jacquic: (Default)
[personal profile] jacquic
I posted here (f-locked) about an article by Julie Bindel and a refutation that [livejournal.com profile] steerpikelet is writing. I had read the article after reading some of the arguments on [livejournal.com profile] steerpikelet's post, and my reading of it was coloured by them. I understood her to be arguing that claiming that gender dysphoria exists implies acceptance of outdated gender stereotypes. But some of the comments on my journal made me question my understanding; and now I'm not sure what I think.

The points arguing against Julie Bindel have been explored very thoroughly in [livejournal.com profile] steerpikelet's post and the comments on it. But some of the points that commenters on my earlier post made I think are valid; for example:

- The author doesn't express herself very coherently. But in my view, how we handle that lack of clarity says as much about us as about her.

- I see the author as asserting that we shouldn't offer the fantasy of a "sex change" to everyone who feels they were born the wrong sex, because a) the procedure is very imperfect and b) there's no "robust scientific evidence" that it resolves gender dysphoria.

- I think Bindel presents a very balanced argument and the central point (as I see it) remains true: gender surgery doesn't change your sex. Only DNA reassignment could achieve that.

- I would also suggest that gender reorientation is body mutilation - you remove functioning organs and replace them with a non-functioning simulcrum of the opposite organ. I wouldn't say that all body mutilation should be avoided, but I do think doctors have a greater responsibility to ensure this is really what the patient wants before proceeding

- I do think that gender is defined by society and so reoriented men and women should be treated as being their chosen sex; however, I also think that transvestites should be, and that way there is no need for surgery. People should just define themselves as they please. (This wonderful piece of logic from [livejournal.com profile] rickbot)

The ever-useful (this is a compliment!) [livejournal.com profile] friend_of_tofu pointed me to this article from November 2008 on a similar topic. [livejournal.com profile] friend_of_tofu describes this article as being offensive and unpleasant, but reading it with fresh eyes, I'm not sure it is. (By which I mean to say, not that I think it is inoffensive and pleasant, but that I actually don't know whether I think it is offensive and unpleasant or not.)

From this November 2008 article: I questioned whether a sex change would make someone a woman, or simply a man who has had surgery.

Seems to me a sensible question to ask. Putting aside her views that the surgery is regrettable in retrospect, even if we were assuming (equally without evidence from my point of view) that it is always successful and the people who have it are happier (yes, I so agree with [livejournal.com profile] herringprincess when she says that the NHS is here for our mental health as well as our physical health), male to female trans people are, factually, people who were born men and have had surgery to cure gender dysphoria, and who are now treated by society as women.

I think that if someone is a woman in how they feel and how they are seen then they should be allowed to work in a female-only rape crisis centre (whether they've had surgery or not), but this is somehow irrelevant to the central question. After all, they should also be good at dealing with the job as well; and there are plenty of women (whether born male or female) who wouldn't be.

Date: 2009-10-31 09:49 am (UTC)
From: [identity profile] friend-of-tofu.livejournal.com
Some bits I thought were offensive and deeply untrue (not exhaustive), and only partly related to offensiveness to trans people:

We became "lesbian and gay", but soon bisexuals shouted, "Us too".

Transsexuals, having received short shrift from heterosexual society, asked to be included in our rainbow alliance

Queer (anyone who is into "kinky" sex)

I for one do not wish to be lumped in with an ever-increasing list of folk defined by "odd" sexual habits or characteristics. Shall we just start with A and work our way through the alphabet? A, androgynous, b, bisexual, c, cat-fancying d, devil worshipping. Where will it ever end?

Date: 2009-10-31 11:57 am (UTC)
From: [identity profile] jacquic.livejournal.com
Yes, that is offensive; but it seems to be quite offensive to all of us! I think she's maybe just got a different idea about society from me.

Sure it might be nice for LGBT people to get together, but I must say that I don't lump them all together in my head, whatever she thinks. We are all lumped together under the umbrella of "humanity" and subdivisions within that are going to be somewhat arbitrary, whether by gender or sexuality or race - there's always someone who doesn't fit into one of the categories.

Date: 2009-10-31 09:49 am (UTC)
freya: (Default)
From: [personal profile] freya
I have never seen it as anything other than common courtesy to refer to people as they ask to be referred to, to not inquire as to anybody's genitals, to not question anybody's right to use gender specific equipment/services providing they are not abusing it.

