When Diagnosis Becomes Belief

Reception by the America First Policy Institute, Detrans Awareness Day, March 12, 2026.

This speech was given by Forrest Smith, Resilience Health Network Ambassador & Detransitioner

Can I have a show of hands, how many of you love America? I’m an American. I’m also an Oregonian. My great-great-grandfather is buried in the Rose City Cemetery. And my mother’s parents and grandparents are buried in a small pioneer cemetery tucked away in the hills of the central Willamette Valley.

How many people have been to Oregon? Raise your hands so I can see who’s missing out on the most beautiful state in the Union.

Okay, enough about me.

I did something unusual and wrote this speech ahead of time. It’s called “When Diagnosis Becomes Belief.” But first I want to introduce you to a word. It’s called “iatrogenic.” And it is truly a modern word and a sign of the times. It means illness or injuries that were caused by the medical profession.

It came about in the 1920s. To give you some context, X-rays were discovered in 1895. Within months they were in use all over the world. People were so enthralled with this new technology, they even created X-ray shoe-fitters. They had no idea how dangerous radiation could be, until their hair fell out the next day. Technicians noticed burns and ulcers. Some had to have fingers amputated. In 1904, a technician died after a grueling battle with radiation poisoning. His name was Mr. Clarence Dally and he was Thomas Edison’s assistant. The case was widely publicized. In 1928 hundreds of radiologists gathered in the second international congress of radiologists to establish a safety commission.

I hope you all see where I’m going with this.

Because radiation poisoning is a physical illness, it makes for a cut-and-dry example of iatrogenic harm. The lessons learned from radiology produced a principle which is used through health and safety law to this day. It’s called “As Low As Reasonably Achievable.” Yes, of course, you should weigh the necessity of the procedure. X-rays are useful. But considering the potential for iatrogenic harm, you should always strive to minimize medical intervention.

That also applies to immaterial interventions, like psychiatric evaluations. The Merriam-Webster dictionary defines the word iatrogenic like this: induced unintentionally by a physician or by medical treatment or by diagnostic criteria.

Notice that even diagnostic criteria can cause harm.

You may have heard of the Rosenhan experiment, which revolutionized the practice of psychiatric diagnosis in the early-1970s. Rosenhan was a college professor who faked his way into psychiatric hospitals by pretending to be a schizophrenic. Once inside, he began acting normal to see how he would be treated. On average it was 19 days before the clinicians noticed and released him. His longest stay was 52 days. Often, he reported, the other patients noticed his sanity before the nurses. Now, a recent investigation discovered that he made up data to publish his study in a scientific magazine. You should read the book that just came out, because it explains the complicity of the psychiatric community.

The Rosenhan experiment burned down the old system of psychiatric care and gave way for a new vision of diagnostic codes—the Diagnostic and Statistical Manual of Mental Disorders Version Number Three—based on symptoms rather than Freudian conjecture. The author of this new model hoped that in time, science would fill in the blanks with underlying biological conditions. Yet, to this day, we don’t know the cause of mental illness. In short, psychiatry has a history of putting the cart before the horse when it comes to science. And that's an important context for the history of sexology and Gender Affirming Care, going all the way back to its origins in the early-20th century. And my thesis about belief.

But first, let’s go back to the Rosenhan experiment and his point about the potential for iatrogenic psychiatric conditions: once a person has been labeled within the medical system, it’s only logical that succeeding clinicians view them through that lens. Ordinary behaviors become “symptoms,” disagreement with clinicians becomes “lack of insight,” and distress may be attributed to the disorder rather than external causes. Even after Rosenhan proved his sanity from within the system, he was released with a condition to his diagnosis: schizophrenia in remission.

That’s exactly how even the best of the best sexologists, like Ray Blanchard and Michael Bailey talk about autogynephilia—the cross-dressing fetish underlying the majority of male-to-female transition. Isn’t that absurd? They describe it as “incurable,” an “orientation unto itself,” and from that belief they jump to the conclusion that some men would be better off castrated, mutilated, and pumped full of estrogen, so they can live out their fantasy as women.

Blanchard really is the best of the best. He worked backwards from the symptom of transsexualism—what I mean is that the desire for sex reassignment surgery is a symptom of something deeper—he dug around the urge to cross-dress and uncovered the bigger picture. But he didn’t dig deep enough.

I want to read to you what the diagnostic criteria sounded like in 1966, when Gender Affirming Care was in its infancy, and the average patient was an adult man. I have here a passage from The Transsexual Phenomenon, which was written by Harry Benjamin. For context, Harry Benjamin was a pioneer in the practice of sex reassignment. Prior to his emigration, from Germany to the United States, he had studied under Magnus Hirschfeld and witnessed the very first experiments in Gender Affirming Care. Not many years after this book was published, The Transsexual Phenomenon, a small group of admirers—clinicians and even a former patient of Benjamin—founded the organization which would one day become the World Professional Association of Transgender Health and began publishing the Standard of Care in his honor. All of which is to say, the following excerpt is from a foundational document to Gender Affirming Care. Here it is:

True transsexuals feel that they belong to the other sex… For them, their sex organs are disgusting deformities that must be changed by the surgeon’s knife. This attitude appears to be the chief differential diagnostic point between the two syndromes—that is, those of transvestism and transsexualism.

The transvestite usually wants to be left alone. He requests nothing from the medical profession, unless he wants a psychiatrist to try to cure him. The transsexual, however, puts all his faith and future into the hands of the doctor, particularly the surgeon.

Does that sound very scientific to you?

