‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

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By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

Oct. 8, 2022Updated 9:01 a.m. ET

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Link to this article (pay wall): https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html

Link to original article: https://globle.io/the-cash-monster-was-insatiable-how-insurers-exploited-medicare-for-billions/

Accused

of fraud by

whistle-blower

Accused

of fraud by

U.S. govt.

Overbilled,

according to

Inspector Gen.

Top 10 Medicare

Advantage

Providers

UnitedHealth Group

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan.

Soon, Half of Medicare Will be Privatized

Medicare Advantage is on track to enroll most Medicare beneficiaries by next year.

Traditional

Medicare

Medicare

Advantage

But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

The fifth company, CVS Health, which owns Aetna, told investors its practices were being investigated by the Department of Justice.

In statements, most of the insurers disputed the allegations in the lawsuits and said the federal audits were flawed. They said their aim in documenting more conditions was to improve care by accurately describing their patients’ health.

Many of the accusations reflect missing documentation rather than any willful attempt to inflate diagnoses, said Mark Hamelburg, an executive at AHIP, an industry trade group. “Professionals can look at the same medical record in different ways,” he said.

The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navycombined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.

Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.

Medicare Advantage Overbilling Exceeds Entire Agency Budgets

Medicare Advantage

overbilling

Between $12 and $25 billion

Children’s Health

Insurance Program

U.S. Customs and

Border Protection

Federal Bureau of

Investigation

Environmental

Protection Agency

Federal prison

system

The increased privatization has come as Medicare’s finances have been strainedby the aging of baby boomers. But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.

For people choosing between traditional Medicare and Medicare Advantage, there are trade-offs. Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.

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But they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.

“Medicare Advantage is an important option for America’s seniors, but as Medicare Advantage adds more patients and spends billions of dollars of taxpayer money, aggressive oversight is needed,” said Senator Charles Grassley of Iowa, who has investigated the industry. The efforts to make patients look sicker and other abuses of the program have “resulted in billions of dollars in improper payments,” he said.

Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.

“It’s an extremely high priority for us,” said Michael Granston, a deputy assistant attorney general for the civil division.

In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles, over the course of four presidential administrations.

Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.

C.M.S. officials declined interview requests. In a statement, the C.M.S. administrator, Chiquita Brooks-LaSure, said the agency recently sought feedback on how to improve the program. “We are committed to making sure that Medicare dollars are used efficiently and effectively in Medicare Advantage,” she said.

The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans. Nearly 80 percent of U.S. House members signed a letter this year saying they were “ready to protect the program from policies that would undermine” its stability.

“You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,” said Representative Lloyd Doggett, a Texas Democrat who chairs the House Ways and Means Health subcommittee.

Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.

“Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,” said Dr. Donald Berwick, a C.M.S. administrator under the Obama administration, who recently published a series of blog posts on the industry. “When you skate to the edge of the ice, sometimes you’re going to fall in.”

Medicare Advantage Is Especially Popular in Many Urban and Suburban Areas

The program’s growth in Democratic strongholds has helped secure it widespread political support.

Share of Medicare patients enrolled

The program’s promise

Congress’s first attempt to design a privatized Medicare plan paid insurers the same amount for every patient with similar demographic characteristics.

In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.

But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.

Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete. Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.

In one early case, a Florida medical practice was accused of falsifying diagnoses to enrich its owner and Humana. When Humana told the doctor who owned the practice that his Medicare risk adjustment, or M.R.A., scores had increased significantly, he responded by email, according to the whistle-blower lawsuit: “Good, I am trying to buy that house based on M.R.A. scores.” The case was settled for more than $3 million.

The doctor denied any wrongdoing. Humana declined to comment on the lawsuit and said it takes compliance “seriously.” The company recently told investors it had been questioned by the Justice Department about its billing practices and expected additional litigation.

At least three insurers were accused of paying doctors or nurses more

for recording additional diagnoses.

UnitedHealth Group

At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.

The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.

One company, Mobile Medical Examination Services, worked with Anthem and Molina, among others. Its doctors and nurses were pushed to document a range of diagnoses, including some — vertebral fractures, pneumonia and cancer — they lacked the equipment to detect, according to a whistle-blower lawsuit. According to the lawsuit, employees who drew patients’ blood often were not provided with a centrifuge or cooler; spoiled blood analyzed a day later produced strange results that could be used to justify valuable diagnoses, including kidney disease and leukemia. The company was acquired by Quest Diagnostics after the case was settled for an undisclosed amount in 2016; Quest said the company complies with all federal and state laws and regulations.

Anthem: The Justice Department suit quotes an executive describing her reluctance to change how it mined medical records for additional diagnoses. The case is continuing.

Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist.

According to the lawsuit, some patients were diagnosed with cancer and heart disease. Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.

The company declined to comment. “We will vigorously defend our Medicare Advantage business against these allegations,” Cigna said in an earlier statement regarding the lawsuit.

Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.

The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.

At least five insurers were accused of failing to remove potentially invalid diagnoses.

UnitedHealth Group

In a statement, the company, now named Elevance, said it would “vigorously defend our Medicare risk adjustment practices” and accused the government of holding it to standards “that are not grounded in formal statutory and regulatory rules.”

Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.

At least two insurers were accused of discouraging care for the new diseases they added.

UnitedHealth Group

Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.

“The cash monster was insatiable,” said Dr. James Taylor, a former coding expert at Kaiser who is one of 10 whistle-blowers to accuse the organization of fraud.

At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.

