Informed Dissent

17 May 2008

As I mentioned in my last blog, for the last several months I’ve been working with my neighbors to agitate against a poorly conceived development proposal in our city. Lately, among the unrelenting flood of email related to that, I’ve been getting messages from queer activist and queer theory colleagues asking me what I think of psychologist Ken Zucker being named chair of the DSM-V Workgroup for Sexual and Gender Identity Disorders. So that makes two political storms raging in my in-box. Any wonder I keep leaving my in-box to go work on my flower boxes?

Well, this week I found that the two storms have one thing in common: uninformed dissent. And you know what I realized as I thought about this, while weeding? Uninformed dissent bugs me about as much as uninformed consent.

This week, on the city side of stuff, a couple of my well-meaning neighbors put out a new flyer about the development proposal to which we are opposed. Problem was, they didn’t fact check it. And they had some really important points wrong, like how much liability the taxpayers hold on this deal.

Who cares? Well, as I lectured them, when you are in the position we are--marginalized and labeled “activist,” up against a powerful figure (the city manager), with nothing but your own time, money, and energy on your side--you cannot afford to be sloppy with facts.

When you are sloppy with facts, you make it way too easy for the guys with the power to write you off as ignorant (which is bad), looney (worse), or a bunch of liars (fatal). When you get an important fact wrong, you undermine the legitimacy of all your claims. Produce a call to arms riddled with errors, and you produce “friendly fire”; you hurt your own side.

I’ve been watching the same sort of thing happen over the debate regarding Zucker and the DSM. Lots of errors about basic facts. Some of these errors have been noted in an open letter from Marshall Forstein, M.D., of Harvard Medical School. Forstein pointed out that in his letter that, contrary to claims made in petitions and frantic emails, “sexual orientation is NOT even an issue for the DSM committee to consider.” He noted that “The American PSYCHIATRIC Association is the organization that publishes the DSM,” not the American Psychological Association. And the DSM “is a guide to diagnosis and NOT to treatment.”

The tone of Forstein’s letter reminded me of my own tone as I lectured my well-meaning neighbors on my porch yesterday. Basically: “Geez, people! You don’t have the most basic facts right! How do you expect to gain and keep allies if you can’t get the facts straight?!”

The errors Forstein chronicled are important, but arguably not as important as the erroneous claims that  Zucker does “conversion therapy,” i.e., that he tries to change children’s sexual orientation from gay to straight, and that he thinks a patient turning out to be transsexual represents a “bad outcome.”

How do I know these are wrong? Well, I asked Zucker. Point blank. It was last summer, as I recall, at a reception just after I had given a major lecture in Vancouver about transforming intersex practice at the International Academy of Sex Research. (I’ve also been pressing him in subsequent conversations, and have started reading his work on GID closely, both so I can understand better his philosophy, methodology, and evidence.)

I asked Zucker: Do you think if a child ends up transitioning sex as an adolescent or adult, that’s a bad outcome? No way, he said. In fact, he pointed out that in that case--when a child grows up to be an adolescent who needs to change sex because that means s/he will be better off--Zucker helps arrange it to make sure it happens.

I asked him, do you think a child growing up to be gay represents an inferior outcome to a child growing up to be straight? He answered that he thought sexual orientation was not a determinant of well-being, and what he cared about was that his patients end up well. He doesn’t care if they end up gay, bi, lesbian, transgender, transsexual, or straight, so long as they are well. Maximize benefit, minimize harm.

So why, I asked him, does he bother “treating” kids with “GID”? His answer was that, if he could help a kid exhibiting distress feel less distress, then he wanted to do that. Thus his practice includes doing therapy with the parents to get them to adjust to the fact that their kid might grow up to be queer. Why? Because his longitudinal studies show that most kids diagnosed with “GID” end up being queer. (Yeah, he does outcome studies to figure out how he is helping and how he is harming, and he’s been doing them for years, unlike the vast majority of the intersex clinicians I’ve dealt with.)

Zucker also said that, if he could make a child feel comfortable with the genitals she or he was born with, without causing harm, then that would be best. As someone who has been a long-time advocate of keeping children’s genitals intact and using psychologists to help parents to accept their “different” children, I admit I was sympathetic to these arguments. In fact, as I thought about it more, I realized that pushing gender-atypical kids towards eventual transition (as some “progressive” therapists seem to do) could be another case of ultimately changing the child surgically to satisfy parental discomfort with the child’s atypicality. Intersex all over again. Yikes.

Does that mean I like everything Zucker does? No way. I worry that, while he might be teaching body comfort, he might also accidentally be inducing shame about being queer. (It’s gotta be hard to convince a kid he’s perfectly OK to be queer if you’re trying to get them to be less gender atypical, as Zucker does. Duh.) And I wish he would get these children and their parents into peer support groups.

