded by genetics. That transsexuality is strongly environmental is consistent with evidence that it develops in adolescence, as the later a phenomenon develops, the less strongly genetic it is likely to be, generally speaking. Indeed, the persistence of Gender Dysphoria is predicted by how young a person is when they first display symptoms: and the younger it develops, the more persistent it is. A primarily environmental explanation would be congruous with a growing body of evidence that many transsexuals wish to revert back, such that they physically resemble their biological sex, some years after transitioning. Indeed, this would be congruous with transsexuality being a paraphilia that becomes more or less intense due to environmental variables.
Gynaecologist Lisa Littman has referred to what she calls “rapid-onset Gender Dysphoria,” in which adolescents with no previous indication of gender confusion appear to very suddenly declare themselves “non-binary” or transgender. Littman avers that this may be the expression of a “social coping mechanism” for other issues, such as adolescent homosexual phases. This is rendered increasingly common by “social contagion.” Indeed, Littman notes that:
Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity.
Unlike with most cases of late-onset transsexuality, this is a predominantly female phenomenon: 82 percent of a sample of parents who reported having an adolescent child who experienced rapid-onset Gender Dysphoria were referring to a daughter, 41 percent of these had expressed interest in a non-heterosexual orientation prior to declaring their Gender Dysphoria, 62 percent had a history of mental illness, and 38 percent belonged to a peer group who had all declared themselves “non-binary” or “trans” at around the same time. In these respects, Rapid-Onset Gender Dysphoria is highly comparable to anorexia. This also seems to occur, in a socially contagious fashion, among adolescent female peer-groups and, as we have discussed, it has the same corollaries as Gender Dysphoria and also correlates with it. It is thus not without good reason that a number of commentators have asked “Is Transgender the New Anorexia?” This is a perfectly reasonable question to ask, at least with regard to Rapid-Onset Gender Dysphoria.
Due to the relative rarity of transsexuality, the studies on its environmental causes are generally clinical studies with small sample sizes, meaning that it behoves us to be cautious of their results. With that caveat, it has been observed that boys who later suffer from Gender Dysphoria tend to be raised in suboptimal environments, in which the parents frequently fight with each other and in which the fathers have low self-esteem and are emotionally distant, while the mothers are high on psychopathology, leading to the boy having an unclear sense of self-value and a high level of anxiety. It has been averred that these conditions may result in sexual identity problems, and that Gender Dysphoria thus has a significant environmental component. Clinical observation of girls with Gender Dysphoria indicates that they tend to have emotionally distant mothers, with whom they are often in conflict and fathers who abuse their mothers, possibly leading the girl to identify as a boy. Another study found elevated levels of Borderline Personality Disorder among the mothers of boys who suffer from Gender Dysphoria. A study in Taiwan found that students with Gender Dysphoria are more likely to have unaffectionate parents. There is evidence that girls with anorexia tend to have emotionally distant mothers as well. Their mothers are more likely to suffer from Alexithymia, that is, having difficulties verbalizing and otherwise expressing emotions. Females with Gender Dysphoria tend not merely to exhibit Autism Spectrum Disorder symptoms but also evidence being higher on measures of psychopathology.
The problem with all of these studies, in terms of understanding the environmental causes of dysphoria, including Gender Dysphoria, is that they are heavily genetically confounded. If the mothers of transgender boys are high on psychopathology, then it may be that being raised by such a mother elevates the likelihood of Gender Dysphoria. But it may also be that such a mother is highly masculinized, or otherwise high in mutational load, and it is this that has led to in utero developmental instability, eventually manifesting in a transsexual son, who is also likely to have inherited, to some extent, his mother’s psychopathic personality traits. The same is true with regard to Borderline Personality Disorder, which is elevated among both transsexuals and their mothers. So, it is extremely difficult to tease out the environmental causes of Gender Dysphoria. It is possible that there is a symbiotic relationship between genetics, in utero developmental instability, and childhood environment, whereby the son of a mother with Borderline Personality Disorder is more likely to manifest this, and thus potentially Gender Dysphoria, due to genetic tendencies, developmental instability due to high mutational load in both himself and his mother leading to developmental instability in utero, and the unstable childhood environment created by his mother. But this hypothesis, while plausible, needs to be formally tested.
