Extraordinary Popular Delusions and the Madness of Crowds, Redux—WPATH Edition

Leaked documents from World Professional Association for Transgender Health practitioners reveal a medical profession in the grips of an ideology-driven social contagion

In an early study of crowd psychology, Extraordinary Popular Delusions and the Madness of Crowds (originally published in 1841 and still in print), the Scottish journalist Charles Mackay documented such delusions as alchemy, fortune-telling, haunted houses, magnetizers, religious relics, and prophecies, and the mad crowds that fell for economic bubbles like the Dutch tulip mania, the Railway Mania, witch crazes, and the South Sea Bubble. “Men, it has been well said, think in herds; it will be seen that they go mad in herds,” Mackay observed, “while they only recover their senses slowly, one by one.”

The redux of my title includes such such popular delusions of the past half century as the Subliminal Messages scare, the Satanic Panic, the Recovered Memory mania, the Self-Esteem movement, the Multiple Personality craze, the Left-Brain/Right-Brain fad, the Mozart Effect mania, the Vaccine-Autism furor, the Super-predators fear, the Drug Abuse Resistance Education (DARE) program that increased teen drug use, the Scared Straight program that made adolescents more likely to offend, the Critical Incident Stress Debriefing (CISD) programmed that worsened anxiety and symptoms of post-traumatic stress disorder (PTSD), and many more that have plagued psychology and psychiatry.

The latest of what is likely to be added to this pantheon of popular delusions embraced by mad crowds is the trans movement as a whole and Rapid Onset Gender Dysphoria in particular, as revealed on Tuesday March 5, 2024 by Michael Shellenberger, Mia Hughes, and their colleagues at Environmental Progress in a 242-page document titled The WPATH Files: Pseudoscientific Surgical and Hormonal Experiments on Children, Adolescents, and Vulnerable Adults. “The World Professional Association for Transgender Health (WPATH) enjoys the reputation of being the leading scientific and medical organization devoted to transgender healthcare,” the authors note. However, after reviewing hundreds of leaked internal documents revealing shocking levels of uncertainty, ignorance, and devotion to outdated and debunked pseudoscientific theories, therapies, and practices, the report’s authors conclude that the opposite is true:

Newly released files from WPATH’s internal messaging forum, as well as a leaked internal panel discussion, demonstrate that the world-leading transgender healthcare group is neither scientific nor advocating for ethical medical care. These internal communications reveal that WPATH advocates for many arbitrary medical practices, including hormonal and surgical experimentation on minors and vulnerable adults. Its approach to medicine is consumer-driven and pseudoscientific, and its members appear to be engaged in political activism, not science.

We devoted an issue of Skeptic to “Trans Matters” (Vol. 27, No. 1) that included an especially thoughtful, sensitive, and deeply-researched cover story by Lisa Selin Davis, “An Overview of the Debate, Research, and Policies”, documenting the massive spike in patients reporting gender dysphoria over the past decade (this data is from a gender clinic in British Columbia but rates are comparable elsewhere). Before 2015, most trans were young boys who identified as female; after 2015 most trans were adolescent girls identifying as males.

As I read the research, the Before Time (pre-2015) was very likely recording real instances of gender dysphoria (GD) in very young children and at a vanishingly rare rate well below 1%; the After Time (post-2015 to today) is very likely a phenomenon called rapid-onset gender dysphoria (ROGD), a label coined by the physician and public health researcher Lisa Littman, after she discovered in her exploratory study based on parental reports that entire peer groups of adolescents and teens were declaring themselves to be transgender, after immersion in social media or exposure in classrooms in which sizable proportions of students identified as anything but cisgender and straight. With watchful waiting and compassionate support for these adolescents, and dealing with their underlying issues of body dysphoria from puberty, autism, anorexia, and normal teen anxiety, sadness, and stress, the vast majority grow out of their self-identity of “being in the wrong body” and/or realize that, in fact, they are gay or lesbian.

