Bestselling author Laurie Frankel and Mayo Clinic expert Dr. Robert Horsley join us to explore Laurie’s deeply moving novel “This Is How It Always Is.” Through the lens of Frankel’s story about a young transgender girl and her loving family, the conversation delves into gender identity, the nuances of gender expression, and the real-world challenges faced by transgender individuals and their loved ones. It’s a thoughtful discussion that underscores how fiction can illuminate the most pressing health and social issues.
Bestselling author Laurie Frankel and Mayo Clinic expert Dr. Robert Horsley join us to explore Laurie’s deeply moving novel “This Is How It Always Is.” Through the lens of Frankel’s story about a young transgender girl and her loving family, the conversation delves into gender identity, the nuances of gender expression, and the real-world challenges faced by transgender individuals and their loved ones. It’s a thoughtful discussion that underscores how fiction can illuminate the most pressing health and social issues.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine:Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. We're going to discuss gender identity, gender transition, and their effect on family dynamics through the book “This Is How It Always Is” by Laurie Frankel.
I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.My guests today are Laurie Frankel, who essentially needs no introduction. This being her third time for her to join us on “Read. Talk. Grow.”
Laurie is the “New York Times” bestselling, award winning author of five novels, including “Family, Family,” which you can listen to information about on episode 45 and also “One Two Three,” featured on episode 16. Laurie is a former college professor who now writes full time in Seattle, Washington, where she lives with her family. “This Is How It Always Is” is Laurie's third novel that was highly awarded, including by Reese Witherspoon, who picked it for her Hello Sunshine book club. Reese is quoted as saying, “Every once in a while, I read a book that opens my eyes in a way I never expected.”
Laurie, welcome back to the show.
Laurie Frankel: Thank you. Thank you so much. I'm so glad to be here talking about this.
Dr. Denise Millstine: Our physician expert guest is Dr. Robert Horsley, who's an internist in the Department of Community Internal Medicine at Mayo Clinic in Arizona. He specializes in the treatment of HIV-AIDS and in LGBTQIA+ care. His research interests include these topics, as well as health care disparities.
Bob, welcome to the show.
Dr. Robert Horsley: Thank you. I'm very happy to be here and excited to talk about this.
Dr. Denise Millstine: “This Is How It Always Is” is a family novel about two loving parents, Rosie and Penn, who are raising five children who include four rambunctious boys and they're highly intelligent, precocious youngest child who's born a boy and then from a very young age, expresses a desire to be a girl. The family navigates the beauty and the challenges of life with their child, who was initially named Claude and then later Poppy, including some very difficult decisions.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll discuss gender identity and gender transition, and particularly in the context of a family.
Laurie, I read “This Is How It Always Is” when it came out, which is many years ago now. I was blown away at the time, and I was so happy to reread it this month and be equally blown away. Thank you for writing this book. For approaching this topic. I know I shared this with you when you joined “Read. Talk. Grow.” previously, but actually “This Is How It Always Is” was an inspiration for creating “Read. Talk. Grow.” because I believe books can help us talk about health topics, particularly those that we sometimes find it challenging to approach. So can you talk about your experience with “This Is How It Always Is” now, eight years later, and how it's in your life in a much different way than it was when it first came out?
Laurie Frankel: Yeah. First of all, thank you. Thank you so much. And I'm so thrilled that the book spoke to you and that it has had some staying power. It's true that a lot has changed in a really pretty short period of time. Eight years isn't that many years. It's not like this was historical fiction, nor did I write it, I mean, it's not been even a decade. I think, and probably Dr. Horsley can speak to this, I think the medical stuff has actually come a long way, even in that really short period of time. And that's all fantastic news. I think some of the stuff that in this book, the conflict in and the indecision and some of the really difficult decisions that had to be made, I think some of those decisions are less difficult than they used to be, which is fantastic news.
I think that politically, for a while, this book was starting to be a little bit dated, which is a wonderful thing. And then that stopped being the case in the last couple of months when things have started to go back the other direction, which is terrible news.
