Religion is a Mental Illness

Therapists Have Betrayed The Parents Of Gender-Confused Kids

Therapists have lost all credibility because of their surrender to a destructive, unscientific ideology. We’ve harmed thousands of parents and kids.

thefederalist.com

There’s something rotten in the state of my profession, the mental health field. While therapists are usually the first to reach out to trauma victims, there’s one group we neglect. Even worse, we blame the victims.

I’m referring to parents of gender-confused kids, whose stories I am hearing firsthand in my office. Parents come to me because I’ve publicly objected to my profession’s faulty views about gender identity and its treatment. How many parents are unable to find help? Judging by the number of recently created organizations and online groups where such parents gather, there are thousands, and the numbers grow by the day.

My patients, and those in the parent-run groups, are shocked, overwhelmed, confused, and anxious. They’re not sleeping or eating. Many have Post-Traumatic Stress Disorder. Why have they turned to one another for help? Why don’t more come to us – psychiatrists, psychologists, social workers, and counselors? We’re the ones with the degrees and experience.

They don’t turn to us because we have failed them.

Of course young people are also victims of the trans craze, but my focus here is their parents’ distress. It is massive and demands acknowledgement.

Following their teen’s bombshell announcement, most parents initially consult with gender therapists or clinics. The vast majority tell them they must unconditionally accept their child’s chosen identity, use a random, unfamiliar name, and help Sara bind her breasts and Michael tuck his genitals.

Parents object, suggesting a slower process and deeper exploration. They insist: we know our child! The ideologues dismiss their parental instincts. They see their discomfort, but brush it off.

Bad Advice

For those therapists, the parents are the problem. Not the child’s social anxiety, autism, irrational thinking, or social media addiction. No, the issue is mom and dad’s refusal to embrace their teen’s two-week-old identity and allow a kid to run the show.

The therapist shares that assessment with parents, sometimes in front of their child. In doing so, the gender specialist strikes heavy blows against a family in crisis, who turned to her with hope and trust: she undermines parental authority and weakens the parent-child bond.

As if that’s not enough, she refers them, following a hasty, incomplete evaluation, to an endocrinologist for hormones to block development. Safe and reversible, the therapist reassures the parents. Your child needs them now. In fact, it’s already late.

She speaks with authority and confidence. There’s a consensus among professionals, she explains. If you reject our advice, the risk of losing your child to suicide is increased.

She threatens this about their child — the center of their lives, their most precious relationship! The therapist may have spent only a short time with him or her, but she knows what’s best.

Some Parents Find the Facts

The parents go home, emotions reeling. Some decide to trust the expert and they’re soon at the endocrinologist’s office, signing consent for drugs that will prevent their teen’s physical, emotional, sexual, and cognitive development. Their child looks happy; they pray it lasts.

Others dive into the research. Sooner or later they are startled to learn the truth: If teens go through natural puberty there’s a 60-90 percent chance of desistance (outgrowing transgenderism, aligning with one’s biology). Changing names, pronouns, and presentation can be a slippery slope and decrease desistance. Once on puberty blockers, desistance is very rare.

Blockers are controversial, have a history of lawsuits, and their off-label use in healthy children is experimental. There is a risk of suicide in gender-questioning teens, but there is no evidence that transition lowers that risk.

No Consensus

Parents learn that the United Kingdom, Sweden, and Finland carefully examined the dangers of hormonal treatment of minors and minors’ ability to give informed consent for such treatments. As a result, those countries made U-turns in their policies; patients must wait until they are 18 for medical intervention. Similar concerns are coming out of New Zealand and Australia.

Bottom line: parents who look further than gender clinics and therapists discover a heated debate regarding how to help kids like theirs. There’s a consensus among experts, they were told. Are you kidding? There is no consensus whatsoever.

So the parents search for a therapist who won’t immediately affirm the new identity, but instead take it slowly, get to know their child, and figure out the appeal to her of a new identity. A clinician with a more cautious, nuanced approach — that’s all parents want. Another shock: there are almost none.

Counting psychiatrists, psychologists, social workers, and counselors, there are more than a million therapists in this country. I located a group of therapists who believe in long-term, exploratory talk therapy for gender-questioning youth, and there are only 60 members, with many outside the United States.

