Pop quiz. Top three ways teens try to kill themselves.
- What ages? - Fifteen to 19.
- All attempts, or successful only? - All.
- Males or females? - Girls.
Poison, usually pills.
Cutting. Suffocation, usually hanging.
- Boys? - Firearms. Jumping. Hanging.
Girls think about suicide twice as often. Boys are four times more likely to succeed.
Girls romanticize. They imagine what they'll look like afterward.
That's why guns are rare.
- Boys are... - Achievers?
Yeah. I guess boys have to be better than girls at something.
- Come on, Heather. What's the problem? - I have homework.
When's your dad gettin' home?
- Why? - Well, you said we could.
[Groans] I know what I said.
Soon. Okay?
You've been telling me that for months.
Stop. Stop it.
- When? - When I don't have homework.
Other methods. Girls in particular.
In very small percentages, transportation related...
running into traffic, driving off the road.
- Thelma and Louise. - Thelma and Louise.
And drowning, though that's pretty rare.
[Door Opens]
[Heartbeat]
[Gasps]
[Breathing Heavily]
[Sniffles]
[Crying]
[Bottle Clatters]
What about burning? Self-immolation.
No way. Not on purpose.
Too painful. Too destructive.
Too horrible to contemplate.
That's the conventional wisdom.
Heather.
[Gasps, Yelps]
[Screams]
Heather! Come on.
- [Siren Wailing] - [Chattering]
So why would a 16-year-old girl deliberately set herself on fire?
[Dings]
[Woman On P.A.] Mr. Harris, please report to Biofeedback.
I tried to put it out, but it hit the curtains. I called 911.
- Is she gonna be okay? - Luckily, you got to her before she was seriously burned.
But, Matt, have you any idea why Heather might have done something like this?
Has she been depressed or unusually quiet? Moody? Acting strangely?
No, she's fine. She's okay. I mean, she's really happy. I would know.
Does she drink or use drugs or any substances that might affect her behavior?
I've never even seen her drink an energy drink.
Heather is state high school champion in the 800 meter.
She's the healthiest girl I know.
Some girls Heather's age... even though they appear well-adjusted on the surface...
have things that they do in private, like cutting, purging.
- [Nurse] Okay? - Not Heather.
How long have you two been together?
- We've known each other since grade school. - Mm-hmm.
- We've been dating for the past six months. - Mm-hmm. Okay.
You say that Heather doesn't drink. But you found her with a bottle.
- Is it possible? Alcohol... - She wasn't drinking, okay?
She was trying to kill herself.
Yeah.
[Woman On P.A.] Dr. Seagal to the pharmacy.
Heather, I'm Dr. Gallagher.
I know you're in pain, so we're gonna make this quick.
Heather, do you feel like talking?
Do you want to tell us what happened?
It was an accident.
I was having a drink and lighting a cigarette, and the bed caught on fire.
I'm really sorry.
Can I go home now?
[Typing]
Gary Masters will be here in a few minutes.
I told Main Admitting to page you when he got here.
Okay. Thanks.
What's he been told?
Uh, that a fire started in his daughter's room.
She was slightly burned, but she's stable.
Right.
Are any of those Becky?
No such luck.
- Who took those pictures? - That private eye I hired.
- Any progress? - [Cell Phone Rings]
- No. - [Cell Phone Beeps]
[Beeps]
I'll see you later.
- Doctor? - Hey, Doctor.
- Am I gonna see you later? - I just had a case come in. Can I call you?
- Uh, not too late. I've got surgery in the morning. - Sure.
[Zan] Bye.
- Mr. Masters? - Yeah.
- Dr. Jack Gallagher. - Is Heather okay?
Yeah. She has a few minor burns. They're a little painful, but she's gonna be okay.
- Can I see her? - Of course. Follow me.
- Dad. - It's okay, honey.
- They said you're gonna be okay. - I'm so sorry.
Don't even worry about it.
The only thing that matters now is for you to get better.
