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A podcast at the intersection of psychology and culture that intimately explores the human experience and critiques the counseling profession. Your host, Stephanie Winn, distills wisdom gained from her practice as a family therapist and coach while pivoting towards questions of how to apply a practical understanding of psychology to the novel dilemmas of the 21st century, from political polarization to medical malpractice.
What does ethical mental health care look like in a normless age, as our moral compasses spin in search of true north? How can therapists treat patients under pressure to affirm everything from the notion of "gender identity" to assisted suicide?
Primarily a long-form interview podcast, Stephanie invites unorthodox, free-thinking guests from many walks of life, including counselors, social workers, medical professionals, writers, researchers, and people with unique lived experience, such as detransitioners.
Curious about many things, Stephanie’s interdisciplinary psychological lens investigates challenging social issues and inspires transformation in the self, relationships, and society. She is known for bringing calm warmth to painful subjects, and astute perceptiveness to ethically complex issues. Pick up a torch to illuminate the dark night and join us on this journey through the inner wilderness.
You Must Be Some Kind of Therapist ranks in the top 1% globally according to ListenNotes. New episodes are released every Monday. Three and a half years after the show's inception in May of 2022, Stephanie became a Christian, representing the crystallization of moral, spiritual, and existential views she had been openly grappling with along with her audience and guests. Newer episodes (#188 forward) may sometimes reflect a Christian understanding, interwoven with and applied to the same issues the podcast has always addressed. The podcast remains diverse and continues to feature guests from all viewpoints.
[00:00:00] Kristopher: Even these medical organizations have the gall to take out a position statement, "Get politics out of medicine." All of them since 2017 or 2018 have been signing on amicus briefs to put gender [00:00:15] ideology into schools, into prisons, into sports, into all these places. They started it and they've been pushing it.
They were the ones who started to try to remold society. They are now using the force of [00:00:30] the government to go into clinicians' offices and force things that are, in my opinion, quite inappropriate in clinicians' offices. You must be some kind of therapist?
[00:00:44] Stephanie: [00:00:45] Today I have the pleasure of welcoming back to the podcast Dr. Christopher Kalibi. He is a child and adolescent psychiatrist in Florida with a long list of qualifications, which you'll be able to find in the show notes. We're not gonna go over all of them up [00:01:00] front. Um, I got to interview him originally on episode number 158, and today we're going to talk about the capture of the field of psychiatry, especially child and adolescent psychiatry, and [00:01:15] especially when it comes to fraudulent gender medicine.
So Dr. Kalibi, welcome back. So good to see you again.
[00:01:22] Kristopher: Great to be back. Thanks for having me.
[00:01:25] Stephanie: And a few notes for our listeners up front. One is I have lost my voice [00:01:30] again. Um, this happens to me a lot because I'm immune-compromised and have kids. So, um, whatever germs they bring home, I get them, and then I lose my voice.
Um, and I do have to use my [00:01:45] voice a lot for a living, so I'm used to just pushing through it. Um, but I will be speaking softly, and I will try to do less talking today, which is, which is great 'cause Dr. Kalebi has a lot to say. So I'm just letting listeners know that. Um, [00:02:00] and the other just sort of thing to get out of the way is that, uh, Dr.
Kalebi, I think you might have been feeling a little self-conscious about your background today since you're not in your office at the moment. For those who are watching on video, would you like to explain your background? Your physical background.
[00:02:13] Kristopher: Uh, yeah, sure. My, [00:02:15] uh, my, my office is being worked on, and, um, I'm in sort of the crafts room, and there's a whole bunch of leather that my wife works on, uh, y- uh, b- behind me, and then a couch that the dog sleeps on and all that kind of stuff.
But it was the, it's the [00:02:30] available room and, uh, you know, it, it, it will not detract from the content of the podcast.
[00:02:35] Stephanie: Very cool. Well, I, I like getting a little window into the creative side of things. And, uh, and now let's, let's transition over to your professional background. So for those who [00:02:45] haven't met you before, tell us about what you do and how you ended up in this, um, battlefield, so to speak.
[00:02:52] Kristopher: Yeah. So, so I answer that question different almost every time because you always get a little different flavor on why, you know, what are the many [00:03:00] factors that brought you here? But I, I consider myself mostly a clinician educator. Um, I see patients. I'm a ch- a child psychiatrist, general psychiatrist, and forensic psychiatrist.
And, you know, I finished-- I started med school in '95, [00:03:15] uh, finished my first resi- residency in 2002, then did the general psychiatry, then did child psychiatry, then I did forensic psychiatry, got done in 2006, and was, you know, mostly seeing patients and doing a [00:03:30] lot of teaching. Uh, I was at LSU Health Science Center in New Orleans for, with my two, two fellowships, and then 11 years on staff, and now I've been, uh, 10 years at the University of South Florida.
I've mostly worked in federally qualified health centers [00:03:45] doing collaborative care or just having a regular clinic, but those are like community clinics. And I've worked about halftime in juvenile corrections. Um, and along the way, you know, psychiatry's a fascinating field. I have lots of things I've been, uh, interested in, presenting on, [00:04:00] teaching people about, um, and that all-- so all that was occurring Prior to this whole new endeavor pushing back against, you know, w- what I considered to be really terrible, you know, clinical care and a lot of inappropriate actions by the [00:04:15] medical organizations.
And I was very active in the medical organizations. I was the co-chair of what's called the Media Committee for the American Academy of Child and Adolescent Psychiatry for a year, uh, years. I was the liaison between that organization, AACAP, and [00:04:30] the American Academy of Pediatrics for six years. So I've really been very active in them.
But I, I saw them, you know, become, uh, advocates rather than scientists, and I've had to speak up. And then the response to speaking up has been terrible because it has mo- been [00:04:45] mostly suppression. So, you know, here I am, uh, hopefully trying to, uh, take the, you know, f- m- to turn this thing around and, and, and sort of s- uh, get care better, improve these organizations, and hopefully get [00:05:00] our, y- you get the public to trust us again, which we, they have a lot of good reasons not to trust us these days.
[00:05:05] Stephanie: I'd like to start off by talking to the public who, who is unsure about who to trust, because this podcast reaches our colleagues [00:05:15] in the mental health field, and it also reaches concerned citizens, including many people who've been dragged into this because, for example, they had a kid declare a gender identity.
Um, and so in my day-to-day work, which I think [00:05:30] most listeners know by now, that when I'm not podcasting, which I only do one day a week, uh, the rest of the time I am specifically hel- helping parents of trans-identified youth. That's, that's what I do. And so a lot of that is, uh, you know, for those who are kind of new to this, helping [00:05:45] them understand the state of the field that they're navigating.
And I have an extremely short list of psychiatry referrals, specifically on my private network list. You know, over the years I've had a lot of therapists reach out to me and, you know, I have this [00:06:00] private referral list. But when people are looking for a psychiatrist for their teenager, I do not know where to send them if they're not in Florida.
I like, I have you, basically. And, um, and sometimes I'll have, you know, a family, especially in like a progressive state like [00:06:15] California, who will describe what they're looking for, and I'll say, "That, that's a perfectly understandable thing to want, and I, I'm not sure that it exists in your state." So I'd love to hear what, what [00:06:30] you say to people who are like, "Why can't I find a, you know, a psychiatrist for my teenager who says that they have gender dysphoria but, you know, also might be on the autism spectrum or have ADHD or they [00:06:45] had, you know, acute social anxiety, panic disorders and phobias starting at e- age 11 or, um, they had some, some trauma that, you know, we haven't been able to, to parse out?"
Like, like when they're looking for someone who's not just gonna take [00:07:00] the gender identity declaration at face value but explore how everything is connected, um, what do you normally say to parents about why that's so hard to find and what sort of the state of the field is?
[00:07:11] Kristopher: Oh, it's a great question and people are reasonably, [00:07:15] um, perplexed by what's going on.
Um, I, y- I'd been using this term for years. I actually used it in my first forensic report, the one I wrote for the, uh, state of Florida defending their law. Uh, so probably that was 2022. [00:07:30] Uh, but it came up on the internet, uh, that someone was talking about the spiral of silence and this is y- I saw this on X and I was like, "Yeah, that's, it was a nice way to put it."
People are silent because they watch what happens to other people when they speak up [00:07:45] and there's been a incredibly powerful, uh uh, how should I, stigmatizing, yeah, propaganda campaign, I'll say, in, in our field, where if you are someone who, [00:08:00] you know, doesn't want to go along with affirming all of these children, uh, you know, you're called anti-trans.
You, there's been psychiatrists who have literally been fired from their jobs, demoted, uh, you know, harassed. So [00:08:15] it, it is unfortunate that there's not more s- psychiatrists and ch- maybe child psychiatrists in particular are not selected for courage. So, I mean, just the reality of th- this type of person that you're gonna get, uh, doctors are pleasers.
They don't want, [00:08:30] you know, to be, uh, they don't wanna take a stance on anything. A good psychiatrist does-- doesn't wanna take a stance on anything that's real controversial or becomes political. So many are silent. So I think, you know, the, the, what they call the [00:08:45] spiral of silence has, has occurred, but it really occurs much more in those states that are very, you know, progressive and are enforcing those norms much more.
It'd be a lot easier, I think, in, uh, somewhere like [00:09:00] Florida to, to find a, a normie psychiatrist who will just do a good regular clinical job because you can... People will speak freely here. Uh, whereas I, I think it is hard to find, uh, people to speak freely. I know colleagues in those states [00:09:15] who, you know, will talk with me.
