Miriam Grossman is an American psychiatrist. The following is an edited extract published by Gender Clinic News of his new essay Lost in Trans Nation: A Child Psychiatrist's Guide Out of the Madness. A very interesting and 'empathetic' read especially for those families facing the problem of a teenage daughter/daughter with 'gender discomfort'..
James sports a scruffy beard. Sarah wears skirts and doesn't bother with pronouns. Taylor wants to talk about college, not testosterone. These small changesall recently seen or reported by patients or their parents, are great. In my book I have described monumental struggles and pains, but I want you to know that there is hope. Young people and their families can be helped with therapy. They can slow down their pace on the assembly line that leads to harm; some even go down. They can accept, even enjoy their bodies. It is far from guaranteed and not always an easy road, but is possible. How do I treat my patients with gender-based discomfort? The same way I treat everyone else: with respect, empathy, curiosity, honesty and with their lifelong happiness and well-being foremost in my mind. I start with: tell me about yourself. I want to know who you are. My patients have been led to believe that they face a simple problem with a simple solution. I explain that this is not the case. They are, like all people, a huge, complex tapestry, of which gender occupies only a small corner. The whole tapestry interests me, not just one corner. We will talk about gender, of course, but instead of automatic affirmation we will look deeper. "In recent years there has been a considerable increase in the number of young people presenting so-called gender dysphoria. This was most likely caused by the same mechanisms that operate when other psychogenic epidemics spread through the population: i.e. from the array of social forces, often for political reasons, to model the manifestation of an underlying non-specific propensity for anxiety, depression, and hopelessness in a vulnerable subgroup of children and adolescents' (Dr. Jordan B. Peterson, preface Lost in Trans Nation). Go deeper. We will try to determine what living as the opposite sex brings. Will it make life better or easier? Is the new identity about becoming someone new or about escaping from who one is? Of course, some of my questions may make patients uncomfortable, but this is the most important decision of their lives and deserves a very careful look. I observe my patient's family. Is there a conflict in the home, is there a parent or sibling who is ill? It must be understood whether he or she suffers from a psychiatric condition such as anxiety, depression, obsessive compulsive disorder, ADD, psychosis or has an autism spectrum disorder or some other form of neurodiversity. Is there a history of adoption, trauma or abuse? Social hardship or bullying? Same-sex attraction? Is trans identity a way of exploring oneself as independent from one's family, a normal task of adolescence taken to the extreme? Stereotyped beliefs may act about 'wrong' men and women. The person may feel that she is not 'manly' and cannot find love or acceptance as she is. Perhaps she or someone she loves has been hurt, feels powerless against male aggression and therefore tries to escape femininity. Perhaps he or she is afraid to grow up. The point is: being 'trans' is a solution, a coping mechanism (a way of coping with conflicts or stressful situations, ed.) but for what problem? This is the mystery we must solve together. One of my main responsibilities is to educate. I am older and wiser, and this benefits my patients. An effective phrase with teenage know-it-alls: "Are you 16 years old? I am 116 years old. During my decades of practice, I have learnt many things, one of which is that people change. A leftist changes and votes conservative. Couples once madly in love, certain of marriage, now jump at each other's throats. A woman who could not have been more certain of wanting an abortion twenty years later is childless and rethinks that decision. People change, I tell my patients. You too will change. Another wisdom I share is that being human means fighting. It means living with limitations and weaknesses. You are not the first person to hate your body, to feel disconnected from your parents and to have no place to belong. You are not the first human being to experience confusion, pain and loneliness. In some circumstances I can share a difficulty of mine with a patient. In this way, she or he learns that I too have difficult moments, but they can be managed. For example, if I fear a patient's response, I can say: 'I have to tell you something, but I have mixed feelings about it because of how you might react'. The patient discovers that I also have a fear of conflict; I feel insecure just like him/her. I have shown how I can tolerate those emotions. A patient needs to feel safe and understood. It is in that trusting and honest space between us that healing begins. I try to act thoughtfulness, humility and above all the compassion. We must have compassion for ourselves and others, including our