How Is This "Repairing" Anybody ???

Since the "religious right wing" in this country (and the United States) likes to keep trotting out the same talking points all the time, I figure any opportunity to point out the complete intellectual dishonesty of these claims is worth the time.

Recently Nigel Hannaford and Tristan Emmanuel both trotted out the case of Chris Kempling as an example of "Christian" free speech being "suppressed". I'm going to take this a little further and make a few more harsh claims about Kempling.

As I have pointed out repeatedly in the past, Kempling's case is not so simple as even that of Stephen Boissoin. Kempling did not "merely" write a letter defending "traditional marriage", but rather he wrote a series of letters deeply critical of what he supposed to be the "gay lifestyle":

Kempling had been employed as a teacher and counsellor at a high school in Quesnel, British Columbia since 1990. In 1997 he began to write a series of letters to the editor of a local newspaper, the Quesnel Cariboo Observer, expressing concern over the presentation of homosexuality in school curricula. Among other things, Kempling's letters objected to the British Columbia Teachers' Federation (BCTF), the union that represents teachers in British Columbia, distributing teaching-aid literature which had been produced by the Gay and Lesbian Educators of BC, and which in his view was erroneous. He also cited various studies that he interprets as showing harm caused by what he described as the "homosexual lifestyle". Kempling, an advocate of reparative therapy, wrote:

"Sexual orientations can be changed and the success rate for those who seek help is high. My hope is students who are confused over their sexual orientation will come to see me." [1]

Now, clearly, Kempling's actions go much, much further than simply "writing a letter". (If anyone has the text of Kempling's letters at hand, let me know, I'd be interested in reading them)

Kempling is an advocate of something often referred to as Reparative Therapy, a questionable, and arguably damaging "therapy" intended to make someone be "not gay".

To give some idea just how damaging "reparative therapy" can be, I refer readers to this case in Manitoba:

A minister and former Christian college instructor has been found guilty of sexually assaulting a young man who sought counselling after he feared he was homosexual.
...
In earlier testimony, the alleged victim, now 29, told court he started meeting Lewis for counselling sessions in early 2000 after his parents caught him viewing gay pornography on the family computer.

Lewis — a family friend and minister — confided he had his own sexual identity issues and the two embarked on weekly counselling sessions designed to “assist me to be straight and to live a straight life,” the man said.

The man said Lewis started a program of “touch therapy,” which included the two kissing and fondling each other and engaging in sexual roleplaying.

This is far, far from being the first serious problem with so-called conversion therapies. From many perspectives, "reparative therapy" runs at odds with a lot of good, solid science. Psychologists have long ago realized that sexual identity as a rule is not responsive to therapy techniques intended to "change" them. You might be able to persuade someone to adopt a different political viewpoint, but in general, it's unlikely that you will change their sexual or gender identity meaningfully through any known therapy technique.

This most recent incident in Manitoba is an example of someone in a position of trust exploiting the patient.

While I do not claim that Kempling would engage in the same tactics, we have to view with skepticism and caution the "therapy" that he is advocating for. The simple fact is that there is little, or no, peer reviewed literature that substantiates the claims that are wrapped around the therapy that Kempling advocates, and plenty of evidence of abuse being wrapped in the cloak of "therapy" instead.

Conversion Therapy and Affirmative Therapy

Now that the LPC government has tabled Bill C-4, it's probably a good time to examine the two terms that are inevitably going to be argued about the most with this legislation.  Specifically, I want to talk about the terms "Conversion Therapy" and "Affirmative Therapy".  

I will be doing this primarily through the lens of mental health therapy, although in the coming debate over Bill C-4, you can expect that to get conflated with medical interventions such as surgeries or hormone therapies.  The relationship between mental health and medical interventions is a separate matter that will be addressed in another article. 

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

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.

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.

Nigel Hannaford: Hacktacular!

What few reservations I had about Nigel Hannaford having become less of a journalist and more of a puppet for the hardline right wing in Canada have just evaporated.

His Saturday tirade is one of the most illogical pieces of reasoning to come forth from him.

In a classic bit of "conservative" reasoning, he tries to tie David Suzuki's statements about climate change to the case of Chris Kempling as a "freedom of speech" issue. A classic "have you stopped beating your wife yet" kind of argument that twists the unreasonable by tying it to something that almost seems rational.

I think Suzuki's statements are laughable, but Hannaford's recount of the Kempling case is utterly brain damaged, and linking the two topics together is simply bad logic.

There's a difference between Suzuki's comments and Kempling - and it's significant. Suzuki is talking about what consequences he feels should apply to politicians who choose to sit on their thumbs with respect to his pet issues.

Kempling is a whole different matter. Among other things, Kempling was in a position of trust with respect to youth, and he was peddling reparative therapy, which is potentially very, very damaging to the client's well-being:

The American Psychiatric Association in its position statement on Psychiatric Treatment and Sexual Orientation states: The potential risks of "reparative therapy" are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone "reparative therapy" relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed.

*** In short, you are unlike to succeed in making people something that they aren't

Hannaford's oversight in failing to understand that Kempling's public positions towards the GLBT community placed him in conflict with the very role that he was contracted to do as a teacher and school counsellor. Kempling may well firmly believe that as a "Christian" he was doing the right thing, but in fact his overall demeanor would have left any GLBT student seeking guidance from him in a truly perilous place indeed.

Instead, Hannaford chooses to connect the two matters as though they are comparable, after all, he claims, Kempling was merely on the "wrong side of an argument". Nothing could be farther from reality. Kempling made it very public, and very clear that he was outright hostile to GLBT people, and worse was willing to profit from trying to "cure" their conditions.

That's a far cry from the kind of silliness that Suzuki may have been advocating, but Suzuki's in no position to cause anyone to be imprisoned. (and I would argue that were such a law to be tabled in the House of Commons that it should not even pass first reading)

Freedom of speech is no luxury, but it is also not unfettered. We all bear a responsibility towards our fellow human beings of civility.

Senator Plett's Speech On Bill C-6

 So, the other day, Bill C-6 passed from the House of Commons to the Senate.  As I had expected, Senator Don Plett led the conservative attack on the bill with a lengthy, long-winded speech full of utter nonsense.  

Let's take a closer look at the speech now that it's in the Hansard, and I've had some time to read it and digest the nonsense that Senator Plett has uttered. 

