The 5th Column in Trans Health Care

I have seen and heard some truly strange things in my time as an activist.  However nothing was odder than what I experienced at this year’s World Professional Association of Transgender Health conference. A senior psychiatrist and psychologist were on a panel, where they strenuously opposed laws banning reparative therapy, especially if those laws included gender identity.  This wouldn’t seem to make any sense on the surface: the American Medical Association, American Psychological Association, and American Psychiatric Association have all denounced reparative therapy as harmful quackery.

However, given that the two were Dr. Richard Green and Dr. Kenneth Zucker, their opposition made a lot more sense.

In the 80’s, Green published “The Sissy Boy Syndrome: The Development of Homosexuality.” He also published a study in 1986 which concluded that “parental discouragement of the boys' girlish behavior tended to result in a more heterosexual orientation.” That is to say, punishing children for gender non-conforming behavior could change their sexual orientation. 

Dr. Zucker has practiced the same sort of coercive behavioral modification on gender non-conforming children since the 1980’s as well. In 1990 his book described the objectives of his therapy: “Two short term goals have been discussed in the literature: the reduction or elimination of social ostracism and conflict, and the alleviation of underlying or associated psychopathology. Longer term goals have focused on the prevention of transsexualism and/or homosexuality." Similarly, a 2003 report in the Journal of the American Academy of Child and Adolescent Psychiatry called Zucker’s techniques "something disturbingly close to reparative therapy for homosexuals." The report that cost him his job at CAMH concluded that the allegation he practiced reparative therapy could not be disproven.

When Richard Green stood up to explain his opposition to bills banning reparative therapy, he framed it in essentially the same ways lawyers for reparative therapists in California and New Jersey did: laws regulating therapists violate freedom of speech, freedom of religion, a patient (or parent’s) right to determine what sort of care is appropriate, and an intrusion on the patient / client relationship. One audience member, who is a practicing lawyer actively involved with cases against reparative therapy, helpfully pointed out that the jury in New Jersey, the 9th Circuit, and the Supreme Court disagreed with him on all counts.

Green appeared agitated, and his response could be summed up with: “Well, I think they’re wrong.”

Dr. Zucker took an even more aggressive approach when he stood up, and was clearly in a mood to fight rather than persuade. He began by insulting the audience, snarkily remarking “it feels like a Bernie Sanders rally in here.”  His primary objection to bans on reparative therapy centered around the risk that a therapist would falsely be accused of practicing it, as he feels he was. This counter-narrative bears some discussion, as it is a relatively new one.

Most therapists, and especially those who work with children, take a risk every time they close the door with a patient that they will be accused of inappropriate or sexual behavior with a minor. The consequences of such allegations are undeniably severe. It stretches credulity that therapists who have been willing to take such a risk of being accused of child molestation for 35-40 years, would suddenly want to close up shop over the much less dangerous risk of being accused of practicing conversion therapy.

Unless, of course, they were practicing reparative therapy to begin with...

Meeting a standard of therapy which ensures you aren’t practicing reparative therapy is easy, however.  Laws against conversion therapy include a rather large loophole for legitimate therapists. These laws provide exceptions for “psychotherapies that provide acceptance, support, and understanding of clients or the facilitation of clients’ coping, social support, and identity exploration and development…” In reality, having a practice which meets these very minimal standards to avoid meeting the definition of reparative therapy is not difficult.

Dr. Zucker also implied that there was no proven harm in discouraging gender non-conforming behaviors. This assertion, in combination with his previous argument about risks, struck me as deeply disturbing on several levels.

Fist, it fails to recognize very public instances of reparative therapy leading to the deaths of transgender youth like Leelah Alcorn, which happened mere miles from where I lived in Ohio.  It also ignored the very real problem of “kidnappings for Christ” in which LGBT youth are signed over to a third party by their parents to be “cured” in a forced labor camp. The idea that there is somehow moral equivalency between a hypothetical inconvenience and minor risk to therapists, and the actual observable harms done to LGBT youth by reparative therapy enterprises like those described above, is asinine.

It also begs the question of whether such mental health professionals are more concerned about their careers than the welfare of the youth they claim to hold so dear.

Finally, the line of thinking that transgender children are a completely different species than lesbian and gay youth where harms are concerned stretches credulity.  In the 1970’s the disgraced George Rekers attempted to prevent “sissy boys” from growing up to be homosexual by having their parents “discourage” (i.e. punish) gender non-conforming behavior.  The results were horrific, and part of why every mental health organization accepts reparative therapy is harmful. But now, 40 years later we are told by Dr. Zucker that applying nearly identical methods to gender non-conforming to prevent them from being transgender (instead of gay) results in zero harm, or that further study is required.

Imagine conducting a study in which 100 puppies are systematically dropp-kicked with a steel-toed boot, and observing that this is usually bad for their physical and mental health. One would not then need to drop-kick 100 kittens with a similar boot to make a reasonable assumption that it would be harmful to them as well. Yet Green and Zucker are insisting that gay and transgender people are so unalike that one will suffer harm from being dropped-kicked, but not the other. Or, that we need far more studies on transgender children before we draw any conclusions about the long-term effects of being punted.

There are a few therapists in the United States who agree with Green and Zucker. Most have the good sense not to oppose such laws in public, but behind closed doors is another matter for a few.

As it is, their efforts may become something of a moot point. There is currently a groundbreaking complaint with the Federal Trade Commission to ban reparative therapy throughout the US as a fraudulent commercial activity.

In the end, the speakers did not win many to their cause. Despite objections from the audience, Dr. Zucker remained combative and defiant throughout the panel. At the end, a non-American doctor who treats transgender youth standing next to me at the back of the room remarked, “I’ve never heard Dr. Zucker speak before, and I’ve tried to keep an open mind. Now that I have, I can say that all the hateful things I’ve heard about him were absolutely true.”