A Tale of Two Clinics

This is a tale of two academic gender clinics -- for one it is the best of times, for the other, the worst.

I will start with the worst -- not only the worst of times, but the worst gender clinic in North America -- at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. The Gender Identity Clinic (GIC) is being closed by the Province of Ontario, after an investigation which led to the dismissal of the clinic's gender identity director, Kenneth Zucker. Dr. Zucker has long been considered by his peers as one of the leading experts in transgender medicine, so much so that he, a psychologist from Canada, was put in charge of the revision of the gender identity section of the psychiatric bible, the DSM 5. (For those who may be unaware, psychiatrists are medical doctors, while psychologists have done advanced professional work in psychology. Sometimes they get along; at other times they do not).

The clinic review was done for the province by independent experts, long after trans health advocates had made the CAMH (also known as "Jurassic Clarke," after its previous name, the Clarke Institute) the poster child of trans conversion therapy. This past year has seen a number of states pass laws banning conversion therapy, years after multiple medical associations had proclaimed conversion therapy harmful to LGBT persons, and this trend was joined by none other than the White House. In other words, it was about time.

The review stated, among many conclusions:

• The GIC's application of its "developmental model" is divorced from important community resources and inconsistent with longitudinal follow-up data on outcomes of gender variant children. Application of heterosexual cisgender as the most acceptable treatment outcome is inappropriate. Pathologisation of family and child is evident; correlational mental health problems are interpreted as causative and run counter to the prevailing clinical worldview on the direction of this correlation. Gender variance itself does not cause psychopathology but rather the distress associated with it does. An aim to treat normal human gender variance is unlikely to be successful and unethical.

• We cannot state that the clinic does not practice reparative approaches (if not outright therapies) with respect to influencing gender identity development.

• Gender variance vs. gender dysphoria should be distinguished and explained.

There is much more - issues of informed consent, accepting the gender variant person as client rather than having treatment driven by the parents, the archaic developmental models being used by the clinic, the lack of a planned successor to Zucker, the lack of community engagement, etc. I suggest those interested read the entire report.

The bottom line is that for decades the Clinic has been promoting a clinical approach to treating gender variant children and adolescents based upon a desire to promote the cisgender heterosexual norm using the confusion of research results generated by the deliberate conflation of trans kids with gender variant gay and straight ones. Muddying the waters has led the profession over the past half century to label trans kids as mentally ill and deviant and in need of reparative therapy. The study made quite clear this was ongoing at CAMH, even if they reported it with a double negative.

The world has changed for the better. Protecting people from trans kids is finally much less important to clinicians than protecting the trans kids themselves, and Dr. Zucker and his team are being forced into early retirement. Some of his allies are disappointed, but science marches on.

Now, for the clinic that has turned itself around, I turn to Johns Hopkins University School of Medicine. JHU has a long history of bias and bigotry - against the mentally ill, African-Americans, women, and the gender variant - and the bête noire of the trans community for the last forty years has been Emeritus Professor of Psychiatry, Paul McHugh. Dr. McHugh, an eating disorders specialist, was brought in by the Hopkins administration in the early 70's to shut down its pioneering gender identity and gender reassignment clinic. I was unprivileged to be evaluated by them at that time, and though the approach was highly sexist, causing me to leave, at least Dr. Money and his team of surgeons were the first to provide a necessary service in the U.S.

Dr. McHugh, with no expertise in sexual medicine, not only shut down the program, he has continued to spread his venom against trans persons from his lofty perches, including the President's Council on Bioethics (Bush43) and the Vatican. There is no question he has caused a great deal of pain to trans persons over the decades, and continues to do so as an emeritus professor.

However, he has the academic freedom to spout whatever nonsense he likes when he's given a platform, and there are enough bigots out there that do just that. That being said, Hopkins cannot muzzle him, and, more importantly, has revamped its program to be very supportive of the trans community. As an example, while the right wing of the Maryland legislature for years intoned the name of JHU in its attacks on the gender identity bill, often quoting McHugh, what they failed to mention was that the Hopkins faculty was in support of the legislation (which passed last year). I read the testimony from their clinic's staff on behalf of the bill in the Senate Judicial Proceedings committee hearing on SB 212. Drs. Kraft, Lehne, and Thomas of the Sexual Behaviors Consultation Unit have written letters for surgery for many women and men, including me. The dinosaurs of the group, mentioned in the Advocate article, such as Thomas Wise and Charles Schmidt, are as surely on their way out as Ken Zucker.

People in need of care very quickly get their information on the grapevine, with the digital grapevine even quicker and more efficient than the pre-internet one. While it would be a better outcome if Wise and Schmidt were let go, most trans persons know not to visit them. Their influence has waned, and should not be exaggerated.

A friend and colleague of mine, Gender Rights Maryland board chair, Sharon Brackett, writes:

Both my letters for surgery came from there. Kate [Thomas]and Greg [Lehne]. I have many friends who also got their letters there as well. Kate has probably seen hundreds of us over 25+ years. I have no data as to what happened to others there. If it [something untoward] happened that is too bad but it is not much different than the treatment I had from one particular genital surgeon on a consult.

While there is great value in understanding the history of medicine's engagement with trans persons, in which Hopkins plays a leading role, articles such as this one in the Advocate paint a picture of an earlier time which should not be seen as a current threat. Quoting our adversaries from the 70's makes as much sense as their quoting research and administrative actions from the same era to use against our civil rights and access to care. The paradigm has changed, and while it's not changing fast enough for some, for those of us who were there near the inception, it's been a remarkable turnaround.

I'd love for McHugh, Schmidt, Wise and Zucker to step back and reflect upon this quote from Dickens in A Tale of Two Cities:

A wonderful fact to reflect upon, that every human creature is constituted to be that profound secret and mystery to every other.

Were they to do so, they could retire with some dignity. They might even announce their retirement with another famous quote from the Dickens classic:

It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.