Today’s essay is Contributing Editor Devorah Goldman’s interview with Miriam Grossman, MD, a board-certified child and adolescent psychiatrist. Dr. Grossman’s new book, Lost in Trans Nation: A Child Psychiatrist’s Guide Out of the Madness, explores the ideas that led to today’s medical protocols for gender dysphoria, how these protocols have devastated families, and how parents can protect their children. Below is a transcript of their conversation, which has been lightly edited for brevity and clarity.
DG: Dr. Grossman, thank you so much for speaking with me. Your appearance in the 2022 documentary What Is a Woman?, by Daily Wire commentator Matt Walsh, was striking, as is your new book. What drove you to write this book at this moment?
MG: I was alarmed as a child psychiatrist. We want people, especially young people, to have a stable sense of identity. When you don’t have a stable identity, it’s a handicap. Part of the role of the psychiatrist is to help people develop and sustain that stability, which can be challenged in so many ways.
So, in fact, we have this phrase or this term: identity crisis. It’s a cliché that men who hit forty or whatever experience a mid-life crisis, and go out and kind of lose themselves. But what is happening there? They are trying to answer questions: Who am I? Where do I fit in? Where am I going in life? But we call that a crisis. It is in its own way a real problem, a legitimate challenge to a stable identity, sometimes with humorous consequences, sometimes with devastating consequences to home life. This concept—that stable identity is a crucial springboard for success—is foundational in both child and adult development.
Yet here we are, my own profession of psychiatry and psychology, endorsing a bizarre belief system that punctures something at the core of our humanity. Are we male or female—what could be more core to identity? Yet we are telling young people it is normal to question that established fact, over and over again.
DG: Creating identity crises.
MG: Yes. And so I delved into it. I wanted to understand why this was being championed by my profession. And I discovered someone by the name of John Money.
Money was a distinguished psychologist and researcher at Johns Hopkins in the fifties. His area of expertise was what was then called hermaphroditism, now called intersex. He was fascinated by these individuals born with ambiguous genitalia. This was at the time before ultrasounds, so we really did discover at birth whether babies were boys or girls. In certain, extremely rare cases, it was not clear from the genitalia whether the baby was a boy or a girl.
Now, these cases represented perhaps 0.02 percent of births, and there’s a vast array of medical conditions and chromosomal conditions that can cause ambiguous genitalia. But again, they are extremely rare. Now, John Money was extremely interested in those kids, and especially in the process of deciding if they would be raised as males or females. His Ph.D. thesis at Harvard focused on that question.
Now, he goes to Johns Hopkins, he opens up a clinic, and he really becomes the worldwide expert on this question. And he came up with a theory, one of the “dangerous ideas” I list in the book. Money was the first purveyor of the dangerous ideas that have led us to where we are now.
His idea was, put simply, that we are born “gender-neutral,” that we are all blank slates, and that our identity as men or women hinges merely on the way we’re treated during the first two and a half to three years of life. Given the debates at the time regarding nature and nurture, and what we knew and didn’t know about chromosomes, this seemed plausible.
Money posed questions regarding what messages babies and toddlers receive from parents and siblings. Are they given dresses or pants, trucks or dolls? This was the fifties after all, right? Sixties. So everything was extremely stereotypical.
Money argued that chromosomes have next to no impact on femininity and masculinity. In other words, whatever interests or behavior or inclinations or personality a person might end up with—virtually all of it is socially constructed, divorced from biology. It is all imposed by society onto a blank slate of a baby, and it all happens within the first two-and-a-half to three years of life. After that, Money said, it’s fixed. There’s no changing it.
So he coined the term gender identity, which, according to him, is an inner feeling or experience of oneself, an inner identity that is nonetheless socially constructed.
Money had no way of proving this, until a young blue-collar family from Canada, who had had twin boys about a year earlier, sought him out for medical assistance. One of their twin sons had undergone a botched circumcision and was permanently disfigured. Without going into too much detail here, Money instructed the parents to raise their boy as a girl and to never disclose the truth. This ultimately led to devastating effects for the whole family—the child was stereotypically masculine in behaviors, interests, and sexual attraction. That boy later discovered that he was not a girl and chose at once to live as a man. But he eventually committed suicide, and his twin brother died of an overdose. Money, meanwhile, lauded this experiment as a success and a vindication of his theory.
An important note: in examining Money’s own background and writings about his life, you discover that he himself had deep discomfort about being a man. So it makes sense that he could come up with a theory like this, outlandish as it seems, and devote so much to establishing his theory as fact.
Without Money’s successful promotion of the idea that gender identity exists, and that it is separate from and more important than anatomy and chromosomes, we would never have reached the point we’re at now, where we are teaching kids in schools that biology does not matter. Telling children their feelings matter more than biological realities is extremely dangerous; we cannot deny our biology without paying a price–sometimes a high one
DG: In the book, you quote Israeli child psychologist Haim Ginott as saying something like “children are like wet cement,” in that virtually anything can make a lasting impression. I wonder to what extent today’s gender activists appreciate or comprehend what they are doing to children, raising them in a world that is so different from the one in which they themselves were raised. Some of them feel they were wronged as children by being given fixed definitions of male and female, and they want to prevent that for coming generations.
