This is a response by Dr. Ray Blanchard to Jack Drescher, MD concerning what he considers to be the many rumors and personal attacks circulating the internet.
(Our responses follow)
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Thank you for your e-mail advising me of the great deal of misinformation that is currently being circulated about my views and positions on the Internet. I am writing to state the facts regarding the most serious of these incorrect notions. Please feel free to quote from this e-mail in whole or in part.
This first notion is that I am transphobic. Nothing could be further from the truth. In 1983 I published the first of a series of research studies demonstrating the beneficial effects of gender transition for transsexuals. I published further research studies demonstrating the positive effects of social transition, hormone treatment, and sex reassignment surgery in a second article in 1983, and then in four more studies between 1985 and 1989. I published literature reviews arguing that sex reassignment surgery was the most beneficial treatment for properly diagnosed transsexuals in 1990 and 2000. In 2007, I testified pro bono on behalf of a transsexual plaintiff who filed suit against the Ontario Ministry of Health in an attempt to force the Ministry to reinstate public funding of sex reassignment surgery. In summary, there is a readily accessible, 24-year-long, completely public record of my support for hormonal treatment and sex reassignment surgery for transsexuals.
The second false notion is that I support reparative therapy (sometimes called conversion therapy), which is a term that denotes the attempt to change homosexual orientations to heterosexual orientations. I do not now, nor have I ever, advocated therapeutic attempts to alter sexual orientation, either in adults or in minors. I have never written any document that could possibly be interpreted to mean that I hold, or previously held, such views. I have never stated that I think the alteration of sexual orientation is desirable or that I think it is possible.
On the contrary, my considerable body of work on the origins of sexual orientation has stressed that sexual orientation in males is probably determined in prenatal life, a theoretical viewpoint that is basically incompatible with the notion that "therapeutic" interventions could alter basic sexual orientation. My publications on biological (and, by implication, immutable) influences on sexual orientation cover a 16-year period from 1992 to 2008.
The foregoing facts are indisputable. Any statements on the Internet claiming that I am either opposed to sex reassignment surgery or in favor of reparative therapy are simply erroneous.
Sincerely,
Ray Blanchard, Ph.D.
Head, Clinical Sexology Services
Law and Mental Health Program
Centre for Addiction and Mental Health
Professor of Psychiatry
Faculty of Medicine
University of Toronto
In response to Blanchard's e-mail, this is a letter to the Organisation Intersex International from M. Italiano of Gendercare, Inc.
I have no doubt that Blanchard believes homosexuality to be rooted in biology. I am sure that he has a vested interest in this, which includes his years of personal research relevant to this topic. It also enables him to suggest that so-called m to f "homosexual transsexuality", is comparatively rooted in biology. Unfortunately, for so-called "non homosexual transsexuals" (which for him, would necessarily include bisexual, asexual and heterosexual m to f transsexuals and which he categorizes as paraphillic), he denies their neuroanatomic intersexuality and their female gender identity claims.
In fact, he denies the feminine essence/gender identity theory of m to f transsexuals, and does not address reports of reversed brain sex in m to f transsexuals. Blanchard may not be transphobic in the traditional sense (ie., technically fear of transsexuals). It is his theory, lack of proper controls, and selection bias, which is harmful to the understanding of those who are transsexual, and for the understanding of transsexuality by professionals (such as those who read the DSM). More harmful to transsexuals and professionals, is his neglect to consider or properly interpret brain sex research correctly. His claims of support for SRS in transsexuals is no more noteworthy than that of his "co-disciple" Anne Lawrence, who supports SRS, and who subscribes to the same type of "no brain" sex model of transsexualism, while denying and misrepresenting gender identity and its relationship to brain sex. I don't think we should be impressed by such support of SRS, in the presence of a homosexual or paraphillic model of transsexualism. Quite the contrary. Furthermore, we don't need adding insult to injury, by hearing the portrayal of transsexual women as "men trapped in men's bodies", or the portrayal of transsexual women as a "man without a penis".
In regards to Blanchard's "homosexualization OR paraphiliazation" of m to f transsexualism, and his contention that he is not transphobic, I say this - perhaps he "enjoys" the representation of what transsexuals mean for him just a little too much.
Letter from Curtis E. Hinkle, founder of the Organisation Intersex International
Concerning Zucker and Blanchard's influence in the APA's revision of the DSM-V
In this e-mail Dr. Blanchard has not addressed the dangers of his theory to the intersex community which posits that there are ONLY two reasons for rejection of one's original sex assignment. I am concerned about the intersexphobia implicit in this
theory.
