Ken Zucker compares ethnic identity conflict and gender identity conflict

Ken Zucker, a psychologist featured in the NPR series on gender identity, recently posted the following on the SEXNET listserv. Are ethnic identity conflict and gender identity conflict analogous? In this post, Dr. Zucker addresses the topic and I thank him for giving me permission to re-post it here:

In the interview I had with the NPR journalist, Alix Spiegel, I posed the question: How would a clinician respond to a young child (in this instance a Black youngster) who presented with the wish to be White? I had already sent Ms. Spiegel an essay that I published in 2006 in which I had presented this analogy and she told me that she was intrigued by the argument.

In this post, I list some references that I have accumulated over the years that discusses issues of ethnic identity conflict in children and adults. In the 2006 paper, I was particularly influenced, rightly or wrongly, by an essay Brody (1963) wrote many years ago. I think it is worth reading. Thus, I did not invent the analogy out of thin air. I had been influenced by three things: first, I was aware of this literature on ethnic identity conflict and I thought it had some lessons in it; second, I had observed, over the years, that some kids that I have seen in my clinic who had a biracial ethnic background also sometimes struggled with that (e.g., wanting to be White, like their mother, and not wanting to be Black or non-white Hispanic, like their father) or wanting to be an American (and not a Canadian) or wanting to be a dog (and not a human). I have thought about these desires as, perhaps, an indication of a more general identity confusion. Third, I was influenced by a remark Richard Pleak made in a 1999 essay, in which he wrote that the notion that “attempting to change children’s gender identity for [the purpose of reducing social ostracism] seems as ethically repellant as bleaching black children’s skin in order to improve their social life among white children” (p. 14). I thought about his argument and decided that it could be flipped. Thus, in the 2006 essay, I wrote:

This is an interesting argument, but I believe that there are a number of problems with the analysis. I am not aware of any contemporary clinician who would advocate “bleaching” for a Black child (or adult) who requests it. Indeed, there is a clinical and sociological literature that considers the cultural context of the “bleaching syndrome” vis-a-vis racism and prejudice (see, e.g., Hall, 1992, 1995). Interestingly, there is an older clinical literature on young Black children who want to be White (Brody, 1963)–what might be termed “ethnic identity disorder” and there are, in my view, clear parallels to GID. Brody’s analysis led him to conclude that the proximal etiology was in the mother’s “deliberate but unwitting indoctrination” of racial identity conflict in her son because of her own negative experiences as a Black person. Presumably, the treatment goal would not be to endorse the Black child’s wish to be White, but rather to treat the underlying factors that have led the child to believe that his life would be better as a White person. As an aside, there is also a clinical literature on the relation between distorted ethnic identity (e.g., a Black person’s claim that he was actually born White, but then transformed) and psychosis (see Bhugra, 2001; Levy, Jones, & Olin, 1992). Of course, in this situation, the treatment is aimed at targeting the underlying psychosis and not the symptom.

The ethnic identity literature leads to a fundamental question about the psychosocial causes of GID, which Langer and Martin do not really address. In fact, they appear to endorse implicitly what I would characterize as “liberal essentialism,” i.e., that children with GID are “born that way” and should simply be left alone. Just like Brody was interested in understanding the psychological, social, and cultural factors that led his Black child patients to desire to be White, one can, along the same lines, seek to understand the psychological, social, and cultural factors that lead boys to want to be girls and girls to want to be boys. Many contemporary clinicians have argued that GID in children is the result, at least in part, of psychodynamic and psychosocial mechanisms, which lead to an analogous fantasy solution: that becoming a member of the other sex would somehow resolve internalized distress (e.g., Coates, Friedman, & Wolfe, 1991; Coates & Person, 1985; Coates & Wolfe, 1995). Of course, Langer and Martin may disagree with these formulations, but they should address them, critique them, and explain why they think they are incorrect. I would argue that it is as legitimate to want to make youngsters comfortable with their gender identity (to make it correspond to the physical reality of their biological sex) as it is to make youngsters comfortable with their ethnic identity (to make it correspond to the physical reality of the color of their skin).

