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: Professional issues
Ted Haggard says sexuality labels "just don't work"
Ted Haggard could have been in my study last summer. Over 190 same-sex attracted men who are heterosexually married took my survey to describe their sexuality. Many of them said the same thing – that labels didn’t fully capture their experience.
Haggard told the Denver Post that labels don’t work. Read the rest at the link.
Haggard’s description is consistent with the results I found. I am still collecting data involving same-sex attracted women in straight marriages. Just a few points on the men:
-191 men completed the survey; referrals came from ex-gay ministries, bisexual groups, mixed orientation couple support groups and via this website.
-Regarding the labels issue, 33% of all respondents qualified their sexual orientation self-description because they felt the labels were not adequately descriptive.
-We found 6 groups of such men with different attaction patterns. Haggard may fit into the “spousosexual” group if his general attractions are for men, but he experiences attraction for his wife. We found 20% of the total group in that category.
-The smallest group was the “ex-gay” group. Just over 6% said they once were attracted to the same-sex primarily and are now primarily attracted to the opposite sex.
-The largest group (40%) were bisexual in their attraction patterns and about one-quarter of the men were primarily attracted to the same sex in the present.
There are many more interesting findings that I am saving for the paper on this research. It should be ready by the end of February for submission. Stay tuned…
Genetics and environment: Interaction in a different key
In previous posts, I wrote about PANDAS, the streptococcus related autoimmune disorder which involves obsessions, compulsions and perhaps more broad anxiety and movement problems. Discussion has been vigorous about the role of pathogens in creating mood and mental health issues.
Genetics as an influence is another biological factor often considered as a causal factor in mental health and behavior. Today, Brain Blogger discusses the influence of genetics and depression in a post with the provocative title, “Stressed by his short allele.” Brain Blogger is an interesting read in that he attempts to bring neurological research to a lay audience in a magazine format.
Regarding depression, stress and genetics, BB writes:
Individual differences in the genetic makeup of the serotonin system have been shown to increase one’s vulnerability to depression, anxiety and other psychiatric conditions, particularly if individuals are exposed to stressful events in their lives. Studies are showing that certain people (those that have the short allele of the serotonin transporter gene) have a greater biological reactivity to stressful events, including a larger hormonal response to stress and a greater brain reactivity to threat. In other words, both the hormonal and brain systems (amygdala) involved in fear and anxiety are more active in response to stress in those individuals who have a certain genetic makeup (short allele). This genetic difference may also account for individual differences in personality; those people who have a short allele for the serotonin transporter have been suggested to exhibit more “anxious” personality traits. This means our differences in gene function may bias our brains and our personalities to create a tendency to be more “negative,” “anxious” or reactive to stress.
Bringing together the PANDAS research with the observations regarding short serotonin gene alleles, one can envision several scenarios. A child with a stubby allele gets strep throat. This child is unfortunate in that the antibodies created to seek and destroy the strep bacteria find and bind with dopamine receptors in the basal ganglia. At that point, the cells designed to kill strep bacteria which are supposed to be hooked up with strep antibodies find this unholy alliance of strep antibody and dopamine receptors and launch their holy war of immunity. Dopamine cells fall in friendly fire thus sending the dopamine-serotonin balance into disarray. This child, being completely unaware of this of course, begins to feel nervous and irritable (mood change). This creates stress in the family and parents who may also have stubby alleles get stressed too. As BB notes, the short-allele brain already primed to be more reactive in the event of stress (the illness itself, the mood change and reaction of parents and sibs) goes into full fledged alert, generating lots of chemicals which basically provide that child with thoughts suggesting something is wrong here (anxiety and depression).
We can also imagine a child with a full sized allele going through the same thing. When the dopamine-serotonin balance is disrupted via an autoimmune disorder, one may see the typical rapid onset of PANDAS symptoms but these will likely not turn into a chronic problem. Furthermore, it is possible that the symptoms will be less intense or that the child will be more easily soothed with even modest parental inputs, thus preventing an escalation of panic.
