Former phalloplasty patient of Dr. Curtis Crane speaks out

In response to our most recent article about Dr. Curtis Crane, we have been contacted by one of Crane’s former patients, who asked us to share this video.

Be aware that the video contains graphic images and video footage pertaining to the phalloplasty surgery and complications experienced by this person.

We thank this former patient for reaching out to us, and for having the courage to speak out.

Catching up with renowned phalloplasty surgeon, Dr. Curtis Crane

by Worriedmom

Third in a series. Part 1 is here. Part 2 is here.

4thWaveNow contributor Worriedmom has practiced civil litigation for many years in federal and state courts.


Since our last coverage of medical malpractice litigation against renowned phalloplasty surgeon Curtis Crane, M.D., we’ve received frequent inquiries about the current status of the lawsuits and his practice. Research has revealed some interesting facts and circumstances about Dr. Crane.

First, as of this writing, there no longer appear to be any open civil cases against Dr. Crane in the state of California. All eight of the malpractice cases that had previously been pending in the San Francisco Superior Court have now been “dismissed with prejudice” (read on to understand the meaning of “with prejudice” in the settlement context, since this doesn’t mean what some folks may assume it does).

Specifically:

Doe v. Crane, CGC-16-550630 was dismissed April 5, 2017.

Carter v. Crane, CGC-16-554254 was dismissed December 10, 2018.

Raynor v. Crane, CGC-17-556713 was dismissed November 8, 2018.

Carson v. Crane, CGC-17-556743 was dismissed October 10, 2018.

Doe v. Crane, CGC-17-557327 was dismissed November 8, 2018.

Davis v. Crane, CGC-17-557363 was dismissed December 10, 2018.

Shepherd v. Crane, CGC-17-559294, dismissed October 3, 2018.

Doe v. Crane, CGC-17-560690 was dismissed March 15, 2019.[1]

A ninth malpractice case, Hansen v. Crane (CGC-18-571442), brought in November of last year, was also dismissed on January 14, 2019. As with the other actions listed above, this lawsuit also alleged malpractice in connection with genital surgery:

Interestingly, the plaintiff in that case alleged that at the time he consulted Dr. Crane, Dr. Crane told him that “none of his patients had ever had a serious complication from phalloplasty, that it was a safe procedure, and that only 5% of his patients have needed surgical repairs.”

As of the writing of this article, however, all of the malpractice litigation filed against Dr. Crane in San Francisco has now been dismissed. What does this mean? It’s impossible to know.

What we do know is that none of these dismissals appear to have been the result of a jury or other type of fact-finding proceeding that evaluated Dr. Crane’s conduct and made any findings about negligence or malpractice. In other words, it does not appear that an independent arbiter has reviewed the facts of these cases and ruled on whether the care provided either complied, or did not comply, with established “standards of care.” This is not surprising, since over 90% of all medical malpractice cases never go to trial.

One might reasonably conclude, then, that all of these actions have been settled out of court. For what amount of damages? We can’t know. It could be zero, it could be $10 million. The amount paid in settlement of such a claim is confidential virtually 100% of the time. The medical liability insurance carrier is, in most cases these days, the party that decides whether or not to settle a case, and this is a “business decision” on the carrier’s part.

From interrogatory answers filed in the Raynor case, cited above, we do know something about Dr. Crane’s professional liability and medical malpractice coverage in 2016, the date the malpractice alleged in that case was claimed to have occurred (see Motion for Relief from Waiver of Discovery Objections dated April 16, 2018, Declaration of Corban J. Porter and Exhibit D thereto):

Private settlement agreements also typically include “NDA” (or non-disclosure agreement) provisions, in which the parties agree to keep all terms of the settlement confidential, and further agree to the payment of damages in the event of a breach. These NDA provisions have, of course, come under public scrutiny as part of the “MeToo” movement and the Stormy Daniels affairs. Some commentators argue that keeping medical malpractice settlement amounts confidential hurts the public:

Secret nondisclosure agreements also affect patient safety by allowing bad doctors and other dangerous medical providers to continue to harm patients because their incompetency is hidden from their present and future patients and employers.

