In Outer Wingnuttia ... The Howling Begins

I wrote about the APA's report on "change therapy" for sexual orientation yesterday.

Today, we have the loons in Outer Wingnuttia squawking about it - and they aren't happy at all.

I'll let Mr. Hooper over at the Good As You blog take apart the pathetic attempt at spin from Exodus.

NARTH, on the other hand delivered some whoppers in their press release.

Unfortunately, however, the report reflects a very strong confirmation bias; that is, the task force reflected virtually no ideological diversity. No APA member who offers reorientation therapy was allowed to join the task force.

Oh dear, apparently NARTH's all upset because nobody "from their team" was on the task force. I think this tells us a great deal about NARTH's approach to research. Good research is impartial. That is to say, it is evidence based, not rooted in political ideology.

The APA report doesn't make any statements without citing what research those statements are based on. There's a lot of a research that they reviewed from NARTH's Nicolosi, Byrd and others - in addition to all the other material they reviewed.

They selected and interpreted studies that fit within their innate and immutable view. For example, they omitted the Jones and Yarhouse study, the Karten study, and only gave cursory attention to the Spitzer study.

Ummm...bullfeathers. Spitzer's work is cited multiple times through the document, as is work by E. Karten. Similarly, the Jones & Yarhouse study from 2007 is in fact cited in the bibliography. NARTH can't even be bothered to read the documents they are criticizing!

In a fit of complete irony, Mark Yarhouse served as one of the scholarly reviewers of this study.

Further, the APA report actually takes the time to explain the problems with reports like Jones & Yarhouse, or Spitzer come to that:

65 A published study that appeared in the grey literature in 2007 (Jones & Yarhouse, 2007) has been described by SOCE advocates and its authors as having successfully addressed many of the methodological problems that affect other recent studies, specifically the lack of prospective research. The study is a convenience sample of self-referred populations from religious self-help groups. The authors claim to have found a positive effect for some study respondents in different goals such as decreasing same-sex sexual attractions, increasing other-sex attractions, and maintaining celibacy. However, upon close examination, the methodological problems described in Chapter 3 (our critique of recent studies) are characteristic of this work, most notably the absence of a control or comparison group and the threats to internal, external, construct, and statistical validity. Best-practice analytical techniques were not performed in the study, and there are significant deficiencies in the analysis of longitudinal data, use of statistical measures, and choice of assessment measures. The authors’ claim of finding change in sexual orientation is unpersuasive due to their study’s methodological problems.

Then NARTH goes on to try and spin the issue of Reparative Therapy causing serious harm to clients:

We believe the report indirectly supports the findings published in the current Journal of Human Sexuality that reveal no significant ill-effects of therapy. Further, if some clients are dissatisfied with the therapeutic outcome, as in therapy for other issues, the possibility for dissatisfaction appears to be outweighed by the potential gains.

The Journal of Human Sexuality? Oh NARTH's Journal of Human Sexuality - their in-house vanity journal. Somehow, I'm not thinking that this is exactly seen as a high value journal outside of NARTH's membership. As Ex Gay Watch points out, the study NARTH is referring to is flawed from the start - and its authors have admitted as much.

I find it deeply troubling that NARTH simply tries to dismiss the prospect of psychological harm experienced by clients of Reparative Therapy dismissively as "dissatisfaction".

The APA report is much more honest about the issue, and state the following:

We concluded that research on SOCE (psychotherapy, mutual self-help groups, religious techniques) has not answered basic questions of whether it is safe or effective and for whom. Any future research should conform to best-practice standards for the design of efficacy research. Additionally, research into harm and safety is essential.

In short, the APA is saying that the research done into various attempts to change one's sexual orientation is so limited, and flawed, that it neither refutes nor substantiates claims of harm.

The problem that groups like NARTH face is that their "research" is simply not credible when you hold it up to scrutiny.

How interesting...

For some random reason, my travels on the web this morning brought me to this little 'human interest' article on CNN.

After reading it, I sat back and mused to myself how utterly mundane the content of the article itself really is. Okay, a bunch of newlyweds are happily revelling in their new status as married. Small things, like checking off the 'married' box on a government form bring a certain novelty to them. This is all fine and dandy, I remember going through similar things when I got married. In fact, if it wasn't for the genders of the members of each couple, I don't think this article would have been written.

It's a nice little reminder to all of us that for all that we may not understand all of the people around us, and the emotional drives that lead them to various places in life, we are all human, and humanity is amazingly diverse.

I decided to do some more digging around on the subject of gay marriage - mostly out of curiousity given the outcome of several 'ballot initiatives' in the recent US federal elections.

For the most part, I found the usual collection of pro- and anti- sites, each brandishing their rhetoric like rusty swords. I won't even bother to reference them - largely because that's not what caught my real attention.

Following linkage from site to site, I eventually tripped across the website for a group called 'NARTH'. Perusing their website is possibly one of the most disturbing, alien experiences I have ever had. Here is an organization of 'Mental Health Professionals' that are claiming that they can make gay people straight.

More or less, their position seems to be largely religious in its foundations, and couched in secular pseudo-science. The usual "it isn't natural" kind of tones emenate forth from the various papers on the website, along with an assortment of assertions that no one would ever think of making towards the heterosexual population. (For example, I don't remember "choosing" my sexuality, so much as I became aware of it. If I didn't choose mine, why on earth would I believe that someone else _chose_ theirs?)

On the surface, much of what NARTH's site says almost sounds reasonable - unless you have a little bit of background in psychology. Reading their articles reminded me of the reactions to Erich von Daniken's "Chariots of the Gods". Superficially much of what he asserts sounds reasonable, until you dig a bit deeper and find that he's got something completely wrong in an area. (Chariots of the Gods made quite a stir in Archeology circles when it came out, and it took a few years apparently for a bunch of specialists in various areas to point out the problems with his theory - it's still a fun read)

I found a few websites speaking "for and against" the ex-gay support groups/ministries whatever. The consensus seemed perfectly split - the ex-gay ministries all pointed to NARTH to provide secular, "scientific" justification for the direction; the sites critical of 'ex-gay' pointed to some of the American Psychological Association's commentary on so-called "reparative therapy" techniques - which more or less state that there is no evidence it works, and worse, it can do significant harm to the patient. (Which would make me very suspicious that any therapist who is a member of NARTH may well be operating in violation of a great many ethical standards - particularly those about doing harm to their patients.)

On the subject of families, NARTH makes the following blunt statement:

5. Same-Sex Marriage

Social science evidence supports the traditional model of man-woman marriage as the ideal family form for fostering a child's healthy development.

