4thWaveNow

Nearly every day, there is a glowing media report about the latest 5-year-old who has been identified as transgender. But one of many examples:

http://boston.cbslocal.com/2015/04/23/parents-share-5-year-old-sons-transgender-journey/

This headlong rush to diagnose minors who are gender nonconforming as “transgender” children needing psychological and medical intervention is a relatively new phenomenon, picking up speed only in the last decade or so.  

In searching the clinical and research literature for the origin and motives behind the diagnosis of GID, I came upon this paper by Nancy Bartlett et al, published in the journal Sex Roles, December 2000. This article (original behind a firewall, but a copy linked here), critiques the DSM IV and the diagnosis of GID as fundamentally flawed and homophobic. The paper is chock-full of citations to studies indicating that gender dysphoria in children is generally transient. I’ll let the authors speak for themselves with the below excerpts. Page numbers refer to the original (firewalled) version.

I’ll say it again (and again and again): The current medical and media message is: “trans until proven otherwise.” This should be seen as malpractice, because sending small children to “gender therapists” and supporting and amplifying their (most likely transient) conviction that they are the opposite sex puts them on the conveyer belt to later medically “transition”—a lifetime of drugs and surgeries.  How many of these young children being currently diagnosed, if left alone, would have grown up to be non-dysphoric gay and lesbian people? At the rate this is all going, we will never know.

(pg 761)

There is a lack of empirical evidence to support the notion of distress caused directly by GID …Certainly, child distress does not seem to be a common reason for referral of children with GID. Rather, the basis for clinical referral is more often parents’ or teachers’ concern regarding the child’s “intense involvement in overt cross-gender play” or the parents’ desire to prevent homosexuality in their child.

 …It has been proposed that distress among at least some children with GID is simply a response to having their desired manner of behaving thwarted (Di Ceglie, 1995; Meyer & Dupkin, 1985; Stoller, 1975; Sugar, 1995; Zucker, 2000). In the literature there are numerous accounts to support such a supposition.

 (p 770)

 Regardless of the fact that homosexuality is not officially considered a disordered outcome, the prevention of homosexuality remains a significant reason for referral of children with GID. It would be naive to believe that prevention of homosexuality is not a motivating factor for at least some of the clinicians who work with children referred for gender-atypicality. Indeed, some researchers and clinicians in the area of GID in children are quite open about such a goal, writing books (e.g., Rekers, 1982, 1991) or belonging to organizations devoted to the prevention of homosexuality (e.g., L. Loeb: see www.narth.com/menus/advisors.html). Thus, although the issue of the risk associated with a homosexual outcome should be moot, it is not. It is crucial that researchers and clinicians in the area of GID in children recognize that the most likely outcome for children with GID, with or without treatment (Green, 1987), is homosexuality, and that homosexuality is a nondisordered outcome. Only a very few children with GID continue to have GID as adolescents or adults.

(p 773)

Retrospective data show that homosexual men and women remember higher rates of childhood cross-gender behavior than do their heterosexual counterparts (see Bailey & Zucker, 1995, for a review). Data from retrospective studies of gay men and lesbians tend to indicate similar childhood gender nonconforming experiences as do prospective studies (cf. Phillips & Over, 1992). Compared to their heterosexual counterparts, for example, more gay men and lesbians recall having enjoyed “cross-gender” activities, dressing like the other sex, and pretending to be the other sex (Bell, Weinberg, & Hammersmith, 1981).

( p775)

…Moreover, much empirical evidence points to GID in those children as nothing more than a conflict between the individual and society, given that the most likely psychosexual outcome, whether a child does or does not receive treatment for GID, is homosexuality. Several authors have noted that it is ironic that the DSM-IV has a category for a childhood psychopathology for which the most likely predicted outcome is homosexuality, which has not been formally considered a pathology for over a quarter of a century (Fagot, 1992; Green, 1994). Labelling children as gender-disturbed when their most likely psychosexual outcome is homosexual is of questionable value, when the DSM-IV does not include this outcome as disordered. It is troubling that in the current peer-reviewed literature, despite it not being officially considered a mental disorder, homosexuality continues to be labelled as a “sex-role disturbance,” a “severe sexual problem,” or even a “diagnosis” (e.g., Dahl, 1988; Rekers, 1986).

 (p 773)

 Ironically, it seems to have been generally accepted in the literature that children with GID are at high risk for adolescent or adult GID (see APA, 1987; Bradley & Zucker, 1990; Rekers, Bentler, Rosen, & Lovaas, 1977; Rosen, Rekers, & Bentler, 1978; Zucker, 1985; Zucker&Green, 1992). Indeed, this line of reasoning has provided much of the basis for endorsing treatment for children with GID, which is unsettling given that a relatively large body of empirical evidence points to GID in adolescence or adulthood as being an outcome for only a small percentage of children with GID.

(p 777)

The previous notion of sexual inversion, and more recently, of homosexuality as mental disorders should be a reminder to mental health professionals about psychiatry’s power to pathologize those who do not fit the social norm (Bem, 1993). With homosexuality as the most likely psychosexual outcome for a child with GID, APA’s Position Statement on Homosexuality is relevant. In 1993, the American Psychiatric Association’s Committee on Gay, Lesbian, and Bisexual Issues of the Council on National Affairs called on organizations and individuals to “do all that is possible to decrease the stigma related to homosexuality wherever and whenever it may occur” (p. 686). It seems as though the inclusion of GID in children as it appears in the DSM-IV does little in responding to this appeal. Although the focus of this paper was on GID in children, it raises a larger question about the concept of “pathology” in general. To what extent do other “disorders” represent conditions that simply violate societal norms?