An electric scooter doesn't have that much in common with a humidicrib. Or a fax machine.

You wouldn't expect someone who made heart monitors to be your first port of call when you wanted an Olympic scoreboard.

Yet all of these inventions — and around a hundred more — once came out of the same Australian factory.

They were all the creations of a pair of brothers, Edward and Donald Both.

Across the middle of the 20th century, the Both brothers built things to meet the challenges of the times — war machinery in the Second World War, electric vans to beat post-war rationing, sports technology for the 1956 Melbourne Olympics, and a lifesaving polio treatment to counter the devastating epidemic.

But where their name was once emblazoned on tools around the world, it's now filtered out of sight.

Even in their home state of South Australia, the brothers' work isn't common knowledge — although their memory is preserved by a few dedicated museum curators and family members.

Who were the Both Brothers?

"Ted" and "Don" hailed from Caltowie near Port Pirie in South Australia and were the eldest and youngest, respectively, of five siblings.

Kaylene Kranz, a relative of the brothers, says their regional roots were a source of their inventiveness.

"If you're in the country, you haven't got the luxury of picking up the phone and say, 'Hey, come and help,'" she says.

Ms Kranz knew both Ted and Don as a young woman — particularly Don, who she recalls as a jolly fellow.

"Ted was the put-together man and Don had ideas and ran the business side of it. But together, they were a formidable team," Ms Kranz says.

Kellie Branson, a curator at the SA Health Museum, said the brothers' genius came from their ability to work in tandem.

"Their brains were opposites, but they still work together to come up with these amazing inventions."

Necessity is the mother of invention

The duo didn't tend to invent brand new things, so much as dramatically improve existing tools. Ted once said he didn't even like the term "inventor" – it implied their ideas had come from nowhere.

"People who imagine a person dreaming up an entire invention and making it work have the wrong idea," he said in a 1950 interview.

"It is a painstaking process, checking each step."

This reticence didn't stop people labelling Ted "Australia's Edison", particularly after his work in the 1940s. 

During World War II, Ted worked on devices that measured machine gun fire, transmitted drawings and diagrams over phone lines, dried blood that could be reconstituted for field transfusions, and helped guided torpedoes. 

The brothers' electric vehicles were a response to petrol rationing. The scooter never made it to market, but Ted also developed electric vans, which were used to deliver bread until the late 1940s.

The drawing-transmitting device, a kind of early fax machine dubbed the Visitel, found uses in confirming horse racing results.

There were more sporting innovations, first with tennis scoreboards for the Davis Cup, then the 14,000-light globe Olympic scoreboard at the MCG.

Ms Kranz says there's even a family story that they "had television sorted" before anyone else in the 1930s, only to have their plans disrupted by the war.

But the brothers' biggest success was in healthcare.

Wooden lung and electric hearts

The iron lung worked better when it wasn't made from iron.

The respirator, first developed in the 1920s, was a lifesaver for people paralysed by polio.

"It was very heavy, cumbersome and expensive to make and produce," Ms Branson says.

At his new wife Eileen's coaxing, Ted decided to spend their honeymoon funds on making a cheaper version in 1937.

"They managed to do one made of plywood," Ms Branson says. The lighter, cheaper, "iron" lung was a twentieth of the cost of commercial iron lungs.

Ted took the invention to London, and within a few years, there were hundreds of wooden respirators being distributed across the Commonwealth, helping surging numbers of polio patients. He was awarded an Order of the British Empire for his work.

Humidicribs, similarly, already existed in the early 1950s, when Don turned his hand to one. But his portable version could more quickly and safely encase premature babies with the right temperatures and humidity.

Then, there are the electrocardiograph (ECG) machines. Doctors had known since the 19th century that placing electrodes over a patient's heart, and recording the signals it emitted, could give vital information about a patient's heart health.

By the 1930s,  ECGs were accurate enough to diagnose patients — but getting the graphs required an arduous film-developing process, which could take weeks.

The Both brothers figured out how to make instant readers: first with glass discs, then with paper and ink-dipped styluses marking out tiny graphs.

"You could use the microscope on top of the machine to view the results instantly," Ms Branson says.

They could also be transported to hospital bedsides, or even over bumpy roads to the patients' homes.

The brothers also worked on electroencephalographs (EEGs) for measuring brain activity.

Ms Kranz, who worked in neurology, found herself using EEG equipment designed by the Both brothers years later — alongside a family cousin who'd stayed with the business.

Making healthcare stylish

From the polished wooden frames to the delicately printed labels, much of the Both equipment is aesthetically pleasing to look at. It's a world away from the bright, boxy plastic of modern medical equipment.

The ECGs fit right in to the halls of the library at the South Australia Parliament, where librarian John Weste has put some of the Both equipment on display.

"I love the design," Dr Weste says.

"It's so beautifully executed — even the carrying cases with the herring bone wood patterns."

Packed into their cases, the early ECGs look less like doctors' tools and more like vintage sewing machines. Ms Branson suspects this is deliberate.

"I think they did design it on the look of some old sewing machines," she says.

For patients who'd never seen an ECG before, a more familiar piece of equipment might be less foreboding.

Other pieces might be mistaken for old radios.

"It wouldn't seem like they were getting a procedure or a reading. It just looked like the radio was next to their beds," Ms Branson says.

Ms Kranz finds this suggestion likely, remembering the beauty of Don and his wife Yvonne's Kensington home on her visits.

"They had a lovely house, and we were always given tea out of beautiful cups in the sitting room," she says.

"So yes, I think so that it wasn't just 'OK, let's sort this', [it was] 'let's make people comfortable while we're making them well.'"

A forgotten chapter

The brothers sold their company to Drug Houses of Australia in the 1960s, but they kept tinkering well into retirement. Ted died in 1987 and Don died in 2005.

Ms Branson, who's been collecting Both equipment for the health museum for years, recently travelled out to Ted's grave in Victoria.

"It's a humble little plaque. No mention of his inventions. It just says: 'Ted Both, OBE, and his dates.'"

Eventually, more company acquisitions and the pace of medical research took the Both name off equipment.

Dr Weste, who's been showing the Both equipment to visitors to the South Australia Parliament, says people are surprised to learn the inventions originated in the state.

"No-one's heard of them. And that's the great tragedy of it," he says.

This is partly why the health museum loans some of the Both equipment out.

"Otherwise, these stories will be hidden away," Ms Branson says.

"We want these people to be out in the light."

Ms Kranz has told her grandchildren about her clever cousins, and she wants them to be more widely known too — but not just them.

She says South Australia has a host of other under-recognised inventors.

Ms Kranz hopes the Both equipment on display will show people how much medicine has changed in the span of less than a lifetime.

"We have our MRIs and our CTs, and our big, whiz-bang machines that twiddle around and go ping, but they managed to diagnose without that in the early days, with very basic stuff."

We mostly used the term ‘disinhibition’ as a mitigation: an invitation to think creatively about how to help our clients stay out of trouble. But sometimes the usage was closer to a condemnation. More than once, I led the process of excluding someone who was being threatening or intimidating – someone ‘too disinhibited’ to safely be included in the community. And even where it was generous, I now see how broad and presumptive my use of the term became. Both in speech and thinking, I had internalised the casual use of an idea from journal articles, medical referral documents and the conversation of clinical professionals.

