APA issues statement regarding GID and the DSM-V

The American Psychiatric Association released a statement on Friday regarding some “inquiries about the DSM-V process.” I suspect many of those inquiries have focused on the disputes over treatment highlighted by the recent NPR broadcast on gender identity, often involving Dr. Ken Zucker. I asked Ken Zucker and Michael Bailey for their reactions to this press release from a transgender advocacy group. Dr. Zucker declined to comment, but sent the following APA statement. Dr. Bailey’s comment follows.

APA STATEMENT ON GID AND THE DSM

May 9, 2008

The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.

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.

Regarding the Transactive organization’s statement about the DSM-V, Dr. Bailey took strong exception to this statement:

“Zucker has stated that a secure gender identity possibly prevents the development of later homosexuality. This raised several red flags for those of us who work with gender non-conforming children, youth and their families. TransActive’s position is that “prevention of homosexuality” should not be the concern of childhood gender identity specialists.”

To which, Bailey said:

This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.

I agree with Bailey, I have seen nothing which would suggest Zucker has a stake in the eventual sexual orientation of children. And I certainly agree with the last sentence which has some special significance to me in light of the cancellation of the APA symposium.

In my opinion, there are some advocates who implore various audiences to trust science but really do not want this unless the outcome suits their advocacy goals.

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  • Boo

    Zucker himself may not advocate trying to prevent homosexuality that way, but there are plenty of people involved in childhood GID treatment who do.

    Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.

    Wow. J Michael Bailey said that? That’s just… wow. Hello Mr. Pot, my name is Mr. Kettle.

    Shall I provide a short list of a few of the ways Dr. J Michael Bailey has chosen to mischaracterize the positions of others who disagree with him?

    He has characterized his critics as all being proponents of the “man trapped in a woman’s body” cliche when the only people you ever hear that phrase from are himself and his allies, or the media. Seriously, search through everything written on the whole Bailey mess and find me one example of his critics actually describing themselves that way.

    In the initial response to his critics on his website, he linked to examples of criticism from Lynn Conway, Andrea James, and what’shernameiforget, and stated “these hostile critics do not want you to read my book.” At the time he linked to their websites, Lynn and Andrea both had prominently displayed links to where the entire book could be read online for free. Kind of an odd strategy if you don’t want people to read it. (To be fair, it could be some kind of weird reverse psychology thing. But his critics don’t use reverse psychology… OR DO THEY??!!!)

    He also said in the same response that his critics were attempting to mislead people into thinking that autogynephilia came from his own research instead of Blanchard, and yet all three critics he linked to made it quite clear that Bailey was recycling Blanchard’s old model.

    In a post on scientificblogging, he claimed that neither Lynn Conway, nor Andrea James, nor Joan Roughgarden, had ever acknowledged that some transsexuals identify with the autogynephilia concept. It took me about a minute of googling to find direct quotes on their websites of Lynn and Andrea acknowledging this, repeatedly. In addition, at the beginning of his own post he linked to a transcript of a radio debate that had involved him and Roughgarden. Right there in the transcript was Roughgarden acknowledging that some people identify with autogynephilia. (I was a bit torn. On the one hand, if anti-trans bigots have to lie, it’s good that their lies are so easy to debunk, but in another way, it’s kind of insulting. Make me work a little next time, guy.)

    He has repeatedly claimed his critics are all “autogynephilic transsexuals” when some of them are people he himself had previously labelled as “homosexual transsexuals.” Many of his critics are also FtMs, who aren’t supposed to be able to have “autogynephilia.”

    He claimed in his book that the only reason Blanchard’s ideas are not widely accepted is that “most sex researchers are not as scholarly as they should be and so don’t keep up with the current scientific journals.” This stuff was first published in the late ’80s, so apparently “most sex researchers” are on a REEEEAAAALLLLLYYY long lunch break. In point of fact, most people in the field are quite well aware of Blanchard’s ideas, but just don’t think they’re a very accurate description of the clients they see.

    So I suppose he is kind of an expert on misrepresenting the positions of others.

  • Pathia

    I don’t know why they have to resort to talking about SSA. Maybe they are mixing it up because NARTH and a few other ex-gay organizations have quoted his research?

    As for the harm of this kind of therapy by trying to enforce their birth gender, that’s harmful enough. I experienced this kind of therapy when I was 6-9, it didn’t work, and I was pulled out. Why? Because I tried to hang myself when I was 9 because of how bad the therapist made me feel. It wasn’t Zucker, mind, but the techniques sound awfully and VERY painfully familiar.

    They may seem relatively harmless to some folks here, but you’re being told this by a strange adult you don’t know in a labcoat, and you stare at him/her, and then shift your gaze to your parents who look conflicted, but in the end nod solemnly that it is true/correct to act differently. This alien authority figure steps in and simply tears you apart with a methodical uncaring voice.

    Even if they weren’t, even if they were actually caring, and compassionate and gentle, I do not remember it. I remember emotional agony, depression, and trying to cut off my air supply with a belt.

