Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Tuesday, August 14, 2012
Pink Boys
There was an interesting article in the Sunday New York Times Magazine on children who behave in ways that are inconsistent with the gender role expectations society holds for them. The article starts by talking about a mom who e-mails the other parents in the pre-school to let them know their son is 'gender-fluid' and will be coming to school in a dress the first day.
I spent a little more than a decade as a consultant to the Johns Hopkins Sexual Behaviors Consultation Unit (SBCU). I also spent a few months working as a resident on an inpatient unit for people with sexual disorders-- though the two systems were completely different entities back then. What differentiated whether a patient went to one versus the other was often a matter of legal involvement: someone who's sexual behaviors got them into legal difficulties (often people with pedophilia) were the domain of the Sexual Disorders group (they also had an outpatient component but I never worked there) and treatment sometimes included hormone injections to lower the patient's sex drive, along with individual and group therapy. No one was admitted to this unit involuntarily, and no one was given hormones involuntarily. The two units have since merged, but there is no longer an inpatient unit, it's all outpatient consultation. Even back then, treating people with pedophilia was a logistically difficult thing: if a patient went to a psychiatrist and said "I've done this awful thing and I want to stop," it had to be reported (it still does) and there is no mechanism for getting help unless the patient requests it prior to acting on such urges, or after he's been caught and the assessment/treatment are part of his legal stipulation or defense.
The SBCU saw people with erectile dysfunction, couples with mismatched sexual drives, people who had troubles with all aspects of the sexual cycle (desire, arousal, climax, etc), those with fetishes, and those with concerns about gender. "Pink boys," a term I've never heard, would fall under that category. Back then (the 1990's, early 2000's) the mentors of the unit felt that parents should encourage their children to adopt gender-appropriate behaviors and play. There was some thought that permissiveness around allowing Johnny to have a Barbie collection might encourage such things.
In "What's So Bad About a Boy Who Wants to Wear a Dress" Ruth Pawdawer, states:
Many parents and clinicians now reject corrective therapy, making this the first generation to allow boys to openly play and dress (to varying degrees) in ways previously restricted to girls — to exist in what one psychologist called “that middle space” between traditional boyhood and traditional girlhood. These parents have drawn courage from a burgeoning Internet community of like-minded folk whose sons identify as boys but wear tiaras and tote unicorn backpacks. Even transgender people preserve the traditional binary gender division: born in one and belonging in the other. But the parents of boys in that middle space argue that gender is a spectrum rather than two opposing categories, neither of which any real man or woman precisely fits.
Twenty years ago I wasn't comfortable with the way psychiatry approached this topic. I didn't believe that a child's gender role choices were necessarily 'choices' or that parenting styles (at least those those with-in some spectrum of "normal"), caused children to want gender-inappropriate dress/toys/identities. The question remains, if this is who you are, shouldn't you come to some comfortable acceptance with yourself? Unfortunately, our world is such that when a boy shows up at school in his princess outfit, other children might not want to play with him, and it can all make for a very confused, painful, and uncomfortable life, so professionals who encourage gender-appropriate roles aren't being mean or stupid or evil, they are just trying to figure out (with the benefit of a crystal ball) what will lead to the best result. And this all occurs where both the individual involved may be fluid with their gender role (some pink boys turn blue), and society is fluid with it's acceptance of everything from left-handedness, to homosexuality, to it's stigmatization of cigarette smokers.
Around that time, my next door neighbor called me to ask if my son would like to take ballet lessons with her daughter (she was 2, he was 3 and they were best friends). I asked my son, "Do you want to take ballet lessons with your friend?" The 3-year-old considered this for a moment and said, "Is that a girl thing? Do they have baseball lessons?" I don't think it was about parenting -- I would have sent him to ballet and assumed is was just another activity with a friend -- I think it was in his brain that made the girlthings-boythings distinction.
Interestingly, girls don't have these issues. There are "girly-girls" with their interest in fairies and princesses, and there are tomboys who wouldn't be caught dead in a ballerina outfit. We don't tend to worry about girls, and playgrounds have the tomboys playing soccer on one side while the girly-girls play fairy princess on the other.