When this book first came out, I got a lot of emails from people saying, “Thank you for writing this. I thought I was the only one,” and I don't get those emails anymore. I don't think that the conversation being had surrounding these issues is honest. I don't even think that the conversation really is about what it's about, but at least it's being had. I don't think there are that many people eight years later who've never heard of a transgender child, who have no idea when they themselves or their kids come to them and say this thing like, oh, I never heard of that. And that is its own kind of progress, I think.
Dr. Denise Millstine: Laurie, I really appreciate those comments. As I mentioned, I read this book many years ago and we've had several interactions since then. And times are changing and this is still an important topic. And these are still voices that need to be heard and understood and supported to the best of our ability. And it would be wonderful to think the world was headed in a direction where all people were being honored and appreciated. But we know that this is very likely something that will go up and down, and it's talking about stories like these and topics like these that I think keeps these voices in the forefront, recognizing some of the challenges that come with gender transition and navigating these topics.
Laurie Frankel: This is what novels suit up for. If these were not difficult, complicated issues, you know you could do it in a social media post. It's because it is difficult and complicated and has lots and lots of sides, and that it changes through time that you need 350 pages worth of conversation. That's what novels are for.
Dr. Robert Horsley: And similarly, like you said a year ago, I agree that I wouldn't have necessarily been like, oh yeah, this is the podcast we need to do right now. But yes, now with everything that has changed and as someone who also goes to continuing education courses and gives talks about just LGBTQ care in general, but also specifically how to care and primary care for transgender individuals, there's been such a big shift over the last six months.
Dr. Denise Millstine: And Bob, I think actually the book was new to you. So can you tell us your reaction to “This Is How It Always Is.”
Dr. Robert Horsley: This was actually the biggest surprise to me was that it was a surprise. Like, I've never heard of this book in my life. And as someone who gives talks on transgender care and stuff. I was like, I've never heard of this. And so it was a great surprise to see that there is a book out there that is speaking on the topics of sort of transgender health, and then also just gender as a spectrum, that isn't necessarily one that is marketed just to people in the LGBTQ community. Cause I feel like, however important that might be, in order to get that outreach to people that may not understand and bring that understanding to them, doing things in forms of books that don't necessarily scream, oh, I am part of the LGBTQ community is actually helpful. So it's going on down both sides. And I think that's what this book is so important doing. So thank you for that.
Laurie Frankel: And thank you for that.
Dr. Denise Millstine: And I think I've heard you say, Laurie, in past interviews…this is not an issues book. This is not a book that you came out to say, I want to teach the public something. This is a story. It's a family story, and this is part of their story. We happen to be highlighting it and focusing on it for the purpose of this conversation and this podcast. But listeners who haven't read “This Is How It Always Is” should know this is a story. It is only one component of it, and we're not going to ruin any of it.
But let's jump in, Laurie, to thinking about these parents. So Rosie and Penn are talking to Claude, who I think is about three years old at the time and as many parents do, said, what do you want to be when you grow up? And so Claude says, I want to be a chef, a cat, a vet, a dinosaur, a train, a farmer. There's a really long list that follows. And I want to be a girl. So Penn responds, sounds great. And Rosie says, you can be anything you want to be when you grow up. Both parents are enormously supportive, but they don't necessarily understand the seriousness with which Claude intends that last, I want to be a girl. Do you think that's common, that it's kind of in this sort of fantastic list, that parents don't necessarily even hear these expressions in that context?
Laurie Frankel: I think, yeah, for sure. Especially when kids are really young. I think probably Claude himself doesn't realize at that point the way in which girl is different from farmer or train. And that does make it not just easy for parents to kind of not notice, but even reasonable. I think it's easy to overreact to a moment like that and in fact, for many kids, it isn't a huge deal that will necessarily impact the rest of their life. And then for some kids, it will. And so for parents who just sort of take that as it comes seems not only a reasonable choice, but in fact a the one I would recommend, I suppose.
