The Battle Upstream: Challenging the false belief causing medical harm

Mia Hughes' speech from The Bigger Picture Conference 2025

---

Genspect is delighted to release the video of Mia Hughes’ speech, The Battle Upstream: Challenging the false belief causing medical harm,” from the Bigger Picture Conference 2025 in Albuquerque. Watch the video (full text below) and learn about Genspect’s Campaign here, FAQs here, and statement on the Use of the Term Re-Psychopathologization, here.

---

The Battle Upstream: Challenging the false belief causing medical harm

There is a parable that is well-known in the medical world. A man is walking along the side of a river when he hears a cry for help. Someone is drowning in the current. He jumps in and pulls the person to safety. Then another person goes by, and another, and another. He keeps at it—saving some, losing others, until he starts to become exhausted. Finally, he realises what he should have realised from the start: he needs to go upstream to find out what’s causing all these people to end up in the river. So up he goes, and there he discovers a monster throwing people into the water.

And that’s when his real fight begins.

In the scandal of gender medicine right now, nations all over the world are that man downstream beside the river. Some, like the United States, are scrambling to save as many victims as they can—with legislation, litigation, and age restrictions aimed at protecting minors.

Others, like Canada (with the exception of Alberta) continue to watch as victims get swept away by the powerful current, not just failing to lift a hand to help, but standing on the riverbank cheering and applauding the carnage.

All the actions to protect young people from this medical scandal must be applauded. But let’s be clear: these victories are downstream. Many are fragile, and quite possibly temporary. Many can be swept away with one change of government and the stroke of a politician’s pen. Then the harm begins anew.

So it is essential to go upstream in search of the monster.

---

The Monster: A False Belief

And what do we find when we go upstream?

It’s not the gang of endocrinologists inducing endocrine disorders in healthy adolescents. It isn’t even the surgeons amputating healthy breasts or disfiguring genitals, though, to be sure, those are unspeakably monstrous acts.

The actual monster is an idea. A false belief. It’s the belief that being transgender is innate, healthy, something to celebrate.

That is what is causing all the devastation.

Now, as everyone in this room already knows, this idea did not emerge from new research about biology or brain sex. It did not come from any groundbreaking discovery of an inner gender essence called a “gender identity” that is fixed and immutable.

It came from trans activism.

The belief was first conceived in the late 1980s, when early trans activists gathered behind the scenes and began plotting their assault on reality. These activists decided that they no longer wanted to be classified as mentally ill or sexually deviant. They didn’t like the stigma; it didn’t suit their political goals.

And because they had the power and the political might, they were able to bring this monster to life. The World Professional Association for Transgender Health, a political activist group that masquerades as a medical association, eagerly jumped on board and launched its depsychopathologization campaign in 2010—framing transgender identities as natural and healthy, and clearing the way for mass medicalization on demand.

The American Psychiatric Association buckled to activist demands next, scrapping gender identity disorder for gender dysphoria—the identity was now healthy; only the distress was labeled disordered.

So, to be absolutely clear: an entire field of medicine was built on a false belief—a fiction created by a political movement to serve its own agenda.

And at no point did anyone stop to question what would be the ramifications of redefining a psychiatric disorder as perfectly healthy and opening up access to medical body modification on demand as a human right.

Of course, anyone paying attention could have foreseen the looming catastrophe. And from where we stand in 2025, we know that the worst case scenario did indeed come to pass.

So, more and more, the gender debate is shifting back towards the reality that trans is a mental illness. But actually defining it precisely as a psychiatric disorder is not quite as straightforward as it may seem.

A few years ago, I asked psychiatrist Az Hakeem whether transgender people are “mad,” and he gave me a beautiful answer. He said: “they’re not mad. They’re confused, and perhaps autistic, and they’ve come to the wrong conclusion.

The madness lies in how society responds to these individuals. Because we don’t try to help them; instead, we collude in this mad way.”

---

---

Extreme Overvalued Beliefs

So, this conversation left me wondering: If trans people aren’t mad, how could sane people behave in such an insane way? How could anyone who is mentally well be so fixated on obtaining such disfiguring health-destroying surgeries?

The answer lies in an obscure psychiatric concept called the overvalued idea or the extreme overvalued belief.

Now, the first time I ever heard the phrase “overvalued idea” was in that very conversation I had with Az Hakeem, but at the time, I confess, I didn’t understand what he meant, and so the significance of it completely passed me by.

It was only later, when I encountered the same concept in a 1995 article by the great Dr. Paul McHugh, that I realized this was the missing piece—and suddenly everything fell into place.

First described by psychiatrist Carl Wernicke in 1892—he called it an overvalued idea—it provides that all important missing link—by differentiating pathological, all-consuming beliefs from delusions and obsessions. The definition on the slide is by Tahir Rahman who elaborated on the concept and called it an “extreme overvalued belief.”

So, a delusion is a false belief that is not shared by others, and delusions are often bizarre and idiosyncratic—such as “aliens are communicating with me through the radio.”

Obsessions are intrusive thoughts that the individual finds disturbing and distressing—often resulting in compulsive behaviors that seek to alleviate the distress.