The point of the article was that there are people who are struggling to deal with their children's gender issues -- it was more about the parents then the kids -- and while there are still no clear answers for what makes the happiest, most well-adjusted kid, there are those who believe that it's better to help a child accept who he is.
We now leave left-handers alone. The Greeks were fine with their pedophiles. Our society shuns them, more so then murderers. Despite our growing rates of obesity, we still blame and ostracize those who are fat: shouldn't we teach people to eat and exercise in a healthy fashion, and beyond that to accept themselves with the awareness that people come in all sizes? And don't get me started on Presidential candidates.
I have no answers, I'll let you chime in.
Here's a link to the Hopkins Sexual Behaviors Consultation Unit. They list the conditions they treat and a phone number to schedule an assessment.
Dr. Chris Kraft, their director of clinical services, has been a podcast guest with us on several occasions, see:
Podcast #21 Chris Kraft on Gender Issues
Podcast #41 Chris Kraft on Conversion Therapy
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22 comments:
The SBCU have been the forefront of of using pathologization as a tool to make the western gender-sex-sexuality paradigm considered healthy while anything else is sick (People come in two types, male and female, they have gender identities based on those bodies and those gender identities are fixed and ahistorical, men and women, and those people have sexualities that are defined by attraction to people with different bodies/genders). It is one of the prime examples of the way psychiatrists work as culture cops, instead of actually supporting people's well-being.
Dr. John Money ordered many surgeries of children throughout their infancy and childhood who had bodies that were not considered male or female enough, leading to inability to experience any genital pleasure. In addition the SBCU pressured families to police their children's gender expression leading to severe psychological problems for these children and families. This was all in the belief that because society is so unforgiving about deviation from considered norms of gender, sex, and sexuality, it is better for people to conform to these norms than live as who they are or want.
The whole idea that distress from having non-normative bodies, genders, and sexualities is indicative of individual psychopathology was and continues to be championed there, as opposed to the the very legitimate response of distress from having your body and identity be denigrated, shamed, avoided, scoffed, and pathologized by others who in pathologizing/shaming get to view their own variant bodies, identities, and desires as normal, healthy, and "right."
If psychiatrists who work focus on gender and sexuality issues want to support well-being, they must take a strong stand against being used as culture cops to police boundaries of acceptable bodies, identities, and desires. Their participation in that project has led to extreme distress and death of many over the past century, and has forced everyone to some extent to police their own selves in ways that limit their freedom and well-being.
I'm curious about why it's still more acceptable for girls/women to behave in so called masculine ways than it is for boys/men to behave in so called feminine ones. Is this attitude seen more in patriarchal societies? I sometimes wonder if we simply place a greater value on male qualities, and so our modern female ideal has shifted to incorporate more masculine attributes while our modern male ideal hasn't grown to include as many feminine ones. Any Gender/Women's Studies folks who can comment? As for the ballet lessons, your son was already able to assign male and female roles to certain activities by age 3 which shows how early children absorb what's considered appropriate gender behavior.
I have never met Dr. Money.
The issues that are brought up here are valid. In today's culture, I think Anon's belief that psychiatrists should not be used as "culture cops" is right.
In my years in the SBCU, where I saw mainly adults, the was no official stance on say gender reassignment. Patients were not told to pursue it, and they were not discouraged if that is what they wanted. The Benjamin criteria at the time required therapy and living as the other gender for 2 years prior to surgical intervention, so there were patients who were seen for therapy.
So much of this is culture-bound, and our culture (or at least parts of it) has become more willing to explore the concept that everyone doesn't need to live life in a precise way. It still doesn't mean that some people won't recoil if a boy comes to school in a dress or insists he's a girl, or that a child with this issue won't suffer.
Some segments of our society are clearly more tolerant, but not all, we still read about hate crimes against transgendered and gay people.
I think we just change with what we find acceptable. How many people owned slaves? How many of us today don't feel sick about that concept?
Not related to gender, but Dinah mentioned slaves. We still have arms length slaves--those people who labor in terrible condition to produce many of our electronic and other consumer goods.
Forget at arms length - have you read up on human trafficking lately?
