Glenn Stanton from Focus on the Family and Joe Nicolosi square off with Dan Siegel and Michele Angello over how to raise gender variant kids today on the Dr. Phil Show. Check local listings for times in your area.
The problem with episodes like this is how polarized it is likely to be with these guests. One side will say gender variance is all environment (well, I hope Glenn doesn’t say that) and the other side will say gender variance is all inborn in every case.
UPDATE: Did anyone else view the show? It was not terribly helpful for the purpose stated which was to help parents who had gender variant children. I will have more to say about it later but the social conservatives offered the close mother-detached father theory of gender variance to open scorn – deserved scorn I might add. The segment was awkwardly edited so that comments were probably not really related to each other as the show was taped.
Thinking about the episode, I have decided not to say much more about it until I can find some video clips. If you didn’t see it, then my descriptions won’t help much. The extreme positions presented left me very frustrated, knowing that most cases of GID do not end up in gender reassignment but also knowing that parenting dynamics in GID situations are not that much unlike families that have no GID kids. Indeed, the woman on the Dr. Phil episode had two other children without gender identity issues. I reported here several months on a mother of twin boys, one with GID and one without any such issues.
Both sides did not address the data points which falsify their perspective. Phil McGraw asked Dr. Siegel why 85% of GID kids do not go on to request gender reassignment. Siegel answered by saying that was a good question and the science isn’t clear but never gave a plausible answer as to why puberty changed these kids in so many cases. On the other hand, Nicolosi is so committed to his theory that he glosses over the problems with parenting theory. As noted above, GID children are often found in families with siblings who are quite gender conforming. Parents report that they do the same things with the GID children as they do with their other children with vastly different results. Most parents with more than one child can relate to this. Kids respond differently to the same environment thus helping to shape different parent and child relationships. Parents cannot be faulted when a GID male hates his gender typical Christmas presents or out of the blue at age 4 says, I want to be a mom and have babies when I grow up. Even if the reparative proponent says we are not blaming the parents just pointing out the causes, the “explanation” fails to account for the fact that the other children in the family did not respond to the parents with gender confusion. Also, as in the case of Dr. Phil’s parent, the mother was not especially close to the son. The reparative proponent is left with a need to assert untestable hidden dynamics which must be true because no exceptions to the theory are allowed. This kind of response from Nicolosi was in clear view on this episode of Dr. Phil. If all you have is a hammer, everything must be a nail.
So both sides of the theoretical debate can be faulted for confirmation bias. Holding tightly to a theory of causation in the face of incomplete science can create a situation where the client in front of you becomes secondary to the felt need to verify the theory.
I soon will be meeting with a group of parents some of who (perhaps all, I am not clear on this as yet) have felt great hurt from the application of reparative drive theory to their children. It must be quite surreal to go to someone who everyone says is an expert only to have that person be so wrong in their guesses about your lives. I am quite sure that those who hold tightly to a theory underestimate the intense anger and frustration this creates in parents. At one point in the Dr. Phil show, Nicolosi criticized the GID mom for getting “emotional.” As Dr. Siegel pointed out, the woman had reason to be emotional. She was on national television talking about the greatest hurt of her life with people who were essentially blaming her for the trauma. I believe I would be upset as well.
Category: gender identity
Gender identity disorder research: Q & A with Kenneth Zucker
As a follow up to the recent broadcasts by NPR and several posts regarding gender identity, here is a Q & A involving J. Michael Bailey and Ken Zucker recently posted on the SEXNET email list. Dr. Zucker is the Head of the Gender Identity Service, Child, Youth, and Family Program and Psychologist-in-Chief at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Dr. Zucker is the chair of the newly appointed Sexual and Gender Identity Disorders working group for the 5th edition of American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V). Dr. Bailey is Professor of Psychology at Northwestern University, prolific sexual orientation researcher and moderator of the SEXNET list. As the NPR article noted, Dr. Zucker has extensive clinical and research experience with persons who experience gender dysphoria. This interview was conducted by Dr. Michael Bailey via email and has been slightly edited for posting here. Both Drs. Bailey and Zucker have reviewed and approved it.