There is of course the specific understanding of trans issues, and that sort of thing requires research, experience and the patience of people willing to explain, but the main issues and prejudices are just people being wilfully rude.

Date: 2009-10-31 10:57 am (UTC)
From: [identity profile] quizcustodet.livejournal.com
I have never seen it as anything other than common courtesy to refer to people as they ask to be referred to, to not inquire as to anybody's genitals, to not question anybody's right to use gender specific equipment/services providing they are not abusing it.

I agree with this sentence entirely up to 'to not inquire... genitals', but I'm not sure that the second half of the sentence is nearly as clear cut.

It seems (to me) pretty obvious that in the case of bathrooms, trans people ought to be able to use whichever gender's bathroom they prefer as I can't perceive any real harm in that to anyone else. But I don't think that that's as clear in regards to a rape crisis centre or similar: I would think that we have to take some allowance of other people's right not to have someone they regard as from the threatening gender in what is meant to be a 'safe space' and reassuring space for the person recently raped.

Surely in regard to gender specific equipment and services we're always going to be balancing one person's right to define their gender with another person's rights, whether to privacy or something else. I think there's quite a big step to assuming that these decisions must always be resolved in favor of the trans people.

Date: 2009-10-31 10:26 am (UTC)
From: [identity profile] rickbot.livejournal.com
I think part of me was tempted to side more with Bindel because I was turned-off by Steerpikelet's post. Bindel offers scientific sources and expresses herself clearly, Steerpikelet titles her piece "For FUCK'S SAKE" and then announces that she's too busy to look into this, but if other people could write the article that would be appreciated.

I think perhaps the trangender community needs to find a better champion.

Date: 2009-10-31 11:59 am (UTC)
From: [identity profile] jacquic.livejournal.com
As always, sensible and concise. Thank you!

Date: 2009-10-31 03:43 pm (UTC)
From: [identity profile] robert-jones.livejournal.com
In fairness to [livejournal.com profile] steerpikelet, her entry itself says that she needs to respond with reasoned arguments and without swearing, but she needs more time and research to pull something decent together.

I do agree though that, "For FUCK'S SAKE" is wholly lacking in persuasive force.

Date: 2009-10-31 10:53 am (UTC)
From: [identity profile] atreic.livejournal.com
I had a big think about these sort of things on my LJ the last time there was a Julie Bindle debate, as I tend to find myself a social leper for sort-of-agreeing with her. Linked in case you find the comments interesting and helpful - I know that I did.

Date: 2009-10-31 11:58 am (UTC)
From: [identity profile] jacquic.livejournal.com
Those are both very interesting - thank you for posting. I shall have a proper read and another think, I think.

Date: 2009-10-31 02:04 pm (UTC)
From: [identity profile] kathrid.livejournal.com
A quote from this post:
"NHS is here for our mental health as well as our physical health"

A comparative quote from the recent article:
"...transsexuals, along with those seeking IVF and cosmetic surgery, are using the NHS for the pursuit of happiness not health."

I think we have the core problem right here. Bindel does not view Gender Dysphoria as something that actually makes people unwell. Her stance makes sense in that case, after all why give people surgery to fix a problem that isn't really a problem for them.

Of course, in this she's basically ignoring the large number of people who suffer extensive psychological problems as a result of their GD, many of whom (in my experience) do feel better when living as their gender of choice and whose mental health improves still further when given the physical treatments available.

I should point out that I'm not sure I know anyone who's actually had surgery, but I know one guy who's on testosterone and have met at least two women who have had some treatment for GD, all of whom seemed fairly happy with the results.

Date: 2009-11-02 05:42 pm (UTC)
From: [identity profile] jacquic.livejournal.com
Ah, yes, very well pointed out. I do know that there are still people who think that poor mental health just requires people to pull their socks up and stop being so miserable... I just often forget this.

PT 1 - the general case

Date: 2009-10-31 03:31 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
Working from first principles:

1: There is something very seriously wrong with anyone who wants major elective surgery to physically and drastically remodel their body. (Note: the above is not intended to be a moral claim any more than it would be to say that someone suffering from pneumonia has something seriously wrong with them).