"U.N.: 2.4 Million Human Trafficking Victims
The UN crime-fighting office announced that 2.4 million people across the globe are victims of human trafficking at any one time, and 80 percent of them are being exploited as sexual slaves."
(from humantrafficking.org)
Granted, 2.4 mill is not a large number, considering our total population and the amount of slaves they had in ye olde days, but it's still 2.4 mill too many.
As for the original topic, then I think that the identities are shifting. I see more and more men behave in ways that were previously reserved for women (dressing up, using moisturisers and even make-up, etc.), and the news reports are now talking about parents fighting for the right of their boys to wear dresses, as opposed to why no one has taken these obviously bad, bad parents into custody for ruining their future.
Furthermore I think that Anonymous 2 is right: We do place a higher value on male than female attributes in the western culture. I think this has a lot to do with women idealizing the manly attributes in order to claim them for themselves, while men have typically adopted the female roles by transforming them (e.g. a woman who plays rugby is manly and a tomboy, while a man who cooks is a modern man in touch with himself).
I think we are working our way towards a balance of a sorts, that hopefully will allow the sexes to have their own quirks, without placing anyone in a iron clad box of "this is who you are."
That's what I keep telling myself anyway, as I buy those pink slacks for my daughter, that I swore I'd never buy!
Dinah says: "It still doesn't mean that some people won't recoil if a boy comes to school in a dress or insists he's a girl, or that a child with this issue won't suffer."
Then why don't psychiatrists treat the people who "recoil" as mentally ill as having some kind of phobic/anxiety disorder, and leave the folks who are living as they like alone. And again, kins who have bodies or genders that are not viewed as typical, especially kids who others think should be boys and should do "boy" things, are often punished overtly and discursively by their families, schools, peers, religious institutions, children's media, and medical/mental health providers physically and emotionally. Their suffering has nothing to do with the domain of psychiatric care, and care provided actually may contribute to that suffering.
Many transfolk and allies scoff at the Benjamin criteria, as it forces trans people to adopt a very narrow view of sex-gender-sexuality, and lets a psychiatrists or psychologist be the judge of whether someone is "man" or "woman" enough, using their own standards. Some psychiatrists won't sign off on any body modification if someone doesn't pick a gendered enough name or consistently wear dresses or do their nails or have long hair (for women). Some doctors don't believe people can/should be trans and gay (trans folk who are attracted to be people of genders similar to their own ex. someone with a "male" body who identifies as a women who is attracted to women). Some doctors don't think their "patients" are "trans enough" if they aren't interested in full sex reassignment surgeries, let alone any at all.
Why should sense of gender and gender expression be considered areas of pathology? Why should people have to submit themselves to mental health care for 2 years and often have to continue living falsely during that time in order to get what they want. I get that sex reassignment surgeries are expensive and not really reversable. However, we allow plenty of other serious procedures that people might regret later without having to put someone in therapy for 2 years (all sorts of cosmetic surgery, tattoos, gastric bypass, etc.). It is just another way to punish/regulate people with non-normative bodies/genders in order to keep their existence from actually challenging the notion of normative bodies/genders all together.
Sex reassignment was pushed on intersex infants at the SBCU, and their pioneering work became medical protocol around the country. Many children grew up resenting their families, doctors, bodies, and themselves because of the frequent painful surgeries they had and were not told much about. I believe many doctors still push surgery on parents, saying it would be easier for the child if they have bodies that look like other kids. What they actually mean is that it would be easier for parents to raise a sex/gender typical child and easier for the rest of the world. Would might be easier for the child is to be raised in an environment where love/support is not dependent on how typical their body parts are or how typically they express gendered behaviors. If kids end up wanting surgery, let it be their decision when they are older (ex. teenagers), so they could have some informed say in the process.
Dinah says: "It still doesn't mean that some people won't recoil if a boy comes to school in a dress or insists he's a girl, or that a child with this issue won't suffer."
Then why don't psychiatrists treat the people who "recoil" as mentally ill as having some kind of phobic/anxiety disorder, and leave the folks who are living as they like alone. And again, kins who have bodies or genders that are not viewed as typical, especially kids who others think should be boys and should do "boy" things, are often punished overtly and discursively by their families, schools, peers, religious institutions, children's media, and medical/mental health providers physically and emotionally. Their suffering has nothing to do with the domain of psychiatric care, and care provided actually may contribute to that suffering.