On this point, however, I take a decidedly developmental perspective. If the primary goal of treatment is to alleviate the suffering of the individual, there are now a variety of data sets that suggest that persistent gender dysphoria, at least when it continues into adolescence, is unlikely to be alleviated in the majority of cases by psychological means, and thus is likely best treated by hormonal and physical contra-sex interventions, particularly after a period of living in the cross-gender role indicates that this will result in the best adaptation for the adolescent male or female (e.g., Cohen-Kettenis & van Goozen, 1997; Smith, van Goozen, & Cohen-Kettenis, 2001; Zucker, 2006). In childhood, however, the evidence suggests that there is a much greater plasticity in outcome (see Zucker, 2005a). As a result, many clinicians, and I am one of them, take the position that a trial of psychological treatment, including individual therapy and parent counseling, is warranted (for a review of various intervention approaches, see Zucker, 2001). To return briefly to the ethnic identity disorder comparison, I would speculate that one might find similar results, i.e., that it would be relatively easier to resolve ethnic identity dissatisfaction in children than it would be in adolescents (or adults). Although I am not aware of any available data to test this conjecture, I think of Michael Jackson’s progressively “white” appearance as an example of the narrowing of plasticity in adulthood.

Two caveats: first, the literature on psychosis and ethnic identity conflict that is cited in no way was meant to imply that transgendered people are psychotic; the comparison is to a very small number of people who have “delusions” of gender change in which the primary diagnosis is Schizophrenia. This was first noted in the DSM-III and remains in the DSM-IV text description; second, I can criticize my own argument along these lines: “Well, this may all be true, but surely there is no evidence for a biological factor that would cause a Black person to want to be White, but maybe there is a biological factor or set of biological factors that either predispose or cause a person with the phenotype of one sex to feel like they are of the other sex (gender).” And to that I would say fair enough.

Bhugra, D. (2001). Ideas of distorted ethnic identity in 43 cases of psychosis. International Journal of Social Psychiatry, 47, 1-7.

Brody, E. B. (1963). Color and identity conflict in young boys: Observations of Negro mothers and sons in urban Baltimore. Psychiatry, 26, 188-201.

Brunsma, D. L., & Rockquemore, K. A. (2001). The new color complex: Appearances and biracial identity. Identity: An International Journal of Theory and Research, 1, 225-246.

Fuller, T. (2006, May 14). A vision of pale beauty carries risks for Asia’s women. New York Times.

Goodman, M. E. (1952). Race awareness in young children. Cambridge: Addison-Wesley.

Hall, R. (1992). Bias among African-Americans regarding skin color: Implications for social work practice. Research on Social Work Practice, 2, 479-486.

Hall, R. (1995). The bleaching syndrome: African Americans’ response to cultural domination vis-B-vis skin color. Journal of Black Studies, 26, 172-184.

Lauerma, H. (1996). Distortion of racial identity in schizophrenia. Nordic Journal of Psychiatry, 50, 71-72.

Levy, A. S., Jones, R. M., & Olin, C. H. (1992). Distortion of racial identity and psychosis [Letter]. American Journal of Psychiatry, 149, 845.

Mann, M. A. (2006). The formation and development of individual and ethnic identity: Insights from psychiatry and psychoanalytic theory. American Journal of Psychoanalysis, 66, 211-224.

Russell, K., Wilson, M., & Hall, R. (1992). The color complex: The politics of skin color among African Americans. New York: Harcourt Brace Jovanovich.

Sanders Thompson, V. L. (2001). The complexity of African American racial identification. Journal of Black Studies, 32, 155-165.

Schneck, J. M. (1977). Trichotillomania and racial identity [Letter to the Editor]. Diseases of the Nervous System, 38, 219.

Stephan, C. W., & Stephan, W. G. (2000). The measurement of racial and ethnic identity. International Journal of Intercultural Relations, 24, 541-552.

Tate, C., & Audette, D. (2001). Theory and research on ‘race’ as a natural kind variable in psychology. Theory & Psychology, 11, 495-520.

