Wednesday, 6 May 2009

Storms over Toronto - and in the APA

A gigantic, messy brouhaha is forming, with forecasts of scattered showers of gigantic egoism, political correctness, and ultra-conservative ideology. Drifts of Bad Science and Bullshit hip deep are expected, along with lawsuits and character assassination.

The problem began in "Jurassic Clarke", now CAMH, the Centre for Addiction and Mental Health in Toronto. It started out with some psychologists doing research in a clinical setting, where patients were their experimental animals, rewarded with cost-free essential medical care when they parroted narratives that fit the researchers theories, and punished by not just withholding, but actually prohibiting treatment if they didn't.

It goes outside Toronto though, and into the workings of the American Psychiatric Association, and the revision of "The Psychiatrist's Bible", the Diagnostic Standard Manual, version 5 (DSM-V).

Sexual and Gender Identity Disorders Work Group

Kenneth J. Zucker, Ph.D. (Chair) Head, Gender Identity Service Clinic, Child, Youth, and Family Program Centre for Addiction and Mental Health Toronto, Ontario, Canada
Ray Blanchard, Ph.D. Professor, Department of Psychiatry University of Toronto Head of Clinical Sexology Services Centre for Addiction and Mental Health Toronto, Ontario, Canada
As I commented in a previous post Transsexual Causation, the American Psychiatric Association, and Interpol:
One thing stands out: both the head and one of the panellists hail from the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. This was formerly known as the "Clarke Institute", and by it's detractors, "Jurassic Clarke". It, and its staff, are "controversial" to say the least. Many in the World Professional Association for Transgender Health (WPATH - formerly HBIGDA) would describe them as "fringe". This is the only institute that has two members on the panel.
Dr. Ray Blanchard resigned from the Harry Benjamin International Gender Dysphoria Association (HBIGDA) in protest to the ethics investigation of his protégé, J. Michael Bailey. Blanchard, a psychiatrist, member of a eugenics think tank, and vocal proponent of repathologizing homosexuality as a mental illness, still runs Toronto’s Clarke Institute as a maximum security processing facility, using the same procedures, locked rooms and shared space areas for pedophiles, rapists, homosexuals, and transsexuals.
Well, now the Royal Canadian Thought Police - er - the touchy-feely Liberalism that infests Canada has reached even the antedeluvian realms of Jurassic Clarke, with predictable results. From The War Within: CAMH battles notorious reputation of Zucker’s and Blanchard’s gender clinics with scathing report:
In the fall of 2007, CAMH’s Diversity Programs Office (DPO) began an investigation to learn more about GLBT community grievances, focusing especially on the many complaints about CAMH’s gender clinics. The study was organized by Annemarie Shrouder, an independent diversity and inclusion expert...
The findings and recommendations of the study were compiled as a CAMH/DPO report during the spring and summer of 2008, and published internally on August 11, 2008
The Executive Summary goes on to say:
The Gender Identity Clinic (GIC) and the Gender Identity Disorder Service (GIDS) have not been well regarded by some members of LGBTTTQQI communities due to negative experiences, underlying operational theories, approach, and treatment philosophy.”
LGBTTTQQI - Oh God. That would be "Lesbian, Gay, Bissexual, Transgender, Transsexual, ????, Queer, Questioning, Intersex". So terminally trendoid that even I can't keep up with the acronym. It's when I see something like this that I seriously question whether I'm on the right side here.

"Not been well regarded". Well, no. The way that Auschwitz and the SS are not well regarded by certain hebraically-capable segments of the population.

Moving right along with the Executive Summary:
Issues raised in particular, are that the clinics have:


- Used the Medical Model (pathologized)
- A greater priority on research, relative to care
- Demonstrated a lack of willingness to engage with LGBTTTQQI communities and engage in dialogue
- Exhibited poor therapeutic communication and engagement. Some identify dismissive, condescending and authoritarian attitudes of staff
- Used a surgery-only track
- Supported and promoted the theories of Homosexual Transsexualism and Autogynephelia
- Used guidelines that are four-times (for hormones) and double (for the real life experience) the current WPATH Standards of Care
Rather than paraphrase, I'll quote Prof. Lynn Conway's article on the shitstorm that erupted.

Zucker’s and Blanchard’s notoriety escalates while the study was underway:

As the DPO study moved forward into 2008, Zucker and Blanchard stumbled onward into ever-increasing controversy.

