Thursday, January 22, 2009

NARTH Demonstrates Their "Science"

I see that NARTH has decided to brag about their recent appearance on Dr. Phil.

Here's Nicolosi's statement.

I took the position that children should not, however, be encouraged to think of themselves--and live as--as the opposite sex. All of the other psychotherapists disagreed with me.

An opening position that sits in direct conflict with the WPATH Standards of Care for managing transgender clients.

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. This includes issues of whether to inform others of the child’s situation, and how others in the child’s life should respond; for example, whether the child should attend school using a name and clothing opposite to his or her sex of assignment. They should also be supported in tolerating uncertainty and anxiety in relation to the child’s gender expression and how best to manage it. Professional network meetings can be very useful in finding appropriate solutions to these problems.

Then Nicolosi goes on to pronounce the following:

"Gender-identity disorder is primarily an attachment problem." These words, spoken by me during the TV interview, were edited out, but they are critical to the understanding of gender-disturbed children. No one on the show discussed this issue.

Where to start with that steaming turd of idiocy? Besides being a classic reframing of the standard right wing 'blame the parents' approach to GLBT people in general, it's just plain wrong. Transsexuals come from all backgrounds, and most are disappointingly ordinary.

Experts in the area of childhood gender-identity disorder (GID) have found certain patterns in the backgrounds of GID children. A common scenario is an over-involved mother with an intense, yet insecure attachment between mother and child. Mothers of GID children usually report high levels of stress during the child's earliest years.

Besides the fact that Nicolosi conveniently doesn't refer to any published papers to substantiate this claim, the claim itself doesn't make any sense when held up against the stories of so many who have transitioned. Raising children is difficult, stressful work to begin with, and raising a child who is transgender - and expresses such at an early age - is going to be all the more so because most parents have no idea what they are dealing with.

The infantile dynamic of "imitative attachment" is such that "keeping Mommy inside" becomes truly a life-or-death issue - "Either I become Mommy, or I cease to exist." This explains why gender-disturbed boys are willing to tolerate social rejection for their opposite-sex role-playing--it feels like death to abandon this perception of themselves as a female.

This is pure conjecture on Nicolosi's part. We do not know enough about how personality develops to make such claims - especially with respect to what is going on in an infant's mind. The one thing I will say is that parents (and other adults) routinely underestimate just how much babies understand of what is going on around them.

No one on the Dr. Phil Show mentioned the implications of taking the opposite approach--actively preparing a boy for future sex-change surgery. Surgery can never truly change a person's sex. Doctors can remove the male genitals and form an imitation of the sex female sex organs, but they cannot make the simulated organs reproductively functional--nor can they change the DNA which exists in every cell of the boy's body to indicate that he is, and always will be, biologically a male.

For starters, this is neither news, nor is it filled with unstated implications. Again, I refer to the WPATH Standards of Care for a clearer sense of guidance in the treatment of youthful transsexuals:

Physical interventions fall into three categories or stages:
1. Fully reversible interventions. These involve the use of LHRH agonists or
medroxyprogesterone to suppress estrogen or testosterone production, and consequently
to delay the physical changes of puberty.
2. Partially reversible interventions. These include hormonal interventions that masculinize
or feminize the body, such as administration of testosterone to biologic females and
estrogen to biologic males. Reversal may involve surgical intervention.
3. Irreversible interventions. These are surgical procedures.
Fully Reversible Interventions. Adolescents may be eligible for puberty-delaying hormones as soon as pubertal changes have begun. In order for the adolescent and his or her parents to make an informed decision about pubertal delay, it is recommended that the adolescent experience the onset of puberty in his or her biologic sex, at least to Tanner Stage Two.
Partially Reversible Interventions. Adolescents may be eligible to begin masculinizing or feminizing hormone therapy as early as age 16, preferably with parental consent. In many countries 16-year olds are legal adults for medical decision making, and do not require parental consent.

Mental health professional involvement is an eligibility requirement for triadic therapy during adolescence. For the implementation of the real-life experience or hormone therapy, the mental health professional should be involved with the patient and family for a minimum of six months.
Irreversible Interventions. Any surgical intervention should not be carried out prior to adulthood, or prior to a real-life experience of at least two years in the gender role of the sex with which the adolescent identifies. The threshold of 18 should be seen as an eligibility criterion andnot an indication in itself for active intervention.

The term 'informed consent' echoes throughout the WPATH SOC. Nobody is talking about surgically altering anybody until the person is old enough to make their own decision on the matter - when they are old enough to make those decisions in the full knowledge of the consequences.

Further, Gender Reassignment Surgery is often necessary to remove the potential for discrimination to take place - namely the legal requirement for surgery before key identification documents may be changed to reflect the individual's chosen gender. Nobody undergoes GRS with any illusions about the limitations of that procedure.

We believe that every effort should be made to help a gender-disturbed boy accept his biological maleness, and be comfortable in life with the intact (not surgically mutilated) body with which he was born.

Again, I refer Mr. Nicolosi back to the WPATH Standards of Care for more practical guidance. Attempting to 'make' a transgender child act different than they express so openly is merely asking for that individual to grow up at war with themselves - a painful state to condemn anyone to. As I have stated before on this blog, and elsewhere, the ethical considerations of managing youthful transition are being actively studied and considered. The reason that the SOC today addresses GID in youth in the cautious way it does is explicitly because practitioners have already learned that GID in youth causes very real distress that needs to be addressed constructively, not suppressed or denied.

With this latest episode, NARTH simply continues to demonstrate what so many in the GLBT world have claimed for so long - that they exist not to do real research, but rather to put a face of legitimacy on the suppositions that religious conservatives make about transsexuals and other sexual minorities in the first place.

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