Questioning Transphobia

New Scientist magazine has published a lengthy article – Psychiatry’s civil war – about the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders and the “open conflict [which] has broken out among the upper echelons of US psychiatry” regarding the attempt to “extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs”.

(Note: Since the article was posted, the American Psychiatric Association has announced that the publication of DSM-V will be delayed until May 2013 to “allow more time for public review, field trials and revisions”.)

The whole article is worth reading, but in particular it has this to say about the redefinition of gender identity:

We are who we say we are

Is history repeating itself? That’s the question facing psychiatrists considering how gender identity should be defined in DSM-V. The APA has a legacy of uneasy relations with the lesbian, gay and transgender community, having included homosexuality in the DSM’s list of psychiatric disorders until 1973. Some transgender activists want issues of gender identity kicked off the list of mental illnesses too.

These activists are up in arms over the membership of DSM-V’s sexual and gender identity disorders work group, in particular the selection of Kenneth Zucker of the University of Toronto, Canada, as its chair. Zucker is reviled by some transgender activists for his work on therapy to reorient children who feel that they were born into the wrong sex. An online petition objecting to the work group’s composition has more than 9500 signatures.

The group is nevertheless likely to recommend changes that could actually ease tensions. One of these is a change in the name of a diagnosis that as currently phrased is inherently offensive to transgender people. “‘Gender identity disorder’ falsely implies that the gender identities of gender variant people are in themselves disordered,” says Kelley Winters, founder of GID Reform Advocates.

The work group has not yet revealed its proposed name, but “disorder” will be dropped. “We’re sensitive to issues of language,” says Zucker. One possibility is “gender dysphoria”, which focuses on the inherent distress of people living in a body that doesn’t match their identity.

That would not satisfy those transgender activists who want issues of gender identity removed from the DSM altogether. But others argue for the retention of a renamed condition to make it easier for those distressed by the mismatch between their identity and their bodies to seek assistance, and also to help those who need sex-change surgery to get it paid for. Even now, many transgender people face problems when insurers refuse to recognise the treatment as a legitimate medical expense.

My opinion on the binary options mentioned in the last paragraph is somewhere between the two viewpoints: I would be more than happy for any mention of gender identity to be dropped provided that trans people are not, as a consequence, denied access to timely, appropriate and free medical treatment. Transitioning needs to be refocused away from a gatekeeping approach to one of facilitation and support.

Additionally, New Scientist has also published an op-ed companion piece – Time’s up for psychiatry’s bible – which suggests that:

With the advent of the internet, there is no longer any compelling need to rewrite the diagnostic criteria for the whole of psychiatry in one go. Yes, diagnoses should be revised as new scientific findings come in. But for this, specialists can be assembled when necessary to address specific areas that have become outmoded. Their suggestions can be posted on the web for comment. More research can be commissioned, if necessary. And when consensus is reached, new diagnostic criteria can be posted online.

Similarly, standing panels could periodically review issues that cut across the whole of psychiatry – such as the inevitable shift away from checklists of symptoms towards a system based on measurements of the underlying biological and psychological determinants of mental health.

Apparently there is resistance to this move towards such a “living document” because such a transition (no pun intended):

[...] would have hurt the APA’s coffers, as a book that becomes a required reference is a big earner; DSM sales since 2000 exceed $40 million.

Which rather leaves me wondering exactly where the APA’s real priorities lie: in providing a framework that would actually help the people who need it, or generating arguably obscene profits at the expense of our health and wellbeing.

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(Curtsey to Martha T.G.O. on the TGEU listserv for the heads-up)

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Cross-posted at Bird of Paradox

Here’s a video (edited by Mila Pavlin of Trans-Ponder) from the recent GID Reform Now protest at the American Psychiatric Association 2009 Annual Meeting. This is the approximately 7-minute speech of Madeline Deutch, MD, that she made to the 150 protesters. A transcription of a large portion of the speech begins below the video.

This video has been removed by the author

(Curtsey to Autumn Sandeen at Pam’s House Blend)

ETA, May 21: Sorry everybody; I have no idea why the link has been removed. I found an alternative link (click here) which seems to play just fine on You Tube – although it too comes up with a ‘video removed’ error when I embed it in this blog page.

