PARENTS' REACTION TO CROSS GENDER BEHAVIOR
Dr. Charles Silverstein recognizes that many of his homosexual patients have experienced negative parent/son relationships, but believes that the answers is parental acceptance: "Someday parents will be accepting of their children's sexual orientation, and they will learn to judge them on their merits the boy's different value system." (Silverstein, p.27)
However, the therapists who work with GID boys report that the family is often very accepting of cross-gender behavior. Green (1974) noted that parental "neutrality" was the initial attitude in about 80% of his cases. In some cases the paternal attitude goes beyond neutrality. Several therapists have noted that a number of mothers used feminist theories to justified their reinforcement of gender non-conformity. Lothstein (1983) reported calls from mothers who had intentionally tried to "feminize" their 1-year-old boys "in order to prepare their children for what they viewed as radically new social roles." Lothstein (1988) also reported the case of a mother who believed she had "induced a gender identity disorder in her 4-year-old son by allowing him to overhear her delivery of antimale speeches to her feminist discussion group."
Zucker and Bradley found that parental ambivalence is "part of the problem," and in many cases the parents' attitudes, "perpetuated the child's gender identity confusion." The parents often express more concern about the possibility that the assessment will upset the child, than about clearly abnormal behavior patterns.(Zucker 1995, p.75)
In one case when the parents of a GID old boy were asked about their son's extensive cross-gender behavior, they stated that they had been positive and encouraging, fussing over him when he paraded around in his dresses. The father commented that they viewed such behavior as "funny." (Zucker 1995, p.222)
In 15% of the cases the mothers had dressed their sons in girls' clothes or allowed others to do so. One mother commented on cross dressing:
he was a year and a half and these two little girls took him and they dressed him up completely from a wig all the way down to shoes. And he started to play with dolls them. Everybody thought it was cute. Everyone laughed.(Green 1974, p.217)
Another mother admitted that her husband was already convinced that their son was a homosexual. Zucker and Bradley have found that parents sometimes seek professional help because they want assurance that there is nothing wrong and that they are overreacting. In one case, Ben, was clearly a "profoundly unhappy youngster whose marked cross-gender identification was accompanied by a variety of socioemotional and relationship difficulties." His parents had not sought therapy because they didn't want to hurt him or make him unhappy. According to his mother, Ben had been a "miserable baby and his parents had "worked hard to make him happy." While the mother admitted that he was often mistaken for a girl, she also was upset at her husband's refusal to let Ben take ballet lessons. (Zucker 1995, p.73)
Parents often inquire about the availability of biological tests in the belief that "some kind of physical anomaly explains their child's problem." One mother admitted hopping that her son was "really a girl" and could have his penis removed. "The mother commented that it would be easier for her if he was a girl, since she had no idea how to help him with his feelings." (Zucker 1995, p.75)
Newman found that in working with parents of GID children:
It is not unusual for parents to shield, tolerate, and rationalize the boy's cross-dressing for years. Mothers generally fear losing the son's companionship as he becomes more masculine and are therefore reluctant to begin a treatment program.(Newman 1976)
Parents rationalize avoiding seeking help. Their reasons include:
1) the problem is being exaggerated and is actually much milder than the person who has pressured the parents to seek help believes it to be,
2) it will go away with time,
3) evaluation or treatment might in some way damage the child's sensitive nature or paradoxically make matters worse by "making the child think about it more," and
4) the feminine son is "destined " to become a homosexual (or other very feminine male) regardless of any intervention, so why bother? (Newman 1976)
According to Newman, "fathers who employ such rationalizations avoid their sons, which compounds and sustains the problem. The mother's 'tolerance' really means insulating her son from the insults of siblings, father, or schoolmates by building a tight cocoon in which he can indulge his feminine play." (Newman, 1976)
Green found that in his experience 50% of the parents of children with GID seek counseling only because of "pressure generated outside the family." However when parental concern over a son's feminine behavior does develop, in 80% of Green's cases it was the mother who was more concerned than father. This may be because the mother is more sensitive to the son's distress and/or more likely to make family decisions.
Green complied the following list of factors found in association with the emergence of boyhood femininity. He points out that it has not been determined as of yet which are necessary factors and which must appear in constellation with other factors:
1. Parental indifference to feminine behavior in a boy during his first years.
2. Parental encouragement of feminine behavior in a boy during his first years
3. Repeated cross-dressing of a young boy by a female.
4. Maternal overprotection of a son and inhibition of boyish or rough and tumble play during his first years
5. Excessive maternal attention and physical contact resulting in lack of separation and individuation of a boy from his mother.