2: Transsexuals claim that something that is wrong with them is that their biological sex does not match their mental/emotional gender.

3: If the above is true then the purpose of the Gender Reassignment Surgery is to make the biological body match the person as closely as is possible.

4: It is always the part that is breaking that is the important one at the time. And utterly unnoticed the rest of the time. I don't notice the presence of air until I have to do without. I am not in a position to judge based on how I respond whether or not such a problem is likely as I do not suffer from it. And from everything I know of you, you fit your biological gender very well. And as neither of us have either suffered from this condition nor have extremely strong training in that field of psychology, neither of us is equipped to judge whether it is true.

5: Many of the people who are in a position to judge - both transsexuals and experts - have found it to be an extremely useful procedure even if it does involve "body mutilation". Given the strong negative impact of the body mutilation, that it is considered worthwhile gives a strong indication that the gender reassignment itself was a medically useful thing.

Note to anyone I have offended by any of the above: My apologies. My intent is to work from a set of premises that [livejournal.com profile] jacquic will accept readily and that still work.

Date: 2009-11-02 05:45 pm (UTC)
From: [identity profile] jacquic.livejournal.com
I agree. Up to point 5: I simply don't know the evidence. I can believe that it is an extremely useful procedure, and to me this sounds more likely (anecdotally) than the original article's saying that it isn't an extremely useful procedure.

So, yes. More actual data needed.

PT2 - Specific points

Date: 2009-10-31 03:31 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
I see the author as asserting that we shouldn't offer the fantasy of a "sex change" to everyone who feels they were born the wrong sex, because a) the procedure is very imperfect and b) there's no "robust scientific evidence" that it resolves gender dysphoria.

Three bales of straw went into making that argument as far as I can tell. Gender Reassignment Surgery is major surgery that produces an imperfect result and that is massively difficult to reverse. And people get confused at times and think some strange things. When someone is wrongly given Gender Reassignment Surgery the results are tragic in two separate directions - first they damage the body, and secondly they effectively give someone gender dysphoria if they didn't have it previously. I am not aware of anyone with genuine gender dysphoria who would wish it on a random person simply for being confused.

I think Bindel presents a very balanced argument and the central point (as I see it) remains true: gender surgery doesn't change your sex. Only DNA reassignment could achieve that.

And I see an argument from incredibly shaky premises as follows:
1: Biological sex is the same as gender. This is not a premise that is agreed with by anyone suffering from gender dysphoria - if they agreed with it then gender dysphoria could not exist.
2: That biological sex is strictly binary rather than simply having a few highly visible characteristics that are strictly binary (or even not even that.

I would also suggest that gender reorientation is body mutilation - you remove functioning organs and replace them with a non-functioning simulcrum of the opposite organ. I wouldn't say that all body mutilation should be avoided, but I do think doctors have a greater responsibility to ensure this is really what the patient wants before proceeding

Greater responsibility than what? There is a reason that gender reasignment surgery requires psychological councelling when e.g. a prostatectomy only offers it. The greater responsibility is already in place and I don't think that anyone would argue that it should be removed because the mistakes are tragic. (There are many who argue that it should be reformed - but this is a different issue).

- I do think that gender is defined by society and so reoriented men and women should be treated as being their chosen sex; however, I also think that transvestites should be, and that way there is no need for surgery. People should just define themselves as they please.

I agree. I also think that if wishes were horses then we'd have a massive manure problem. And saying that the perfect society would be (whatever) doesn't help people now. Furthermore, biological sex is as matters stand very strongly linked to gender.

I think that if someone is a woman in how they feel and how they are seen then they should be allowed to work in a female-only rape crisis centre

Actually, here I have a lot of sympathy with the centre. The female only clause is because if anywhere needs to be a safe space then a rape crisis centre is pretty close to top of the list. And if rape victims see mtf transsexuals as being men, it will cease to be a safe space. I don't think that this is right - but I think that the situation leading to people needing rape crisis centres is so fucked up that battles should be taken elsewhere first.

Of course, that is not the argument that Bindel has made.

Re: PT2 - Specific points

Date: 2009-10-31 06:09 pm (UTC)
From: [identity profile] editor.livejournal.com
What do you mean when you refer to "three bales of straw"?