Uh, but many colleagues will talk off the record for one reason or another, their institution, you know, maybe a family member's involved, maybe they are in a group practice and other people in the practice are afraid that they'll get in trouble or it'll be [00:09:30] financially, uh, painful for them to... You know, even people in Florida have told me that.
Like, "I totally agree with you, but I don't wanna, uh, I'm, I'm in private practice with other people and I'm just afraid, if I'm honest, that I would be punished or will become a target and I don't wanna [00:09:45] mess up my partnership or my partners or other people around," you know? So it has really been a very successful stigmatization campaign that, uh, was m- was really enabled by the medical organizations because they're the [00:10:00] ones that are supposed to promote open dialogue, uh, scholarly discourse, allow for disagreement.
I mean, how we come closer to the truth is that those organizations, if they're functioning properly, allow people to [00:10:15] debate things, and through that debate we can figure out both the error in our arguments and also the errors in o- in other arguments. Um, but once the psychiatric and the other medical organizations all sort of got taken over [00:10:30] by the gender, which really all they had to do was take over the one committee, 'cause in these organizations, the committee is the experts.
And, you know, if you go to, let's say, the psychotherapy committee, it'd be pretty hard to take it over because you have a bunch of old-timers that have been doing psychotherapy for 40 [00:10:45] years, and, you know, they-- you couldn't just displace them. But gender medicine was brand new, and so all the enthusiasts who came in and already believed in it took over those committees and really moralized it and made it into a, a human rights type campaign.
It wasn't [00:11:00] really about evidence. It was about supporting this, you know, idea of these children that are, like, you know, they're born in the wrong body, uh, et cetera, et cetera, whatever ideology that they've sort of co- co- put into this. And so what really happened was the [00:11:15] organizations took those people's sort of word on it, and often the people who run these organizations are not even doctors, right?
So you have a bunch of laypeople i- you know, in addition to the heads of the organizations. And, um, through that, [00:11:30] you silenced the debate and you stigmatize others, and you put the force of those organizations sort of behind it and, you know, here we are. So, so I don't really have a lot, uh, easy ways for parents, although what I say is if you, if you have any psychiatrist you [00:11:45] trust, even if they're in another state, they may know people in your state that has talked to them privately.
They may have some idea about who would be a, a good provider. Um, but you're right, it's, it's not easy, and I don't have an easy answer for that.
[00:11:57] Stephanie: I wanna play devil's advocate for a [00:12:00] moment because I think that wh- when you talk about how successfully the field has been captured and how much a particular narrative has dominated, that same narrative has dominated the minds of these [00:12:15] youth that you and I are advocating for ethical treatment of, and it affects their perceptions and biases, their expectations and fears going into therapy or psychiatry.
So it puts the clinician in a [00:12:30] very uncomfortable position. You know, I have parents who, for example, themselves at home are using the kid's new name and pronouns because they've been essentially bu- [00:12:45] bullied and manipulated into it. There's been psychological blackmail, and they're hoping for a therapist or psychiatrist that's not going to affirm their kid.
And when we explore that, it's like, well, [00:13:00] hold on. If you yourself as a parent don't even feel comfortable using your kid's own name in your home because they're going to explode, they're going to threaten self-harm, they're gonna have a three-hour meltdown that's affecting your other kids. If [00:13:15] you yourself don't feel comfortable speaking that name, what makes you think that you can take your kid to someone they're supposed to entrust their mental health to, they're supposed to be vulnerable with, and that [00:13:30] person is going to use their birth name or, you know, refer to them in a biologically accurate way, and somehow earn their trust and get them to wanna open up and get them to wanna come back and keep talking about their mental health?
Like, how do you think this works? I've unfortunately had to have that [00:13:45] conversation with parents, and they, they realize that it is a bit of a trap. But, um, can you help us understand from the psychiatrist's perspective, what position are you in when a kid is coming to you [00:14:00] or their parents are bringing them to you for mental health treatment and they have this expectation that you have to see and treat them a certain way, or otherwise you don't respect them?
[00:14:09] Kristopher: Well, it's a, it's a challenge. I mean, I think whenever someone comes in with a very [00:14:15] rigid belief system, which we get in psychiatry in a number of disorders, I mean, this is not the only, uh, disorder where, uh, someone's gonna say something that you know is inaccurate, but they're gonna believe it very strongly, and how are we-- how do you help that person move [00:14:30] forward?
And, you know, sometimes you have a hope that they will get to a more flexible, alternative-seeking, um, you know, functional way to, to think Like also sometimes you [00:14:45] just work with the person where they're at, uh, in terms of, "Hey, what can, what can we actually solve here today?" You know, can we-- Maybe, maybe I, I don't really try to address that.
I-- Certainly I'm not the type of psychiatrist that would feed it or try to make it worse by, [00:15:00] or how, or make it worse by endorsing something. But I also know that sometimes you may be, um, relegated to not being able to take on all challenges a-all at the same time, and maybe it is [00:15:15] worthwhile to start with something small, hopefully build a relationship with the person over time, and hopefully learn to work with the family systems or other systems around this child to help, uh, [00:15:30] everyone get on the same page and, and move them forward.
But it is-- Y-you know, you're presenting these, um, you know, almost impossible clinical dilemmas because it is. If, if someone's getting reinforced and, uh, a person that you didn't mention, but it could be like the [00:15:45] school, the teacher, the school counselor, other counselor. I mean, there may be, may be a number of people reinforcing, you know, a basically a social transition, and then you're, you know, one person fighting against the, you [00:16:00] know, all, all these other ones.
And so yeah, it, it's, it's a, you know, kind of an unwinnable, uh, situation sometimes.
[00:16:07] Stephanie: It's a very difficult position. Um, so tell us about this recent article in [00:16:15] the American Journal of Psychiatry. I believe you have the honor of being the first, although I'm sure it's frustrating that it took this long and this much effort.
But, um, but you published the first, [00:16:30] um, what is it, op-ed? What would you call it? I--
[00:16:33] Kristopher: Well, it was a letter to the editor.
[00:16:34] Stephanie: Letter to the editor-
[00:16:36] Kristopher: Uh-huh.
[00:16:36] Stephanie: Yep ... in the American Journal of Psychiatry about the quality of evidence for pediatric gender medicine, the silencing of, [00:16:45] of opposition, and you wrote about this on your Substack.
That's the piece I actually read, not, not the one in the journal article. I read the Substack piece. But tell us about what you said, how you got that published, what the response has been.
[00:16:56] Kristopher: So it started with a [00:17:00] opinion piece that wa- that, the, the title was "From Crisis to Action," and it was by Breslau and colleagues, and it was in the American Journal of Psychiatry.
That's the journal we're talking about, which some-- in [00:17:15] psychiatry we call it the Green Journal, but it's the flagship journal of the American, uh, Psychiatric Association. So it's a major journal. And even though the American Psychiatric Association has been, for a long time, advocating really [00:17:30] aggressively for youth gender medicine and affirmation and all the...
But they've had basically no articles on youth gender medicine. So they've, they have other journals. There's a, some, sometimes the stuff is mentioned a little bit. But they're, first of [00:17:45] all, they're not a child journal. Uh, and secondly, they, you know, there, there's not much published research. And actually, if they pub- Uh, you know, are gonna publish research, the, they're, they're, they know that the research is not that great in [00:18:00] this field, so it's also a little bit easier for them to advocate when they're not actually publishing data because the data's not really all that good.
So they've been able to sit on the sidelines, but they published what is really... I, I would please tell everyone, 'cause this is not [00:18:15] paywalled, uh, the Breslau article, and it basically argues that as psychiatrists, it's our duty to lobby politicians and teach judges and, uh, talk to school boards and [00:18:30] all these, um, political, really ideological actions, uh, to fight for gender medicine in general.
But clearly, since they were very highly focusing on the laws, they're really focusing on, on youth gender medicine, and they're also, you know, [00:18:45] basically sports, uh, you know, prisons. I mean, they, they, they, they're arguing that across the board that we should become advocates. Um, so, you know, the, uh, there's many, many problems with that, right?
Of course, you [00:19:00] know, are psychiatrists experts in turning upside down society, that we know how to remodel society? What, what, where did, would we get that expertise? I mean, we're supposed to decide that sex is not gonna be an important marker anymore [00:19:15] and, and somehow gender identity is gonna place- replace it in all these facets of human life?
I mean, you know, this goes to laws, it goes to bureaucracies in schools and in other workplaces. Uh, it's going to, you know, all sorts of implications of, of what's in [00:19:30] Breslau. So actually, the, the first author is Kathleen McDevitt, who if people are following the field, they know that she's a, you know, really a, a great writer and knows the research really, really well.
So she and I wrote [00:19:45] an article Basically saying, for one, uh, well, we, we titled it Pediatric Gender Medicine: Psychiatry's Duty to Model Respectful Disagreement. And so that's the title in part because the Breslau article was [00:20:00] peppered with anti-trans every... Oh, you know, anti-trans, anti-trans, anti-trans. So, you know, it's all anyone who urges caution, anyone who has a different approach, anyone who is, is sort of put under this label.
