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When Daphne Scholinski was fourteen years old, her distraught parents had her committed to a psychiatric institute in Chicago. She had become unmanageable, they said. She was doing poorly in school, experimenting with drugs, defying her parents. And she would not do anything to soften her behavior or appearance. Her hair was short, she liked playing baseball, and she wouldn't wear dresses. At Michael Reese Hospital, her psychiatrist gave her a diagnosis: Oppositional Defiant Disorder complicated by Gender Identity Disorder. He placed Daphne on a behavior modification program along with individual and group counseling sessions. Part of Daphne's treatment consisted of cosmetics therapy: Every day, Daphne's treatment partner became her beauty consultant, applying lipstick, rouge, eyeliner, foundation, and eye shadow to Daphne's face. Professional counselors talked to Daphne about ways she could appear more feminine. Daphne was asked about her sexual fantasies. Her friendship with another girl on her ward was treated as a problem. When she spoke of male friends, she was told she was making progress. Daphne spent four years in psychiatric institutions, all because she was "an inappropriate female," she says today. Her "treatment" didn't change her feelings about dresses or baseball or hair length. It only made her feel insecure, as though who she was wasn't acceptable to the world. It only made her sad.
Daphne's case is not unique. Across the country, there are parents who have looked at their "gender-atypical" little girls and boys and decided that the kids needed psychiatric treatment. The treatment for childhood Gender Identity Disorder can consist of behavior modification and play therapy for young children. Stubbornly gender-variant teenagers may be subjected to a regimen of psychotropic drugs, sometimes in locked treatment centers. According to the leading researchers in the psychiatric community, one child in a thousand suffers from "gender dysphoria," or intense unhappiness with their sex. The exact number is unknown. Such treatment is causing controversy. Some parents are resisting the suggestion from school and private therapists that their children are ill. Instead, they're banding together to protest; they want to stop what they see as the systematic and institutionalized practice of looking at this atypical behavior and calling it a mental illness. Groups like GenderPAC and GIDreform.org are petitioning the psychiatric community to drop Gender Identity Disorder from the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of the mental health community. The controversy is pitting the established mental health community against a group of upstart parents who are bent on nothing less than changing society. "Homosexuality was dropped from the list of mental illnesses in 1973," says one activist. "So why is GID--sometimes called 'pre-homosexuality'--still in there?" In the early 1990s, Phyllis Burke set out on a quest to uncover the roots of gender. As a lesbian mother, she had become sensitive to suggestions made by others that, without a male role model, her son would grow up not knowing how to be a man. "I wanted to be able to be a better mother," she recalls in an interview from her home in San Francisco. "What I found was a Pandora's box." Burke tore through records of old federal grants, spoke with dozens of psychologists, psychiatrists, and former GID patients, traveled to conferences, read hundreds of scholarly papers, and came to one conclusion: GID is a sham. It's a convenient tool for the psychological community that abets homophobia in the adult population, and it's been used over the years as a bludgeon for unruly kids or those who refuse to conform to gender stereotypes. After three years of research and writing, Burke's Gender Shock: Exploding the Myths of Male and Female was published in 1996. It quickly became the focal point of a gender storm. In the book, Burke traces the genesis of the GID designation and treatments back to the 1950s. In the 1970s, a psychologist at UCLA named George Rekers opened a clinic for children. He got hundreds of thousands of dollars to fund his studies, finding children (often through newspaper ads) and testing treatments on them.
