Tuesday, February 9, 2016

placing Ken Zucker's clinic in historical context

So an article by Jesse Singal called "How the Fight Over Transgender Kids Got a Leading Sex Researcher Fired" recently appeared on NY Mag. I was interviewed for it, but none of what I said was included in the final piece. This is perfectly fine, of course - no one is obligated to use my quotes in their article. But I did feel that the most important point that I stressed (i.e., placing the current Zucker clinic debate in the historical context of the long history of gender reparative therapies) was not duly acknowledged in Singal's article.

Given this omission, I thought that it might be useful for me to share my responses to Jesse's interview questions below. I have removed Singal's actual questions (since I did not ask for permission to use them). But I did paraphrase them to give readers an idea of what I was responding to.


I will walk you through my understanding of the basics before answering your questions.

First, it is important to note at the onset (as you may already be aware of) that it is generally accepted that gender identity (identifying as a woman, man, and/or other alternatives) and gender expression (expressing feminine, masculine, and/or androgynous behaviors, affinities, and interests) are different things. They may line up in a given individual (e.g., feminine women, masculine men), but in some people they differ. There are people who strongly cross-gender-identify but who are not gender-conforming (with regards to gender expression) post-transition, and there are plenty of feminine men, masculine women, and androgynous people who have no desire whatsoever to transition. 

Second, we know that people who do strongly cross-gender-identify and eventually transition (i.e., transsexuals) may take different paths: Some are insistent that they are really a boy or girl from the earliest ages, while others may realize this later in life and/or are gender-questioning for many years before ultimately deciding to transition. It is also widely accepted (e.g., even by Zucker, as you mentioned) that people who do strongly cross-gender-identify (or in psychiatric terms, people who are highly gender dysphoric) are generally happier and healthier upon transitioning to their identified gender. 

Third, when people talk about gender-non-conforming or gender-variant children, these kids are typically categorized this way based on their atypical gender expression (i.e., assigned-boys with feminine affinities/behaviors, assigned-girls with masculine affinities/behaviors). We know that some of these kids will strongly and persistently cross-gender-identify. Others may occasionally or sporadically claim to be the other gender, but may not grow up to be cross-gender-identified. Still others who fall into (or who don't fall into) this class may never explicitly cross-gender-identify as children, but nevertheless eventually follow that path and transition later in their lives.

While this may seem messy, I personally know people who fall into each of the above categories, and I don't believe that anything that I have just said is controversial within trans communities or among knowledgable researchers/therapists. So given these (widely accepted) facts, let's move onto where we seemingly diverge on the issue at hand.

Historically, gender-reparative therapies (such a Zucker's, but they have been espoused/practiced by many practitioners others in the past) were designed to turn gender non-conforming children (via positive & negative reinforcement) into gender conforming children. (They also used to regularly involve electroshock therapy, but that's another story.) I encourage you to check out the books Gender Shock: Exploding the Myths of Male and Female (by Phyllis Burke) and The Last Time I Wore a Dress: A Memoir (by Dylan Scholinski) - while neither (as far as I recall) specifically discuss Zucker's practice, they both show that historically these practices were intended to steer kids toward gender conforming behaviors (regardless of identity). The diagnostic justification for these practices was the GID in Children diagnosis in the previous DSM (DSM-IV-TR), which was heavily critiqued by feminists, queer and trans activists at the time for broadly pathologizing gender non-conforming behavior (not specifically cross-gender-identification). 

Zucker's stance has always been the same: While not explicitly condemning trans or gender-non-conforming people, he has maintained that these children's lives will be easier if they can be grow up to be more gender-normative. But in the last decade or so, as LGBTQ acceptance has grown (with public recognition that many gay people are also gender non-conforming), and as the practice of allowing trans children the possibility of socially transitioning (with physical transitioning only coming if/when the child is old enough and desires it), Zucker and his supporters' arguments have shifted. Nowadays, gender reparative therapy is being sold as allowing these children the possibility of being gay rather than trans, or as not needlessly shuttling children into potentially unnecessary hormone regimes and surgeries. Indeed, this is the premise of that Dreger article that I critiqued.

The problem is, this argument is not only revisionist, but it creates a false dichotomy. Because no one is going around forcing gender non-conforming children into cross-gender-identifying or socially transitioning. The organizations advocating on behalf of gender-variant children and the non-gender-reparative clinics that work with these kids will tell you (if you ask them, and you most certainly should) that social transitioning (and puberty-delaying drugs, if they are older) is only being recommended for children who strongly and persistently cross-gender-identify. If a child is simply gender non-conforming or gender questioning, these people/organizations/clinics will encourage them to explore their genders (i.e., without socially transitioning), and try to provide support for them to do so without shame or stigma.

[question edited out, about gender non-conformity and identity]

So when you say "gender" here, you seem to mean gender expression. As I already mentioned, I (and most trans activists and advocates) recognize that gender identity and gender expression are different things, and reject the notion that some ways of being gendered are better than others. While you may find *some* trans people who disagree with me on this, what I am saying is consistent with what transgender activism has been advocating since the 1990s. We are striving for a world where all manifestations, identities, and expressions of gender can exist without value judgments.

In contrast, encouraging children to not behave in gender non-conforming ways, and claiming that a well-adjusted trans person is a worse outcome than a "gender-repaired" non-trans person (as Zucker's camp claims/insinuates) are definitive value judgments regarding gender. So your question seems better suited for them.

