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The brave detransitioned woman Keira Bell, who was put on puberty blockers after three one-hour sessions, knows this all too well. The вЂњ rush to treatвЂќ is a recipe for irreversible damage and regret. Are those really the only two options? For a movement that decries the binary, its commitment to this discrete dichotomy is relentless. I imagine white-coated professionals telling her what parents hear today: to affirm my trans identity right away or prepare for a completed suicide. Mom was already under so much pressure-vulnerable, afraid, and desperate to help. I can see my motherвЂ™s haggard face and imagine her plight had my 1980s gender-bending taken the form of вЂњcoming out as trans,вЂќ as it does today. I realize now that my ER apologies have been operating in some form for most of my life: IвЂ™m sorry for being here, sorry for the trouble, sorry for the mess I am making.ДЄdoptees happen to be overrepresented among those presenting at clinics with gender dysphoria. I am adopted, yet no thought of any effects from that primal wound ever crossed his or my motherвЂ™s mind. I can only shake my head now at this erudite physicianвЂ™s puzzling over me. My mother responded as insistently that nothing had happened before that fateful summer of abuse. Curiously, he insisted to my mother that my despair was so deep, there had to be an earlier trauma, something that happened before the age of two. Richards and I did not talk about the sexual abuse.

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Most interestingly, I was being treated for a вЂњchemical imbalance.вЂќ My showing up at the hospital full of pills led to my being put on more pills, as if my problem primarily were somehow in my brain.Д«ut as Robert Whitaker, a Pulitzer Prize finalist for his investigative journalism on psychiatric medicine, observes, вЂњ our mental health arises in environments, not just the inside of our head.вЂќ As I progressed from one medication to another to see what might help, Dr. I remember Transactional Analysis circles, Ids, Egos, and arrows, and very little else. I continued for several years under his care, but the main thing I got out of our sessions was his kind attention. Richards, the soft-spoken, fatherly psychiatrist who was on call that night. Suicide obviously wasnвЂ™t the right answer, but were pharmaceuticals the solution? I immediately became attached to Dr. I didnвЂ™t really want to die, but I needed help, and this attempt was my desperate cry for it. Suicide had long been a false siren in my imaginings, offering relief and a way of escape.

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I could tie a manвЂ™s necktie as deftly and neatly as my father, I wore one so often.ДЄt sixteen, I could not envision a healthy self, an вЂњuntaintedвЂќ body free from shame. As I developed, I sought an androgynous appearance, which for me was both a style and a shield. I hated myself, and I hated my female body, scorning it as the source of my vulnerability and betrayal. Most of what had been in our downstairs bathroom medicine chest was now in me.ДЄfter sexual abuse at age ten, my subsequent years had been filled with suicidal ideation. Soon a thin tube was up my nose and down my throat, liquid charcoal slowly descending, making its way to my stomach to absorb the numerous prescriptions I consumed in my first major suicide attempt. I apologized profusely in between heaves, reaching out and cupping my hands to try to catch it, as if that would somehow help. I felt so bad about the mess I was making. Who could blame her, after our late-night trip to the ER and the projectile vomiting that began as soon as I walked through the hospitalвЂ™s sliding doors?

From her own crumpled position in a bedside chair, Mom scrambled for the emesis bowl too late, triggering her exasperated expletive. From delirious dreams, I sat up, mumbling that I felt sick. She was worn and weary-stretched beyond her maternal limits. I was sixteen the first time I heard my mother curse.