The following is a true story, with names and identifying information changed to protect patient privacy. The author is a medical professional. We present it as part of an ongoing series on children and the transgender movement. A long-form piece on the topic will follow next week.–Eds. 

“Maybe there is a beast… maybe it’s only us.”
                           –William Golding, Lord Of The Flies

The patient was an 11-year old boy who appeared younger than his stated age. He wore a pink tutu and bounced in his chair like a jack-in-the-box, his eyes darting about the room.

“Can you tell me a little bit about what happened before you came to the hospital?”

“Noo,” he whined. “I don’t want to talk to you.”

“It will only take a few minutes, and then you can go back with the other kids.”

“But I don’t like talking about these things!"

“I understand, but I’m the one who decides how long you stay here.” I set my eyes upon him. “So if you just answer a few questions I can help you get back home.”

“But this isn’t my fault! It’s my parents.”

“What do you mean?”

“They’re always putting me in the middle.” He hugged his tiny frame. “They hate each other.”

“I’m sorry to hear that,” I said gently. “I’m sure it makes things really hard.”

“I already told you I don’t like talking about these things.” The boy grabbed the tutu and twisted it back and forth. “This place is stupid anyway.”

“I understand you don’t like being here, but there is concern that you might hurt yourself. Are you feeling suicidal?”

“Noo!” He stamped his foot. “That was just for one second. Because of what my dad said.”

“Oh? What did your father say?”

“He won’t call me ‘Lucy.’ My mom always tells him that’s my new name, but he doesn’t accept it.” The boy scowled. “He’s a dick.”

“I see. And who came up with that name?”

“My mom.” The boy brightened. “She said it’s way better than my old name. Plus she buys me all these dresses. She said she loves having a daughter.”

“Interesting. How do you fee—”

“Can we stop now?” The boy tugged on the tutu again. It seemed like it might tear. “I’ve answered all your questions.”

“We’re almost done. How do you feel about the conflict between your parents? It must be very upsetting.”

The boy stopped fiddling with his clothes and slumped in the chair, his face downcast. “I feel like I’m a little sailboat between two ships.” He lifted his head and our eyes locked. “Do you know what I mean? 

“I do,” I said quietly. “That’s a powerful description. They’re putting you in a terrible spot.”

He sat there motionless, his eyes moist.

“I know that these things are difficult to discuss. I appreciate you answering my questions. Do you feel ok?”

“I’m ok.” He rubbed his face into his pink shirt sleeve, leaving a trail of snot. “Can I go?”

“Sure. But I’m going to have to talk to your parents too before you can leave.”

 He scuttled out of the room and into the common area. I followed and glimpsed his mother amidst the other adolescents. She bustled between them like a headmistress, eyes gleaming as she bloviated about the meaning of “LGBTQIA” for her tiny audience. A nurse watched warily on the perimeter with arms folded. I strode toward her. 

“I’m going to take Luke’s mother into the interview room, but this is inappropriate. We can’t have parents interacting with the other kids.”

“Yeah, she won’t stop talking to them,” the nurse grumbled. “It’s like she’s here to make friends. She loves the attention.”

“Well let’s put a stop to it.” 

The nurse nodded, and I called the mother’s name and beckoned. She followed me into the interview room and we sat. She was a lumpy, middle-aged woman with a wild mane of frizzy hair and a pharisaic expression.

“I wanted to talk to you about Luke.” 

Her eyes narrowed. “You mean Lucy. We don’t use her old name. That’s deadnaming her.”

“I see. In any case, your child is here due to endorsing suicidal ideation. Sounds like the child has been in therapy since you and the father have separated, but the child’s symptoms have been getting worse. It seems related to conflict between you and the father. What are your thoughts?”

 The mother scowled. “How is a daughter to feel if her own father doesn’t accept her true self? It’s abusive any way you cut it. I normally don’t use foul language, but I have to say that he’s a real dick.” She placed her hand over her heart. “You should know that I’m a tireless advocate for my daughter. I even have a Facebook page devoted to Lucy’s transformation. I can show you if—”

“That’s not necessary. Right now we’re primarily concerned with stabilizing the child’s acute symptoms of depression and ensuring that he can manage his safety.”

A frown flickered across her face. “You mean she.”

“Mhm, I don’t expect your child will need to be with us for too long. On our unit, we help kids develop healthier ways of managing their emotions, and we try to facilitate communication within families. Just to let you know, I’ll be speaking with Luke’s father as well to get his perspective. Any other questions for now?” 

She clasped her hands. “No, but I want you to know that all I care about is Lucy’s well-being. I can even stay after visiting hours if it would be helpful.” She sighed dramatically. “I just want her to be ok." 

“I understand, but we don’t allow families to stay beyond visiting hours.” I stood and opened the door for her. “I’ll have one of the nurses escort you out.”

