The directors of the Child and Adolescent Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH) have been presented with an opportunity to finally get on the right side of history. Will they take it?
There has been a flurry of new interest in the clinic well known for encouraging children to conform to gender norms and offering psychological treatment that discourages children from growing up to be transgender. Having published over 100 articles that advocate this approach, the clinic has, unsurprisingly, been at the centre of several decades of serious criticism. But recent events have upped the stakes, and those of us who have long been critical of the clinic's approach are watching.
This controversy became impossible to ignore when NDP MPP Cheri DiNovo announced the tabling of a private member's bill on March 11 that would bar Ontario health professionals from attempting to prevent a young person from growing up to be LGBT, a practice referred to in the bill as "conversion therapy."
A petition calling for the termination of clinic head Kenneth Zucker had been circulating online for some months. And on February 4 CAMH announced that an external six-month review of the clinic would be conducted in response to community concerns.
Calling this a controversy is putting it lightly.
In the latest twist, the clinic's founder, psychiatrist Susan Bradley, has issued a letter calling on DiNovo to withdraw her proposed legislation.
Bradley's missive contends the bill "infringes on [a] patient's and parent's rights to seek appropriate treatments for their children." But it contains a number of erroneous claims, the first of which is her presentation of the clinic as merely a passive recipient of parents' concerns.
There are indeed many parents who are concerned about a child whose gender doesn't fit the mould. Will their child be excluded? Will they be excluded because of their child? These are reasonable questions, and the overwhelming majority of professionals who work in this area, including Stephen Feder from Ottawa's Children's Hospital of Eastern Ontario, now describe their task as supporting parents to understand that gender diversity is not a problem and that their children need support for their identity in order to be well.
While Bradley describes the clinic as simply responding to parental worries, if we look a little closer we find the clinic actively engaged in casting gender diversity as a worry in the first place.
In 2006, a U.S. family that was seen at CAMH's clinic described their treatment on National Public Radio. The mother recalled being told to forbid her son to play with his favourite toys, clothes and female friends in order to make him more masculine.
Describing this type of parental instruction in their 1995 book, Zucker and Bradley write: "Some parents, especially the well-functioning and intellectually sophisticated ones, are able to carry out these recommendations easily and without ambivalence."
And what happens when parents don't carry out these recommendations?
In 2012, Zucker and colleagues wrote in the Journal Of Homosexuality: "When parents have significant reservations about setting limits on the child's cross-gender behaviours… this requires considerable discussion."
Bradley's letter states that this treatment does not involve "coercion." This is an interesting choice of words, since "coercive" is precisely the term Oakland child psychiatrist Herbert Schreier used when asked in 2013 to comment on the CAMH model.
As clinic head, Zucker stated in a 2008 article in the journal Neuropsychiatrie De L'enfance Et De L'Adolescence that the clinic would support some adolescents or teens to transition to a new gender, because older youth are seen as already established in a trans identity. Young children, on the other hand, are described as being "malleable."
It would be better, the clinic has said in no uncertain terms, not to be trans. Zucker and colleagues wrote in 2012 in the Journal Of Homosexuality: "If the parents would like to reduce their child's desire to be of the other gender, the therapeutic approach is organized around this goal."
Bradley's letter states that this is not "conversion therapy" and that to use this term is to conflate religious attempts to "cure" gays and lesbians with what she refers to as the work of "modern-day" mental health professionals.
It is true that the terms "conversion therapy" and "reparative therapy" have a history of being used to describe efforts, often religious-based, to convert lesbians and gays to heterosexuality. It is true that this type of treatment has often been conducted on adults. So what, then, should we call it when a therapist tries to prevent a young child from growing up to be trans?
"Conversion therapy" is currently standing in as the term of use. We could debate that, but the lack of an agreed-upon term for a problem does not make it less of a problem. And a very big problem it is.
In 2011, the World Professional Association for Transgender Health (WPATH) stated that "treatments aimed at trying to change a person's gender identity" are "no longer considered ethical." In January of this year, the Canadian Association of Social Workers issued a statement that reads in part: "Any professional attempt to alter the gender identity or expression of a young person to align with social norms [is] an abuse of power and authority."
In the 2006 Yogyakarta Principles drafted by international LGBT human rights experts, the CAMH program sounds strikingly similar to the description of "medical abuse" in that gender identity is treated as a condition to be "treated, cured or suppressed." Last week, Liberal Health Minister Eric Hoskins, who has welcomed DiNovo's bill, announced he will be asking medical colleges to amend regulations to specify that the practice of "conversion therapy" amounts to professional misconduct. As of last year, the right to self-identify one's gender is protected in the Ontario Human Rights Code for residents of any age.
Bradley's letter expresses concern that DiNovo's bill infringes on a "parent's right" to choose treatment for their child. But let's be clear here. Bradley is asking us to worry that those parents who want their child to be more gender-normal might lose their "right" to enlist professionals to help them achieve this goal. The children, in this case, have no choice. If it's not already clear, this is the reason for DiNovo's legislation.
In comments to the Toronto Star, CAMH's medical director Kwame McKenzie described the issue as follows: "Therapists are caught in the middle, between parents who may want their girl to be a girl, and boy to be a boy. And at the moment, you have some professionals who say, 'Okay, we should support the parents,' and some people in various groups in the community who say, 'No, you should support the child here.'"
If by "various groups in the community," McKenzie means the overwhelming majority of medical and mental health professionals in this field as well as international human rights experts, then I suppose we can agree on this formulation of the debate. But again we are debating whether parents should get to decide who their child is.
Most professionals agree that in the majority of cases it doesn't have to come down to a battle between the child's will and the parents'. Instead, they say most parents, if supported and educated, will be able to let go of their expectations and support their child, whoever he or she turns out to be. What DiNovo's legislation will do is ensure that the professionals who respond to these parents will have this goal in mind. And finally bring the mental health profession onto the right side of history.
Jake Pyne is a Trudeau Scholar and Vanier Scholar in the McMaster School of Social Work.