Mercedes Allen

Dr. Zucker Fights Back, and the APA's Special Exemption on Reparative Therapy Remains

Filed By Mercedes Allen | February 06, 2009 3:30 PM | comments

Filed in: The Movement, Transgender & Intersex
Tags: gender identity, gender identity disorder, Lynn Conway, reparative therapy, transgender

Q: When is reparative therapy not reparative therapy?

A: When the patients are gender variant children. Then it's okay, or so the implicit judgment from the American Psychiatric Association would still seem to say. But more on that in a moment.

The debate surrounding one of the controversial doctors assigned to revise the diagnoses used for either treatment or invalidation of transsexuals (plural diagnoses, as in, Gender Identity Disorder or Transvestitic Fetish -- the latter of which poses the invalidation concern, whether it will ultimately be alongside a proposed theory of "Autogynephilia" or merged with it) has taken a turn. Someone has stated that allegations against Dr. Zucker have been turned over to Canadian authorities, and in turn, Dr. Zucker has leveled legal threats against someone else who has posted a link to an article on a website on which it was mentioned.

1) Notices and Allegations

Dr. Lynn Conway has been threatened with legal action. This stems from a news feed byte that she ran on her website, which says:

01-17-09: Organisation Internationale des Intersexués (OII): "The self-proclaimed experts on intersex: Zucker and Lawrence", by Curtis Hinkle
"I am sure that many intersex people were aware that the APA had brought out a booklet on intersex. However, I am not sure that many understand how problematic it is to many intersex people to see some of the following names associated with this booklet: Margaret Schneider, Walter O. Bockting, Randall D. Ehrbar, Anne A. Lawrence, Katherine Louise Rachlin and Kenneth J. Zucker. At first glance, the booklet seems apparently harmless. However, that is what's so clever about it. It's a way for the Clarke/Northwestern clique to get their nose under the (intersex) tent and then later "come on in"."

According to attorney Peter Jacobsen, this segment contains "defamatory allegations of criminal conduct and sexual abuse," although I can't find them anywhere in the above statement. This legal notice was also sent to the University of Michigan's Information Technology User Advocate, possibly to push a third party to end the news feed and/or to defame her among employer and colleagues.

At issue is the fact that the above segment links to an article by Organisation Intersex International. For what it's worth, that link doesn't contain "defamatory allegations of criminal conduct and sexual abuse," either, although it is alleged elsewhere on OII's website that some allegations of misconduct have been turned over to Canadian authorities (wth no more information than that). OII does some important work, being the most active and vocal opponent to the surgical assignation of gender to intersex infants at birth, while other Intersex organizations appear to have either abandoned that fight or even condoned the practice. Gender "normalization" was discredited many years ago, starting with the tragic case of David Reimer, but the disciples of Dr. John Money have continued to endorse it, and this is where OII and Dr. Zucker first found themselves at odds.

The implication of the legal notice is a bit confusing. Dr. Conway is accused of libel for linking to a website that suggests elsewhere on that website that a legal situation may be developing? Dr. Zucker is a Canadian resident, and a Canadian precedent set in 2008 by the British Columbia Supreme Court (the matter was not appealed to the federal level) in defense of Google, Yahoo, Wikipedia and others, states that unless there is an explicit comment made by the person doing so, simply linking to a piece of writing that might be considered defamatory (note that OII's article has not been ruled defamatory, nor has any legal action been taken regarding it at this time) is not defamation itself.

I'd say that considering the circumstances, it's pretty reasonable to call this an intimidation tactic.

With regards to the "defamatory allegations of criminal conduct and sexual abuse," all I know is that these are an issue for the courts to decide. If there is something legally actionable, then I would hope that capable legal counsel and support finds its way to those who need it; if there isn't, then I would hope that this becomes obvious early on, before the potential battle drags down well-meaning people, essential organizations and just plain bloggers who report about it.

2) Reparative / Aversion Therapy: The Question Remains

What isn't a legal matter and is open for debate is the continued exemption that the APA is giving to reparative therapy as applied to gender variant kids. The APA has stated very strongly that they do not support reparative therapy, and consider it a dangerous and harmful attempt at treatment. At one point in the statement, they refer to both gender identity and sexual orientation as being intrinsic:

"Sexual orientation, like gender identity, appears to be established early in life. There is no evidence that altering sexual orientation is an appropriate goal of psychiatric treatment. There are single case reports of changes or increased flexibility in the capacity to respond heterosexually -- or homosexually -- during psychotherapy, but no specific treatment to permanently realize such changes has been documented. Clinical experience suggests that attempts to change sexual orientation may occasionally result in behavioral changes for some motivated individuals for limited periods of time, but that such changes often are accompanied by depression, anxiety, and other symptoms."