Dr. James Taylor is one of 10 whistle-blowers who have accused Kaiser of fraud. “The cash monster was insatiable,” he said.
Dr. James Taylor is one of 10 whistle-blowers who have accused Kaiser of fraud. “The cash monster was insatiable,” he said.Rachel Woolf for The New York Times

Marc T. Brown, a Kaiser spokesman, said in a statement, “We are confident in our compliance with Medicare Advantage risk-adjustment program requirements,” and added, “Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from C.M.S.”

Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.

A civil trial accusing UnitedHealth of fraudulent overbilling is scheduled for next year. The company’s internal audits found numerous mistakes, according to the lawsuit, which was joined by the Justice Department. Some doctors diagnosed problems like drug and alcohol dependence or severe malnutrition at three times the national rate. But UnitedHealth declined to investigate those patterns, according to the suit.

Matthew Wiggin, a spokesman for the company, called the inspector general’s report “misleading.” He said the company uses diagnostic coding to improve patient care, and noted that the whistle-blower in the lawsuit had not worked for the company in nearly a decade. “Our chart review process complies with regulatory standards,” he said, adding, “Our robust compliance program also proactively seeks to identify fraud, waste and abuse in the system.”

The company countered by suing Medicare, arguing that it wasn’t required to fix inaccurate records before regulations changed in 2014. It won at first, then lost on appeal. In June, the Supreme Court declined to hear the case.

Inaction at Medicare

Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.

Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments. Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.

The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposedduring the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.

Some of the agency’s top leaders have had close ties to industry. Marilyn Tavenner, a former C.M.S. administrator, left in 2015, then ran the main trade group for health insurers; she was replaced by Andy Slavitt, a former executive at UnitedHealth. Jonathan Blum, the agency’s current chief operating officer, worked for an insurer after leaving the agency in 2014, then became an industry consultant, before returning to Medicare last year.

Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”

There are signs the problem is continuing.

“We are hearing about it more and more,” said Jacqualine Reid, a government research analyst at the Office of Inspector General who has analyzed Medicare Advantage overbilling.

The Justice Department has brought or joined 12 of the 21 cases that have been made public. But whistle-blower cases remain secret until the department has evaluated them. “We’re aware of other cases that are under seal,” said Mary Inman, a partner at the firm Constantine Cannon, which represents many of the whistle-blowers.

But few analysts expect major legislative or regulatory changes to the program.

“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”

Alicia Parlapiano contributed graphics

More Trans Teens Are Choosing ‘Top Surgery’

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Small studies suggest that breast removal surgery improves transgender teenagers’ well-being, but data is sparse. Some state leaders oppose such procedures for minors.

Sept. 26, 2022

Dr. Sidhbh Gallagher’s unusual embrace of social media platforms like TikTok has made her one of the most visible surgeons in her field.
Dr. Sidhbh Gallagher’s unusual embrace of social media platforms like TikTok has made her one of the most visible surgeons in her field.Eva Marie Uzcategui for The New York Times

Michael, 17, arrived in the sleek white waiting room of his plastic surgeon’s office in Miami for a moment he had long anticipated: removing the bandages to see his newly flat chest.

After years of squeezing into compression undershirts to conceal his breasts, the teenager was overcome with relief that morning last December. Wearing an unbuttoned shirt, he posed for photos with his mother and the surgeon, Dr. Sidhbh Gallagher, happy to share his bare chest with the doctor’s large following on social media.

“It just felt right — like I’d never had breasts in the first place,” Michael said. “It was a ‘Yes, finally’ kind of moment.”

Michael is part of a very small but growing group of transgender adolescents who have had top surgery, or breast removal, to better align their bodies with their experience of gender. Most of these teenagers have also taken testosterone and changed their name, pronouns or clothing style.

Few groups of young people have received as much attention. Republican elected officials across the United States are seeking to ban all so-called gender-affirming care for minors, turning an intensely personal medical decision into a political maelstrom with significant consequences for transgender adolescents and their families.

Gender-related surgeries, in particular, have been thrust into the spotlight. Arizona and Alabama passed laws this year making it illegal for doctors to perform gender-related surgeries on transgender patients under 18. Conservative commentators with large followings on social media have recently targeted children’s hospitals that offer gender surgeries, leading to online harassment and bomb threats.

Genital surgeries in adolescents are exceedingly rare, surgeons said, but top surgeries are becoming more common. And while major medical groups have condemned the bans on gender-related care for adolescents, the surgeries have presented challenges for them.

Much research has shown that as adults, transgender men generally benefit fromtop surgery: It relieves body-related distress, increases sexual satisfaction and improves overall quality of life. A few smallstudies of transgender adolescents suggest similar benefits in the short term.

But some clinicians have pointed to the rising demand and the turmoil of adolescent development as reasons for doctors to slow down before offering irreversible procedures. Although medical experts believe the likelihood to be small, some patients come to regret their surgeries.

The World Professional Association for Transgender Health, an international group of gender experts who write best practices for the field, had been planningfor months to set new age minimums for most gender-related surgeries, including endorsing top surgery for adolescents age 15 and up. Although the guidelines are not binding, they provide a standard for doctors across the world. But this month, the group abruptly withdrew the proposals, a shift reflecting both political pressures and a lack of consensus in the medical community.

There are no official statistics on how many minors receive top surgeries each year in the United States. The New York Times surveyed leading pediatric gender clinics across the country: Eleven clinics said they carried out a total of 203 procedures on minors in 2021, and many reported long waiting lists. Another nine clinics declined to respond, and six said that they referred patients to surgeons in private practice.

Dr. Gallagher, whose unusual embrace of platforms like TikTok has made her one of the most visible gender-affirming surgeons in the country, said she performed 13 top surgeries on minors last year, up from a handful a few years ago. One hospital, Kaiser Permanente Oakland, carried out 70 top surgeries in 2019 on teenagers age 13 to 18, up from five in 2013, according to researchers who led a recent study.