Dr. Denise Millstine: Yeah, I appreciate that. Bob, one of the early scenes we see Claude make a princess dress that he loves so much and he very much wants to wear all the time, including to school. Can you talk about the importance of dress in gender expression and how this is related but different from gender identity?
Dr. Robert Horsley: Thank you for that question, because that's where they can be polarly different from each other or very congruent. So gender expression is how you present yourself to the outside world and how you sort of want to be perceived depending on how old you are as well. And it's a social norm. If you go to Scotland to the Highland Games. I always talk about this and you're wearing a kilt, which is a skirt. It is seen as very manly, but if I wear that same thing even to work, it is not seen as manly.
Dr. Denise Millstine: In the United States.
Dr. Robert Horsley: Right, yes. In the United States. And so in the society Claude's in, yes that is seen as very feminine. And so that would be considered as a feminine gender expression. And we also know as kids developing, kids develop by experimenting with everything. It's not uncommon to have a little boy try on mom's high heels. It's not uncommon for a little girl to wear dad's suit. That's not really that weird. They're allowed to experiment. I think that's the confusing part for a lot of parents, because now that we're bringing these topics more to the fore part of our brains, they're questioning every little decision that a kid makes. And really, when we look retrospectively at it, if we're thinking of like, oh, does this person who wants to have a more feminine gender expression actually transgender or not? But it really is that you need a lot of data over a lot of time to really retrospectively look at, rather than trying to be sort of proactive about it necessarily.
Dr. Denise Millstine: So can you just succinctly tell our listeners the difference between gender identity and gender expression again.
Dr. Robert Horsley: Gender identity is what you are inside, that you physically are that you cannot change. And so that is a spectrum in and of itself. And then we have gender expression, which is sort of the outward things that you wear, do, act that socially show that you're part of that gender spectrum of male to female or in between.
Dr. Denise Millstine: And you quickly talked about where that's congruent or not congruent. What did you mean by that?
Dr. Robert Horsley: So not everybody who has a gender expression that is masculine identifies deep within themselves that they are male, but maybe for social reasons, maybe for safety reasons, maybe for they're still trying to figure it out reasons, they find that the male gender expression is the thing that they're going to do.
Dr. Denise Millstine: Thank you. That's really helpful and I think can be confusing for a lot of people.
Laurie, I wanted to stay on the topic of dress and clothing. So Rosie's mother is the children's loving grandmother, Carmelo. Carmelo takes Claude shopping for a bathing suit for the summer and says, you're old enough to pick out the suit that you want. What did Claude pick?
Laurie Frankel: Claude picks a bikini, and I think that's a really good example. I mean bikinis are cool looking if you are five and lots of five-year-olds of any number of gender identities might want one. If you believe that child to be male, then that gender expression might be a sign that actually that child is going to be transgender or is transgender. Or it might not be. It might just be that bikinis are fun. And either one of those things is great.
One of the things that I think is so interesting about gender expression when we're talking about clothing, is that I think that girls have a lot more flexibility than boys. And so I think that, you know, they actually like they make what they call boy shorts for girls to wear. Because the other thing about bathing suits is thet’re really revealing. And so certainly we can imagine without any alarm at all, a little girl who doesn't want to be looked at, who doesn't want to show that much skin, who's afraid of getting sunburned. You know, who doesn't want to shave? I mean, there are all sorts of reasons why a girl or a woman might wear shorts rather than a tiny bikini.
And I think that that very few people would be concerned or look askance at that. But when you reverse those, when you have little boys or older boys or men who are wanting to wear bikinis, suddenly we're very, very concerned. And so that seems to me to be a problem on, like, any number of fronts, without even getting to whether these children are trans or not. Just that there's limitations of gender expression and really just expression in general. That is, maybe this little boy wants to wear a bikini because he knows himself to be a girl inside. Or maybe it's because of some other expression that has nothing to do with gender. It looks more like a superhero. All sorts of reasons like that.
Dr. Robert Horsley: It’s shiny.
Laurie Frankel: It's shiny, you know, it has the character on it that is all of the rage, you know in the movie that we just saw. Like, there's so many different ways that all of us but children especially want to express themselves. They're nothing to do with gender.