Unfortunately, watchful waiting and compassionate support is not a practice that WPATH appears to recommend to medical and psychological practitioners; instead, “gender affirming care” calls for them to go along with whatever their (almost always) underage patients tell them that they want, which is often invasive, irreversible, and life-changing Hormone Replacement Therapy (HRT) and/or surgery, including the amputation of healthy breasts in females (a double mastectomy, or “top surgery”) and the surgical removal of otherwise healthy genitals and reproductive systems that will never again function normally (“bottom surgery”). Detransitioners—those who transitioned then changed their minds and sought to return to their “assigned at birth” sex (a number that is growing by the month)—are discovering that they can never have biological children (they’re told “don’t worry, you can always adopt”), can never breast feed (they’re told they can “strap on” milk-delivering faux-breasts and become “chest feeders”), and can never experience the full range of normal sexual functioning, including orgasms, not to mention numerous drug side-effects, surgical complications, infections, mounting medical bills not covered by insurance, and the like. As the authors of the WPATH Files note:

This report will show that this is a violation of medical ethics and, as is revealed by its own internal communications, WPATH does not meet the standards of evidence-based medicine. It will further show that the ethical requirement to obtain informed consent is being violated, with members admitting that children and adolescents cannot comprehend the lifelong consequences of sex-trait modification interventions, and in some cases, due to poor health literacy, neither can their parents.

Before I review some of these documents, let me note that I have covered this topic before in this column, for example, answering the question “What is a Woman, Anyway?”, on the trans swimmer Lia Thomas in particular, and on trans athletes in female sports in general. I personally know two (MTF) trans adults who transitioned well into adulthood and are happy they did so, I recognize that there are people who genuinely experience GD (which is different from ROGD), and I stand by my statement in the last column that:

Of course we should support trans rights for the same reason we support the rights of people of color, women, and gays: it is immoral (and in many cases illegal) to discriminate against someone based on such immutable characteristics as skin color, gender, and sexual preference, so gender identity should be included in our ever-expanding moral circle and our ever-bending moral arc. The problem arises when there are conflicting rights claims.

In the WPATH Files what we see is the rights of underage adolescents and vulnerable adults being violated by the very people tasked with protecting them, so I agree with the authors’ call for “the U.S. government to oversee a bipartisan national inquiry to investigate how activists with little respect for the Hippocratic Oath could have risen to such prominence as to set the Standards of Care for an entire field of medicine, leading to the medical abuse of minors and vulnerable adults.”

What follows are some of the more revealing—and in many cases egregious—examples of uncertainty, ignorance, and embrace of pseudoscientific ideas revealed in the “semi-private conversations inside WPATH’s internal online forum for discussing specific medical cases,” along with my comments (below each screen shot):

Note that this post is from Marci Bowers, often tagged as “the world’s preeminent ‘gender-reassignment’ surgeon” and who self-identifies as “a woman with a trans history” (i.e., a Male-to-Female [MTF] trans), revealing that medical professionals had no idea of the consequences of transitioning youth. The correspondent inquires about the consequences for fertility and orgasmic response post transition. “The fertility question has no research that I’m aware of,” Bowers admits, but suggesting that puberty blockers will “preclude those opportunities.” Oh is that all? What about orgasms? Again, Bowers is “unaware of an individual claiming ability to orgasm” after puberty blockers. Say again?

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Here is a man (AMAB = Assigned Male at Birth) who self-identifies as a non-binary female who is taking Cialis/Viagra (presumably to enhance his—sorry, her—erections) who wonders if they breast feed their 7-month old will the meds get into the infant’s system. Apparently the amounts would be so small that the infant would not experience “any adverse effects” such as, what, erections?

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Here's a therapist who practices EMDR (Eye Movement Desensitization and Reprocessing), the long discredited treatment for PTSD/trauma. These people are years behind the science. A 2022 literature review, for example, concluded: “Taken as a whole, this small body of work suggests that eye movements do not reliably affect susceptibility to misinformation, nor do they appear to enhance memory, but they do seem to increase spontaneous false memories.” False Memory Syndrome is the correct interpretation of what was happening in the 1990’s Recovered Memory Movement in which adult patients in psychotherapy were convinced by quack therapists that they had been sexually molested as children, even though the patients had no memory whatsoever of such abuse, nor was there any corroborating evidence such crimes ever occurred. Astonishingly, there were cases of aging parents who were tried, convicted, and imprisoned for sexual molestation based on nothing more than bogus “recovered memories,” a mass hysteria that came to an abrupt end when lawyers sued therapists for malpractice. See Carol Tavris’s account of this madness here.