“I can’t honestly think of another field where the volume has exploded like that,” said Dr. Karen Yokoo, a retired plastic surgeon at the hospital.

Experts said that adolescent top surgeries were less frequent than cosmetic breast procedures performed on teenagers who were not transgender. Around 3,200 girls age 13 to 19 received cosmetic breast implants in 2020, according to surveys of members of the American Society of Plastic Surgeons, and another 4,700 teenagers had breast reductions.

In the past decade, the number of people who identify as transgender has grown significantly, especially among young Americans. Around 700,000 people under 25 identified as transgender in 2020, according to the Williams Institute, a research center at the University of California, Los Angeles, nearly double the estimate in 2017.

Gender clinics in Western Europe, Canadaand the United States have reported that a majority of their adolescent patients were seeking to transition from female to male.

Because breasts are highly visible, they can make transitioning difficult and cause intense distress for these teenagers, fueling the demand for top surgeries. Small studies have shown that many transgender adolescents report significant discomfort related to their breasts, including difficulty showering, sleeping and dating. As the population of these adolescents has grown, top surgery has been offered at younger ages.

Another notable change: More nonbinary teenagers are seeking top surgeries, said Dr. Angela Goepferd, the medical director of the Gender Health Program at the Children’s Minnesota hospital, who is nonbinary. (The program does not perform operations but refers patients to independent surgeons.) These adolescents may want flatter chests but not other masculine features brought on by testosterone, like a deeper voice or facial hair.

After many months of deliberations over its new guidelines, the World Professional Association for Transgender Health initially decided to endorse top surgeries for adolescents 15 and up, part of a suite of changes that would have made gender treatments available to children at younger ages. But the organization backtracked this month, after some major medical groups it had hoped would support the new guidelines bristled at the new age minimums, according to Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the president of WPATH, who is transgender.

“We needed consensus,” Dr. Bowers said. “I just think we need more strength for our argument and a better political climate, frankly, in order to propose this at a younger age.”

Instead, the guidelines kept the previous recommendations, published a decade ago, allowing surgeries for minors on a case-by-case basis.

Because teenagers in most states must be 18 before they can provide medical consent, surgeons require parental consent and approval letters from mental health care providers. The two- to four-hour procedure costs anywhere from $9,000 to $17,000, depending on facility and anesthesia fees. The procedure is often not covered by insurance until patients turn 18.

As demand has grown, Dr. Gallagher, the surgeon in Miami, has built a thriving top surgery specialty. The doctor frequently posts photos, FAQs and memes on Facebook, Instagram and TikTok, proudly flouting professional mores in favor of connecting with hundreds of thousands of followers.

Her feeds often fill with photos tagged #NipRevealFriday, highlighting patients like Michael whose bandages were just removed. On her office windowsill sits a framed nameplate with one of her best-known catchphrases on TikTok: “Yeet the Teet,” slang for removing breasts.

Dr. Gallagher said she performed top surgeries on about 40 patients a month, and roughly one or two of them are under 18. Younger patients are usually at least 15, though she has operated on one 13-year-old and one 14-year-old, she said, both of whom had extreme distress about their chests.

The surgeon said that most of her patients, teenagers and adults alike, found her on TikTok. Her online presence has drawn sharp criticism from right-wing media, as well as from some parents and doctors who say she uses the platform to market to children.

“She goes to the beat of her own drum,” Dr. Bowers said. “For a lot of us, that’s troubling.”

Dr. Gallagher said she doubted she had the influence her critics ascribe to her. “Most of the time I’m just trying to deliver educational content,” she said.

Why I wrote this article. Over the past year, surgeries for transgender adolescents have become the focus of heated political debates. I wanted to report on what the research shows about breast removal for this small group of young people, exploring both the benefits and the risks.

‘Comfortable in my own skin’

When Michael first saw Dr. Gallagher’s TikTok page last summer, he was immediately intrigued. (Michael and others in this article asked to be identified by first or middle names because they were concerned about their privacy.) He liked the photos of her patients, observing that their scars had healed well, and liked that she seemed to be an ally of the transgender community.

Michael’s mother, Annie, had gradually come around to the idea of surgery after years of watching him suffer, she said.

Since hitting puberty at age 10, Michael said he felt a gnawing discomfort about his breasts. By the time he was 12, he wore hooded sweatshirts every day in their Miami suburb.

In eighth grade, after he had several severe panic attacks at school, Michael said he started seeing a therapist, who encouraged him to talk about his body issues. He experimented with small ways to appear more masculine, such as tucking his long curly hair into a beanie and wearing boys’ clothes.

“It was the first thing I ever did to try and make myself more comfortable in my own skin,” Michael said.

He came out to his parents as a transgender boy when he was 14. A year later, at the start of the pandemic, he started weekly testosterone injections while doing remote school. He got into strength-training and his voice dropped, a second puberty he relished but was grateful to undergo privately.

Michael started in-person school feeling “10 times happier,” he said, but his chest still tormented him. Testosterone and exercise had shrunk his breast tissue, making it easier to conceal with a binder. But the garment could restrict his breathing and give him panic attacks. He began seeing a psychiatrist, who prescribed antidepressants.

When Michael was 17, Annie said, she decided that waiting another year for surgery would put him in too much pain. Because her insurance covered the procedure only for adults, she took out a loan to help pay for it.

Michael’s psychiatrist initially wrote a letter signing off on the surgery. But he later revoked it, putting the surgery in limbo, Annie said. After Michael started a higher dose of antidepressants, the psychiatrist endorsed the surgery as planned.

