Four mass shooters, all transgender-identified, all with severe documented psychiatric histories, all connecting their violence to gender identity distress in their own words. Jeff and Ness lay out the case files — Nashville, Minneapolis, Tumbler Ridge, Pawtucket — then trace the clinical framework that is architecturally designed not to see the connection. They also break down the Cass Review, the Fox Varian malpractice verdict, the Sage Blair case, and what Gallup's 2025 data reveals about a generational identity shift nobody can adequately explain. When ideology overrides clinical rigor, somebody pays the price.