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Hypothesis 3: ROGD is an appropriate coping mechanism for transgender children of gender critical parents.

Posted by bconijn on 01 Sep 2018 at 18:28 GMT

Considering the observed worsening of mental well-being after the coming out of the adolescents and young adults (AYA), I would say that further research into the causes of this ROGD phenomena is desired. We might also want to better understand the extremely high prevalence of mental health problems within the studied population (79%), prior to their coming-out.

As we are dealing with mental health problems, we have to take the social environment wherein these exist into account. For example, that their parents, the sampled population, are all highly skeptical of the concept of innate gender identity. How this relates to the interaction between parents and child has to be taken into account when trying to understand those mental health problems. Lisa Littman fails to take this into account in the discussion of her findings.

The parents go to great lengths to prevent their child from transitioning. For example by:
- inducing fear: "expressing concerns for the child’s future if they take hormones and/or have surgery".
- questioning or denying their feelings: "disagreeing with the child about the child’s self-assessment of being transgender"
- preventing them from exploring their feelings: "recommending that the child take more time to figure out if their feelings of gender dysphoria persist or go away", "calling their child by the pronouns they used to use" and "calling the child by their birth name"
- questioning their sanity: "recommending that their child work on other mental health issues first to determine if they are the cause of the dysphoria" and "recommending a comprehensive mental health evaluation before starting hormones and/or surgery"
- trying to contact and influence the clinician that their child sought help from: "For the most part, I was extremely frustrated with providers NOT acknowledging the mental disorder, anxiety, depression, etc before recommending hormone replacement therapy.", "When we phoned the clinic, the doctor was hostile to us, told us to mind our own business.", "The pediatrician/‘gender specialist’ did not return calls or emails from the primary care physician who requested to talk with her about my son’s medical history before she saw and treated him" and "I asked the risk manager at [redacted] if they'd considered a personality disorder."

From this we might conclude that a large part of the sampled population employed coercive methods, such as gaslighting and questioning to prevent their children from transitioning. Those methods are known to negatively affect mental health[1]. As those are mainly employed after the AYA's coming-out, this might explain the observed worsening of mental well-being. Considering that "the AYA calls the parent transphobic and abusive", we might assume that AYA's had correctly identified this threat to their mental well-being and therefore protected themselves by isolating themselves from their family. Of course, planning a transition itself is stressful, especially without support from your family and even more so when it might cause them to lose their family. This stress can further explain the observed worsening of mental well-being. However, I assume that these are well-meaning and caring parents, so what causes them to do this to their children?

Most parents report that their child has been socially isolated or even bullied during childhood. I presume this motivated parents to seek professional help, who subsequently identified a mental disorder or neurodevelopmental disability as the cause of this isolation or bullying. Hence, a treatment would be recommended to help the child suppress the associated symptoms to fit in better with their peers. This means that the child is held responsible for being isolated and bullied, which is a form of victim-blaming that is probably also used by the child's peers. In a sense, the therapist and parents are siding with the bullies.

As such treatment fails to address the underlying cause, it can only work when it uses coercive measures, such as those described above. The child is thought that they are deserving of isolation and bullying by nature and have to hide their true-self to be deserving of love and care. Naturally, the child will feel abandoned and, if they sought support from their parents, betrayed. However, the child depends on their parents for survival and hence had no choice but to vigilantly suppress their non-conforming behavior and interests. This explains why parents are unable to see any signs of gender dysphoria up until the child's coming-out.

This prolonged and extremely threatening situation from which escape is virtually impossible, will likely result in the child developing complex post traumatic stress disorder [2,3]. Considering that C-PTSD is not recognized in any version of the DSM, it will likely be misdiagnosed as a different disorder or disability. This explains the extremely high prevalence of mental health problems within the studied population (79%).

This situation will persist until adolescence or (young) adulthood, when they become more independent and start looking for support elsewhere. When they find information about gender diversity and can relate to it, this might very well be their first experience with feeling accepted and valued, regardless of who they are. This means they found a possible way out of the traumatic situation that they are currently in. Of course they will start spending time on this as if their life depends on it, because it does. They can't keep going on like they did, considering the tremendous amount of effort they've been putting in hiding their true-self and the detrimental effect this has on their mental well-being. Of course this makes them very optimistic and hopeful for the future, because it's the first time they actually feel like having one. Of course they will try to resist any attempts of their parents from pursuing this goal.

Does this mean they are really transgender? Maybe they are, maybe they're not, but they're not going to find out until they try. Does this mean it will solve all their mental health problems? Probably not, but it is a start and probably the first solution that addresses the underlying problem. Does it mean they're growing up? Definitely. What should you do if you doubt that they're transgender? Well, apologize and show them that they're deserving of your love and care regardless of their interest or how they identify. That would fulfill their need of being loved and cared for and, if they're indeed not transgender, this would remove the reasons they have for pursuing transition. This "gender affirmative" approach has already been tried and proven effective. Especially in cases where the child turned out to be not transgender.[4]

Of course this hypothesis is highly speculative, but so are the two hypotheses set forth in Lisa Littman's paper. However, I have lived experience of the discussed phenomenon and my hypothesis does a much better job at explaining the observed results. I appreciate that this phenomenon is being researched, as those children suffer real harm and deserve to be understood. However, Littman failed to talk with the children and instead only surveyed the parents, who won't be critical of their own behavior. This causes the paper to be biased in a way that allows it to be misused by parents to justify above mentioned coercive methods, in particular gaslighting. This poses a serious risk of mental harm for the children involved and thus is a very serious ethical issue.

[1] Dorpat, Theodore L. Gaslighting, the double whammy and other methods of covert control in psychotherapy & analysis. Jason Aronson Inc., 1996. P. 6-8
[2] ICD-11: Complex post traumatic stress disorder. World Health Organization, 2018.
[3] Walker, Pete. Complex PTSD: From surviving to thriving: A guide and map for recovering from childhood trauma. Azure Coyote, 2013.
[4] Ehrensaft, Diane. The gender creative child: Pathways for nurturing and supporting children who live outside gender boxes. The Experiment, 2016. Chapter 4.

Competing interests declared: I have lived experience with the phenomenon described in the article. I'm a transgender woman, member of Mad Pride Nederland and seek to end coercion in mental health care.

RE: Hypothesis 3: ROGD is an appropriate coping mechanism for transgender children of gender critical parents.

Ring replied to bconijn on 17 Sep 2018 at 22:01 GMT

Well said!

No competing interests declared.