The tests--many still used today--strike Burke as Orwellian. In one, a child being tested is asked to draw the figure of a person. Girls who draw boys first, predominately, or in positions of power and strength, are suspect, as are boys who draw princesses or mommies. The Barlow Gender-Specific Motor Behavior test examines such things as how far from the back of a chair a seated child's buttocks are--farther is "masculine," closer is "feminine." All the precision of science was applied in developing these tests to measure such things as the angle between the wrist and the hand, how often a child touched his or her hands together in front of his or her body, and how far the hips swayed as the child walked across the room. Especially damning for boys was a lack of hand-eye coordination. In keeping with the behaviorist theories of the time, Rekers devised treatments that treated gender-atypical children with an intricate system of rewards and punishments. "Becky," a seven-year-old girl brought to UCLA, was diagnosed with "female sexual identity disturbance." She liked basketball and climbing and she refused to wear dresses. She liked "rough and tumble play." In the clinic, Becky was watched through a one-way mirror as she played in a room equipped with two tables, one of dress-up clothes, the other of toys. Each table had boy-appropriate toys at one end (football helmet, army belt), girl-appropriate toys (lipstick, baby doll, Barbie) at the other. Becky wore monitoring equipment as she played, consisting of a wristwatch-like "counter" (similar to those worn to keep score at golf) and a "bug-in-the-ear" through which she could hear the voice of her therapist talking to her from behind the mirror. As Becky played, she was interrupted from time to time and told to press the wrist counter if she had only played with girls' toys since the last time she heard the doctor's voice. Becky grew anxious to accumulate points to please her doctor. In this way, Becky was supposed to be trained to develop an aversion to masculine playthings. Other parts of Becky's therapy consisted of having a team of four therapists come into her bedroom at home to watch, take notes on a clipboard, and time her with a stopwatch as she played with her toys. After seven months, she was declared cured, now showing "a decrease in excessive aggression and an increase in general compliance." Parents who brought their children to Rekers had to agree to participate in the "curing" of them. "Kraig," a four-year-old who participated in the UCLA Feminine Boy Project, was also monitored in the clinic's play-observation room. Only this time, it was his mother who wore the bug-in-the-ear, listening for her behavioral cues from the folks behind the wall. While playing, "Kraig would have seen her suddenly jerk upright, and look away from him toward the one-way window," Burke reports (based on transcripts of his case): His mother was being prompted, through the earphones, by the doctor. She was told to completely ignore him, because he was engaged in feminine play. Kraig would have no understanding of what was happening to his mother. On one such occasion, his distress was such that he began to scream, but his mother just looked away. His anxiety increased, and he did whatever he could to get her to respond to him, but she just looked away. She must have seemed like a stranger to have changed her behavior toward him so suddenly and for no apparent reason . . . He was described as being in a panic, alternating between sobs and "aggressing at her," but again, when his distraught mother finally looked at him and began to respond, she stopped mid-sentence and abruptly turned away, as if he were not there. Kraig became so hysterical, and his mother so uncomfortable, that one of the clinicians had to enter and take Kraig, screaming, from the room. Kraig's treatment continued in this vein. He was also put on the "token system" at home. Inappropriate, feminine behaviors earned him a red token, masculine ones, a blue token. Each red token earned him a spanking from his father. After more than two years of treatment, Kraig's behavior had turned around. He was now described by his mother as a "rough neck," and he no longer cared if his hair was neat or his clothes matched. But when he was eighteen, after years of being held up (under a pseudonym) by Rekers as "the poster boy for behavioral treatment of boyhood effeminacy," Kraig attempted suicide, because he thought that he might be gay. Five years after publication, Gender Shock is out of print, yet it still serves as a touchpoint for the anti-GID activists. Burke remains concerned that this "shocking pocket of psychiatric practice" is still thriving. "The government is still subsidizing this," she says. "Since the 1970s, more than $1.5 million has been awarded from the National Institutes of Mental Health for the study of children who don't meet the gender norms. George Rekers--the same man who declared Susan Smith sane, by the way--still believes that girls who don't wear dresses are disturbed. These clinics have a vested interest in finding these children and 'treating' them--it's their livelihood. There are still cases of teenagers being hospitalized against their will for GID."
