More on the Dr. Phil Show Little Boy Lost – Sparks fly among guests

This clip features some give and take between panelists on the Dr. Phil Show episode on gender identity issues. In this segment, Dr. Siegel defends moms by saying there is no evidence that being too close to a boy will make him want to be a girl. Dr. Nicolosi says Siegel is oversimplifying his reparative theory. What do you think?
Lights, camera, action!

The Dr. Phil Show on gender identity, Part 3 – Should puberty be delayed?

Near the end of the Dr. Phil Show on gender identity, two guests who were not on stage provided a mini-introduction to the controversy of using hormones to delay puberty. Dr. Jo Olson and Dr. Eva Cwynar are two prominent doctors who work in the field of gender disorders and endocrinology. And action!

From the Dr. Phil website, here is a rough transcript of their comments.

Dr. Phil turns to two more medical professionals in the audience. Endocrinologist Dr. Eva Cwynar says parents need to wait and see what happens with puberty and not give in to their child’s fantasy of wanting to become the opposite sex. Dr. Jo Olson, pediatrician with the Transgender Clinic of Children’s Hospital Los Angeles, says children are born this way, and she helps kids make the transition through hormone therapy.
“Dr. Olson, at what point do you begin that?” Dr. Phil asks.
“It’s a different process for each child. It’s really important to recognize that young people and their families come in at very different stages of this process. Many of the people we see have actually already gone through puberty, but we do have some patients who are young, in the 12- to 16-year-old age range as well,” Dr. Olson says. “However, I want to say that we don’t just provide hormone therapy for young people, and not all young people who want to transition get hormones. We have a multi-disciplinary approach in our clinic, where they are assessed by a psychologist who is extremely familiar with gender-questioning youth, gender identity disorder and the issues that these young people face, as well as the case manager who understands what these young people go through. And hormones are not the end of the story for every young person.”
“And you work with the family members as well. It’s not just something you do to the child in isolation,” Dr. Phil says.
“Absolutely, and we have many parents who experience this same kind of mourning,” she says, referring to Toni.
“Dr. Cwynar, do you think there’s ever a point when hormone-blocking therapy is appropriate?” Dr. Phil asks.
“I do,” Dr. Cwynar says. “I think that, as everybody mentioned before, there’s a spectrum of this transgender, and I do believe as well that gender is a definition between the eyes and not between the legs, and that there are certain chemical phenomena, chromosomal phenomena, that occur both in utero and as we develop that make us appear as one sex, but is actually a different sex. I prefer waiting through puberty to see what actually happens when the hormones kick in. There are situations where you have distress and suicidal ideations and because of that, hopefully the family will be there for the child to help them get through that process. So, I like to see the whole adolescence be complete, essentially, before I do anything permanent.”

This is among the most controversial of issues and one with which I have had some professional involvement. I will give one example and then some links from past blog posts which address similar gender identity concerns.
Among several similar cases, I recall a family in conflict where the mother wanted to delay puberty for a GID child but the father did not. In short, the child now post-puberty is strongly identified with the biological gender. Delaying puberty would have been a mistake and the earlier wish to consider it vanished. Other cases are not so clear cut and hence the controversy.
Here are some relevant links to past posts:
Two families, two approaches to gender preferences
Gender identity disorder research: Q & A with Kenneth Zucker
Ken Zucker compares ethnic identity conflict and gender identity conflict
APA issues statement regarding GID and the DSM-V
The Man Who Would Be Queen – Chapters 1 & 2
American Psychological Association comments on DSM gender identity issue
60 Minutes Science of Sexual Orientation: An update from the mother of twins
60 Minutes Science of Sexual Orientation mother of twins, part 2 (this 2 part series is highly recommended)