Dr. Denise Millstine: I love how it's a pink bikini that Claude chooses and it makes him so happy. He is thrilled to own this clothing that he didn't craft from something of his mother's or how have to craft from something that existed. He got to purchase this bathing suit that is really meant to look like this, and to fit his body, child's body and all of that.
Laurie Frankel: Yes.
Dr. Denise Millstine: Bob, there's a lot of support for Claude to wear this bikini, sort of everybody accepts it. And then come the end of the summer, they go to the public pool. And this is one of the first, I think, difficult decisions that Penn and Rosie have to make, because Claude wants to wear his favorite bathing suit to the pool.
And I love this quote, Laurie, but I hope you'll comment on it, Bob. Penn found he could not say to his son, the suit you love is okay at home, but not in public. While Rosie would not say, we're proud of you in private, but ashamed of you at the pool. So they get to the pool. There are sideways glances. There are rude comments, And the family handles it with as much grace as possible. I wonder if you could give some advice to families who are having this type of experience. How to manage that? What are some ways to approach that or be prepared for that?
Dr. Robert Horsley: I feel like it's difficult, especially if you're talking about a five-year-old. Because I think part of it is having a discussion and I'm going to liken this back, oddly enough, to actually more of a social issue. So my wife grew up in Rome as a little kid. In Rome, girls don't wear tops when they're going to the pool. It's just bottom. So pretty much boys and girls have the exact same swimwear. Well, her mom was starting to train them to wear American appropriate bathing suits because they knew they were going back to the States and really just explained, like, just that's the way United States is, man, like you. Somehow you got to sort of like, go with the flow to a certain extent.
So I think it's easier the older the child is to have a discussion also about there is going to be some kind of social issues that are going to come up if you decide to go 100% with what you are all the time. So are you ready for that battle, which we hope can become less and less over time with stuff with things like this and just education usually. But at the same time, the way you can be supportive is supporting the child in the decision that they make regarding that. So if they are okay and welcoming of people making comments and stuff, then it's the parent's job to back them up and support them. If they go to the pool, Claude’s wearing the bikini and the management says something and you're like, well, this isn't against any rules. Stick up for your kid. Or if you're, you know, a lot of the things people are saying or affecting the child, say something. And it doesn't have to be super in their face and trying to fight them. It really could just be saying something loudly about how proud you are of them. I feel like the problem is, is that because we have all of these other social things going on in our brains now, we're worried about, well, what is everyone else thinking of us? And as the adults in the situation, you have to be able to sort of separate that and understand like the bigger picture.
Laurie Frankel: And I think to that, it's worth noting that 5-year-olds and 15-year-olds, kids are going to face social pressure and mockery, I mean, if you are 5 or 10 or 15 and you show up at a pool, someone is going to make fun of you. I think this is the way of children, and kids tend to handle that pretty well, too.
And so I think that sometimes adults feel like, oh, you're making fun of my kid because his toes are too long or two hairy or whatever. That's fine. Boys will be boys. We don't mind that, but but this other thing that I can't allow, I can't have to happen, like, so much so that I'm going to say to my kid, you need to pretend to be somebody else in public.
And you know, where we draw those lines, I think is is really important. I mean, it's where the title of the book comes from. Most parents will not have a transgender kid, but most parents will have a child who is sometimes gender nonconforming, and all parents will have a child who is sometimes nonconforming. Period. Sometimes your kid is weird because kids are weird, and other kids will make fun of them. If you don't want that, then don't have children or go to pools.
Dr. Denise Millstine: Stay in your bubble.
Laurie Frankel: Stay in your bubble.
Dr. Robert Horsley: Well, and I think it also takes into account the discussion, just family to child about safety as well.
Laurie Frankel: Right.
Dr. Robert Horsley: Sometimes we're doing these things because we know it's not safe to express this depending on the social situation. And so sometimes you're teaching them how to survive right now, while we're working on everything else that's going on.
Laurie Frankel: Yes, unfortunately. Very unfortunately I agree.
