Open Letter to the American Psychiatric Association

(or view the Word document from the website),

A network of communities in Calgary, Edmonton, and rural Alberta.

For information, contact:

Mercedes Allen,

For Immediate Release.

Calgary, AB, Canada (26may08). Bearing in mind that:

  • Transgender advocates are privy to a far wider sampling of transgender persons than clinicians typically are, and;
  • Community advocates have access to a greater degree of information due to more frequent and frank discussion with community persons, and;
  • The transgender community is experienced in advocating for itself medically and is able to recognize a serious cause of concern,

… it is the hope of the Alberta community that the American Psychiatric Association will listen to and weigh our concerns with the seriousness they deserve.

We, like many in the transgender community, are deeply troubled by the appointment of two persons to the Sexual and Gender Identity Disorders Work Group currently charged with revising the entries for Gender Identity Disorder in preparation for the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We do realize that the doctors in question quite probably really do wish to help people and believe that they are doing so – it is not their personalities we have issue with, but their views to achieve this. We also realize that the DSM does not recommend treatment, only diagnoses – however, one of the diagnoses apart from “Gender Identity Disorder” is also at issue, and there is also the likelihood that given the sanction by the APA as foremost experts on the diagnosis, they will also be conferred with the perception of being foremost experts on the treatment of these conditions.

The person selected as chair of this group, Dr. Kenneth Zucker, is an advocate and practitioner of reparative therapies for transgender children. The American Psychiatric Association and the American Psychological Association have both strongly opposed such treatments in the past, and have demonstrated reparative therapies to be extremely harmful to individuals. Dr. Zucker claims that this therapy does not harm children, because he believes that their identities and sexual orientations are more malleable and can be swayed by socialized conditioning when enforced both by the therapist and the childrens’ parents. Experiences of members of our community in Alberta who have undergone versions of similar (enforced) reparative therapies during different periods of treatment (1974, 1990s, 2005) have shown to us that this is a very damaging practice, and does not “repair” anything — it only serves to force one to hide it, drive it deeper and live a suffocating existence until a crisis point is reached. Too often, that crisis point results in suicide, partly driven by a distrust of therapists and a lack of other options.

Dr. Zucker’s belief in the malleability of childrens’ identities follows in the path set by Dr. John Money, whose belief in the fluidity of gender identity in childhood is well-documented. Dr. Money’s famous test case, David Reimer (a.k.a. “John/Joan”) became a shining example of the failure of this philosophy, and Dr. Zucker’s continued endorsement of it also encourages prolonging the damaging process of assigning gender to intersex infants at birth. Dr. Zucker has repeatedly advocated adding “Disorder of Sex Development” (a controversial and stigmatic term for intersex persons) to diagnostic classification, with surgical intervention in infancy made obligatory.

Dr. Zucker has been part of a circle of persons who have been the focus of warnings and controversy within the transgender, intersex, and larger gay and lesbian communities for a number of years. This circle includes persons such as author J. Michael Bailey, Dr. Alice Dreger, Dr. Susan Bradley and Dr. Anne Lawrence (who though transgender herself, is far from representative of the transgender community). They are not on the Work Group, although it is possible that they may currently be consultants or selected as alternates (and it would concern us deeply if it were so).

This Work Group also includes Dr. Ray Blanchard, who — as you have pointed out in a press release — is assigned to the Paraphilias portion of the Work Group. This actually positions him to potentially do significant harm to our community, by providing him with the opportunity to shape the entry for “Transvestitic Fetish” into his own controversial, highly contested and discredited theory of “Autogynephilia.” In this model, male-to-female transsexuals who are bisexual or attracted to women (and possibly female-to-male transsexuals who are bisexual or attracted to men – his theory currently does not yet have much account for female-to-males) would be classed as autogynephiles, rather than with Gender Identity Disorder. This is a significant portion of our population, which would be diverted from a diagnosis of GID to a paraphiliac categorization purely because of their sexual orientation.