Gender identity disorder research: Q & A with Kenneth Zucker

As a follow up to the recent broadcasts by NPR and several posts regarding gender identity, here is a Q & A involving J. Michael Bailey and Ken Zucker recently posted on the SEXNET email list. Dr. Zucker is the Head of the Gender Identity Service, Child, Youth, and Family Program and Psychologist-in-Chief at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Dr. Zucker is the chair of the newly appointed Sexual and Gender Identity Disorders working group for the 5th edition of American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V). Dr. Bailey is Professor of Psychology at Northwestern University, prolific sexual orientation researcher and moderator of the SEXNET list. As the NPR article noted, Dr. Zucker has extensive clinical and research experience with persons who experience gender dysphoria. This interview was conducted by Dr. Michael Bailey via email and has been slightly edited for posting here. Both Drs. Bailey and Zucker have reviewed and approved it.

Bailey: Both NPR shows used the phrase “a girl trapped in men’s bodies.” How common is this concern over body image?
Zucker: I would say that, in general, there has not been a lot of good empirical research on body image issues in pre-pubertal children with GID. In adolescence, the Dutch group has reported clear evidence of body image dissatisfaction as one finds in adults. One of my PhD students has a dissertation that should be defended later this year in which we studied body image in boys with GID compared to clinical and community controls. We did detect significant body image differences among the three groups: body image in general and in relation to gender-specific anatomic dysphoria. The boys with GID had a poorer body image in general and, of course, with regard to gender-specific anatomic dysphoria. It is only a first pass at this issue and I will report on this down the road after the dissertation is defended.
Bailey: The case on the second NPR show is of a child (natal boy) who had extreme temper tantrums when not allowed to engage in feminine behaviors. Is this common in the kids you see, or is there something unusual about these kids?
Zucker: This is not uncommon. Some parents will report that if they try to limit cross-dressing that this can be very distressing for the boys. Some parents describe it as “he needs his fix.”
Bailey: You are more familiar than anyone else I know with the difference between the British and Dutch treatment centers that yielded the findings that only 20% of the British kids but 100% of the Dutch kids pursued sex reassignment eventually. Did the Dutch center focus on older children (who were less likely to change their minds)? To the extent that the samples were comparable, it is a shocking difference in outcome.
Zucker: I don’t think the British group has published their data yet. But, yes, the Dutch group data are on adolescents and I think that the British group is talking about clients first seen in childhood, not adolescents. The Dutch group now has a paper that is close to being “in press” on their first follow-up of GID children and then followed up later. The GID persistence rate for their boys was about 20% and the persistence rate for girls was 50%. Their persistence rate for boys appears to be similar to what I have summarized for the boys seen in my clinic (Zucker, 2005), but higher than the 12% rate for girls that we published earlier this year (Drummond et al., 2008). The Dutch group speculates that their girls were, at initial presentation, more extreme in their cross-gender behavior than the girls that we reported on, but that will require more careful analysis.
Bailey: The NPR show, and some people on it, kept implying that some of these kids are “really” transgender, and others are not. I suspect you don’t agree with this way of thinking about it, although you recognize that some kids are more likely to become transgender adolescents and adults than other kids are. Can you remind us which factors are associated with persistence of GID from childhood?
Zucker: I don’t think we know yet. Two possible candidates are age at initial evaluation (later age associated with greater persistence rates) and quantitative metrics of cross-gender behavior in childhood.

By persistence rate, Dr. Zucker is referring to the percentage of GID children who are still GID at a later assessment. In the Dutch group, as well as in Dr. Zucker’s research sample, most boys who want to be girls in childhood, end up as men who do not want to be women. For women in the Dutch sample, half remain GID. I think the assessments of low persistence of GID provide some helpful information to parents who wonder about puberty delay and behavioral interventions with their GID children.
Thanks to Drs. Bailey and Zucker for permission to post this conversation.