parents. They too are human, with limitations and struggles. They are doing or have done their best, and it was not so bad. In the end the choice is theirs, I tell my patients, their identity is in their hands. At the same time, whether they require new pronouns or surgery, there are risks. I am obliged to point out that what they are doing has huge implications. What will their lives be like in ten, twenty, fifty years? There may be a high price to pay. I remind patients that as a doctor I deeply appreciate the wisdom of the body. They may think they have all the information they need, they may be convinced they are informed about social and medical interventions, but I know they are not. From new names to mastectomies and vaginoplasties, must understand the risks and be aware of the ongoing controversy. If I neglect to outline those risks and the debate I am not doing my job. And if he or she comes back crying: look what I did to myself, why didn't you warn me? Speaking of risks, this is a risk I am not willing to take. At some point I strongly encourage patients with gender difficulties to reading the stories of detransitioners or watching their videos. When patients are unwilling, or unable to know the dangers of medicalisation, or claim to be indifferent and trusting, these are red flags. We all have a degree of doubt when faced with important decisions. Every decision has advantages and disadvantages. Trusting and being wrong is dangerous. It is also part of my job gently challenge and plant seeds. Being of an older generation, I ask my young patients to define their new language and explain their beliefs. I am curious. I want to learn from them. If their definitions or explanations do not satisfy me, I will say so. The objective is recognise that each of us is a mosaic of male and female. Honour the mosaic and leave the body alone. And to parents: you must also respect your child's mosaic. He or she may not correspond to your ideas about masculinity and femininity. When I said before that my approach with transgender patients is just like with any other patient, I omitted a salient point. There is a huge difference. After their short weekly sessions, my patients go back to their friends, schools and social media, a world bound to the Articles of Faith that enshrine gender identity as sacred and forbid any question. It is daunting, to say the least, to build a connection with highly indoctrinated patients. They have heard over and over again that there is an answer to their situation: transition. They cannot tolerate the doubts I sow. The obstacle could be insurmountable. Zoe was an eleventh grader attending a school in Boston where the cost of tuition was higher than the average annual family income. Her mother informed me that in middle school Zoe and her friends all declared themselves LGBT, only they had not decided which letter. Once I tried to inform Zoe that for safety reasons a minor like her living in Sweden or Finland would not have access to puberty blockers. She put her hands over her ears and shouted: 'Don't talk to me about trans children who cannot receive medical treatment! Don't you know that fifty per cent of us try to commit suicide?" To his accused of being transphobic, I replied 'I am anti-sufferance, not anti-trans'. I could almost hear his friends and influencers in the room with us frowning at me. He refused to meet with us again. In my many years as a doctor I have had patients with severe schizophrenia, incurable cancer and other very serious conditions. No one has ever fired me. You understand why I say that Is fighting dangerous ideas more difficult than fighting dangerous diseases? When the young person has sworn allegiance to the Articles of Faith, the challenge facing parents and therapists is brutal. Parents who have not yet faced the situation, please listen to the mothers and fathers of children with rapid onset gender dysphoria. Many of them openly say that they live in hell and They want to warn you and teach you something before you find yourself in their shoes. They are trying to rescue you from the impossible position they find themselves in: a child who announces that in order to stay in that family he must be sustained in its self-destruction. These are the parents who, when they catch a glimpse of you in a park or a shopping centre holding your child's hand, or school-age sons and daughters who are still attached to you, who still trust you, feel a stab in their hearts: if only you knew what you might be facing. Your children are like a sponge, ready to absorb whatever they encounter. They are a work in progress and you are their scaffolding, providing support and structure. If you do not provide a belief system, a compass or a meaningful base from which to understand the world, identify truths and lies and distinguish right and wrong, trust me, others will be eagerly waiting to do just that. Before you know it your child will be a pawn, a foot soldier in a foreign crusade spreading dark and dangerous ideas, and you will be the toxic parent in a home that is no longer a safe space. (translation by Marina Terragni)