While I’m at it, I wish Zucker would really get what my friend and colleague Paul Vasey has documented with Nancy Bartlett--that the occasional distress that comes with gender atypicality in childhood appears to be culture-specific and thus culture-induced. It is NOT a necessary component of childhood gender atypicality, as Paul and Nancy have shown through their studies in Samoa.  (Contact me if you’d like an offprint.) I also wish Zucker would introduce these families to adults of various queer identities, so they could see that real, lovely, wonderful people grow up to be queer and happy and successful. I think, like the typical pediatric clinician, Zucker underestimates the helpful (i.e., calming, de-shaming) effects of those sorts of encounters.

I should probably also note here that several of the DSM-related petitions and emails circulating through the ether also get the facts wrong on psychologist Ray Blanchard. For example, they claim Blanchard is against SRS (sex reassignment surgery) for folks who are transgender. Well, I could take that claim, spread it in my garden, and get some mighty nice tomatoes to grow from it. Not only has Blanchard done studies showing that people who transition are much better off, he’s also taken those studies and used them to successfully argue in favor of government funding for transition.

Does that mean I agree with everything Blanchard does? No again. For example, I think his approach requires too many hoops to get to medical transition. I’ve written about the hoop problem, though not nearly as eloquently as philosopher Jacob Hale in an excellent ethical critique that I published with Paul Vasey in a special journal issue. (Contact me if you’d like an offprint of Jake’s masterpiece.)

So hang on, how could the Zucker and the Blanchard I know of be so different than the two being e-assaulted? To explain that, I’ll quote from an email from James Cantor, an out gay man who works with Zucker and Blanchard, whom I met during my research into the Bailey book controversy. James and I have been talking this last week about how challenging it can be to answer the sorts of “When did you stop beating your wife?” emails he’s been getting.

James wrote to me:

Don't get me wrong: I am a strong supporter of healthy debate. But in the current round of accusations, no one is actually disagreeing with Zucker (or Blanchard) at all; they are disagreeing with what the blogs are selectively twisting their statements into, but never actually said, meant, or believed. [...] The problem is compounded by people who are satisfied with cutting-and-pasting comments from blog to blog, but without doing any investigating of their own. [...]  I believe that much of the current friction is from people spin-doctoring statements into half-truths to give themselves an opportunity to stand on a soapbox blog and declare the other side as evil.  Although these people call themselves activists, they are of the Al Sharpton rather than the ML King sort.

You know what’s ironic about all this? This kind of misattribution is exactly what I used to suffer from, early in my work in the intersex rights movement. I used to run into clinicians and media people who would tell me that Alice Dreger thought that when a child was born with a sex anomaly you should “do nothing” and “raise them without a gender.” I never said any of that. And you know, among my sexology detractors, who actually represented my work correctly? Kenneth Zucker. He didn’t agree with me (I think he still doesn’t entirely), but he bothered to get me right.

Enough blathering. Let me get to the point: For dissent to be effective, for it to be sustainable, for it to be ethical, it has to be factually right. You have to get people’s positions right. Start there, people. That’s why we are winning with intersex--because we bothered to get the facts right.

If we lose the fight for transgender rights (which seems impossible), if we lose the fight against the city manager (which seems quite possible), we still need to have our integrity in tact. To fight on.

Now, I’m off to ask Zucker a question that this blog has helped me clarify: If your primary approach to little kids born with typical genitals to get them to feel good about their bodies and to get their parents to adjust to their children’s needs, why isn’t that your approach for children born with atypical genitals?


N.B.: If you’re interested in reading more material on educated activism, please see my page for activists.


Postscript, May 30, 2008:

Subsequent to this blog, the APA issued a statement regarding Zucker’s practice and philosophy of treatment. I quote from it here because I believe it confirms what I reported from above from my conversations with Zucker:

The philosophy of Dr. Zucker’s team is to provide client-centered care that maximizes benefit and minimizes harm to each child or youth.  The goal of treatment is a well-adjusted youth, regardless of ultimate gender identity or sexual orientation, who feels she or he has been genuinely helped by her or his healthcare providers.  [...] Dr. Zucker’s therapeutic approach has no relationship to so-called reparative or sexual conversion therapies that attempt to change homosexual orientations to heterosexual ones.  The goal of his therapy is the opposite of conversion therapy in that he considers well-adjusted transsexual, gay, lesbian or bisexual youth to be therapy successes, not failures.

Four trans rights groups (the National Center for Transgender Equality, the Transgender Law and Policy Institute, the Transgender Law Center, and TransYouth Family Allies) have also issued a new statement on this matter, including this:

Though no consensus exists among transgender people about whether and how a GID diagnosis should be in the DSM-V, there is certainly agreement that decisions made by the APA about transgender and gender non-conforming people will deeply affect the lives of millions of transgender adults, adolescents and children.

We have met with and strongly encouraged the APA to closely adhere to its stated commitment to scientific process regarding diagnosis of transgender people. We are confident that a fair, unbiased review of current knowledge can result in a DSM-V that can move society toward a more rational and humane understanding of transgender people.

We encourage our transgender brothers and sisters to approach this issue with thoughtful consideration of all available information.

I would love to link to the complete versions of both of these statements. If anyone knows where they are online, please contact me so I can link them.