Ed. Note — This is part two in a series on trans issues and the DSM V, continued from the July 26 issue of Q-Notes.
The Chair and many members on the APA (American Psychiatric Association) sexual and gender identity disorders workgroup for the DSM V, scheduled for release in 2012, are far removed from the mainstream of thought regarding what it is to be trans. There are two troubling aspects regarding their method of diagnosis and therapy. One addresses next month’s topic, etiology. The other is a treatment called reparative therapy.
For a better understanding it is helpful to know a little history. This regimen has its roots in behaviorism, which found its most radical exposition in the writings of B.F. Skinner. The premise is that behavior modification, enabling (often read as coercing) individuals to conform to an “acceptable and encouraged” behavior, can be achieved through conditioning techniques akin to Pavlovian theory. One such technique is aversion therapy, a treatment advocated by Kenneth Zucker. Zucker heads the workgroup and, given that it has been loaded with others who espouse similar gatekeeper mentality, it’s certainly worrisome that these “clinicians” have undue authority.
A recent NPR article sheds much light on the controversy. It highlights lives of two trans children who receive radically different forms of treatment. The article describes a patient who was seeing Zucker and then contrasts his regimen of treatment with that of Diane Ehrensaft. Both are psychologists and gender specialists whose approaches to trans facilitation are diametrically opposed. It is worth noting that Zucker is affiliated with CAMH in Toronto, Canada, which has come under much fire lately regarding its views of trans and intersex persons. Zucker and his colleagues, including Alice Dreger, Ray Blanchard, J Michael Bailey and Paul McHugh, have been chastised for what has been described as their trans hostile approach to care and their habitual withholding and/or denial of treatment desired by clients. They have become more gate closers than facilitators or guides.
Bradley, Zucker’s patient, expressed a desire for “all things feminine” from a very early age. At age two, Bradley chose to be Dorothy for Halloween. In time, Bradley’s mother Carol became concerned over the aversion to “all things male.” She sought advice from Zucker after Bradley, then almost six, came home bloody after being bullied at school. His diagnosis was gender identity disorder (GID).
In Zucker’s opinion, the best of all possible outcomes is for the patient to accept the birth gender. The treatment was designed to remove all reminders of girls’ things from Bradley’s life, whereupon the repression of the child’s affirmed gender gave rise to a) hoarding/hiding of special toys he liked, and b) drawings of dresses, rainbows and princesses, and the like: all icons Zucker considered to be inappropriate and which had been denied Bradley.
Diane Ehrensaft never uses the diagnosis “GID.” Her client also expressed desire for a feminine gender identity and expression at an early age. Ehrensaft never attempted to recondition “Jonah” but encouraged the child to find her true self. The result? As stated by Jona’s mom, Pam, when shopping for Jona’s first dress, “I thought she was gonna hyperventilate and faint because she was so incredibly happy. … Before then, or since then, I don’t think I have seen her so out of her mind happy as that drive to Target that day to pick out her dress.”
These are only two examples, but they indicate a marked difference in how we either guide trans youth forward or how we impose gatekeepers’ standards. Jona was encouraged to find herself, to autonomously decide what gender identity and expression best suited her true self. The joy she expressed to her Mom was real and there is every reason to believe she will grow to be a well-adapted adult. Conversely, Bradley was administered aversion therapy and it’s evident that not only will a happy childhood be unlikely, but that the trauma suffered at Zucker’s hands will be life affecting.
The APA has decried the efficacy of reparative therapy with respect to homosexuality, as well as having removed it as a mental illness from the DSM in 1973. Unfortunately, gender diversity is still considered a mental illness and Zucker believes that “coddling” GID children and allowing them to live their lives as their self-affirmed gender is a less than perfect outcome. Collaterally, Zucker has endorsed NARTH (National Association for Research & therapy of Homosexuals), an organization that still holds reparative therapy camps for “wayward” gay and lesbian individuals where the brainwashing is supposed to “cure” them. Then they can become members of PFOX…Parents and friends of ex gays. There seems to be, however, a high rate of recidivism and many individuals eventually reaffirm their diversity.
A quote from the NPR article really puts Zucker’s cognitive disconnect in perspective: “Because Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker’s therapy — which seeks to condition children out of a transgender identity — is unethical.
But that isn’t how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.
“Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? … I don’t think we would,” Zucker says.
Mind boggling…and this is the person who chairs the sexual and gender identity workshop for DSM V revision!
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