Recently the American Psychiatric Association (APA) announced their new panel for the revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Named as chairperson of the work group for “Sexual and Gender Identity Disorders (GID)” is Dr. Kenneth Zucker, known for his reparative therapy work on transgender children with Dr. Susan Bradley. Additionally we have Ray Blanchard, who famously renamed “transvestism” to “transvestic fetishism,” a term that is based on sexual fantasies in the DSM-IV (1994). There are other changes made by both Blanchard and Zucker. Mr. Blanchard is also the creator of the term “autogynephilia.” For the sake of brevity, I will concentrate on Dr. Zucker’s ideologies and the potential negative influence on DSM-V.
Dr. Zucker explains for NARTH How Should Clinicians Deal With GID In Children.
Dr. Zucker admits that there are complex social and ethical issues surrounding the politics of sex and gender in postmodern Western culture. He note that the “most acute ethical issue may concern the relation between GID and a later homosexual sexual orientation. Follow-up studies of boys who have GID that largely is untreated, indicated that homosexuality is the most common long-term psychosexual outcome.”Dr. Zucker says that clinicians have an ethical obligation to inform parents of the relationship between GID and homosexuality. Clinical experience suggests that psychosexual treatments are effective in reducing gender dysphoria and that individual counseling and parental counseling are both effective methods of treating GID.
Mentioned in NARTH’s “Gender Identity Disorders In Childhood And Adolescence: A Critical Inquiry And Review Of The Kenneth Zucker Research by the NARTH Scientific Advisory Committee (March 2007).”
Developmental Course and Outcome: Regarding psychosexual differentiation [the persistence and desistance of GID], three outcomes have been identified: (1) persistence of GID with a co-occurring homosexual sexual orientation; (2) desistance of GID, with a co-occurring homosexual sexual orientation; and (3) desistance of GID, with a co-occurring homosexual sexual orientation. Outcome (2) has been the most common among boys- with girls not well studied. From a developmental perspective this suggests that gender identity, at least among children with GID, is malleable and likely influenced by psychosocial experiences, such as therapeutic interventions.He points out that it is legitimate for parents to establish limits for their children on cross-gender behaviors. If not, the behavior is, in effect, being reinforced.
Children and adolescents who are resistant to psychosexual treatment may be candidates for early hormonal treatment but only after all other options have been exhausted. The clinician may consider two options: management of the condition until the child is 18 and can be referred to an adult clinic or the early institution of sex hormones.
Dr. Zucker has long insisted that GID is nothing but a child’s cross-dressing play created by psychological fantasies that need to be eradicated by removal of Barbie dolls (as explained by J. Michael Bailey). This assertion punishes gender-variant children who may be diagnosed by gender specialists as valid GID cases, and causes them to be misunderstood by parents and friends. This is made worse when Dr. Zucker constantly addresses GID children by the wrong pronouns and reinforces the weight of society’s expectations concerning maleness and femaleness in their lives. Lynn Conway explains the modus operandi of Dr. Zucker with his close colleague and often key defender of his theories, Mr. Bailey.
Letting these children go through the transition course only when “all other options have been exhausted,” after all the potential psychological and emotional distress placed upon these children and finances spent by their parents at Dr. Zucker’s “gender identity clinic,” is akin to putting an innocent man to prison without evidence, but letting him go only when new found evidence proves the man innocent in the end. His failure to separate sexual identity with sexual orientation, and instead implicating homosexuality as a form of GID, would feed this very notion used by most ex-gay ministries, adding to the existing archaic views of what “causes” same-sex attraction. These are just some of the issues that may arise if there are potentially discriminatory amendments to the current DSM-IV, especially if the DSM-V gives ex-gay ministries and anti-gay proponents that room.
Ex-Gay Watch recently asked the APA for their comment regarding the appointment, to which they responded in a statement that was also mailed to several other websites:
The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.
There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.
All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.
The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:
Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.
Paraphilias, chaired by Ray Blanchard, Ph.D.
Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.
Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012.
Although the transgender community can breathe a sigh of relief to the appointment of gender specialist Peggy T. Cohen-Kettenis as the chair of the GID subcommittee for the work group, it does not address the LGBT’s immediate concerns that a reparative therapist, and one who performs such on children, is still heading the entire work group. It is the hope of many that the soon to be appointed APA Task Force for the GID study can do justice and redress the balance of whatever prejudicial theories Dr. Zucker plans to uphold.
It is still debatable, however, whether Dr. Zucker is indeed attempting to prevent future homosexuality by overcoming GID. Joseph Nicolosi and Dr. Zucker were both mentioned in an LA magazine article back in 2003.
On Joseph Nicolosi:
Even those who support the GID diagnosis do not dispute that some who use it are driven by ideology. The best-known of these is psychologist Joseph Nicolosi, a founder of the National Association for Research and Therapy of Homosexuality.NARTH promotes therapies that claim to convert homosexuals to heterosexuality, and Nicolosi has long been associated with right-wing groups. He declined to speak with Out, but in his 2002 book, A Parent’s Guide to Preventing Homosexuality, Nicolosi uses terms such as “pre-homosexual,” “gender-confused,” and “gender identity disorder” interchangeably. He is working with children with the goal of preventing them from growing up to be gay or lesbian.