  • http://www.transactiveonline.org Jenn Burleton

    Dr. J. Michael Bailey stated the following in his response to a portion of our organization’s position on the appointment of Dr. Kenneth Zucker as Chair of the Sexual and Gender Identity Disorders DSM-V workgroup:

    “This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.”

    I respectfully suggest that our position paper does not mis-characterize Dr. Zucker’s personal beliefs or clinical approach to the treatment of gender non-conformity in children and adolescents. In support of this statement, I submit the following -

    This statement by Dr. Zucker was quoted by Frank York on the NARTH (National Association for Research and Therapy of Homosexuality) website. It originally appeared in a 2004 issue of Child and Adolescent Psychiatric Clinics of North America

    Dr. Zucker admits that there are complex social and ethical issues surrounding the politics of sex and gender in postmodern Western culture. He notes 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.”

    The concern seems to focus on Dr. Zucker’s sense that NOT treating male children for GID will most commonly result in them becoming homosexual. Do we not “treat” people for conditions in the hope of preventing what might be considered by some to be a negative outcome?

    Most transgender identified (as opposed to general spectrum gender non-conforming) children do much better in every way when supported and respected for their gender identity expression. Which begs the question, is Dr. Zucker treating the child in a way that is in their best interests, or simply to satisfy the desires of parents, therapists and culture? Furthermore, we believe that Dr. Zucker and others are using reparative & aversion techniques in treatment of GID in children and youth as a way to encourage only gender stereotypical expression and as a smokescreen for discouraging the potential of a gay or lesbian sexual orientation.

    Zucker goes on to say, in the same article quoted above:

    “… 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.”

    Our experience and a significant body of research indicates that, in fact, there is very little, if any, objective correlation between core gender identity and sexual orientation. The statement by Dr. Zucker that “psychosexual treatments are effective in reducing gender dysphoria” is, to be blunt, chilling and should be a glowing red flag to any parent or caregiver who would even consider takent their child to Dr. Zucker or others who follow his treatment guidelines and methods.

    Continuing from the same article, Dr. Zucker states:

    “While Zucker perceives gender identity and sexual orientation, especially among males, to become more fixed with age, he believes the data suggest a much greater plasticity in childhood.”

    This belief contradicts the American Academy of Pediatrics which stated in 1999 that – “A child’s awareness of being a boy or a girl starts in the first year of life. It often begins by 8 to 10 months of age, when youngsters typically discover their genitals. Then, between 1 and 2 years old, children become conscious of physical differences between boys and girls; before their third birthday they are easily able to label themselves as either a boy or a girl as they acquire a strong

    concept of self. By age 4, children’s gender identity is stable, and they know they will always be a boy or a girl.”

    The above position by the AAP is most often assumed, in our cissexist culture, to apply only to cisgender children, however all evidence points to this being the case with the vast majority of transgender children as well. The fact that their anatomy may not match their gender identity does not, in any way, invalidate the certainty of their gender non-conforming identity.

    And finally, from the same article, we have this:

    And if a secure gender identity prevents the development of later homosexuality, as Zucker acknowledges as a possibility, parents should be informed of the research on the relationship between the two. Zucker’s priority is “helping these kids be happily male or female,” but he also acknowledges that the treatment process does, in some cases, apparently avert homosexual development .

    And in support of parents’ rights to avert a homosexual outcome for their children, Zucker cites a persuasive quote from Richard Green: “The right of parents to oversee the development of children is a long -established principle. Who is to dictate that parents may not try to raise their children in a manner

    that maximizes the possibility of a heterosexual outcome?

    In light of this, I must ask, Dr. Bailey, precisely how have we mis-characterized Dr. Zucker’s position regarding preventing or to use his own words, averting a homosexual outcome?

    TransActive stands 100% behind our previous statement, and we further state, unquivocally that:

    Gender Identity pre-dates and is independent of Sexual Orientation in children.

    Transgender identity in children is rooted in pre-natal development, as evidenced by both clinical research, historical analysis and anecdotal information.

    Transgender & gender non-conforming children & youth are more well-adjusted, happier, healthier and more productive when supported in their expression of their gender identity, including allowing them, if they so desire, to transition to their target gender.

    Dr. Zucker’s treatment methods damage children and their families, including the one recently profiled on the NPR program.

    Non-conforming gender identity, including transgender identity, is no more a ‘disorder’ than is cisgender identity. It is simply more rare.

    Sincerely,

    Jenn Burleton

    Executive Director

    TransActive Education & Advocacy

    Portland, OR

  • http://chrysalismission.blogspot.com/ Donna

    Jenn Burleton does an excellent job delineating the positions of Zucker – as explained by Bailey, who had to have his positions explained by Ann Dreger. It seems they are always mischaracterized. The truth is they seem to be talking out of both sides of the mouth. In facing criticism of his book “The Man Who Would Be Queen” – Bailey first suggested that his “scholarly” effort was mischaracterized, then in an interview on San Francisco radio with Dr. Joan Roughgarden speaking for the transgender community began to claim his work wasn’t “scholarly” but “journalistic”. What is most frustrating is that it appears there is little representation in this work group from the more mainstream view of GID. Statiscally speaking, if you have a bag with 100 marbles in it, 98 of which are red and only 2 are blue – how the heck did the APA pull out the 2 blue marbles???