Many transfolk and allies scoff at the Benjamin criteria, as it forces trans people to adopt a very narrow view of sex-gender-sexuality, and lets a psychiatrists or psychologist be the judge of whether someone is "man" or "woman" enough, using their own standards. Some psychiatrists won't sign off on any body modification if someone doesn't pick a gendered enough name or consistently wear dresses or do their nails or have long hair (for women). Some doctors don't believe people can/should be trans and gay (trans folk who are attracted to be people of genders similar to their own ex. someone with a "male" body who identifies as a women who is attracted to women). Some doctors don't think their "patients" are "trans enough" if they aren't interested in full sex reassignment surgeries, let alone any at all.
Why should sense of gender and gender expression be considered areas of pathology? Why should people have to submit themselves to mental health care for 2 years and often have to continue living falsely during that time in order to get what they want. I get that sex reassignment surgeries are expensive and not really reversable. However, we allow plenty of other serious procedures that people might regret later without having to put someone in therapy for 2 years (all sorts of cosmetic surgery, tattoos, gastric bypass, etc.). It is just another way to punish/regulate people with non-normative bodies/genders in order to keep their existence from actually challenging the notion of normative bodies/genders all together.
Sex reassignment was pushed on intersex infants at the SBCU, and their pioneering work became medical protocol around the country. Many children grew up resenting their families, doctors, bodies, and themselves because of the frequent painful surgeries they had and were not told much about. I believe many doctors still push surgery on parents, saying it would be easier for the child if they have bodies that look like other kids. What they actually mean is that it would be easier for parents to raise a sex/gender typical child and easier for the rest of the world. Would might be easier for the child is to be raised in an environment where love/support is not dependent on how typical their body parts are or how typically they express gendered behaviors. If kids end up wanting surgery, let it be their decision when they are older (ex. teenagers), so they could have some informed say in the process.
As for practical next steps, which won't happen, I would vote for a removal of all paraphilias and gender identity disorders (and related disorders)from the DSM. This does not mean that sexual behavior that is non-consensual/forced on someone (adults engaging children in sex acts, frotteurism, etc.) should not still be considered immoral and criminal (I think they should be at least), but they should not be pathologized as well. If people have sexual desires they find distressing and want to seek psychiatric support in reducing their distress about those desires, I don't necessarily see that as problematic, but I don't see it as much different than someone seeking psychiatric support for any other distress they are experiencing. This would help get mental health professionals out of the business of supporting the regulation of gender/sex/sexuality by policing boundaries of healthy/unhealthy bodies/genders/desires.
This was a lot to cover, but I really resent that psychiatrists still are in position to contribute to the regulation of people's genders, bodies, and sexualities. If psychiatrists want to be more just/ethical, this is an area of their power they need to come to together on ton relinquish. Whether they like it or not, this power gives medical legitimacy to all sorts oppression happening in our society, and if they want to reduce that oppression (and the distress/impairment it frequently leads to), stop pathologizing/normalizing sex/genders/sexualities.
Logistically, it's a bit hard to treat large segments of society in a psychiatrist's office. Mine only seats 3 people, but I can pull in 2 more chairs. And as one anon has pointed out, it's really not (or shouldn't be) psychiatry's domain to dictate what societal standards are. We have our left wingers and our tea partiers and many things we don't agree on, it's not psychiatry to say "you should be like the kid in the dress and something is wrong with you if it makes you uncomfortable."
The thing about having paraphilias and gender issues removed as diagnoses is that it would prevent people from getting care-- sorry that's not a diagnosis, your insurance won't pay. There are many many people with paraphilias who don't see this as a problem and don't see psychiatric care. No one is knocking on their doors saying "ya gotta get help for that foot fetish." DSM labeling allows for diagnostic consistency for research purposes, insurance reimbursement, and it often gives people relief to have a label and know that they aren't the only the person in the world with that problem. Having said that, I'm no big DSM fan and won't be purchasing the next one.
