piny,

I didn’t mean to suggest that adolescents never consider or make a physical transition, or to attribute to Michelle the claim that there ought to be therapeutic intervention to “correct” GID in young kids because a failure to do so would lead to them ending up gay. I didn’t infer from her mention of the “outcome” statistics that that’s what she believes. If I did inadvertently suggest that, I apologize for being unclear.

The point I was trying to make about age is that, as I understand it, an issue that’s unlikely to come up at the age of 7 or 8 in a case like this one. A few years later, closer to adolescence, sure, but at that point we’re moving rapidly away from the diagnostic territory of “GID in Children” anyway, and towards “GID in Adolescents and Adults.” My understanding may be mistaken; if so I retract that claim, but I’d still make the more specific claim that it doesn’t have much to do with what this particular kid and her mother say they’re concerned about at this particular moment, or with the details of how the school is dealing with them. And I’d also fall back on the other argument against the basic problem with the way that the medical establishment holds medical aids to transition hostage to medicalized labels and “disorder” diagnoses.

The stuff about “outcome” statistics wasn’t meant to suggest that Michelle personally believed that there was something wrong with adolescents being gay. Rather that if one believes that there’s nothing wrong with being gay, nothing wrong with not being gay, nothing wrong with being trans, and nothing wrong with not being trans (which for all I know is what Michelle believes; otherwise I would have been arguing about that rather than just asserting it), then that correspondingly undermines the claim that there’s anything that ought to be called “disordered” or of “clinical interest” here, and to that extent it’s unclear why you’d need a diagnostic category for it, let alone a diagnostic category that’s used to justify psychotherapeutic intervention (at least not for children who don’t actively seek it out for themselves, rather than being shoved into it by anxious adults), let alone a diagnostic category that’s counted as a mental “disability” for legal purposes.

If I had to guess at Michelle’s motives I’d be very unlikely to guess that it had to do with personal attitudes of homophobia or transphobia, and much more likely to guess that they have to do with the tendency in our culture to elevate professionalized psychiatry and medicine as the primary or only way to understand the things that are most important to our lives, and the “mission creep” for medicalized labels that this inevitably leads to, no matter how ill-founded or inappopriate that model may be in a given area. But that’s just speculation, and I’ll happily take it all back if I’m wrong.

Rosehiptea,

As Holly mentions, the major distinction in types of treatment has to do with whether the diagnosis is made in childhood or later in life. Shrinks are generally respectful enough of their adults patients’ wishes and strongly held convictions, at least on this specific point, not to simple-mindedly force them into efforts to “correct” their transgenderism. Not so for children, where all kinds of nasty behavioral therapy are commonly employed to “cure” them.

Michelle,

I think that when the common features of “diagnostic category” are explicitly described “symptoms,” while the thing itself is explicitly labeled a “disorder” and it is classified as an Axis I Clinical Disorder, it’s a bit odd to suggest that the purpose of the diagnostic category is primarily descriptive, rather than prescriptive. When professional medical practitioners describe a set of behaviors and attitudes in terms that are directly and deliberately taken from the medical study of disease, and describes them as causes for “clinical attention,” it is pretty strongly suggested that there’s something wrong with people who have that “disorder.”

As for the professional ethics in sex-reassignment surgery, it has basically nothing to do with the use of Gender Identity Disorder as a “diagnostic category” in eight year old children, which was the context of the discussion. However, I think that if the sole raison d’etre for this diagnostic category is in order to pander to the prejudices of doctors who can only be persuaded to acknowledge their trans patients’ considered judgment when said patients can get another doctor to sign off on it in the form of an Official Diagnosis certifying that they’re “disordered,” that’s a pretty slender reed to lean on. I’d hope that maybe we can start talking about changes that are important for our lives without first having to get a medical label slapped on it.

As for the study of “outcomes” in children labeled as having GID, cf. Speck’s reply. (Incidentally, last I checked, the DSM-IV TR says that 3/4 of anatomical boys diagnosed with GID end up living as homosexual or bisexual males in their late adolescence; the corresponding figure for anatomical girls diagnosed with GID are said to be unknown.)

