Child psychiatrist Susan Bradley, MD, FRCP(C), founded the Child and Adolescent Gender Identity clinic at the Toronto Center for Addiction and Mental Health (CAMH), originally the Clarke Institute of Psychiatry, in 1975. She continued to direct that clinic until 1982, when Dr. Kenneth Zucker took over as head of the clinic after joining as a student in 1977. Dr. Bradley was subsequently employed at Toronto Sick Kids Hospital, where she was chief of the department of child psychiatry. She was also head of child and adolescent psychiatry at the University  of Toronto from 1989 until 1999. She is currently professor emerita at University of Toronto, and is writing a book about supporting youth with high functioning Autism Spectrum Disorder.

Dr. Bradley recently wrote an article for the Post-Millennial about the current political and clinical climate surrounding issues of childhood and adolescent gender dysphoria; highly recommended.

We will be posting a lengthy 4thWaveNow interview with Dr. Bradley in the near future. Stay tuned.

Below, Dr. Bradley responds to a recent paper by Damien Riggs (associate professor of social work) and Clare Bartholomaeus (research associate) of Flinders University, Adelaide, Australia entitled “Gaslighting in the context of clinical interactions with parents of transgender children.”

The piece is, in essence, an attack on skeptical parents of trans-identified children, in the form of three “fictionalized case studies.” Riggs and Bartholomaeus characterize parents who do not fully affirm their child as transgender as engaging in “identity-related abuse”; they use the term over 30 times in their paper. According to the authors, “abuse” and “gaslighting” include such transgressions as not using preferred pronouns; cancelling appointments; and not agreeing to medical transition on the timetable preferred by Riggs and other providers engaged in pediatric transition.

The authors counsel therapists to try to see a child privately when parents are not sufficiently obsequious. They even refer to non-compliant parents as abuse “perpetrators”:

Authors suggest therapists should find “creative ways” to make private contact with the child

We have included more screen captures from the Riggs article in Dr. Bradley’s response below. However, we will not be deconstructing the entire paper in detail. We strongly encourage readers to examine it closely.

by Susan Bradley, MD, FRCP(C), Consultant Child Psychiatrist

 Where is Damien Riggs coming from?

That’s what I had to ask myself when I read his diatribe against parents of youth who have recently expressed their feelings of gender dysphoria. His position seems to be this: Parents who are reluctant to simply buy into his belief that anyone who expresses feelings of gender dysphoria must be “trans” and supported in their transition with no questions asked, are not being adequately supportive of their child; further, he terms this parental skepticism “identity-related abuse.” But it’s natural for any parent of a youth expressing such feelings, particularly if they are of recent onset, to wonder “why?” or “how come now?” Such sudden changes in identity would make anyone question what is really going on inside that person.

Parents are “gaslighters” if they question hormone blockers or want to slow down medical intervention

To be a parent of a child undergoing such a radical change in identity is a very stressful experience, with conflicting feelings of wanting to support their child, but also wanting to be sure that what they want really makes sense. If this child has a previous history of feeling rejected by peers, many parents will be aware of the damage that has been done to their self-esteem, and rightly see them as vulnerable to those who offer acceptance, at whatever cost.

But Damien Riggs, the therapist advising us, seems to see things in black and white terms: if they voice any feelings of being “trans” they must be “trans”. What about those individuals who change their minds? Does the therapist know for sure that my daughter is not going to change her mind? How do we know that this sudden, intense interest is different from other intense interests the child may have had in the past? How do we know what impact interventions such as puberty blockers will have on her future, especially if she changes her mind?

“Cisgenderist” parents who misgender their kids should not be allowed to apologize

These are just some of the questions that would go through the minds of any caring parent in that situation. If the therapist does not address these concerns in a straightforward manner, most parents would then begin to wonder if they are in the right place to help their child. Failing to engage wholeheartedly in the “therapy” would be one way of trying to deal with their uncertainty when they sense that the therapist is not open to a discussion about their concerns.

This hardly qualifies  as “gaslighting,” a term defined in the dictionary as “behavior intended to manipulate someone by psychological means into questioning their own sanity” or behavior that “seeks to sow seeds of doubt” about their reality or beliefs. To the contrary, those parents are behaving as most parents would in a situation where they do not feel heard.

From the description of the process of therapy engaged in by Damien Riggs, there appears to be no attempt to help parents be understood in terms of what most would regard as very normal worries about a process that seems to be moving forward with little thought for the persons involved. There is no evidence of intent to deceive by these parents; only a lack of faith in the person directing their child’s treatment, who after all, has very little prior knowledge of that child, their issues, their vulnerability, or their ability to make a competent decision about life-altering interventions.

I would argue that Damien Riggs’ accusations about the parents “gaslighting” is unethical and lacking in understanding of the relationship between child and parent. Amongst other things it is the parents’ job to protect the interests of their children until they reach an age when they are capable of doing so by themselves.  Riggs appears not to understand the importance of this relationship when he mislabels the rather normal reactions of parents with a rapid onset dysphoric child as “gaslighting”.

Parents who ask for a diagnosis for their trans-identified children are gaslighters.

If Damien Riggs had done a careful assessment of the youth, particularly, the girls with rapid onset gender dysphoria (ROGD), he would have understood that most of these young women had begun to have homoerotic feelings as they moved into adolescence. Experiencing crushes on same-sex peers is not unusual both in individuals who later become lesbian, but also in heterosexual women.

However, if you are a teen who has had social difficulties, it is easy to feel that having these feelings will make you feel more “weird” than you may already feel. Homophobic slurs are common amongst teens, further increasing anxiety about acceptance in these young girls. The process is easy to uncover if you—as a therapist—ask the right questions, in that these young women desperately want friends and someone who accepts them. The internet sites for “trans” individuals are very welcoming of anyone who expresses interest. Because many of these young women are not really skilled at self-reflection, finding a simple solution (“I’m trans!”) that makes them feel accepted seems perfect. Unfortunately, as we all know, life is more complicated and what seems like a simple way of feeling good may not be a good long term solution.

Caring parents take time to understand and accept mental health issues even when they are more common than the belief that one is in the wrong body. Recent onset gender dysphoria is a rather sudden change in how the youth sees herself, and although some of these individuals may eventually decide that transitioning is best for them, many will realize that they are lesbian and can explore that and find acceptance in a same-sex relationship without having to change their bodies. They need time to understand their feelings and explore ways of finding the best solutions for them. Parents can usually participate in being supportive when they understand what their child is struggling with and how they can help.  For Riggs to blame parents for not accepting his approach wholeheartedly is not what those of us in mental health are trained to do.