Ken Zucker

  • Drowssap

    Maybe I’m just a simple man. I read it, and I don’t even know what I read.

  • Diane

    I think it would be great if he looked at his own treatments in regards to this analogy between ethnic identity and gender identity. I mean if a white person listens to “black music” and wears “black clothes” would he recommend a series of treatments that involved taking away their music and clothes until all they had left was Hank Williams and cowboy boots? I would hope not, but that is EXACTLY what he is doing with gender.

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  • Mary

    Interesting concept. While there are black people who do bleach their skin (see any black cosmetics section or counter and in such places as Brazil) when is it too much? Plastic/cosmetic surgery is at an all time high. We are literally mutilating our bodies for a more “fitting” picture of what we “feel” inside. Who draws the line and where? And are our disorders that we live in the wrong bodies or that we do not accept who we are?

  • Diane

    “We are literally mutilating our bodies for a more “fitting” picture of what we “feel” inside”

    Really? Generally when I hear of people getting boob jobs, nose jobs, or botox they are worried about what OTHERS think about them. They generally aren’t saying “I’m a C cup on the inside”.

    I think the fundamental flaw in Zucker’s treatment is that instead of trying to teach these children how to live a world where they are different he is trying to alter their identity so they won’t appear different. He has flat out said that he treats them because when they get older “women will want to date men who act like men, not like women”. Firstly it takes coupling to be the end good, while this may be true for many people it is not essential. Secondly is assumes that no one will be attracted to them because they aren’t normal, this just isn’t true.

    Additionally there is an assumption that surgery and hormones are the only route a transgendered person will take, the reality is many don’t. I would agree that many do have surgery and alter their body but I suspect many of them feel pressured to pursue surgery because of societies expectation that they appear to be a normal man or woman. This is apparent in the increased rate of transsexualism where homosexuality is outlawed.

    What is the pattern that makes these children hate their birth gender so much. Is there be some sort of clear cause and effect pattern occurring in parenting and society to create that loathing in a child? If it is not occurring from the outside then there is a good chance the answer rests in some essential difference in their biology and behavioral treatments would be harmful and ineffective in the long term.

  • Mary

    Diane – As I concluded – Is it that the disorder is we live in the wrong body or cannot accept our bodies as they are.

    Mmmmm. I think a lot of women getting boob jobs and lipo are more persuaded by media etc…. but they also have a higher rate of suicide. I still wonder where is the disorder really.

    Alot of people are uncomfortable with their birth body.

  • http://aebrain.blogspot.com Zoe Brain

    First, is it desirable that a child’s gender identity match the original soma? I think it is, all other things being equal. Transition by changing body to match brain is hard, it’s costly, it’s not risk-free, it’s imperfect and it involves loss of function (ie fertility). Before a personality is fully grown, it would be reasonable to change the brain to match the body if possible.

    So if there was some kind of pill or magic potion that could affect such a change, and by that I mean a change to the child’s brain, and without any side-effects or sequelae, it would be at least arguable that it would be a good thing. I personally would require consent from both patients and parents, but if such a thing existed, I’d say it was ethical to provide it, and not ethical to refuse to provide it.

    The trouble is….. this is not without side-effects. Moreover, it doesn’t work very well at its primary aim.

    It’s all about neurology. I’ve been convinced by the evidence that “Gender Dysphoria” is caused by relatively primitive parts of the brain being atypical. It’s simplistic to say a cross-gendered brain, or an Intersexed brain, but close enough. Now brains, especially in young children, are somewhat plastic. The plasticity varies with individuals, and the more primitive the area we’re talking about, and the older the individual, the less plastic it is.

    In order to affect such changes to primitive neural structures, we need the equivalent of a sledgehammer. Torture, prolonged and intense. Even then, it won’t usually work, but it will sometimes. There will be sequelae, suicidal ideation, depression, psychosis even in many of those who are “cured”, so the negative consequences are pretty severe, regardless of outcome. The usual result will be only a partial “cure”, and often only temporary, as the underlying cause for the atypical neurology in the first place still remains.