My kids have both gone to progressive schools where they have been taught to value and respect diversity. It's an interesting concept, because "tolerance" has been emphasized, but there is no tolerance of the intolerant (so you're not permitted to express beliefs that homosexuality is wrong, even if that's what your religion says or that's what you personally believe), and there was the sense that rules could be broken if you were "diverse"-- so I would here from the kids that public displays of affection were not allowed, or that the dress code did not allow for funky hair colors (eg Green), but these rules did not apply to the transgender/gay kids who could kiss in the halls and have green hair. And the constant cries for diversity seemed hollow in schools that had 10% of the student population African American when the city is 70%. On the plus side, the gender-varient kids, and certainly the gay kids, were not bullied, and all had friends.
My best guess is that Dr. Money did what he thought was in the best interest of the child given what was known then. As more gets known, things change, and I don't believe that it is still the current standard to surgically alter intersex children as infants without carefully considering the complex issues here. Times change, we learn more, pendulums swing.
"The thing about having paraphilias and gender issues removed as diagnoses is that it would prevent people from getting care-- sorry that's not a diagnosis, your insurance won't pay."
If people are distressed enough to seek care, I bet they would meet criteria for an anxiety or depressive disorder NOS at least, and that diagnosis can be used for insurance purposes.
I doubt many people seek treatment for paraphilias, even if they do find their experience of having them distressing. because their insurance will pay for their care. Paraphilic diagnoses carry a lot of stigma that can affect people's lives in all sorts of negative ways, and getting official diagnoses submitted to insurance providers makes those diagnoses semi-public. This could affect people's work, custody issues, non-related criminal proceedings, etc. And even if their distress related to their "paraphilia" or the "paraphila" itself is diminished to the patient's liking, they still carry that label with them all their lives on their medical records and insurance records. Let alone there isn't any good evidence for "treatment" of "paraphilias" beyond blunting people's sexual desires. Also, the assertion that people get relief from being given a named disorder only highlights the power we give Medicine/Psychiatry to regulate what's normal/pathological in our lives. Why should poeple have to own a pathology when other people with similar or different attractions don't. Did gay people en masse find relief pre-1973 when they went to a psychiatrist and told they had a disordered sexuality, regardless of whether or not it was problematic to them? Was it not convincingly argued by the brave activists who quickly convinced the APA to remove homosexuality as a disorder that labeling sexualities/attractions as disordered increases distress/stigma/discrimination for folks who can be labeled with that disorder?
As it relates to Gender Identity Disorder, a big debate in the trans community is whether or not to seek removal of Gender Identity Disorder from the DSM, because it hopes that one day it can be used to help pay for very expensive sex reassignment surgeries. As is the case right now though, people are pathologized for having genders and insurance companies still won't pay for surgery, even after the 2 years of compulsory therapy. Some people are willing to go through the motions if it might mean covered surgery, but even that only affects such a small amount of people (transfolk with good health insurance, significant wealth/income, and who meet doctors' narrow concepts of sex and gender). Most transfolk only do some body modification, it is more likely to be hormone use than surgery, and a lot of folks don't even get care/hormones from doctors because it is too expensive.
As for giving people the benefit of the doubt because of their lack of knowledge in their time, I find it pretty insensitive. Real harm was done and real harm continues to be done because of the work of Money (and others), without much redress to people deeply affected. This goes for LGBQ folk, transfolk, intersex folk, people in the kink community, and people with all sorts of non-normative sexual desires and gender presentations. Your arguments for continued pathologiziation seem weak to me, and the best rationale I have for continued pathologization is to add weight to the criminalization/immoralization of these folks and in doing so, make straight, gender-typical folks feel healthier and experience privilege.
As for your kids' school, I think poor/inconsistent handling of diversity issues are indicative that the administration does not actually have a good grasp of a lot of the issues. When queer kids behavior that is against the rules is not addressed, it is more likely because the adults around are uncomfortable talking about gay/sexual issues and/or are afraid that they will be seen as bigoted. If no one is allowed to make-out in the hallways, that should be consistently applied. I agree that what you are calling a progressive school is likely a more affluent school that is disproportionally white and wealthy, and issues of racial/economic justice/diversity are under-addressed as well.