Bailey: Both NPR shows used the phrase “a girl trapped in men’s bodies.” How common is this concern over body image?
Zucker: I would say that, in general, there has not been a lot of good empirical research on body image issues in pre-pubertal children with GID. In adolescence, the Dutch group has reported clear evidence of body image dissatisfaction as one finds in adults. One of my PhD students has a dissertation that should be defended later this year in which we studied body image in boys with GID compared to clinical and community controls. We did detect significant body image differences among the three groups: body image in general and in relation to gender-specific anatomic dysphoria. The boys with GID had a poorer body image in general and, of course, with regard to gender-specific anatomic dysphoria. It is only a first pass at this issue and I will report on this down the road after the dissertation is defended.
Bailey: The case on the second NPR show is of a child (natal boy) who had extreme temper tantrums when not allowed to engage in feminine behaviors. Is this common in the kids you see, or is there something unusual about these kids?
Zucker: This is not uncommon. Some parents will report that if they try to limit cross-dressing that this can be very distressing for the boys. Some parents describe it as “he needs his fix.”
Bailey: You are more familiar than anyone else I know with the difference between the British and Dutch treatment centers that yielded the findings that only 20% of the British kids but 100% of the Dutch kids pursued sex reassignment eventually. Did the Dutch center focus on older children (who were less likely to change their minds)? To the extent that the samples were comparable, it is a shocking difference in outcome.
Zucker: I don’t think the British group has published their data yet. But, yes, the Dutch group data are on adolescents and I think that the British group is talking about clients first seen in childhood, not adolescents. The Dutch group now has a paper that is close to being “in press” on their first follow-up of GID children and then followed up later. The GID persistence rate for their boys was about 20% and the persistence rate for girls was 50%. Their persistence rate for boys appears to be similar to what I have summarized for the boys seen in my clinic (Zucker, 2005), but higher than the 12% rate for girls that we published earlier this year (Drummond et al., 2008). The Dutch group speculates that their girls were, at initial presentation, more extreme in their cross-gender behavior than the girls that we reported on, but that will require more careful analysis.
Bailey: The NPR show, and some people on it, kept implying that some of these kids are “really” transgender, and others are not. I suspect you don’t agree with this way of thinking about it, although you recognize that some kids are more likely to become transgender adolescents and adults than other kids are. Can you remind us which factors are associated with persistence of GID from childhood?
Zucker: I don’t think we know yet. Two possible candidates are age at initial evaluation (later age associated with greater persistence rates) and quantitative metrics of cross-gender behavior in childhood.
By persistence rate, Dr. Zucker is referring to the percentage of GID children who are still GID at a later assessment. In the Dutch group, as well as in Dr. Zucker’s research sample, most boys who want to be girls in childhood, end up as men who do not want to be women. For women in the Dutch sample, half remain GID. I think the assessments of low persistence of GID provide some helpful information to parents who wonder about puberty delay and behavioral interventions with their GID children.
Thanks to Drs. Bailey and Zucker for permission to post this conversation.
60 Minutes Science of Sexual Orientation mother of twins, part 2
At last, I am posting some follow up comments made by Danielle, mother of the twin boys featured in the 60 Minutes segment, Science of Sexual Orientation. Part one is here and should be read first.
Danielle said this in her initial email:
I often wonder “if” I had told Adam that “yes” he could be a girl when he became old enough would he have stayed on that track of thought? However, at the urging of his therapist I told him I understood he was a girl yet he was really a boy and couldn’t be a girl.