And yet there has been an ongoing implicit exemption made in regards to reparative therapy when applied to trans kids. The American Psychiatric Association has had plenty of time to address the discrepancy, issue an explanation as to why their position does not extend to this situation, or to have words with the people who continue to embarrass them on this point, and deal with everything quietly. Instead, reparative therapists who treat kids are still given prestigious positions and implicit endorsement, and treated as the foremost experts in the field.

3) Because That is What This is All About

If Dr. Zucker's complaint against Dr. Conway seems to hold little water, one finds a more likely basis for a grudge in the fact that in her news feed, Lynn Conway has continued to point out the reports of his use of reparative therapy -- here, here, here, here, and here, for a few examples. Even though a number of these reports appear neutral or supportive of the therapy discussed, there are still signs that reparative therapy is forcing these kids to submerge and hide identities and anguish, in order to smile for the doctor and look "cured..." a result vaguely reminiscent of what the APA describes in its statement on reparative therapy.

This continually damaging treatment -- and the APA's continual habit of looking the other way -- needs to be addressed. It's time to press for a statement on what their position really is.

Crossposted to DentedBlueMercedes

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Brynn Craffey Brynn Craffey | February 6, 2009 4:06 PM

Thanks for posting this! Obviously, not only is it worrisome that these damaging opinions regarding gender-variance remain so widespread and powerful, but that those with vested interests in keeping it that way are trying to use the law to maintain the status-quo.

Hopefully, Dr. Conway will tell motherZucker's legal eagles to have unlubricated sex with themselves.

I have met and thoroughly admire Dr.Conway and her efforts to call out these theories on autogynephilia amd reparative therapy as what they are - junk science that does far more harm than any good it could possibly ever even remotely do. This crap violates the most basic premise of all medicine: First do no harm. The APA should follow Dr. Conway's lead and reinforce their their lack of support for reparative therapy ASAP.

Why Zucker, et. al. were ever put into the position of controlling the update of this portion of the DSM-V is beyond logic and all semblance of intelligence. It is obvious Zucker and his legal chickens took a page from certain others and want to use legal intimidation as a way to prop up their own flawed cause and views. What they really need to do is take an aerial intercourse at a motivated pastry.

Allegations have recently been made of misconduct. Ones I do not believe to be true - it is routine at CAMH for gender-variant children's genitalia to be handled by the treating psychologist, and them to be ordered to "accept that they are just gay" as part of the reparative therapy. There is a specific exemption on the usual APA ban on all "reparative therapy" for gender-variant children, and this is regarded as quite usual practice. The treatment is sanctioned. Whether it should be or not is another matter, but the point is that there's no evidence of anything unusual that could be construed as professional misconduct.

Psychiatrists should be aware that their actions while evaluating patients can easily be misconstrued by those presenting with mental health issues, and to take appropriate precautions. They should also be aware of the unfortunate consequences of over-reaction by over-enthusiastic legal teams they may have retained.

I have issues with Dr Zucker's views on reparative therapy, but have no doubt that his standards of conduct are exemplary according to current practice. It is the fact that this *is* current practice that I find wrong, but given that it is, an allegation of professional misconduct can't succeed.

Anyway, this is turning into a dirty mess. Things will get sensationalised, distorted and blown out of all proportion.

If Dr Zucker *is* guilty of misconduct, then the blame lies not with him, but with the system that allows gender-variant children to be abused in this way. It would be a very dangerous precedent to set, that psychologists (Dr Zucker is a PhD not a medic) who do nothing out of the ordinary, nothing that hasn't been going on for decades, be individually pilloried for it.

Yes, it couldn't happen to a nicer guy. It's still unjust. The only good thing is that it may draw attention to the way gender-variant children continue to be treated, and cause the standards to be changed.

The text of the letter with the allegations is on several websites now but it looks like it was pulled from OII's recently. I won't reproduce it here in deference to legal concerns that the owners of the blog might have. It is a direct accusation of sexual abuse by Zucker himself outlined by one of his former patients, who says she was 9 years old at the time.

OII has a lot of great writing debunking Zucker and his cronies that have occupied WPATH and the DSM committee, and the Accord Alliane (formerly ISNA, which was too "full of angry activists" for the insurance industry's taste). In particular, they outline how "feminine boys" (who generally turn out to be gay men in adulthood) are used to create the phony "gender identity disorder" as a tool to pathologize adult transsexual women (not men, because FtM's don't exist to these people)

There is a chain of events starting with the removal of transsexuality and it's replacement by adult GID, and the creation of a disorder category for boys who aren't butch enough, which is childhood GID. Child GID, adult GID- two completely different groups linked disingenuously by similar terminology in the DSM. It would be an interesting account of institutional corruption if it were viewed from the outside, and wasn't such a dire emergency to many.

Oh wait I found it, it's still at OII in appendix A of Zucker-complaint.

" is routine at CAMH for gender-variant children's genitalia to be handled by the treating psychologist."

Pedophile's dream job.

As far as a web link, it's -- as far as a contact email or phone #, I'm quickly coming to the conclusion that most of those available for sounding off are dead ends, and that the APA as an organization has simply buckled down and covered their ears (I'm willing to take suggestions).

