NPR: 2 families, 2 approaches to gender identity

NPR has a terrific and nuanced story on a difficult and challenging topic. One issue to dispose of right away, the story is headlined Two Families Grapple with Sons’ Gender Preferences, which may suggest to some that those boys make a choice about their gender identity.

As their story makes clear, little choice is involved. To people of my sexual identity (I self-identify as gay) using the words gender identity in the title would be more precise. Please forgive the quibble and let’s move on… Why on earth would any child ever choose to go through this:

Bradley had always had a preference for girls’ things. From his earliest days he had chosen girls’ dolls, identified with female characters and gravitated toward female children. But Carol had never thought to care. As far as she was concerned, it wasn’t a loaded gun; it wasn’t a lit cigarette. She says it had really never crossed her mind to say, “I’d really rather you played with a truck.” [...]

It was a single event that transformed her vague sense of worry into something more serious. One day, Bradley came home from an outing at the local playground with his baby sitter. He was covered in blood. A gash on his forehead ran deep into his hairline.

“What had happened was that two 10-year-old boys had thrown him off some playground equipment across the pavement because he’d been playing with a Barbie doll — and they called him a girl,” Carol says. “So that sort of struck me, that, you know, if he doesn’t learn to socialize with both males and females … he was going to get hurt.”

Carol decided to seek professional help. Bradley’s school referred her to a psychologist in Toronto named Dr. Ken Zucker, who is considered an expert in gender identity issues. After several months of evaluation, Zucker came back with a diagnosis. Bradley, he said, had what Zucker called gender identity disorder.

Zucker’s treatment for children younger than 10 is to behaviorally move them back to the gender they were born with. No more dolls for Bradley. He would only be allowed to play with trucks from here on out.

Another family, another treatment:

Jonah was 2 when his father, Joel, first realized that no amount of enthusiasm could persuade his child to play with balls. Trucks languished untouched. Fire engines gathered dust. Joel says Jonah much preferred girl toys, even his stuffed animals were female. [...]

Then around the age of 3, Jonah started taking his mother Pam’s clothing. He would borrow a long T-shirt and belt, and fashion it into a dress. This went on for months — with Jonah constantly adjusting his costume to make it better — until one day, Pam discovered her son crying inconsolably. [...]

Joel and Pam also ended up in front of a gender specialist — Diane Ehrensaft, a psychologist in Oakland. Joel remembers an early session when Pam talked about her concerns.

“I remember her talking to the therapist and saying something to the effect of, like, you know, ‘I’d be OK if Jonah just was gay, I just don’t want … him to be transgender.’ And the therapist just laughed, she said, ‘You know, 15 years ago, I had people on this couch saying, ‘I don’t mind him being a little effeminate, as long as he’s not gay,’” Joel says.

In fact, Diane Ehrensaft’s approach could not have been more different than the approach of Bradley’s therapist. Like Zucker, Ehrensaft is a gender specialist…

Ehrensaft, however, does not use that label. She describes children like Bradley and Jonah as transgender. And, unlike Zucker, she does not think parents should try to modify their child’s behavior. In fact, when Pam and Joel came to see her, she discouraged them from putting Jonah into any kind of therapy at all. Pam says because Ehrensaft does not see transgenderism itself as a dysfunction, the therapist didn’t think Pam and Joel should try to cure Jonah.

Which approach would you choose? We have to have empathy for these parents because there is no clarity among the experts they turn to for help. Advocates of Ehrensaft’s approach use the history of cultural assumptions and acceptance of homosexuality as a model and a guide:

Thirty-five years ago, homosexuality was considered a mental illness — a pathology so severe that it required aggressive therapeutic intervention. According to Jack Drescher, former chairman of the American Psychiatric Association’s committee on gay and lesbian issues, one treatment was to try to condition homosexuals out of their sexual preference by attaching them to electrical shock machines and shocking them every time they were aroused by homosexual pornography.

Today, however, the APA’s position is that therapies that try to turn homosexuals into heterosexuals are unethical. Homosexuality is now considered to be a normal variant of human behavior, so though a therapist might treat a person because they struggle with the stigma associated with homosexuality, therapists who practice in accordance with the guidelines established by the association don’t treat the behavior itself.