Okay - seems almost reasonable. Just for fun, I decided to see what the APA had on the subject:

Psychological research provides no evidence to justify discrimination against same-sex couples and families. Accordingly, it is the longstanding policy of the American Psychological Association (APA) to deplore “all public and private discrimination in such areas as employment, housing, public accommodation, and licensing” against gay men and lesbians, as stated in a 1975 policy resolution of the Council of Representatives. The Association more recently stated its support for the “provision to same-sex couples of the legal benefits that typically accrue as a result of marriage to same-sex couples who desire and seek the legal benefits” in a 1998 Council resolution. Psychological research and association policy are not consistent with legislation proposed at the federal and state levels that would amend the U.S. Constitution or state constitutions, respectively, to prohibit marriage between same-sex couples.

The document was much longer, and much more detailed than this conclusion - it's actually a rather enlightening read. Some of what it asserts is contrary to what I would call "common wisdom", but the APA does try to couch its assessment in terms of research findings which should substantiate their assertions with some degree of "concrete" information.

Perhaps most disturbing about the NARTH website were two things:

1. The President of NARTH's page

2. The absolute absence of e-mail addresses for contacting NARTH - except for one associated with the membership page - and it directed to an e-mail address kept on yahoo.com.

If NARTH was bona fide, and legitimate, I would expect that it would be possible to contact them through e-mail or other means. The cloak of anonymity they try to create leaves one suspicious that they are fully aware that they are skating on the dangerous edge of things, especially where their members are engaging in this kind of therapy.

However, tying back to what started this commentary, I find myself looking at the Massacheusetts experience with Gay Marriage, and asking - "did the world end?" No, it did not. Further, it seems that those who are now married under those laws are experiencing the same happiness and validation that I did when I got married. Why would I deny someone that experience?

As for people's issues with gay sexuality - remember the words of Pierre Elliott Trudeau:

"The state has no business in the bedrooms of the nation."

Remember, the human race is infinitely variable, infinitely diverse. We are all different, and it does society no good to marginalize someone for being different.

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): 

http://www.narth.com/docs/gid.html 

Zucker promotes his NARTH-like notions of reparative therapy for kids with gender variance, reviewed here on another ex-gay site: 

http://www.leaderu.com/orgs/narth/childhood.html

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.

Bullying As Therapy - Part I

The internet never quite forgets. For those of us who track the more insane ravings of the truly unhinged, Google's "cache" is an amazingly useful tool.

Late last week, an amazingly unhinged screed was posted on the NARTH website. By the end of the day yesterday, it had been yanked off NARTH's website, apparently after they got a significant amount of heat.

The screed was a reaction to a private school in Oakland, CA taking specific steps with respect to how they handle cross-gender identified students.

Perhaps what is most surprising is the emergence in the recent years of parents who are acknowledging and actively supporting their children who claim a cross-gender identity. On one hand, I commend the parents for being open to a surprising twist in life; on the other hand, I worry a little about whether this is setting things up for a reverse problem later in life should the child conclude that they are not transgender after all. However, that is a complex psychological topic for further investigation on my part.

The
original post on NARTH quotes Dr. Berger as follows:

Dr. Berger reacted to the San Francisco Chronicle article by observing:

I think that a lot of this is nonsense and is being pushed by people who have an agenda to disrupt society in order to further some perverted goals such as the acceptance of pedophilia, and, of course, the attempted "normalization" of homosexuality.
From a medical/scientific perspective, the notion of a child of five being "transgendered" is absolute garbage. This is a child wanting attention and wanting to play "dress-up," with an added layer of unhappiness.

That essentially is the issue for most of these children. They are unhappy. They don't have a "biological" based "gender identity disorder." They are unhappy; they have an envy of certain aspects of the opposite sex role -- and wish to pursuit it for as long as they can.

Tolerant parents, tolerant schools, tolerant societies, might let them get away with it. No one should be surprised that avant-garde California or sun-drenched Florida should be places where the tolerance is highest.

The notion that a person is really someone of the opposite sex "trapped in the wrong body" is poetic stupidity. It doesn't exist in reality. A person wishing to change their external manifestations to appear to be a person of the opposite sex is someone very unhappy with being their "real" sex and/or believing in some idealized fantasy of how much better it is to be of the opposite sex.

We don't treat distorted fantasies with mutilating surgery.

Here in cold Canada, I often talk with mothers of small children who routinely complain about how difficult it is to get their children dressed in the winter in the multiple layers of clothing they need to go off to school. I suggest to them that they make it clear to their children that they will leave home -- or that the school bus will come -- at such-and-such time, and they will go whether they are ready or not. I suggest that going just one day in their pajamas or underwear will be enough to "cure" them of their procrastination.

I suggest, indeed, letting children who wish go to school in clothes of the opposite sex -- but not counseling other children to not tease them or hurt their feelings.

On the contrary, don't interfere, and let the other children ridicule the child who has lost that clear boundary between play-acting at home and the reality needs of the outside world. Maybe, in this way, the child will re-establish that necessary boundary.

It is a mistake for various interfering, ignorant, and biased busybodies to try to "counsel" the other children into accepting the abnormal. It is very healthy to be able to draw the line between what is healthy and what is sick.

I am sure that if we looked carefully, we could find some significant personal issues and aberrations in the parents of these children. These children don't have such problems without there having been some groundwork laid by their parents in some way.

Dr Joseph Berger, FRCP, DABPN, DLFAPA

I can guess that NARTH received a lot of static for posting that in the first place - it is uniquely unhinged, especially for someone who claims to be a psychiatrist in the first place. At the very least, he should be professionally censured for several reasons - not the least of which is essentially advocating bullying as an acceptable form of socialization in the schoolyard.

Looking further at what he writes, I'm going to have to dissect it assertion by assertion:

From a medical/scientific perspective, the notion of a child of five being "transgendered" is absolute garbage. This is a child wanting attention and wanting to play "dress-up," with an added layer of unhappiness.

No, this is not garbage. Most people's first long term memories anchor somewhere between the ages of 3 and 5 years (a few people like me have memories that are clear and go back further, but the average seems to be around 3 to 5 years of age). The anecdotal evidence from transgender people in their adult years is quite clear that their sense of being 'boy' or 'girl' - and in the "wrong body" goes back to their earliest memories, whether or not they were able to express those feelings at the time.

The notion that a person is really someone of the opposite sex "trapped in the wrong body" is poetic stupidity. It doesn't exist in reality. A person wishing to change their external manifestations to appear to be a person of the opposite sex is someone very unhappy with being their "real" sex and/or believing in some idealized fantasy of how much better it is to be of the opposite sex.

