Is the two-type typology of bipolar disorder a good theory? Are bipolar I and bipolar II "really" different conditions, or slightly different presentations of "the same" condition, part of a "bipolar spectrum" along with cyclothymia? In our current state of knowledge, this is debateable, but if our understanding of the etiology of bipolar disorder were to advance, and we were to find evidence that that bipolar I has a different underlying _causal structure_ from bipolar II with decision-relevant consequences, like responding to different treatments, that would support a policy of thinking and talking about them as mostly separate things—even while they have enough in common to both be kinds of "bipolar". The simple high-level category ("bipolar disorder") is a useful approximation, in the absence of knowing the sub-category (bipolar I _vs._ II) and the subcategory is a useful approximation in the absence of knowing the patient's detailed case history.
-With a _sufficiently_ detailed causal story, you could even dispense with the high-level categories altogether and directly talk about the consequences of different neurotransmitter counts or whatever—but lacking that supreme precise knowledge, it's useful to sum over the details into high-level categories, and meaningful to debate whether a one-type or two-type typology is a better statistical fit to the underlying reality whose full details we don't know yet.
+With a _sufficiently_ detailed causal story, you could even dispense with the high-level categories altogether and directly talk about the consequences of different neurotransmitter counts or whatever—but lacking that supreme precise knowledge, it's useful to sum over the details into high-level categories, and meaningful to debate whether a one-type or two-type taxonomy is a better statistical fit to the underlying reality whose full details we don't know yet.
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-In the case of male-to-female transsexualism, we notice a pattern where androphilic and non-androphilic trans women seem to be different from each other—not just in their sexuality, but also in their age of dysphoria onset, interests, and personality. Many authors have noticed this clustering of traits, [while disagreeing about the underlying causality](/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/).
+In the case of male-to-female transsexualism, we notice a pattern where androphilic and non-androphilic trans women seem to be different from each other—not just in their sexuality, but also in their age of dysphoria onset, interests, and personality. Many authors have noticed this clustering of traits under various names, [while disagreeing about the underlying causality](/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/).
[Blanchard]
-[Veale, Clarke, and Lomax](/papers/veale-lomax-clarke-identity_defense_model.pdf) attribute the differences to whether defense mechanisms are used to suppress a gender-variant identity.
-
-[Vitale] http://www.avitale.com/developmentalreview.htm
+[Veale, Clarke, and Lomax](/papers/veale-lomax-clarke-identity_defense_model.pdf) attribute the differences to whether defense mechanisms are used to suppress a gender-variant identity. [Anne Vitale](http://www.avitale.com/developmentalreview.htm) identifies distinct groups (Group One and Group Three), and hypothesizes that the difference is due to degree of prenatal androgenization.
[Serano 2020]
-Is a two type typology of male-to-female transsexualism a good theory? Is it "really" different conditions, or slightly different presentations of "the same" condition?
+Is a two type typology of male-to-female transsexualism a good theory? Is it "really" two different conditions (following Blanchard _et al._), or slightly different presentations of "the same" condition (following Veale _et al._)?
+
+At the high level of taxonomy—if I have to choose between a one-type and a two-type theory—then I think the two-type theory is superior. But I also think we can do better and say more about the underlying causal structure that the simple two-types story is approximating, and hopefully explain anomalous cases that look like "noise" to the simple theory.
+In the language of causal graphs
+
I think I do have a pretty good guess at what's going on: https://en.wikipedia.org/wiki/Causal_graph ]
![transition causal graph](/images/transition_dag.svg)
[3. cultural/ideological factors]
+
_(Thanks to the immortal [Tailcalled](https://surveyanon.wordpress.com/) for discussion.)_