The Breakdown of Selection and Gender Dysphoria
This leaves us with a further question: Why has there been a rise, in recent years, in the prominence of transgenderism? This may be partly explicable in terms of the Social Epistasis Amplification Model, which has been presented by Michael Woodley of Menie and his colleagues. They note that Darwinian selection has relaxed considerably since 1800 in advanced Western countries. In 1800, the child mortality rate was 40 percent; it is now 1 percent. Before the Industrial Revolution, those who had mutations (which are almost always detrimental to mental and physical health) were purged from the population every generation. These mutations of the body, which led to a poor immune system and dying from childhood diseases, for example, were comorbid with mutations of the mind, such as inclinations towards maladaptive sexuality or any form of behavior that would likely reduce fertility. This is because the mind is 84 percent of the genome. This renders it a massive target for mutation, meaning that if you have mutant genes of the body, you will almost certainly have mutant genes of the mind.
This dramatic change in infant mortality would have a number of related effects. Firstly, there would be more people with maladaptive mutations of the mind, such as deviant sexuality or even a propensity towards Gender Dysphoria. Secondly, these people would be more likely to be maladaptively influenced by hormones in utero. Thirdly, society would be influenced, in a maladaptive way, by these maladapted people—thus the term “spiteful mutants,” coined by Woodley of Menie and his team—which would interfere with the development of some non-mutants. Indeed, some of these “spiteful mutants” might actively encourage easily influenced young people to experiment with the idea that they are “non-binary,” to believe that this was “normal,” or to believe that it was a social good to be non-binary or transsexual.
Moreover, such “spiteful mutants” would act to undermine institutions and ideas that promoted the development of adaptive behavior and ways of thinking, such as religiousness. In modern societies, religiousness is associated with mental and physical health, as well as fertility. This would be consistent with evidence that significantly genetic conditions, such as depression, can be socially contagious. If you, as a genetically healthy person, spend time with a “spiteful mutant,” he can render you maladaptively inclined. And we would expect the process to occur relatively quickly. Religiousness would hold maladaptive ideas at bay until a tipping point was reached, after which a society would switch relatively promptly to maladaptive behaviors. It seems that once approximately 25 percent of the population holds a particular counter-cultural view, then the society loses confidence in the dominant viewpoint and starts to move, quite rapidly, towards the counter-cultural one. This would explain the relative rapidity with which traditional religious ideas, including religion-inspired sexual taboos, have collapsed in many Western countries since the 1960s.
In the 1950s, in Western countries, a person would be less likely to know about the existence of transsexuals. If he happened to suffer from Gender Dysphoria himself, he would likely do he could to repress this, knowing that he would be shunned if he did not. He might, possibly, even believe that such behavior would anger his god. This ability, to force yourself to think in a socially adaptive manner, is known as “effortful control.” In the following decade, these social controls that militated against maladaptive thinking and behavior, such as religion, began to collapse. At the time of writing, it might be argued that it is “socially adaptive” to force yourself to believe that much in the above discussion must be false, despite the fact that it is based on careful scientific studies, with the results often being widely replicated. This is best exemplified in the firing of Maya Forstater, mentioned above, for stating a scientific fact. As we noted, she lost her Employment Tribunal in which she challenged her firing. Judge James Taylor, presiding over the tribunal, made the following ruling:
If a person has transitioned from male to female and has a Gender Recognition Certificate (GRC), that person is legally a woman. That is not something [Miss Forstater] is entitled to ignore. [Miss Forstater’s] position is that even if a trans woman has a GRC, she cannot honestly describe herself as a woman. That belief is not worthy of respect in a democratic society. Even paying due regard to the qualified right to freedom of expression, people cannot expect to be protected if their core belief involves violating others’ dignity and creating an intimidating, hostile, degrading, humiliating, or offensive environment for them.
In other words, believing in the empirical truth, and asserting that you believe in the empirical truth, is a stance that is not, in itself, “worthy of respect in a democratic society.” There should be no legal protection for those who construct a worldview based on science, reason, and empirical evidence, if aspects of this worldview lead to negative emotions in some people, specifically people who have mind-body dysphoria. Such a ruling might be seen to strongly incentivize “effortful control” in order to convince oneself that “Black is White.”
A Cuckoo in the Nest
As transsexuality have become increasingly prominent, it’s only natural that many have grown suspicious that transsexuals are taking on these new identities mendaciously—that is, they are swapping genders as a way of gaining attention or even advantage. It could be argued that if you are a narcissist—and thus strongly desire validation, admiration, and sympathy—then you might be able to convince yourself that you are born in the wrong body. In a society in which being a member of a supposedly victimized group is valued—a reversal of what was previously the case—then unscrupulous people are incentivized to reinvent themselves on occasion.