Re: PT2 - Specific points

Date: 2009-10-31 06:21 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
The argument is a massive strawman.

Re: PT2 - Specific points

Date: 2009-10-31 06:44 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
"Gender Reassignment Surgery is major surgery that produces an imperfect result and that is massively difficult to reverse. And people get confused at times and think some strange things. When someone is wrongly given Gender Reassignment Surgery the results are tragic in two separate directions - first they damage the body, and secondly they effectively give someone gender dysphoria if they didn't have it previously. I am not aware of anyone with genuine gender dysphoria who would wish it on a random person simply for being confused."

According to JacquiC's summary, Ms. Bindel is making the claim that "we shouldn't offer the fantasy of a "sex change" to everyone who feels they were born the wrong sex". Which as far as I can tell is not something that anyone wants to do for reasons I've gone into above.

Re: PT2 - Specific points

Date: 2009-10-31 07:43 pm (UTC)
From: [identity profile] editor.livejournal.com
If I understand you correctly, you're saying that the implication that sex change surgery is offered to "everyone who feels they were born the wrong sex" is a "straw man" because in reality such surgery is (you argue) offered only to those with genuine gender dysphoria.

If I've got that right, I have to ask: when someone "feels they were born the wrong sex", how is that not "genuine" gender dysphoria?

Re: PT2 - Specific points

Date: 2009-10-31 08:23 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
"And people get confused at times and think some strange things."

It is fairly common for people growing up to go through phases of thinking things about themselves that simply aren't true for a short while. And other people are simply mistaken in what they believe. As for how to tell, I don't know the details and have never claimed to be a professional psychiatrist.

And no, I don't argue that surgery is only offered to those with genuine gender dysphoria. I argue that it should only be offered to people with genuine gender dysphoria - and I have already stated reasons that those with gender dysphoria would probably be among the last people to disagree. Current processes are, regrettably, imperfect when it comes to diagnosis.

Re: PT2 - Specific points

Date: 2009-10-31 09:05 pm (UTC)
From: [identity profile] editor.livejournal.com
So in fact you agree with Bindel that sex change surgery is currently being offered indiscriminately. This being the case, once again I have to ask: where precisely do you see a misrepresentation in the original argument?

Re: PT2 - Specific points

Date: 2009-10-31 09:13 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
You appear to be of the belief that any mechanism to try to work out what is best that does not have a 100% accuracy rate is the same thing as indiscriminately.

And the misrepresentation is that Bindel is claiming that getting the right people for gender reasignment surgery is even slightly controversial.

Re: PT2 - Specific points

Date: 2009-10-31 09:38 pm (UTC)
From: [identity profile] editor.livejournal.com
That surgery is being offered indiscriminately isn't my own conclusion: that's just what I get from the article. If you believe it's mistaken, I won't argue with you: I've seen no first-hand evidence either way.

I am however still perplexed about this "straw man". Bindel's point is that there ought to be controversy, because the acceptance of body dysphoria as a condition appears to challenge a fundamental tent of [a certain breed of] feminism.

Re: PT2 - Specific points

Date: 2009-10-31 10:24 pm (UTC)
From: [identity profile] neonchameleon.livejournal.com
The straw man is that the other side want anything indiscriminate. She's making some very uncontroversial points in the part summarised then doing her best to imply the other side opposes them.

And that is not how I read Bindel at all. When I read her I see her as supporting the breed of feminism that the existance of gender dysphoria challenges. And because it challenges her feminism, it (and not her feminism) must therefore be wrong.

Re: PT2 - Specific points

Date: 2009-10-31 11:36 pm (UTC)
From: [identity profile] editor.livejournal.com
She does have a dubious tendency to hide behind the passive voice (e.g. "supporting the diagnosis and availability of surgical intervention is seen as a view right-thinking liberals should adopt"). But she speaks directly of people being "railroaded into surgery", and cites a doctor arguing that children should be allowed to self-diagnose gender dysphoria. Unless we believe she is fabricating these cases, the indiscriminate offer of surgery (which, to be fair, is at any rate my own extrapolation) is no straw man.

As to your last point: your reading is the same as mine.

Re: PT2 - Specific points

Date: 2009-10-31 10:36 pm (UTC)
From: [identity profile] kathrid.livejournal.com
...the acceptance of body dysphoria as a condition appears to challenge a fundamental tent of [a certain breed of] feminism.

