Politicians are not psychiatrists

The toddler — “Chris,” not her real name — was only two years old when she told her parents, “I am a boy.” They weren’t alarmed at first, but as her fixed idea persisted, concern set in. When, age seven, Chris punched her vagina in anger, they sought family therapy at CAMH’s Child, Youth and Family Program’s Gender Identity Service (GIS).

Dr. Ken Zucker, Clinical Lead at the GIS, and acknowledged as one of the world’s foremost authorities in this domain, supervised and participated in Chris’s therapy, which was intense and protracted. But by age 11 Chris voluntarily identified as female, grew out her cropped hair and asked for girl clothes. Now 19, her mind and body remain in sync.

Chris’s parents feel immense gratitude to Dr. Zucker for sparing their daughter a lifetime of hormone treatments, and possibly major surgery. They also feel lucky in their timing.

For Ontario’s Bill 77, now on the cusp of passage, known as the Affirming Sexual Orientation and Gender Identity Act 2015, will ban funding for “any services rendered that seek to change or direct the sexual orientation or gender identity of a patient, including efforts to change or direct the patient’s behaviour or gender expression,” and will ban health professionals like Dr. Zucker from “carry(ing) out any practice that seeks to change or direct the sexual orientation or gender identity of a patient under 18 years of age.”

For trans activists this is a victory. Over the past decade, the trans rights movement has successfully promoted the alignment of gender dysphoria (the DSM-5 terminology for Gender Identity Disorder) with sexual orientation, advancing the false idea that therapy for the former — which, if undertaken in childhood, has a solid record of success in re-connecting gender identity with biological reality — is comparable to “conversion therapy” for gays, acknowledged by most mental-health professionals, including those at the GIS, to be ineffective and unethical.

Sexual orientation and gender dysphoria are in fact distinct phenomena, and Bill 77’s conflation of the two is based in progressive sexualidentity correctness rather than mental-health epidemiology. On the evidence, a ban on conversion therapy alone can be justified, but a ban on gender-dysphoria therapy cannot. Unfortunately, the inclusion of trans rights under the LGBT consciousness-raising umbrella encourages an assumption of parity, and obscures the unsoundness of Bill 77’s one-size-fits-all approach.

I spoke with Dr. Susan Bradley, professor emeritus at the University of Toronto, now retired from psychiatric service at CAMH and the Sick Children’s Hospital, who founded the GIS in 1975. She considers Bill 77 “disgraceful.” Dr. Bradley hopes to testify to the Justice Committee today, but believes it is “a charade even having this public meeting,” since “Minister of Health (Eric) Hoskins has been unresponsive to our efforts to have a discussion of the complexity of the situation.”

According to Dr. Bradley, gender dysphoria is rarely a unilateral problem. Such children, she says, are usually born with “temperamental vulnerability.” A number of them harbour “traits within the autism spectrum” or have OCD, as was the case with Chris, above. In the short term, valorizing the fixed idea of these typically strong-willed children can understandably seem the most practical and least demanding route for empathetic parents and educators. Yet, while therapy is far more stressful, the payoff is inestimable. (Dr. Zucker and his team, it should be noted, are not dogmatists, and for older children whose crossgender identity is fixed, they support gender transition and hormonal therapy.)

It is not society’s fault that over 40 per cent of transgendered people attempt suicide, either before or after transitioning. A 2011 long term Swedish study that followed a 30-year trajectory of 324 people who had sex reassignment surgery found that suicide rates 10 years after surgery were 20 times that of the non-trans population.

Suicide is a sign of depression. If depression persists in so many people who have surmounted the only perceived

Ontario’s Bill 77, the Affirming Sexual Orientation and Gender Identity Act, is a dangerous overreach

obstacle in the way of their happiness, clearly gender dysphoria is only one manifestation of a cluster of psychological difficulties in play here. Surely it is the government’s first responsibility to try to prevent suicides rather than to validate emotive claims made by those least capable of assessing their condition with objectivity.

Bill 77 rewards feelingsbased political activism and punishes reason-based, apolitical research. The implications of this legislation are grave. For when politicians usurp the role of mentalhealth professionals, taking it upon themselves to decide what is a disorder and what is not, what obviously distressing syndromes deserve to be researched and treated and what “should” not be, they are not only shortchanging those afflicted with gender dysmorphia and handicapping their anguished parents’ search for help, they are effectively undermining the entire field of psychiatry. The ill-conceived and over-reaching Bill 77 sets a dangerous precedent.