I dare say that just about every transsexual that is now living in their chosen gender would disagree with this entire assertion. The psychological aspects of gender identity are complex and multifaceted. I'm appalled that a man who is ostensibly a trained psychiatrist would dismiss the experiences and feelings of so many people out of hand as "invalid" simply because he is unable to comprehend them.

I suggest, indeed, letting children who wish go to school in clothes of the opposite sex -- but not counseling other children to not tease them or hurt their feelings.

On the contrary, don't interfere, and let the other children ridicule the child who has lost that clear boundary between play-acting at home and the reality needs of the outside world. Maybe, in this way, the child will re-establish that necessary boundary.

This is the point where I got quite upset reading this screed. As far as I am concerned, this is nothing more than an incitement to bully children who are different. I didn't appreciate the thugs that decided to make my early school years unpleasant, and it certainly didn't change my behaviour to be something other than it is. I fail to see how applying Berger's reasoning to GLBT students is going to change those students. Will it isolate them? Yes. Make them bitter and resentful? Yes. Change their identity? Highly unlikely.

Berger then ends his tirade with the classic "blame the parents" line:

I am sure that if we looked carefully, we could find some significant personal issues and aberrations in the parents of these children. These children don't have such problems without there having been some groundwork laid by their parents in some way.

Few things are dafter than such statements. The claim that GLBT people come out of dysfunctional families is patently false. For every case like that, there are ten that suggest otherwise. How functional - or dysfunctional - a family has little to do with such issues. If that were the case, children raised by gay parents would have a higher probability of turning out gay - they don't.

Berger, along with his "colleagues" in NARTH need to be censured for doing nothing less than putting prospective clients into a form of jeopardy - making it painfully clear that judgement will be a part of their treatment.

More Argument By False Authority

It appears that NARTH is at it again. This time, we find them quoting a psychiatrist on gender identity issues - of course in a manner intended to deride and denigrate transsexuals as illegitimate people.

Follow things far enough, and you find the NARTH article linking to an opinion piece on MercatorNet, a "newsmagazine", with a suspiciously overt Christian Conservative slant to its articles. Why an organization like NARTH that is ostensibly about research would like to what is so obviously pure opinion is beyond me, but link they did.

The article itself is rather long winded, and boils down to "we shouldn't provide gender transition as a treatment for transsexuals, we should treat them as mentally ill instead".

Newsweek also avoided the other key debate about this difficult issue: whether or not transgenders have a mental illness or merely an inconsequential desire.

Since the term "transgender" is rather broad, covering anyone who exhibits some degree of cross-gender identity - from cross-dressing occasionally to transsexuals, this is actually a very misleading statement. The Newsweek article was actually quite specifically focused on transsexuals.

If you are talking about non-transsexuals, then yes, there are legitimate questions as to the degree of their cross-gender identity. (In many respects, this is no different than is often found among bisexuals, who experience varying degrees of attraction to members of either sex. Some bisexuals are primarily heterosexual, with some undercurrent of same-sex interest, others are much more fluid in their experiences of attraction.) However, since the Mercatornet article is focused upon the provision of surgical gender alignment to patients, let's be clear that they should be referring to transsexuals.

However, this is only the beginning of the writer's attempt to dismiss the validity of the transsexual narrative. By misusing the terminology, the author sets the stage to proceed with attempting to invalidate that narrative by insinuation and distortion:

A few years ago I attended a program at the American Psychiatric Association’s Annual Conference. An editor of the DSM was under attack for describing gender identity disorder as a mental illness. But in the course of the debate, in a remarkable display of having your cake and eating it too, the transsexual woman who argued against its inclusion was forced to admit that a DSM diagnosis was necessary after all. Why? Because otherwise people suffering from the disorder could not get their health insurance company to cover the cost of the procedures.

There is a classic error of logic being presented here. The author has attempted to spin it into the "you just need the diagnosis for money". This is false. As I have pointed out before, the DSM is a lexicon needed by medical professionals (both mental health and physicians) in order to communicate in a meaningful manner:

The mistake many people make is that they assume that a diagnostic category in the DSM actually means that someone so diagnosed is "mentally ill". The reality is that for a large number of conditions described in the DSM, the person is not "mentally ill" in the sense that they cannot function in society, but rather the diagnostic category serves primarily as part of a lexicon so that professionals can adequately discuss the particulars of a patient's case with a reasonably common understanding of meaning.

I'm rather appalled to see that Theron Bowers conveniently ignores this reality - especially when Dr. Bowers is a psychiatrist! (Of course, I should point out that Dr. Bowers does not list either sexuality or gender as an area of specialty - and those areas are unique specialties indeed!)

The author conveniently cites writers like Dr. Paul McHugh and Michael Bailey - both authors that in varying degrees seek to refute the transgender narrative. (How you refute someone's life experiences, I do not know, but they keep trying)

Although Theron Bowers does not resort to the language of religiosity, it's pretty obvious that the argument has its roots in the religion. Dr. Bowers does not speak to the clinical realities for transsexuals (such as the fact that the Standards of Care (a document which provides guidelines for treatment of transsexuals) is quite detailed about the management of these cases, and promotes a high degree of professional caution with respect to the clients.

Amusingly, Bowers cites Bailey's assertion:

However, sex researcher J. Michael Bailey in his book, The Man Who Would Be Queen, notes the decision for sex reassignment has a "rational component" and that the "large majority of boys who start out looking transsexual ultimately do not pursue sex reassignment."

Cross-gender children are rare indeed, and still relatively poorly understood. While only a handful of children that exhibit cross-gender behaviour at an early age go on to pursue gender transition, one should point out that the SOC document itself is quite clear about caution, and recognizing that not everybody who is cross-gender identified needs to transition.

However, unlike what Bowers and others attempt to infer, that does not mean that nobody needs that treatment. (Even Bailey, whose positions are generally held in some contempt among transsexuals, admits that some people legitimately need to transition and are quite successful afterwards)

I find it somewhat ironic that in order for NARTH to find pieces that back up their narrow-minded view, they have to resort to people writing opinion pieces in non-refereed publications, and riding upon the fact that the author has a PhD or MD, without actually wondering aloud whether the author has a clue about the subject at hand. (Bowers appears not to, rather relies on a bad mixture of assumptions, public policy commentary and assertions that are weakly supported at best)

It tends to reinforce the perception that these people aren't about research, and are more about forwarding a highly politicized agenda that involves the bully-boy tactics of denying others their stories.

