Several commenters have mentioned and quoted from Michael Bailey’s book, The Man Who Would Be Queen.
Click this link to read the first two chapters of the book.
The Man Who Would Be Queen is published by Joseph Henry Press.
PS – Much has gotten in the way of the second part of Danielle’s remarks on gender identity issues, but they are coming soon…
Tag: Michael Bailey
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.
APA issues statement regarding GID and the DSM-V
The American Psychiatric Association released a statement on Friday regarding some “inquiries about the DSM-V process.” I suspect many of those inquiries have focused on the disputes over treatment highlighted by the recent NPR broadcast on gender identity, often involving Dr. Ken Zucker. I asked Ken Zucker and Michael Bailey for their reactions to this press release from a transgender advocacy group. Dr. Zucker declined to comment, but sent the following APA statement. Dr. Bailey’s comment follows.
APA STATEMENT ON GID AND THE DSM
May 9, 2008
The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.
The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.
The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.
There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.
All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.
The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:
– Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.
– Paraphilias, chaired by Ray Blanchard, Ph.D.
– Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.
Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012.
Regarding the Transactive organization’s statement about the DSM-V, Dr. Bailey took strong exception to this statement:
“Zucker has stated that a secure gender identity possibly prevents the development of later homosexuality. This raised several red flags for those of us who work with gender non-conforming children, youth and their families. TransActive’s position is that “prevention of homosexuality” should not be the concern of childhood gender identity specialists.”
To which, Bailey said:
This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.
I agree with Bailey, I have seen nothing which would suggest Zucker has a stake in the eventual sexual orientation of children. And I certainly agree with the last sentence which has some special significance to me in light of the cancellation of the APA symposium.
In my opinion, there are some advocates who implore various audiences to trust science but really do not want this unless the outcome suits their advocacy goals.
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
Genes and sexual orientation: Tale of two activists
Over at Americans for Truth About Homosexuality (AFTAH), Pete LaBarbera alerted his readers that he was on WGN last night in connection with a story about “gay genes.” He noted in a mass email yesterday (did anyone see it?):
Americans For Truth will be featured tonight in a story on the cable super-station WGN-TV, based in Chicago, concerning the latest academic pursuit of the “gay gene.” It will air between 9:00 and 10:00 Central Time on WGN which reaches across the country. You can learn more about the (liberal biased) Northwestern U. “genetic homosexuality” study at www.gaybros.com. As you know, pro-homosexual advocates are seeking to prove that homosexuality is genetic — with the hope of then declaring the issue outside the bounds of moral debate.
While this is not a strong denouncement of the project, it appears that AFTAH believes the research led by Alan Sanders is biased from the start. LaBarbera is right that some activists would like to prove a genetic source of homosexuality (case in point below). However, what if there are genetic components to sexual orientation? Is there any way to discuss or research these factors without being considered “liberal” and/or “biased?” Isn’t a blanket dismissal of pre-natal factors just as biased?
On the other hand, as if to prove LaBarbera’s point, enter Wayne Besen’s new videos from Dean Hamer and Jack Drescher. To Dean Hamer, Besen poses the question, “Is homosexuality inborn?” Hamer replies that “there is more and more evidence that sexual orientation has a strong biological component.” Hamer then points to two “population based studies of twins.” One is Kendler’s study in the US and the other is Bailey and Martin’s study in Australia. Hamer says these studies “have shown that genes are the single most important factor in whether a person is gay or straight or somewhere in between.” He said the studies have been replicated and are convincing. I will save for another post a detailed response to those statements, but for now I will say that I do not agree with Dr. Hamer’s characterizations. For instance, in the Australian study, the actual concordance of homosexuality among male identical twins was only 11%. Kenneth Kendler and colleagues in 2000 found a higher concordance (31.6% combining males and females), but did not designate genetics as being a determining factor. About his study of twins, Kenneth Kendler told the BBC,
By no means is sexual orientation genetically determined but clearly genes are playing some role by interacting with a range of environmental factors.
Dr. Drescher’s video provides a more nuanced and I think accurate reading of research. About those who say they know what causes sexual orientation, Dr. Drescher says, “The truth of the matter is, we don’t know, nobody knows, and anybody who says that they know is lying to you.” Drescher also presents a reasonable view of the role of sexual abuse saying that for individual people, such abuse could play a role but as a general rule, believing abuse to be at root is an unfounded stereotype.
Now, coming full circle back to the website LaBarbera noted in his email – gaybros.com, we find a nuanced and I believe accurate view that cuts between activists Besen and LaBarbera. Here are a couple of excerpts:
At the present time, there is no uniformly accepted theory of why some men and some women develop a sexual orientation that is more or less exclusively focused on members of their own sex.
and
Most contemporary researchers believe that sexual orientation – the general disposition of people toward homosexuality, bisexuality, or heterosexuality – is the result of both biological factors and psychological experiences. Most researchers do not believe that sexual orientation is the result of nature (biology, including genetics) alone or nurture (environment) alone. What researchers want to know is how specific factors in biology and psychology interact to guide sexual development. These researchers therefore look for biological and psychological differences between homosexual and heterosexual people, both men and women.
Then after listing the many studies which find biological factors correlated with sexual orientation (e.g., finger length ratio differences, brain differences, etc.), the website says this:
These studies are designed to show a correlation between a trait and sexual orientation. This is not the same as showing that a trait causes sexual orientation. What is not yet known is whether these traits and sexual orientation have a common origin in genetics or other biological influences on development, though these hypotheses are being pursued. In any case, these lines of research are suggestive rather than definitive. Among other factors, it is these and other uncertainties that prompt continued research.
These statements sound anything but biased to me. All concerned would do well to heed them. Working hard to spin what is known may play well to activists but saying homosexuality is or isn’t all “genetic” or “inborn” or “environmental” does not well represent what is known. We need to follow the research where it leads and hold our theories loosely.