    In my estimation, the negative consequences outweigh any possible benefits by an order of magnitude. The effects on the mental health of the parents, who have to inflict the bulk of the torture, cannot be disregarded either.

    Changing the body to match the brain has many disadvantages.; but attempting to change the brain to match the body (when it still may have enough plasticity in some cases) has far more disadvantages.

    Or if you want a sound byte from the parent in me, rather than the scientist, “Torturing children is wrong”.

  • http://www.wthrockmorton.com Warren

    Zoe – I have a post coming up in a couple of days or maybe tomorrow which shows a persistence rate of 20% for GID (kids still wanting to transition in adolescence or adulthood). So the some children may be many children. Are you aware of other research with higher persistence rates for GID?

  • Diane

    Cohen-Kettenis & van Goozen appear to have a study with a persistance rate of 66% which is possibly higher.

  • http://aebrain.blogspot.com Zoe Brain

    Hi Warren!

    I’m trying to locate the primary sources for the usually-quoted figure that 70% of children with GID lose it by adolescence. Certainly most “grow out of it” without treatment, though nearly all become homosexual if they do.

    I’ll see if I can dig up my copy of the Praeger Handbook of Transsexuality, that’s my first call if an online search fails.

    It would be easier if I was a psychologist rather than a computer scientist… I’ve had to learn this stuff myself, traipsing through PubMed and the like.

    Whether or not the children being treated at CAMH Toronto include non-TS children (one third are “sub clinical” even by DSM-IV-TR standards) with resultant “success rate” inflation is unknown.

    Gooren et al’s work on 100+ TS children who transitioned in adolescence show they have a zero regret rate, but the criteria for treatment are very strict. Far more so than Zucker et al’s testing.

    I’ve been trying to find good data on results for children with no therapy, children with aversive therapy, and children with affirming therapy. Goodness knows we should be able to acquire this, there are enough cases. The trouble is that the majority who have affirming therapy are treated by individual mental health professionals, and no statistics are kept.

    The best data we have on follow-up with aversive therapy is A follow-up study of girls with gender identity disorder. Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ. Dev Psychol. 2008 Jan;44(1):34-45.

    This would indicate a 12% persistence rate including subclinical cases, and a 20% persistence rate for diagnosable ones. It’s perplexed by some 17% of the cases being Intersexed – in one case a “girl” was actually a boy who had been surgically re-assigned as female earlier simply on the basis of microphallus. When “she” showed a male gender identity, “she” was given aversive therapy, with apparently some success.

    There’s so little data, it sometimes seems that no-one wants to know.

  • Boo

    There’s a HUGE difference between perceiving that one might fit in better with an altered characteristic and what transkids go through.

    Find me a black child who exhibited “marked and persistent” spontaneous “white” behavior from 2 years old, then we’ll talk. (What the heck would that even look like?)

    “I must live in the suburbs and vote Republican!!!! WAAAAAHHHHHH!!! Get out of my way, I have to mow the lawn in my plaid pants!!!”

  • http://www.intersexualite.org/ Curtis E. Hinkle

    Zucker’s logic seems contradictory because he does favor “bleaching” intersex kids without consent and he is on record that it really doesn’t make much difference because gender identity is so extremely malleable.

    By “bleaching” intersex kids, I am simply using his analogy. By his arguments, you could bleach children and raise them as white or you could paint white children black and raise them as black if you used his arguments that he applies to raising children who had their penis burnt off as a girl.

    See the following video interview:

    http://www.youtube.com/watch?v=mnozs83MIZ4

  • Sophia

    Hello Warren

    I gain the impression that Kenneth Zucker is trying to find rationalizations for his own scientific opinions, which illustrates the possibility that he himself may have som doubts about what he is saying. Either that or he is all too aware of what others are saying.

    I think he has possibly blown it with this one though. He quotes Brody a lot and therin lies his problem when Brody was commenting on the race issues he could not really say anything other than “The parents instilled self loathing” because any other opinion would suggest that the then brutality suffered by the African American community was having the “Desired” (By Racists) effect. I remember seeing a photograph of a woman at some rally in the deep south holding up a placard saying “Don’t you wish you were white?” That is Zucker’s problem with this analogy.