Active readers will probably imagine a few hundred more scenarios.
I recently spoke with Susan Swedo at the NIMH who provided invaluable information regarding PANDAS. She agreed with me that we are at the beginning of this line of research and thinking. There is no doubt that psychological trauma is stressful and thus impacts mental health. However, the mechanisms of extended impact may be much different than psychodynamic theorists imagine.
The more of this kind of information we can get to patients the better in my view. It is helpful for people to understand the tricks their brain is playing on them when they get the intuition that they must engage in a compulsive action in order to relieve anxiety. Or when everything is really going well and they constantly fear the worst. Our active, monitoring minds play tricks on us and we are learning more about how those tricks are constructed in part via pathogens in the environment interacting with a genetically prepared host.
PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci
I recently became aware of this condition where a variety of emotional and psychiatric symptoms arise due to an adverse reaction to the strep virus. I hope to raise awareness and note the import of understanding this condition for mental health professionals and consumers.
Years ago, I specialized in child mental health and saw cases of anxiety with no apparent precursor. Despite my psychodynamic training, it became clear to me that family dynamics played little to no role in the etiology of these conditions. However, in some of the cases, I could find no clear explanation. I suspect I was dealing with PANDAS. Some background:
PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. The term is used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette’s Syndrome, and in whom symptoms worsen following streptococcus infections such as “Strep throat” and Scarlet Fever.
The children usually have dramatic, “overnight” onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody, irritable or show concerns about separating from parents or loved ones. This abrupt onset is generally preceeded by a Strep throat infection.
How does Strep throat lead to PANDAS?
What is the mechanism behind this phenomenon? At present, it is unknown but researchers at the NIMH are pursuing a theory that the mechanism is similar to that of Rheumatic Fever, an autoimmune disorder triggered by strep. throat infections. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and “attack” the heart valves, joints, and/or certain parts of the brain. This phenomenon is called “molecular mimicry”, which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with Rheumatic Fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham’s Chorea or St. Vitus Dance.
In PANDAS, it is believed that something very similar to Sydenham’s Chorea occurs. One part of the brain that is affected in PANDAS is the Basal Ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Sydenham Chorea.
In other cases, the child with PANDAS can become fearful, especially surrounding separations from parents. Mood swings have an abrupt onset and are more extreme than prior to the strep infection. There is a clear and dramatic change.
The best treatment seems to be antibiotics to address the strep infectiom. However, even after the infection is ended, the antibodies can remain in the child with negative impact.
I suspect many counselors have seen children with PANDAS without knowing it. The following description seems quite plausible:
Typically, a child with undiagnosed PANDAS may be taken to the Psychologist and/or Paediatrician for treatment of an onset or exacerbation of ADHD symptoms, oppositional behaviours or OCD. Stimulant or anti-depressant medication may be prescribed and/or a behavioural intervention or counselling initiated. As the infection passes and the strep antibodies reduce, the symptoms gradually subside and parents and clinicians believe that the intervention was successful. However then there is another strep infection, the symptoms return and the process is repeated. The problem is that the brain is being continuously damaged by the repeated attacks by streptococcus antibodies; and after each attack the recovery of damaged brain tissues may not be as complete as we would hope. Eventually the child may develop a chronic psychiatric disorder
This condition should cause health professionals to reconsider models of personality and psychopathology development. Counselors advising parents who have a child with PANDAS might be tempted to propose environmental theories for sudden anxiety states. However, such hypotheses would be far off. Counselors should take detailed health histories even with adult clients given how this biological causal factor gradually coould compromise mental health and lead to a psychiatric condition. Rather than hunt for psychic trauma, a bacterial trauma may be implicated.
