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From the Front Lines: Fighting Back at WPATH


I’m currently attending the inaugural conference of the US branch of the World Professional Association for Transgender Health (WPATH). WPATH is responsible for compiling the Standards of Care, meant to guide best practice for all professionals who work with trans* and gender variant people. It’s a collection of psychiatrists, psychologists, psychotherapists, doctors, surgeons, endocrinologists and pediatricians. Some are trans* themselves. Many are not. The organization has long had its politics, as organizations do. Indeed, it’s a particularly political area: trans* and gender variant people have been pathologized as mentally ill merely for existing for most of the history of Western medicine.

Something important happened here yesterday [Friday February 3] that I want to share with you. Sitting in a stuffy room on the kind of chair you only find at conferences or weddings, I got to witness something I think we should be talking about, both because of what it represents for the area of transgender mental healthcare and for what it speaks to in our wider context today.

The session was particularly full, and it was particularly full because of who one of the speakers was. Dr. Kenneth Zucker is a very big name in trans*gender mental healthcare. He has been responsible for helping to develop the diagnosis in successive editions of the Diagnostic and Statistical Manual, currently the DSM-V, which has been used to identify and treat trans*gender children, adolescents, and adults. He is extensively published in the area.

Late last year, his Gender Identity Clinic at the Center for Addiction and Mental Health in Toronto was shut down after an independent review. It was found, following years of activism by trans*people who passed through the clinic, that his practices constituted a form of conversion therapy and had been actively harmful to the children and adolescents he treated.

Crucial to this outcome, too, I think, is the fact that there has been a sea change in the field in general. It’s now recognized by mental health practitioners that trans*gender and gender variant people experience horrific levels of social and economic oppression, violence, stigma, and suicidality. The latest study, the 2015 U.S. Transgender Survey , conducted by the National LGBTQ Task Force and the National Center for Transgender Equality, indicates that little has changed in the lives of trans*people in America in the last couple of years despite some high-profile media attention. It’s also recognized that the higher levels of mental health issues in this population are due to minority stress and oppression, not to the fact of being trans*gender. The research to conclusively back this up includes the Family Acceptance Project at San Francisco State University, and a 2016 study in the journal Pediatrics. These indicate, respectively, that family acceptance of a gender variant young person results in more positive outcomes around sexual health, substance use, depression, and suicide; and that trans*gender children who experience family support show the same levels of anxiety and depression as the general population. So Dr. Zucker’s line, that it’s better for the sake of the child or adolescent themselves if a trans*gender identity can be prevented, is now comprehensively outdated and demonstrably wrong. Trans*identities cannot be prevented, any more than sexual identities can. What can be prevented is the suffering caused by refusing to accept a trans*person, by shaming them, by subjecting them to behavior modification therapies that will not work, or by stigmatizing them and making their lives literally unlivable.

It’s a question currently under lively debate at the conference as to why Dr. Zucker was given a platform at this conference. It’s important to tell you about the young trans* woman who stood up during the session and objected to his presence and then walked out along with a group of people. This group protested outside the doors of the session and were treated like criminals by the conference security: threatened and silenced. They were comprised predominantly of trans*people of color, and in that enactment is an entire article on the power dynamics in the field I alluded to above, if not of America itself. But more about that in a minute.

During Dr. Zucker’s talk, which proceeded unimpeded after the walk out, he used terminology that has been questioned for its implicit assumptions by Dr. Diane Ehrensaft, most recently in her latest book, The Gender Creative Child. His final point was that the latest research is indicating that supporting young children in socially transitioning – that is, helping them to live in the gender identity they know themselves to be, which is the intervention shown to result in the most positive outcomes for their mental health, instead of forcing them to live in the gender identity they were assigned at birth – results in more trans*gender adults (or, in his terminology, “persistors,” people who never change their decision about their gender identities). Although he did not engage this question, one might add that gender affirmative practices, if they allow people to persist in being who they are, also result in more trans*people surviving their adolescences and becoming healthy adults who can live happy and connected lives. Presumably, he continues to believe that it’s better not to be trans.*

Although his presence caused much hurt, and although I found both his manner and his conclusions personally and professionally offensive, I was also struck by how out of date he sounded. In his very attempts to push back the tide, in his scientifically-couched, and yet still irascible attempts to refute the way trans* mental health is now being written about and beginning to be practiced, he seemed like an old dinosaur thrashing about as it died.

Meantime, the young, trans*gender, people of color were being harassed outside for having their say. This culminated in a list of demands and an emergency meeting with the WPATH board of directors later that evening. Hot off the press is the news that Dr. Kenneth Zucker is being sent home (he was due to speak again the following day) and that an apology is being issued.

And while there is more to say about this whole event, and about the issues of how trans*gender and gender variant people are treated by our medical – and indeed, all our other social – systems, it seems important to leave you with two images from all this. The one is of an old dinosaur thrashing about as he dies, still dangerous, but with no hold on the future. The other is a group of young, marginalized, gender variant, people of color standing outside a set of closed doors in protest, and, ultimately successfully, facing off against security personnel called on them by the organizers of a conference about them. Let’s remember those images as we face what’s coming in the next four years.

Note from the author, March 1 2017:

This article was written on the night of the events described below, and many important things transpired afterwards that are not reflected here.

A community-authored account of the full story is in process, and a link to that article will be provided here once it is available. A serious omission in my original article was a focus on how transgender women of color led the events, from the beginning moments described above.

As my colleagues Sand Chang and Daniel Blumrosen pointed out to me, “This is something that has happened throughout history – erasure of trans women of color leadership – and it has contributed negatively to TWOC representation by and often allowed white, cis folks to write the stories of TWOC lives.”

They also point out that my description of the group as “young, gender variant, and trans*” was inaccurate and offensive to some transgender people, for whom the umbrella term “trans*” functions as an act of erasure. Many of the women involved were not “young”, but experienced activists, and they were all clinicians, providers, and professionals themselves.

My failure to represent them correctly continued a tradition of disempowering and infantilizing transgender people, particularly transgender women of color. Of course none of this was my intention – I intended to celebrate what they had achieved so far (and we now know they went on to achieve much greater victories in this matter in the follow-up meetings they organized with the WPATH board), and to craft a vision of the future which belonged to them, and not to the overpowering and objectifying mental health tradition represented by the work of Kenneth Zucker.

Nevertheless, my impact was other than my intention, borne in no small part out of my own position of privilege and ignorance as a cisgender white woman. I appreciate the generosity exemplified in Sand Chang’s and Daniel Blumrosen’s engagement with me, and the opportunity it gives me to apologize to the community.

I hope this addendum to the article goes some way to providing a fuller and more accurate picture of events, and I urge you to read the full version of what happened in the words of those directly involved in the activism and hard work that achieved such positive results.



Natasha Distiller

Natasha Distiller

Natasha Distiller is in private practice in Berkeley. She combines working as a therapist with writing and teaching about social and gender justice. Visit her website at www.natashadistiller.com for more about her work, or visit her Facebook page at https://www.facebook.com/counselingfromtheheartandmind/.

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