Tuesday, August 14, 2012
There was an interesting article in the Sunday New York Times Magazine on children who behave in ways that are inconsistent with the gender role expectations society holds for them. The article starts by talking about a mom who e-mails the other parents in the pre-school to let them know their son is 'gender-fluid' and will be coming to school in a dress the first day.
I spent a little more than a decade as a consultant to the Johns Hopkins Sexual Behaviors Consultation Unit (SBCU). I also spent a few months working as a resident on an inpatient unit for people with sexual disorders-- though the two systems were completely different entities back then. What differentiated whether a patient went to one versus the other was often a matter of legal involvement: someone who's sexual behaviors got them into legal difficulties (often people with pedophilia) were the domain of the Sexual Disorders group (they also had an outpatient component but I never worked there) and treatment sometimes included hormone injections to lower the patient's sex drive, along with individual and group therapy. No one was admitted to this unit involuntarily, and no one was given hormones involuntarily. The two units have since merged, but there is no longer an inpatient unit, it's all outpatient consultation. Even back then, treating people with pedophilia was a logistically difficult thing: if a patient went to a psychiatrist and said "I've done this awful thing and I want to stop," it had to be reported (it still does) and there is no mechanism for getting help unless the patient requests it prior to acting on such urges, or after he's been caught and the assessment/treatment are part of his legal stipulation or defense.
The SBCU saw people with erectile dysfunction, couples with mismatched sexual drives, people who had troubles with all aspects of the sexual cycle (desire, arousal, climax, etc), those with fetishes, and those with concerns about gender. "Pink boys," a term I've never heard, would fall under that category. Back then (the 1990's, early 2000's) the mentors of the unit felt that parents should encourage their children to adopt gender-appropriate behaviors and play. There was some thought that permissiveness around allowing Johnny to have a Barbie collection might encourage such things.
In "What's So Bad About a Boy Who Wants to Wear a Dress" Ruth Pawdawer, states:
Many parents and clinicians now reject corrective therapy, making this the first generation to allow boys to openly play and dress (to varying degrees) in ways previously restricted to girls — to exist in what one psychologist called “that middle space” between traditional boyhood and traditional girlhood. These parents have drawn courage from a burgeoning Internet community of like-minded folk whose sons identify as boys but wear tiaras and tote unicorn backpacks. Even transgender people preserve the traditional binary gender division: born in one and belonging in the other. But the parents of boys in that middle space argue that gender is a spectrum rather than two opposing categories, neither of which any real man or woman precisely fits.
Twenty years ago I wasn't comfortable with the way psychiatry approached this topic. I didn't believe that a child's gender role choices were necessarily 'choices' or that parenting styles (at least those those with-in some spectrum of "normal"), caused children to want gender-inappropriate dress/toys/identities. The question remains, if this is who you are, shouldn't you come to some comfortable acceptance with yourself? Unfortunately, our world is such that when a boy shows up at school in his princess outfit, other children might not want to play with him, and it can all make for a very confused, painful, and uncomfortable life, so professionals who encourage gender-appropriate roles aren't being mean or stupid or evil, they are just trying to figure out (with the benefit of a crystal ball) what will lead to the best result. And this all occurs where both the individual involved may be fluid with their gender role (some pink boys turn blue), and society is fluid with it's acceptance of everything from left-handedness, to homosexuality, to it's stigmatization of cigarette smokers.
Around that time, my next door neighbor called me to ask if my son would like to take ballet lessons with her daughter (she was 2, he was 3 and they were best friends). I asked my son, "Do you want to take ballet lessons with your friend?" The 3-year-old considered this for a moment and said, "Is that a girl thing? Do they have baseball lessons?" I don't think it was about parenting -- I would have sent him to ballet and assumed is was just another activity with a friend -- I think it was in his brain that made the girlthings-boythings distinction.
Interestingly, girls don't have these issues. There are "girly-girls" with their interest in fairies and princesses, and there are tomboys who wouldn't be caught dead in a ballerina outfit. We don't tend to worry about girls, and playgrounds have the tomboys playing soccer on one side while the girly-girls play fairy princess on the other.
The point of the article was that there are people who are struggling to deal with their children's gender issues -- it was more about the parents then the kids -- and while there are still no clear answers for what makes the happiest, most well-adjusted kid, there are those who believe that it's better to help a child accept who he is.
We now leave left-handers alone. The Greeks were fine with their pedophiles. Our society shuns them, more so then murderers. Despite our growing rates of obesity, we still blame and ostracize those who are fat: shouldn't we teach people to eat and exercise in a healthy fashion, and beyond that to accept themselves with the awareness that people come in all sizes? And don't get me started on Presidential candidates.
I have no answers, I'll let you chime in.
Here's a link to the Hopkins Sexual Behaviors Consultation Unit. They list the conditions they treat and a phone number to schedule an assessment.
Dr. Chris Kraft, their director of clinical services, has been a podcast guest with us on several occasions, see:
Podcast #21 Chris Kraft on Gender Issues
Podcast #41 Chris Kraft on Conversion Therapy