Even though long known as a trans-reparatist, Zucker was selected on May 1, 2008 [7 ] to lead the revisions of the American Psychiatric Association's pronouncements on 'sexual and gender identity disorders' in the Diagnostic and Statistical Manual of Mental Disorders (DSM) [8], and Blanchard was selected as a member of Zucker’s committee.

With Zucker and Blanchard thus empowered, it became clear that chances for removal of GID from the DSM were slim to none, and trans people are likely to be stigmatized as ‘mentally ill’ for another decade or more.

Then on May 8-9, 2008, National Public Radio broadcast a heartbreaking documentary [9 ] contrasting Zucker's decades-old reparatist methods [10] to more modern treatment methods, such as those of Norman Spack, M.D. of Boston [11]. The Torontoist followed up on May 9, 2009 by exposing Zucker's reparatist treatment of gender-variant children, in an article entitled "But For Today I Am A Boy" [12].

These events set off a storm of protest in the trans community – a protest made visible in a petition against Zucker's DSM selection [13] that gained over 9,500 signatures. This was followed by a petition “Against human rights violations of apparently gender variant children and adults” [14]. On May 28, 2008, the National Gay and Lesbian Task Force (NGLTF) issued a press release [15] protesting Zucker's and Blanchard’s selection.

To make things even worse, Zucker’s close confidant Alice Dreger attempted to prevent a panel critical of Zucker and his colleagues from being held at a National Women’s Studies Association conference in the spring of ‘08. Dreger’s noisy efforts failed to stop the panel, and only served to reveal the Machiavellian maneuverings of Zucker’s clique against their critics [16].

As a result of these events, CAMH became even more widely known as a world-center of repressive, stigmatizing, pathologizing, reparatist treatment of transgender people – undoubtedly blindsiding the well-intentioned DPO study which had just gotten underway.

Zucker’s actions following the publication of the report:

Following the internal publication of the CAMH/DPO report, Zucker himself began making highly personal attacks against his critics.

On September 19, 2008, Peter Jacobsen, an attorney for CAMH, Zucker and Blanchard, wrote an e-letter to Rosalyn Forrester threatening her with legal action for posting the petition “Against human rights violations of apparently gender variant children and adults” [14], even though that petition was a fair exercise in free speech. When the letter failed to reach Ms. Forrester, Jacobsen followed up with an e-letter on Nov. 24, 2008, reiterating his threat of legal action [17].

The letter to Ms. Forrester was clearly an attempt at intimidation, and one without foundation. Zucker had no grounds for the threatened lawsuit and did not follow-up with any legal action.

On January 27, 2009, Zucker went a step further, by falsely accusing Lynn Conway of libel in a letter sent by CAMH attorney Peter Jacobsen to Lynn and to her university [18] – in a clear attempt to suppress Lynn's website on the eve of an IFGE workshop that would prove additionally embarrassing to Zucker [19].

News of Zucker's bizarre attack quickly spread, as in a Queerty article entitled "Dr. Kenneth Zucker's War on Transgenders" [20]. Lynn documented what had happened in a report in her website entitled “Lynn Conway's Trans News Updates: The webpage Zucker attempted to suppress” [21]. Lynn went on to uncover evidence that Zucker had a habit of threatening his critics with legal action [22] and that he used a CAMH-paid attorney to make these threats.

Zucker’s unfounded attack on Lynn was further documented in an interview on CBS-News/LOGO-TV, and reported in [23, 24, 25]
Professor Conway could justly be described as having a bee in her bonnet about such issues. On the other hand, I haven't exactly been reticent in my pungent comments about CAMH, Dr Zucker's use of children as experimental animals, and Blanchard's Theory of Autogynephilia, so my objectivity is questionable too. Being arrogantly informed that I'm either a Gay man who has had himself mutilated so he can bed unsuspecting straight men, or a paraphilliac sex maniac who gets a sexual thrill by imagining himself with an attractive girlie body will do that. (hint - it's not about sex, OK? Oh, never mind)

Meanwhile, the grown-ups are involved in issues like this:
From Psychiatric News February 20, 2009 Volume 44, Number 4, page 13:
The remaining symposium, "In or Out? A Discussion About Gender Identity Diagnoses and the DSM," will focus on diagnostic issues specific to gender identity disorder, particularly the issues of having gender identity disorder listed in DSM-V and the implications of removing it. Several leaders in the transgender community will speak at this symposium.

