Guest Blogger

Stop Trying to "Fix" Trans People

Filed By Guest Blogger | June 21, 2008 10:30 AM | comments

Filed in: Living, Living, Transgender & Intersex
Tags: American Psychological Association, child care, DSM V, Kenneth Zucker, Matt Kailey, NPR

Editors' note: Matt Kailey is the author of Matt Kailey.jpgJust Add Hormones: An Insider's Guide the Transsexual Experience, the editor of Focus on the Fabulous: Colorado GLBT Voices, 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. 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.

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.


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Robert Ganshorn Robert Ganshorn | June 21, 2008 1:16 PM

Matt, I have signed the petition and sent it off to 20 friends of mine. Thank you for your posting. This is really Gay!

Deeds not words!

Signed the petition, forwarded it to at least 20 friends too.

Thanks for the heads up, Matt.

Brynn Craffey Brynn Craffey | June 21, 2008 5:32 PM

Thanks for the heads-up on this, Matt!! I'd been feeling too overwhelmed by other issues to pay it sufficient attention when I first heard about it, but your post inspired me to read further about Dr. Zucker, which compelled me to go sign the petition! I hope it has the desired effect of pushing him off the committee.

The more I learn about this guy, the more I wonder how he got on that committee. There absolutely needs to be more dialogue between trans community leaders and medical professional organizations.

Hasn't the APA already defended their choice and denied the petition?

Hi Matt

I've blogged on the issue over at BiGender and the Brain, giving references to some of the papers alluded to.

I have very different conclusions from that of Zucker, as well as a moral and ethical aversion to his conducting of cruel and inhuman medical experimentation on children. I'll state my conclusions below:

Sexual Orientation is set by hormonal factors before birth. So is Gender Identity. Often, if Gender Identity "goes wrong", so will Sexual Orientation, but the converse is not true. Gays have no significant cross-gendered gender identity issues, some (not all) will merely retain "effeminate" or "butch" behaviour to some late in life. And many will never be either.

About half of those with cross-gendered identity have matching cross-gendered sexual orientation, however.

Cross-gendered behaviour in young children is associated with cross-gendered sexual orientation, not necessarily cross-gendered gender identity. Cross-gendered thinking patterns, and by that I mean socialisation, emotions etc are associated with cross-gendered gender identity. Different parts of the brain are involved, and it's all slightly interconnected and fuzzy about the edges. About a third of people are bi-gendered, meaning they could function adequately in either gender role, depending on circumstances.

What this means is that only about 30% of assigned-male kids whose behaviour is stereotypically feminine will be transwomen: the majority will be gay (though some could function just as well as transwomen, they are "bi-gendered".). And we can't tell which, unless we examine thinking patterns too. Behaviour, while relevant, is neither causal nor definitive, it is suggestively symptomatic.

Where I differ from Zucker is that I think this is essentially unchangeable, it's pre-ordained by neurological patterns set before birth, that cause gross measurable differences in developed neurology later. The development can possibly be de-railed in a few cases by the use of torture over many years, as we know Post-traumatic stress can change neurology, but the results are unpredictable and usually result in other sequelae - undesirable side effects such as dysfunctionality and psychosis.

Neither cross-gendered sexual orientation nor cross-gendered gender identity is a "mental illness", they are natural variations in neural morphology. Having said that, cross-gendered gender identity is also often associated with a cross-gendered body map, something determined in a nearby part of the brain. The discomfort of having the wrong-shaped body is severe, and universally leads to life-threatening mental distress that can only be alleviated by changing the body to match the brain.

When certain parts of the brain are cross-gendered compared to the body, the hormonal mix the brain is bathed in has a mismatch with the morphology, so dysfunction results too.

So while "transgendered" people with cross-gendered or partly cross-gendered gender identity but no body map issues are as normal and functional as gays, and require no medical intervention, those who are "transsexual" do. Not because they have a mental illness, but a physical one. Some will just require hormones to think straight, others require surgery too. And while a large proportion of those will have a sexual orientation that matches their cross-gendered gender identity, many will not. Children assigned as male when young, who have both female-typical behaviour and female-typical thinking, will usually become straight transwomen early in life. Children assigned as male when young, who have male-typical behaviour but female-typical thinking, will often become lesbian or bisexual transwomen later in life.

Not always. I didn't - I'm straight. Things get fuzzy round the edges in biology.

Oh, and the same things apply to guys too, just reverse the polarity.

Some transmen will have an almost fanatical obsession about becoming able to "write their names in the snow", and to others, it won't be as big a deal. Some will end up gay or bi, others straight.

One of the better things happening in science today is that the guys are no longer being ignored: there's starting to be significant numbers of papers about them too.

Many of the papers are about Intersexed people too. Children with 46xx chromosomes but CAH, so masculine-looking at birth, usually show stereotypical male behaviour during childhood, and end up attracted to women. But a significant proportion, perhaps 10%, have significant gender identity issues, and some transition to female. The majority are just normal, straight guys though (who often have to watch their salt intake, they may have medical issues in other areas). Did I mention that biology is messy? Thought so.

I was under the same impression. There have been a number of petitions going around about this, and not many people in power positions take online petitions with any degree of importance, anyway.

As for my feelings about Zucker, I oppose reparative therapy, period. However, APA is a private organization and can appoint whomever they choose. When this came down, I discussed the matter with a friend who had been very active in transgender political circles, and has the education I lack in matters psych; she warned the petitions and the like would not be well received, and that the medical/scientific community would tell us to wait for the final report. That's what's happening, sure enough. We'd best prepare to refute the final result of the panel, especially Zucker's reparative therapy, and Blanchard's autogynenonsense. Or whatever it's called. It doesn't apply to me, no matter how much he might want to try to make it do so.

Over at Beacon Broadside, where this post originally appeared, the APA sent a PR person to comment on the post defending Zucker, so I'd say that Polar's instincts are dead-on. Still, it's important that a message be sent to the APA that many people find Zucker's work hurtful and ill-advised.