Perhaps most amusing is the assertion that a transsexual needs psychiatric treatment, as if there is no program of treatment involving psychotherapy before surgery - a reality that exposes the lies of these people for what they truly are.

So Much For Reparative Therapy

For the last ten years or more, the "Pray away the Gay" crowd in the religious right has been trying to prop up NARTH to provide the appearance of legitimacy for their position that "homosexuality can be changed/cured/prayed away".

As reported on CNN, the American Psychological Association chose to review the real research on such programs (not the spewage from Paul Cameron, or the various lobby groups, but actual peer reviewed research that has been published in reasonable journals), and released their report titled Appropriate Therapeutic Responses to Sexual Orientation.

The upshot of their findings:

The appropriate application of affirmative therapeutic interventions with adults is built on three key findings in the research: (a) an enduring change to an individual’s sexual orientation as a result of SOCE is unlikely, and some participants were harmed by the interventions; (b) sexual orientation identity, not sexual orientation, appears to change via psychotherapy, support groups, or life events; and (c) clients benefit from approaches that emphasize acceptance, support, and recognition of important values and concerns.

In short, reparative therapy is snake oil. Something which most critically thinking people would have long ago figured out.

Ironically, NARTH founder Joseph Nicolosi's work is heavily cited in this study:

Nicolosi, J. (1991). Reparative therapy of male homosexuality. Northvale, NJ: Jason Aronson.
Nicolosi, J. (1993). Healing homosexuality. Northvale, NJ:Jason Aronson.
Nicolosi, J. (2003). Finally, recognition of a long-neglected population. Archives of General psychiatry, 32, 445-447.
Nicolosi, J., Byrd, A. D., & Potts, R. W. (2000). Retrospective self-reports of changes in homosexual orientation: A consumer survey of conversion therapy clients. Psychological Reports, 86, 1071-1088.
Nicolosi, J., & Nicolosi, L. A. (2002). A parent’s guide to preventing homosexuality. Downers Grove, IL: InterVarsity Press.

Although, Nicolosi's work is cited primarily in the background chapters describing the discussion itself, and in particular advocacy from groups like NARTH.

Where Nicolosi's research is actually cited or discussed for its merits, it comes in for some fairly harsh criticism:

A meta-analytic review of 14 research articles (Byrd & Nicolosi, 2002) is not discussed in this report. The review suffers from significant methodological shortcomings and deviations from recommended meta-analytic practice (see, e.g., Durlak, Meerson, & Ewell-Foster, 2003; Lipsey & Wilson, 2001) that preclude reliable conclusions to be drawn from it.

For instance, to assess whether sexual orientation had changed, Nicolosi et al. (2000) performed a chi-square test of association on individuals’ prior and current self-rated sexual orientation. Several features of the analysis are problematic. Specifically, the nature of the data and research question are inappropriate to a chi-square test of association, and it does not appear that the tests were properly performed. Chi-square tests of association assume that data are
independent, yet these data are not independent because the row and column scores represent an individual’s rating of his or her past and present self.

Recent studies have investigated whether people who have participated in efforts to change their sexual orientation report decreased same-sex sexual attractions (Nicolosi et al., 2000; Schaeffer et al., 2000; Spitzer, 2003) or how people evaluate their overall experiences of SOCE (Beckstead & Morrow 2004; Pattison & Pattison, 1980; Ponticelli, 1999; Schroeder & Shidlo, 2001; Shidlo & Schroeder, 2002; Wolkomir, 2001). These studies all use designs that do not permit cause-and-effect attributions to be made. We conclude that although these studies may be useful in describing people who pursue SOCE and their experiences of SOCE, none of the recent studies can address the efficacy of SOCE or its promise as an intervention.

Childhood interventions to prevent homosexuality have been presented in non-peer-reviewed literature (see Nicolosi & Nicolosi, 2002; Rekers, 1982). ... Thus, we concluded that there is no existing research to support the hypothesis that psychotherapy in children alters adult sexual orientation.

Not exactly a promising assessment ... and arguably invalidates many of the shibboleths held by the advocates of "change therapy".

H/T: Commenter "SB" for bringing this to my attention

What is CCC anyways???

After reading today's column by Mr. Chandler in the Globe and Mail regarding the current leadership of the Conservative party, I decided it was time to sit down and give some more serious analysis to Mr. Chandler's "Concerned Christians" group, and just who they align themselves with.

So going to their "moral links" page, I found the following:

Political Links:

The Conservative Party
The Christian Heritage Party

Media Links:

The Western Standard (anyone else remember "Alberta Report"???)

"Traditional Family" Links: (anti-{abortion/equality/homosexual...})

Canada Family Action Coalition
RealWomen Of Canada
Focus On The Family Canada

Anti-Abortion Links

British Columbia Parents & Teachers For Life
Campaign Life Coalition
Alberta Pro-Life
Birthright

Anti-Sexuality:

Pure Intimacy
NARTH

• www.hopeforhomosexuals.com - sharing a message of faith, hope, and love.
• Stephen Bennett Ministries - An organization run by a former homosexual who has "been there, and done that." After eleven years and well over 100 sexual relationships with men, Stephen Bennett was radically changed by the love of Jesus Christ.
• www.settingcaptivesfree.com - An online course provided by the Georgia-based organization called Setting Captives Free, designed to help homosexuals find redemption from sin and their true purpose in life.
• www.becomingreal.org - we're here. To talk about same-sex attraction openly, honestly and with a Christian perspective, in a way that will be helpful to you in your journey.

So...lessee what we have here - 3 links to political and media organizations; 3 links to "family values" groups {a euphemism for those that idealize the 1950's "nuclear family" model - and forget all of the problems with that model}; 4 links to anti-abortion groups, and 6 links to groups that want to save homosexuals (and others) from their supposed sins.

Essentially, 10 of the groups that this bunch align with want to dictate how the people of this land conduct themselves sexually. If you add in the 3 "family values" links - which are inevitably shrill in their horror over homosexuality, the vast majority of the linkage are to groups who want to poke their nose in your bedrooms. (Not to mention tell you how you should live an upstanding "Christian(tm)" life).

I am actually rather amazed by this. You would think that they might actually have links that would lead the reader to something persuasive - like scripture perhaps, or to the websites of their various member's churches. No, instead, they are spending all of their space and energy worrying about other people's sexuality.

The purely theological arguments don't bother me - you can pretty much make scripture say whatever's convenient at that time. Do a quick examination some time, and you will find it's relatively easy to find interpretations of biblical scripture that are quite accomodating of sexual variance.