This disorder came up on another thread regarding causes of same-sex attraction. There is no evidence as yet that a virus/bacteria could create a similar autoimmune reaction which would effect brain development or perhaps glutamate levels in the developing brain. However, it appears that behavior and emotional experience are effected in PANDAS. Is it a stretch to think other experiences (e.g., sexual attraction) might be altered in some similar manner?
Part 2 discusses a paradigm shift in treatment stimulated by PANDAS.
Year in review: Top ten stories of 2008
As in year’s past, I have enjoyed reviewing the posts from the year and coming up with the top ten stories.
1. Cancelation of the American Psychiatric Association symposium – Amidst threat of protests, the APA pressed to halt a scheduled symposium dedicated to sexual identity therapy and religious affiliation. Whipped up by a factually inaccurate article in the Gay City News, gay activists persuaded the APA leadership to pressure symposium organizers to pull the program. Gay City News later ran a correction.
2. The other APA, the American Psychological Association, released a task force report on abortion and mental health consequences. Basing their conclusions on only one study, the APA surprised no one by claiming abortion had no more adverse impact on mental health than carrying a child to delivery. I revealed here that the APA had secretly formed this task force after a series of research reports in late 2005 found links between abortion and adverse mental health consequences for some women. New research confirms that concern is warranted.
3. Golden Rule Pledge – In the wake of Sally Kern saying homosexuality was a greater threat to the nation than terrorism, I initiated the Golden Rule Pledge which took place surrounding the Day of Silence and the Day of Truth. Many conservative groups were calling for Christian students to stay home. This did not strike me as an effective faith-centered response. The Golden Rule Pledge generated some controversy as well as approval by a small group of evangelicals (e.g., Bob Stith) and gay leaders (e.g., Eliza Byard). Some students taking part in the various events were positively impacted by their experience.
4. Exodus considers new direction for ministry – At a leadership training workshop early in 2008, Wendy Gritter proposed a new paradigm for sexual identity ministry. Her presentation was provocative in the sense that it generated much discussion and consideration, especially among readers here. It remains to be seen if Exodus will continue to move away from a change/reparative therapy focus to a fidelity/congruence ministry focus.
5. New research clarifies sexual orienatation causal factors – A twin study and a study of brain symmetry, both from Sweden and a large U.S. study shed some light on causal factors in sexual orientation.
6. Letter to the American Counseling Association requesting clarification of its policies concerning counseling same-sex attracted evangelicals. Co-signed by over 600 counselors (many of whom were referred by the American Association of Christian Counselors), I wrote a letter to the ACA requesting clarification regarding how counselors should work with evangelicals who do not wish to affirm homosexual behavior. The current policy is confusing and gives no guidance in such cases. Then President Brian Canfield replied affirming the clients self-determination in such cases. He referred the matter back to the ACA ethics committee. To date, that committee has not responded.
7. Paul Cameron’s work resurfaces and then is refuted – Insure.com resurrected Paul Cameron’s work in an article on their website about gay lifespans. The article was later altered to reflect more on HIV/AIDS than on homosexual orientation. Later this year, Morten Frisch produced a study which directly addressed Cameron’s methods.
8. Mankind Project unravels – This year I posted often regarding the Mankind Project and New Warriors Training Adventure. Recently, I reported that MKP is in some financial and organizational disarray.
9. Debunking of false claims about Sarah Palin’s record on support for social programs – I had lots of fun tracking down several false claims made about Sarah Palin during the election. Her opponents willfully distorted her real record to paint her as a hypocrite. I learned much more about Alaska’s state budget than I ever wanted to know but found that most claims of program cuts were actually raises in funding which not quite as much as the agencies requested. However, overall funding for such programs increased.
10. During the stretch run of the election, I became quite interested in various aspects of the race. As noted above, I spent some time examining claims surround Sarah Palin’s record. I also did a series on President-elect Obama’s record on housing, including an interview with one of Barack Obama’s former constituents.
I know, I know, number 10 is an understatement. (Exhibit A)
Happy New Year!