Then, one day, someone challenged me on the term. I was in a staff meeting with my colleague Callum, himself the survivor of a brain injury from a car accident. He described how, that morning, a client called Yvette had noted his earrings and asked him about his sexuality in a way he had felt was derogatory. He’d told her how he felt, and was now asking the team for feedback on his handling of the situation. That’s when I used the ‘d’ word.

I don’t know if I really thought Yvette was disinhibited; the idea had just become an ingrained, reflexive part of my vocabulary. So when Callum noted how reliant my use of the term was on cultural and moral assumptions, how it risked dehumanising Yvette and foreclosing other interpretations of her behaviour, it was like somebody opening a window I’d thought was painted shut. As I thought about it afterwards, I wondered what I’d been doing for the past two decades. In attributing behaviour to disinhibition, had I been making my own life easier by reducing our clients’ motives to something that didn’t require investigation? Had I, in fact, been constructing them as people who didn’t have motives, only impulses? Where did the idea of disinhibition even come from?

The literature paints Gage as a kind of avatar for behavioural dysfunction

As I looked into the history of the term, I began to suspect I might have fallen for a pseudoscientific idea. I learned that, while neuroscientists have shown that brain injury survivors sometimes struggle with certain tests of attentional and motor control, there’s little evidence linking this kind of ‘executive’ disinhibition with behavioural change – the social disinhibition I had been attributing to our clients. Instead, theories about this kind of disinhibition tend to rely on case studies.

I began researching the lives of two 19th-century figures who have both been described as disinhibited. The first was a railroad construction foreman, Phineas Gage. The second was the photographer Eadweard Muybridge (born Edward Muggeridge in England). The two were contemporaries, and both lived in San Francisco for a time. Both were injured in accidents. But there the similarities end. Despite Muybridge’s brain injury being well documented and despite it transforming him, as some claim, in profound and disastrous ways, he scarcely features in the brain science literature, and his legacy remains predominantly that of an artistic and technical genius. Gage, by contrast, became famous for the outrageous behaviour that supposedly resulted from his injury. The literature paints him as a kind of avatar for behavioural dysfunction, with every other aspect of his life overshadowed by his status as disinhibition’s patient zero. Why are the legacies of these two ‘disinhibited’ people so different? I believe the answer tells us almost everything we need to know about the condition, about its origins and its continued use today.

On the day of his accident in September 1848, Phineas Gage was working near the town of Cavendish in Vermont, using an iron ‘tamping rod’ to pack an explosive charge into a hole. The charge exploded prematurely, firing the iron straight through his head. Miraculously, Gage survived. He was transported, bloodied but conscious, to his hotel room, where a doctor called John Harlow cleaned and dressed his wounds. Gage convalesced for 73 days and then returned to his hometown in neighbouring New Hampshire. Harlow described Gage’s recovery as ‘without a parallel in the annals of surgery’, attributing it to Gage’s ‘physique, will, and capacity of endurance’ and to the ‘recuperative powers of nature’. But Harlow also noted a marked change in Gage’s personality: formerly a ‘favourite’ among his men and a ‘shrewd, smart business man’, Gage had become ‘fitful, irreverent, indulging at times in the grossest profanity.’ Gage was now ‘a child in his intellectual capacity’, Harlow continued, with ‘the animal passions of a strong man’. So changed was he, claimed Harlow, that friends and acquaintances said he was ‘no longer Gage’. The doctor concluded that this decline was a consequence of the damage done by the tamping iron to the frontal lobes of Gage’s brain.

Initially reported as a curiosity, the story’s scientific significance began to gain recognition in 1878, when the Scottish neurologist David Ferrier used it in an influential lecture series. Ferrier was responsible for popularising the idea that dominated the brain sciences during the 20th century – that of cerebral localisation, mapping the brain’s division into discrete functional zones. He also promoted the idea that the frontal lobes inhibit physical activity in order to allow for mental reflection. Terms like ‘executive function’ and ‘disinhibition’ came later when the theory was elaborated across the 20th century, but the central idea was the same as that hinted at by Harlow and stated plainly by Ferrier: that the frontal lobes were responsible for the inhibition of the animal passions that might disturb temperate, ethical behaviour. This formulation aligned with Sigmund Freud’s influential tripartite model of the human psyche in which the impulsive id is modulated by the more discerning ego and inhibited by the morally oriented superego. Disinhibition became paradigmatic of the localisation agenda, and Gage became its standard-bearer.

If you search ‘frontal lobe injury’ online, you’ll find a version of Gage’s story rehearsed on every page

More than a century later, Gage’s transformation would still be referenced as the quintessential case study. ‘He took to gambling and sleeping with prostitutes,’ as the neuroscientist David Eagleman said in a talk at the Royal Society for the Arts in 2010. ‘He could not be trusted to honour his commitments,’ wrote the cognitive neuroscientist Hanna Damasio and colleagues in 1994; Gage ‘began a new life of wandering [and] never returned to a fully independent existence.’ Damasio’s coauthor and partner Antonio used Gage’s life as a major reference point in his prizewinning and widely translated book, Descartes’ Error (1994), describing Gage’s failure to secure steady work due to ‘poor discipline’ and his subsequent ‘career as a circus attraction’ at Barnum’s Museum in New York City, ‘vaingloriously showing his wounds … peddling misery for gold.’ This bleak portrait ends with Gage’s final days and death, believed to be from a seizure, in 1860:

In my mind is a picture of 1860s San Francisco as a bustling place, full of adventurous entrepreneurs engaged in mining, farming, and shipping … But that is not where we would find [Gage] if we could travel back in time. We would probably find him drinking and brawling in a questionable district, not conversing with the captains of commerce … He had joined the tableau of dispirited people who, as Nathanael West would put it decades later, and a few hundred miles to the south, ‘had come to California to die.’

Since Descartes’ Error, claims about Gage have included a 2016 paper that described him as an ‘extremely cruel’ person who ‘enjoys harming people’, and the terms ‘abusive’ and ‘harsh’ were used in a 2020 editorial. He changed, as one commentator wrote in 2000, from a ‘mild-mannered, responsible foreman’ to ‘an aggravated, antisocial deviant’.

In 2018, Gage was chosen as the first of six ‘essential landmark case reports’ for neuropsychiatry. If you search ‘frontal lobe injury’, ‘frontal lobe disorder’ or ‘executive functions’ on Wikipedia today, you’ll find a version of Gage’s story rehearsed on every page. If you search functional localisation, it’s a picture of Gage’s skull from Harlow’s paper that greets you, pierced by the tamping iron like an olive on a cocktail stick.

The sensational impact of this version of Gage’s story would be fine if it weren’t for the fact that it’s largely fictional.

There are three primary sources written about Gage by people who met him. Harlow wrote his first report in 1848, limited to an account of the recovery, and a second in 1868, which reproduced the first and added further interpretations. Another physician, Henry Bigelow, wrote a paper after meeting Gage the year following the accident. Of the two, only Harlow mentions Gage’s personality change. His total word count on the subject is just over 300. At no point does he ask Gage about it or offer any quotes from him – Gage was dead by the time Harlow wrote the second paper. Nothing written by anyone who knew Gage before his injury survives, only paraphrases noted down by the two doctors. So, the sources are scant to begin with. And, according to the psychologist and historian Malcolm Macmillan in 2008, most of those who have written about Gage since the primary sources were published do not appear to have checked them, promoting some aspects of the story, ignoring others and embellishing liberally. Macmillan’s conclusions were echoed in a separate 2022 review of more recent Gage literature, which found that half of the 25 papers analysed gave negative descriptions of Gage that were not based on the primary sources.

