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.
Category: Professional issues
Gay City News prints letter clarifying sexual identity therapy
Part of the chorus of dissent bringing down the recent APA symposium was an April 24 article in the Gay City News, called “Junk Science on Stage.” In that article, some false claims were made about sexual identity therapy and my work. I addessed themhere on the blog recently.
Generally, “junk science” is a phrase used by advocates when they want to discredit views with which they disagree. The tobacco industry used the term to describe the research on second hand smoke and generally the term is little more than an ad hominem attack. Such was the case in the GCN report.
So I am glad that Paul Schindler, editor of GCN and author of the article in question, allowed me to make the record clear about the SIT framework. At the end of the letter, he acknowledges the error.
UNDERSTANDING SEXUAL IDENTITY THERAPY
05/22/2008
To the Editor:
In “Junk Science on Stage” (by Paul Schindler, Apr. 24-30), a claim was made about the Sexual Identity Therapy framework. The SIT framework was to be presented at the cancelled May 5 American Psychiatric Association symposium on religion, therapy, and homosexuality.
Gay City News described SIT this way: “‘Sexual Identity Therapy,’ which [Throckmorton] says he has successfully applied to help patients ‘alter homosexual feelings or behaviors’ and live their lives ‘heterosexually’ with ‘only very few weak instances of homosexual attraction.'”
This is false. The article attributes to me claims about SIT I have never made. In fact, the SIT framework says this: “Prior to outlining the recommendations, let us define what they are not. They are not sexual reorientation therapy protocols in disguise.”
The SIT framework, first contemplated formally in 2005, does not provide any means to do what the Gay City article references – “alter homosexual feelings…” etc. These quotes are taken out of context from a 1999 speech. Putting these phrases in quotes makes it appear that I was interviewed for the article and quoted in reference to SIT, which is not true.
Endorsed by Robert Spitzer, the former editor of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and former American Psychological Association president Nicholas Cummings, the SIT framework provides guidance for therapists who work with clients experiencing sexual identity conflicts but does not prescribe beliefs about homosexuality or religion. The SIT framework specifically discourages several practices conducted by reparative therapists and so it is disappointing that the Gay City News wrongly suggested that my presentation would somehow support their work.
Warren Throckmorton, PhD
www.sexualidentity.blogspot.com
EDITOR’S NOTE: Paul Schindler acknowledges Dr. Warren Throckmorton’s advisory that he made the statements about the results of his therapeutic work, quoted in Schindler’s article, prior to the development of his Sexual Identity Therapy framework.
Note my statement about reparative therapy. You cannot be in compliance with the SIT framework and tell clients that you (the therapist) know why people are homosexual. Explaining a theory and helping clients find themselves in it is not the way we believe this work should be done. We likewise do not promote a view of same-sex attraction that views it as a disorder to be cured or grow out of. The GCN article created a false picture of what the symposium would discuss and falsely attacked me for trying to promote views I do not hold.
60 Minutes Science of Sexual Orientation: An update from the mother of twins
Recently, I posted a link to a NPR broadcast outlining two approaches to treating children who are gender non-conforming in their play and activity preferences. In light of that broadcast and the controversies surrounding these different approaches, I provide an update from Danielle, the mother of twin boys first featured in a 60 Minutes broadcast originally aired on March 12, 2006. The segment, titled Science and Sexual Orientation, was by any measure a provocative program. The producer answered numerous questions about the show on the CBS website and many blogs, including this one, provided commentary. I still use the clip in some of my classes to illustrate a variety of issues regarding how the media interprets sexual orientation research.
One of the most interesting aspects of the show was Leslie Stahl’s interview with twin 9-year-old boys, Adam and Jared. Recently, the mother of the twins, Danielle, wrote researcher Michael Bailey with an update regarding her son, Adam. Dr. Bailey and Danielle allowed me to share the note on the blog. She does not preach or lecture but rather reports on her experience. First, to set the stage, I want to reproduce an excerpt of the 60 Minutes segment introducing Adam and Jared:
The bedrooms of 9-year-old twins Adam and Jared couldn’t be more different. Jared’s room is decked out with camouflage, airplanes, and military toys, while Adam’s room sports a pastel canopy, stuffed animals, and white horses.