- Okay? - Okay.
Daddy's here. It's okay.
It's okay.
[Jack] Gary, I'm just gonna spit this out.
We believe that Heather, uh...
she deliberately tried to set herself on fire.
Has anything like that ever happened before?
No. No!
Sh-She's popular, beautiful.
All... All the major colleges are already coming after her.
She'll get a full scholarship to any one of 'em. She has her boyfriend, good grades.
What?
Her mom.
My wife committed suicide when Heather was 10.
We... Well, we sort of fell apart after it happened.
But then things eventually got back to normal.
Heather and I became closer than we ever were before.
Can't be easy raising a... raising a girl on your own.
But it was. Right off the bat, she was into sports.
Every weekend, we'd spend it on the field.
Heather on the track, me with the stopwatch.
She really got the goods.
Why didn't she say something? Why didn't she tell me?
She's a teenager, Gary.
This is my fault.
Her last meet, I pushed her too hard.
I had her training twice a day... a 40-20-20 protein-to-carb diet.
Look. You know what? I'll bring her home, take it easy, scale back the training.
Well...
it's not quite that simple.
Whenever somebody tries to commit suicide...
we're... we're compelled by law to keep them here on a 72-hour hold.
But it won't ever happen again. I'm telling you, it was just the pressure.
Maybe.
Can you think of anything else in her life that might be troubling her?
No.
Track is her life.
[Jack] She's insisting it wasn't a suicide attempt.
- What's her father do? - He's an auto mechanic.
And, uh, he's her coach... or trainer.
Is this everything the paramedics found in her room?
Yeah. Listen. If he's her trainer, maybe he's pushing her too hard.
Maybe she's cracking under the pressure of competition.
- I've got a feeling she might be in the closet. - 'Cause she's an athlete?
- She's got a pretty hot boyfriend. - You ever seen those?
- No. - Having a boyfriend doesn't make you straight.
I've had boyfriends. My gaydar is never wrong. Almost never.
- Seen those? - No.
It... Besides, gay teenagers are twice as likely to attempt suicide as straight ones.
She tried to set herself on fire.
It's not the death of choice for a teenage girl of any persuasion.
She's an athlete. How about this? Abuse of anabolic steroids can lead to psychosis.
Maybe she's on diet pills. She could have an eating disorder.
Maybe she's pregnant.
Well, let's get her blood work done. Check those hormone levels.
Let's get these analyzed.
[Woman On P.A.] Orderly to Room 16 West. Orderly to Room 16 West.
That's impressive.
- Do you ever take a rest? - I'm fine.
[Inhales, Exhales]
[Groans] You're the main doctor, right?
- The one who told my dad I can't leave? - You can leave.
Just as soon as we make sure you're okay.
Look, I realize it was a stupid thing to do.
[Sighs] It's like my dad told you... too much pressure.
- It just got to me. - I understand.
You win a big race, you go home...
you take a shower in 151 proof rum and celebrate by setting a match to yourself.
Sounds reasonable.
What do you want from me? I don't have all the answers.
Pretty sure you've got more than I do.
Well, what do you want to hear?
I'm a teenager? I'm upset a lot? I have problems?
Okay. Let's start with the problems.
What could they be?
Boyfriend? No.
He seems nice.
Schoolwork? No. You seem very bright.
Your father said you were very close to your mum.
You really gonna ask me about that?
About how it felt to come home one day and be told your mother killed herself?
How the hell do you think it felt?
I have no idea. My mum's playing golf in Florida.
- Is it difficult to talk about? - You know, I don't need this crap.
I just want to get the hell out of this loony bin and get back to the track.
I did it, okay? But I'm not gonna do anything like that again.
Might be worth a go.
Statistics say that, uh...
you'd be more successful the second time.
[Screaming]
Heather...
let me help you.
You can't.
I don't think anyone can.
[Beeps]
Ladies. Toxicology.
- Hot off the presses. - Steroids. Performance enhancers.