Now, nine months after the operation, Michael is in his senior year of high school. He said he is focused on the parts of his life that have little to do with his gender: doing theater tech at school, seeing friends, painting and applying to college.

He also feels less pressure to prove his masculinity than before, he said. He’s growing out his hair and uses he, she and they pronouns. In June, he took his girlfriend to the prom, wearing a brown suit and a pearl necklace.

Weighing the risks

In 2018, doctors at the pediatric gender clinic at Children’s Hospital Los Angeles published a study of 136 transgender patients ages 13 to 25, half of whom had undergone top surgery. Adolescents who had not undergone the procedure reported significantly more distress because of their chests.

Roughly one-third of those who underwent surgery reported ongoing loss of nipple sensation. Only one patient expressed occasional feelings of regret, when imagining wanting to breastfeed a future child.

“There’s very few things in the world that have a zero percent regret rate. And chest surgery, clinically, I’ve experienced that,” said Dr. Johanna Olson-Kennedy, the lead author of the study and medical director of the clinic in Los Angeles, which began offering surgeries in 2019.

But the study had caveats: Most patients were surveyed less than two years after their surgeries, and nearly 30 percent could not be contacted or declined to participate.

Few researchers have looked at so-called detransitioners, people who have discontinued or reversed gender treatments. In July, a study of 28 such adults described a wide array of experiences, with some feeling intense regret and others having a more fluid gender identity.

Because so few studies have looked at detransitioning, many doctors are asking young patients and their parents to provide consent without acknowledging the unknowns, said Kinnon MacKinnon of York University in Toronto, the researcher who led the study, who is transgender.

“I know personally many, many, many trans men that have benefited and are happy with their medical transition and their top surgery. I would put myself in that category,” Dr. MacKinnon said. “But just as a researcher, I do feel like there are questions that are deserving of answers and have implications for clinical care.”

Jamie, a 24-year-old college student in Maryland, was raised as a girl and began identifying as a transgender boy in the eighth grade. After being sexually assaulted in her junior year of high school and then dropping out, she said, she started taking testosterone. Three months later, just after she turned 18, she underwent top surgery at a private practice in Massachusetts.

For the next few years, Jamie said, she thrived. Testosterone made her feel energetic, and her anxiety dissipated. She went back to school and got certified as an emergency medical technician.

But when she was 21, her father, who was dying of Alzheimer’s, no longer recognized her. She fixated on her wide hips, which she worried stood out next to her facial hair and deep voice. After a date where she had sex with a straight man, she said, she realized she had made a mistake.

“I realized I lost something about myself that I could have loved, I could have enjoyed, I could have used to feed children,” Jamie said. She said she grieved for months and contemplated suicide.

This spring, after a year of fighting her insurance company to cover the procedure, she had surgery to reconstruct her breasts. She never told her original surgeon that she had changed her mind, partly because she also blamed herself. Sometimes, she said, “I still don’t like being a woman.”

Many surgeons say that they rarely hear about patients with regret. But it’s unclear how many, like Jamie, never inform them.

Dr. Gallagher of Miami said that she follows up with patients for up to a year. “I can say this honestly: I don’t know of a single case of regret,” Dr. Gallagher said in May, adding that regret was much more common with cosmetic procedures.

But one of her former top surgery patients, Grace Lidinsky-Smith, has been vocal about her detransition on social media and in news reports.

“I slowly came to terms with the fact that it had been a mistake born out of a mental health crisis,” Ms. Lidinsky-Smith, 28, said in an interview.

She had top surgery when she was 23. About 16 months later, Ms. Lidinsky-Smith said she called and emailed her medical providers, including Dr. Gallagher’s office, to tell them she had detransitioned.

When asked about Ms. Lidinsky-Smith’s case, Dr. Gallagher amended her stance, recalling that years ago a former patient left a voice mail message expressing regret over a surgery.

“At the time, we wondered, Is it a hoax?” Dr. Gallagher said.

Chilling effect

Republican politicians in states across the country are pushing to ban all gender-affirming care for adolescents, focusing much of their rhetoric on surgeries.

In Florida, where the medical board is considering such a ban for minors, Gov. Ron DeSantis has argued that surgeons should be sued for “disfiguring” children. In Texas, where parents of transgender children have been investigated for child abuse, Gov. Greg Abbott has calledgenital surgeries in adolescents “genital mutilation.”

Dr. Bowers, the president of WPATH, said that politicians should not be involved in personal medical decisions. “They just don’t understand this care, so they just want to shut it down,” Dr. Bowers said. “That is a very dangerous precedent.”

Although most of the new state actions against gender care for minors are tied up in litigation, they have had a chilling effect.

Earlier this year, a Dallas children’s hospital shut down the only pediatric gender clinic in Texas, citing political pressure from the governor’s office. This month, a woman was arrested on charges of making a false bomb threat to Boston Children’s Hospital after it was targeted online for its pediatric gender program. Dr. Gallagher has also received threats online and said she might hire security guards for her office.

Other clinics have dropped scheduled procedures. William, 14, who has identified as a boy since he was a young child, was supposed to see a plastic surgeon in Plano, Texas, for top surgery in May. But the surgeon canceled the appointment in March because the medical center’s malpractice insurer stopped covering top surgeries for minors.

In August, William and his family flew to California, paying $10,000 more to get the procedure out of state.

Two weeks later, William started ninth grade as just another boy in school. He looks forward to swimming with his shirt off and going to class without wearing a binder.

“It’s like something was unburied,” William said. “My chest was just covering what was always there.”