Finally, these litigations were also dismissed “with prejudice,” which means that the plaintiff cannot bring another lawsuit based on the same facts. This makes sense, because otherwise no defendant would ever pay money in settlement of a litigation if he or she knew that the plaintiff could simply re-file the same lawsuit another day.  So, it’s important to understand: When dismissal “with prejudice” is entered as part of a settlement, it does not indicate that anyone has ruled on the merits of the case.

That’s it for our legal update, but for those of us who are interested in Dr. Crane and his business model, there have been some additional developments.

Most important, it appears that Dr. Crane may no longer be performing surgery in the state of California (although his medical license is still current in that state). His prior practice, Brownstein & Crane Surgical Services, seems to be out of business. Any internet searches for brownsteincrane.com result in a re-direct to “Crane Center for Transgender Surgery,” a practice operating in California and Texas.

In and of itself, this is not surprising. According to the Crane Center’s Facebook page, Dr. Brownstein retired in 2013, after having performed “thousands of FTM chest surgeries” and passing this extensive knowledge along to Dr. Crane.

What is notable is that, as of the time of our earlier article in 2018, Brownstein-Crane was a thriving California transgender medical practice. According to the Wayback Machine, which is the only source for information on the practice, back in March of 2018, Brownstein-Crane, in addition to Dr. Crane, employed:

  • Thomas Satterwhite, M.D. (plastic surgeon);
  • Heidi Wittenberg, M.D. (OB/GYN, surgeon);
  • Michael Safir, M.D. (uro-genital reconstructive surgeon);
  • Ashley DeLeon, M.D. (uro-genital surgeon);
  • Charles Lee, M.D. (micro-surgeon);
  • David Chang, M.D. (surgeon);
  • Gabriel Kind, M.D. (plastic surgeon); and
  • Michael Parrett, M.D. (plastic surgeon).

A photograph that appeared on Brownstein-Crane’s now-defunct website.

Of all those doctors, today only Drs. DeLeon and Safir remain affiliated with Dr. Crane. Dr. Crane now appears to practice in Austin, Texas, and has been joined there by Dr. Richard Santucci (together with Dr. DeLeon); Dr. Safir holds down the fort in San Francisco and has been joined by Dr. Angela Rodriguez. Dr. Crane’s website indicates that information about the Crane Center’s doctors is “coming soon.”

It’s not clear when Dr. Santucci joined Dr. Crane’s practice, but he does not appear to have been part of the earlier Brownstein-Crane incarnation:

Source.

Not to worry, though: Dr. Safir remains busy in San Francisco.

 Source.

The Crane Center has wasted no time in accessing potential new patients, sending attractive representatives to attend such conferences as Gender Odyssey in San Diego and the Philadelphia Trans Wellness Conference, and sponsoring art festivals and pride events.

For an added bonus, prospective patients may even be able to receive a free initial surgery consultation, right there at the conference!

What is the story behind Dr. Crane’s relocation to Texas?

It’s impossible to know. Perhaps some of his current or former patients will enlighten us.


[1] Interestingly, on March 7, 2019, Crane’s defense counsel in this case was ordered to pay a $1,800 sanction for “misuse of the discovery process.”

No Child is Born in the Wrong Body … and other thoughts on the concept of gender identity

by William J. Malone, M.D., endocrinologist (Twitter: @will_malone).

with contributions from Colin M. Wright, Ph.D., (Twitter: @SwipeWright), biologist and Eberly Research Fellow at Penn State University;  and Julia D. Robertson (Twitter: JuliaDRobertson), journalist, award-winning author and Senior Editor of The Velvet Chronicle.  

Author’s note, 23 August 2019: This essay has been updated with a new graphical representation of sex-related differences in personality. The original essay had distribution curves showing an 85% overlap of personality traits between males and females. This comparison was based on earlier studies that have been criticized for having design limitations that underestimate sex-related personality differences (link).  More recent studies show the overlap to be more in the 30% range. While the degree of overlap is an area of ongoing debate and study, the consequences for the gender-atypical individuals at the tail ends of the overlapping distributions remain the same. For further reading about sex-related differences and ways to measure them, see the following exchanges between experts in the field: (link) (link) (link).