Dr. Robert Horsley: Yeah.
Dr. Denise Millstine: Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine: And this jumps forward a little bit in the book and we'll come back. But might be a time to talk about Claude goes on a play date with a boy who he's been friends with for many years and is cared for by a father who is angry. And, gosh, how do you say this nicely? Really close minded to gender fluidity and literally threatens their life.
Laurie can talk a little bit about that. It's so heartbreaking.
Laurie Frankel: It is heartbreaking. I mean, both that scene and the one that follows it where we have, it gets threatened in actual gun violence, were ones that I kept trying to take out of the book because they're heartbreaking in a book that I think is otherwise loving and hopeful and and optimistic and, you know, it sort of proceeds with this idea that with the love and support of your family and community, you can do anything, can and should.
And so I kept trying to take those scenes out, and I couldn't, because they are the reality in lots of parts of this country and lots of parts of the world. And it did not seem to be honest, to have this conversation without them, nor to speak to Bob's point, to suggest to kids or to parents like, oh, just be who you want to be. And if as long as you're strong and keep your chin up, the world will fall in line. It's not true. And sometimes when that doesn't happen, somebody is mean to you at the pool. And sometimes when that doesn't happen, you get shot and killed. So the consequences are tremendous. It wasn't honest to ignore them, much as I wish both as a novelist and as a human, I could.
Dr. Denise Millstine: It wouldn't be accurate. You've created a world where Claude is lucky to have the parents he has, the grandmother he has. Even a lot of the social supports that he has in terms of the school professionals. But that in and of itself is idealized in the novel to be essentially as good as it could be, but it would be foolhardy to think that this navigation of gender transition is not going to be fraught with something. Bob, do you want to comment.
Dr. Robert Horsley: And I appreciate that you left that in there because it gives a little more, at least authenticity for that perspective. Because I forget the exact numbers, but the vast majority of transgender individuals have experienced some kind of physical violence out in society. It's not interpersonal violence. It's not just one on one sort of thing. It's somewhere out in society, in public, they have experienced violence, and a lot of times it's actually in bathrooms, which is why bathrooms were such a big thing back in 2018ish times and a little beforehand of trying to get gender neutral bathrooms or which bathrooms to use because of how and one anxiety provoking is for transgender individuals, but two because there is actually a place where a lot of people do not feel safe that are transgender.
Dr. Denise Millstine: That's really so powerful. Can you talk a little bit, Bob, about the school professionals. So one of the principles that maybe the first principle, when Claude is going to school says to Penn and Rosie, relax, guys. Claude's not our first child with special needs. And Claude is not the district's first transgender child. To which Penn sort of is taken aback kind of. Whoa whoa whoa, we haven't decided that's how we're labeling Claude yet. But the principal insists that it's necessary to provide this label to the teachers so that they, for example, know how Claude wants to be addressed. Can you talk about the importance of these types of labels, particularly in a school or a professional setting?
Dr. Robert Horsley: It's such a vast area to dive into because it takes a lot of different aspects, right? So at least right now, there are still legal rules in place where you cannot discriminate, including sex, gender, those kinds of things. And so I think that is sometimes where administration from either school or work would want that label, so that it's more of a protection for the employee or the student.
The issue is, is that that comes along with a lot of other social issues. If that label is just slapped on someone without them willingly saying that to everyone. And two, there's this concept of outing people, that is really bad. So and it's not just transgender individuals, but anyone who doesn't necessarily conform to our binary ideas that are pretty old school. In the ways of if that individual who is transgender, for example, doesn't want other people to know that they're transgender, that's their right to not have to inform them. The problem is, is when you have to tell all the teachers, well, it's probably going to come out somehow to the entire class, right? It's just the way it is.
It's a complex thing, and arguably it's a little more of a discussion, individual to individual, as to how much do they identify with what transgender actually means to the rest of society. Because arguably, you're giving that word to everyone else so that they can make a whole bunch of assumptions about you. You could also just tell all the teachers; my name is this. Please call me this. And my pronouns are these, and you could just do that as well. It doesn't have to be. We have to tell them that they're transgender.
