Stop Trying to “Fix” Trans People

Today's post is from Matt Kailey, the author of Just Add Hormones: An Insider's Guide the Transsexual Experience (Beacon Press, 2005), the editor of Focus on the Fabulous: Colorado GLBT Voices (Johnson Books, 2007), and the managing editor of Out Front Colorado, Colorado's oldest and largest GLBT publication.

Trans people aren't broken. We aren't looking to be "fixed," and we have no need of a repairman. We have spent decades trying to convince the Western world of this, and forgive us if some in our ranks were starting to feel a little optimistic about our progress – until, maybe, now.

Just when we thought that an end to the tinkering around with our brains might be in sight – at least for those who are very far sighted – along comes a repairman in the form of Dr. Kenneth Zucker, a non-transman who, like so many before him, thinks he knows what's better for us than we do. Dr. Zucker thinks he can "fix" us – whether we want him to or not.

Now Dr. Zucker might be merely an annoying interruption in our otherwise peaceful day – some scam artist who knocks on our door and tells us that our roof or our driveway or our air conditioning is in disrepair and that he can fix it for cheap – and we could easily tell him that we have our own service, thank you very much, and close the door in his face. Unfortunately, in this case, there's one small catch – Dr. Kenneth Zucker has been appointed by the American Psychiatric Association to serve as the chair for the Sexual and Gender Identities Disorder task force that reviews the new version of the DSM – the Diagnostic and Statistical Manual that is used by psychiatrists, psychologists, and therapists to diagnose mental illness. And, in this regard, Dr. Zucker is no mere annoyance knocking on our door. He is a very dangerous man – and not just to trans people.

Dr. Zucker believes in reparative therapy. Just say the words and shudders go through the gay and lesbian communities as members recall involuntary hospitalizations, forced hormone "treatments," and even electric shock "therapy" designed to "cure" same-sex attraction. Luckily for gay men and lesbians, homosexuality was removed from the DSM in 1973. Same-sex attraction is no longer considered a mental illness, and even though ex-gay programs still exist, the failure rate is high, and most national professional medical and mental health groups – including the American Psychiatric Association – have taken the position that homosexuality is not an illness and cannot be "cured." The American Psychiatric Association even issued a position statement in 1998 saying, in part, that it "opposes any psychiatric treatment, such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation." But, with Dr. Zucker's appointment, those days may be over – and they may be nowhere in sight for trans people.

Consider the case of Bradley, recently featured on a two-part series on transgendered children presented by NPR. Physically a male, Bradley began expressing preferences for "female" toys, clothing, and activities as a toddler. He refused to play with "boy" toys or with male peers. At the age of six, he entered therapy with Dr. Zucker, who insists that the way to treat young children who display signs of gender identity disorder is to immerse them in all things appropriate to their birth gender, so Bradley was forced into boys' clothing and boys' activities. The problem was that, when his "girl" toys were taken away, he refused to play at all – an unfortunate, unhappy, and unhealthy position for a six-year-old to be in.

After eight months of therapy, Bradley's mother says that he has made some "progress." He still can't be exposed to "girl" toys, or he will want to play with them. He panics when he sees the color pink and insists on covering his eyes so he won't be drawn to it. But he has been able to tell his parents that he no longer wants to be a girl, although his mother says that it sounds like a "stock" answer – something that he is saying because it's what she wants to hear. She believes that he still plays only with girls at school – but he then comes home to an entirely different set of expectations. And this is "progress"?

Compare Bradley's situation with that of Jonah (featured in the same NPR segment as Bradley), who was two years old when his parents realized that no amount of persuasion would entice their "son" to play with typical "boy toys," and nothing they could say or do would steer him away from the dresses he was so desperate to wear. Luckily, his parents recognized that Jonah was really a girl – that it was his body, not his identity, that was the problem – and they took steps to allow their daughter to start living the life she was meant to live. Jonah became Jona, and she is now a happy little girl. Jona's therapist, Diane Ehrensaft, has a different view of transgenderism than does Dr. Zucker. In fact, she thinks Zucker's mode of therapy is "unethical," and likens it to the reparative therapy foisted on gay men and lesbians before it was determined that homosexuality was not a mental illness.

