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Drop the doll!

Drop the doll!

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Toronto's gender identity clinic aims to set kids aright when they're young - very young
When Jackie (not his real name) was two and a half years old, his mother noticed he was "really into" Wizard Of Oz dolls like Dorothy and the Wicked Witch - and he was especially interested in their shoes. Jackie had tantrums when the shoes were lost, liked to play with his mother's shoes and hair clips, and persistently asked for a "pink Barbie."

This behaviour prompted Jackie's mother to take him to her pediatrician, who put her in touch with Dr Ken Zucker.

Zucker is the head psychologist of the Child And Adolescent Gender Identity Clinic at Toronto's Centre For Addiction And Mental Health (formerly the Clarke), and his clinic has probably diagnosed more kids with gender identity disorder (GID) than any other facility in the world.

The clinic is only one of three or four in existence. As Zucker says, "because the field is so small, you know everybody and there's not a lot of competition."

But that doesn't mean there's not a lot of controversy. While some of his fellow psychologists see Zucker as the foremost international authority on GID in kids, many activists are outraged at Zucker's approach.

Critics say GID is nothing but an invention to deal with parental anxiety about having a homosexual child. And they don't like Zucker's attempts to encourage children to behave as people expect them to behave. Some feminist professors teach his articles to University Of Toronto graduate students as examples of gender-biased research.

Then what exactly do you do when a biological boy - and sissies outnumber tomboys at Zucker's clinic by six to one - reaches for a Barbie instead of a toy gun?

During her pregnancy, Jackie's mother was convinced she would deliver a girl. As Zucker quotes her in a 1993 article he wrote about Jackie's case, "He was supposed to be Jacqueline."

From the beginning, she had anxiety that Jackie may turn out to be gay. She told Zucker that if her child is gay or transexual she would not "mourn," but she expressed concern because her husband went nuts whenever Jackie expresses feminine interests and also criticizes him for "talking like a girl."

In Zucker's draw-a-person test, Jackie first drew a girl, and only after being coaxed drew a male figure. In two observed play sessions, Jackie chose feminine toys, like a Barbie instead of a dart gun. He played equally with male and female clothing, though. In an interview, Jackie said that he knew he is a boy, not a girl, and that he would grow up to be a daddy, not a mommy. In his dreams he is always a boy, and he did not think he ever really is a girl.

To many of us, Jackie and his fascination with Oz, sparkly red shoes and Barbie might seem to be a gay man in the making, a pre-homosexual child trapped in a typically homophobic North American nuclear family. But that's not the way things work in the realm of GID.

It all starts with the diagnosis. As a concept, GID first appeared in 1980, in the third edition of the Diagnostic And Statistical Manual (DSM III) - the guide the medical profession uses to decide what's a mental disorder and what's not. DSM III is also the first edition of the manual to omit homosexuality as a disorder.

According to some activists, GID was invented to deal with parental anxiety about their child's potential sexual orientation, anxiety triggered by his or her cross-gendered identification and behaviour.

Although GID is not supposed to be diagnosed on the basis of "simple nonconformity to stereotypical sex role behaviour" (ie average sissies and tomboys), Dr Zucker asserts that a pattern of cross-gendered behaviour can itself be a problem.

For him, the cross-gendered child "is saying each and every day by his [or her] behaviour that they are, in fact, not feeling good about who they are. Because they are constantly trying to be someone else."

Other experts disagree with the GID diagnosis altogether. Some think that the very existence of such a treatment centre is more likely to stigmatize children as fags and fairies than offer them a haven. Others, such as psychiatrist Justin Richardson from the Columbia Centre For Lesbian Gay And Bisexual Mental Health, say that Dr Zucker fails to imagine "female type play [in boys] that could be creative and expressive."

Richardson says clinicians should distinguish between cross-gendered play that is joyless and repetitive, and cross-gendered play that is pleasurable and expressive. It would be more helpful, Richardson says, "not to focus on gendered behaviour, but on the quality of psychological experience.

"Dr Zucker stays at the level of behaviour too much; he doesn't offer a deep psychological explanation about how and why a boy might be playing with a doll."

