The battle over infants with cross-gender desires

NPR Radio’s All Things Considered just had an interesting feature on two six-year old boys who identify with and want to be girls. It’s something that might be diagnosed as gender identity disorder or GID and the programme looks at how the two psychologists dealt with the issue in very different ways.

One psychologist, Ken Zucker, suggested that the family encourage their son to only associate with traditionally male toys and activities to encourage him to be more comfortable with his born sex, while the other, Diane Ehrensaft encouraged the family to allow their son to explore his cross-gender interests.

Whatever your immediate reaction to these approaches the psychologists in the programme make interesting points on both sides of the debate:

Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker’s therapy ‚Äî which seeks to condition children out of a transgender identity ‚Äî is unethical.

But that isn’t how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.

“Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? … I don’t think we would,” Zucker says.

If a black kid walked into a therapist’s office saying he was really white, the goal of pretty much any therapist out there would be to make him try to feel more comfortable being black.

Gender identity disorder is a controversial area. The diagnosis requires “a strong and persistent cross-gender identification” and significant distress related to the birth gender.

Some cross-gender people feel they are being labelled as mentally ill for having atypical gender desires and suggest that any associated distress is because they have to live in a society that marginalises their life choices.

There are some proponents that maintain that any cross-gender identification is an illness, although these are often the same people that think that being gay is a disorder and run ‘treatment centres’ for homosexuality.

Perhaps unsurprisingly, it seems Zucker’s work is quoted rather favourably by many of these organisations – something that has given him a bad name amongst some parts of the the LGBT community. Although, from what I can make out, he’s never associated himself with any of these views or organisations.

The mainstream professionals who defend the GID diagnosis usually suggest that the distress, rather than the desire itself, is key and this legitimises its classification and treatment. From this point of view, happy and adjusted transgender people would not be considered to have a disorder.

The program is well worth listening to as it tackles many of these thorny issues of gender politics.

Incidentally, the producer is Alix Spiegel, who produced 81 words, one of the finest documentaries on the history of psychiatry I’ve ever heard.

It looks at the how homosexuality was de-listed as a mental illness, but is more than that, it’s also a moving story from Spiegel’s family. The remarkable thing was that the the two were inextricably linked.

I’ve mentioned it before on Mind Hacks, but I highly recommend it if you’ve not encountered it before.

Link to NPR programme on cross-gender desires in children.
Link to audio archive of 81 words (click ‘Full Episode’ for free stream).

6 Comments

  1. rhizome
    Posted May 13, 2008 at 1:27 am | Permalink

    Gender is meaningfully different than race here because it is more ‘social’ than ‘biological.’
    The gender/sex distinction isn’t just an academic quibble in this case, because “traditionally male toys and activities” simply aren’t as natural or inevitable as, e.g., one’s skin color.

  2. Mark(p.s.)
    Posted May 14, 2008 at 4:40 pm | Permalink

    Sexual identity is unlikely to be changed from birth. Doesn’t anyone remember the John/Joan case of the boy infant with a botched circumcision, turned into a girl? The psychiatrist called it a success, the patient called it a failure. The patient in adolesence knew they were different , the lies to cover up the medical mistake did not work.

  3. Posted May 14, 2008 at 11:11 pm | Permalink

    Actually, gender identity does seem to have a physiological area in the brain, known as the Sexually Dimorphic Nucleus. Google it.
    One part of this nucleus corresponds to sexual preference (straightness or gayness) and the other to gender indentity (boyness or girlness).
    There’s a bit on in in Carlson (2001?) Physiology of Behaviour, nth Edition.
    Sorry for not giving a proper reference…
    Mark is quite right about the John/Joan case (I read about this in a developmental text).
    What causes the Sexually Dimorphic to occasionally pick a different gender or sexual orientation to the normal one? Prenatal testosterone? Genes? Does anyone know yet or have a theory?

  4. kforeman
    Posted May 18, 2008 at 7:30 pm | Permalink

    An interesting look into the reparative therapy proponent who is in charge of revising gender identity disorder in DSM-V:
    http://www.bilerico.com/2008/05/uh_oh.php

  5. Posted May 18, 2008 at 9:45 pm | Permalink

    Zucker seems to be linked to ‘reparative therapy’ by his opponents, but I can’t actually find any evidence that he supports this approach at all. I’d be interested to hear of any evidence either way though.

  6. ConcernedMan
    Posted October 6, 2012 at 8:16 am | Permalink

    Both of the approaches are wrong.

    The kid thinks he’s a “girl” because a great deal of his personality lines up with what society says should be a “girl”.

    Has any psychologist ever tried this?:

    Let the kid play with what ever he wants. If you force him to only play with boy toys it will just make him further convinced that in order to be himself he has to change his body.

    Instead teach the kid that boys and girls can do what ever they want, and that all there is to being a “boy” is having boy parts and all there is to being a “girl” is having girl parts, that people have ideas about how boys and girls should behave but that some people don’t conform to those ideas yet they are still their physical sex boy or girl.

    Then by adulthood the child associates the concepts of “boy” and “girl” with physical form rather than the various social constructs that get glued to it. The dysphoria is because the kid’s concept of gender is overcomplicated. Just divorce “gender” from the symbolic things people associate with gender and maybe people wouldn’t want sex changes.

    Note: Shouldn’t be taken for medical advice. I’m not a doctor, but everytime I’ve read about treatment of children expressing gender identity issues the only two suggestions seem to be “make the kid conform” or “let the kid transition”, why can’t there be a middle ground?


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