Laurie Frankel: I will add that this is one of the ways, that things have changed a lot since this book came out eight years ago. It varies widely, not just state to state, but school district to school district. But lots and lots of schools have realized exactly that. This problem is really best, that this problem is not a problem. It's in fact, I want to put that, that there's nothing bad that happens if you allow kids to say, here's what my name is, and here's what my pronouns are.
And in fact, if you make asking them what every one, all of the kids with their names, but from the beginning, from kindergarten, what their names and pronouns are, then this not only isn't a problem, but it never becomes a problem. And it does not cause school districts to do anything that they weren't already doing.
You know, elementary schools spend an awful lot of time and energy and money addressing special needs. Special needs, a variety of varieties. If you have a child who needs like one-on-one attention to in order to read, well then yes, that requires a faculty person, that requires a room in which that learning to happen, that requires a lot of accommodating in order to make those accommodations.
This isn't true for trans kids. There are already two bathrooms. We were already not policing who goes into which bathroom. We are letting the kids go into whichever bathroom it is. And so they don't need anything special. They don't need teachers to make a huge deal. They don't need anything. They need somebody to listen. When at the beginning of the school year, the parent emails and says, hey, my kid goes by this name and this pronoun, and you put that in the computer and then you walk away. That's the only thing that needs to happen.
Dr. Robert Horsley: I guess that's why I've always had a hard time wrapping my head around why people have a hard time calling somebody by a different name. My legal name is Robert. No one, including any of my teachers ever in my life, ever called me Robert. So there must have been something on a form in the 90s that said, what's your kid's preferred name or what do they go by? So I don't think it's really that much of an issue, like you said.
Laurie Frankel: It's not an issue. It's not it's and surely that is true of all sorts of of kids who go by all sorts of names other than the name on their forms. Most official forms actually have a space for that. Like what is your name and what do you go by? We're already doing this. It's only a problem if we make it a problem. If we don't, then it isn't at all.
Dr. Denise Millstine: I feel compelled to add right here, because we are so lucky to have Bob, whose legal name is Robert, with us, who provides primary care to transgender people because there are situations where it's important, for example, for Dr. Horsley to know if you are transgender and, for example, have a cervix even though you are male. If you have a cervix, you need to have your cervical cancer screening done. If you have a prostate, you need to have your prostate cancer screening done even though you are a girl.
So just one little public service announcement that, particularly for adults, that it is important that they have a health care professional who sees them in all of their needs for their physical health, that has nothing to do with the book but I just couldn't resist.
Dr. Robert Horsley: The questionnaires should be relatively standardized now that when you go see a doctor, they will ask you an organ inventory. And that's what that's meant for, because I have some people that identify as gender nonconforming or gender queer, and that can mean a lot of things to a lot of different people. And really, if it's not filled out first time I see somebody, I fill it out and I just say, we just need to know what organs you have and what you were born with and what are enhanced or taken out so that we know how to treat you for whatever medical issues going forward. And then also less people have to ask you these things because then it's in the chart.
Laurie Frankel: Yes and to that, what I would add is yes, obviously. Absolutely. Your doctor must have that information. What happens often is that the school district will say, therefore I need that information too. It's really important for this just in case an emergency happens at school and it's very difficult for. Listen, I imagine things for a living, and it's hard for me to imagine the scenario where something happens on the playground, and that's a piece of information that if the kindergarten teacher doesn't have, it will be a disaster or after school clubs. And yet that is often leveraged using an excuse to collect that information, which is very necessary for your doctor to have and not at all necessary for your school to have one.
Dr. Robert Horsley: Interestingly that I have this talk to doctors all the time. It's also not, don't make every visit about their transition. It's called broken arm syndrome. Cause if they fell off a ladder and really all it is that they broke their leg. I mean, you might need to know what medications they're on and that's about it. You don't need to know what genitalia they have.
So I always talk to people like, why are we asking this question? Are we asking this question so that we can legally identify you, so that we can know what organs you have, like why? And that actually gives you a more specific answer. If you can ask that question in a more specific manner as well.