The Dishonesty of "Ex-Gay" Therapy

I've ranted about the notion of so-called Reparative Therapy techniques as applied to GLBT people by various religious and pseudo-religious organizations.

Just before Christmas last year, Ted Haggard was forced to step down from his position as pastor for an evangelical congregation after it became newsworthy that he had carried on multi-year affair with Mike Jones.

At the time, the usual list of suspects rallied around Haggard and said they would work to "help him through" his "struggle with homosexuality".

Today, we see Mr. Haggard claiming that he is entirely straight now.

Were his dalliances with Mike Jones a one time thing, I'd almost be inclined to believe Haggard had done little more than "an exploration". I'm sorry to say that a three plus year long affair doesn't exactly sound like a "one time dalliance" to me - it sounds rather like a persistent pattern.

The Rev. Ted Haggard emerged from three weeks of intensive counseling convinced he is "completely heterosexual" and told an oversight board that his sexual contact with men was limited to his accuser.

Now, I'm not saying that there aren't people who benefit from "reparative therapy", or the kind of "intensive" program Haggard has been subjected to, but I suspect that there is more to this picture than meets the eye.

First, I can't imagine how a three week long course of therapy (or even 3 month) is going to significantly change a pattern that has been ongoing for many years. I'm more than a little suspicious of the claim that Haggard's "only" dalliances were with Jones - I would have to guess that he has been "checking out" the guys for a long time, whether he wanted to admit that he found them attractive or not.

Second, if I look at Haggard's past behaviour, his actions are clearly someone who is bisexual - even if his attraction to men is "secondary" (or relatively weak). While he may be able to live primarily a heterosexual life, that does not change the reality. Were he but a teenager, I'd be inclined to guess that it was the fleeting experimentation of youth. Haggard is no teenager, which leads me to suspect that the pattern of behaviour is in fact well-entrenched. Okay, so he only got caught once. If I use the "shoplifter rule", he's probably been at it for quite a while.

I would be much more comfortable if the claim that he felt he "could life in an exclusively heterosexual" relationship. Just because he is attracted to men doesn't make him a homosexual - in fact, the reality that he is also (apparently) happily married to a woman suggests clearly that he is bisexual. (Big deal!).

Instead, the dishonest twits that cook this crap up claim that he is "cured" and has somehow mystically shed his attraction to men.

On Bill C-6 - Conversion Therapy

 Bill C-6's next step is on to the Senate once the House of Commons holds a third reading vote.  I expect the usual suspects like Senator Plett will do their level best to muddy the waters and confuse things.  Let's take a closer look at what the uproar is really about.  

Because They Lie - ALL THE TIME

The right wing hysteria over sexuality continues unabated. Today's installment comes in the form of Lifesite's response to the APA Report on Sexual Orientation conversion therapy.

This is a piece which is filled with ad-hominem attacks, distortions and outright lies about the psychology profession, and in particular how psychologists handle clients with sexual and gender identity issues.

It starts off with a whopper, too:

A man goes to a psychologist with a problem. "Doctor," he says, "I'm suffering terribly. I feel like a woman trapped inside the body of a man. I want to become a woman."

The psychologist responds: "No problem. We can discuss this idea for a couple of years, and if you're still sure you want to be a woman, we can have a surgeon remove your penis, give you hormones for breast enlargement and make other changes to your body. Problem solved."

Gratified, the first patient leaves, followed by a second. "Doctor," he says, "I feel terrible. I'm a man but I feel attracted to other men. I want to change my sexual preference. I want to become heterosexual." The psychologist responds: "Oh no, absolutely not! That would be unethical. Sexual orientation is an immutable characteristic!"

The irony of this little tale is that, while reading like a joke, it is in reality an accurate description of the mental health professions today. While dismissing and condemning reparative therapy for homosexual orientation, the majority of psychiatrists and psychologists in Anglophone North America have embraced the concept of "sex change," a procedure that does nothing more than mutilate the patient to appease his confused mind.

Lie #1: The implication that getting a therapist's backing for gender reassignment is trivial. It's not. A good therapist will help their client explore all of the options open to them, and will not make a recommendation for surgery before they are satisfied that the patient is making a choice that is in their best interests.

Lie #2: That there is an equivalence between GRS as part of the treatment for transsexualism and sexual orientation change therapy. The APA is in fact quite consistent in this regard. The long term research evidence has repeatedly shown that sexual orientation does not change measurably over time, nor does gender identity - homosexual identity and cross-gender identities tend to be surprisingly fixed and unresponsive to therapeutic efforts to change them.

Lie #3: Gender Reassignment Surgery is "mutilation". Not for the patient it isn't. For those who truly need it, GRS is part of a three pronged approach to treatment which includes therapy, hormones and yes - surgery. Surgery is the last step, taken primarily when the patient has been living in their chosen gender for a long period of time. From the patient's perspective, having genitalia which are at odds with their overall presentation is a source of ongoing distress. The long term studies (Pfaefflin et. al., 1992) demonstrate repeatedly that the outcomes post surgery are positive in all but a tiny handful of cases.

The refusal of the organization to accept the increasingly strong evidence against its position is another reminder of how entrenched the sophistry of sexual hedonism has become among the leaders of the organization.

In recent years, a number of studies have been published in peer-reviewed psychology journals, indicating that significant numbers of patients who voluntarily participate in therapy to change their sexual orientation are successful and happy with the results. Combined with numerous individual testimonies by former homosexuals, evidence in favor of the practice is overwhelming.

Yet another lie. The APA statement was quite clear about the methodological problems that those published studies suffer from. The APA did not simply dismiss them out of hand, but in fact reviewed them, and pointed out some of the methodology problems that they suffer from. The fact that a paper was published in a journal does not mean that it is without flaws.

However, the authors of Essential Psychotherapy and its Treatment, a standard text in medical schools, disagree with the APA's leadership, and say that the newer studies vindicate sexual reorientation therapy.

The newest edition (2009) notes on page 488 that, "While many mental health care providers and professional associations have expressed considerable skepticism that sexual orientation could be changed with psychotherapy and also assumed that therapeutic attempts at reorientation would produce harm, recent empirical evidence demonstrates that homosexual orientation can indeed be therapeutically changed in motivated clients, and that reorientation therapies do not produce emotional harm when attempted (e.g., Byrd & Nicolosi, 2002; Byrd et al., 2008; Shaeffer et al., 1999; Spitzer, 2003)."