ETA, May 23: There’s also a You Tube vid of Kelley Winters’ speech here

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Cross-posted at Bird of Paradox

Via Reform GID Now:

Protesters call for Reform of Gender Disorders at American Psychiatric Association Convention

What: San Francisco, California. A coalition of transgender community advocates and mental health providers will gather in San Francisco May 18 to protest how the American Psychiatric Association (APA) is handling revisions to “gender identity disorder” and related diagnoses in their fifth edition of the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM-V).

Where: At the corner of 4th Street and Howard Street –Outside the Moscone Center

When: Protest starts at 6:00pm, Monday May 18th

Who: Community leaders scheduled to speak include Julia Serano, PhD; Madeline Deutsch, MD; Masen Davis, MSW; Kelley Winters, PhD; Danielle Askini, MSW; Mara Keisling; Andrea James, MA; Lore Dickey, PhD; Michele Angello, PhD; and Rebecca Allison, MD.

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Cross-posted at Bird of Paradox

Via In The Life comes this useful overview of “the controversy raging over the inclusion of Gender Identity Disorder in the American Psychiatric Associations Diagnostic and Statistical Manual“, examining whether GID should be removed from the forthcoming DSM-V, or reclassified.

At the risk of oversimplifying and making sweeping generalisations, TS/TG adults are as reliant on a diagnosis of GID as we are pathologised by it, because healthcare systems around the world require the diagnosis before we can access hormones, surgery, etc. The challenge seems to be how to balance those needs with the destigmatisation of TS/TG people by both the medical profession and mainstream cis society.

That same pathologisation results in gender variant children being subjected to so-called reparative therapies by parents and mental health professionals that regard adult transsexuality or homosexuality as a “bad outcome”.

[youtube=http://www.youtube.com/watch?v=z0__63nNP1g]

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(Cross-posted at Bird of Paradox)

A possibly interesting development (or is it a stitch-up?) with regard to the DSM revision process seems to be suggested by this press release from the APA yesterday (link here to PDF):

ARLINGTON, Va. (April 28, 2009) – The American Psychiatric Association (APA) Board of Trustees has established a task force on the treatment of Gender Identity Disorders (GID) to address concerns about the relative lack of evidence-based treatment guidelines and to determine if guidelines should be developed. The task force was created on a recommendation by the APA Committee on Gay, Lesbian, and Bisexual Issues.

The board asked the task force to review the literature on the treatment of Gender Identity Disorder at different ages and to report back with “an opinion as to whether or not there is sufficient credible literature to take the next step and develop treatment recommendations.”

The board asked the task force to communicate with the Diagnostic and Statistical Manual of Mental Disorders (DSM) work group on Gender Identity Disorder, which can serve as a resource on diagnostic issues during the term of the task force.

After the May 2008 announcement of DSM-V work group membership, the APA received many inquiries regarding the Gender Identity Disorders work group on treatment. These inquiries most often dealt with treatment controversies for GID in children, rather than issues related specifically to the DSM text and diagnostic criteria. While the diagnosis and treatment of mental disorders are inextricably linked, separation of the diagnostic mission of the DSM work groups from the evaluation of treatment issues is especially important.

At first reading it suggests that the APA is actually taking seriously the criticism received regarding (a) “the relative lack of evidence-based treatment guidelines” and (b) “treatment controversies for GID in children“.

Both these points seem to refer to reparative treatments for the condition – treatments which don’t appear to have had any meaningful success and indeed may have caused more harm than good.

But, of course, when the Task Force has been asked “to communicate with the Diagnostic and Statistical Manual of Mental Disorders (DSM) work group on Gender Identity Disorder” – chaired by Ken Zucker – whose reparative techniques are under criticism here – and with Ray Blanchard (chair of the Paraphilias Subcommittee and inventor of the mental illness he terms autogynephilia) – well, it doesn’t really inspire confidence that this will be an unbiased, objective and independent review.

Plus ça change, plus c’est la même chose…

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(Cross-posted at Bird of Paradox)

There’s a new Facebook group (link here) aimed at highlighting the controversial policies and practises which are carried out at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Lynn Conway has also posted a wealth of information on the TSRoadmap site (link here) about CAMH and its staff, including Ken Zucker and Ray Blanchard. In addition to their favoured ‘reparative therapy’ approach at CAMH, they have also been the subjects of some controversy following their appointments to the American Psychiatric Association’s Sexual & Gender Identity Disorders Work Group, which is charged with reviewing the Diagnostic and Statistical Manual of Mental Disorders (DSM) – a hugely influential document which includes five different diagnoses for ‘Gender Identity Disorder’ (GID).

