In this paper, I review the evidence for social contagion of gender dysphoria in adolescents and the contagion evident in associated professions and professional bodies. I begin with a review of the historical phenomenon of social contagion, demonstrating that it predated the digital age. I then review the nature of social contagion and the mechanisms by which certain phenomena are propagated through social networks. Social network analysis, the method applied to study contagions of all kinds, was first developed and used in public health as a way of determining the spread of diseases. For the spread of social phenomena among adolescents, three mechanisms – peer contagion, deviancy training and co-rumination in peer groups – have been identified as “spreaders.” Four possible causes of peer effects – endogenous, exogenous, correlated and social media – all amplify the spread of information in a social network. Four areas of empirically established social contagion in adolescents – marijuana use, eating disorders, suicide and emotion – are presented as a prelude to the discussion of how the same processes are at work in the social contagion of gender dysphoria in adolescence. Specific mechanisms of transmission such as low gender typicality, peer victimization, ingroups, the trans-lobby, and the role of social media in rapid onset gender dysphoria (ROGD) in adolescents and the role of social media are proposed. Preliminary statistical support for social contagion in gender dysphoria are presented. I conclude with a discussion of how social contagion affects medical, legal educational and sporting institutions and their role in the propagation and perpetuation of gender dysphoria in young people.
Keywords: social contagion, gender dysphoria, transgender, adolescents, professional bodies
Introduction (or Go To Full Article Here)
“Gender identity” [is defined] as “a person’s internal sense of being male, female, or something else [author’s italics] (American Psychological Association).
Although it is tempting to blame the phenomenon of social contagion on the digital age, in which people, young and old, remain symbiotically tied to their social media devices, eagerly scanning their screens for the latest news, fashion, holiday location, rave party, or dating site to assuage their “fomo” (i.e., fear of missing out), social contagion predated the advent of the cyberage, thereby placing its origins squarely in the minds of humankind, thus assigning social media to its role as one of many efficient conduits.
Social contagion before the digital age abounds. In 1774, Johann von Goethe (1990) published a novel, The sorrows of young Werther, in which an idealistic young man finds his actual life too difficult to reconcile with his poetic fantasies, including his unrequited love for his friend’s fiancée. He eventually becomes so depressed and hopeless by the perceived emptiness of his life, he commits suicide. Goethe was able to capture the nameless dread and endless longing of the human condition so well that his novel spawned a number of suicides, committed in the same way that Werther had killed himself, by shooting (Phillips, 1974). Such was the alarm created by this phenomenon, the book was banned in several European cities.
More than two hundred years later, in 1984, the suicide of a young Austrian businessman, who threw himself in front of a train, initiated a spate of similar suicides that averaged five per week for nearly a year. Sociologists argued that this alarming occurrence was amplified by media coverage that glamorised suicide by providing graphic images of the suicidal act and details of the young man’s life. When media exposure of the event was curtailed and then stopped completely, the suicide rate dropped by 80 percent almost immediately. Although the influence of suggestion and imitation on suicide rates was dismissed by Durkheim (2005/ 1897), Phillips’s (1974) work indicated that these factors do indeed play a significant role in the increase in suicides following a publicised suicide.
In 1841, a Scottish journalist, Charles Mackay (2012) wrote a book entitled Extraordinary popular delusions and the madness of crowds. In the preface to the first edition of the book, the aim of writing it is stated thus:
…to collect the most remarkable instances of those moral epidemics … to show how easily the masses have been led astray, and how imitative and gregarious men are, even in their infatuations and crime (p. 1)…Popular delusions began so early, spread so widely, and have lasted so long, that instead of two or three volumes, fifty would scarcely suffice to detail their history… The present may be considered…a miscellany of delusions, a chapter only in the great and awful book of human folly (p. 3).
The preface to the second edition in 1852 continued this theme:
Nations,… like individuals, …have their whims and their peculiarities; their seasons of excitement and recklessness… whole communities suddenly fix their minds upon one object and go mad in its pursuit; …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. At an early age in the annals of Europe its population lost their wits about the sepulchre of Jesus and crowded in frenzied multitudes to the Holy Land; another age went mad for fear of the devil and offered up hundreds of thousands of victims to the delusion of witchcraft… the belief in omens and divination of the future… defy the progress of knowledge to eradicate them entirely from the popular mind… Men… think in herds; …they go mad in herds, while they only recover their senses slowly, and one by one [Author’s italics] (p. 7).
Mackay’s book is about popular delusions and the madness of crowds. Today, we use the term social contagion to describe the “spread of phenomena (e.g., behaviours, beliefs and attitudes) across network ties” (Christakis & Fowler, 2013, p. 556). Using very large datasets (e.g., Framingham Heart Study) that have collected longitudinal data on original participants (Original cohort), as well as their children (Offspring cohort) and their children’s children (Third generation cohort) and including their spouses, siblings, friends and neighbours, Christakis and Fowler have shown that social network effects, known as clustering, remain strong and can extend to those up to three degrees of separation from the original cohort. Such effects have been demonstrated across a large range of factors by different researchers using differing datasets. Examples include overweight/obesity, sleep patterns, smoking, alcohol abuse, alcohol abstention, marijuana use, loneliness, happiness, depression, cooperation, and divorce among others.
Social network analysis, the method applied to study contagions of all kinds, was first developed and used in public health as a way of determining the spread of diseases (e.g., influenza, HIV/AIDS) that resulted in pandemics. It was subsequently applied to the challenges of introducing changes and innovations in the health system (Blanchet, 2013). Its applications have since expanded with the advent of computers, the internet, mobile and smart phones, and social media. Members of a network play different roles in the dissemination of innovations. A small number will adopt early (i.e., early adopters). Some of these will become opinion leaders who are central to the network who contaminate their “peers” (homophily) who in turn will influence those others at different levels of the network.
There are three types of social networks; (i) egocentric (networks assessing a single individual); (ii) sociocentric (social networks in a well-defined social space, such as a hospital or a school); and (iii) open system networks (e.g., globalised markets, social media). Each network consists of nodes (members), ties (between nodes), and measures of centrality, density and periphery or distance between the nodes. Networks with high centrality are the most effective in disseminating information or innovation. A key example with respect to this discussion is the transactivist lobby that has achieved spectacular success in a short time in changing health care, educational practices and legislation related to transgender individuals. Other characteristics of networks include cohesion (number of connections within a network) and shape (distribution of ties within the network) (Otte & Rousseau, 2002).
In this article, I explore the influence of social contagion on the disquieting upsurge in the number of children and young people whose parents are presenting to gender clinics around the world for advice regarding social transition, puberty blocking agents, cross sex hormones, and ultimately surgery in an attempt to change their gender. First, I examine the concept of social contagion and the mechanisms by which it influences behaviour and attitudes. Then I review four key adolescent behaviours that have been shown to be subject to social contagion. I then argue that the most heuristic explanation for the rapid increase of young people who believe that they are transgender and consequently seek irreversible medical remedies to assuage their gender dysphoria is social contagion. Finally, I explore the social contagion (i.e., clustering) of medical practice with respect to treatment of gender dysphoria, the precipitous policy making in professional bodies and legislation appearing in its support, and changes to policy and practice in education and sport despite our collective failure to date to fully understand the phenomenon of gender dysphoria and its rapid, epidemic-like spread in the Western world.