[question edited out, about "watchful waiting"]

As I said, this is precisely what those of us on the anti-gender-reparative-therapy side advocate, albeit without sending the child off to someone like Zucker, who will instruct the kid not to engage in any gender non-conforming behaviors - which you have to concede is hardly value-judgment neutral. Children are highly aware of the fact that when they are told not to do something, the implication is that this "something" is bad or wrong.

[question edited out, about children showing up at Zucker's clinic possibly not being really trans]

1) These kids are not magically showing up a Zucker's clinic. They are brought there by parents who are confused or disturbed about their child's gender non-conformity. And today, in the internet age (where parents can do their own preliminary investigation into gender variance and potential therapists), it's likely that many parents who chose Zucker over other alternatives were specifically seeking out reparative/conversion therapy. 2) These children are not necessarily brought in for "gender dysphoria" but for gender non-conformity. I've already conceded (as most trans activists & advocates would), many of these gender non-conforming kids will not grow up to be cross-gender-identified. 

But to turn your argument around: Why, if supposedly 80% (as you said, a statistic that is highly suspect, as explained here: http://www.huffingtonpost.com/brynn-tannehill/the-end-of-the-desistance_b_8903690.html ) of these children are merely non-conforming with respect to gender expression, why force them to endure reparative/reinforcement therapies designed to thwart their cross-gender-expresssion? It makes absolutely no sense! If you are totally fine with cross-gender-expression, but concerned about cross-gender-identity, why would you center your therapy (as Zucker has) on prohibiting cross-gender-expression?

The answer is (as I mentioned above), these reparative therapies were always intended to thwart/correct cross-gender-expression (as well as identities). Which leads me to this next statement/question of yours:

[question edited out, suggesting that Zucker used withholding/denying of preferred gender expression as a temporary measure to gauge the child's gender dysphoria]

Frankly, this is all revisionist history. Historically, gender reparative has involved shaming/withholding/restricting cross-gender-expression, not just for a short amount of time, or as a brief test, but as the foundational goal of this behavioral therapy. Over my many years of trans activism (since 2001), I have met a few people who were sent to Zucker as children, and what they shared with me was similar to what is reported in the books I cited above: That it was reparative therapy meant to attenuate or eliminate cross-gender-behavior and expression.

Here's what I don't know: Perhaps in the last few years, Zucker modified his approach, and used restriction of cross-gender-expression as a test (as you suggest) to "determine the persistence of a child's dysphoria." But even if this *were* the case (which I doubt), it would be an extremely inane test, as we already know that cross-gender-expression doesn't necessarily indicate . . . cross-gender-identity.

Alternatively, maybe Zucker believes that restricting cross-gender-expression would have the effect of "converting" kids who were cross-gender-identified. In which case, I refer you to WPATH's determination (as I cited in the previous email):

Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical.

[question edited out, asking if "nudging" the child toward gender conformity might be okay if it is part of a program that respects the child's wishes and well being]

Wow, this seems convoluted to me. First, "nudge" is an especially euphemistic way of putting this. A "nudge" would be what a parent does if their kid proclaims that they will be a astronaut when they grow up, and the parent says "well, not everybody can be an astronaut." Gender non-conforming kids get lots of "nudging" from their parents and peers about their behaviors. They get sent to Zucker when the nudging doesn't work. For these kids, what you call "nudging" is a more blatant "withholding/restricting" of their expressions or identities. But then you ask (in the same sentence) if this withholding/restricting is OK if it's [my paraphrasing: part of a broader approach that respect's the child's well being & wishes]. How can telling a child not to play with girls, or play with girls' toys (if that's what they want to do, and which is why their parents brought them to Zucker's clinic in the first place) ever possibly be respectful of "the child's wishes and feelings"?

[question edited out, about what is the right approach for cross-gender-identified young children]

So I am not trained to make a decision like this. And if you asked the people who are trained in this (which you most certainly should do), I am sure that they will tell you that it's dependent on the individual's context and circumstances. 

But I do believe that most of us on the non-gender-reparative-therapy side of the debate would agree with this: The most important thing is for the child to grow up to be happy and well-adjusted - whether it's as a trans person, or as a non-trans person. And instructing/demanding a gender non-conforming child to *not* to play with girls or feminine toys (or boys and masculine toys) will ultimately foster shame and stigma, which is not in any way conducive to happy and well-adjusted outcomes. 

In those cases where children do socially transition at the age of five, they are still free to explore their genders, and decide to transition back to their birth-assigned gender if they wish to. How is this worse than exploring their genders in their birth-sex assigned? (Unless you assume that being/becoming trans is an inherently bad/inferior thing, in which case you're the one making a value judgment, not me).

I hope this answers your questions. And like I said, you should most definitely seek out the opinions of people who work with/for gender variant/non-conforming children, and people who have endured gender reparative practices, as they will be able to address the many issues that I haven't/cannot.

Postscript for those new to this subject: see also NPR's piece Two Families Grapple with Sons' Gender Identity, Brain Child's piece Drop the Barbie!, Kelley Winter's piece The Gender Gulag: Voices of the Asylum, and Casey Plett's piece Zucker's "Therapy" Mourned Almost Exclusively By Cis People.

Note added 2-19-16: a counter-letter/petition by trans & health providers and professionals who support CAMH's decision to close Zucker's GIC clinic has recently been published. Also, Parker Molloy (who like me, was interviewed for, but not included in, Singal's article) recently highlighted other shortcomings in the piece in her post About that New York Magazine article on Kenneth Zucker.

In August 2016, I published an essay called Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates, which addresses many of these same issues, but in even more depth.

[note: If you appreciate this piece and want to see more like it, please check out my Patreon page]

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