6. Absence of an older male as an identity model during a boy's first years or paternal rejection of a young boy.
7. Physical beauty of a boy that influences adults to treat him in a feminine manner.
8. Lack of male playmates during a boy's first years of socialization.
9. Maternal dominance of a family in which the father is relatively powerless.
10. Castration fear (Green, 1974, p.212)
Castration fear can be caused by parental threats to the penis as a form of discipline or medical treatment of penis. One of the patients reported being circumcised at age five. (Green, 1974, p.229)
After reviewing the literature on the subject, Zucker and Bradley concluded: "we were unable to identify in any case reports a clinician who felt that the parents unequivocally encouraged a masculine identity in their sons." (Zucker 1995, p.277)
Once GID has been diagnosed treatment is recommend by most of the therapists who work with these children. According to Zucker and Bradley, "In our clinical experience, we have found no compelling reason not to offer treatment to a child with gender identity disorder." They found that in most cases the youngsters were "very troubled" and came from troubled families. Therapists who work with GID children --Zucker, Bradley, Green, Newman, Stoller, and Rekers --"believe that the earlier treatment begins, the better." (Zucker 1995, p.282) Most are optimistic. According to Zucker and Bradley:
It has been our experience that a sizable number of children and their families achieve a great deal of change. In these cases, the gender identity disorder resolves fully, and nothing in the children's behavior or fantasy suggest that gender identity issues remain problematic. (Zucker 1995, p.282)
In the following case Rekers reported a dramatic change:
When we first saw him, the extent of his feminine identification was so profound (his mannerisms, gestures, fantasies, flirtations, etc., as shown in his "swishing" around the home and the clinic, fully dressed as a woman with a long dress, wig, nail polish, high screechy voice, slatternly seductive eyes) that it suggested irreversible neurological and biochemical determinants. After 26 months follow-up, he looked and acted like any other boy. People who viewed the video taped recordings of him before and after treatment talk of him as "two different boys. (Rekers, 1974)
According to Newman, feminine boys are remarkably responsive to treatment:
Feminine boys treated between the ages of 5 and 12 gradually become less feminine and more masculine . Cross-dressing and feminine fantasy play diminish rapidly and the boys become more verbally and physically aggressive toward their mothers in almost all reported cases. Teasing and social rejection by male peers decreases and is replaced by acceptance. During the initial 12-24 months of treatment, these patients begin to enjoy being accepted as boys and their acceptance is a strong, continuing reinforcer. (Newman, 1976)
Newman points out that an important part of treatment involves anticipating and overcoming parental rationalizations. According to Newman, "In the rare case in which there is no covert parental resistance, therapeutic change may occur with extraordinary speed." With young children parental attitudes are crucial to the process. Newman finds that the mother may need help "in tolerating her son's initial unhappiness when he is told not to cross-dress" and "in recognizing and reinforcing specifically masculine behavior." In one case a boy ho had become substantially less effeminate after 15 months of treatment suddenly began to regress to effeminate behavior. When questioned:
the son revealed...that for the last two months been wearing a pair of his mother's high-heeled shoes...the mother admitted in her session that he had given the shoes to her son...With help, she was able to see that her behavior had been an effort to sabotage the treatment...This enabled her to begin to work more seriously on her fears of losing her son's companionship and on her hatred toward her husband and father and her fear that her son was going to become "just like them." (Newman, 1976)
An unpublished journal kept by the mother of a boy in treatment revealed how the mother's love and strength was a crucial factor in her son's treatment. In spite of resistance on the part of the father and frequent regression on the part of the son, she continued to encourage the father/son relationship. (Nicolosi, unpublished) Green and Newman report similar cases. Once these mothers understood the risks, and recognized their son's need for involvement with the father, they pushed the father to spend time with the son and encouraged masculine activities.
In addition to involvement with the father Newman believes that the effeminate boy needs a male therapist:
The preference for feminine behaviors seems to be based upon a deficit in learning masculine behaviors from an appropriate model. Once the therapists provides this model, identification occurs, new behaviors are learned, and the feminine behaviors are gradually given up. (Newman, 1976)
Involvement with a male therapist often produces some change in the boy, and makes it easier for the father to relate to his son.
Zucker and Bradley believe that treatment is appropriate for GID children because the children show evidence of the distress, disability, and disadvantage which are required to make the diagnosis that a disorder exists. Disorder presupposes "negative consequences of the condition, an inferred or identified orgasmic dysfunction, and an implicit call for action." Distress describes the subjective complaint and discomfort; disability, functional impairment across a wide range of activities; disadvantage, the negative sequelae occurring when the individual interacts with aspects of the physical or social environment. In Zucker and Bradley's view, childhood gender identity disorder matches the definition of distress because from a very early age GID youngsters "feel a sense of discomfort regarding their status as boys or girls." Additionally, these children show general behavioral psychopathology, and impaired peer relations.