Some of Dr. Blanchard’s theory falls apart when looking at comparative data. We certainly know women who enjoy dressing up and feeling sexy — to assume that entire transgender identities amount to a sexual-only motivation for similar behaviour is remarkably short-sighted and sex-negative, as well as reminiscent of early attempts to entirely pathologize womens’ sexual pleasure under a wide, sweeping diagnosis of “nymphomania.” Just because the “self as female” is present in fantasy does not make it the trigger, nor is “feeling sexy” a paraphilia of itself. Dr. Blanchard’s theory, which contends that transsexual behaviour is sexually motivated also fatally overlooks the fact that for male-to-female transsexuals, hormone therapy greatly reduces libido or in some cases negates it entirely, often with little regret from the transsexual.

In our community experience, it has been seen that gender identity (who we are) and sexual orientation (who we love) are completely independent aspects. Drs. Zucker and Blanchard have a history at the Centre for Addictions and Mental Health (CAMH) to treat transsexuals based on their sexual orientation, dividing them among what they term “homosexual transsexuals” and “autogynephiles.” This is the basis upon which we postulate the model of what they are likely to approach DSM discussion with, and betrays a poor understanding of sexual orientations of transsexuals at the most fundamental part of their philosophy. The symptoms of overwhelming conviction of being a gender other than their birth sex, the sense of living behind a mask and feeling that their birth sex is foreign to them, the distress or impairment in social, occupational, or other important areas of functioning, the co-morbidity of depression, anxiety, culturally-induced stress, post-traumatic-stress-disorder and even suicide ideation — these are common symptoms among the vast majority of transsexuals who seek medical treatment and surgery, regardless of their orientation. Division of the community among lines of orientation does not address any of these key issues.

Together, the history of treatment by Drs. Zucker and Blanchard generates a model in which one form of treatment (reparative therapy) is advocated for transgender youth, a second (medical transition including hormone therapy and genital reassignment surgery, a.k.a. GRS) for a small number of transgender adults with a particular sexual orientation (i.e. using the philosophy that GRS will make them “heterosexual”), and a third (paraphiliac treatment of “autogynephilia”) for transsexuals of other sexual orientations — and this still leaves a few unexplained anomalies. Occam’s Razor tells us that the simplest, most direct explanation that encompasses all of the data is probably the right one. Drs. Zucker and Blanchard give three explanations and methods of treatment for three contrived groups of data and still do not account for everything. It is our hope that the American Psychiatric Association recognizes the potential embarassment to them as well as to damage to our community to be had as a result of seeming to endorse this model.

This combination of philosophies threatens to bring about a situation in which surgical intervention is mandated for non-consenting and non-aware infants with indeterminate genitalia, while surgical intervention is opposed for a significant number of consenting adult transsexuals.

We realize that the American Psychiatric Association has intended to assign what they believed to be the most knowledgeable individuals to the task of revising the DSM. However, it has long been our community’s experience that their treatment is harmful, and their ideas dangerous. While we don’t presume to dictate who should be charged with redefining the “Gender Identity Disorder” or “Transvestitic Fetish” classifications in the DSM (it might, however, be advisable to consult with those the transgender community considers to be medical allies), it is imperative that these two individuals, their clique and their philosophies be carefully re-examined.

On behalf of transgender, transsexual, gender-variant and intersex persons in the Province of Alberta, Canada, our allies, our families and our youth, stands opposed to the appointment of Dr. Kenneth Zucker as Chair and Dr. Ray Blanchard as member of the Sexual and Gender Identity Disorders Work Group. We urgently request that the American Psychiatric Association reconsider this decision.


Mercedes Allen, with signatories

6 thoughts on “Open Letter to the American Psychiatric Association”

  1. I don’t know how to do it, but it would seem there may be at least one or two malpractice suits filed against Zucker, Blanchard, et. al. Not to mention the strong probability that some of those “treated” by these zealots sadly may have even commited suicide. If that kind of information was made available along with petitions to the APA for the removal of Zucker, et. al., there would be a much stronger case for making it happen.

  2. I am intrigued by your letter. I have 6 transgender patients in my practice, 4 mtf and 2 ftm. The intersex issue and surgical changes at birth has caused significant issues for 2 of the 6. I understand your concerns regarding the upcoming revisions of the DSM. As a former state president of the APA I can offer no additional insight or assistance, only my solidarity. To affect change on a grand scale will take continued efforts and I encourage you to continue to raise your voice so that you may be heard.

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