On the way home from the hospital, I dialed the patient’s father. He picked up at once.

“This is Dr. Gopal. I’m calling about Luke.”

“Yes, yes, I’m so glad you called. I’ve been so worried.”

“I understand. I wanted to talk with you about his treatment.”

“Of course. How’s he doing?”

“Well, he appears to be quite stressed by the conflict between you and his mother. And I did notice he seems young for his age, almost as if he’s regressed. It was difficult to have a productive conversation with him.”

“Yes, yes, he’s been doing worse and worse.” There was a pause and I could hear his rapid breathing. “I’m sorry I’m just overwhelmed. I really don’t know what to do. How is he right now?” 

“Don’t worry, he’s in a safe, contained space now. We’ll take good care of him. But I wanted to hear your thoughts about what’s been going on at home, and in particular any conflict that’s occurred between his mother and you." 

“Conflict?! I’ve been made into a pariah. Pitted against my own son!” His voice was ragged. “Luke is not transgender, you have to believe me. When he’s at my house, he never wants to wear dresses, never wants to change his name. That kind of stuff only comes out with his mom. I think she’s using it against me to get full custody.”

“I see. She does seem to be manipulative, and she appears to enjoy the attention as well.”

“Yes, she posts all these pictures of him in dresses on Facebook, just for the likes!” The father’s voice quavered. “I just don’t know what to do…I’m losing control. Yesterday I tried to pick him up for our time together but she had taken him to the emergency room and said that he was suicidal, and I’m painted as the villain!” He burst into strangled sobs. 

I closed my eyes and nodded, feeling deep compassion for his plight. “It’s a terrible situation. But it’s important to maintain composure and stand up for yourself. Your status as a father is at stake.”

“You’re right, I need to pull myself together.” He breathed deeply and his voice steadied. “So what should I do?”

“Can you tell me more about the dynamic between Luke and his mother?"

“They’re close, but it seems really unhealthy. She’ll put him in these tight dresses and tell him she’s always wanted a girl. And Luke has told me that when he goes along with it he feels closer to her.”

“That makes sense. Your son actually seems pretty boyish, so it’s surprising that he would identify as a girl. Although nowadays there’s a real power in claiming victim status, so I often see kids identifying as trans in order to avoid responsibility and get attention.”

“Absolutely. The whole thing seems crazy to me, but when I said that to his teacher, she threatened to call CPS on me!” He paused for a moment. “Something else that’s bothered me is how often Luke’s mother takes him to the doctor.”

“What do you mean?”

“He’s a healthy kid but she probably takes him to urgent care every week for supposed constipation, headaches, little things like that. He’s always missing school. It doesn’t make sense.”

“Interesting.” I stroked my chin. “Have you ever heard of Munchausen syndrome by proxy?”

“I may have heard it before, but I don’t recall. What is it?”

“It’s a disorder where a caretaker, usually the mother, brings her child to doctors to be evaluated for fabricated complaints. She’ll appear quite concerned and even distraught about her child’s symptoms, but in reality she’s using the child as an instrument to serve her own needs. People with this disorder have an emotional void inside them, and they seek compassion and attention from healthcare providers to fill it up.” 

“Wow.” The father was silent for a few seconds. “You know, that really resonates with me. I think that might be going on with Luke’s mother.”

“It’s a form of emotional abuse. So if it’s happening, it would be a major cause of Luke’s depression and behavioral problems.”

“That makes sense,” the father sighed. “You’ve given me a lot to think about.”

“Ok, we have to stop now, but I think Luke will be able to leave the hospital within the next day or two. I don’t believe he’s an imminent danger to himself.”

“Thank goodness. I really appreciate your help.” 

“No problem, I wish you the best of luck.” 

The remainder of the boy’s hospital course was unremarkable but for a few outbursts that occurred when his mother visited. However, he responded well to the boundaries implemented by staff and was discharged in 36 hours.

A few months later, I received an email from Luke’s father requesting my assistance in the context of the parents’ custody battle. He had done more research on Munchausen syndrome by proxy and recalled that years ago, Luke’s mother would read about the condition in psychology textbooks. “She was obsessed with Munchausen,” he wrote. I agreed to perform further analysis of Luke’s case by visiting his school and interviewing his teachers. 

The following Monday morning I met Luke’s 5th grade teacher, a bumptious young lady with a bowl cut and a rainbow button pinned to her pantsuit that said “ALLY.” She folded her arms across her chest and looked me up and down. “Well, Doctor. How can I help you?”

 “I’ve been asked by Luke’s father to do additional research that could inform their custody arrangement. Anything you can tell me regarding Luke’s mental health, behavior, or relationship with his parents would be helpful.”

