A Modest Proposal to End Insanity, Part II

Evidence of medical malpractice is mounting

In Part I, I offered a Swiftian modest proposal for reducing social anxiety in young people. I argued that parents should affirm their children’s desire to consume a diet consisting solely of mac and cheese and fried Oreos, “because trained psychotherapists agree that by age eleven or twelve, ‘all children know who they are and what’s best for them to eat’ and the parents need to affirm that.”

It sounds crazy, but I didn’t make this last bit up. I read it in Abigail Shrier’s book Irreversible Damage: The Transgender Craze Seducing Our Daughters, in which she interviewed Katherine, mother of a transgender teen. Like many parents, Katherine did not want to accept her daughter Maddie’s self-diagnosis of being a boy trapped in a girl’s body, but still wanted to try to understand and support her. She called ten different therapists and described how her daughter had never had a history of gender dysphoria, asking for direction. Katherine reported to Shrier that “all of the therapists said the same thing to me. They said: ‘At this age, kids know who they are:’ If Maddie thought she might be transgender, then—by definition—she was.”

I know that the science of gender and sex is complicated. I am even willing to admit that a very small percentage of adults might benefit from gender transition. And I certainly agree that every single human being deserves to be granted the dignity of love, compassion, and acceptance of their personhood, full stop. But what is infuriating is how insane it is for professionals to say that “at this age, kids know who they are”—which is tantamount to agreeing that their given body is diseased or a mistake—and then nudge them toward often irreversible medical interventions designed to “fix” them. 

Since everyone agrees that adolescence is a time of hormonal confusion, social anxiety, and impressionability, why do we think it’s okay for the inmates to run the asylum in this area? When Riley hits puberty in Inside Out 2, a frenetic wrecking crew comes into headquarters and destroys the place. Anxiety and other new emotions threaten her entire sense of self precisely because that sense of self is still in the process of being formed—it is inchoate, fragile. Anyone can see that rushing to judgment about any permanent medical decision during this time makes no sense at all. And we’re not talking about getting tattoos here.

It’s anecdotal evidence, but it’s still evidence of what can only be called malpractice. In each story that Shrier and Lahl tell in their respective books, the psychiatric and medical establishment affirmed the self-diagnosis of the child. They did so in the absence of scientific evidence that medical transition would solve the child’s gender dysphoria, depression, or anxiety. The psychiatric and medical establishment made it easy for these young people to get what they thought will solve the problem. One young woman reported being able to get testosterone after a single thirty-minute phone call with a doctor. Another said the doctor asked her how much testosterone she would like—and gave her the highest dose allowed. The schools then protected the kids’ right to this decision as if they were protecting them from parental abuse. The parents were left powerless, convinced (or simply pressured) by the experts to follow along or risk the child’s suicide. Cat’s story indicates how this often works:

When she was seventeen, her gender dysphoria had not gone away, and her parents took her to see a gender therapist, the “head honcho of gender care in Sacramento”, who they thought could actually help her. At this point, she was suffering from an eating disorder and some other serious mental health issues. But instead of addressing her issues, the therapist affirmed her “trans identity.” At that first appointment, he told her that all her issues were caused by her gender dysphoria, and at the third appointment, he recommended that Cat begin medically transitioning with testosterone.

In nearly all these cases, the only thing standing in the way of major medical decisions were parents who were rendered powerless. The consensus of those in power is that to care for self-declared trans youth requires affirming them in their “true” identity as a different sex. 

In 2022, the governor of Texas directed state officials to open child abuse investigations into families who send children to gender affirming care. (I think this is a very unwise move—you don’t solve government overreach with more overreach.) In his response, Joe Biden called this an “attack on transgender youth” and said that “affirming a transgender child’s identity is one of the best things a parent, teacher, or doctor can do to help keep children from harm, and parents who love and affirm their children should be applauded and supported, not threatened, investigated, or stigmatized.” 

The statement that “affirming a transgender child’s identity” is one of the best things one can do to “help keep children from harm” (that is, preventing suicide) has not been proven in any way—not to mention its anemic definition of “harm.” It also assumes things we have never assumed before: that a child knows what’s best, and the worst way to hurt a child is by not giving her what she thinks she needs. Bring out the fried Oreos.

Lahl and Fell conclude their book arguing that change will come only when lawsuits begin to reveal how broken and negligent gender affirming care is right now. Existing standards for care (when you can find them) are not being followed:

Layla Jane (Kayla Lovdahl) is suing the same hospital, along with several doctors, for “ideological and profit-driven medical abuse”. She says she was given puberty blockers and cross sex hormones after a single session with a psychologist, and her breasts were removed when she was thirteen after one consultation with the surgeon. Like the other young women in this book, she was not assessed or treated for her comorbid mental illnesses. The suit notes, “there is no other area of medicine where doctors will surgically remove a perfectly healthy body part and intentionally induce a diseased state of the pituitary gland misfunction based simply on the young adolescent patient’s wishes.”

Since medical interventions like top surgery (double mastectomy) are irreversible, caution must be the order of the day. To say otherwise is simply and flatly insane.

This brings us back to my original question: What’s driving this kind of insanity? What has happened that has made it socially acceptable—and maybe even desirable—for us to betray our own values, morals, and convictions (not to mention verifiable facts) when it is politically expedient to do so? We must puzzle and puzzle on this until our puzzlers get sore. And my puzzler has been sore on this issue for a long time. It touches on a question that has been the center of my research on the moral imagination and the power of story—namely, what makes it possible for us to see the truth about ourselves and to change our minds when we are misguided? That is the question I will address in the concluding installment of this series next month.

Christina Bieber Lake is the author of Beyond the Story: American Literary Fiction and the Limits of Materialism. She is a Contributing Editor for Current.