I don't think this is necessarily true. That the idea that GD is biologically based challenges that branch of feminism, I accept.

However, it is entirely possible GD is based in the gender perception of society, some people's inability to fit in with that perception and the resultant mental stress caused when everyone treats you a certain way; which then makes them horrendously uncomfortable with any kind of interaction and eventually leads you to conclude that you are the wrong sex.

At that point GD, while remaining a very real problem for the people who have it, doesn't threaten Bindel's version of feminism at all.

Bindel obviously doesn't believe that GD is biologically caused, but seems to be of the opinion that therefore it can't be a real problem for people, rather than considering this other possibility that our gender-normative society is causing GD in people.

Re: PT2 - Specific points

Date: 2009-10-31 10:53 pm (UTC)
From: [identity profile] kathrid.livejournal.com
Gah. I hate it when I forget what pronouns I've been using half-way through an important sentence or paragraph.

Re: PT2 - Specific points

Date: 2009-10-31 11:40 pm (UTC)
From: [identity profile] editor.livejournal.com
Don't worry, your comment is still far more coherent than Bindel's. And personally I think it sounds a lot more realistic.

Re: PT2 - Specific points

Date: 2009-11-01 12:07 am (UTC)
From: [identity profile] kathrid.livejournal.com
It just puzzles me why she has such lot against the attempts to treat this, given it doesn't necessarily threaten her ideology. Given this and what I've pointed out about her comment on health vs. happiness above, I've been tending not to give her the benefit of the doubt on the issue.

Re: PT2 - Specific points

Date: 2009-11-02 02:09 pm (UTC)
From: [identity profile] rickbot.livejournal.com
This was me: "I would also suggest that gender reorientation is body mutilation - you remove functioning organs and replace them with a non-functioning simulcrum of the opposite organ. I wouldn't say that all body mutilation should be avoided, but I do think doctors have a greater responsibility to ensure this is really what the patient wants before proceeding"

Your response: Greater responsibility than what? There is a reason that gender reasignment surgery requires psychological councelling when e.g. a prostatectomy only offers it. The greater responsibility is already in place and I don't think that anyone would argue that it should be removed because the mistakes are tragic. (There are many who argue that it should be reformed - but this is a different issue).

Greater responsibility than they currently demonstrate. I think there should be significantly more counselling and much greater hurdles. Sorry if that was not entirely clear.


And this was me too: "I do think that gender is defined by society and so reoriented men and women should be treated as being their chosen sex; however, I also think that transvestites should be, and that way there is no need for surgery. People should just define themselves as they please."

I agree. I also think that if wishes were horses then we'd have a massive manure problem. And saying that the perfect society would be (whatever) doesn't help people now. Furthermore, biological sex is as matters stand very strongly linked to gender.

The thing about horses shitting is a bit of a tangental argument, and besides I believe we'd have more of a problem with running out of hay and having far too many rotting horses. You also seem to make the mistake of believing I commented to Jacqui my thoughts on how I would like society to be largely as a means of helping people. It is not. It was a means of conveying to Jacqui how I would like people to behave in an ideal society.


I also wrote the bit about "gender surgery doesn't change your sex. Only DNA reassignment could achieve that", but you seem to be okay with that so I'll leave it.

Re: PT2 - Specific points

Date: 2009-11-02 05:49 pm (UTC)
From: [identity profile] jacquic.livejournal.com
You also seem to make the mistake of believing I commented to Jacqui my thoughts on how I would like society to be largely as a means of helping people. It is not. It was a means of conveying to Jacqui how I would like people to behave in an ideal society.

I understood this. And I think it's important, too. Never mind any actual real-life constraints, it's worth knowing how you'd behave and like others to behave in an ideal world, even if it's not possible.

I am sure that if you really wanted to "help people" you wouldn't make the mistake of thinking that posting on my LJ would get you anywhere along this road.