Again, another distortion, bordering on an outright lie. The APA's report is clear in pointing out that the evidence regarding the effectiveness of "reorientation therapy" and its potential to do harm is simply too sparse to be conclusive. The APA clearly left the door open for future research to be methodologically complete.

Although the homosexualist leadership at the APA tries to rationalize these relationships by claiming that they are caused by social stigma or other factors, their claims ring hollow. Many stigmitized groups exist in society that display none of the pathological tendencies of homosexuals, and these tendencies appear even in countries that are very tolerant of homosexual behavior, such as the Netherlands.

Yes, and in any country with a "western Christian" background, no matter how legally tolerant they may be, there is still an enormous amount of social pressure to conform with the Christian view that homosexuality is evil. It will be decades, if not centuries before sexual and gender minorities are free from the constant pressure to conform to a standard they cannot possibly meet.

I must also point out the ad-hominem attack that Lifesite's writer launches at the APA, accusing the authors of the recent report of being "homosexualists", "homosexual activists" etc. This is a recurring standard of attack from those who lack actual evidence to back up their claims - attack the authors of the "opposing" claims instead of actually addressing the subject matter.

The defense and even the promotion of mental health experts who defend child sex abuse is a terrifying, but expectable movement down the slippery slope of sexual hedonism embraced by the powers that be at the APA. It not only threatens homosexuals, who are deceived by the seductive argument that their orientation is nothing to worry about, but psychology and psychiatry themselves.

We've had several centuries of Christian proscriptions against homosexuality. It hasn't worked on the whole, and I have yet to see credible evidence that attempts to change someone's sexual identity actually work. (Much less any serious studies of transsexuals in a similar vein) We know that homosexuality has been a part of our society since the dawn of time. We also know that whatever attempts to suppress or eliminate it that have been undertaken have not been successful.

It seems to me far more constructive to help someone accept who they are, and learn to deal with their feelings constructively. Telling them to deny themselves and attempt to be something that they are not. Those who are free to live their lives openly and authentically are ultimately happier, and more productive members of society.

The outcome of the current battle over the science of homosexuality may well determine the future of the mental health professions as a whole. Will they turn back from the brink, or plunge into the abyss? And what will become of the societies that heed their counsel?

What battle? It strikes me that it's more of a "faith versus science" argument these days. On one hand, we have faith, and faith-based groups masquerading as scientific (NARTH) claiming something about sexual identity and orientation that they have yet to substantiate. Then there's what happens when rational evaluation of the evidence occurs - it tends to result in the very interesting report the APA recently released.

Once again, the religious right has to dredge up the old saw about how society is going to collapse because of homosexuality. It's hard to imagine how society would ever collapse when the incidence of homosexuality appears to have been pretty constant throughout human history - regardless of how open a society is towards it.

More From The Illogical File

If you haven't encountered Dale O'Leary before, you can be forgiven - one has to tread into the swamps of religiously driven pseudo-science to find his writings. (He was one of the authors of the horrendous paper on the "ethics" of gender reassignment surgery I dissected back here)

He's surfaced again - a year late, it seems, to respond to the APA's study on reparative therapy - and like other attempts at reason from this sector, he's busy cherry picking facts and in doing so gets it entirely wrong. (The actual APA report is here)

1) Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality—in other words, they do not indicate either mental or developmental disorders.

The use the term "per se" confuses the issue. It is true that same-sex sexual attractions, behavior, and orientations are not in and of themselves (per se) indicative of anything. Given the variety of human behavior and attractions in different cultures, throughout history, and among the variety of mankind, nothing can be said about all persons with same-sex attraction, everyone who engages in same-sex behavior, or claims a particular sexual orientation. However, there is substantial evidence that same-sex attraction is a sequel of disturbed early childhood, in particular a failure to achieve a secure attachment to the mother1 and a failure to identify with the same sex parent and peers2. There is also evidence that persons with SSA are more likely to have been victims of childhood abuse,3 including sexual abuse,4 or other exposure to age inappropriate experiences. A number of well designed large sample studies have found that persons with SSA are more likely to suffer from psychological disorders, substance abuse problems,5 and suicidal ideation.6 Men who have sex with men are at high risk for contracting an STD, including HIV.7 While not every persons with SSA falls into these categories, a significant percentage do. There is on the other hand no replicated evidence that SSA is genetically or congenitally predetermined and therefore a natural and unchangeable variant.8 Therefore, it can be argued that there is evidence that SSA in some cases (or some might argue in most cases) is associated with a psychological or developmental disorder.

O'Leary makes several assertions here which, had he bothered to actually read the report in its entirety, he would find it addresses.

Assertion: Homosexuality is a result of childhood and/or family dysfunction.

From the APA Report:

Theories that certain patterns of family relationships cause same-sex sexual orientation have been discredited (Bell et al., 1981; Freund & Blanchard, 1983; R. R. Green, 1987; D. K. Peters & Cantrell, 1991).

Assertion: Homosexuality is associated with childhood sexual abuse

From the APA Report:

Some individuals who present with requests for SOCE may have clinical concerns that go beyond their sexual orientation conflicts. These may include mental health disorders, personality disorders, or trauma- related conditions that influence the presentation of sexual orientation conflicts and distress (cf. Brown, 2006; Drescher, 1998a; Glassgold, 2008; Haldeman, 2001; Iwasaki & Ristock, 2007; Lasser & Gottlieb, 2004; Mohr & Fassinger, 2003; S. L. Morrow, 2000; Pachankis et al., 2008; Schneider et al., 2002; Sherry, 2007; Szymanski & Kashubeck-West, 2008). Such conditions may require intervention separate from or in conjunction with the intervention directed at the sexual orientation distress. For instance, some clients who seek SOCE may have histories of trauma (Ponticelli, 1999), and in some individuals sexual abuse can cause sexual orientation identity confusion and other sexuality-related concerns (Gartner, 1999). Other individuals seeking SOCE may make homosexuality the explanation for all they feel is wrong with their lives (Beckstead & Morrow, 2004; Erzen, 2006; Ponticelli, 1999; Shidlo & Schroeder, 2002). This displacement of self-hatred onto homosexuality can be an attempt to resolve a sense of badness and shame (cf. Brandchaft, 2007; Drescher, 1998a), and clients may thus need effective interventions to deal with this self-hatred and shame (Brandchaft, 2007; Linehan, Dimeff, & Koerner, 2007; Zaslav, 1998).