However, even the way you are framing the debate, that some kids are "diverse" and some kids are unlabeled ("normal" maybe?) shows that discursive privilege of "normal" kids is still alive and well. My bet is that straight kids' sexuality in your kids' school is still seen as natural/normal and is encouraged in all sorts of ways (school dances, separate locker rooms, health curricula that focuses on straight kids' sexualities, other academic curricula that glosses over GLBTQ history or people, straight teachers who feel comfortable talking about their other-sex spouses without much thought but would prob be much more noticable for gay teachers to be similarly "out" with their relationships, etc.) I still bet plenty of straight kids find ways to hold hands or make-out in and out of school, and the image/idea of them doing so is not considered offensive, atypical, or sick by others. Queer kids experience that judgement no matter where they are, and a progressive school is likely to be the safest place they have access to do things that straight kids take for granted everyday.
On Dinah's not being tolerant of intolerance statement: I remember when my town FLIPPED OUT when a mosque was scheduled to be built. And I when I say they flipped out I mean there were protests and cries that Sharia Law was coming, Muslims were going to kidnap pet dogs, it would be a haven for terrorists...and it really just didn't bother me that much. I didn't even know what was going on when I would wear hijab I(head scarf) and I would get dirty looks or people would refuse to talk to me or offer customer service. Of course then I found out that a group of Muslims were trying to build a mosque, lots of people were pissed off, and I put it together. But I didn't even feel like I had to tolerate it. They were just there, and if that is the type of world they want to live in then they can go live in that world. There really isn't too much we have to tolerate in this world. Whether it be Muslims, trans people, whatevs. Maybe it's not about putting up with people and hoping they'll just go away. Maybe it's more about just accepting that they are there and live and let live.
I mean really...I couldn't figure out why people were so freaked out about a little mosque. They were acting like Muslims are a bunch of stray cats who are going to crap on their porches and hiss at their pet dogs and they either have to tolerate them or push them to leave. People can despise gays, Muslims, and whatever other group of people they just happen to despise. But there is no reason to burn down a Chick-fil-A over it. You don't wanna tolerate homophobic chicken sandwiches, then don't eat the sandwiches. Pissed off that Muslims exist, then don't go to their mosque.
I remember walking down the street once in hijab, when I still wore it, and a guy yelling at me (F*** Muslim!) from his car and cursing at me and telling me to get out of this country. And I immediately felt so frustrated, because I didn't have my digital camera with me and I wanted to take pics of him flipping out so I could make fun of him later on the internet to my friends. I still crack up over that.
I'm weird. I don't tolerate anyone. I just mock them on the internet. But I know I can't really talk either, because I don't wear hijab anymore so I don't ever get harassed (Personal choice. Not from pressure from crazy people to take it off). If I
still wore it, I might feel more like I have to tolerate people and I would be more grumpy.
@Jane:
I think you are missing the piece that gender nonconforming kids, and queer/trans folks in general, have historically and continue to be pathologized as mentally ill. While I also believe psychiatrists play a role in determining if people's religious beliefs are "legit" or psychotic (ex. If someone prays by getting on their knees and believes a god listens and responds to that prayer, that seems to be considered normal, but if they pray to a god by talking to that god through a hairdryer, and the person believes that god responds and communicates back, they might be labeled psychotic), but not to the ingrained and pervasive extent they do for regulating people's sexed/gendered bodies and identities.
As for your last comment, "If I
still wore [a hijab], I might feel more like I have to tolerate people and I would be more grumpy," you highlight an issue of visibility and your mental health. While lots of folks have an option to some extent to alter their bodies to not look "variant," that they would be compelled to do so because it would make things easier or make them feel "less grumpy" shows a significant burden people who experience systemic oppression. Having to choose between living as one would like or making changes to better adapt to folks who experience more privilege is a stressor in itself, and for folks who lack much choice in changing their appearance, they live in much more stressed states as their visibility marks them for all sorts of over and discursive discrimination.