He is on record as being in favor of "deconstructing the feminine essence narrative" and his latest contribution to the Archives on Sexual Behavior has that title. If this is so, then what about children who have a feminine essence narrative imposed on them surgically without consent? If the child rejects that, his theory would claim that the child had a paraphilia or sexual orientation issue and the surgeon who did this would always be right about the gender assignment because in essence, his theory denies such a
construct.
If there is no such thing as a "feminine essence narrative" or core gender identity, then why impose one on intersex infants? This theory erases intersex experience and will make life extremely difficult for any intersex person who does not conform to the gender assigned or to gender roles and it will reinforce further stigmatization and pathologization of intersex children and adults.
I am also concerned that the letter that Blanchard has circulated is an attempt to obfuscate the facts.
In that letter he wrote:
"In 2007, I testified pro bono on behalf of a transsexual plaintiff who filed suit against the Ontario Ministry of Health in an attempt to
force the Ministry to reinstate public funding of sex reassignment surgery."
To someone living in a country like the United States, this could be very misleading. As a matter of fact, it does not represent the situation accurately in a Canadian context either. There is NOTHING pro bono about Blanchard testifying, nor any other member of CAMH. This obfuscates the issues.
Canada has a universal health care system. As an American citizen working in Canada, Blanchard is PART of that health care system and receives his funding to run the clinic from the Ontario provincial government. He is solely the government's AUTHORITY on this issue. He appeared in court to represent the Ontario government who pays him and the CAMH. That is not pro bono. And he obviously is interested in keeping his funding from the provincial government so it would be a conflict of interest to go to court on behalf of his employer and testify that public funding should NOT be given for the very segment of health care he is paid for by the government to deliver.
It is important to note, as indicated by the letter that Blanchard wrote, that ONLY U.S. academics closely affiliated with Blanchard and the CAMH were cc'd as well the APA press. No Canadian CPA executives were cc'd at the same time, other than publishing on the CPA's listserv which ALL Canadian members receive. And this has been symptomatic of the problem because the way the CAMH has worked, it has made sure that the APA and the CPA have no idea what the other is doing in their respective affiliations with Blanchard as well as the CAMH while the Ontario Ministry of Health, like the APA and the CPA, which fund Ray Blanchard and the CAMH with public money, assume he and Zucker are qualified since the APA recognizes them in the United States.
The CAMH has a history of ignoring Canada, while presenting themselves as if they are representing Canadian interests and standards. However the facts are very different. It is well known within the CPA and by other academics across Canada that Ray Blanchard and the CAMH members in gender care and research have limited to no affiliation or interactions with the SOGII community or conferences.
So it appears we have a source of free money with an "expert" (Blanchard) being paid by the Ontario government which keeps on giving.
Their focus is solely the U.S., funded by public Canadian provincial dollars, while keeping Canadians in the dark and bullying and intimidating those who have the courage to speak up or who dare to alert the government and health care system of what is going on which has been very well documented over many years.
Also, this letter is almost exclusively about sexual orientation when what we in the trans and intersex community have been mainly concerned about are GENDER IDENTITY issues. Is there any mention of gender identity issues in this letter? I only see gender transition - but no mention of why one might transition.
Blanchard solely speaks of reversion therapy as it relates to sexuality but he conveniently omits any reference to reversion therapy as it relates to gender, since he does not accept gender identity as a valid construct in his model of transsexualism. Gender issues are a subset of sexual orientation and paraphilias whereas experts recognize sex, sexuality and gender as different issues. He also omits that Zucker, his right hand man, and he have worked together on "children reversion" as it relates to gender identity.
GID does exist. It is a social construct of normal human development which everyone has. There is nothing to fix; it is society and people like Blanchard and Zucker that need to be fixed.
The CAMH is seen as an embarrassment to Canada because of its progressive views on these issues and its commitment federally to human rights and diversity, something the CAMH is in no way affiliated with and this is one of the main reasons why the current petition to the APA to remove them from the committee for revising the DSM-V is important.
Kind regards,
Curtis E. Hinkle
Founder, OII
http://www.intersexualite.org/
Response from Sophia Siedlberg, OII Spokesperson in the United Kingdom
In fairness to Professor Ray Blanchard, I do not hold him responsible for the unpleasantness of the past five years or so, where his theories have been used by some others to publicly mock and humiliate particular minority groups. The issue with Blanchard is simply the theory itself and what he does not say concerning the antics of his "Advocates". It is this I have difficulty with. Basically the core tenet of his theory about transsexualism and gender identity as a whole is that male sexuality defines all. When discussing transsexualism he makes the basic assumption that a male to female transsexual is motivated by some masculine sexual desire that has been misdirected. There is an underlying issue here, and that is most male to female transsexual people simply do not relate to this concept. There are some that do, but they are not representative of everybody with this particular issue. As a biologist myself I deal with biological facts and have also read competing theories which to me seem more credible, if only because there is some hard test tube science which appears both logical and well documented. This would be the theories presented by Professor Dick Swaab.