Armand, another child profiled in the NPR series, had an experience similar to Jona's. His need to be female also became apparent around the age of two, and his parents tried to seek help for their unhappy "son" until they finally found a therapist who diagnosed gender identity disorder. Armand, now Violet, is undergoing a controversial treatment designed to block male hormones and thus a male puberty, making it easier for her to transition later on if she decides this is what she wants to do. The ramifications of this type of intervention are not fully understood, but with fifty percent of transgendered children ideating suicide, according to Jenn Burleton, the Executive Director of TransActive Education & Advocacy (TEA) and West Region Coordinator and Board Member of PFLAG-Transgender Network (TNET), this type of treatment is probably far better than the potential alternative.

As profiled in the NPR series, both Jona and Violet are much happier and emotionally healthier since being allowed to live in the female gender that matches their internal identity. Bradley, on the other hand, is still struggling with his attempts to remain male and seems, with little joy, to be saying and doing the things that he knows are expected of him. Is he "fixed"? It is unlikely, since even the current DSM says that treatment for childhood gender identity disorder is "likely to be long-term with small gains made on underlying issues as treatment progresses" and that a prognosis for treating the disorder is "mixed" and that "same-sex identification may be very difficult to achieve."

Given all this, it's a strange turn of events indeed that Dr. Zucker has been appointed to serve as the chair for the Sexual and Gender Identities Disorder task force for the new DSM, made even more bizarre by the fact that Zucker believes that there is a relationship between gender identity disorder and homosexuality. Writing for the Child and Adolescent Psychiatric Clinics of North America, Zucker says, "Follow-up studies of boys who have GID that largely is untreated, indicated that homosexuality is the most common long-term psychosexual outcome."

If this is truly the case (and I would be interested in seeing these "studies," because my experience in meeting literally hundreds of male-to-female transsexuals and hundreds of gay men over the last ten years does not bear this out), then it appears that Dr. Zucker's reparative therapy for children with gender identity disorder is aimed at preventing adult homosexuality. And if homosexuality is not a diagnosable mental illness, as per the American Psychiatric Association, then it would follow that attempting to stop it by using reparative therapy with children with gender identity disorder would not be appropriate.  To go even further, it would seem that, combining Dr. Zucker's argument about reparative therapy for gender identity disorder and the American Psychiatric Association's position on homosexuality, gender identity disorder, like homosexuality, should not be a diagnosable mental illness.

I put no stock in Zucker's argument or in his therapeutic methods. While I agree that GID should be removed from the DSM, my reasoning is simplistic and has nothing to do with homosexuality – I don't believe that gender identity issues constitute a mental illness.  But if the American Psychiatric Association supports Zucker's views, and it must, given his appointment on the DSM task force, then it has only two choices for recourse: put homosexuality back in the DSM or take GID out. Oh, wait – there is a third: dump Zucker. Get him off of that task force before he damages – beyond repair – any more lives.

If you agree that Dr. Kenneth Zucker should be removed from the task force, sign this petition. You might also want to read "Drop the Barbie!" by Stephanie Wilkinson from Brain, Child magazine; Matt Kailey's post on pregnant transman Thomas Beatie; and this NPR story about new therapies for transgender adolescents.

Comments

[EmJay]

Thank you! I have a 4 1/2 year old child with a penis who demonstrates preferences that more closely align with typical "girl" things. We have been an open accepting family and even go to a church where he is praised for wearing his dresses. A couple of friends sent me the link to the NPR report and I was amazed. I have never considered my child's preference for pink, dolls, sparkles, ballet and dresses to be anything other than a personal preference. It never even occurred to me that is was a disorder that I needed to seek professional help with. My child is happy even if he doesn't fit within other people's norms. He might be transgendered. He might be homosexual. Do I really have to decide that for him at 4 1/2? He certainly can't make the choice yet. There is nothing wrong with him. He is not hurting anyone. Now once he starts school and starts getting the wrong messages about who he is, then it might be time for some help, but not to change him only to help him cope with an unjust society.