Macmillan offered a very simple test: if a description of Gage isn’t quoted from the primary sources, then it is ‘not a fact about Phineas Gage’. The number of Gage-related statements that have failed the test quickly mounts up. What Eagleman and Antonio Damasio said about Gage drinking, brawling, gambling and visiting prostitutes aren’t facts. Neither was Damasio’s description of Gage working ‘vaingloriously’ as a ‘circus attraction’. The available sources suggest he appeared at a museum (no circus) and was mostly alone when touring New England after his injury, and none of them give any detail about the manner in which he presented himself. Hanna Damasio’s claim that Gage ‘began a new life of wandering’ seems to be extrapolated from a single use of the word ‘wanderings’ by Harlow, in context of the difficulty he had in tracking down Gage in later life. Nowhere did Harlow or Bigelow suggest that ‘wandering’ was typical of Gage’s post-injury existence. These authors may have become aware of their errors in the years since they were published, but I can’t find any evidence of retractions.

The available facts about Gage fly in the face of claims made about his transformation and reduced capacities

Of the various falsehoods written about Gage, perhaps the one most clearly contradicted by the primary sources is the Damasios’ claim that Gage ‘could not be trusted to honour his commitments’ and that he ‘never returned to a fully independent existence’. In fact, the sources make no mention of Gage being dependent on anyone from the time he recovered from the injury until the last year of his life when he succumbed to illness. They also clearly state that, after he gave up his public appearances, he worked at a livery stable for 18 months and then he moved to Valparaíso in Chile where, according to Harlow, he worked for nearly eight years, ‘caring for horses, and often driving a coach heavily laden and drawn by six horses’.

As Macmillan pointed out, the available facts about Gage fly in the face of claims made about his transformation and reduced capacities. Macmillan gave a carefully sourced description of the demanding nature of Gage’s job in Chile: the dependability required of him in rising in the small hours, loading passengers’ luggage and possibly handling fares; the high level of dexterity and sustained attention necessary for driving six horses; the foresight and self-control involved in navigating the unwieldy coach along the crowded and sometimes treacherous Valparaíso-Santiago road. He also pointed out that Gage, at first a stranger to Chile, would have had to learn something of its language and customs and ‘deal with political upheavals that frequently spilled into everyday life’.

When discussing social disinhibition, most researchers cite cases in addition to Gage, but very few miss out Gage. His was the story that started off the whole idea and has remained by far the most frequently referenced, both in the clinical literature and in wider English language publishing. Given just how weak the evidence of his disinhibition really is, this level of reliance on his case seems astonishing. By contrast, we know with great confidence that our second historical figure, Eadweard Muybridge, did something terrible in the years after his accident. Something both violent and criminal, for which he was tried but not convicted.

Raised in a middle-class family in England, Muybridge arrived in San Francisco in 1855 to open a bookselling business. He was still there in 1860 when Gage died. But by July of that year, when he was 30 years old, he had decided to sell the business and set out on the first leg of a long journey back to Europe. ‘After taking supper at a house on the road, I left on a stage drawn by six wild mustangs,’ he later described. He had no memory of what happened next but recounted what a fellow passenger had told him:

[A]fter travelling half an hour the break got out of order and the mustangs ran away. I tried to get out of the boot of the stage by cutting the canvas with a knife. Here the stage struck a stump and I was thrown out. Two passengers were killed and all injured.

Nine days later, Muybridge found himself ‘lying on a bed at Fort Smith, 180 miles from the place.’ As well as the period of unconsciousness and amnesia, he reported double vision, the loss of his sense of smell and taste, and a degree of ‘confused ideas’. These acute symptoms, he said, lasted three months but he continued to have treatment for a year. He spent several years back in England and Europe after the accident.

Brain experts speculate that Muybridge’s injury may have ‘unveiled his artistic and inventive genius’

After he returned to California in 1867, Muybridge’s friends noted a significant change, stating that he was ‘not the same man in any respect’ after the injury. Formerly a ‘genial, pleasant and quick businessman’, these friends said he was now ‘very eccentric’, ‘his ways and expression of face were odd’ and he was ‘not so good a businessman’. As further evidence, one friend cited the fact that he had altered the spelling of his name, and another that his hair colour had changed from black to grey. Also, that Muybridge brought some $4,000 worth of goods from Europe but refused to sell any to him. Another friend described Muybridge’s inconstancy after the injury, telling of how he would now often make bargains or contracts only to renege within 24 hours, and would refuse to take payment for a photograph ‘if he did not see beauty in it’. The same friend mentioned a ‘strange freak’ of an incident in which the photographer insisted on having his picture taken while sitting above a precipice at Yosemite Valley.

A handful of brain experts have made diagnostic claims about Muybridge in retrospect. The neurosurgeon Sunil Manjila and his colleagues take Muybridge’s impaired senses as confirmation of frontal brain injury. Among the signs of altered personality, they list his habit of changing his name and the ‘unorganised and disjointed’ nature of his landscape photographs, which they describe as ‘an enigma’ to the viewer. They also speculate that Muybridge’s injury may have ‘unveiled his artistic and inventive genius’ spurring him to take copious nude images in defiance of a culture in which ‘controversy about nudity was significant’. The California-based psychologist Arthur Shimamura takes the same images as evidence of an ‘obsessive-compulsive’ tendency, adding that Muybridge’s ‘social disinhibition’ is demonstrated by his inclusion of his own nude body.

Indeed, the change in Muybridge’s career path appears stark. From a humble bookseller he became one of the most influential photographers in history, credited with new techniques that reduced shutter speeds from several minutes to less than a second, and with capturing the first ever images of animals in motion.

More salient than any of these observations, however, and the reason why any of them have been committed to paper, is the astonishing act of violence Muybridge committed in October 1874. Earlier that year, he discovered that his wife, Flora, had become romantically involved with a local theatre critic and, by one biographer’s description, ‘swindler’ called Harry Larkyns. Soon after that, Muybridge came to suspect that his infant son was in fact Larkyns’s child. Muybridge travelled to the town of Calistoga, 75 miles north of his home in San Francisco, and knocked on Larkyns’s door. When Larkyns appeared, Muybridge shot him in the chest with a pistol. Larkyns died at the scene. Muybridge did not resist arrest, freely admitting to the murder, and was held in custody until his trial the following February.

It’s this saga of betrayal and murderous jealousy that Manjila and colleagues refer to when they speak of Muybridge’s ‘emotional instability, aggressiveness, and possessiveness … after the accident’. And the testimonies offered by Muybridge’s friends about the changes caused by his brain injury all come from newspaper reports covering his subsequent trial. When Shimamura speaks of Muybridge having ‘emotional outbursts’, he’s referring to a description given in the San Francisco Chronicle of the moment Muybridge’s acquittal was handed down:

[H]is eyes were glassy, his jaws set and his face livid. The veins of his hands and forehead swelled out like whipcord. He moaned and wept convulsively, but uttered no word of pain or rejoicing.

This context has profound implications for the way we understand the descriptions of Muybridge’s character. If the testimonies of his friends are to be believed, it was the instability brought on by the brain injury that led Muybridge to kill Larkyns. ‘The killing would have surprised me much before his accident but not much after it,’ said one defence witness, according to the Sacramento Daily Union. The brain scientists take it at face value – labelling the murder as Exhibit A in their argument for Muybridge’s disinhibition.