Um, in their reply to our article, they're like, "Oh, we [00:20:15] were just talking about the laws." I, I'm-- It's pretty clear that they, that they're not really just talking about the laws, but that, that is what they said. Um, so we argued, for one, y- it is if psychiatrists are gonna be taken seriously, we have to have [00:20:30] open scholarly discourse, and we shouldn't be stigmatizing, uh, other viewpoints.
Um, and in particular, when you talk about gender medicine, we brought up that the evidence for these interventions is, is [00:20:45] very low to low quality in terms of supporting benefits, and the harms are, are obvious and clear. So, you know, w- there's not a good risk-benefit analysis for this. The-- And that fact, despite the, the, [00:21:00] despite that there's been, you know, at least 17 system- high-quality systematic reviews, uh, of youth gender medicine, that fact had never been mentioned in a jour- in the jour- in this journal.
So, you know, this is how [00:21:15] terrible the state of, of discourse is in these journals. The major child, uh, psychiatric journal Of the American Psychiatric Association, probably the biggest and most important psychiatric journal in the world, has never once mentioned all those systematic [00:21:30] reviews showing the very low and low-quality evidence supporting gender medicine.
So right there, it's kind of a victory, although it's kind of, you know, pathetic that that has never been in these, in this journal before. The next thing that we talked about was that the, there has been this [00:21:45] suppression of voices within, all over medicine, but particularly within the American medical, uh, establishment.
So they have gone out of their way, the, the editors at all those journals, the people who run American Psychiatric [00:22:00] Association, American Academy of Pediatrics, American Academy of Child & Adolescent Psychiatry, Endocrine Society, uh, all of those organizations have gone out of their way to suppress, uh, those who are [00:22:15] raising caution, those who, you know, believe this to be, you know, terrible clinical care, those who just would like to see the typical scientific dialogue that we have for most everything else.
I mean, everything that's sort of [00:22:30] not political, uh, some of these same journals have great articles on. If you read my Substack, I talk about, uh, how you're gonna find a discussion on placebo effects, on all sorts of other things [00:22:45] in the American Journal of Psychiatry. So they can talk about it, you know, when it comes to psychedelics, they can talk about it, the, the placebo effect when it comes to TMS and other brain, you know, scanned, uh, other new, uh, interventions.
They can talk about it when they're talking [00:23:00] about psychopharmacology studies. But there has been zero-- The, the word placebo effect has not been mentioned in this journal related to, um, related to gender medicine. And gender medicine, of all things, should be [00:23:15] expected to have the largest placebo effect, because you have all these celebratory, uh, you know, or, or these organizations supporting it in a celebratory way, all this community support for it, this, like, deep-ingrained belief that it's part of a new, you know, wave of, uh, [00:23:30] you know, fancy treatments that are so helpful, life-saving, all the things that, that, you know, we, we know that that's not accurate, but it, that has been publicized so much.
And placebo effects are largely about expectations. And so when you plant those expectations, you would [00:23:45] expect a very large placebo effect in gender medicine. And so, you know, the fact that, that that has never been mentioned just kind of shows, you know, how, how terrible the journals have been. The other thing is, funny enough, uh, the people at the Amer-American Journal of Psychiatry, they recently repub...
[00:24:00] uh, published a review on somatic treatments and their effects on suicidality Right? So, you know, while Breslow is claiming that this, this stuff is life-saving, right in the same journal, they have a review of [00:24:15] all of the things that psychiatrists use, and they have to admit that only clozapine and lithium are the only two medications that have some decent evidence that they actually reduce completed suicide, and that all of our other medicines really don't.
But you know what was not even [00:24:30] mentioned in that article on suicide? Cross-sex hormones, puberty blockers, right? You know, or surgeries, right? So it's not even on the f- you know, in the field of, you know, in, in the review. So, you know, it, it is pretty incredible that these journals, like, have a [00:24:45] complete double standard that's the, the critiques that are perfectly okay for other interventions, much s- you know, safer, non-invasive interventions Are not there.
So, um, y- y- the, the other, you know, point which [00:25:00] I mentioned with the title is that this, this whole idea that there's been a, um, really dysfunctional cheerleading and that, uh, that the American Academy of, of... or the American Psychiatric Association in this, this case, [00:25:15] is really leaving behind clinical care and wanting us to be something that psychiatrists are not and should never be.
'Cause w- you know, we need to actually provide... Our, our job of being good clinicians is hard enough, and we need to be really humble what [00:25:30] we can do and what we can't do. And to oversell what we can do is terrible, and to, to not talk about harms is terrible. But, and then to, to say that we're mental health experts and we can get into, like, reconfiguring society, what a, what a [00:25:45] terrible, uh, uh, um, idea.
So anyway, on, on, on all those counts, we, we had to raise those issues, and at least we did get published. So once again, it's kind of a victory. It's nice that there's-- if people are following that journal. But in cour- uh, of course, [00:26:00] letters to the editor, I mean, they could choose to take the paywall down, but they, they don't.
So it's paywalled, so it's hard for people to access either our letter to, uh, to the editor or the response by Breslau, which... And the response was just as terrible as the [00:26:15] article. I mean, but if, you know, if you wanna try to get access to it, I mean, it, it, it won't surprise. There's nothing new and, and certainly nothing that discounts anything that me and, uh, Dr.
McDevitt said.
[00:26:26] Stephanie: Well, I wanna hop around a bit because some of the points [00:26:30] you just made connect to something else that we put on our possible agenda for today, a topic I'm very, very interested in, which is the heuristics and biases affecting clinicians and the public. When you talk about the Breslau article [00:26:45] arguing that it is a psychiatrist's duty to become an activist, to step way outside the realm of the psychiatry office or the telehealth office, as it were, and go to your [00:27:00] state capital, talk to people across a variety of f- I mean, that, that's a, that's a pretty, um Large claim, right?
And, uh, you, you question, you know, how realistic it would [00:27:15] be to argue for that even if the evidence base were sound um, just because that- that's just, you know, not... Most people only have room to do one job. And then in psychiatry, [00:27:30] in counseling, uh, there are al- also ethical considerations when we step outside that role.
I've talked about this very openly on my podcast w- w- with regard to me going from being a therapist to having other roles in society. Anyway, my point is, [00:27:45] when you talk about this idea that's being widely pushed for, um, that psychiatrists, that counselors, that people should step outside of their normal job description, become activists for this [00:28:00] cause Um, I feel like that really connects to some insights you probably have to share about, you know, what are the heuristics and biases, the cognitive distortions and logical fallacies that are [00:28:15] driving this kind of narrative?
What, what lies are clinicians believing that have them stepping into this role?
[00:28:23] Kristopher: Anyone who's been following psychiatry for a long time realizes that even if you wanna look at our m- older [00:28:30] traditions like Freud, um, y- you would say that there are some built into that, that we have a unconscious that often fools us a little bit, right?
That we might repress things or deny things, right? That's part of that. And if you look at cognitive [00:28:45] therapy, we have cognitive distortions. We have... Or we jump to conclusions. You know, we, um, catastrophize, you know? So for a long time, clinically, mental health providers have known that people fool [00:29:00] ourselves.
Well, over the last 50 years or so, there's been this growth in what some people call behavioral economics that has also-- It was psychologists who really started this, but it's studying how we systematically get things [00:29:15] wrong, and that our brains are really built for efficiency more than they are for accuracy.
And we have, you know, sort of different ways we can approach things, and we have the capability of being rational and getting things right. If we sit down, we really crunch the numbers, [00:29:30] we do the calculations, or we write out things. A human brain can be incredibly rational, but most of the time, we use the fast and frugal brain just to make a decision based kind of on this efficiency model of, [00:29:45] "Hey, I'm like them.
This kinda looks like that. This seems like something that goes along with something that I already believe." And so for the most part, we, um, will often just go with [00:30:00] a more tribal look at things. So for one, I think when it comes to y- you know, youth gender medicine and how we got into these ideas, which on their face are, you know, not really strong clinical ideas and are way, way outside what we [00:30:15] normally would be doing In part, it appealed to people's, uh, sense of themselves as virtuous, and it also came down to, um, this whole idea of, hey, we had got things wrong with [00:30:30] sex and gender before, and now there's advocates, and we really need to...
And so rather than actually looking at the details, we just took a, a kind of a moral stance like, "Hey, that must be the right new thing to do. This is a new human rights [00:30:45] movement. This is a new-- I feel good. These people who are selling it to me seem so excited and so enthusiastic. Let me jump on board. Let me be one of the good people."
And so it's really easy for human beings to fool themselves, especially when [00:31:00] there is a, um, w-when it, it seems like your tribe is going in a certain direction and there's this moral claim. Uh, uh, so people get into mental health. I mean, obviously you're a counselor and, uh, you, you know, you know this. I mean, people really want to have a great [00:31:15] relationship with their patients.
They wanna help them. They wanna have a warm, fuzzy feeling. They want people to say, "Thank you, Doc, that was awesome. I really appreciate it." When you actually practice, you realize that it's much more complex than that, and that's not how if you're doing good clinical care that a lot of [00:31:30] your interactions are gonna go because you also have to set boundaries.
You also have to be realistic. You have to use facts and be rational. And so, um, we, we are in this state where the more that it becomes like [00:31:45] political advocacy and more that it becomes like ideology, the more we've set behi-be-the aside the usual, uh, caution, the usual just like, "Hey, let's look at the research.