    It is certainly the case (Probably 30 % as mentioned here) that some transsexual folks are saying what they are expereincing, it is very real and no amount of environment based theorizing will chage it. So it would be reasonable to conclude that that transsexualism is as much an inborn characteristic as skin color or anything else.

    In which case Kenneth Zucker appears to be holding up a placard saying “Don’t you wish you were normal” add to this the reputed brutality of his “Conversion process”. (I say reputed because I don’t fully know what he does to “make people normal”) and Zucker looks bad.

    It really looks like Kenneth Zucker is making a business out of making children fit sex stereotypes. In effect “Bleaching them”. It is a matter of opinion I admit, but the article does read like a rationalization for something people really do not like than it does a comparison between ethnic conflict and the current debate about gender identity.

    I think the use of this analogy was a very bad mistake on his part and has only caused him to face yet more criticism.

  • Grace

    I’m 33 and have FTM tendencies. I feel very strongly that I would RATHER been treated by psychotherapy to develope a female identity, than live with the medical issues of transition. I know some members of the TG community would be very critical of this choice.

    I don’t condemn other people who choose transition. But with many illnesses there is more than one treatment option, and often the patient has some say in which one. I think transitioning Tss should be free from discrimination and harassment. I’m OK with legalizing gay marriage.

    I am a lifelong liberal and “Jack Catholic”, none of this decision on my part is motivated by politics or religion. I don’t consider it a moral issue.

    But I think that I would have a better life, if I could learn how to be a woman rather than become a transitioning TS.

  • http://aebrain.blogspot.com Zoe Brain

    Grace,

    Other people don’t get a say in it. Only you can say what’s right for you. Not me, and not anyone else.

    The odds are against it working, but some people aren’t strongly gendered. There are many men who can function as women, and many women who can function as men. Those who like myself are relatively strongly gendered may even be in the minority. Even I managed to do the “boy act” for 47 years.

    Good Luck. And maybe you could give me some tips, I never did learn how to be a woman. I did learn how to be myself though, and to my surprise, I’m more feminine than I ever thought possible.

  • Grace

    Maybe things would be different if our current society had some options for people to live with gender identities/roles other than just “man/boy” or “girl/woman”. But unfortunately that doesn’t happen for the most part. Sure you can find queer communities where people live as “third gender” and such, but it’s a marginal society. To travel freely in this world, for the most part you have to either fly one way or the other.

    It’s fascinating to read about societies with various “alternate” roles in various isolated and far off cultures. But in practice most of those alternate roles are for bio-males who are neither TS nor “conventionally masculine”. To here of such things for females (that don’t involve some steep conditions such as lifelong celibacy or worse) seems kind of rare and obscure. Even the biological arrangement of the Gethenians from Ursula LeGuin’s “Left Hand of Darkness” seems a bit enviable in some ways. Of course there are plenty of downsides to Gethen in the way of the society and the climate!!

    But I don’t know how to find such worlds. And if you want the freedom to move through society like anyone-instead of being in a queer ghetto-the options are pretty much being a passable transitioned transexual (and the medical aspects of that, I don’t want), or just sucking it up being feminine. If you don’t want to spend your life on hormone injections, you might as well at least see if you could be taught to enjoy being feminine instead of hating it.

  • Jayhuck

    Isn’t Ken Zucker the same therapist who has had many problems with the kids he has treated? The example you gave from the – I believe it was an NPR story Warren, is a good example of just how kids can and probably will work around his therapy – not to mention the damage he may be doing

  • Jayhuck

    Warren,

    Is it not interesting that there is a parallel between a black kid wanting to be white and a gay guy wanting to be straight – surely we can’t ignore this similarity either?

  • Jayhuck

    Oh c’mon – Ken Zucker is talked about and is seemingly supported by NARTH – that diminishes his credibility a great deal.

  • Jayhuck

    I think the fundamental flaw in Zucker’s treatment is that instead of trying to teach these children how to live a world where they are different he is trying to alter their identity so they won’t appear different. He has flat out said that he treats them because when they get older “women will want to date men who act like men, not like women”. Firstly it takes coupling to be the end good, while this may be true for many people it is not essential. Secondly is assumes that no one will be attracted to them because they aren’t normal, this just isn’t true.