More insidious are groups like NARTH and Birthright which cloak their position in words that attempt to claim a legitimacy of apparent impartiality. (Or at least a degree of "clinical" validity) Birthright does it by careful omission of the term Abortion anywhere in their literature; NARTH by making clinical psychological claims that are virtually impossible to substantiate.

You can look at this and say "so what?". The problem is that these organizations have no interest in rational investigation that would potentially call question to the conclusions they so desperately want to find. (e.g. that sexual orientation is mutable). How many people will they harm irrevocably in their zeal for achieving some social ideal that they've dreamt up based on history and biblical scripture?

How many laws would they demand a hypothetical Conservative government promulgate that would marginalize citizens of this country?

Although I suspect that the narrow-minded thinking of groups like this belongs to a very small percentage of the population, their vocal protestations make them very important to watch - carefully. I suspect the coming policy convention of the Conservative party in Montreal will have serious implications for the party's ongoing viability. How strong is the "social conservative" faction in that party? Are they strong enough to derail the party's move towards a message that will play well outside of Alberta? (Probable - in fact likely)

Will it be enough to cause the party to fracture? Possibly.

Attempting Erasure of Transsexuals

A paper was published in a journal called "The National Catholic Bioethics Quarterly" last year. Titled The Psychopathology of Gender Reassignment Surgery, this paper attempts to lay out why it is wrong to provide Gender Reassignment Surgery to transsexuals.

I've spent a fair bit of time since I ran across this paper pulling apart its web of tangled reasoning. (and tangled it is) My first inclination is to go through it point by point and describe why each paragraph is leaping to incorrect conclusions or is so filled with assumptions that the authors clearly have failed to adequately research the subject they are writing on. However, that would produce a huge, tedious rebuttal that doesn't really address the underlying problems with this paper.

In my study of this paper, I have come to recognize a series of serious flaws in the assumptions and evidence that the authors have used. These include basing their description of what Transsexualism is on some deeply flawed theoretical models; drawing on sources that are, at best, marginal voices in the research and treatment community and ignoring data and sources that clearly arrive at different conclusions than the authors of the paper set out to find.

In short, the authors set out to confirm the conclusions they already had in mind, and paid little heed to the breadth and depth of the research field.

The first thing that the authors set out to do is invalidate the notion of transsexualism. They do this through several basic tactics. First, they use the emotionally loaded language of "mutilation" to describe Gender Reassignment Surgery. Any reasonable assessment of the ethical implications of a given procedure would be expected to stay away from such language in the early stages of the paper as it clearly prejudices the interpretation of subsequent data.

The paper proceeds to describe transsexualism using Blanchard's notion of Autogynephilia. Fortunately for transsexuals in the world today, Blanchard's model isn't exactly the dominant theoretical model describing transsexuals. In fact, the view that gender identity occurs in a spectrum has become much more prevalent. The problem with the Autogynephilia model is that it uses two fairly absolute categorizations to describe transsexuals - both firmly rooted in the language of sexual identity. Whether we are talking about the "Kinsey Scale" (which was emulated by Harry Benjamin for transsexuals), such attempts to define bounded categories tend to break down when applied to the breadth and depth of human diversity. As a thought experiment, try defining what it means to be 'a man' or 'a woman' in today's society - it's trickier than you might imagine. Then consider how difficult it is to categorize people in general.

The narrative discussion about transsexuals in general focuses intensely on people's sex lives, while ignoring the far more crucial discussions around the individual's adaptation and integration with society. While we are certainly all sexual beings in some capacity, it seems to me more than a little problematic to attempt to describe people based on their sexual behaviours. Worse, the reference material cited to derive this narrative is often based on such small numbers as to be better viewed as anecdotal evidence rather than population evidence. Sadly, the authors hold up numerous anecdotes about poor adaptation and misconceptions as being "the general case", a logical inference that simply does not stand up to any reasonable analysis.

Sadly, they even go as far as to reference a television show called Sex Change Hospital, as if such a program is going to be any kind of meaningful guide to the breadth and depth of experience that is humanity. Even worse, their criticism is that the people who have surgery aren't always "perfectly passable". Transsexuals, like the rest of the population come in all sorts of shapes and sizes - not everybody is model material, how dare they apply such a standard to transsexuals? Such programs tend to emphasize the physical change that surgery brings, but do not (and cannot) explore the complex and often bewildering path that is transition - that goes on with the patient and their therapist over a period of years.

The paper implies that there are always underlying psychological problems associated with Gender Identity Disorder (GID).

Some therapists too readily accept a patient’s “I feel trapped in the wrong body” explanation and do not probe—let alone help the patient to resolve—the patient’s underlying narcissism, anger, and inability to embrace the reality of their sexual identity.

To make such a claim is indeed spurious. The WPATH Standards of Care are very clear about the handling of comorbid conditions.

For Children:

3. Therapy should focus on ameliorating any comorbid problems in the child’s life,

For Adults:

Ideally, the clinician's work is with the whole of the person's complexity. The goals of therapy are to help the person to live more comfortably within a gender identity and to deal effectively with non-gender issues.

Assuming that a therapist is knowledgeable and working within the WPATH SOC guidelines, one might reasonably suspect that recommendations for steps such as surgery aren't likely to be made until other related issues are dealt with adequately.

Inevitably, as one might expect, the writers turn to NARTH for more "experts" to reinforce their overt hostility to transsexuality and its treatment. They quote a paper published on NARTH's website by a Dr. Breiner - a particularly offensive piece of work that I have already analyzed here.

Following down the NARTH path further, we find the usual attempt to establish childhood sexual abuse as a causal or root factor in transsexualism. We've seen this before with homosexuality - it wasn't a terribly successful strategy before, and I know of no legitimate research that establishes any kind of reasonable causal relationship beyond the usual assertions that large numbers of have been abused sexually as children. This is an old saw, and one that doesn't deserve further consideration without serious evidence to establish its veracity.

Similarly, the attempt to link transsexuality with masochism is not only a very feeble argument, it's at best spurious to make such an association. While there are no doubt some transsexuals who are interested in S&M play, drawing the conclusion that their masochistic fantasies led them to transition is dubious at best.

When the authors finally do start addressing the ethical issues involved in providing treatment to transsexuals, they do so from this framework of questionable theoretical models, really awful logic and blatant misinformation. Needless to say, their conclusions are similarly flawed.

I'm going to restate some of their conclusions in my own words, in part because the objections the authors raise are often done in a manner that is elliptical relative to what they conclude.