Why, then, don’t we find Muybridge alongside Gage in neuropsychology textbooks or Wikipedia articles about frontal lobe function? The simplest answer is that neither the testimonies about his personality change nor the retrospective assessments of the clinicians are believable. Some of them amount to very little even on paper – the mention by his friends of Muybridge’s hair changing colour and his idiosyncratic approach to business, for example. But, more pressingly, the testimonies were given in support of an insanity plea submitted by Muybridge’s defence council, in the hope of saving him from the death penalty. How sure can we be that his friends would have said the same things without the urgent stakes of the trial hovering in their minds?

Even if we accept the testimonies as the whole truth, it’s notable that the jury present at the trial roundly rejected the insanity plea. In violation of the law and of the judge’s instructions, when they acquitted Muybridge, it was on the grounds that Larkyns’s death was not a murder committed by a mad person but a justifiable homicide committed by a sane one. Perhaps they’d read the interview with Muybridge published by the San Francisco Chronicle while he was in prison awaiting trial. He is quoted as saying:

I objected to the plea of insanity because I thought a man to be crazy must not know what he was doing, and I knew what I was doing. I was beside myself with rage and indignation, and resolved to avenge my dishonour.

As Rebecca Solnit observes in her Muybridge biography River of Shadows (US)/Motion Studies (UK) (2003), and as the jury surely knew, his crime was ‘not an act of impulse but a carefully laid plan’.

We are prevented from explaining away Muybridge’s motives through the attribution of disinhibition

Muybridge was clearly irascible and potentially dangerous, but the richness of the historical record about him makes it hard to tell a simple story. He is often remembered as a genius or an innovator. Solnit describes him as ‘the man who split the second, as dramatic and far-reaching an action as the splitting of the atom.’ She then explicitly characterises him in terms of contradictions:

The alienation that is a hallmark of Muybridge’s personal life is evident in his photographs; the independence of vision in the photographs also characterised his maverick life. But the masterful clarity of Muybridge’s photography is in stark contrast to the emotionally over-wrought man on exhibit in the trial.

Independence and masterful clarity exist in tandem with alienation, a maverick nature and emotional overwhelm. Muybridge is afforded all of these competing aspects of self without compromise. No one characteristic is taken as dominant or final. Even – or especially – as regards the murder, we are prevented from explaining away Muybridge’s motives through the attribution of disinhibition. The historical record tells us he killed Larkyns because he wanted to, because he was angry and humiliated, because he believed he was in the right, and for a host of complex emotional reasons we will never have access to.

While the complexity of the records prevents reductive interpretation of Muybridge, it is, in Macmillan’s words, ‘the very slightness of reliable fact which allows myths about Phineas [Gage] to flourish’. But that’s not all: the relative social standing of the two men has also played a role in shaping their respective legacies.

Muybridge’s work as an artist and his status as one seem to have acted as prophylactics, first against criticism during his lifetime and then against reductive interpretation in retrospect. The art historian Sarah Gordon has written about the way Muybridge’s human nudes were received when they were first published. Included in his second series of motion studies, made at the University of Pennsylvania, the work was supervised by the specially formed body dubbed the ‘Muybridge Commission’. Led by the university’s provost William Pepper and including a selection of authoritative figures, the Commission was formed explicitly to mitigate the effects of Muybridge’s questionable reputation and ensure safe passage for the pictures after publication. According to Gordon, the Commission deliberately attached a scientific-sounding name – Animal Locomotion – to the publication and a ‘prohibitively high price’ so that ‘only wealthy, upper-class individuals and members of institutions would have immediate access to the photographs’. They then signed up many of their own powerful friends and institutional contacts as subscribers: the former US president Rutherford B Hayes, the inventor Thomas Edison, the writer and critic John Ruskin, the industrialist Cornelius Vanderbilt, the universities Harvard, Yale and Johns Hopkins, the Library of Congress, and the Smithsonian Institution all bought copies. The Commission later sent a copy to the Sultan of Turkey, ruler of the Ottoman Empire. As Gordon puts it: ‘Pepper and his colleagues … relied both on their social status and on the public’s uncritical trust in professionals to shield images of the nude body from moral scrutiny.’

The forces of social status and uncritical trust in professionals that worked so well in Muybridge’s favour did the opposite for Gage. During his life, he may well have had friends. People were willing to employ him. He was cared for by his family towards the end. And there’s no suggestion in the primary sources that he ever became isolated or spurned from any community. However, without powerful or wealthy friends to defend his reputation, the story told about Gage by Harlow operated in isolation after his death. In the absence of dissenting voices, it was treated as fair game by commentators with their own professional agendas.

Appropriate behaviour isn’t maintained by the individual. It’s produced collectively through continual negotiation

The comparison of these two people illustrates the core problem that dogs the idea of social disinhibition: the fact that it relies for its meaning on the highly variable interpretation of what constitutes appropriate behaviour. The members of the jury at Muybridge’s trial – recruited explicitly to represent the wider community’s ethical priorities – believed it was appropriate for Muybridge to kill his wife’s lover. In fact, not only was Muybridge acquitted for the murder, he was celebrated, as recorded in the Sacramento Daily Union:

A large crowd gathered in front of the court-room, and as Muybridge descended the steps a free man, they cheered vociferously and long. He was surrounded by the crowd, every man of which seemed anxious to congratulate him first.

These events are fascinating and slightly baffling from a contemporary perspective – to explain them might take a whole new essay. But they demonstrate how unpredictable morality is and show something important about how it works: what constitutes appropriate behaviour isn’t something maintained by the individual. Rather, it is produced collectively through continual negotiation. The individual brain can’t take sole responsibility for the practices we all rely on for counterbalancing our wilder impulses. That’s why we have legal systems. And when people do get isolated, they are at greater risk of criminalisation.

Among those who have accepted the revision of the Gage story, the consensus seems to be that his character probably did change but that any disinhibition that did occur was temporary. But it’s important we subject even this claim to counter-proposals, that we ask what else might have provoked such a temporary change, assuming we believe in it. Some have suggested that psychological trauma might have played a role. On meeting Gage in the hour after his injury, Harlow found his patient ‘perfectly conscious’ but ‘getting exhausted from the hemorrhage [sic]’ which had made him and the bed on which he lay ‘one gore of blood’. Another witness described how, at one point Gage got up and vomited ‘a large quantity of blood, together with some of his food’ and how ‘the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor, together with the blood, which was forced out at the same time’. So, yes, traumatic.

But maybe Gage was just pissed off. The idea that a person could not only have an injury of the kind Gage survived, come very close to death, lose sight in one eye, then lose their job, and not feel at least a little aggrieved and confused for a while seems an unworldly expectation. As research conducted by the University of Oxford demonstrates, survivors of life-changing injuries report profound and varied impacts on their attitudes, whether their injuries included neurological consequences or not.

During a phone conversation as I was writing this essay, my former colleague Callum, who first got me thinking about disinhibition, described his own experience of behavioural change in the aftermath of brain injury:

I don’t remember the first 10 days after my injury, but friends later told me about some of the funny, wild things I said during that time, like when one of them came to visit and I suggested, in front of my family, that we smoke a joint together. Then, later on, between about one and three months after the injury, I remember wheeling myself out of the hospital many times, even though I’d been told again and again not to do things on my own.