Many health care professionals and mainstream medical organizations endorse the concept of an innate gender identity.[a]  They define gender identity as the “internal, deeply held” sense of whether one is a man or a woman (boy or girl), both, or neither, and report that it can be reliably articulated by children as young as 3-5 years old.[b]

A growing number of scientists, philosophers, and health care professionals reject this concept or at least the above definition.[c]  Developmental studies show that children have only a superficial understanding of sex and gender at best.  For instance, up until age 7, children often believe that if a boy puts on a dress, he becomes a girl.[d]  This gives us reason to doubt whether a coherent concept of gender identity exists at all in young children.  Additionally, the concept relies on stereotypes that encourage the conflation of gender with sex.

However, starting at a young age, children do tend to exhibit preferences and behaviors that we associate with sex.  For example, male children display more aggressive behavior than female children.[e]  In addition, “cross-sex” behavior, or more accurately cross-sex stereotypical behavior, is often predictive of later same-sex attraction.[f]  Can all of these findings be integrated?

To start, just as sex influences the development of bodies, it also influences brains.  There are in-utero differences in hormone exposures (male testosterone surge at eight weeks gestation for example), and distinct developmental pathways are triggered based on the XX or XY chromosomal make-up of neurons.[g]  The integration of these sex-related processes with environmental pressures gives rise to an individual’s personality and preferences.

It follows then that population-based studies have demonstrated sex-related differences in personality and preferences that are independent of social influences.  When social influences are weakened (in more egalitarian societies), the sex-related differences in personality and preferences increase.[h] [i]  This suggests that as environmental pressures become relaxed, innate sex-specific preferences surface.

A closer look at personality traits shows that when analyzed together as a group, there is a roughly 30% overlap between sexes.[j] [*]  This is graphically represented below.  The consequence of this overlap is that adolescent males who fall on the left end of the male pattern (blue, “masculine”) curve, and adolescent females who fall on the right end of the female pattern (pink “feminine”) curve, are going to have personality traits that are different than the majority of other members of their own sex.  In fact, due to the significant overlap of personality traits between males and females, the personality traits of some females will be more “masculine” than those exhibited by some, or even most males, and vice versa.

Consequently, an adolescent female may find her behavior, personality traits, and preferences more “masculine” than most girls and most boys.  This could lead her to incorrectly conclude that she is the opposite sex.  That child’s parents could become confused as well, noticing how “different” their child’s behavior is from their own, or from that of their peers.  That child simply exists at the end of a behavioral spectrum, and “sex-atypical” behavior is part of the natural variation exhibited both within and between the sexes.  Personality and behavior do not define one’s sex.

There are approximately 40 million children in the United States between the ages of four and fourteen.  The above distribution curves estimate that roughly four million of them have personality profiles that are “sex atypical”, but still part of the natural distribution of personalities within each sex.  Our culture-at-large is incorrectly telling them that they may have been born in the wrong body.  The propagation of this biological falsehood, in addition to other newly identified factors, is likely contributing to the growing number of transgender identifying high school students (now estimated to be 2%), and the rapid rise in adolescents presenting to gender clinics.[k]

There would be less confusion if the distributions wholly overlapped.  It would be the norm that males and females display completely overlapping personality traits.

The broad, but normal distribution of personality traits also explains studies showing a 28% concordance of a transgender identity in twins.[l]  Twins have identical chromosomes, and likely have similar sex-related behaviors as well as environmental influences on their behavior.  Using twin adolescent males as an example: if their behaviors are at the “feminine” end of the male-typical distribution, they could both become confused as to what their behaviors and preferences mean about their sex.  Whether they develop gender dysphoria as a consequence of that is another issue.  If gender dysphoria does develop, 85% of the time it will resolve with uninterrupted puberty.[m]

What is being called “gender identity” is likely an individual’s perception of how their own sex-related and environmentally influenced personality compares to same and opposite sexed people.  Put another way, it’s a self-assessment of one’s stereotypical degree of “masculinity” or “femininity,” and it’s wrongly being conflated with biological sex.  This conflation stems from a cultural failure to understand the broad distribution of personalities and preferences within sexes and the overlap between sexes.