Rachel Dolezal is the most notorious example of this kind of behavior. A biologically White woman raised in Montana, Dolezal adopted typically African-American dress, hair, and speech patterns and, at a relatively young age, became President of the NAACP chapter of Spokane, Washington—a high-status position that, presumably, would not have been open to a White. When Dolezal’s deception was revealed, she was excoriated int he media as a liar or con artist—or even, ironically, as the ultimate expression of “whiteness”; but there is reason to believe that Dolezal genuinely felt that she was part of the Black experience, either through effortful control or, perhaps, childhood trauma. More recently, Dr. Jessica Krug, formerly of George Washington University, did something similar, posing as Black for many years and apparently taking advantage of the “diversity” regime currently dominant in Western academia.
So, if you are a White, heterosexual male—and excluded from the new victimhood nobility—you may find yourself drawn towards transgenderism, particularly if you already suffer from the array of psychological problems associated with it, which we discussed above. There has been some notable pushback to transwomen entering women’s domains, particularly women’s sports. But the trend is well underway and seemingly unstoppable. In 2019, CeCe Telfer became the first transsexual athlete to win an N.C.A.A. track-and-field championship (in the 400-meter hurdles), and across all sports, transwomen are competing as women and, not surprisingly, finding success. Sports are segregated by sex for a reason, and biological males have obvious advantages in the areas of strength, quickness, and aggression in intersexual competition; this rule holds even for biological men who have undergone hormonal therapy after transitioning.
Regarding the “consciousness” of transexuals, we should remember that deception—and even self-deception—can sometimes be an evolutionary strategy. The cuckoo bird, for instance, engages in what is known as “nest parasitism”: the cuckoo mother lays an egg in the nest of another species, usually after kicking out one of the eggs already there. The cuckoo hatchling then proceeds, instinctively, to banish other competing hatchlings from its new nest, becoming its adoptive mother’s sole focus. Whether or not the hatchling is “conscious” of its ruthless subterfuge is of academic concern. The fact is, it acts in a way that increases its well-being and ability to survive. If society is structured to incentivize and valorize transsexuals, then we should not be surprised that it produces more transsexuals—along with a myriad of new ethical and identitarian dilemmas.
Returning to Alex
So, we have substantially made sense of transgenderism, which is best understood as both a dysphoria and as a paraphilia. In this regard, it has the key correlates of both, including severe disturbances of personality. This would perhaps explain the aggressive narcissism which many people have observed in transsexuals, with autism (and thus masculinization) possibly being the factor that connects everything together.
This brings us back to Alex, my friend from Durham University. There was an irrational and bombastic side to Alex. He attended left-wing protests, where he could be rather rambunctious. His Master’s thesis, Logic in Context: Some Considerations Concerning the Philosophy, Sociology and History of Logic (2006), begins with a quote from the English philosopher A. A. Luce (1882-1977), beneath which Alex wrote: “I will remark without hesitation that I regard the contents of this quote as arrant and polemical nonsense.” Part of the quote is further referred to as “gibberish.” In the student bar that night back 2001, Alex’s logical abilities rather broke down in the face of a student of Arabic, who asked Alex what he hoped to achieve by what he was doing. Alex commented that what he was doing was only logical to other transgender people, to which it was retorted that there’s no such thing as subjective logic—something Alex well knew. Indeed, Alex could be rather dogmatic. This led him, for example, to present the fallacious argument, in the pages of Philosophy Now magazine, that “race” is a purely social construct, simply because “races” have some genes in common. This position, manifestly, fails due to the fact that races, as examples of humans, will, by definition, have some genes in common. This, however, was the same person who set up a talk at the Durham University Philosophy Society entitled, “Is Feminist Philosophy a Contradiction in Terms?” This event was advertised on a poster featuring Pamela Anderson in black underwear.
My friends and I were dumbfounded by what we discovered about Alex back in December 2001. One of my classmates, who was also at Alex’s 21st, later remarked that such behavior was simply a manifestation of Alex’s “avant-garde genius”:
He’s going to do it. He’s actually going to mutilate his body. Maybe he’s not mentally ill at all. Why would anybody who was a man want to become a girl? Most men wouldn’t even entertain something so fucking insane. But not Alex. No way! He’s too avant-garde! That guy is a fucking avant-garde genius. I can only conclude that this is some sort of ultimate act of violent, avant-garde artistic sarcasm.
Interestingly, in 2008, there was an essay competition in the magazine Philosophy Now, where you had to answer the question: “Who is the Best Philosopher?” Rather than advocate for Heraclitus or David Hume, “Andrea” argued that she was. This breathtakingly original tactic meant that she was one of the winners. Her essay was entitled: “The answer is: Me!”
I didn’t see Alex, or Dreya, much in the Spring term. But in my final term at university, the same comical situation kept recurring. I would walk up the road of Victorian houses to the university library and a slender, pretty blonde girl would smile at me and wave from the other side of the road. “This is my lucky day!” I would think to myself . . . before realizing that it was Alex.