But, moreover, I don’t see what the point of bringing this up is in the first place. If 3/4 of GID-diagnosed kids turn out to be gay, then so what? There’s nothing wrong with being gay and there’s nothing wrong with not being gay. There’s nothing wrong with wanting to live as a girl (or boy) when you’re 8 and then deciding you want to live as a gay man (or lesbian) when you’re 16. There’s nothing wrong with wanting to live as a girl (or boy) when you’re 8 and then deciding that you want to continue living as a woman (or man) when you’re 16. There’s nothing wrong with changing the gender you want to live as every four months, if you feel like it. If only a few kids diagnosed GID end up seeking sex-reassignment surgery as adults, what of clinical interest follows from that? It’s certainly not any kind of argument for therapeutic intervention with the kids with strong, persistent cross-gender identification (either potential outcome–remaining trans or not remaining trans–is fine, so what’s the big deal?). Nor is it an argument for trying to get the government to treat 8 year old kids with strong, persistent cross-gender identification as if they had a mental “disability.”

ThickRedGlasses,

“The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” . . . People with Gender Identity Disorder are going to be significantly distressed by being in the wrong body, even if the social stigma goes away.

A significant part of my point is that the criteria having to do with “impairment in social [or] occupational … functioning” are basically bogus. They’re a way of shifting the responsibility for other people’s discrimination and bullying onto the victims of the discrimination and bullying. In reality, insofar as there’s a “disorder” here, it’s because other people have a problem, not because kids labeled as having GID have a problem.

As far as “clinically significant distress” goes, as far as I know, there’s been no positive evidence presented to the effect that the little girl in question feels that way, and I see little reason to assume that she does. Not everybody who wants to live as a member of a gender different from the one they were assigned at birth is especially concerned about the anatomical details of their body, especially not when they are still years away from puberty.

If, on the other hand, she does feel that way, then in any case that’s a separate issue from the accommodations that the school should or shouldn’t make for her. They don’t have much control over her personal feelings about her genitals. The issue at hand is how they will or won’t deal with the questions about her immediate social environment–whether or not teachers and classmates call her by her chosen name, allow her to to come to school dressed as a girl, do or don’t harass her, etc.

From a clinical standpoint, I’d question the utility of creating a gender-specific diagnostic category if the only purpose is to group together people who are (1) trans and (2) depressed or anxious or dysphoric about their bodies. There’s nothing wrong with (1) per se, and there’s already a ton of different diagnostic categories to cover (2), so why come up with a new one just to single out the fact that one subgroup of people who develop (2) are also (1)?

Holly:

Thank you for posting this. I love how the genital correctness blowhard brigade keeps falling back on the idea that anyone who doesn’t go out of their way to make life unpleasant for this kid (e.g. by refusing to call her by her chosen name, or by harassing or punishing her for wearing the “wrong” set of clothes to school) must, therefore be “bending over backwards” to suit her delicate sensibilities. Rather than, you know, just not going out of their way to be obnoxious to an eight-year-old kid in the name of heteropatriarchal social engineering.

ThickRedGlasses:

Wouldn’t this child be considered disabled under the Americans with Disabilities Act? Gender Identity Disorder is considered considered a mental disorder, so shouldn’t this girl be covered by ADA?

I think we’d be better off not going there.

So-called “Gender Identity Disorder” is a basically political, not medical diagnosis. It’s been used repeatedly as an excuse for quack psychiatrists and anxious or controlling parents to inflict all kinds of torture, mislabeled “therapy,” in the name of “curing” their trans kids, or even mildly gender-deviant kids, of their “disorder”. In fact there is absolutely nothing wrong or crazy or disordered about a kid born anatomically male who wants to live as a girl (or vice versa), and I think it would be a serious mistake to reinforce and institutionalize the notion that there is, whatever short-term advantages you might hope to gain from it.

A few decades ago, Homosexuality was considered a mental illness and included as a category in the DSM. But if that diagnosis were still on the books, I think it would be counterproductive, to say the least, for gay liberationists to try and use it to get accommodations under the ADA.