Conclusion #1:

GRS is unethical because it doesn't "really" change someone's sex. (That is to say a MTF transsexual will not be able to bear children after surgery)

I don't think anybody denies the limitations of GRS as it stands today. To say that it is therefore "mutilation" is to suggest that any surgery that reshapes the body at all is mutilation as well.

The accusation that because the person is not able to directly procreate after surgery ignores the fact that for many transsexuals, the dysphoria they experience is so severe that it is unlikely that they would procreate in the first place. Further, it reduces human sexual and romantic partnerships to the production of babies - a position that treats the people involved as mere objects, rather than as human beings.

Transsexuals are really just lying about themselves

This is possibly one of the most offensive accusations that you can level at a transsexual. The journey through one's inner self that is part and parcel of a thoughtful, reasoned transition takes one well beyond the idea that they could be "lying" to themselves.

The archetype of the 'transsexual as deceiver' is rooted in the same rubric that leads the authors to assume that the deeply flawed model of Autogynephilia actually meaningfully describes the overall population of transsexuals. One of the most glaring problems with Bailey's "The Man Who Would Be Queen" book is the fact that most of his subjects were found in drag bars. That's like going into an outlaw biker bar to interview motorcyclists and concluding that all motorcycle riders belong to criminal gangs.

Conclusion #3:

Transsexuals are demanding that others lie on their behalf and they have no right to do so

Those who believe that it is impossible to change a person’s sex do not want to be insensitive to others, but neither should they be forced to lie by calling a man a woman or by calling a woman a man.

If someone is clearly presenting as a woman, treat them as a woman - it's not difficult. To call someone who is obviously MTF trans "sir" or "he" when she is obviously living as a woman is just as wrong as the schoolyard bully calling his target a "sissy".

The religious objection that it is impossible to "change one's sex" is a personal belief, and should be kept personal.

Conclusion #4:

By providing GRS, the caregivers are not providing a medically justified procedure, and as such they are collaborating with the patient's mental disease

This is a restatement of Paul McHugh's position, which I have already addressed on this blog.

I will however, reinforce my statements about McHugh's position with the following from the WPATH Standards of Care (v6):

Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective,"cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.

The ethical objections that are raised in this paper are also addressed quite effectively in the WPATH Standards of Care as follows:

How to Deal with Ethical Questions Concerning Sex Reassignment Surgery. Many persons, including some medical professionals, object on ethical grounds to surgery for GID. In ordinary surgical practice, pathological tissues are removed in order to restore disturbed functions, or alterations are made to body features to improve the patient’s self image. Among those who object to sex reassignment surgery, these conditions are not thought to present when surgery is performed for persons with gender identity disorders. It is important that professionals dealing with patients with gender identity disorders feel comfortable about altering anatomically normal structures. In order to understand how surgery can alleviate the psychological discomfort of patients diagnosed with gender identity disorders, professionals need to listen to these patients discuss their life histories and dilemmas. The resistance against performing surgery on the ethical basis of "above all do no harm" should be respected, discussed, and met with the opportunity to learn from patients themselves about the psychological distress of having profound gender identity disorder.

It is unethical to deny availability or eligibility for sex reassignment surgeries or hormone therapy solely on the basis of blood seropositivity for blood-borne infections such as HIV, or hepatitis B or C, etc.

It is a sad statement that the paper's authors could not even have been bothered to examine the WPATH Standards of Care, which addresses their concerns most directly.

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.

NARTH - Bad Science Masquerading

When an article appeared on NARTH's website entitled "Transsexuality Explained", I braced myself for some pretty awful reasoning ... I wasn't disappointed.

Just as NARTH wants people to believe that homosexuality is "abnormal" and "curable", they would dearly like us all to believe that transsexualism is somehow invalid. (Go ask a transsexual sometime how they feel about someone else declaring their entire life experience "invalid")

The author of this boldly titled paper is Sander J. Breiner - a man who's involvement in sexuality appears to start and end with NARTH, most of his online CV is in domains well outside the domain, much less focused on the highly specialized field of gender identity. This gap in Breiner's background is significant because it influences his analysis of evidence that he cites.

I'll scroll to the end of Breiner's argument to start with because it contains an important gem that reveals his assumptions:

However, when an adult who is normal in appearance and functioning believes there is something ugly or defective in their appearance that needs to be changed, it is clear that there is a psychological problem of some significance.

The more pervasive and extensive is this misperception of himself, the more significant is the psychological problem. The more the patient is willing to do extensive surgical intervention (especially when it is destructive), the more serious is the psychological problem.

Superficially, Breiner is almost sounding reasonable here. However, in making this claim, he is confusing two distinct diagnostic categories. He is claiming (quite incorrectly) that Gender Identity Disorder as a variation of Body Dismorphic Disorder.

Let's consider the key criteria for both for a moment:

Body Dismorphic Disorder:

A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.

B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

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 preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.

B. Persistent discomfort with his 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 or assertion 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; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.

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.

What I'd like to draw your attention to is the fact that the emphasis NOT upon the physiology, but in fact upon the social role associated with a given gender:

A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).

B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

Which is dramatically at odds with Body Dismorphic Disorder, where the focus is very much upon the physical manifestation of the body:

A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.

The point I'm trying to get to here is that when we are talking about transsexualism, we are talking more about the social role which an individual lives in far more than the physical changes that are associated with the condition, and that is such a key distinction that it calls into question a great deal of Dr. Breiner's analysis.

Individually, the topics that Breiner attempts to string together to arrive at his conclusion that in fact a transsexual is not a transsexual suffer from some basic logical errors, and inferences that simply do not hold up to scrutiny.

The transsexual male, who was not part of a university/medical school treatment program, will often take hormone treatment (self-prescribed and administered); and play a feminine role with unsuspecting heterosexual males (often as a prostitute). They will play the part as if they are a passive feminine object. Their approach has many masochistic behavioral qualities. However, their thinking about how they are tricking, fooling and using others has a clearly sadistic dynamic. Their histories almost invariably demonstrate a mother figure who is at least domineering, manipulative and controlling.

This is quite amusing, as it is filled with a series of completely invalid assumptions and associations.

1. Inference: Many transsexuals are prostitutes. Although there are sex-trade workers who are transsexual, they are often in that world out of economic necessity, rather than out of any real choice.

2. Claim: Transsexuals come from dysfunctional backgrounds. This is so blatantly false it isn't even funny. By far the majority come from perfectly normal family backgrounds. Although some percentage may well have bad family histories, such sweeping generalizations simply don't hold together when you explore the stories of these people more rationally.