Re: PT2 - Specific points

Date: 2009-11-03 10:24 am (UTC)
From: [identity profile] rickbot.livejournal.com
It also strikes me that we're not so far from such an idyllic society anyway - you'd need to be a real cynic to call it a 'wish' that society could be tolerant of transvesties and transgendervolk. Gays can marry, adopt children and legislation enshrines their right not to be denied services or be subjected to any other discrimination or abuse on the basis of their sexuality. The debate as to whether transsexuals can have marriage rights was raised in parliament and seriously considered in 2003. I don't think it went very far, but the idea is now somewhat moot as they can anyway have a civil partnership with any gender they choose. I think we're getting close to a world of great tolerance. Large amounts of horse manure doesn't cut it.

Re: PT2 - Specific points

Date: 2009-11-03 10:53 am (UTC)
From: [identity profile] rickbot.livejournal.com
I've just noticed that the bales of hay making up Darien's argument could be used to feed the horses created by mine. Obviously Darien and I have very complementary points to make.

Date: 2009-11-01 12:24 am (UTC)
From: [identity profile] pw201.livejournal.com
But in my view, how we handle that lack of clarity says as much about us as about her.

Hmmm... it's not very surprising that transexuals who've been through a bad time trying to get treatment are angry with Bindel for saying their preferred treatment shouldn't be given. We might be able to apply the principle of charity to her argument, but they might not want to. In fact, when dealing with people who have been discriminated against, the onus is on her to be clear, as well as on readers to be charitable. As an argument, that article is terrible.

I see the author as asserting that we shouldn't offer the fantasy of a "sex change" to everyone who feels they were born the wrong sex, because a) the procedure is very imperfect and b) there's no "robust scientific evidence" that it resolves gender dysphoria.

I certainly hope that doctors don't offer the fantasy of a "sex change" (which I understand from reading [livejournal.com profile] auntysarah's journal isn't the preferred term for the surgery) and that they'd make people aware of the risks involved in such radical surgery. But that's a different question to whether the surgery should be given at all.

Is there robust scientific evidence for the theory that "gender is a social construction", an idea which is apparently a tenet of Bindel's feminism? She certainly seems to be willing to put other people through some pain so that tenet can be upheld. I hope her evidence is very impressive, otherwise what business is it of hers if transexuals do look like they're in Grease (which, IME, they don't)?

But even if she's right, we don't live in a society where the self-evident truth that gender is a social construction is acknowledged by everyone. So what do you do with someone who is convinced they're the wrong sex?

gender surgery doesn't change your sex. Only DNA reassignment could achieve that.

But is chromosomal sex the only useful way to define gender? It's a scientifically useful category (though just saying that XY=male, XX=female doesn't quite carve nature at its joints: you've also got to think about intersex people), but that doesn't seem to be what transexuals are interested in. They want to feel like, and be treated as, the opposite sex from the one they were born into. That is something hormones and surgery can help with.

The question of whether the surgery should be available on the NHS is a separate question to whether people should be performing the surgery at all. I'd hope there was sufficient scientific evidence that it worked before public money was spent on it. Given the NHS is perpetually short of money, I'd be surprised if there wasn't at least some evidence, but I'm not an expert.

Date: 2009-11-14 04:08 pm (UTC)
From: [identity profile] alicephilippa.livejournal.com
Chipping in late…

The trans community is very angry with what Bindel has said over the years in relation to trans women in particular. She seems to blame the gender steroetype of women on the tiny number of trans women that exist.

The terms "sex change" and "sex swap" are very much deprecated and generally used only in articles that mock/denigrate trans women. It is more usual to use Gender Realignment Surgery (GRS) these days.

Gender stereotypes are a social construct, that much is true. Gender though is not, nor is it a binary that people like Bindel try to portay it. I'm sure we've all come across the tomboy or the femmy boy? Neither of whom fit the gender stereotype yet are unarguably female or male.

Chromasomal sex is decidedly not straight forwards. In basic GCSE type biology it is (XX = female, XY = male), but in reality there are women who are XY and you'd never get away with insisting they are male, and vice versa. There are also a not insignificant number of folks who are XXY and XXXY. Karyotyping doesn't tell the full picture.

As to whether GRS should be available on the NHS? Well, there is over 30 years of exprience with the surgery, and for the vast majority of people undergoing it it has been a great success. It is also, on the grand scale of things, a not very expensive surgery. There are some people on medication that costs more per annum that one surgery costs. For the vast majority who benefit from it it is money well spent. The alternative is in some cases the "unexplained 'male' suicide".
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