She peered at me above her glasses. “Well ‘Lucy,’ as we call her, has caused quite a stir at school.”

“Oh?” 

“Yes. I’ve always been against oppressive gender norms, but her mother has inspired me to deepen my understanding of gender fluidity, and it’s been my mission to impart that to my pupils.” She waved her hand to indicate the progressive cant plastered across the classroom walls.

“Interesting. And how has Luke reacted to this?”

“Well we go out of our way to show her that she’s special.” She sighed. “But it’s still hard. The kids tease her relentlessly when she wears dresses, and she gets so worked up she can’t even get her work done. Unfortunately, 11-year-olds aren’t the most enlightened bunch.”“I see.”

“But we’re not giving up,” she said, shaking her head. “At the mother’s request, we’ve hired a gender dysphoria specialist to work with Lucy, and we’ve given her a separate changing room for gym class.”

“And the father? How does he fit into all this?" 

“He doesn’t. I’ve got half a mind to call CPS on him. He’s a stodgy, cis-white male!” she squawked, raising her finger like a scold.

“I see,” I said, avoiding her hysterical glare. “How do you think the conflict between the parents affects Luke?”

“It’s terrible. She constantly has to leave school for doctor’s appointments. I think probably her father’s attitude is what’s making her sick.”

“Right.” I made a show of checking my watch. “Ok, thanks for the information. I need to meet with the principal now, but I appreciate you speaking with me.”

“That’s too bad,” she frowned. “I wanted to tell you more about my theories of what’s going on. Here’s my card. Don’t hesitate to reach out"

I took her card and on my way out noticed two signs straddling the exit, one that said “Gender-Free Zone,” the other “Smash the Patriarchy.” I walked on to the principal’s office, flicking the teacher’s card into the nearest trash bin without breaking stride.

The principal was a balding nebbish in an unbuttoned polo who stood excitedly as I entered. “Doctor Gopal, so nice to meet you! Please sit down. Can I get you anything?” He smiled obsequiously.

“I’m fine, thank you. I just wanted to talk with you about Luke. His father has asked me to do some additional research that may shed light on the custody arrangement.”

“Of course, of course.” He plopped into his chair. “How can I help?"

“Well I’ve already spoken with his teacher. But I’d like to get your view on Luke too.”

“Sure.” He smiled. “By the way, I’m curious. What did you think of his teacher’s point of view?”

“Well, I think you probably know she’s aligned with the mother. And she doesn’t seem too fond of the father. And perhaps white men in general,” I added.

“That’s a fair statement, but I try to give her the benefit of the doubt.” He leaned forward and lowered his voice. “Between you and me, she’s going through a divorce. Husband cheated on her.”

“I see. Well what do you make of Luke’s situation?”

“Luc—” he hesitated. 

“Go ahead and use his legal name. We shouldn’t indulge children’s demands to be referred to by certain pronouns and nicknames. It gives them a distorted sense of entitlement.” 

“Thanks. Luke’s an interesting case. He’s been having a hard time controlling his behavior. Actually excuse me one moment.” He got up to peer into the hallway and then locked his office door. “Ok, now that we have complete privacy I’m going to be honest with you. Luke’s the tip of the iceberg. We’ve seen an explosion of the trans phenomenon. And they all seem to have behavioral problems." 

“Sure,” I nodded. “On any given day on the adolescent psych ward where I work, up to a quarter of the kids identify as transgender, and the vast majority of them have nascent personality disorders.”

“Interesting.” The principal’s head bobbled as he considered this. “But could it all be because they’re born in the wrong body? 

“Have you forgotten the vicissitudes of youth? In the past, kids who didn’t fit in might dress in black or dye their hair, but now at the slightest hint of gender dysphoria, parents, teachers, and even medical professionals put kids on the path towards irrevocable medical decisions and sterilization.”

The principal stared back, glassy-eyed. I pressed on. “The prevalence of adults who identify as transgender is less than 0.5%, but up to 50% of the adolescents I see in the hospital claim to be trans, gender dysphoric, or non-binary, and many are already taking hormones, some as young as 11 or 12. It’s appalling.” I shook my head. “We’re failing these kids.”

The principal fell back in his chair, beads of sweat glistening upon his forehead. “I suppose children don’t have the wherewithal to decide these matters, but we’re living in different times. I don’t want to be seen as the intolerant white guy.” He mopped his brow. “When Luke’s mother sends us letters demanding that everyone address him as ‘Lucy,’ I’m not going to risk my job arguing with her over antiquated principles.”

I looked away. On one wall of the principal’s office were his august diplomas, including a Master’s degree in European History. Behind him was a bronze plaque with the inscription “Esse Quam Videri.” I sighed inwardly and returned to his craven face. “Well, I think that’s all the information I need for now.”