The Clarke Institute is a Toronto mental institution charged with serving gender-variant clients in the area. Under the direction of Ray Blanchard, it has become widely known as one of the most notorious facilities in the world in terms of controlling access to medical services.

According to their website they offer services, including for “those who wish to manage their cross-gender feelings and the expression of those feelings while remaining in their original gender role.” This is another way to describe reparative therapy similar to groups who claim to “cure” gays and lesbians.

Much of the anti-trans thinking in the world today emanates from The Clarke, long nicknamed “Jurassic Clarke” in the trans community for its regressive policies.

(Via TSRoadmap)

However, even a recent internal report has voiced concerns about “dismissive, condescending and authoritarian attitudes” at CAMH and cites the following key concerns:

1. Homophobia has been cited as one of 3 major internal issues
2. LGBTTTQQI issues are not part of the cultural competency of all staff
3. Although there are Queer & Trans-specific services in the Addictions program, these are not offered in Mental Health
4. The Gender Identity Clinic (GIC) and the Gender Identity Disorder Service (GIDS) have not been well regarded by some members of LGBTTTQQI communities due to negative experiences, underlying operational theories, approach, and treatment philosophy.

(Direct link here to PDF of the full report – and – direct link here to PDF of the executive summary)

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(Cross-posted at Bird of Paradox)

[youtube=http://www.youtube.com/watch?v=JBRCo1KDX_o]

Transcript:

Staying Sane
365Gay News
Logo
Originally aired 26 February 2009

Ross Palombo: A transgender university professor targeted, she says, for speaking out, and her fight against a prominent psychiatrist may help others keep their sanity. Chagmion Antoine has that story from New York. Chagmion.

Chagmion Antoine: Ross, even though homosexuality was removed from the American Psychiatric Association’s list of mental illnesses back in 1973, people who are transgender are still diagnosed with gender identity disorder today. And one professor at the University of Michigan says that’s crazy talk.

Chagmion Antoine (voiceover): Lynn Conway has been fighting for the rights of transgender people ever since her own experience cost her her job in the 1960s. Now she’s a professor emeritus at the University of Michigan, and her website is a respected resource for trans people all around the world. So why is she being sued for libel by one of the world’s leading researchers on gender identity?

Professor Lynn Conway: This isn’t between Dr. Zucker and Professor Lynn Conway, this is between Dr. Zucker and the entire transgender community.

Chagmion Antoine (voiceover): Dr. Kenneth Zucker, a Toronto-based sexologist, spent his career diagnosing children with gender identity issues as mentally ill. When he was appointed to the APA as an authority on gender identity disorders last year, Conway sounded the alarm.

Professor Lynn Conway: Dr. Zucker and his clinic are the sources of decades of pseudoscience claiming that transgender people, especially transgender children, are mentally disordered and in need of reparative therapy. I seek to expose that.

Chagmion Antoine (voiceover): And she did. Zucker’s appointment to the APA’s committee was protested by trans people around the world.

Mishyana: To say the least, Dr. Zucker is not appropriate for this position.

Chagmion Antoine (voiceover): Zucker fired back with this letter to Conway, threatening to sue. He never followed through. Zucker declined to comment to 365, but Conway says his scare tactics are meant to draw attention from the bigger picture.

Professor Lynn Conway: There are a lot of us out there. A lot of us are actually rather cool people. I think he’d enjoy meeting us all.

Chagmion Antoine: Here’s an interesting fact. Lynn Conway is also a pioneering researcher in computer chip technology. She literally helped write the book. Ross.

Ross Palombo: Thanks, Chagmion.

Lynn Conway’s side of the story can be found by clicking here.

I’ve been unable to find any response from Kenneth Zucker; if anyone knows of such a thing, please post the link in the comments and I’ll update this post accordingly.

The TS Roadmap website’s page about Kenneth Zucker can be found by clicking here.

(Cross-posted at bird of paradox)

BirdofParadox has all the details.

An excerpt from Lynn Conway’s report:

Summary and Findings:

The APA Task Force Report on Gender Identity and Gender Variance [APA08 - PDF here] greatly underreports the prevalence of “gender identity disorder” by a factor on the order of 10 to 20.