So you can see that trans fits into neither definition. But it does fit perfectly into the category of an extreme overvalued belief.

These beliefs aren’t bizarre and idiosyncratic like a delusion, and they aren’t unwanted and distressing like an obsession. They’re rigidly held, non-delusional convictions, shared by others in the culture or subculture, relished by the individual, and defended with passion until they harden into certainty.

Crucially, the person doesn’t see their conviction as abnormal at all; to the holder, the belief is entirely rational—because so many others around them also share it. Over time it grows stronger, more resistant to challenge, and ultimately powerful enough to drive action—even violence—in its service.

In fact, this little-known psychiatric concept is most often applied to understanding extreme acts of violence.

From the mass shootings by white supremacists in Norway, Christchurch, and Buffalo, to school shooters from Columbine to Sandy Hook, the perpetrators were not psychotic. They were propelled by powerful beliefs—shared, amplified in subcultures, and reinforced until those beliefs consumed their whole being.

And those deadly contagions are twofold: not only do the beliefs spread, but the acts themselves become templates. Every shooting inspires the next; every manifesto and every headline fuels another isolated young man to commit mass murder.

And now, tragically relevant, we appear to be witnessing the birth of another frightening contagion borne out of extreme overvalued belief: the targeted assassin, where the violent young male fixates on a single symbolic enemy.

Transgender Identification as an Extreme Overvalued Belief

Just as these violent actions are fueled by overvalued ideas, so too is the trans phenomenon—very different in expression, but identical in structure.

In the case of this contagion, the overvalued belief is that being trans is natural, healthy—that trans is a whole new kind of person.

Think about it: these kids aren’t identifying as having a poorly defined psychiatric disorder called gender dysphoria. They’re certainly not identifying as having a paraphilia. They’re identifying as trans—a reified identity now celebrated as a brave new way to be human.

Once young people collide with this dangerous belief loose in our culture, they plunge themselves into the worlds of TikTok, YouTube, and Instagram, endless feeds that glorify and amplify the belief until it consumes them.

The idea is simple, emotionally charged, highly transmissible, and very very alluring: your suffering has a single cause—you are trans—and your salvation lies in medical body modification.

All the way back in 1892, Wernicke observed that these beliefs don’t start out as all-consuming; they become overvalued in incremental steps, and they can only take hold when no countervailing perspectives are present in a person’s life.

More than a century later, we see exactly what he described, but Wernicke could never have imagined the hermetically sealed digital echo chambers of the internet, where no corrective forces can penetrate.

The result is chillingly predictable: exposure to extreme ideas, reinforcement by those in the culture or subculture, and then action. For some, the action is violence against others. For others, it is violence against their own bodies—castration, mastectomy, phalloplasty.

Like violence, the trans contagion is also twofold: not only does the belief that trans is natural and healthy spread, but so too does its medical embodiment. Every celebrity showered with adoration for coming out as trans, every student applauded by teachers and peers, becomes a template that draws more vulnerable young people in— who then absorb the belief, become all-consumed by it, and pursue radical, permanent disfigurement in its name.

Because this is the key difference. Society recognizes the beliefs that lead to murder as dangerous and pathological. But when the overvalued belief is “I am trans” society does the opposite. Governments enshrine it in law. Doctors pick up their syringes and scalpels. The media romanticizes it. And schools don’t just celebrate it; they teach it as scientific fact.

And anyone who suggests the belief is harmful is swiftly punished.

Again: The madness lies in society.

---

The Rhythm of History

As the famous saying goes: history doesn’t repeat, but it does rhyme.

The parable I opened with comes from the book Try to Remember, by Dr. Paul McHugh, which is an account of his battle the last time large swathes of society fell under the spell of a dangerous, overvalued belief unleashed by a political movement.

Then it was the belief in repressed memories—the idea that a person could endure years of the most horrific child sex abuse but have no memory of it until they found themselves under the care of an “expert” in recovered memory therapy.

McHugh tells of pulling three desperate men out of the river. Loving fathers and uncles who suddenly found themselves accused of the most heinous crimes by female relatives swept up by the madness. After the third, McHugh realised he had to go upstream.

What he found was a gang of psychiatrists consumed by this overvalued belief, whose actions resulted in hundreds of thousands of false accusations of child sex abuse, normally against loving parents or family members. These allegations fell like a bomb on households, obliterating loving relationships, shattering reputations, and destroying lives.

It’s hard to believe that we didn’t learn from this catastrophe, but here we are again, just a few decades later, in the exact same place.

Only now, the belief has captured not just psychiatry, but endocrinology and surgery as well. Whole branches of medicine have fallen under its spell. And that is what makes it so dangerous.

It is not only patients who are consumed by the belief. It is the doctors too. WPATH is their insulated echo chamber—where no counteracting views or opposing ideas can penetrate. So they march forward—injecting hormones, amputating healthy organs—true believers in the fantasy that the 21st century has unveiled a new kind of human being.