[Steve]

Good for you, EmJay! And good for Matt. Also recommended: Eve Sedgwick's great essay (now more than 15 years old!) "How to Bring Your Kids Up Gay." I don't think the essay itself is freely available online (you can find it online through university portals, and in her book Tendencies), but here is an online discussion, and here's another. There's been so much change for the better on such matters over the past decade-plus that it's just bizarre to see an institution like the APA taking a step backwards, while the rest of society moves forward nonetheless.

[American Psychiatric Association]

Dr. Zucker's work has been portrayed inaccurately. Here is an excerpt from a statement on his approach:

In all patients, regardless of age, the focus of therapy is the patient’s gender identity, not the patient’s sexual orientation. This therapeutic approach has no relationship to so-called reparative or sexual conversion therapies that attempt to change homosexual orientations to heterosexual ones. The goal of Dr. Zucker’s therapy is the opposite of conversion therapy in that he considers well-adjusted transsexual, gay, lesbian or bisexual youth to be therapy successes.

Dr. Zucker has studied various therapeutic approaches for children and youth with gender identity concerns. The goal of treatment is a well-adjusted youth, regardless of ultimate gender identity or sexual orientation. Dr. Zucker has offered a variety of treatment options for these children and youth, understanding that options may vary greatly with the age of the client. For the younger clients, therapy options include helping the child to overcome discomfort with his or her body, i.e., helping clients learn to live comfortably in their natal sex.

Many children and youth with gender identity issues present with other problems (e.g., anxiety, depression, substance abuse) that do not disappear automatically when the gender issue is resolved. Dr. Zucker’s service diagnoses and initiates treatment for these additional problems. Similarly, the parents of many children at Dr. Zucker’s service have significant emotional problems or marital problems that require separate interventions.

For adolescent patients, including those who first came to the clinic as young children, Dr. Zucker follows the Standards of Care Guidelines of the World Professional Association for Transgender Health. The treatment options include helping patients make a satisfactory transition to the opposite sex, including the institution of hormonal treatment to facilitate transition. In some cases, treatment may also include helping an interested adolescent obtain sex-reassignment surgery.

The DSM is about diagnoses. It does not address treatment. Accurate information from the APA on the DSM development process is available at:

http://www.psych.org/MainMenu/Research/DSMIV/DSMV/APAStatements.aspx

[Steve]

It's good to see the APA engaged in these debates: thanks for stopping by. But it doesn't sound-- from news coverage, at least-- like Dr. Zucker is, to use a word the statement above uses, "helping." And it sounds like Zucker provides an example of exactly the dynamic Sedgwick identified back in the early 1990s: depathologizing adult homosexuality by pathologizing, instead (perhaps a better word would be "mistreating"), problems of gender identity, and then insisting that gay folks are mentally healthy, as long as the gay men act masculine, and gay women are femme. That's progress, compared to the 1950s, but it's 2008: queer folks deserve more.

[sunny beach]

Interesting article. I heard the original NPR broadcast and one of the best analogies for Dr. Zucker's practice is that it's like trying to raise an African American child as Chinese. Simply put an absurd notion.

[Dale]

I will read more into this later. It sounds interesting and controversial. I feel bad for those kids....

[Susan Seagris]

I was also born a male, but I always knew I was female, from as far back as I can possibly remember. Long story there. But it wasn't until I became an adult and starting making/paying for the changes myself was I ever happy. Now I am 100% female and finally I am at ease with myself. You have NO idea how good I finally feel about myself and who I am.

[Obie Holmen]

The American Psychological Association has debunked reparative therapy in a report issued August 5.