When Stahl came for a visit, Jared was eager to show her his G.I. Joe collection. “I have ones that say like Marine and SWAT. And then that’s where I keep all the guns for ’em,” he explained.
Adam was also proud to show off his toys. “This is one of my dolls. Bratz baby,” he said.Adam wears pinkish-purple nail polish, adorned with stars and diamonds.
Asked if he went to school like that, Adam says, “Uh-huh. I just showed them my nails, and they were like, ‘Why did you do that?'”
Adam’s behavior is called childhood gender nonconformity, meaning a child whose interests and behaviors are more typical of the opposite sex. Research shows that kids with extreme gender nonconformity usually grow up to be gay.
Danielle, Adam and Jared’s mom, says she began to notice this difference in Adam when he was about 18 months old and began asking for a Barbie doll. Jared, meanwhile, was asking for fire trucks.
Not that much has changed. Jared’s favorite game now is Battlefield 2, Special Forces. As for Adam, he says, “It’s called Neopets: The Darkest Faerie.”
Asked how he would describe himself to a stranger, Jared says, “I’m a kid who likes G.I. Joes and games and TV.”
“I would say like a girl,” Adam replied to the same question. When asked why he thinks that is, Adam shrugged.
In this email, Danielle reveals that at one time Adam thought he would like to be a girl. In fact, she considered puberty delaying drugs to allow Adam more time to reflect about his gender identity. At one point, he wanted to be a girl and bear a child via his own body.
With this update, Danielle discloses that Adam is not as definite about wanting to transition as he once was. She reports that he has adopted a male identification, albeit a somewhat unconventional one. Here is her update:
Adam has changed since we did the 60 Minutes show. He is the same yet different. From the research done a gazillon years ago about children like him- he’s basically following the guidelines as they were told to me. One day I would love to get my hands on the actual research papers! Anyway, he turns 12 on [recently]. He still shows a preference for society labeled “girl” items, yet he no longer states he wants to change his body into a girl. He no longer talks about having a baby from his actual body or wanting to know when he will start to grow his breasts.
I think most of these changes are due to society (school peers) and his awareness of the actual facts of life. His favorite color is now purple instead of pink and he still prefers to buy “girl” tennis shoes. He dreams of becoming an actor/model and being a professional chef. As I stated, from what I know of this past research, he’s reaching the age where he’s blending in with his peers. I expect the next two years of Middle School to be difficult ones. Then he goes into High School where differences are just a way of life. I’m thinking he may actually find out who he is some time towards the end of High School. Again it follows what I know of this mysterious research paper.
I belong to several email groups with other families that have children like Adam. I don’t participate much because I’m not sure if most of them are following the right path with their children. 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 felt he was a girl yet he was really a boy and couldn’t be a girl. A lot of the parents are allowing their children to grow long hair, dress 100 % as a girl, and go to school with a girl name and girl clothing. Therefore they are totally embracing their child in the opposite sex role. The children are living that role and that life style. So have I done my son an injustice by telling him that he has a boy’s body and even if he wants to be a girl during school hours he had to be the boy as his body was made? Then again, I have allowed him to wear just about anything he was comfortable wearing.
It’s a dilemma that I don’t think we will know the end of until this generation of children grows up. What happens if some of these children that have male bodies but are living life as a girl all through grade school finally reach an age where they decide they really don’t want to have a sex change and be a physical girl? Then what will the ramifications be on that child because of the parents’ actions?