    Amen! I’d also love Zucker to elaborate on what men acting like men means – LOL

  • http://www.wthrockmorton.com Warren

    Jayhuck said:

    Oh c’mon – Ken Zucker is talked about and is seemingly supported by NARTH – that diminishes his credibility a great deal.

    Jayhuck – Is Ken Zucker a member of NARTH? Does he support their work? Do you know anything about him at all?

  • Boo

    Of course, Zucker works at CAMH, where his colleagues offer gender reassignment to adults. They do so reluctantly, with tons of delays and hoops and forced scripts they all have to pretend to act out and very few people actually manage to run the gauntlet, but some do.

    So I wonder what he’d have to say about why his racial analogy doesn’t apply to adults?

  • Jayhuck

    Warren,

    I know some things about him. Anybody that is supported as much as he is by NARTH should be someone whose words we pay special attention to. NARTH is an organization who has lost all professional credibility, so when they support someone, like they do Mr. Zucker, it should at least raise a flag for us.

  • http://www.ifge.org Denise Leclair

    The question is: What part of you is real? Is your body more “real” than your soul?

    It is ironic that people who claim moral high-ground act as though the body trumps the soul, when to realize that your soul transcends your body is the essence of spirituality.

    Zucker would bleach our souls to save our bodies.

  • Patrick McCoy

    Your article cites a black child wanting to be white. I am left wondering if this is because of racism he has experienced and thinks being white will eliminate it.

    I definitely believe in being born into the “wrong” ethnicity exists, though. I was born a Caucasian male. Some would argue this gives me an unearned privilege in American society. However, I do not want this. I have an innate feeling that I was supposed to be Spaniard/of Latin dissent. I never have felt I fully belonged here in the U.S., but when I visited Spain I knew I was home.

  • Eddy

    God grant me the serenity

    to accept the things I cannot change;

    courage to change the things I can;

    and wisdom to know the difference.

    Living one day at a time;

    Enjoying one moment at a time;

    Accepting hardships as the pathway to peace;

    Taking, as He did, this sinful world

    as it is, not as I would have it;

    Trusting that He will make all things right

    if I surrender to His Will;

    That I may be reasonably happy in this life

    and supremely happy with Him

    Forever in the next.

    Amen.

    –Reinhold Niebuhr

    (I originally intended to copy the familiar ‘Serenity Prayer’ and honestly did not know that there was more to it than we usually read or quote. I elected to copy the whole thing for the benefit of others who also didn’t know that there was more to it.)

    Truth is that we can’t change our ethnicity…and we aren’t born into the ‘wrong’ ethnicity. Our ethnicity simply is what it is…it’s in the genes passed onto us by our parents. We can, however, respond negatively to the trappings of those cultures and we have the freedom to appreciate what other cultures have to offer…even appreciating them more than our own.

    Also, i don’t think ‘Caucasian’ quite fits the definition of an ethnicity. Rather, it’s a term used to describe a host of ethnicities (German, Irish, Italian, Greek, Lithuanian, Slovakian, etc.) as differentiated from a few that display stronger ethnic roots and bonds (as a whole). (You have people of German descent who have thoroughly blended into American culture and then you have the Pennsylvania Dutch (Deutch…from Germany) who have a unique expression of their ethnicity; on the other hand, you have Blacks and Latinos, where some have thoroughly blended, but where the majority retain a strong bond to their ethnicity. It seems to be very fluid.

  • Jayhuck

    Eddy,

    Truth is that we can’t change our ethnicity

    That’s true in one sense, but there have been times that, for all practical purposes, people HAVE changed their ethnicity – at least they have been able to fool everyone around them that they are not members of the ethnic group they were born into – that’s saying quite a bit I think!

  • Eddy

    My bad–

    it seems the definition of ethnicity goes beyond background.

    Per Wiki dictionary:

    ethnic traits, background, allegiance, or association.


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