60 Minutes Science of Sexual Orientation: An update from the mother of twins


Recently, I posted a link to a NPR broadcast outlining two approaches to treating children who are gender non-conforming in their play and activity preferences. In light of that broadcast and the controversies surrounding these different approaches, I provide an update from Danielle, the mother of twin boys first featured in a 60 Minutes broadcast originally aired on March 12, 2006. The segment, titled Science and Sexual Orientation, was by any measure a provocative program. The producer answered numerous questions about the show on the CBS website and many blogs, including this one, provided commentary. I still use the clip in some of my classes to illustrate a variety of issues regarding how the media interprets sexual orientation research.
One of the most interesting aspects of the show was Leslie Stahl’s interview with twin 9-year-old boys, Adam and Jared. Recently, the mother of the twins, Danielle, wrote researcher Michael Bailey with an update regarding her son, Adam. Dr. Bailey and Danielle allowed me to share the note on the blog. She does not preach or lecture but rather reports on her experience. First, to set the stage, I want to reproduce an excerpt of the 60 Minutes segment introducing Adam and Jared:

The bedrooms of 9-year-old twins Adam and Jared couldn’t be more different. Jared’s room is decked out with camouflage, airplanes, and military toys, while Adam’s room sports a pastel canopy, stuffed animals, and white horses.
When Stahl came for a visit, Jared was eager to show her his G.I. Joe collection. “I have ones that say like Marine and SWAT. And then that’s where I keep all the guns for ’em,” he explained.
Adam was also proud to show off his toys. “This is one of my dolls. Bratz baby,” he said.
Adam wears pinkish-purple nail polish, adorned with stars and diamonds.
Asked if he went to school like that, Adam says, “Uh-huh. I just showed them my nails, and they were like, ‘Why did you do that?'”
Adam’s behavior is called childhood gender nonconformity, meaning a child whose interests and behaviors are more typical of the opposite sex. Research shows that kids with extreme gender nonconformity usually grow up to be gay.
Danielle, Adam and Jared’s mom, says she began to notice this difference in Adam when he was about 18 months old and began asking for a Barbie doll. Jared, meanwhile, was asking for fire trucks.
Not that much has changed. Jared’s favorite game now is Battlefield 2, Special Forces. As for Adam, he says, “It’s called Neopets: The Darkest Faerie.”
Asked how he would describe himself to a stranger, Jared says, “I’m a kid who likes G.I. Joes and games and TV.”
“I would say like a girl,” Adam replied to the same question. When asked why he thinks that is, Adam shrugged.

In this email, Danielle reveals that at one time Adam thought he would like to be a girl. In fact, she considered puberty delaying drugs to allow Adam more time to reflect about his gender identity. At one point, he wanted to be a girl and bear a child via his own body.
With this update, Danielle discloses that Adam is not as definite about wanting to transition as he once was. She reports that he has adopted a male identification, albeit a somewhat unconventional one. Here is her update:

Adam has changed since we did the 60 Minutes show. He is the same yet different. From the research done a gazillon years ago about children like him- he’s basically following the guidelines as they were told to me. One day I would love to get my hands on the actual research papers! Anyway, he turns 12 on [recently]. He still shows a preference for society labeled “girl” items, yet he no longer states he wants to change his body into a girl. He no longer talks about having a baby from his actual body or wanting to know when he will start to grow his breasts. I think most of these changes are due to society (school peers) and his awareness of the actual facts of life. His favorite color is now purple instead of pink and he still prefers to buy “girl” tennis shoes. He dreams of becoming an actor/model and being a professional chef. As I stated, from what I know of this past research, he’s reaching the age where he’s blending in with his peers. I expect the next two years of Middle School to be difficult ones. Then he goes into High School where differences are just a way of life. I’m thinking he may actually find out who he is some time towards the end of High School. Again it follows what I know of this mysterious research paper.
I belong to several email groups with other families that have children like Adam. I don’t participate much because I’m not sure if most of them are following the right path with their children. I often wonder “if” I had told Adam that “yes” he could be a girl when he became old enough would he have stayed on that track of thought? However, at the urging of his therapist, I told him I understood he was a girl yet he was really a boy and couldn’t be a girl. A lot of the parents are allowing their children to grow long hair, dress 100 % as a girl, and go to school with a girl name and girl clothing. Therefore they are totally embracing their child in the opposite sex role. The children are living that role and that life style. So have I done my son an injustice by telling him that he has a boy’s body and even if he wants to be a girl during school hours he had to be the boy as his body was made? Then again, I have allowed him to wear just about anything he was comfortable wearing.
It’s a dilemma that I don’t think we will know the end of until this generation of children grows up. What happens if some of these children that have male bodies but are living life as a girl all through grade school finally reach an age where they decide they really don’t want to have a sex change and be a physical girl? Then what will the ramifications be on that child because of the parents’ actions?
It’s not like my child has Down syndrome and I can go to the library and check out 100s of books to get guidance on how to raise him. There just isn’t much out there for parents who face raising a child like my Adam. I have so many questions about parenting him and very little answers. So I go with my gut and wonder daily if I have made the wrong decision or if these other parents are making the wrong decision. Then again, what may be the wrong decision for one child in this situation may be the right decision for the other. Ah, what a world we live in! Fifty years ago we wouldn’t even be having these types of conversations or email groups.
I have to share something about Adam. I have often wondered how these other kids are developing compared to Adam. Many in the groups have started hormone therapy to stop puberty in the kids. That way the kids have more time to mature and make the final decision about the course of their lives. For the boys they won’t develop the deeper voice and the Adam’s apple and male characteristics. If they decide to transition the theory is that it will be easier without these developments. I made an appointment for Adam to have some baseline tests done. I was seriously thinking about doing the hormone therapy for him to give him more time too. However, much to my surprise he was ready deep into puberty. The doctor said we could still proceed with it but I really couldn’t expect to have undone what was already there. He was developing much earlier than expected. Now his twin, Jared, still hasn’t started into puberty. So, my question is – with boys that follow gender non-conformity – do they start developing earlier than their peers? I realize we won’t have the answer for many, many more years to come.

First of all, I am grateful to Danielle and Dr. Bailey for permission to reproduce this communication. Second, I think it is important for clinicians and advocates alike to reflect on what we can learn from this experience. As far as I can determine from available research, most boys who want to be girls later become men who don’t want to become women. Using the new paradigm with Adam may have altered his future in ways that could have added significant complication to his life.
Given that this email was sent to Dr. Bailey, I asked him for commentary.

Danielle is an admirable and unusual mother. She went to great lengths to protect Adam and to show him that she loved him regardless of his gender-related behavior and self-concept. She let Adam express his femininity (e.g., fill his room with “girls'” toys), while providing him with honest feedback about the likely results of his choices, outside their home. She also hesitated–in my view sensibly so–from encouraging Adam to begin a gender transition during childhood. I have met Adam, and I have read Danielle’s updates. I would be surprised at this point if Adam decides to change his sex. He seems a happy boy, and I expect he will become a happy young gay man.
I wonder, with Danielle, about the implications for gender-atypical children whose parents take the other, emerging, approach: allowing children to change their genders preliminary to biological sex changes in adolescence. Children like Adam start showing their behavior early (Adam at 18 months). All evidence we have suggests that only a minority (20% or fewer) of boys like Adam become women eventually. But if parents let boys become girls at childhood, will this drive up the probability? It seems highly plausible that it would. Sex reassignment is not minor medical intervention. It involves major surgery and lifelong hormonal treatments. All other things being equal, sex reassignment is something to be avoided. Of course, not all other things are equal. If a 6 year old boy wants to be a girl, it will cause him more short-term pain to refuse than to acquiesce. The costs and benefits are hard to estimate, and Danielle has been frustrated in her search for data-supported answers. It would be a fitting reward to her admirable example if people could set aside their differences (and the government could uncharacteristically support research on a controversial topic relate to sex), and begin to collect and share requisite data.
Danielle and Adam should remind us that even if treated liberally, gender-atypical children will not necessarily choose sex reassignment. Indeed, perhaps the most liberal goal of all is to allow gender-atypical children to be comfortable in their own (non surgically altered) skin. By all appearances, that is what Danielle has accomplished.