When a girl reports that she “feels like a boy” or “is a boy”, that sentiment may reflect her perception of how her personality and preferences compare to the rest of her peers.  Also, if she has concrete thinking characteristic of an autism spectrum condition, she may not be “sex-atypical” in her behavior but could be falsely perceiving herself to be.  These scenarios don’t apply to all cases of gender dysphoria, as many other triggers are described.[n]  Counseling can help gender dysphoric adolescents resolve any trauma or thought processes that have caused them to desire an opposite sexed body.[o] [p] [q]

To summarize, there is a lack of understanding when it comes to the distribution of sex-related personality and behavioral differences.  This lack of understanding has led to confusion.  That confusion impacts children who fall at the extreme tail-ends of the distribution, who are statistically more likely to grow up to be gay, lesbian, or bisexual adults if allowed to experience uninterrupted puberty.n  Additionally, telling a child that he or she was born in the wrong body pathologizes “gender non-conforming” behavior and makes gender dysphoria less likely to resolve.a

In conclusion, no child is born in the wrong body.  Adults should expand their understanding of what normal male and female behavior and preferences look like.  They should understand that being male and being female both come with a wide range of personalities, preferences, and possibilities.

[*] The first version of this essay used distribution curves showing an 85% overlap of personality traits between males and females.  This comparison was based on earlier studies that have been criticized for having design limitations (looking at one trait at a time, not correcting for measurement error) that underestimate sex-related personality differences (link).  More recent studies show the overlap to be more in the 30% range. While the degree of overlap is an area of ongoing debate and study, the consequences for the gender non-conforming individuals at the tail ends of the overlapping distributions remain the same.  For further reading about sex-related differences and ways to measure them, see the following exchange between experts in the field: (link) (link) (link).


References

[a] Hembree, Wylie, T, P., Louis, Hannema, E, S., . . . G, G. (2017, September 13). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society * Clinical Practice Guideline. Retrieved from https://academic.oup.com/jcem/article/10

[b] Gender identity. (2018, May). Retrieved from https://www.caringforkids.cps.ca/handouts/gender-identity

[c] Byrne, A. (2019, January 10). What Is Gender Identity? Retrieved from https://arcdigital.media/what-is-gender-identity-10ce0da71999

[d] Martin, Carol. “Cognitive Theories of Early Gender Development.” Semantic Scholar, 2002, pdfs.semanticscholar.org/69e9/67157a01cb0af9252650195e7adb99578364.pdf.

[e] Harbin, S. J. (2016). Gender Differences in Rough and Tumble Play Behaviors. International Journal of Undergraduate Research and Creative Activities,8(1). doi:10.7710/2168-0620.1080

[f] Childhood Cross-Gender Behavior and Adult Homosexuality. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.1300/J529v12n01_03

[g] Wheelock, M., Hect, J., Hernandez-Andrade, E., Hassan, S., Romero, R., Eggebrecht, A., & Thomason, M. (2019). Sex differences in functional connectivity during fetal brain development. Developmental Cognitive Neuroscience,36, 100632. doi:10.1016/j.dcn.201

[h] Giolla, E. M., & Kajonius, P. J. (2018). Sex differences in personality are more significant in gender-equal countries: Replicating and extending a surprising finding. International Journal of Psychology. DOI:10.1002/ijop.12529

[i] Archer, J. (2019). The reality and evolutionary significance of human psychological sex differences. Biological Reviews. doi:10.1111/brv.12507

[j] Kaiser, T., Del Giudice, M. D., & Booth, T. (2019). Global sex differences in personality: Replication with an open online dataset. Journal of Personality. doi: 10.1111/jopy.12500

[k] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives60(3), 345–366. doi: 10.1080/00332925.2017.1350804

[l] Diamond, M. (2013). Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation. International Journal of Transgenderism,14(1), 24-38. doi:10.1080/15532739.2013.750222

[m] Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry,28(1), 13-20. doi:10.3109/09540261.2015.1115754

[n] Gender dysphoria is not one thing. (2017, December 07). Retrieved from https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/

[o] Zucker, Kenneth & Wood, Hayley & Singh, Devita & Bradley, Susan. (2012). A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder. Journal of homosexuality. 59. 369-97. 10.1080/00918369.2012.653309.

[p] Vries, Annelou & Cohen-Kettenis, Peggy. (2012). Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach. Journal of homosexuality. 59. 301-20. 10.1080/00918369.2012.653300.

[q] Clarke, Anna Churcher, and Anastassis Spiliadis. “‘Taking the Lid off the Box’: The Value of Extended Clinical Assessment for Adolescents Presenting with Gender Identity Difficulties.” Clinical Child Psychology and Psychiatry, vol. 24, no. 2, 2019, pp. 33

How Mental Illness Becomes Identity: Tumblr, a Callout Post, Part 2

by Helena

Helena is a 21-year-old woman who identified first as nonbinary, and later as a transgender man, from 2013 through 2018. In 2016, she began medical transition by taking testosterone, and detransitioned two years later. During her teen years, Helena was an avid member of several Tumblr “communities”: trans/gender identity, eating disorders, and self-harm.

