Sunday, May 20, 2007

Distorting Reality ... Further

My semi-regular traipse through the religious right-wing blogs and news aggregators turned up a particularly ridiculous piece about Boston Children's Hospital opening a pediatric gender clinic.

To read the Lifesite article, one would think that they were proposing to offer young children all sorts of things that children shouldn't need to deal with:

Dr. Spack’s interest in transgender issues has included association with bondage and sadomasochistic groups—he presented a workshop at the Transcending Boundaries conference in Worcester last November, organized by PFLAG and co-sponsored by the New England Leather Alliance.


Of course, one might rightly wonder if there is a moral justification for trying to force a child to be dishonest with themselves, as it is not unusual for transgender people to report that they "knew" by the time they were old enough to understand that boys and girls are different.

I find it particularly amusing that Lifesite tries to tie Dr. Spack's work back to both the Gay and Lesbian world as well as to the BDSM. While an interest in human sexuality is going to lead (eventually) to contact with transgender people, inferring a relationship between gender identity and BDSM is laughably irrational.

Certainly, in recent months, there have been stories in the news about young transsexuals receiving treatment that have caused a stir among the "social conservatives" who seem utterly incapable of empathizing with anybody.

Anyhow, I went digging to see just how badly Lifesite's pseudo-journalism had mangled reality. A few minutes with Google turned up some much more reasonable information, starting with this news release.

On February 23, a new multidisciplinary clinic at Children's Hospital Boston's saw its first patients with what are called disorders of sexual differentiation (DSD). ... While Children's has long treated the physical manifestations of DSDs, the new clinic is also designed to address psychosocial issues that may arise from genital and gonadal variability. In addition to urologists, endocrinologists and geneticists, the team includes social workers, nurses who have run support groups and a research psychologist.


Okay, now we start to get something resembling a bit of sanity here. We aren't talking about "just" transsexuals, but also intersex children. Knowing that in recent years, the idea of treating intersex cases as some kind of emergency that required immediate surgical intervention has been questioned
, it's not surprising that hospitals would start to offer services which involve the child as well:

In the past, DSDs were regarded as medical emergencies that needed to be addressed immediately. Parents were not always involved in the decision-making process, which varied from center to center. In recent years, however, adult patients have formed national advocacy groups that have changed the thinking about how to manage DSDs, and today, families are intimately involved in the decisions.

"It's more important to make the best decision than to make the fast one," says Norman Spack, MD, of the Endocrinology division at Children's, who co-directs the new clinic with David Diamond, MD, of Urology. "In some cases, it can take weeks to decide what's best for the patient," he says. "It's a team decision now, and no matter what's done, the parents need support and the children need to be followed." Follow-up research will be conducted to determine the efficacy of the approaches taken and patient satisfaction as they enter adult life.


If you are going to deal with the ambiguity of intersex patients, it seems not unreasonable to extend the clinical mandate to include gender identity patients as well, which is what this clinic appears to have done:

Unique in the Western hemisphere, the clinic will also care for children and young adults who present as transgendered—those who have no known anatomic or biochemical disorder, yet feel like a member of the opposite sex. Such feelings can emerge early, even in the preschool years, and can cause considerable psychological distress. For that reason, transgendered young people are often assumed to have a psychiatric disorder and are placed on psychotropic medications. By late adolescence, a high percentage have attempted suicide.


Ah - something considerably more intelligible emerges from the picture. Again, the reality is far from the hysterical screaming of Lifesite's authors, and grounded in a legitimate concern on the part of the practitioners for the well being of the patients. I believe the correct term would be "empathy" - something that the howling nuts at Lifesite have completely lost somewhere along the way.

Of course, The HBIGDA Standards of Care for transgender youth are pretty clear about the caution with which treatment must proceed:

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. ...


Although the Clinic does not state that they are aligning their practice with the long-established SOC guidelines, it seems unlikely to me that they would deviate significantly from them either. Those guidelines have been in use for quite some time now.

[Update:]
The Toronto Star has an interesting article about young transsexuals this morning. (Which reflects the commentary made by the gender clinic above)
[/Update]

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