Since this email, I have corresponded more with Danielle. She has added some additional detail which I will report tomorrow. Specifically, she describes how she has responded to Adam when he has expressed questions about transitioning.

APA issues statement regarding GID and the DSM-V

The American Psychiatric Association released a statement on Friday regarding some “inquiries about the DSM-V process.” I suspect many of those inquiries have focused on the disputes over treatment highlighted by the recent NPR broadcast on gender identity, often involving Dr. Ken Zucker. I asked Ken Zucker and Michael Bailey for their reactions to this press release from a transgender advocacy group. Dr. Zucker declined to comment, but sent the following APA statement. Dr. Bailey’s comment follows.

APA STATEMENT ON GID AND THE DSM
May 9, 2008
The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.
The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.
The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.
There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.
All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.
The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:
– Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.
– Paraphilias, chaired by Ray Blanchard, Ph.D.
– Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.
Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012.

Regarding the Transactive organization’s statement about the DSM-V, Dr. Bailey took strong exception to this statement:

“Zucker has stated that a secure gender identity possibly prevents the development of later homosexuality. This raised several red flags for those of us who work with gender non-conforming children, youth and their families. TransActive’s position is that “prevention of homosexuality” should not be the concern of childhood gender identity specialists.”

To which, Bailey said:

This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.

I agree with Bailey, I have seen nothing which would suggest Zucker has a stake in the eventual sexual orientation of children. And I certainly agree with the last sentence which has some special significance to me in light of the cancellation of the APA symposium.
In my opinion, there are some advocates who implore various audiences to trust science but really do not want this unless the outcome suits their advocacy goals.

Ken Zucker compares ethnic identity conflict and gender identity conflict

Ken Zucker, a psychologist featured in the NPR series on gender identity, recently posted the following on the SEXNET listserv. Are ethnic identity conflict and gender identity conflict analogous? In this post, Dr. Zucker addresses the topic and I thank him for giving me permission to re-post it here:

In the interview I had with the NPR journalist, Alix Spiegel, I posed the question: How would a clinician respond to a young child (in this instance a Black youngster) who presented with the wish to be White? I had already sent Ms. Spiegel an essay that I published in 2006 in which I had presented this analogy and she told me that she was intrigued by the argument.
In this post, I list some references that I have accumulated over the years that discusses issues of ethnic identity conflict in children and adults. In the 2006 paper, I was particularly influenced, rightly or wrongly, by an essay Brody (1963) wrote many years ago. I think it is worth reading. Thus, I did not invent the analogy out of thin air. I had been influenced by three things: first, I was aware of this literature on ethnic identity conflict and I thought it had some lessons in it; second, I had observed, over the years, that some kids that I have seen in my clinic who had a biracial ethnic background also sometimes struggled with that (e.g., wanting to be White, like their mother, and not wanting to be Black or non-white Hispanic, like their father) or wanting to be an American (and not a Canadian) or wanting to be a dog (and not a human). I have thought about these desires as, perhaps, an indication of a more general identity confusion. Third, I was influenced by a remark Richard Pleak made in a 1999 essay, in which he wrote that the notion that “attempting to change children’s gender identity for [the purpose of reducing social ostracism] seems as ethically repellant as bleaching black children’s skin in order to improve their social life among white children” (p. 14). I thought about his argument and decided that it could be flipped. Thus, in the 2006 essay, I wrote:
This is an interesting argument, but I believe that there are a number of problems with the analysis. I am not aware of any contemporary clinician who would advocate “bleaching” for a Black child (or adult) who requests it. Indeed, there is a clinical and sociological literature that considers the cultural context of the “bleaching syndrome” vis-a-vis racism and prejudice (see, e.g., Hall, 1992, 1995). Interestingly, there is an older clinical literature on young Black children who want to be White (Brody, 1963)–what might be termed “ethnic identity disorder” and there are, in my view, clear parallels to GID. Brody’s analysis led him to conclude that the proximal etiology was in the mother’s “deliberate but unwitting indoctrination” of racial identity conflict in her son because of her own negative experiences as a Black person. Presumably, the treatment goal would not be to endorse the Black child’s wish to be White, but rather to treat the underlying factors that have led the child to believe that his life would be better as a White person. As an aside, there is also a clinical literature on the relation between distorted ethnic identity (e.g., a Black person’s claim that he was actually born White, but then transformed) and psychosis (see Bhugra, 2001; Levy, Jones, & Olin, 1992). Of course, in this situation, the treatment is aimed at targeting the underlying psychosis and not the symptom.
The ethnic identity literature leads to a fundamental question about the psychosocial causes of GID, which Langer and Martin do not really address. In fact, they appear to endorse implicitly what I would characterize as “liberal essentialism,” i.e., that children with GID are “born that way” and should simply be left alone. Just like Brody was interested in understanding the psychological, social, and cultural factors that led his Black child patients to desire to be White, one can, along the same lines, seek to understand the psychological, social, and cultural factors that lead boys to want to be girls and girls to want to be boys. Many contemporary clinicians have argued that GID in children is the result, at least in part, of psychodynamic and psychosocial mechanisms, which lead to an analogous fantasy solution: that becoming a member of the other sex would somehow resolve internalized distress (e.g., Coates, Friedman, & Wolfe, 1991; Coates & Person, 1985; Coates & Wolfe, 1995). Of course, Langer and Martin may disagree with these formulations, but they should address them, critique them, and explain why they think they are incorrect. I would argue that it is as legitimate to want to make youngsters comfortable with their gender identity (to make it correspond to the physical reality of their biological sex) as it is to make youngsters comfortable with their ethnic identity (to make it correspond to the physical reality of the color of their skin).
On this point, however, I take a decidedly developmental perspective. If the primary goal of treatment is to alleviate the suffering of the individual, there are now a variety of data sets that suggest that persistent gender dysphoria, at least when it continues into adolescence, is unlikely to be alleviated in the majority of cases by psychological means, and thus is likely best treated by hormonal and physical contra-sex interventions, particularly after a period of living in the cross-gender role indicates that this will result in the best adaptation for the adolescent male or female (e.g., Cohen-Kettenis & van Goozen, 1997; Smith, van Goozen, & Cohen-Kettenis, 2001; Zucker, 2006). In childhood, however, the evidence suggests that there is a much greater plasticity in outcome (see Zucker, 2005a). As a result, many clinicians, and I am one of them, take the position that a trial of psychological treatment, including individual therapy and parent counseling, is warranted (for a review of various intervention approaches, see Zucker, 2001). To return briefly to the ethnic identity disorder comparison, I would speculate that one might find similar results, i.e., that it would be relatively easier to resolve ethnic identity dissatisfaction in children than it would be in adolescents (or adults). Although I am not aware of any available data to test this conjecture, I think of Michael Jackson’s progressively “white” appearance as an example of the narrowing of plasticity in adulthood.
Two caveats: first, the literature on psychosis and ethnic identity conflict that is cited in no way was meant to imply that transgendered people are psychotic; the comparison is to a very small number of people who have “delusions” of gender change in which the primary diagnosis is Schizophrenia. This was first noted in the DSM-III and remains in the DSM-IV text description; second, I can criticize my own argument along these lines: “Well, this may all be true, but surely there is no evidence for a biological factor that would cause a Black person to want to be White, but maybe there is a biological factor or set of biological factors that either predispose or cause a person with the phenotype of one sex to feel like they are of the other sex (gender).” And to that I would say fair enough.
Bhugra, D. (2001). Ideas of distorted ethnic identity in 43 cases of psychosis. International Journal of Social Psychiatry, 47, 1-7.
Brody, E. B. (1963). Color and identity conflict in young boys: Observations of Negro mothers and sons in urban Baltimore. Psychiatry, 26, 188-201.
Brunsma, D. L., & Rockquemore, K. A. (2001). The new color complex: Appearances and biracial identity. Identity: An International Journal of Theory and Research, 1, 225-246.
Fuller, T. (2006, May 14). A vision of pale beauty carries risks for Asia’s women. New York Times.
Goodman, M. E. (1952). Race awareness in young children. Cambridge: Addison-Wesley.
Hall, R. (1992). Bias among African-Americans regarding skin color: Implications for social work practice. Research on Social Work Practice, 2, 479-486.
Hall, R. (1995). The bleaching syndrome: African Americans’ response to cultural domination vis-B-vis skin color. Journal of Black Studies, 26, 172-184.
Lauerma, H. (1996). Distortion of racial identity in schizophrenia. Nordic Journal of Psychiatry, 50, 71-72.
Levy, A. S., Jones, R. M., & Olin, C. H. (1992). Distortion of racial identity and psychosis [Letter]. American Journal of Psychiatry, 149, 845.
Mann, M. A. (2006). The formation and development of individual and ethnic identity: Insights from psychiatry and psychoanalytic theory. American Journal of Psychoanalysis, 66, 211-224.
Russell, K., Wilson, M., & Hall, R. (1992). The color complex: The politics of skin color among African Americans. New York: Harcourt Brace Jovanovich.
Sanders Thompson, V. L. (2001). The complexity of African American racial identification. Journal of Black Studies, 32, 155-165.
Schneck, J. M. (1977). Trichotillomania and racial identity [Letter to the Editor]. Diseases of the Nervous System, 38, 219.
Stephan, C. W., & Stephan, W. G. (2000). The measurement of racial and ethnic identity. International Journal of Intercultural Relations, 24, 541-552.
Tate, C., & Audette, D. (2001). Theory and research on ‘race’ as a natural kind variable in psychology. Theory & Psychology, 11, 495-520.
Ken Zucker

