The history of “T” research and clinical care
Transgenderism, similarly to homosexuality, used to be viewed as a disease. Not surprisingly the early research within mental health and behavioral fields focused on getting rid of distress associated with being assigned a sex at birth that was different to the gender that the person identified as having. During this time, clinicians did their best to try and “fix” trans individuals and help their families cope with the “treatment”.
However, as time went on practitioners realized that despite their best efforts their clinical interventions were just not helpful. The treatment they offered was just not effective.
This realization led to the introduction of “gender identity dysphoria” (GID) in the Diagnostic Statistical Manual (DSM). The DSM is the equivalent to the medical profession’s bible. The DSM helps clinicians identify what’s “right” and what’s “wrong” with patients.
Even though making a diagnosis of GID is complicated, in essence within the DSM, GID is basically when an individual experiences discontent with the sex they were assigned at birth and or the gender identity or role associated with that sex.
More recently, there have been efforts to remove GID from the DSM or change it to gender dysphoria or gender identity discomfort.
The removal of GID from the DSM has been described as being extremely important. This is because the removal of GID from the DSM will signify to the medical community (including counselors, allied health professionals and psychologists) that transgenderism, in all its beautiful forms, is not a disease.
This is what happened with homosexuality. Homosexuality was removed from the DSM in 1972. Its removal was viewed as a landmark in terms of enabling further acceptance of sexual orientation minorities within society.
You’re OK and… and um well the research community is just trying to catch up
In keeping with this relatively recent shift in understanding about trans issues, contemporary research mostly supports the view that transgenderism is not a disease.
Researchers have begun to embrace the understanding that trans identities are a consequence of the androgen dosage (or no dosage or no delivery) at certain times during brain development while in the womb (i.e., while in utero). These dosage levels account for the feminization or masculization of the brain.
Admittedly, there are some researchers from some fields that rely more on socially constructed notions of gender. These types of researchers may not place a heavy emphasis on biochemical-neurological explanations and they may not be impacted upon by these developments.
Nevertheless, even though our understanding of transgender origins has mostly improved. Many people in society and clinicians, including physicians, still struggle with accepting transgender individuals, their families and the normality of trans. This misunderstanding has led to stigmatization.
It has also led to and sustained challenges for trans families. For example, this includes the challenges in dealing with the continued marginalization and uncertainty that accompanies loving someone with a gender orientation that does not fit in with the male-female binary.
Well let’s find out.
How much research has been published on trans issues in relation to marriage, couple and family therapy?
Trans research articles
In 2012 researchers from the University of Nevada (Las Vegas) and the Texas Woman’s University, led by Dr Blumer, went out to find out exactly how many trans research articles have been published.
They then examined the content of the articles they found through what’s called a “content analysis”. Content analysis mostly involves examining the information included within each document according to a predefined list.
They worked out how many trans research articles had been published by systematically looking at all of the articles published in 17 marriage, couple and family therapy journals between 1997 and 2009.
All in all, they found 12,289 articles had been published in these journals between 1997 and 2009. But after they removed articles that weren’t research they were left with 10,739 article. Then out of these 10, 379 articles they only found nine that focused on transgender issues or gender variance as a topic. This meant that only 0.0008% of articles focused on gender variance and transgenderism in all of those journals over that thirteen-year period.
The trans research articles that they found mostly focused on relationships and civil liberties in relation to trans issues. They concluded that more research on trans issues needs to be done. Pink Families agrees with them.
What can researchers do to address the lack of trans research?
The authors suggested five strategies to help address this lack of trans research.
- Researchers must improve their approach to include trans issues, trans individuals and families.
- Researchers should better understand the difference between sexual orientation and gender orientation.
- Researchers and publishers should address their own bias in relation to including and / or publishing trans issues.
- Researchers should broaden their focus to include trans experience. Don’t just focus on diagnosis, etiology and medical topics.
- Involve trans individuals in research advisory groups to ensure trans issues and perspectives are considered and addressed.
One of the promising findings of the study was that there has been an increase in articles that include trans content in recent years. Even though this is encouraging, we still have a long way to go.
What can we do to help?
Also, it’s perhaps encouraging to know that we can get involved and help shape the research of the future, especially as many prestigious funding bodies now require service-users to be involved in research advisory groups for studies that they fund. Some of these large funding bodies look less favorably on research grants that don’t involve service-users in the preparation of the bid.
Also, many of us are employed as researchers and so we can help shape the research agenda as well. Involving trans individuals on research advisory boards will help ensure the relevance and acceptability of the research.
So, it seems that part of the solution to this problem rests with us. Let’s get involved and help shape the research agenda in order to increase the volume and quality of trans research.
Blumer MLC, Green MS, Knowles SJ, Williams A. Shedding Light on Thirteen Years of Darkness: Content Analysis of Articles Pertaining to Transgender Issues in Marriage/Couple and Family Therapy Journals. Journal of Marital and Family Therapy 2012;38(s1):244-256.