It’s not like my child has Down syndrome and I can go to the library and check out 100s of books to get guidance on how to raise him. There just isn’t much out there for parents who face raising a child like my Adam. I have so many questions about parenting him and very little answers. So I go with my gut and wonder daily if I have made the wrong decision or if these other parents are making the wrong decision. Then again, what may be the wrong decision for one child in this situation may be the right decision for the other. Ah, what a world we live in! Fifty years ago we wouldn’t even be having these types of conversations or email groups.
I have to share something about Adam. I have often wondered how these other kids are developing compared to Adam. Many in the groups have started hormone therapy to stop puberty in the kids. That way the kids have more time to mature and make the final decision about the course of their lives. For the boys they won’t develop the deeper voice and the Adam’s apple and male characteristics. If they decide to transition the theory is that it will be easier without these developments. I made an appointment for Adam to have some baseline tests done. I was seriously thinking about doing the hormone therapy for him to give him more time too. However, much to my surprise he was ready deep into puberty. The doctor said we could still proceed with it but I really couldn’t expect to have undone what was already there. He was developing much earlier than expected. Now his twin, Jared, still hasn’t started into puberty. So, my question is – with boys that follow gender non-conformity – do they start developing earlier than their peers? I realize we won’t have the answer for many, many more years to come.
First of all, I am grateful to Danielle and Dr. Bailey for permission to reproduce this communication. Second, I think it is important for clinicians and advocates alike to reflect on what we can learn from this experience. As far as I can determine from available research, most boys who want to be girls later become men who don’t want to become women. Using the new paradigm with Adam may have altered his future in ways that could have added significant complication to his life.
Given that this email was sent to Dr. Bailey, I asked him for commentary.
Danielle is an admirable and unusual mother. She went to great lengths to protect Adam and to show him that she loved him regardless of his gender-related behavior and self-concept. She let Adam express his femininity (e.g., fill his room with “girls'” toys), while providing him with honest feedback about the likely results of his choices, outside their home. She also hesitated–in my view sensibly so–from encouraging Adam to begin a gender transition during childhood. I have met Adam, and I have read Danielle’s updates. I would be surprised at this point if Adam decides to change his sex. He seems a happy boy, and I expect he will become a happy young gay man.
I wonder, with Danielle, about the implications for gender-atypical children whose parents take the other, emerging, approach: allowing children to change their genders preliminary to biological sex changes in adolescence. Children like Adam start showing their behavior early (Adam at 18 months). All evidence we have suggests that only a minority (20% or fewer) of boys like Adam become women eventually. But if parents let boys become girls at childhood, will this drive up the probability? It seems highly plausible that it would. Sex reassignment is not minor medical intervention. It involves major surgery and lifelong hormonal treatments. All other things being equal, sex reassignment is something to be avoided. Of course, not all other things are equal. If a 6 year old boy wants to be a girl, it will cause him more short-term pain to refuse than to acquiesce. The costs and benefits are hard to estimate, and Danielle has been frustrated in her search for data-supported answers. It would be a fitting reward to her admirable example if people could set aside their differences (and the government could uncharacteristically support research on a controversial topic relate to sex), and begin to collect and share requisite data.
Danielle and Adam should remind us that even if treated liberally, gender-atypical children will not necessarily choose sex reassignment. Indeed, perhaps the most liberal goal of all is to allow gender-atypical children to be comfortable in their own (non surgically altered) skin. By all appearances, that is what Danielle has accomplished.
Since this email, I have corresponded more with Danielle. She has added some additional detail which I will report tomorrow. Specifically, she describes how she has responded to Adam when he has expressed questions about transitioning.
David Scasta talks on NPR about the APA symposium
On NPR’s Bryant Park Project, David Scasta talked about the cancelled symposium. You will need to listen to the audio to get the discussion since the article is not a transcript.