Given that he doesn’t remember it, the first of these examples probably falls within what clinicians would call post-traumatic amnesia (PTA) – an acute period in which head trauma patients aren’t forming new memories and can often be disoriented. Since it was after Callum’s PTA had ended, the second example could have been labelled disinhibition: the kind of inconvenient behaviour that makes life hard for institutional staff and about which survivors can be both stubborn and wily. Callum was clear that both examples were out of character but that they still held meaning. ‘In the first instance, even though my family were a bit surprised at what I was saying, it also reassured them that I was still the same person. I was suggesting doing things that demonstrated I remembered my friends, even if my family didn’t want to hear about those things.’

This persistence of self was something Callum also emphasised about the apparent disinhibition. Disobeying doctors’ orders by wheeling himself out of the hospital may have been atypical for his pre-injury character, but this behaviour still belonged to him rather than to some mysterious new identity ‘unveiled’ by the injury. ‘I’m not a different person,’ he said. ‘I’m me after something traumatic has happened to my brain. It was still me doing those things. It was me who was disinhibited.’ And he also insisted that the behaviour held value. ‘I did it because it made me feel good. It was a way of proving to myself that I could do things. Maybe, on some biological level, I had to be that brave and confident because I was going through something so enormous.’

The descriptions have to reflect human experience, rather than reaching for simple or dramatic images

This is the first time I’ve come across an explanation of disinhibition that treats it as purposeful for the person; as necessary in some way, rather than as a symptom to be suppressed. Nevertheless, it’s consistent with certain theoretical frameworks, like that of the influential German neurologist Kurt Goldstein, who believed that the behaviour of the injured person always drove towards self-actualisation, a term he introduced.

We’ll never know how Gage might have interpreted his own behaviour after the accident. But in influencing the perception of frontal lobe injuries, getting his story straight still matters. As the philosopher and psychologist Stephan Schleim points out: the myths about Gage ‘might stigmatise patients and their families and even lead to a self-fulfilling prophecy, if people are then excluded and denied treatment as hopeless cases’.

The brain sciences have an important role to play in formulating descriptions that help people understand and articulate what has happened to them, that illuminate the path towards self-knowledge and self-compassion, that provide concrete ideas for coping. But for this to be helpful, the descriptions have to reflect human experience, rather than reaching for simple or dramatic images because they support a favoured theory.

Because he was not famous, we have very little written down by Gage. And because he was not an artist in any recognised sense, we don’t have an archive of things he made. But we do have two photographs of him. Identified in 2009 and 2010, they represent the nearest thing we have to a first-person testimony.

Gage may not have operated the camera but we can assume that he prepared himself and made decisions about how he wished to be presented. And the pictures created are in stark contrast to the way Gage has been represented for so long by the research literature. He appears upright, clean-shaven and neatly dressed, with a steady expression and a firm grip on his tamping iron. His left eyelid is closed – he lost the sight in that eye – but you have to look very closely to detect any other sign of his injury. To me, he looks a little older in one photograph than in the other, but he wears a very similar outfit. Perhaps not a person with a great deal of money, then, but someone determined to make a good impression, someone who cares, you might say, both about himself and about the experiences he creates for others. (Compare these sober portraits with the provocative ones Muybridge created of himself in the nude.)

What’s truly iconic about Gage is that he survived, both as a body and a person

The stories told about Gage and the theories of frontal lobe function that draw on his life speak powerfully to our beliefs about morality and free will. But they are not really scientific. Instead, they are drawn from spiritual beliefs and superstitions. They revive the 17th-century ideas of Thomas Hobbes about civilisation’s role in suppressing the most barbarous aspects of human nature. They sustain imagery from pseudosciences like phrenology, in which personality and morality were ‘read’ in the shape of a person’s skull. They reinforce hierarchical metaphors of the human soul belonging to ancient Greeks like Plato, who believed reason was ‘immortal’ and ‘divine’ and was placed in the head, closer to the heavens, as a sign of its superiority to the emotions residing in the torso.

In a 2020 review of the concept of social disinhibition, the neurologist and psychiatrist Edward Huey suggested that the idea became widespread because it was ‘compatible with strongly held cultural beliefs about the importance of inhibiting inherent drives and desires’. It remained popular because of what he calls its ‘intuitive appeal’ and because of its simplicity. And it’s this same simplicity, he writes, that should now provoke us to discard the concept: ‘[T]he theory of disinhibition has been overextended. It is used to explain so much that is now poorly defined and vague.’ He argues not for a single theory to replace disinhibition but for a wider, more tailored approach to investigating the many different circumstances currently lumped together under its umbrella.

Maligned for more than a century, Gage deserves a better legacy. As one group of commentators put it in 2018:

Phineas Gage, touted as the archetypal case of prefrontal behavioural syndrome, may actually be as important for demonstrating the possibility of functional recovery after severe traumatic brain damage during adulthood.

It’s a sentence that offers two directions for the future. The pursuit of simple explanations is a symptom of the desire for psychology to operate like a natural science – a case of wishful thinking. If we could stop thinking of the brain like it’s a Rubik’s cube, then perhaps we would have more capacity to talk about what’s truly iconic about Gage: that he survived, both as a body and a person. Perhaps we could remember him not as the gothic monster imagined in the literature but instead as someone who rescued dignity from catastrophic circumstances, who achieved both self-reliance and meaningful connection, without the aid of rehabilitation professionals, and against extraordinary odds.

And if we want to improve our theories about brain injury, it would be better to develop them in partnership with living brain injury survivors rather than basing them on the lives of those long departed. It might be more time-consuming to work this way, and the results may not be free of contradiction. But that’s people for you. They don’t always make sense.

The question of whether Christians in a country where they are not the majority, should dictate rules for everyone is a complex issue that intersects with principles of democracy, religious freedom, pluralism and historical justice. In Australia, a nation with a historically Christian majority, but an increasingly diverse religious and cultural landscape, this question takes on unique significance when viewed through the lens of Indigenous Australian perspectives. Aboriginal and Torres Strait Islander peoples, with spiritual and cultural traditions spanning over 60,000 years, offer profound insights into governance, coexistence and the consequences of imposed systems. Their experiences of colonisation, often justified by Christian ideologies and their contemporary advocacy for self-determination provide a critical framework for evaluating the implications of a Christian minority dictating rules.

This post explores these perspectives in depth, arguing that Indigenous principles of balance, reciprocity and respect for diversity reject the notion of any minority imposing its values on a pluralistic society. Instead, governance in Australia must prioritise inclusivity, particularly for Indigenous peoples whose sovereignty was never ceded, to ensure a just and equitable future.

Indigenous Spiritualities and Governance Models

Indigenous Australian cultures are grounded in spiritual traditions that are among the oldest continuous systems of belief in the world. Known as the Dreaming or Dreamtime, these traditions are not merely religious but encompass law, ethics, kinship and environmental stewardship. The Dreaming is place-based, tying specific clans and nations to their lands, waters and ancestral beings. Each Indigenous group – over 250 language groups existed before colonisation – has its own stories, laws and protocols, creating a mosaic of governance systems that operated through consensus and mutual respect.

In pre-colonial Indigenous societies, governance was decentralised and relational. Elders, as custodians of Lore (customary law derived from the Dreaming), facilitated decision-making through dialogue, ensuring decisions reflected the needs of the community and the land. As Gunditjmara scholar Tyson Yunkaporta explains in Sand Talk (2019), Indigenous knowledge systems prioritise “patterns of connection” over hierarchical control, fostering balance between individuals, communities and the environment. This contrasts sharply with centralised, top-down models of governance, including those historically associated with Christian institutions in colonial contexts.