The symposium:
S6. "In or Out?": A Discussion About Gender Identity Diagnoses and the DSM (DSM Track DM03)

1. The DSM-V Revision Process: Principles and Progress William E. Narrow, M.D.
2. Beyond Conundrum: Strategies for Diagnostic Harm Reduction Kelley Winters, Ph.D.
3. Aligning Bodies With Minds: The Case for Medical and Surgical Treatment of Gender Dysphoria Rebecca Allison, M.D.
4. The Role of Medical and Psychological Discourse in Legal and Policy Advocacy for Transgender Persons in the U.S. Shannon P. Minter, J.D.

Does a condition that manifests as severe psychological distress, but which can be cured only through physical rather than psychiatric intervention really belong in a psychiatric diagnostic manual? The distress is real, and the dysfunction until treatment is given very real, even life-threatening. But what if the condition is actually biological?

There's something even more interesting from my viewpoint, and potentially of at least equal significance:
S10. The Neurobiological Evidence for Transgenderism

1. Brain Gender Identity Sidney W. Ecker, M.D.
2. Transsexuality as an Intersex Condition Milton Diamond, Ph.D.
3. Novel Approaches to Endocrine Treatment of Transgender Adolescents and Adults Norman Spack, M.D.
You know, this thing called Science.

I am very much afraid that Science, Facts, and Objectivity will take a back seat here. Everything has become too politicised. We have one side that is doing it's best to make Mengele look like a piker, and the other side who will only be content when they hear what they want to hear, because they've been treated so dismissively for so long. Such things as medical diagnoses are playthings in a power game.

Although it's great to see some input by articulate and (it has to be said) courageous Trans people in the first panel, I'm troubled by it. It appears that the question of whether I'm to be judged "mentally ill" won't be decided on objective fact, but on desirability or otherwise of inclusion from a political and social viewpoint. Whether for political reasons, in order to have the necessary surgery, we have to accept the label of "mentally ill" even though the problem's obviously biological.

Maybe I really am mentally ill, because I see this as being utterly crazy. We should be making such decisions based on objective facts, not morally justified outcomes. The question of justifying treatment is a separate issue, and should be fought for separately.

(Zoe - so the price of maintaining your precious Scientific Purity is the lives of people you know, now that "you've got yours"?
SHUT UP Zoe! And maybe my soul will be damned for eternity for saying this, but Yes It Is, if need be. Yes we do have a duty to honesty, to integrity, to the Scientific method, for doing our imperfect best, for "calling 'em how we sees em" and "letting the chips fall as they may", OK? Because if we don't do that, then such things as Integrity and Honour and even Love become meaningless. Without Intellectual Integrity we're no better than the canting religious nutters who ignore anything that doesn't fit in with their bigoted worldview.
That's OK then Zoe. Just checking.)

Now where was I...

Oh yes, expect fur and feathers to fly over this one. I suspect that in the short term, the DSM-V will be revised to eliminate "Gender Identity Disorder" and replace it with the paraphilia (like pedophilia, necrophilia etc) of Autogynephilia, regardless of the evidence. Then it will be ignored, not because it's rubbish, but for "good and worthwhile social reasons". And that the lawyers will get rich, and even more shouting, ranting and legal shennanigans will go down before this is all finally settled by the Gods of the Copybook Headings. Reality always wins, eventually.

Or maybe the others on the DSM-V panel won't let themselves be over-ruled by the chairman and his colleague. There are some good people there. But maybe not, and plausible and novel concepts woven from empty air will be accepted without peer review and testing.

From Transvestic Disorder and Policy Dysfunction in the DSM-V:
Dr. Blanchard proposes to change the Specifier Options to the diagnosis. The current Transvestic Fetishism diagnosis has a single specifier, “With Gender Dysphoria: if the person has persistent discomfort with gender role or identity.”7 Blanchard’s proposal would replace this with a specifier of “Autogynephilia (Sexually Aroused by Thought or Image of Self as Female).”
I ask the elected leadership and Board of Trustees of the American Psychiatric Association to affirm in a public statement that gender identity and expression which differ from assigned birth sex do not, in themselves, constitute mental disorder and imply no impairment in judgment or competence. I ask the DSM-V Task Force to honor this principle in the DSM-V by removing the current category of Transvestic Fetishism and rejecting Dr. Blanchard’s proposal to replace it with Transvestic Disorder. Finally, I invite members, allies and affirming care providers of the transcommunity to voice their concerns by publishing comments to this essay at I will forward these postings to the APA and DSM-V Task Force at the APA Annual Meeting in May.

