Voices - Identity Crisis; Duncan Osborne
OUT magazine (Los Angeles, USA), April edition, 2003
ISSN 1062-7928 © Liberation Publications Inc.
Voices - Identity Crisis
While psychiatrists and psychologists debate gender identity disorder,
Duncan Osborne finds support for this diagnosis from a surprising
group - young transsexuals.
Beginning at age 5, Karl Bryant would make the one-hour drive with his
parents to the University of California, Los Angeles, every other Saturday
to see psychiatrist Richard Green. The trip always ended with a treat,
Bryant recalls: He got to press the elevator button to take them to Green's
office on the third floor.
Bryant, now 40, was seeing the
psychiatrist because he was insufficiently masculine. Green was studying
66 "feminine boys," as he later called them in his 1987 book, The "Sissy
Boy Syndrome" and the Development of Homosexuality.
Bryant was one of his subjects.
"We had conversations that allowed him
to bring up the subject of boys who want to be girls," Bryant says. "My
general sense is that it was a way for him to push me on the fact that it
was not normal or not the way things should be .... In part he was trying to
understand what I was thinking."
But that was not all. "There was some
measure of cure involved in it," Bryant says."Getting me to be more
masculine was the goal or, at least, to see that I should be more masculine.
If that wasn't his message to me, it was what I heard."
Bryant liked and wanted to please
Green, whose message started to get through. "I remember one week in the
process I brought a towel with me to show Dr. Green," Bryant says. "This
was sort of my proof that I had been playing as Superman that week."
Three years of visits were
supplemented by follow-up sessions, which included psychological testing
- until Bryant quit at 13. "I went for a few years, and then I said, I don't
like this,"' Bryant recalls. "He would ask me about things, including my
sexual fantasies and things that for a 13-year-old are a little threatening ....
I think I was fantasizing about men. This was the 1970s. There were no
gay-straight alliances. I didn't want to be conscious of that myself, and
having him asking me about it kind of undermined that."
Any effort to reform GID threatens to collide with a growing trend
among transsexuals: earlier transitions that rely on a GID diagnosis to set
the process in motion. In fact, many transgendered people strongly
support the current GID diagnosis
In 1980, Green's work led to a new
diagnosis - gender identity disorder - in the third edition of the
Diagnostic and Statistical Manual of Mental Disorders, the American
Psychiatric Association's official list of mental illnesses. The disorder is
characterized by a "strong and persistent cross-gender identification," and
patients must express significant discomfort with their gender.
GID could become a flash point in San
Francisco at the APA's annual meeting in May, when a session will debate
reforming the diagnosis. That session reflects a growing debate within the
psychiatric association. While gay groups have called on the association to
reform or eliminate the diagnosis, that demand has been complicated by
an emerging population of transgendered youths who seek to transition
earlier than their predecessors. Since the first step in that transition for
these teens is often a GID diagnosis, transgender activists are divided
about this issue.
In children, behaviors leading to a
diagnosis can include cross-dressing, wanting to be - or insisting that he or
she is - the other sex, rejecting same-sex playmates, and embracing toys or
games stereotypically associated with the other sex. Adolescents and
adults must express a desire to alter their sex through surgery or
hormones or say that they are the wrong sex.
While many GLBT adults will recall that
they engaged in gender-bending behavior as kids, the GID diagnosis is
intended for only the most extreme cases. Think for a moment of the
cross-dressing little boy in 1997's haunting film Ma Vie en Rose
rather than the kid who occasionally tries on clothes of the opposite
Some psychologists and psychiatrists
use the diagnosis on GLBT kids in an attempt to turn them into
heterosexual adults. Other professionals reject the idea that adult
homosexuality or transsexuality can be prevented but believe they can use
the diagnosis to help kids and teenagers with GID who are deeply
The diagnosis, which is rare, is clearly
associated with adult homosexuality or, less often, transsexuality. Among
the 44 "sissy boys" Green followed long-term, 75% were either gay or
bisexual, and one wanted sex reassignment. Psychologist Kenneth J. Zucker,
the head of Toronto's Child and Adolescent Gender Identity Service at the
Centre for Addiction and Mental Health, is a leading GID expert who has
seen roughly 625 children or adolescents since 1978.
"The majority of kids will have resolved
their gender dysphoria and identify themselves as gay" Zucker says.
