Gender Identity Disorder and Current Media Trends
Bobby's Story
To the causal observer, "Bobby" is a seemingly healthy six-year-old boy. He has large, bright eyes, he speaks quickly and energetically, and he comments precociously on the world around him. His teachers say that he is brimming with creativity, and nearly always perfectly well behaved. So it would come as a surprise to most people to learn that Bobby's first-grade teacher has called in Bobby's parents for a private meeting about their son's recent trouble at school. The teacher recounts how Bobby, normally such a good little boy, becomes intractable during any gender-based activity in the classroom. When the class is divided into boys and girls, Bobby insists on grouping with the girls rather than the boys. He tries to use the girls' restroom at recess, and several times he has come to school wearing a "skirt"-apparently a blanket smuggled out of home in his backpack.
Bobby's mother tearfully acknowledges that her son acts similarly at home. He frequently asks his mother why he has to live as a boy, and refuses to play with any toys but Barbie dolls and his mother's clothes for dress-up. He throws incredible temper tantrums if any of this is denied him. Bobby's teacher assures Bobby's parents that there is nothing "wrong" with their son-he is a "transgender child." His cross-gender behavior is just a "normal human variation," the teacher says, and so long as his family accepts and affirms Bobby's transgenderism, the acting out at school and tension at home will cease. The teacher speaks approvingly of new "puberty blocker" drugs that Bobby can take in a few years to prevent further masculinization of his body. Once 18, he will be eligible for a full sex-change operation to complete his "transition" into his true female identity.
Battle for GID Children
The scenario described above, as bizarre as it may seem, reflects a disturbing new trend and the goal of some pediatricians and child advocates for children experiencing gender identity confusion. Pro-transgender activists and their allies in the medical profession are in the midst of an aggressive media campaign to normalize child Gender Identity Disorder. In the past year, following a Barbara Walters 20/20 story on the topic, there has been a trend of increasingly high-profile media coverage of GID children, which frequently presents the support and encouragement of a cross-gender identity in young children as the solution to their gender dysphoria. Stephanie Guinan, Trans-Coordinator for the national gay advocacy organization PFLAG, writes in a follow-up article on the 20/20 coverage, "The only recourse for these children is to dress as they identify and hope that no one remembers what is really under their clothes."
Recent coverage has included a 5-page article in the November 2008 issue of The Atlantic magazine and culminated in a January 13 episode on the Dr. Phil show. With the partial exception of the Dr. Phil episode, which included Dr. Joseph Nicolosi, a past President of NARTH and researcher Glenn Stanton as guests, the coverage of the battle for GID children has been deafeningly one-sided. The article "A Boy's Life" in The Atlantic, while briefly quoting Dr. Kenneth Zucker on the harms of sex-change treatment, devotes little time to a convincing exposition of his theories and practice, and seems more concerned with paying lip service to some vague notion of point-counterpoint than fostering a true clash of ideas. Meanwhile, the pro-sex reassignment "Trans-Health Conference" is presented as a cutting-edge, enlightened gathering of researchers and medical professionals, rather than the ideologically-driven, politically-charged gathering that its website betrays it to be.
Dr. Nicolosi comments on the NARTH website that while Dr. Phil treated him and Glenn Stanton courteously, his careful description of the importance of attachment in child GID and reparative therapy was cut from the final edit of the show. Indeed attachment, as professionals from Zucker to Nicolosi to even pro-transgender researchers like Dan Siegel realize, is central to understanding both healthy child development and effective therapeutic interventions. As therapists like Zucker and Nicolosi remind us, the psychosocial factors involved in the etiology of GID in children are hardly obscure - the "triadic-narcissistic" family model proposed by Nicolosi, the background of chaotic "family noise" that Zucker mentions, describe the same basic family dynamics that create GID in young boys. The little boy, often temperamentally sensitive, experiences an enmeshed, smothering over-attachment with the mother-often a dominant personality herself-while the father remains physically or emotionally absent and withdrawn.
Decades of clinical experience and an often-overlooked yet significant body of published research confirm this model as typical. Even pro-transgender researchers such as Dr. Heino F.L. Meyer-Bahlburg, professor of clinical psychology at Columbia University and committee member of the World Professional Association for Transgender Health, writes of the family dynamics of GID boys, "The boy with GID is often particularly close to the mother or/and another woman, such as a grandmother, teenaged sister, a nanny or a neighbor. The father may be closer to another child or may be on the fringes of family life altogether."
This, then, is the central problem in using puberty blockers or sex-reassignment operations to respond to a child's GID: they do not treat the true causes of GID, and thus, can never be truly effective solutions. Rather, invasive and intensive procedures to indulge the illusion that a GID boy is really a "girl trapped in a boy's body" serve only to soothe the consciences of parents in dysfunctional families while turning a blind eye to underlying pathologies and the resulting victimization of their child. Dr. Zucker comments in a 2003 letter in Psychiatric News:
"Consider, for example, a 3-year-old girl who repeatedly states that she is a boy or that she wants to be a boy. Her parents reply by telling her that she is a girl, and the child's reaction is to cry and insist otherwise. Hill's interpretation of such distress is that it is merely the result of the parents' reaction, not the possibility that the child is also struggling with a complex feeling state. Of course, if the parents went along with the child's fantasy that she was a boy, there would be no overt distress, but it would hardly solve the underlying problem and would merely reinforce it."
The view of those who would claim GID in children as a "normal variant" of human behavior and label GID children with an intransigent "trangender" identity could been viewed as reckless in the extreme. This perspective does not see these children as complex emotional and psychological beings, but rather, as individuals with a plumbing problem, to be corrected with hormones and surgery. A child with GID does not need a sex change or a skirt to hide his or her "complex feeling states" behind-what the child really needs is counseling. If a little boy like "Bobby" from the story at the start of this article is drugged up on puberty blockers, he remains a little boy drugged up on puberty blockers in a dysfunctional family environment.
Research by Susan Coates finds that 53% of the mothers of GID boys meet the clinical diagnosis for Borderline Personality Disorder or show depressive symptoms. Such data is almost expected in a psychodynamic model of the development of GID, but the normalization of GID has the dangerous potential to ignore these factors and perpetuate psychological trauma. Of course, transgender activists often seem to predicate the father's detachment from his GID son on the boy's GID itself, rather than the other way around-perhaps they would shamelessly advocate a similar "blame the child" approach in the case of BPD mothers as well.
Broader Themes
The ancient creed of medicine, in the words of the Hippocratic Oath, is to "do no harm." Therapeutic practice has, until the modern age, always recognized its task to serve human nature -not to work against it, not to try to "improve" it, and never to destroy it. The deconstruction of the sexual categories of male and female, essential to human nature and vital for the transmission of that nature, can never produce a sustainable result. Dr. Paul McHugh, psychiatry director at Johns Hopkins Hospital, writes bitterly of what he has witnessed of these destructive trends: "We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it."
The children diagnosed today with GID are a new generation that will either thrive from sound interventions that respect the integrity of the human person, or perish in the self-defeating "treatments" that attack the image of the naturally gendered individuals they were born to be. Let us never shy from defending the masculinity or femininity that are their birthright; let us never be afraid to tell the truth.
- David Daleiden
(This special report for the National Association for Research and Therapy of Homosexuality represents the author's perspective on current media trends. While it does not necessarily reflect the official viewpoint of NARTH or all of our members it is an important contribution to the important discussion on the issues surrounding Gender Identity Disorder in children. NARTH © 2009)
