Saturday, February 15, 2014

Wente Is Getting It Wrong ... Again

I suppose it should come as little or no surprise that Margaret Wente is getting things wrong again.  This time, she is expounding on the treatment of transgender children.
Suddenly transgender kids are everywhere – in the news, on Dr. Phil and in your neighbourhood. School boards have developed detailed transgender policies. Clinics to treat transgender kids have sprung up. A condition that used to be vanishingly rare, perhaps one in 10,000 children or less, now seems common. In a random sampling of 6th- to 8th-graders in San Francisco, kids were asked if they identified as male, female or transgendered – 1.3 per cent checked off the transgendered box. 
She concludes with:

It’s a mark of social progress that we are increasingly willing to accept people on their terms, for who they are. But maybe we’re manufacturing more problems than we’re solving. If we really want to help people, we should remember the old rule: First, do no harm. 
Through the entire article, she relies on two authorities - Dr. Kenneth Zucker and Alice Dreger.   Zucker, along with his colleague at CAMH Ray Blanchard, have long been seen by the transgender community as deeply problematic - for good reason.

Ken Zucker is a psychologist at the Clarke Institute (aka "Jurassic Clarke") in Toronto. Zucker is famous for forcing gender-variant children into reparative therapy to conform to his expectations for male and female behavior in children. He considers transsexual women a "bad outcome" for gay men. 
Zucker is a darling of the "ex-gay" movement because of his work "curing" gender-variant children. Here is a piece featuring his work via ex-gay group NARTH (National Association for Research & Therapy of Homosexuals): 
Zucker promotes his NARTH-like notions of reparative therapy for kids with gender variance, reviewed here on another ex-gay site:
We already know that so-called "reparative therapy" doesn't work for homosexuality, what on earth makes Zucker, or anyone else, think that it has any validity for transgender people.

As for Ms. Dreger, anyone silly enough to get into bed with J. Michael Bailey and defend the atrocious work that he wrote called "The Man Who Would Be Queen" has a serious credibility problem in the first place.

Quoting from Ms. Dreger, Wente draws the following:
Here’s more unwelcome news from Ms. Dreger. A child’s gender issue may merely be a symptom of other family problems. “The dirty little secret is that many of these families have big dysfunctional issues. When you get the clinicians over a beer, they’ll tell you the truth. A lot of the parents aren’t well in terms of their mental health. They think that once the child transitions, all their problems will magically go away, but that’s not really where the stress is located.” Clinicians won’t say these things publicly, she says, because they don’t want to sound as if they’re blaming gender problems on screwed-up families. 
Can we dredge any more old tropes?  We used to blame the parents for their kids being gay, now we're replaying that same ridiculous script when someone's child turns out to be transgender?  Give me a break.  If Ms. Wente had bothered to even do a little bit more research, she would have found that Ms. Dreger is grossly distorting the picture.

The WPATH SOC V7 provides the following guidance to mental health professionals:

Provide family counseling and support- ive psychotherapy to assist children and adolescents with exploring their gender identity, alleviating distress related to their gender dysphoria, and ameliorating any other psychosocial difficulties
This is extremely important when examining what Dreger is saying.  Namely that she is implying that the treatment community has a mass conspiracy afoot to deny that there are "other problems" that are at the root of being transgender.  If that was the case, the WPATH SOC would not contain language like this.  Dreger's claims are very similar to those of Walt Heyer - whose misadventures negate his own claims of misdeeds and malice on the part of the treatment community.

Wente's argument also draws the following from Dreger:

For some people, including some adolescents, transgender treatment is lifesaving. But these treatments are neither simple nor benign. They may, among other things, retard maturation, suppress your growth or render you sterile. And in the end, medical science cannot create a body that makes you forget you were born the other sex. “Some kids need it, but for the kids who don’t, it’s dangerous,” she says. “All else being equal, it’s better to avoid long-term hormone therapy and major surgery that removes a lot of tissue.” 
Disturbingly, data on long-term outcomes for transgender kids are scarce. No one is tracking the evidence on puberty-blocking intervention either. “We are doing major interventions and we have shockingly little idea what the outcomes are,” Ms. Dreger says. You get the sense that what we have is not so much a rational approach to a psychosocial issue as a radical ideological experiment. 
Let's see ... the percentage of the population that is transgender is tiny to begin with.  It's going to be an even smaller percentage who are going to be able and willing to express those desires before they reach puberty.  Ironically, most transsexuals know that they are trans long before the age of puberty.  If the option not to go through "the wrong puberty" exists, dear god, but it would be a blessing for so many.

Dreger's claim that there is a lack of long term consequences data available is also highly questionable.  Given the fact that Dr. Spack has been been running his clinic in Boston since 2007, the criticism about "long term consequences" is debatable.  The fact is that just about every transsexual who has transitioned wishes that they had done so earlier than they did.  We already know the consequences of insisting that transsexuals go through puberty the wrong way, and then try to undo it through transition as adults - the psychological trauma is no small thing to deal with, and the cost of living life in the wrong body is impossible to calculate.

Quoting Zucker:

Gender dysphoria (formerly known as gender identity disorder) means being at odds with your biological sex. It’s not the same as being born with ambivalent genitalia, or being gay. The popular shorthand is “being born in the wrong body,” although that formulation probably does more harm than good. Sex-reassignment treatment is appropriate for some (although by no means all) adults who are unhappy with their gender identity, and some go on to live significantly happier lives. 

But for kids, especially younger ones, the issue is much more problematic. Gender confusion is often temporary. About three-quarters of little kids who have issues with their gender – boys who want to be princesses, girls who throw their dresses in the garbage – will be comfortable with it by adolescence, according to Dr. Zucker. (Many of them will grow up to be gay or bi.) Gender confusion can also be a handy label for whatever ails a child (or her family). That’s why Dr. Zucker takes a watch-and-wait approach. He even advises parents of princessy six-year-olds to say, “You’re not a girl. You’re a boy.” 
The point that needs to be made (again), is that the WPATH SOC is similarly clear about caution regarding the introduction of physical interventions:
Before any physical interventions are consid- ered for adolescents, extensive exploration of psychological, family, and social issues should be undertaken, as outlined above. The duration of this exploration may vary considerably de- pending on the complexity of the situation.  ...
In order for adolescents to receive puberty- suppressing hormones, the following minimum criteria must be met: 
1. The adolescent has demonstrated a long- lasting and intense pattern of gender non- conformity or gender dysphoria (whether suppressed or expressed);
2. Gender dysphoria emerged or worsened with the onset of puberty;
3. Any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment;
4. The adolescent has given informed consent and, particularly when the adolescent has not reached the age of medical consent, the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process. 
These are not trivial claims, and an ethical practitioner is going to be very careful in making this kind of assessment and recommendation ... and that is for a reversible intervention.

Here is where Ms. Wente makes me quite annoyed.  Her article makes it sound like there is a sudden epidemic of children who are transgender springing up, and that these children are being "exploited" by greedy treatment providers.

Of course, she engages with Zucker and Dreger, two people who are going to validate her assumptions.  Does she expand her research to include Dr. Spack?  No.  Does she even take the time to review the WPATH SOC?  No.

Ms. Wente should be ashamed of doing such sloppy research, and the Globe and Mail should be embarrassed for publishing such tripe.

1 comment:

Anonymous said...

I thought the scummiest part of that article was when Dreger claims that medical professionals are secretly admitting to her that she's right.

Sounds eerily similar to when ant-gay bigots claim some gay person secretly admitted to them that they totally are trying to recruit children.