Because Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker’s therapy — which seeks to condition children out of a transgender identity — is unethical.

But that isn’t how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.

“Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? … I don’t think we would,” Zucker says.

A gay man, my sympathies are with Ehrensaft. Zucker’s approach, however, continues to thrive and I suspect is dominant.

I would add that I am adamantly opposed to surgical interventions for children. And that opinion is informed both by the professional work my partner did with transgender people in NYC, and the excellent 2001 Nova documentary, Sex Unknown, which comes at this issue from an important, opposite angle.

In that documentary we get the story of Max Beck:

When I was born, the doctors couldn’t tell my parents what I was: They couldn’t tell if I was a boy or a girl. Between my legs they found “a rudimentary phallus” and “fused labio-scrotal folds.” They ran their tests, they poked and prodded, and they cut open my belly, removed my gonads, and sent them off to Pathology. My parents sat in the hospital cafeteria, numb, their hearts as cold as the Manhattan February outside. [...]

After five weeks of study and surgery, they weren’t any closer to the truth; mine was a fuzzy picture. Not even the almighty gene provided any clear answers, since it was discovered that I was a mosaic, with some cells in my body having the XY genotype and others having XO. The decision was made to raise me female.

Here the doctors made the decision, a physical decision (in Zucker’s terms, they chose whether Max would be black or white), and with that decision the story begins.

The parents tried desperately to do as the doctor ordered and raise Judy (now Max) as a girl, even as he knew – as only he could know, from the knowledge deep inside him of his essential self rather than from any external signals or anything anyone said – that he was a male.

This story lends credence to Ehrensaft’s view. I urge you to view it. read about it. (Unfortunately, Nova’s not available online. It is, however, in heavy reruns!)

Right now Morning Edition has Part 2 of their story on air. I’ll have more to say after listening.

Thanks Holly!

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  • Lynx

    I have a sad prediction: Bradley will be one of a legion of children who will hide everything from her parents. She is being forced in the closet. She started feeling like a girl as a BABY, if that's not evidence to the effect that he's actually a she, I don't know what is. I have no doubt that her parents want what's best for her, but I also think it's likely that she will face terrible issues in life unless they accept her for who she is. The whole part about being defensive about “yes, I'm a boy OK?!” and hiding what she does at school screams not of recovery, but of learning to lead a double life. For a child that absolutely needs to think her parents are behind her 100% it must be a terrible burden to think that they don't want to love who she really is (a child that young isn't going to understand that they absolutely love her, but are just mistaken about her needs).

    I don't suppose it's necessary to state where I stand on this issue. I grew up in S.F, with gays and transgendered all around me. Sometimes you can see it in very young children, children far too young to be “choosing” to act in that fashion. Some of the stories of transgendered are heartbreaking and often similar; I always knew I was different, I dressed up with mommies clothes, if they caught be I'd get hell for it, I had to run away etc. etc. Usually their gender identity made them miserable because of the lack of acceptance, but they found themselves unable to change it.

    I don't support surgical intervention until it's absolutely clear what the gender is, and I think vague genders at birth must be treated exactly as such. If you don't know, don't choose by a roll of dice. Give the baby a relatively neutral name (like Joe- Joseph/Josephine), dress them in neutral colors (yellow, red etc.) and wait, it'll probably become clear when they are very very young.

  • mikkel

    Considering the growing amount of scientific evidence from MRIs, odor preferences, etc. that support that transgender people literally think like their “preferred” identity, it's very clear to me that it's not a choice, and it's not a simple disagreement to think that it is. Now, I'm not saying that we should be sticking people into machines and letting them decide (the same goes for homosexuals), I'm just saying that there is inconvertible proof of biological differences and I have no idea how any expert could dismiss that.

    Of course I've never understood the choice vs. ingrained thing at all, since I can't believe that people care how other people live their life.