During an appearance on Fox’s The O’Reilly Factor, Nicolosi said, “For parents who want their children to go in a heterosexual direction, I’m available.” He has made similar claims in the past. In a 1998 speech, he said he was treating about 25 “pre-homosexual boys,” including 5- and 6-year-olds as well as some as young as 3. “These boys want to be girls,” he said in the speech. “They are denying their masculinity. They are preoccupied with feminine activities. They are infatuated with Barbie dolls ….”
On Dr. Zucker:
Zucker asserts that Nicolosi’s work is unsupported by any evidence, but he adds that some who object to the diagnosis are as prone to confuse politics with science as Nicolosi is.”Nicolosi is deeply embroiled in sexual politics, so it is not surprising that he takes this particular position with regard to GID, but there are people who have no sexual orientation ax to grind who would also see GID as a phenomenon that causes kids a lot of trouble,” Zucker says. “He has very strong views about things, and the boundary between the clinical issues and the ideological issues seem a little blurry to me, just as with gay politicos on the Left.”
Surprisingly, Dr. Zucker allows NARTH continuous use of his theories to justify NARTH’s position on GID without further complaint.
Nevertheless, the obvious outcome is well observed; the appointment of Dr. Zucker on his second revision of the DSM since 1994 would open a new back door for conversion therapies which the APA currently is opposed to, while maintaining GID as a mental disorder. And the first victims would be transgender children. Jenn Burleton is the Executive Director of TransActive Education & Advocacy (TEA) and also the West Region Coordinator & Board Member PFLAG-Transgender Network (TNET). Her credible work for the past few years centers on trans children and their parents. They recently released a strong position statement in regards to Dr. Zucker’s appointment.
She shares her exclusive views for Ex-Gay Watch:
Dr. Kenneth Zucker’s theories about the authenticity of transgender identity in children & youth are well-known, particularly to those of us who specialize in working with transgender and gender non-conforming children, youth and their families. He stands behind the notion that, in the vast majority of cases, childhood gender non-conformity is nothing more than an indicator or ‘warning sign’ of future homosexual orientation by a child or adolescent.Many transgender & gender non-conforming children already suffer from feelings of depression, anxiety, self-destructive behavior and low self-esteem as a consequence of parental and societal disapproval of their gender identity expression. In fact, current statistics indicate that at least 50% of transgender children ideate suicide. These children, if treated by Dr. Zucker and others who agree with him, are then subjected to further cissexist oppression and rejection of their core gender identity.
Dr. Zucker has gone so far as to offer his so-called ‘expert’ testimony about the legitimacy of childhood transgender identity in custody cases where one parent is opposed to the other parent’s support and recognition of their child’s transgender identity. His testimony is usually given on behalf of the parent who is in opposition.
In a recent story on National Public Radio, Kenneth Zucker is quoted as saying; “Most of the kids we are seeing are saying they want to be the opposite sex,” Zucker says “To me, that’s saying they are unhappy with a basic part of themselves… If the sine qua non of a disorder is distress, I think it is a disorder in the sense of being unhappy about who they are.”
This statement illustrates Zucker’s inability to grasp or respect transgender identity as an independent, core identity. While the children may be “saying they want to be the opposite sex”, what they are feeling is that they already have a gender identity that is, to one degree or another, in conflict with their assigned sex and externally perceived gender identity. For Zucker to say that he believes these courageous children are unhappy with themselves further indicates his misguided position that the problem lies with the child, rather than with a misogynistic and cissexist society’s treatment of that child.
Based upon the very name of the work group Dr. Zucker has been selected to Chair, he seems to be exceedingly unqualified to play a key role in revising and defining the guidelines that will be used for years to come in treating transgender and gender non-conforming children and youth. Transgender identity is not a “sexual disorder”, as gender identity and sexual orientation/function are two different things. And since Dr. Zucker, for the most part, rejects the concept of Gender Identity Dysphoria (GID) in children and youth as nothing more than pre-homosexual behavior, he is an odd helmsman for a ship he doesn’t believe exists.
Dr. Kenneth Zucker’s appointment to this committee, along with that of his associate Dr. Ray Blanchard will, in my opinion, contribute to a continuance and possibly strengthened renewal of destructive therapeutic treatment or, more specifically, non-treatment of our most precious transgender and gender non-conforming children and youth. He is to childhood gender identity care what Joseph McArthy was to patriotism.
Let us note for the record; this is the promise made by the APA to all lesbians, gays, bisexuals and transgenders.
Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.
In fulfillment of this promise, it is our wish that the APA watch Dr. Zucker closely to prevent any attempts to impose his own theories on the DSM-V, theories which are completely irrelevant to nearly the entire LGBT population. The APA should be wary of a doctor who believes gender-variant children are potential homosexuals, and who wishes to practice reparative therapy to cure GID, particularly since the removal of homosexuality from the DSM in 1973.
A special thanks to Ms. Jenn Burleton.