Lost in Trans Nation: A Child Psychiatrist's Guide Out of the Madness, by Miriam Grossman MD, Skyhorse, 360 pages

Puberty blockers, vaginoplasty, phalloplasty, and gender affirming care—none of these terms were mainstream five years ago. Today, as article after article and book after book demonstrate, these terms describe the harm done to thousands of children. The progressive states of Europe have begun rolling back their government-endorsed support of transgender ideology and surgery, while both the United States and Canada have federal administrations pushing for increases in such “care” at taxpayer expense.

The problem is real. The question is, what can we do about it? Miriam Grossman’s new book Lost in Transnation: A Child Psychiatrist's Guide Out of the Madness promises in both title and text to give parents solutions to the transgender craze. Unfortunately, Lost in Transnation fails to understand the nature of the enemy and the necessary response.

Transgender ideology is an iteration of the myth of modernism: You are a spiritual substance contained within your body, and through surgical changes you can make your body align with your inner self. This is not a scientific problem, where people make wrong choices because they lack data. Grossman limits her conclusions to what she can support by scientific studies, and fails to engage with the transgender narrative on the level of truth.

In a discussion of the American Academy of Pediatrics, Grossman notes that “While these issues may warrant attention, so does the permanent disfigurement and sterilization of kids without strong evidence of lasting benefit.” It is logically impossible for “strong evidence” of “lasting benefit” to come from “permanent disfigurement and sterilization of kids,” but Grossman does not conclude that the AAP’s standards are wrong. Instead, she implies that further study is warranted before such a conclusion can be drawn. Her reliance on scientific study fails to recognize that transgender ideology is a myth. The answer to a false myth is not scientific studies, but a more true explanation of reality.

For the imaginary parent searching for all existing studies of transgender questions, Grossman summarizes those clearly. She offers parents scripts modeling hard conversations with children who request opposite gender names and pronouns. She describes children who have gone through therapy and found healing from their disorders through therapeutic conversations. She illustrates the healthy therapeutic approach in contrast to gender affirming care: A therapist should seek to peel back the layers of causality and thought to determine why a boy or girl seeks an alternate identity, rather than affirming that desire and using licensure to facilitate access to puberty blockers and surgery. The stories she tells are Grossman’s most effective sections. She brings the readers into her mindset, and shows her concern for children who pursue self-harm.

Her overall argument, however, suffers from several significant flaws. Grossman critiques the cult of the expert that sweeps children into the gender affirmation pipeline (social, hormonal, and surgical transition). She depicts parents who go along with therapists, doctors, and WPATH guidelines because that’s what the experts say. But she does this after having established her own credentials as an expert, and refuses to say that the people she condemns are wrong. Instead, she shows that they lack scientific evidence and consensus for their decisions, advice, and actions.

If scientific evidence supporting immediate transition could be produced, Grossman leaves open the possibility that she would support the decisions made by medical professionals. “To this day mental health professionals are at one another’s throats over the proper approach to patients with gender dysphoria. There is no consensus.” Even if consensus existed, gender affirming care would still be a wrong application of therapy. Grossman’s analysis does not specifically condemn gender affirming care, but suggests that without consensus parents should not permit it.

Grossman offers direct advice to parents. Her advice rejects the transgender narrative, but fails to offer a positive vision of the human person in its place. Her analysis recalls Jesus’ words about the man whose demon was cast out; without replacing the demon with right worship, the demon returned to the man’s soul with seven other spirits, “and the last state of that person is worse than the first” (Matthew 12:45).

A wrong idea must be replaced with a right idea, but Grossman does not offer specific right ideas to replace transgender ideology. Below is a representative quote where Grossman writes directly to parents:

To all that I would add: your child is a sponge, ready to absorb whatever comes his way. He is a work in progress, and you are his scaffolding, providing support and structure. If you don’t provide a belief system, a compass, or some meaningful foundation from which to understand the world, identify truth and lies, and know right from wrong, trust me—others are waiting eagerly to do just that. Before you know it, your child is a pawn, a foot soldier in a foreign crusade of dark and dangerous ideas, and you’re the toxic parent with a home that’s unsafe.

Without grounding the “moral compass” she recommends, Grossman leaves parents without specific help to combat transgenderism on an imaginative level. 

People do not join or leave cults because they read studies showing the benefits or harms of cultlife. Instead, they are motivated by charisma and the story told by the cult. If Matt Walsh is right to call transgenderism a cult, then a scientific analysis is insufficient. It is self-evident that halting puberty is harmful; removing either the penis or vagina is a violation of human health. We don’t need scientists to study this question and write up the conclusions.

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Instead, we need to live a different story. Rather than embracing a neo-gnostic vision of the self as encased within the body, the healthy imagination perceives reality as a gift. The task of education is to prepare the person, body, mind, and soul, to receive that gift and live within it. The task does not require further use of children as scientific guinea pigs. Our need instead is to re-enchant the mind to perceive the wonder of reality, and to live in alignment with the real.

Transgender ideology is not a failure of science. Science cannot declare the objects it studies right or wrong; that is a moral, philosophical, and ultimately theological question. Transgender ideology is a theological myth that posits the self as creator of reality, with the body as its primary act of creation. The myth is self-evidently false: No human has the power to alter the body at will, which is where hormones and surgery comes in.

Transgenderism promises happiness it cannot deliver. Happiness is located within the creational order, and the transgender myth demands rejecting the very grounds of happiness. Grossman appeals to scientific studies to help parents respond to children who hear the siren call of transgenderism, but in doing so she brings the wrong weapons to the fight. This fight is not won with scientific evidence, but rather through learning the right story about ourselves. Humans are not gods. We do not make reality. Instead, we are contingent beings in a complex world who find happiness in learning to receive reality and live within the gift.