What struck me as bizarre was the reaction of those advocating Blanchard’s theory when Professor Swaab published his findings. Blanchard’s advocates appeared to act in a manner that suggests they wish to silence Swaab. This is the problem. It is one thing to have academic rivalry, but it is quite another when the outcome of that affects people's lives. While Professor Blanchard is in no way as guilty as some of his advocates when it comes to dirty tricks, he has not exactly spoken against the misuse of his ideas by a number of his colleagues. On the contrary he has appeared to go along with this while never asking questions. For around six to eight years various communities have been derided, mocked and demeaned in the scientific and regular media, by his colleagues, and whatever his personal record concerning his advocacy for the rights of these groups, he has consistently failed to either distance himself from the misuse of his theories, or to defend those they have been applied to in a harmful manner and he has not exactly allowed for open debate when it comes to competing theories. (Such as those of Swaab).
It is clear from this that Professor Blanchard has clearly invested much in his theories (And in all honesty who would not defend their own theories) but he has allowed others to misuse the theories and this compromises his own position. The point being that as his advocates appear to be involved in the preparation o DSM-V along with Blanchard himself, this looks more like the need to apply a pet theory or ensure some "Blanchard Legacy". Well, this is no longer science but agenda driven medicine and that usually leads to problems. This is why I think Blanchard is unsuitable for the position he is about to take at the APA.
Response from Y. Gavriel Ansara, Organisation Intersex International, Spokesman on Multicultural Issues
Dear Dr. Drescher,
Congratulations on your recent appointment to the DSM-V committee.
I have read Dr. Blanchard's response to what he refers to as misinformation. While I agree that some of the remarks have been misleading, there are some that remain even after reading his reply.
The notion of "homosexual transsexual" and "heterosexual transsexual" is shoddy methodology unbecoming of a scientist. Mounting evidence documents the many affirmed men and women who prefer same gender partners in their affirmed genders. Referring to a self-identified gay man who was designated female at birth as a "heterosexual" is not only inaccurate, but misleading when these distinctions are made for clinical purposes.
The notion that women in the process of gender affirmation who were designated male at birth are somehow paraphilic if they find wearing women's lingerie arousing ignores the fact that many cisgender women assigned female at birth also find wearing women's lingerie arousing. The double standard used in clinical protocols seems discriminatory and without a valid empirical basis.
In addition, while Dr. Blanchard's letter states his unequivocal rejection of reparative therapy with gay, lesbian, and bisexual people, nowhere does he make a similar statement concerning reparative therapy with trans and intersex people. This is highly relevant in light of the following salient facts:
-The American Psychiatric Association released a Fact Sheet in 1994 against reparative therapy for sexual orientation. (See footnote below.)
-Dr. Zucker DOES advocate for reparative therapy in trans and intersex children, as evidenced by his current work. (Several intersex children were included in his recently published paper on children whom he had diagnosed with "GID".)
-APA's failure to discipline Dr. Zucker for his work demonstrates a discriminatory policy toward trans and intersex people, given that his work would not be sanctioned if he did the same reparative therapy with non-trans and non-intersex gay, lesbian, or bisexual children.
-Dr. Blanchard continues to maintain strong, amiable professional ties to Dr. Zucker and has not (to my knowledge) issued any public statement challenging Dr. Zucker's usage of reparative therapy for trans and intersex children.
-American Psychological Association (NOT your APA :) ) has recognised on their web site that gender variations that include bigender and gender queer are not inherently pathological. http://www.apa.org/topics/transgender.html#whatare
Given the rigid gender and sexuality essentialism that is apparently espoused by both Drs. Zucker and Blanchard, how will people whose realities do not fit within their heterosexist gender stereotypes fare in DSM-V?
I understand that this may be a sensitive topic for you given your recent appointment, but please understand that you may be one of the only professionals with the potential to avoid severe damage to real people whose realities do not fit the artificial "true transsexual" narratives espoused by some of your colleagues.
I would be interested to hear your thoughts in response to this email and you are free to write to me privately . I will not share any of your communications with me if you wish them to remain confidential.