Please note the language of the APA report. Unlike O'Leary, the APA is very careful to describe these conditions as coincidental with, not causally related to, the client's sexual identity. The APA is very cautious about drawing causal relationships between conditions for good reasons - when one looks at the broad spectrum of people who were (for example) victims of child abuse, it's not clear that even a significant fraction of those people turned out to be homosexual.

Assertion: Homosexuals are at a higher risk for other psychological conditions.

The APA Report addresses this concern in the quote I provide above.

Assertion: Men who have sex with men (MSM) are at higher risk for STIs

From a purely psychological perspective, this hardly seems relevant. Although it certainly is indicative of O'Leary's biases, since it is a common assertion made by the religious set to justify their "opposition" to homosexuality.

Assertion: While not every persons with SSA falls into these categories, a significant percentage do. There is on the other hand no replicated evidence that SSA is genetically or congenitally predetermined and therefore a natural and unchangeable variant.8 Therefore, it can be argued that there is evidence that SSA in some cases (or some might argue in most cases) is associated with a psychological or developmental disorder.

Ah ... the classic circularity which confuses correlation with causation. The APA is very careful not to make any assessment of causal factors related to homosexuality because what evidence exists is far from conclusive. Unfortunately for O'Leary, his fantasy that because there has been no "gay gene" found that the causes must lie in other correlations doesn't exactly hold up. (I discussed this in more detail here, here and here.

O'Leary doesn't let reason get in his way though, as he proceeds to try and disprove other basic tenets of the APA's report.

2) Homosexuality and bisexuality are stigmatized, and this stigma can have a variety of negative consequences (e.g., minority stress) throughout the life span.

Sexual acts between two persons of the same sex, along with adultery, fornication, and sexual paraphilias, are condemned by a number of religions as always contrary to God’s law. Since these religions are based on unchangeable revelation, these doctrines cannot be altered. Therefore, engaging in same-sex relations will always be considered by some as unacceptable. Love and compassion for those who struggle with temptation does not require acceptance of these behaviors. Freedom of religion protects the right of persons, who believe that homosexual acts are always wrong, to state their belief publicly and teach this conviction to their children without fear of discrimination. Such convictions are not bigoted, discriminatory, homophobic, or hate speech.

It is true that the realization that a significant portion of the community believes that a person’s behavior is not acceptable may make that person feel bad. Persons engaging in homosexual behavior may wish to silence those who disapprove. They may wish to have their behavior universally accepted; but so long as people have freedom of religion this situation will not change.

I don't know whether to laugh or cry over this self-serving bunch of tripe. Instead of addressing the very real issue of stigmatization, O'Leary provides us with a self-serving justification of why he thinks it's his right to demand that GLBT people be limited in their lives.

I would argue that his interpretation of "Freedom of Religion" is deeply flawed - at least with respect to the Canadian Charter of Rights. I've discussed the principles of how different rights intersect with each other elsewhere on my blog.

... and yes, when those anti-gay statements amount to propaganda, they are no better than what the Nazis spread about Jewish people in the 1930s. Make no mistake about it.

3) Same-sex sexual attractions and behavior occur in the context of a variety of sexual orientations and sexual orientation identities, and for some, sexual orientation identity (i.e., individual or group membership and affiliation, self-labeling) is fluid or has an indefinite outcome.

Gay activists would have us believe that SSA is a normal, and unchangeable variant, but numerous studies have found that SSA is fluid.9 If as the evidence shows it is possible for SSA and behavior to change spontaneously, then why can’t a person seek psychological therapy or spiritual counseling to affect a change in SSA or behavior?10

The APA report doesn't actually say this. What it does say is that the evidence supporting reparative therapy is deeply flawed (big shock there), and that reparative therapy doesn't produce the results claimed.

What the APA does advocate is a therapeutic environment that will help the client achieve a degree of self awareness and self acceptance that they did not have before - in a manner that respects the spiritual, social and sexual context that the client lives in.

4) Gay men, lesbians, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects.

Same sex relationships differ in many essential aspects from a marriage between a man and a woman. Two persons of the same sex cannot consummate a marriage - the one and only act that joins a man and a woman as one flesh. They cannot conceive a child that is the fruit of their union and their joint biological offspring. Every child acquired by a same-sex couple has been separated from one or both biological parents. Such a separation is perceived by the child as a loss. Every child raised by a same-sex couple lacks a parent of one or the other sex. Two persons of the same sex lack the psychological and emotional complementarity that is part of a husband and wife union. Finally, it is interesting to note that exclusivity is not considered essential for male couples.11

The usual "but homosexuals can't procreate" argument. I've heard this a thousand times as an argument against gay couples. It's a crock. This argument is based on a myriad of assumptions about heterosexual relationships and how they differ from homosexual relationships ... and aren't based on a single scrap of evidence that I've ever seen.

As for exclusivity, as much as the religious set likes to get their panties in a twist every time they talk about gay promiscuity, they do so while turning a blind eye to the frequency of what they should rightly call adultery among heterosexuals. Extra-marital affairs (on both sides of the marital bed) are surprisingly common, and to criticize homosexual couples for being open about them is hypocritical at best, and a double standard at worst.

As for offspring, how many children are raised in single parent households? By step parents? ... by adoptive or foster parents?

5) Some individuals choose to live their lives in accordance with personal or religious values (e.g., telic congruence).

Some individuals not only choose to live their lives according to God’s revealed law, but also believe that since truths of revelation and the truths discovered by science come from the same source, when both are properly understood they will agree. The term "values" degrades this belief into mere personal opinion; one person "values" one thing, another "values" something else. Those who believe in the congruence of revelation and science, reject this kind of relativism. They hold that it is possible through revelation and science to approach truth and that certain opinions are simply wrong. However, they respect the right of those who oppose them to be wrong and to defend their beliefs. While gay activists demand universal acceptance and affirmation for themselves, they use every method within their grasp to silence and marginalize those who disagree with them.

More self-serving malarkey from O'Leary. He clearly hasn't bothered to read the entire report from the APA - or if he has, he failed to comprehend a sizable chunk of it. If he had bothered to read the APA's report thoroughly he would have realized that this forms a significant part of how the clinical environment should be managed.

ConservaPedia - When You Can't Deal With Reality

Apparently, when you can't deal with moderation - as is done with Wikipedia - the conservatives in the US have cooked up their own Conservapedia.

To say that Conservapedia is...well...limited in its depth is an understatement. It appears that its contributors have conveniently failed to actually read relevant material.