Let's look at the statistics." Um, and [00:32:00] I can go through a few of the biases that I think are specifically in play. I mean, one of them, uh, you, they call them my side bias, which is, you know, we're, and most mental health professionals are on the political left. It's really easy to like look at [00:32:15] surveys and who they do-donate money to.
I mean, there's all these. And so when you look at now that it has become a legal issue, I think this furthers those who feel like a, a tribal identity on the left to thinking like, "Those people are on the [00:32:30] other side. They must be terrible. We won't even look at their ideas." And so interestingly because so many of the people who are fighting back against gender medicine and new gender medicine are on the left, but there, there's an assumption because the [00:32:45] Republicans basically have passed laws against this that it's a Republican idea to be against it and it allows people sort of not think about it and just reflexively think, "Oh, this is some kind of political thing," rather than a-actually analyzing the ideas.
So the my side bias is [00:33:00] one The other thing is the, um, introduction of a lot of the terms and the language of what I'll call, I mean, I think this is a sort of false term, but, and this is a great example, [00:33:15] gender-affirming care in its own right, right? So when you start cr- m- manipulating language and creating terms, and then those terms are used over and over and over again, there's this thing called the availability bias, where you start making decisions [00:33:30] n- um, based on what is in your head and what's a- what's available to you, right?
So things that come to mind easily is what you, is what will occur to you. And so y- you know, kinda they say if you throw enough mud against a wall, some of it sticks. Or like my dad [00:33:45] used to say, "Repetition is the mother of learning." And so you do, you just repeat again and again and again, and they changed all the language, and then they repeat the language, and they basically are keep pushing the language, and then all of a sudden it normalizes all this [00:34:00] language where we never really debated who, where in any of these medical journals have we talked about, well, what are the pluses and minuses of saying there even is such a thing as a transgender child?
Is that something we should say? Because, you know, if we kept with the old [00:34:15] language, transsexual, would you really say that there's a transsexual child? If we would've kept that language, it might have protected these kids from a premature assignment, right? But then you get that assignment because the book, you know, the DSM people [00:34:30] decide, and, you know, 12 people sitting in a room who are all gender specialists, right?
I mean, this is, this is the whole clinical consensus thing. And they change the language, and then this language becomes popularized, and then everyone's like, "Well, the [00:34:45] experts have said this is the language. Of course, it makes sense. We must go with it." And so availability bias, it, it works on a number of, of levels.
But I think through the language manipulation, it has really changed how people think and [00:35:00] allowed people to, to adopt, which is really a, um, you know, n- a really ideological, uh, viewpoint that there is such a thing as a transgender child. It's a, it's not a natural cord- category, it's a category we've made up.
[00:35:15] It, there wa- there wasn't transgender children up until two minutes ago, you know? This is the thing that when I was growing up, this didn't exist. Now, there were girlish boys, there was boyish girls. There are kids who have difficulty with their own body. But we know that most of those kids grow up and come to [00:35:30] peace with their body.
We know most of those kids, you know, a lot of them, especially the males, will grow up to be same-sex attracted They need help and support. We don't want them to get a hard time. But to call them this category of this, you know, adult thing, uh, has, [00:35:45] has been really, you know, it's b- that has been a terrible disservice, you know, to society done by the DSM and the people that were in that committee, and I think it has operated mostly through these biases, um, that, that sort of cause people to, um, [00:36:00] you know, reflexively adopt some of the, the thinking that goes along with the label.
[00:36:05] Stephanie: So the tribalism runs strong here. Uh, the availability bias, the power of repetition, and it, it's so contagious 'cause you just... I, I [00:36:15] remember coming out of that fog in 2020 of just realizing, I was like, "I'm just repeating things that other people are saying 'cause I'm assuming that someone did their research here, but what if we're all wrong?"
Like, I remember coming out of that haze. Um, you know, you also [00:36:30] mentioned being rational, and I wanted to kind of add this fine point on that, that- There are many conversations I find myself having on a regular basis because of my c- my ROGD parent coaching work. And one of them, [00:36:45] you know, I would say the last few weeks, at least once a week, I find myself laughing at something that a parent is saying and, and I respond with, you know, "I, I wish that intelligence was a protective factor, but it's [00:37:00] actually a risk factor when it comes to trans identification in youth."
You know, the parent who's like, "My daughter is so smart. I don't know how she fell for this nonsense." It's like, "Well, yeah, yeah, that's actually a risk factor," right? And, and I think the distinction [00:37:15] I'd like to make is being rational versus rationalizing, because a powerful intellect is really good at rationalizing.
Um, and there's a difference between making the decision, the conscious [00:37:30] decision, I'm going to try to be rational even if what I find is emotionally uncomfortable or threatens my ego or my certainty or what I think I know, right? That's a distinct mental state from [00:37:45] the one that I think as humans we more often more commonly fall into, which is we start with an unconscious emotional drive or need, and then from there, our intellect gets to work doing its [00:38:00] job, serving that, that need or that drive, that want, that feeling that came first.
And so, I mean, my whole course is based on this. I, I break down all the ways that this operates in, in these young [00:38:15] people. So I just wanna make that distinction, being rational versus rationalizing. Um, there's a couple of other, um, psychological drivers that I have on my list, and I'm curious for your thoughts on this.
So another bias I hear in the [00:38:30] sentiment of Breslow and, you know, people who think similarly to that is w- what I'd call sort of a rescuer complex with, uh, more than a hint of grandiosity in it, which I think is one of those pieces of [00:38:45] shadow that shows up in a lot of people who go into helping work, right?
And, and it's part of the reason that we're supposed to learn about countertransference and to have some self-awareness of those blind spots 'cause the, you know, everyone knows what the road to hell is [00:39:00] paved with. And that's, that's how we got to so many dark places. I guess the one other thing I wanted to mention, too, on my own personal, like, top 10 list of biases that I think are shaping our, our field is reaction [00:39:15] formation.
Um, so this is a psychodynamic term for listeners who aren't familiar with it, and here's, here's one way to illustrate this I recently retweeted a graphic showing that conservative white Americans [00:39:30] who have long been deemed by the woke left as the most racist people on the planet demonstrate about the same level of in-group bias as every other racial group, 'cause every racial group besides [00:39:45] white people has an in-group bias preference.
They prefer to be around people of their own background. Um, it's exceptionally and uniquely liberal whites that have a masochistic bias in the [00:40:00] reverse direction, right? Which is that they claim at least to have more antipathy toward people of their own skin color than toward people of other backgrounds.
So, um, I'd call that masochism, right? If you think that you [00:40:15] belong to a category that is unworthy of human dignity, that every other category is better than the category that you belong to, I'd call that masochistic. I'd call it a risk factor for exploitation, too, because if you believe [00:40:30] that you're, you're bad or wrong because of your, your race or sex or whatever it is, then you're kind of opening yourself up to people who would use that to harm you.
And, uh, one of the therapists in my, uh, in my [00:40:45] ex group of mutuals commented, "I wonder if this is reaction formation." And I was like, "Bingo." So reaction formation, I like to explain this concept because I think it comes up a lot. And so just to catch up listeners, it's ... [00:41:00] I think of it as the, the grain of sand in the oyster that turns into a pearl.
When something irritates you, like you have a feeling that doesn't match who you think you are, sometimes you wanna get [00:41:15] rid of that feeling. You wanna get rid of that feeling so badly that you kind of coat it in a shiny, sweet, soft substance that looks very much like the opposite feeling. So perhaps there's someone you dislike, but you dislike that you dislike that person because you think of yourself as a really nice person and, uh, so you [00:41:30] don't know why you dislike this person, and so you hate that you dislike them, so you really go out of your way to be extra nice to them That's reaction formation.
It's, it's a psychological defense. We all do it from time to time. Some people have it as a bigger personality [00:41:45] trait than others. And I think there's an element of reaction formation in the pro-trans mania, because at an instinctual level, it hits us all, this feeling, uh, the uncanny valley of transgenderism, the way that it [00:42:00] just instinctively feels dangerous or, or gross, or there's, there's something weird.
There's a wolf in sheep's clothing. There's something that's not adding up, right? And we have these instincts to protect us that sense when something's off. It feels [00:42:15] to me like a lot of people are kind of rejecting that part of themselves that, that goes, "Oh, I don't like this." And then they're like, "Oh, but it's bad.
It's wrong to dislike this. Am I transphobic? Oh, no." And so then there's a reaction formation that goes the opposite way. "No, no, no, [00:42:30] I'm not transphobic. I love trans people. I would, I would lay down my life for trans people. I would go to the state capitol for trans people." So I think that that might be one of the hidden drivers.
What do you think?
[00:42:41] Kristopher: I've never heard it- Put in that way, [00:42:45] but I, I think, yeah, I mean, I think you're onto something because there is a programmed sort of natural way that we would, um, assess the male or female body of someone and sort of what's a [00:43:00] prototypical male or female body. And when we see features that are like a mix or that are, don't fit, uh, you know, or sort of stereotypical pro- but it is preprogrammed because it seems to be na- uh, evolved, and it probably is an [00:43:15] important thing to be evolved because, uh, you know, obviously sex is i- in- integral, integrally related to the species, you know, moving on.
Um, and when you see a mismatch, you may have a, uh, a reaction to [00:43:30] that which is a negative reaction. And I think that this is part of what is a difficult thing for gender non-conforming people is that they get that negative reaction if you don't fit into the stereotype. And I think it, it's interesting 'cause that's like [00:43:45] a real phenomenon, I think, for anyone who doesn't look the part clearly of one sex or the other.