From an Indigenous perspective, the idea of a Christian minority dictating rules for all Australians is fundamentally at odds with these principles. Imposing a singular framework, whether religious or secular, disregards the diversity of beliefs and practices that Indigenous governance respects. Yuin Elder Uncle Max Dulumunmun Harrison has emphasised that Indigenous ways of being are about “living in harmony with the land and each other,” not dominating others’ worldviews. A Christian minority imposing its values would disrupt this harmony, echoing the colonial imposition of foreign systems that Indigenous peoples have resisted since 1788. Such an approach would undermine the relational and inclusive ethos of Indigenous governance, which values coexistence over control.

Historical Context: Christianity and the Colonial Project

The arrival of British settlers in 1788 marked a catastrophic rupture for Indigenous Australians, with Christianity playing a central role in justifying colonisation. The doctrine of terra nullius – the legal fiction that Australia was “land belonging to no one” – was rooted in Eurocentric and Christian assumptions that Indigenous peoples lacked recognisable systems of governance, spirituality, or land ownership. Colonial authorities, often in partnership with Christian missionaries, sought to “civilise” Indigenous peoples by converting them to Christianity and erasing their cultural practices. This was not merely a spiritual project but a mechanism of control, aimed at assimilating Indigenous peoples into a European, Christian social order.

Missions and reserves, established by organisations like the Aborigines Protection Board, were key instruments of this policy. Places like Hermannsburg in the Northern Territory and Yarrabah in Queensland became sites where Indigenous peoples were confined, their languages suppressed and their children taught Christian doctrines. The Stolen Generations, a policy spanning from the late 19th century to the 1970s, saw tens of thousands of Indigenous children forcibly removed from their families, often under the auspices of Christian welfare organisations. These children were placed in missions or foster homes where they were indoctrinated into Christian values, stripped of their cultural identities and subjected to abuse. As Arrernte and Kalkadoon scholar Marcia Langton has stated, “The imposition of Christianity was a tool of assimilation, designed to erase our identities and sever our connection to Country.”

This history profoundly shapes Indigenous perspectives on Christian influence in governance. For many Indigenous Australians, Christianity is inseparable from the trauma of dispossession, cultural erasure and intergenerational harm. The legacy of missions and forced conversions has left deep scars, with many communities still grappling with the loss of language, ceremony and kinship ties. Allowing a Christian minority to dictate rules risks perpetuating this legacy, imposing a framework that historically marginalised Indigenous voices and sovereignty. As Palawa writer Nakkiah Lui has argued, “The idea of any group imposing their beliefs on others feels like a continuation of the colonial project, which we’re still trying to heal from.”

Yet, Indigenous experiences with Christianity are not uniform. Some Indigenous Australians have embraced Christianity, integrating it with their cultural practices in syncretic ways. In Arnhem Land, Yol?u communities have blended Christian worship with traditional ceremonies, creating practices that honour both their ancestral Lore and Christian teachings. Similarly, Indigenous Christian leaders like Pastor Ray Minniecon, a Kabi Kabi and Gurang Gurang man, have used their faith to advocate for reconciliation and social justice. These perspectives suggest that Christianity, when practiced in dialogue with Indigenous values, can coexist within a pluralistic society. However, even these communities typically reject the idea of domination, favouring mutual respect over unilateral rule.

Contemporary Indigenous Advocacy and the Rejection of Imposed Systems

In modern Australia, Indigenous perspectives on governance are articulated through advocacy for self-determination, treaty-making and constitutional recognition. The 2017 Uluru Statement from the Heart, a historic consensus document endorsed by Indigenous leaders across the continent, calls for a First Nations Voice to Parliament, a Makarrata Commission for truth-telling and agreement-making and a process of healing colonial wounds. The Statement reflects a vision of governance that is collaborative, inclusive and respectful of Indigenous sovereignty while engaging with Australia’s diverse population. It explicitly rejects imposed systems, seeking “a fair and truthful relationship” between Indigenous and non-Indigenous Australians.

The Uluru Statement provides a critical lens for evaluating the question of a Christian minority dictating rules. Indigenous peoples, who comprise approximately 3.2% of Australia’s population (around 800,000 people according to the 2021 Census), have long been marginalised in Australia’s political and legal systems. The Statement’s call for a Voice underscores the importance of representation for minority groups, ensuring their perspectives shape national decision-making. If a Christian minority were to impose laws, it would sideline not only Indigenous voices but also those of other religious and secular Australians, contradicting the pluralistic ethos Indigenous leaders advocate. As Anangu leader Rachel Perkins has argued, “Our survival as First Nations peoples depends on systems that respect our differences, not erase them.”

Moreover, Indigenous perspectives highlight the interconnectedness of land, people and law, which often clashes with Christian or Western governance models. For example, Indigenous custodians like the Wangan and Jagalingou people have opposed projects like the Adani coal mine, asserting their custodial rights over Country against development supported by some Christian-aligned political factions. A Christian minority dictating rules might prioritise its moral or economic agendas – such as traditional family values or resource extraction – over Indigenous land rights, further disenfranchising First Nations peoples. This tension underscores the need for governance that respects Indigenous sovereignty and environmental responsibilities, which are central to their worldview.

The 2023 Voice referendum, though unsuccessful, further illuminated Indigenous perspectives on inclusive governance. The campaign for a constitutionally enshrined Voice was driven by a desire for structural inclusion, not domination by any single group. The referendum’s defeat, influenced by misinformation and political polarisation, highlighted the challenges of achieving consensus in a diverse society. From an Indigenous perspective, allowing a Christian minority to dictate rules would exacerbate these challenges, bypassing democratic processes where Indigenous advocacy is slowly gaining traction. As Wiradjuri journalist Stan Grant noted, “We seek a seat at the table, not to control it, but to ensure our voices are heard.”

Challenges and Tensions Within Indigenous Communities

Indigenous perspectives on Christianity and governance are not monolithic, reflecting the diversity of over 250 Indigenous nations. Some Indigenous Christians may argue that their faith aligns with broader societal good and could inform laws, particularly on issues like community welfare or reconciliation. For example, Indigenous Christian organisations like the Grasstree Gathering bring together Aboriginal and Torres Strait Islander believers to advocate for justice within a Christian framework. Leaders like Brooke Prentis, a Wakka Wakka woman, emphasise shared values like compassion and healing, which resonate with both Christian and Indigenous principles.

However, even Indigenous Christians often frame their advocacy within a broader call for mutual respect, not domination. The tension arises when Christian values are proposed as universal, potentially clashing with Indigenous Lore or the beliefs of other Australians. For instance, debates over same-sex marriage or voluntary assisted dying have seen some Christian groups, including Indigenous Christians, oppose reforms that align with secular or progressive values. Yet, many Indigenous communities, particularly younger generations, support these reforms, reflecting a commitment to individual autonomy and cultural diversity. This intra-community diversity underscores the complexity of Indigenous perspectives and the need for governance that accommodates multiple voices.

Another challenge is the power imbalance rooted in Australia’s colonial legacy. Indigenous peoples remain under-represented in political and legal institutions, with only a handful of Indigenous parliamentarians (e.g. Senators Lidia Thorpe and Jacinta Nampijinpa Price) and no constitutional guarantee of their voice. Allowing any minority, including Christians, to dictate rules could deepen this marginalisation, as it bypasses the democratic processes where Indigenous advocacy is seeking reform. The lack of a treaty or formal recognition of Indigenous sovereignty further complicates this dynamic, leaving First Nations peoples vulnerable to imposed systems, whether secular or religious.