When Ken Zucker looks at a little boy wearing his mother's high-heels, he sees something very different than what Phyllis Burke sees. Zucker, the leading figure in the treatment of Gender Identity Disorder in children today, is psychologist-in-chief and head of the Child and Adolescent Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto. To Phyllis Burke, he is everything that's wrong with the mental health establishment. A native New Yorker, Zucker has a full beard and eyes that crinkle when he smiles. He looks like an illustration for a sixties-era therapist, sympathetic and compassionate. He contends that what he's doing is saving children from a lifetime of rejection and depression. Children with GID are noticeably disturbed, Zucker insists. They are not really kids who just happen to be more open to the play-styles of the opposite sex. "I would remind the gender critics that these children aren't really showing flexibility in their gender behavior. In most cases, the kids with GID are as rigidly stereotypical as normal children--only they've adopted the rigid roles of the opposite sex from what they were born with. There is no joy in their play. They're struggling, experiencing social ostracism and difficulty establishing friendships with children of their own gender. These are children who pray to God to change them into the opposite sex." Moreover, for children to have a chance to fit in when they're teenagers and adults, treatment must start young--even as young as three or four years old. "Developmental studies show that children work on their gender identity when they're little," he says. "So if one believes that feeling content with their gender is important for proper development, one has to think about how to facilitate that happiness." Over the last twenty years, Zucker has published reams of papers in professional journals, contributed chapters on GID to psychiatric textbooks on childhood mental illnesses, and in 1995 published his own handbook (with colleague Susan Bradley), Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. He works as a clinician as well, evaluating the children who are brought to him from all over Canada and the United States. He appears in the media frequently as an expert on gender issues in children. The Gender Identity Clinic has treated over 500 children since the mid-1970s. Six times as many boys as girls are treated. It is not a diagnosis that is made lightly, Zucker says. For a child to be accurately diagnosed with GID, he or she must demonstrate cross-gender behavior in a persistent fashion. "This is not a sometime thing, it's all the time and intense," Zucker says. Treatment for GID at Zucker's clinic builds on the behaviorist model used in the UCLA studies that Burke wrote about. Zucker and his colleagues try to uncover the psychodynamics in the family that might be at the root of the child's gender distress. Girls may develop GID, he believes, because they've formed the perception that being a girl is weak or dangerous. One little girl he saw recently, for example, had witnessed her mother being assaulted by the mother's boyfriend. A boy, on the other hand, in a family where the mother is suffering from depression and is emotionally unavailable, might make an effort to act like a girl to get closer to her. While he won't go so far as to pin the blame for GID on parents, they are at fault, he believes, when they ignore or reinforce their two- or three-year-old's cross-gender behavior. "Most parents think it's cute and just a phase. So for a stretch of time it's tolerated or reinforced. Then when it comes time to go to nursery school and the boy wants to wear a dress, they get worried and come to us."
The first step in treatment at the Gender Identity Clinic, then, is to generate a hypothesis about what is leading the child to think that being the other sex would make him or her happier. Then Zucker confers with the parents on a treatment plan, usually consisting of sessions between a therapist and the parents in addition to individual counseling with the child. The therapist tries to help the parents resolve whatever difficulty in the family may be causing the child's gender confusion and tries to help the child accept and embrace his or her gender. Parents are encouraged to set limits on the cross-gender behavior of the child. "We urge them to say, 'Let's figure out what other things you can do besides play with that doll,'" Zucker says. "In some situations, we have to work hard with parents' own issues about gender. Could be a mother who's had difficulty with the men in her life and has a lot of mixed feelings toward men. That gets translated to the boy, and her fear that he'll grow up to be like those men causes him to reject being a boy." GID treatment can last from one to several years, Zucker says. It ends when the parents feel their goals have been reached (or when the insurance runs out). Success is marked by a lessening of the child's preoccupation with the other gender, cessation of cross-dressing, and the establishment of friendships with a member of the same sex. Does cross-dressing, even repetitive and intense, mean a child is gay? Can we even talk about "gay" kids in the years before their secondary sex characteristics and grown-up sexual urges surface? Is there such a thing as a "pre-homosexual" child--one who is all but destined to become gay? If so, is there any way to divert that child's path away from an adult homosexual identity or lifestyle? Asked how gender-atypical behavior in children relates to their later sexual orientation, scientists and therapists nearly always invoke the work of Dr. Richard Green. In 1987, Dr. Green published the results of his longitudinal study of boys called The "Sissy Boy" Syndrome and the Development of Homosexuality. He followed forty-four gender-variant boys from childhood to young adulthood. Seventy-five percent of the boys grew up to identify themselves as homosexual or bisexual. (Note that the opposite isn't necessarily true. Not all gay men were effeminate as children, despite the evidence here that most effeminate boys will grow up to be gay.) So what's the point of treating them at all? "At this point, I cannot make any statement about how therapy affects later sexual orientation," Zucker says, clearly choosing his words carefully. "But certainly many parents bring their children to me because they would prefer that they not grow up to be gay." He points out that the children studied by Green underwent no therapy for their gender confusion. "At my clinic, we've seen four times the number of children, many of them beginning at age three"--about fours years younger than the average child in Green's study.