Link to article: https://www.nytimes.com/2022/09/26/health/top-surgery-transgender-teenagers.html

An open letter: why I’m leaving the cult of wokeness by Africa Brooke

~ janellsthoughts ~ Leave a comment

An open letter: why I’m leaving the cult of wokeness by Africa Brooke
— Read on ckarchive.com/b/d0ueh0h67mpd

An open letter: why I’m leaving the cult of wokeness by Africa Brooke

If there’s one thing I’m NOT afraid of, it’s being ‘cancelled’.

If being cancelled means me living in integrity as a human being who thinks for themselves, CANCEL ME TODAY!

I repeat; I am not afraid.

What I’m truly afraid of is existing in a world that forces me to submit to an ideology without question, otherwise I’m to be shamed (or pressured to shame myself) and cast out of the community.

A world that tells me that because I inhabit a black body; I will forever be oppressed and at the mercy of some omnipresent monster called ‘whiteness’.

That because of the colour of my skin; I am a victim of an inherently racist system by default – and me rejecting the narrative of oppression means that I am in fact, in denial.

How empowering!

*You know, as someone that comes from Zimbabwe, a country where the general population is truly oppressed, it perplexes me that oppression is now being worn as an identity piece in most parts of the West, especially by those who claim to be ‘progressive’*

What I’m truly afraid of is existing in a world that forces me to consider the colour of my skin and my gender (and that of others) at every fucking turn, instead of living by Martin Luther King’s teachings and prioritising the content of mine and other people’s character.

I dread the prospect of a world where context, nuance, critical thinking, meritocracy, mathematics, science, and rationality are considered tools of ‘white supremacy’, and the rule is that you’re not allowed to question or argue this senseless statement – especially if you’re white.

A world that is conditioning you and I to believe that we will always be trapped in some weird hierarchy because of our race, our genitals, our physical abilities, our neurodiversity, our sexuality, and our politics.

And that if we do not agree on every single thing, it’s a sign that we are interacting with an enemy – or at the very least, someone to be wildly suspicious and judgmental of…instead of another complex human being worthy of being seen and heard.

I wish this world I’m speaking of was just a figment of my imagination, but we are already inside it. Our suitcases have been unpacked here for quite some time.

This absolutist, authoritarian world is being fiercely crafted under the guise of ‘social justice’, and I want no parts in this. I AM OUT.

As someone that, politically speaking, leans left on most things (although I’m neither left or right) – the current state of affairs and this push for obedience at all costs is NOT what I signed up for.

I never signed up to be hit over the head with disempowering narratives that tell me that I need to refer to myself as a ‘person of colour’ (how is this different being called a ‘coloured’ person?), a minority, a marginalised person, and BAME (UK version of BIPOC).

I cannot stand any of these terms.

Please, if we ever need to address my racial identity, which we really don’t need to do as often as you might think…BLACK works just fine, it’s not a dirty word.

And remember; it’s okay if the language I mentioned before is affirming for you, we are allowed to disagree – but for ME, it does nothing but give me false reminders of my supposed oppression…which rubs me the wrong way entirely because I AM NOT OPPRESSED.

I think it’s key that we begin to accept that black people don’t all share a singular experience, nor do we share the same brain.

Shocking, I know.

‘We are not a monolith’ has become a common statement within communities that identify as marginalised, and while I wholeheartedly agree, we’re definitely not a monolith…

I’ve noticed that despite this being a popular mantra – when someone ‘steps out of line’ or dares to think differently…it’s a different story. You will often have the pleasure of being told that you are in denial and have some kind of internalised disorder;

‘internalised racism’, ‘internalised anti-blackness’, ‘internalised misogyny’, ‘internalised sexism’, ‘internalised homophobia’, ‘internalised transphobia’, ‘internalised white supremacy’…

Meaning NOTHING can be questioned.

Fun. Culty. Vibes.

Honestly, I want better for us because it’s all getting a bit much in these social justice/woke spaces, and it scares me to know that it’s become controversial to address any concerns or express a differing viewpoint.

It’s becoming dangerous to address reality. You either agree and comply, or you shut up.

I’m so happy that these are conversations that are now happening with many black people in my life, including my family who spend very little time online, are willing to have healthy debates, and couldn’t give a crap about identity politics. These are the people who have really helped me free myself from the dogmatic thinking.

It’s necessary for me to mention that I’m having these conversations with black people because some individuals think that it’s only white people who are pushing back against wokeism, and it’s far from the truth.

What is worrying though is how many more of us feel afraid to talk to our own friends, our partners, our spouses, our colleagues, our family – of fear of being branded as ‘wrong-thinkers’. How are we supposed to understand each other if we’re living in constant fear of saying the ‘wrong’ thing?

It’s even harder if you’re white because there’s usually someone just waiting to call you racist. And according to the woke manual, if you’re white you’re supposed to just accept that label. If you do question it or defend yourself, it’s taken as confirmation that you ARE in fact a white supremacist.

If you DARE express any fears or signs of being rightfully upset, you’ll be accused of ‘centering your white feelings’, and of exuding ‘white guilt’ or ‘white fragility’. With all disrespect, I don’t understand the purpose of these cultish, degrading, racist terms.

How are they helping us move forward? Is this true social justice? How is this helping the black community? How is this shaping a world where you and I aren’t judged by the colour of our skin? Are we really trying to eradicate racism with racism?

The LITERAL definition of racism is “prejudiced against or antagonistic towards a person or people on the basis of their membership of a particular racial or ethnic group”. And yet some people have suddenly decided that white people cannot experience racism, nor are they permitted to dispute this insane claim.