Dr. Denise Millstine: I feel like we could talk all day. I want to talk a bit about the siblings, Laurie. So at that same scene at the pool, going back to the bikini, Penn is talking to one of his other children. His name is Ben and he's already a very intense, anxiety prone child. He's worrying about lots of things for the upcoming school year, and Penn asks him of all these worries, which one is the biggest? And he says, by far I'm most worried about what's going to happen to Claude when he goes to school this year.
Can you talk about the impact on the family?. Maybe not necessarily the parents, but the siblings and maybe refer to that how it's portrayed in the book.
Laurie Frankel: Yeah, sure. I was wed to those five kids. Almost everything about a book for me changes over the course of drafting it, because I cut so much along the way. And in early days, both my agent and my editor said, five is too many children. Like, I can't keep track of them all. And I said, I will revise this until you can keep track of them all, because I was wed to those kids for two reasons.
One is indeed transitions of this magnitude, be they gender transitions or any kind of transitions, impact everyone in a family. And that's a good thing, not a bad thing, but it does no good to pretend it isn't true. And I wanted to look at how a transition like this affects the people who love you, and particularly the people who love you unconditionally. The people who are not going to say, “Get out of my house, I disown you. I won't love you if you persist in this.” I'm not interested in those people. I want those people to go away. But there's a lot of room between that and saying, of course, of course, I love and support you. But how is an open and difficult question. How to love and support you is an open and difficult question, and I wanted to talk about that too.
I also wanted to look at as wide varieties of kids as possible. And as I said before, kids are weird. Though all kids are weird. And sometimes when kids are weird, we're like, oh, aren't you quirky and creative and interesting. And we want to nurture that. And sometimes when kids are weird, we're like, you need a label and a diagnosis and medication and therapy. And I'm very, very interested in where we draw those lines. So and to the point also, Ben is someone, you know, we do often diagnose and medicate anxiety and therapy anxiety these days in children. But we aren't so far passing laws endeavoring to take away those children's rights for medical care on that basis.
And so I wanted to look I wanted to compare and contrast these things as much as I could, you know, and there's frankly, a lot of gender nonconformity in this family, but only some of it alarms. There are a lot of behavior that we would describe as outside the proffered boxes. They are non-binary behaviors and some of that we applaud and some of it we do not. And I'm very interested in where we draw those lines.
Dr. Denise Millstine: And all the way back to the traditional quote unquote traditional structure of the family. You have the mother who is the physician and the father who is a storyteller, a writer who is really the primary caretaker for these children in the home. So, yeah, if you start to look at it, you, we need a course just on this book. I’m certain of it.
Laurie Frankel: Yeah, I set out to mix up their gender roles as much as possible. She's a doctor and pretty hardcore one and he is a stay-at-home dad. He is a writer, but not the kind who makes any money. But for all of that, I think she's very much the mom. And he's very much the dad. In a way I tried to undo and could not. And so that's interesting too.
Dr. Denise Millstine: Yeah, absolutely. Bob, we haven't even got to the part where Claude becomes Poppy and we're almost out of time. So to let the listeners who haven't read the book know the family, after some serious traumatic events and awakenings, realize they need to move to a community where Claude, later Poppy, will be safe, and they move at a time when Poppy is ready to be Poppy. Arrives as this beautiful, wonderful little girl and the family makes a pretty snap decision as to who they were going to share the transition with. And this leads to tension at points in the novel, which you don't have a novel without tension, Laurie. Right? But you can you talk about maybe how glorious that was for Poppy to have those years of just being able to be herself, and then how that became challenging and your thoughts?
Dr. Robert Horsley: I feel like it's so hard to describe to people that haven't had to go through a similar thing, but there are a lot of things you can probably make similes to. So things like and these are a lot more minimal compared to what someone like Poppy would be going through. But just think about how hard it is if you you're going to that family like holiday, that you pretty much don't like anybody there, but you got to sort of suck through it the entire time.