He pauses. "My job is to help them accept their gender. The success of treatment is subjective; it has to be defined by the parents. If the child is treated early enough, the outcome is much more likely to be positive." It's the possibility of misdiagnosis that worries the anti-GID activists. Is the real cause of these children's distress internal or external? How easy is it to distinguish between the boy who is sad because he feels he is a girl trapped in a boy's body (as the DSM definition suggests), and the boy who is made to feel sad or ashamed because he prefers the dress and play usually associated with girls? The former is a problem within the child; the latter, many argue, is a problem with society. The former, if it persists into adulthood, is symptomatic of transsexuality, the latter (if the longitudinal studies of Green and others are accurate) may presage homosexuality--or may be just a phase. These are very different conditions. Does it make sense to treat all these kids the same? "GID means that here is a child who is born into the wrong body. But gay kids' behavior in early childhood can mimic the behavior of the GID child. But they're really just normal gay boys." So says Catherine Tuerk, a psychotherapist and nurse who runs a support group for parents of gender-atypical children in the greater Washington D.C. area. Tuerk knows about homophobia and the clinical treatment of GID from first-hand experience. She and her husband, a psychoanalyst, have a gay son, now 33, who as a child demonstrated all the classic signals of GID--the cross-dressing, the hatred of rough-housing, the preference for girl playmates. Fearing that he would become homosexual (and petrified that they had somehow contributed to their child's "disturbance"), the Tuerks subjected Joshua to an intense regimen of psychoanalysis and therapy between the ages of eight and twelve, and again when he was a teenager, all geared toward keeping his interests in feminine things at bay.
It seemed to work. Josh told his parents he was not and never would be homosexual. He knew how much it meant to them that he do "boy" things, so every evening when his father was due home from the office, he'd go outside by himself and kick a football around, even though he hated it. He dated girls. He tried to keep his parents' anxiety at bay. Finally, he went away to college--and came back from his junior year abroad to tell his parents he was gay. "We were devastated. It took us a long time to accept it," she says. "But now I realize that we had abused him by placing him in therapy. The advice we took from the psychiatric community was truly abusive." Tuerk has undergone an energetic atonement, first by joining and later becoming president of her local Parents, Families and Friends of Lesbians and Gays (PFLAG) chapter, then by founding the support group for parents of "gentle boys." Every month for the last three years, she and a clinical psychiatrist have led parents in discussions designed to move them from fear, anger, and grief over their children's possible homosexuality to acceptance. She is open about the damage her past mistakes have inflicted on her relationship with Josh. And Josh has spoken and written about the anger left over from his "treatment." "I spent the first twenty years of my life absolutely hating myself," says Josh today. "After I accepted that I was gay, I spent five years feeling angry with my parents--my mother in particular. Now I feel angry at the situation, the mistakes they made because they didn't know any better." Other adult "survivors" of GID treatment are equally resentful of the society that forced treatment on them. Daphne Scholinski, the girl who underwent cosmetics therapy, was released at the age of eighteen ("just when my insurance ran out," she notes dryly). She felt no different than when she was admitted, even though her mental health counselors declared her "cured." For years afterwards, she says, she was wary of the world and intensely unsure of her place in it. She came close to suicide. As she writes in her memoir of those years, The Last Time I Wore a Dress, "In the hospital, I lost my ability to trust myself. In any interaction, I'm always thinking, I must be the one screwing up." Far from changing her, Daphne's treatment only delayed her acceptance of herself as a gay woman, she says. She couldn't think of herself as a lesbian until she was an adult. These days, she is mostly sad and bewildered that she had to endure treatment for Gender Identity Disorder: "I still wonder why I wasn't treated for my depression, why no one noticed I'd been sexually abused, why the doctors didn't seem to believe that I came from a home with physical violence. Why the thing they cared the most about was whether I acted the part of a feminine young lady. The shame is that the effects of depression, sexual abuse, violence: all treatable. But where I stood on the feminine/masculine scale: unchangeable. It's who I am." The battle over GID is intensely personal and unpleasant at times. Scientists are hardly neutral parties in the gender wars. Phyllis Burke reports that one researcher into gender identity, upon learning she was a lesbian, said to her, "I guess you don't like to think of yourself as a freak." Activists in the anti-GID community call Zucker's work "a tragedy of the highest magnitude." Zucker himself, asked his opinion of Gender Shock, admits that he "totally blocked out" his hours-long interview by Burke. He dismisses her book as "simplistic" and "not particularly illuminating," the work of a journalist whose views shouldn't be put into the same camp as those of scientists like Richard Green or himself. When her book was published, in 1996, Burke says, she began receiving threats. Fear for her own and her son's safety caused her to stop speaking publicly about the subject. She accuses Zucker of engaging in "doubletalk" and arguing his findings "in bad faith."