The underreporting of GID prevalence derives from a deliberate misuse of clinical definitions and a failure to mention known calculation errors in sources.

The unreasonably low prevalence numbers are given to three significant figures in the Report, as if they were precisely accurate – while failing to mention well-known sources of estimation error.

The Task Force then dismisses recent work by Olyslager and Conway that had exposed large errors in earlier studies by calling that work a “minority position” – as if a scientific analysis must be certified by a majority vote, rather than judged on its merits.

The Task Force further dismisses the work of Olyslager and Conway by insinuating that citation by “transgender activists” somehow reduces its validity – while failing to cite it themselves.

Finally, the Task Force fails to mention recent scientific studies that report far higher-levels of GID prevalence than does their Report.

Please read Helen G’s post for more details – she covers it in pretty much the same detail I would.

The short form is that the APA task force is claiming that GID occurs approximately 1/20th the rate it actually does in the real world, allowing them to claim it’s a rare condition and probably supporting Zucker’s reparative therapy for trans children, since he’d be able to assure parents that it’s unlikely their child really has GID.

And they’ve picked some real doozies. From the Bilerico Project:

Editors’ note: Frequent guest blogger Mercedes Allen looks at who’s in charge of deciding the fate of Gender Identity Disorder in the DSM-IV.

A short time ago, I’d discussed the movement to have “Gender Identity Disorder” (GID, a.k.a. “Gender Dysphoria”) removed from the DSM-IV or reclassified, and how we needed to work to ensure that any such change was an improvement on the existing model, rather than a scrapping or savaging of it.

Lynn Conway reports that on May 1st, 2008, the American Psychiatric Association named its work group members appointed to revise the Manual for Diagnosis of Mental Disorders in preparation for the DSM-V. Such a revision would include the entry for GID.

On the Task Force, named as Sexual and Gender Identity Disorders Chair, we find Dr. Kenneth Zucker, from Toronto’s infamous Centre for Addictions and Mental Health (CAMH, formerly the Clarke Institute). Dr. Zucker is infamous for utilizing reparative (i.e. “ex-gay”) therapy to “cure” gender-variant children. Named to his work group, we find Zucker’s mentor, Dr. Ray Blanchard, Head of Clinical Sexology Services at CAMH and creator of the theory of autogynephilia, categorized as a paraphilia and defined as “a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman.”

Drs. Blanchard, Zucker, J. Michael Bailey (whose work has even gone so far as to touch on eugenics) and a small cadre of others are proponents of dividing the transsexual population by sexual orientation (“homosexual transsexuals” vs. “autogynephilic”) and have repeatedly run afoul of the World Professional Association for Transgender Health (WPATH, formerly HBIGDA), and openly defied the Standards of Care that WPATH maintains (modeled after the original SoC developed by Dr. Harry Benjamin) in favor of conversion techniques. Blanchard and Bailey supporters also include Dr. Alice Dreger, who re-stigmatized treatment of intersex, controversial sexologist Dr. Anne Lawrence, and Dr. Paul McHugh, who had set out in the begining of his career to close the Gender Clinic at Johns Hopkins University and has been one of our most vocal detractors.

An additional danger that gay and lesbian communities need to be cognizant of is that if Zucker and company entrench conversion therapy in the DSM-V, then it is a clear, dangerous step toward also legitimizing ex-gay therapy and re-stigmatizing homosexuality.

Big warning signs, yeah.

Mercedes also added contact info for the APA to object to this mishandling:

The APA press release states that for further information regarding this, to contact Rhondalee Dean-Royce (rroyce@psych.org) and Sharon Reis (sreis@gymr.com), though it’s possible that they may govern the press release only, rather than have any involvement in the decision to appoint Zucker. The APA itself is headquartered at 1000 Wilson Boulevard, Suite 1825, Arlington VA, 22209. Their Annual General Meeting is currently being held (May 3-8, 2008) in Washington, DC.

I’m poorly situated (Western Canada, with no travel budget) to lead the drive for this, which I see as a very serious danger to the transgender community. So I am calling on the various Transgender and GLBT organizations to band together to take action on this, and will assist in whatever way that I and AlbertaTrans can.

I am also calling upon our allies and advocates in the medical community and affiliated with WPATH to band together with us and combat this move which could potentially see WPATH stripped of its authority on matters regarding treatment of transsexuals.