Allow me to pick something apart here by doing a "compare-and-contrast" between the Conservapedia article on Gender Identity Disorder and the corresponding Wikipedia Article on the same subject.

To say that the opening description of GID in the Conservapedia article is "lightweight" is something of an understatement:

Gender identity disorder is a medical diagnosis for a mental disorder according to the DSM IV, which indicates a "strong and persistent cross-gender identification."

A couple of points of criticism here: First of all, there are references to the Diagnostic and Statisical Manual for Mental Disorders (DSM) without actually identifying the DSM correctly or providing appropriate cross-linkage to related material.

Second, a degree of caution should be used around the phrase "medical diagnosis". Although the DSM is a diagnostic tool, my own experience with it says that it is far more of a lexicon used by professionals to describe a client's condition rather than something that triggers a specific path of treatment.

In comparison, the Wikipedia entry starts with the following description:

Gender identity disorder, as identified by psychologists and physicians, is a condition in which a person has been birthed one gender, usually on the basis of their sex at birth (compare intersex disorders), but identifies as belonging to another gender, and feels significant discomfort or being unable to deal with this condition.

And now we come to the first outright factual error in Conservapedia's entry:

A set of International Standards of Care [3] guide most physicians, and therapists around the world in a widely accepted medical process that begins with Reparative Therapy intended to dissuade patients from the permanent and irreversible physical alterations that could seriously damage their mental health.

Although WPATH is an international organization that publishes a Standards of Care protocol document, it is a bit of a reach to suggest that this protocol is universally applied by practitioners working with transgender clients.

The great fallacy here is the idea that anything in the SOC is even vaguely related to the notion of "Reparative Therapy". In fact, a careful reading of the SOC and the protocol that it implies leaves the decision making very much in the hands of the client. While the therapist may to some extent guide, they certainly are not going to attempt to dissuade the client. (negative persuasion is more typical of so-called "gender programs" run by the Clarke Institute in the late 1970s.)

In comparison, the Wikipedia article provides the following abbreviated version of the DSM-IV pages on the subject which are much more complete:

DSM-IV

The current edition of the Diagnostic and Statistical Manual of Mental Disorders has five criteria that must be met before a diagnosis of gender identity disorder (302.85) can be given:[2]

1. There must be evidence of a strong and persistent cross-gender identification.
2. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.
3. There must also be evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.
4. The individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia).
5. There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.

On the subject of treatment, Wikipedia provides the following comment about dissuasive therapy:

... Today, mohttp://www.blogger.com/img/gl.link.gifst medical professionals who provide transgender transition services now reject conversion therapies as abusive and dangerous, believing instead what many transgender people have been convinced of: that when able to live out their daily lives with both a physical embodiment and a social expression that most closely matches their internal sense of self, transgender and transsexual individuals live successful, productive lives virtually indistinguishable from anyone else ...

As well as a link to a lengthy article on the WPATH SOC.

The next bit of supposition is just so astoundingly brain damaged that I don't know how to read it:

However, the Kinsey model fails to account for a significant amount of transsexuals, who appear to be attracted to the the gender that they identify as. As a resolution, modern and typically liberal transgender activists have tended to present a model that transsexuals are fundamentally a man or woman trapped in the body of the other, and that their sexual orientation is entirely independent of their gender identity.[4]

The first thing that goes through my mind is that the Kinsey model has exactly nothing to do with gender identity in the first place. Kinsey focused on sexual attraction, not gender identity. The second issue that this paragraph suffers from is that the writers assume that "transgender activists" are "liberal" (often, transgender people are, but political leaning has little to do with one's identity). The last sentence is important, as it contains a subtle inference that is simply not substantiated by the evidence. (Far too many transgender people clearly do find their gender and sexual identities are distinct aspects of their being to ignore).

Critics of this common model for transsexualism, like J. Michael Bailey point out that such a model fails to properly account for the empirically evidence that transsexuals typically lie in two separate and distinct categories: whereas some males are so naturally effeminate and homosexual that it makes more sense for them to be women, than to continue to struggle and/or fail as men.

Okay - around about the time that anybody quotes J. Michael Bailey as a legitimate counterpoint model for transsexuals, they've lost the rhetorical argument. Bailey has already admitted to making unfounded inferences in drawing his conclusions. In my view, that's right up there with the so-called "critics" of evolution - most such critiques are based on amazingly bad science to start with.

Quite frankly, factual and semantic errors aside, Conservapedia is so obviously ideologically biased that it hardly represents any kind of credible source for reference information. Ignoring reality doesn't exactly help either.

Toying With Theoretical Models - Part III: What Evidence Must Be Addressed

This is part III of a series of essays:

Part I Motivations

Part II Obvious Problems

Part III What Evidence Must Be Addressed

Part IV Towards A Layered View

Part V Beauty and the Beast

Part VI The Critical Thoughts


In the previous two discussions, I have tackled my motivations for writing this series, and described some of the legitimate (if trivially obvious) issues that complicate the discussion of human behaviour and its analysis.

In this essay, I will take a few bytes of space to talk about the evidence and interpretation issues that have to be considered when the discussion turns towards human sexual behaviour.

Conflicting Evidence:

- Mutability of sexual orientation. This is a key point in the discussion, especially when the Christian Religious side of the conversation weighs in. While the public documentation that APA seems "absolute", with statements like The reality is that homosexuality is not an illness. It does not require treatment and is not changeable.. Meanwhile, at NARTH, we find the following The right to seek therapy to change one's sexual adaptation should be considered self-evident and inalienable. which clearly suggests a belief that sexual orientation is mutable.

- Validity of Experience. Any model of human behaviour must be able to reasonably express the described experiences of all of the participants. So, while on one side of the coin, we have the experience of many heterosexual and homosexual people that find it impossible - or at least inconceivable - that they might change their orientation, we also have the ex-gays that claim that they have made precisely such a change. Any model which promotes one view at the expense of invalidating someone else's life experience is suspect.

- Fluidity of behaviour. There are those whose behaviour is highly fluid across the range of human sexual behaviours. This covers a lot more than merely gender related attraction, but other factors that come into play such as age. There are young people who are sexually uninterested, and seniors who live active sex lives - and it seems that everyone has their "mate" somewhere out there. Similarly, the reported failure rates for reparative therapy techniques suggest that human behaviour doesn't necessarily change, regardless of the motivations of the patient.