My Patient’s Sad Experience

My patient “Cheryl” is an example of a traumatized parent. Her 18-year-old autistic daughter, her only child, identifies as a man and has been on testosterone for six months. Cheryl is convinced she and her husband were misled by a gender clinic and that “Eva” did not have adequate evaluations and therapy. For the first time in her life, Cheryl is taking psychiatric medication for her constant crying, sleeplessness, and anxiety.

Cheryl feels she’s at odds with everyone: Eva, family members, friends, schools, doctors, therapists, politicians, the media, and the culture. On how many fronts can one person fight?

I was not surprised when Cheryl told me, “Sometimes I wish my daughter had cancer. The whole world would be there for me.”

Doctors at Johns Hopkins tell Cheryl to embrace her child’s “evolving sense of self.” But when she first heard the lowered pitch of Eva’s voice, Cheryl threw up. A double mastectomy is planned; the thought of it floods her with panic and horror. She fears for Eva’s physical and emotional health, including her sexual health.

Cheryl also grieves for the biological grandchildren she’ll never have. But there’s nothing to be done about any of it. Horror, fear, helplessness, and grief are Cheryl’s constant companions, outside of the days when she just feels numb.

We Must Challenge the Narrative

There are thousands of parents like Cheryl. Where are the psychiatrists, psychologists, social workers, and counselors who will validate their experiences without judgment? How is it we’re able to serve the emotional needs of sexual offenders and murderers but not the traumatized, grieving parents of transgender children?

It’s because to do so would challenge the entrenched narrative in our field: that denying biology is part of normal development, and if “transphobic parents” would just accept that, it will be all rainbows and unicorns for their kids.

Few of us challenge that narrative, at least publicly, so parents have turned to one another in droves to cry, rage, and brainstorm. But they can’t even meet openly; the woke environment forces them underground. They fear losing their jobs and relationships, even their child, if exposed. Hence the secret meetings, private Facebook pages, made-up names, and extensive vetting. They hide in the dark as if they’re guilty of some awful crime.

This is an appalling betrayal of parents. To my colleagues: we’ve lost all credibility because of our surrender to a destructive, unscientific ideology. We’ve harmed thousands of parents and children, and they’ve had it with us.

Not too long ago, doctors performed frontal lobotomies as a cure for severe mental illness. They severed connections in the brain with crude instruments inserted through the eye socket. It was a barbaric but mainstream procedure, performed on about 40,000 people.

Right now in the United States, girls as young as 13 are having mastectomies and minor boys are castrated. What will it take to put the breaks on the massive transing of children? Call me a cynic, but I’m guessing a few huge lawsuits.

Trust me, the lawyers are coming, and victims will finally have a public platform. They will tell the world of the nightmare that descended on their precious children and families, leaving them traumatized and broken.

I eagerly await that day. Until it comes, I will be meeting with Cheryl every week, validating her story, helping her cope, and weeping along with her.

"When I tell people what I’m afraid of, nobody says to me ‘ooh, that makes sense. You should be afraid of that.’ They may be sympathetic to my suffering or they might laugh at how silly it is, but no one I have ever met has ever reinforced it.

In fact, I pay for a man to tell me at regular intervals that my fear is ridiculous. Perhaps not in so many words, but there’s actually a service for that. It’s called a therapist. That’s what therapists do, they politely tell you that your fears are ridiculous.

And although it’s been hard to beat this fear, it can be beaten. In large part because no one is reinforcing it. I can only imagine how much darker my darkest days would have been, and how much longer I would have suffered them had the whole world been telling me to be afraid.”

-- Allison Tieman

A transgender psychologist has helped hundreds of teens transition. But rising numbers have her concerned

Erica Anderson took more than half a century to come out as a woman. Now she works with teens in a rush to transition.

www.latimes.com

BERKELEY — Day after day, emails pour into Erica Anderson’s inbox from parents struggling to support their teenagers coming out as transgender.

“He’s been depressed and anxious since the pandemic began, and over the past few days he has shared with me that he’s pretty sure he’s trans,” said one message about a 17-year-old.

“I am very worried that my child is being pressured into wanting to take [puberty] blockers, ‘because that is the next step,’ ” said another. “We are supportive and have helped them to socially transition, but the medical part somehow for her at 13 does not seem right.”

