January 11, 2016

Open Letter to the Board of Trustees of the Centre for Addiction and Mental Health:

We, the undersigned, are professional clinicians and academics who work in the areas of human sexuality, gender identity, and related fields. We are writing to express our dismay and disapproval of recent actions of Toronto’s Centre for Addiction and Mental Health (CAMH), specifically, the closure of the Child and Adolescent Gender Identity Clinic and the apparent firing of its Clinical Lead, Kenneth J. Zucker, Ph.D. We object to these actions because they appear primarily politically motivated and to have been rationalized and justified, after the fact, by public statements extremely damaging to Dr. Zucker’s professional reputation. We further object to the indifference towards research and scholarship implied by the CAMH’s closure of a 40-year-old clinic that had been a world-leader in the field of childhood gender identity disorder. We are also very concerned about the welfare of many Canadian children and families who were served by this Clinic, whose mental health needs have essentially been dismissed by CAMH through its actions.

A close reading of the publicly available documents and their timeline points to the inescapable conclusion that the motivation of the CAMH in closing the Clinic was primarily political. In January 2015, the CAMH was approached by transgender activists with complaints about Dr. Zucker’s treatment approach.[1] The essence of the trans activists’ complaint appears to be Dr. Zucker’s position that the first line of approach with younger gender-dysphoric children is to help them accept their anatomic sex. This complaint of course overlooks that, in cases of older children whose cross-gender identity proved persistent, Dr. Zucker actually recommended medical interventions paving the way to sex reassignment. Furthermore, although Dr. Zucker’s attackers deliberately (mis)-applied the phrase “conversion therapy” to refer to Dr. Zucker’s approach, he never, in fact, attempted to influence children’s eventual sexual orientation—a fact acknowledged by the CAMH itself.[2]

In February 2015, the CAMH announced the appointment of external reviewers for the ostensible purpose of conducting an objective, hands-off review of the Child and Adolescent Gender Identity Clinic.[3] In March 2015, many months before the external assessors’ one-day site visit, CAMH spokesperson Kwame McKenzie, M.D., announced that the waiting list for children to be seen at the Clinic had already been closed.[4] At the time, there were dozens of families waiting for the help of Dr. Zucker and his colleagues, because the Clinic enjoyed such a high reputation among families who had been served.

The external review, dated November 2015, although problematic in many regards, did not in fact recommend closure of the Clinic.[5] The CAMH proceeded to close the Clinic anyway—an indication that this was their prior intent however the external review turned out—and announced this decision in a press release.[6]

The CAMH subsequently publicized the Clinic closure in a way that clearly implied that Dr. Zucker had been fired for substandard professional practice, inappropriate behavior, or both. In December 2015, Dr. McKenzie publicly apologized through the general media that clinical practices in the Clinic were not “in step with the latest thinking” and at the same time announced that Dr. Zucker is “no longer at CAMH.”[7] The implication that Dr. Zucker had been fired because of substandard professional practice is inescapable.

At the same time, the CAMH posted the external assessors’ report on its official website—a report that contains statements highly damaging to Dr. Zucker’s professional reputation. An example is the written statement of an unidentified former patient, a female-to-male transsexual presumably on testosterone medication, that “Dr. Zucker asked him to remove his shirt in front of other clinicians present, laughed when he complied, and then referred to him as ‘a hairy little vermin’” (p. 16). The CAMH’s decision to post anonymous, unverified, and unexamined claims seems incomprehensible unless to bolster their shaky bases for closing the Clinic and firing (and attempting to humiliate) Dr. Zucker.

As troubling as the CAMH’s cynical and self-serving sacrifice of a 35-year employee is their apparent indifference to the collective scholarship and expertise of the sex research community and the psychiatric community. Despite the existence of numerous international experts on gender identity disorder, the CAMH picked two external assessors with no track record of empirical studies or other serious scholarship in childhood gender issues. They chose to use the opinions of non-experts as the reason—or pretext—for severing their relation with one of the foremost international experts in the area of childhood gender identity disorder, indeed, in the broader area of clinical research on human sexuality. In 2006, Dr. Zucker was elected President of the International Academy of Sex Research (IASR), the most selective organization for researchers in human sexual behavior. He has been, since 2002, the Editor-in-Chief of the Archives of Sexual Behavior, one of the leading journals in its field. (The Executive of the IASR recently met in the wake of this controversy to formalize its unanimous and unconditional support of Dr. Zucker for his ongoing leadership of the Journal and communicated this to the publisher.) On the basis of these and numerous other achievements, he was chosen in 2008 for the distinguished position of Chair of the Work Group for Sexual and Gender Identity Disorders for DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association). Dr. Zucker’s new accomplishments did not end in 2008; he was, in July 2015, awarded a million-dollar grant by the Canadian Institutes of Health Research to study brain changes in gender-dysphoric adolescents who are being prescribed hormonal medication to simulate the appearance of the opposite biological sex. (This grant would have helped to establish evidence-based clinical care for adolescents who do need to transition.) These coveted grants are awarded only to the most meritorious researchers on the basis of an extensive peer review process, and this grant speaks to the significant research carried out by Dr. Zucker.

The closure of a clinic headed by an internationally prominent clinician, scholar, and researcher must stand as a warning to any clinical researcher who is or considers working at the CAMH: In the event of a conflict with activists for a fashionable cause, the CAMH might well sacrifice them—and the individuals and families they serve in their clinics—for some real or imagined local political gain.

We the undersigned are grateful to Dr. Zucker for his outstanding clinical and research work carried out for decades. He is a responsible, compassionate, pioneer researcher and clinician. He should be commended at this point in his outstanding career instead of being shunned by an institution that we hope has only temporarily lost its way.

If you are willing to sign this petition, please do the following:

1. When you sign the petition, please be sure to include your highest degree. **Omit all periods and commas**

2. Please be sure under "Comments" to include your institutional affiliation.

3. Please forward this petition to 5 of your colleagues who may also wish to sign it, and ask them to do the same using the url http://www.ipetitions.com/petition/boardoftrustees-CAMH

Sincerely,

John Bancroft, MD

Ray Blanchard, PhD

Lori Brotto, PhD

Richard C. Friedman, MD

Cynthia Graham, PhD

Martin Lalumière, PhD

Heino F. L. Meyer-Bahlburg, Dr rer nat

Jim Pfaus, PhD

Eric Vilain, MD, PhD

Kim Wallen, PhD

[1] http://www.thestar.com/opinion/commentary/2015/12/17/discredited-treatment-of-trans-kids-at-camh-shouldnt-shock-us.html

[2] http://www.metronews.ca/news/canada/2015/06/12/ontarios-lgbt-conversion-therapy-ban-now-what.html

[3] http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Pages/CAMH-to-make-changes-to-Child-and-Youth-Gender-Identity-Services.aspx

[4] http://www.ctvnews.ca/health/conversion-therapy-controversy-at-camh-transgender-clinic-1.2287619

[5] http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Documents/GIC-Review-26Nov2015.pdf

[6] http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Documents/backgrounder-cyfgicreview.pdf

[7] http://www.theglobeandmail.com/news/toronto/camh-to-wind-down-controversial-gender-identity-clinic-services/article27766580/