Two families, two approaches to gender preferences

This National Public Radio broadcast provides a look at the controversies surrounding how to treat gender identity concerns in childhood. Essentially dividing the field into two camps, the program follows the treatment choices of two families. One approach, represented by Kenneth Zucker, advocates making “the child comfortable with the sex he or she was born with.” The reporter elaborates further:

So, to treat Bradley, Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups. Boys would find his feminine interests unappealing. Girls would want more boyish boys. Bradley would be an outcast.

Zucker’s approach is contrasted with Oakland, CA therapist, Diane Ehrensaft’s approach. She advocates:

She describes children like Bradley and Jonah as transgender. And, unlike Zucker, she does not think parents should try to modify their child’s behavior. In fact, when Pam and Joel came to see her, she discouraged them from putting Jonah into any kind of therapy at all. Pam says because Ehrensaft does not see transgenderism itself as a dysfunction, the therapist didn’t think Pam and Joel should try to cure Jonah.
Ehrensaft did eventually encourage Joel and Pam to allow Jonah to live as a little girl. By the time he was 5, Jonah had made it very clear to his parents that he wanted to wear girl clothes full time — that he wanted to be known as a girl. He wanted them to call him their daughter. And though Ehrensaft does not always encourage children who express gender flexibility to “transition” to living as a member of the opposite sex, in the case of Jonah, she thought it was appropriate.

The whole program is intriguing, controversial and worth a review.
UPDATE – The second part of this story is out today here and a school district in Southeastern PA is confronting this issue.