  • Cammurabi

    I find it interesting that in America culture we, for some reason, typically identify homosexuality with femininity. I think that we're discussing two very different things here. The boys could very well be heterosexual and just prefer doing things that are considered effeminate in American culture. The confusion between effeminacy and homosexual behaviors, or even the idea that homosexuality was a sexual orientation that dominated one's orientation, would have surely been a surprise to the ancient Greeks or the Japanese samurai.

  • mikkel

    Well Cammurabi, this is less about homosexuality and more about gender identity. I agree with you about the sexuality/femininity thing, but the article also had this

    By the time he was 5, Jonah had made it very clear to his parents that he wanted to wear girl clothes full time — that he wanted to be known as a girl. He wanted them to call him their daughter.

    That is not about being gay/straight but about gender. I believe most transsexuals are actually straight inasmuch as they are attracted to the opposite gender of the one they identify as.

    Now I don't really know many transsexuals, but I also found this quote interesting

    In other words, allowing a child like Jonah to transition in kindergarten will essentially track him into becoming a transgender adult. And for Zucker, no child under the age of 10 or 11 can be definitively labeled transgender. He says that kids' gender identities are flexible. And that even a child like Jonah, who appears to be absolutely consistent from the ages of 1 and 2, can change.

    I think that this is an interesting position to take, and from what I've read I'm not sure it's true. I am always critical when people try to label kids as gay/straight since that is about sexuality and most of the time doesn't come into play until near puberty. Just because a kid likes playing with dolls doesn't mean that he'll be gay. So I agree that until about 10/11 (at least, I know a lot of people that didn't realize until 17-18) it's not wise to judge about sexuality.

    On the other hand, boy/girl is one of the first constructs that we identify with. I have a hard time seeing (does anyone know differently?) that many people would self identify as a different gender only to change their mind. I think it is far more likely that they will simply repress their urges.

    It seems like Zucker was way too fixated both on the sexual aspect and the physical aspect: “”We're not talking about minor medical treatments. … You're talking about lifelong hormonal treatment; you're talking about serious and substantive surgery,” he says.” like the child will instantly be taken to be fixed once the diagnosis is made. It's appropriate to delay those sorts of changes until they are older (and I can see how lots of therapy to figure out the best way to express the gender might be required) but that is different than not allowing them to express who they are.

  • EEllis

    See one of my problems is at 5 who even realizes that they are dressing a certain way? Some kids play army and some prefer house but there is always overlap between them and it's hard to see the need to define someone that young. My other concern is that I your sexual identity can be effected by things experienced. Sometimes people go “gay” who may not be. The blanket hate from the gay community over the idea that anyone would try to “cure” them sometimes obscures the fact that some people do needed help. Right now it's hard to see the individual thru the issues.

  • Lynx

    EEllis, I suspect the matter of dressing in a certain way occurs as a response to the disconnect between what you feel inside and what your eyes tell you is your gender. Simply put, the child feels like a girl, thinks she's a girl, identifies as a girl, but during bath time sees her wee-wee and hears parents, teachers etc. calling her “he”, which causes distress. Probably wanting to wear dresses is a way of reaffirming that they are female, a way of compensating for the biological reality.

    While I don't reject the idea that some people can go through confusion with their orientation, the rejection to conversion “therapy” is justified for several reasons:
    1. The minute you need “therapy” it's because you have a “pathology”. By accepting gay to straight (funny how there are NO cases of straight to gay therapy huh?0) therapies, you are implicitly saying that being gay is a pathology, a bad thing, hence the rejection from the gay community. Of course there could be people who are going through a time of confusion and need help, but therapy must be oriented towards helping you be what you really are, not pre.designed to be uni-directional gay to straight, but leaving open the possibility that you are really gay and it's the straight feelings which are the anomaly.
    2. The “Ex-gay” movement is pretty much exclusively made up of fundamentalist Christians. This is not a group of people who base their work on psychological or medical sciences, but on religion. Homosexuality is sin, therefore it must be a choice always and “curable” always. Conversion advocates view ALL gays as actually straights suffering from a pathology. This does not engender friendship from gays, as you might imagine.
    3. A child who is 2 and is self-identifying as another gender is a pretty strong argument in favor of it being biological and not a lifestyle choice, since I would suppose very young children self identify based on instinct, not based on a sophisticated internal simulation of what a female and a male is and what sounds better.