But no matter what, they cannot actually relate to being brought up in a world without those clear definitions. So they can’t meaningfully understand what children today are experiencing when they’re taught, as “wet cement,” these incredibly strange ideas.
MG: I think that you’re being very generous. I think that a lot of the activists don’t have such altruistic motives. But in any case, I do want to bring up the fact that the mental health community is just ranting and raving about the amount of depression and anxiety and suicidal behaviors that currently exist among young people. There’s a lot of panicked language and waving red flags, and at the very same time they are—
DG: They’re creating their own clients.
MG: They are shoving these confusing and insidious ideas down kids’ throats. They are promoting these ideas. The American Academy of Pediatrics, the American Psychological Association, the American Academy of Child and Adolescent Psychiatry, they all drank the Kool‐Aid, and they are all telling kids that they could be born in the wrong body, and that it’s normal to have these feelings, and that it’s a variant of normal human expression to want your healthy body irreversibly damaged, your breasts to be removed.
DG: I’m glad you brought up these institutions. How have these and other medical associations across specialties, which represent people like you, been captured by extremists on this issue? How did Money’s bad idea capture the Western medical imagination?
MG: Well, Money was not only wrong, he was a bad person—a pedophile who promoted incest, among other things. But he succeeded because he was an egotistical tyrant with elite credentials. He strove to gain as much publicity as possible, writing articles and books not only for professional audiences, but for lay audiences. He took his ideas about gender identity and the corresponding bogus—now utterly disproven—results, lied about them, and promoted his research as being genuine when it was nothing of the sort.
But he made a very good impression. He was articulate and smart and sophisticated. He was the professor wearing the tweed jacket, who’d gone to Harvard and had the right tastes. Yeah, people listened to him, just like they’re listening to experts now.
DG: On the subject of experts, something that has struck me about the elitism of medical institutions in particular is that they are talking down to people like you, who are just as qualified to put forward informed views on medical practice and biological reality.
MG: This has happened many times before in history, that small groups of people with bad ideas get into power. This is nothing new; we shouldn’t be shocked by it. This is how bad ideas gain steam, especially when people who know better stay silent, or feel compelled to do so. My inbox is filled with notes from doctors, nurses, social workers, psychologists, all saying they agree with me, but can’t say it publicly.
DG: What galvanized you to become more public with your views? What sets you apart from the many people who love and agree with what you’re saying but don’t feel equipped to speak out?
MG: First of all, I’m at the end of my career. I’m not just starting off and having to worry about being rejected from job applications or being fired. So I don’t have that issue to deal with. Although I have been turned away from work because of my positions. But I survived.
Secondly, I have been seeing these families for a few years now. I have patients who no longer have a penis, who now have a so-called “vagina.” I have patients who have been made infertile, patients in their twenties, by surgeons who carved them up without taking a moment to explore their mental health. I have talked to too many young women who have had their breasts removed and now regret it, and it’s sinking in that they won’t be able to nurse one day. So I have been living it in this way.
And oh, the parents. I have a whole chapter in the book about the parents. For the parents, . . . I want you to know that I spoke to a mother, who recently contacted me, and she is a survivor of a genocide. I can’t say where it was, but it was one of the genocides that have happened in the past 30, 40 years. And in that genocide, she lost her family, her husband, and a limb. Now, she has a child who’s transgender, and she told me that that experience with her son is harder than anything she’s gone through in her life.
DG: My God.
MG: So you asked me what is pushing me to do this. It is the rage I feel over the suffering I’ve encountered. I couldn’t contain the rage that I feel toward the people propagating these atrocities. I just couldn’t contain it, so that’s why I do what I do.
DG: Thank you. As much as I was aware of what these surgeries and other physical processes entail, reading about them in detail in your book was, it was heartbreaking and just so difficult to get through. But I also appreciated that you shed light on the parents who I think are often the quieter actors in this. I think there are some detransitioners who are very outspoken, and courageously so, but parents dealing with their children’s crises occupy a strange role. But as you detail in the book, some parents protesting their children’s medical transitions have been legally challenged and even imprisoned.
MG: Well, let me explain. The reason why so many parents have to be anonymous is because they’re still hoping and praying that their child is going to come back.
MG: There are parents that speak out, that will use their names, but this has only recently become more common. So I feel that I need to speak for the parents. And as you saw, I dedicated the book to them—to 500 parents from 17 countries. The book is dedicated to them, because my profession is painting these parents as if they’re the bad guys for not accepting their child’s fake persona of the opposite sex. My profession has entirely abandoned those parents and their struggle. So you see, I’m angry.
But anyway, getting back to the question of institutions, let’s discuss the American Academy of Pediatrics.
That is a major medical organization. It claims it has 67,000 members. I want parents to understand that when they go to their pediatrician, doctors are busy and we don’t have time to do research on every subject that we are supposed to know about. So, we are taught throughout our training, that we trust our professional organizations. Makes sense, right?