According to Saghir and Robins:
Of the male homosexuals who fulfilled the criteria for polysymptomatic effeminacy in childhood, a large majority of them (77%) reported having had no male buddies, having avoided boys' games and having played predominantly with girls. All of them were called sissy and were teased about it by their schoolmates. It was an unhappy experience that most of them recalled very vividly. (Saghir, p.18)
Bates, et al. noted among their 28 subjects a "lack of rewarding ways of dealing with peers and adults (especially males)." and a "combination of effeminacy, fearfulness, social aversiveness and immaturity" which produced unhappy children. Of the subjects 20 "were judged to be less happy than most children, and only 1 was judged to be more happy; 15 were seen as less independent than normal, and only 4 as more independent; and 18 were seen as immature overall for their ages, and only 3 as more mature." (Bates, 1974)
The DSMIV recognizes the unhappiness that accompanies the disorder, "In young children, distress is manifested by the stated unhappiness about their assigned sex. Preoccupation with cross-gender wishes often interferes with ordinary activities. In older children, failure to develop age-appropriate same-sex peer relationships and skills often leads to isolation and distress, and some children may refuse to attend school because of teasing or pressure to dress in attire stereotypical of their assigned sex. (DSMIV, p. 534)
Phobic reactions to normal childhood activities are not healthy or normal. Compulsive behavior patterns, inflexibility and rigidity are symptoms of a problem. It is not healthy to reject one's father nor to wish to belong to the other sex nor to feel chronically unhappy with one's body. Given the evidence, it seems clear that boys with GID and/or chronic unmasculinity boys are not happy, well adjusted children who are just "different" and need acceptance, but disturbed children who deserve immediate and effective treatment.
Prevention of future problems is also possible. In 1963 Daniel Brown presented a paper on homosexual and family dynamics. He reviewed the evidence available at the time -- evidence which has since been confirmed in numerous studies -- and pointed out that parents and teachers should be educated about "the decisive influence of the family in determining the course and outcome of the child's psychosexual development." Brown pointed out that given what was known about child development:
There would seem to be no justification for waiting another 25 or 50 years to bring this information to the attention of those who deal with children. And there is no excuse for professional workers in the behavioral sciences to continue avoiding their responsibility to disseminate this knowledge and understanding as widely as possible.(Brown, 1963)
Unfortunately, 35 years after Brown's speech parents are less aware of the information on how to prevent gender identity pathology than they were in 1963.
HOMOSEXUALITY AS A DISORDER
It should be pointed out that there is substantial, and growing opposition to treatment for childhood GID. Mallen (1983) and Zuger (1970) hold that GID is the result of the child's fundamental homosexuality. Bell, Weinstein, and Hammersmith argue that prehomosexual boy may be "different" to begin with and that the cause of the problem is society's "rigid standards of acceptable behavior."( Bell p.218-219) They call for a change in society's expectations.
According to an article in the American Psychological Association Monitor (June, 1997) the APA's Committee on Lesbian, Gay, and Bisexual Concerns and the Committee on Women discussed the GID diagnosis and the drafting of a resolution to depathologize childhood gender-identity disorder and change the DSM. The argument is: if homosexuality is not a pathological disorder, then why should gender identity non-conformity which is the precursor of homosexuality be considered a disorder.
Some therapists, including Zucker and Bradley, believe that one can support treatment for GID without considering adult homosexuality as a disorder. Others believe that if GID is a disordered condition, then the consequences of GID (adult homosexuality) are disordered. If the boy had not suffered from GID, he would not need to adopt homosexuality as a solution. According to Bieber:
The capacity to adapt homosexually is, in a sense, a tribute to man's biosocial resources in the face of thwarted heterosexual goal-achievement. Sexual gratification is not renounced; instead, fears and inhibitions associated with heterosexuality are circumvented and sexual responsivity with pleasure and excitement to a member of the same sex develops as a pathologic alternative.
An adaptation which is basically an accommodation to unrealistic fear is necessarily pathologic; in the adult homosexual continued fear of heterosexuality is inappropriate to his current reality. We differ with other investigators who have taken the position that homosexuality is a kind of variant of "normal" sexual behavior. (Bieber 1962, p.303)
Moberly also sees adult homosexuality as a way in which a person who experiences a state of incomplete development tries to solve the problem. According to Moberly, "There are legitimate needs involved in the homosexual condition." These are not sexual needs but needs for non-sexual same-sex relationships which were not properly met in childhood. Moberly believes that when the person is able to appropriately meet these same-sex needs, the homosexual needs will gradually disappear. (Moberly, p.32)
Therapists who believe that homosexuality is a developmental disorder which can be treated respect homosexuals as persons who have struggled with a difficult burden, and hope that increased understanding of how childhood experiences effect identity development and adult behavior will lead to compassion toward those who homosexual attraction, as well as pointing the way toward prevention.
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