October 23, 2023 - 4:35pm

Dr. Michelle Forcier, a blue-haired professor and paediatrician from Rhode Island, was the breakout star of Matt Walsh’s 2022 documentary, What is a Woman? In a bizarre exchange, Walsh asked, “If I see a chicken laying eggs and I say that’s a female chicken, did I assign female? Or am I just observing a physical reality that’s happening?” Forcier responded, “Does a chicken have a gender identity? Does a chicken cry? Does it commit suicide?” 

As it turns out, chickens don’t cry but do come home to roost, something Forcier found out this week. Forcier — along with Dr. Jason Rafferty, another prominent gender-affirming clinician who authored the American Academy of Pediatrics’ 2018 policy statement on gender-affirming care; a psychotherapist named Julie Lyons; and a Rhode Island healthcare provider, Thundermist Health — faces a new lawsuit brought by Layton Ulery, a detransitioned woman. 

The Daily Mail, which obtained a copy of the lawsuit, reports that Ulery was struggling with severe mental health issues, including symptoms of dissociation (at the time, she believed she had multiple “alter” personalities) and a troubled life history that included lack of social support, food insecurity and other material hardships, experiences of sexual abuse and bullying, substance abuse, membership in a controlling cult from childhood, and having undergone what Ulery describes as “conversion therapy” to change her sexual orientation. That was all before she started down the road to transition:

Ulery said that when she first went to see [Julie] Lyons she did not consider herself to be transgender, but was quickly pushed towards transgenderism and alleges that Lyons ‘fixated’ on the fact that she had male alter identities […] Further than pushing her to transition, the lawsuit alleges that she ‘crossed numerous lines’ in their sessions, including inviting her boyfriend into a therapy session where they performed “experimental hypnosis techniques” on her.
- Daily Mail

Ulery was subsequently referred to Rafferty, then Forcier, and alleges that both physicians prescribed testosterone despite her serious mental health comorbidities and concerns that Ulery raised, including “dangerous mood swings, fits of anger, more frequent bouts of depression, and feeling even more disconnected from herself and her sexuality than she was” before starting testosterone. 

Rafferty’s clinical notes show that he saw her as a “high-risk” patient, citing the emotional and sexual abuse she had suffered and the precarity of her current situation with no income and not enough food to eat. Rafferty then specified that “current goals” of treatment included “masculinising hormones” and “top surgery” but that the patient was experiencing “internal turmoil between alters about [the] meaning of gender identity that likely requires additional support and exploration”. Yet apparently Rafferty saw nothing serious enough to delay the administration of testosterone injections. 

These are shocking allegations. But this isn’t the first tangle “gender-affirming care” has had with dissociative identity disorder. At the 2022 World Professional Association for Transgender Health conference in Montreal, a session was dedicated to helping providers transition patients who claim to have multiple personalities. These “alters” or “headmates”, presenters claimed, each possess their own sense of gender identity and desired gender presentation — identities and presentations that may be in conflict with one another. 

One “headmate” may desire a masculine presentation, which may require testosterone and a double mastectomy. Another may prefer a feminine appearance. Dr. Christopher Wolf-Gould lamented that patients must often “choose” between their trans identities and their identities as “plurals”, since clinicians may balk at facilitating hormonal and surgical interventions for such complicated psychiatric cases. 

Assuming that one buys into such a contested diagnosis in the first place, these cases raise difficult questions about the possibility of consent and the potential for medical harm and regret. How does a clinician adjudicate conflicts within the self about which irreversible interventions to pursue, when “headmates” disagree? 

“If it’s a small system [with a limited number of ‘headmates’], it’s preferable to interview each headmate. But if it’s a huge system with thousands of headmates, interview a council [of ‘headmates’],” Wolf-Gould advised, before conceding that, “obviously, they share a body, so they have to make one decision.” 

It shouldn’t take a legal case alleging serious medical harm to see that something has gone badly wrong in this area of medicine. The evidence of harm has been out in the open for years. Unfortunately — and tragically — this won’t be the last of it.

Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.