"We're also going to find that around 15% have significant gender
dysphoria that has persisted into adolescence and young adulthood to the
point where they are wanting sex reassignment .... If we add on to that a
small minority of kids who report being heterosexual, we're seeing a real
range of outcomes."
Activists have criticized Zucker, but he
counters that his efforts are intended to help the child be happy with his
or her gender. Zucker works with parents to restrict behaviors such as
cross-dressing or cross-gender role playing while encouraging the child to
value his or her current gender. It is the child's discomfort that he is
"Just yesterday I spoke with a 5-year-old
who reported that being a boy made him sad," Zucker says. "We know
that kids with GID are subject to a whole range of social problems. If one
can avoid those problems, that would be a basis for treatment."
Zucker usually tells parents that their
child is likely to grow up gay and that his efforts will not change that. "As
a clinician, my ethical obligation is to tell parents about what treatment
does or doesn't do," he says. "We will usually let parents know that the
most common psychosocial outcome is that they usually grow up to be
Responding to questions faxed to him at
Charing Cross Hospital in London, where he heads the Gender Identity
Clinic, Green makes a similar argument. "The treatment program for the
boys whom I saw with parents was to help them be happier being male,
integrate more confidently into a mixed-gender peer group, and reduce
alienation with a parent, usually [the] father," Green writes.
Though both Green and Zucker have
been attacked, they are not easy pigeonholed as antigay, some gay
psychologists and psychiatrists have praised Zucker's work And Green was
instrumental in removing homosexuality from the DSM in 1973; he
has also been an expert witness in lawsuits opposing discrimination based
on sexual orientation or gender identity. He is a past president and
longtime member of the Harry Benjamin International Gender Dysphoria
Association, the group that sets the standards of care for transsexuals.
Even those who support the GID diagnosis do not dispute that some who
use it are driven by ideology. The best-known of these is psychologist
Joseph Nicolosi, a founder of the National Association for Research and
Therapy of Homosexuality.
NARTH promotes therapies that claim
to convert homosexuals to heterosexuality, and Nicolosi has long been
associated with right-wing groups. He declined to speak with Out,
but in his 2002 book, A Parent's Guide to Preventing Homosexuality,
Nicolosi uses terms such as "pre-homosexual," "gender-confused," and
"gender identity disorder" interchangeably. He is working with children
with the goal of preventing them from growing up to be gay or lesbian.
During an appearance on Fox's The
O'Reilly Factor, Nicolosi said, "For parents who want their children to go
in a heterosexual direction, I'm available." He has made similar claims in
the past. In a 1998 speech, he said he was treating about 25 "pre-homosexual
boys," including 5- and 6-year-olds as well as some as young
as 3. "These boys want to be girls," he said in the speech. "They are denying
their masculinity. They are preoccupied with feminine activities. They are
infatuated with Barbie dolls ...."
While Nicolosi cites the work of GID
experts, Zucker and Green dismiss him, though they do not question the
diagnosis. "There are people who claim they can 'cure' adult homosexuals
too, but I don't accept either the need for a 'cure,' or their reported
outcomes," Green writes in response to Out's questions. "I don't know
of any evidence that treating children with gender identity disorder
interrupts later homosexual orientation."
Zucker asserts that Nicolosi's work is
unsupported by any evidence, but he adds that some who object to the
diagnosis are as prone to confuse politics with science as Nicolosi is.
"Nicolosi is deeply embroiled in sexual
politics, so it is not surprising that he takes this particular position with
regard to GID, but there are people who have no sexual orientation ax to
grind who would also see GID as a phenomenon that causes kids a lot of
trouble," Zucker says. "He has very strong views about things, and the
boundary between the clinical issues and the ideological issues seem a
little blurry to me, just as with gay politicos on the Left."
Efforts by those "gay politicos" to
reform the diagnosis date back several years. The American Psychiatric
Association formed a committee in 1998 to look into allegations that the
diagnosis was being abused. It finished its work in 2000, but the report
has not been made public. In 1999 a dozen leading GLBT and women's
groups wrote to Alan Tasman, then the APA's president, seeking a dialogue
on GID. That effort went nowhere, but a rancorous debate within the ranks
of the association has begun.
