A little boy who enjoys playing with dolls, avoids sports and other rough activities, prefers the company of girls, and says that he wants to take care of babies when he grows up is likely to be diagnosed with gender identity disorder—even though such behavior is perfectly acceptable in girls. “Behaviors that would be ordinary or even exemplary for gender conforming boys and girls are presented as symptomatic of mental disorder for gender nonconforming children,” says Katharine Wilson, Ph.D., an advocate for GID reform. “For boys, these include playing with Barbie dolls, homemaking and nurturing role play, and aversion to cars, trucks, competitive sports and ‘rough and tumble’ play. For girls, pathology is implied by playing Batman or Superman, competitive contact sports, ‘rough and tumble’ play, and aversion to dolls or [to] wearing dresses. It is unclear whether the intent of the DSM is to reflect such dated, narrow and sexist gender stereotypes or to enforce them.”
The diagnostic criteria for GID have been steadily broadened in successive revisions of the DSM, critics of the diagnosis point out, and the broadening of the criteria points to its essentially subjective (and disciplinary) character. “Recent revisions of the DSM have made these diagnostic categories increasingly ambiguous, conflicted and overin-clusive,” says Katherine Wilson. “The result is that a widening segment of gender non-conforming youth and adults are potentially subject to diagnosis of psychosexual disorder, stigma and loss of civil liberty.” Wilson and other activists fighting to have GID redefined or removed from the DSM point out that even children who do not express discomfort with their gender identity are now subject to the diagnosis, if significant adults in their life (parents, teachers) feel that their behavior is inappropriate for their gender. “GID of Children is clearly not limited to ego-dystonic subjects. High functioning children may be presumed to meet criteria A and B on the basis of cultural nonconformity alone,” Wilson argues. “A child may be diagnosed with gender identity disorder without ever having stated any desire to be the other sex.” She points out that “overbroad diagnosis contributes to the stigma and undeserved shame that gender nonconforming youth must endure,” and that parents who accept their children’s gender nonconformity “live in fear of persecution by courts, school officials, and government agencies who infer a broad interpretation of GID of Children and seek punitive treatment remedies.”
Critics of the diagnosis have also pointed out the paradoxical fact that while homosexuality is no longer included in the DSM as a psycho-pathology, research shows that boys diagnosed with GID in childhood are far more likely as adults to identify as gay men than as transsexuals or cross-dressers. They argue that the GID diagnosis is thus being used by parents and clinicians to target children (mostly boys) suspected of being “pre-homosexual.” Although “there are simply no formal empirical studies demonstrating that therapeutic intervention in childhood alters the developmental path toward either transsexual-ism or homosexuality,” according to experts, gender-variant children and adolescents are subject to a range of interventions focused on changing their behavior and self-concept. In a paper titled “The Disparate Classification of Gender and Sexual Orientation in American Psychiatry,” Wilson notes that “American psychiatric perceptions of etiology, distress, and treatment goals for transgendered people are remarkably parallel to those for gay and lesbian people before the declas-sification of homosexuality as a mental disorder in 1973.”
There is also a clear parallel between the treatment of intersexual children and transgendered children, many allege. Just as the bodies of intersexual children are surgically manipulated to conform to anatomical sexual dimorphism, transgendered children are subjected to psychiatric interventions focused on having them conform to socially sanctioned standards of gendered behavior and appearance.
Transgender youth face formidable challenges. Along with all the other conflicts and confusions associated with adolescence, they must come to terms with a gender identity that all of society tells them is “wrong” or “bad” or “sick.” “No single group has gone more unnoticed by society, or abused and maltreated by institutional powers, than youth with transgender needs and feelings,” say Gianna E. Israel and Donald E. Tarver II, M.D., in their book Transgender Care. “The overwhelming message from family, adult society, and youth peers says that gender nonconformity is a sick, mentally unstable condition to be feared, hated, and ridiculed.” All adolescents struggle to understand and accept their gender and sexuality, but for transgendered kids this is a perilous pursuit, fraught with risk and uncertainty. The pressure to conform to societal expectations of “normal” behavior and appearance comes from all sides—parents, school authorities, the media, and (most daunting for an adolescent) peers. Though there are no Robert’s Rules of gender posted at home, in schools, and in churches, the rules exist and are often harshly enforced by peers, parents, and school authorities.
People who have never known a lesbian, gay, or transgendered child often assume the child knows exactly who he or she is. Nothing could be farther from the truth. The process of self-realization and self-understanding is often a slow and painful one. People surrounding the child may take note of the child’s gender variance long before the child articulates a sense of being different. In a healthy, accepting environment, the child’s process of self-discovery is facilitated by the emotional support provided by a loving family—even when the family knows little about gender variance per se. Family members simply love the child and respect his or her individuality, without requiring that he or she conform to certain codes of dress and behavior. “If there is any cure for children or youth with gender-identity issues, it can be found in the key words acceptance, androgyny, compromise, and communication. It is important for parents to recognize that all children need to be accepted for what they are, not for what others believe they should be,” say Israel and Tarver.
But such understanding remains all too rare. “Parents with resources large or small will spend their last penny trying to help their young son or daughter conform to their concept of what is ‘normal,’” according to these researchers. When a family is coping with other Stressors, such as alcoholism, separation and divorce, or financial problems, the gender-variant child is very often scapegoated as the source of the family’s difficulties. The same thing happens in families devoted to maintaining the appearance of perfection. “Because gender-identity conflicts are still perceived as a mental health disorder by uninformed care providers, today’s transgender youth still are at risk of being treated in the same manner gays and lesbians encountered years ago. Sadly, these treatment approaches are little more than abuse, professional victimization, and profiteering under the guise of support for parents’ goals.”