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Me and My Dysphoria Monster by Laura Kate Dale, published by Jessica Kingsley in 2022, is a perfect illustration of what ‘gender affirmation’ means. As the government is proposing the ‘social transition’ of children in primary schools (albeit only ‘very rarely’), the following guest post by a child clinical psychologist is a useful analysis of a book that illustrates clearly how social transition is the opposite of what we should be doing.

Me and My Dysphoria Monster by Laura Kate Dale

There is a tradition in self-help psychology books for children of externalising their feelings to make them more manageable – well-respected examples include the ‘Starving the Anxiety/Depression/Stress Gremlin’ series by Kate Collins-Donnelly. These books are informed by cognitive behavioural principles and encourage kids to stand up to their gremlins. The message to kids is that just because an ‘anxiety gremlin’ might say something doesn’t mean it’s true. The way to starve the gremlin is to stop listening to it. The more you listen to it, the bigger and more powerful it gets. 

At first glance, I thought that the Dysphoria Monster would be of similar ilk. In this picture book which is listed for children aged 6-10 (but with text which is more suited to 3-6 year olds) Nisha is born male and they have a ‘dysphoria monster’ which follows them everywhere. It gets bigger whenever anyone refers to them as a boy or says that they must use the boys’ toilets or play on the boys’ sports team. Nisha wants their ‘dysphoria monster’ to go away. It controls their life, they cannot go swimming or play. The monster is depicted as huge, frightening and growing bigger every day.

Within a cognitive-behavioural model, the solution here would be for Nisha to discover that their monster is only thoughts and feelings, and that thoughts and feelings are not fact. This is what the Gremlin series (and cognitive behaviour therapy) suggests. The monster would shrink when Nisha realises that they can go swimming and play, even if the monster tells them not to. Cognitive behaviour therapy would encourage Nisha to stand up to their monster.

This isn’t what happens here. Instead, Nisha meets Jack, a trans man, who tells Nisha that sometimes doctors get it wrong, and tell people they are a boy when they are actually a girl. Jack says to Nisha ‘Our monster is the little voice that knows who we are and who we want to be when we grow up’. 

In other words, the monster is right and Nisha should listen to them. This is the opposite of what a psychologically informed approach would suggest.

Jack tells Nisha that the way to manage the monster is to behave as if the monster knows best. Nisha is actually a girl. Nisha goes away, changes their pronouns, grows their hair and starts to wear dresses. They are then reported as being ‘happier about myself’. The monster keeps shrinking when Nisha uses the girls’ toilets and plays on the girls’ sports team.

And Nisha ‘grew up to be the happy and smiling woman I always wanted to be’.

That is the end of the story, apart from a detailed guide for parents which tells them that Mermaids, the advocacy group which has been rocked with scandals in recent years ‘offer great support and resources’ and tells them only to look for support from places which offer ‘gender affirming care’. This means that they are advising parents not to consider any other viewpoint than that which is promoted in the book. 

In short, this is a book which promotes social transition as the only answer to gender dysphoria. It gives young children the message that if they socially transition, they will be happier, more confident and will grow up into the opposite sex. Just like that.

Social transition is often presented (as in this book) as a low impact, almost trivial thing to do. It is, however, a powerful psychosocial intervention with the potential to do lasting damage. It is not a trivial thing to tell a child that they can change sex and to present that child to the world as the opposite sex. Children do not understand the realities of biological sex differences. There is good evidence that before the age of 6-7, children think that clothes and outwards appearance is what makes a person male or female. To them, a boy with long hair in a dress is a girl, because that is all they know. They have no concept of what it really means to transition. They really do believe that if they change their clothes and name, they could grow into a person of the opposite sex. When adults reinforce that by telling them that they are right, their developing sense of reality is affected. It will have a profound developmental effect.

Social transition is alluring because it can alleviate short term distress. It is not hard to change a child’s hair, clothes and pronouns and no one is the wiser. However, it just kicks the problem down the hallway because in the longer term puberty is coming. At this point, the child will start to realise that being male or female is not as simple as changing hair and clothes. There is evidence that for the large majority of children with gender dysphoria, if their parents engage in ‘watchful waiting’ – supporting and accepting the child but not socially transitioning them – as they go through puberty their gender dysphoria will resolve and they will accept their biological sex.

Social transitioning inevitably makes natural puberty much more distressing. Everyone (and the child themselves) has been told that this child is a girl, and now they are starting to go through a male puberty. They are completely unprepared for this because they really did believe that they could choose. They did not understand biological reality and the adults did not help them do so. Social transition sets kids up for extreme distress at puberty – to which they are often told that the answer is medicalisation. Puberty blockers and then cross-sex hormones.

Which is what makes this book so irresponsible. It promotes transition as a way to feel happier and more confident, with no mention at all of the medical and surgical interventions which Nisha must go through if they want to grow into anything different than the boy that they were born. And of course, no mention of the fact that Nisha can never grow into a biological woman who can function reproductively. It does this at an age when children are highly suggestible and when they believe what adults tell them.

In addition, there is a focus on toilets and sports teams in this book which seems out of place in the story.  Nisha’s gender dysphoria is particularly focused around toilets and sports teams – these are, of course, two hotly contested areas where women are campaigning for the preservation of single-sex spaces and competitions. Nisha’s monster only shrinks when they are allowed to go to the girls’ toilet and play on the girls’ sports team. The message is very clear, Nisha’s feelings are more important that the needs of the girls to have single sex sports teams or toilets. In fact, the girls do not feature as personalities at all. It’s all about Nisha.

This is not an empowering book. This is a book which tells children that if they have distressing thoughts and feelings, they should act upon them and behave as if they are true. Cognitive behaviour theory and evidence tells us that whilst this might alleviate short term distress, this will result in those feelings growing more distressing in the long term. 

This book portrays transition as the only path out of gender dysphoria and tells children that following social transition, they will be able grow into the opposite sex. Young children will literally believe this. They have no reason not to. It is deeply unfair and harmful to them to sell them this narrative which can only lead to long term distress and disappointment.

In addition it has a thinly veiled political agenda regarding males identifying into women’s toilets and sports teams. These things have no place in a book for young children.

Further posts by the same author:

The Gender Book by Cassandra Corrigan

A childhood is not reversible

When a teenager says they’re transgender