During my student teaching (spring 2009), I had a student who was genetically a boy, but who had been dressing, and "passing" as a girl at school since he started school. His parents were blue-collar and hoping he would outgrow this "phase", so he had no visible support from anyone. The other students did not seem to know he was genetically a boy. As an eighth-grade student, he was in puberty, wanting to make a permanent sex-change, and wanting to take hormones to prevent development of masculine body features. It was painful to see him in conflict with his family, and alone without support. Kids like that need a supportive environment and access to therapy. It may not be a mental illness to feel like a woman trapped in a man's body, but these people have to put up with a lot of abuse from family, friends, and strangers, and ought to have insurance coverage for supportive therapy.
So after reading the article, I see my question was addressed by the author.
"These days, flouting gender conventions extends even to baby naming: first names that were once unambiguously masculine are now given to girls. The shift, however, almost never goes the other way. That’s because girls gain status by moving into “boy” space, while boys are tainted by the slightest whiff of femininity. “There’s a lot more privilege to being a man in our society,” says Diane Ehrensaft, a psychologist at the University of California, San Francisco, who supports allowing children to be what she calls gender creative. “When a boy wants to act like a girl, it subconsciously shakes our foundation, because why would someone want to be the lesser gender?” Boys are up to seven times as likely as girls to be referred to gender clinics for psychological evaluations. Sometimes the boys’ violation is as mild as wanting a Barbie for Christmas. By comparison, most girls referred to gender clinics are far more extreme in their atypicality: they want boy names, boy pronouns and, sometimes, boy bodies."
@A Girl,
I know it off topic but to respond to your question of whether I have heard of human trafficking: yes. I do believe that it is the rare person who possesses a sex slave, while a tremendous percentage of the population seems to have an Isomething or other device (I don't mean to single out one company). I am also guilty.
@Sunny:
Yes kids who have genders are not supported by the people they care about most could benefit from getting access to support, but why must they be diagnosed with a disorder for them to do so? If they must be, if things are difficult enough to seek mental health support, why shouldn't a less stigmatizing label like anxiety or depressive disorder NOS be used? It is really unfair to locate pathology on individuals who are just trying to manage a life with some dignity, especially children, when the adults in their life (parents, school, etc.) are a big part of the problems they face and they do not have legal rights to challenge or avoid them. And in the case of the student at your school, what makes you think her parents would let her go to an affirming mental health professional on their dime/insurance?
Sunny, if the parents allow the child to go around passing as the opposite gender, isn't that a form of support? Obviously, I don't them.
We started out with the anger that John Money would have children sexually assigned to a specific gender with the belief that they would adapt better. It is by diagnosing -- and categorizing -- people with specific symptoms (be it a systolic blood pressure above 160 or a desire to dress like a girl) that we can follow them and learn, but we can't know beforehand what is best. So homosexuality starts as diagnosis, and with time, people observe that there are gay people who are well-adjusted and contribute to society and don't seem to be seeking any type of 'help.' Then we can say, ah ha, maybe this is not a disorder, and the diagnosis can be removed. But without lumping people together for a while, we can't figure out how to best help them and we learn from our misdirection.
I could run a poll and ask readers if they think fetishes and gender dysphoria should be considered psychiatric diagnoses.
I have no personal investment in this, I treat people who come looking for me, I'm not hunting them down. With kids, it's very hard because the parents are sometimes the ones who want them "fixed."
Okay, I'm done.
@Anon above: I for sure agree that it's different for trans people when they are noticeably transgendered than it is for me. I took off hijab because that was what I wanted to do and it was between God and me. But when I did wear it...whoa! That would be very sad to think of a transgendered person who tried to start looking more like his or her original sex out of pressure, or a woman who removed her hijab from social pressure. Sometimes we have to follow our hearts, no matter how strange it looks.
And I get that LGBT people have been pathologized by pdocs and Islam never has...but my point really is that there are always going to be people who will try to rain on your parade. Everyone is going to find people who finds ways to discredit them for who they are. And so that is why I really don't buy into the tolerance thing anymore. I just kind of accept that people are not perfect, they do bad/misguided things, it's not always fair, and I try to let them live in their world (and me in mine) as much as possible. Psychiatry is like this as well. It is not a perfect field, and it has lost a lot of support and credibility over the years from disgruntled psych patients. But I would say they are improving. LGBT is no longer a sign of mental illness in the DSM. Dinah mentioned concerns about teaching children to accept themselves, and it sounds like psychiatry is getting better in that regard. It's really kids that have it the worst, because they can't just tell a psychiatrist, "I disagree with you. I accept that you think I am disordered, but I think being gender fluid is fine and I have no reason to see myself that way. Have a nice life." They get pressure from parents to get "help."