But when people transition, they are also, they're creating that, right? So they're bringing that to them, uh, to, you know, uh, [00:44:00] in theory to meet how they feel on the inside, but yet are often gonna be creating that situation where people do have that reaction to them. And people who have that reaction may feel that they need to then overcome that reaction 'cause they don't want to be negative [00:44:15] towards people.
And, you know, clearly, you know, all of us would love a world where people are as kind to other people as possible, yet it is also true that we are slightly evolved primates that have instinctual reactions, and we can't just [00:44:30] wish them away. These are all-- We have to compromise with our innate programming and find ways to all live together.
I would love a world where people kinda live and let live. I think that this is part of [00:44:45] the, a lo- a lot of what I hear w- when people talk about the, this issue of, of how to handle this. They're like, "Well, I'm very libertarian. I just want to- people to live and let live." Well, I'm fine with that as long as people are not pretending [00:45:00] that medical interventions are good for people when, when there's not evidence that they are, uh, when people are downplaying the harms of these things, and when you start to throw away boundaries and, [00:45:15] um, customs built on sex that are there for a reason and actually protect people and are important for society in a number of ways.
And so, um, yeah, I think exa- you're, what you're saying about reaction formation, uh, I think, has a lot behind it. It's, it [00:45:30] probably is a, uh, a piece of what's going on.
[00:45:32] Stephanie: And when it comes to the activism piece, um- There's a, there's a huge connection between that and what you were just saying because out of all the [00:45:45] people who pursue medical so-called transition or sex trait modification procedures, um, drugs and procedures, out of all the people who do that Uh, first of all, you and I have major issues [00:46:00] with how the matter of informed consent is handled, right?
And within that mishandling of informed consent, there's kind of this hidden narrative or expectation that [00:46:15] society will bend to accommodate you. And I think the, um, the push for, let's say, psychiatrists to become pro-trans activists, I think this is one of the things that, that bridges that, right? Is [00:46:30] that if a psychiatrist is playing a role in affirming someone's sense of gender identity and ushering them along that path, then they're essentially saying, "I'm gonna place my bets on this working out for you.
[00:46:45] I'm gonna look into my crystal ball and say that you indeed will be happier living as your imaginary gender identity than living in the body you have now. And part of how I'm gonna [00:47:00] ensure that I'm right about that is I'm gonna pave the world for you. I'm gonna roll out that red carpet. I'm gonna be one of the people making sure that wherever you go, you get affirmed, you get admitted to [00:47:15] the, the bathrooms, the locker rooms, the sports teams, the competitions, the scholarships, the prisons that align with your felt sense of gender identity."
So if we were to do the informed consent process [00:47:30] more honestly, there would be a lot more caveats on many fronts, but one of them might be, "You know what? I can't actually tell you how the world is going to respond to you. I can't tell you that people are gonna like you and welcome you and see you the way that you wanna [00:47:45] be seen.
Um, I can't tell you that the laws are going to protect your ability to go into the spaces that you wanna go to at the expense of the people of the opposite sex who feel differently about this." [00:48:00] So I kind of feel like part of the push for therapists and psychiatrists to be activists on this issue is maybe stemming from this recognition that they've essentially obligated themselves to be part of, you [00:48:15] know, what makes this work for people.
And, and I, I deeply question if the informed consent process were more honest on that front as well as on the medical front, if there were no expectation this is gonna get you [00:48:30] into the environments you wanna be in, how many people, especially the males, would still go through with this? Or how many of them are going through with it specifically because they want access to opposite sex spaces?
[00:48:41] Kristopher: Well, I, I, I would agree with you that there is a, um, [00:48:45] incredible lack of informed consent on those issues, that's totally true. And that, yes, I believe that a number of the, um, uh, activists have [00:49:00] basically decided that they're no longer just clinicians. This is part of their mission to change society to go along with how they practice, you know?
So it's, it is interesting. Social transition is the [00:49:15] only, um, a time in psychiatry that you're asking everyone else to go along with the belief system of the person, right? So it's like, okay, this is a little strange that we are promoting social transition, [00:49:30] everyone going along with the belief system. We don't do that in anything else in mental health.
Like, why the exception here? And maybe it is not done for good reasons because we don't control the thoughts and actions of the whole rest of the [00:49:45] world, and we can't make any guarantees about whole, the whole rest of the world, whether we wanted to or not. I mean, whatever my opinion is on these things, I can't make the world, you know, go along with social transition if I, even if I wanted to.
So this is, this is one of those, um, [00:50:00]
[00:50:00] Stephanie: unfortunate,
[00:50:01] Kristopher: uh, uh, um, uh- But it's unfortunate, but it is directly related to the philosophy of care that these gender clinicians are promoting, [00:50:15] right? They are pro- they are sort of speaking for the rest of society that we're gonna all operate in a certain kind of way.
And I think that the fact that they are actually doing harm to society and causing a lot of strife into society is not mentioned [00:50:30] enough. I mean, I think that the professional medical organizations have caused lots of strife in society. They started this. They started the politicalization. They started the-- And it, this is just a reaction to their [00:50:45] inappropriate efforts to remold society in this ideological vision.
And so, you know, I hear, "Oh," you know, and, and even these medical organizations have the gall to take out a, a position statement, "Get [00:51:00] politics out of medicine." You know, they, they're, they say that. All of them, since 2017 or 2018, have been signing on amicus briefs to put gender ideology into schools, you know, into [00:51:15] prisons, into, you know, sports, into all these places.
They started it, and they've been pushing it. It, it, it is-- They were the ones who started to try to remold society. And so for them to say to get [00:51:30] politics out of it, the, the whole conversion therapy laws, this is a prime example. They are now using the force of the government to go into clinicians' offices and force things that are, in my opinion, quite inappropriate in clinicians' offices, right?
[00:51:45] So, so they are using their muscle through the government to muscle into actual clinicians' offices, and then they have the gall to say, "Oh, get politics out of, you know, healthcare," when they get some laws [00:52:00] that they don't like So yeah, this is a, this is a huge issue and, um, I think, you know, the world is waking up that these medical organizations and the activists have done a lot of harm and caused a lot of strife and, you know, here we are to move forward and [00:52:15] hopefully, you know, make some of that harm go away and create a better world.
But, um, yeah, I think people are reasonably, uh, quite upset with, with both the activist, uh, clinicians and with the medical organizations that have really been their muscle, you know, to, to put this to, to force [00:52:30] society, uh, in some really unhealthy ways.
[00:52:32] Stephanie: In your AJP article and your Substack article and also earlier in this conversation, you mentioned the placebo effect and I thought you, you stated this really clearly in your Substack piece.
I wanna [00:52:45] invite you to speak to it more because you say, you know, they talk about the placebo effect and these, these other things that can affect outcomes, um, when it comes to anything else and yet we see this exceptionalism around how gender is treated, just like we see [00:53:00] exceptionalism about how gender is treated when it comes to suicide and suggestibility, for instance, right?
There's a, there's a well-known ethos in, in psychiatry, psychology and medicine that, uh, you, you don't want to mishandle discussion of [00:53:15] suicide to create suggestibility in vulnerable people. So that goes out the window. Everything we know about this placebo effect goes out the window. Um, I'd, I'd love to just invite you to spell that out a little bit more clearly for those who are just getting caught up to speed on this [00:53:30] issue.
Like how does the placebo effect or expectancy affect the outcomes with, uh, gender medicine?
[00:53:39] Kristopher: Okay, yeah, it's an important topic, and I, I'll, I'll bring in an-- I'll bring in the nocebo effect too, 'cause this is, [00:53:45] this is an important subtopic. Um, the placebo effect is everywhere in medicine. People often feel better just from going to a clinician and being offered something and taking that something even [00:54:00] when it is an inert substance.
So we think of placebo effect mostly as a sugar pill or an, a, an inert pill that doesn't have anything. And we know it has a large effect because of medication trials in, in especially depression and anxiety, [00:54:15] um, which of course relate to gender dysphoria. I mean, these are two highly comorbid and probably really mixed into how can you have d- dysphoria about your body and not have some anxiety and depression, right?
These are, these are mixed in. [00:54:30] So those are the strongest placebo effect in those, right? So this is a Bushore I, I cited in a, in, in a 2024 article that did analysis on nine different categories of, of, of psychiatric, uh, conditions. And no one will be [00:54:45] surprised that there's not that much placebo effect in treatments for, for the more medically well-known sort of diseases in psychiatry, like real schizophrenia and bipolar disorder, more biological, uh, disorders that, [00:55:00] you know, placebos don't do that much more.
But, uh, there's a continuum, and it's the most for anxiety and depression. And the placebo is higher in societies that expect more and believe in antidepressants. So it's really interesting, and over time, as belief in [00:55:15] antidepressants went up, the placebo effect went up. And maybe the placebo effect is going down now because people have realized that the antidepressants don't beat placebo that much.
So we now have this ebb and flow, but it really, uh, what you think about a treatment is really [00:55:30] powerful and can cause you to benefit from that treatment. But the-- so that has been-- so we've never really proven that the small gains that sometimes are noticed from some of these, uh, interventions that the clinicians are saying must come [00:55:45] from the intervention, we don't really know, and that there's a really good reason to think that actually those are placebo effects.