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Here is a discussion of Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder (MPD), explaining that consent for transitioning must be obtained from each "alter" (alternative personality). DID and MPD is a bogus diagnosis. There is no such thing as multiple personalities, so there can be no "alternate" personalities to give consent. The entire diagnosis was founded on two famous cases that turned out to be fraudulent: Sybil and Eve (as in The Three Faces of Eve). The real Sybil—Shirley Mason (played by Sally Field in the film version)—admitted she made it all up: "I do not really have any multiple personalities. I do not even have a 'double.' ... I am all of them. I have been lying in my pretense of them." As for Eve, the real woman was Chris Costner Sizemore (played by Joanne Woodward in the film rendition), and her three faces eventually transmogrified into over 20, until a book revealed that the psychiatrist who diagnosed her was sexually and financially abusing her. Nevertheless, such quack diagnoses didn’t stop this surgeon from cutting off the healthy breasts of a DID woman, or carving out fake vaginas in two DID men:

For a complete debunking of these and additional bogus psychological theories, therapies, and treatments, see 50 Great Myths About Popular Psychology by the late Scott Lilienfeld and colleagues, and his more scholarly debunking in Science and Pseudoscience in Clinical Psychology. Skeptic’s own columnist Carol Tavris has debunked these and more quack psychology in our pages (for example, see her article on trans issues here).

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This post-op trans woman (a man) later "discovered that I was not suffering from any actual pathology related to being trans.” Yet, she claims to still experience cPTSD, ADHD, anxiety, and depression. O-kay.

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This exchange shows a practitioner reasonably conflicted about starting a patient on HRT (Hormone Replacement Therapy) with so many problems, but is nevertheless told it’s “the right thing to do”!

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Here a WPATH member complains that their client was denied insurance coverage for surgery until completing a year of HRT, stating that they think the patient needs surgery “for her physical and mental health, along with her safety.” Safety?

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This surgeon isn’t sure how to handle patients requesting “non-standard” procedures, such as top surgery without nipples (“non-binary” means “non-nipples”?) and “phallus-preserving vaginoplasty.” The latter is non-standard indeed, inasmuch as normal vaginoplasty involves removing the penis, testicles and scrotum. This patient apparently wants both. In a follow-up missive Dr. Satterwhite explains: “With every patient I operate on, I always take a patient-centric approach and I let my patient lead the journey (not me).” Therein lies the problem when you’re dealing with underage patients who are otherwise not allowed to drive, drink, smoke, vote, serve in the military, get tattoos, and more. Why would anyone—much less medical professionals—think that adolescents could make adult decisions about such life-altering treatments?

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Note not only the age of onset of this condition (non-binary), 13, or that the testosterone request comes from the child and not a parent, guardian or medical professional, but that on top of all that this kid is purposefully starving themselves to look “more non-binary”. Presumably this means anorexia. Whatever this youngster is experiencing it is not going to be ameliorated by transgender medical treatments. This is medical malpractice, pure and simple, and it has to stop.

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I could go on and on with dozens more such revelatory correspondence from the WPATH Files, so let me close with this observation from John Mackay, who presciently put his finger on the problem we are experiencing today: “We find that whole communities suddenly fix their minds upon one object, and go mad in its pursuit; that millions of people become simultaneously impressed with one delusion, and run after it, till their attention is caught by some new folly more captivating than the first.”

I have little doubt that when the ROGD trans social contagion runs its course it will be replaced by something else, but without politicians or attorneys intervening in the meantime I am not at all confident that the WPATH community is capable of self-regulation and course-correction away from the flagitious path they’ve been on. Still, in the long run, optimist that I am, I hope lessons will be learned from this episode, as they were with the aforementioned previous popular delusions; and with that hope I will give the last word to Mackay:

Let us not, in the pride of our superior knowledge, turn with contempt from the follies of our predecessors. The study of the errors into which great minds have fallen in the pursuit of truth can never be uninstructive. As the man looks back to the days of his childhood and his youth, and recalls to his mind the strange notions and false opinions that swayed his actions at the time, that he may wonder at them; so should society, for its edification, look back to the opinions which governed ages that fled.

Amen, brother.

Michael Shermer is the Publisher of Skeptic magazine, Executive Director of the Skeptics Society, and the host of The Michael Shermer Show. His many books include Why People Believe Weird Things, The Science of Good and Evil, The Believing Brain, The Moral Arc, and Heavens on Earth. His latest book is Conspiracy: Why the Rational Believe the Irrational. His next book is: Truth: What it is, How to Find it, Why it Matters, to be published in 2025.