Thank you for giving me the opportunity to address your committee.
I am a clinical and research psychologist. Since 1976 I have seen over 1,600 children and adolescents who experienced gender dysphoria. I was the chair of the sexual and gender identity disorders work group that was part of the task force for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. I have published over 300 peer-reviewed articles and book chapters on this topic, so I feel that I have the necessary background to address elements of Bill C-6.
Up front, let me state that I am in full agreement that mental health clinicians should not attempt to change the sexual orientation of individuals under the age of 18 years. However, I want to point out quite strongly that contemporary mental health clinicians do not engage in such practice and have not done so for decades. Mental health clinicians do not practise conversion therapy with gay, lesbian or bisexual adolescents.
Where I disagree quite strongly with Bill C-6 is in its additional focus on gender identity in children and adolescents. Since the State of California passed similar legislation in 2012, there has been an insidious conflation of sexual orientation and gender identity. Not only does the proposed legislation erroneously conflate two very distinct psychological phenomena, but it also completely ignores developmental considerations.
The original criticisms of sexual orientation change efforts were targeted at the unsuccessful efforts by clinicians to try to change the sexual orientation of adults. Bill C-6, by conflating sexual orientation, now targets clinicians who work with children as young as the age of three years and their parents.
In my view, this is a serious mistake. Do politicians appreciate this conflation? The background scientific material provided to the committee by Phillips and Walker is completely silent with regard to what is known about best-practice therapy for children and adolescents with gender dysphoria. No well-trained mental health clinician attempts to coercively change the gender identity of either a child or an adolescent. Well-trained clinicians consider what the best therapeutic approach might be to reduce gender dysphoria, a mental health diagnosis in DSM-5, and the distress associated with it. There are various ways in which this can be accomplished.
The problem with Bill C-6 is as follows.
In clause 5, proposed section 320.101 defines “conversion therapy” in part as “a practice, treatment or service designed to change a person's...gender identify to cisgender”. Yet, the same proposed section states that this does not include “a practice, treatment or service that relates...to a person's exploration of their identity or to its development”. Bill C-6, like many initiatives that have preceded it, is completely vacuous in defining what such exploration would look like or constitute. Let me give you a couple of examples.
A three-year-old boy expresses a very strong desire to be a girl. When asked why he wants to be a girl, he tells his parents that he likes very much to play with Barbie dolls and to wear dresses. Under Bill C-6, can a mental health clinician explore with such a child this belief? For example, would it be acceptable to point out that boys can play with Barbie dolls too?
A seven-year-old boy expresses a very strong desire to be a girl. When asked why, he says that all the boys in his classroom at school are mean and rough. In contrast, all the girls in his classroom are kind and gentle. He does not want to be mean or play rough. Under Bill C-6, can a mental health clinician explore with such a child these beliefs? For example, would it be acceptable to point out that not all boys are mean and rough and that not all girls are kind and gentle?
A 14-year-old girl expresses a very strong desire to be a boy. This girl also has a diagnosis of autism spectrum disorder, which includes the propensity to think in very binary terms. Because she does not feel like other girls, she thinks that the only option is to be a boy. Under Bill C-6, can a mental health clinician explore with this adolescent the idea that there are many ways that one can be a girl?
In my view, Bill C-6 should be modified in one of two ways. One is to delete entirely any reference to gender identity and restrict it to sexual orientation, the original target of criticism of conversion therapy. Failing that, Bill C-6 should be extensively revised in terms of explaining the scope of what exactly it means to engage in exploration of gender identity or its development—in other words, provide objective markers.
Such a revision would help both clinicians and families that have a child or adolescent experiencing gender dysphoria understand what the legislation truly intends to target.
Thank you.