The false dilemma regarding the topic of transgender children

The Dialectic and Syllogism

Since the pandemic, it has been made evident that our brains love binaries: “clean versus unclean,” “vaccinated versus unvaccinated,” “supporting Black lives or supporting the police,” “MAGA Republicans versus Woke Democrats.” We like our choices to be either right or wrong and much of this binary thinking comes from a dominance of our left brains. Iain McGillchrist argues that our left brains thrive on making things simplistic and their main goal is to manipulate for a solution. The right brain, on the other hand, sees things in a relational way and how to understand them in the whole picture, i.e. more “grey” and less of a “black-and-white” perspective. In his book, The Master and His Emissary: The Divided Brain and the Making of the Western World, he makes the case that “the left hemisphere has taken over our minds and reshaped the world in its image in a way that is good for neither humans nor the planet and everything that lives on it.” See: https://www.cbc.ca/radio/ideas/neuroscientist-argues-the-left-side-of-our-brains-have-taken-over-our-minds-1.6219688

The problem is that when something is complex, putting things in a binary can create an unhealthy fallacy because we are forced to create a dichotomy of right versus wrong, even though many options are available to us. For example, a politician may say, “You either support the police or you support the criminal.” A married person may say, “I either need to stay with this person or be miserable for the rest of my life.” A binary does not work for either of these situations because both things can be true. One can support the police and want less corruption. One can stay married and work on the marriage. It seems simple enough. Nevertheless, many of our political, religious, and personal discussions involve people stating things in a false binary and not considering that there are many options available, or that two things can be true for them. Dialectical Behavioral Therapy helps people replace their binaries (only one thing can be true) with a dialectic (two things can be true at once). For example, I can be angry with my wife and love her. One can be anxious about going to a party and want to go. Someone can want to protect their kids from harm and want them to take risks. Life is full of paradoxes that contain truth on both sides, and in many situations, two things can be true at once.

Currently, there is a false dilemma regarding the topic of transgender children. Recent debates over transgender rights have divided this issue into a binary in which one is either fully supportive of a child who may want to transition, or they are transphobic. However, this false dichotomy does not work because children are not adults and there are other options available. It is fully possible to support the rights of adults who may want to transition and to want children to wait until they are fully developed. This discussion cannot be broken down into an either/or syllogism since it involves the brain development of a child. Two things can be true at once.

For the record, I have seen adult clients who decided to transition later in life. All of them told me how it took years to make this decision and they only started to transition after years of reflection. Reflection is the ability to make a choice while knowing the long-term risks and rewards. I will not discuss transitioning for adults in this essay; rather, my main point is that children cannot be equated with adults because they are different in their ability to reflect, since children do not have the ability to anticipate long-term risks when making decisions. It is not that they won’t; they literally cannot. Their neophyte brains are unable to foresee how decisions will affect them later in life. Children cannot distinguish how hormone, sex-assignment therapy, or surgeries will alter their natural growth prior to adulthood. Since they cannot consider these risks, is it ethical for a society to ask people who do not have that capacity to make determinations that will affect them later in life? Even if you don’t believe this premise, is it “transphobic” to offer skepticism to the proposition that children should have the resources to transition, even though developmental studies indicate that a child’s brain is unable to perceive considerable liabilities?

I will argue that asking children to make this type of reflective decision is counterintuitive to the basic premise of child development, and in this essay, I will offer the following argument:

1. People should not transition unless they are fully functioning adults who understand long-term risks.

2. Children are not fully functioning adults who understand long-term risks.

3. Therefore, children should not make these decisions until they are ready.

I do not believe the above syllogism makes one “transphobic” and will briefly argue that it is fully possible to support the freedom of adults who want to transition and offer legitimate concerns about how this is applied to children.

Child Development: A Brief Summary

The basic premise of child development is not difficult to comprehend. Its essential premise is that a child’s brain is undeveloped and unprepared for making long-term decisions compared to the brain of an adult. The prefrontal cortex plays a central role in cognitive control functions, predicting the consequences of our actions, anticipating events in our environment, and helping us plan for the future. Neuroscientists generally agree that we cannot understand the risks to our behavior until the age of 26 — which is why people are often willing to take out tens of thousands of dollars in student loans but often regret it when they start a career. If you’d like to read more on the prefrontal cortex, go to prefrontal.org.