This piece is the second in a series of articles that analyze aspects of Tumblr Helena has observed as detrimental to the massive numbers of youth who call the site their virtual home. The focus of this article is the self-harm and pro-anorexia Tumblr worlds. Part 1 is here.

Helena can be found on Twitter @lacroicsz and is a member of the Pique Resilience Project, a group of four detransitioned/desisted women creating multimedia content about their experiences.


In Part 1, I described a few elements of Tumblr’s design that compromise the perception and communication of its users. Now we will take a look at some of the ways Tumblr’s unique atmosphere has given life to dangerous subcultures that have engulfed the lives of countless young people, mostly girls, in the last decade.

Introverted, angst-ridden, struggling adolescents across the globe are now faced with the risk of becoming inundated with content from self-harm blogs, pro-anorexia blogs, social-justice blogs that encourage self-diagnosis of mental illness, the use of mental illness as social currency, and gender identity ideology that is even more logically flawed and emotionally driven than in the mainstream. In this piece, I will discuss the self-harm community, and the pro eating-disorder community, both of which I have had personal experience belonging to. The community surrounding gender identity and dysphoria, the one with which I am most familiar, will be discussed in depth in Part 3.

Self-Harm Tumblr

The community of bloggers that filmed and shared photos, gifs, and written glorifications of self-harm behavior, often called “self-harm Tumblr” or “self-harm blogs,” was nearly eradicated when Tumblr prohibited the practice in 2012, but the long-term impact of such a dark and abnormal presence on the character of the site–and the teenagers who use(d) it–are still very evident. During their heyday, these blogs permeated Tumblr with graphic, slow motion, black-and-white gifs of razors slicing through flesh or dramatic quotes about suicide that were available simply by typing “self-harm” or “suicide” into the search bar.

Here’s how it worked: Imagine you’re a sad teenage girl circa 2012. Maybe you hate your body, or you’re conflicted about your sexuality, or you don’t fit in with your peers, or your home life is disordered. You’ve started using Tumblr a lot; you love that you can search anything you’re thinking of in the moment and instantly be gratified with awesome fan art of your favorite characters or updates on your favorite TV shows. But on this day, it’s not your teen idol or some BBC show that’s on your mind. Instead, it’s painful thoughts of self-hatred or even suicide. Maybe it’s the crushing feeling that your parents don’t love you. Maybe they’re too busy fighting to reassure you they probably do. Whatever it is, it’s not good, and like with everything else, you don’t have many places to turn to with this kind of thing. Your parents won’t understand, you don’t want to bother your best friend with your complaining for the umpteenth time that day, and listening to emo songs isn’t hittin’ like usual. So you do what you always do when you’re lonely and stimulated: you go on Tumblr. You type “depression” in the search bar, and a thousand posts like this come up:

Feels good. Feels validating. All that energy vibrating in your chest is matched by the black-and-white moving picture on the screen in front of you. You scroll down, and what do you know, there’s more. An infinite supply, always updating, because thousands of people just like you are posting more and more of these depression-aesthetic memes every day.

Now let’s say that at some point you do begin to self harm. Maybe you saw it in a music video, or your best friend started doing it, or you even saw it in a Tumblr gif, but through whatever means, the thought of venting your feelings into your own skin with a razor blade finds its way into your head. Or maybe you want to self harm, the desire is burning within you, but you’re scared. Not to worry, go back to Tumblr and type in “self harm” or “cutting.” You’ll get another infinite supply of addictive, dopamine machine guns. But this time, they’re bloody. A lot of them are matched with captions that strike you as relatable. The gore is mesmerizing, you can’t look away. There’s something about watching blood pour or ooze (whether from your own self harm or from one of these gifs) that feels analgesic. Before you know it, you’ve been lying there in your bed for hours, body limp except for your thumb stroking your smartphone’s screen as you scroll through these countless images.