Dinah,
Are you really trying to justify the use and power of psychiatric diagnosis in labeling already stigmatized people as a means of being generally helpful? I can think of no example where that has been the case. I can think of instances in the history of modern medicine/psychiatry where this has been disastrous.
If anything, as you kind of say, being labeled and harmed pushed people who survived into community where they could actually learn more about themselves and each other and put a challenge to those who thought them sick, criminal, and/or immoral.
What I think psychiatric (and perhaps other medical diagnosis) does is to create false delineated boundaries between health and disease, creating a discourse that certain people/behavior that are already privileged in many ways are associated with health/naturalness, and folks who are already oppressed in many ways are associating with disease/unnaturalness. Even though there is no indication of any actual pathology or that the pathology is associated with a any group in a meaningful way, deployment of pathologization adds a pseudoscientific layer of justification to particular systems of power. Additionally, in terms of people's mental health, diagnosing can affect people at their deepest levels of senses of self.
I respect your ability to have "no personal investment in this" and treat patients who come to you, however, Psychiatry as an institution, whether we like it or not, has and does support the conditions that lead to much of the distress the kids in the article are apt to experience and the justification their parents, peers, schools, and communities have in hurting them.
The tomboy isue is interesting. I think it might come down to what was described in the article:
"girls gain status by moving into “boy” space, while boys are tainted by the slightest whiff of femininity"
For the most part, this seems to be the case. There is a kind of fear that gaining any feminine characteristics would mean losing masculine characteristics, which in turn would mean a loss of power in society.
I touched on this in a recent blog post about this article (http://just10morethings.blogspot.com/2012/08/gender-nonconformity.html bit of a shameless plug there ;) )
As for your son's astute observation - I think it's interesting how quickly children seem to learn to identify with a certain group, and then to take on as many charactersistics of that group as they can..
@Sweatshop Anonymous
I agree that we still need to maintain a vigilance towards sweatshop labour, but not for the resons you might think.
Look at China - the original sweatshop HQ. They "only" had a 15% rise in minimum salary this year. I say only, because the two years before that, it was 22%. In fact, it has now become so expensive to produce goods in China, that they've taken to opening factories in Bulgaria. So, while my company is shipping jobs to China, they in turn are shipping them to Bulgaria, and I can only wonder when Bulgaria will start sending them back to us.
In other words, it would seem that economists who claim that sweatshops ultimately bring prosperity, weren't completely wrong (Although I agree that there's a lot of shady stuff going on, such as double book-keeping, etc).
In the meantime, slavery is on the rise (arguably - it's hard to get exact numbers). And while we may "only" be talking roughly 1.9 million women, the wast majority of these work in bordels, where they service several customers each night. Even assuming that many of these are return customers etc., that's still a lot of people who come into contact with someone who is a modern day slave. And then there is the up to two million children who are estimated to be "working" in the modern sex trade ...
Granted, "your" sweatshops and "my" modern day slavery are sometimes two sides of the same coin - it's called debt bondage. I'll leave the googling to you, it's such a "fun" topic to read up on.
Some references:
1) Sweatshops
http://www.ft.com/cms/s/0/847b0990-36a2-11e1-9ca3-00144feabdc0.html#axzz23tBoMReq
http://www.zerohedge.com/news/europe-now-chinas-sweatshop-great-wall-starts-building-cars-bulgaria
http://www.independent.org/publications/working_papers/article.asp?id=1369
http://www.greenamerica.org/programs/sweatshops/whattoknow.cfm
2)Human Trafficking
http://www.notforsalecampaign.org/?gclid=CM2asZ3q8LECFYEXzQodHlwACQ
http://news.bbc.co.uk/2/hi/in_depth/world/slavery/default.stm
http://www.antislavery.org/english/slavery_today/what_is_modern_slavery.aspx
http://www.state.gov/j/tip/what/index.htm
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