Wanting to be clear, she wrote to elaborate:
This was my response when he was three years old. We thought it would be confusing for that age of a child to hear he could be a girl but not until he was older. Later in his life I was up late watching a tv show about transgender surgery. Adam had awaken and was watching the show behind me – I didn’t know he was there. I heard a gasp. When I turned around there was my Adam staring intently at the tv. He asked me in a shocked whisper “Can I do that surgery and be a girl?” I told him “yes” he could but not until he was 18 years old. He became very excited. You have to understand the differences in his age. I believe the information I gave him at each step was based on age appropriate responses. He did stare at me for a bit and asked me if I would really let him do something like that if he wanted. I assured him I would if it would make him happy. He wanted to know why I would help him change his body. I informed him because I loved him and I didn’t want him to be sad or hurt. He asked me if I really loved him that much. My response was a very sound “yes!” that seemed to please him very much.
The last time Adam and I talked about him being able to change his body into a girls body Adam was indecisive. Again, I believe it’s the age/stage of his life and awareness of all around him. This conversation occurred after Tyra Banks had issued an invitation to be on her show. At that time Adam advised me he wasn’t sure what he wanted to do. He didn’t know if he should change his body so he could be a girl, stay with a boys body, if he was straight sexually or gay. Again, I believe his answer and confusion to be age appropriate. I declined the show offer because I didn’t want him to expose himself when he was so unclear about his future. I didn’t want to “lock” him into any particular role. That was when I decided to proceed with the hormone therapy to give him more time and maturity to decide what he wanted for himself. However he was already fully into developing so we decided not to go ahead with the treatments.
We are in the process of working on another television project. I am allowing Adam to participate because I believe the show will allow him to show his confusion and be himself as he is for a 12 year old. This lead us to another conversation about the issue. For all of his wise wisdom he informed me he still didn’t know what he wanted to do. “After all Mom, I’m only 12. I’m not suspose to know 100% for sure where my sexuality belongs. I’m suppose to be able to explore and decide later” And that’s where I have left it. For him to be a normal 12 year old child, maturing, developing and exploring the possibilities of his future. I’m here to guide him, support him, and show him all the possibilities of the future. I can love him, hold him, praise him and catch him if he falls. That’s my role as a parent.
I then wrote to her to clarify how these thoughts related to her parenting decisions, specifically with his name and school. She said:
The issue of what name to use during school was never really discussed. I wouldn’t have allowed him to use a girls name at school even if he had pushed me to do so. He was “Adam” and that was that.
During school hours he could wear what he wanted as long as it followed the school dress code. He only asked to wear a dress to school a few times. My response was always that his brother couldn’t wear his fireman clothing so he couldn’t wear his dresses to school however, he did wear them around the house. He did wear a girls black sweater with gold thread for two years. He wore girls tennis shoes all his life because of the color and sparkles and still wears them. He would wear girl shirts; however, in today’s fashion world, sometimes it’s difficult to tell the difference except in color. In his younger years, he wore girl jeans with sparkles but only for about an year then he didn’t want to wear them anymore. But the really feminine clothing was only at home. My life was easier dealing with this issue because I had twins. His twin wanted to be a fireman. He had everything to do with a fireman just like Adam had everything to do with being a girl. My rule was that the girl clothing (dresses, heels, jewelry, skirts, femme blouses, makeup) and the fireman clothing stayed home when we went to the library, grocery store, grandma’s, church, school and so on. My main reason for my restrictions were due to my parents who are totally against Adam’s gender issues. However, his Nana didn’t care what he wore so he could take his dresses to her house and wear them over there. I did have an issue at school once where the principal asked me if I could get Adam a different book bag (his was pink) and buy him different shoes (his were white with a pink logo on them). I advised her that he wasn’t breaking any rules by his choices so I wouldn’t make him give them up. I told her I could give in to him and allow him to wear dresses to school if she really wanted to push me since there isn’t a dress code that says he can’t. She backed off after that. However, I wouldn’t have ever allowed him to wear a dress to school anyway. Yes, I had restrictions about what he wore and did in society but he did have a bit of freedom by his choice of shoes.
I again want to thank Danielle for her candid comments. I have received emails from parents and professionals who are glad for this glimpse into how one parent reasons through these difficult issues.
American Psychological Association comments on DSM gender identity issue
The other APA (the psychologists) has now commented on the appointment of Ken Zucker to the psychiatrist’s APA DSM task force.