If you’ve never self harmed before, this might make you wanna try. Click here to view some examples of Tumblr self-harm posts, but be warned–they are graphic. These images, and the act of self harm, will make you feel better for a moment by flooding your body with endorphins as it resonates with and then tries to cope with the  stinging pain, but the second another stressor, another hopeless thought comes your way, you have to go back again. It’s a deal with the devil, but there’s a reason so many kids have been seduced into shaking his hand.

No one is born with the desire to slice their flesh every time they feel upset, and previously, self-harming behavior was seen only in the most severe psychiatric cases. Ordinary teenage girls were not cutting themselves to the point of hospitalization a few generations ago, and the statistics reflect that. According to a study released in 2017 which evaluated ER visits for nonfatal injuries amongst adolescents from 2001 to 2015, rates of ER visits among youth “showed no statistically significant trend until 2008, increasing 5.7% annually thereafter and reaching 303.7 per 100 000 population in 2015. Age-adjusted trends for males overall and across age groups remained stable throughout 2001-2015. Overall age-adjusted rates for females demonstrated no statistically significant trend before 2009, yet increased 8.4% yearly from 2009 to 2015. After 2009, rates among females aged 10 to 14 years increased 18.8% per year—from 109.8 per 100, 000 in 2009 to 317.7 in 2015. Rates among females aged 15 to 19 years showed a 7.2% increase on average per year during 2008-2015.” (Mercado et. al.)

Note the statistic that the rates of female self-injury hospitalizations were stagnant until 2008, when they suddenly began increasing. Keep in mind that correlation does not equal causation, and cultural phenomena seldom have one clear explanation, but the fact that Tumblr was launched in 2007, and really picked up speed in 2008, should not go ignored in this discussion.

These self-harm blogs were not simply the online diaries of depressed teenagers, but a thriving community in which mental illness became identity. The images, and the captions that accompany them, often reinforced depressive ruminations, such as: No one cares about the self harmer, the self harmer will be depressed forever, and suicide and self harm are justifiable ways of coping with negative emotions. It is this way of thinking, this immersion in depressive thought, and the resentment and alienation that results from suffocating yourself in this maladaptive coping mechanism on a constant basis, that paved the way for later subgroups surrounding mental illness.

Pro-Anorexia Tumblr

“Pro-Ana” culture existed years before Tumblr, with the first pro-Ana websites emerging in the 1990s, when the already existing real-life pro-Ana movement moved online. The issue was brought to public attention in 2001 when Oprah Winfrey discussed it on her television show, and the world was shocked to learn that not only was anorexia a prevalent threat to young girls, but that many of these girls seemed overjoyed to be suffering from it.

Since the pro-Ana movement has been so widespread for so long, there’s actually quite a bit of literature and research on the topic of social contagion and eating-disorder “symptom pooling,” that is, when sufferers of the same mental illness band together and form an echo chamber that exacerbates the symptoms of the illness. This article from the Social Issues Research Centre gives a good introduction to the inner workings of popular pro-ED websites, and much more information is available online. Pro-Ana culture is known for its users’ belief that they are not sick, but simply being themselves and making a lifestyle choice to be more “disciplined” than people who do not choose to be anorexic. The name “Ana,” as opposed to using the terms “anorexia” or “eating disorder,” personifies the illness almost as a goddess to be worshipped.

Pro-Ana ideology is one contradiction after the next, with users glorifying the illness, how it has empowered them, how in-control and serene they feel when they starve, how much better their life is since finding their pro-Ana friends, and how they “trigger” each other to victory–yet, in the next breath, advising that “if you don’t have an ED, turn away now. You don’t want to be like me.” It is a highly addictive formula of community, purpose, coping mechanisms, and a simultaneous god and victim complex.

While all of this is pretty standard for pro-Ana communities, the Tumblr pro-Ana community is unique. It doesn’t (and never did) have the same degree of vitriol, and has always been heavier on victimization. While some pro-Ana communities see themselves as a quasi-political class who have the right to starve themselves because that’s what they believe is right for them, the Tumblr pro-Ana community treats anorexia more like the mental illness it is. This doesn’t come close to solving the problem, though, since Tumblr has some twisted attitudes towards mental illness in the first place. Whereas other pro-Ana communities focus on the sheer act of starvation as fulfillment through self-mastery, the Tumblr pro-Ana community sets its sights on the end goals of the perpetual diet. Many of them view it less as a lifestyle choice for the rest of their lives, but more as a necessary evil to achieve a standard of living that is tolerable to them. They focus on what they will be able to do when they are thin, how they will look, and how much better life will be. Then, they can stop starving (or so they believe)– almost as if their anorexia is a transition to a different existence, a new body, a new life (the parallels with the trans/gender dysphoric Tumblr communities are quite obvious here).