This then leads to most white people choosing to not say anything at all (which creates resentment because that’s the nature of suppression & self-censorship), and some choose to comply and pretend they are on board with anything and everything (whilst also secretly resenting that they can’t truly express their thoughts, ideas, feelings, etc).

To me all of this confirms that when it comes to ‘wokeness’, critical social justice, and the beast that is cancel culture, you will never win. You will NEVER get it right. If you choose to stand back, ‘educate yourself’ privately and quietly; you’ll be accused of being violent via your silence…

And if you speak out, ask questions, or express valid confusion from the dehumanising generalisations and character assassinations; you’ll be denounced for centering your ‘white feelings’.

This sounds like psychological warfare to me.

I can’t be the only one that also finds this language eerie.

This is cult behaviour!

And for saying the above I’m sure someone out there will lovingly label me a ‘white apologist’…

This is where we’re at people.

And like I said at the beginning, when it comes to this – I am unafraid.

This is my open letter detailing some of the things that have led me to this point, because if there’s anything that this past year has taught me; it’s that my wellbeing and that of those around me (including the collective), is infinitely more important than any temporary discomfort that might come from me doing what I know to be right.

I also want to let you know that I’m not writing this to convince you of anything, your agreement is welcome but it’s not a requirement. I’m not writing this from a place of animosity or anger.

I’m not writing this on behalf of any individual, group, movement, organisation, or community. I am not an activist, a social commentator, a feminist, an academic, or any other label apart from the ones I claim publicly.

I am writing this to free myself.

I am writing this for myself.

And for you if you need it.

Just like you; I am entitled to my own opinions, I have every right to question things that don’t feel aligned with my values, morals, ethics, and beliefs. I have every right to push back if I recognise that I’m being forced to comply with ideologies and practices that don’t make sense to me (which is how I’ve felt this past year).

I don’t want to live my life in a fearful and paranoid state. I don’t want to spend my life thinking that everything that doesn’t go my way is because of my skin colour, I don’t want to spend the rest of my life unable to have insightful conversations with those that think differently to me…I really don’t.

I’m tired of hearing that because I’m black I should feel victimised. That because I’m black I should agree with everything that black people do and say (surely NOONE should have this expected of them).

None of these narrow definitions of human existence or blackness help me. None of it helps my community. It’s keeping us small. It’s keeping us stuck, afraid, and defensive. I reject the idea that I am a victim. I reject the idea that I am oppressed.

I reject the idea that white people only exist to oppress and should be reminding me of their privilege every 2 seconds, while simultaneously telling me that they are above me.

How is this helpful!? If anything, it’s deeply offensive and condescending.

There’s no question about it; being black is a beautiful part of who I am, but it’s not all I am – not even close. My identity (race, gender, sexuality, body parts) will never be more important than my humanity, my spirit, and my wholeness. EVER.

Because of this, I fervently reject the idea that all white people are racist and must be shamed into confessing their sins and admitting complicity in all of their ancestors indiscretions…simply because of the colour of their skin. I reject this bullshit idea that every white person walking this planet is ‘inherently racist’.

Do we even know what we’re saying? or are we just regurgitating/parroting things, and now it’s gotten out of control.

I honestly struggle to see how shaming others (or shaming yourself) for having white skin is an essential part of fuelling true social change. Surely this is regressive? It also sounds a little like the very thing we’ve spent years moving away from…

The truth of the matter is that my own ancestors have participated in some FUCKERY and I would not want to live the rest of my life being punished for their actions. A lot of what I’m seeing in the woke/critical social justice spaces is not about creating a better world, it seems to be about punishment and revenge.

And it’s doing nothing but trampling on the work true Activists are doing and have been doing for centuries!

I do have to take a moment to acknowledge those who are doing fantastic work and making a long-lasting impact in their communities, instead of perpetuating fear and manipulating people’s emotions by convincing them they will always be victims.

I’m done with the insidious brainwashing of wokeness.

I’m committed to understanding human behaviour (this is also at the core of what I do professionally), I’m committed to compassion and kindness without excusing that which must be acknowledged.

I’m well aware of the systems we live under. I know what’s happening in the world. I’ve lived it. I acknowledge reality, but I refuse to be a slave to a disempowering narrative that rarely focuses on actual solutions.

I never want to forget that you can still be compassionate with those you don’t agree with. And this way of thinking is what I CHOOSE because it makes my time on planet earth better, you don’t have to take it on if it doesn’t work for you.

I want to live a life that isn’t centred around identity politics and all that comes with it, so much more in my life takes priority.

I want to remain open to new ideas, perspectives, and thoughts – so that I can grow, course correct where necessary, and make a genuine impact on a local and global level.

I want to give people the benefit of the doubt and continue using discernment instead of making sweeping harmful (often lazy) assumptions based on the colour of people’s skin or their gender.

I refuse to take on the black or white thinking because I’ve seen and experienced the grave harm that does.

As I move into this next season of my life, I’m more interested in the grey area – where we all exist.

The nail in the coffin for me was all the events that took place last Summer.

Last Summer in the height of the Black Lives Matter movement, I noticed a shadowy part of me emerging and although I didn’t judge it, I wasn’t comfortable with what was coming up.

All the critical social justice dogma I’d been consciously and unconsciously imbibing over the past 2 years began taking a HUGE toll on my mental health, and I hadn’t even realised that I wasn’t functioning as a full human being – until it reached it’s peak.

The unpleasant internal experience I had is what led me where I am now, which is why I’m a firm believer that welcoming discomfort in is one of the most loving things you can do for yourself.

On social media at that time I was DEEP is various social justice echo chambers that shared more than enough infographics, stories, feed posts, IG LIVES, to make my fight or flight response go nuts. I was in constant fight mode, and wasn’t aware.

