Emotional Blackmail in a White Coat

How “gender-affirming care” is reinforcing patterns seen in borderline personality disorder

As someone with extensive clinical experience working with suicidal teenagers and adults, it was the lie that gender transitions are necessary to prevent suicide that opened my eyes to how deeply depraved the trans agenda truly is. This outrageous assertion is contradicted by study after study and defies basic common sense. Surgeries and cross-sex hormones are not suicide prevention. It dumbfounds me that mental health professionals have become the ringleaders of this dysfunctional emotional manipulation, because we are supposed to know that repeated or coercive suicide threats are a pattern endemic to borderline personality disorder.

People often ask me how I became involved in opposing the trans movement. The short version is this: in 2021, I returned to a counseling job after a four-year disability leave to discover that nearly half of the girls in my clinic identified as non-binary. I quickly realized this was new. I wasn’t surprised to find the kids adopting an identity label; it is typical for teens to experiment with their identities. But I was shocked by my colleagues’ behavior.

Instead of exploring why these young people gravitated toward the nonbinary label, the other therapists in the practice instantly affirmed their identities and even demonized parents who questioned them. I soon understood that it wasn’t just happening in my workplace. Trans affirmation was suddenly everywhere, not a grassroots phenomenon but a widespread agenda with heavy financial backing.

Therapists trained by major mental health institutions like the American Psychological Association (APA), the National Association of Social Workers (NASW), and the American Association of Marriage and Family Therapists (AAMFT) were taught to promote the lie that people must transition or die.

Faced with a widening gap between our ideological beliefs and California’s strict COVID mandates, I left my job. Displaced yet again, I felt I had nothing left to lose. I started making public Instagram videos about my observations. A few of these common-sense videos went viral, and I was flooded with messages from parents who told me they were pressured by therapists to transition their children and warned that their child would otherwise commit suicide. This insanity had become a new normal, but there was nothing normal about it.

Anyone with reputable mental health training learns about attachment theory, trauma, and how both connect to behaviors associated with borderline personality disorder. Borderline is not something people are born with, though there is some evidence for a genetic predisposition. They develop it due to trauma and disrupted early attachments. Individuals with borderline traits experience intense and unstable emotions, a shaky sense of self, and engage in attention-seeking behaviors. This often leads to impulsive actions, chaotic relationships, mood swings, chronic emptiness, risky behaviors, and empty threats of suicide. Most of these are rooted and driven by fear of abandonment and stunted emotional development.

People with borderline traits struggle to maintain meaningful relationships, and their lives are often tumultuous. They frequently place themselves in attention-seeking situations and then play the victim. They may categorize people in black or white terms, either idealized and perfect, or demonized as completely evil. They are, in layman’s terms, all about the “drama.” They are good at generating excitement, but beneath their fun exterior, they often feel profoundly empty inside.

One of the most common ways they attempt to stabilize this fragile sense of self is through self-harm. Cutting, substance abuse, promiscuity, eating disorders, and repeated suicide threats are mechanisms for controlling the people around them. Does any of this sound familiar? These are the same patterns being ingrained and reinforced by the entire trans movement, including mental health professionals.

Unbelievably, the therapists who are supposed to be “trauma-informed” and trained to recognize this type of emotional manipulation are now actively promoting threats of self-harm the moment a gender identity is declared. If a child says, “If you don’t affirm my name and pronouns, I will kill myself,” therapists coddle and appease these demands without question and pressure parents to do the same. Even vulnerable patients who are merely questioning their identity are led to believe this narrative by ideologically captured therapists.

This is not kindness. These therapists are inducing multiple layers of disordered psychological patterns in their patients. Not only are they reinforcing the lie that it is possible to change sex and that those experiencing distress about their gender must medically transition to feel whole, but they are also giving young patients a road map to a personality disorder while simultaneously providing a pathway to medically assisted self-harm. The craziest part is that the American Psychological Association (APA), the National Association of Social Workers (NASW), and the American Association of Marriage and Family Therapists (AAMFT), led by the World Professional Association of Transgender Health (WPATH), have all rubber-stamped this emotional blackmail.

The lie that people must “transition or die” is harmful on the face of it. It sends a devastating message to struggling young people: survival requires painful and irreversible medical procedures. Plus, it emphasizes superficial appearance and an external locus of control, a sure recipe for psychological disaster. Any person who genuinely feels destabilized by being “misgendered” or “deadnamed” can never hope to achieve lasting stability. They cannot thrive because the suicide trap fosters an obsession with external validation, with such high stakes and no internal locus of control; they are set to crumble. The only way for them to find lasting contentment is through understanding how their efforts and decisions shape their lives.

One of the most widely used therapeutic modalities for borderline has been Dialectical Behavior Therapy (DBT). Used widely in the 1990s, DBT teaches patients to see the world in shades of gray through “wise mind.” They learn to use mindfulness skills to regulate extreme emotions and develop healthy “interpersonal effectiveness skills” or the capacity to maintain healthy relationships by asserting their needs, setting boundaries, and preserving their self-respect. DBT inculcates an ethos of personal responsibility by focusing on “building a life worth living” and practicing “radical acceptance” of what cannot be controlled. When taught properly, DBT stands in direct opposition to the entire premise of the trans movement. DBT patients learn that while threatening suicide may keep people close in the short term, attention-seeking suicide threats ultimately lead to loneliness, disconnection, and emptiness.

I believe the borderline playbook is intentional; designed by nefarious actors who know exactly what they are doing. For example, I attended a therapist’s luncheon where Dr. Johanna Olson-Kennedy was the featured speaker. Olson-Kennedy is one of the most influential clinicians in the country and the former medical director of the Children’s Hospital Los Angeles, one of the largest pediatric gender-affirming care clinics in the US (until the federal government pulled its funding). She infamously insisted, when asked about the capacity of adolescents to consent to irreversible surgeries such as a double mastectomy, “if you want breasts at a later point in your life, you can go and get them.” She falsely and repeatedly claimed in expert reports and affidavits submitted in court cases that puberty blocking drugs are “fully reversible,” and delayed the release of a major NIH study, which showed there is no mental health improvement for patients given puberty blockers. She has been claiming that children must be affirmed as trans, or they will kill themselves, since at least 2012, when she starred in an NBC show entitled “Living a Transgender Childhood.”

At the luncheon I attended, she again confidently asserted that kids would die if they did not get affirmed as transgender. The audience, all mental health professionals, clapped enthusiastically at the end of her talk.

It is still shocking to me that otherwise intelligent professionals and major mental health associations can no longer see what is obvious: the question Olson-Kennedy poses to parents, “Would you rather have a dead daughter or a living son?” is far from innocent. It employs exactly the same emotionally manipulative tactics seen in those struggling with a personality disorder. Whether they know it or not, by amplifying such grandiose, unsubstantiated claims, gender affirming therapists are colluding with borderlines and creating new borderlines in the process.

Pamela Garfield-Jaeger has extensive clinical experience treating suicidal patients in a variety of mental health settings. She had led DBT-based therapy groups and can see right through the manipulation of trans activists. Pamela is the author of “A Practical Response to Gender Distress: Tips and Tools for Families”, available on Amazon, and a charming children’s book called “Froggy Girl”. froggygirlbook.com, thetruthfultherapist.org. She can be reached through her website, thetruthfultherapist.org, and on X at @pgarfieldjaeger.

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