The fight to remove GID from the books has stalled, despite ongoing lobbying by the National Gay and Lesbian Task Force, GIDreform, Scholinski, and GenderPAC. According to transgender activist and Executive Director of GenderPAC Riki Wilchins (born a man, s/he now identifies with no single gender), representatives from American Psychiatric Association have refused to meet with the coalition allied against GID, always claiming that they are "too busy" or that decisions about the DSM are made "from the bottom up." "What they're saying is that it's still okay to pathologize gender independence," Wilchins says. "These kids being locked up for pre-homosexuality have no voice, no lobby. As a culture, we've got to do something, we've got to stop eating our kids alive." Until the psychological community changes its practices, adds Tuerk, parents who are worried about the behavior of their children should tread carefully. "It's unsafe to go to just any practitioner," she says. "The majority of them rely on ideas and practices established twenty years ago. You could end up with the same bad advice we got." The safest course of action for parents of gender-atypical children seems to be to urge their children to divide their lives between their public selves and their private selves. The goal is to provide a safe space for these children, a place where they can act upon their impulses without being mocked or attacked. Phil and Teri Melese, for instance, have taught their eight-year-old son Etienne that dresses are okay to wear inside the house, but not outside. If he feels the need to dress-up outside, he wears a big T-shirt, long enough to mimic a dress but acceptable as boy-wear. "It's really clear what society accepts and doesn't accept," says Teri Melese. "We try to make him aware that he's okay, but that society doesn't always accept some of the things he'll want to do." This "feel good and fit-in" approach, Catherine Tuerk says, is far more humane than trying to quash every manifestation of gender-atypical behavior. "My husband likens it to being Jewish in an anti-Semitic culture," she says. "You're still Jewish, but you don't wear your yarmulke outside." Maybe it seems dishonest to maintain this public/private schism. But parents who buck society's expectations can land themselves even bigger problems. Take the case of the Lipscomb family. In the fall of 2000, just after the start of the school year, an anonymous phone call was made to the Franklin County Children's Services in Columbus, Ohio. The caller told the social worker that she believed a little boy in the local elementary school, Zachary Lipscomb, was being mistreated by his parents. The boy wasn't receiving the medication prescribed for his attention deficit disorder. He didn't go to the therapy he was assigned to. But what was worse, his parents had just enrolled him in first grade--as a girl. They had decided, they said, to support their child's life-long insistence that he was really a she. The Department of Social Services sprang into action. They received an emergency court order and promptly removed Zachary/Aurora Lipscomb from the custody of his parents. "That case raises complicated philosophical issues," Zucker says. "Do parents have the right to raise their child in whatever sex they see fit? God knows what the answer is. My main argument is that by letting him live as a girl at such a young age, they're assuming he could not grow up to be happy as a boy. Six is just too early to close the door." What the Lipscomb case does show is that our culture is more rigid about gender roles than we may believe. And that there is evidence that we're doing a disservice not only to children diagnosed with a bogus mental illness, but to all children who feel constrained by traditional gender roles, Burke argues. Studies at the University of California at Berkeley show that infants' brains at birth are identical--but that the brains of adult men and women are different. To Burke, that means what parents and others do with children literally affects the structure of a child's brain. Brain-imaging studies show that the brains of gender-atypical people are larger and more complex than those of gender-rigid people. Loving parents who want the best for their children, therefore, ought to encourage a broad range of behaviors and identities.