MG: So, if someone comes to me with OCD, for example, and I want to find the latest recommendations regarding new medications and so forth, I’m going to go to the American Academy of Child and Adolescent Psychiatry and look it up. I’m going to trust what they have over there. Why not? Why shouldn’t I? Of course I’m going to trust them.
Now, the problem is when it comes to this issue of gender identity and being transgender; on this particular subject the organizations have been captured by activists.
They’re at the helm, they decide policy. That includes deciding which letters to the editor will be printed in the medical journals, which research articles will be accepted for publication, which topics will be discussed at annual meetings, and what doctors and parents across the country will be told to do.
That’s a lot of power. In 2018, the American Academy of Pediatrics published a policy statement on the care of transgender and gender-diverse youth. It was written by one doctor, and it basically just regurgitated the entire belief system underlying gender ideology, including the ideas that sex is assigned at birth, that sex is on a spectrum, that children have innate gender identities that must be immediately accepted by adults. This was a publication from a medical association, but it lacked any medical foundation. It claimed their policy is supported by high-quality evidence of benefit, but that’s not true.
Since then, some pediatricians have started speaking up.
One pediatrician, Julia Mason, began the process of submitting a resolution to the powers that be of the American Academy of Pediatricians. One year after another, it has been dismissed. The resolution calls for a re-examination of that 2018 policy statement, asking for a re-evaluation of the evidence. After all, this is what has happened in the United Kingdom, Sweden, Norway, and Finland. Just in the past three years, all those countries have done in-depth analyses of the research, of the data, and they have decided to do a 180 on treating kids with gender dysphoria. So in other words, the medical authorities in all those countries are doing the opposite of what the American Academy of Pediatrics is now calling for and has called for since 2018.
DG: It really is alarming. There’s a silencing of medical debate in America that is not happening in other countries.
MG: It’s a tyranny. There are currently 24 pediatricians who have signed Julia Mason’s resolution to the American Academy of Pediatrics. And as we speak, as far as I know, it still is not going to be considered.
Parents need to understand that when they take their child to the pediatrician, and the pediatrician is going to turn to her professional organization for advice, she—or he—is just going to repeat what this organization is saying. Frontline doctors who aren’t engaged in research are meant to believe that this represents a medical consensus. The U.S. Assistant Secretary for Health, the admiral Dr. Rachel Levine, keeps saying there’s a medical consensus. There is not.
DG: Something I have started doing a little of, and hope to do more of, is to examine the medical papers—often erroneous or retracted papers—which are used to fuel social movements. They so often lack rigor or even the kinds of results they are touted as presenting.
MG: Excellent. Yes, I’m glad more people are re-examining the research fueling these treatments; it’s become increasingly clear how little basis there is for them.
DG: To end on a—hopefully—hopeful note, perhaps we can discuss steps forward. Many people are calling on parents to homeschool their kids, in order to shield them from gender ideologues in schools and so forth. There are the pediatricians you mentioned who signed this resolution. The subtitle of your book is “A Psychiatrist’s Guide Out of the Madness.” How would you advise that America emerge from this madness?
MG: My book is not only for parents dealing with this issue immediately in their own lives, but for people who want to prevent this. One key, which seems small, is to challenge the statement that sex is assigned at birth. Sex is established at conception, not “assigned at birth.” Children are permanently established as males or females many months before birth. I want kids to hear this from their parents before they are exposed to the “assignment” language elsewhere. I want them to recognize the idea of sex being assigned at birth as the bizarre, anti-scientific myth that it is.
DG: Thank you. Absolutely. Something else that I really loved about your book was your section on sex education. I thought you offered brilliant insights there. I know you wrote a separate book about sex education, where you talk about the way kids and young people are taught about sex and reproduction as if it’s a mechanistic, soulless experience, almost like the sexual play depicted in Aldous Huxley’s Brave New World.
You offer another model for how we might approach reproductive education, one that emphasizes motherhood and fatherhood. I don’t think this need be done in a preachy way, but in a way that brings science, including psychology, to discussions of human relationships. For example, you pointed out the beauty of nursing, the bonding that occurs between a mother and child, and so forth. In short, you suggest reforming sex-ed to make it more about the life cycle.
MG: Right. Well, I bring that up in the context of the mastectomies that are being done on girls who think that their breasts are just sex objects for guys, and who have never meaningfully encountered another point of view. They just have no concept of the magnificent biology of the breast, of nursing, and of the oxytocin bonding that occurs between mother and baby. This is one of my favorite subjects.
The female biological system is filled with wonders.
DG: I think that is a good note to close on. Dr. Grossman, thank you very, very much again for speaking with me, and for writing this very important book. I hope more doctors will join you in speaking out as a result.
Important announcement: Introducing our new Ethics Advice Column! This week, submit your ethical questions to Chris Tollefsen, our expert in natural law philosophy and ethics. Each quarter, we will publish Chris’s responses to select questions.