I was being indoctrinated; this means “to teach a person or a group to accept a set of beliefs uncritically”.

I found myself subconsciously looking for things that would piss me off, which is a symptom of wokeness that seems to show up in many people – hundreds of you have shared your own experiences with me in the past month alone and the similarities in our stories are alarming.

Before reacting to things, I did ZERO in-depth research of my own. It’s almost as if facts were an unwelcome guest. Anything that didn’t align with the beliefs I held about race, sex, gender, politics, etc – I rejected (this was all unconscious). I didn’t question the sources I was getting information from, it was all taken as objective truth.

It was ALL reactionary, I was alon autopilot.

I didn’t realise I had many people on pedestals that they shouldn’t have been on in the first place (no fault of their own, I put them there), I was operating purely based on emotions and feelings that gave my nervous system the signal that I was under threat.

And that’s the energy I acted and spoke from.

I rashly unfollowed some people on my social media who I’d decided should have ‘spoken up’ in support of Black Lives Matter (an organisation I have now done my own extensive research on, but that’s a whole other story) – simply because (based on my egos time frame) they weren’t responding as and when they ‘should’ have.

I’m sure I re-shared something about ‘white silence’ being ‘violence’ (an oversimplified and unfair statement I no longer agree with, and you can watch the lengthy live I did with Rukiat where I go into some of this).

I also publicly shamed an unsuspecting man who had messaged me to question me about my conduct (I immediately assumed he was white…he was mixed race). And even though his approach was not a welcome one, he wasn’t unkind to me – which is why I’m not proud of the unkind way in which I reacted…not responded, reacted.

What frightened me was the applause I got from over 4,000 people when I called out this man in an Instagram post – I didn’t say anything wild, but I did deconstruct his direct message publicly with the intention to embarrass him, not to resolve anything – to embarrass.

I was honestly shocked by how many people used the environment I had created to exercise pack mentality, and to casually shame and scold a stranger – of which I take responsibility for as the person that created that environment.

I now know that publicly shaming someone is a common tactic used in most woke spaces and echo chambers on social media, and it’s so normalised. This is the kind of thing that quickly leads to bullying, doxing, stalking, and harassment…and sometimes ends in suicide.

After seeing the responses applauding me, I removed the post and started asking myself some questions; who am I doing this for? why did my interaction with this man need to be publicised? what is really the root of the anger I feel? is this a performance on my behalf?

what research have I done to support the ideology I’m leading with? are there any alternative sources that can give me more information or provide clarity on the situation I’m reacting to? do I really believe this or am I regurgitating something I read/heard/saw somewhere?

I’m of the thinking that there is such a thing as justified anger, and I believe that all emotions and modes of expressions have their place – but I know myself well enough to know that the way I handled that particular situation was not necessary.

This incident led me start evaluating my own behaviour and doing more research around the cancel culture phenomenon. And it’s just one recent example of how some of this stuff has showed up in my life over the past 2 years.

SO, why am I calling ‘WOKENESS’ a cult?

Well, first lets start by defining what the term woke even means. It’s a term that been around for a very long time but has (in my eyes) lost all of it’s credibility and meaning in recent years.

Woke: a term embedded in US Black History and social justice which originally meant being aware, well-informed, and up to date with what was happening within the community.

“Stay woke became a watch word in parts of the black community for those who considered themselves self-aware, questioning the dominant paradigm, and striving for something better” – and these are the sentiments I will always stand for, however…

This is NOT how it’s playing out these days, and you can read this interesting article to get a timeline of how it’s evolved over the years, and I’ll continue sharing with you the specific pockets of ‘wokeness’ and social justice that I have divorced myself from.

I can no longer be an active participant in any culture or movement that encourages groupthink, outrage on demand, fear and violence, revamped segregation, fabricating history, cancellations masked as accountability, self-centredness…

normalisation of racism towards white people, the disempowerment of black people masked as social justice, the constant redefining of existing language, ignoring self-responsibility, constant pathologizing, oppressed vs oppressor mentality, and the pressure to conform and comply…

It’s exhausting.

And honestly, I have better things to do with my time.

Not to mention, it’s killing us.

I also find it very telling that people who are married to these woke spaces will immediately assume that those that are requesting for more compassion, understanding, room for discussion, removal of censorship – only want these things so they can have free reign to be bigots, sexist, ‘fascists’, racists, homophobes, etc.

As a free-thinking black woman who most definitely wants more compassion, understanding, healthy discussion, empathy, removal of censorship, more tolerance and acceptance when it matters most…I can guarantee you that my final goal isn’t so I can be a racist sexist fascist alt-righter extremist.

LOL.

And if you can understand this, what makes someone who happens to be white any less sincere if they want the exact same thing as me?

Which many people do!

I hope you can sort of see just how oversimplified and flawed this madness is.

I often laugh about the ridiculous nature of it all, but what’s concerning is that it’s spreading like wildfire, it’s causing lasting harm, and it’s distracting us from the very real work that needs to be done to tackle injustice and unite us as human beings.

I will stick to my guns by saying that the turn we’re taking because of critical social justice and this current strain of branded monetised wokeness – is not going to take us to the promised land (SPOILER: there is no utopia, I’m sorry to break it to you).

As someone who will never stop advocating for human rights (fairness, equality, access to resources, respect, independence – for ALL, not just for people who share my skin tone and gender), I have come to realise that I do not need to be part of any groups or wear any labels to make a positive contribution to this planet of ours.

This is also why I do not identify as a feminist.

Just like everything else I’ve spoken about so far; the current wave of commodified feminism is so far removed from my core values; honesty, respect, interconnection, equality, individuality etc.