So you know, I just accepted an invitation to join the board of OII. Some brief facts about me: I am an affirmed man of trans experience who was designated female at birth. I identify as a gay man (man attracted exclusively to men). I am a polycultural immigrant, and as far as professional background., have worked on the editorial staff of Developmental Psychology (peer-reviewed journal of the OTHER APA) for about 3 years, provided training to psychologists and physicians (including co-presenting at a Grand Round with Drs. Norm Spack and Jody Rich), and will be starting postgraduate studies in psychology at the University of Surrey in the UK in September.
Kind regards,
Gavi
(This is a non-English men's nickname; I go by male pronouns and have a substantial beard, thanks to T :) .)
Y. Gavriel Ansara
Executive Director
Lifelines Rhode Island/Cuerdas de Salvamento
Post Box only:
11 South Angell St. #314
Providence, RI 02906
401.369.9680
Lifelines Rhode Island: Accepting People As We Find Them.
We are the only statewide nonprofit organization focused on the needs of transgender, transsexual, Two Spirit, gender variant & intersex (TGI) people in RI and nearby regions.
We promote full equality and civil rights for people with diverse bodies and genders.
FOOTNOTE:
The American Psychiatric Association released a Fact Sheet in 1994-SEP which stated:
There is no published scientific evidence supporting the efficacy of 'reparative therapy' as a treatment to change ones sexual orientation. It is not described in the scientific literature, nor is it mentioned in the APA's latest comprehensive Task Force Report, 'Treatments of Psychiatric Disorders (1989)'.
There are a few reports in the literature of efforts to use psychotherapeutic and counseling techniques to treat persons troubled by their homosexuality who desire to become heterosexual; however, results have not been conclusive, nor have they been replicated. There is no evidence that any treatment can change a homosexual person's deep seated sexual feelings for others of the same sex.
Controlling the definitions. Controlling the right to be.
by Curtis E. Hinkle
17 May 2008
Summary: Zucker, Blanchard and Cohen-Kettenis, influential members of this committee, will control the definitions, i.e. diagnoses. GID could be redefined as a SEX disorder which could make it problematic for therpaists to recommend any reassignment treatments for individuals under their care.
The DSM controls the definitions not the treatments
The DSM is concerned with diagnoses, not treatments per se. However, that is why people that are ideologically motivated with very little, if any, empirical data to support their theories should not be placed in charge of the definitions or diagnoses. Here is the problem. Drucker will have input into the DIAGNOSES, not the treatments (and I am convinced that these people have more in common with his thinking than people are aware of. I know that Dr. Peggy T. Cohen- Kettenis has changed drastically in the last few years after becoming influenced with Zucker's ideology). But the treatments are not the issue for Zucker and many of these people that have been influenced by him. In my opinion, they want NO TREATMENTS. I am convinced that the motivation is to tie the hands of those who would desire to provide treatments and they might be able to do that by controlling the definitions, i.e. the diagnoses. In other words, if the members of this committee, some of which I know have been influenced by the views of Zucker which are that gender identity, as opposed to gender role, is extremely malleable, even more malleable than sexual orientation (and I don't accept this because I have read studies which would indicate just the opposite which appear to have more empirical data to support them), then reassignment may eventually become almost impossible, if not outright impossible in the years to come.
The theory that Blanchard et al. are expounding has two key elements which will have enormous impact on redefining transsexuality in such a way that
- it is NOT really a GENDER identity disorder at all and
- with ONLY TWO categories possible for all people with "gender confusion" which appears to be the word that is becoming more and more common with intersex people (the term used by Dr. Peggy T. Cohen-Kettenis in writing about intersex people with different intersex variations) and I feel it will become more common when speaking of persons that previously were "gender dysphoric" or with a "GID"
Conflating “gender confusion” in people with intersex variations with trans issues
Using intersex to reinforce the idea of “gender confusion” is invalid in my opinion. It can be confusing to be intersex in a world that is structured in such a way that we don't fit in and if we learn to express ourselves in languages which by their structure makes it almost impossible to have a "hermaphroditic" essence narrative. Blanchard has taken the term that Dreger used "feminine essence narrative" (which she triviliazes by citing Bailey who asks – what the hell a gender identity is) and prefers "feminine essence theory". He does not accept such a theory. Here is the problem that neither Dreger nor Blanchard deal with: an essence narrative is based on how a child uses language to relate their own sense of self – how they use the verb "to be" to identify themselves and describe themselves.