The Problem with Parentification

When adults do not apply the basic principles of child development (i.e., that a child’s brain cannot make reflective decisions), they may end up parentifying the child. Parentification is when a child is forced to take on the role of an adult. It can be applied in many ways, but its salient approach is when a parent assumes that a child can interpret the world as an adult would. For example, when a parent says to a 4-year-old, “You’ve been bad for taking the cookie. I think you’re manipulating your dad and me,” they are using a type of parentification because they are assuming that their 4-year-old can effectively control their environment at the behest of others (which is a role of an adult). I understand some parents may be thinking, “Well, yes! My kids do that all the time! They run my life!” As a father of three, I concur. However, manipulating people is quite complicated because it requires some awareness of what people want while subjecting them to one’s own internal demands. Quite complex! The art of manipulating only comes in teenage years when the adolescent brain is capable of understanding empathy and rebellion. But, a 4-year-old? Not so much. That’s much later.

When adults make mistakes by applying strategies based on assumptions that do not apply to a child’s age bracket, they can cause indirect trauma. Emotional Parentification is when a child’s emotional and psychological needs are poorly recognized or ignored. This is often seen in neglected single-family homes, where the single parent has to work all day and the child is expected to care for their siblings in a way that is not appropriate for their age. This is not about kids looking out for one another, being more responsible, or doing chores; rather, emotional parentification is when children are expected to be an emotional support and caregiver to their siblings or, in some cases, even their parents. Later in life, they may serve as a scapegoat to keep the family peace and act as a mediator. They may also develop an unhealthy sense of anxiety in trying to be the perfect child, or, in some cases, girls may develop an unhealthy attachment to older men.

Logistical parentification is when a child is expected to meet the physical needs of a family, which is common in many poor or immigrant families. These children often have to work at a very young age, which can have a negative impact on their schooling. Many of these children have to drop out of school at a young age because they are expected to pay bills so the lights can stay on. These kids are not able to spend time playing, sleeping, or engaging in their academics; instead, they are taking on roles that should be fulfilled by a parent. Many of these children will often be highly responsible in their careers but may develop addictive patterns later in life. Since their childhood was deprived of the necessary experiences, they may feel they have the right to “play” and may become addicted to substances.

Many transgender children do not come from single-parent homes, nor are they poor, nor are they expected to take care of the physical needs of the family. However, parents and educators often assume that a child can understand the concept of sex versus gender prior to adolescence, assume that they understand long-term risk when their brains may not be able to perceive this information adequately, and assume that their concept of role expectations (what it means to be a male or female) is advanced enough to make a determination in their natural environment. Not all parentified children turn out to be unsuccessful individuals; many of them can be successful later in life due to their emotional resilience. I have counseled many of these children and adults, and they are some of my favorite people to sit with and listen to, for their strong sense of determination that today’s “soft and spoiled” children can learn from.

However, there is also a sense of grief in the room. I have witnessed parentified children weep in my office because their childhood innocence was taken away. I once sat with a 13-year-old girl who had a bipolar mother and an emotionally abusive father. She would tell me stories about how she would get her mother medicine to calm her down and turn on a show for her father so he wouldn’t scream at her mother. One session went as follows:

I asked, “When did you start doing this (taking care of your parents)?”

She said, “Well, I remember wearing a training diaper…Maybe 4? Not sure.”

“Goodness,” I said. “I am so sorry. It seems like you lost much of your childhood and you’re still young. You know, you don’t have to be an adult for another five years. It’s okay to be a kid.”

After several of these back-and-forth conversations and earning her trust, she said, “Well, shit. How am I supposed to do that?”

We both laughed and I said, “Well, it will take time. I’m going to help you stop caring so much for people who should be caring for you. I will help you seek out help from people who have the wisdom to help you. You’re a kid; you’ll never get these years back.” Eventually, I was able to help her reach out to her healthy grandfather, and I would reframe her thoughts when she felt she needed to care for everyone else. Right now, as far as I know, she is doing well. The last conversation we had we had talked about her crushes on boys and how people annoy her in high school (typical teenage behavior).

How Child Development offers scrutiny to transgender discussions

What is ignored in transgender discussions is how children are not at an age to understand the complexities of sex or gender. As stated, children are not fully functioning adults who understand long-term risks, nor are they able to understand the ramifications of what hormones or sex assignment therapy will do to them. Nevertheless, professional doctors, therapists, and surgeons are now performing what will be lifelong procedures that will drastically change and affect their natural development. Similar to the parent of the parentified child, they assume that children have the mental capacity to understand these complex decisions, even though they cannot predict the consequences of these actions. How are these decisions made? The most general rule is insistence. The HRC states that “no medical intervention is required for gender affirmation” and that “children should be allowed to explore their gender identity without pressure or coercion.”

