Gatekeeping, and the Assumption of Morality
It can be hard not to push ourselves into everything we see, sometimes. Heavens know, I have a hard time not at least visualizing myself as a part of the story, no matter what it might be. That’s one of the requirements of empathy, after all — to be able to at least look at how a situation might relate to us, or how other peoples’ circumstances do. It’s imperfect in part because the data we have is always going to be incomplete: we can’t simulate another person’s thought process, not least if we’ve never actually met them. The diversity of the human experience simply doesn’t allow for it. And that causes us to fill in gaps with our own experience, and… well, the phrase ‘lost in translation’ is a good one. Or possibly lost in transition. And the more leaps one has to make between subject and audience, the more chances there are for what was originally a full picture to become distorted, warped, and more like a patchwork quilt than anything whole.
So when I say that I don’t know what Jamie Reed was thinking when she provided the now-infamous article (warning: the entire website is a cognitohazard) to the ‘Free Press’, I do mean that in a handful of ways. As what she calls a case manager at a hospital treating trans youth, she admits to having very sparse interaction with patients, along the lines of exchanging a few words. Similarly, she has little information on what patient history might entail, what counselors might have been worked with, how long the patients had been dealing with gender issues. She does know the general distribution of how patients were defined by doctors earlier in their lives. So I don’t know what her thought processes were, but it strikes me as likely that she was filling in a lot of gaps herself. And if I were to take the articles following at face-value, so too would I be.
But one line in a recent NPR show, which had a brief interview with her, does make me wonder about something, to which I suspect I already have an answer:
JAMIE REED: The documents that I believe the doctors were working under were routinely cast aside and considered on some level suggestions. Which from a medical perspective felt like it was whatever the doctor decides at that day in time goes. And there was no operating framework or guideline to provide this care.
How does Reed make this claim? She has no access to doctor-patient privilege. If a patient has a referral after visiting quite a few doctors (and it does typically take a few), perhaps their history will speak of a more dire need to obtain assistance immediately than would otherwise be the case. Perhaps they are more or less dysphoric than others, something which is very difficult to say for sure precisely because we mask. For some, the situation may even be critical: in a study by the Williams institute, 51% of adults were said to have attempted suicide at one point in their lives, and youth are much more at risk due to any number of different factors.
Reed, however, took a specific, sparse data set and filled in the holes based on preconceptions which she had no call to make... and possibly data from untrustworthy sources. Coming to a conclusion following that, she quit her job at the hospital and moved on to expressing her concerns publicly, blowing a whistle at the hospital’s practices.
More of a dog whistle, really. But it could be worse. She could have stayed.
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As Abigail Thorn has recently put it in her video about finding care from the NHS, there are a lot of steps involved in finding care with regards to gender dysphoria, dysmorphia, or even simply transitioning.
(Note: one does not have to have any kind of dysphoria to choose to transition. For a lot of us that strongly informs the choice, but some folks just feel more comfortable on the other side of things, or somewhere in between, or not even at all.)
There’s more than a lot to unpack in her video about a broken system where everyone involved is mad in some fashion or another — the Catch-22 references are brilliant, by the way — but my biggest takeaway is this:
At every stage of care, there is someone who can stop it.
Thorn specifically references one of the first GPs to whom she went. The GP said that they would be so kind as to forward a referral. Then they didn’t. They made excuses, they claimed to have lost important paperwork, etc. The clock continued to tick away, and finally it became vitally clear that the GP simply did not want to do it. Care was, at that point, halted, until other avenues were explored.
Similarly, there are ways in which a person can become a clog in the works no matter how small their part is in a cycle. Take the point of a receptionist who simply doesn’t want to let trans people have care. Oh, there might be any number of reasons. They may feel a moral need to prevent that from happening. They may, perhaps, be beholden to others who feel that way (though that’s a train of thought I shan’t be delving into tonight). Maybe they’re just tired and forgetful and things get lost in the passthrough. Once again, I can’t say because I’m not privy to the circumstances. The end result, however, is the same: care proceeds, or doesn’t, based on one person. Then another. And another.