I will have some comments about this as the day goes on…
Ken Zucker compares ethnic identity conflict and gender identity conflict
Ken Zucker, a psychologist featured in the NPR series on gender identity, recently posted the following on the SEXNET listserv. Are ethnic identity conflict and gender identity conflict analogous? In this post, Dr. Zucker addresses the topic and I thank him for giving me permission to re-post it here:
In the interview I had with the NPR journalist, Alix Spiegel, I posed the question: How would a clinician respond to a young child (in this instance a Black youngster) who presented with the wish to be White? I had already sent Ms. Spiegel an essay that I published in 2006 in which I had presented this analogy and she told me that she was intrigued by the argument.
In this post, I list some references that I have accumulated over the years that discusses issues of ethnic identity conflict in children and adults. In the 2006 paper, I was particularly influenced, rightly or wrongly, by an essay Brody (1963) wrote many years ago. I think it is worth reading. Thus, I did not invent the analogy out of thin air. I had been influenced by three things: first, I was aware of this literature on ethnic identity conflict and I thought it had some lessons in it; second, I had observed, over the years, that some kids that I have seen in my clinic who had a biracial ethnic background also sometimes struggled with that (e.g., wanting to be White, like their mother, and not wanting to be Black or non-white Hispanic, like their father) or wanting to be an American (and not a Canadian) or wanting to be a dog (and not a human). I have thought about these desires as, perhaps, an indication of a more general identity confusion. Third, I was influenced by a remark Richard Pleak made in a 1999 essay, in which he wrote that the notion that “attempting to change children’s gender identity for [the purpose of reducing social ostracism] seems as ethically repellant as bleaching black children’s skin in order to improve their social life among white children” (p. 14). I thought about his argument and decided that it could be flipped. Thus, in the 2006 essay, I wrote:
This is an interesting argument, but I believe that there are a number of problems with the analysis. I am not aware of any contemporary clinician who would advocate “bleaching” for a Black child (or adult) who requests it. Indeed, there is a clinical and sociological literature that considers the cultural context of the “bleaching syndrome” vis-a-vis racism and prejudice (see, e.g., Hall, 1992, 1995). Interestingly, there is an older clinical literature on young Black children who want to be White (Brody, 1963)–what might be termed “ethnic identity disorder” and there are, in my view, clear parallels to GID. Brody’s analysis led him to conclude that the proximal etiology was in the mother’s “deliberate but unwitting indoctrination” of racial identity conflict in her son because of her own negative experiences as a Black person. Presumably, the treatment goal would not be to endorse the Black child’s wish to be White, but rather to treat the underlying factors that have led the child to believe that his life would be better as a White person. As an aside, there is also a clinical literature on the relation between distorted ethnic identity (e.g., a Black person’s claim that he was actually born White, but then transformed) and psychosis (see Bhugra, 2001; Levy, Jones, & Olin, 1992). Of course, in this situation, the treatment is aimed at targeting the underlying psychosis and not the symptom.
The ethnic identity literature leads to a fundamental question about the psychosocial causes of GID, which Langer and Martin do not really address. In fact, they appear to endorse implicitly what I would characterize as “liberal essentialism,” i.e., that children with GID are “born that way” and should simply be left alone. Just like Brody was interested in understanding the psychological, social, and cultural factors that led his Black child patients to desire to be White, one can, along the same lines, seek to understand the psychological, social, and cultural factors that lead boys to want to be girls and girls to want to be boys. Many contemporary clinicians have argued that GID in children is the result, at least in part, of psychodynamic and psychosocial mechanisms, which lead to an analogous fantasy solution: that becoming a member of the other sex would somehow resolve internalized distress (e.g., Coates, Friedman, & Wolfe, 1991; Coates & Person, 1985; Coates & Wolfe, 1995). Of course, Langer and Martin may disagree with these formulations, but they should address them, critique them, and explain why they think they are incorrect. I would argue that it is as legitimate to want to make youngsters comfortable with their gender identity (to make it correspond to the physical reality of their biological sex) as it is to make youngsters comfortable with their ethnic identity (to make it correspond to the physical reality of the color of their skin).