“How do we decide whether an adolescent in the throes of so much turmoil can make such a medically consequential, irreversible decision?” another said about a 15-year-old’s pleas for testosterone injections.

The parents come to Anderson, 71, in part because she herself is transgender. Anderson also stands out because she is one of the few clinical psychologists specializing in transgender youth to publicly question the sharp rise in adolescents coming out as trans or nonbinary.

She has helped hundreds of teens transition. But she has also come to believe that some children identifying as trans are falling under the influence of their peers and social media and that some clinicians are failing to subject minors to rigorous mental health evaluations before recommending hormones or surgeries.

“I think it’s gone too far,” said Anderson, who until recently led the U.S. professional society at the forefront of transgender care. “For a while, we were all happy that society was becoming more accepting and more families than ever were embracing children that were gender variant. Now it’s got to the point where there are kids presenting at clinics whose parents say, ‘This just doesn’t make sense.’ ”

Her skepticism — and her willingness to speak directly to the public — puts her at the center of America’s culture war over trans kids.

Legislation to ban gender-affirming medical interventions for anybody under 18 has been passed or introduced in more than a dozen conservative states. In February, Texas Gov. Greg Abbott, who has described gender surgeries as “child abuse,” instructed state officials to prosecute parents who allow their kids to medically transition — a directive that Anderson condemned as “horrifying.”

On the other side, trans activists want to tear down barriers to transitioning, with some accusing Anderson of having abandoned them.

“From the very beginning of the history of psychology, cisgendered, heterosexual psychologists made this grand notion that trans and queer people were crazy and couldn’t make decisions for themselves,” said D. Ojeda, senior national organizer at the National Center for Transgender Equality in Washington.

Anderson sees herself in the middle.

“The people on the right … and on the left don’t see themselves as extreme,” she said. “But those of us who see all the nuance can see that this is a false binary: Let it all happen without a method or don’t let any pass. Both are wrong.”

[..]

The first U.S. gender clinic dedicated to youth opened in Massachusetts in 2007. Today there are more than 60.

In 2017, federal health researchers surveyed high school students in 19 school districts and found that 1.8% identified as transgender — 2½ times the best estimate made five years earlier.

Clearly, the decline in social stigma has allowed more teens to come out.

Anderson, though, began to wonder whether that was the full story. About 2016, when she began working with the Child and Adolescent Gender Center at UC San Francisco Benioff Children’s Hospital, she noticed a growing group of transgender youth: adolescents who had not appeared to question their gender much, or at all, before puberty.

Some drifted from one identity to the other: gender-questioning, trans, nonbinary, gay. And many of their cases were complicated by anxiety, depression, autism, bipolar disorder or other mental health conditions that predated their desire to transition.

“A fair number of kids are getting into it because it’s trendy,” she told the Washington Post in 2018. “I think in our haste to be supportive, we’re missing that element.”

At the same time, she was careful not to overstate her point.

“I can assure you, transgender identity is not something one catches,” she said in an interview the following year after being elected the first transgender president of the U.S. arm of the World Professional Assn. for Transgender Health, or WPATH.

As millions of teenagers across the U.S. went into quarantine in 2020, Anderson found herself meeting more and more parents who were startled when their children came out as trans. The UC San Francisco adolescent gender center where she worked saw a total of 373 new patients last year — up from 162 in 2019.

The teens tended to tell similar stories: They were in online school, had a lot of time on their hands and were spending more time on social media. TikTok, Instagram and YouTube, and even video games, allowed teens to craft virtual identities that they could then try out in the real world.

Online, a stream of transgender influencers and activists told teens that if they felt uncomfortable with their bodies, or didn’t fit in, maybe they were trans. Some coached kids on how to bind their breasts, how to change their name and pronouns at school, how to push their parents for testosterone.

“To flatly say there couldn’t be any social influence in formation of gender identity flies in the face of reality,” Anderson said. “Teenagers influence each other.”

In four decades as a psychologist, Anderson had witnessed waves of adolescents develop eating disorders and repressed memory syndrome. Research suggests that peer influence and social trends played a key role. Was gender identity really the only sphere of adolescent development immune from social influence?

“What happens when the perfect storm — of social isolation, exponentially increased consumption of social media, the popularity of alternative identities — affects the actual development of individual kids?” Anderson said. “We’re sailing in uncharted seas.”