"Otherwise children end up as half of who they could be," she says. "We have to learn to stop being threatened by children who are gender-independent. The idea of gender as flexible and cosmetic should be applied to all people, not just gay people. Then parents can stop worrying about children who don't conform."
Despite all the seemingly obvious answers to the question "What makes a person male or female?" no one has come up with the definitive answer. Gender, it turns out, is a mystery. We teach our toddlers the difference based on simple physiology: boys have a penis, girls have a vagina; girls can have babies, boys can't. Yet we know that the boundaries of that definition aren't rock solid: A woman can be a woman without having a child and a man can still be a man without having a penis. Ask adults about the distinction between male and female and they're likely to dredge up eighth-grade biology: It's all in the chromosomes. Of the twenty-three pairs of chromosomes in each human cell, one pair in women is XX, while the corresponding pair in men is XY. But that too fails as a litmus test. There are numerous women whose genetic makeup harbors a rogue Y chromosome, and men who have none. (All of this, of course, also leaves aside the issue of people born with ambiguous genitalia and those born with an odd complement of sex organs--people who used to be called hermaphrodites and are now called "intersexuals"--such as one ovary and one testis.) There is still no generally accepted theory in the scientific community about whether there are biological causes of homosexuality (or transsexuality, for that matter). Zucker notes that there is no direct evidence that GID children have prenatal hormonal abnormalities. This has not stopped him and others from investigating possible biological correlations. A study that he will publish later this year, for instance, shows that boys with GID have a higher rate of left-handedness than non-GID children. Another study shows that boys with GID weighed less at birth than a comparison group. Both may point to very subtle but definitive prenatal hormonal abnormalities. Zucker believes that even if there is a biological factor that contributes to the development of GID, behavioral therapy such as the kind his center provides can still be useful. Others believe that no treatment can trump nature. According to Anne Fausto-Sterling, a professor of biology and women's studies at Brown University, about one-and-a-half to two percent of all babies born "do not fall strictly within the tight definition of all-male or all-female, even if the child looks that way." And Wilchins notes that there is a movement afoot to halt surgeries on infants who are born with ambiguous genitalia. Like Wilchins, more people are choosing to live outside the strict male/female dichotomy.
In society at large, gender-bending is surfacing everywhere, from Saturday Night Live re-runs (the gender-indeterminate character "Pat" and "Lyle: The Effeminate Heterosexual") to films like Billy Elliott. The life of a gender-atypical person could be traced in a triple bill of recently released movies: Ma Vie en Rose, a portrait of a little French boy whose intense desire to be a girl causes anguish in his family; But I'm a Cheerleader! , a satire of the (real life) treatment centers where teenagers suspected of homosexuality are sent to learn appropriate behavior, dress, and desires; and Boys Don't Cry, the true story of a teenage girl named Teena Brandon who adopted the persona of a boy (Brandon Teena) and was murdered because of it.
But pop cultural interest in gender-bending, along with the now decades-old academic interest in Madonna, RuPaul, and "subverting the dominant paradigm," hasn't had much effect on how middle American mamas (or daddies) treat their offspring. How many parents--even the really committed liberals among us--dress their baby boys in frilly pink? How many would slip the matching floral headband on his head? How many of them are inordinately relieved when their daughter agrees to put on a dress to visit Grandma? We proclaim our willingness to embrace difference in our children and to "support them in their choices," yet we are still profoundly uncomfortable with certain specific boundary-testing behaviors. Decades after the idea of gender-neutral parenting came into vogue, we still mostly conform to stereotypes in everything from the toys we provide our toddlers to the clothes our teenagers wear or the color of the outfits we buy for our friends' newborns.
In 1993, Anne Fausto-Sterling published a paper in the journal The Sciences entitled "The 5 Sexes: Why Male and Female Are Not Enough." She claims that "labeling someone a man or a woman is a social decision. We may use scientific knowledge to help us make the decision, but only our beliefs about gender--not science--can define our sex. Furthermore, our beliefs about gender affect what kinds of knowledge scientists produce about sex in the first place."
If she's right, the controversy surrounding gender identity and the treatment of Gender Identity Disorder is not due to our incomplete understanding of human biology. It may be that we have created the myth of male and female and we are loathe to give it up.
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