- Not exactly. - High-dosage estrogen.
Estrogen?
Heather did say she'd been taking vitamins since she was a little girl.
Teenage girls have been known to take estrogen to make their breasts larger.
Starting as a child?
[Dings]
[Zan] I think the sun's coming up.
We don't have much time. [Chuckles]
[Chloe] So you didn't know what you were taking?
Not a clue. Dad's in charge of the supplements.
Did you ask him about the estrogen?
Not yet. Are you on the pill?
Um, no. I, uh... I haven't gotten my period yet.
My dad says it's really common for female athletes...
to get their periods late because of the muscle-to-body fat ratio.
Besides, I'm still a virgin.
Any pressure from Matt to try to change that?
[Chuckles] Of course. He's a guy. But he respects me.
What does your dad think?
He doesn't control my life.
Just the workouts and diet.
He's just always looking out for me.
You're lucky you have such a good relationship with your dad.
You don't?
When I was 15, I came out to my parents.
My father was so understanding, he threw me out of the house.
He said that I was evil, a bad influence on my brothers and sisters...
and that I needed to repent.
So I took a bus from Bakersfield to San Francisco...
and wound up at the gay and lesbian center.
That's where I met my adoptive parents. Two great guys.
Wow.
My dad would never throw me out, no matter what I did.
That must have been so awful.
It was hard. But not as hard as living a lie.
I brought some things for her. Heather won't want to break training.
I see that. That's okay.
Gary, I've got a question for you.
Why is Heather taking hormone supplements?
She have a medical condition?
I guess I should've told you. Heather's been under a psychiatrist's care.
Really? How long's she been in treatment?
A while.
Look, I think you should talk to him.
Is this anything to do with your wife's death?
Just call him.
It's complicated.
Dr. Paul, this is Jack Gallagher.
Jack, Dr. Paul is a chair of psychiatry at Harrison School of Medicine.
- Glad to meet you, Jack. - Hey.
So, um, how's she doing?
Well, we were sort of hoping you'd tell us.
Well, Heather's not a regular patient of mine.
I've seen her occasionally over the years as a favor to her father.
He called yesterday and asked me to resume full treatment...
which I hope to do as soon as you process her.
Dr. Paul is requesting that Heather be released into his care.
Obviously she's receiving excellent care here.
It's just that I've known Heather almost all her life...
so I feel I'm in the best position to help her...
since we've already established a therapeutic relationship.
Sure. Yeah, any idea why she tried to kill herself?
I wish I knew.
Can you tell me why she's taking estrogen?
Heather's in therapy for psychosexual behavioral issues.
Don't know if you're familiar with my work but...
A little. Could you be more specific?
I'm afraid I can't. Not without the family's permission.
And I'd really appreciate your help in getting the paperwork started.
Heather's here on a 72-hour hold.
Heather's been through a traumatic experience.
She needs to be at home with her family...
and in therapy with someone who knows and understands her.
Understands her, but doesn't have a clue why she set herself on fire.
Doctor.
[Woman On P.A.] Nurse Estrada to Light Therapy.
- Jack. - Hey. How's she doing?
Keeps asking to be let out for a run.
Maybe that's exactly what we should do.
[Victoria] Australian Aborigines.
- Yolngu tribe of Northern Australia. - Mm-hmm.
Have you ever heard of psychosexual flexibility?
No.
A theory suggesting gender identity can be created by environment.
No. Biology wins every time. Nature versus nurture.
Yeah. Not if you're Yolngu.
They raise all the kids as boys, even the girls.
Give 'em a loincloth, give 'em spears, make 'em fight.
And they live that way their whole lives.
- What's this got to do with Heather? - They were both studied...
and written about in medical journals by Dr. Timothy Paul.
[Heather] Hey.
Hey, hey.
- Guess who I met today. - Who?
Dr. Paul.
Oh.
- Told me you've known him for most of your life. - I guess.
- How often do you see him? - Every couple months.
What for?