We have empathetic allies within the APA, and most are doing what they can from their position (i.e. testing and debate of the DSM revision), but I don't see the issue regarding Lynn Conway as something they feel they can do anything about -- certainly not without professional and possibly legal repurcussions.

What I think we need to do is something more along the lines of open letters and petitions to put the pressure on the APA again -- to clarify their stance on reparative therapy and explain why a reparative therapist is given such credence. I'm a bit skeptical of the power of online petitions, but maybe that's one of the few tools we have on this?

This is a SLAPP suit, generally ineffective in the US against the more stubborn educated middle-class targets with access to lawyers, but highly effective against the less educated, poor, or apathetic. British-derived law tends to be more protective against libel (remember the Irving case where a respected American academic historian critic had to go to England and prove that she was correct to label him a Holocaust-denying hack and not a real historian. She won, but it cost her time and trouble.). Canadians - I am not familiar with the details of their (relatively) new Constitution.

In the States, a psychologist handling a patient's genitals would be guilty of gross misconduct*. That psychologist isn't a physician, has no reason to make a patient disrobe, and if information is needed about physiology and function is needed, should be able to look at the pediatric endocrinologist's report.

*(sex therapists working with adult voluntary patients exempted)

That's a great point; why are people at CAMH trying to treat 'sexual' issues in children? Parents really go for this? Is this sexology business really that far gone? Something is very wrong here.

Is there anywhere on the net where we can get the treatment protocols for CAMH's child sex program? Or any of their programs for that matter. I do remember seeing some of their "GID" assessment program. One of the first things they do is hook the patient's genitals up to some kind of meter and show them porn. That way they know who is faking it, right?

But I'm really disappointed with the lack of interest by the gay community. Reparative therapy is bad for adults, but ok when inflicted on children? If these kids were in "treatment" to turn them into women, the uproar would be intense. But because it's about keeping gay boys gay, and "norming" the trans kids into gay boys, everyone seems just fine with it.

But because it's about keeping gay boys gay, and "norming" the trans kids into gay boys, everyone seems just fine with it.

Yes. Its all good as long as gays get theirs, and trans women, men, and others get hurt.

Gays approve reparative therapy for trans...right here

Now, its easy to blame the HRC, and feel all good about being a trans oppressor, but, ask yourself, where did the HRC come from? How many gays here have supported some gay on trans hate venue with the 'logic' that the good outweighed the bad?

The fact that the HRC and other gay-hate on trans still exist, the fact that gay pundits still openly insult, exclude and demean trans women, the fact that my rights are seen as expendable to the Great God of Gay special rights, this should tell you something.

The gay rights machine has zetro moral authority as long as gay orgs support discriminatory and defamatory work like this.

And yes, the expectation that this will be dismissed to protect a gay special rights hegemony tells me what I too wish wasn't true. I am just unwilling to be quiet about it.

"Allegations have recently been made of misconduct. Ones I do not believe to be true - it is routine at CAMH for gender-variant children's genitalia to be handled by the treating psychologist, and them to be ordered to "accept that they are just gay" as part of the reparative therapy."

I don't see how a therapist handling a kids penis or vagina could be viewed as anything other than misconduct. It's the kind of thing I would have felt that I was required to report as abuse when I worked in social services. The American Psycholigical Association brief defintion follows>

"What is Child Sexual Abuse?
There is no universal definition of child sexual abuse. However, a central characteristic of any abuse is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity. Child sexual abuse may include fondling a child's genitals, masturbation, oral-genital contact, digital penetration, and vaginal and anal intercourse. Child sexual abuse is not solely restricted to physical contact; such abuse could include noncontact abuse, such as exposure, voyeurism, and child pornography. Abuse by peers also occurs. "

If this type of contact is normal in the course of treatemnt for gender variant kids at a major teaching facility - I shudder to think what some solo practioners may be doing. And I hope this treatment method was reviewed by their legal people, ethics board and they got an advisory opinion from the child welfare authorities - and reviewed this "treatment" as being necessary for every kid it was imposed upon.

Could you imagine the outcry if a therapist were to touch the vagina of a girl attracted to other girls to "help" them become comfortable with heterosexuality?

Of course - ethical guidelines don't apply if you're a transgender or transsexual kid.

I hope Canada has something similar to American "abuse of process" laws where a person can counter-claim someone else who's obviously just trying to use the legal system to intimidate. Stuff like this makes me mad!

The APA annual meeting is in San Francisco this year -- May 16-21.

There will be some presentations that are gender-affirming, but it wouldn't hurt for people in the area to attend to demonstrate and to meet the thousands of psychiatrists who will be milling about. Most have never met a trans person, or heard from an ally of a trans person. This will be a great opportunity for those types of interactions.

Zoe, I disagree about blaming the system but not Zucker if this be true. Kind of like guns don't kill people. People do.