And these might be really negative interventions. They may not help at all. They may even be doing some damage, but the placebo effect makes them appear [00:56:00] like they're helping. So that's one part. And then the nocebo effect is when you think something isn't gonna help, then it actually, you'll notice more side effects if it's a pill and they tell the side effects and they, you know, really emphasize them.
[00:56:15] Or if you think something is gonna hurt you, you're more likely to feel some negative effect from it. Well, the nocebo effect is what they're doing to psychotherapy, because they are saying psychotherapy doesn't work, we don't need psychotherapy, don't do psychotherapy, just get your hormones and [00:56:30] surgeries, that's what you need.
And so they've actually undermined the appropriate treatment through the nocebo effect whilst they pumped up the inappropriate treatment, the hormones and the surgeries. So yeah, it's a huge issue, and normally in [00:56:45] scholarly discourse on this, we would've vetted this, there would've- the Allison Clayton ar- article from 2023 is brilliant on it.
It goes through the whole thing. You can, you can look at that. Uh, but yeah, so, so it has been talked about, but not in any American medical [00:57:00] journals. None of our journals have mentioned the word placebo in a co- along with gender medicine at all. You ca- I, I dare you to find one mention of, of any of the American major medical journals.
I would love to see it. I mean, maybe there is one, but I read a lot of [00:57:15] journals and I really know this subject very well, and I haven't seen it.
[00:57:18] Stephanie: I've never heard that point about the nocebo effect and psychotherapy for gender dysphoria articulated so clearly, and, and you just spelled it out. Thank you for that.
You know, this, this reminds me of something [00:57:30] I find myself saying to my parent coaching clients when their kids express exactly what you just described, right? Their kids say, "Therapy won't work for me," or they say, "You just wanna make me see a conversion therapist," which always makes me wonder, like, what do [00:57:45] they think conversion therapy is exactly?
You know? And, and the way I explain it to my clients that makes them get it instantly is usually these are clients who really trust me. They listen to my podcast or they read my blog before they signed up for my course. They did my course before they signed up to work with [00:58:00] me. By the s- by the time they sign up for parent coaching, they were like, "We think you're the best.
We love you." Like, "You're, you're our, our desperate plea. Like, we will do whatever you say." You know, I have many clients who think very highly of me, and so that is, [00:58:15] uh, that's partly placebo, right? Because they have so much faith that I can help, that creates a foundation. You know, if this were therapy, we would call that an idealizing transference, and we would look at that as having some possible downsides.
But [00:58:30] because this is coaching, because I'm very directive and educational and transparent, um, I, I want my clients to take my advice. Um, and so it works. It works if they trust me. And, and what I say to them [00:58:45] in the middle of all of that, because they do trust me, is I say, "Imagine if you thought I was full of shit You would be right.
If you thought I was full of shit, I would not be able to help you. There would be no point in coaching because if you mistrusted my intentions, if you [00:59:00] thought nothing I said ever worked, right, then, then I would literally not be able to help you. The entire premise of me being able to help you rests on the trust and faith that you've put in me.
You know, in this case, you put it in me for [00:59:15] reasons, right? Because I have said things that have resonated, and you've tried things I've advised and they've worked. But you know, when I say that to my clients, they get it instantly. They're like, "You're right. Yeah, it's because we have faith and a good relationship that your advice, it [00:59:30] means anything to us," right?
And so this really kind of sheds that light of contrast on their kids. It's like that is a kid in that moment, especially if it's like a, a teenager, like a 16-year-old saying, "Therapy won't help me. You just want me to see [00:59:45] a conversion therapist," whatever. It's like in that moment, that kid is exercising their free will to sabotage themselves, and they are absolutely correct.
They're using their autonomy to create a self-fulfilling prophecy. If they believe that therapy can't help, [01:00:00] if they believe that the only treatment for gender dysphoria is social and medical transition, then they've made that true for themselves. I articulate this, by the way, more in my ROGD repair article.
It's called The Belief That Builds Its Own Cage. Uh, it's about [01:00:15] how kids kinda work themselves into that mental state. But I love the way that you explain that, and I'm gonna have to start using the phrase nocebo effect more when this comes up.
[01:00:25] Kristopher: Y- yeah, I mean, it really is, once again, a really underexplored [01:00:30] issue.
I mean, people in the business understand that they're badmouthing psychotherapy and stigmatizing it has been terrible. But I mean, this is a, um, this is a very clear example of a really ethically [01:00:45] problematic, of another aspect of it that, that has been ethically problematic. You're, you're, you're taking what is really the appropriate clinical approach and you're dissuading the population that should be served by [01:01:00] that approach.
And yeah, it, it, it really, once again, is when, when people look back at this episode, and hopefully historians and other people will write books so we don't do these stupid things again, um, or we you know, or we do it, don't do it quite as bad, uh, [01:01:15] they, they will have to take a look at that.
[01:01:16] Stephanie: Well, Chris, where do you think we're going from here?
I mean, it was definitely a step forward for psychiatry that you were able to publish this critique at all to kind of begin the dialogue, [01:01:30] but it feels like a small step forward, and it feels like it should've been able to happen sooner. It feels like progress is slow, especially when compared to the mountain of evidence of how harmful this stuff is.
You know, and then every now and then [01:01:45] something will come across our radars that reminds us that back when I was a kid and back when you were probably in college, like we had detrans testimony then, right? Like we've known the evidence of harm for a lot longer [01:02:00] actually than, than we give credit to sometimes.
So, um, how, how does that make you feel, and where do you think things are headed? Do you feel optimistic or pes- pessimistic about psychiatry?
[01:02:13] Kristopher: Well, it's hard to feel [01:02:15] optimistic because I'm trying to, uh, introduce scholarly dialogue, and for the most part it's getting shot down. I mean, with this one letter to the editor is not sufficient.
Um, the m- the organization I've been most [01:02:30] involved with, the American Academy of Child & Adolescent Psychiatry, they rejected two submissions for the upcoming conference, which is next month In Atlanta. I have, I'm on two other panels not related to gender, so I'm doing other things. [01:02:45] But the crazy thing is, uh, you know, and if you look at, you know, they can't give you an answer why.
It's basically ad to- ad hominem, you know, attacks and a refusal to forum the authors of the [01:03:00] HHS report. So this is the people who wrote the, myself included, I'm one of the authors. But, you know, I had put together panels. Even if you disagree, you would think that the, you would want them to come to a professional medical organization and to discuss these things and for the [01:03:15] membership to hear the viewpoints.
I mean, I think part of the reason that they, you know, are, don't want us on stage is they know that our arguments are better than theirs, and, uh, they, they, they don't want the membership hearing it. And, and they realize that they'd be very popular [01:03:30] and that many of the members, probably most of the members, agree that this is terrible care.
But they have been, you know, pushed into silence, uh, by, you know, by the activists and by the organization stigmatizing. So it's hard for me to be optimistic. I think for a long time in, [01:03:45] you moving forward, we'll probably have geography-related care where, you know, y- like if we have in some other things in medicine, where some things are available in some places, in some states it's just not available.
And so I, you know, I, I'm optimistic [01:04:00] that things will normalize more in the states that don't have a medical option. I think that that's healthier for kids growing up. It takes stuff a lot off the table. I think it's just, you know, the anxiety le- level can go down for everyone. Um, maybe through, [01:04:15] um, you know, maybe, maybe some of this will just through money and payment and Medicaid and all that.
But, you know, you, if the election changes to a Democrat next time around, you have to assume that they're gonna re, you know, re-up on all these things and everything that Trump has done is, will be undone. So [01:04:30] it's sad that we're sort of prisoners to that political, you know, wh- whims rather than just coming up with what is good clinical care and doing that.
Uh, so yeah. So I'm not super optimistic. I mean, the medical organizations seem to really just be digging in [01:04:45] and haven't really, you know, extended any kind of olive branches or it seemed to, you know, be willing to really forum constructive disagreement or scholarly dialogue. And the real one, I mean, I mentioned this in, at the end, my, on my fourth part of the, uh, my Substack, but [01:05:00] the APA has incredible power because they're, they're making up the DSM-6 as we speak.
You know, there's people formulating. And are they gonna continue down the activist road that they did with the DSM-5? Probably. So, you know, we, we have no [01:05:15] indication that they, they really have decided that they're gonna have, uh, a mixed even, uh, group, you know, it seems like we're gonna have basically, 'cause it's a consensus-built document, so they're gonna have m- to my [01:05:30] mind, you know, activists creating the DSM-6 just like they did with the 5, and it's gonna continue to cause strife in society and problems and all this.
So it can't be too... I mean, maybe things turn around quicker than I think, but it seems like we're gonna continue to have [01:05:45] some real problems.
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[01:06:26] Kristopher: Let me mention two things that I could direct clinicians to.
One is [01:06:30] Vumedi. If you know V-U-M-E-D-I. It's a, it's like a free CME kind... You-- I don't even think you get CME, but it's, it's a, um, kinda like a YouTube for different presentations. And I have put up my-- When I presented at the [01:06:45] APA two years ago, I was part of a panel, and it was on youth gender medicine. That has been up for a while.
It has over 1,000 views and lots of nice comments. And I just put up my presentation [01:07:00] from IACAPAP, which is the International Child Psychiatry Organization. So I did that presentation in Hamburg on July 4th, and I, and I re-, um, I redid the video for Vumedi. So that is [01:07:15] now up also. So if clinician-- If someone who's a clinician, this is clinician only, it's not like a YouTube, you have to sign up.