Checkups, exams... the usual stuff. Can we talk about something else?
What about your regular doctor? Pediatrician?
Nope. Just Dr. Paul.
What kind of exams, Heather?
[Shouting, Grunting]
[Crying]
It's okay, Heather. It's okay.
- What do you see? - It's ugly!
I'm so ugly.
- No, that's not true. - Yes, it is.
Even my mother thought so.
Why? Why would you say that?
Before she died...
she couldn't even stand to look at me.
There were always tears in her eyes.
It's okay.
[Whirring]
Dr. Gallagher. Is Heather okay?
What's this?
- Gary, uh, I know. - Know what?
That your daughter, Heather, is really your son.
[Dings]
A simple circumcision.
How many of them happen all over the world every day?
What are the chances the hospital screws up and leaves your baby mutilated?
- How did Dr. Paul get involved? - Dr. Paul came over to the house...
with the attorney from the hospital.
- They offered us a settlement. - Money.
Let me guess. The free services of Dr. Paul?
He said our son would go through life a cripple... that Heather didn't have to.
And the hormones?
When she was eight, I had to start giving her those pills.
Estrogen, to stimulate the secondary sex characteristics.
I mean, it's okay to be a tomboy, right?
Sure.
Worked till now.
Gary, did she ever ask you any questions... about sex?
All the time. Basically, we lied to her.
My wife would come to bed crying most nights.
She wanted to tell Heather everything.
But Dr. Paul insisted we shouldn't.
I think that's why she killed herself.
She couldn't live with the guilt anymore.
Knowing what we did, unable to tell Heather the truth.
When did you tell her?
I didn't.
[Sighs]
Well, your question really refers to sensory integration disorder.
But we'll pick that up.
- A moment, Doctor. - Dr. Gallagher.
I'm about to begin a class. I suggest you make an appointment.
This is hardly convenient.
Would it be more convenient if I dragged you out of here on your ass?
Okay. I can see you're upset.
Let me assure you, I had every intention of discussing the case with you as soon as I...
After your next article was published. Journal of Psychosexual Development, 1998.
"The Case of Henry M., Boy Raised as a Girl."
Newborns are psychosexual blank slates.
Gender identity is acquired through experience.
I was one of the first to document this.
My study was groundbreaking.
Putting a dress on a boy doesn't make him a girl. It makes him confused and angry.
It makes him wake up one morning in the lock ward of a mental facility.
Her.
My patient is female in every significant way, Doctor.
- Convince me. - I don't have to convince you.
I have the family's support, 100%.
- That's a family you destroyed. - Oh, for God sakes, Doctor.
Do you have any idea how rare it is...
to study a surgically reassigned child through their entire development?
Sure, it's rare. And it's useful for your career.
- When were you gonna tell her? - Prior to the second surgery.
- What surgery? - Replacement of the cosmetic vulva...
with an artificial vagina.
This is over.
I don't think so, Doctor. Heather is still my patient.
You try and contact that girl or her father again, and I'll put them in touch...
with a lawyer that will burn you in a very public disgrace!
In the meantime, I will have your license.
[Nora] What are the chances of this happening?
One in 400,000 males have anatomic anomalies that result in female assignment.
I did some research.
- That's good work. - So what now?
I think she deserves to know.
She's a minor. It's for her father to decide.
[Jack] I tried to convince him.
And that Doctor... that so-called Doctor Paul...
he's got him brainwashed.
You're talking about a clear breach of medical ethics here.
How does Heather fit into those ethics?
I think if we turn her loose in her current state...
she's likely just to become another teenage suicide statistic.
I agree.
- [Door Closes] - Nora, this girl's lost.
As your boss, I'm advising you to leave it alone.
As the mother of a teenage daughter...
do what you feel is right.
## [Acoustic Guitar]
[Knocking]
- Hey. - Hey.
Mmm.
- Time for a quick bite? - I wish I could.
What's goin' on?
