It was one of those news items that almost slipped by everyone, despite the potential ramifications that it could have for the transgender community and its allies. Days after the fact, Lynn Conway reported that on May 1st, 2008, the American Psychiatric Association (APA, not to be confused with the American Psychological 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 “Gender Identity Disorder” (GID), the classification that governs how transsexuals are diagnosed and then treated. It was a day or two more before it would ring out like a shot.
The news was that one of the most controversial doctors dealing with the transsexual community, Dr. Kenneth Zucker, was named to chair the work group. Appointed to work with him was Dr. Ray Blanchard, another extremely controversial figure, and Zucker’s mentor. Both hail from Toronto’s Centre for Addictions and Mental Health (CAMH, formerly the Clarke Institute), which has drawn criticism and concern from transsexuals across North America. Dr. Zucker is infamous for utilizing reparative (i.e. “ex-gay”) therapy to “cure” gender-variant children (the APA recently put out a press release that correctly affirms that he does not apply this treatment to change sexual orientation but misses the essence that it is still practiced nonetheless regarding gender identity). Dr. Ray Blanchard is Head of Clinical Sexology Services at CAMH and creator of the theory of autogynephilia, defined as “a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman,” a theory that does not match the experience of most transsexuals. 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”). Meanwhile Dr. Zucker also endorses the potentially damaging procedure of assigning gender to intersex infants at birth, a practice that was halted in many centres when Dr. John Money’s theory that gender is malleable in children proved tragically wrong. This was demonstrated in his own classic test case, the female-to-male intersexed person of David Reimer, known in Money’s writings as “John / Joan.”
It should be pointed out that most of the transgender community realizes that these doctors honestly wish to help transsexual populations and believe that they are doing so. Characterizing them as evil is unfair. CAMH, too, has a positive reputation in many other areas of treatment in which they engage. However, the research, treatment and theories from these doctors and the gender clinic they operate are the subject of much dissention. CAMH has itself bragged about turning away approximately 90% of the people who come to them for treatment, and so it is inevitable that these therapists see a primarily narrowly-slanted cross-section of the community.
TransActive Education and Advocacy (TAEA), Transgender American Veterans Association (TAVA), AlbertaTrans.org and others have issued press releases asking that the APA reconsider these appointments. The National Center for Transgender Equality (NCTE), Transgender Law Center, Transgender Law and Policy Institute and Transgender Youth Family Allies (TYFA) followed with a joint statement expressing concern, as have the National Gay and Lesbian Task Force (NGLTF) and ally organizations.
However, there has been some confusion generated by the panic surrounding this controversy. The DSM does not in fact recommend treatments, only diagnoses, although some concern remains that giving these therapists authority over the diagnosis also gives them a perception of authority regarding the treatment. Some of the controversy extends beyond the listing for GID to that of “Transvestitic Fetish,” a category of paraphilia that some fear Dr. Blanchard is likely to modify to encompass autogynephilia, and potentially cause many transsexuals’ diagnoses to be diverted to this category.
This event has also coincided with the reinstatement of health care coverage of Gender Reassignment Surgery (GRS) in Ontario, as it is the same clinic and the same therapists who are given exclusive authority to approve or deny treatment at every step. Many local activists consider this a bittersweet victory, as the return to the same situation from ten years ago really does not leave them any further ahead.
Moving forward, the hopes are twofold: there is some effort to fight the exclusivity given to CAMH in Toronto, and there have been statements and discussions with allies within the APA who are part of the checks and balances used in establishing diagnoses. Via the latter, the doctors at the centre of the issue will likely be put to task, but we will not know the outcome until the DSM-V edition is published, which is expected in 2012.
Both cases, however, demonstrate a need for some liaison body between transgender advocates, who see a much larger and more honest sampling of transsexual people, and the medical professionals who care for them. Perhaps this is the next step.
”Mercedes Allen is a writer who blogs at http://dentedbluemercedes.wordpress.com/, has been featured on bilerico.com, PageOneQ and others, and has also developed the website at AlbertaTrans.org as a resource for transgender information and support.”
