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?

One of the key discoveries of neuroscience in the late 20^th and early 21^st centuries is the extraordinary malleability of the human brain throughout the life span.  Neuroplasticity—the ability of even an adult brain to change firing patterns and regenerate neurons in response to experience—is yet another aspect of settled human knowledge that is being ignored in the rush to diagnose children and adolescents as transgender and in need of medical intervention.

But you don’t even need the latest findings in neuroscience to poke a giant hole in transactivist logic. Long before scientists established that adult brains are so malleable, it has been known that kids’ brains are far more neuroplastic than those of adults. It’s why a child can recover near total function after a brain injury or stroke in a way an adult cannot. It’s why kids become fluent in multiple languages with no “foreign” accent. Their brains have to be plastic–how else could they learn and change throughout childhood?

Those involved in transgender activism and pediatric treatment—who say they have science on their side—have a standard line about puberty blockers, the use of “preferred pronouns,”  and all the rest of the childhood gender dysphoria dogma: “It won’t harm the child.  Only the truly transgendered will choose medical transition after puberty. The rest (the majority) will choose their natal sex.” (Of course there are no published studies on this, although there is plenty of data showing that most gender dysphoric kids grow up to be gay, lesbian, or bisexual if simply left alone by “gender specialists” and scared parents.)

But the assertion that pediatric gender therapists and MDs are doing no harm (like the rest of the flimsy rationalizations they use) flies in the face of basic, settled neuroscience.

Because of neuroplasticity, those kids who have been “identified as” transgender and treated as the opposite sex throughout childhood will be influenced and molded by that experience (as they are molded by all the other experiences they have). In effect, they will learn the idea that their bodies “don’t match” their gender via their childhood experiences. Unlike any other transient childhood fantasy (e.g., that they are actually Batman), they will be repeatedly validated in the idea that biological reality–their actual bodies–is mistaken, and must eventually be changed to match their subjective feelings. What they think, even how their brains are wired, will be influenced by what they are told, and how they are treated by everyone around them. What would happen if a child with body integrity identity disorder (BIID) was repeatedly validated in the idea that (say) their left leg was “wrong” and should eventually be amputated?

Every other field of science has taken neuroplasticity into account in decisions about best treatment. For the current treatments for gender dysphoric kids to make any sense at all, you have to believe that the brain is fixed, unchangeable from birth, and completely impervious to life experience. In other words—the exact opposite of what reams of brain research and clinical experience have taught us in the last several decades.

This antiquated notion of a static brain creates such a huge logical hole in the pediatric transgender rationale, the entire flimsy edifice should eventually collapse if scientists and clinicians ever get the courage to base their treatments and recommendations on actual evidence and science.

                                         *******

Postscript: Think I’m wrong? I’d love to see some researchers step up to do a longitudinal study comparing two groups of adults who were: (1.) Dysphoric kids who were sent to gender therapists and called by their preferred pronouns, given puberty blockers, and otherwise validated in their idea that they are “trapped in the wrong body”  and (2.) Dysphoric kids who were supported for just being themselves, regardless of gender stereotypes, as the sex and in the bodies they were born with, with no messaging or validation from “specialists” or parents that they are the opposite sex. How many remain dysphoric as adults and move on to medical transition after childhood?

Who’s recruiting? (Hint: no one.) Time to get started!