Oh, I was just sitting here wondering how best to deliver some, uh...
some devastating news to a 16-year-old girl.
Mmm.
You know, I can't tell you how many times I've had to tell a family...
that even though we got the tumor out...
their husband, their son, their daughter will be blind, or worse.
- How do you do it? - Truth.
- Mm-hmm. - Tell 'em we did everything in our power, and we failed.
I tell 'em I'm sorry, and I am.
- Change of subject? - Yeah.
Okay. [Chuckles]
So, I have this time-share in Vail.
Amazing condo.
Ski in, ski out.
I don't know what you're doing over Christmas...
but I'd have to book it pretty soon.
[Chuckles] Christmas?
I don't even know what I'm doin' tomorrow.
Okay. Sure.
You know, I really should, uh...
I should take Heather out for a run.
Yeah.
[Clears Throat]
- [Door Opens] - Call you later?
I usually do about five or six miles.
You think you can handle it?
[Scoffs] Probably not.
Heather, something's been bothering me.
Your reaction when you looked in the mirror.
Can you tell me what you saw?
Can you describe it for me?
[Breathing Heavily]
- [Woman's Voice] Look at him. - Whoo! Ooh!
God, that's ugly.
Keep 'em high. Keep 'em high. Ten more seconds.
[Chattering, Laughing]
Heather. Right now, what's happening?
They're laughing.
Why? What are they laughing at?
It's me. I'm...
I'm inside out. I'm not right.
It's okay.
[Sniffles]
I'm gonna tell you something...
something that...
something that you should have been told a long time ago.
I know why you're all messed up and confused.
There's a reason why.
There's a reason why, when you look in the mirror...
what you see isn't you.
When you were born...
[No Audible Dialogue]
[Dings]
[Snoring]
- It wasn't a dream. - No.
[Knocking]
Get out.
You told her.
All this time, you knew, and you never said.
Dr. Paul said that if we raised you as a boy...
- you'd never be able to have a normal life. - What?
Is this normal to you?
Why did you listen to him? You were my parents!
We relied on Dr. Paul. We thought we were lucky that he took an interest in you.
So you just let him turn me into a freak.
I wanted to protect you. I never cared whether you were a girl or a boy.
- You're my baby. - You know what? You're not my father!
Because a father wouldn't do this to his kid.
- I hate you. - Baby, please don't...
- Get out. You need to leave. - Baby, please.
Get out! Get out!
Gary.
Gary, she had to know. She was coming apart.
I should've told her myself...
but I didn't have the guts.
She's gone.
Just give her some time.
That's all she needs right now.
I think we both know better.
Guess I always knew I was different.
[Sighs] You probably know all about how that feels.
There's no way to compare what you're going through and what I experienced.
I mean, like, I always felt strange...
like in the shower rooms with the other girls.
They'd talk about sex and stuff, and what they were going through.
When I went on my first date, had my first kiss...
it was all wrong.
Have you ever looked at yourself? Really looked at yourself?
What? Like with a hand mirror?
No. God, no.
It's way too embarrassing. I hate looking at my body.
I'll be around.
How are you... How are you doin'?
Not so good.
How's she doin'?
I don't know how we can even consider releasing her.
She hasn't processed what's happened to her.
What do you propose?
It's okay. You can tell me.
Okay. When I was...
When I was born...
they, um... they made a... a mistake.
Who made a mistake?
The... [Exhales]
The doctor...
who was...
circumcising me.
Wait. I... I don't...
Circumcising?
She needs to know what her choices are.
The female reconstructive surgery or the male surgery...
and transgender counseling to transition back.
- You're right. - There has to be something we can do to help her.
Whoa, whoa. Wait a minute.
Look, what are you saying?
Hey. Let it play out.
Matt, I didn't know until yesterday.
You're a guy? You... Look, this is not my fault. This is...
- You came on to me. - No, Matt, I...
- No, don't touch me. - Please, Matt!
[Heather] He shouldn't have saved me.
Maybe he should have left me there.