The general rule for determining whether a child is transgender or non-binary (rather than gender nonconforming or gender variant) is if the child is consistent, insistent, and persistent about their transgender identity. In other words, if your 4-year-old son wants to wear a dress or says he wants to be a girl once or twice, he probably is not transgender; but if your child who was assigned male at birth repeatedly insists over the course of several months — or years, that she is a girl, then she is probably transgender.[1]

There are multiple problems with this statement, and I will compare this rule with what the CDC looks for in milestones. According to the CDC, most children will pretend to be something else during play (e.g. a superhero or a dog). They will often change their behavior based on where they are (e.g. a place of worship or a playground). They will begin saying sentences with four or more words and start asking simple questions like “What is a crayon for?” They will start to serve themselves food or pour water with adult supervision and unbutton some buttons on clothing (see CDC). The HRC makes the fallacy of equivocation because a child’s “insistence” is radically different from someone who is risk-averse and conscious in their late 30s. The child’s world is pretend, role reversal, and play, and they are barely able to button their own clothes.

Depression and Child Burdens

One of the pushbacks trans activists may say is, “We must help trans-kids so they don’t commit suicide.” I agree, but suicide is rooted in Major Depressive Disorder, which is often only diagnosed around 12–17 and not in young children (even then, we have to be careful since diagnosis during puberty is so fluid). Depression in children often involves emotions that are carried down from either a parent or a source that is asking the child to do something beyond their expectation (see the story of my client above). For example, why would a 7-year-old be having “suicidal thoughts” about their world unless they are being told information they are not meant to be responsible for? I will often see many depressed children who carry a load they are not meant to carry, such as a son who is saddened that his father is not with his mom and blames himself. Child depression is often rooted in social withdrawal and a need to find friends. This can often explain why more children are identifying as trans, even though many times many of these children never had those thoughts prior to their depression. When their friendships changed, they often felt the social strain to fit in while many in their age group explored “gender variables.” Why then? Why now? It would be clinically helpful to discuss how suicide can stem from the cycle of a parentified child who carries an unhealthy amount of shame and guilt the parent passes onto them. When a parent passes down unreasonable expectations, such as trying to figure out what gender they are prior to puberty, that child will often feel a sense of pressure to make a choice, even though the choice being asked of them is not age appropriate. Childhood depression often can stem from demands in their environment. Even though all depressed children are not parentified, many trans kids often carry burdens and emotions that are “beyond them.” This needs to be another variable when discussing transgender children. The problem here is not with the child, but with what is being demanded of them.

The Need for Play

Suicidal thoughts often arise when the expectation of a child’s insistence “must be because they are trans” (as the Human Rights Campaign presupposes), rather than the child’s mental state — as in the case of the 4-year-old seeing the world as pretend or the teenager just learning how to rebel. What is disturbing is that several doctors, therapists, and educators have professionalized parentification to an art form. They will take the general rule of insistence without considering a child’s need for play. Play is essential for kids because it helps them (even teenagers) to manipulate their surroundings before facing real consequences. Play allows children to take risks and improvise their environment to build a sense of confidence later in life. Play is fantasy and it is a good thing we protect their fantasies because imagination is how our world will progress through creativity. Without play, children will have less self-esteem and anxiety and are more prone to depression. Regarding my client above, her humor and sense of play have skyrocketed. She feels she can take risks again without feeling the need to be the mediator or provider. Caregivers must preserve and protect a child’s right to play. If we do not, we rob them of that innocence and place them in a world they are not ready for.

One final thing here, contrary to fully-functioning adults, research indicates that if children who identify as trans waited until they were adults, 75–95% end up identifying as their biological sex (https://www.tandfonline.com/doi/abs/10.3109/09540261.2015.1115754?journalCode=iirp20). If I may reframe this finding, if you brought your child to see me and I were to say, “I have a pill that would make all your child’s problems go away, but he has around an 85% chance of getting Stage 3 cancer, would you allow your child to take it? If not, would you be a neglectful parent if you were to say no? In the same way, parents are not neglecting their self-identifying trans kids if they encourage them to wait until adulthood.

Conclusion: Two things can be true at once

I started this essay with the option that two things can be true at once: it is fully possible to support the freedom of adults who want to transition and offer legitimate concerns about how this is applied to children. This dialectic is a reasonable option in future discussions regarding transgender rights and concerns. One can support the liberty of an adult who chooses to transition and be very careful with children. Asking something from a child when they cannot understand the long-term ramifications is professional parentification. Taking medications or removing sexual organs should only be done when someone can make a significant reflection on what this will do, how it will affect their sexual relationships (one cannot have an orgasm after sex assignment surgery), and how these medical risks will affect them physically when they are applied (higher chance of bone cancer and heart attack). The last thing we ought to do is take a child’s sexual requests seriously so we can make a point at the expense of their own bodies. After all, it is not about the parent or how they see the world; it is about what is best for the child.