From Drafts from the DSM-V workgroup are out and they're continuing to pathologize trans people:
Blanchard proposes keeping the current disagnostic criteria for "transvestic fetishism" -- only now it's a "transvestic disorder," which by definition, according to Blanchard, can only occur among hetero men. (Apparently gay crossdressers and women who crossdress don't exist in his world.) Blanchard would also add two subcategories -- "transvestic disorder with fetishism" and "transvestic disorder with autogynephilia" -- based on "unpublished research, which I conducted specifically for the Paraphilias Subworkgroup." [emphasis mine]
Hmmm... I guess it's too much to ask that proposed diagnostic criteria, one that affects a huge number of people's lives, be based on research that's withstood peer review...
As I said, a storm is coming.


Anonymous said...

I think one of the "T"s stands for "Two Spirit".

Some allies have expressed their "Initial Fatigue".

-- Cathy Cat

Mercedes said...

I haven't had time to disseminate the information I've been getting regarding the revisions because of the Alberta $#!tstorm, but if I'm not mistaken, this is a stage at which Blanchard can propose whatever he wants, and real science can despatch it.

One proposed change in another area, the Sexual Dysfunctions Work Group, proposes to remove the "causes distress" requirement from all categories. This doesn't affect the Paraphilias or Gender/Sexual Work Work Groups, but it does pathologize asexuals, who might be perfectly happy without a sexual element in their lives. Will try to address this and more such proposals soon.

Anonymous said...

Hi Zoe, Now that I'm on the other side of transition I feel confident in expressing a meaningful opinion, something that non-trans people will never understand. I use to be trans but now I'm cured thanks to some wonderful surgeons and a great therapist to help guide me. I have never felt so normal in my whole life now that I'm living my life as my true self and I'm terribly disheartened that somebody would deny others of this remarkable cure. And for what, self glorification? Cross sex hormone experiments were conducted in the 1800's on chickens (due to them laying eggs providing simple access to embryos). In the early 1900s science learned to do the same with mammals. Yet all of this scientific evidence was pushed to the rear due to the likes of pop psychologist like John Money who convinced everybody that the problem was all in our heads. If only we had the right upbringing, etc. We now know that this is B.S. and yet we are still in the same trap relegated to the dark ages and for what, so that someone can make a name for himself? This is how we got here in the first place. Thank God for people like you Zoe and others such as Dr. Milton Diamond and professor Conway who are giving their all to help educate (and I don't use that word lightly)the unknowing.

Thank you Zoe,
aka Wild Fortune

Battybattybats said...

The APA seems intent on scientific humiliation and self-destruction.

I have no idea what they are thinking but this is idiocy.

And speaking of their beloved paraphilias, how do they comprehend studies like the one from last year that found greater mental health amongst some BDSM practitioners than non-practitioners?

"In fact, says Dr Richters, men into BDSM scored significantly better on a scale of psychological wellbeing than other men.

"This seems to imply that these men are actually happier as a result of their behaviour, though we're not sure why," she said.

"It might just be that they're more in harmony with themselves because they're into something unusual and are comfortable with that.

"There's a lot to be said for accepting who you are."

At the other end of the spectrum - least happy - were men who reported being attracted to men but had never acted on their desire and didn't regard themselves as gay.

Researchers said the study helps break down the reigning stereotype that people into bondage and discipline were damaged as children and were therefore "dysfunctional".

Maybe they are scared of the paraphillias being chopped down to just the unethical nasty stuff and they'll lose their comfortable gravy train of harmless patients?

Laserlight said...

"Without Intellectual Integrity we're no better than the canting religious nutters who ignore anything that doesn't fit in with their bigoted worldview."

Delete "religious", insert "political", and it works every bit as well. As evidenced by current events in the US. [sigh]
Emigration is looking better all the time.

Zoe Brain said...

To some people, politics *is* their religion. That's mainly on the Left, but some folks think their ultra-conservative political views accurately reflect their religion. Even the most superficial reading of scripture would contradict that - so they don't read it.

As a counterexample, Cardinal Pole and I have basic disagreements, but at least his Eminence knows what he's talking about. He has integrity, even if our axioms differ.

Gina said...

Great rant Zoe.

Curtis Hinkle was also served with the defamation threat letter from Zuker.

What do you make of the new WPATH board? Think they will hang onto Z?