You really believe that?
[Sighs] No. But he's probably spread the word by now.
So forget school. Forget friends. Forget everything.
You're giving up? Doesn't sound like you.
Me?
Who's that?
Chloe told me you scared the crap out of Dr. Paul.
I wish I could have been there to see it.
He's out of your life.
Thank you.
Heather, you don't really have a reason...
to trust anyone in my profession to... to act in your best interest.
- Well, you guys have at least been straight with me. - [Mouths Words]
Well...
Is this the part where you tell me how I should live the rest of my life?
No. [Chuckles]
No. This is the part where I tell you that tonight...
we're gonna finish what you started.
A rebirthing ceremony?
Metaphorically. It's more like moving on, shedding her skin.
Haven't people suffocated during these ceremonies?
In cult settings, with no medical supervision. This won't be that.
Jack, you know, half this country already believes...
that psychiatry is some sort of witch-doctoring...
and you want this hospital to prove it to them?
She needs this, Nora. She needs to put the past behind her.
So you're assuring me that this ceremony is completely safe.
- Completely. - Fine.
[Elevator Bell Dings]
Except that it involves fire.
Hey.
Every culture has a rite of passage.
Child to adult. Unmarried to married.
Entrance into a community, for example.
Like a graduation ceremony.
Exactly. Tonight we're here to celebrate...
a spiritual passage from the past to the present.
The Native Americans... they believe that...
Well, they believe that any violence done to the body is also done to the spirit.
Your spirit... needs to be repaired and the damage healed.
And you've chosen fire as the mechanism.
So tonight, we do too.
How'd you guys get all this stuff?
From your father. He kept 'em.
I want you to choose something that, uh, you feel...
well, you feel like it no longer represents you.
Something that might be holding you back.
Then what?
Put it in the fire.
Burn what you want, keep what you want.
You decide.
[Flames Crackling]
[Sighs]
I remember this.
I know he loves me.
He didn't want to hurt me.
Then that might be something you want to keep.
How do you feel?
The same...
but different.
You are different.
It was just a campfire.
All we did was burn things and talk.
- It didn't really change anything. - Well, that's up to you.
Ceremonies and rituals have power, but...
only as much as you want to give them.
Just tell me you're not gonna try anything like...
I'm past that.
Good.
Well, then, you're on your way.
- You sure you want me to do this? - I'm sure.
I'm not Vidal Sassoon.
I trust you.
[Beeps]
[Woman On P.A.] Nurse Estrada to Light Therapy. Nurse Estrada to Light Therapy.
Hey, got a minute? There's someone I want you to meet.
- Wow. - What do you think?
Looks great.
- So you've made your decision. - No.
I just felt like maybe I should see the world...
from another perspective for a while before I do.
- Not a bad idea. - Yeah.
All right. What do you see?
I see me.
[Knocking]
Hey. I was gonna call you. Want to grab some lunch?
I need you to cut the crap.
Okay. Now you lost me.
[Stammering] I asked you about a ski vacation.
- You acted like I pulled out a ball and chain. - I did?
- Sorry. - A-About what?
That, uh, I asked, or that you blew me off?
Both. I couldn't have responded any differently.
Okay. Now I'm lost.
Jack, what is this?
Are we just sex buddies, or is this something real?
You know, I need you to tell me what you think...
the ground rules are for you, and maybe I'll play...
maybe I won't.
Okay. There is something.
What? Do you have some sort of disease?
- You have six months to live? What? - Worse. I have a sister.
[Patting Couch]
She's my twin.
She's schizophrenic. She's wandering around the streets of L.A. somewhere.
[Sighs] Every so often, she calls me.
She doesn't say anything, but I know it's her.
So I'd love to go skiing with you, but I can't.
I have to be here in case she needs me.
We can spend Christmas here.
- One fake fireplace. - Right.
Near the beach.
[Elevator Bell Dings]
[Dings]
[Child] Show's on!
English - US - SDH