#  #  #

In early 2021, Anderson logged into a Zoom meeting with a team of experts at UC San Francisco to meet a new patient and his family.

He was 13, and about two months earlier he had started identifying as male. According to his parents, it wasn’t until puberty that he had shown any sign of distress over gender.

A pediatrician had already put him on testosterone, even though he had not met with a psychologist.

“Why is this kid on testosterone so precipitously?” Anderson asked her colleagues.

It did not take long for the team to agree to discontinue the hormone and offer a referral to a gender specialist.

Numerous studies show that transgender teens are more likely than their peers to experience depression and anxiety and that gender-affirming care can help relieve those problems.

But questions remain about how to weigh the benefits of medical interventions against the risks, which include sterility, decreased bone density and other potentially permanent side effects.

Most studies demonstrating the benefits focus on teens who went through extensive mental health evaluations or adults who currently identify as transgender. Neither group may be representative of teens seeking care today — much like the universe of people who apply to college differs from the universe of those who graduate.

Nobody comprehensively tracks how often adolescents in the U.S. receive gender-affirming medical interventions, and what few statistics exist on how often those who transition go on to regret the decision are highly contested.

Most experts agree that teens should get an evaluation before receiving medical interventions. The debate within the field is over how rigorous it should be and whether mental health professionals should be involved.

In December, WPATH proposed new standards of care for transgender youth: minimum ages of 14 for hormone therapy, 15 for chest masculinization and 17 for genital surgeries — and only after comprehensive assessments showing patients meet the “diagnostic criteria of gender incongruence” and demonstrate “persistent” gender incongruence or nonconformity for “several years.”

Unlike Anderson, some healthcare providers see the proposal as a setback because they say it adds roadblocks compared with the current guidelines, which are more than a decade old.

They suggest that teenagers can be trusted just as much as adults when it comes to knowing their gender identity, and point out that the latest proposed guidelines for adults eliminate any requirement for mental health assessments.

“Being trans or gender diverse is not a mental illness, and compulsory psychotherapy is not the standard of care in the gender-affirming medical model,” said Dr. AJ Eckert, medical director of the Gender and Life-Affirming Medicine Program at the Anchor Health Initiative in Stamford, Conn., and the state’s first out nonbinary trans doctor.

“Forcing transgender and gender diverse youth through extensive assessments while their cis peers are affirmed in their identity without question conveys to [them] that they are not ‘normal,’ ” they said.

Eckert also dismissed the idea that peer pressure is driving some teens to identify as trans: “Is it trendy to be one of the most marginalized and vulnerable groups?”

In Eckert’s program, a patient learns about treatment options during a one-hour intake interview. Therapy is not required.

For Anderson, a member of the American Psychological Assn. committee that is writing guidelines for transgender healthcare, providers who pursue medical treatment for children without rigorous evaluation risk committing malpractice. She said clinicians should not dismiss cases like that of Keira Bell, who sued Britain’s only youth gender clinic, claiming that after “a series of superficial conversations” with social workers she was prescribed puberty blockers at 16 and underwent a mastectomy at 20 — only to regret the decision and later resume life as a woman.

“Giving over to hormones on demand will result in many more cases of poor outcomes and many more disappointed kids and parents who somehow came to believe that giving kids hormones would cure their other psychological problems,” Anderson said. “It won’t.”

#  #  #

Anderson’s website promises to “help you become your authentic self” and her Twitter bio proclaims “Working for a radically inclusive world for _all_ transgender people.”

Some cases, she says, are relatively straightforward. After a year of weekly conversations with Liz, a 15-year-old who had no mental health issues and had long questioned her gender before she came out as a girl, Anderson wrote a letter of support this year for a puberty blocker implant and estrogen patches.

Many cases are more complicated. Take Cody, a 16-year-old with tousled pink hair and a high, lilting voice, who identifies as trans male.

He and his parents allowed The Times to observe a recent Zoom session with Anderson, their second one-on-one meeting. She began by asking him what words he used to describe his gender.

“That’s hard,” he said. “The way I describe it is vaguely abstract … I’m a guy, but slightly to the left.”

“OK,” Anderson said. “Well, orient us. Right and left — what’s that?”

“Oh, to the left just means slightly not,” Cody said. “If you take, like, a normal guy? And then just kind of take away a little bit of the guy part, but you don’t go anywhere.”