- Persistence of Behaviour. Regardless of the morality of sexual behaviour, we must recognize its relative persistence. Consider the furor over the release of a sex offender from prison. Of all the people that we incarcerate, these individuals uniquely hold the record for this highest rates of recidivism. Along with the long history of repression that homosexuals have experienced in law and society, I think this is an important point to recognize. Even offenders like Toft who have willingly participated in therapeutic programs aimed at helping him manage those aspects of his sexuality that are dangerous to others are considered a high risk to reoffend. This suggests that the behaviours involved are much more persistent than conscious choices might suggest.

Limitations of Evidence:

- Psychological data is very difficult to quantify. Analysis must include the personal bias of the individuals interviewed, as well as the bias of the persons gathering the data. Cultural bias may also be a factor in the data gathering process, with questionnaires being particularly prone to "researcher bias". (for example, the MMPI has been criticized for precisely such issues, resulting in rework of the questions over time.

- Methodological errors or conflicts. Reparative Therapy has been heavily criticized for sampling bias as well as participant selection criteria, and similarly, Kinsey's results have been criticized by the conservative community because of where he drew his study population from, among other issues. The validity of these criticisms is a topic in its own right, but one that I will mostly try to leave at the door in this series.

- Ambiguity. There are significant unknowns in any study of human behaviour. In particular the roots and origins of any particular behaviour are seldom clear. At best, we might be able to formulate probable causes in individual cases.

On Using Straw Man Arguments To Support "Conversion Therapy"

If you have been living under a rock for some time, you may not have noticed the uproar over so-called "conversion therapy" techniques.  They have been declared unethical by the major mental health associations, outright banned in a number of states, and so on.  However, that doesn't stop their advocates from promoting an intellectually dishonest, coercive approach to things.

This week, I found the following paper lurking on Academia.edu:

Earp, B. D., & Vierra, A. (in press). Sexual orientation minority rights and high-tech conversion therapy. In D. Boonin (Ed.), Handbook on Philosophy and Public Policy. Basingstoke: Palgrave Macmillan. Available online ahead of print at https://www.academia.edu/36145698/Sexual_orientation_minority_rights_and_high- tech_conversion_therapy  

Now, I'm going to give the authors a little more latitude than I might had they been psychologists, psychiatrists or social workers who might actually work with the affected population.  They aren't - they are philosophers, and they are trying to make an argument for a public policy stance.

However, their argument is fundamentally a straw man.  They ask the reader to imagine a future where some combination of technologies allows for an "effective" sexual orientation conversion therapy to take place.

MisUnderstanding Transsexuals and Transition

Every so often, I see someone start talking about transsexuals and transition. They almost always do it from an externalized perspective and inevitably make some statements that are guaranteed to make various members of the transgender community angry.

So, when Jerry Maneker wrote a post that pointed to Don Charles' post entitled "Frankengender", I got curious and went and read it.

I have to take great exception to some of the assumptions in Mr. Charles' writing, because they lead him down a path to conclusions which are just plain, outright incorrect.

... "Gender reassignment" is a cynical hoax which exploits vulnerable people and leaves them forever chasing a false legitimacy; it's so cruel, so despicable, so horribly inhumane, I can barely stand to think about it. The really tragic part is, a person's inborn Transgender status is every bit as legitimate as conventional male or female biology, but nobody will acknowledge that fact.

As I've said before, there's nothing wrong with most Transsexual patients that broader, more realistic definitions of male and female wouldn't cure.

I think this statement underscores a key assumption about transsexuals that is, to say the least, incorrect.

He's inverted things from the usual assumption that non-trans people make. Instead of claiming that it's all about the physical (surgical), he tries to make a variation on the Rad-Fem claim that gender is largely rooted in the social. (and sadly, has misconstrued it in a manner consistent with the objections that both social conservatives and radical feminists raise about transsexuals)

His misunderstanding here arises from a failure to recognize that Gender is a complex, multi-dimensional aspect of our being. At the very least it involves the intersections of the physical, social and psychological aspects of us. (and, as if we can't possibly get any more difficult to comprehend, the social and psychological aspects are likely in themselves comprised of many different threads of identity!)

The claim that "broader definitions of man and woman" would "cure" transsexuals is, highly debatable. While more flexible notions of gender would certainly help alleviate some of the stigma that transsexuals encounter in life, it cannot and will not address the cognitive dissonance that so many transsexuals experience prior to transition and (for some) surgery.

But feelings of disgust for the body you were born with is a mental health issue requiring mental health services. You don't treat mental health issues with radically invasive surgical procedures!!! That's barbaric!

I've seen this claim made before by other opponents of treatment for transsexuals. Coming from someone who apparently is connected in general with the GLBT community, I'm particularly disappointed to see it.

The problem is that it falls into the same category as so-called "reparative therapy" for homosexuals. Trying to change something as fundamental as gender or sexual identity using therapy just plain old doesn't work - at least not for those whose identity is firmly at the extreme end of things.

I can appreciate his "horror" at the nature of gender surgery - most males express that response when thinking about Male to Female GRS.

However, for transsexuals in general, GRS is an effective part of the treatment process (although a fairly late stage of the overall treatment). I would invite Mr. Charles to spend some time reading Pfaefflin et. al.'s study of post-surgical outcomes before he goes too far down the path of condemning the availability of surgery for those who need it.

I will also refer to the WPATH Standards of Care briefly to substantiate my point that there is more at play here than a single dimension of experience:

Options for Gender Adaptation. The activities and processes that are listed below have, in various combinations, helped people to find more personal comfort. These adaptations may evolve spontaneously and during psychotherapy. Finding new gender adaptations does not mean that the person may not in the future elect to pursue hormone therapy, the real-life experience, or genital surgery.

This is significant, because it underscores a clear understanding in the treatment community that surgery is but one dimension of a much broader scope of treatment.

When it comes to surgery itself, I would like to bring your attention to section X of the v6 Standards of Care:

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.

While I would to some extent agree with Mr. Charles' assertion that GRS is not a cure per se, we can't cure a lot of conditions yet. But we have known treatments that are effective. Whether you like the SOC or not, the protocol they describe is demonstrably effective at both the individual and population levels over the long term. (Pfaefflin et. al.'s survey of post-surgery results corroborates this claim quite nicely)

It's an option for Transfolk, not a necessity!