Richard Isay, clinical professor of
psychiatry at Weill Medical College of Cornell University in Manhattan and
the author of Becoming Gay: The Journey to Self-Acceptance,
published an article in Psychiatric News in 1997 urging that GID be
removed from the DSM. Isay argued that the diagnosis "implicitly labels
homosexual boys as mentally disordered," noting that every adult gay
male patient he had seen over 30 years reported some "'feminine' traits
Perhaps as many as two thirds of
lesbians and gay men recall that at some point they exhibited behaviors
typical of the opposite sex, though rarely to the degree found in GID kids,
according to some studies. What these children are expressing is the early
development of a gay, lesbian, or transgendered adult. Sissies and tomboys
are just young queers, and they are not mentally ill.
"I would say each of the gay men that
I have seen have had one or more gender-atypical traits during their
childhood," Isay said. "I'm concerned by the treatment of GID, which is ... to
help these boys conform to cultural stereotypes rather than supporting
Zucker responded in a professional
journal that Isay's piece was "a poorly reasoned, revisionist view that,
almost effortlessly and with little reflection, attempts to undo 40 years of
empirical research and theoretical work on the topic." One conclusion of his
was a zinger: "Lastly, one must raise the thorny and difficult question of
Isay's professional credentials to comment on the validity of the diagnosis
of gender identity disorder," Zucker wrote. "As far as I can ascertain ... Isay
has never published an empirical, data-based, peer-reviewed journal
article on anything pertaining to gender identity disorder in children."
The APA's Committee On Gay, Lesbian,
and Bisexual Issues told a senior association officer that it "would like to
ensure that someone familiar with some of the problematic features of and
conceptual confusion in the GID is assigned to the appropriate work group"
for the fifth edition of the DSM, according to the January 2002 edition of
"Spectrum," an APA newsletter. Jack Drescher, MD, the committee chair,
would not comment on the specifics of the committee's work.
"I'm happy to say that we are talking
about it," Drescher says. "We very much hope that when the final
committees are formed to work on the next version of the DSM, there will
be inclusion of various points of view."
Any reform effort, however, threatens
to collide with a growing trend among transsexuals: earlier transitions that
rely on a GID diagnosis to set the process in motion. In fact, many
transgendered people strongly support the the current GID diagnosis.
Avery Porch, who started life as a
biological female, for instance, felt from an early age that he was a boy. "I
would destroy all Barbies that I received," says Porch. "I would cut their
heads off or melt them in microwaves."
At 18, he found a sympathetic
counselor and started on hormones in 2001; chest reconstruction surgery
came the next year. The process would not have begun so early without
the GID diagnosis. "It's made my transition a lot easier," he says. "If the
diagnosis did not exist, it would be even harder for people to
Similarly, "Jenny," a 19-year-old
Englishwoman, was also helped by the GID diagnosis. At 16, England's
"mature minors law" allowed her access to medical care, and she started on
hormones as part of her transition [the magazine omits here that she also
had sex reassignment surgery]. Now she has moved to a new city and
started college, and she does not call herself a transsexual. That is her past
- she is now simply a young woman. "My body feels pretty great to me,"
she says. "Every time I happen to see myself naked in the mirror I think,
My God, that look so great. Transitioning - that relieved a large amount of
But not all transgender activists think
that the diagnosis is needed. "Transgendered adults who get the diagnosis
are split over whether it's a good or bad thing," says Riki Wilchins,
executive director of the Gender Public Advocacy Coalition. Wilchins points
out that only a small portion of people who transition can get insurance
reimbursement for their medical procedures. While the diagnosis may help
those individuals, "at the same time this means that everyone who applies
for medic help ends up being diagnosed as having a mental illness,"
Wilchins says. Others argue that the diagnosis is not necessary, since some
medical procedures for transsexuals are delivered without it.
This complicated situation puts
activists in a difficult position: How do they get help for transgendered
teens and adults while protecting the children who are more vulnerable to
abuse of the GID diagnosis?
"I think that the single most important
thing is that there be a consensus that trying to change a child's gender
identity or gender expression is unethical or harmful," says Shannon
Minter, the legal director at the San Francisco-based National Center for
Lesbian Rights and a female-to-male transsexual.
Whether such a consensus is even
possible remains an unanswered question. Can psychiatrist and
psychologists who have banked their careers on the diagnosis, queer
activists who oppose it ideologically, and right-wingers who use it in their
efforts to extinguish homosexuality agree on anything?
Indeed, the debate is growing more
heated - which may only guarantee that the youngest queers will continue
to face a difficult road as they come to terms with gender identity and