Toward a Collaborative and Inclusive Future

Indigenous perspectives offer a powerful critique of minority rule, grounded in both historical trauma and cultural principles of balance and reciprocity. They reject the notion of a Christian minority dictating rules, seeing it as a continuation of colonial imposition that disregards Indigenous sovereignty and cultural diversity. Instead, Indigenous governance models – rooted in consensus, connection and respect for Country – provide a blueprint for a pluralistic Australia where no group dominates, but all contribute to shared decision-making.

To incorporate Indigenous insights, Australia could draw on models of co-governance from other settler-colonial nations. In New Zealand, the Treaty of Waitangi (1840) has facilitated partnerships between M?ori and the Crown, ensuring M?ori voices shape policy while respecting broader societal diversity. In Australia, a similar approach might involve constitutional recognition of Indigenous sovereignty, as proposed in the Uluru Statement, alongside protections for religious and cultural pluralism. This could take the form of a First Nations Voice to Parliament, treaty processes, or co-management of land and resources, ensuring Indigenous authority is respected without excluding other communities.

For Christian communities, Indigenous perspectives invite reflection on their role in a multicultural society. Rather than seeking to dictate rules, Christians could engage in dialogue with Indigenous peoples, learning from their emphasis on community, land and consensus. Initiatives like Reconciliation Action Plans, supported by some Christian organisations, demonstrate how faith communities can contribute to justice and inclusion without domination. For example, the Catholic Church’s acknowledgment of past harms through the NATSICC (National Aboriginal and Torres Strait Islander Catholic Council) shows a willingness to listen and collaborate, aligning with Indigenous calls for truth-telling.

Broader Australian society also has a role to play. The growing diversity of religious identities – 43.9% Christian, 38.9% no religion, 3.2% Muslim, 2.7% Hindu and 2.4% Buddhist in the 2021 Census – demands governance that balances minority rights with collective decision-making. Indigenous perspectives, with their focus on relationality, offer a framework for navigating this diversity. By prioritising dialogue over imposition, Australia can avoid the pitfalls of minority rule, whether by Christians or any other group.

Practical Implications and Policy Considerations

Implementing a governance model informed by Indigenous perspectives requires practical steps. First, Australia must advance the Uluru Statement’s recommendations, particularly the establishment of a First Nations Voice. This would ensure Indigenous representation in decisions that affect them, including those involving religious influence. Second, strengthening secular governance, as mandated by Section 116 of the Constitution, is critical to preventing any religious minority from dominating. This includes reviewing practices like parliamentary prayers, which some argue privilege Christianity in a pluralistic nation.

Third, education and truth-telling are essential for addressing the historical role of Christianity in colonisation. Incorporating Indigenous histories into school curricula and supporting initiatives like the Healing Foundation can foster understanding and reconciliation. Finally, fostering interfaith and intercultural dialogue, including between Indigenous communities and Christian groups, can build mutual respect. Programs like the Australian Intercultural Society, which brings together diverse faith leaders, offer a model for such engagement.

Conclusion

Indigenous Australian perspectives provide a compelling case against allowing a Christian minority to dictate rules in a diverse nation. Rooted in 60,000 years of cultural and spiritual wisdom, these perspectives highlight the dangers of imposed systems, drawing on the trauma of colonisation where Christianity was a tool of dispossession. Indigenous governance models, with their emphasis on balance, reciprocity and respect for diversity, reject unilateral rule in favour of collaborative decision-making. The Uluru Statement from the Heart and contemporary Indigenous advocacy further underscore the need for inclusive governance that respects sovereignty while engaging all Australians.

In a future Australia, where Christians may become a minority (with 43.9% identifying as Christian in 2021), governance must reflect the nation’s multicultural reality. Indigenous insights offer a path forward, advocating for systems that honour difference without domination. By learning from First Nations peoples, Australia can build a society where no group – Christian, Muslim, secular, or otherwise – imposes its will, but all contribute to a shared, equitable future. This vision, grounded in justice and mutual respect, aligns with the aspirations of a nation still grappling with its colonial past and striving for a reconciled present.

Post Views: 108

by Evan Urquhart

A report on youth gender medicine by the Drug Regimen Review Center, a little-known body operating out of the University of Utah, was released late last week by the Utah legislature. The Salt Lake Tribune and a small number of other news outlets have highlighted a few aspects of this report, particularly the finding that youth gender medicine is safe, effective, and comparable to other mainstream medical treatments. They’ve also mentioned its length, over 1,000 pages. But what’s actually in it?

The full pdf for the DRRC’s evidence review is available for download here.

A Comprehensive Review of the Evidence

“Notably, our searches yielded a larger number of primary studies than any of the systematic reviews that underwent data extraction,” the report states proudly on page 117. The authors found a total of 277 studies that included data on over 28,000 young people with gender dysphoria. 

The report focuses on 89 studies of puberty blockers or gender-affirming hormone therapy that looked at several “high-priority outcomes” around mental health, psychosocial changes, body changes and body image, and/or key health risks while weeding out case reports and purely descriptive studies. The methods and findings of these 89 were summarized, and each one was evaluated for risk of bias. The report also extracted data from seven previous systematic reviews and four published guidelines.

Here’s an example from one of the many tables that make up much of the report, in this case a table analyzing risk of bias:

The authors found a range of study quality in the data, from lower to higher. The conclusion section (which starts on page 116) strikes a note of seeming bemusement at the conventional wisdom, which has held that the evidence for this care is limited and of poor quality. “The conventional wisdom among non-experts has long been that there are limited data on the use of GAHT in pediatric patients with GD. However, results from our exhaustive literature searches have led us to the opposite conclusion,” the report states.

The report has two parts, with Part I being the main review of the evidence in published literature and Part II being a return to the previously gathered literature with a focus on studies reporting long-term (5+ year) outcomes. The second part found limited data, which is summarized with a note that the literature was not substantial enough to draw any conclusions.

One notable section deals with rates of regret, desistance, and detransition in the literature. A table from pages 109-114 includes 32 studies that reported rates of persistence, desistance, or regret in their findings. While it remains impossible to state a single “detransition rate” the collected studies provide a good way of thinking about the range of possibilities, from stopping treatment and restarting, to stopping/losing care due to insurance issues or an overly great travel distance to the clinic, to patients who stop because they now identify with their birth gender. 

Many mainstream media have misreported this data in ways that overstate the prevalence of detransition and misconstrue it as being synonymous with regret and re-identification with birth sex.

Here, the authors state in the conclusion section, “With regards to any misgivings that stakeholders may have about allowing pediatric patients to receive pharmacologic (and frequently surgical) treatments over concerns about future regret, we found (based on the N=32 studies) that there is virtually no regret associated with receiving the treatments, even in the very small percentages of patients who ultimately discontinued them. Reasons for discontinuing GAHT are varied, but changed minds about gender identities is only a very minor proportion overall.”

A Truly Independent Review?