Is GRS necessary for all transfolk? No. For some? Absolutely. The issue around surgery funding is that when you view it as "purely optional" (and therefore something the individual must pay for out of their own pocket), you create a situation where the most severely affected by their gender issues likely will never have access to the treatment they need for economic reasons. (Granted, I'm a Canadian, and I have a somewhat different perspective on funding for medical treatment than is common in many parts of the United States ... I see great value in not driving people with medical needs into bankruptcy)

I think that Mr. Charles' has grossly misunderstood that although it is a fraction of transfolk who actually have gender surgery performed, that doesn't make it less important and valid for them than any other medical intervention for a condition. Perhaps I should point out here that medical intervention for mental conditions such as schizophrenia aren't exactly ideal solutions either - at best they are marginal attempts to manage the symptoms the patient is experience ... but the patient is much better off with that imperfect treatment than with no treatment at all!

. . . they expect me to swallow this whopping big lie about "gender dysphoria", a "neurological disorder" for which no neurological therapy exists. Instead, major cosmetic surgery including breasts and reproductive organs is the only effective treatment! It's the most demented thing I've ever heard of.

For those who experience and live with whatever the causes of being trans happen to be, the consequences are very intensely real. To the point that the suicide rate (and suicide ideation rates) among transsexuals in particular are many, many times higher than the population as a whole. It's not just suffering, Mr. Charles, it can be so destructive as to be beyond debilitating. While I would agree that the clinical models used to date are imperfect, they are a damn sight better than nothing.

In this case, the pit in question is a "civilization" that seethes with entrenched transphobia. That's the abnormality that needs to be corrected . . . and it's still there! Quackery like "gender dysphoria" and Frankengender "sex change" operations keep it there.

I will agree that there is an entrenched degree of transphobia in society, and that it deserves to be expunged from society. One of the things Mr. Charles' has misunderstood, and misrepresents through his entire argument is the role of the therapist (at least the good ones).

A good therapist will help their client work through and beyond the transphobia in society and themselves. Guess what? - even after that process has worked its way through in a reasonable fashion, we still find that there are transsexuals who are not willing to live with the incongruity of feeling and living as female in our society without the gender surgery to align body and soul.

The point, Mr. Charles, is that for a fair number of transfolk surgical intervention is part of the solution. The rest of the solution comes from within - an inner journey that is at least as moving and powerful to those who undertake it as your own journey into faith no doubt was.

As for changing society's paranoia about transgender people as a whole, the only way that's going to happen is for those who are trans to live well and be positive examples within our circles. Sadly, when the most generous of estimates place the rate of transgender identity at somewhere in the 1 in 3000 range(and personally, I think that's very optimistic), the odds of there ever being enough transsexuals to influence the greater mass of society into a more engaged, thoughtful place are tiny indeed.

It is one thing to argue for excising transphobia from society, but it is quite another to do so without acknowledging the very real need for transsexuals to change their bodies.

If you get angry e-mails about your posts on the subject, it is no doubt because so many would read what you are advocating as an attempt to erase their own narratives. Generally speaking, erasure tends to result in cranky people. Not everyone who is transgender is content to live in the nether world betwixt and between.

Personally, Mr. Charles, I would strongly suggest spending some time talking with therapists and other treatment professionals who are part of WPATH, and a little more time in the clinical literature about transsexualism before you go making proposals like "fixing the mind". It seems to me that your own thinking is filled with as much subjective nonsense on the topic as comes from the likes of Peter LaBarbera and Julie Bindle.

[Update 19/08/10]
Reductio ad Absurdum

In the comments over at Jerry Maneker's blog, the conversation took a turn for the surreal and outright ridiculous when Jerry writes the following in reply to one of my comments:

If there were no transphobia in society, it is unlikely that there would be many transexuals who would feel "like they were born into the wrong body."

Ummm...right. So eliminating transphobia will reduce the number of transsexuals - I can't even begin to express how ridiculous that kind of reasoning is. The degree and extent of transphobia in society today is enormously lower than it was thirty years ago; and the numbers of transsexuals hasn't exactly dropped off, has it?

As for the argument that eliminating transphobia would allow more transfolk to live comfortably without pursuing surgery, that's at best a bald assertion with no evidence to back it up.

I'm sorry to say it, but even within the broad GLBT community, there's an immense amount of misunderstanding of transgender folk as whole, and transsexuals in particular. It's truly sad when people opine about how to deal with the plight of others without bothering to inform themselves in a meaningful way about those people.
[/Update]

Promoting a Comment Thread

I don't normally bump things out of comment threads, but Roger's last comment back here deserves a more thorough commentary than I think is appropriate in a comment.

What follows is my own thinking on Roger's comment:

I think the reality that behavioural science will arrive at has been quite elegantly expressed in The Sexual Spectrum: Exploring Human Diversity. (although heavily anecdotal, the author puts forward a rather well reasoned model)

Reality is this - human behavioural attributes exist along a continuum for any "attribute pair" you wish to describe Heck, I'm left handed - mostly, but there's some things I do right handed (and when it comes to throwing a ball, I'm basically hopeless), so even there, it's not an absolute - I have some degree of ambidexterity.

Where sexual identity is involved, it's likely a bimodal distribution, with a huge weight towards heterosexual behaviour at one end of the spectrum, and a smaller, but significant bump on the homosexual end of the scale. In between you find a small percentage of people who express some significant degree of bisexual behaviour. (Please note, I'm working heavily from inference here, and there's probably several lifetimes worth of hard research to confirm my suspicions)

My strong suspicion is that most people are "tethered" to some point along the spectrum, and although they may be able to express themselves differently to some degree or another, someone who is "firmly" heterosexual, or firmly homosexual just won't get very far trying "the other field" so to speak.

What confuses the issue are those who fall in the middle. The bisexuals whose "tether" is long enough to allow them to drift towards either a primarily homosexual or primarily heterosexual presentation, and then at some later time to apparently "change" their identity. (What has actually changed is the outward expression of their sexual identity, not the core attribute they are "tethered" to).

Personally, I suspect that most of the "success" stories out of the "reparative therapy" game are precisely such people. Similarly, I suspect that the "failures" are in fact firmly within the "homosexual" side of the spectrum, and are going to find it as difficult to "change" as it would be to convince a solidly heterosexual person to become a practicing homosexual.

Attempting to "change" someone's sexual identity by therapy is unlikely to be successful unless they fall into the category of "bisexual", and there you are not changing their identity so much as their social expression of it. Attempting to force the issue by coercion of any sort is apt to be extremely damaging to the individual in the long term.