Think of that every day, pretty much for your life. And then finally, when you're allowed to be yourself, that weight is just lifted off. So I think it's something, it's very hard to imagine the weight of that, but at least you can sort of think about it in that respect. And so for lack of a better way of describing it, Poppy is allowed to finally be Poppy. Finally, told socially that they're allowed to be themselves. And I think that gets some criticism sometimes from people, too, because they're like, well, I was interested in things as a kid, but I wasn't allowed to. Well, we learned that from a lot of things all the time in history, that just because somebody else wasn't allowed to do it doesn't mean that that was the right thing to do.
And so to help sort of address that idea, it's one of those…there's a very big difference between there is something physically dangerous you're not allowed to do versus something that's socially like, yeah, that's sort of not acceptable. That's a little different. And then exploring that and really realizing that you yourself are that and you're not allowed to be that, that it's such a big weight to have walking with you every single day.
I think sometimes the problem is, is once you're allowed to be yourself completely, it feels even sometimes worse because now you know what it's like to feel like the weights off. To then know that maybe it's better to hide some of that once in a while and not completely be yourself, just even for safety reasons like we been talking about.
Now I think that changes setting to setting. And you don't have to do that all the time. But I think it's also up to the individual to choose when they want to tell people. I think that's part of the reason why that move is important is because now Poppy is just Poppy. Poppy does not have to be transgender. Poppy is just Poppy.
Dr. Denise Millstine: And those young years are so glorious for her. And she has a lot to navigate. Laurie, tell us what becomes of Poppy.
Laurie Frankel: You know, she moves across the country owing to in part to her mother's irrational fears, which is the thing that happens to people with mothers. Mothers are full of fears, rational and otherwise. And she concludes that there are safer places for Poppy to be herself and to be herself without question. And then she goes forth and be’s. She be’s without question. She is who she is.
One of the things that I wanted to speak to in this book, which I hear from trans people all the time, is that their being trans is not the central part of their identity necessarily. For lots of people who are non-binary, their gender ambiguity might very much be something that they think about every day. For lots of trans people, they are the gender that they are, and there are all sorts of ways to transition, physical ways and emotional ways and social ways, and a thousand combinations thereof. But then they're not thinking, oh, I used to be something else.
Oh, I'm pretending to be someone. They're not pretending to be someone else. They didn't used to be someone else. The before time is the time that it took for other people in the world to get their heads around something that they knew was true all along. And so for Poppy, it ceases to be an issue. It ceases to be a question. There is no longer a decision about what am I going to wear to the pool?
She's going to wear a bikini to the pool. Nobody is going to think anything of it, because she's a girl who wears bikinis to the pool. And that isn't untrue at any level. So she gets to be the child that she is without question. And I think it is what we want for all of our children. I think it's what all of us want for all of our children. I feel like that is the thing that we could all agree on.
Dr. Denise Millstine: Absolutely. I couldn't agree more. And she does continue to navigate challenges. But to your point, what teenager does not and what young person does not, and some of those are around gender identity and expression, but most of them are around just being a young person who's growing up and into themselves.
Laurie Frankel: Yeah, right. And all children keep secrets from their friends and their parents, and no children disclose medical history to the parents of their playdates. So yes, she has challenges and trouble to make friends and interpersonal drama. No one has no problem. Everyone has interpersonal drama. So pinning that on gender identity, I mean, it's not just untrue, it's frankly absurd.
Dr. Denise Millstine: Our listeners are going to have to read the book to explore it, and we do hope you will, because it is such a powerful, remarkable book. Thank you so much, Laurie, for coming back to the show and for writing this book. And thank you, Bob, for having this conversation with me.
Dr. Robert Horsley: Thanks for having me.
Laurie Frankel: It's my pleasure. Thank you for having me.
Dr. Denise Millstine: Listeners interested in these topics can listen to episode 15 “The Natural Mother of the Child,” and also check out the conversations with Laurie in episodes 16 for her book, “One, Two, Three,” where we talked about autism and episode 45, where we talked about Laurie's book, “Family, Family.”
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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