  • Dainna

    Zucker has nothing researched or published within the past two decades which can support his positions or beliefs. Likewise, Blanchard has only his own opinions, with nothing in the way of recent (past 10-15 years) to support his positions, and Lawrence is his protege; Lawrence’s Doctorate is not even in the mental health field.

    The BIG question is why this committee is SO one sided, with people who do not have any data or research from this century….

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

    Bailey wrote:

    “This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.”

    *************************

    I don’t really think that the issue is explained by Zucker as a means to prevent homosexuality but to prevent transsexuality but there is no proof that feminine boys will be transsexuals at any significant rate, so it would appear that what is being treated in fact is pre-homosexuality in childhood and to no effect because most still grow up to be homosexual men. There is no proof that transsexuality was prevented by the treatment because there are no studies which prove that feminines boys grow up to be transsexuals at any rate that is statistically significant. There are also many masculine boys that grow up to be transsexuals.

    So technically, Zucker can state that it is not homosexuality per se that is being “treated” but since most of these boys grow up to be homosexual men, all they have proved is that they have done nothing except try to enforce gender conformity which has no statistical link to transsexuality that is significantly higher than homosexuality (actually there is a much higher link with homosexuality). So why

    call it gender identity disorder in childhood?

    Some quotes from the Bailey’s “Queen” book:

    “I do not ask Edwin about his childhood because I do not need to. I already know that Edwin played with dolls and loathed football, that his best friends were girls. I know that he was often teased by other boys, who called him “sissy””. (Page x in book) (See also page xi, where Bailey describes whom he knows Edwin would like to have sex with, being the feminine adult man, with which Bailey describes Edwin as being.)

    “Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual. His experience has convinced him that if a boy with GID becomes an adolescent with GID, the chances that he will become an adult with GID and seek a sex change are much higher. And he thinks the kind of therapy he practices helps reduce this risk” (Page 30 in book)

    “….Zucker believes that most boys who play with girls’ things often enough to earn a diagnosis of GID would become girls if they could. Failure to intervene increases the chances of transsexualism in adulthood, which Zucker considers a bad outcome.” (Page 31 in book)

    “Still most boys who want to be girls become men who don’t want to be women.” (Page 32 in book)

    “…Zucker’s therapy seems kinder and more consistent, and thus more likely to be effective. Zucker believes that it is, although he is the first to ackowledge that no scientific studies currently support the effectiveness of what he does.” (Page 34 in book).

  • Sophia

    Hmm

    Predictable, Another blog, probably another “Defender of Bailey” according to some critics, and then after about 20 posts we will read the defenders of Bailey (The HSTS hit squad) complaining about the usual list of critics appearing to refute Bailey, and quite frankly it is getting a bit repetitive.

    Let me see, Huffington Post, Scientific Blogging, then that Northwestern news blog, now here.

    Perhaps it needs to be said again. because Professor Bailey does this every time he goes public. “Professor Bailey with all due respect there are people do not agree with you why is that so hard to accept?”.

  • http://www.patheos.com/blogs/warrenthrockmorton/ Warren

    @Sophia:

    Assuming you are correct, why do you suppose that might be?

  • Sophia

    Hello Warren

    It just seems to be going round and round in circles. My view is that Bailey has based his ideas on those of Ray Blanchard, fair enough, there are competing theories each of which stand or fall on their merits. I do not have a problem with that, but I do find it a little odd that Bailey talks about defamation when he seems to have invested a lot of time and effort provoking people. Even when many of his collegues said “Tone it down just deal with the sceince” he went right on ahaead and published his works, from his “parental choice” paper that proposed screeneing out “potentially homsexual fetuses” through “The man who would be Queen” Where he later said in public he said “I said they [transsexual folks] are especially suited for protsitution not best suited for prostitution”. Then its “Gay Straight or Lying”. Any criticism of this is met with “Oh it is political correctness”. Yes but he does not exactly avoid silencing his critics. Talk of double standards.

    As for the appointment of Zucker and Blachard there are, what 3500 signatures objecting to that at the last count? Seems to me people do not agree with what is being imposed on them by some in the medical profession. And when the CAMH and Northwestern academics stir the hornets nest they then do this. carefully controlled damage limitation. It is becoming a bit of a regular spectacle.

    I just wish they would all speak face to face and settle these disputes.

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  • amanda hunter

    zucker is a fraud i was treated when i was 14. I had no one to talk to for years i felt alone i felt i could not trust my parents because they sent me to him. I don’t blame them they were miss lead. force him to do boy things nothing that girls do he will be fine. I was afraid if i said anything i would be sent back to this fraud. he has no idea how we think or feel i was alone for years with no one i could talk too. i have in the last few months made friends with other transsexuals i am going out i figured out who i am and zucker is all wrong he has no clue who we are. i have been chating with a younger transgirl (i wont give her age she is seeing zucker, i and others have warned her about him. he keeps asking who she wants to have sex with not her gender identity. i told her any time she wants to talk i’m here to listen. i don’t want that so called Dr. to do to her what he did to me. it feels good to help her and great to stop him from hurting her.


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