On this point, however, I take a decidedly developmental perspective. If the primary goal of treatment is to alleviate the suffering of the individual, there are now a variety of data sets that suggest that persistent gender dysphoria, at least when it continues into adolescence, is unlikely to be alleviated in the majority of cases by psychological means, and thus is likely best treated by hormonal and physical contra-sex interventions, particularly after a period of living in the cross-gender role indicates that this will result in the best adaptation for the adolescent male or female (e.g., Cohen-Kettenis & van Goozen, 1997; Smith, van Goozen, & Cohen-Kettenis, 2001; Zucker, 2006). In childhood, however, the evidence suggests that there is a much greater plasticity in outcome (see Zucker, 2005a). As a result, many clinicians, and I am one of them, take the position that a trial of psychological treatment, including individual therapy and parent counseling, is warranted (for a review of various intervention approaches, see Zucker, 2001). To return briefly to the ethnic identity disorder comparison, I would speculate that one might find similar results, i.e., that it would be relatively easier to resolve ethnic identity dissatisfaction in children than it would be in adolescents (or adults). Although I am not aware of any available data to test this conjecture, I think of Michael Jackson’s progressively “white” appearance as an example of the narrowing of plasticity in adulthood.
Two caveats: first, the literature on psychosis and ethnic identity conflict that is cited in no way was meant to imply that transgendered people are psychotic; the comparison is to a very small number of people who have “delusions” of gender change in which the primary diagnosis is Schizophrenia. This was first noted in the DSM-III and remains in the DSM-IV text description; second, I can criticize my own argument along these lines: “Well, this may all be true, but surely there is no evidence for a biological factor that would cause a Black person to want to be White, but maybe there is a biological factor or set of biological factors that either predispose or cause a person with the phenotype of one sex to feel like they are of the other sex (gender).” And to that I would say fair enough.
Bhugra, D. (2001). Ideas of distorted ethnic identity in 43 cases of psychosis. International Journal of Social Psychiatry, 47, 1-7.
Brody, E. B. (1963). Color and identity conflict in young boys: Observations of Negro mothers and sons in urban Baltimore. Psychiatry, 26, 188-201.
Brunsma, D. L., & Rockquemore, K. A. (2001). The new color complex: Appearances and biracial identity. Identity: An International Journal of Theory and Research, 1, 225-246.
Fuller, T. (2006, May 14). A vision of pale beauty carries risks for Asia’s women. New York Times.
Goodman, M. E. (1952). Race awareness in young children. Cambridge: Addison-Wesley.
Hall, R. (1992). Bias among African-Americans regarding skin color: Implications for social work practice. Research on Social Work Practice, 2, 479-486.
Hall, R. (1995). The bleaching syndrome: African Americans’ response to cultural domination vis-B-vis skin color. Journal of Black Studies, 26, 172-184.
Lauerma, H. (1996). Distortion of racial identity in schizophrenia. Nordic Journal of Psychiatry, 50, 71-72.
Levy, A. S., Jones, R. M., & Olin, C. H. (1992). Distortion of racial identity and psychosis [Letter]. American Journal of Psychiatry, 149, 845.
Mann, M. A. (2006). The formation and development of individual and ethnic identity: Insights from psychiatry and psychoanalytic theory. American Journal of Psychoanalysis, 66, 211-224.
Russell, K., Wilson, M., & Hall, R. (1992). The color complex: The politics of skin color among African Americans. New York: Harcourt Brace Jovanovich.
Sanders Thompson, V. L. (2001). The complexity of African American racial identification. Journal of Black Studies, 32, 155-165.
Schneck, J. M. (1977). Trichotillomania and racial identity [Letter to the Editor]. Diseases of the Nervous System, 38, 219.
Stephan, C. W., & Stephan, W. G. (2000). The measurement of racial and ethnic identity. International Journal of Intercultural Relations, 24, 541-552.
Tate, C., & Audette, D. (2001). Theory and research on ‘race’ as a natural kind variable in psychology. Theory & Psychology, 11, 495-520.
Ken Zucker