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You are old when the world has moved on beyond anything that you can understand or sympathize with. I am not referring here to technical advances that only an infinitesimal proportion of the population can ever understand, or to the blizzard of laws and regulations that leave even specialist lawyers and accountants anxious, bemused, and out-of-date.

I refer rather to new social assumptions, mores, and philosophies that are completely at variance with any that you have hitherto known. When I saw the following title on the website of the Journal of the American Medical Association, I knew that I was as obsolete as any Russian aristocrat had been in 1925:

Early Adoption of Expanded Gender Options in National Provider Identifiers.

What exactly, or even approximately, did this mean?

The NPI in America is an obligatory electronic register of doctors, osteopaths, medical assistants, psychologists, medical students, nurses, pharmacists, dentists—in fact, anyone who may contribute to patients’ electronic health records. How far this contributes to the health of patients is anyone’s guess, but it certainly provides a lot of data, as well as contributing (no doubt) to the feeling that Big Brother is watching you.

Until recently, the NPI divided those inscribed on it to one of two sexes, male and female: or, as the Bible might have put it, male and female recorded it them.

But from April 2024, the NPI included two other categories on its register: X, meaning “unspecified or other gender identity,” and U, meaning “undisclosed.” The difference between “unspecified” and “undisclosed” is one that the scholastics of gender studies might debate with the subtlety of the theologians of old counting the number of angels who can dance on the head of a pin. The academics of gender studies departments in universities need not for the moment fear redundancy: There will always be absurdity enough for them to occupy the fug that they call their minds.

The purpose of the article—or at least its ostensible purpose—was to measure the difference in the number of people on the NPI who described themselves as X or U, according to the states in which they lived and practiced. The states themselves were divided into two categories: those that had “protective” policies toward the new alphabet soup of genders, and those that had “harmful” policies toward them.

The definitions of “protective” and “harmful” were provided by an organization called the Movement Advancement Project, a nonprofit think tank whose very name seems Orwellian to me. Was it movement as such, in any direction whatever, that was to be advanced, as if movement would not occur without it, or was it particular movement in any particular direction that was to be advanced? The MAP’s description of its “work and mission” on its website was a masterpiece of connotation without denotation:

We work to create a thriving, inclusive, and equitable America where all people have a fair chance to pursue health and happiness, earn a living, take care of the ones they love, be safe in their communities, and participate in civic life.

I have long thought that public declarations are not worth making unless their denial is similarly worth the effort. (Whether this assertion should itself be similarly judged, I leave to the philosophers of paradox to decide.) Let us, then, take the denial or opposite of the above description of MAP’s “work and mission”:

We work to prevent a thriving, inclusive, and equitable America…etc., etc.

Or alternatively:

We work to create an impoverished, socially exclusive, and inequitable America, where everyone will have little chance to pursue health or happiness…etc., etc.

It is precisely over what constitutes equity and justice that disputes arise, because human existence is so complex and filled with ambiguities and contradictions, in which unintended consequences are the rule rather than the exception, and in which agreement even over what is most desirable is never universal.

To divide social policies into “protective” on the one hand and “harmful” on the other is to conceive of the world with all the subtlety of Old Major’s slogan in Animal Farm: Four legs goods, two legs bad. Slogans such as this are not intended, of course, to express any truth, moral or empirical: They are intended to extend the power of those who devise them and persuade others to intone them as if they were indubitable.

Be that as it may, the authors of the article found that among the 123,773 people who registered on the NPI between 3 April and 6 July 2024, 0.7 percent chose either U or X. Unsurprisingly, perhaps, 1.2 percent of those who were involved in “behavioural health” (a sinister term, if ever there was one), or in social care, chose U or X, while only 0.2 percent of doctors did so. Those in what the authors call “gender negative policy environments” were half as likely to choose “gender-expansive options” as those in “nonnegative policy environments.”

The article concludes:

Further research is necessary to understand the complex dynamics introduced by the expansion of NPI gender options for clinicians and to assess whether this data collection practice effectively enhances equity and inclusion among gender-diverse clinicians.

This amounts to little more than an implicit plea for more regulation by the equity police, who will forever find more categories of inequitably treated people to save from injustice, all at public expense, creating for themselves well-paid, comfortable jobs while sowing mistrust, resentment, and competitive grievance in the population.

If the price of liberty is eternal vigilance, the price of equity, as defined by those who equate fairness with equality of outcome between arbitrarily chosen categories of people (which are potentially even more numerous than the number of genders according to the most gender-expansive of ideologues), is endless surveillance, form-filling, denunciation, mistrust, confession of sin, ideological legerdemain, self-righteous indignation, bullying, resentment, and intellectual dishonesty—among other things.

When the history of our times comes to be written, I hope that our descendants will marvel at our collective madness. This assumes, of course, that the madness will have passed; though if it has, it will almost certainly have been replaced by collective madness of another kind. Man will remain:

Sole judge of truth, in endless error hurl’d:
The glory, jest, and riddle of the world!

Theodore Dalrymple’s latest book is On the Ivory Stages (Mirabeau Press).