But if you're any k- type of clinician, I believe you can sign up. It's free, and you can kinda see two of my more recent presentations there. Um, so that's [01:07:30] for one. Um, for two, at the child psychiatry conference, I have brought in, I'm chairing a panel with, um, the Prison Yoga Project as one of my pe- I'm involved with the Prison Yoga Project.
I l- I'm big into the yoga service movement, [01:07:45] and, uh, it's a wonderful organizations. I've worked in juvenile corrections for a long time and, uh, so their executive director is gonna talk. Uh, someone who's an expert on pediatric, um, anxiety disorders, so a somatic anxiety [01:08:00] disorder, CBT expert who's a psychologist in the Atlanta area, nationally known expert, really good.
And then someone who is an expert on, um, uh, somatic dis- disorders, unexplained somatic disorders, is also gonna talk. So this is [01:08:15] not a panel on gender per se, but it is a panel on somatic distress and different ways that people deal with somatic distress. So I think it's really very close to what if we were looking rationally at gender, what we would be doing, [01:08:30] uh, which would include a lot of like CBT that targets very directly some of the body-related distress that people have.
Um, the functional somatic disorder person will, uh, present on holistic, you know, kind of present what they do with [01:08:45] people that have, have unexplained somatic problems like you know, non-epileptic seizures, et cetera, et cetera, which I feel like, uh, has a lot of commonalities. And obviously the pr- the yoga, I, I believe that, you know, these mind-body techniques and moving your [01:09:00] body and getting a healthy body, these are all things for all populations.
But for p- people who have somatic distress, this is one way out of somatic distress of any kind. So, um, that's a little bit of an advertisement for my presentation, but it's [01:09:15] also a, like, "Hey, this would be," if we lived in a, a rational world, we would be using these full range of interventions for all patients with any type of somatic distress, right?
There's a lot of things that work and that we can do with patients. Um, and [01:09:30] a, a lot of times people are not getting good care. A lot of times they get a lot of medicines, honestly, and I don't think that that, that's usually a great solution. It usually doesn't lead to that much, uh, progress.
[01:09:41] Stephanie: So on that note, you're pointing to a [01:09:45] way forward in the treatment of gender distress, what that would look like holistically.
And one significant component is that somatic piece. Uh, a lot of these youth have dissociative symptoms, they have autism, they have sensory issues. They're not fully present in [01:10:00] their bodies. And then they're complaining of something that they call gender dysphoria, but a lot of it is a lot like body dysmorphia.
So what you're saying with that somatic piece really makes sense and maybe one sort of final note for us to [01:10:15] explore before we wrap up is this topic of what holistic treatment of gender dysphoria would look like if we didn't have the stifling political climate. And so you mentioned the somatic and [01:10:30] sensory aspect of treating this holistically.
Um, I was curious for your thoughts as well on the overlap between obsessive compulsive disorder and gender dysphoria, because I see that so much in so many ways. These [01:10:45] kids either have diagnosed OCD or they sure sound a lot like they have undiagnosed OCD that's become fixated on the gender issue. And in fact, I've even heard stories [01:11:00] where the more I unpack the situation with the parents, the more of an understanding they're able to convey to me, the more I sense that even The suicidal ideation was more along the [01:11:15] lines of that which you see in obsessive compulsive disorder intrusive thoughts, um, than what you, what you see in depression.
And I've heard stories of clinicians not handling this responsibly. So for example, you know, um, here's what I mean by [01:11:30] that, right? A kid might fill out some sort of inventory at their, you know, their annual exam with their pediatrician or a visit with a psychiatrist or a therapist, and it will ask anything about thoughts of self-harm or suicide, and they might [01:11:45] say yes on that when they've never disclosed struggling with this problem before.
Then, you know, that gets reacted to in a way that I, upon, you know, examining the parent's report, don't, don't think was necessarily the best. You know, [01:12:00] especially when you introduce the emotional blackmail and the therapist saying, "Would you rather have a l- happy child or a dead child?" All that bullshit that we know goes on.
Um, but when we unpack it, there's a lot of [01:12:15] evidence that some of the suicidal ideation, at least, that gets reported is more along the lines of what we see in OCD where there's an intrusive thought. And here's how I explain this to parents. I say we all have thousands of thoughts a day. Most of us who [01:12:30] aren't super neurotic, those thoughts just come and go.
We don't necessarily heavily fixate on them, although of course if there's something that's really worrying or bothering us in our lives, we'll find ourselves thinking about it more, just like you're thinking obsessively about your kid right now coming to me in [01:12:45] parent coaching 'cause you have a real concern, right?
So of course you're worried. But if you're not abnormally high in neuroticism, if you're not exceptionally prone to depression and anxiety, if you have a random thought that doesn't match who you are, you're just like, [01:13:00] "Well, that was a weird thought," and you let it go. I say with a, with someone with diagnosed or undiagnosed obsessive compulsive disorder or that tendency, they'll have a thought that floats by that, uh, doesn't match their sense of who [01:13:15] they are, and they freak out.
Um, in therapy with teens I used to call that the dis- disaster detector in your brain. You could think of it like a little robot scanning the horizon of your thoughts, like is there any problem here? And the moment it spots a thought that [01:13:30] is ego dystonic, which I explain in my course as well, right? A thought that doesn't match who you think you are, what kind of thoughts you think you should have Alarm bells go off.
And ironically, those alarm bells, that reaction actually magnifies, [01:13:45] intensifies the thought, latches emotion onto it, and then can in, in OCD trigger compensatory compulsive behaviors. So, you know, even some of the suicidal ideation can be more like, you know, "I wonder what would happen if I stab myself with that [01:14:00] knife?"
It could be like an intrusive thought, right? And then they don't, they don't actually have any desire to act on that. It's more like, "Oh, what did I just think? Oh, no. Ah, am I... Is there something wrong with me? Am I crazy," right? So it's, it's more the anxiety attributed to [01:14:15] the random thought rather than, "Wow, brain, interesting stuff you're coming up with.
Let's just let that go." Um, so I just wanted to kind of bring in this element to the conversation while we were touching on something adjacent to it, 'cause I feel like it's something that doesn't get addressed enough, the distinction [01:14:30] between intrusive thoughts of self-harm or suicide that show up in someone with OCD versus actual depressive suicidal ideation or suicidal ideation that bears more resemblance to something you might see in, like, borderline [01:14:45] personality disorder, for instance.
[01:14:46] Kristopher: Yeah, I mean, that's a nice, uh, clinical, uh, point and I think well taken. Uh, obviously patients with OCD have these unwanted continual thoughts, and we'd like them to get to a place where [01:15:00] they would react with a thought's just a thought. You know, in, uh, in the old time we used to say delete junk mail. You know, get it to where they're just clouds in the sky passing by and not hold onto them.
W- every human being has thoughts [01:15:15] that they don't prefer to have or didn't want to have. Uh, but the intensity and type of thought in patients with these obsessive, you know, characteristics, whether it's OCD diagnosed or it's just someone who has... And a lot of the, um [01:15:30] transgender identified kids have something that, that you may ca- you know, put in the O- OCD s- uh, ballpark or, or category, but you also could put in the extreme overvalue- or the overvalued belief [01:15:45] category, like an intense, it's like a less intense than a delusion, um, but it's there, it's really persistent, it's really strong, they're very fixated on it.
And so the... And there is literature on that. So there's [01:16:00] literature on OCD with overvalued beliefs mixed in. A lot of times OCD isn't purely just those unwanted thoughts. They have this, uh, mix of these, uh, delusional, uh, quasi-delusional thoughts [01:16:15] mixed in. And so yeah, you're, you're, you're onto something there.
There are sort of protocols or, or some, the clinical suggestions for helping people to, you know, get some distance, to help them not identify with those thoughts, to, uh, think more flexibly, [01:16:30] get alternatives, not hold on to things. Uh, yeah, so you're, you're, you're right that a lot of the, um... Y- people jump when you hear suicide and, uh, and it's, and it's somewhat unfortunate because there's two really [01:16:45] unfortunate pieces of it.
One is that often it ends to, it ends up amping up everyone's anxiety unnecessarily. There, this could be a very low-risk kid that really doesn't have suicidal thoughts. The, they had [01:17:00] thoughts pop in their head, but there was no intent, there was no plan. They're, they've n- they've not, they're, they're not truly suicidal.
They just had a thought pop in their head. So we don't need to hospitalize a patient like that. We don't need to, you know, put in the super [01:17:15] high-risk protocol, but we can help them, you know, de- deal with that, right? There's clinical approaches, mostly in therapy, that would help with that The second is sometimes the response to voicing suicidal ideation is [01:17:30] inadvertently rewarding and can sculpt up further behaviors in the same way and may end up then undermining the, um, you know, mental health and success of the kid.
And so I know I work in c- closed settings and corrections. You see [01:17:45] kids that, you know, really never were suicidal, didn't voice suicidality on the outside. Then they're locked up, but they see like, "Hey, if I say I'm suicidal, I get a one-on-one." Sometimes if someone's like gonna, you know, beat my ass up, it's better to have a one-on-one than it is to, [01:18:00] you know, deal with that, right?