By way of example, I'd like to relay an experience I had with a course I took a few years ago.

It was a leadership training course, and quite a good one (or so I thought). Naturally, one of the exercises was a Myers-Briggs personality type test. I scored an amazingly strong "I" (introverted) score on the test. (Not surprising to me - I like little better than a quiet evening with a glass of wine, my parrot and a good novel to read) Several of my classmates were quite shocked by this revelation that I am a strong introvert - apparently they hadn't guessed at all from how I conduct myself at work.

Near the end of the course, the instructor paid me quite a delightful compliment. He told me that although I was a very strong introvert, I had developed some very good ways to manage myself in my day to day work life.

I do not claim that it's easy for me to do that - there are days where my role at work exacts a frighteningly high price from me, and I go home and make like a hermit for a few days.

On the Introvert/Extrovert scale, I'm a strong Introvert, but I can "play" as if I'm an extrovert. Trust me, I don't "get it" where extroverts are concerned. Put me in a room full of people and I just want to escape - I don't get "energized" by the experience - but there are those who certainly do. (and similarly, they don't "get it" where my proclivity to go home and find a good book is concerned!)

My point is this - although I can "act" the part, sooner or later my "tether" gets over stretched, and like a great big bungee cord yanks me back home sooner or later. The further it gets stretched, the more dramatic my reaction when I find myself "pulled back".

(again, this is anecdotal evidence I present here, but it should give you some sense of where I come from when discussing these issues)

Sadly, this leaves the religious "conversion" advocates like Kempling just as high and dry as they are using the more polar model. It still comes down to attempting to "change" something that is simply not responsive to therapy.

Just as you can't turn me into a person energized by a roomful of social interaction, I do not think that one can make a homosexual turn into a heterosexual (or vice versa). They may "act" straight, but like me when I have to play the running extrovert, sooner or later the price for that expression will be paid. It is only those who land in the "bisexual" part of the continuum who are close enough to drift into either side that will "seem" to change.

The Price "Christianity" Exacts From People

The outright abusiveness of some who profess that their actions are done in the name of "all that is holy" annoys me to no end some days.

We often hear of the horrors of so-called "reparative therapy". It's awful enough what they will attempt to tell someone who is gay or lesbian to do to themselves.

Then there is what they will do to their families. Read that link - it is heartbreaking how the writer's relatives pressured the father in all sorts of ways, ultimately separating father from his offspring - solely because of their moral objections to his partner.

I admire the writer's clarity and strength of character at such a young age, and I am appalled by the behaviour of her aunt and uncle in particular. If those are "family values", then it's time to hold these brutes up to account for what they are doing to individuals and families.

Dear Abbey:

Back here, semi-anonymous commenter "Abbey" writes a real doozy which deserves its own treatment.

Writes Abbey:

You all profoundly misunderstand the Christian position.

Christianity does not preach hatred for LGBT people.

What you call 'orientation' we call temptation.

What you all see as an identity, we see as a behavior.

We are ALL sinners. Homosexual acts are just one sin among thousands - if not millions of others. The fact that many people suffer from this particular temptation is NOT an indication that the 'rules' should be changed.

Note to anonymous: In ancient Greece it was typical for a man to have a wife for procreation and a boy for 'recreation' (pederasty).

Since one of the goals of homosexual activists is to eliminate age of consent laws I can only conclude we are not emerging from the 'dark ages' we are returning to them...

This is so rich in the "getting it wrong" department that it deserves to be taken apart, piece by piece...

Christianity does not preach hatred for LGBT people.

Funny. I keep hearing that, then we get cases like Boissoin, Whatcott or Chandler's Freedom Radio Network popping up after ostensible "Christians" come out and make what amount to "calls to arms" against GLBT people - effectively inciting violence against them. While Christianity may not preach hatred, there is an amazing amount of vile hatred that is committed in the name of Christ. Or perhaps, you'd like to consider the case of Julie Nemecek who was fired from her job ... for being transsexual. Why? Because the so-called "Christians" running her place of employment decided they couldn't control her life adequately. How "loving" and "compassionate" of them.

What you call 'orientation' we call temptation.

What you all see as an identity, we see as a behavior.

Go take some clinical psychology courses on these topics. It's obvious that you think that someone can "just pray away the gay" because it's nothing more than "temptation" and "behaviour" - meanwhile you conveniently ignore all of the evidence that demonstrates that what you claim is "behaviour" (which suggests mutability) does not in fact respond well to therapies designed to provoke change. (Including the often proposed notion of "reparative therapy" as proposed by organizations like NARTH and Exodus).

As Naomi Lakritz's column pointed out, GLBT people no more sat down and "chose" to be what they are any more than you did (I presume that you are quite emphatically heterosexual). In fact, consider the social prejudice that these people face daily, and one would have to suspect that someone would only tread such a path out of a deeply seated necessity. (Certainly, this is true of Transsexuals, and I presume it to be true to a large degree for GLB people as well)

We are ALL sinners. Homosexual acts are just one sin among thousands - if not millions of others. The fact that many people suffer from this particular temptation is NOT an indication that the 'rules' should be changed.

Nice claim, but it neither addresses, nor justifies the topic at hand. Lakritz's column was going after the christianists like Boissoin and others whose acts against GLBT people are outright vicious, and arguably incite others to engage in beatings and worse against GLBT people. The notion of "sin" belongs within a church and a faith community. Why should your notion of "sin" be used to judge and demonize others?

As for "changing the rules", your dogma on this topic merely demonstrates an ongoing lack of understanding (and willingness to understand) the reality that the rational evidence makes clear: GLBT people are still human beings, and generally honest, decent citizens - quite undeserving of the kind of vitriolic attack that Boissoin has made.

Note to anonymous: In ancient Greece it was typical for a man to have a wife for procreation and a boy for 'recreation' (pederasty).

Since one of the goals of homosexual activists is to eliminate age of consent laws I can only conclude we are not emerging from the 'dark ages' we are returning to them...

Let me be amazingly clear about something here. Homosexuality refers to someone being attracted to members of the same physical sex. Pedophilia implies attraction to children. These are not synonyms, and you grossly distort reality when you try to claim that homosexuals are pedophiles. (which is the implication of what you a blathering about)

The claim that homosexual activists want to "eliminate age of consent" laws is patently false, a myth perpetrated by the christianist right in an effort to continue demonizing a group of people.