There’s a lot of self-righteousness, virtue signalling, self-centeredness, and a lack of empathy in most of what I see being presented today as feminism – and again; it seems to be about revenge, superiority, and personal branding.

It’s also not uncommon to be made to feel unintelligent, wrong, and inferior in a lot of these supposedly ‘safe spaces’ – simply because you don’t identify with the label or agree with all the view points of the group.

IT’S TIRING, and I wish more people knew that you can still believe in and advocate for equality and fairness without wearing a label like a badge of honour. My mission isn’t to be superior to anyone, nor do I want to see the demise of any gender.

I believe that we should all have equal rights and opportunities, and I’m also realistic about the differences we have as human beings – I celebrate those differences. In a world obsessed with labels and titles, I would rather let my values and actions speak for themselves.

These are the times when I am incredibly grateful for the upbringing I’ve had, both in Zimbabwe and here in the UK. I’m grateful that I was raised to think for myself, and that’s what I’ll continue to do.

I was raised to not judge people based on the colour of their skin, gender, class etc – no matter what. And that’s what I’ll continue to do.

YES, I could choose to carry animosity in my heart based on the pain my ancestors experienced and the injustice still taking place in many different parts of the world – but what does that do for me, my mental state, my community, and those I interact with in the present day?

I’d rather acknowledge reality, and focus on solutions.

I wasn’t really raised to ask many questions, but in adulthood asking powerful questions (even when they are simple) is something that has become a non-negotiable – and that’s what I will continue to do.

I will continue to trust myself and question things. I will do my own research before responding purely based on emotion. I will keep myself open to having challenging conversations if I have the capacity to do so, and if I don’t have the capacity to engage, I will still not shut anyone down – unless absolutely necessary.

My biggest realisation has been that most of these people that pose as Social Justice Warriors, Activists, Agents of Change etc – don’t actually want to improve and repair society. They don’t want a better world. For some the goal is to make things worse.

A lot of the people I know in these spaces have brands, careers, and management teams from this. Their livelihood depends on them playing this role, which often means that they will continue to find everything wrong with society instead of making consistent efforts to unite and truly empower.

There’s a sinister side many people aren’t comfortable speaking about because of the potential backlash, and it’s unfair to those of us who end up being sucked into these echo chambers and movements through the promise of community and betterment.

Most of us just want to help. We want to see change! In our personal lives, and in the world we exist in. This leaves us vulnerable to questionable ‘leaders’, influencers, and organisations who set themselves up so that you cannot question their practices or agenda.

The similarities of wokeness/critical social justice to fundamentalist religion (something I’m VERY familiar with) is why I choose to call it a cult, the framework and tactics are eerily similar…

It usually goes a little like this; find/attract a vulnerable person, make them feel like they belong so they can trust you, tell them exactly what they want to hear, and once they become loyal – it is easier to sell them outlandish concepts and to make them ‘repent’ for ‘sins’ they have supposedly committed…

the person then regresses and begins to rely on their ‘leader’ or the ideology to shape their thoughts and their world view. They are introduced to an enemy and are encouraged to cut themselves off from the outside world and anyone else who doesn’t agree with or follow the ideology (us vs them mentality).

Once cut off from everyone, the individual is more dependent on the leader or the group, and then it becomes increasingly difficult to leave. Just like an abusive relationship! This is exactly what I’m seeing in the woke/feminist/critical social justice spaces.

Despite it all, the individual is often unaware of what’s really happening and will continue to believe that they are acting on their own accord. The prison walls remain invisible. But it’s possible to break out!

It’s why I’ve decided to speak out. And if you don’t agree with what I’m sharing, and this has not been your experience – that’s okay. I will always respect your right to own your experiences and perspectives. I ask that you do the same for me.

We live different lives, we have different views. It’s normal.

What ISN’T normal, is forcing people to comply and bow down to an ideology, simply because YOU think it’s the right one.

If you resonate with what I’ve shared in this letter, please know that you are not alone.

You are allowed to change your mind. You are allowed to grow. You are allowed to walk away. You are allowed to put your foot down. There is no one way to ‘do the work’.

You don’t have to pray to a single political idea, movement, or group – nor do you have to agree with EVERYTHING presented to you as the absolute truth.

You are not morally inferior or superior to anyone else.

And remember that we still have to co-exist on this planet, so expecting everyone you encounter to agree with every belief or view that you hold – is fucking wild, LOL.

If you have read this far, I appreciate your time and your attention. Any typos you see, represent the sheer passion flowing through me.

I’ll stop here because I could go on, there is always more to say. I feel like this letter is just the foundation of the conversations I REALLY want to have so I will likely explore some of the specificities in podcast form and through my newsletter.

I’m considering producing and hosting a limited podcast series that specifically talks about these themes. Don’t worry, my existing podcast Beyond the Self won’t be going anywhere! In the meantime; you can find me on Instagram if we’re not already connected.

Although my work as a Mindset Coach, Speaker, and Consultant has nothing to do with social justice, cancel culture, wokeness etc – this is something I’ll continue to speak about because it directly speaks to 2 of my biggest areas of focus, which in this case are collective self-sabotage and psychological manipulation.

I encourage you to break out of any echo chambers (especially on social media) and explore yourself BEYOND your race, your pronouns, your genitals, your sexuality, your physical capabilities, your politics – those things have their place but there is so much more to you.

And in fact, when you do go beyond those neatly prescribed boxes, you become more secure within your identity. I urge you to unsubscribe to anyone and anything that is stripping you of your humanity, your agency, and is proving to be detrimental to your mental wellbeing.

You deserve better, let’s never stop speaking up!

Love always,

Africa

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