24545A5200000578 2891267 image m 45 1419947436741 201x300 Gender dysphoria and the tragedy of conversion therapy  The suicide of Joshua Alcorn on December 28, 2014 marked the tragic end of his young life. He was seventeen years old. His suicide attracted worldwide attention as he published a suicide note on Tumblr in which he related the stress of suffering gender dysphoria (he felt he was a girl living in a boy’s body).

This stress was too much for him to bear so he opted for suicide. He adopted the name Leelah in his suicide note. He leaves behind his grieving parents, younger siblings and the rest of those who knew and loved him. Details are emerging as to the stress he endured and a degree of dysfunction in his family.

He came from Christian family; his parents (Doug and Carla Alcorn) did not understand what he was experiencing and essentially told him to “pray it away.” He said in his suicide note that his parents sent him to conversion therapy for treatment. Compounding this tragedy was the lynch mob mentality that took hold. Doug and Carla Alcorn experienced harassment, even a call from activist Dan Savage that they face prosecution. Is this warranted?

Their son Joshua suffered from gender dysphoria, formerly called gender identity disorder. It is defined by the Canadian Psychological Association as follows:

Gender dysphoria refers to the unhappiness that some people feel with their physical sex and/or gender role. The term transgender refers to many different ways that a person may experience their gender identity outside the simple categories of male and female. (Canadian Psychological Association)

A diagnosis of gender dysphoria is determined by a mental health professional (psychiatrist, psychologist or psychotherapist) when the following symptoms are observed in the patient and persist for at least six months:

  • repeatedly stated desire to be, or insistence that he or she is, the other sex
  • in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
  • strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
  • a strong rejection of typical toys/games typically played by one’s sex.
  • intense desire to participate in the stereotypical games and pastimes of the other sex
  • strong preference for playmates of the other sex
  • a strong dislike of one’s sexual anatomy
  • a strong desire for the primary (e.g., penis, vagina) or secondary (e.g., menstruation) sex characteristics of the other gender (PsychCentral)

While gender dysphoria afflicts people of all ages, as Dr. Domenico Di Ceglie (child psychiatrist) notes, “children, particularly adolescents, and their families often find the experience of a gender identity disorder [gender dysphoria] painful and unbearable, and adolescents are at high risk of suicide attempts.” (Gender identity disorder in young people) Treatment options for an adolescent suffering from gender dysphoria and their family include behavioural therapy, individual psychotherapy, family therapy and group therapy directed toward reaching the following objectives:

To foster recognition and non-judgemental acceptance of gender identity problems

To ameliorate associated behavioural, emotional and relationship difficulties (Coates & Spector Person, 1985)

To break the cycle of secrecy

To activate interest and curiosity by exploring the impediments to them

To encourage exploration of the mind—body relationship by promoting close collaboration among professionals in different specialities, including a paediatric endocrinologist

To allow mourning processes to occur (Bleiberget al, 1986)

To enable symbol formation and symbolic thinking (Segal, 1957)

To promote separation and differentiation

To enable the child or adolescent and the family to tolerate uncertainty in gender identity development

To sustain hope (Gender identity disorder in young people)

Another treatment option is sex reassignment surgery. This option is expensive. The Encyclopedia of Surgery lists the cost for male to female reassignment is $7,000 to $24,000; whereas, the cost for female to male reassignment can exceed $50,000. Currently in the United States, however, sex reassignment surgery is not widely covered in health insurance plans.

Sex change surgery Gender dysphoria and the tragedy of conversion therapy

Yet according to the Transgender Legal Defense and Education Fund, coverage is mandated by law in the following jurisdictions: California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont and Washington, and Washington, D.C. In December, 2014 Governor Andrew M. Cuomo of New York State issued the order “An issuer of a policy that includes coverage for mental health conditions may not exclude coverage for the diagnosis and treatment of gender dysphoria.” (as cited in The New York Times)

In addition, in May, 2014 the United States Department of Health and Human Services overturned the exclusion of sex reassignment surgery from the Medicare program, an exclusion that was in force from 1981.

However, while sex reassignment surgery is an option, it is stressed by the governing bodies of the various psychiatric and psychological associations, including the Royal College of Psychiatrists and the Canadian Psychological Association, that surgical intervention cannot be justified until adulthood. In this regard, the Royal College of Psychiatrists maintains:

surgical intervention should not be carried out prior to adulthood, or prior to a real life experience for the young person of living in the gender role of the sex with which they identify for at least two years. The threshold of 18 should be seen as an eligibility criterion and not an indicator in itself for more active intervention, as the needs of many adults may also be best met by a cautious, evolving approach (as cited in Gender identity disorder in young people)

Sadly, what the Alcorn family experienced with their son Joshua, his struggle with gender dysphoria and suicide was not an unusual outcome. Though treatment options are available for sufferers of gender dysphoria and the prognosis for those diagnosed with gender dysphoria and receiving treatment is hopeful, it does no good if they are not employed.

An inquest into the suicide of Joshua Alcorn should bring to light the events that ended in this tragedy. Hopefully, recommendations will follow also as to how such an outcome may be avoided for other youth at risk. Gender dysphoria is a reality and untreated, particularly in adolescents as in this case, it too often ends in suicide.

Doug and Carla Alcorn will have to live with the consequences of their decisions concerning their son’s care for the rest of their lives and it looks as though they still do not understand the pain he experienced.

Doug Alcorn made the following comment, in response to the public reaction to the news of his son’s suicide: “We love our son, Joshua, very much and are devastated by his death. We have no desire to enter into a political storm or debate with people who did not know him.

We wish to grieve in private. We harbor no ill will towards anyone… I simply do not wish our words to be used against us.” (as cited in Wikipedia) While I think they failed in their duty as parents to seek proper care for their son, I do not doubt they loved him. That said, I think the public at large should respect their wishes and leave them to mourn and get on with their lives in private.