    In any event I would LOVE to read what Clarissa has to say on this subject, being as she's the one with actual, you know, knowledge of psychology.

  • Robyrt

    Playing devil's advocate here – as a boy, I was a lot like the first child in that article, being called girly because of my fondness for girls and their accoutrements. My fundamentalist Christian parents responded by buying me trucks, Hardy Boys novels, etc. just like the psychologist above recommended. I eventually grew out of it, and am now a well-adjusted straight male.

    I'm not advocating the ex-gay movement or anything, just saying that it's not always right to jump on perceived gender identity before someone is old enough to realize or articulate what they really feel.

  • SportinLife

    “So that sort of struck me, that, you know, if he doesn’t learn to socialize with both males and females … he was going to get hurt.” Carol decided to seek professional help.

    I read this as Carol blaming her son for getting beaten up. She's taking the side of the playground bullies and telling her son he needs “treatment” because other people hate him for being too feminine. She probably wouldn't see it that way, but I can't find any way around my interpretation.

  • mikkel

    Yeah but I encourage you to go to the link and read it and see if it changes your opinion.

    Then, on Halloween, the calculus began to tip.

    To simulate Dorothy's hair, Carol covered Bradley's blond crewcut with a brown tea towel. Bradley loved it. In fact, he became obsessed with his tea-towel hair. For months afterward he would wake up every morning and put the towel on his head. When Carol tried to remove it, he would protest.

    “It was really obsessive,” Carol says. “We really had to negotiate times when he just couldn't wear it anymore. … He seemed to feel uncomfortable and nervous sometimes when he didn't have this hair, this tea-towel hair.”

    and

    “I mean, he tells us now that he doesn't dream anymore that he's a girl. So, we're happy with that. He's still a bit defensive if we ask him, 'Do you want to be a girl?' He's like 'No, NO! I'm happy being a boy. …' He gives us that sort of stock answer. … I still think we're at the stage where he feels he's leading a double life,” she says. “… I'm still quite certain that he is with the girls all the time at school, and so he knows to behave one way at school, and then when he comes home, there's a different set of expectations.”

    I presume as a child you didn't start wanting to take on the physicals characteristics of girls and dream about being one.

  • CStanley

    As much neutrality as possible until puberty seems the most wise course to me. As mikkel mentions, sexuality itself doesn't assert itself until the child biologically becomes an adult (what we think of as adolescent- but having reached sexual maturation.) So why judge childhood behaviors one way or another? Lynx, for example, mentions being able to 'tell' about young kids in her experience in a locality where transgender was completely accepted- but how do we know that some of the kids who displayed those tendencies weren't encouraged-either overtly or unintentionally by well meaning open minded parents- to become more transgendered than they really are? Why not stop hyperventilating over whether or not it means anything that a kid likes to play dress up or even role play as the opposite gender? That seems to me like it could EASILY be just part of ordinary fantasy play that kids do to explore their reality, instead of needing to feel feminine because that's their true identity. My boy likes to pretend he's Captain Jack Sparrow but I don't think he's going to grow up to raid merchant vessels at sea- and on occasions when he chooses to play with his older sister's old dress up clothes or LOL- a recent obsession with a very girlie diary- I don't attribute any future adult behavior or identity to that behavior either.

    In short- my admittedly layperson's opinion is- just let them be kids.

  • SportinLife

    mikkel, I'd already read the transcript before I came to my opinion, so no, doing so doesn't change it. I'm not trying to render a judgment on Carol so much as use her as an illustration of how accepted–and even expected–violence against feminine boys and men is in our society. It seems wrong to me that the bullies aren't the ones being hauled off to be treated.