I last saw Alex (or Dreya) in September 2002, when we met up in Bristol in the southwest of England. Just back from a holiday in Malta with his parents, Alex was planning to do a Master’s degree in Political Philosophy at the University of Sussex in Brighton, a seaside town in southern England, known for its gay scene. We lost touch.
In October 2009, I was scrolling through the Mail Online, when my attention was drawn to a photograph of a pretty girl wearing a mortar board and graduation robes. I knew her from somewhere. Who was she? You guessed it: it was Alex. So much had happened in the meantime. He had been working as a prostitute in Brighton, operating out of his own home. And he had been found dead, and the flat, set on fire. The report said nothing about his transsexuality. Once I got over the shock, I knew immediately what must have happened. I could imagine it vividly. Some middle-aged, single man, probably uneducated, a laborer or something, pays Alex for sex. He comments on how amazingly neat Alex’s vagina is or how uncommonly perfect his breasts are. Alex, in his autistic innocence, replies, “Yes. Well, they are very perfect, unnaturally perfect, but that’s because I was actually born male, so, like, that would explain their near-perfect shape.” The manly builder, who prides himself on his manliness, realizes that he’s had sex with a man. He completely loses all self-control. He strangles Alex and then he sets fire to the flat in the hope of avoiding detection.
I was sure that this was what had happened. I was so sure that I telephoned the newspaper to tell them so. The News Desk journalist was incredulous at being informed that “Andrea Joanna Waddell” (as was now the name) was once “Alexander John Waddell.” He didn’t believe me. He asked if anyone could corroborate what I was saying, so I gave him the phone number of a friend from university who did just that. It turned out that my instinct was shared even by the prosecution when the case came to trial in May 2010. The murderer, a 42-year-old Sky TV fitter called Neil McMillan, pleaded “not guilty,” but was convicted due to forensic and CCTV evidence. He had paid Alex £140 for sex but, at some point, also being very drunk, he lost his temper, punched Alex in the face, and strangled him. Alex fought back, leading to scratches and cuts on McMillan, but to no avail. We’ll probably never know why McMillan strangled Alex, but the prosecution was convinced that it was likely because McMillan discovered that Alex was transsexual. The prosecuting barrister, Mr. Russell-Flint, said “McMillan may have attacked her in anger and in drink after discovering she had once been a man.”
As the trial progressed, Alex’s naivety became ever clearer. He kept £37,000 in cash at his flat in a filing cabinet in the sitting room. He advertised his services on websites such as one called “Adult Works.” Alex had even contacted the “National Union of Prostitutes” to ask how he could go about paying tax on his earnings. In June 2010, McMillan was handed a life sentence, with the judge instructing that he serve a minimum of 22 years. Then in November, McMillan was found guilty of having raped a woman in a hotel room in September 2009, just a few weeks before he had murdered Alex. He was sentenced to be detained at Her Majesty’s Pleasure. After the original trial, Alex’s family revealed yet more tragic information about him:
Her life reads like a catalogue of disasters. She was bullied at school, knocked down by a car in Battersea, mugged in Prague, and once attacked by a gang of young thugs in Reading. While completing her second degree she developed acute ulcerative colitis which was nearly fatal, but she underwent successfully surgery resulting in an ileostomy, which was later reversed.
The family had said, in 2009: “Andrea was often incapacitated by pain and unable to work, and we know she was concerned about how to make a living and be independent. If her decision on how to achieve this took her down unusual paths, who are we to judge?”
I am not so much interested in judging Alex, either. But we should try to understanding him and people like him. This is especially important now that such people are increasingly socially prominent—and particularly now that you can lose your job if you fail to accept their assertions about gender and identity as unconditional facts. In January 2020, Rachel Levine was appointed by U.S. President Joe Biden as assistant health secretary, making “her” the first openly transgender federal official.
Alex suffered from Gender Dysphoria and Paraphilia. Consistent with these being manifestations of dysphoria and paraphilia, Alex was autistic and seriously physically and mentally ill, points also congruous with these traits being products of developmental instability and high mutational load. Even his left-wing viewpoints have been shown to be associated with evidence of mutational load, which makes sense, as they tend to correlate with not having children, meaning that those who hold them are maladaptive.
Of course, saying this may be regarded as a “judgment” upon Alex (albeit one empirically based). But if more people had “judged” Alex, and helped him through his mental illness—rather than encouraged him to make a virtue out of it—he may well have been alive today, perhaps writing poetry, reviewing cutting-edge cocktails, and leading his local Philosophy Society.