“All Things Considered” on NPR ran a two day story on children and gender identity. Two days ago, they ran a story on two families with toddler to preschool boys who are attracted to girl-oriented toys, colors–one of whom sees himself as a girl, changing his name from Jonah to Jona as he entered school. His parents now refer to him as their daughter. Yesterday, they ran a story about a prepubescent boy wanting to take hormones to delay or stop puberty. You can click here to read or hear the stories and additional content on their site.
What makes this fascinating is the two psychologists interviewed. The first, Dr. Ken Zucker, sees the problem as gender identity confusion, something to be modified. The second psychologist, Dr. Diane Ehrensaft, sees it as something biological and fixed and then the job is to help the child and parents transition to transgender. Dr. Zucker rejects that idea and likens the acceptance/transition approach to that of accepting that a Black child wants to be thought of as white (I wonder if he would also liken it to accepting a psychotic child’s hallucinations were real). His response sounds behavioral in that the boy has his dolls and dresses removed and play with boy type toys is reinforced. Dr. Ehrensaft opposes this as controlling and suggests the best treatment is to go with the flow and allow the child to express him/her self as they see fit:
Ehrensaft, however, does not use that label [gender identity]. 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.
“She made it really clear that, you know, if Jonah’s not depressed, or anxious, or having anything go on that she would need to really be in therapy for, then don’t put a kid in therapy until they need it,” Pam says.
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.
While I disagree with his approach, I would humbly suggest that Zucker’s diagnostic view is more accurate. Children may go through fixations and personality response types that do not carry into adulthood. To treat even an entrenched viewpoint of a small child as fixed is unethical. A child simply does not fully understand themselves and the world yet. We do not accept our children’s fears of monsters as normal, we do not accept our children’s hitting to get their way. Why? We know they are not old enough to understand. We empathize but correct.
This is not like trying to make a left handed child be right-handed, to force feed peas when the child gags. Our identities may be rooted in biology, they are not fixed. Zucker rightly accuses some of being essentialists–a form of biological reductionism. Even the APA does not do that when it comes to personality. A child cannot be given a personality disorder until 18 because we know that personality is flexible even when shaped and rooted in early years.
However, Zucker seems harsh in that his treatment is to remove all girl playtoys. While I would not want a child of one gender to accept and believe they are the opposite gender, I would want they and the parents to expand their view of gender. If a boy likes pink, silky things, dolls, etc. so what? There is nothing essentially male about trucks. My wife as a child was a cowboy. She’d be more likely to have six shooters than a doll. Thankfully, her family didn’t make it an issue (which may be the cause of some folks’ gender identity confusion).
Of course, a family will want to draw some lines, such as saying no to referring to oneself as the opposite sex. “No, God made you a boy, but he gave you interests in soft things…” Instead of wearing dresses which in our culture isn’t the norm, the boy might be able to enjoy softer materials.
It would seem that some, in the interest of helping everyone self-actualize, lose their ability to think critically about child development. This is not unlike the misguided notion that all bad behaviors are about low self esteem and so we should only praise. In fact, many have too much esteem of self and so abuse others.
ADDED: Check out this link for a local Philly news article on the subject of a transgendered 9 year old and see that they spoke to the ever controversial Paul McHugh from Johns Hopkins.
Musings on Faith and Psychology 