And so you have lots of reasons that this starts, but then when the pattern starts and they start doing it, you get more and more of it when it kind of works for them on a certain level. And then at some point, people are taking it like, "Okay, well, we can't [01:18:15] keep rewarding this. Now we have to not reward."
And then they're like, "Oh, well, now I have to up the ante. Now I actually have to do something in order to get that response that I had before." And so this is really iatrogenic harm that comes from the pattern that really got sculpted up [01:18:30] in the environment. And, you know, good providers, and understand this, and systems are supposed to have ways to, you know, not re- neg- reinforce these things, but it absolutely happens and, you know, in this population, there's a number of iatrogenic harms that can come [01:18:45] when, when people are inappropriately, um Overreacting or inappropriately reacting to these ex- expressions.
Yes,
[01:18:54] Stephanie: you're
[01:18:54] Kristopher: correct.
[01:18:55] Stephanie: So for those who are watching on video, you saw my big reaction. For those who are just [01:19:00] listening, I was, I was non-verbally emphatically nodding along to Dr. Kalebi's last point just there, and, uh, this comes up so much in my parent coaching work because a lot of the families that come to me are in crisis, and they've had some severe [01:19:15] meltdowns.
They've had hospitalizations. They've had threats of violence, and this is one of the reasons that I educate parents in my course and in my coaching on the psychological concept of an extinction burst because that's the technical term for what Dr. Kalebi [01:19:30] just explained, that if, if a behavior has been rewarded, even if that's not how you think of it, right, you think you're just managing the crisis or, you know, but then you start to recognize that you have accidentally incentivized something like threatening [01:19:45] suicide or talking about suicide as a way of getting extra sympathy, getting parents to cave in on a boundary, getting more time to work on an assignment.
Whatever the, the secondary gain, the reward is there, you've accidentally incentivized this behavior. You realize you've [01:20:00] made a misstep because if you keep doing this, if you and everyone else around this youth keep rewarding suicide threats, what you get is borderline personality disorder, and that, that's, that's not good.
You don't want that, right? The, the, the, [01:20:15] there's a lot of neuroplasticity going on in this window. This kid does not have to turn out to be someone who learns that threatening to kill myself is how I get my way in relationships. You, we don't want to create that pattern. So yes, when you realize that you've accidentally started to create that [01:20:30] pattern, you absolutely need to change gears, but this is why I warn parents this is one of the most dangerous moments because you don't just change your behavior and have the kid adapt right away.
There is a very awkward gap in the middle where they have to learn that behavior does not pay off anymore, and before that, [01:20:45] they're gonna ratchet it up and up and up, right? "Oh, I just need to push harder." So, um, uh, parents, you need help if you're in a situation like that. You need to talk to someone like Dr.
Kalebi or someone like myself. I help people with this plan every single [01:21:00] week. When you are about to enforce new boundaries and you can predict some kind of behavioral escalation, you really need to think through how you're gonna handle that escalation so that on the one hand you can stop incentivizing bad behavior, [01:21:15] um, but on the other hand you can, uh, prevent things from getting out of control, and for some families it's a very, very difficult balance to strike.
[01:21:22] Kristopher: Stephanie, let me add that what I say to people is that, listen, sometimes you have to create a crisis [01:21:30] because you know that you're gonna now set a limit. There's gonna be r- but- If you're gonna wisely create a crisis, hey, you know, maybe you need to take a day off, maybe you need to plan when this crisis comes.
You know, this is gonna be on a day that you can handle it, that it doesn't [01:21:45] just come haphazardly. So unfortunately, like yeah, you're, you're gonna have to put in extra work and be extra prepared for a period of time. Plus, the reality is you can never bring risk to zero. If you're s- if you're gonna, like, [01:22:00] try to think that there's never any risk of anything, then you're, you're gonna be a prisoner to whatever manipulations that are out there.
So the, the reality is plan these interventions at a time that you can do them, be realistic, get the family [01:22:15] together, be ready to create that crisis, and then if you need to, create the crisis, because if it-- and maybe sometimes they, you know, might lead to a hospitalization, it might lead to a behavioral incident, but you do have to set boundaries, and you do [01:22:30] have to stop patterns that are iatrogenically increasing risk and increasing harm.
So yeah, at some point you, you do need to set that boundary.
[01:22:39] Stephanie: Absolutely. Uh, it reminds me of a riddle. So the riddle is there's a man walking through a train [01:22:45] trunnel, uh, train tunnel, and a train starts coming at him. He runs toward it. He doesn't have a death wish. Why? Well, the answer is because the nearest exit to the tunnel was the one he had [01:23:00] to run toward.
Um, the, this, the wisest strategy for him in that moment was actually to run toward the danger. That was the one that stacked the odds in his favor, and sometimes parenting a teenager in crisis is exactly like that. [01:23:15] I help parents think these things through and, you know, usually they're so afraid of the crisis they do see coming that they can't see the other crisis that'll come if they avoid that one.
And so when, when we're planning for a crisis, like, just like you say, we're planning for the crisis that's likely [01:23:30] to do the least amount of harm. We're anticipating that some amount of crisis is, uh, unavoidable in this situation, so how do we sort of force things to come to a head in a contained way?
Almost like, um, a controlled burn in [01:23:45] wildfire management, right? You, you purposely do the controlled burn because if you don't, then you're gonna have a bigger forest fire that's out of control.
[01:23:52] Kristopher: Hey, I like the controlled burn analogy. That's a good one.
[01:23:56] Stephanie: Well, it's fun to talk shop with you a little bit. I mean, I know we're talking about some really dark [01:24:00] stuff, but, um, this is our, this is our day-to-day work.
People definitely need these tools and concepts. I'm really grateful for what you're doing. So what do you say to people... I mean, you must get referral requests all the time. Uh, you know, like I say, I, I don't [01:24:15] even know if I have that many more psychiatrists on my referral list besides you, and you're in Florida.
So, um, what do you say to people looking for a psychiatrist that they can trust?
[01:24:29] Kristopher: Well, I try to [01:24:30] find someone who is a good psychiatrist but is under the radar, and there are a lot out there, so that's... So this, for one, you know, there, there's more than you think. Uh, I know, you know, in my area that, that there's a lot of good psychiatrists and, and, [01:24:45] and, uh, you know, they...
But most of them are just busy practicing, so they, they, and many of them kind of would Uh, speak up if they were asked, but no one ever asks them and they're just busy, you know, living their life. So there are clinicians out there. Um, unfortunately, [01:25:00] you know, yes, not as many taking a public stand. Uh, there's-- depending on where you're at, you know, that you may be really hard to find.
Uh, you know, I have very limited space to see, you know, so I basically don't usually take, uh, clients, you know, individually. I, [01:25:15] I'm just, uh, running my resident clinics and, uh, doing my correctional work and trying to fight this battle through, you know, forensic work and public advocacy. Um, so I don't have much space myself even.
Uh, so yeah, it's a, it's [01:25:30] a difficult issue, but there are better pr- there are providers out there. Uh, usually old-time psychiatrists usually get it. Many of them don't wanna be involved with this fight, but they lived through an era where we didn't really have this as a problem, so they-- that's act-actually a [01:25:45] pool that usually...
And many of them are more trained in therapy than the current generation of psychiatrists, so they a-actually, you know, are more able to, you know, u-use the therapeutic tools, the psychotherapy tools, uh, that, you know, are really the most appropriate response, [01:26:00] unless there's some clear, you know, indication for medication.
It's, it, uh, you know, usually that's not a, um, main part of treatment in these cases, so yeah. I mean, most of the kids are on medicines, but they're usually on medicines and it didn't really help very much, and here we are, [01:26:15] right? If medicines were such a, a panacea, they wouldn't have kept having all the struggles that they have.
But yeah, and unfortunately, it's a, it's, uh, not easy to find a good provider.
[01:26:24] Stephanie: All right. Well, thank you for being one of the trustworthy ones. Dr. Kalebe, where can people find you?
[01:26:29] Kristopher: Well, I do [01:26:30] have @drkalebe on X. I have a Substack under my name and, uh, you know, there's a few articles, uh, floating around that I've written.
Uh, you can actually probably find a bunch of my forensic reports too if you Google my name. Many of them are publicly [01:26:45] available, so I'm out there.
[01:26:46] Stephanie: And thank you for your work with, uh, the HHS review as well. And I'll just remind listeners one more time, if you wanna hear more from Dr. Kalebe on this podcast, he previously appeared on episode number 158, so I'll include that link in the show notes as well.
Thank [01:27:00] you so much, Dr. Chris Kalebe. Good to see you, as always.
[01:27:03] Kristopher: Great seeing you too, Stephanie.
[01:27:06] Stephanie: Thank you for listening to You Must Be Some Kind of Therapist. If you enjoyed this episode, kindly take a moment to rate, review, [01:27:15] share, or comment on it using your platform of choice. And of course, please remember, podcasts are not therapy, and I'm not your therapist.
Special thanks to Joey Pecoraro for this awesome theme song, Half Awake, [01:27:30] and to Pods by Nick for production. For help navigating the impact of the gender craze on your family, be sure to check out my program for parents, ROGD Repair. Any resource you heard mentioned on this [01:27:45] show, plus how to get in touch with me, can all be found in the notes and links below.
Rain or shine, I hope you will step outside to breathe the air today. In the words of Max Ehrmann, "With all its sham, [01:28:00] drudgery, and broken dreams, it is still a beautiful [01:28:15] [01:28:30] world."