Others say institutional attitudes toward GID is hard on families. Although Dr Zucker is very clear that treatment requires parental consent, one parent I spoke to who disagreed with their former spouse about Dr Zucker's recommendations says, "We almost lost our child to him, to the Clarke."

Such fears seem more credible given the current case in Columbus, Ohio, where parents claim their six-year-old child was taken away by children's services because they were supporting the biological boy's decision to identify and live as a girl.

In response to such criticism, Dr Zucker says Richardson's view is "too simplistic… not in touch with clinical reality." He points out that many of his critics are not trained to work with children or lack professional credentials; he also believes that those whose life experience has personally involved them in the issues are biased and unable to be objective.

This still leaves the issue open as to what these children will grow up to be. Zucker says GID-diagnosed children are at risk for adult transexualism, and says that "in pragmatic terms, if one can avoid that path… one has an easier life."

There is little conclusive evidence that GID kids will grow up to be transexual. Dr Zucker himself acknowledges that many parents are motivated to change their child's cross-gendered behaviour primarily because they fear their child will grow up homosexual.

How do these boys, a majority of whom grow up to be gay, retroactively make sense of their experience at the clinic?

"I always say the goal of therapy is to help the child feel better about his gender and, with regards to sexual orientation, let's let the chips fall where they may," says Zucker. "Some [former patients] are doing great, some are not doing well at all… [Amongst] those who are gay, most of them, not all, will say they're glad that their parents helped them feel better about their gender because being gay is hard enough.

"There are others that are pissed off, that say, 'My parents were homophobic and blah blah….' But it's more complicated than that."

Zucker says that the ethical issues in providing treatment "are moot until we can know whether treatment can alter the natural history of a child's sexual orientation." But this statement seems a little odd given the conviction in both medical circles and queer communities that even should one want to change one's sexual orientation, it is extremely difficult and even counterproductive to attempt to do so.

There is an abundance of anecdotal evidence that the diagnosis of GID has been and is still being used against gender non-conforming lesbian, gay and bisexual adolescents in order to institutionalize them, at least in the US. Dr Zucker says he has not come across any such cases himself.

Zucker's treatment involves includes psychodynamic therapy and redirection. He insists that the parents prohibit cross-gendered behaviour, albeit "in a non-authoritarian way."

"Allowing a little boy to cross-dress just perpetuates… [his] confusion," Zucker says. He is critical of parents who do not see pervasive cross-gendered play as a symptom of a child with problems. Parental permissiveness and encouragement may contribute to the child's GID, he says.

But south of the border at least one parent-support group, run by a child psychiatrist and a psychiatric nurse practitioner in the Washington, DC, area, takes the opposite approach. They encourage parents to create safe spaces for cross-gendered play. They focus on working through issues of homophobia and "femphobia" with the parents of sissy boys and teach skills like bully management.

"All our kids would probably be diagnosed with GID," says Catherine Tuerk, one of the group's facilitators. "We rescue them from therapy. All of them will probably grow up to be perfectly normal gay men."

She encourages parents to become advocates for their children and to treat their cross-gendered interests with respect.

A number of individual practitioners are also adopting this approach. One child psychiatrist in private practice in Toronto (who did not want to be named because of Zucker's power in the community) says that when she works with gender atypical children, she tries "to let them know their thoughts, feelings and behaviours are all acceptable. I try to communicate my enjoyment and respect for the unique ways they express themselves, and I encourage their parents to do the same."

She is pessimistic about Dr Zucker's work. "The children I've seen who have been through the program typically say how they got help with their so-called problem," she says. "But they look uncomfortable and defeated, and they tend to avoid talking about their sexuality."

Some community activists suggest focussing more on changing society rather than kids. Rupert Raj is a community activist and gay transgendered man who is studying to get his MA in counselling psychology. He advocates "a holistic approach that moves beyond the focus on the individual to encompass the family, educational system, service providers and the community."

Raj anticipates that just as lobbying and political pressure transformed the medical profession's - and the mainstream's - perception of homosexuality, so too it will transform notions of gender and gender appropriate behaviour.

"The Clarke is behind the times," he says. "They have to rethink their assumptions, re-look at the idea of GID in kids. Surely there must be other treatment options. We are moving into a time when transgendered people and androgynous people are more accepted."
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