The principal stood and offered his clammy hand. “Listen, it’s been fascinating to chat with you. Please let me know if I can ever be of help again.” I turned to leave. “Or even if you want to get a beer sometime,” he called as I proceeded down the hallway. “Would love to hear more of your thoughts.”

I didn’t respond. The next day Luke’s father contacted me to let me know that he had received the following email in the middle of the night, ostensibly from Luke: “Dear Dad, I am mature enough to choose my own clothes. It’s invalidating and abusive that you can’t see me for who I am, and I refuse to live with you anymore.” He also reported that during his time with Luke, the mother would lurk near his house and attempt to lure Luke away. She would stalk them when they visited the playground and once called the police to say that Luke was riding his skateboard while unattended. 

I spent the next week reviewing additional statements by Luke’s therapist, who reported that Luke had never brought up his gender in therapy, and from family friends who observed that the mother loved creating drama and would do anything to be seen in a sympathetic light, including manipulating her son to believe that he was a girl.

After I submitted my report the father informed me that the judge had viewed it favorably and set a court date for one month later. When I arrived at the courthouse I saw that a small group of protestors, presumably invited by the mother, had assembled outside to wave their placards like prophets of doom. I waded into the hysteria only to be blocked by a scrawny young man holding a sign that said “Children Should Be Free to Choose Their Gender.” Next to him was an obese, blue-haired harpy screaming something incoherent. I set my jaw and pointed in between them to the courthouse steps, and they parted to let me pass.

I proceeded into the dim courtroom and sat down in the back. The parents were sitting separately at the black tables before the judge’s bench. The father turned to flash me a thumbs-up and then huddled with his lawyer as they whispered to one another. The mother sat primly with her head held high.  There was a hush as the judge made her entrance, her black robes billowing behind her like a storm cloud. She was short and squat and sported a military cut.

“All rise!"

She glanced at her ledger and looked down upon us like a panjandrum. “I want to inform you that Judge Adams has recused himself from the case. We have discovered comments he made in the past that call into question his ability to decide this case impartially.” There was a gasp from the crowd. The mother turned and blew a quick kiss toward the boy, who sat in the front row wearing a dress. Next to him was his grandmother, who tried to restrain him as he squirmed about.

“First order of business is requesting a more comprehensive psychological evaluation of the child and parents. While I appreciate Dr. Gopal’s efforts”—she paused to glare above her horn-rimmed glasses—“I would like something more grounded in modern psychology and the science of gender fluidity. Until then court is adjourned.”

She rapped her gavel peremptorily and people began filing out. The mother bustled over to the boy and took him by the hand to lead him out. He was crying and had smeared his makeup all over his face like a sad clown.

I sighed and walked outside. The protestors had dispersed and I stood on the court steps beneath an American flag that waved forlornly in the wind. After a few minutes the father came out and approached me. He pushed back his unkempt hair, exposing sunken blue eyes.

“Jesus, I guess you can’t even rely on the legal system to be fair.” He threw up his hands. “I mean, what if you just want to raise your kid to be normal, for God’s sake? Is there any place for people like that?”

“Fewer and farther between,” I sighed. “I’m so sorry it didn’t work out.”

“They’re all loons,” he muttered. “Do you know that Luke’s mother is getting speaking invitations from different schools? To talk about her struggle to raise a trans kid!”

“That’s terrible.” I shook my head. “What’s your next move?”

“Oh, I’m not letting this go.” He clenched his fists. “I’ll keep fighting for my son.”

“Good for you. Don’t give up.”

“I won’t,” he avowed, his eyes afire. I extended my hand and he shook it earnestly.

I would receive a message from him about a year later informing me that the mother had won primary custody of Luke. While under his mother’s care, Luke’s behavior deteriorated and he continued to be hospitalized every few months for violent outbursts, refusal to attend school, and suicidal ideation. The father wasn’t sure he could keep fighting.

But today, there was still a sense of hope. I walked away from the courthouse toward my car only to see that the block preceding it had been cordoned off for a local Catholic school’s recess. The children had spilled out into the street to play. In one corner the boys had started an impromptu game in which they whipped a volleyball at each other as hard as they could. I watched as the ringleader stalked one of his corpulent peers and flung it at his backside with glee. The unfortunate boy howled and the rest of the ragtag crowd erupted in cheers.

I grinned and walked on to the other end of the block where the girls had congregated. They stood in a circle clapping and singing while a couple of girls danced in the center, long tresses shining in the sun as they pirouetted like paragons of grace. In their midst was the head nun, her white habit like a beacon. She patrolled the block and chided the rowdiest children, a sapient smile upon her lips as they sulked in response but ultimately fell in line and went back to playing. The church bell tolled, and I turned to march uphill.