In 1973 the APA removed homosexuality from its list of “diagnoses,” and in its place they created a new “diagnosis” – gender identity disorder.
The essential feature of this so-called illness is a marked and persistent rejection of one’s biological gender and a repeated desire to be of the opposite gender.
I’ve touched on these issues in the posts on homosexuality. So I won’t repeat that material here. There is a recently reported development, however, that warrants some attention. A recent Associated Press article out of Chicago reports that sex-changing treatment for children is “on the rise.” This report was picked up by media outlets all over the country, and probably overseas.
Essentially what’s happening is this. Children who say that they want to be of the opposite gender are being taken by their parents to doctors for treatment. Treatment seems to consist of confirming the child’s choice to be of the opposite gender and administering puberty-blocking drugs. Then when they reach age 18 they can have a sex-change procedure. It is reported that children as young as four have been treated, and that breast removal surgery has been performed on girls as young as 16.
The puberty-blocking drugs are administered as monthly injections. Each injection costs $1,000.
Of course one could say: It’s a free country. If boys want to be girls or girls want to be boys – let them be so. But there are some issues here that ought to at least be articulated.
The first is the role of reinforcement. If a little boy says to his parent “I want to be a girl,” from a behaviorist perspective this is conceptualized as an operant. If this utterance is reinforced, then the probability of its recurrence increases. If it is not reinforced, the probability of its recurring decreases. So the parent’s response is critical. If the parent becomes immediately attentive and solicitous, asking questions, showing concern, etc., then the child is more likely to repeat the statement and continue to the point of insistence. Similar considerations, of course, apply to other aspects of a child’s speech. If a child says “I have a headache,” he may have a sore head, or he may simply have discovered that this is a good way to get attention and sympathy and even release from chores, etc.. There is no simple way to distinguish which scenario one is dealing with. People become hypochondriacal because of over-reaction of parents to trivial or even non-existent complaints. But by the same token, children can become dead when parents under react to legitimate complaints. The point being that parenting isn’t easy and this is a particularly thorny area in which parents ultimately have to rely on their best judgment.
The problem with gender identity disorder is that it makes no distinction between the child who expresses a yearning to be of the opposite gender simply because these kinds of utterances have been reinforced, and the child who has perhaps some genuine biological anomaly. As with all DSM “diagnoses,” if you emit the behavior, you’ve got the illness. And of course if you’ve got the illness, then you need to be treated!
Growing up in the 50’s, boys and girls were treated very differently. Boys were given toy guns; girls were given dolls. Boys were dressed in sturdy clothes; girls in frillier garb. Boys were encouraged towards rough, active play; girls towards quiet, sedate play. And so on. And there were always a few individuals who deviated from these norms – girls who liked to play with the boys and boys who liked to play with the girls.
Then in the 60’s one started to hear criticism of traditional gender stereotyping. It was said that we should be raising our children (boys and girls) more androgynously – that boys would benefit from increased tenderness and sensitivity, and girls would benefit from an increase in self-reliance and forthrightness. This movement, if it could be called that, has wrought huge changes in our culture, and I think most people view these changes as positive.
But have we gone too far when we encourage four-year-old boys to become girls? With the invention of the gender identity disorder “diagnosis,” the APA has facilitated this trend.
Wanting to be of the opposite gender is NOT an illness; it is behavior – verbal behavior. And any attempt to understand this behavior that ignores well-established behavioral dynamics is on very shaky ground.