Cody has ADHD and expressed suicidal thoughts during the pandemic. His parents came to Anderson at the end of last year after he said he wanted to go on hormones. They weren’t ready to agree to any irreversible physical changes until he spent more time exploring his gender identity.

After his first session with Anderson, he complained to his mom that he felt interrogated.

But Anderson starts from the premise that questions are the key to understanding.

In her view, gender-affirming care is not accepting everything a teen says at face value, but engaging with the patient in an empathetic, open-minded way. She thinks of it as something of a detective game — listening to the kids and parents and piecing together the history.

So Anderson kept on asking questions.

What did Cody mean, she asked, when he referred to his gender as abstract?“

Not one or the other,” he said. “But also in, like, multiple other dimensions.”

“A lot of the people I’m friends with experience gender more as like a specific vibe rather than a physical category,” he went on. “One friend says that their gender is the same vibe as a raccoon. They’re not saying that their gender is a raccoon. They’re saying that their gender has the same, like, chaotic, dumpster vibes as raccoons.”

“Dumpster?” Anderson asked. “What would the human version of that be like?”

“There isn’t one; it’s just the same chaotic energy that their gender has,” Cody said. “Which is why it’s, like, very hard to explain. It’s just kind of like a dialect — a way to talk about gender that just kind of builds up within groups.”

Anderson does not presume to understand how everyone who identifies as transgender thinks. While she embraces a somewhat conventional female identity — sleek blond hair, manicured red nails, a glittery pink iPhone — many teens cultivate more esoteric ideas of gender.

Some feel uncomfortable as girls but do not identify with cisgender men. Many opt for androgynous looks: baggy pants, hoodies, short hair. Sometimes they want top surgery but are not interested in hormones. Or they want just enough testosterone to lower their voice but not enough to grow body hair. Some, she believes, construct gender identities so idiosyncratic that they struggle to develop shared meaning.

After asking Cody more about his history of gender distress, his chats with his parents and what might ease his discomfort, she arranged to meet him the following week.

It would likely take months of exploration or longer to decide whether Cody was ready for hormone therapy.

[..]

Over the last few months, some European countries have reversed course and urged more caution.

In February, health authorities in Sweden, a pioneer in trans healthcare, said that “uncertain science,” rising numbers of people who regret transitioning and potential side effects prompted the nation to restrict using hormone treatments for most people under 18.

France’s National Academy of Medicine also advised caution in the use of blockers or hormones for youth, citing potential side effects. “The risk of over-diagnosis is real, as evidenced by the growing number of young adults wishing to ‘detransition,’ ” the academy said.

No matter how closely Anderson follows the guidelines for trans care, she worries she could make the wrong call.Every time she logs on to meet a client, she thinks of all the harms she could inflict — by inaction, by not being supportive enough, by rushing someone through the process.

Some activists have accused her of pretending to be an ally while justifying bigotry that restricts access to medical services.

“You are killing children with your hate,” one anonymous critic wrote on Twitter.

Last fall, Anderson left UC San Francisco to focus on her private practice. Since then she has written numerous op-eds and given various interviews. She has organized transgender women’s luxury retreats in the Mexican Riviera and online seminars for parents of transgender kids. But she is also angling for a new career as a television host — filming a pilot for a show in which she hopes to educate the public about diverse identities and bring “some kind of sanity to a highly polarized environment.”

More than a decade after Anderson transitioned, she is not in touch with her ex-wife, but she has a happy relationship with both her adult children. After dating men and women, she has a girlfriend. She feels more accepted as a trans woman now than she ever imagined possible.

But she sometimes wonders whether she should quit working with trans youth.

“I have these private thoughts: ‘This has gone too far. It’s going to get worse. I don’t want any part of it,’ ” she said. “I worry that people will accuse me of setting the train in motion, as part of those who advocated the affirmative approach to gender in youth, even though that’s not a reasonable account of what happened.”

For now, Anderson continues to raise questions in her practice and in the media.

In doing so, she follows the advice she gives teens whose friends tell them “Don’t doubt it. You’re trans.”

“I have a dictum: When in doubt, doubt,” she said. “Questioning is a good thing. How are you going to find out if you are lockstep with whatever conclusion you come to first?”