Transsexualism is the only disease I can think of that is defined by the patient’s faith in the cure. And while Blanchard introduced systematic methods, his conclusion is still based on an unfalsifiable belief. But the worst part is that today’s medical authorities—like WPATH—deny any accountability. They distance themselves from Benjamin and Blanchard, not for any scientific reason, but because they want to open the doors even wider. Thus a change in the diagnostic criteria, from Gender Identity Disorder to Gender Dysphoria, sneaked through in a Trojan Horse.

The authors of “The Amsterdam Cohort,” noticed a twenty-fold increase in patients seeking treatment for Gender Dysphoria between the late-1970s and 2015. While the total numbers went up, a smaller percentage of patients went on to medicalize, which researchers attributed to increased visibility on social media and a lowered threshold for seeking treatment.

“Milder forms of Gender Dysphoria,” they called it.

When the average age of adult male patients dropped by ten or eleven years, the same innocuous explanation was thrown out. No further ethical consideration about adolescent impulsivity, sterilization, or the increased likelihood of regret.

In fact, the medicalization of children, teenagers, and young adults was celebrated. It was coordinated by medical providers who wanted to improve the cosmetic results of sex reassignment, to avoid unhappy late-in-life transitioners. Once again, putting the cart before the horse.

Then in 2015 a new cohort appeared like an iceberg in the path of the Titanic. It was the Rapid Onset Gender Dysphoric girl, a complete anomaly in decades of consistent statistical results. Even a 5th-grade could identify the spike in that graph, pictured in “The Amsterdam Cohort,” and freely available online. It may as well be a Litmus test for true scientists, if they appear willing to offer an alternative explanation to that number. But the powers that be were silent. And it was finally the parents of those girls and an American public health researcher who observed that the behavior of Gender Dysphoria—at least in teenage girls—was similar to that of a social contagion.

I’m sure everybody in this room knows what happened next. WPATH led the charge to shut down the conversation, not on scientific grounds, but ideological reaction. And over 60 medical organizations followed suit. It’s no surprise that the first winning lawsuit came from one of those girls.

But I’m more interested in the foundation of Gender Affirming Care and the patients who would otherwise be labeled as incurable dysphorics. Because not only does that diagnosis affect how the physician sees the patient in a clinical setting, it also affects how the patient sees themselves. It shapes the course of their lives and who they associate with. Over many years, whole communities can emerge and new identities are born, ones that may not have existed if the diagnosis wasn’t there to begin with. And at that point, when diagnosis becomes belief, you may as well call it an iatrogenic religion.

Which is where I want to zoom out and look down from 20,000 feet. Because what’s happening today isn’t exactly new. What we now call autogynephilia and even transsexualism was rampant in the ancient world. It emerged from the east in the earliest chapters of Classical Antiquity. A cult of ecstatic cross-dressing eunuchs—the priests of Cybele—was recorded by Greek historians. They were featured in the tragi-comic plays of Euripides, either as satire of an inferior culture or a warning of social decay.

Once the cult of Cybele landed in Rome, it became embedded in the state. You see, they came under the auspice of prophecy and brought with them a sacred meteorite. Imagine how convincing that would be to a pagan empire. At first, the ritualistic devotion to Cybele, which included castration and cross-dressing, was strictly relegated to those foreign-born priests. But over the centuries, it seems the behavior spilled into the culture, as evidenced by the poems of Catullus and The Satyricon, which was ostensibly written by a member of Nero’s court.

Of course, some people believe that the ancient understanding of the world was so primitive, that we have nothing to learn from their histories. I disagree. It’s true that they lacked modern technology, scientific instruments, and even statistical methods. But the basic schools of thought were there. The Epicureans for example, were the first materialists. They believed in imperceptibly tiny, indissoluble particles which they called atoms. The universe was an infinite expanse of these tiny bodies, colliding in space. Nothing more.

I hope you see where I’m going with this. The Epicureans were the first empiricists, like the prominent sexologists I mentioned earlier, they believed only in what could be seen or, paradoxically, rationalized from their belief in atoms. You see, even the materialist must take a leap of faith in order to arrive at his conclusion. No matter how useful science may be in grounding our judgements in facts, it doesn’t suffice as a worldview. Nor can it provide a cohesive culture. Like that allegory of the six blind men groping an elephant, each one believing they have something different in their hands, rather than a small part of the whole.

It should come as no surprise that when the old Stoic philosopher Epictetus put the Epicureans on blast, he did so by drawing a line between their philosophy and the castrated priests of Cybele.

Drunken madness goads the priests of Cybele—human nature is just that irresistible. A vine cannot behave like an olive tree, nor an olive tree like a vine—it is impossible, inconceivable. No more can a human wholly efface his native disposition; a eunuch may castrate himself but he cannot completely excise the urges that, as a man, he continues to experience. And so Epicurus removed everything that characterizes a man, the head of a family, a citizen, and a friend, but he did not remove our human instincts.

And that human instinct, ladies and gentleman, is faith.

When we lose our faith in something higher, we place it in ourselves, and that selfishness tears us apart. In the Early History of Rome, the ancient author Livy opined that there’s no better medicine for a sick mind than the study of history. Because history gives us the opportunity to learn from past mistakes. And Western Civilization has made this mistake before.

Once it was brought into Rome, ritualistic castration and fetishistic exhibitionism ran its course like an incurable scourge. But it did end. And a thousand years passed before it emerged again. So you see, the culture war isn’t new. That’s not to say things haven’t changed. They have. For all the reasons I already mentioned about science. But also theologically, politically, we live in a society that cares for the rights of every individual. Catullus, the ancient Roman poet, wrote the story of the first castrated priest, lamenting his mistake. But there were no detransitioners.

And that’s why I’m excited about organizations like Genspect and the Resilience Health Network, because as far as I know, they’re the first of their kind in the history of humanity, bringing us this much closer to healing our broken world.

Read AFPI's press release on Detrans Awareness Day here.