It started when one of my travels through the swamps of the wingnut-o-sphere turned up this article talking about how a young transsexual is receiving treatment in Germany. Naturally, the even more wingnutty crowd over at "Americans For Truth" had to pop up echoing statements made by the ironically male spokescreep for "Concerned Women for America" here - both of which are suddenly instant experts in the topic of gender identity. (Normally both of these groups claim to be experts on homosexuality, but recently they have begun turning their vitriolic attacks towards transgender/transsexual people as well)
The Lifesite article contains all sorts of the usual hostility towards the young person and the practitioners involved. It starts with placing the word diagnosis in quotes in the headline and more or less heads downhill from there. They pull up a US psychiatrist, Dr. Paul McHugh to heap scorn on the diagnosis of the German therapists involved in the case. (From what I can tell, McHugh is one of several psychiatrists whose work is often cited by groups like NARTH, whose sole objective is to invalidate the life experiences of anyone who doesn't fit into a pretty narrow view of "normal")
A little more digging turns up a much longer, but more reasonable analysis on Speigel's website. The Spiegel article tells us quite a bit about Kim, and she sounds like a pretty typical 14 year old girl to me (even if the chromosomes would say otherwise). Whether intentional or not, the article quite nicely "normalizes" the whole business:
His parents found stories on the Internet about men and women who felt so unhappy in their own bodies as children that they came out as transsexuals and underwent sex-change operations as adults. They weren't all freaks -- there were engineers and lawyers, artists, programmers and teachers -- and it wasn't easy.
...
The P. family wanted a less complicated future for their Tim, but they've also found reasons for optimism. They've learned that transsexuality has nothing to do with homosexuality. It's not about feather boas and red-light districts so much as identity. Transsexuals aren't "queer birds" -- they want the perfectly normal life of the opposite sex.
Ah, now we start to get a sense that this isn't just "something out of the blue", or even necessarily all that surprising. (Baffling to someone who has not encountered the condition perhaps, but not necessarily surprising in the greater picture of human diversity)
There's a couple of things about the Lifesite (and other wingnut faction) articles that really bothers me. First, is the insinuation that the diagnosis is somehow questionable on the basis of the age of the patient. It also seems to try implying that the diagnosis is somehow an ad-hoc thing.
A dig through my copy of the DSM-IV (TR), turns up a quite a lengthy discussion of the clinical aspects of transsexualism. Lurking in the diagnostic criteria, I find the following bits:
Diagnostic Criteria for Gender Identity Disorder
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).
In children, the disturbance is manifested by four (or more) of the following:
(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) In boys, preference for cross-dressing or simulating female attire; in girls insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex.
(4) intense desire to participate in the stereotypical games and pastimes of the other sex.
(5) strong perference for playmates of the other sex
...
B. Persistent discomfort with is or her sex or sense of inappropriateness in the gender role of that sex.
In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear orassertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; ...
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
[DSM IV-TR, P 581]
I've only included the criteria for children, as that is a significant component of what is described in the Spiegel article:
At the age of two, Tim tried on his older sister's clothes, played with Barbies and said, "I'm a girl." Her parents thought it was a phase, but at the age of four Tim was still bawling after every haircut. At last he ran into his room with a pair of scissors and hollered that he wanted to "cut off my thing!" -- and it was clear to his parents that the problem was serious. From then on, at home, Tim went by "Kim."
After studying the DSM, I found myself curious about the guidelines for treatment that might be in play - especially in a tricky situation such as one involving a youth. A bit of searching with Google eventually led me to The World Professional Association For Transgender Health (Formerly the "Harry Benjamin International Gender Dysphoria Association"), which has what is probably the definitive set of professional guidelines regarding the treatment of transsexuals.
Sure enough, there is a rather lengthy chapter talking about the guidelines around treating the condition in youth. Unsurprisingly, they are also not "absolute" rules, but carefully nuanced in their writing so that a professional will be able to adapt them appropriately to a situation.
For example, when psychological intervention is sought:
Psychological and Social Interventions. The task of the child-specialist mental health professional is to provide assessment and treatment that broadly conforms to the following guidelines:
1. The professional should recognize and accept the gender identity problem. Acceptance and removal of secrecy can bring considerable relief.
2. The assessment should explore the nature and characteristics of the child’s or adolescent’s gender identity. A complete psychodiagnostic and psychiatric assessment should be performed. A complete assessment should include a family evaluation, because other emotional and behavioral problems are very common, and unresolved issues in the child’s environment are often present.
3. Therapy should focus on ameliorating any comorbid problems in the child’s life, and on reducing distress the child experiences from his or her gender identity problem and other difficulties. The child and family should be supported in making difficult decisions regarding the extent to which to allow the child to assume a gender role consistent with his or her gender identity. ...
If you've read this in any detail, it should be quite clear that these guidelines were not drawn up "ad-hoc", but rather are carefully constructed to oblige the professionals involved to be very careful and thorough in their assessment of the situation they are presented with. (I grant, it's rather like reading legalese or other domain specific languages, and most readers will no doubt scan it)
The Wingnuts make it sound like the parents have almost committed child abuse by helping their daughter realize herself. If you read the Spiegel article, and the HBIGDA Standards of Care against each other, it becomes quite clear that although they have certainly chosen the more difficult path as a family, it is certainly not a form of abuse nor does it appear that coercion is involved.
The right-wingnuts have started using the term "gender confusion" lately. It has been derived from the notion of "gender dysphoria" (where dysphoria often referred to a complex set of emotions expressed by transsexual patients as a result of the conflict they felt between their identity and their physical selves). It may seem ironic, but it seems to me that the least confused person is the young lady in question. Lifesite's authors, Peter LaBarbera and "Concerned Women for America" are the people who are really confused.
[Update]
I received a link to this story - I wonder if it will make it onto the radar scope of Mr. LaBarbera or not?
[/Update]
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