American Psychological Association
Office of Public Affairs
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Statement on Gender Identity Disorder and the Planned Revision of the Diagnostic and Statistical Manual
May 2008
There has been some recent confusion regarding the American Psychological Association and work being done on the next version of the Diagnostic and Statistical Manual (DSM). The DSM is a publication of the American Psychiatric Association, not the American Psychological Association (APA). Questions regarding the DSM-V and the Sexual and Gender Identity Disorders Work Group should be directed to the American Psychiatric Association.
For many years, the American Psychological Association has worked to end discrimination, including discrimination based on sex, gender identity and sexual orientation. APA is committed to taking a leadership position among the mental health professionals, scientists and scholars who are addressing the issues surrounding gender identity and transgenderism. APA formed a task force in 2005 to study gender identity and gender variance. This group has been reviewing both the scientific literature and APA policies related to these issues and developing recommendations for education, training, practice, and further research.
The task force has completed a report that is slated to be presented to APA’s governing Council of Representatives in August. It will make a series of recommendations, including that APA call upon psychologists to provide appropriate, nondiscriminatory treatment to all transgender and gender-variant individuals. It is expected that the Council will adopt the report and its recommendations.
The task force did not take a position with regard to the gender identity disorder diagnosis because there was no consensus among its members. Indeed, there is no consensus among professionals working in the field; reputable scientists continue to disagree about GID. Regardless of the disagreement concerning the GID diagnosis, there is a need for greater consensus on treatment of gender dysphoria. The task force strongly supports the development of practice guidelines for transgender clients.
APA believes that no psychological disorder should be stigmatized or used as the basis for discrimination. People who are concerned about issues having to do with their gender identity should have access to appropriate and non-discriminatory treatment. Mental health providers need to educate themselves about how to provide such care.
Responses to Possible Questions:
Q.What is the American Psychological Association’s position with regard to the appointment of Dr. Kenneth Zucker and Dr. Ray Blanchard to the work group reviewing GID? Are you actively working to have them removed?
A. APA is pleased that well-qualified psychologists who are also members of APA have been included in the leadership of this aspect of the DSM revision. We are also aware that there are substantive disagreements in the field over the GID diagnosis and over the treatment of gender dysphoria. We call on this group and others working on the new DSM to apply the highest professional standards in reviewing the science and we encourage the careful consideration of all legitimate perspectives.
Q.Why did the American Psychological Association allow Dr. Kenneth Zucker to be part of its task force on gender identity?
A. APA’s Task Force on Gender Identity was given a very specific charge — to complete a review of the research literature on gender identity and transgenderism and to make recommendations based on that review. Nominations to the Task Force were widely sought and appointments to the task force, including that of Dr. Zucker, were made through a very thorough review process based on an individual psychologist’s research, clinical expertise and experience. As is the case with all APA task forces, the final work product is grounded in the strongest, peer-reviewed science available and undergoes a rigorous review process within the APA governance structure before it can become APA policy. Ultimately, what becomes APA policy must be well-grounded in science not individual opinion.
UPDATE – Elsewhere the American Psychiatric Association issued a statement reviewing the credentials of Dr. Zucker, which are impressive indeed.
National Gay & Lesbian Task Force questions the APA on DSM choices
There appears to be a growing schism within LGBT circles regarding the APA appointments of Kenneth Zucker and Ray Blanchard to the Sexual and Gender Identity Disorders Work Group (see the APA statement here). Today, the National Gay and Lesbian Task Force issued a press release calling Zucker and Blanchard “clearly out of step with the occurring shift in how doctors and other health professionals think about transgender people and gender variance.”
The APA and Jack Drescher has stepped up in favor of the appointments.
Thus far, to the best of my knowledge, the opposition has primarily been from transgender advocacy groups and writers. The press release stops short of calling for the appointments of Zucker and Blanchard to be canceled, but rather expresses disappointment. I wonder if any other advocacy groups will follow suit.