In most of the medical industry, there’s comparatively little gatekeeping outside of proper medical practice. Just as many involved, but they don’t seem to run into as many concerns. Hip replacements get shunted through with a dance. Nose jobs, nose problem. Butt implants? 2B or not 2B, that is the question. Okay, that’s enough of that. But the point is, for the most part, most of these are incredibly life-changing (and frequently irreversible) and yet have few gatekeeping points. So what’s the deal?
In the title of this piece, I mentioned morality, and here’s where that comes in. Because there’s another specific medical practice in which clogs seem to appear in rapid and recurring fashion. To wit: abortions. And the parallels are stark.
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Gatekeeping as a word refers to the idea that a person is standing there at a gate, and can open or close it to block the path as they see fit. The gatekeeper is the sole arbiter of progress, and requires a set of rules to be fulfilled before the gate is opened. In the canonical definition, these rules are frequently arbitrary: as the theoretical shift moves over, one gatekeeper might let a person through under entirely different circumstances than the last. One can get waived through if they know the gatekeeper well. Or, for that matter, in this analogy, bring a six-pack of their favourite beer. (Ah, the joys of privilege.)
So let’s take a look at abortion, and this Mother Jones article from back in 2014 — yes, before Dobbs, before Roe v. Wade was overturned — how literal judges were engaging in their own form of gatekeeping to keep youth from having abortions, all in the service of morality.
EACH YEAR, HUNDREDS of girls in Florida petition judges for permission to have abortions; the nationwide number is likely in the thousands. But those statistics only include the girls who make it to court. Poorly trained court staff, anti-abortion judges, and a spate of increasingly restrictive laws have made it harder than ever for minors to exercise their legal rights.
Abortion foes have pushed for new restrictions because they believe the process, which is known as judicial bypass, is simply a loophole girls use to avoid talking to their parents. “Judges are rubber-stamping these requests,” Ohio Right to Life warned in a press release in 2011, just after John Kasich, the state’s new Republican governor, signed a bill making the bypass process stricter.
But a review of more than 40 cases, along with interviews with minors and their attorneys, reveals that in much of the country, obtaining a judge’s approval to get an abortion is a mammoth struggle.
This all sounds very familiar.
Now, for gatekeeping on abortion, the obvious goal is right there: run out the clock. Come to a point where the subject is unable to abort due to general refusal to proceed, and no matter what certain elements might say, nobody does 3rd-trimester abortions without a profound need. The baby remains alive, that’s the important thing, no matter whether it’s dead of starvation and exposure 6 months later after their progenitor’s booted onto the streets.
Or the parent kills themselves. Because that happens, you know. It happens a lot.
(Also, I use ‘it’ here because to a certain class of person, the baby is an object.)
So here we bring it together. For trans folks, the pattern of gatekeeping (by everyone!) for dubious reasons (morality!) until it’s too late (or seems to be) goes by a very different name these days. It’s one which speaks its roots even as it’s repurposed in a pseudomedical context. It’s called ‘desistance’, and it originally refers to rates of criminals who stop committing criminal acts. A lovely term, right?
Now it’s used in conversion torture to describe those who choose not to transition anymore, so you can see some obvious priors, if you’re paying attention at all.
Where the two come together is that for a lot of trans folks, eventually we just give up. There are too many obstacles. Too many gates being kept with functionally insane rules. Too feminine. Not feminine enough. Too masculine. Doesn’t want surgery? Wants it too soon. Or of course, the classic ‘too young / too old’ dichotomy.
For many of us, we then give up on ourselves.
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So what’s the main point here? Mostly that in certain methods of care — abortions, AIDS, women’s health, gender care, etc. — there are arbiters at every stage of the process, even on the simplest of levels, and ostensible morality takes its toll at every step, until it’s often too late.
Far too many people like Reed think that their morals are sufficient cause for them to deny other people treatment at a glimpse (or seek denial of care), when they know nothing about the actual case or the person behind it. And I do mean a glimpse — not even a glance, just the equivalent of a moment’s perception through the corner of an eye.
They don’t know what the other person’s thinking, how their life got to be that way. But they’ve chosen to arbitrate anyway, unable to step out of the situation and recognize that they’re not a part of it. They fill in the gaps and they make their decisions based on that.
Their seeming morality empowers them as the gatekeepers, and the more steps there are in the process, the more likely it is you’ll run into one — and when you do, they’ll shut everything down. It’s not even hard.
They just have to… stop.