  • Lynx

    CStanley, but if you ask your son if he's a boy or a girl, he'll tell you he's a boy. Does he want to wear a dress to school? What about his name, does he want a female name, does he want to be addressed as “she”? I of course assume not, and in fact I'm betting that if you took any regular boy and asked him to do any of these things they would act at LEAST as uncomfortable as these children are with being treated like boys.
    To me it's a matter that Cammurabi touched on; being effeminate and being gay (or transgendered) are not in any way equivalent (never mind that the word transgendered itself groups many different sorts of people). From my also layperson view, liking girly things is not a mere lower level than feeling you are a girl, it's a totally different quantity. I was a complete tomboy through early adolescence and I still relate much better to men than women, but I never EVER thought I was a boy, or even thought I'd rather be a boy, nor did I ever feel attraction to girls I just liked (and still like) stuff that boys happen to like (other than sex with women, which I understand is high on their list).
    The children I've seen with certain gender vague traits (there's no way I could tell from a casual observation if a child has GID) have been both in SF and in Madrid, BTW. As for the accepting atmosphere, the few kids I've seen close up to see their surroundings I assure you acted that way because they could not help themselves. I'm 90% that if they could wave a wand and be normal, they would, because children are very cruel, and these kids got no end of hell for being different.

    I agree about not forcing a child, one way OR the other though. But it's not easy when the issue is children who wish to be identified by one gender. At that point, a decision sort of has to be reached, it would seem.

  • runasim

    I'm bothered by the across-the-board generalizations here, both in how the child's gender identity is determined and how child rearing practices are recommended.

    Behaviors are pointers, but it's not always clear what they point to.
    Also, I don't know how much help extreme cases are in provididing guidance for parents whose children appear to indicate a gender preference , but it's borderline.

    In the best of all possible worlds, I would delay final decisiona as long as possible (no surgery) and just concentrate on removing anxiety from the child's process of developing his/het final self-identity.,

    The outside world makes it tough, both for the child and for the parents. Fitting in is a huge challenge and it's potentially deep scar producing.

    The existence of phases is real, too.

    Not trying to influence the child has an effect, just like overt attempts to inluence him do. Some people grow up with neuroses because their parents forced them to take arduous piano lessons. Other people blame parents for not making sure they could play the piano well.

    Where is the golden middle, the safe road??

    My sympathies are as much for the parents as for the children.. If only they had a crystal ball to tell them what the outcome would be. They have to navigate in the dark on that score, however.

    I come back to concentrating on the individual child, on what helps him get through his days in a harsh world.
    I don't see any easy answers, exept for the gemeral; rule pf avoiding extremes and removig anxiety.

    .

  • mikkel

    Oops, you must not have it in thread mode. My comment was to Robyrt. Of course I don't think there is a justification for violence.

  • mikkel

    runasim: I can't say I disagree, except I am under the impression that questioning your gender identity is pretty rare and therefore any serious questioning could be considered “extreme.” I'm not sure it's like the Kinsey scale of sexuality. Even transvestites and drag queens have very quick and solid answers on which gender they identify as.

    But in general what you said is a pretty good rule for parenting. Also I think it's impossible to not have your child look back and question “what if” in something being different! What if my dad had forced me to play tennis when he wanted to, I might have been a pro…

  • SportinLife

    You're right, I didn't. Thanks for the tip!

  • EEllis

    “funny how there are NO cases of straight to gay therapy huh?”
    Are you serious? That's absurd. Many people have had issues that they have sought therapy for and found thru that therapy that they were gay. Trying to be something you're not screws with everything in your life with consequences well overshadowing what goes on in the bedrooms. When you read about the kid I start seeing other non gender issues so of course I wonder and think that it is most likely way to soon to label this kid as anything.

  • CStanley

    Lynx, all I'm really saying is that I can easily imagine that some people overdo it and mistake the kids who are just role playing for a kid who self identifies as the other gender. As mikkel said, the latter is probably pretty rare and my hunch is that some kids in more traditional households are forced into adopting a traditional gender role rather than the one he/she self identifies as, and that the opposite is probably also true- that some kids raised in liberal environments might be overly encouraged to adopt the nontraditional role and eventually come to see him/herself that way even though it wasn't innate. I'm making the argument that it's probably nature plus nurture, with some small subset being a certain way due to nature and then others becoming that way due to nurture.