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transsymbolEarlier this week, we made good mention of some troublesome news regarding the American Psychiatric Association (APA), the Diagnostic and Statistical Manual (DSM), and one Kenneth J. Zucker.Be forewarned: I?m about to get wordy. Please also have faith that this is well worth the time spent reading.Some backtracking may first be in order. The DSM is easily considered the ?bible? or ?ultimate guide? for any mental health professional making diagnoses, treating patients, and/or looking for 3rd party payers (e.g., insurance providers). Published by the APA, the DSM is currently in its 4th edition (DSM-IV), with a 5th revised edition (DSM-V) slated for completion in 2012. Past revisions of the DSM have included the addition of Post-Traumatic Stress Disorder (PTSD) to the DSM-IV and the removal of homosexuality (which had appeared prior as a sociopathic, then sexual deviate personality disorder) in the DSM-III. As historically evidenced, the DSM and APA are capable of doing both great good and great harm; it is the latter that I am most concerned about.While homosexuality was finally removed from the DSM in 1982, Gender Identity Disorder (GID) remains. Currently, the DSM-IV groups GID, sexual dysfunction, and paraphilias under the umbrella of ?sexual and gender identity disorders.? With DSM-V currently in the works, this grouping is also up for revision. Enter: Kenneth J. Zucker.
APA STATEMENT ON GID AND THE DSMMay 9, 2008The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:* Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.* Paraphilias, chaired by Ray Blanchard, Ph.D.* Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012.
This may sound well and good, until one begins researching Dr. Zucker. Currently serving as the Head/Psychologist-in-Chief of the Gender Identity Service, Child, Youth, and Family Program at the Centre for Addiction and Mental Health in Toronto, Dr. Zucker?s history of treating gender identity disorder in children and youth is vast. Further research of his career digs up another nugget of gold: Zucker has many ties with the Ex-Gay movement, which uses reparative/conversion therapy for treating homosexuality (e.g., turning homosexuals into heterosexuals). You see where this is heading, right? Zucker uses reparative/conversion therapy to ?cure? GID in trans* children and youth; and he cautions, ??clinicians have an ethical obligation to inform parents of the relationship between GID and homosexuality." (Quote culled from narth.com)The APA has a position statement against reparative therapy (not to mention a GLBT committee, staffed by GLBT psychiatrists who oppose reparative/conversion therapy). Considering this stance, it makes little to no sense that they would see it fit to place Zucker, an active practitioner of reparative/conversion therapy, as head of the GID Workgroup; but, alas, they have.While a select few have accused me of being alarmist, I think that is far from the case: the threat that I see is quite real. Zucker?s appointment both saddens and frightens me on multiple levels. While I agree that including GID in the DSM can be helpful in procuring insurance coverage for expensive hormone replacement therapy (HRT) and sex reassignment surgery (SRS), I?ve found little evidence that Zucker supports either; instead, the reworking of the DSM?s GID entry will be chaired by someone who is an active practitioner of rehabilitating trans* children and youth via nigh-stone age methods. And while the APA has been careful to state that Zucker?s influence will not extend to clinical treatment of transpersons, I find it difficult to believe that his methods will go entirely ignored. It is a slippery slope that the APA is traversing, especially in a sociopolitical climate that still stigmatizes both homosexuality and transsexualism/genderism.Online writing about Zucker (his past, present, and future; along with reactions from GLBT, heterosexual, and/or cisgendered folks) is plentiful. Below is a sampling links that I highly recommend perusing.There is a wealth of information (along with informative links) to be found at the Transgroup Blog.Read what Ex-Gay Watch has to say about Zucker and Bradley.Delve into Zucker on Transsexualism at TS Roadmap.Listen to a heart-rending piece on two transsexual/gendered children (one of whom is being treated by Zucker) at NPR.I cannot stress enough that we need to be informed, and then let the APA know what we think. This is an issue that matters to all of us: homosexual, bisexual, queer, and heterosexual; transsexual/gender and cissexual.sigtal Health in Toronto, Dr. Zucker?s history of treating gender identity disorder in children and youth is vast. Further research of his career digs up another nugget of gold: Zucker has many ties with the Ex-Gay movement, which uses reparative/conversion therapy for treating homosexuality (e.g., turning homosexuals into heterosexuals). You see where this is heading, right? Zucker uses reparative/conversion therapy to ?cure? GID in trans* children and youth; and he cautions, ??clinicians have an ethical obligation to inform parents of the relationship between GID and homosexuality." (Quote culled from narth.com)The APA has a position statement against reparative therapy (not to mention a GLBT committee, staffed by GLBT psychiatrists who oppose reparative/conversion therapy). Considering this stance, it makes little to no sense that they would see it fit to place Zucker, an active practitioner of reparative/conversion therapy, as head of the GID Workgroup; but, alas, they have.While a select few have accused me of being alarmist, I think that is far from the case: the threat that I see is quite real. Zucker?s appointment both saddens and frightens me on multiple levels. While I agree that including GID in the DSM can be helpful in procuring insurance coverage for expensive hormone replacement therapy (HRT) and sex reassignment surgery (SRS), I?ve found little evidence that Zucker supports either; instead, the reworking of the DSM?s GID entry will be chaired by someone who is an active practitioner of rehabilitating trans* children and youth via nigh-stone age methods. And while the APA has been careful to state that Zucker?s influence will not extend to clinical treatment of transpersons, I find it difficult to believe that his methods will go entirely ignored. It is a slippery slope that the APA is traversing, especially in a sociopolitical climate that still stigmatizes both homosexuality and transsexualism/genderism.Online writing about Zucker (his past, present, and future; along with reactions from GLBT, heterosexual, and/or cisgendered folks) is plentiful. Below is a sampling links that I highly recommend perusing.There is a wealth of information (along with informative links) to be found at the Transgroup Blog.Read what Ex-Gay Watch has to say about Zucker and Bradley.Delve into Zucker on Transsexualism at TS Roadmap.Listen to a heart-rending piece on two transsexual/gendered children (one of whom is being treated by Zucker) at NPR.I cannot stress enough that we need to be informed, and then let the APA know what we think. This is an issue that matters to all of us: homosexual, bisexual, queer, and heterosexual; transsexual/gender and cissexual.sig