The barrage is based on a vicious mischaracterization of “gender-affirming care,” which is the practice all of these hospitals use. As Scientific American recently explained, the term describes a range of medical care from simple recognition of transgender children’s needs and rights to providing hormone treatments including puberty blockers, and “supporting the process of gender development rather than directing children through a specific course of gender transition or maintenance of cisgender presentation.” Only a limited number of transgender youth opt for surgery, and most cannot receive genital replacement surgery until they are adults.

Boston Children’s Hospital explained that, contrary to the claims of right-wing provocateurs, it only provides gender-affirming hysterectomies to transgender people 18 and older. Nonetheless, it was barraged with “hostile internet activity, phone calls, and harassing emails including threats of violence toward our clinicians and staff,” culminating in a bomb threat that brought police to the hospital.

“It’s actually crazy. I can’t even imagine being one of my patients,” Justine Lee, a craniofacial and pediatric plastic surgeon in Los Angeles who performs gender-affirming surgeries, told The Washington Post. “I can’t think of any other medical condition that would result in this level of hate.”

Vice’s David Gilbert reported on the wave of right-wing extremist threats on Aug. 17. “Long past time to start executing these ‘doctors,’” wrote participant in the pro-Trump message board formerly known as TheDonald. “Demons like this do not deserve to breathe! Crimes against humanity=DEATH,” one Telegram user. “These people are physcopaths [sic] and should be locked up,” commented another.

As Gingerich reports, Fox News has played a central role in generating the deluge of threats, primarily by endorsing and amplifying the smear artists on social media and other political figures, including QAnon-loving Congresswoman Marjorie Taylor Greene:

Between August 18, when the network’s first segment attacking Boston Children’s Hospital aired, and August 31, when Fox aired its most recent segment, attacking Chicago’s Lurie Children’s Hospital, the network aired 7 segments and spent more than 20 minutes vilifying the hospitals. Notably, three of the Fox prime-time shows featuring the attacks are in the top 10 most-watched cable news programs in the country — Tucker Carlson Tonight, The Ingraham Angle, and Jesse Watters Primetime.

Carlson’s program has been leading the pitchfork parade. A day after Vice reported on the wave of threats, Carlson hosted a segment in which he called gender-affirming the “sexual mutilation of children.” It included anti-trans extremist Chris Elston of Canada, who called it “the biggest child abuse scandal in modern medicine history.”

Greene also appeared as part of the discussion, discussing her proposal for national legislation to outlaw gender-affirming care. She said these practices are “actually an assault, and it’s child abuse,” adding: “This practice should never happen. It’s disgusting and appalling. It’s an embarrassment to our country.”

Gender-affirming care, she claimed, “is really genital mutilation, it’s puberty blockers that cause chemical castration, teenage girls actually having their breasts chopped off, teenage boys being castrated. This needs to be illegal, and I’m going to introduce a bill, called Protect Children’s Innocence Act, and it would create a law that would cause it to be a Class C felony for any person involved in so-called ‘gender-affirming care.’”

On Aug. 30, Carlson invited LibsOfTikTok proprietor Chaya Raichik onto his show after Boston Children’s was hit with a bomb threat to counter the growing narrative about the violence. He claimed that Raichik had provided proof of nefarious intent at Children’s National Hospital in D.C. by calling up two care providers there and claiming (dubiously) she had a 16-year-old daughter and was wondering if she could obtain a hysterectomy, then being told she could.

“Yeah, castrating kids,” Carlson intoned. “They admitted it, flat out.” He went on to claim that Children’s National was “castrating young people, minors for no legitimate purpose whatsoever,” adding that Raichik, whose tweets were taken down, was “committing actual journalism.”

Children’s National spokespersons explained toThe Washington Postthat neither of the people to whom Raichik spoke were qualified to respond accurately, and that it does not perform hysterectomies on women under 18.

The next night, Carlson continued the narrative by intoning: “Most people trust children's hospitals implicitly. They just didn't know the details — but thanks to the internet, we now do.” He went on to claim that “some of these hospitals are performing horrifying experiments on children,” including “things you think would be crimes but that apparently aren't and that are going on in children's hospitals in the United States.”

He then invited right-wing propagandist Chris Rufo—progenitor of the phony “critical race trheory” hysteria—onto his show to explore the claims further. Rufo falsely claimed that Lurie Children’s Hospital in Chicago was promoting “‘trans-friendly’ sex toys for children,” citing a resource document designed for teachers.

Gingerich found that while Fox only covered the threats as a springboard for attacking the hospitals, both CNN and MSNBC did cover them specifically—but spent relatively little airtime (five minutes and 13 minutes, respectively) on the story.

This is how stochastic terrorism—also known as “scripted violence”—has always worked: create messages that target a specific “enemy” or threat with extreme demonization and dehumanization, then disavow the consequences when your audience unsurprisingly acts on them in violent and threatening fashion.

As Chip Berlet explains in his essay on scripted violence:

The potential for violence in a society increases when the mass media carries rhetorical vilification by high profile and respected figures who scapegoat a named ‘Other’. This dangerous ‘constitutive rhetoric’ can build an actual constituency of persons feeling threatened or displaced. Or to put it another way, when rhetorical fecal matter hits the spinning verbal blades of a bigoted demagogue’s exhortations, bad stuff happens.

The resulting violence can incite a mob, a mass movement, a war, or an individual actor. Individual actors who engage in violence can emerge in three ways. They can be assigned the task of violence by an existing organizational leadership; they can be members or participants in an existing organization, yet decide to act on their own; or they can be unconnected to an existing organization and act on their own. According to the US government definition, a ‘Lone Wolf’ is a person who engages in political violence and is not known by law enforcement agencies to have any current or previous ties to an organization under surveillance as potential lawbreakers. The person committing the violence may expect or even welcome martyrdom, or may plan for a successful escape to carry on being a political soldier in a hoped-for insurgency. Either way, the hope is that ‘a little spark can cause a prairie fire’. Revolution is seldom the result, but violence and death remains as a legacy.

We saw this in action recently, when anti-LGBTQ “groomer” hysteria generated by far-right social media whipped up right-wing extremists into threatening a Pride event in Coeur d’Alene, Idaho, and even more recently in Boise. As Daily Kos’ Hunter says, the right is stoking fascist violence against transgender Americans, and it’s working.