3. In emphasizing a specific subgroup of the overall population of transsexuals, Breiner is creating the false association between gender identity and sexual identity - suggesting by inference that there is an enormous physical, sexual component to the psychological motivations involved. Again, as with Michael Bailey's thinking, Breiner has made the very fundamental error of inferring that this is very fundamental to the picture when it is not.

Breiner goes on to discuss "his experiences" with a gender identity program at Wayne State University, which I can find no trace of either the program nor of Breiner's participation in it. (If any readers out there are familiar with this program, please feel free to pass on what you know - if you have references to it, that would be great!)

My clinical experience in participating with the Wayne State University program has been corroborated by others at the University as well as at Johns Hopkins University, a medical school even larger and with a longer-lasting program.

Of course, what Breiner isn't telling us here is that most of the formalized "Gender Clinic" programs run by University and hospital organizations gradually closed down over the late 1980s and early 1990s. Why? In part because they had run their course as useful constructs for both transsexual patients and the legitimate need to have a more rigorous understanding of the condition itself. This doesn't mean that treatment doesn't exist, but that it has taken on a more flexible form with the individual patient an active participant in the progression.

However, let us move on to examining Breiner's observations about the outcomes of those formalized programs, shall we?

He is a well spoken and reasonable, dependable historian; well spoken and seemingly reasonable in all areas -- except how he feels about himself in terms of his gender and his body image. He describes himself as somehow feeling that something inside is trying to come out -- that somehow or other -- the real self is being restricted and limited.

This is actually a surprisingly reasonable statement in itself. It is hardly surprising given the social taboos that wrap around the often conjoined subjects of gender and sexuality that an adult will present a cautiously worded, almost hesitant sounding description of themselves and their emotional state. That there would be room for "doubts" to be examined is easily understood as a perfectly rational response to a lifetime spent avoiding themselves.

All tests by psychologists and psychiatrists in testing his judgment of reality (except in his body image) is within normal limits. There is no evidence of psychosis or any significant problems in any other area than his body image (related to gender only). He is cooperative and patient and helpful in his manner. His only area of insistence is concerning his belief about his body and the need to become a woman. He is not afraid of psychological and psychiatric evaluation. However, he is not interested in intensive psychoanalytic/psychotherapy for a period of months or years. He firmly believes that his problem is not psychological but that it is truly on an organic basis.

Around about this point, Breiner starts to go awry, and either has misunderstood or misrepresented his clients. I suspect that a lot of patients have never really considered the origins of their condition when they present for treatment. However, it is also quite understandable that many would assume that feelings that had followed them since early childhood would be seen as having some very fundamental cause. What Breiner should be taking away from this observation is the fact that transsexuals often present with feelings that they have struggled with ever since they were very young. Feelings which have caused them a great deal of anxiety and distress, and that no matter what the patient has tried have resurfaced some time later.

Further, by the time the patient is asking for clinical help, what the client believes to be the "origins" of their state is quite immaterial.

Initially, there is less tension and discomfort psychologically experienced by the patient. He begins to feel better about himself and hopeful about his future as a woman. Despite the physical, social and economic discomforts, he is positive and cooperative in every way in the program. ...Between six months to two years following the completion and healing of the surgery the surgeons begin to request more evaluations from the psychiatric division of this program. The surgeons do not understand what is transpiring because the patient is now asking for more surgery.

This is an interesting pattern that Breiner is putting forward. It feels a little too anecdotal to me. Although there are some number of patients who do pursue additional surgery to address various physical issues that they feel make them 'less than ideal' in their chosen gender, Breiner merely gives us the anecdote without really putting forth any concrete evidence that measures the frequency of such occurrances, nor does he address what the psychiatric evaluations he alludes to found.

I think Breiner would be wise to consider the intense pressure that society exerts upon women to be "beautiful" by often arbitrary standards. Given that a Male to Female transsexual comes to life in the world of women with a few "handicaps" by the common measures of beauty, it should come as little surprise that some will resort to drastic measures to conform. Looking more rationally, it's hardly as if genetic women don't engage in similar practices.

Having presented us with an anecdotal "pattern", Breiner brings us to his grand revelation about transsexuality:

At this point in the process, I, along with other psychoanalyst colleagues concluded that the disturbed body image was not an organic at all, but was strictly a psychological problem. It could not be solved by organic manipulation [surgery, hormones], no matter how well intentioned or brilliantly successful it was done.

Rationally speaking, current medical interventions intended to assist transsexuals are limited in scope and the outcomes are necessarily imperfect. Whether the root cause of transsexualism is organic (e.g. a genetic variation or a difference in brain structure) is almost irrelevant, in my view. If the cause is "purely psychological", that doesn't invalidate the basic path of treatment - especially in the absence of any reasonable alternatives in treatment.

But the significance of the psychological difficulty should not be minimized by a patient's seeming success socially and professionally in other areas. This principle of isolated significant psychopathology indicating serious psychological problems (despite their ability to function in all other areas of life) is well known psychiatrically, historically, and by the judiciary.

This conclusion became so well established at Wayne State University that the program was eventually discontinued. The much larger and more extensive program at Johns Hopkins University and medical school in Baltimore, Maryland was discontinued for the same reason.

In short, Breiner would like us not to provide relief to transsexuals because he believes that there is some "underlying, unknown" psychopathology that has not yet been identified. We know that that transsexuals aren't delusional in any clinical sense, nor by his own experience, has there been any significant evidence of other serious psychological problems - just the distress that results from a lifetime spent feeling as though one should be living in a different gender role.

While Breiner's hypothesis that there is some "deep underlying psychopathology" involved that is driving the patient, his claim is just that - a claim. Since Christine Jorgensen became a public figure in the 1950s, we have the work of a great many people that do not provide evidence of "hidden" psychological issues.

In fact, Breiner is violating the principles of Occam's Razor by supposing some unknown pathology. Most of what he is raising as points to suggest that transsexualism isn't real are readily explained in terms of the social and societal pressures that shape the lives of every person in this world, and are hardly surprising or necessarily unique to transsexuals.

Citing False Authority

The wingnut crowd in Canada, like their compatriots south of the border love to point to all sorts of crappy research work to justify their bigotry.

In this case, we find American College of Pediatricians ranting on about how evil it is for gays to be parents.