Rejecting the right of the person to affirm their own essence narrative
There is no other way to describe an "essence" objectively than to analyze the way the child is constructing sentences with the verb "to be". What I find disturbing is that these "experts" including Dr. Cohen-Kettenis are not dealing with the possibility that many people
with intersex variations develop what Stoller wrote about many years ago – a 'hermaproditic identity". Instead of considering that possibility, what one reads about is "gender confusion". What is confusing is that an intersex child has no possibility in any European
language to conceptualize any identity other than male or female and the society in which the child lives reflects this same structure – it is bigendered: men and women. This is confusing to many intersex children. However, drawing conclusions about gender identity from intersex children is very confusing itself because I have learned from listening to people who transition who had no known intersex variation that they were usually very clear about their sex, something which is not typical of many intersex children depending on the intersex variation. Another element of confusion is caused because these "experts" overlook that the reason that intersex children often don’t reject their assigned sex is that the "gender identity" is in fact more flexible because many of us do have what is an undefined gender identity (something which is very different from transsexualism) so we can often live as either sex and the reasons for an intersex person rejecting an assignment can have NOTHING to do with gender identity at all. The reason can simply be the body has developed in another direction inconsistent with the original assignment.
I know from reading Blanchard, Zucker and Dr. Peggy T. Cohen- Kettenis that they all have similar ideas now and their ideas are problematic for people who are assigned one sex which is incompatible with their well-being and wish to reject that sex assignment.
Redefining intersex as a mental sex disorder
Berenbaum collaborated with Bailey in what was billed as the "Tomboy Project" which studied CAH-girls. I am convinced that in the future we will have a category called "autoandrophilia" and this is where I have a real ax to grind with people who have no empirical data to support such theories but who are given this power to DEFINE what "gender identity" is because they don't believe in "essence narratives". If you don't believe in essence narratives, then as a linguist I would conclude that you do not believe what anyone says about themselves unless it meets your expectations of what they SHOULD say about themselves. This is dangerous and it puts patients in a catch-22. Only the expert knows what you are – you don't. Since I am not exclusively androdphilic or gynephilic, I could be redefined as an "autoandrophile." I am convinced that people with 5-alpha reductase will be among the first "rejectors' of male assignments (and that is the assignment for 5-alpha reductase in early infancy according the DSD consensus) to be defined as autogynephiles. These "experts" are conflating sex variations with mental disorders with no understanding of the experience of the intersex people's own "essence" because they have not been listening. They have been shouting over any objections that MANY of us have been trying to say.
Homosexuality would have to be repathologized if Zucker and Blanchard et al. redefine transsexuality
Now, if GID is not about gender but SEX, and there are only two diagnoses, one of which is based on HOMOSEXUALITY, what treatments can be ethically justified by therapists if homosexuality is NOT also reintroduced as a TREATABLE disorder? If you include autogynephilia, then you have to include homosexuality because the theory that Blanchard and others are propagating posits that there must also be "trans" people motivated by homosexual orientation (and ONLY those two categories). This erases intersex and trans experience and the essential definitions that we often use to give meaning to our own sense of being – our own definitions of ourselves and if we are not allowed to define ourselves within the system to the best of our ability, then I don't see anyway to improve our well-being within that system – only further marginalization and stigma.
Language and Identity
Language is important and the DSM is a document which is using language in a certain way – in order to define a set of diagnoses. But how does one diagnose an identity and that is what this discussion is about.
Why is it a valid statement if Bailey states (as he did in his own book) that he is a heterosexual man?
Why is it a valid statement if Alice Dreger states that she is a woman?
However, if I make one of those statements, why is that statement less valid? There is no way to measure identity. Hooking people up to measure their sexual arousal will never indicate anything about their identity any more than my giving people a test in English to determine if they were an American because there are Americans who do not speak English and there are people who speak English who are not American. We have rules for becoming an American and one of them is just being born in the United States. Other people choose to come to the United States and become an American but are they any less American? How would we determine who is more American than another person? This is similar to what this discourse is about.
What Bailey, Zucker and Blanchard are doing is using antiquated psychological methods based on behavior to determine identity. How does an American behave? Well, it would depend on the person who is identifying as an American.
Being an American is an identity but it is also determined by a process. The process however does not presuppose a set of predetermined genetic, racial or behavioral factors which define the category.
Being and identity (an essence narrative) are intricately linked and there will never be a way of knowing what someone's identity is without listening to them. Bailey and Dreger's identity as a man and woman is no more valid than mine and that is the problem. They are defining me and telling me they know who they are but they also know who I am. No. They do not. Only I know who I am.
Before reading these letters, you can find background information on the following pages:
CALL TO ACTION FROM KRISTEN WORLEY: CLICK HERE