There is a heartbreaking air of hopefulness in the anorexic community on Tumblr. They are not pro-Ana because they chose it to feel superior, they are pro-Ana because they feel they must be. They cannot survive another day seeing their reflections, and the fat they see on their bodies (even when there is none left) is more than aesthetically displeasing to them: it contains the very cause of all of their suffering. Every moment of pain since birth has been because they are too fat, they eat too much, they’re too out of control–as if losing a dangerous amount of weight would resolve the mental patterns that drove them to take such self-destructive measures in the first place.

Tumblr pro-Ana is a much more hopeful, naive pro-Ana culture than others online. It was born of the original culture in the 1990s, but influenced by the unique attitude Tumblr has developed towards self-harming behavior and mental illness. Users will repeat again and again, “no one chooses to be anorexic…” “if I could stop being this way I would…” and to a certain extent, this is true. No one can “snap out” of an eating disorder, but the Tumblr culture goes beyond acknowledging the difficulty of recovery. Anorexia is viewed not as a lifestyle choice, like in other pro-Ana communities, but as an inescapable battle bestowed upon these girls that they must fight, else they will never be happy. They were born to be redeemable failures, out-of-control gluttons, and every miserable moment traces back to the pounds that could be lost. Their only hope at survival is to beat their bodies into submission to rid themselves of the visible, tangible, evidence of their curse: fat. This is how anorexia ceases to be defined as a mental illness, ceases to be defined as a “lifestyle”, and begins its definition as an identity. It transcends the material and becomes spiritual. Some people are just born to suffer like this, and they have to learn to love it.

To an outsider, it seems convoluted. Unbelievable, even. It is so far removed from sanity that it is difficult for me to explain in a way that will convey even a fraction of the many ideological layers that have developed within Tumblr’s pro-Ana community. But to them, at least to the extent they are able to convince themselves, it’s not that crazy. It makes sense: you’re a fat ugly failure and you have to do something about it! Extreme normalization of this truly dangerous behavior has always existed in pro-Ana circles, where anorexics even go so far as to see their path as superior to a non-anorexic existence. On other pro-Ana sites, this looks like intense competition, purposefully “triggering” others by being heartlessly demeaning and catty, and exchanging tips on how to hide the severity of their illness from parents, friends, and doctors (including within inpatient psychiatric facilities).

On Tumblr, the approach is similar but less aggressive. “Meanspo” (meaning something to the tune of “mean thinspo,” a type of post in which the writer purposefully writes triggering, mean, messages but warns the reader beforehand) is distinguished from other posts, because as opposed to other communities’ competitive, vicious nature, the Tumblr pro-Ana community is soft and friendly. They understand themselves as a large congregation of friends, helpless in the face of the symptoms they share, and the only way to help each other is to be very sweet and lose as much weight as possible, to stave off the demons.

And if you’re not in the mood to be called a fat pig, don’t worry, there’s “sweetspo”: thinspo that is kind and loving, something these girls might not usually experience. Or if they do, they don’t feel worthy of accepting this love from anybody but Ana. But don’t get it twisted, Ana is only nice in the context of getting you back on track to lose weight. No “you don’t deserve to do this to yourself,” no “you don’t have to torture your body to avoid suffering.” There is no option presented by the pro-Ana community that does not fit within the confines of the ideology; rather, comforting sentiments are used to strengthen the sense of emotional isolation and dependency members of the community feel.

Something that has always been intriguing about the pro-Ana movement is its propensity for viewing itself almost as a minority group of sorts. On the original forum platforms for pro-Ana discussion, this manifested in members believing anorexia is a “lifestyle”, and that their choices deserve to be respected. A “good Ana doesn’t die”, and doctors or loved ones who attempt to intervene are violating the autonomy of the anorexic. With this came a militancy designed to keep girls in line and constantly living and spreading the lifestyle, because an easygoing, accepting atmosphere would not achieve results. This is why the pro-Ana social contagion reached the levels it did in the 1990s and early 2000s; it was a fierce battleground where the narrative proclaimed that only the strong survive, and the strongest will place first. But really it was the resulting group belligerence that emerged from this narrative, rather than the any truth to the narrative itself, that carried so many young women and girls through years of self destruction.