And pathology spreads beyond the clinic. Parents who tell effeminate boys they are girls. Teachers who secretly transition children behind their parents’ backs. Politicians who zealously pass laws to ensure the scandal continues. All acting pathologically. All in service of the same belief.

Once again: the madness lies in society.

Re-psychopathologization

Which is why today, Genspect is officially calling for the re-psychopathologization of transgender identities, through the lens of the extreme overvalued belief. Not to stigmatize. Not to marginalize. But to restore clarity and compassion.

Because this IS a pathological condition—an all-consuming fixation that demands careful psychiatric intervention.

Whether the trans-identified person is an autogynephilic man, a gender nonconforming homosexual, or an autistic adolescent muddling through puberty—if they have come to the conclusion that their trans identity is healthy, and it is their body that needs to be fixed, that is the wrong conclusion. What they need is not hormones or surgeries, but ethical psychotherapeutic support to help them recognize that the belief itself is pathological.

The 2010 declaration by WPATH to “de-psychopathologize” “gender variance” was not based on scientific discovery but on political advocacy. And it unleashed catastrophic harm by framing ethical psychotherapy as conversion therapy and igniting a social contagion.

But it wouldn’t be accurate to say that WPATH’s campaign failed. One of the goals of depsychopathologization was to secure full unfettered access to hormones and surgeries for anyone who desired them. So in that sense, it was actually a roaring success.

But time’s up WPATH: Fifteen years of harm is fifteen years too many.

Genspect’s call for re-psychopathologization is not motivated by politics. It is motivated by truth and respect for the Hippocratic Oath. And by the duty to protect children, adolescents, and vulnerable adults from being consumed by this dangerous belief.

Yet, re-psychopathologization must be grounded in compassion, recognising that the young people caught up in this are innocent victims, who, in a state of extreme vulnerability, were thrown into the powerful current. These victims had the misfortune of coming of age in an era of collective madness, when safeguarding was abandoned at the altar of politics and medical body modification was sold as the cure for adolescent angst. They are blameless. And many are afraid.

They deserve care and understanding—but above all, they deserve the truth.

So Genspect calls upon governments, medical associations, and psychiatric bodies to abandon WPATH, to reject the ideological incoherence of depsychopathologization, and restore safeguarding by recognizing the pathological belief driving transgender identities.

---

A Plea to Those Who Shape Culture

Before I close, I must speak to all who play a role in shaping our culture: journalists, activists, educators, politicians, and every public figure taking part in this debate.

First, to a certain cohort of journalists. Understand the weight of your influence. Put a trans celebrity on a magazine cover, glorify a trans identity, and you strengthen this dangerous belief.

Repeat activist misinformation—like ‘gender-affirming care is life-saving,’ or smear those protecting children as ‘anti-trans’—and you fortify the overvalued belief that salvation lies in irreversible medical interventions.

But my plea goes further. To activists who spread this belief. To teachers who pass it on to children. To politicians who enshrined it into law without even understanding it. You are all complicit in sustaining the harmful belief driving this scandal.

By oversimplifying complex issues for votes or clicks, stripping away nuance, and reducing everything to us versus them—trans allies versus transphobes, the virtuous left versus the fascist far right—opposing viewpoints are demonized resulting in those essential countervailing perspectives being shut out. This creates the perfect conditions for dangerous overvalued beliefs to become all-consuming.

Remember this: people act on these beliefs in different ways, but the pattern is the same. One engraves political slogans on his bullets. Another has a surgeon engrave customized mastectomy scars on her body.

Those of us in the public sphere must recognize the power we hold. We can either fan the flames of these dangerous beliefs, or we can help extinguish them. Choose carefully.

Slay the Monster

Now, I know some people think this monster is too powerful—that it can’t be beaten, and therefore the fight is not worth waging.

But let’s remember how all this began. Back in the 1980s, a small group of trans activists hatched a plot: to take an absurd, illogical overvalued belief—that being transgender is innate, natural, healthy—and force all of society to live in a fictional world built on it.

Given the sheer audacity of that plot, I find it hard to believe there weren’t voices of doubt. Naysayers saying it couldn’t be done. But if such voices existed, they were ignored. And the activists pressed on until they succeeded in nothing less than reshaping reality itself.

And they didn’t just persuade people to politely look the other way.

They rallied good, decent people to march in the streets demanding that teenagers sacrifice their health, their fertility, and their sexual function in the name of this belief.

They convinced governments to write laws based on a non-existent, fictional concept.

They enlisted well-meaning teachers to poison the minds of a generation with absurd lies.

And they drove doctors to amputate healthy organs and call it medicine.

If they could succeed in creating that false reality, then surely we can succeed in restoring truth. Because our cause is not built on lies but on logic and reason. Not on ideology but on sound ethical principles. Not on harm but on healing.

And so we return to the parable. We cannot stay downstream forever, pulling injured bodies from the current while the monster wreaks havoc upstream. We must confront it head on. Because this belief is too dangerous and too destructive to be left standing. We simply have no choice but to defeat it.

Mia Hughes is the author of The WPATH Files, and director of Genspect Canada.

---