According to the "American College of Pediatricians" (sounds impressive, doesn't it?):

The research literature on childrearing by homosexual parents is limited. The environment in which children are reared is absolutely critical to their development. Given the current body of research, the American College of Pediatricians believes it is inappropriate, potentially hazardous to children, and dangerously irresponsible to change the age-old prohibition on homosexual parenting, whether by adoption, foster care, or by reproductive manipulation. This position is rooted in the best available science.

Wait a second here - on the one hand, they admit that the research is limited in this domain. Then, they turn around and claim that it's a "bad thing" to allow gays to be active parents because of the science?? Excuse me? But that's little more than a classic creationist "lack of absolute proof is disproof" argument.

They try to base their argument in a review of "available research":

Data on long-term outcomes for children placed in homosexual households are very limited and the available evidence reveals grave concerns. Those current studies that appear to indicate neutral to favorable results from homosexual parenting have critical flaws such as non-longitudinal design, inadequate sample size, biased sample selection, lack of proper controls, and failure to account for confounding variables.

They base this on comments in the following literature:

Robert Lerner, Ph.D., Althea Nagai, Ph.D. No Basis: What the Studies Don't Tell Us About Same Sex Parenting, Washington DC; Marriage Law Project/Ethics and Public Policy Center, 2001.

3 P. Morgan, Children as Trophies? Examining the Evidence on Same-sex Parenting, Newcastle upon Tyne, UK; Christian Institute, 2002.

4 J. Paul Guiliani and Dwight G. Duncan, "Brief of Amici Curiae Massachusetts Family Institute and National Association for the Research and Therapy of Homosexuality," Appeal to the Supreme Court of Vermont, Docket No. S1009-97CnC.

I've added linkage to the websites of the various publishing organizations. All of them are either religious and anti-gay, or just outright anti-gay. None has exactly got a wonderful track record for producing good research. (Goodness knows most of what is published in NARTH's name hardly constitutes 'peer review' quality research!)

I will agree that studies of gay parents are going to suffer from a variety of problems, especially around the issue of sample size - we are after all talking about a very small minority to begin with, and social pressures would cause a fair number of people to be uneasy about participating in any study, but that does not render the study itself entirely invalid. (Which is, of course, what they are trying to insinuate)

A little bit of superficial searching turns up the fact that American College of Pediatricians is a small, relatively recent startup organization created by a handful of pediatricians who are social conservatives. Unsurprisingly, their research is
clearly biased.

Meanwhile, if one looks around at what the mental health professionals are saying, we get a whole different picture:

Canadian Psychology Association
American Psychology Association

I imagine there are lots of studies were I inclined to go digging through the journal literature in the domain. (I'm not, but I am a darn sight more likely to believe the APA or the CPA have taken a position based on the research, rather than what they want the research to say (e.g. NARTH).

Dr. Phil & Focus on the Family on "Feminine" Children

I don't know where to start with Dr. Phil's show today.

Viewers flooded the message board with letters and impassioned opinions after Dr. Phil’s first show on gender-confused kids. This hotly contested topic is back on the table. Should parents support a child's decision to live as the opposite sex, or is it the parent’s job to guide the child into his or her biological gender?

The first thing that makes me angry with this is the use of the exceedingly misleading term 'Gender Confusion'. For someone purporting to have a decent background in psychology, he should know that "gender confusion" is an invention of the religious right, intended to denigrate and diminish transgender people as a whole.

Special Thanks

* Dr. Joseph Nicolosi
Narth.com
* Glenn Stanton
Focus on the Family
* Dr. Dan Siegel
* Dr. Michelle Angello
* Dr. Jo Olson
* Dr. Eva Cwynar

Great - so far, of those players, we have two people from known anti-GLBT organizations, and only one of the rest appears to have any qualfications at all with respect to gender and sexuality - Dr. Michele Angello.

Did the idiots at "Dr. Phil" even contact WPATH to get someone who actually specializes in gender identity issues?

Granted, I'm not sure anyone from WPATH would touch a program involving Dr. Phil, much less the inclusion of NARTH and Focus on the Family.

Instead, they bring in people who think that gender identity issues are trivial and easily dismissed, or that gender roles should be strictly enforced:

The question:

I have written Focus before (over the years) about how to handle the feminine behavior that my 8 yo son exhibits. He LOVES long hair. As a toddler he would put hi s blanket on his head and declare that he was a girl for the day. We eventually took the blanket away, but there has always been something in its place. He would rather braid his sisters' doll's hair than just about anything.

The other day I (Mom) got after him for playing w/ his sister's American Girl Doll. I raised my voice and told him to put it away "now!" Then I got myself together and spoke w/ him about how this desire to fix girl's hair honors God. I asked him to pray about it and told him I would too, but I am not gleaning any fabulous wisdom, yet. Until today, when I'm convinced, God lead me to this site, just at this time so I could post this question.
...

The response from FOTF's Stanton:

Thank you so much for your note. It is important to understand the age, and you say this boy is 8. That is a pretty advanced age for this kind of behavior, but do not fear. It is VERY important that MOM be the one that does the "scolding" of more feminine boys and dad do the "redirecting" play...good cop/bad cop kind of thing. Dad MUST be the good cop for boys, to help welcome them into this curious world of men.

It sounds like you are doing that, which is good. It will be important to talk to the boy about his desires and have him explore what is behind them...redirecting him gently toward masculine understanding of that, such as "Hey, some men have long hair. Some men are hair dressers." Connect a seemingly feminine interest with masculine ideals. What this will do and help with is helping understand the world of men, by connecting it to something he can currently relate to. It is the idea of moving the chess piece of gender understanding and identity one small move at a time.

This is important. My son dealt with, around the age of 4, loving to dress up with his sisters in their dresses and stuff. We did the above and it worked great.

Oh goody - this one's ripe. Not only do we implicitly blame the parents for this, he then suggests nothing more than rigid enforcement of gender roles based on stereotypes.

I have a newsflash for this idiot - if this child is transsexual, he already is - all of the attempts at behaviour modification techniques you can try are doomed to fail. The most you will accomplish is alienating and shaming the child into hiding how they feel.

If they aren't transsexual, then chances are that as the child goes through puberty, things will settle down into something quite normal. Frankly, the parents making the kind of worried fuss that they are is the problem, not the child's behaviour.

Blaming the parents is just downright offensive. Parents can influence a child's behaviour, but there are some things that simply cannot be influenced. Besides, just what is wrong with a boy that has "stereotypically feminine" interests? We nudge and wink at 'masculine girls' and call them 'tomboys', but it is some kind of tragedy when it's a boy? Please, get over it.

Dr. Phil gets a giant brickbat for giving the wingnuts a platform to spew their misleading, deceitful nonsense.