Other ideological groups on Tumblr are also popularly associated with a similar militancy, but the core dysfunctions of these groups, including the Tumblr pro-Ana community, are unique in the way they create psychological dependence. Other pro-Ana communities would create this dependence by fostering a competitive atmosphere in which it would be unacceptable to fall behind. Members were expected to display their starting weight, current weight, progress, and goal weights on every post and comment in the form of a signature. There would be daily threads requesting Anas to post their food intake diaries, and it would be an absolute disgrace to answer that you had Granny Smith apple slices, chicken breast, and 2.5 tootsie rolls when other girls only drank cucumber icewater all day. If you couldn’t run with the Alphas, the whole pack left you behind, it was that simple. In contrast, emotional dependency is created on Tumblr more through curating the pro-Ana community as a (conditionally!) loving and accepting oasis where everyone can feel “included” as an Ana, even if they aren’t underweight and even binge sometimes! Isn’t that nice?

Like pathological groups elsewhere on Tumblr, everyone is valid and included. You don’t need to lose any weight to be anorexic, it’s the thought that counts.

Now, don’t get me wrong, you can have a pretty severe eating disorder and not be stick-thin and struggle to lose weight as quickly as you would like, but it wouldn’t clinically be anorexia. Combinations of symptoms from anorexia, bulimia, avoidant/restrictive food intake disorder, and binge eating disorder are considered an Eating Disorder Not Otherwise Specified (or, EDNOS), and the concept used to be reasonably acceptable on other pro-Ana sites. Being hardcore anorexic (avoidant of food) or, to a lesser extent, bulimic (compensating for food not avoided by purging) was preferable (as long as it showed results), but the attitude that everyone must be included or else they won’t feel like they have a real eating disorder fundamentally contradicts the competitive nature of the ideology. On the non-Tumblr pro-Ana sites, girls who were overweight were encouraged to take up the lifestyle, but they were essentially second-class citizens compared to the veterans who had managed to maintain a low or underweight BMI, and they would not be considered sufficiently anorexic until they had proven their disorder. On Tumblr, young girls have managed to reconstruct mental disorder into a family just as complex, passionate, and loving as any real one can hope to be.

 

 

As of this writing, the self-harm and pro-ED cultures online have been forced to withstand quite a bit of censorship. Tumblr blogs that post gory content are deleted, and pro-Ana content is monitored, though to a lesser extent; explicit pro-Ana content can still be found. To evade Tumbler censorship, users employ special tags to find each other, like #not pro just using tags, or #anarexya. The culture has morphed to encompass “thinspo” that is less about skeletal, sickly bodies and more about conventionally attractive, slim Instagram models, and lots of memes (see the tag #proedmemes). Memes and aesthetically pleasing photos of pretty women (and in some cases, trans men) motivate this new generation of eating-disordered females, without showing off the glaring red flags of past generations, where the disordered behavior was purposefully exaggerated, rather than hidden away for preservation. When explicit visual content is impermissible, the disordered females must rely more heavily on emotionally based community interaction to motivate themselves to engage in painful, unnatural behavior like starving or purging; in way, it makes these communities even more inviting.  For more examples, see the below gallery of current pro-Ana content.


I hope everyone is now sufficiently disturbed by the goings-on in the online communities comprised of teenage girls, and the disorders they have manifested in our society. The risk of being devoured and digested by these poisonous digital chambers and their respective ideologies extends to your daughters, sisters, granddaughters, and cousins. They lie open in waiting for any unsuspecting, naive young girl whose emotional terrain is still unknown and unfamiliar. The similarities between the self-harm, eating-disorder, and gender-identity ideological communities cannot be overstated, and we would be fools to ignore the role of Tumblr.com in the shocking and drastic increases in adolescent female gender dysphoria that have presented over the last five or so years.

In Part 3, I hope to do some measure of justice to the labyrinthine ideological shenanigans of this virtual community. Something in our culture has created the perfect storm for the explosion of gender-identity ideology, and as a detective would prioritize searching a suspected criminal’s bedroom, Tumblr may as well be the first place we look for clues.