Unlike the highly publicized Cass Review, which was released in the UK in 2024, the Utah review is low on opinion and high on reviewing the evidence. In the places where it does state some of the authors’ conclusions, such as on pages 116-118, it hews closely to what was found in the literature. This stands in contrast with the Cass Review, which opined on a wide variety of topics, from the cause of trans identity to the use of pornography, often departing widely from the evidence base to do so. A recent HHS Review, ordered by the Trump administration, did much the same, but with even less rigor. 

This more data-driven approach may be due to the nature of the DRRC and, by extension, the report’s authors. The opposite of high-profile, the Center is described on its website as a longstanding partner of the Utah State Department of Health with a focus on reducing costs associated with prescription drugs for Medicaid patients. The Center has no apparent connection to transgender health care, but it does have more than 20 years of experience evaluating prescription drugs and their evidence base.

Mainstream Media Silence

In contrast to the Cass Report and Trump’s HHS document, no national mainstream media organizations have run stories on the Utah evidence review as of this reporting. Major politicians who sponsored Utah’s ban on youth gender medicine (and commissioned this report) seem inclined to ignore it, according to reporting by the Salt Lake Tribune. As a political document, this review may make few waves due to its inconvenient conclusions, which would seem to go against the grain of popular opinion and conventional wisdom, not to mention mainstream media sentiment. 

For those whose primary interest lies in the actual evidence on gender-affirming care and best practices for treating young people with gender dysphoria, however, the comprehensive nature of this review may well make it an essential reference for quickly finding, comparing, and evaluating the many studies on youth gender medicine that were published between 2010 and 2023. 

On Tuesday May 20 the State Library of Queensland was set to announce the 2025 winners of the black&write! fellowship, which each year grants two Aboriginal and Torres Strait Islander writers $15,000 and a publishing opportunity with University of Queensland Press.

But hours before the ceremony was due to commence, the announcement was abruptly postponed.

One of the selected winners was K.A. Ren Wyld, a Martu author based in south of Adelaide, for her unpublished novel Whichway Shimmering Dust. Wyld had flown to Brisbane ahead of the Tuesday evening ceremony, but upon arriving at the library that morning, was taken upstairs for an impromptu meeting with State Librarian and CEO Vicki McDonald.

“I was pulled in for this very brief, polite conversation,” Wyld tells InReview.

“I wasn’t given much information; just basically that my fellowship was being rescinded, the award ceremony was going to be cancelled, and they’ll begin the process of informing the black&write! team, judges, guests and other shortlisted writers.”

In the meeting, McDonald read from a tweet Wyld had posted in October 2024, following Israel’s killing of Hamas leader Yahya Sinwar.

Wyld tells InReview she was not fully aware who Sinwar was when she posted the tweet, which described Sinwar as a ‘martyr’  who was “resisting colonisation”. Wyld says she posted the comment in an “emotional moment”, seeking to show solidarity with Palestinians in her feed after seeing graphic, widely shared footage of his final moments released by the Israeli government.

“I saw a video of a man who looked similar to my age, who was under attack, and was fighting back, one-armed, in a chair. All I saw this outpouring of emotion around the world of people who obviously loved and respected him.”

Wyld thought she deleted the post shortly afterwards.

By Tuesday afternoon, Queensland’s arts minister John-Paul Langbroek was citing the post in parliament while announcing the government had “taken the decision that this award should not be presented at the State Library”.

Langbroek told parliament that, “These comments are not only deeply offensive, but also risk dividing our multicultural community at a time when unity and respect are more important than ever.

“Whilst I support the principles of free expression and creative diversity, any perception that taxpayer funded awards being granted to individuals who justify terrorism undermines public trust both in our institutions and in the cultural sector more broadly,” he said.

Langbroek’s office told InReview it raised concerns with the State Library on Friday, May 16.

On Tuesday, McDonald published a statement saying: “media coverage and commentary today in relation to the personal views of the recommended recipient has overshadowed the intent of the awards”.

McDonald said the library would “undertake an independent review of the suite of awards and fellowships we administer”.

“It will have specific focus on how we balance our strong commitment to freedom of expression and our role as a State Government funded cultural institution.”

Wyld, who formerly published under the name Karen Wyld, has previously won a South Australian Literary Fellowship from the State Library of South Australia and Writer’s SA, a 2022 fellowship as part of the South Australian Literary Awards, and the 2020 Dorthy Hewitt Award for an unpublished manuscript for her novel Where the Fruit Falls.

She has also been a contributor to InReview, and serves as a mentor in the InReview First Nations Mentorship program.

Wyld has also revealed that a reporter from The Australian had seemingly been tipped off to the ministerial intervention – an email from the newspaper requesting comment arrived in her inbox shortly before the meeting with McDonald. The reporter disclosed that Queensland Arts Minister had “written to the State Library asking organisers to reconsider your appropriateness for the award”.

“They knew before I did, and they even knew before the black&write! team did,” Wyld says.

The broadsheet had criticised Wyld’s pro-Palestinian views and social media posts before. In two February articles published in the wake of Khaled Sabsabi’s high-profile removal as Australia’s Venice Biennale representative, Wyld was named in a list of past Creative Australia funding recipients who have condemned Israel’s campaign in Palestine. The black&write! program receives funding from Creative Australia and the Copyright Agency.

In those reports, columnists from The Australian accused Wyld of being a “lunatic” and “terrorist sympathiser” while highlighting the October tweet.

Wyld rejects The Australian and minister’s characterisation of her posts.

“It’s pearl-clutching hyperbole, and for what purpose? To silence me, a nobody. I don’t have a big spread of influence, I don’t have power and privilege.”

Wyld was one of two fellowship recipients out of a shortlist of six, selected by a First Nations judging panel based on the literary merit of their submitted manuscripts. Past recipients of the career-making fellowship include Claire G Coleman, Ali Cobby-Eckermann, Alison Whittaker and Nardi Simpson.

Coleman called on the State Library to reinstate the judging panel’s choice, and said she was “disgusted by this decision and the chilling effect it will have on Indigenous writers across the country”.

The Australian Society of Authors said it was “disturbed” by the government’s decision, writing in a statement that: “It sets a dangerous precedent for creators – irrespective of their political views – that opportunities awarded on the basis of literary merit can be retracted if the creator is subject to complaints about their political ideas and expressions.”

It is the latest high-profile example of Australian cultural institutions stripping opportunities from artists who have shared pro-Palestinian views, from the State Library of Victoria’s cancellation of a series of writers workshops in March 2024, to Creative Australia’s dumping of Sabsabi and curator Michael Dagostino in February.

Wyld says her winning manuscript, Whichway Shimmering Dust, had been written to highlight the legacies and ongoing injustice of the Stolen Generations.

“That book was to honour the Stolen Generations and to bring back up the discussions on justice before everyone passes away,” she says.

“Next week is the 28th anniversary of the Bringing Them Home report, and only 6 per cent of the recommendations have been actioned.

“This is what they’ve silenced. They’ve not silenced just me, a writer. They’ve silenced the calls for justice, both here and currently in Palestine. We cannot forget that we’re watching a livestreamed genocide; what are we supposed to do with those images that we see, with the horror that we wake up and witness day after day after day?”

Responding to questions from InReview, the minister’s office pointed to Tuesday’s parliamentary speech and suggested contacting the State Library regarding “their decision to withdraw the award”.

The State Library of Queensland was contacted for comment. However, its official statement, updated on Thursday, states the “decision was made by the Queensland Government”.

“State Library of Queensland complied with that decision and postponed the black&write! ceremony and rescinded the fellowship to K.A. Ren Wyld,” it read.